New records in aerobic power among octogenarian lifelong endurance athletes

Fast and slow myofiber nuclei, satellite cells, and size distribution with lifelong endurance exercise in men and women

We previously observed lifelong endurance exercise (LLE) influenced quadriceps whole-muscle and myofiber size in a fiber-type and sex-specific manner. The current follow-up exploratory investigation examined myofiber size regulators and myofiber size distribution in vastus lateralis biopsies from these same LLE men (n = 21, 74 ± 1 years) and women (n = 7, 72 ± 2 years) as well as old, healthy nonexercisers (OH; men: n = 10, 75 ± 1 years; women: n = 10, 75 ± 1 years) and young exercisers (YE; men: n = 10, 25 ± 1 years; women: n = 10, 25 ± 1 years). LLE exercised ~5 days/week, ~7 h/week for the previous 52 ± 1 years. Slow (myosin heavy chain (MHC) I) and fast (MHC IIa) myofiber nuclei/fiber, myonuclear domain, satellite cells/fiber, and satellite cell density were not influenced (p > 0.05) by LLE in men and women. The aging groups had ~50%-60% higher proportion of large (>7000 μm2) and small (<3000 μm2) myofibers (OH; men: 44%, women: 48%, LLE; men: 42%, women: 42%, YE; men: 27%, women: 29%). LLE men had triple the proportion of large slow fibers (LLE: 21%, YE: 7%, OH: 7%), while LLE women had more small slow fibers (LLE: 15%, YE: 8%, OH: 9%). LLE reduced by ~50% the proportion of small fast (MHC II containing) fibers in the aging men (OH: 14%, LLE: 7%) and women (OH: 35%, LLE: 18%). These data, coupled with previous findings, suggest that myonuclei and satellite cell content are uninfluenced by lifelong endurance exercise in men ~60-90 years, and this now also extends to septuagenarian lifelong endurance exercise women. Additionally, lifelong endurance exercise appears to influence the relative abundance of small and large myofibers (fast and slow) differently between men and women.

Periodized Aerobic Training between Thresholds Improves Submaximal Cardiorespiratory Parameters in Octogenarians

BACKGROUND AND AIMS

The worldwide aging population is expanding, with more individuals living into their 80s. Physiological functions decline gradually with age, compounded by sedentary lifestyles. Incorporating physical activity into daily routine is crucial for maintaining independence. This study aimed to assess a periodized high-intensity aerobic training program (PEZO-BT) in octogenarians, focusing on submaximal ergospirometry effects.

METHODS

A total of 48 non-frail octogenarian subjects (12 females, 36 males) were randomized into control and intervention groups. All subjects underwent submaximal cardiopulmonary exercise testing with gas analysis at baseline, stopping after the respiratory compensation point (RCP). Our intervention group completed a 14-week PEZO-BT aerobic training program. The outcomes were oxygen consumption at first ventilatory threshold (VO2AT), ventilatory efficiency slope (VE/VCO2), oxygen uptake efficiency slope (OUES), cardiorespiratory optimal point (COP), oxygen pulse change (ΔVO2/HR) from anaerobic threshold (AT) to respiratory compensation point (RCP), and power output at anaerobic threshold (POAT).

RESULTS

Mixed ANOVA examined time and treatment effects. If significance emerged, post hoc t-tests were used to compare significances between groups. The homogeneity of variance was assessed using Levene's test. Chi-square tests compared ergospirometry criteria and ventilatory performance within groups. The mean differences at post intervention were significant in VO2AT (p < 0.001), VE/VCO2 (p < 0.001), ΔVO2/HR (p < 0.05), and POAT (p < 0.001), while OUES and COP were not significant (p > 0.05). However, clinical effects were observed in the entire intervention group.

CONCLUSIONS

Training improved exercise capacity and workload. Overall, this periodic aerobic and high-intensity interval training (HIIT) program yielded significant improvements in cardiorespiratory fitness (CRF) in previously untrained octogenarians with and without comorbidities. The findings suggest implications for promoting long-term healthy aging.

Self-reported walking pace and 10-year cause-specific mortality: A UK biobank investigation

OBJECTIVE

To investigate associations of self-reported walking pace (SRWP) with relative and absolute risks of cause-specific mortality.

PATIENTS AND METHODS

In 391,652 UK Biobank participants recruited in 2006-2010, we estimated sex- and cause-specific (cardiovascular disease [CVD], cancer, other causes) mortality hazard ratios (HRs) and 10-year mortality risks across categories of SRWP (slow, average, brisk), accounting for confounders and competing risk. Censoring occurred in September 30, 2021 (England, Wales) and October 31, 2021 (Scotland).

RESULTS

Over a median follow-up of 12.6 years, 22,413 deaths occurred. In women, the HRs comparing brisk to slow SRWP were 0.74 (95% CI: 0.67, 0.82), 0.40 (0.33, 0.49), and 0.29 (0.26, 0.32) for cancer, CVD, and other causes of death, respectively, and 0.71 (0.64, 0.78), 0.38 (0.33, 0.44), and 0.29 (0.26, 0.32) in men. Compared to CVD, HRs were greater for other causes (women: 39.6% [6.2, 72.9]; men: 31.6% [9.8, 53.5]) and smaller for cancer (-45.8% [-58.3, -33.2] and - 45.9% [-54.8, -36.9], respectively). For all causes in both sexes, the 10-year mortality risk was higher in slow walkers, but varied across sex, age, and cause, resulting in different risk reductions comparing brisk to slow: the largest were for other causes of death at age 75 years [women: -6.8% (-7.7, -5.8); men: -9.5% (-10.6, -8.4)].

CONCLUSION

Compared to slow walkers, brisk SRWP was associated with reduced cancer (smallest reduction), CVD, and other (largest) causes of death and may therefore be a useful clinical predictive marker. As absolute risk reductions varied across age, cause, and SRWP, certain groups may particularly benefit from interventions to increase SRWP.

Multitissue responses to exercise: a MoTrPAC feasibility study

We assessed the feasibility of the Molecular Transducers of Physical Activity Consortium (MoTrPAC) human adult clinical exercise protocols, while also documenting select cardiovascular, metabolic, and molecular responses to these protocols. After phenotyping and familiarization sessions, 20 subjects (25 ± 2 yr, 12 M, 8 W) completed an endurance exercise bout (n = 8, 40 min cycling at 70% V̇o2max), a resistance exercise bout (n = 6, ∼45 min, 3 sets of ∼10 repetition maximum, 8 exercises), or a resting control period (n = 6, 40 min rest). Blood samples were taken before, during, and after (10 min, 2 h, and 3.5 h) exercise or rest for levels of catecholamines, cortisol, glucagon, insulin, glucose, free fatty acids, and lactate. Heart rate was recorded throughout exercise (or rest). Skeletal muscle (vastus lateralis) and adipose (periumbilical) biopsies were taken before and ∼4 h following exercise or rest for mRNA levels of genes related to energy metabolism, growth, angiogenesis, and circadian processes. Coordination of the timing of procedural components (e.g., local anesthetic delivery, biopsy incisions, tumescent delivery, intravenous line flushes, sample collection and processing, exercise transitions, and team dynamics) was reasonable to orchestrate while considering subject burden and scientific objectives. The cardiovascular and metabolic alterations reflected a dynamic and unique response to endurance and resistance exercise, whereas skeletal muscle was transcriptionally more responsive than adipose 4 h postexercise. In summary, the current report provides the first evidence of protocol execution and feasibility of key components of the MoTrPAC human adult clinical exercise protocols. Scientists should consider designing exercise studies in various populations to interface with the MoTrPAC protocols and DataHub.NEW & NOTEWORTHY This study highlights the feasibility of key aspects of the MoTrPAC adult human clinical protocols. This initial preview of what can be expected from acute exercise trial data from MoTrPAC provides an impetus for scientists to design exercise studies to interlace with the rich phenotypic and -omics data that will populate the MoTrPAC DataHub at the completion of the parent protocol.

Exercise and Experiments of Nature

In this article, we highlight the contributions of passive experiments that address important exercise-related questions in integrative physiology and medicine. Passive experiments differ from active experiments in that passive experiments involve limited or no active intervention to generate observations and test hypotheses. Experiments of nature and natural experiments are two types of passive experiments. Experiments of nature include research participants with rare genetic or acquired conditions that facilitate exploration of specific physiological mechanisms. In this way, experiments of nature are parallel to classical "knockout" animal models among human research participants. Natural experiments are gleaned from data sets that allow population-based questions to be addressed. An advantage of both types of passive experiments is that more extreme and/or prolonged exposures to physiological and behavioral stimuli are possible in humans. In this article, we discuss a number of key passive experiments that have generated foundational medical knowledge or mechanistic physiological insights related to exercise. Both natural experiments and experiments of nature will be essential to generate and test hypotheses about the limits of human adaptability to stressors like exercise. © 2023 American Physiological Society. Compr Physiol 13:4879-4907, 2023.

Exercise and ageing impact the kynurenine/tryptophan pathway and acylcarnitine metabolite pools in skeletal muscle of older adults

Exercise-induced perturbation of skeletal muscle metabolites is a probable mediator of long-term health benefits in older adults. Although specific metabolites have been identified to be impacted by age, physical activity and exercise, the depth of coverage of the muscle metabolome is still limited. Here, we investigated resting and exercise-induced metabolite distribution in muscle from well-phenotyped older adults who were active or sedentary, and a group of active young adults. Percutaneous biopsies of the vastus lateralis were obtained before, immediately after and 3 h following a bout of endurance cycling. Metabolite profile in muscle biopsies was determined by tandem mass spectrometry. Mitochondrial energetics in permeabilized fibre bundles was assessed by high resolution respirometry and fibre type proportion was assessed by immunohistology. We found that metabolites of the kynurenine/tryptophan pathway were impacted by age and activity. Specifically, kynurenine was elevated in muscle from older adults, whereas downstream metabolites of kynurenine (kynurenic acid and NAD+ ) were elevated in muscle from active adults and associated with cardiorespiratory fitness and muscle oxidative capacity. Acylcarnitines, a potential marker of impaired metabolic health, were elevated in muscle from physically active participants. Surprisingly, despite baseline group difference, acute exercise-induced alterations in whole-body substrate utilization, as well as muscle acylcarnitines and ketone bodies, were remarkably similar between groups. Our data identified novel muscle metabolite signatures that associate with the healthy ageing phenotype provoked by physical activity and reveal that the metabolic responsiveness of muscle to acute endurance exercise is retained [NB]:AUTHOR: Please ensure that the appropriate material has been provide for Table S2, as well as for Figures S1 to S7, as also cited in the text with age regardless of activity levels. KEY POINTS: Kynurenine/tryptophan pathway metabolites were impacted by age and physical activity in human muscle, with kynurenine elevated in older muscle, whereas downstream products kynurenic acid and NAD+ were elevated in exercise-trained muscle regardless of age. Acylcarnitines, a marker of impaired metabolic health when heightened in circulation, were elevated in exercise-trained muscle of young and older adults, suggesting that muscle act as a metabolic sink to reduce the circulating acylcarnitines observed with unhealthy ageing. Despite the phenotypic differences, the exercise-induced response of various muscle metabolite pools, including acylcarnitine and ketone bodies, was similar amongst the groups, suggesting that older adults can achieve the metabolic benefits of exercise seen in young counterparts.

Older Adult Aerobic Capacity, Muscular Strength, Fitness and Body Composition After 20+ Years of Exercise Training: A Systematic Review and Meta-Analysis

Older adults (≥ 65 years) are recommended to participate in regular exercise to maintain health in late adulthood. The impact of long-term (20+ years) exercise training that align with the American College of Sports Medicine's (ACSM) recommended guidelines has not been evaluated for older adults. To address this, a systematic review and meta-analyses were performed regarding the effects of long-term exercise training on older adult aerobic capacity, muscular fitness, and body composition that meet the ACSM's recommendation for weekly training volume. Ten studies with individuals that performed cardiorespiratory or resistance exercise met the inclusion criteria for the systematic review. Data from five included studies were analyzed in meta-analyses to determine the relationship between the effects of cardiorespiratory training on fitness and body composition measured in the same subjects. Main findings include higher cardiorespiratory fitness (MD: +11.36 mL/kg/min, 95% CI: 5.63 to 17.09 mL/kg/min, p < 0.01) in older adults who performed long-term cardiorespiratory exercise that was found in conjunction with lower percent body fat (MD: -5.41%, 95% CI: -7.65 to -3.17%, p < 0.01). Higher volume of cardiorespiratory exercise beyond the minimum recommendations did not impact benefits. Additionally, resistance-trained older adults showed greater muscular strength and lower percent body fat with comparable cardiorespiratory fitness to sedentary older adults. These findings primarily highlight a preservation of cardiorespiratory fitness and lower risk of mortality and cardiometabolic disease risk for older adults who participate in long-term cardiorespiratory and exercise that meet the ACSM's recommended weekly training volume.

Skeletal muscle morphology, satellite cells, and oxidative profile in relation to physical function and lifelong endurance training in very old men

In the current study, we compared muscle morphology in three advanced aging cohorts that differed in physical function, including a unique cohort of lifelong endurance athletes. Biopsies from the vastus lateralis muscle of seven lifelong endurance athletes (EAs) aged 82-92 yr, and 19 subjects from the Uppsala Longitudinal Study of Adult Men (ULSAM) aged 87-91 yr were analyzed. ULSAM subjects were divided into high- (n = 9, HF) and low- (n = 10, LF) function groups based on strength and physical function tests. The analysis included general morphology, fiber type and cross-sectional area, capillarization, deficient cytochrome c oxidase (COX) activity, number of myonuclei and satellite cells, and markers of regeneration and denervation. Fibers with central nuclei and/or nuclear clumps were observed in all groups. EA differed from LF and HF by having a higher proportion of type I fibers, 52% more capillaries in relation to fiber area, fewer COX-negative fibers, and less variation in fiber sizes (all P < 0.05). There were no differences between the groups in the number of myonuclei and satellite cells per fiber, and no significant differences between LF and HF (P > 0.05). In conclusion, signs of aging were evident in the muscle morphology of all groups, but neither endurance training status nor physical function influenced signs of regeneration and denervation processes. Lifelong endurance training, but not higher physical function, was associated with higher muscle oxidative capacity, even beyond the age of 80.NEW & NOTEWORTHY Here we show that lifelong endurance training, but not physical function, is associated with higher muscle oxidative capacity, even beyond the age of 80 yr. Neither endurance training status nor physical function was significantly associated with satellite cells or markers of regeneration and denervation in muscle biopsies from these very old men.

SPORTS INJURIES IN HIGH-LEVEL AEROBIC GYMNASTICS ATHLETES

ABSTRACT Introduction: With the rapid development of aerobic gymnastics worldwide, research is required to constantly increase. Objective: Analyze the main causes of sports injuries, proposing measures for prevention, treatment, and rehabilitation, as well as providing a theoretical basis for reducing the risk of sports injuries and actively seeking ways and measures to prevent and treat sports injuries in aerobic gymnastics athletes. Methods: Statistical-mathematical analysis was used, mainly including the coefficient of variation method, correlation matrix method, and factor analysis. The common variable of the trend of sports injuries was found. Results: The research shows that the scientific awareness, self-protection, and injury prevention of aerobic gymnastics training strengthen the ideological education and theoretical guidance of athletes, improve athletes' awareness of sports injuries, regulate technical specifications, strengthen fitness training and improve Chinese competitive aerobics. Conclusion: In the healthy period before injuries, we should take various measures to improve physical fitness and skills, enabling good health work in the acute period after injuries and understanding the working principle of early diagnosis and treatment to better use treatment time. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Oxygen uptake ( V ˙ O2) and pulmonary ventilation ( V ˙ E) during military surface fin swimming in a swimming flume: Effects of surface immersion

Introduction: During military fin swimming, we suspected that oxygen uptake ( V ˙ O₂) and pulmonary ventilation ( V ˙ E) might be much higher than expected. In this framework, we compared these variables in the responses of trained military divers during land cycling and snorkeling exercises. Methods: Eighteen male military divers (32.3 ± 4.2 years; 178.0 ± 5.0 cm; 76.4 ± 3.4 kg; 24.1 ± 2.1 kg m^-2) participated in this study. They performed two test exercises on two separate days: a maximal incremental cycle test (land condition), and an incremental fin swimming (fin condition) in a motorized swimming flume. Results: The respective fin and land V ˙ O_2max were 3,701 ± 39 mL min^-1 and 4,029 ± 63 mL min^-1 (p = 0.07), these values were strongly correlated (r ² = 0.78 p < 0.01). Differences in V ˙ O_2max between conditions increased relative to l; V ˙ O_2max (r ² = 0.4 p = 0.01). Fin V ˙ E _max values were significantly lower than land V ˙ E _max values (p = 0.01). This result was related to both the significantly lower fin Vt and f (p < 0.01 and <0.04, respectively). Consequently, the fin V ˙ E _max / V ˙ O_2max ratios were significantly lower than the corresponding ratios for land values (p < 0.01), and the fin and land V ˙ E _max were not correlated. Other parameters measured at exhaustion-PaO₂, PaCO₂, and SO₂ - were similar in fin and land conditions. Furthermore, no significant differences between land and fin conditions were observed for peak values for heart rate, blood lactate concentration, and respiratory exchange ratio R. Conclusion: Surface immersion did not significantly reduce the V ˙ O_2max in trained divers relative to land conditions. As long as V ˙ O₂ remained below V ˙ O_2max , the V ˙ E values were identical in the two conditions. Only at V ˙ O_2max was V ˙ E higher on land. Although reduced by immersion, V ˙ E _max provided adequate pulmonary gas exchange during maximal fin swimming.

Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations

Although the benefits of regular physical activity on cardiovascular health are well established, the effects of strenuous endurance exercise (SEE) have been a matter of debate since ancient times. In this article, we aim to provide a balanced overview of what is known about SEE and the heart-from epidemiological evidence to recent cardiac imaging findings. Lifelong SEE is overall cardioprotective, with endurance master athletes showing in fact a youthful heart. Yet, some lines of research remain open, such as the need to elucidate the time-course and potential relevance of transient declines in heart function (or increases in biomarkers of cardiac injury) with SEE. The underlying mechanisms and clinical relevance of SEE-associated atrial fibrillation, myocardial fibrosis, or high coronary artery calcium scores also remain to be elucidated. © 2022 American Physiological Society. Compr Physiol 12:1-19, 2022.

State of Knowledge on Molecular Adaptations to Exercise in Humans: Historical Perspectives and Future Directions

For centuries, regular exercise has been acknowledged as a potent stimulus to promote, maintain, and restore healthy functioning of nearly every physiological system of the human body. With advancing understanding of the complexity of human physiology, continually evolving methodological possibilities, and an increasingly dire public health situation, the study of exercise as a preventative or therapeutic treatment has never been more interdisciplinary, or more impactful. During the early stages of the NIH Common Fund Molecular Transducers of Physical Activity Consortium (MoTrPAC) Initiative, the field is well-positioned to build substantially upon the existing understanding of the mechanisms underlying benefits associated with exercise. Thus, we present a comprehensive body of the knowledge detailing the current literature basis surrounding the molecular adaptations to exercise in humans to provide a view of the state of the field at this critical juncture, as well as a resource for scientists bringing external expertise to the field of exercise physiology. In reviewing current literature related to molecular and cellular processes underlying exercise-induced benefits and adaptations, we also draw attention to existing knowledge gaps warranting continued research effort. © 2021 American Physiological Society. Compr Physiol 12:3193-3279, 2022.

The Aging Athlete: Paradigm of Healthy Aging

The Exercise Boom of the 1970's resulted in the adoption of habitual exercise in a significant portion of the population. Many of these individuals are defying the cultural norms by remaining physically active and competing at a high level in their later years. The juxtaposition between masters athletes and non-exercisers demonstrate the importance of remaining physically active throughout the lifespan on physiological systems related to healthspan (years of healthy living). This includes ~50% improved maximal aerobic capacity (VO₂max) and enhanced skeletal muscle health (size, function, as well as metabolic and communicative properties) compared to non-exercisers at a similar age. By taking a reductionist approach to VO₂max and skeletal muscle health, we can gain insight into how aging and habitual exercise affects the aging process. Collectively, this review provides a physiological basis for the elite performances seen in masters athletes, as well as the health implications of lifelong exercise with a focus on VO₂max, skeletal muscle metabolic fitness, whole muscle size and function, single muscle fiber physiology, and communicative properties of skeletal muscle. This review has significant public health implications due to the potent health benefits of habitual exercise across the lifespan.

Exercise in Octogenarians: How Much Is Too Little?

The global population is rapidly aging, with predictions of many more people living beyond 85 years. Age-related physiological adaptations predispose to decrements in physical function and functional capacity, the rate of which can be accelerated by chronic disease and prolonged physical inactivity. Decrements in physical function exacerbate the risk of chronic disease, disability, dependency, and frailty with advancing age. Regular exercise positively influences health status, physical function, and disease risk in adults of all ages. Herein, we review the role of structured exercise training in the oldest old on cardiorespiratory fitness and muscular strength and power, attributes critical for physical function, mobility, and independent living. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Nutrition for Older Athletes: Focus on Sex-Differences

Regular physical exercise and a healthy diet are major determinants of a healthy lifespan. Although aging is associated with declining endurance performance and muscle function, these components can favorably be modified by regular physical activity and especially by exercise training at all ages in both sexes. In addition, age-related changes in body composition and metabolism, which affect even highly trained masters athletes, can in part be compensated for by higher exercise metabolic efficiency in active individuals. Accordingly, masters athletes are often considered as a role model for healthy aging and their physical capacities are an impressive example of what is possible in aging individuals. In the present review, we first discuss physiological changes, performance and trainability of older athletes with a focus on sex differences. Second, we describe the most important hormonal alterations occurring during aging pertaining regulation of appetite, glucose homeostasis and energy expenditure and the modulatory role of exercise training. The third part highlights nutritional aspects that may support health and physical performance for older athletes. Key nutrition-related concerns include the need for adequate energy and protein intake for preventing low bone and muscle mass and a higher demand for specific nutrients (e.g., vitamin D and probiotics) that may reduce the infection burden in masters athletes. Fourth, we present important research findings on the association between exercise, nutrition and the microbiota, which represents a rapidly developing field in sports nutrition.

Lifelong Endurance Exercise as a Countermeasure Against Age-Related [Formula: see text] Decline: Physiological Overview and Insights from Masters Athletes

Maximum oxygen consumption ([Formula: see text]) is not only an indicator of endurance performance, but also a strong predictor of cardiovascular disease and mortality. This physiological parameter is known to decrease with aging. In turn, physical exercise might attenuate the rate of aging-related decline in [Formula: see text], which in light of the global population aging is of major clinical relevance, especially at advanced ages. In this narrative review, we summarize the evidence available from masters athletes about the role of lifelong endurance exercise on aging-related [Formula: see text] decline, with examples of the highest [Formula: see text] values reported in the scientific literature for athletes across different ages (e.g., 35 ml·kg^-1·min^-1 in a centenarian cyclist). These data suggest that a linear decrease in [Formula: see text] might be possible if physical exercise loads are kept consistently high through the entire life span, with [Formula: see text] values remaining higher than those of the general population across all ages. We also summarize the main physiological changes that occur with inactive aging at different system levels-pulmonary and cardiovascular function, blood O₂ carrying capacity, skeletal muscle capillary density and oxidative capacity-and negatively influence [Formula: see text], and review how lifelong exercise can attenuate or even prevent most-but apparently not all (e.g., maximum heart rate decline)-of them. In summary, although aging seems to be invariably associated with a progressive decline in [Formula: see text], maintaining high levels of physical exercise along the life span slows the multi-systemic deterioration that is commonly observed in inactive individuals, thereby attenuating age-related [Formula: see text] decline.

The Oxygen Cascade During Exercise in Health and Disease

The oxygen transport cascade describes the physiological steps that bring atmospheric oxygen into the body where it is delivered and consumed by metabolically active tissue. As such, the oxygen cascade is fundamental to our understanding of exercise in health and disease. Our narrative review will highlight each step of the oxygen transport cascade from inspiration of atmospheric oxygen down to mitochondrial consumption in both healthy active males and females along with clinical conditions. We will focus on how different steps interact along with principles of homeostasis, physiological redundancies, and adaptation. In particular, we highlight some of the parallels between elite athletes and clinical conditions in terms of the oxygen cascade.

Hormonal and Metabolic Changes of Aging and the Influence of Lifestyle Modifications

Increased life expectancy combined with the aging baby boomer generation has resulted in an unprecedented global expansion of the elderly population. The growing population of older adults and increased rate of age-related chronic illness has caused a substantial socioeconomic burden. The gradual and progressive age-related decline in hormone production and action has a detrimental impact on human health by increasing risk for chronic disease and reducing life span. This article reviews the age-related decline in hormone production, as well as age-related biochemical and body composition changes that reduce the bioavailability and actions of some hormones. The impact of hormonal changes on various chronic conditions including frailty, diabetes, cardiovascular disease, and dementia are also discussed. Hormone replacement therapy has been attempted in many clinical trials to reverse and/or prevent the hormonal decline in aging to combat the progression of age-related diseases. Unfortunately, hormone replacement therapy is not a panacea, as it often results in various adverse events that outweigh its potential health benefits. Therefore, except in some specific individual cases, hormone replacement is not recommended. Rather, positive lifestyle modifications such as regular aerobic and resistance exercise programs and/or healthy calorically restricted diet can favorably affect endocrine and metabolic functions and act as countermeasures to various age-related diseases. We provide a critical review of the available data and offer recommendations that hopefully will form the groundwork for physicians/scientists to develop and optimize new endocrine-targeted therapies and lifestyle modifications that can better address age-related decline in heath.

Effects of aging and lifelong aerobic exercise on expression of innate immune components in human skeletal muscle

The purpose of this investigation was to evaluate the effects of aging and lifelong exercise on skeletal muscle components of the innate immune system. Additionally, the effects of an acute resistance exercise (RE) challenge were explored. Three groups of men were studied: young exercisers (YE: n = 10, 25 ± 1 yr; V̇o_2max: 53 ± 3 mL/kg/min; quadriceps size: 78 ± 3 cm²), lifelong aerobic exercisers with a 53 ± 1 yr training history (LLE; n = 21, 74 ± 1 yr; V̇o_2max: 34 ± 1 mL/kg/min; quadriceps size: 67 ± 2 cm²), and old healthy nonexercisers (OH: n = 10, 75 ± 1 yr; V̇o_2max: 22 ± 1 mL/kg/min, quadriceps size: 56 ± 3 cm²). Vastus lateralis muscle biopsies were obtained in the basal state and 4 h after RE (3 × 10 reps, 70% of 1 repetition maximum) to assess Toll-like receptors (TLR)1-10, TLR adaptors (Myd88 and TRIF), and NF-κB pathway components (IκΒα and IKKβ) mRNA expression. Basal TLR3, TLR6, and TLR7 tended to be higher (P ≤ 0.10) with aging (LLE and OH combined). In general, RE increased expression of TLR1 and TLR8 (P ≤ 0.10) and TLR3 and TLR4 (P < 0.05), although TLR3 did not respond in OH. Both TLR adaptors also responded to the exercise bout; these were primarily (Myd88, main effect P ≤ 0.10) or exclusively (TRIF, P < 0.05) driven by the OH group. In summary, aging appears to increase basal expression of some innate immune components in human skeletal muscle, and lifelong aerobic exercise does not affect this age-related increase. An exercise challenge stimulates the expression of several TLRs, while the TLR adaptor response appears to be dysregulated with aging and maintained with lifelong exercise. Partially preserved muscle mass, coupled with a notable immunity profile, suggests lifelong exercisers are likely better prepared for a stress that challenges the immune system.NEW & NOTEWORTHY Findings from this investigation provide novel insight into the effect of aging and lifelong aerobic exercise on structural components of the innate immune system in skeletal muscle of humans. Data presented here suggest aging increases basal expression of select Toll-like receptors (TLRs), and lifelong exercise does not impact this age-related increase. Additionally, acute exercise stimulates gene expression of several TLRs, while the adaptor response is likely dysregulated with aging and maintained with lifelong exercise.

Physiological Responses and Nutritional Intake during a 7-Day Treadmill Running World Record

Ultra-running comprises running events longer than a marathon (>42.2 km). The prolonged duration of ultra-running leads to decrements in most or all physiological parameters and considerable energy expenditure (EE) and energy deficits. SG, 47 years, 162.5 cm, 49 kg, VO_2max 4 mL/kg/min⁻¹/2.37 L/min⁻¹, ran continuously for 7 days on a treadmill in 3 h blocks followed by 30 min breaks and slept from 1–5 a.m. Heart rate (HR) oxygen uptake (VO₂), rating of perceived exertion, weight, blood lactate (mmol·L⁻¹), haemoglobin (g·dL), haematocrit (%) and glucose (mmol·L⁻¹), and nutrition and hydration were recorded. SG ran for 17.5 h/day, covering ~120 km/day at ~7 km/h. Energy expenditure for each 24 h period was 6878 kcal/day and energy intake (EI) was 2701 kcal/day. EE was 382 kcal/h, with 66.6% from fat and 33.4% from carbohydrate oxidation. 7 day EI was 26,989 kcal and EE was 48,147 kcal, with a total energy deficit (ED) of 21,158 kcal. Average VO₂ was 1.2 L·min⁻¹/24.7 mL·kg·min⁻¹, Respriatory echange ratio (RER) 0.80 ± 0.03, HR 120–125 b·min⁻¹. Weight increased from 48.6 to 49.5 kg. Haemoglobin decreased from 13.7 to 11 g·dL and haematocrit decreased from 40% to 33%. SG ran 833.05 km. SG exhibits an enhanced fat metabolism through which she had a large daily ED. Her success can be attributed to a combination of physiological and psychological factors.

Is the healthy respiratory system built just right, overbuilt, or underbuilt to meet the demands imposed by exercise?

In the healthy, untrained young adult, a case is made for a respiratory system (airways, pulmonary vasculature, lung parenchyma, respiratory muscles, and neural ventilatory control system) that is near ideally designed to ensure a highly efficient, homeostatic response to exercise of varying intensities and durations. Our aim was then to consider circumstances in which the intra/extrathoracic airways, pulmonary vasculature, respiratory muscles, and/or blood-gas distribution are underbuilt or inadequately regulated relative to the demands imposed by the cardiovascular system. In these instances, the respiratory system presents a significant limitation to O₂ transport and contributes to the occurrence of locomotor muscle fatigue, inhibition of central locomotor output, and exercise performance. Most prominent in these examples of an "underbuilt" respiratory system are highly trained endurance athletes, with additional influences of sex, aging, hypoxic environments, and the highly inbred equine. We summarize by evaluating the relative influences of these respiratory system limitations on exercise performance and their impact on pathophysiology and provide recommendations for future investigation.

The Physiological Characteristics of an 83-Year-Old Champion Female Master Runner

PURPOSE

To examine the cardiorespiratory, muscular, and skeletal characteristics of an 83-year-old champion female master athlete (called DL in this study) who had set multiple world running records in the 80-to-84-year-old age group.

METHODS

Measures of maximal oxygen uptake, maximal heart rate, maximal isometric torque for knee extensor muscles, thigh and triceps surae muscle volumes, and bone mineral density (BMD) of the proximal femur region were evaluated. Based on previously published equations, physiological age was determined for maximal oxygen uptake, maximal heart rate, and maximal isometric torque. Muscle volumes for the dominant leg were compared with previously published sex- and age-matched data using z scores. For BMD, T score and z score were calculated.

RESULTS

DL had the highest maximal oxygen uptake (42.3 mL·min-1·kg-1) ever observed for a female older than 80 years of age, which gave her a remarkable physiological age (27 y). By contrast, she had a physiological age closer to her biological age for maximal isometric torque (90 y) and maximal heart rate (74 y). The z scores for thigh (0.4) and triceps surae (1.1) muscle volumes revealed that DL's leg muscles were affected almost as much as her sex- and age-matched peers. The T score (-1.7) for BMD showed that DL had osteopenia but no osteoporosis, and the z score (0.7) showed that DL's BMD was similar to that of females of the same age.

CONCLUSION

This single case study shows that the remarkable cardiorespiratory fitness coupled with intensive endurance training observed in a female master athlete was not associated with specific preservation of her muscular and skeletal characteristics.

Effects of aging and lifelong aerobic exercise on basal and exercise-induced inflammation

Age-associated chronic basal inflammation compromises muscle mass and adaptability, but exercise training may exert an anti-inflammatory effect. This investigation assessed basal and exercise-induced inflammation in three cohorts of men: young exercisers [YE; n = 10 men; 25 ± 1 yr; maximal oxygen consumption (V̇o2max), 53 ± 3 mL·kg-1·min-1; quadriceps area, 78 ± 3 cm2; means ± SE], old healthy nonexercisers (OH; n = 10; 75 ± 1 yr; V̇o2max, 22 ± 1 mL·kg-1·min-1; quadriceps area, 56 ± 3 cm2), and lifelong exercisers with an aerobic training history of 53 ± 1 yr (LLE; n = 21; 74 ± 1 yr; V̇o2max, 34 ± 1 mL·kg-1·min-1; quadriceps area, 67 ± 2 cm2). Resting serum IL-6, TNF-α, C-reactive protein, and IGF-1 levels were measured. Vastus lateralis muscle biopsies were obtained at rest (basal) and 4 h after an acute exercise challenge (3 × 10 repetitions, 70% 1-repetition maximum) to assess gene expression of cytokines [IL-6, TNF-α, IL-1β, IL-10, IL-4, interleukin-1 receptor antagonist (IL-1Ra), and transforming growth factor-β (TGF-β)], chemokines [IL-8 and monocyte chemoattractant protein-1 (MCP-1)], cyclooxygenase enzymes [cyclooxygenase-1 and -2 (COX-1 and COX-2, respectively), prostaglandin E2 synthases [microsomal prostaglandin E synthase 1 (mPGES-1) and cytosolic prostaglandin E2 synthase (cPGES)] and receptors [prostaglandin E2 receptor EP3 and EP4 subtypes (EP3 and EP4, respectively), and macrophage markers [cluster of differentiation 16b (CD16b) and CD163], as well as basal macrophage abundance (CD68+ cells). Aging led to higher (P ≤ 0.05) circulating IL-6 and skeletal muscle COX-1, mPGES-1, and CD163 expression. However, LLE had significantly lower serum IL-6 levels (P ≤ 0.05 vs. OH) and a predominantly anti-inflammatory muscle profile [higher IL-10 (P ≤ 0.05 vs. YE), TNF-α, TGF-β, and EP4 levels (P ≤ 0.05 vs. OH)]. In OH only, acute exercise increased expression of proinflammatory factors TNF-α, TGF-β, and IL-8 (P ≤ 0.05). LLE had postexercise gene expression similar to YE, except lower IL-10 (P ≤ 0.10), mPGES-1, and EP3 expression (P ≤ 0.05). Thus, although aging led to a proinflammatory profile within blood and muscle, lifelong exercise partially prevented this and generally preserved the acute inflammatory response to exercise seen in young exercising men. Lifelong exercise may positively impact muscle health throughout aging by promoting anti-inflammation in skeletal muscle.NEW & NOTEWORTHY This study assessed a unique population of lifelong aerobic exercising men and demonstrated that their activity status exerts an anti-inflammatory effect in skeletal muscle and circulation. Furthermore, we provide evidence that the inflammatory response to acute exercise is dysregulated by aging but preserved with lifelong exercise, which might improve skeletal muscle resilience to unaccustomed loading and adaptability into late life.

Do changes in middle-distance running kinematics contribute to the age-related decline in performance?

OBJECTIVES

The aim of this study was to assess ageing-related changes in middle-distance running kinematics and performance in master athletes.

METHODS

Male athletes (n=157; 57±13.3 years) competing in the 800- and 1500-m runs at the German Master Athletics Outdoor Championships 2018 were filmed and the bending-over angle, brake angle, leg-stiffness angle, propulsion angle and hip-flexion angle measured.

RESULTS

Leg-stiffness and propulsion angle decreased with age (all p<.001), while bending-over, brake and hip-flexion angle increased (all p<.001). Bending-over, propulsion and hip-flexion angles were smaller in 800- than 1500-m races, while the brake angle was larger in 800- than 1500-m races (all p<.001), with no significant difference in leg-stiffness angle between disciplines. In the last round, hip flexion was lower compared to earlier rounds in both distances (p<.001). Age was the major predictor for performance in both races (800-m R_adj²=0.74; p<.001, 1500-m R_adj²=0.80; p<.001), with a minor impact of technique (improved R_adj² to 0.84 and 0.86, respectively).

CONCLUSIONS

The study revealed that the ageing-related decline in running performance of master athletes was primarily explicable by age with only a small contribution of changes in sprint kinematics.

"You Can Sit in the Middle or Be One of the Outliers": Older Male Athletes and the Complexities of Social Comparison

Sporting events for older adults are proliferating in both popularity and participation numbers, mirroring the growth that is occurring globally with an aging population. Preliminary evidence indicates that older athletes have a tendency to compare themselves (in terms of their performance, participation, and aging) to inactive older adults deemed “worse-off.” Our aim was to examine the stories and experiences of older, male Masters athletes, not only in terms of their own lives and in relation to others but also in the broader context of current (neoliberal) policies that promote sport across the lifespan. We use social comparison theory to interpret our findings and highlight the strengths and limitations of social comparison as a psychological strategy. For this study, 17 male competitive athletes (age range from 70 to 90 years) who participated in either the 2013 or 2017 World Masters Games were interviewed as part of a larger project on the meaning of sport in their lives. Seven different sports were represented, and participants hailed from multiple countries. Within the interpretive paradigm, we used qualitative methods to interview each participant, analyze individual transcripts, and develop common themes across the data set to address the aforementioned aims. Our two major themes were, Sport as social comparison:“It’s the competitive nature” and Downward comparisons. A number of participants commented on the nature of sport, and competitive sport in particular, as being important to their motivation to train and prepare. Within the theme of Downward comparisons, we established two categories: Resisting loss and Assigning blame. While downward comparisons were used by our participants to separate themselves from other seniors of the same age, thereby bolstering their sense of self, participants also tied those comparisons to neoliberal notions of individual and moral responsibility for health. Participants believed that compromised health was due to individual negligence and bad decisions, with little reference to uncontrollable factors, such as non-modifiable risk factors for disease, disability, and/or socioeconomic status, which could be affecting people’s lives or decisions. Ultimately, our findings show that the useful psychological strategy of social comparison for maintaining a positive sense of self and performance may also have some negative individual and societal consequences.

Aging and Physiological Lessons from Master Athletes

Sedentary aging is often characterized by physical dysfunction and chronic degenerative diseases. In contrast, masters athletes demonstrate markedly greater physiological function and more favorable levels of risk factors for cardiovascular disease, osteoporosis, frailty, and cognitive dysfunction than their sedentary counterparts. In many cases, age-related deteriorations of physiological functions as well as elevations in risk factors that are typically observed in sedentary adults are substantially attenuated or even absent in masters athletes. Older masters athletes possess greater functional capacity at any given age than their sedentary peers. Impressive profiles of older athletes provide insight into what is possible in human aging and place aging back into the domain of "physiology" rather than under the jurisdiction of "clinical medicine." In addition, these exceptional aging athletes can serve as a role model for the promotion of physical activity at all ages. The study of masters athletes has provided useful insight into the positive example of successful aging. To further establish and propagate masters athletics as a role model for our aging society, future research and action are needed. © 2020 American Physiological Society. Compr Physiol 10:261-296, 2020.

Skeletal muscle size, function, and adiposity with lifelong aerobic exercise

We examined the influence of lifelong aerobic exercise on skeletal muscle size, function, and adiposity. Young exercisers [YE; n = 20, 10 women (W), 25 ± 1 yr], lifelong exercisers (LLE; n = 28, 7 W, 74 ± 2 yr), and old healthy nonexercisers (OH; n = 20, 10 W, 75 ± 1 yr) were studied. On average, LLE exercised 5 days/wk for 7 h/wk over the past 52 ± 1 yr. The LLE men were subdivided by exercise intensity [Performance (LLE-P), n = 14; Fitness (LLE-F), n = 7]. Upper and lower leg muscle size and adiposity [intermuscular adipose tissue (IMAT)] were determined via MRI, and quadriceps isotonic and isometric function was assessed. For the quadriceps, aging decreased muscle size, isotonic and isometric strength, contraction velocity (men only), and power (P < 0.05). In women, LLE did not influence muscle size or function. In men, LLE attenuated the decline in muscle size and isometric strength by ~50% (P < 0.05). LLE did not influence other aspects of muscle function, nor did training intensity influence muscle size or function. For the triceps surae, aging decreased muscle size only in the women, whereas LLE (both sexes) and training intensity (LLE men) did not influence muscle size. In both sexes, aging increased thigh and calf IMAT by ~130% (P < 0.05), whereas LLE attenuated the thigh increase by ~50% (P < 0.05). In the LLE men, higher training intensity decreased thigh and calf IMAT by ~30% (P < 0.05). In summary, aging and lifelong aerobic exercise influenced muscle size, function, and adipose tissue infiltration in a sex- and muscle-specific fashion. Higher training intensity throughout the life span provided greater protection against adipose tissue infiltration into muscle.NEW & NOTEWORTHY This is the first study to examine skeletal muscle size, function, and adiposity in women and men in their eighth decade of life that have engaged in lifelong aerobic exercise. The findings reveal sex and upper and lower leg muscle group-specific benefits related to skeletal muscle size, function, and adiposity and that exercise intensity influences intermuscular adiposity. This emerging cohort will further our understanding of the health implications of maintaining exercise throughout the life span.

Aging induces a step-like change in the motor ability structure of athletes

Many studies have investigated how aging decreases human strength and endurance. However, understanding the effect of aging on human motor ability requires more than knowledge of the separate temporal profile of individual motor function because the structure of human motor ability is multi-dimensional. We address the effect of aging on the multi-dimensional structure of human motor ability by investigating the performance records of athletes in track events across various age groups. We collected the performance records of 446 top-level decathletes whose ages ranged from 20 to 74, and performed a principal component analysis of the records in 100m, 1500m, and 400m races, which require strength, endurance, and the mixture of both, respectively. Our analysis shows that aging results in a substantial and sudden change in the motor ability structure, contrasting sharply with the gradual decrease in performance in each track event. The rapid structural change develops around the age of 50, which is much earlier than the “breakpoint” of 70 years suggested in multiple previous studies. Our findings indicate that the structural change in motor ability can significantly precede the failure in the overall motor performance.

Distinct patterns of skeletal muscle mitochondria fusion, fission and mitophagy upon duration of exercise training

AIM

Healthy ageing interventions encompass regular exercise to prevent mitochondrial dysfunction, key player in sarcopenia pathogenesis. Mitochondrial biogenesis has been well documented, but mitochondrial remodelling in response to exercise training is poorly understood. Here we investigated fusion, fission and mitophagy before and after an exercise intervention in older adults.

METHODS

Skeletal muscle biopsies were collected from 22 healthy sedentary men and women before and after 4 months of supervised training. Eight lifelong trained age- and gender-matched volunteers served as positive controls. Transmission electron microscopy was used to estimate mitochondrial content. Western blotting and qRT-PCR were used to detect changes in specific proteins and transcripts.

RESULTS

After intervention, mitochondrial content increased to levels of controls. While enhancement of fusion was prevalent after intervention, inhibition of fission and increased mitophagy were dominant in controls. Similarly to PARKIN, BCL2L13 content was higher in controls. The observed molecular adaptations paralleled long-term effects of training on physical fitness, exercise efficiency and oxidative capacity.

CONCLUSIONS

This study describes distinct patterns of molecular adaptations in human skeletal muscle under chronic exercise training. After 16 weeks of exercise, the pattern was dominated by fusion to increase mitochondrial content to the metabolic demands of exercise. In lifelong exercise, the pattern was dominated by mitophagy synchronized with increased fusion and decreased fission, indicating an increased mitochondrial turnover. In addition to these temporally distinct adaptive mechanisms, this study suggests for the first time a specific role of BCL2L13 in chronic exercise that requires constant maintenance of mitochondrial quality.

Cardiorespiratory fitness and cardiovascular disease - The past, present, and future

The importance of cardiorespiratory fitness (CRF) is now well established and it is increasingly being recognized as an essential variable which should be assessed in health screenings. The key findings that have established the clinical significance of CRF are reviewed in this report, along with an overview of the current relevance of exercise as a form of medicine that can provide a number of positive health outcomes, including increasing CRF. Current assessment options for assessing CRF are also reviewed, including the direct measurement via cardiopulmonary exercise testing which now can be interpreted with age and sex-specific reference values. Future directions for the use of CRF and related measures are presented.

Cardiovascular and skeletal muscle health with lifelong exercise

The purpose of this study was to examine the effects of aerobic lifelong exercise (LLE) on maximum oxygen consumption (V̇o_2max) and skeletal muscle metabolic fitness in trained women ( n = 7, 72 ± 2 yr) and men ( n = 21, 74 ± 1 yr) and compare them to old, healthy nonexercisers (OH; women: n = 10, 75 ± 1 yr; men: n = 10, 75 ± 1 yr) and young exercisers (YE; women: n = 10, 25 ± 1 yr; men: n = 10, 25 ± 1 yr). LLE men were further subdivided based on intensity of lifelong exercise and competitive status into performance (LLE-P, n = 14) and fitness (LLE-F, n = 7). On average, LLE exercised 5 day/wk for 7 h/wk over the past 52 ± 1 yr. Each subject performed a maximal cycle test to assess V̇o_2max and had a vastus lateralis muscle biopsy to examine capillarization and metabolic enzymes [citrate synthase, β-hydroxyacyl-CoA dehydrogenase (β-HAD), and glycogen phosphorylase]. V̇o_2max had a hierarchical pattern (YE > LLE > OH, P < 0.05) for women (44 ± 2 > 26 ± 2 > 18 ± 1 ml·kg^-1·min^-1) and men (53 ± 3 > 34 ± 1 > 22 ± 1 ml·kg^-1·min^-1) and was greater ( P < 0.05) in LLE-P (38 ± 1 ml·kg^-1·min^-1) than LLE-F (27 ± 2 ml·kg^-1·min^-1). LLE men regardless of intensity and women had similar capillarization and aerobic enzyme activity (citrate synthase and β-HAD) as YE, which were 20%-90% greater ( P < 0.05) than OH. In summary, these data show a substantial V̇o_2max benefit with LLE that tracked similarly between the sexes, with further enhancement in performance-trained men. For skeletal muscle, 50+ years of aerobic exercise fully preserved capillarization and aerobic enzymes, regardless of intensity. These data suggest that skeletal muscle metabolic fitness may be easier to maintain with lifelong aerobic exercise than more central aspects of the cardiovascular system. NEW & NOTEWORTHY Lifelong exercise (LLE) is a relatively new and evolving area of study with information especially limited in women and individuals with varying exercise intensity habits. These data show a substantial maximal oxygen consumption benefit with LLE that tracked similarly between the sexes. Our findings contribute to the very limited skeletal muscle biopsy data from LLE women (>70 yr), and similar to men, revealed a preserved metabolic phenotype comparable to young exercisers.

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.

Dietary Protein, Muscle and Physical Function in the Very Old

There is an ongoing debate as to the optimal protein intake in older adults. An increasing body of experimental studies on skeletal muscle protein metabolism as well as epidemiological data suggest that protein requirements with ageing might be greater than many current dietary recommendations. Importantly, none of the intervention studies in this context specifically investigated very old individuals. Data on the fastest growing age group of the oldest old (aged 85 years and older) is very limited. In this review, we examine the current evidence on protein intake for preserving muscle mass, strength and function in older individuals, with emphasis on data in the very old. Available observational data suggest beneficial effects of a higher protein intake with physical function in the oldest old. Whilst, studies estimating protein requirements in old and very old individuals based on whole-body measurements, show no differences between these sub-populations of elderly. However, small sample sizes preclude drawing firm conclusions. Experimental studies that compared muscle protein synthetic (MPS) responses to protein ingestion in young and old adults suggest that a higher relative protein intake is required to maximally stimulate skeletal muscle MPS in the aged. Although, data on MPS responses to protein ingestion in the oldest old are currently lacking. Collectively, the data reviewed for this article support the concept that there is a close interaction of physical activity, diet, function and ageing. An attractive hypothesis is that regular physical activity may preserve and even enhance the responsiveness of ageing skeletal muscle to protein intake, until very advanced age. More research involving study participants particularly aged ≥85 years is warranted to better investigate and determine protein requirements in this specific growing population group.

Physiological Redundancy and the Integrative Responses to Exercise

The biological responses to acute and chronic exercise are marked by a high level of physiological redundancy that operates at various levels of integration, including the molecular, cellular, organ-system, and whole-body scale. During acute exercise, this redundancy protects whole-body homeostasis in the face of 10-fold or more increases in whole-body metabolic rate. In some cases, there are "trade-offs" between optimizing the performance of a given organ or system versus whole-body performance. Physiological redundancy also plays a key role in the adaptive responses to exercise training and high levels of habitual physical activity, including the positive effects of regular exercise on health. Appreciation of the general principles of physiological redundancy is critical to (1) gain an overall understanding of short- and long-term responses to exercise, and (2) place physiological responses occurring at various levels of integration in perspective.

Testing a Model of Successful Aging in a Cohort of Masters Swimmers

Due to their high physical functioning, masters athletes are regularly proposed to exemplify successful aging. However, successful aging research on masters athletes has never been undertaken using a multidimensional successful aging model. To determine the best model for future successful aging research on masters athletes, we had masters swimmers (N = 169, M age = 57.4 years, 61% women) self-report subjective successful aging, and physical, psychological, cognitive, and social functioning. Using this data we tested one hypothesized and three alternative successful aging models. The hypothesized model fit the data best (-2LL = 2052.32, AIC = 1717) with physical (β = 0.31, SE = 0.11), psychological (β = 0.25, SE = 0.11), and social (β = 1.20, SE = 0.63) functioning factors significantly loading onto a higher order successful aging latent factor. Successful aging should be conceptualized as a multidimensional phenomenon in future masters athlete research.

Different Training Modalities Improve Energy Cost and Performance in Master Runners

Purpose: The aim of this study was to compare the effects of continuous moderate-intensity and discontinuous high-intensity training on running performance in master runners.

Methods: Thirty-four male master runners (47.2 ± 7.4 years) were assigned to three different groups: continuous moderate-intensity training (CMIT), discontinuous high-intensity training (DHIT), and control group (CON). CMIT and DHIT performed 8-week of supervised training (3 session·wk⁻¹; ~35 km·wk⁻¹) while CON maintained their normal training habits (3–4 session·wk⁻¹; ~50 km·wk⁻¹). Peak oxygen consumption (V˙O_2peak) and peak running speed (v_peak) during incremental treadmill exercise, gas exchange threshold (GET), speed at GET, energy cost of running (Cr), and 5-km performance were evaluated before and after training.

Results: Following the training period, both CMIT and DHIT significantly reduced Cr (−4.4 and −4.9%, respectively, P < 0.05), increased speed at GET (3.4 and 5.7%, P < 0.05) and improved 5-km time-trial performance (3.1 and 2.2%, P < 0.05) whereas no differences were found for V˙O_2peak and GET (as %V˙O_2peak). After training, v_peak improved only for DHIT (6%, P < 0.05). No differences were found in any variable for CON.

Conclusions: This study indicates that both CMIT and DHIT may positively affect running performance in middle-aged master runners. This improvement was achieved despite a significant reduction of the amount of weekly training volume.

Age-related decline in endurance running performance – an example of a multiple World records holder

This study examined the age-related decline in endurance running performance of one of the greatest master runners ever, Ed Whitlock, who died recently. His running performances from 1500 m to marathon were analyzed for 5 periods of 5 years from 65–69 years to 85–89 years. Despite exceptional running performances for his advanced age, the rate of decline in his performances increased after 80 years and was drastically amplified after 85 years.

Role of Inactivity in Chronic Diseases: Evolutionary Insight and Pathophysiological Mechanisms

This review proposes that physical inactivity could be considered a behavior selected by evolution for resting, and also selected to be reinforcing in life-threatening situations in which exercise would be dangerous. Underlying the notion are human twin studies and animal selective breeding studies, both of which provide indirect evidence for the existence of genes for physical inactivity. Approximately 86% of the 325 million in the United States (U.S.) population achieve less than the U.S. Government and World Health Organization guidelines for daily physical activity for health. Although underappreciated, physical inactivity is an actual contributing cause to at least 35 unhealthy conditions, including the majority of the 10 leading causes of death in the U.S. First, we introduce nine physical inactivity-related themes. Next, characteristics and models of physical inactivity are presented. Following next are individual examples of phenotypes, organ systems, and diseases that are impacted by physical inactivity, including behavior, central nervous system, cardiorespiratory fitness, metabolism, adipose tissue, skeletal muscle, bone, immunity, digestion, and cancer. Importantly, physical inactivity, itself, often plays an independent role as a direct cause of speeding the losses of cardiovascular and strength fitness, shortening of healthspan, and lowering of the age for the onset of the first chronic disease, which in turn decreases quality of life, increases health care costs, and accelerates mortality risk.

Masters Athletes: Exemplars of Successful Aging?

Global population aging has raised academic interest in successful aging to a public policy priority. Currently there is no consensus regarding the definition of successful aging. However, a synthesis of research shows successful aging can be defined as a late-life process of change characterized by high physical, psychological, cognitive, and social functioning. Masters athletes systematically train for, and compete in, organized forms of team and individual sport specifically designed for older adults. Masters athletes are often proposed as exemplars of successful aging. However, their aging status has never been examined using a comprehensive multidimensional successful aging definition. Here, we examine the successful aging literature, propose a successful aging definition based on this literature, present evidence which suggests masters athletes could be considered exemplars of successful aging according to the proposed definition, and list future experimental research directions.

Physical Activity, Aging, and Physiological Function

Human evolution suggests that the default position for health is to be physically active. Inactivity, by contrast, has serious negative effects on health across the lifespan. Therefore, only in physically active people can the inherent aging process proceed unaffected by disuse complications. In such individuals, although the relationship between age and physiological function remains complex, function is generally superior with health, well being, and the aging process optimized.

Case Studies in Physiology: Maximal oxygen consumption and performance in a centenarian cyclist

The purpose of this study was to examine the physiological characteristics of an elite centenarian cyclist who, at 101 yr old, established the 1-h cycling record for individuals ≥100 yr old (24.25 km) and to determine the physiological factors associated with his performance improvement 2 yr later at 103 yr old (26.92 km; +11%). Before each record, he performed an incremental test on a cycling ergometer. For 2 yr, he trained 5,000 km/yr with a polarized training that involved cycling 80% of mileage at "light" rate of perceived exertion (RPE) ≤12 and 20% at "hard" RPE ≥15 at a cadence between 50 and 70 rpm. His body weight and lean body mass did not change, while his maximal oxygen consumption (V̇o_2max) increased (31-35 ml·kg^-1·min^-1; +13%). Peak power output increased from 90 to 125 W (+39%), mainly because of increasing the maximal pedaling frequency (69-90 rpm; +30%). Maximal heart rate did not change (134-137 beats/min) in contrast to the maximal ventilation (57-70 l/min, +23%), increasing with both the respiratory frequency (38-41 cycles/min; +8%) and the tidal volume (1.5-1.7 liters; +13%). Respiratory exchange ratio increased (1.03-1.14) to the same extent as tolerance to V̇co₂ In conclusion, it is possible to increase performance and V̇o_2max with polarized training focusing on a high pedaling cadence even after turning 100 yr old.NEW & NOTEWORTHY This study shows, for the first time, that maximal oxygen consumption (+13%) and performance (+11%) can still be increased between 101 and 103 yr old with 2 yr of training and that a centenarian is able, at 103 yr old, to cover 26.9 km/h in 1 h.

Master Athletes Are Extending the Limits of Human Endurance

The increased participation of master athletes (i.e., >40 years old) in endurance and ultra-endurance events (>6 h duration) over the past few decades has been accompanied by an improvement in their performances at a much faster rate than their younger counterparts. Aging does however result in a decrease in overall endurance performance. Such age-related declines in performance depend upon the modes of locomotion, event duration, and gender of the participant. For example, smaller age-related declines in cycling performance than in running and swimming have been documented. The relative stability of gender differences observed across the ages suggests that the age-related declines in physiological function did not differ between males and females. Among the main physiological determinants of endurance performance, the maximal oxygen consumption (VO_2max) appears to be the parameter that is most altered by age. Exercise economy and the exercise intensity at which a high fraction of VO_2max can be sustained (i.e., lactate threshold), seem to decline to a lesser extent with advancing age. The ability to maintain a high exercise-training stimulus with advancing age is emerging as the single most important means of limiting the rate of decline in endurance performance. By constantly extending the limits of (ultra)-endurance, master athletes therefore represent an important insight into the ability of humans to maintain physical performance and physiological function with advancing age.

Exercise, ageing and the lung

This review provides a pulmonary-focused description of the age-associated changes in the integrative physiology of exercise, including how declining lung function plays a role in promoting multimorbidity in the elderly through limitation of physical function. We outline the ageing of physiological systems supporting endurance activity: 1) coupling of muscle metabolism to mechanical power output; 2) gas transport between muscle capillary and mitochondria; 3) matching of muscle blood flow to its requirement; 4) oxygen and carbon dioxide carrying capacity of the blood; 5) cardiac output; 6) pulmonary vascular function; 7) pulmonary oxygen transport; 8) control of ventilation; and 9) pulmonary mechanics and respiratory muscle function. Deterioration in function occurs in many of these systems in healthy ageing. Between the ages of 25 and 80 years pulmonary function and aerobic capacity each decline by ∼40%. While the predominant factor limiting exercise in the elderly likely resides within the function of the muscles of ambulation, muscle function is (at least partially) rescued by exercise training. The age-associated decline in pulmonary function, however, is not recovered by training. Thus, loss in pulmonary function may lead to ventilatory limitation in exercise in the active elderly, limiting the ability to accrue the health benefits of physical activity into senescence.

Effects of age on marathon finishing time among male amateur runners in Stockholm Marathon 1979-2014

PURPOSE

The purpose of the present study was to investigate the age-related changes in the endurance performance among male amateur marathon runners.

METHODS

Subjects were taken from the 36 Stockholm Marathons held from 1979 through 2014, and age and finishing time were analyzed for a total of 312,342 male runners.

RESULTS

The relation was found to be a second-order polynomial, t = a + bx + cx ², which models 99.7% of the variation in the average running time t as a function of age x. The model shows that the marathon performance of the average runner improves up to age 34.3 ± 2.6 years, thereafter, the performance starts to decline. A quantification of the age's influence on running time shows that it accounts for 4.5% of the total variance seen in the performance data.

CONCLUSION

These outcomes indicate that the effect of age on performance in endurance running events is clearly measurable, quantifiable, and possible to describe. At the same time the findings indicate that other factors, such as training, affect the performance more. A comparison with the elite showed peak performance at the same age, but the rates of change in performance with age, improvement as well as degradation, was found to be higher among the elite.

Unravelling the mechanisms regulating muscle mitochondrial biogenesis

Skeletal muscle is a tissue with a low mitochondrial content under basal conditions, but it is responsive to acute increases in contractile activity patterns (i.e. exercise) which initiate the signalling of a compensatory response, leading to the biogenesis of mitochondria and improved organelle function. Exercise also promotes the degradation of poorly functioning mitochondria (i.e. mitophagy), thereby accelerating mitochondrial turnover, and preserving a pool of healthy organelles. In contrast, muscle disuse, as well as the aging process, are associated with reduced mitochondrial quality and quantity in muscle. This has strong negative implications for whole-body metabolic health and the preservation of muscle mass. A number of traditional, as well as novel regulatory pathways exist in muscle that control both biogenesis and mitophagy. Interestingly, although the ablation of single regulatory transcription factors within these pathways often leads to a reduction in the basal mitochondrial content of muscle, this can invariably be overcome with exercise, signifying that exercise activates a multitude of pathways which can respond to restore mitochondrial health. This knowledge, along with growing realization that pharmacological agents can also promote mitochondrial health independently of exercise, leads to an optimistic outlook in which the maintenance of mitochondrial and whole-body metabolic health can be achieved by taking advantage of the broad benefits of exercise, along with the potential specificity of drug action.

The ageing neuromuscular system and sarcopenia: a mitochondrial perspective

Skeletal muscles undergo structural and functional decline with ageing, culminating in sarcopenia. The underlying neuromuscular mechanisms have been the subject of intense investigation, revealing mitochondrial abnormalities as potential culprits within both nerve and muscle cells. Implicated mechanisms involve impaired mitochondrial dynamics, reduced organelle biogenesis and quality control via mitophagy, accumulation of mitochondrial DNA (mtDNA) damage and respiratory chain defect, metabolic disturbance, pro-apoptotic signalling, and oxidative stress. This article provides an overview of the cellular mechanisms whereby mitochondria may promote maladaptive changes within motor neurons, the neuromuscular junction (NMJ) and muscle fibres. Lifelong physical activity, which promotes mitochondrial health across tissues, is emerging as an effective countermeasure for sarcopenia.

Physical activity is not associated with spirometric indices in lung-healthy German youth

In lung disease, physical activity improves lung function and reduces morbidity. However, healthy populations are not well studied. We estimate the relationship between spirometric indices and accelerometric physical activity in lung-healthy adolescents.895 nonsmoking German adolescents without chronic lung disease (45% male, mean±sd age 15.2±0.26 years) from the GINIplus and LISAplus cohorts completed questionnaires, spirometry, 7-day accelerometry and an activity diary. Physical activity was measured as minutes, quintiles and regularity of daily moderate, vigorous and moderate-to-vigorous physical activity (MVPA), participation in sport and active commuting to school. Primary outcomes were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC and forced expiratory flow at 25-75% of FVC; they were separately correlated with physical activity and adjusted for confounders of respiratory function, including early-life exposures.Adolescents averaged 40 min MVPA per day, typical for European youth. 79% participated in sports and 51% commuted actively. An association was suggested between 3% higher FVC (∼100 mL) and either extreme MVPA quintile or percentage of days with >30 min MVPA (p<0.05). However, after Bonferroni correction all associations between spirometry, active lifestyle and physical activity were nonsignificant.Spirometric indices were not significantly associated with active lifestyle or measures of activity in lung-healthy adolescents after adjustment for confounding and multiple-comparison artefacts.

Physical activity in older age: perspectives for healthy ageing and frailty

Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent. Despite the highly publicised benefits of physical activity, the overwhelming majority of older people in the United Kingdom do not meet the minimum physical activity levels needed to maintain health. The sedentary lifestyles that predominate in older age results in premature onset of ill health, disease and frailty. Local authorities have a responsibility to promote physical activity amongst older people, but knowing how to stimulate regular activity at the population-level is challenging. The physiological rationale for physical activity, risks of adverse events, societal and psychological factors are discussed with a view to inform public health initiatives for the relatively healthy older person as well as those with physical frailty. The evidence shows that regular physical activity is safe for healthy and for frail older people and the risks of developing major cardiovascular and metabolic diseases, obesity, falls, cognitive impairments, osteoporosis and muscular weakness are decreased by regularly completing activities ranging from low intensity walking through to more vigorous sports and resistance exercises. Yet, participation in physical activities remains low amongst older adults, particularly those living in less affluent areas. Older people may be encouraged to increase their activities if influenced by clinicians, family or friends, keeping costs low and enjoyment high, facilitating group-based activities and raising self-efficacy for exercise.

Physiology of sedentary behavior and its relationship to health outcomes

PURPOSE

This article reports on the findings and recommendations of the "Physiology of Sedentary Behavior and Its Relationship to Health Outcomes" group, a part of a larger workshop entitled Sedentary Behavior: Identifying Research Priorities sponsored by the National Heart, Lung, and Blood Institute and by the National Institute on Aging, which aimed to establish sedentary behavior research priorities.

METHODS

The discussion within our workshop led to the formation of critical physiological research objectives related to sedentary behaviors, that is, if appropriately researched, would greatly affect our overall understanding of human health and longevity.

RESULTS AND CONCLUSIONS

Primary questions are related to physiological "health outcomes" including the influence of physical activity versus sedentary behavior on the function of a number of critical physiological systems (aerobic capacity, skeletal muscle metabolism and function, telomeres/genetic stability, and cognitive function). The group also derived important recommendations related to the "central and peripheral mechanisms" that govern sedentary behavior and how energy balance has a role in mediating these processes. General recommendations for future sedentary physiology research efforts indicate that studies of sedentary behavior, including that of sitting time only, should focus on the physiological effect of a "lack of human movement" in contradistinction to the effects of physical movement and that new models or strategies for studying sedentary behavior-induced adaptations and links to disease development are needed to elucidate underlying mechanism(s).