Issues particular to the aging athlete Robert J Petrella, MD, PhD, FCFP, FACSM

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1 Issues particular to the aging athlete Robert 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

2 Disclosures - Consultant with Carbylan Biosurgery, Sanofi Biosurgery - Grant support for research activity from CIHR, PHAC, Amgen, Carbylan Biosurgery, Sanofi Biosurgery, Novartis, Pfizer, Tedec-Meiji

3 Aging and Dependency Interaction

4 Aging and Disease Risk Ischemic heart disease (IHD) mortality in each decade of age vs usual blood pressure at the start of the decade. Kazem Rahimi et al. Circ Res. 2015;116:

5 Aging and Chronic Disease Interaction

6 Influence of age on maximal oxygen consumption (VO2max) in men and women

8 Aging and Exercise Interaction

The Effects of Exercise on CV and Brain Health Neurophysiological changes in brain function, volume, and efficiency Exercise is associated

capacity for exercise to promote neurogenesis and brain plasticity Kennedy et al.

9 The Effects of Exercise on CV and Brain Health 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 Kennedy et al., J Alzheimers Dis, 2017;108(7): Cardiovascular health and associated risk factors Exercises may attenuate the vascularrelated 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

12 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): , November 2015.

14 Recommendations for all adults

15 Recommendations for Master Athletes Gregory A. Tayrose, MD, Bryan G. Beutel, MD,* Dennis A. Cardone, DO, and Orrin H. Sherman, MD

16 Herman by Jim Unger.

17 Preparticipation Medical Screening

19 ACSM update to safe exercise adoption Updating ACSM's Recommendations for Exercise Preparticipation Health Screening. RIEBE, DEBORAH; FRANKLIN, BARRY; THOMPSON, PAUL; GARBER, 2 CAROL; WHITFIELD, GEOFFREY; MAGAL, MEIR; PESCATELLO, LINDA

20 Petrella A, Gill D, Petrella RJ; APNM 2018

21 Petrella A, Gill D, Petrella RJ; APNM 2018

22 Petrella A, Gill D, Petrella RJ; APNM 2018

23 Petrella A, Gill D, Petrella RJ; APNM 2018

24 Case for 3-step screening approach 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 Petrella A, Gill D, Petrella RJ; APNM 2018

28 Paul aged 85y In 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.

29 Jacinto, aged 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 years of age and above), 10 to 15 repetitions per set may be more appropriate.

30 Tao, aged 98 years 6. Flexibility training: these exercises should stretch the major muscle groups, be performed at least four repetitions 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

31 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

34 Thank you!

35 Vo2max by sport

SHS FITNESS ACROSS THE P.E. CURRICULUM

SHS FITNESS ACROSS THE P.E. CURRICULUM Five Health-Related Fitness components: Flexibility the ability to move a joint through a full range of motion A regular program of stretching may incorporate dynamic