Authors: Mike Climstein, PhD, FASMF, FACSM, FAAESS, Joe Walsh, MSc, Ian Timothy Heazlewood, PhD, Mark DeBeliso, PhD, FACSM
Corresponding Author:
Dr. Mike Climstein
Clinical Exercise Physiology, School of Health and Human Sciences
Southern Cross University (Gold Coast Campus)
Bilinga, Qld 4225
Australia
michael.climstein@scu.edu.au
+617 5509 3330
Dr. Mike Climstein (FASMF, FACSM, FAAESS, AEP) is with Clinical Exercise Physiology, Southern Cross University, School of Health and Human Sciences, Bilinga, Queensland, Australia; Adjunct Associate Professor with The University of Sydney, Exercise, Health and Performance Faculty Research Group, Sydney, New South Wales, Australia.
Joe Walsh is affiliated with the Faculty of Engineering, Health, Science and the Environment, Charles Darwin University, Darwin, Northern Territory, Australia.
Ian Timothy Heazlewood is Associate Professor and Theme Leader Exercise and Sport Science in The College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.
Mark DeBeliso is Professor, Department of Physical Education and Human Performance, Southern Utah University, Cedar City, USA
Endurance masters athletes: A model of successful ageing with clinically superior BMI?
ABSTRACT
Master athletes (30yrs and older) are aged individuals who exercise regularly and compete in organized competitive sport. The long-term physical activity/exercise should afford these individuals health benefits, one of which should be apparent in body mass index (BMI), a simple index for identifying overweight and obese athletes.
Purpose: To investigate the BMI of endurance masters athletes and determine if this cohort demonstrated clinically favourable BMI as compared to sedentary controls or the general population. A systematic review of electronic databases (CINAHL, Cochrane, Medline, PubMed, PsycINFO, Scopus, Web of Science) for studies where BMI was measured in either masters athletes, World Masters Games athletes or veteran athletes.
Results: Database searches identified 7,465 studies, of which nine met our inclusion criteria. The mean BMI of all the studies was found to be significantly (p<0.001) lower in masters athletes as compared to controls (23.4 kg/m2 (±0.97) versus 26.3 kg/m2 (±1.68)). Additionally, for all studies mean masters athlete BMI was classified as normal (BMI >18.5 to <25.0 kg/m2) whereas the majority (77.8%) of the controls BMIs were classified as overweight (BMI >25.0 to < 30 kg/m2). In all studies, masters athletes had lower BMI compared to controls, this difference was found to be significant in 44.4% of the studies, where significance was not found masters athlete BMI was -2.6% to -18.6% lower than controls. In all studies, the mean BMI was lower in masters athletes (as compared to controls) and this favourable BMI would afford masters athletes reduced risk with regard to the development of a number of cardiometabolic diseases, osteoarthritis and certain types of cancer.
Keywords: BMI, health, obesity, veteran athlete, World Masters Games
Introduction
The global prevalence of obesity has increased at an alarming rate over the past 30 years, with an estimated 10 percent of the world’s population now meeting the classification criteria (body mass index, BMI > 30.0 kg/m2) for obesity (2). In Australia, the percentage of adults classified as obese has increased two-fold in the past two decades with approximately 11.2 million adults classified as overweight or obese, 42 percent of which are males and 29 percent females (3). The increased prevalence of obesity has been linked to economic cost in terms of tens of billions of dollars in lost productivity and increased mortality in the Australian population (39). This elevated level of obesity is attributed to four million deaths in 2015 and 120 million disability-adjusted life years.
Recent research by Pharr and colleagues (32) identified an elevated risk of developing a number of chronic diseases and disorders which included hypertension (HTN), dyslipidemia, type 2 diabetes mellitus (T2dm) and coronary heart disease. Other documented chronic diseases associated with obesity includes cerebrovascular disease, gallbladder disease, sleep apnoea, mental illness (depression/anxiety), insulin resistance, atherosclerosis, osteoarthritis, and some cancers (kidney, postmenopausal breast, endometrial, colon) (33).
Masters athlete is a term applied to individuals aged typically over 30-35 years of age (varies by sport) who exercise on a regular basis to compete in organized competitive sport(s) (17). Over recent years there has been considerable growth in the number of masters athletes competing in organized sports (26). For example, approximately 45 percent of the finishers of the New York marathon were masters athletes and the 2009 World Masters Games (WMG) attracted over 28,000 competitors from approximately 100 countries (36). Hawkins et al. (19) has proposed that masters athletes represent a model of successful ageing however, at that time there was a paucity of data available to support this premise in this unique cohort. The obesity pandemic and its relationship with physical activity and aging is a multifaceted, complex problem (46).
We have previously reported the health aspects of masters athletes who participated in rugby union and found a reduced incidence of chronic disease and disorders and reduced use of prescription medications (8). Research on the masters athletes competing at the Sydney WMG has included research on body mass index (38, 39, 42, 43), injury incidence (21, 40, 44), psychology (1, 9, 20, 23, 35, 47) and health of competitors (7, 9-12, 38, 40, 41). Recent investigation of WMG athletes identified significantly reduced cardiovascular risk with clinically superior resting blood pressure (systolic and diastolic, p<0.001) and blood lipid profiles (p<0.001) as compared to the Australian general population (10). Given these findings, we postulated that the reduced risk of chronic disease(s) may, in part, be attributed to a normal (>18.5 to <25.0 kg/m2) BMI. Therefore, the purpose of this study was to review the existing scientific literature on studies investigating endurance masters athletes and WMG athletes. It should be noted that it may be inappropriate to draw meaningful conclusions in athletes with the possibility of enhanced muscle mass, this inference to health is unreliable as it may be due to increased muscularity. There may also be some causation by sport, for example athletes may be preferentially attracted to compete in a sport if they have a natural physiological advantage due to the specific demands of the activities involved (45). This may influence the utility of comparing BMI for endurance athletes as there may be some potential attraction or retention of masters athletes in endurance running based off a particular anthropometric ratio of body mass to height.
METHODOLOGY
Only published, full-length scientific research articles in English where BMI was measured, were considered for inclusion. We included all studies where BMI was the primary outcome measure or secondary outcome measure in studies which included endurance masters athletes, WMG athletes or veteran athletes. Our strategy, given the limited research on this cohort, was to include studies where significant differences were identified, non-significant differences were identified or where statistical comparisons between groups was not conducted. We delimited our search to only masters athletes, WMG athletes and veteran athletes who were generally classified as endurance athletes. To be eligible for inclusion, studies must have had a comparison group (i.e., sedentary controls or the general population).
The EBSCO reference system was utilized to search multiple databases simultaneously and search methods included a multistep electronic search of the literature using CINAHL, Medline, PsycINFO, OvidSP, PubMed, Scopus and SPORTDiscus. Search terms were individualized to the specific database using Boolean operators (where appropriate) and included BMI, endurance athlete, master athlete, older athlete, Pan Pacific Masters Games (22), veteran athlete and World Masters Games.
RESULTS
A total of nine studies (6, 13-15, 24, 25, 28, 34, 37) met our inclusion criteria and were included in this review (Table 1), four of the studies reported significant differences between groups, four studies reported non-significant differences between groups and one study did not conduct statistical analysis of BMI between groups. Of the nine studies, masters athlete participants’ numbers ranged from 10 to 87 (controls 10 to 20,015 participants) and had a mean (group) age of 61.6yrs (range 61.6-73.3yrs) versus controls mean age of 64.5yrs (range 64.5 to 77.0yrs) (p=0.592). The mean BMI for masters athletes across all the nine studies was significantly (-12.4%, p<0.001) lower than controls at 23.4 kg/m2 (±0.97) versus 26.3 kg/m2 (±1.68). With regard to individual studies, four of the studies (6, 15, 24, 37) reported significant differences between masters athletes and controls. Four studies (13, 25, 28, 34) reported non-significant differences however, the calculated (percentage) differences between masters athletes and controls ranged from -2.5% to -17.2%. With regard to BMI classification, in all of the nine studies the mean BMI for the masters athletes was within the range classified as normal (BMI >18.5 to <25.0 kg/m2) whereas the majority (77.8%) of the control groups BMI would be classified as overweight (BMI >25.0 to <30.0 kg/m2). Only two of the control groups (25, 34) had a group mean BMI within the range classified as normal
DISCUSSION
The aim of this review was to investigate the BMI of masters athletes competing in endurance sports and determine if their BMI would be classified as normal (BMI >18.5 to <25.0 kg/m2) and would be significantly lower than sedentary controls or the general population. A total of nine studies were included in this review (249 masters athletes, 20,366 controls) with masters athlete participant mean age ranging from 61.6-73.3yrs (controls 64.5 to 77.0yrs). The mean BMI for the masters athletes across all of the included studies was significantly (p<0.001) lower (-12.4%) than controls (23.4 kg/m2 vs 26.3 kg/m2)) and in all the studies mean BMI for masters athletes was within the range for classification as normal. These BMI findings in masters athletes are lower (-13.2%) than the recent US National Health and Nutrition Survey findings (16). These findings are also lower (-19.2%) than the Australian general population (27.9kg/m2) (4). Additionally, given the sparse research conducted on BMI in masters athletes we believed it was important to include studies where non-significant differences (or no analysis) were found between groups with regard to BMI. It is interesting to note that in the four studies where BMI was not significantly different between groups and where BMI was not statistically analyzed, BMI was consistently lower (-2.6% to -18.2%) than the comparison group.
None of the masters athlete studies reported a mean BMI in the overweight or obese classification whereas Ng and colleagues (29) reported the global proportion of overweight and obese adults at 38.0% and that the prevalence of obesity has tripled over the past 40 years. The Global BMI Mortality Collaboration (18) found in a study of 10,625,411 individuals (Asia, Australia, New Zealand, Europe, and North America) that all-cause mortality (total number of deaths attributed to a condition) was lowest in in individuals with a normal BMI (>18.5 to <25 kg/m2). Mortality was found to be higher as BMI increased, for example in those individuals classified overweight (BMI >25.0 to <30.0 kg/m2) all-cause mortality was seven percent higher and 20 percent higher in those classified as obese (BMI >30.0 kg/m2). Bays and colleagues (5) investigated the prevalence of T2dm, HTN and dyslipidemia in 215,354 individuals in the USA. They found that an elevated BMI (> 25.0 kg/m2) was significantly (p<0.001) associated increased prevalence of T2dm, HTN and dyslipidemia. Zheng and Chen (48) investigated BMI as a risk factor for the development of knee osteoarthritis (OA). These authors reported that the development of OA was 2.5-fold more likely for individuals who had a BMI classified as overweight (BMI >25.0 to <30.0 kg/m2) and 4.6-fold more likely in individuals classified as obese (BMI >30.0 kg/m2) as compared to individuals classified as normal BMI. The relationship of BMI has also been investigated (27) with regard to coronary heart disease, Lyall and colleagues (27) reported increased risk (35%) of coronary heart disease and an increased BMI.
Master athletes and their associated long-term adherence and participation in exercise training can be considered an advanced mode of physical activity. Participation in exercise and physical activity has long been recognized an a significant health intervention to maintain health and independence (30). This review of endurance masters athletes attempted to demonstrate if masters athletes would exhibit a clinically beneficial BMI, a recognized health index. We found the endurance masters athletes, as a group, consistently had a clinically superior BMI when compared to sedentary controls or the general population, which is a promising finding.
There are limitations to our findings, namely BMI does not take into account lean tissue and fat tissue in its determination. This is our rationale for delimiting our study to only endurance masters athletes as those masters athletes participating in strength and power sports will typically be more muscular, hence possessing more lean mass which skews BMI (31). Despite this limitation, we hypothesized BMI in endurance masters athletes would be lower than controls, we found this hypothesis was correct for all studies included in this review. An additional limitation to this study is our assumption that the lower BMI found in endurance masters athletes resulted in a lower incidence of chronic diseases and disorders, which we were unable to determine based upon the studies selected.
CONCLUSIONS
Physical activity and exercise have robust scientific support that demonstrates there is a strong inverse independent association between physical-activity and cardiovascular-disease related mortality. The benefits are in part attributable to the modifications that occur to risk factors.
Body mass index is such a modifiable risk factor associated with several chronic diseases and conditions. The relationship between obesity and physical activity at older ages is complex, however our study demonstrated that masters endurance athletes had significantly lower BMI than controls and that their mean BMI scores were situated within the range designated as normal for BMI. This would imply reduced risk of conditions such as T2dm, cardiovascular disease, stroke, HTN, osteoarthritis, sleep apnoea and some cancers within this cohort as well as reduced risk of morbidity. Whilst there is still some issue of causation to address, it would be appropriate to recommend (subject to appropriate health screening and other precautions, such as correct exercise instruction and gradual training progression) participation in masters endurance sports as a noteworthy health intervention to maintain or improve health, via improved BMI, for older adults.
APPLICATIONS IN SPORT
Participation in masters sports is associated with an improved BMI as compared to the general population. This reduced BMI is associated with a number of health benefits which includes reduced prevalence of heart disease, stroke, certain cancers, prevention of T2dm, joint problems and other health conditions. These health advantages afford MAs improved quality of life
ACKNOWLEDGMENTS
We would like to extend our sincere thanks to Professor Pat O’Shea, friend, mentor and avid master athlete for instilling a passion for research; you are sincerely missed but not forgotten.
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