1. The Effect of High Impact Exercise on Skeletal Integrity in Master Athletes Nicole Velez, MSI Amy Zhang, MSI University of Pittsburgh

2. Osteoporosis is a common problem that affects 55% of the people 50 years of age and older. It is characterized by a disturbance in the relationship of resorption to synthesis. Lower bone mass density (BMD) associated with greater risk of fracture. More than 1/3 of adults over 65 fall each year. LEADING CAUSE of injury death in older adults. Background:

3. Previous studies indicate the importance of weight bearing exercise in the maintenance of skeletal integrity. Bone density at specific sites can be maintained in older men by running. Long term training exclusively in cycling can lead to decreased total & regional BMD. BMD of critical fracture points can be improved to a larger extent with physical activity than HRT in postmenopausal women.

4. Background: Limitations of past studies: SMALL sample size Do not examine low AND high impact exercises simultaneously. Do not examine influence of NUTRITION on BMD. Little data on ELDERLY Fail to consider relationship of MUSCLE STRENGTH and BIOCHEMICAL MARKERS.

5. Background: Bone Remodeling Cytokine synthesis & secretion lead to osteoclast recruitment and differentiation. Osteoclasts secrete protons & proteases that dissolve mineral matrix & break down collagen. Activation of surface osteoblasts Changes in PTH, thyroxine, GH & estrogen initiate bone growth. MARKERS: Formation p1np ALP PTH Resorption NTx CTx

6. Background: Pittsburgh’s unique opportunity this summer: –Host to 12,000 senior athletes for 3 weeks –Variety of low and high impact exercise competitions –One time chance to assess the BMD in healthy and fit elderly

7. To determine if BMD in the spine, forearm, hip and heel is higher among athletes in high impact events vs. those in medium and low impact events. To examine if BMD in master athletes is related to age, gender, body composition, type & duration of exercise, nutrition, quality of life and lower extremity strength. To examine biochemical markers of bone turnover & determine whether athletes are vitamin D sufficient with normal parathyroid hormone function. Specific Aims:

8. Hypothesis: When compared to athletes in low and medium impact sports, master athletes competing in high impact sports will demonstrate: –GREATER BMD in the spine, hip, forearm and heel. –GREATER MUSCLE STRENGTH in the lower extremity.

9. Methods – The Subjects: 40 Runners (High Impact ) 40 Cyclists (Medium Impact ) 40 Swimmers (Low Impact) 120 Men & Women Inclusion Criteria: participants in 2005 games, age >= 65 Exclusion Criteria Current medications that might bone (bisphosphonates, HRT, parathyroid hormone) or bone (glucocorticoids, certain anticonvulsants)

10. 1.BMD 1.total body, spine, hip & forearm using DXA Hologic QDR-4500A 2.heel using Lunar Achilles InSight Works (General Electric). 3.Classification by WHO guidelines: normal: BMD above –1 SD of peak bone mass osteopenia: BMD between –1 and -2.5 SD osteoporosis: BMD below –2.5 SD Methods–Outcome Variables:

11. 2. Lower extremity strength Kistler Instrument tension/compression load cell Isometric strength of left quadriceps and hamstrings Peak torque and peak torque to body weight ratio 3. Patient characteristics Age, gender, body composition 4. Calcium & Vitamin D intake 5. Type & duration of physical activity Methods–Outcome Variables: #MET hours/week = (activity MET equivalent ) x (h/week)

12. Methods – Analysis: 1.BMD parameters characterized by mean +/- SD & 95 % confidence intervals. 2. Correlation analysis among predictor variables and BMD. 3. Analysis of variance (SAS GLM) for each BMD to make pair comparisons of interest. 4. Pearson rank correlation coefficient used to assess the correlation of DXA BMD with heel ultrasound measurements. Comparison of BMD among the three groups:

13. Results – Sample Description: 44 runners 66% men 91% Caucasian Mean Age: 73 BMI: 23.5 kg/m2 43 swimmers 58% men 91% Caucasian Mean Age: 73 BMI: 27.22 kg/m2 Active Motivated Educated – 98% high school graduates Health-Concious – 0% smoking, Comorbidity < 1

14. Results – Main Findings: BMD in athletes compared to age- matched population. (Note: p <.01 at all sites except femoral neck in runners.

15. Results – Gender Differences: Athletes compared to age-matched population by sport and gender. SwimmersRunners Females statistically different from normals at more sites than males.

16. Results – Main Findings: BMD in swimmers vs. runners using DXA. No statistically significant difference at any site. Heel stiffness index in swimmers vs. runners using Lunar Achilles. Calcaneal bone density higher in runners (p =.03).

17. Results – Nutrition & Exercise: Calcium Intake Vitamin D Intake Recommended 1500 mg Runners 1853 mg Swimmers 1577 mg 600 IU 763 IU 727 IU No correlation between dietary intake and BMD.

18. Results –Blood Analysis: ALP (IU/L) HGB (g/dL) HCT (%) ALB (g/dL) CA (mg/d) 73.0913.9240.554.229.14 76.6314.2441.664.049.21 No correlation between serum findings and BMD.

19. Study strengths & limitations LIMITATIONS Unique sample of the elderly population. Other influencing factors (income, educational status not addressed). Potential subjects already diagnosed with osteoporosis excluded. Self-report questionnaires. Volunteer bias STRENGTHS Comparison of low and high impact sports. Olympic population provides insight into the healthy and fit elderly. Potential role of muscle strength addressed.

20. Conclusions: BMD in Senior Olympians is significantly higher than their age-matched counterparts at almost all sites. Female athletes show the greatest difference when compared to non-athletes. No significant differences between runners & swimmers except in the calcaneus. Neither serum findings nor dietary intake of calcium and vitamin D predict BMD in master athletes.

21. Potential Significance: Larger data set on skeletal integrity of elderly. Offer an initial look at the role of nutrition and exercise frequency on BMD. Provide recommendations for which type of activities might best help maintain bone mass in elderly and thus incidence & fatality of falls.

22. Future Directions: Consider BMD correlation with lower muscle strength Analyze biochemical markers & consider their correlation with BMD Recruit more master cyclists Include a control group of age-matched, non- athletic locals

23. QUESTIONS??