Shared decision making in athletes with cardiovascular disease: what we can learn from a masters athlete

A 75-year-old male cyclist began suffering from palpitations on exertion. Symptoms terminated spontaneously with cessation of physical activity. The episodes caused significant distress with an impact on physical performance and quality of life. An echocardiogram showed a dilated left atrium, and an exercise ECG demonstrated that episodes of atrial fibrillation developed when his ventricular rate was above 140 beats per minute. Rate control could not be offered due to a history of sinus bradycardia nor rhythm control due to low likelihood of success. Anticoagulant therapy was commenced but discontinued at patient request as he considered risks to outweigh benefits given his desire to continue cycling. Management of athletes with atrial fibrillation is based on guidelines for the general population; however, treatment goals for athletes may differ. Shared decision making is essential to allow patients to make informed decisions about their care, accepting that individuals view treatment risks and benefits differently.

Masters Athlete Screening Study (MASS): incidence of cardiovascular disease and major adverse cardiac events over five years of screening

Background The long-term implications of cardiovascular disease (CVD) in masters athletes, and whether screening decreases their risk of major adverse cardiac events (MACE) is unknown. Purpose To evaluate the incidence of CVD and MACE over five years of a screening study. Methods Masters athletes (≥35 years) from a variety of sports without previous history of coronary artery disease (CAD) underwent yearly cardiovascular screening. The screen consisted of anthropometrics, blood pressure, resting electrocardiogram, modified American Heart Association 14-element recommendations, cardiovascular event questionnaire, physical examination (year 1) and Framingham Risk Score (years 1–3). Participants with an abnormal screen according to the European Association of Cardiovascular Prevention and Canadian Cardiology Society Guidelines underwent further evaluations (computed coronary tomography angiography was not included for all athletes but based on clinical assessment). Participants who withdrew during the study received a follow-up questionnaire to determine MACE and vital status. Results In the first year of the Masters Athlete Screening Study, 798 masters athletes (62.7% male, 54.6±9.5 years) were screened; 91 (11.4%) of the cohort were found to have CVD. CAD was the most common diagnosis (69.2%). During the following four years, there were an additional 89 CVD diagnoses with an incidence rate of 3.58/100, 4.14/100, 3.74/100, 1.19/100, for years two to five, respectively. Fifteen participants had more than one diagnosis. The most common diagnoses over the five years were arrhythmias (n=33; 37.1%), aortic dilatation (n=20; 22.5%), CAD (n=18; 20.2% (5 obstructive, 13 non-obstructive)) and other (n=7; 7.9%) (myocarditis (n=2), myocardial bridging (n=1), cerebrovascular disease (n=1), dilated cardiomyopathy (n=1), probable Long QT syndrome (n=1), papillary fibroelastoma (n=1)). A total of 10 MACE occurred (two cardiovascular deaths, five myocardial infarctions and three cerebrovascular accidents). All events occurred in male athletes (63.6±12.5 years). Out of the 136 participants that received the lost to follow-up questionnaire, 101 (74.3%) completed it. Of those, one male athlete underwent percutaneous coronary intervention. The incidence of MACE over the study period was 0.30/100 athletes per year. Conclusion Yearly cardiovascular screening of masters athletes identified ∼3 new diagnoses per 100 athletes per year. Ten MACE occurred despite yearly screening and high CV fitness of masters athletes. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): MITACs and CIHR

Motivations for the training effort of Romanian masters athletes

The aim of this study was to investigate the motivations of Romanian Masters athletes to train for endurance running in order to participate in half-marathon competitions. The research method used was the survey. This tool consisted of a questionnaire that was purposely developed for the present research. Out of the 111 experienced respondents practising running for 13 years on average, 61.8% are men and 38.2% are women. The results are different and are mainly focused on reaching a state of well-being (67%) for both men (67.2%) and women (66.7%); there are significant differences between the 35-44 and 55+ age categories (t = 2.776, p < 0.01). This motivation has contributed to maintaining and improving physical performance with aging. Women are more motivated than men to run for health benefits. In conclusion, we believe that paying attention tomotivation is important in terms of encouraging people of all ages to play outdoor sports, promoting a healthy lifestyle based on exercise and managing grassroots sport. The Masters athlete is a rich source of information regarding a person’s ability to maintain maximum physical performance and physiological function as they get older. The impressive capacity for physical performance and physiological functioning makes Masters athletes a model for society.

Defining Training and Performance Caliber: A Participant Classification Framework

Throughout the sport-science and sports-medicine literature, the term “elite” subjects might be one of the most overused and ill-defined terms. Currently, there is no common perspective or terminology to characterize the caliber and training status of an individual or cohort. This paper presents a 6-tiered Participant Classification Framework whereby all individuals across a spectrum of exercise backgrounds and athletic abilities can be classified. The Participant Classification Framework uses training volume and performance metrics to classify a participant to one of the following: Tier 0: Sedentary; Tier 1: Recreationally Active; Tier 2: Trained/Developmental; Tier 3: Highly Trained/National Level; Tier 4: Elite/International Level; or Tier 5: World Class. We suggest the Participant Classification Framework can be used to classify participants both prospectively (as part of study participant recruitment) and retrospectively (during systematic reviews and/or meta-analyses). Discussion around how the Participant Classification Framework can be tailored toward different sports, athletes, and/or events has occurred, and sport-specific examples provided. Additional nuances such as depth of sport participation, nationality differences, and gender parity within a sport are all discussed. Finally, chronological age with reference to the junior and masters athlete, as well as the Paralympic athlete, and their inclusion within the Participant Classification Framework has also been considered. It is our intention that this framework be widely implemented to systematically classify participants in research featuring exercise, sport, performance, health, and/or fitness outcomes going forward, providing the much-needed uniformity to classification practices.

Goal Setting in Masters Sport An Autoethnography of a Masters Kettlebell Athlete and Coach

The purpose of this paper is to describe the nuances of goal setting in coached Masters sport from the perspective of a Masters athlete (MA) who is also a Masters coach. Thus, this paper is an autoethnography of how the first author’s experience in goal setting plays out as a MA with an online coach, and as a coach, coaching other MAs in-person. Data were collected through a series of guided reflexive journal entries, prompted by follow up questions from the second author to create narrative visibility. Journal entries were analyzed to determine what, when, where, how, and why the first author uses goal setting. In Masters sport, goals are set using many of the same principles described in the literature from different sport contexts; however, this autoethnography indicates that it is important for goal setting to originate from the MA to account for individual motives, and then to be communicated with, negotiated by, and supported from the coach with an interdependent, adult-oriented approach.