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Senior Play: The Graying Of Sports Medicine
By Shirley S. Wang, the Wall Street Journal
October 9, 2007
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Sports medicine, long geared to the needs of young athletes, is branching out to help older people remain active and athletically competitive as they age.
And while much of the new attention is focused on so-called masters athletes -- those over 40 who regularly compete in organized events -- doctors and trainers say many of the strategies and services these athletes use can help anyone improve their workouts and other daily routines to stay active and healthy.
"This is the first generation who have lived with physical activity in their whole lives," says Marje Albohm, an athletic trainer and director of Sports Medicine and Orthopedic Research at OrthoIndy, an orthopedic group in Indianapolis. "Their goal, and [trainers'] goal in advising them, is to maintain their desired level of physical activity throughout the life span."
The University of Pittsburgh recently opened a wellness center called the Performance and Research Initiative for Masters Athletes, offering competitors over 40 years old a package of medical care, nutrition counseling, mental training and physical therapy previously aimed only at younger athletes. In May, the editor of the American Journal of Sports Medicine called for more research on how older athletes recover from injury and how quickly they can get back to recreation or competition. In August, the American College of Sports Medicine and the American Heart Association issued new recommendations for physical activity that for the first time include guidelines specifically intended for older adults.
It's a burgeoning market. Those over age 55 make up the fastest-growing segment of health-club members: There were 8.5 million in 2006, up from 1.5 million about 20 years ago, according to the International Health, Racquet and Sportsclub Association. Doctors say they're seeing greater numbers of patients playing sports into older age, and masters events are increasingly popular.
About 10,000 competitors are expected to participate in the Huntsman World Senior Games, an event in which anyone over 55 can compete in sports including basketball, triathlon and mountain biking. The games, which began this week in St. George, Utah, have grown every year since they started in 1987.
For those who have been exercising all their lives, getting older may mean changing exercise routines. But sports-medicine experts are quick to stress that changing doesn't mean slowing down or stopping physical activity.
As the body ages, muscles become slower and weaker, most significantly affecting speed, balance and the ability to recover from injuries. Researchers and doctors say to compensate for these changes, older athletes should focus more on balance and flexibility, in addition to pure strength and cardiovascular training. These are important for physical activity at any age, but particularly so in middle age and beyond, when overuse injuries and falls are of greater concern.
"The worst thing is to become injured by choosing inappropriate activities, or to re-aggravate an old injury," says Ms. Albohm of
OrthoIndy.
Studies of active, older athletes have yielded encouraging findings related to health and aging. A June study in the International Journal of Sports Medicine found that average marathon times remained essentially the same from the 20s through the 40s and then declined less than 5% a decade in the 50s and 60s.
Regular exercise into older age, even at less-intensive levels than marathon running, can slow age-related changes in heart rate, aerobic capacity and muscle mass. Numerous studies show that greater physical activity is associated with decreased risk of cardiovascular disease, hypertension, diabetes and obesity.
The new physical-activity guidelines from the American Heart Association and American College of Sports Medicine urge older adults to design workout routines around their own abilities to reach the activity goal for all adults: 30 minutes of moderate exercise five days a week. For some older individuals that may mean a moderately paced walk, for others a three-mile run. The idea is to induce "noticeable" but not large changes in heart rate and breathing, the guidelines say.
Balance, in particular, is emerging as an important element for older people, according to doctors, researchers and the guidelines. Older muscles are smaller and slower and respond less efficiently when we need to brace ourselves, making us more vulnerable to falls, says Marjorie Woollacott, director of the Motor Control Lab at the University of Oregon's Department of Human Physiology in Eugene.
Practicing tai chi, a form of martial art, helps both healthy and frail individuals improve balance, according to several studies, including a recent randomized controlled trial published in the August issue of the Journal of the American Geriatric Society.
Experts also suggest using balance boards and balls, and challenging your body while doing activities, such as by running up and down a curb rather than sticking to flat ground, says Waneen Spirduso, professor of kinesiology and health education at the University of Texas-Austin who researches how the body's motor system changes with age.
Variety -- or cross-training -- is also important for everyone, say sports-medicine doctors, but particularly for older individuals, whose bodies may not be able to handle extreme stress on certain body parts, leading to injury. More-active older athletes may need to alternate between high-intensity and lower-intensity activities every other or every third day, doctors say.
"A mixture of activity is optimal," says Miriam Nelson, director of Hancock Center for Physical Activity and Nutrition at Tufts University, Boston, and lead author of the updated exercise guidelines for older adults. This means, for instance, that golfers should continue to hit the driving range, but they also need to stretch and go to the weight room regularly.
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Prima, the program for masters athletes in Pittsburgh, focuses on all of these elements in designing programs for elite athletes, and also for sedentary older individuals who want to become more active, says Vonda Wright, an orthopedist and the program's director. Prima's 12-week "Start" program, which opened in June, caters to this latter group with the goal of helping them train slowly to a point of being able to run a 5K race.
Finally, doctors and trainers -- and another recommendation for older adults from the ACSM/AHA guidelines -- say stretching to warm up before exercise and to cool down afterward is particularly important as people age. The belief is that improved flexibility from stretching helps prevent such injuries as pulled muscles, though little research is available that makes the case.
Older athletes should be especially vigilant about injury because "it takes longer for the body to adapt to stress" in older age, says Bruce Reider, director of sports medicine at the University of Chicago and author of the American Journal of Sports Medicine editorial calling for additional research on aging athletes.
The slowed resilience of the body makes it more likely that an overuse injury could occur. If you notice a "crescendo" or buildup of pain across sessions that worsens or seems to linger on, you may have an injury, says Dr. Reider.
Individuals may consider getting professional help to resume or establish a healthy exercise plan. In looking for a trainer or a health club, ask about credentials. Athletic trainers must be licensed, for instance, but there are many certifications for personal trainers. Make sure the professionals understand their goals for fitness, whether it's running a marathon at age 75 or going to the park with grandchildren, and have worked before with "people like you," says Tufts's Dr. Nelson.
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