Relationship of body composition and cardiovascular fitness to lipoprotein lipid profiles in master athletes and sedentary men

Body Mass Index in Master Athletes: Review of the Literature

Background

Masters athletes (MAs) have led a physically active lifestyle for an extended period of time or initiated exercise/sport in later life. Given the benefits of physical activity and exercise we investigated if body mass index (BMI), an indirect health indicator of obesity, was clinically superior in MAs as compared to controls or the general population.

Methods

Seven databases (Medline, PubMed, Scopus, Web of Science, CINAHL, PsycINFO, Cochrane) were electronically searched for studies on BMI (kg/m²) or as a percentage of BMI categories (underweight, normal, overweight, obesity) in MAs.

Results

Of the initial yield of 7,431 papers, 60 studies met our inclusion criteria and were used in this literature review. Studies identified were classified as: endurance sports (n = 14), runners (n = 14), mixed sports (n = 8), cyclists (n = 4), soccer (n = 4) swimmers (n = 3), non-specific (n = 3), orienteering (n = 2), World Masters Games (n = 2) and individual sports (n = 5). Where BMI was presented for the group of MAs the mean was 23.8 kg/m² (± 1.1) with a range from 20.8 kg/m² (endurance runners) to 27.3 kg/m² (soccer players), this was significantly lower (p < 0.001) than controls ( −9.5%, 26.13 ± 1.7 kg/m²). Where gender specific BMI was reported the mean for male MAs was 23.6 kg/m² (± 1.5) (range 22.4 kg/m² endurance to 26.4 kg/m² swimmers) and 22.4 kg/m² (± 1.2) for female MAs (range 20.8 kg/m² mixed to 24.7 kg/m² WMG).

Conclusion

In most, but not all studies the BMI of MAs was significantly lower than controls. A clinically superior BMI affords MAs reduced risk with regard to a number of cardiometabolic diseases, osteoarthritis and certain types of cancers.

Muscle morphology and performance in master athletes: A systematic review and meta-analyses

INTRODUCTION

The extent to which chronic exercise training preserves age-related decrements in physical function, muscle strength, mass and morphology is unclear. Our aim was to conduct a systematic review of the literature to determine to what extent chronically trained master athletes (strength/power and endurance) preserve levels of physical function, muscle strength, muscle mass and morphology in older age, compared with older and younger controls and young trained individuals.

METHODS

The systematic data search included Medline, EMBASE, SPORTDiscus, CINAHL and Web of Science databases.

INCLUSION CRITERIA

i) master athletes mean exercise training duration ≥20 years ii) master athletes mean age of cohort >59 years) iii) at least one measurement of muscle mass/volume/fibre-type morphology and/or strength/physical function.

RESULTS

Fifty-five eligible studies were identified. Meta-analyses were carried out on maximal aerobic capacity, maximal voluntary contraction and body composition. Master endurance athletes (42.0 ± 6.6 ml kg^-1 min^-1) exhibited VO_2max values comparable with young healthy controls (43.1 ± 6.8 ml kg^-1 min^-1, P = .84), greater than older controls (27.1 ± 4.3 ml kg^-1 min^-1, P < 0.01) and master strength/power athletes (26.5 ± 2.3 mlkg^-1 min^-1, P < 0.01), and lower than young endurance trained individuals (60.0 ± 5.4 ml kg^-1 min^-1, P < 0.01). Master strength/power athletes (0.60 (0.28-0.93) P < 0.01) and young controls (0.71 (0.06-1.36) P < 0.05) were significantly stronger compared with the other groups. Body fat% was greater in master endurance athletes than young endurance trained (-4.44% (-8.44 to -0.43) P < 0.05) but lower compared with older controls (7.11% (5.70-8.52) P < 0.01).

CONCLUSION

Despite advancing age, this review suggests that chronic exercise training preserves physical function, muscular strength and body fat levels similar to that of young, healthy individuals in an exercise mode-specific manner.

Aging, Fitness, and Marathon Times in a 91 Year-old Man Who Competed in 627 Marathons

Aging is associated with a decline in maximal aerobic capacity (VO_2max) that may be attenuated by chronic endurance exercise. This case study chronicles the changes in marathon times in a 91 year old man who completed 627 marathons and 117 ultramarathons over 42 years. He began running marathons at age 48. His yearly best times remained fairly constant at ~240 minutes from age 50 – 64 years and then gradually rose to about 260 minutes in his early seventies followed by a curvilinear deterioration as he approached his ninth decade. His times plateaued at ~ 600 minutes in his late eighties. Between ages 68 and 89 his VO_2max declined from 43 to 20 ml/kg/min. His marathon times were highly correlated with his VO_2max (r²=0.87). The decline in marathons times and VO_2max may reflect the contributions of biological aging, changes in exercise training volume and intensity, injuries, and comorbid disease.

Urinary creatinine excretion rate and mortality in persons with coronary artery disease: the Heart and Soul Study

BACKGROUND

In persons with coronary artery disease, low body mass index is associated with greater mortality; however, it is uncertain whether low muscle mass is a risk factor for mortality in this setting.

METHODS AND RESULTS

In this study, 903 individuals with coronary artery disease provided 24-hour urine collections. We measured urine creatinine and volume and calculated creatinine excretion rate, a marker of muscle mass. Cox proportional-hazards models evaluated the association of creatinine excretion rate with mortality risk. Over a median follow-up of 6.0 years, 232 participants (26%) died. Compared with the highest sex-specific creatinine excretion rate tertile, the lowest tertile (<1068 mg/d in men, <766 mg/d in women) was associated with >2-fold risk of mortality (hazard ratio, 2.30; 95% confidence interval, 1.51 to 3.51) in models adjusted for age, sex, race, cystatin C-based estimated glomerular filtration rate, body mass index, traditional cardiovascular disease risk factors, and C-reactive protein levels. The association was essentially unaltered with further adjustment for physical fitness, left ventricular mass, left ventricular ejection fraction, or fasting insulin and glucose levels.

CONCLUSIONS

Lower creatinine excretion rate is strongly associated with mortality in outpatients with coronary artery disease, independently of conventional measures of body composition, kidney function, and traditional coronary artery disease risk factors. Future studies should determine whether low creatinine excretion rate may be a modifiable risk factor for mortality among persons with coronary artery disease, potentially through resistive exercise training or nutrition interventions.

Accuracy of body mass index in diagnosing obesity in the adult general population

BACKGROUND

Body mass index (BMI) is the most widely used measure to diagnose obesity. However, the accuracy of BMI in detecting excess body adiposity in the adult general population is largely unknown.

METHODS

A cross-sectional design of 13 601 subjects (age 20-79.9 years; 49% men) from the Third National Health and Nutrition Examination Survey. Bioelectrical impedance analysis was used to estimate body fat percent (BF%). We assessed the diagnostic performance of BMI using the World Health Organization reference standard for obesity of BF%>25% in men and>35% in women. We tested the correlation between BMI and both BF% and lean mass by sex and age groups adjusted for race.

RESULTS

BMI-defined obesity (> or =30 kg m(-2)) was present in 19.1% of men and 24.7% of women, while BF%-defined obesity was present in 43.9% of men and 52.3% of women. A BMI> or =30 had a high specificity (men=95%, 95% confidence interval (CI), 94-96 and women=99%, 95% CI, 98-100), but a poor sensitivity (men=36%, 95% CI, 35-37 and women=49%, 95% CI, 48-50) to detect BF%-defined obesity. The diagnostic performance of BMI diminished as age increased. In men, BMI had a better correlation with lean mass than with BF%, while in women BMI correlated better with BF% than with lean mass. However, in the intermediate range of BMI (25-29.9 kg m(-2)), BMI failed to discriminate between BF% and lean mass in both sexes.

CONCLUSIONS

The accuracy of BMI in diagnosing obesity is limited, particularly for individuals in the intermediate BMI ranges, in men and in the elderly. A BMI cutoff of> or =30 kg m(-2) has good specificity but misses more than half of people with excess fat. These results may help to explain the unexpected better survival in overweight/mild obese patients.

Cardiac structure and function in monozygotic twin pairs discordant for physical fitness

Cross-sectional studies in athletes and untrained subjects suggest that exercise training induces adaptations in cardiac structure and function. However, the role of genetic variation on the results has largely been ignored in these studies. The purpose of this study was to investigate the effects of long-term volitionally increased physical activity on electrocardiographic and echocardiographic parameters in male monozygotic twin pairs discordant for physical activity and fitness. On the basis of the mailed questionnaires, a telephone interview, and the inclusion criteria, 12 pairs of young adult male monozygotic twins were recruited from a Finnish twin cohort. All subjects completed a maximal oxygen uptake (V̇o2 max) test and electrocardiography and echocardiography studies. Nine pairs had at least 9% difference in V̇o2 max and were selected for further analysis and for a second echocardiography study. Twins were divided into the more (MAG) and less active group (LAG), according to their V̇o2 max. On average, MAG had 18% higher V̇o2 max compared with LAG. In electrocardiography, MAG had 29% ( P = 0.02) higher Cornell voltage and 37% ( P = 0.01) higher right-side hypertrophy index. In echocardiography, no significant differences were observed between the groups, and left ventricular mass index was only 7% ( P = 0.16) higher in MAG. These results show that the volitionally increased physical activity that has led to an 18% increase in cardiorespiratory fitness induces greater changes in electro- than echocardiographic parameters. Electrocardiographic changes were suggestive of left ventricular hypertrophy, and echocardiography showed a similar but statistically nonsignificant trend.

Maximal Aerobic Capacity Testing of Older Adults: A Critical Review

Most of the data that describe maximal oxygen uptake (VO(2max)) and the requirements for its attainment have been developed using young adults as subjects. Many older adults are unable to satisfactorily complete a maximal exercise effort in a standard exercise stress test. This review describes exercise tests currently available to measure VO(2max) in older adults. PubMed and CINAHL databases were searched for studies including healthy individuals older than 65 years with reproducible descriptions of the testing protocol. The research on VO(2max) testing in healthy individuals older than 65 years is limited, does not describe the protocols in detail, and/or lacks information on the psychometric properties of the exercise tests. There is a need for refinement of the few existing protocols for testing aerobic capacity in older adults, as well as the development of new protocols specifically applicable to older adults. Consensus on the criteria defining VO(2max) attainment during exercise in older adults is required, as well as agreement on the most appropriate exercise protocols and equipment, specific to older adults, to successfully fulfil these criteria.

Relationships of body mass index with blood pressure and serum cholesterol concentrations at different ages

BACKGROUND AND AIMS

Only limited information has been available on the effects of age on the relationship between obesity and other atherosclerotic risk factors, such as blood pressure and serum lipids. The purpose of this study was to investigate the effects of age on the relationships of obesity with blood pressure and serum cholesterol concentrations.

METHODS

A community-based cross-sectional study was performed on 157,902 workers in Yamagata, Japan. Blood pressure and serum total and HDL cholesterol concentrations were measured, and body mass index (BMI) and atherogenic index were calculated. The correlations of BMI with blood pressure, serum cholesterol concentrations and atherogenic index in different age groups were compared.

RESULTS

BMI showed significant positive correlations with systolic and diastolic blood pressures, serum total cholesterol level and atherogenic index, and showed a significant negative correlation with serum HDL cholesterol level. The relationships of BMI with systolic and diastolic blood pressures became weaker with advancing age in both men and women after 30 and 40 years of age, respectively. The relationships of BMI with serum total cholesterol level and atherogenic index also became weaker with advancing age after 30 years of age in men and after 40 years of age in women. There was no age-dependent tendency in the relationship between BMI and HDL cholesterol, however. The above age-dependent changes were more prominent in men than in women.

CONCLUSION

The relationships of obesity with blood pressure, serum total cholesterol level and atherogenic index in the elderly are much weaker than in the young.

Predictors of adipose tissue lipoprotein lipase in middle-aged and older men: relationship to leptin and obesity, but not cardiovascular fitness

The effects of long-term endurance exercise training, body composition, and cardiovascular fitness (VO2max) on the activity of adipose tissue lipoprotein lipase (AT-LPL) and lipoprotein lipids were examined in 66 healthy age-matched middle-aged and older men (mean +/- SE, 61 +/- 1 years). We compared subcutaneous abdominal (ABD) and gluteal (GLT) heparin-elutable AT-LPL activity in 19 master athletes (VO2max > 40 mL/kg/min) and 20 lean sedentary men (VO2max < 40 mL/kg/min) versus 27 obese sedentary men (VO2max < 40 mL/kg/min; body fat > 27%). Fasting insulin and leptin levels were similar in master athletes and lean sedentary men, but were lower than in obese sedentary men. There were no differences in fasting values for total cholesterol or low-density lipoprotein cholesterol (LDL-C) among the groups, but master athletes had lower triglyceride (TG) values (P < .05) and higher high-density lipoprotein cholesterol (HDL-C) and HDL2-C (P < .05) than obese and lean sedentary men. There were no regional (ABD v GLT) differences in the activity of AT-LPL in these groups, but obese sedentary men had higher levels of ABD AT-LPL (2.1 +/- 0.3 nmol/10(6) cells x min) than lean sedentary men (0.8 +/- 0.2) and master athletes (0.5 +/- 0.1, P = .01). Similar results were observed for GLT AT-LPL. Both ABD and GLT AT-LPL activity correlated positively with percent body fat (r = .46 to .54, P < .001), fasting insulin (r = .37 to .45, P < .001), and leptin (r = .61 to .65, P < .0001), but not with VO2max. In stepwise multiple regression analysis, leptin was the main independent predictor of ABD (R2 = .43, P < .0001) and GLT (R2 = .40, P < .0001) AT-LPL activity. Plasma TG correlated positively (r = .32, P < .01) and HDL-C correlated negatively (r = -.32, P = .02) with ABD AT-LPL activity, but these relationships were not significant after controlling for percent body fat or leptin. The results of this study indicate that in healthy middle-aged and older men, the major determinants of AT-LPL activity are obesity and its major associated hormones, leptin and insulin, not cardiovascular fitness, and also suggest that the higher HDL-C levels observed in endurance-trained men are not associated with increased AT-LPL activity.

Predictors of age-associated decline in maximal aerobic capacity: a comparison of four statistical models

Studies assessing changes in maximal aerobic capacity (VO2 max) associated with aging have traditionally employed the ratio of VO2 max to body weight. Log-linear, ordinary least-squares, and weighted least-squares models may avoid some of the inherent weaknesses associated with the use of ratios. In this study we used four different methods to examine the age-associated decline in VO2 max in a cross-sectional sample of 276 healthy men, aged 45-80 yr. Sixty-one of the men were aerobically trained athletes, and the remainder were sedentary. The model that accounted for the largest proportion of variance was a weighted least-squares model that included age, fat-free mass, and an indicator variable denoting exercise training status. The model accounted for 66% of the variance in VO2 max and satisfied all the important general linear model assumptions. The other approaches failed to satisfy one or more of these assumptions. The results indicated that VO2 max declines at the same rate in athletic and sedentary men (0.24 l/min or 9%/decade) and that 35% of this decline (0.08 l . min-1 . decade-1) is due to the age-associated loss of fat-free mass.

Exercise-induced silent myocardial ischemia in master athletes

High-physical activity levels are associated with reduced risk of symptomatic coronary artery disease (CAD). However, there are a number of reports of exercise-related sudden death and myocardial infarction in aerobically trained athletes. This study compared the prevalence of exercise-induced silent myocardial ischemia on maximum graded exercise tests with tomographic thallium scintigraphy in 70 master male athletes (63 +/- 6 years, mean +/- SD) (maximum aerobic capacity, VO2max >40 ml/kg/min) and in 85 healthy untrained men (61 +/- 7 years) with no history of CAD. The prevalence of silent ischemia (exercise-induced ST-segment depression on electrocardiogram and perfusion abnormalities on thallium scintigraphy) was similar in athletes and untrained men; 16% of the athletes (11 of 70) had silent ischemia compared with 21% of the untrained men (chi-square = 0.81, p = 0.36). No athletes had hyperlipidemia, systemic hypertension, or diabetes mellitus. However, the apolipoprotein E4 allele was present in 9 of the 11 athletes with silent ischemia compared with 2 of 32 athletes with normal exercise tests (chi-square = 24, p = 0.0001). These results suggest that older male athletes with the apolipoprotein E4 allele are at increased risk for the development of exercise-induced silent ischemia.