April 1st, 2013
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?
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
- high blood pressure
- heart failure
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
- the incidence of atrial fibrillation in middle-aged endurance athletes is rare
- 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
- 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
- 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.
- 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.
- Patil, H and others (2012) Cardiovascular damage resulting from chronic excessive endurance exercise. Missouri Medicine, 109(4): 312-321.
June 6th, 2012
Did you know moderate intensity training in males is useful in the prevention and treatment of sexual dysfunction? Howver, in young athletes, high intensity training, especially in endurance athletes, can reduce testosterone levels.
Low testosterone levels in young athletes has been shown to lead to reductions in both health and performance. Specifically, low levels of the hormone have been linked to overtraining, decreases in muscle mass, increased risk of bone fractures, cardiovascular accidents, and sports-related anemia, as well as stress-related diseases such as hypertension.
Critically for competitive athletes both young and old, testosterone deficiencies can also reduce muscle strength, reduce aggressiveness in competition, lower the regeneration of muscles after training, and lower the sex drive! Not good I say! Here is some Italian research I recently read that investigated the prevalance and symptoms of undiagnosed testosterone defeiciency in athletes between 50 and 80 years old.
183 caucasian male athletes >50 years were examined as part of pre-participation health screening by medical practitioners. The athletes were from different sports (tennis, swimming and track and field), were not taking supplements or drugs that affected results, had no previous diagnosis or awareness of testosterone deficiency. They had been training regularly for the last 10 years for an average of 8.1 hrs/week. Serum total testosterone was measured in the blood, and questionnaires administered as measures of erectile dysfunction (International Index of Erectile Dysfunction), depression levels (Center for Epidemiological Studies Depression Scale) and amount of physical activity (International Physical Activity Questionnaire). Hypogonadal athletes (mild or severe testosterone deficiency) were statistically compared with eugonadal (normal testosterone levels) athletes as controls.
Severe or mild testosterone deficiency was observed in 12% and 18%, respectively, of the athletes. The highest prevalence of testostreone deficiency was in athletes >70 years (27.5% – severe deficiciency and 25.0% – mild deficiency). Testosterone levels were not related to age, training duration, or questionnaire scores. No differences were observed for erectile dysfunction, levels of depression or chronic disease markers such as hypertension between normal and severely testosterone deficient athletes.
The results strongly suggest that many masters athletes over 50 years of age may be testosterone deficient and not know it. This would suggest that as part of our yearly check-up (yes guys get it done – and find a doctor with a small hand for that prostate test!), we might consider getting our testosterone levels checked. If deficient in that area, consider testosterone replacement therapy after discussion with your doctor. Talk over and contraindications to the therapy and ensure that if you compete you look at getting a therapeutic use exemption from your peak sporting body.
Source: Di Luigi, L. and others (2010). Prevalence of Undiagnosed Testosterone Deficiency in Aging Athletes: Does Exercise Training Influence the Symptoms of Male Hypogonadism? Journal of Sexual Medicine. 7(7): 2591-2601.
May 10th, 2012
Most masters athletes I know are competitive. Some like to win medals, most love doing PB’s or beating their friends at events they’ve trained together for. Some like to achieve goals they didn’t think were possible before they discovered they can do great things if they are smart about their training and listen hard to their bodies.
Most of us will also look for an advantage if it’s legal and available. For example, we know caffeine can help improve our endurance performance, that creatine (monohydrate) can help us recover between efforts if we are involved with team sports, and that sports drinks help us during endurance events longer than an hour in length, especially in the heat.
A recent review published in the peer-reviewed journal Nutrition has examined what ergogenic (performance-enhancing) dietary aids such as the above substances may be useful in older people. They reviewed 327 articles to come up with their list of what works in older folk. Here is what they concluded works.
- Creatine is made up of amino acids from our body and produced naturally in the liver. It is also naturally available from meat and fish we eat. It is also one of the most widely available and used supplements that does enhance performance in athletes that do repeated efforts of high intensity such as team players or when doing weight training or repeat sprints in training. It has also been shown to enhance muscle size in weight trainers both young and old. A number of studies on older people have shown that taking creatine at the dose of 0.3 mg / kg body weight for 5-14 days with or without weight training can increase muscle mass and strength and power. Similar studies examined creatine effects in older endurance cyclists and found no improvement in cycling performance suggesting that it’s only speed, strength and power and not endurance that’s improved with creatine supplementation. Creatine iscommonly sold in gyms, health food shops and chemists but should be used with caution in masters athletes with kidney issues.
- Caffeine is one of the most well-studied ergogenic (work-enhancing) aids. It increases attention and improves endurance when taken in dosages between 4-6 mg / kg body weight (One No Doz tablet contains 100 mg and a cup of coffee between 50-100 mg. Click here for exact amounts of caffeine per product. Only one study has examined the effect of caffeine on performance in people over 60 years. They were given capsules of caffeine at the dose of 6 mg/kg of body weight and performed exercise 1 hr later. The had better endurance, less perceived effort, and greater strength compared to a placebo (no caffeine) trial.
- Caffeine/Creatine combination appears to have promise to enhance sprinting power – at least in young athletes. One study showed improved sprinting power when taking creatine (0.3 gm / kg body weight for 5 days) then caffeine (6 mg /kg body weight) an hour before sprint running.
- HMB (beta-hydroxy-betamethylbutyrate) That’s why it’s know as HMB! is derived from a naturally occuring amino acid called leucine. It’s used by young athletes to increase muscle size and strength. research has shown that consuming HMB between 250 mg / day and 6 gm / day increased cycling performance but the effect is greater in previously untrained people. In one study with 70 yr olds doing weight training twice a week they improved strength in some exercises but not others. No known side effects have been observed in people consuming between 3 and 6 gm / day.
- Ubiquinone (Co-enzyme Q10) helps generate aerobic energy in the muscle cell’s power house, the mitochondria. Some research has shown benefits of supplementing (100 mg / day) with it at the end of weight training sessions. The one study that did use older people (60-74 years) and compared them with 22-38 year olds showed no age or cycling performance differences when supplementing at 120 mg day for 6 weeks.
- Carnitine is an amino acid that helps us burn fat in those mitochondria pwer houses in our muscle cells. In young swimmers, taking 2 gm of carnitine twice a day for a week has been shown to increase epeat 5 x 100m swim performance. While no studies have been done in older athletes, a couple of carnitine supplementation studies (2 gm / day for periods over 6 weeks or more) showed reduce feelings of fatigue and six-minute walk time in non-athletes over age 65 years.
- Resveratrol is found in red grapes (and red wine but in smaller amounts), mulberries and peanuts. In older rats it’s been shown to enhance endurance performance. No exercise-related studies have been done in humans. However, health-wise it’s been suggested but not proven to have cardioprotective and anti-diabetes benefits in humans.
Limited research has been done in the area of ergogenic aids and masters athletes. However, it appears that, similar to younger athletes, caffeine and creatine, especially in combination, may have beneficial effects in sprinters while caffeine in the right dosage and timed correctly can benefit endurance performance. Finally, creatine appears to benefit strength and power-based athletes or team sport players who have to repeat speed during a game.
For more detailed reading on what legal ergogenic aids work in athletes young and old, including the dosages, timing and side-effects, read Chapter 18 of my book The Masters Athlete titled Performance-enhancing supplements and the masters athlete.
Source: Cherniak, E.P. (2012). Ergogenic dietary aids for the elderly. Nutrition, 28: 225-229.
May 9th, 2012
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.
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.
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.
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.
March 14th, 2012
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 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.
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.
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.