Aging athlete and musculoskeletal
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The percent of the U.S. population 65 years of age and older rose from 11.2% in the 1980 census to 12.5% in the 1990 census.
About one-third of people past the age of 65 have some impairment in the ability to perform activities of daily living.
Body composition changes with advancing age. Loss in muscle mass causes age-associated decreases in basal metabolic rate, muscle strength, and activity levels. The loss of muscle mass is referred to as "sarcopenia."
Sarcopenia is the primary cause of age-related decrease in muscle strength. Reduced muscle strength in the elderly is a significant cause of increased disability. For example, the high prevalence of falls among institutionalized elderly people may be due to reduced muscle strength and sarcopenia.
As humans age, even though they can offset the loss of muscle mass with exercise, they still lose muscle fibers. Instead of developing new muscle fibers from exercise, as younger individuals do, older people can only increase the bulk of existing muscle fibers.
There is a potential role for testosterone and growth hormone in reversing age-related muscle loss. These naturally occurring hormones decline with age. Studies have found that administration of growth hormone to older people leads to an increase in muscle mass, but not necessarily an increase in strength or function.
Testosterone replacement increases both muscle mass and upper limb strength.
Both of these two hormones remain under investigation as potential treatments for sarcopenia and other age-related problems.
The good news is that these changes may not be entirely an inevitable consequence of aging. Data is available demonstrating that regular exercise can directly affect body fat stores and maximal aerobic capacity in older people.
One study compared the effects of resistance training to those of diet restrictions alone in obese women. They found that resistance exercise training led to increased strength and gains in muscle size as well as preservation of fat free mass during weight loss.
Possible contributory factors to musculoskeletal injury in the older athlete are:
• Decreasing flexibility with aging as a result of lack of use.
• Decreased nerve conduction and reaction time-15% decrease between the ages of 30-70.
• Decreased hearing and/or vision which can affect gait
• Osteoarthritis (degenerative joint disease), rheumatoid arthritis.
• Decreased muscle mass leading to decreased strength and shock absorption.
• Osteoporosis may predispose older individuals to increased fractures. Regular weight bearing exercise may help to prevent fractures.
The American College of Sports Medicine (ACSM) guidelines for developing and maintaining cardiorespiratory and muscular fitness recommend exercise at intensity levels of 50-85% VO2max; 60-90% HR max, or 40-85 METS (maximum MET level). Three to five sessions per week (frequency), for 20-60 minutes (duration) completes the prescription. Resistance training recommendations include one set (8-12 repetitions) of 8-10 exercises that condition major muscle groups at least two times each week. The older athlete may have pre-existing medical conditions (e.g. arthritis, coronary artery disease, obstructive lung disease) or certain age-related changes that hinder the achievement of the ACSM's guidelines. Starting an older athlete at levels below those outlined may be indicated. Exercising at lower levels may provide some modest aerobic benefit.
Among some of the specific adaptations to exercise are improvements in cardiac output, a decline in resting heart rate, lowered levels of cholesterol, a drop in blood pressure, and increased cardiovascular fitness. Improvements in minute ventilation and vital capacity also are improved. Perhaps just as important are improvements in mood and self-esteem.
Aging leads to a decrease in maximum heart rate and an overall decline in maximum cardiac output (the amount of blood the heart can pump). Both of these factors limit athletic performance. When younger athletes exercise, the size of the muscle in the walls of the heart chambers increases. This, in turn, increases the force with which the heart can pump, producing a higher cardiac output and, therefore, a lower heart rate. The heart rate slows because it is working more efficiently. In older athletes, heart muscle size is not increased by exercise as quickly or efficiently. But, it still can be done... just more slowly.
With aging there is a decline in blood flow to the brain, which is associated with a decrease in reaction time. Sense of balance also deteriorates with aging.
Aging leads to a decrease in overall lung capacity and a decline in the ability of the lungs to transfer oxygen from the air into the bloodstream. This means less overall strength and endurance.
Aging causes a decline in V02 max, or the maximum volume of oxygen consumed by the body per heartbeat. This is a prime measure of fitness.
VO2 max declines steadily and predictably with age at about 1.5% per year. Highly trained older athletes show a smaller rate of decline, only 0.5% per year. In studies of athletes, VO2 max closely parallels the decline in maximum athletic performance that comes with age. For this reason it has been suggested that VO2 max makes an excellent measure of physiological rather than chronological aging.
Another problem for older athletes is injury. Older athletes are much more likely to injure themselves than younger athletes. As with all athletes, a careful warm-up period with stretching exercises is important for reducing the chance of injury.
Bone loss is another factor associated with aging. This is especially a worry for women who tend to have less skeletal mass than men and who also lose bone more quickly. After menopause, women lose bone at an average rate of 2% to 3% per year, while age-matched men lose bone at a rate of only 0.4% per year. Bone loss cannot be entirely prevented; however the rate of loss can be slowed through regular exercise, especially weight or resistance training.
Aging also leads to a marked decrease in flexibility. This is a result of changes in the body's connective tissue, combined with the development of arthritis. Lack of flexibility means that the knees, hips, and other joints must bear greater stress during exercise. This stress can cause injury to joints.
Back pain occurs in nearly two-thirds of all adults and also seems to be a more frequent problem with aging.
Older athletes should do extra warm-up and flexibility exercises in order to prevent injury. As with all stretching exercise, these should be performed with a steady and smooth motion.
Back problems are related to particular sports. For example, overhead racket sports tend to increase stress on the neck and low back. The overhead service motion in tennis can aggravate neck and shoulder problems also. Cyclists with back trouble can lessen the strain on their low back by lowering the seat. Swimming types such as the breast stroke cause back problems because of the arching of the back required during the stroke. Running uphill can aggravate low back problems.
Excessive running can be more of an issue with the aging athlete than with younger athletes. Common exercise injuries in older runners include back pain, bursitis, stress fracture, hamstring injury, problems with the (patella) kneecap, shin splints, Achilles tendonitis, heel pain, Morton's neuroma (a benign nerve tumor in the foot), calluses, bunions and many other leg and foot problems. While these also occur in younger runners, they can be more frequent in older individuals. The standard treatments for most of these conditions include rest, orthotics, non-steroidal anti-inflammatory drugs or other pain medications, and physical therapy. For some runners, a difference in leg length plays a role in many of these conditions. This often can be treated with orthotics (inserts in the shoes). All runners should use shoes with good mid-sole cushioning and should change shoes every 250 to 500 miles. Grass, dirt and wooden tracks are less stressful to the body than concrete or asphalt.
Older runners are also more prone to fall-related injuries. Often, the reason is loss of balance; in this situation, it is a good idea to add balance exercises to the workout regimen.
Another common cause for falls in older people is dizziness and fainting due to dehydration. Following a fall, older people are at greater risk of developing subdural hematomas, collections of blood in the area between the brain and the skull.
Swimmer's may develop "swimmer’s shoulder". This condition is caused by repeated trauma to the rotator cuff tendons as they rub against the acromion, the bony roof of the shoulder. It occurs in up to 60% of competitive swimmers. Older swimmers are more likely to encounter rotator cuff rupture than younger swimmers. Another injury more common in the older athlete is rupture of the long head of the biceps tendon. Both of these injuries may require surgical repair. Older athletes with vision problems might consider using corrective swim goggles made by an optometrist.
Older swimmers should be wary of developing hypothermia when swimming in cold water. The ability to regulate body temperature lessens with age.
Older cyclists are more likely to suffer from compressive nerve syndromes in the arms. An example would be handle-bar palsy in the hands. Other cycling injuries that are common in older people include upper limb fractures (in particular the wrist, forearm, and collar bone), shoulder dislocations, sprains, lacerations and abrasions. Using the correct seat height, wearing padded gloves, and not resting on the hands while riding can help cyclists avoid many overuse injuries. Neck pain and stiffness can also occur – generally in patients with pre-existing neck problems such as arthritis. Incorrect rider position is a very common contributing factor to overuse injuries.
Older persons are at increased risk for injuries due to inclement weather, such as dehydration in the summer and hypothermia in the winter. Altitude sickness is another common problem. Acute altitude sickness can occur at heights as low as 6,000 ft (1830 meters). Symptoms including heart palpitations, cough, headache, sleeplessness, nausea, vomiting, and difficulty breathing. This condition can be fatal. It may be more common in older climbers. Any older person who begins climbing should work intensively on balance.
Common overuse injuries in golfers include rotator cuff (shoulder) problems, cervical (neck) disc or osteoarthritis problems, lower back pain and epicondylitis (golfer's or tennis elbow). Wrist disorders are common in older golfers because of continual torsion of the wrist during the golf swing. Many of these problems can be avoided by warming up before starting and by doing stretching exercises. Core strengthening- strengthening the abdominal muscles as well as the muscles that support the back- are recommended. When overuse injuries occur, doctors normally prescribe rest and pain medication.
Tennis players, as they get older, are more prone to develop tendinopathies such as "tennis elbow", rotator cuff injuries, and Achilles tendon problems.
While older athletes are more prone than younger athletes to a sports injuries, most of these can be prevented or treated with a combination of preparation, targeted exercise and conditioning, and common sense. In addition, active participation in a variety of sports and exercise can give older people a longer and better quality life.
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