Triathletes over Fifty: Staying Healthy & Injury-free

Due to a large number of questions from my athletes who are aging up into their 50s or older, I am undertaking a series called “Tri over Fifty”. Each article will discuss a different aspect of participating in our wonderful sport for those fifty years of age and older.

Is it safe for athletes over fifty to train for triathlons?

The answer is almost certainly a resounding “Yes”. However, let’s discuss some of the benefits and risks of this type of training. The benefits of physical activity in aging are well demonstrated and include improved cardiovascular, pulmonary and muscular systems, as well as improved brain function.^?1? While aerobic fitness doesn’t improve cognitive ability in people without any difficulties, there is a definite relationship between those with regular, habitual physical activity such as masters athletes.^?2? But along with the benefits of regular physical activity come risks, such as injuries from either overtraining, acute trauma and cardiovascular events. ^?3?

Why 50? Well, to start with, I just joined this decade of life, so I can identify with the many challenges that come with it. Some are common to younger decades as well such as family commitments, caring for kids who may still live at home and being in prime earning years of your job. However, others have more in common with the decades to come, such as problems with arthritis, menopause, andropause, development/arrival of chronic health problems such as heart disease or cancer. Fifty marks a point in our lives when we may no longer feel youthful, but we are far from old age.

The most recent question I received was from a 54-year-old athlete, Dan B., who asked: “How can I remain injury-free at 54 years old while training for triathlons?” Without knowing more about Dan’s specific background, I am going to make some assumptions for this series.

• You’re interested in maintaining an active lifestyle whether it’s in triathlon or another sport
• You’re worried about the best and healthiest way to train, given your lofty goals
• You’re tolerance for certain activity levels or recovery strategies is narrower than it used to be
• You’ve been training for triathlon at least since your 40s, and have noticed changes in your body
• You’ve had previous, minor injuries that may be nagging or take longer and longer to recover from

In this article, I want to discuss the most important of these three first…issues related to the heart.

Is Triathlon Training Healthy for the Heart?

Exercise and regular activity are some of the best prescriptions a physician could write for her patients! In this modern world of a pill for every problem, you’d need a dozen or more different pills to even come close to the benefits of exercise, and it still wouldn’t be close. People who are routinely active have up to 50% fewer cardiac events in middle life than their sedentary comparisons. ^?4?

Some additional benefits include decreased depression and anxiety, lowered risk of dementia, stronger bones, fewer falls, lowered blood pressure, better lipid profile, fewer strokes, lowered risk of multiple types of cancer and more. Feel free to download the infographic here and share, or print it out and use it as a reminder of why you should exercise.

Cardiovascular Issues from Endurance Training

The benefits of exercise on the heart are well known. The heart accommodates and adapts to the demands we place on it in the same way our muscles adapt as we lift weights. Initially, there is some minor damage, and after recovery, the muscle rebuilds and repairs itself to be stronger and able to handle more stress. Some adaptations are normal and beneficial like the ones we already discussed. But others may be harmful and lead to sudden death, chronic abnormal heartbeats, or inability to pump blood adequately.

The amount of endurance training that leads to abnormal heart problems is still not completely known, but there does seem to be a sweet spot of about 20-30 minutes of moderate activity daily (ie a 15 minute/mile jog or walk, cycling at 15-20mph).^?5? Triathletes, marathoners and other endurance athletes often train 5-10 times more than these beneficial durations. Below I list several different types of abnormal adaptations from an abundance of endurance exercise. These fall into three categories of issues related to muscle tissue, blood flow, and electrical conduction.

Problems with Blood Flow

• Sudden blockage of an already narrowed artery causing a heart attack or leading to cardiac arrest
• Already narrowed arteries which may cause angina. Often early signs of angina are ignored or unrecognized.

Problems with Muscle Tissue:

• Thickening of muscle fibers causing blockage of blood flow (Hypertrophic Obstructive Cardiomyopathy)
• Scarring of muscle tissue causing myocardial fibrosis
• Stretching of muscle tissue causing cardiomyopathy or atrial fibrillation

Problems with the Electrical Conducting System of the Heart

• Atrial Fibrillation, often chronic, that may contribute to fatigue or cause strokes
• Ventricular Fibrillation caused by a heart attack. This results in complete collapse and loss of consciousness called a Cardiac Arrest, which is often deadly…more often than not.

Risks of Sudden Cardiac Death in Triathletes

Two case series articles have been published that sought to gather and categorize deaths occurring in triathletes. One was published a few years ago and at that time was the most comprehensive article dealing with the topic.

In the US, all identifiable deaths during USA Triathlon races between the years 1985 and 2006 were analyzed. The overall risk was 1.74 per 100 000 (2.40 in men and 0.74 in women). The rate did not seem to differ based on the type of event. Most of these deaths occurred during the swim leg. At autopsy, nearly half had cardiac-related abnormalities such as narrowed arteries or an enlarged heart.^?6?

In February of 2020, a similar case series was published in the UK that looked at triathlon related deaths between the years The overall risk of triathlon-related deaths in the UK was 0.5 per 100,000 participants. Of these half were thought to be due to pre-existing cardiac conditions.^?7?

The risk of dying during a triathlon due to a heart-related condition is not zero but it’s fairly low. Nevertheless, age is a risk factor for developing heart disease. If you have not had a cardiac evaluation by your primary care doctor, please make an appointment as soon as possible. Screening tests may include an electrocardiogram (EKG or ECG), an echocardiogram or an exercise stress test. If you have anyone in your family that has ever had heart disease make sure your physician knows this as well, as it increases your own risk.

Silent heart disease in athletes has been the cause of death in two personal friends of mine, and a third friend was successfully resuscitated after a bicycle ride. All had been healthy & active their entire lives, and their endurance activities most likely prolonged their lifespan. So please don’t let the fact that you’ve been active stop you from getting a checkup and screening with your physician.

Thank you so much for reading this far. Next up in my “Tri over Fifty” series, I’ll discuss the muscle-related side effect of aging called sarcopenia, and again will discuss the benefits of triathlon training in combatting this monster.