Tom Brady will keep playing football, older athletes can, too

Tom Brady plans to play after 40, and doctors say so should you.

Tom Brady, the 39-year-old New England Patriots quarterback who just won his fifth Super Bowl, says he isn't retiring. That may be disappointing to his wife, the Atlanta Falcons and Ravens fans. But it may be reassuring to many 40-plus amateur athletes. Dr. Louis Kovacs, a physician at the Arnold Palmer SportsHealth Center at MedStar Union Memorial Hospital, explains what older athletes who want to keep playing their favorite sport should look out for as they age actively.

For people who routinely exercise or play a sport, should they scale back or make changes after 40?

It is certainly important to continue physical activity well into adulthood, given the wide-ranging benefits of exercise. Generally speaking, as we age it gets harder to maintain bone and muscle mass, and we tend to gain more fat. Most individuals reach their peak bone mass some time in their 20s. A steady, slow decline in bone mass usually occurs thereafter. Bones are constantly adapting to the forces on them, and weight-bearing exercise in moderation like walking, jogging or running stimulates the bones to stay strong. There's no convincing evidence that running is better for this than walking, so pick something you enjoy and can stick with. The bones need fuel to respond, so it's important to have enough calcium and vitamin D. Maintaining muscle mass and strength is also beneficial for overall health and injury prevention, so doing some kind of resistance training (e.g., weights, plyometrics) is important. In the already active 40- or 50-something (and above), it is important to pay attention to the normal declines in strength, muscle mass, bone mass, flexibility and ability to recover that come with aging, and adjust your workout routine accordingly. That often means special attention to a proper warm-up to activate the muscles and reduce injury risk, and to cool-down and stretching after activities. It may also mean breaking up the routine that worked for you in your younger years and mixing in some cross-training. Doing the same routine day in and day out can lead to patterns of overuse and injury. Mix it up with a variety of weight-bearing/impact (e.g., running) and nonweight-bearing (e.g., cycling, elliptical, rowing, [cross country] skiing) cardiovascular activities, as well as some strength training.

What kinds of athletic problems are people most likely to face as they age?

Athletic injuries in adulthood generally come in a few types. Many of these are faced by younger athletes, and some are specific to the older athlete. There are the overuse injuries like tendinitis and stress fracture that come from doing the same thing over and over again without allowing the body to adequately recover and heal. The recovery process takes longer as we age, so it's important to recognize that and build it in to the weekly routine. Then there are the seemingly more sudden and acute injuries like tendon/ligament/muscle tears and traumatic fractures. Sometimes those are just bad luck, but sometimes they're the result of improper preparation for an activity. The later group we see frequently in our "weekend warriors." Someone who's relatively sedentary, with inadequate muscle strength, flexibility, and/or bone strength may find themselves out of their depth and at increased risk of injury as a 40 or 50 year old doing something they may have taken for granted in their younger years. Preparation is key, and is all the more important as we age. It takes more than just doing some stretches or a brief jog before playing a flag football game, for instance, with athletes half your age. It takes time to prepare the body to accept those stresses, and that means training to play rather than just going out and playing if it's been weeks, months, or years since the last time.

How should they respond to a sudden or even gradual ache or pain?

Basic initial care of an injury is important. Identify the site of pain and what makes it better or worse, then listen to your body and follow its recommendations. If it hurts to run, take a break from that for a few days. If it hurts even to walk, spend some time off your feet and think about seeing a physician sooner rather than later. If it hurts to do overhead lifting or "axial loading" activities (think squats, dead lifts and related movements), then take a break from those as well. The old abbreviation RICE (rest, ice, compression, elevation) applies here, but I prefer a somewhat updated version: POLICE. That stands for protect (perhaps with a bandage, dressing, or even a cast/splint/brace provided by a physician), off-load (take stress and/or weight off the area of injury; notice this has replaced "rest" and can minimize sedentary time and allow for some activities that don't affect the injury directly), ice, compression and elevation.

When is a trip to the doctor necessary?

This isn't so different from the recommendations I would make for a younger athlete. The main difference is that the older athlete tends to have more aches and pains that tend to be longer lasting and result from less dramatic circumstances. Sudden and severe pain warrants evaluation by a physician. Milder pain that doesn't resolve in a couple days, or that significantly affects activities or sleep should also be formally evaluated.

What is the importance of keeping active as you age?

In addition to the benefits to bone health, strength and injury risk, there is good evidence to suggest that exercise can improve cardiovascular health, reduce risk of diabetes, reduce risk of developing certain cancers, treat and reduce the risk of obesity and it's consequences, improve mood and reduce all-cause mortality.

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