Veteran team sport players have great heart health

Introduction

We all know that physical activity is beneficial for several risk factors of cardiovascular disease and all-cause mortality. We also know that if we improve our aerobic fitness we increase our chances of living longer. However, despite this knowledge, the number of people meeting the recommendations for physical activity is lowest in older people. Why? Because with normal ageing, body fat increases and muscle mass decreases and these changes are more evident in the physically inactive than active people. Obesity is related to several metabolic and cardiovascular diseases and obese men have been shown to have 2.6 times higher mortality from cardiovascular disease than normal weight men.

Research has shown a strong relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. Research has also shown that lean unfit men had higher risk ratios for cardiovascular and all-cause mortality than obese but fit men. These findings highlight the importance of endurance fitness in older people to prevent heart disease and live longer. Moreover, no differences in risk ratios were found between lean and obese but fit men.

Research has also shown that higher levels of endurance fitness are related to more vigorous training rather then low to moderate intensity endurance training.  In team sports, a recent study has shown that the exercise intensity is high during recreational soccer independent of age, gender, the level of training and social background and that recreational soccer is an effective health-promoting activity for untrained men and women aged 20–45 years.

But is recreational soccer a health-promoting activity for the very old? This study aimed to investigate whether lifelong participation in recreational soccer results in superior exercise capacity and cardiovascular health status for elderly (65-85 years old) in comparison to age-matched active men with no regular exercise training as well as strength-trained and endurance-trained elderly men.

Methods

A number of performance measures and indicators of cardiovascular health were measured in elderly soccer players (n = 11) compared to endurance-trained (n = 8), strength-trained (n = 7) and untrained (n = 7) age-matched men. The 33 men aged 65–85 years underwent a testing protocol including measurements of cycling performance, maximal oxygen uptake (VO2max) and body composition, with muscle fibre type and capillarisation determined from a muscle biopsy from the thigh.

Results

In the veteran soccer players, peak aerobic power on the bike was significantly greater (203 ± 20 watts) than in the untrained older men (150 ± 16 watts) and strength-trained men (156 ± 22 watts), but similar to the performance of the endurance-trained older men (201 ± 38 watts). Fat percentage was significantly lower in the veteran soccer players (21.8 ± 4.9%) than the untrained men (28.3 ± 2.1%) but not the endurance-trained (20.7 ± 4.4%) or strength-trained older men (21.7 ± 6.4%). VO2max was not significantly different in the soccer players (30.2 ± 4.9 ml O2 · min−1 · kg−1) compared to untrained (only 14% higher) and ST (only 9% higher), but 22% lower than the endurance-trained older men. The number of capillaries per fibre (a measuer of blood carrying capacity in muscles) was significantly higher  (almost double) in the soccer players compared to both the untrained and strength-trained men but similar to that of the endurance-trained men.

So what?

The scandinavian and UK researchers concluded that both the exercise performance and cardiovascular health profile of lifelong veteran soccer players are markedly better than for age-matched untrained males. Moreover, the exercise capacity and muscle aerobic capacity of veteran soccer players are also superior to lifelong strength-trained athletes and comparable to veteran endurance athletes. Given how important endurance capacity is for reducing cardiovascular disease and all-cause mortality, the study strongly supports older individuals engaging in team sports to enhance the quality and quantity of life into older age.

Source: Randers and others (2014). . Journal of Sports Sciences, 32(13): 1300-1308.

 

Masters endurance athletes more at risk of heart arrythmias

Introduction

Over the last 5-10 years I have become aware of a number of former elite endurance athletes having heart issues. This is counter intuitive given endurance athletes are considered to have strong hearts. However, over the last 10 years research is increasingly showing that the incidence of arrhythmias is higher in athletes, especially in elderly athletes with a lifelong training history in marathons, ultra-marathons, ironman distance triathlons and long distance bicycle races. An arrhythmia is any change from the normal sequence of electrical impulses in the heart. The electrical impulses may happen too fast, too slowly (bradycardia), or erratically so that the heart can’t pump blood effectively.

Bradycardia, defined by a resting heart rate <60 beats min−1, is the most frequent rhythm disturbance in response to endurance training where the resting heart rate can be ~30 beats min−1 and even lower at night. Cyclists Sir Chris Hoy and Tour de France winner Miguel Indurain reportedly had resting heart rates of 30 and 28 beats per minute. Although the bradycardia is usually a harmless adaptation to endurance training, it can become a pathological condition. It was previously thought to affect the electrical activity of the heart that starts in what is called the sinus node (see photo) which is an area of specialized cells in the upper right chamber of the heart that controls the rhythm of your heart.

The most compelling evidence of a link between endurance training and sick sinus syndrome comes from a study of former professional cyclists. Their average heart rate was lower, sick sinus syndrome was more frequent, and pacemaker implantation for bradyarrythmias was more frequent relative to a control group with matched cardiac risk factors. Similarly, a high incidence of pacemaker implantation has been reported in elderly marathon runners.

Historically, this slowing of the heart rate was thought to be the result of a change in the nervous system stimulation of the heart muscle through the sinus node, the pacemaker structure in the heart muscle itself. However, a recent animal study is the first to show that the heart rate adaption to exercise training is not the result of changes in this nervous system control of the heart, and instead is primarily the result of a training-induced remodelling of the sinus node within the heart itself.

Methods

Rats were trained for 12 weeks (1 hour per day, 5 days per week) by aerobic interval training (uphill running) alternating between 4 min at 85–90% of the maximum oxygen uptake and 2 min active recovery at 50% of maximum oxygen uptake. Experiments were also carried out in mice that were trained for 4 weeks (1 hour per day, twice a day, 7 days per week) by swimming. Resting heart rates, electrical activity of the heart, as well as actual tissue samples from the sinus node of sedentary and trained animals were analyzed.

Results

The resting heart rate of the trained rats and mice was ~26% and ~20%, respectively, lower than the heart rate of untrained animals. The resting heart rate of exercise-trained human subjects in various studies varies between ~17–26% lower than the heart rate of inactive people, a reduction similar to that observed in the animal models in the present study. This decrease is less than in elite human athletes. However, severe bradycardia or heart rate slowing in human athletes is uncommon. A protein found in the sinus node (the heart’s pacemaker) changed in response to training with a decrease in an important pacemaker protein, known as HCN4, a protein that is responsible for the low heart rate seen in fit animals.

So What?

With lifelong endurance training, research has consistently shown that veteran endurance athletes have a higher incidence of sinus node disease and artificial pacemaker implantation than normal individuals. Historically, we always believed this was due to changes in the nervous system stimulation of the heart. The present study, although done on rats and mice, suggests the slowing of the heart rate may be due to actual remodeling of the sinus node in the heart wall that actually stimulates the heart muscle to beat. The researchers believe that this finding may also help explain syncope (fainting) in the young athlete as well as other heart rhythm disturbances in older athletes including atrial fibrillation, heart block, bundle branch blockand even sudden cardiac death.. They suggest that it is likely that these disturbances may be the consequence of an actual remodeling of other parts of the heart that are responsible for electrical activity in the heart and perhaps in combination with a pre-existing heart condition in the case of sudden cardiac death.

Critically, the researchers suggest endurance exercise is undoubtedly beneficial for the cardiovascular system, but at the same time intense endurance training over many year can have harmful effects, especially in elderly athletes with a lifelong history of training and competing in endurance events like marathons, triathlons and ironman. They conclude that although endurance exercise training can have harmful effects on the heart, it is more than outweighed by the beneficial effects. Importantly, the researchers also know that this animal study’s findings need to be reproduced in humans and that more research is needed before we could draw conclude that too much endurance training is bad for the heart health of veteran athletes who have undertaken years of endurance training.

Source: D’Souza, A. and others (2014). Exercise training reduces resting heart rate via downregulation of the funny channel HCN4. Nature Communications, 5, Article 3775.

Heart damage from too much training??

Introduction

There’s been some recent media speculation that older endurance athletes are more prone to heart problems than healthy age-matched people. Just after one of our readers advised me of this negative press, a mate in his mid-60’s and pioneer of Ironman triathlon in Australia and now a lecturer in sport coaching at an Ozzie university told me he has had a pacemaker inserted. This goes against the common belief that aerobic exercise is good for you in that it keeps many of the heart disease risk factors in check. So what does the research really say when it comes to this supposed increased risk of heart problems in older endurance athletes?

The Facts

Exercise is increasingly been seen as medicine. In fact, internationally, there has been a movement started called Exercise is Medicine. The movement is being driven by the enormous amount of scientific evidence supporting the value of doctors prescribing exercise as medicine rather than pills!! Consistently and unequivocally recent research has found that regular exercise prevents and treats many of our common and deadly chronic diseases including:

  • coronary artery disease
  • diabetes
  • obesity
  • high blood pressure
  • heart failure
  • depression

Moreover, people who do regular physical activity have lowere rates of disability and an average life expectancy about 7 years longer than non-exercisers.

However, as with any drug there appears to be a safe upper range dose of activity above which there may be adverse effects that may outweigh the benefits above. For example, a long-term study published in 2011 in the highly prestigous medical journal the Lancet tracked 416,000 Taiwanese people over about 8 years and found that there was a protective health effect up to about 60 minutes of daily vigorous (huff and puff!) exercise. Another recent longitudinal study 0f 52,000 adults found that running distances of up to 19.9 miles/week, speeds of 6-7 miles/hour, or frequencies of 2-5 days/week were associated with a lower risk of all-cause mortality, whereas higher mileage, faster paces, and more frequent running were not associated with better survival.

Very recently, there has been some suggestion that long-term endurance vigorous training such as that greater then the doses above may increases the risk of atrial fibrillation (irregular heart beat). This review article presented many studies conducted over the last 15 years that have suggested training too hard for too long can increase the risk of atrial fibrillation in healthy middle-age men. They suggested that although such training may prevent coronary artery disease, it might also cause of atrial fibrillation.

An increasing amount of research evidence also suggests that training and competing long term in ‘extreme’ endurance events such as marathons, ultramarathons, ironman triathlons and very long cycling or swimming events can cause transient problems and damage to the heart walls and chambers as evidenced through blood markers. However, these problems return to normal within 7-10 days after stopping training.

In veteran extreme endurance athletes such as my mate, this consistent heart muscle damage and repair process may lead to heart fibrosis (thickening and stiffening of the heart valves and muscle). Over years, this may lead to heart arrythmias (irregular heart beats).

However, recently another group of cardiology researchers critically analysed these studies that suggested increased risk of heart issues in older endurance athletes (like me and my mates) who train long and hard and often. These researchers concluded that the

  1. the incidence of atrial fibrillation in middle-aged endurance athletes is rare
  2. if a risk exists, it is limited to vigorous endurance exercise only and in those middle-aged men with other risk factors such as smoking or high blood pressure
  3. there is no increased risk in healthy middle-aged men with a normal heart who have no blood pressure issues and no other risk factors
  4. Critically, the researchers concluded that the beneficial effects of exercise will offset this low risk which, even if increased, remains very low.

The So What?

As with any issue in science, research typically is inconclusive. There are always studies and papers that contradict each other. While a number of studies over the years have shown a potential increased risk of heart issues in older athletes who train long and hard and often, other studies suggest the risk is very low in these athletes if they are healthy and have no other risk factors. Moreover, the current concensus appears to be that while the the risk is very low, the benefits of such training outweigh the low risk of heart issues. For me, I intend to keep training regularly unless my body tells me otherwise!

Chapter 4 (Principles of Training the Masters Athlete), Chapter 6 (Endurance Development in the Masters Athlete), Chapter 10 (Periodisation and Peaking for the Masters Athlete), Chapter 13 (Preventing Overtraining in the Masters Athlete) and Chapter 14 (Staying Healthy and Illness-Free) are excellent guides and how-to chapters when it comes to optimising your training and preventing health issues as an older athlete. Each chapter is now available online as a pdf. Check it out by clicking here.

Sources:

  1. Delise, P. and others (2012) Does long-lasting sports practice increase the risk of atrial fibrillation in healthy middle-aged men? Weak suggestions, no objective evidence. Journal of Cardiovascular Medicine, 13: 381-385.
  2. Patil, H and others (2012) Cardiovascular damage resulting from chronic excessive endurance exercise. Missouri Medicine, 109(4): 312-321.

Does Playing Team Sport into Older Age Protect Us from Chronic Disease?

Introduction

We all know that being active into older age helps protect us from the ravages of chronic disease and many age-related disorders. Indeed, research has shown that the more aerobically fit we are the better off we are in preventing cardiovascular disease, diabetes, hypertension, and some forms of cancer. But what about older people that play team sports? Are they as well protected against these age- and lifestyle-related diseases as masters endurance athletes.

A mate of mine, Associate Professor Mike Climstein, from Bond University on Australia’s Gold Coast has looked into this question and recently published his findings.

The Research

Mike and his international research team conducted an online survey of 216 35-plus year old Rugby Union players attending the International Golden Oldies World Rugby Festival. They examined the player’s medical history and some physiological measures then statistically compared the under 50’s and over 50’s players then compared the incidence of chronic disease and conditions with those of a normal Australian population.

The Results

Below are dot-pointed findings from the study:

  • The incidence of smoking was low (8.8%) at averaged 72.4 cigarettes per week
  • The percentage drinking alcohol was high (93.1%) at 11.2 drinks per week (Recommended is 2 drinks per day)
  • The top 6 chronic diseases/conditions reported were: 1. hypertension(18.6%) 2. arthritis (11.5%) 3. asthma (9.3%) 4. high blood fats (8.2%) 5. diabetes (7.5%) 6. gout (6%)
  • When compared to the incidence of chronic disease/conditions in a normal age- and gender-matched Australian population, the older rugby players had significantly lower incidence of anxiety, arthritis, and depression but higher incidence of diabetes, and hypertension
  • Medications were common with 13% taking blood pressure tablets, 8% blood fat lowering medications, 6% anti-inflammatories and 4% blood thinning drugs. Those over 50 years of age were taking significantly more blood pressure, blood thinning and blood fat lowering drugs than the younger players.
  • The rugby players over 50 years had a higher waist circumference (a heart disease risk factor) than the younger players.
  • In general, the players under 50 reported a higher incidence of most chronic conditions and diseases compared to the older players.

So What?

The results suggest that playing team sports into older age may not protect masters athletes from some chronic diseases/conditions such as diabetes and hypertension. Moreover, the results suggest that younger team players need to be more aware of their lifestyle habits than older players when it comes to maintaining optimal health into older age.

For more reading based on what science supports for successful aging, read Chapter 1 of my book The Masters Athlete that identifies the Keys to Successful Aging.

Source: Climstein, M. and others (2011). Incidence of chronic disease and lipid profile in veteran Rugby athletes. World Academy of Science, Engineering and Technology, 80: 1095-1099.

Fitter Men Live Longer

Introduction

It pays to invest in aerobic fitness into older age with the dividend being extra years added to your life. A long-term study from the USA has just found that men who scored highly on aerobic fitness while in their 40’s and stayed fit into their 50’s were 30% less likely to die over the next decade than their unfit mates. The same study also found that men who improved their endurance fitness over that time lowered their risk of death by 40%.

The Research

The researchers examined the separate and combined relationships of changes in endurance fitness and body mass index (BMI)  with death rates from both all causes and death rates from cardiovascular disease (CVD) in 14,345 men (average age 44 years). Fitness was estimated from maximal treadmill test. Changes in fitness and BMI were tested after 11 years and the men were classified into loss of fitness, stable fitness, or gain in fitness groups.

The Results

At the time of the last test, 914 of the men had died from all-causes and 300 from CVD. The men who had maintained fitness showed a 30% lower risk from all causes and 27% lower risk of dying of CVD. However, the men who improved their endurance fitness lowered their risk of all-cause death by 40% and CVD death risk by 42% compared to the men who lost fitness. Crucially, for every 5-10% improvement in aerobic fitness, the risk of death dropped 15% and 19% for all-cause and CVD death, respectively. Moreover, aerobic fitness was far more important than BMI change in determining the risk of death.

So What?

Yet more evidence that we masters athletes need to stay active into older age. Masters endurance athletes know how important aerobic exercise is for both quality and quantity of life. Interestingly, our power / strength and team playing colleagues also benefit from the relatively smaller changes these type of training have on aerobic fitness.  So stick with it team!

For more information on successful aging and what science says are the keys to successful aging, see Chapter 1 of my book The Masters Athlete.

Source: Lee, D.C. and others (2011). Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study. Circulation 124(23): 2483-2490.