Health in older women athletes

Highlights

• Physical activity in the past can be protective against osteoporosis in postmenopausal women.

• Former athletes are characterized by better endothelial function and metabolic profile.

• Former female athletes are at lower risk for developing breast cancer.

• Professional sport acts negatively on the pelvic floor and is a risk factor for urinary incontinence in future.

Abstract

Physical activity has been identified as a protective factor against a wide spectrum of diseases, but little is known about the link between older women's health and their professional involvement in sport in the past. The aim of this narrative review is to characterize and summarize the available data concerning the influence of physical activity on morbidity and mortality in former female athletes. Concerning bone health, it seems that physical activity in the past can be protective against osteoporosis in postmenopausal women, but these data come from observational studies only. Also the cardiovascular system appears to benefit in older women from regular sport in the past. This refers mainly to better heart efficiency, and improved endothelial function and metabolic profile. The incidence of different types of neoplasms, especially breast cancer, is also decreased in former athletes. Professional sport, on the other hand, acts negatively on the pelvic floor and is a risk factor for urinary incontinence. The overall effect on mortality is difficult to assess, because of many parameters, such as the sport's intensity, variety of the sport and exposure to extreme danger in some disciplines. Also, caution should be kept in interpretation of the data because of the shortage of well-designed studies.

Introduction

Physical activity is commonly recognized as healthy behavior and an important part of modern life. A large body of evidence shows that regular physical activity plays a protective role against the development of several conditions, such as cardiovascular disease (hypertension and thromboembolic stroke), type 2 diabetes, osteoporosis, obesity, colon cancer, breast cancer and psychiatric illness (depression and anxiety) [1]. Recently, some evidence has been found concerning a negative correlation between physical activity and cognitive decline among women [2]. According to the American College of Sports Medicine and the American Heart Association, “all healthy adults (between 18 and 65 years) need moderate-intensity aerobic physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week” to promote and maintain health [1]. It is also postulated that the health benefits related to physical activity are dose-dependent, and therefore individuals may benefit from increasing their amount of physical activity. On the other hand, intense physical effort in young women can lead to functional hypothalamic amenorrhea with profound hypoestrogenism. Strenuous exercise with a concomitant restrictive diet can further interfere with health, leading to the development of the female athlete triad (FAT), in which low energy availability coexists with amenorrhea and osteopenia or osteoporosis [3]. A typical finding in women affected by FAT is also endothelial dysfunction, which can later manifest itself as cardiovascular disease [3]. In this light, the relationship between physical activity and health seems to be ambiguous, changing from being positive when the sport activity is moderate, to negative when it becomes persistent and strenuous. Little is known about how professional sport can affect women's future health.

The aim of this narrative review is to characterize the health effects of physical activity in former women athletes. Specifically, we reviewed available data from the Medline database addressing questions regarding general health and specific conditions known to be affected by physical activity in women who were athletes in the past. The Medline database was accessed on July 15th 2014.