By Daryl Buchanan | News & Views

Cardiologist Elizabeth Dineen, DO, FACC, FAHA, wants the cardiopulmonary rehabilitation community to get familiar with masters athletes — and how individualized treatment plans should drive their care.

This category of athlete, aged 35 years and older, trains vigorously to meet performance goals, compete in organized events, and/or participate in recreational sports. However, this sustained level of physical activity may put them at risk for serious cardiac events. When masters athletes are evaluated by a cardiovascular professional, unique heart health issues may arise. Potential issues include atrial fibrillation and coronary atherosclerosis. Determining a safe amount of exercise is paramount for these fitness enthusiasts.

Dineen, who works with Mayo Clinic in Florida, will lead a live AACVPR webinar on June 30 that highlights the red flags to watch out for and what needs to be considered when caring for these masters athletes.

“This group includes people participating in Ironman competitions and marathons, but also people in recreational sports leagues like soccer, basketball, and pickleball. Overall, a masters athlete is pushing their body and exercising multiple times a week,” Dineen emphasizes.

While most studies show that exercise is beneficial for this population, she says the impact of strenuous physical activity points to wear and tear on the heart that needs to be better understood.

Despite the risks masters athletes may face, Dineen lists tools that can help cardiovascular professionals detect and treat these patients. Echocardiograms, MRIs, and CAT scans are among the options that can be used to find red flags in the heart. Coaches, sports cardiologists, and sports medicine physicians also play an important role in masters athletes’ treatment plans. They can inform an individualized return to sports exercise, guided by the exercise test. “When they have an understanding of the baseline of an athlete they can then plan ways to ramp up their cardiac rehab. There are medical papers that offer guidance for this approach,” explains Dineen.

The conversation surrounding this topic comes as data and research point to the reasons many masters athletes suffer cardiac events, coronary artery disease being a primary culprit. This visibility may also help debunk the mindset that physically fit individuals do not need cardiac rehab or evaluations to ensure their heart is healthy. Moreover, Dineen says it can reinforce how cardiac rehab can be helpful for all ages and fitness levels.

“A lot of athletes will get referred to cardiac rehab and they will say, “Oh, I’m not going to go. That’s for old people.” Or they will show up and see older patients who got an open heart surgery and not want to stay. I think it’s important to learn how we meet people where they are and make sure we offer an individualized and meaningful plan,” Dineen suggests.

Evaluation and treatment discussions surrounding masters athletes may also spur changes in how older performance athletes are treated by cardiac specialists. These individuals do report symptoms to their doctors, but there needs to be an awareness that closer examinations may be needed.

Dineen notes that staff at stress testing labs may stop people from exercising when their heart rate reaches a certain target. As a result, their physical limits are not fully evaluated. An incomplete test, in turn, could lead to false reassurances about health status. This scenario also leaves a patient with an exertional symptom that wasn’t revealed and was potentially left untreated.

Dineen hopes webinar attendees will gain a better understanding of masters athletes and how they can best be treated. “I think attendees will realize that exercise is still considered beneficial for basically everyone. You just have to individualize it. Learn about the various imaging and exercise tests that we do to help risk stratify this population,” Dineen says.

“Another important takeaway,” she concludes, “will be learning about the potential for a sports or athlete-based cardiac rehab pathway and how that can be customized as well, certainly as an area of ongoing discussion.”