Middle-aged Athletes Research Articles

Abstract 4145828: The Interplay Between Exercise Load, Myocardial fibrosis, Ventricular Systolic Dysfunction and Ventricular Arrhythmias

Background: An increased prevalence of myocardial ventricular fibrosis, ventricular dysfunction and arrhythmias has been reported amongst highly trained endurance athletes, but trials investigating these adverse phenotypes in adequately sized and accurately phenotyped cohorts are largely lacking. We aimed to define the prevalence of ventricular fibrosis, ventricular systolic dysfunction, arrhythmia and their interplay in healthy endurance athletes. Methods: We analysed a male cohort of 244 young elite endurance athletes (20yr), 134 middle-aged recreational athletes (56yr) and 65 middle-aged non-athletic controls (55yr). CMR assessed for non-hinge point and hinge point late gadolinium enhancement (NH-LGE and H-LGE) and LVEF and RVEF. 24-hour Holter was performed to assess ventricular arrhythmia. Complex arrhythmia was defined as couplets, triplets and NSVT. Exercise load was based on questionnaires. Multiple logistic regression assessed the relationship between exercise load, LGE, ventricular systolic dysfunction and ventricular arrhythmia. Results: Middle-aged athletes had more NH-LGE (19.4% vs 9.2% vs 4.5%, p<0.001) and H-LGE (29.9% vs 13.8% vs 15.6%, p=0.002) than middle-aged controls and young athletes respectively. Lifetime hours of endurance exercise and age increased the odds of NH-LGE (OR 1.034, 95% CI 1.001-1.069, p=0.044 and OR 1.032, 95% CI 1.006-1.058, p=0.014). A LVEF<50% and/or RVEF<45% was more prevalent in middle-aged and young athletes compared to controls (23.1% % vs 20.5% vs 7.7%, p=0.029). A higher lifetime training load increased the odds of RVEF<45% (OR 1.059, 95% CI 1.014-1.105, p=0.009). LGE did not predict LVEF>50% or RVEF<45%. Both complex arrhythmia and a burden of >0.1% VPB were more prevalent in middle-aged athletes compared to young athletes but not compared to controls (26.1% vs 9.8% vs 12.3%, p<0.001 and 13.6% vs 4.9% vs 7.7%, p=0.012 respectively). NH-LGE and RVEF<45% increased the odds of VPB burden >0.1%. (OR 3.845, 95% CI 1.465-10.089, p=0.006 and OR 5.230, 95% CI 1.698-16.106, p=0.004 respectively). Conclusion: NH-LGE is associated with exercise load and more prevalent in middle-aged athletes compared to younger athletes and age-matched controls. When present, LGE is not associated with a reduced ventricular function. On the other hand, NH-LGE and reduced RVEF are risk factors for increased ventricular ectopic burden and middle-aged athletes show significantly more complex arrhythmia compared to younger athletes.

Predictors of coronary artery calcification in middle-aged and older athletes: the MARC-2 study

Predictors of coronary artery calcification in middle-aged and older athletes: the MARC-2 study

Associations between repetitive head impact exposure and midlife mental health wellbeing in former amateur athletes.

Repetitive head impacts (RHI) have been suggested to increase the risk of developing a neurodegenerative disease, and many of these individuals develop a preceding mental health diagnosis. Given the lack of studies among amateur athletes, this study aimed to examine mental health outcomes in middle-aged amateur athletes who have been exposed to RHI through contact sport participation. This is a single site, cohort study involving former amateur athletes aged between 30 and 60 with at least 10 years of organized contact or non-contact sport participation. All participants completed demographic and mental health questionnaires. Mental health outcomes included symptoms related to depression, anxiety, post-traumatic stress disorder (PTSD), attention deficit hyperactive disorder (ADHD), and aggression. Self-reported data on mental health diagnoses and associated prescription were elicited and used to estimate odds ratios (OR). Data from 41 contact athletes and 22 age/sex-matched non-contact athletes were available for analysis. The contact group exhibited a 2.25-fold higher likelihood of being diagnosed with mental health disorders and 1.29-fold higher likelihood of using associated medications compared to the non-contact group. The contact group reported significantly higher PTSD-related symptoms [4.61 (0.03,9.2), p=0.05] compared to the non-contact control group. While not statistically significant, the contact group showed increased depressive [2.37 (0.05, 4.79), p=0.07] and ADHD symptoms [4.53 (0.51, 9.57), p=0.08] compared to controls. In a secondary analysis, a distinct trend emerged within the contact group, revealing pronounced elevations in mental health symptoms among individuals with lower socioeconomic status (<$50,000/year) compared to higher income subgroups, and these symptoms decreased as income levels rose [depression: -3.08 (-4.47, -1.7), p<0.001; anxiety: -1.95 (-3.15, -0.76), p=0.002; ADHD: -4.99 (-8.28, -1.69), p=0.004; PTSD: -4.42 (-7.28, -1.57), p=0.003; aggression: -6.19 (-11.02, -1.36), p=0.01]. This trend was absent in the non-contact control group. Our data suggest that even individuals at the amateur level of contact sports have an increased likelihood of being diagnosed with mental health disorders or experiencing mental health symptoms compared to non-contact athletes. Our findings indicate that socioeconomic status may have an interactive effect on individuals' mental health, particularly among those with a long history of RHI exposure.

The relationship between workload and exercise-induced cardiac troponin elevations is influenced by non-obstructive coronary atherosclerosis.

The relationship between exercise-induced troponin elevation and non-obstructive coronary artery disease (CAD) is unclear. This observational study assessed non-obstructive CAD's impact on exercise-induced cardiac Troponin I (cTnI) elevation in middle-aged recreational athletes. cTnI levels of 40 well-trained recreational athletes (73% males, 50 ± 9 years old) were assessed by a high-sensitive cTnI assay 24 h before, and at 3 and 24 h following two high-intensity exercises of different durations; a cardiopulmonary exercise test (CPET), and a 91-km mountain bike race. Workload was measured with power meters. Coronary computed tomography angiography was used to determine the presence or absence of non-obstructive (<50% obstruction) CAD. A total of 15 individuals had non-obstructive CAD (Atherosclerotic group), whereas 25 had no atherosclerosis (normal). There were higher post-exercise cTnI levels following the race compared with CPET, both at 3 h (77.0 (35.3-112.4) ng/L vs. 11.6 (6.4-22.5) ng/L, p < 0.001) and at 24 h (14.7 (6.7-16.3) vs. 5.0 (2.6-8.9) ng/L, p < 0.001). Absolute cTnI values did not differ among groups. Still, the association of cTnI response to power output was significantly stronger in the CAD versus Normal group both at 3 h post-exercise (Rho = 0.80, p < 0.001 vs. Rho = -0.20, p = 0.33) and 24-h post-exercise (Rho = 0.87, p < 0.001 vs. Rho = -0.13, p = 0.55). Exercise-induced cTnI elevation was strongly correlated with exercise workload in middle-aged athletes with non-obstructive CAD but not in individuals without CAD. This finding suggests that CAD influences the relationship between exercise workload and the cTnI response even without coronary artery obstruction.

Cardiovascular screening of elderly athletes.

The permanently growing interest in amateur and professional sports activities among young, middle-aged and elderly athletes raises serious concerns about athletes' health, the safety of physical training, and the sports-related risk of sudden cardiac death and other cardiovascular complications during exercise. In recent years there has been an increasing number of cases of sudden cardiac death during physical effort. At present, life expectancy in the most developed countries grows rapidly and the number of people >65 years dramatically increases. Moreover, biological age of the population is lower. Subsequently, relevant increase in the number of elderly athletes involved in various types of sports activities has been reported in many countries. It was also demonstrated that physical activity has strong beneficial effect on cognitive functions, psychomotor performance and thus exercise capacity, which is very important for the elderly people in their everyday routine activities. Nonetheless, it should be remembered that participation in amateur and professional sports activities may be associated with risk of serious cardiovascular events in the elderly athletes often suffering from various civilization diseases. It is also reported that the number of elderly people after interventional cardiology procedures, open heart surgery and cancer treatment (chemotherapy, radiotherapy), who wish to participate in various sports activities, systematically grows. The authors of the paper conduct a literature review on cardiovascular risk assessment in the elderly athletes including the contemporary cardiology diagnostic methods and diagnostic schemes to prevent sudden cardiac death and other cardiovascular events during exercise. The controversies over efficacy of particular diagnostic tools to detect cardiovascular diseases in the elderly athletes and worldwide epidemiologic data concerning risk of sudden cardiac death during physical exercise have been also presented. Here, the authors have derived suggestions for establishment of comprehensive diagnostic schemes to prevent sudden cardiac death during sports activities. Med Pr Work Health Saf. 2024;75(3):233-241.

Exercise-induced cardiac troponin release in athletes with versus without coronary atherosclerosis.

The magnitude of exercise-induced cardiac troponin (cTn) elevations is dependent on cardiovascular health status, and previous studies have shown that occult coronary atherosclerosis is highly prevalent among amateur athletes. We tested the hypothesis that middle-aged and older athletes with coronary atherosclerosis demonstrate greater cTn elevations following a controlled endurance exercise test compared with healthy peers. We included 59 male athletes from the Measuring Athletes' Risk of Cardiovascular events 2 (MARC-2) study and stratified them as controls [coronary artery calcium score (CACS) = 0, n = 20], high CACS [≥300 Agatston units or ≥75th Multi-Ethnic Study of Atherosclerosis (MESA) percentile, n = 20] or significant stenosis (≥50% in any coronary artery, n = 19). Participants performed a cycling test with incremental workload until volitional exhaustion. Serial high-sensitivity cTn (hs-cTn) T and I concentrations were measured (baseline, after 30-min warm-up, and 0, 30, 60, 120, and 180 min postexercise). There were 58 participants (61 [58-69] yr) who completed the exercise test (76 ± 14 min) with a peak heart rate of 97.7 [94.8-101.8]% of their estimated maximum. Exercise duration and workload did not differ across groups. High-sensitivity cardiac troponin T (Hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI) concentrations significantly increased (1.55 [1.33-2.14]-fold and 2.76 [1.89-3.86]-fold, respectively) over time, but patterns of cTn changes and the incidence of concentrations >99th percentile did not differ across groups. Serial sampling of hs-cTnT and hs-cTnI concentrations during and following an exhaustive endurance exercise test did not reveal differences in exercise-induced cTn release between athletes with versus without coronary atherosclerosis. These findings suggest that a high CACS or a >50% stenosis in any coronary artery does not aggravate exercise-induced cTn release in middle-aged and older athletes.NEW & NOTEWORTHY Exercise-induced cardiac troponin (cTn) release is considered to be dependent on cardiovascular health status. We tested whether athletes with coronary atherosclerosis demonstrate greater exercise-induced cTn release compared with healthy peers. Athletes with coronary atherosclerosis did not differ in cTn release following exercise compared with healthy peers. Our findings suggest that a high CACS or a >50% stenosis in any coronary artery does not aggravate exercise-induced cTn release in middle-aged and older athletes.

Handling Sports Injuries using the PEACE Method and Nutritional Management of Athletes After Sports Injuries

This community service implementation aims to provide understanding to athletes and coaches in Pekalongan Regency regarding how to treat sports injuries using the PEACE method and nutritional management of athletes after sports injuries. In this way, it is hoped that coaches and trainers can handle the problems of middle-aged athletes when training and taking part in competitions so that athletes' achievements, especially in Pekalongan Regency, can be maximized. A coach must of course know how to organize nutrition for his athletes during pre-competition, competition and after competition, especially after it is discovered that the athlete has suffered an injury. This is done to maintain the athlete's performance while taking part in the event. The problem in Pekalongan Regency is that there are still many athletes and coaches who do not know how to treat sports injuries using the PEACE method and nutritional management after sports injuries. The reason is that so far there is only one trainer in Pekalongan Regency, who doubles as a technical, mental trainer and nutritionist. Seeing this problem, it is necessary to provide understanding to athletes and coaches regarding injury management and nutritional management for athletes. In carrying out this service, reflection, lecture, practice and discussion methods are used. This service activity went smoothly, respondents were enthusiastic about taking part in this activity. After respondents were given an explanation and understanding regarding handling sports injuries and nutritional management, they carried out a PEACE method practicum and created a nutrition program for athletes after sports injuries.

Atrial fibrillation in middle-aged athletes: Impact on left atrial, ventricular and exercise performance.

High volume endurance training may increase the risk of paroxysmal atrial fibrillation (AF) in middle-aged athletes. Limited data are available describing the cardiovascular phenotype of middle-aged endurance athletes, or the impact of AF on atrial function and exercise performance performed in sinus rhythm. The purpose of this study was to characterize LA phasic function at rest and during exercise in athletes with paroxysmal AF, and to determine its impact on exercise performance. Fifteen endurance trained males (EA) (56 ± 5 years) without AF and 14 endurance trained males with paroxysmal AF (EA-AF) (55 ± 8 years) underwent echocardiography during cycle-ergometry at light and moderate intensities. Resting LA maximal volumes were similar between EA and EA-AF (30 ± 4 vs. 29 ± 8 ml/m2, p = 0.50), and there were no differences in atrial electromechanical delay (AEMD). During moderate intensity exercise, EA-AF had reduced LA conduit (30 ± 6 vs. 40 ± 5 ml/m2, p = 0.002) LA booster volumes (17 ± 5 vs. 21 ± 4 ml/m2, p = 0.021), and reduced LV stroke volumes (100 ± 12 vs. 117 ± 16 ml, p = 0.007). These results demonstrate that exercise testing in athletes with AF unmasks evidence of adverse functional cardiac remodelling that may contribute to impaired exercise performance. It is unclear whether these functional alterations are the consequence of AF. Reductions in LA conduit volume, LA booster volume, and LV stroke volume during exercise may be helpful in clinical management and distinguishing pathologic from physiologic remodelling.

Systemic Sirtuin 1 as a Potential Target to Mediate Interactions Between Body Fat and Testosterone Concentration in Master Athletes.

Evidence indicates that master athletes have higher concentration of Sirtuin 1 (Sirt1), lower body fat (BF), and greater activity of the hypothalamic-pituitary-gonadal axis in comparison to untrained peers. However, no published data have demonstrated possible mediation effect of Sirt1 in the interaction of BF and testosterone in this population. Therefore, this study compared and verified possible associations between Sirt1, BF, fat mass index (FMI), testosterone, luteinizing hormone (LH), and testosterone/luteinizing hormone (T/LH) ratio in middle-aged master athletes (n = 54; 51.22 ± 7.76years) and control middle-aged peers (n = 21; 47.76 ± 8.47years). Venous blood was collected for testosterone, LH, and Sirt1. BF was assessed through skinfold protocol. Although LH concentration did not differ between groups, master athletes presented higher concentration of Sirt1, testosterone, and T/LH ratio, and lower BF and FMI in relation to age-matched nonathletes. Moreover, Sirt1 correlated positively with testosterone and T/LH ratio, negatively with BF, and was not significantly correlated with LH (mediation analysis revealed the effect of BF on testosterone is mediated by Sirt1 and vice versa; R2 = .1776; p = .032). In conclusion, master athletes have higher testosterone, T/LH ratio, and Sirt1, and lower BF and FMI in relation to untrained peers. Furthermore, Sirt1 was negatively associated with BF and positively associated with testosterone and T/LH ratio. These findings suggest that increased circulating Sirt1, possibly due to the master athlete's training regimens and lifestyle, exhibits a potential mediation effect on the interaction between endocrine function and body composition.

Vortex formation time in female athletes

Regular, vigorous physical activity can have a significant impact on cardiac function, leading to cardiac morphological alterations that may be challenging to distinguish from pathological changes. Therefore, new screening methods are needed to accurately differentiate between adaptive changes and pathological alterations in athletes. Vortex formation time (VFT) is an emerging method that shows potential in this regard, as it involves the formation of a rotating vortex ring in the left ventricle during the early filling phase of diastole. In this study, we investigated the difference in VFT between two groups of women: professional handball players and healthy middle-aged female athletes, along with their corresponding control groups. By using echocardiography-Doppler analysis of the heart, VFT was calculated based on the left ventricular ejection fraction, the ratio between the end-diastolic volume and the diameter of the mitral annulus, and the ratio of the atrial contraction volume to the total inflow via the mitral valve. The study reveals a significant increase in VFT in both professional handball players and middle-aged female athletes compared to their respective control groups. Moreover, statistically significant differences between handball players and middle-aged female athletes were observed, indicating that the level of physical activity may affect the VFT. These results suggest that VFT could be a promising screening tool for identifying cardiac adaptations due to long-term vigorous training, potentially enabling more accurate diagnoses of cardiac morphological alterations in athletes.Graphical abstractRepresentation of the graphical abstract of the conducted research

Predictors of coronary atherosclerosis in middle-aged and older endurance athletes

Abstract Background Exercise improves cardiovascular health, but emerging evidence indicates that coronary atherosclerosis is more prevalent in middle-aged and older endurance athletes than sedentary peers. It has been shown that greater lifelong exercise volumes and exercise training at a very vigorous intensity are associated with higher coronary artery calcification scores (CACS). Nevertheless, the underlying mechanisms responsible for accelerated coronary atherosclerosis in veteran athletes are unknown and largely unexplored. Purpose To identify predictors of CACS in middle-aged and older endurance athletes. Methods Cardiac CT scans were performed on 284 middle-aged and older male athletes of the MARC-2 study to assess CACS. Participants were stratified to CACS=0, CACS: 1-100, CACS: 101-400, or CACS &amp;gt;400. Participant characteristics, traditional cardiovascular risk factors, biomarker concentrations, nutrition characteristics, perceived stress scores, and usage of immune-modulating and performance-enhancing drugs were compared across CACS subgroups, whereas linear regression with backward elimination was used to determine associations with ln(CACS + 1). Results Participants were 60.0 [Q1-3 56.3-66.0] years old, had a weekly training load of 25.7 [16.9-35.2] MET-h, BMI of 24.5 [22.9-26.7] kg/m2, systolic blood pressure (SBP) of 140±18 mmHg, and reported 0.3 [0.0-8.0] smoking pack years. CACS was 31 [0-132], with 29% of athletes having CACS of 0, 40% 1-100, 18% 101-400, and 13% &amp;gt;400. Participants with CACS &amp;gt;400 were older (p&amp;lt;0.001), had higher SBP (p=0.004), had smoked more pack years (p=0.003), and had more often a family history of cardiovascular disease (p=0.001), compared to lower CACS groups. After backward selection, our final multivariable model (R2=0.12) revealed that alcohol intake (p=0.021), smoking pack years (p=0.027), and SBP (p=0.004) had a positive relationship with CACS, while total fat intake (p=0.005) had an inverse relationship with CACS. We also found a significant interaction effect between weekly training load with alcohol consumption (p=0.017) and SBP (p=0.028), indicating that the association of alcohol and SBP with CACS was stronger for individuals performing higher exercise volumes. Conclusion Alcohol consumption, smoking history, and SBP were the strongest predictors of CACS in our cohort of middle-aged and older male endurance athletes, whereas the effect size of alcohol consumption and SBP on CACS was larger for participants with higher training loads. Our findings indicate that high exercise volumes do not eliminate the cardiovascular risk associated with an unhealthy lifestyle.

Temporal relationship between training and episodes of atrial fibrillation in endurance athletes

Abstract Background Prolonged endurance training promotes exercise-induced cardiac remodeling and atrial fibrillation (AF), the most common arrhythmia among middle-aged endurance athletes. However, there is a lack of data on the impact of training sessions on the recurrence of AF episodes and current guidelines do not provide specific training recommendations for athletes diagnosed with AF. Both sympathetic stimulation during exercise and parasympathetic activity after exercise are possible mechanisms for recurrent episodes of AF. Purpose To assess the temporal relationship of training sessions with recurrent AF episodes among endurance athletes with paroxysmal AF. Methods The Effects of Detraining in Endurance Athletes with Atrial Fibrillation Trial is an international multicenter randomized controlled trial that includes athletes engaged in regular endurance sports ≥five hours per week, diagnosed with paroxysmal AF. AF episodes lasting ≥30 seconds were registered using wireless insertable cardiac monitors (ICM) and reviewed by an experienced cardiologist. Training sessions were registered using sports watches. We analyzed AF episodes and training data for the period from ICM implantation to randomization, and report event rates and rate ratios with 95% confidence intervals (CIs) for recurrent AF episodes during or within 3 hours after training sessions, compared to &amp;gt;3 hours after training. Results Eighteen athletes (1 female, 17 male) with a median age of 55 years (range 44-74) were included. The combined duration of monitoring was 845 days/20,280 hours (median 38.5, range 12-97 days). The athletes performed a total of 619 hours of training during 559 training sessions. In total, 66 AF episodes (median 1, range 0-15) were registered, of which 37 (56%) occurred within 24 hours after the start of a training sessions. Ten AF episodes (15%) occurred during a training session, 12 (18%) occurred within 3 hours after a training session and 44 (67%) occurred &amp;gt;3 hours after training. Figure 1 shows recurrent AF episodes during training (red bars) and within 24 hours from the start of a training session (blue bars) and smoothed density estimates. The event rate per 24 hours was 0.39 for AF during training, 0.17 the first 3 hours after training and 0.06 &amp;gt;3 hours after training. As compared to &amp;gt;3 hours after training, the rate ratio was 6.6 (95% CI 3.8 to 11.6) for recurrent AF episodes during training sessions and 3.9 (95% CI 2.2 to 6.9) for AF episodes during or within 3 hours after training. Conclusion Among middle-aged endurance athletes with paroxysmal AF, the rate of recurrent AF episodes was highest during and within 3 hours after training sessions. The impact of training and the pathophysiology of exercise-induced AF should be investigated further, with the aim of developing preventive strategies specific to athletic populations.Figure 1

The Experiences of Endurance Athletes With Atrial Fibrillation: Tensions and Takeaways.

Growing evidence indicates that chronic high-intensity endurance exercise predisposes male, middle-aged athletes to increased risk of atrial fibrillation (AF). The aetiology of AF in endurance athletes is multifactorial and remains incompletely understood. Despite their unique training demands, AF care in athletes remains largely based on evidence derived from the general population. Understanding the experiences of athletes with AF provides a necessary foundation for addressing challenges in managing their condition and identifying gaps in care. The purpose of this interpretive descriptive qualitative study was to describe the experiences and perspectives of endurance athletes living with AF. Masters athletes diagnosed with AF and aged between 35 and 60 years were recruited internationally through cardiology practices and social media. Ten middle-aged, male endurance athletes with AF and >1,500 lifetime training hours participated in individual, semi-structured interviews. Data were analysed using inductive thematic analysis. Three key themes were constructed: (1) tensions with training, (2) tensions with treatment plans, and (3) tensions with clinicians. Participants experienced a wide range of symptoms from AF that significantly affected their ability to train, and reacted negatively to medical treatment strategies that affected their exercise capacity and training performance. Athletes experienced tensions with providers who failed to acknowledge their athletic needs. Our results highlight the unique difficulties that male athletes with AF face in navigating between training and their disease, treatment, and clinicians. Shared decision-making between the athlete and provider is likely necessary for effective management of athletic AF.

The effect of chronic exercise training and acute exercise on power spectral analysis of heart rate variability.

Moderate to vigorous physical activity performed regularly is cardioprotective and reduces all-cause mortality, concomitant with increased resting heart rate variability (HRV). However, there are contradictory reports regarding the effects of chronic and acute exercise on nocturnal HRV in those performing exercise well-beyond physical activity guidelines. Therefore, the purpose of this study was to compare the power spectral analysis components of HRV in middle-aged endurance athletes (EA) and recreationally active individuals (REC) and explore acute exercise effects in EA. A total of 119 EA (52, 49-57 years) and 32 REC (56, 52-60 years) were recruited to complete 24h Holter monitoring (GE SEER 1000) in the absence of exercise. Fifty one EA (52, 49-57 years) then underwent 24h Holter monitoring following an intense bout of endurance exercise. Power spectral HRV analysis was completed hourly and averaged to quantify morning (1000-1200h), evening (1900-2100h), and nocturnal (0200-0400h) HRV. EA had greater very low frequency (VLF) and low frequency (LF) (both p< 0.001) compared to REC. LF/high frequency (HF) was greater in EA at 0200-0400h (p=0.04). Among all participants, the change in HR and HF from 1000-1200 to 0200-0400h was negatively correlated (r=-0.47, p< 0.001). Following acute exercise in EA, only nocturnal HRV was assessed. VLF (p< 0.001) and HF (p=0.008) decreased, while LF/HF increased (p=0.02). These results suggest that in EA, both long-term and acute exercises increase nocturnal sympathovagal activity through an increase in LF and decrease in HF, respectively. Further work is required to understand the mechanism underlying reduced nocturnal HRV in middle-aged EA and the long-term health implications.

Exploring The Underlying Mechanisms Of Increased Coronary Atherosclerosis Among Middle-aged And Older Athletes

Exploring The Underlying Mechanisms Of Increased Coronary Atherosclerosis Among Middle-aged And Older Athletes

A Study of Motor Functional Asymmetry Indicators in Different Sportsmanship Level Esports Athletes

Purpose. to research and analyze of the indicators of functional asymmetry in different sportsmanship level esports athletes.&#x0D; Methods. the study involved 20 middle-aged athletes (18±1.53) years old, divided into groups according to their sportsmanship. Group 1: elite players of semi-professional teams in CS:GO and DOTA 2 disciplines, n=10, age (19.2±0.50) years. Group 2: amateur CS:GO and DOTA 2 players, n=10, age (18.2±1.04) years. The functional asymmetry of the movements of the upper limbs was determined using a special program for tablet computers running iOS, developed at the departments of martial arts, computer science and biomechanics of the KhSAPC.&#x0D; Results. It has been established that in terms of the number of clicks per unit of time, elite esports athletes are dominated by amateurs by 5.54% on the left and 5.14% on the right hand; in terms of visual motor reaction time, elite esports athletes prevail by 5.54% on the left hand and 5,07% on the right hand; elite esports athletes showed a 13.3% shorter left-hand click duration, but amateurs showed a 6,83% shorter right-hand click duration.&#x0D; Conclusions. Players with a higher level of preparedness tend to have less asymmetrical movements. In the proposed test, elite athletes demonstrate a greater number of movements per unit of time; at the 2nd stage of testing, the differences are significant (p&lt;0.05). At the same time, the reaction time of more skilled players is less than that of amateurs; at the 2nd and 4th stages of the test, the differences are significant (p&lt;0.05). Indicators of functional asymmetry of movements of the upper limbs informatively characterize the level of preparedness of esports athletes and can be included in the program for monitoring the physical condition of players in cybersport.

The Complex but Fascinating Relationship between Sport and Atrial Fibrillation: From Pathophysiology to the Clinical Scenario

Atrial fibrillation (AF) is the most common cause of hospital admission among all arrhythmias in the general population. Moreover, AF represents the most common arrhythmia in the athletic population as well. The complex but fascinating relationship between sport and atrial fibrillation has not yet been fully clarified. Although the benefits of moderate physical activity in controlling cardiovascular risk factors and in reducing the risk of atrial fibrillation have been widely demonstrated, some concerns have been raised about the potential adverse effects of physical activity. Endurance activity in middle-aged men athletes appears to increase the risk of AF. Several different physiopathological mechanisms may explain the increased risk of AF in endurance athletes, including the imbalance of the autonomic nervous system, changes in left atrial size and function and presence of atrial fibrosis. The goal of this article is to review the epidemiology, pathophysiology and clinical management for AF in athletes, including pharmacological and electrophysiological strategies.

Advanced glycation endproducts and dicarbonyl compounds are not associated with coronary atherosclerosis characteristics in middle-aged and older male athletes

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation. Background Cardiovascular disease is the leading cause of mortality worldwide and is dominated by coronary atherosclerosis. Moreover, coronary atherosclerosis is the most common cause of sudden cardiac death among athletes and current screening methods lack sufficient accuracy for identifying individuals at high risk. Advanced glycemic end products (AGEs) and dicarbonyl stress markers are generated during normal metabolism and aging, but increase in the presence of hyperglycemia, oxidative stress and inflammation. Several studies have demonstrated that higher concentrations of AGEs in plasma predict both the presence and severity of coronary atherosclerosis, as well as mortality. AGEs and its dicarbonyl precursors in atherosclerotic plaques have also been demonstrated to predict rupture-prone phenotypes. Plasma AGEs and dicarbonyl precursors might be a novel way to screen for high-risk coronary atherosclerosis in middle-aged and older athletes. Purpose To assess the association between plasma AGEs and dicarbonyl compounds with the presence of coronary plaques, plaque characteristics and coronary artery calcification scores in a population of middle-aged and older amateur athletes. Methods We measured concentrations of AGEs and dicarbonyl stress markers in plasma with dilution ultra-performance liquid chromatography tandem mass spectrometry in middle-aged and older athletes from the Measuring Athletes’ Risk of Cardiovascular Events (MARC) 2 study cohort. Coronary plaques, predominating plaque characteristics (&amp;gt;50% calcified, non-calcified, or mixed plaque composition), and coronary artery calcification scores were assessed using coronary computed tomography. We explored associations with linear and logistic regression analyses and compared groups with the Mann-Whitney U and Kruskal-Wallis tests, while correcting for multiple testing. Results 284 men were included with a median age of 60 [56-66] years, body mass index of 24.5 [22.9-26.7] kg/m2, and an average weekly exercise volume of 41 [26-57] Metabolic Equivalent of Task-hours. Coronary plaques were detected in 241 participants (83%), with calcified, non-calcified, and mixed plaques constituting &amp;gt;50% of plaques in 42%, 12%, and 21%, respectively. Median CAC score was 31 [0-132]. None of the AGEs or dicarbonyl stress markers were associated with presence of plaques, any of the plaque characteristics (Figure 1), or coronary artery calcification score categories (Figure 2) in adjusted analyses (P&amp;gt;0.05). Conclusion Concentrations of AGEs and dicarbonyl stress markers could not be used to identify coronary plaques, different plaque characteristics or coronary calcifications in this cohort of middle-aged and older athletes. These findings suggest that AGEs and dicarbonyl stress markers cannot be used as a screening method for high-risk coronary atherosclerosis.

Return to Sport in Middle-aged and Older Athletes After Unicompartmental Knee Arthroplasty at a Mean 10-Year Follow-up: Radiographic and Clinical Outcomes

Background: Return to sport is essential information when an athlete contemplates surgical intervention. Young athletes, <30 years of age, may undergo complex cartilage procedures or femoral/tibial osteotomies to successfully treat single-compartment knee osteoarthritis. Unicompartmental knee arthroplasty (UKA) may offer an attractive alternative option to middle-aged/older athletes with timely return to the same sport without a lengthy rehabilitation. Purpose: The purpose of this study was to determine if athletes are able to return to the same level of vigorous and moderate sports after fixed-bearing intramedullary nonrobotic UKA and the specific sports activities that these athletes continued to participate in at a minimum of 5 years. We hypothesized that UKA in the appropriately selected middle-aged/older athlete would yield high return to sport after UKA with high patient satisfaction. We also hypothesized that UKA would allow athletes to return to their sports of choice. Study Design: Cohort study; Level of evidence, 3. Methods: We identified 245 patients who underwent a UKA by a single surgeon between 2003 and 2017. Athletes were included if they participated in vigorous or moderate sports, as defined by the American College of Sports Medicine, and had minimum 5-year follow-up. The primary outcome was return to vigorous or moderate sports after UKA. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living score, KOOS Sport and Recreation score, Lysholm score, Patient Acceptable Symptom State (PASS) analysis, and radiographic analysis. Results: An overall 169 athletes met the inclusion criteria and were evaluated for return to sports. A total of 98% (165/169) returned to vigorous or moderate sports participation. The mean ± SD time to return to sport was 5.2 ± 2.3 months in the 39- to 50-year-old cohort, 5.8 ± 3.2 months in athletes aged 51 to 64 years, and 5.2 ± 3.0 months in athletes aged ≥65 years. A total of 143 athletes had minimum 5-year clinical and radiographic follow-up (mean, 10 years; range, 5-19 years). Maintenance of vigorous and moderate sport was seen in 99% (142/143) of athletes at a mean 10 years. In athletes who participated in vigorous sports, the mean Lysholm score was 85 ± 17, and 83% reached the PASS for KOOS Sport and Recreation. Radiographic analysis revealed no evidence of implant loosening (ie, subsidence, radiolucency) or osteolysis, and limb alignment and posterior slope of the implant were within normal limits. Conclusion: Athletes returned to sport at a mean 5 months after UKA implantation, with 98% (165/169) participating in vigorous or moderate sports. UKA is recommended as an alternative procedure in middle-aged and older athletes with single-compartment osteoarthritis who are contemplating a return to vigorous or moderate sport.

Preservation of Right Ventricular Function in Middle-Aged Recreational Endurance Athletes

Preservation of Right Ventricular Function in Middle-Aged Recreational Endurance Athletes