Being physically active may significantly improve musculoskeletal and overall health, and minimize or delay the effects of aging, according to a review of the latest research on senior athletes (ages 65 and up) appearing in the September issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). It long has been assumed that aging causes an inevitable deterioration of the body and its ability to function, as well as increased rates of related injuries such as sprains, strains and fractures; diseases, such as obesity and diabetes; as well as osteoarthritis and other bone and joint conditions. However, recent research on senior, elite athletes suggests usage of comprehensive fitness and nutrition routines helps minimize bone and joint health decline and maintain overall physical health. "An increasing amount of evidence demonstrates that we can modulate age-related decline in the musculoskeletal system," said lead study author and orthopaedic surgeon Bryan G. Vopat, MD. "A lot of the deterioration we see with aging can be attributed to a more sedentary lifestyle instead of aging itself."  A basic tenet perpetuated by popular culture and medical professionals alike - that running wears out your knees and causes arthritis - was turned on its head a few years ago when a large-scale study found that runners had a lower incidence of hip and knee replacements than the general population.  Running, as well as other types of physical activity, helps to maintain the strength of muscles, bones, joints, and connective tissue, as well as helping to maintain a lower body mass index - eliminating the number one cause of hip and knee replacement, namely, being overweight.

The positive effects of physical activity on maintaining bone density, muscle mass, ligament and tendon function, and cartilage volume are keys to optimal physical function and health. In addition, the literature recommends a combined physical activity regimen for all adults encompassing resistance, endurance, flexibility and balance training, "as safely allowable for a given person."  This includes:

• Resistance training. Prolonged, intense resistance training increases muscle strength, lean muscle, and bone mass more effectively than aerobic exercise alone. Moderately intense resistance regimens also decrease fat mass. Sustained lower and upper body resistance training improves bone density and reduces the risk of strains, sprains and acute fractures.
• Endurance training. Sustained and at least moderately intensive aerobic training promotes heart health, increases oxygen consumption, and has been linked to other musculoskeletal benefits, including less accumulation of fat mass, as well as maintenance of muscle strength and cartilage. Elite senior athletes that this research examined engaged in a minimum of 150 to 300 minutes a week of endurance training, in 10 to 30 minute episodes. Less vigorous and/or short-duration aerobic regimens are also  beneficial, although less so.
• Flexibility and balance. Flexibility exercises are strongly recommended for active older adults to maintain range of motion, optimize performance, and limit injury. Two days a week or more of flexibility training - sustained stretches - are recommended.

The study also recommends quality nutrition for older, active adults to optimize health performance. For senior athletes, a daily protein intake of 1.0 to 1.5 g/kg is recommended.  Protein intake contributes to muscle development and maintenance, so it is of utmost important that all seniors include adequate protein in their diets to stymie the loss of muscle mass (sarcopenia) that occurs with advancing age.  This loss of muscle leads to a drastic decrease in functional capacity, and eating enough protein will help to mitigate this loss.  Basal metabolic rate decreases with age, so older adults need to choose their calories wisely to ensure a high quality diet. "Regimens must be individualized for older adults according to their baseline level of conditioning and disability, and be instituted gradually and safely, particularly for elderly and poorly conditioned adults," said Dr. Vopat. According to study authors, to improve fitness levels and minimize bone and joint health decline, when safely allowable, patients should be encouraged to continually exceed the minimum exercise recommendations. BG Vopat, SA Klinge, PK McClure, PD Fadale. The Effects of Fitness on the Aging Process. Journal of the American Academy of Orthopaedic Surgeons, 2014; 22 (9): 576 DOI: 10.5435/JAAOS-22-09-576