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Atrial Fibrillation in Older Athletes

A study from Norway shows that 13 of 78 (16 percent) older competitive cross country skiers have atrial fibrillation, a condition in which the upper chambers of the heart flutter and collect blood (European Journal of Cardiovascular Prevention & Rehabilitation, February 2010). Blood that is not moving collects in the upper chambers of the heart where it can form clots that travel to the brain to block the flow of blood to cause a stroke. Almost all people who suffer from atrial fibrillation at any age are treated with drugs to prevent clotting, since they are at increased risk for strokes and heart attacks. However, the older endurance athletes are different from other people with atrial fibrillation.

• The incidence of atrial fibrillation in these great older endurance athletes is the same as for non-athletic Norwegian men over 75. However, the skiers developed their atrial fibrillation at the average age of 58, which is much younger than its occurrence in the general population.

• People who suffer from atrial fibrillation usually have a history of something damaging their hearts, such as high blood pressure, high cholesterol, heart disease, heavy drinking or chronic inflammation, but ten of the 13 skiers with atrial fibrillation had none of these risk factors. The older endurance athletes have the highest rate of fibrillation without any known cause in the entire world's literature.

• The vast majority of endurance athletes live significantly longer than average citizens.

Nobody has adequate data to show why athletes are at increased risk for atrial fibrillation or whether they are at increased risk for forming clots. My explanation is that life-long endurance athletes have large healthy hearts that contain much more heart muscle than nerves. This can interfere with the normal sequence of an electrical impulse starting each heart beat from a spot in the upper heart that causes the upper heart to contract. This electrical messages then travels along nerves down to the lower heart to cause it to beat. The large athletic healthy heart has such large muscles that they outgrow the nerves that carry each heart beat so that not all upper heart electrical impulses pass to the lower heart. Future studies will show whether this is harmful or a harmless condition in athletes.

Since doctors have no data to show that older endurance athletes with atrial fibrillation are not at increased risk for strokes, they usually put them on drugs to prevent clotting. The symptoms of atrial fibrillation include:
• a sensation of a rapid or irregular heartbeat
• a fluttering feeling in the chest
• sudden anxiety that the heart is beating irregularly
• sudden dizziness or faintness
• sudden shortness of breath
• sudden chest pain
• sudden loss of strength going up stairs or getting up from a chair
• sudden fatigue anytime

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Dear Dr. Mirkin: Why does athletic performance deteriorate with aging?

Aging causes a much greater loss of strength than endurance, coordination or recovery time (Current Aging Science, February 17, 2010). Each muscle is made up of thousands of single muscle fibers and each year you lose many muscle fibers. No amount of exercise can prevent the lose of muscle fibers, muscle size and strength. For example, the vastus lateralis muscle of a 20 year old has almost 800,000 fibers. In a 60 year old, it has only 250,000.

Aging prevents muscles from responding to insulin. Insulin drives amino acids into muscles to help them recover from exercise and maintain strength. Using radioactive amino acids, researchers showed that insulin drives amino acids into muscles much more effectively in 25-y/o than in 60-y/o. Three exercise sessions per week for 20 weeks markedly increased blood flow in the legs of the older subjects and reversed some of the age-associated muscle wasting (American Journal of Clinical Nutrition, September 2009).

The best way to prevent loss of strength with aging is to do the same stress-and-recover workouts used by competitive athletes. However, this could cause heart attacks in people who have blocked arteries. On one day, take a more intense workout by running or cycling faster or lifting heavier weights. Your muscles will feel sore on the next day so you should take very casual slow workouts for as many days as it takes for the muscle soreness to disappear. Only when your muscles feel fresh should you take your next intense workout.

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Dear Dr. Mirkin: How can I keep from losing height as I get older?

The bones of your spine are separated by pads called discs. As you age, these discs dry out and become smaller. However, regular exercise compresses and relaxes these discs as you move up and down. This helps to keep the discs from shrinking and maintains your height. Regular exercise also helps to strengthen bones and keep them from bending or being crushed.

One study showed that people who exercise regularly lose only half as much height as people who never exercise -- just 2.6 centimeters compared with 5.5 centimeters. If you have not already started exercising to prevent heart attacks, diabetes, high blood pressure, high cholesterol and loss of mental function, and just to keep you feeling good, you should exercise to help you stand taller as you age.

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June 21st, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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