EQOL Journal (2018) 10(1):
REVIEW ARTICLE
Sunčica Poček 1 • Tatjana Trivić 1 • Roberto Roklicer 1 • Sergej M. Ostojić 1 • Patrik Drid 1✉
Received: 26th April, 2018 |
DOI: 10.31382/eqol.180601 |
Accepted: 6th June, 2018 |
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© The Author(s) 2018. This article is published with open access. |
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Abstract
This article represents a review of the existing literature on possible
Keywords former athletes • physical activity • metabolic syndrome • diabetes mellitus • cardiovascular health
Introduction
It is probable that physical activity in childhood and youth has a positive impact on participation at a later age. Physical exercise for the elderly seems to play a particularly important role, especially in the prevention of slowly progressing functional deficiencies. According to Backmand et al. (2006), increasing physical exercise is associated with improved physical daily ability. Engaging in a phy-
✉patrikdrid@gmail.com
1Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
sically active
Former athlete, especially at an elite level according to Batista & Soares (2014), is associated with a decreased likelihood for the prevalence of major chronic disease risk factors (). Physical exercise influences not only physical fitness, but also psychological and social ability (Backmand et al., 2006).
Functional abilities in later life may be compromised due to negative consequences of injuries sustained during sports (Maffulli et al., 2010; Simon & Docherty, 2017). Linger in adulthood which may have been caused by the high level athletic demands possibly make participants unable to stay active as they are getting older, and in such a way may impair their
Physical Activities, according to the Compendium (Ainsworth et al., 2011), based on the intensity of exercise performed between each sport, with their respective metabolic equivalent (MET) intensity levels, athletes could be classified by the various sports they used to participate in. Sports categories were defined as (Pate et al., 1995): light sports (˂3.0 METs or ˂4 kcal/min; walking, golf, bowling) moderate
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triathlon, decathlon, swimming, basketball, handball, and soccer).
According to the adult recommendations from the American Heart Association and the American College of Sports Medicine (Haskell et al., 2007), subjects are considered to have lower physical activity than recommended (Lower PAR) if after career termination they engage in less than 30 minutes a day on 5 days a week of aerobic, moderate- intensity, or less than 20 minutes a day on 3 days a week of
This article represents a review of the existing literature on possible
Method
Search of databases was performed through Web of Science and Science Direct including following key
words: former athletes, metabolic risk factor/syndrome, cardiovascular health and diabetes mellitus. Studies were included if they (i) were original research; (ii) evaluated the health status in terms of abovementioned key words (iii) retired athletes as the study subjects. Exclusion criteria for choosing studies for this review was if they were published in other language than English, book chapters, thesis or dissertations, case reports, review
articles, conference abstracts, editorials commentaries or expert opinion.
Results
Metabolic syndrome (MetSyn) is a group of metabolic risk factors that can directly develop cardiovascular disease (Expert Panel on Detection, 2001), and also increase the risk for developing type
IIdiabetes mellitus (Grundy et al., 2005). Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, 2008) emphasize the association of physical activity with numerous health benefits, such as lower incidence of CVD (Kohl, 2001), and diabetes mellitus type 2 (Kelley & Goodpaster, 2001). This interaction partly occurs through components of the metabolic syndrome (Laaksonen et al., 2002) such as weight control and
6
improved functioning of the cardiovascular system. Also, several CVD risk factors are favorably modified by
Metabolic syndrome is defined according to criteria of the International Diabetes Federation: waist circumference ≥94 cm plus any two of the following factors: (a) triglycerides ≥1.7 mmol/l or specific treatment for this; (b) HDL ˂1.03 mmol/l or specific treatment for this; (c) systolic BP≥130 or diastolic BP≥85 mm Hg or treatment of previously diagnosed hypertension; fasting plasma glucose ≥5.6 mmol/l or previously diagnosed type II diabetes (Alberti et al., 2006).
Former athletes use healthier lifestyles, and that may give them an advantage regarding the risk factors that describe the syndrome (Table 1). In addition, recommended levels of physical activity engagement seems to play an important role in the association with metabolic syndrome, even in those subjects who have never played any competitive sport (Batista & Soares, 2013).
Male former
EQOL Journal (2018) 10(1):
type 2 diabetes had those participants with the most LTPA in later life (Laine et al., 2014).
Table 1. Health status of former athletes in terms of metabolic syndrome
Aim |
Subjects |
Sex |
Test/measure |
Results |
Batista & Soares, 2013
Whether former athletes are better protected against MetSyn and if this hypothetical
protection is dependent on sex, career, or later lifestyle?
Form el |
M |
Demographic |
ath |
|
info |
|
+ |
|
225 |
|
Behavioral and |
|
F |
biological |
Form |
|
characteristics |
nonel athl |
|
|
|
|
Physical and |
168 |
|
biochemical |
Controls |
|
measurements |
|
|
|
98 |
|
|
No significant differences in the likelihood of MetSyn among
Batista & Soares, 2014
Whether the prevalence of behavioral and biological risk factors of former elite athletes (both men and women), differed from nonelite athletes and nonathletes?
Form el |
M |
Demographic |
ath |
|
info |
|
+ |
|
225 |
|
Behavioral and |
|
F |
biological |
Form |
|
characteristics |
nonel athl |
|
|
|
|
Physical and |
168 |
|
biochemical |
Controls |
|
measurements |
|
|
|
98 |
|
|
Besides alcohol consumption, former elite athletes had minimum 70% less probability for the other behavioral risk factors than nonathletes. Speaking of biological factors, minor differences exist in being overweight/obese, and only among female elite athletes appeared significant odds ratio (0.09, p < 0.001) in comparison to nonathletes.
Kelly et al., 2014
The association
between mild TBI (mTBI) and pituitary and metabolic function in retired football players?
Form |
M |
Demographic |
NFL athl |
|
info |
68 |
|
Behavioral and |
|
|
biological |
|
|
characteristics |
|
|
Physical and |
|
|
biochemical |
|
|
measurements |
MetS was present in 50% of subjects.
Pituitary dysfunction and MetS are relatively common in retired
professional football players and may be significant contributors to their poor QoL.
Laine et al., 2014
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EQOL Journal (2018) 10(1):
Prevalence of impaired glucose regulation in male Finnish former elite athletes and age- and area- matched controls?
Form |
M |
Oral Glucose |
|
|
Tolerance Test |
Athl |
|
|
|
|
Anthropometric |
392 |
|
data |
(72.7±6.1) |
|
Assessment of |
Controls |
|
smoking habits |
|
|
|
207 |
|
Assessment of |
(71.6±5.6) |
|
LTPA |
|
|
|
∑=599 |
|
|
Compared with the controls, the former elite athletes had a significantly lower risk of type 2 diabetes (OR 0.72, 95%CI 0.53, 0.98). The risk of type 2 diabetes decreased with increased LTPA volume (OR 0.98, 95% CI 0.97, 0.99 per
Laine et al., 2016
Former male elite athletes have lower body fat percentage, lower risk for MS, and NAFLD in late life independent of the volume of current LTPA?
Form |
M |
Anthropometric |
|
|
data |
Athl |
|
|
|
|
Blood pressure |
392 |
|
|
|
|
Blood sampling |
(72.7±6.1) |
|
|
|
|
Assessment of |
Controls |
|
MS |
207 |
|
|
NAFLD
(71.6±5.6)
LTPA
∑=599
Compared with the controls, the former athletes had lower body fat percentage (24.8% vs 26.0%, P = 0.021), lower risk for NAFLD (OR 0.61, 95% CI
Overweight and obesity, and the accumulation of metabolically detrimental visceral adipose tissue might be protected by
8
Observations in previous study have shown that a career as a
Diabetes mellitus
Diabetes is continuing to be an international rising health burden. The estimate for 2010 of 285 million adults with diabetes is 67% higher than the 2004 published estimate for the year 2000, and 2030 estimate of 439 million is 20% higher than the same study’s estimate for 2030 (Shaw et al., 2010).
EQOL Journal (2018) 10(1):
that physical activity appears to be protective for NIDD (Table 2). Non – insulin dependent diabetes risk is reduced by modifiable behavioral practices such as weight control (i.e., optimal BMI) and physical activity (Wyshak, 2002).
According to Wyshak (2002)
Table 2. Diabetes mellitus in former athletes
college graduates. In former college athletes, diabetes was reported by 0.9% and by 1.7% in
Aim |
Subjects Sex |
Test/measure |
Results |
Laine et al., 2017
Whether vigorous physical |
Form |
|
activity during young |
|
|
adulthood |
Athl |
|
is associated with costs of |
1314 |
|
diabetes medication in |
||
|
||
later life? |
Controls |
|
|
860 |
|
|
∑=2174 |
MDiabetes medications data
According to the costs of medications, medications were divided into two
classes: insulin
Among former endurance athletes (mean 81 € [95% CI
insulin was used by 0.4% in former endurance athletes while in the control group it was used by 5.2% (p = 0.018)
Wyshak, 2002
Risk factors |
Form |
F |
Questions on |
for diabetes in female |
|
|
|
former college athletes |
Athl |
|
health, |
compared with |
|
|
|
nonathletes? |
1945 |
|
medical history, |
|
Controls |
|
behavioral practices, |
|
|
|
and family history |
|
1995 |
|
|
1.3% of the entire group of college graduates reported
Cardiovascular health
A constellation of functional, structural, and electric cardiac adaptations refers to as athlete’s heart and can occur as a result of regular intensive exercise over an extended period of time (Spirito et al., 1994; Utomi et
al., 2013). The type and extent of these cardiac adaptations, according to the Morganroth theory, are dependent on the pursued sport (Morganroth et al., 1975). Eccentric left ventricular hypertrophy, normal diastolic function and
9
EQOL Journal (2018) 10(1):
increases in cardiac output. Conversely, strength training, characterized by brief but dramatic increases in afterload, is proposed to result in concentric left ventricular hypertrophy. Although this adaptive response has not been consistently shown in strength athletes, developing concentric hypertrophy have been shown by American Style football players (Utomi et al., 2013; Weiner et al., 2013). Hypothetically, enlargement of the aorta would be expected as a result of these hemodynamic loads and indeed, changes have been demonstrated in the elastic properties of the aorta in elite, top level athletes (D’Andrea et al., 2012). Although elite athletes have remarkably larger ascending aortic dimensions than the other population, indicated by studies (D’Andrea et al., 2012; Iskandar & Thompson, 2013), these changes still fall within established limits for the general population and aren’t quite large (Boraita et al., 2016). Very few athletes
mm(Kinoshita et al., 2000; D’Andrea et al., 2012;
Boraita et al., 2016) according to arbitrary cut off used to define aortic enlargement in practice guidelines and clinically.
Being a former
10
lineman in contrary to
The risk for levels of selected coronary artery disease risk factors or coronary artery disease risk factors of former athletes after career cessation from active sports are more associated with the
Compared to the area and age matched controls, former endurance athletes have lower prevalence of hypertension, smoke less, and have higher intensity and volume of LTPA (Sarna et al., 1997). Even though the previous medical history may play an important role, vigorous LTPA during the entire lifetime relates good with cardiovascular health (Johansson et al., 2016).
EQOL Journal (2018) 10(1):
Table 3. Cardiovascular health of former athletes
Aim |
Subjects |
Sex |
Test/measure |
Results |
Kumar Dey et al., 2002
Effects of
Active |
M |
Anthropometric |
older athl |
|
obesity parameters |
52 |
|
Blood lipids |
Sedentary |
|
Blood pressure |
older athl |
|
|
|
|
VO2 max |
54 |
|
Questionnaire- |
|
|
|
Sedentary |
|
concerning the total |
older non |
|
|
athl |
|
physical activity |
56 |
|
|
There was significant difference between the groups in the selected CAD risk factors. The SOD had significantly higher mean values in weight, BMI, body fat percentage, total cholesterol,
Kettunen et al., 2015
Life expectancy and mortality among former elite athletes and controls
Form |
M |
HR analysis of |
Median life expectancy in the endurance sports (79.1 |
|
|
years, 95% CI 76.6 to 80.6) and team sports (78.8, 78.1 |
|
Athl |
|
deaths |
to 79.8) was higher compared to controls (72.9, 71.8 to |
2363 |
|
|
74.3). Risk for total mortality adjusted for birth cohort |
|
|
and socioeconomic status was lower in the team (0.80, |
|
|
|
|
|
Controls |
|
|
0.72 to 0.89) and endurance (HR 0.70, 95% CI 0.61 to |
|
|
0.79) sports athletes, and slightly lower in the power |
|
1657 |
|
|
|
|
|
sports athletes (0.93, 0.85 to 1.03) compared to controls. |
|
|
|
|
|
|
|
|
Heart rate (HR) for ischemic heart disease mortality was |
|
|
|
lower in the team (0.73, 0.60 to 0.89) and in the |
|
|
|
endurance (0.68, 0.54 to 0.86) sports athletes. Heart rate |
|
|
|
for stroke mortality was 0.59 (0.40 to 0.88) in the team |
|
|
|
and 0.52 (0.33 to 0.83) in the endurance sports athletes. |
|
|
|
The risk for |
|
|
|
in the power sports (0.40, 0.25 to 0.66) and in the |
|
|
|
endurance (HR 0.20, 0.08 to 0.47) sports athletes |
|
|
|
compared to controls. The power sports athletes, |
|
|
|
especially boxers, had increased risk for dementia |
|
|
|
mortality (HR 4.20, 2.30 to 7.81). |
Johansson et al., 2016
Effects of previous and current physical activity on cardiovascular health?
Form |
M |
Body mass |
Athl |
|
index (BMI), |
|
|
fasting serum |
99 |
|
glucose, blood |
Controls |
|
pressure, lipids, |
|
|
|
49 |
|
and |
|
|
Athletes performing vigorous LTPA had more elastic arteries than athletes performing moderately or no LTPA. Vigorous LTPA during the entire lifetime relates good to cardiovascular health, even though the previous medical history can play an important role.
11
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cardiac and carotid artery ultrasonography
structure and function
Gentry et al., 2017
Evaluation ascending aortic dimensions in former elite athletes and comparison to a
similar age and ethnic control group.
Form |
M |
Height and weight |
Athl |
|
4 BP readings |
206 |
|
CT scan for |
|
|
asssesement of |
Controls |
|
coronary calcium |
759 |
|
burden |
|
|
|
|
|
Cardiovascular |
|
|
history |
|
|
questionnaire |
When compared with the controls mean ascending aortic diameter was significantly larger in retired NFL athletes (38±5 versus 34±4 mm; P<0.0001).
Larger aortic area indexed to height, after adjustment, is predicted by former NFL status (standardized β coefficient of 0.2; P<0.001)
Hazard ratios for ischemic heart disease mortality and for stroke mortality are lower in endurance and team sports athletes than in controls. Mortality for dementia is increased in power sports athletes. Comparing to men who were healthy as young adults, elite athletes have higher life expectancy of
Conclusion
It has been shown that male former athletes are more physically active than age – matched control individuals. More than 60% of former elite male athletes are engaged in competitive sports or leisure time physical activity throughout their adult life after retirement (Batista & Soares, 2014). This behaviour is also common in female former elite athletes. Former athletes tend to adopt healthier lifestyles, which may give them an advantage in relation to risk factors taking into account metabolic risk
factor/syndrome, diabetes mellitus and cardiovascular health. Health benefits of physical activities, moreover, depends of engagement at recommended levels, even in subjects who have never been athletes.
Conflict of interests
There are no potential conflicts to declare.
Acknowledgments
This work was supported by the Serbian Ministry of Education, Science and Technological Development (grant number 179011), the Provincial Secretariat for Science and Technological Development (grant number
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How to cite this article:
Poček, S., Trivić, T., Roklicer, R., Ostojić, S. M., & Drid, P.
APA:(2018).
Poček, Sunčica, et al.
MLA: status: a mini review." Exercise and Quality of Life 10.1 (2018): 5- 15.
Poček, Sunčica, Tatjana Trivić, Roberto Roklicer, Sergej M
Chicago: Ostojić, and Patrik Drid.
(2018):
15