Kenneth H. Cooper, M.D., M.P.H.Kenneth H. Cooper, M.D., M.P.H.Founder & Chairman Founder & Chairman

The Cooper Aerobics CenterThe Cooper Aerobics Center12200 Preston Road12200 Preston Road

Dallas, TexasDallas, Texas

Kenneth H. Cooper, M.D., M.P.H.Kenneth H. Cooper, M.D., M.P.H.Founder & Chairman Founder & Chairman

The Cooper Aerobics CenterThe Cooper Aerobics Center12200 Preston Road12200 Preston Road

Dallas, TexasDallas, Texas

Aerobics:Aerobics:Past. Present. Future.Past. Present. Future.

Aerobics:Aerobics:Past. Present. Future.Past. Present. Future.

American Adult Exercise Habits 1968-2008American Adult Exercise Habits 1968-2008American Adult Exercise Habits 1968-2008American Adult Exercise Habits 1968-2008

ExercisingExercisingExercisingExercising19681968

< 24 %< 24 %19681968

< 24 %< 24 %1984198459 %59 %1984198459 %59 %

1990199040 %40 %1990199040 %40 %

JoggingJoggingJoggingJogging < 100,000< 100,000< 100,000< 100,000 34 million34 million34 million34 million 30 million30 million30 million30 million

48 % 48 % CVD CVD

Russia: Russia: 31 %31 %

Poland: Poland: 36 %36 %

Hungary: Hungary: 40 %40 %

Romania: Romania: 60 %60 %

American Adult Exercise Habits 1968-1990American Adult Exercise Habits 1968-1990American Adult Exercise Habits 1968-1990American Adult Exercise Habits 1968-1990

1968 - 19901968 - 19901968 - 19901968 - 1990Medical TreatmentMedical Treatment

33 %33 %Medical TreatmentMedical Treatment

33 %33 %Lifestyle ChangeLifestyle Change

67 %67 %Lifestyle ChangeLifestyle Change

67 %67 %

Cigarette SmokingCigarette Smoking

Blood Pressure ControlBlood Pressure Control

Cholesterol ReductionCholesterol Reduction

Stress ManagementStress Management

Increased ActivityIncreased Activity

CV DeathsCV Deaths 48 % 48 %

CV DeathsCV Deaths 48 % 48 %

Annual Deaths Related to Tobacco UsageAnnual Deaths Related to Tobacco UsageUnited Nations Agency (Feb 2010)United Nations Agency (Feb 2010)

Annual Deaths Related to Tobacco UsageAnnual Deaths Related to Tobacco UsageUnited Nations Agency (Feb 2010)United Nations Agency (Feb 2010)

5 Million5 Million Cardiovascular DiseaseCardiovascular Disease

CancerCancerDiabetesDiabetesOther Chronic DiseasesOther Chronic Diseases

600,000600,000 Secondhand SmokeSecondhand Smoke

5 Million5 Million Cardiovascular DiseaseCardiovascular Disease

CancerCancerDiabetesDiabetesOther Chronic DiseasesOther Chronic Diseases

600,000600,000 Secondhand SmokeSecondhand Smoke

Smoking FrequencySmoking Frequency(WHO Feb 2010)(WHO Feb 2010)

Smoking FrequencySmoking Frequency(WHO Feb 2010)(WHO Feb 2010)

ChinaChina 31.4% (Men 57.4%)31.4% (Men 57.4%)

IndiaIndia 33.9% (Men 57.0%)33.9% (Men 57.0%)

United StatesUnited States 19.8%*19.8%*

ChinaChina 31.4% (Men 57.4%)31.4% (Men 57.4%)

IndiaIndia 33.9% (Men 57.0%)33.9% (Men 57.0%)

United StatesUnited States 19.8%*19.8%*

**Cost: $196 million/yr in medical costs and productivityCost: $196 million/yr in medical costs and productivity

American Adult Exercise Habits 1968-1990American Adult Exercise Habits 1968-1990American Adult Exercise Habits 1968-1990American Adult Exercise Habits 1968-1990

1968 - 19901968 - 19901968 - 19901968 - 1990Medical TreatmentMedical Treatment

33 %33 %Medical TreatmentMedical Treatment

33 %33 %Lifestyle ChangeLifestyle Change

67 %67 %Lifestyle ChangeLifestyle Change

67 %67 %

Cigarette SmokingCigarette Smoking

Blood Pressure ControlBlood Pressure Control

Cholesterol ReductionCholesterol Reduction

Stress ManagementStress Management

Increased ActivityIncreased Activity

CV DeathsCV Deaths 48 % 48 %

CV DeathsCV Deaths 48 % 48 %

Source: JAMA, Mar 10, 2004, Vol. 291, No. 10.

Actual Causes of Death 1990

Tobacco

400

Diet/E

xerc

ise

300

Alcohol

100

Infe

ctio

n

90

GunsSex

M. V

eh.*

Drugs

20

050

100150200250300350400450

De

ath

s (1

000

's)

DrugsDiet/ExerciseAlcoholInfection

TobaccoSex RelatedMotor VehiclesGuns

35 3047

435

365

7529 20

4385

17

*Alcohol-related deaths:1990 – 22,0842000 – 16,653

/2000

Body Mass IndexBody Mass Index

130 130

65 ÷ 6565 ÷ 65 x 703 = 21.7 BMIx 703 = 21.7 BMI

165 165

65 ÷ 6565 ÷ 65 x 703 = 27.5 BMIx 703 = 27.5 BMI

ExamplesExamples

Range BMIRange BMI < 25< 25 NormalNormal25 – 3025 – 30 Overweight (66 %)Overweight (66 %)

> 30> 30 Obese (34 %)Obese (34 %)

BMI =BMI =(Weight in kilograms )(Weight in kilograms )

(Height in meters squared)(Height in meters squared)

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

No Data <10% 10%–14%

Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)

2007

Source: CDC’s Division of Diabetes Translation. National Diabetes Surveillance System availableat http://www.cdc.gov/diabetes/statistics

No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%

Source: “Mending Broken Hearts,” National Geographic, Feb. 2007

Price-Adjusted Per-Capita Medicare Spending

Percentages of Overweight or Obese Youth Aged Percentages of Overweight or Obese Youth Aged 10-17 Years in 200710-17 Years in 2007

Source: Source: Child and Adolescent Health Measurement Initiative: 2007 National Survey of Children's Health

Worldwide Obesity 2010Worldwide Obesity 2010Worldwide Obesity 2010Worldwide Obesity 2010

HighestHighest

CountryCountry WomenWomen MenMen

United StatesUnited States 36%36% 32%32%

MexicoMexico 35%35% 24%24%

ChileChile 32%32% 19%19%

LowestLowest

CountryCountry WomenWomen MenMen

JapanJapan 3%3% 3%3%

KoreaKorea 4%4% 4%4%

SwitzerlandSwitzerland 8%8% 9%9%

Source: Organization for Economic Cooperation and Development data on OBCD member countriesSource: Organization for Economic Cooperation and Development data on OBCD member countries

Source: George Washington University, 2010

The Annual Cost of Excess Body WeightThe Annual Cost of Excess Body Weight(Sick Days, Productivity, Fuel)(Sick Days, Productivity, Fuel)

Obese (> 30 BMI)Obese (> 30 BMI)

WomenWomen $4,879$4,879

MenMen $2,646$2,646

Overweight (25-30 BMI)Overweight (25-30 BMI)

WomenWomen $524$524

MenMen $432$432

Proportion of Overweight ChildrenProportion of Overweight Childrenin the United Statesin the United States

Proportion of Overweight ChildrenProportion of Overweight Childrenin the United Statesin the United States

4.2%6.5%

15.3%

4.6% 5%

15.5%

0%

5%

10%

15%

20%

6-12-year-olds 12-19-year-olds

1963-1970 1976-1980 1999-2000 2000-2004

Source: Centers for Disease Control and Prevention, 2003.

18.8%

•• 1 out of 3 children will develop diabetes (higher in 1 out of 3 children will develop diabetes (higher in Hispanics and African-Americans)Hispanics and African-Americans)•• 1 out of 3 children will develop diabetes (higher in 1 out of 3 children will develop diabetes (higher in Hispanics and African-Americans)Hispanics and African-Americans)

There is an epidemic of adult-onset diabetes being There is an epidemic of adult-onset diabetes being seen in children. It is estimated that among children seen in children. It is estimated that among children born after the year 2000:born after the year 2000:

There is an epidemic of adult-onset diabetes being There is an epidemic of adult-onset diabetes being seen in children. It is estimated that among children seen in children. It is estimated that among children born after the year 2000:born after the year 2000:

If they develop adult-onset diabetes before 14 years of If they develop adult-onset diabetes before 14 years of age, it is estimated that that will shorten their lifespan age, it is estimated that that will shorten their lifespan by 17 to 27 years. As a result, this may be the first by 17 to 27 years. As a result, this may be the first generation in which parents live longer than their generation in which parents live longer than their children.children.

If they develop adult-onset diabetes before 14 years of If they develop adult-onset diabetes before 14 years of age, it is estimated that that will shorten their lifespan age, it is estimated that that will shorten their lifespan by 17 to 27 years. As a result, this may be the first by 17 to 27 years. As a result, this may be the first generation in which parents live longer than their generation in which parents live longer than their children.children.

The Cooper InstituteThe Cooper InstituteThe Cooper InstituteThe Cooper Institute Cooper ClinicCooper ClinicDallas & Craig RanchDallas & Craig Ranch

Cooper ClinicCooper ClinicDallas & Craig RanchDallas & Craig Ranch

Cooper FitnessCooper Fitness Center & Spa Center & Spa

Dallas & Dallas & Craig RanchCraig Ranch

Cooper FitnessCooper Fitness Center & Spa Center & Spa

Dallas & Dallas & Craig RanchCraig Ranch

The Guest LodgeThe Guest LodgeThe Guest LodgeThe Guest Lodge

Cooper Wellness ProgramCooper Wellness ProgramCooper Wellness ProgramCooper Wellness Program

Cooper VenturesCooper Ventures

Cooper Concepts

CooperBenefits

CooperLife

Cooper Weight Loss

0 2 4 6 8 10 12 14 16 18 20 22 24 26

2

6

10

14

1

8

22BALKE BALKE

PROTOCOLPROTOCOL

At 25:00 min speed

Increases 0.2 mph/per min

Calculated 3.3 mph Speed

Minutes

Gra

de

(%

)

Definitions Of Fitness CategoriesDefinitions Of Fitness CategoriesFor MalesFor Males

Definitions Of Fitness CategoriesDefinitions Of Fitness CategoriesFor MalesFor Males

Fitness Category*

<30 30 - 39 40 - 49 50-59

Very Poor <14:59 <13:59 <12:29 <10:02

Poor 15:00-18:06 14:00 – 16:59 12:30 15:29 10:03 – 12:59

Fair 18:07 – 22:05 17:00 – 20:59 15:30 – 19:59 13:00 – 16:59

Good 22:06 – 26:00 21:00 – 24:42 20:000 – 23:13 17:00 20:29

Excellent 26:01 – 28:59 24:43 – 27:09 23:14 – 26:15 20:30 – 23:59

Superior 29:00+ 27:10+ 26:16+ 24:00+

*Based on the Cooper Clinicmodified Balke treadmillprotocol

Fitness Category*

<30 30 - 39 40 - 49 50-59

Very Poor <14:59 <13:59 <12:29 <10:02

Poor 15:00-18:06 14:00 – 16:59 12:30 15:29 10:03 – 12:59

Fair 18:07 – 22:05 17:00 – 20:59 15:30 – 19:59 13:00 – 16:59

Good 22:06 – 26:00 21:00 – 24:42 20:000 – 23:13 17:00 20:29

Excellent 26:01 – 28:59 24:43 – 27:09 23:14 – 26:15 20:30 – 23:59

Superior 29:00+ 27:10+ 26:16+ 24:00+

*Based on the Cooper Clinicmodified Balke treadmillprotocol

FitnessCategory*

<30 30-39 40-49 50-59

Very Poor <10:29 <9:29 <7:59 <6:14

Poor 10:30 – 13:15 9:30 – 11:59 8:00 – 10:29 6:15 – 8:29

Fair 13:16 – 17:27 12:00 – 15:20 10:30 – 13:59 8:30 – 11:20

Good 17:28 – 20:59 15:21 – 18:59 14:00 –16:59 11:21-- 14:03

Excellent 21:00 –24:18 19:00 – 21:59 17:00 – 20:09 14:04 – 17:00

Superior 24:19+ 22:00+ 20:10+ 17:01+

*Based on the Cooper Clinic modified Balke treadmill protocol

FitnessCategory*

<30 30-39 40-49 50-59

Very Poor <10:29 <9:29 <7:59 <6:14

Poor 10:30 – 13:15 9:30 – 11:59 8:00 – 10:29 6:15 – 8:29

Fair 13:16 – 17:27 12:00 – 15:20 10:30 – 13:59 8:30 – 11:20

Good 17:28 – 20:59 15:21 – 18:59 14:00 –16:59 11:21-- 14:03

Excellent 21:00 –24:18 19:00 – 21:59 17:00 – 20:09 14:04 – 17:00

Superior 24:19+ 22:00+ 20:10+ 17:01+

*Based on the Cooper Clinic modified Balke treadmill protocol

Definitions Of Fitness CategoriesDefinitions Of Fitness CategoriesFor FemalesFor Females

Definitions Of Fitness CategoriesDefinitions Of Fitness CategoriesFor FemalesFor Females

Age-Adjusted All-Cause MortalityAge-Adjusted All-Cause Mortalityby Fitness Groups, Menby Fitness Groups, Men

Age-Adjusted All-Cause MortalityAge-Adjusted All-Cause Mortalityby Fitness Groups, Menby Fitness Groups, Men

0

10

20

30

40

50

60

70

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40

50

60

70

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Fitness and All-Cause Mortality, MenFitness and All-Cause Mortality, MenFitness and All-Cause Mortality, MenFitness and All-Cause Mortality, Men

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Very PoorVery PoorVery PoorVery Poor PoorPoorFairFair

PoorPoorFairFair

GoodGoodExcellent/SuperiorExcellent/Superior

GoodGoodExcellent/SuperiorExcellent/Superior

UnfitUnfit

FitFit

Health & Longevity Fitness

Aerobic Fitness

Exercising and AgingExercising and AgingExercising and AgingExercising and Aging

Telomeres are protective tips on bundles Telomeres are protective tips on bundles of genes inside cellsof genes inside cells

Every time a cell divides, telomeres get Every time a cell divides, telomeres get shortershorter

Aging occurs as cells reach the end of the Aging occurs as cells reach the end of the telomere and die telomere and die ── muscle weakens, skin muscle weakens, skin wrinkles, and thinking cloudswrinkles, and thinking clouds

Telomeres are protective tips on bundles Telomeres are protective tips on bundles of genes inside cellsof genes inside cells

Every time a cell divides, telomeres get Every time a cell divides, telomeres get shortershorter

Aging occurs as cells reach the end of the Aging occurs as cells reach the end of the telomere and die telomere and die ── muscle weakens, skin muscle weakens, skin wrinkles, and thinking cloudswrinkles, and thinking clouds

Arch of Int Med, Jan 28, 2008

Exercise and AgingExercise and AgingExercise and AgingExercise and Aging

• 2,401 British Twins2,401 British Twins

Long-term study, length of telomeres measuredLong-term study, length of telomeres measured

• 2,401 British Twins2,401 British Twins

Long-term study, length of telomeres measuredLong-term study, length of telomeres measured

Arch of Int Med, Jan 28, 2008

ExerciseExercise(min/wk)(min/wk)

Reduction in AgeReduction in Age(years)(years)

16:0016:00 BaselineBaseline

100:00100:00 5.0 - 6.05.0 - 6.0

180:00180:00 9.09.0

Aerobic FitnessAerobic Fitness

35 Aerobic points/week35 Aerobic points/week

Run 2.0 miles < 20:00 minutes 4x/weekRun 2.0 miles < 20:00 minutes 4x/week

Walk 3.0 miles < 45:00 minutes 5x/weekWalk 3.0 miles < 45:00 minutes 5x/week

Aerobic dance 45:00 minutes 4x/weekAerobic dance 45:00 minutes 4x/week

Health and Longevity FitnessHealth and Longevity Fitness

15 aerobic points /week15 aerobic points /week

Walk 2.0 miles < 30:00 minutes 3x/weekWalk 2.0 miles < 30:00 minutes 3x/week

Walk 2.0 miles < 35:00 minutes 4x/weekWalk 2.0 miles < 35:00 minutes 4x/week

Walk 2.0 miles < 40:00 minutes 5x/weekWalk 2.0 miles < 40:00 minutes 5x/week

Walk 3.0 miles < 45:00 minutes 2x/weekWalk 3.0 miles < 45:00 minutes 2x/week

Aerobic dance 45:00 minutes 2x/weekAerobic dance 45:00 minutes 2x/week