Aging athlete and musculoskeletal
The onset of disability traditionally has begun at about age 60. About one-third of people over age 65 have some impairment in performing activities such as walking.
A recent Today Show segment was entitled Why 50 is the new 30.
Increased health consciousness has been fueled by changes in diet as well as exercise. Unfortunately, aging also leads to physiologic changes which adversely affect the ability of the baby boomer athlete to perform. Age brings 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 slows down because it is working more efficiently. In older athletes, heart muscle size is not increased by exercise as quickly or efficiently. 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. As people age, they lose both muscle strength and muscle mass. Decline in muscle mass is termed sarcopenia. Human muscles are classified as either Type I or Type II. Most of the muscle lost from sarcopenia is what is known as Type IIa, or "fast-twitch," muscle fibers. Type I muscles are slow to contract and contribute to physical endurance; Type II muscles are faster to contract and are associated with strength and power. As humans age, even though they can offset the loss of muscle mass with exercise, they still lose Type II fibers at the same rate. What happens is that instead of developing new muscle fibers from exercise, as when younger, older people can only increase in bulk of the remaining fibers. In addition, with age, the ability to control the activation of muscles declines. This leads to loss of coordination and strength.
Testosterone replacement seems to increase 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.
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 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. VO2 is a fairly straightforward breathing test. Another problem for older athletes is injury. Older athletes are much more likely to injure themselves than younger athletes. However, it has been found that even with this increased likelihood of injury, older runners tend to be physically superior to the average person of their age. As with all athletes, a careful warm-up period with stretching exercises is important for reducing the chance of injury. Loss of bone 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 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 gradually injure 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 curvature and stress the spine, and aggravate lower back problems. The overhead service motion in tennis can aggravate neck problems also. Cyclists with back trouble might improve their symptoms by lowering the seat. Head-up swimming motions, such as the breast stroke, cause back problems by causing arching of the back. Running uphill can be worse for the lower back than running on a flat surface. The type of pain felt often provides a clue to the cause. Pain from disc damage is worse when sitting or standing. Night pain suggests an inflammatory condition or perhaps the presence of a tumor or other growth near the spine. Sciatica, or pain radiating down the back of the thigh and legs, without back pain is usually caused by the entrapment of a nerve. Pain from spinal stenosis, or narrowing of the canal surrounding the spinal cord, is worse when walking and when the back is stretched. Herniated discs produce worse pain when sitting.
Most common runners' injuries have one thing in coming; they are caused by too much running. This becomes truer with age. 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. 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 the length of the legs plays a role in many of these conditions. This often responds to 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 and are particularly recommended for older runners. 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 dangerous subdural hematomas, or collections of blood from an injury that collect in an area between the brain and the skull. One of the signs of subdural hematoma is a sudden change in mental status, including loss of consciousness, anxiety, loss of memory, and giddiness. Swimmer's may develop a particularly nagging problem. Dubbed swimmers shoulder, this malady is caused by repeated rubbing of the rotator cuff muscles against the acromion, a bone in the shoulder. It occurs in up to 60% of competitive swimmers. An upper arm strap may relieve some of the pain caused by this condition. Older swimmers are more likely to suffer rotator cuff rupture than younger swimmers. Another injury more common in the older athlete is rupture of the long portion of the biceps tendon. Both of these injuries may require surgical repair. Older swimmers should avoid using hand paddles; these increase the risk of impingement syndromes (where the rotator cuff is pinched between the head of the humerus [upper arm bone] and the shoulder blade). Fins can be used by older swimmers, except those with certain knee conditions. Older athletes with vision problems might consider using corrective swim goggles made by an optometrist.
Older cyclists are more likely to suffer from compressive nerve syndromes in the arms. An example would be handle-bar palsy in the hands. These are mostly caused by over exertion. 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 most overuse injuries. Neck pain and stiffness can also occur generally in patients with pre-existing neck problems. Urethritis, (inflammation of the urethra), and saddle pressure sores can be prevented by using a padded seat and padded cyling shorts. 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 and difficulty breathing. This condition can be fatal. It may be more common in older climbers. Older climbers are more likely to suffer fractures. 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 pain is common in older golfers, because of continual extension and twisting of the wrist during the golf swing. Many of these problems can be avoided simply by appropriately warming up the body before starting and by doing stretching exercises. Muscle strengthening exercises, especially the back muscles, are key to preventing and treating many golf injuries. 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. Older athletes are more prone than younger athletes to a range of sports injuries. Most sports injuries can be prevented or treated with a combination of preparation, targeted exercise and conditioning, and common sense. Almost all studies suggest that active participation in a variety of sports and exercise can give older people a longer and better quality life.
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