Issues particular to the aging athlete€¦ · throughout the day) aerobic activity. 4. Mode of activity: any activity that uses large muscle groups, which can be maintained continuously,

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