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Risks and Health Issues Associated With Aging


Some health issues are statistically more likely for athletes over the age of 40 and significantly increase in likelihood for athletes over 55. For example, the incidence of sudden death from cardiac arrest is significantly higher in people older than 35. The most common cause is underlying coronary artery disease, which is more prevalent in those over 50 (Chugh, 2015). Most sports-related sudden deaths from cardiac issues occur in middle age (Marijon et al., 2015), and the risk is highest in individuals who do not habitually train. A responsible trainer should recognize the heightened risks and take any symptoms seriously. 


Warning signs should never be ignored. Although the overall risk is relatively small statistically, it becomes increasingly real for those who are older (55+) and deconditioned. These athletes should be more closely monitored, and any individual who is specifically at risk (i.e., has suspected coronary artery disease, chest pain, unexplained shortness of breath, dizziness or heart medication) should immediately be referred to a suitably qualified medical practitioner for assessment. 


We recommend careful application of relative intensity and graduated introduction for deconditioned clients, because the trainer cannot know whether there is an underlying medical condition. Exercise may act as a trigger for cardiac pathology (Cunningham et al., 2017), although it is worth noting that contrary to popular belief, a significant number of cardiac sudden deaths occur outside the sporting arena and during sleep (Finocchiaro et al., 2016). The general consensus in the medical literature is that the benefits of exercise significantly outweigh the risks. There is also a greater likelihood of an older client being medicated, and medication can produce unexpected side effects with physical exertion (Schetz et al., 2015). For example, the combination of blood-pressure medication, cholesterol-lowering medication and physical exertion can cause muscle pain, dizziness and confusion in some cases. Additionally, there is an increased fall/trip risk in the elderly, and fear of failing is a major psychological inhibitor to activity.


Some risks and health conditions are specific to the older female athlete. Menopause creates a myriad of issues that vary in impact between individuals. Exercise is crucial to minimize the symptoms of menopause (Mayo Clinic, 2016), but it can be difficult to stay motivated during this transition, and it is likely that there will be a transient decline in performance until symptoms settle. Hot flashes are a common symptom, and the trainer needs to be sensitive to the impact that this has on the athlete’s ability to cope with intensity.


Pelvic floor issues are also common and can affect an athlete’s will to train. Older female athletes may encounter pelvic floor issues that result in exertional urinary incontinence (leaking) when jumping. Women who have had children have a heightened risk. In more serious cases, there is also the risk of pelvic organ prolapse when undertaking load-bearing exercises. Avoidance behavior in relation to jumping and running may indicate to the trainer that there is an underlying pelvic floor issue that needs to be addressed. These issues should not be normalized, and the trainer has an important role in educating the client as to the risks and referring her to an appropriately qualified medical practitioner. Although common in female athletes, note that urinary incontinence can also be an issue for older male athletes; some researchers suggest it could be an issue for up to 40 percent of men over 60 years of age (Kozomara-Hocke et al., 2016).


Post-menopausal female clients may also have reduced bone density, which places them at specific risk of stress fractures. This risk can be managed by being conservative with loads and training volume. Where a medical condition is identified, it is imperative that the client seeks appropriate medical care and that the trainer operates within the guidance provided by the practitioner.


None of these issues are necessarily impediments to training, provided that the trainer is sensitive, supportive and willing to adjust the program accordingly. Age-related health issues may present a challenge for a younger trainer who is unlikely to have any relevant firsthand life experience and may be unaware of what the client is experiencing. The affiliate owner needs to understand that an older athlete may be very unwilling to confide in a younger trainer.


In addition to medical issues, the trainer also needs to provide an environment that reduces the risk of injury. There is a heightened injury risk for a deconditioned athlete of any age but significantly more so for an older deconditioned athlete. It takes longer to recover if injured, making the impact of injury greater, and for some injuries, the older athlete is unable to recover at all. For example, partial-tear rotator cuff injuries rarely heal in an older athlete (Tokish, 2014). Regular training and fitness decrease injury risk (Tayrose et al., 2015). The trainer should work to avoid injury at all costs because a single injury may impact the athlete’s ability to continue training. Whereas a young adult will readily bounce back from injury, an older athlete will require significant hands-on management from the trainer to recover from an injury. Due to this high cost of injury, the trainer should always err on the side of caution when there is any indication of injury state. Where a younger athlete may be able to train through pain, tightness or fatigue, it is simply too risky for an older athlete to do so. The masters athlete will often be willing to take risks, but the trainer has an important role in determining when the athlete should rest.


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