Submitted by Mark DeBeliso, Joe Walsh, Mike Climstein, Ian Timothy Heazlewood, Jyrki Kettunen, Trish Sevene and Kent Adams
Athletes competing at the World Masters Games have either initiated exercise later in life or pursued a physically active lifestyle for an extended period. There is a paucity of information regarding the prevalence of chronic health disorders for this unique cohort of mature adults. PURPOSE: To investigate the different aspects of health of the Sydney 2009 World Masters Games North American participants. METHODS: An online survey was developed to investigate participant demographics, physiological measures of health, and medical health history. Questionnaire responses were collected from competitors representing 95 countries in 28 sports. Data were culled to focus on North American participants for comparison purposes (Centers for Disease Control and Prevention). RESULTS: A total of 928 participants from Canada and the United States (age 52.6±9.8 yrs) completed the survey, with 55% reported having previously competed in the World Masters Games. The top five sports were football (25.6%), track and field (15.4%), swimming (8.4%), volleyball (8.2%), and softball (7.8%). Very few (2.5%) reported currently smoking with an average of 65 cigarettes per week, while 13.6% were ex-smokers. Alcohol consumption (82.0% of the participants) averaged 4.7 drinks week, while 0.6% were ex-drinkers. The top five chronic disorders were rheumatoid arthritis or osteoarthritis (10.0%), hypertension (HTN 9.1%), hyperlipidemia (8.0%), asthma (6.5%), and depression (5.3%). Top three operative treatments were knee replacement or repair (12.2%), hernia repair (6.1%), and herniated disc surgery (2.0%). Top four prescription medications were anti-HTN (6.9%), thyroid hormones (6.6%), hypolipidaemic (6.0%), and medications to increase bone strength (5.9%). Prevalence was significantly lower versus the general US population for HTN, hyperlipidemia, arthritis, asthma, and depression (all p-values <0.01). CONCLUSION: Chronic disease and disorder indicators reported by participants of the 2009 World Masters Games were significantly lower versus the general US population. APPLICATIONS IN SPORT: Competitive sport in mature aged participants requires adherence with physical activity. Exercise adherence in competitive masters sport may promote successful aging and a counter measure to many chronic diseases.
The World Masters Games (WMG) is the largest International sporting competition in terms of participant numbers. In 2009, the Sydney World Masters Games attracted 28,089 competitors who represented 95 countries competing in 28 sports (21).
The benefits of participation in masters athletic competition has been previously investigated with Hawkins and others reporting positive adaptations in musculoskeletal health (4, 8, 18, 25), improved glycaemia (15, 16) and considerable health benefits associated with the long-term exercise participation (5, 17, 20, 24). Although long-term participation in sport (and physical activity) is advocated by health professionals, the advanced age of participants is also commonly associated with an increased incidence of chronic diseases such as coronary artery disease, hypertension, hypercholesterolemia, and diabetes (25). However to date, the incidence of these pathologies in the Masters Athlete cohort remains undocumented.
The WMG have been in existence since 1985, surprisingly there is limited scientific literature available on this unique cohort. The purpose of this study was to attain a large representative sample to document various aspects of demographics and health indices for this population. Further, this study attempted to address if advanced physical activity later in life as expressed through masters competition and the associated exercise adherence are reflected with health indices and a lower incidence of chronic disorders. This article focuses on North American participants at the 2009 WMG and is a continuation of a series of reports based on methods and data collected at the 2009 WMG (1, 2, 9, 10, 19, 23, 24).
Institutional approval was attained from the Australian Catholic University Human Research Ethics Committee, Bond University Human Research Ethics Committee, and organizational approval was attained from the WMG organizing committee. Competitors provided informed consent electronically prior to enabling access to the online research survey.
Survey Design and Implementation
A cross-sectional, observational study was completed using an online web-based questionnaire (LimeSurvey, an open source survey application). The survey consisted of three sections, basic demographics (gender, age, smoking and drinking status), medical history (personal or familial, surgical, prescribed medications), and physiological parameters (lipid profile, fasting plasma glucose). The survey questions consisted of array, single choice, multiple choice, list dropdown, numerical input and short answer free text. Filters (where appropriate) were utilized to expedite completion of survey. The questionnaire was piloted on 70 non-participants following which only minor changes were made to medical terminology. The survey was activated on October 15th 2009 and was closed on February 26th 2010.
The WMG organizing committee stipulated that collection of research data attached to this study was to be gathered via online. Hence, all WMG competitors who provided a valid email address were sent an invitation to participate in the study.
A total of 28,676 competitors representing 95 countries and competing in 28 sports took part in the WMG. Of those who competed, 24,528 electronically registered for the games. Those who electronically registered were sent an invitation to participate in the study. A total of 8,072 consented to participate and responded to the online survey; a response rate of 28.2% (see Figure 1). Of the 8,072 participants, 928 were from Canada or the United States and are the focus of this report.
Figure 1. 2009 Sydney WMG survey process
Statistical analyses were performed using SPSS statistical software package (Version 17.0, Chicago Illinois, USA). Normally distributed data were described using mean ± Standard Deviation, frequencies or percentages. Pearson chi-square tests were used to determine if statistical differences existed between genders and groups. A p-value was set a priori of <0.05 to determine statistical significance.
The top five countries by participation numbers were Australia, Canada, New Zealand, USA, and the UK (see Table 1). Table 2 provides details as to North America participants by gender and age. Figures 2 through 6 are participant pyramids (age by gender) for the top five sports participated in by North Americans (football, track and field, swimming, volleyball, and softball).
Table 1. World Master games participation by country (top 5)
Figure 2. Football participants via age and gender, 25.6%.
Figure 3. Track and Field participants via age and gender participation, 15.4%.
Figure 4. Swimming participants via age and gender participation, 8.4%.
Figure 5. Volleyball participants via age and gender participation, 8.2%.
Figure 6. Softball participants via age and gender participation, 7.8%.
The participant physiological measures of health and medical health history are detailed in Table 3. When comparing incidences of chronic disorders, surgical procedures, prescription medications (Rx), injury (type and locale) between genders, differences were noted for HTN, asthma, hyperlipidemia, hernia repair, shoulder repair, Rx-HTN, Rx-hypolipidemic, bronchodilators, muscle or tendon injury, legs-injury, and spine or back injury. Males had a significantly greater incidence of each of the indices with the exception of bronchodilator use. Interestingly (or counter intuitively), female competitors had a greater use of bronchodilators while male competitors reported a significantly greater incidence of asthma (73% male vs. 27% female).
Table 3. Prevalence of chronic disorder, surgical procedure, prescription medication, injury type and locale
Where * = p<0.05, and ** = p<0.01, statistical difference between the genders.
Table 4 provides the incidence of chronic disorders of North American WMG participants compared to the US general population as reported by the US Centers for Disease Control and Prevention (3). The top five chronic disorders reported by North American competitors were rheumatoid and osteoarthritis, HTN, hyperlipidemia, asthma, and depression. For each of the top five chronic disorders, the North American participants reported a significantly lower prevalence than that of the US population (all p-values <0.01).
Table 4. Incidence of chronic disorder of SWMG participants compared to US general population
Incidence of smoking was 2.5% (averaging 65 cigarettes per week), while 13.6% reported being ex-smokers. The tobacco use was far below the reported US population smoking prevalence of 19% (3). Eighty-two percent of the participants reported consuming alcohol (averaging 4.7 drinks per week), while <1% reported being ex-drinkers. The average of 4.7 drinks per week is well below the standards for heavy drinking for both males and female (3).
The number of adults over the age of 65 is projected to double by the year 2050 (11). This dramatic growth is primarily the result of the aging “baby boom” generation and an increase in life expectancy (22). Baby boomers will create an unparalleled increase in the number of older adults, peaking between the years 2010–2030. This factor is compounded by an increase in life expectancy. Current projections estimate that by 2050 life expectancy will increase from 79.3 to 84.3 years for females and 72.5 to 79.7 years for males (22). With the tremendous growth of the older adult population, issues surrounding the aging population health status and quality of life are important public concerns that need to be addressed (11).
The process of aging is associated with declines in both physiological and psychological function that lead to the onset of chronic illness or morbidity (6). Fiscal expenses related to disabled older adults place economic burden on society. In 1987, three out of every five health-care dollars were spent on the elderly and costs are expected to increase dramatically (11).
This study focused on masters athletes competing at the 2009 Sidney WMG. Masters athletes have either pursued a physically active lifestyle for an extended period or have initiated exercise or sport in later life. Sport competition and the associated exercise adherence could be considered an “advanced form of physical activity”. Regular participation in physical activity has been identified as the most significant health intervention strategy to help adults as well as older adults maintain health and functional independence (13, 14). Hence, this study attempted to address if advanced physical activity as expressed through masters competition and the associated exercise adherence could be beneficial with regards to lowering the number of chronic disorders and improving health indices.
The data collected during this study suggests that the prevalence of chronic disorders among North American WMG competitors is significantly lower than that reported for the US population (3). These very positive results are based on a participant pool of 928 individuals whom have engaged in sport for an extended period of time or have initiated exercise or sport in later life. Hence, the prescription of masters level competition to the recreational exerciser or sedentary individual must be approached with caution. Individuals could be advised to move from sedentary towards recreational exercisers, adhering to exercise on a regular basis and possibly employing basic principles of periodization (12). Those who are currently recreational exercisers could be advised to adapt current exercise programs to be more of a sport training philosophy that employs periodization principles with yearly macro cycles (12). Individuals in this phase of sport training could then focus on developing the necessary sports skills to participate in a given sport eventually leading to masters sport competition. While there is no assurance that any individual could rise to the level of an international masters athlete, the process of pursuing competition level performance may provide the health related benefits expressed by the participants in this study.
When considering if health professionals should advise aging clients to pursue advanced physical activity through masters competition, one must evaluate the risk versus benefit. Specifically, is there an elevated injury risk associated with participating in masters completion or the associated exercise adherence related to training for competition? A recent study by Walsh et al. (23) focused on injury incidence of masters athletes competing in football sports (association football, touch football, and rugby union). Football sports are high-speed in nature and include frequent impacts with players and the ground. The results of the Walsh et al. (23) study suggested that there was no age-related difference in injury classification type, location, incidence, time off work, or missed training when compared to younger athletes (<50 years of age). Hence this study (23) lends support to the notion that the health related benefits of participation in masters competition may outweigh the potential injury risks.
The issue of causation must also be considered. Namely, the question of whether competing in masters sport promotes a reduced incidence of chronic disorders or alternatively whether people who are not afflicted by chronic disorders participate in masters sport by preference. Future investigations, including factor analysis using psychological data as well as medical history may resolve this issue of causation.
This report suggests a reduction in the prevalence on chronic disorders for North American competitors participating in the WMG. Other studies (1, 2, 9, 10, 19) have examined the social and psychology welfare of masters athletes, presumably resulting from experience of competition or the exercise adherence related to training for competition. The results of the aforementioned reports suggest that indices of social and psychology well-being are positively influenced via the experience of masters level competition.
A clear benefit of the preparation to compete in sport as a master level athlete relates to the ability to perform activities of daily living (ADL). The inability to perform ADLs is an indicator of physical disability (7). Older adults who are unable to perform one or more ADLs are at greater risk of losing functional independence. Estimates suggest that 47.3% of adults 65-77 years of age are disabled and that this percentage climbs to over 70% for those 80 years of age or older (22). While no specific evidence is provided via this study, rational thinking would suggest that individuals able to compete at an advanced sport level (masters athletes) could easily manage the physical demands associated with ADLs.
Should health care professionals prescribe advanced physical activity via masters level competition (including the associated adherence to exercise)? The authors forward the following response, “Combine the psychological and social benefits of competing in masters sports with the advanced ability to perform ADLs (in the absence of chronic disorders) and one could argue that the quality of life has been shifted dramatically in the positive direction”.
A record of demographical data, including several indices of health (smoking, drinking, incidence of chronic disease or disorder, surgical procedure, prescribed medication, injury history) was successfully collected for a large representative sample of North American athletes who participated in the 2009 WMG. This data will allow a detailed understanding of significant factors affecting this unique cohort as well as potential health implications for long-term exercise adherence as recommended by health professionals.
APPLICATION IN SPORT
Competitive sport is an advanced form of physical activity and requires exercise adherence. Health care professionals encourage physical activity and more specifically exercise adherence as a countermeasure to many chronic diseases and as a mechanism for successful aging. The data culled during this study suggests that the exercise adherence associated with competitive masters sport may reduce the incidence of many common chronic diseases in masters athletes.
The authors would like to acknowledge the support provided by the Sydney World Masters Games Organizing Committee and the information technology support provided by Evan Wills which was instrumental in the successful completion of this project.
Further, to our friend and mentor, Professor John Patrick O’Shea, you are missed and never forgotten.
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