Middle-aged Athletes Research Articles

Apical Left Ventricular Akinesis in Middle-Aged Endurance Athlete: A Clinical Dilemma

The author reports on the history of a middle-aged male athlete who had sudden acute left pure motor hemiparesis due to a ischemic stroke 7 days after prolonged and strenuous exercise with severe physical fatigue. No chest pain or fever had been reported at that time, only a general feeling of weakness. In hospital all the examinations carried out led to the exclusion of paradoxical embolism via Patent Foramen Ovale. No other investigation was carried out and no anomalies were detected, therefore the patient was discharged with a diagnosis of cryptogenic stroke and neurologic follow up. Two years later the athlete underwent further investigations such as echocardiographic examination which showed a clear left ventricular apical akinesis. On suspicion, therefore, of coronary artery disease a coronary angiography was performed for suspected critical narrowing of the left coronary descending artery branch. However, the coronary angiogram showed patent coronary artery. Assuming that the left ventricular apical akinesia was probably the genesis of ischemic stroke for the formation ofapical thrombus that has migrated into the cerebral circulation occluding the anterior cerebral artery, other examinationswere performed to visualize the cardiovascular findings of the damaged left ventricle apical A cardiac CMR showed a akinetic and thinned left ventricular apex. The LGE showed an aspect of LV apical transmural fibrosis most probably to be attributed to an inflammatory event, that is, to an extended myocarditis, even if the morphological and functional pattern of CMR appears suggestive for an ischemic event. A contemporary coronary computed tomography showed patent coronary arteries as well as profound myocardial bridging at the middle segment of the anterior interventricular artery. The dilemma is thus: the athlete had had extensive myocarditis that had affected the function of the LV apex or he had had a heart attack caused by underlying but hemodynamically significant myocardial bridge?

Arthroscopic rotator cuff repair of large and massive rotator cuff tears in middle-aged and elder sport athletes

Arthroscopic rotator cuff repair of large and massive rotator cuff tears in middle-aged and elder sport athletes

Physical therapists' role in prevention and management of patellar tendinopathy injuries in youth, collegiate, and middle-aged indoor volleyball athletes.

Patellar tendinopathy is highly prevalent in all ages and skill levels of volleyball athletes. To illustrate this, we discuss the clinical, biomechanical, and ultrasound imaging presentation and the intervention strategies of three volleyball athletes at different stages of their athletic career: youth, middle-aged, and collegiate. We present our examination strategies and interpret the data collected, including visual movement analysis and dynamics, relating these findings to the probable causes of their pain and dysfunction. Using the framework of the EdUReP concept, incorporating Education, Unloading, Reloading, and Prevention, we propose intervention strategies that target each athlete's specific issues in terms of education, rehabilitation, training, and return to sport. This framework can be generalized to manage patellar tendinopathy in other sports requiring jumping, from youth to middle age, and from recreational to elite competitive levels.

Cardiovascular Imaging of Prominent Crista Terminalis

The differential diagnosis of intracardiac masses that involves the right atrial chamber include vegetation, thrombus or tumours, and anatomic normal variants such as crista terminalis. Size, shape,location, mobility and attachment of the mass combined with the clinical findings help differentiate etiology. Two Dimensional Trans Thoracic Echocardiography (TTE) became the gold standard test for the diagnosis of intracardiac masses and further examination such as transesophagealechocardiography (TEE) and Cardiac Magnetic Resonance (CMR) improved the accuracy. The cardiovascular imaging is crucial to establish a correct diagnosis for proper management and therapy. Here the author describes the case report of a healthy middle-aged athlete who underwent echocardiography for sports preparticipation screening which detected the presence of a peduncolated right atrial mass of uncertain nature. Because of the strong suspicion for small right atrial mixoma, he underwent CMR that showed a small enhancing mass adherent to the right atrial posterior wall typical of prominent crista terminalis. This report of rare Crista Terminalis muscular bridge that mimicks right atrial mixoma gives new information for the understanding of the aspect of complex and strange right atrial anatomy

The exercise heart rate profile in master athletes compared to healthy controls.

Endurance exercise protects the heart via effects on autonomic control of heart rate (HR); however, its effects on HR indices in healthy middle-aged men are unclear. This study compared HR profiles, including resting HR, increase in HR during exercise and HR recovery after exercise, in middle-aged athletes and controls. Fifty endurance-trained athletes and 50 controls (all male; mean age, 48·7±5·8years) performed an incremental symptom-limited exercise treadmill test. The electrocardiographic findings and HR profiles were evaluated. Maximal O2 uptake (52·6±7·0 versus 34·8±4·5mlkg(-1) min(-1) ; P<0·001) and the metabolic equivalent of task (15·4±1·6 versus 12·2±1·5; P<0·001) were significantly higher in athletes than in controls. Resting HR was significantly lower in athletes than in controls (62·8±6·7 versus 74·0±10·4 beats per minute (bpm), respectively; P<0·001). Athletes showed a greater increase in HR during exercise than controls (110·1±11·0 versus 88·1±15·4bpm; P<0·001); however, there was no significant between-group difference in HR recovery at 1min after cessation of exercise (22·9±5·6 versus 21·3±6·7bpm; P=0·20). Additionally, athletes showed a lower incidence of premature ventricular contractions (PVCs) during exercise (0·0% versus 24·0%; P<0·001). Healthy middle-aged men participating in regular endurance exercise showed more favourable exercise HR profiles and a lower incidence of PVCs during exercise than sedentary men. These results reflect the beneficial effect of endurance training on autonomic control of the heart.

Rationale and design of the Measuring Athlete's Risk of Cardiovascular events (MARC) study : The role of coronary CT in the cardiovascular evaluation of middle-aged sportsmen.

BackgroundMore than 90 % of exercise-related cardiac arrests occur in men, predominantly those aged 45 years and older with coronary artery disease (CAD) as the main cause. The current sports medical evaluation (SME) of middle-aged recreational athletes consists of a medical history, physical examination, and resting and exercise electrocardiography. Coronary CT (CCT) provides a minimally invasive low radiation dose opportunity to image the coronary arteries. We present the study protocol of the Measuring Athlete’s Risk of Cardiovascular events (MARC) study. MARC aims to assess the additional value of CCT to a routine SME in asymptomatic sportsmen ≥45 years without known CAD.DesignMARC is a prospective study of 300 asymptomatic sportsmen ≥45 years who will undergo CCT if the SME does not reveal any cardiac abnormalities. The prevalence and determinants of CAD (coronary artery calcium score ≥100 Agatston Units (AU) or ≥50 % luminal stenosis) will be reported. The number needed to screen to prevent the occurrence of one cardiovascular event in the next 5 years, conditional to adequate treatment, will be estimated.DiscussionWe aim to determine the prevalence and severity of CAD and the additional value of CCT in asymptomatic middle-aged (≥45 years) sportsmen whose routine SME revealed no cardiac abnormalities.Electronic supplementary materialThe online version of this article (doi:10.1007/s12471-014-0630-0) contains supplementary material, which is available to authorized users.

Cardiovascular evaluation of middle-aged individuals engaged in high-intensity sport activities: implications for workload, yield and economic costs

BackgroundThe European Association of Cardiovascular Prevention and Rehabilitation (EACPR) recommends cardiovascular evaluation of middle-aged individuals engaged in sport activities. However, very few data exist concerning the impact of such position...

Short-term periodized aerobic training does not attenuate strength capacity or jump performance in recreational endurance athletes

The purpose of this study was to investigate the effects of three different distributions of aerobic training on the isokinetic strength and vertical jump performance [SJ, CMJ and Abalakov (ABA)] in thirty middle-aged endurance athletes (38.7 ± 9.8 yrs; 174.7 ± 6.5 cm; 72.0 ± 9.8 kg). Three zones of training were required to quantify volume of training: Zone 1, low-intensity-training < VT1; Zone 2, threshold-training, between VT1 and VT2; and Zone 3, high-intensity-training > VT2. The INC group (n = 10) began training in the Zone 1 and then gradually built up training in Zone 2 and Zone 3, thereby increasing the intensity of aerobic activity over the 4-week training period. The CON group (n = 10) performed the same activity every week in Zones 1, 2 and 3. The FRE group followed a free distribution of endurance training loads (n = 10). The results showed significant decreases in peak torque knee extension 30° (p < 0.05) in CON group and significant decreases (p < 0.05) in ABA in FRE group. Results provide a physiological basis to support several performance studies that consistently indicate 5 d·wk(-1) endurance training does not impair strength development over the short term. In conclusion, variations in volume and intensity in training groups did not interfere with isokinetic strength and vertical jump performance.

Pushing the limits: exercise stress in the healthy human heart.

Pushing the limits: exercise stress in the healthy human heart.

Marathon run: cardiovascular adaptation and cardiovascular risk

The first marathon run as an athletic event took place in the context of the Olympic Games in 1896 in Athens, Greece. Today, participation in a 'marathon run' has become a global phenomenon attracting young professional athletes as well as millions of mainly middle-aged amateur athletes worldwide each year. One of the main motives for these amateur marathon runners is the expectation that endurance exercise (EE) delivers profound beneficial health effects. However, with respect to the cardiovascular system, a controversial debate has emerged whether the marathon run itself is healthy or potentially harmful to the cardiovascular system, especially in middle-aged non-elite male amateur runners. In this cohort, exercise-induced increases in cardiac biomarkers-troponin and brain natriuretic peptide-and acute functional cardiac alterations have been observed and interpreted as potential cardiac damage. Furthermore, in the cohort of 40- to 65-year-old males engaged in intensive EE, a significant risk for the development of atrial fibrillation has been identified. Fortunately, recent studies demonstrated a normalization of the cardiac biomarkers and the functional alterations within a short time frame. Therefore, these alterations may be perceived as physiological myocardial reactions to the strenuous exercise and the term 'cardiac fatigue' has been coined. This interpretation is supported by a recent analysis of 10.9 million marathon runners demonstrating that there was no significantly increased overall risk of cardiac arrest during long-distance running races. In conclusion, intensive and long-lasting EE, e.g. running a full-distance Marathon, results in high cardiovascular strain whose clinical relevance especially for middle-aged and older athletes is unclear and remains a matter of controversy. Furthermore, there is a need for evidence-based recommendations with respect to medical screening and training strategies especially in male amateur runners over the age of 35 years engaged in regular and intensive EE.

Slow Recovery of the Right and Left Ventricular Deformation after Conversion from Atrial Fibrillation

Atrial fibrillation (AF) is a possible complication of sport in middle-aged athletes. When sinus rhythm has been restored, at what time is deformation restored too? This question has never been answered. We studied an one 47-year old cyclist and runner with acute lone atrial fibrillation. A day before, he trained hard intervals and felt at the next day an irregular rhythm, training was not possible. He told this would occure 2 times a year , but after the light training the irregular puls will disappear. At the chest-pain unit we performed echocardiography inclusive strain measurements of the right and left ventricle during atrial fibrillation and immediately after the recovery of the sinus rhythm. He recovered to sinus rhythm during the exercise test. Global strain was at the moment of atrial fibrillation – 11.8%, direct after the recovery of the sinus rhythm -17,2%, and -20.5% at the next day, even though the normalized diastolic function directly after conversion from AF. It seems to be that the heterogenity of the deformation need time to recovery after the conversion to the sinus rhythm, even though the diastolic function seems to be normalized. The further endurance training should be continued only after normalization of deformation values.

Evidence of imbalanced adaptation between muscle and tendon in adolescent athletes

Adolescence may be regarded as a critical phase of tissue plasticity in young growing athletes, as the adaptation process of muscle-tendon unit is affected by both environmental mechanical stimuli and maturation. The present study investigated potential imbalances of knee extensor muscle strength and patellar tendon properties in adolescent compared with middle-aged athletes featuring long-term musculotendinous adaptations. Nineteen adolescent elite volleyball athletes [(A), 15.9 ± 0.6 years] and 18 middle-aged competitively active former elite volleyball athletes [(MA), 46.9 ± 0.6 years] participated in magnetic resonance imaging and ultrasound-dynamometry sessions to determine quadriceps femoris muscle strength, vastus lateralis morphology and patellar tendon mechanical and morphological properties. There was no significant age effect on the physiological cross-sectional area of the vastus lateralis and maximum knee extension moment (P > 0.05) during voluntary isometric contractions. However, the patellar tendon cross-sectional area was significantly smaller (A: 107.4 ± 27.5 mm(2) ; MA: 121.7 ± 39.8 mm(2) ) and the tendon stress during the maximal contractions was significantly higher in adolescent compared with the middle-aged athletes (A: 50.0 ± 10.1 MPa; MA: 40.0 ± 9.5 MPa). These findings provide evidence of an imbalanced development of muscle strength and tendon mechanical and morphological properties in adolescent athletes, which may have implications for the risk of tendon overuse injuries.

Right ventricular adaptations and arrhythmias in amateur ultra-endurance athletes

ObjectiveUltra-endurance sports are becoming increasingly popular in middle-aged amateur athletes. Right ventricular (RV) arrhythmogenic remodelling has been described in high-level endurance athletes, like professional cyclists. The clinical relevance for amateurs...

Ultra-endurance sports have no negative impact on indices of arterial stiffness

Marathon running has been linked with higher arterial stiffness. Blood pressure is a major contributor to pulse wave velocity (PWV). We examined indices of arterial stiffness with a blood pressure-independent method in marathon runners and ultra-endurance athletes. Male normotensive amateur runners were allocated to three groups according to former participation in competitions: group I (recreational athletes), group II (marathon runners) and group III (ultra-endurance athletes). Indices of arterial stiffness were measured with a non-invasive device (VaSera VS-1500N, Fukuda Denshi, Japan) to determine the cardio-ankle vascular index (CAVI, primary endpoint) and brachial-ankle PWV (baPWV). Lifetime training hours were calculated. Cumulative competitions were expressed as marathon equivalents. Linear regression analysis was performed to determine predictors for CAVI and baPWV. Measurements of arterial stiffness were performed in 51 subjects (mean age 44.6 ± 1.2 years): group I (n = 16), group II (n = 19) and group III (n = 16). No between-group differences existed in age, anthropometric characteristics and resting BP. CAVI and baPWV were comparable between all groups (P = 0.604 and P = 0.947, respectively). In linear regression analysis, age was the only independent predictor for CAVI (R(2) = 0.239, β = 0.455, P = 0.001). Systolic BP was significantly associated with baPWV (R(2) = 0.225, β = 0.403, P = 0.004). In middle-aged normotensive athletes marathon running and ultra-endurance sports had no negative impact on arterial stiffness.

Contradictory Statements

The article by Scharhag et al. offers a plethora of information, but I am missing a concrete value for a healthy limit to endurance exercise. The section on changes to the ECG contains two apparently contradictory statements: Atrial fibrillation is more common among middle-aged and older endurance athletes than it is among athletically inactive persons of the same age. On the other hand, it has been found that moderate endurance training, as performed in preventive-fitness programs, may actually lower the risk of atrial fibrillation in old age. The only explanation for this contradiction is the intensity of the endurance exercise. More intense training is more likely to result in overstretching of the left atrium. Atrial remodeling then enables atrial fibrillation. Medicine can define clear threshold values for blood pressure, pulse rates, and cholesterol concentrations. For me as a general practitioner it would be very important to know a definite threshold value for healthy physical endurance exercise. What can I recommend to my patients as moderate endurance exercise? Research is currently not able to provide evidence based data to answer this question, which is relevant for routine clinical practice. Many years ago, the campaign “Trimm dich [get fit] Aktion 130” was launched. However, a general pulse rate of 130 for everyone is not differentiated enough and probably not scientifically supported either. I would welcome definitive values, based on age and weight. To this end, age-dependent performance in watts/kg body weight could be used. Even more simply, an endurance exercise threshold could be given as a percentage of the maximum age-related pulse rate. This could form the basis for future studies. -

Surgical Treatment of Osteoarthritis in the Middle-aged Athlete

Middle-aged athletes represent adults from the age of 35 to 60 years for the purposes of this discussion. The prevalence of knee osteoarthritis increases with age, and older people are staying active longer. The indications for opening wedge high tibial osteotomy (owHTO) continue to grow. owHTO correct malalignment to unload the medial joint in middle-aged athletes with a varus knee who want to return to high-impact activities. owHTO may be combined with cartilage preserving procedures, or with ligament reconstructions. We describe our preferred surgical technique and surgical implant with advanced guidance system to create predictable accurate results.

Physical Therapy Management of Knee Osteoarthritis in the Middle-aged Athlete

Osteoarthritis (OA) is prevalent in today's population, including the athletic and recreationally active "middle-aged" population. OA is a degenerative condition of the articular/hyaline cartilage of synovial joints and commonly affects the knee joint. In general, athletic participation does not specifically influence a higher incidence of knee OA in this population; however, traumatic injury to the knee joint poses a definitive risk in developing early-onset OA. The purpose of this article is to review evidence-based nonpharmacological interventions for the conservative management of knee OA. Manual therapy, therapeutic exercise, patient education, and weight management are strongly supported in the literature for conservative treatment of knee OA. Modalities [thermal, electrical stimulation (ES), and low-level laser therapy (LLLT)] and orthotic intervention are moderately supported in the literature as indicated management strategies for knee OA. While many strongly supported conservative interventions have been published, additional research is needed to determine the most effective approach in treating knee OA.

Treatment of OA of the Knee in the Middle-aged Athlete

Knee arthroscopy for patients with osteoarthritis remains controversial. The outcome of arthroscopic debridement in a patient with symptomatic arthritis, and in the absence of mechanical symptoms, is inconsistent and short lived. However, in carefully selected patients with mild or moderate arthritis on standing radiographs, with the acute onset of symptoms, well-localized joint line pain, and painful mechanical symptoms, improved knee function can be expected. Regardless, the natural history of the disease process is unaltered. Patients, especially higher demand middle-aged athletes, must be counseled about the prognosis of degenerative arthritis, the limited positive effects of the arthroscopic procedure, the potential for complications, and the probable need for reconstructive surgery in the future.

The Treatment of Osteoarthritis in the Middle-aged Athlete

The Treatment of Osteoarthritis in the Middle-aged Athlete

Treatment of Osteoarthritis of the Middle-aged Athlete

Unicompartmental knee arthroplasty (UKA) has increasingly become an attractive alternative to total knee arthroplasty for early intervention. Clinical and biomechanical studies have shown that UKA offers advantages in early recovery, more natural function, and patient satisfaction. The literature has also shown that UKA exhibits a higher rate of revision than total knee arthroplasty, particularly in registry studies that include patients from outside of high-volume specialty centers. Patient-specific UKA offers the potential to close the gap between the known advantages of a partial knee solution and the documented risk of early revision. On the basis of the patient's own imaging data, patient-specific UKA allows for an anatomically matched implant design that provides personalized fit, full coverage of the tibial cortical rim, and preserves the femoral articulating geometry. These design advantages are paired with a patient-specific instrument system that provides reliable component placement and simplified balancing.