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Issues particular to
the aging athleteRobert J Petrella, MD, PhD, FCFP, FACSM
CAC Sport and Exercise Medicine
CAC Care of the Elderly
Professor Family Medicine and Kinesiology
Western University
Medical Director
Canadian Center for Activity & Aging
London, Canada
- Consultant with Carbylan Biosurgery, Sanofi Biosurgery
- Grant support for research activity from CIHR, PHAC,
Amgen, Carbylan Biosurgery, Sanofi Biosurgery, Novartis,
Pfizer, Tedec-Meiji
Disclosures
Aging and Dependency Interaction
Kazem Rahimi et al. Circ Res. 2015;116:925-936
Ischemic heart disease (IHD) mortality in each decade of age vs usual blood pressure at the start
of the decade.
Aging and Disease Risk
Aging and Chronic Disease
Interaction
Influence of age on maximal oxygen
consumption (VO2max) in men and women
Aging and Exercise
Interaction
The Effects of Exercise on CV and Brain
Health
Kennedy et al., J Alzheimers Dis, 2017;108(7):3017-3022
• Neurophysiological changes
in brain function, volume, and
efficiency
• Exercise is associated with
upregulation of neurotrophins (e.g.,
BDNF)
• Neurotrophins influence the
development, differentiation and
maintenance of brain cells
• Neurotrophins are believed to mediate
the capacity for exercise to promote
neurogenesis and brain plasticity
• Cardiovascular health and
associated risk factors
• Exercises may attenuate the vascular-
related burden on the brain by
improving vascular health (e.g.,
endothelial function)
• The positive effects of exercise on
hypertension, diabetes and
hypercholesterolemia is associated with
better cognition
• Exercise may reduce the risk for stroke,
vascular-related brain atrophy and
white matter hyperintensities
Updating ACSM's Recommendations for Exercise Preparticipation Health Screening.RIEBE, DEBORAH; FRANKLIN, BARRY; THOMPSON, PAUL; GARBER, CAROL; WHITFIELD, GEOFFREY; MAGAL, MEIR; PESCATELLO, LINDA Medicine & Science in Sports & Exercise. 47(11):2473-2479, November 2015.
Recommendations for all adults
Recommendations for Master Athletes
Gregory A. Tayrose, MD,† Bryan G. Beutel, MD,*† Dennis A. Cardone, DO,†
and Orrin H. Sherman, MD†
Herman by Jim Unger.
Preparticipation Medical Screening
2
ACSM update to safe exercise adoption
Updating ACSM's Recommendations for Exercise PreparticipationHealth Screening.RIEBE, DEBORAH; FRANKLIN, BARRY; THOMPSON, PAUL; GARBER, CAROL; WHITFIELD, GEOFFREY; MAGAL, MEIR; PESCATELLO, LINDA
Petrella A, Gill D, Petrella RJ; APNM 2018
Petrella A, Gill D, Petrella RJ; APNM 2018
Petrella A, Gill D, Petrella RJ; APNM 2018
Petrella A, Gill D, Petrella RJ; APNM 2018
Petrella A, Gill D, Petrella RJ; APNM 2018
Reason for Screen Out n*
Stress Test Impressions 8
Reason for stopping stress test: Light-headedness/Dizziness 1
Reason for stopping stress test: Chest Pain 1
Reported heart problems (i.e., Chest Pain/Tightness/Angina) 7
Hypotension (SBP<100 and/or DBP <60 mmHg via any
measurements during stress test)
4
Case for 3-step screening approach
Paul aged 85yIn healthy adults, including middle-aged, old, and very old (80+ year) cohorts:
1. Frequency of training: 3 to 5 days per week.2. Intensity of training: 55%–65% to 90% of maximum heart rate, or 40%–50% to 85% of maximum oxygen uptake reserve or maximum heart rate reserve; although the recommended relative intensity for training remains constant, regardless of age, the absolute intensity of training, expressed as METs, decreases with increasing age.3. Duration of training: 20 to 60 minutes of continuous or intermittent (minimum of 10-minute bouts accumulated throughout the day) aerobic activity.4. Mode of activity: any activity that uses large muscle groups, which can be maintained continuously, and is rhythmical and aerobic in nature, for example, walking, jogging (in place or moving), running, stationary or outdoor cycling, swimming, skipping rope, rowing, cross country skiing, stair climbing, skating, and various endurance game activities.
Jacinto, aged 77
5. Resistance training: one set of eight to 10 exercises that condition major muscle groups 2 to 3 days per week is recommended (at least initially); however, multiple-set regimens may provide greater benefits if time allows; most persons should complete eight to 12 repetitions of each exercise, to volitional fatigue; however, for older and more frail persons (approximately 50–60 years of age and above), 10 to 15 repetitions per set may be more appropriate.
Tao, aged 98 years
6. Flexibility training: these exercises should stretch the major muscle groups, be performed at least fourrepetitions per muscle group for a minimum of 2 to 3 days per week, and include appropriate static, ballistic, or modified proprioceptive neuromuscular facilitation (contract/relax, hold/relax, active/assisted) techniques; the elite senior athlete may, however, far exceed these thresholds and physical training dosages (ie, points 1–6) in order to achieve the performance levels that are required for competition.
Issues particular to the aging athlete
• Improving risk, reducing dependence, enjoying life
⏤ Evidence is unequivocal
⏤ Aging athletes achieve extraordinary results
• Screening
⏤ Recreational athlete
⏤ Master’s athlete
⏤ 3-part pre-participation process
• Training
⏤ One size does not fit all
⏤ FIT principles apply
⏤ Chronic disease must be considered
⏤ Adjust concomitant therapy to athlete goals
Resources
ACSM Guidelines
AHA Guidelines
CSEP GAQ
CCAA
Referrals
EIM Canada
CASEM
CSEP
CAC SEM
CCAA
Thank you!
Vo2max by sport