Week 8 - older athlete Flashcards
Discuss osteoarthrotis
Caused by: roam, meniscal tears, infections, genetic causes
Effects: Loss of joint space, osteophytes, subchondral scerosis, subchoncral cysts, reduces synovial fluid, reduced ligament, capsule and tendon elsasticity
Some evidence suggests that knee joint loading exercise seems to not be harmful for articular cartilage in people at increased risk of, or with, knee OA
Discuss changes in intervertebral discs with ageing and the effects of exercise on the IVD
While the nucleus pulposus of a younger disc is more likely to prolapse/herniate, an older disc is more likely to degenerate, and this can be associated with pain and loss of function Shepper et al 2010
Dehydration relates to loss of water and proteoglycans in the nucleus pulposus
Collagen Type I is also replaced with Type II causing discolouration of the disc
Discs become stiffer, absorb and distribute load less evenly, and more prone to injury
Effect of exercise:
Movement promotes hydration and nutrition of the IVD
Loading types that are likely beneficial are dynamic, axial, at slow to moderate movement speeds, and of a magnitude experienced in walking and jogging
Static loading, torsional loading, flexion with compression, rapid loading, high impact loading and explosive tasks have potential to be detrimental to the IVD
Reduced physical activity and disuse appear to be detrimental for the IVD
Discuss changes in muscle strength with age
Muscle fibres change from Type 11 to Type 1
There is a reduction of muscle mass, with a selective loss in the cross-section (type 11 fibres).
Deterioration of end-plate structures
Impaired excitation-contraction coupling.
Eg
10 weeks of 3x weekly 10min progressive resistance exercise training of hip and knee extensors in 100 nursing home residents with a mean age of 87 years
>100% increase in muscle strength
Increased gait speed and stair climbing Fiatarone 1994
10 weeks of leg press training in subjects aged 60-65 years
increased 1RM leg press by 42%
significant increase in vastus lateralis cross-sectional area Lixandrao 2015
Discuss changes in muscle flexibility
In a study comparing static stretching & Pilates in 36 women over 60 years
Pilates was found to more effective for improving flexibility in older women compared with static stretching Campos de Oliveira 2016
In a study on yoga on 56 women over 50
practicing yoga postures once a week led to an increase in spinal joint mobility & flexibility of the hamstring muscles Grabara 2015
Discuss balance
A study involving 30 62-70 year old women completing 8-week intensive Tai Chi training
significantly improved balance performances on a range of tests (and lower limb strength) Huang et al 2007
Discuss bone density
Effects of Age:
Maximum bone density occurs around age 30, and reduces thereafter
Rate of reduction increases with inactivity, and is faster in women during menopause
Effects of Exercise:
Prior to 30y load bearing exercise can increase bone density, and after can significantly reduce the rate of loss
‘Exercise & Osteoporosis’ 2016 National Osteoporosis Society
Discuss cardiac function
Effects of Age:
VO2 max, HR & SV decrease with age
VO2 max shows progressive decline between 25y & 75y of 10-45%
Effects of Exercise:
Decline can be altered by exercise- older athletes can achieve & maintain VO2 max of non-athlete 20y younger
Aerobic exercise increases heart size, heart muscle thickness, LV size, VO2 max, SV, max CO, blood flow to active muscle and venous return McArdle et al
A study completed by 3545 healthy male cross country skiers
cumulative years of regular endurance exercise gradually increase the risk of atrial fibrillation Myrstad et al 2014
The majority of sports-related sudden cardiac deaths in endurance events occur in athletes >35yo Chugh SS et al 2015
Discuss pulmonary function changes
Effect of Age: From 30-60 years
Lunge capacity reduces
Size of alveoli increases
Respiratory muscles weaken
Diastolic support structure weakens
Gas exchange kinetics slow
Effects of Exercise:
Athletes >60years consistently demonstrate greater values for pulmonary function tests (inc. total lung volume and forced expiratory volume) than sedentary healthy counterparts McArdle et al 1996
Exercise can improve respiratory function in older adults with asthma and COPD
Discuss environmental changes
Effects of Age:
Increased tendency towards dehydration
Reduced efficiency of thermoregulation in response to increased core temperature during exercise due to reduced cardiac output, heart rate and peripheral blood flow Inbar et al 2004
Decreased capacity for shivering in response to lower core temperatures
Impaired ability to perceive temperature
Effects of Exercise:
Specific effects of exercise on ability to respond to and regulate environmental factors unknown
Case study:
46yr old, male, extensive cardiac history; Angina, CABG 7yrs ago, stents 6yrs ago, stable dose meds for hypertension, Aspirin, PRN GTN not used for >3yrs. Last 4yrs ECHO stable, No ECG changes 3yrs, yearly review with cardiology and no new interventions for 3yrs.
13 week Expedition to Tanzania; 3 weeks WASH programme, 3 weeks trekking, 3 weeks office based role.
Considering the age of the athlete, what particular considerations might you have?
Would you want any investigations?
How might you plan their management?
During feedback how their situation developed during the expedition will be presented with opportunity to discuss, and then the real outcome, again with opportunity to discuss
Case study:
56yr old, female, knee repair surgery 5 years ago, can hike and has managed UK southwest coast path over course of a season since operation. Hypertension; well managed by low salt diet and exercise.
4-week programme, 2 weeks trekking in Scottish highlands, 2 weeks natural resource management project clearing invasive plant species.
Considering the age of the athlete, what particular considerations might you have?
Would you want any investigations?
How might you plan their management?
During feedback how their situation developed during the expedition will be presented with opportunity to discuss, and then the real outcome, again with opportunity to discuss
64yo male GB duathlete presents to physiotherapy with gradual onset of groin pain, affecting cycling, 6 weeks before European Championships
Considering the age of the athlete, what particular considerations might you have?
Would you want any investigations?
How might you plan their management?
During feedback how their situation developed during the expedition will be presented with opportunity to discuss, and then the real outcome, again with opportunity to discuss
Slim female 54yo 3 day eventer presents to GP a week after a fall from her horse during training for an upcoming event with severe sudden onset low back pain
Considering the age of the athlete, what particular considerations might you have?
Would you want any investigations?
How might you plan their management?
During feedback how their situation developed during the expedition will be presented with opportunity to discuss, and then the real outcome, again with opportunity to discuss
68yo cyclist with left hip & shoulder grazes and a headache presents to minor injuries after a fall while training to complete an etape in France the following week
Considering the age of the athlete, what particular considerations might you have?
Would you want any investigations?
How might you plan their management?
During feedback how their situation developed during the expedition will be presented with opportunity to discuss, and then the real outcome, again with opportunity to discuss
55 year old female runner preparing for the Edinburgh Marathon Festival Half in a month presents to her GP having become abnormally short of breath in the past month
Considering the age of the athlete, what particular considerations might you have?
Would you want any investigations?
How might you plan their management?
During feedback how their situation developed during the expedition will be presented with opportunity to discuss, and then the real outcome, again with opportunity to discuss
