The Masters Athlete

Ageing changes the athlete in predictable ways, though the rate varies and is strongly influenced by continued training. Aerobic capacity, measured as maximal oxygen uptake (VO2 max), declines with age, by roughly ten percent per decade in sedentary people, but the decline is smaller in those who keep training, and much of the observed fall in masters athletes tracks reductions in training volume rather than age alone. This ten percent figure is an approximate population observation rather than a fixed rate, and the decline varies with age, sex, training history and exercise mode. The cardiovascular changes include a consistently reduced maximal heart rate, with changes in maximal stroke volume, cardiac output and vascular stiffness that reflect several central and peripheral factors and vary between individuals.

Beyond the heart and lungs, the musculoskeletal system ages too. There is a gradual age-related loss of muscle mass, strength and power. When this becomes a clinical syndrome of low muscle strength with reduced muscle quantity or quality, and in severe cases reduced physical performance, it is termed sarcopenia. Bone density falls, particularly in women around and after the menopause, increasing the risk of stress injuries. Tendons and other soft tissues become less elastic, cartilage changes make osteoarthritis (OA) more likely, and recovery between hard sessions takes longer. Hormonal changes, including the menopause in women, add further effects. None of this means decline is inevitable in the trained athlete: maintained aerobic and resistance training preserves fitness and muscle far better than ageing alone would predict, which is why masters athletes are studied as examples of successful ageing.

The injuries seen in masters athletes reflect the physiology above. Overuse tendinopathy is common, and the Achilles and rotator cuff are frequently affected. Bone stress injuries are more likely where bone density has fallen. Muscle strains and osteoarthritis-related joint pain also become more common. These patterns reflect a combination of sport exposure, previous injury, training load, recovery, strength, bone health and other health conditions rather than ageing alone, and because recovery needs are often greater and highly individual, injuries from doing too much too soon are common, particularly when an athlete returns to sport or increases intensity quickly.

Health issues extend beyond injury. Cardiovascular risk rises with age and is the leading cause of exercise-related sudden death in this group, so it is assessed in its own right in the older athlete rather than assumed to be low because someone is fit. Bone health matters, especially in women around the menopause, where reduced oestrogen accelerates bone loss, and the menopause brings other symptoms that affect training. The need for longer recovery is itself a health issue, since inadequate recovery drives overuse injury and underperformance. None of this argues against sport: the health benefits of continued exercise in older age are substantial, and the clinical job is to enable safe participation rather than to discourage it.

Managing the masters athlete is about adapting training rather than restricting it. Training is individualised with adequate recovery built in, since recovery needs are highly individual and are often the limiting factor for older athletes. Resistance training is central, because it counters the age-related loss of muscle mass, strength and power, supports bone density, and protects joints by strengthening the muscles around them, and it is one of the most effective interventions in this group. Some higher-intensity work, such as intervals, helps preserve maximal oxygen uptake and power, but it can carry a higher injury risk in some older runners, so it is introduced with appropriate progression, scheduling and monitoring and balanced with lower-impact cross-training. Proprioception and balance work are targeted to demonstrated deficits, sport demands or falls risk rather than prescribed routinely, and regular mobility work maintains range of movement.

Nutrition and medical care complete the picture. Adequate dietary protein supports muscle maintenance, and attention to calcium and vitamin D supports bone health, prioritising dietary adequacy and individual assessment rather than assuming supplements are needed. Cardiovascular risk is managed actively, with the detailed assessment of the older athlete addressed on its own page, and the menopause is supported where relevant. Osteoarthritis risk is increased by previous joint injury and some high-level sporting exposures, but regular activity remains beneficial, and osteoarthritis is managed with exercise, load management and the wider non-operative approach rather than avoidance of activity. The overarching aim is to keep the masters athlete training and competing for as long as possible, treating age-related change as something to work around and mitigate rather than as a reason to stop, which is exactly why masters athletes serve as a model of healthy ageing.

• •The masters athlete is generally aged 35 and over (varies by sport) and is a model of healthy ageing; maintained training attenuates much age-related decline.
• •Maximal oxygen uptake falls by roughly ten percent per decade in sedentary people, but the decline is smaller with maintained training and tracks training volume; maximal heart rate and cardiac output also fall.
• •Age-related loss of muscle mass, strength and power (a clinical syndrome termed sarcopenia when it meets defined criteria) and reduced bone density (especially in women around the menopause) are key changes.
• •Common injuries include overuse tendinopathy, bone stress injuries, muscle strains, osteoarthritis-related pain, and Achilles and rotator cuff problems.
• •Resistance training is central (countering age-related muscle loss and supporting bone and joints); some interval work helps preserve maximal oxygen uptake but can carry higher injury risk, so progress with appropriate scheduling and monitoring.
• •Assess cardiovascular risk in its own right, support bone health with adequate dietary protein, calcium and vitamin D, and manage the menopause and osteoarthritis rather than discouraging exercise.