Aging and marathon times in an 81-year-old man who competed in 591 marathons.

I t has been hypothesized that the age-associated decline in maximal aerobic capacity (VO2max) is attenuated in healthy endurancetrained athletes who continue to engage in habitual exercise compared with sedentary persons.1–6 However, data are disparate because some studies find no significant difference between the absolute decline in VO2max with age in athletes and their sedentary peers,7,8 or they find even greater absolute decreases in VO2max with age in athletes than in sedentary people.9,10 Therefore, this hypothesis remains controversial. In this case report we chronicle 3 decades of marathon training, racing, and aerobic capacity testing over a 12-year period in an 81-year-old man who has run 591 marathons. This study was approved by the University of Maryland Institutional Review Board and the subject signed informed consent for participation in this study. • • • An 81-year old white man began running marathons at the age of 49. As of December 1, 2001, he had competed in 591 marathons. Over the course of his running career, he kept detailed training logs reflecting total mileage, number of races, yearly best race times, and yearly race time averages. As part of a larger study in master athletes,7,9,11 starting at age 68 years, this man also made 6 visits to our facility over a 12-year period for measurement of VO2max. Eligibility criteria for entry into the master athlete study, as previously described,7 included: (1) exercised vigorously 4 times/week, with a VO2max 2.5 SDs above the ageadjusted norm1; (2) nonobese (body mass index 26 kg · m); and (3) no history of coronary artery disease, diabetes mellitus, hyperlipidemia, or hypertension. VO2max was determined using a modified Balke protocol as previously described.9 Initially, the treadmill speed was set to produce approximately 70% of the subject’s predicted maximal heart rate. The elevation of the treadmill was increased from 0% to 4% after 2 minutes, to 6% after 4 minutes, and then increased by 2% every minute until the subject reached voluntary exhaustion, and could not continue to exercise. For the first test, ventilation was collected through a low-resistance, low-dead space, 3-way mixing valve (Otis McKerrow, Bayview Medical, Baltimore, Maryland) into a mixing chamber and a 120-L Tissot spirometer. The expired gas concentrations were measured every 30 seconds using Beckman carbon dioxide and oxygen analyzers (Beckman Industries, Fullerton, California). For the subsequent follow-up tests, the expired gas concentrations were measured every 20 seconds via indirect calorimetry using a Sensor Medics 2900 Metabolic Cart (Yorba Linda, California). All VO2max tests fulfilled the following criteria: (1) heart rate at maximal exercise 95% of the age-predicted maximal heart rate; (2) respiratory exchange ratio 1.10; and (3) VO2 reaching a plateau during the final stage of exercise (i.e., the increase in VO2 was 0.2 L · min 1 during the final increase in workload. VO2max is expressed in L · min , or in ml · kg 1 · min . During the first decade of training, there was initially a decrease in his yearly best marathon time (Figure 1). He achieved his personal best marathon time at age 51 years. His yearly best marathon race times remained fairly constant, approximately 230 minutes/ race, until age 64 years. From age 65 to 73, there was another plateau in his marathon race times. His average race time was approximately 260 minutes. There was a marked and progressive deterioration in his marathon times as he approached his ninth decade of life, due largely to the fact that he was now walking, not running during much of the marathon. The subject noted that over the 3 decades, his focus had changed from improving his marathon performance to increasing the number of marathons completed. Average weekly mileage during the first decade of training was 28 miles · week , followed by 33 miles · week 1 for the second and third decade (Figure 2). It is noteworthy that his average weekly miles of training per week peaked at 42 miles/week at age 72 years. The number of marathons completed each year increased from approximately 6/year in the first decade to 20/year in the third decade. The number of marathons run per year peaked at 38/year at age 73 (Figure 2). Between the ages of 70 and 80 years, he competed in 320 marathons. At age 81 he competed in 24 marathons. Measurements of VO2max from age 68 to age 80 are shown in Figure 3. Between ages 68 and 72 years, his VO2max was unchanged at approximately 43 ml · kg 1 · min . A marked decrease in VO2max was noted at the age 76. There was a continued decrease in From the Department of Medicine, Division of Gerontology, University of Maryland School of Medicine and Geriatrics Research Education and Clinical Center, Baltimore Veteran Affairs Medical Center, Baltimore, Maryland. This work was supported by Grant K24 AG 00930 from the National Institute on Aging; training Grant T32 AG00219 from the National Institutes of Health, Bethesda, Maryland; and a grant from the Department of Veteran Affairs Geriatric Research, Education, and Clinical Center, Washington, DC. Dr. Katzel’s address is: Baltimore VA Medical Center BT/18/GR, Baltimore, Maryland, 21201. E-mail: lkatzel@grecc.umaryland. edu. Manuscript received October 30, 2002; revised manuscript received and accepted January 13, 2003.