P ART I Nutritional Concerns of Athletes
CHAPTER 5 CHAPTER 5 Nutritional Concerns of Elderly Athletes
B. Foods
The older athlete should consume a varied diet that includes six or more servings of bread, fortified cereals, rice, and pastas, focusing on whole-grain and enriched foods. These food choices make important contributions of dietary fiber and folic acid. Foods fortified with folate may help the elderly to lower blood homocysteine levels, possibly reducing the risk of cardiovascular disease.172
Three or more servings of deeply colored (green, orange, yellow) vegetables should be eaten daily to provide vitamin C, folic acid, vitamin A, and fiber. Cruciferous vegetables (beets, broccoli, cabbage, kale), which contain antioxidant phytochemicals, are recommended for their potential to prevent cancer.172
Two or more servings of fruit are recommended every day. To contribute dietary fiber, eating whole fruit rather than fruit juice is recommended.172
Three servings of dairy products (milk, yogurt, cheese) should be eaten daily, making an effort to choose low-fat products. These foods are important sources of protein, calcium, riboflavin, and vitamin D (fortified milk and yogurt).172
Meats, poultry, fish, dry beans, eggs, and nuts should provide two or more servings per day, with food choices made based on variety, preference, availability, cost, ease of preparation, and tenderness.172 Lean cuts of red meats should be chosen no more than twice per week, with portion sizes limited to about 3 oz. (~85 g). Fish, a good source of omega-3 fatty acids, may lower the risk of cardiovascular disease if consumed at least once every week. Dry-bean dishes provide dietary fiber and protein. Eggs are an excellent source of reference protein,190 and nuts may be cardiopro- tective if eaten weekly in modest amounts of about 5 oz. (~142 g), by virtue of their omega-3 fatty acids and mostly unsaturated fats.262
Fats, oils, and sweets should be used sparingly, especially in the older adult, whose energy needs have declined. The general guidelines for the U.S. population, that total fat intake should be
≤ 30% of energy, with saturated fat limited to 8–10% of energy, and cholesterol ≤ 300 mg/d,186 should be applicable to the older adult populations.172,263 Most would agree that trans fatty acids,
Figure 5.2 The modified food guide pyramid for people over seventy years of age. (Adapted from Russell, R.
M., et al., J. Nutr. 129:751-753, 1999. With permission.) 8199/C05/frame Page 90 Thursday, August 10, 2000 3:44 AM
NUTRITIONAL CONCERNS OF ELDERLY ATHLETES 91
found mostly in products containing hydrogenated fats, should be limited because of adverse effects similar to, or greater than, those of saturated fats,172,263-267 while others believe that more convincing evidence is needed.268-270
Many older adults may not be receiving maximum nutritional benefits from calcium and vitamins B12 and D, for reasons mentioned above, and may therefore need to take dietary supple- ments of one or more of these nutrients.172 Several research reports99,271,272 and reviews273-276 contain recommendations regarding indications, contraindications, and doses.
V. SUMMARY
In the next 30 years, the proportion of the U.S. population aged 65 years and over is expected to increase to 20%. The process of aging is characterized by tendencies toward involution and functional impairment, and most people can expect an increased proportion of abdominal fat, reduced lean body mass, and reduced bone mineral density to accompany aging.
Regular physical exercise, consisting of a balanced aerobic and resistance-training exercise regimen, can modify many of the aging-related physiological and metabolic changes and improve quality-of-life factors for the older adult. Even the frail elderly and the very-old elderly groups can participate in well-planned, low-risk, life-improving exercise programs.
Group heterogeneity, lower energy requirements, greater likelihood of morbidity and use of pharmaceuticals will dictate individual exercise and nutrition prescriptions. Choices of foods with greater nutrient density, dietary fiber, and disease-preventing nutrients should be emphasized.
Adequate hydration and the need for a deliberate rehydration plan are especially important for physically active elders.241 Supplements of calcium, vitamin D and vitamin B12, nutrients that for many of the elderly may be inadequately ingested, absorbed or metabolized, should be considered.
Finally, we cannot overemphasize the importance of seeking qualified, continuing medical and dietary advice to individualize the exercise and nutrition program for optimum health and longevity.
REFERENCES
1. Rock, C. L., Nutrition and the older athlete, in Nutrition in Exercise and Sport, 3rd ed., Driskell, J.
and Wolinsky, I., Eds., CRC Press, Boca Raton, FL, 1998, pp. 481-494.
2. Crespo, C. J., Keteyian, S. J., Heath, G. W., and Sempos, G. T., Leisure-time physical activity among U.S. adults. Results from the third national health and nutrition examination survey, Arch. Intern.
Med., 156, 93, 1996.
3. Yusuf, H. R., Croft, J. B., Giles, W. H., Anda, R. F., Casper, M. L., Caspersen, C. J., and Jones, D.A., Leisure-time physical activity among older adults. 1990, Arch. Intern. Med., 156, 1321, 1996.
4. Wilcox, S. and Storandt, M., Relations among age, exercise, and psychological variables in a com- munity sample of women, Health Psychol., 15, 110, 1996.
5. Lee, C., Factors related to the adoption of exercise among older women, J. Behav. Med., 16, 323, 1993.
6. O’Brien, S. J. and Vertinsky, P. A., Unfit survivors: exercise as a resource for aging women, Geron- tologist, 31, 347, 1991.
7. Wilcox, S., Age and gender in relation to body attitudes. Is there a double standard of aging?, Psychol.
Women Quart., 21, 549, 1997.
8. Hobbs, F. B. and Damon, B. L., U.S. Bureau of the Census, Current Population Reports, Special Studies, P23-190, 65+ in the United States, U.S. Government Printing Office, Washington, D.C., 1996, p. 8-3.
9. Day, J. C., U.S. Bureau of the Census, Current Population Reports, P25-1130, Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050, U.S. Government Printing Office, Washington, D.C., 1996, p. 9.
8199/C05/frame Page 91 Thursday, August 10, 2000 3:44 AM
92 NUTRITIONAL APPLICATIONS IN EXERCISE AND SPORT
11. Hobbs, F. B. and Damon, B. L., U.S. Bureau of the Census, Current Population Reports, Special Studies, P23-190, 65+ in the United States, U.S. Government Printing Office, Washington, D.C., 1996, p. 1-1.
10. Chernoff, R., Baby boomers come of age: nutrition in the 21st century, J. Am. Diet. Assoc., 95, 650, 1995.
12. U.S. Bureau of the Census, Current Population Reports, Special Studies, P23-193, How We’re Chang- ing. Demographic State of the Nation: 1997, U.S. Government Printing Office, Washington, D.C., 1997, p. 1.
13. Ventura, S. J., Anderson, R. N., Martin, J. A., and Smith, B. L., Births and deaths: preliminary data for 1997, Nat. Vital Stat. Rep., 47, 5, 1998.
14. Pamuk, E., Makuc, D., Heck, K., Reuben, C., and Lochner, K., Socioeconomic status and health chartbook. Health, United States, 1998, National Center for Health Statistics, Hyattsville, MD, 1998, 88.
15. Peters, K. D., Kochanek, K. D., and Murphy, S. L., Deaths: final data for 1996, Nat. Vital Stat. Rep., 47, 21, 1996.
16. McNeil, J. M., Americans With Disabilities: 1994-95, U.S. Bureau of the Census, Current Population Reports, Household Economic Studies No. P70-61, U.S. Government Printing Office, Washington, D.C., 1997, p. 2.
17. Nieman, D. C., Physical activity and aging, in Fitness and Sports Medicine, an Introduction, Bull Publishing, Palo Alto, CA, 1990, pp. 359-385.
18. Hunter, S. C., The ageless athlete, J. Med. Assoc. Ga., 81, 283, 1992.
19. Ausman, L. M. and Russell, R. M., Nutrition in the elderly, in Modern Nutrition in Health and Disease, 8th ed., Shils, M. E., Olson, J. A., and Shike, M., Eds., Lea and Febiger, Philadelphia, 1994, pp. 770- 780.
20. Evans, W. J., Effects of aging and exercise on nutrition needs of the elderly, Nutr. Rev., 54, S35, 1996.
21. Poehlman, E. T., Arciero, P. J., and Goran M. I., Endurance exercise in aging humans: effects on energy metabolism, Exerc. Sport Sci. Rev., 22, 251, 1994.
22. Voorrips, L. E., van Staveren, W. A., and Hautvast, J. G., Are physically active elderly women in a better nutritional condition than their sedentary peers? Eur. J. Clin. Nutr., 45, 545, 1991.
23. Visser, M., Harris, T. B., Langlois, J., Hannan, M. T., Roubenoff, R., Felson, D. T., Wilson, P. W., and Kiel, D. P., Body fat and skeletal muscle mass in relation to physical disability in very old men and women of the Framingham Heart Study, J. Gerontol. A. Biol. Sci. Med. Sci., 53, M214, 1998.
24. Fielding, R. A., The role of progressive resistance training and nutrition in the preservation of lean body mass in the elderly, J. Am. Coll. Nutr., 14, 587, 1995.
25. Evans, W. J. and Cyr-Campbell, D., Nutrition, exercise, and healthy aging, J. Am. Diet. Assoc., 97, 632, 1997.
26. Evans, W. J. and Campbell, W. W., Sarcopenia and age-related changes in body composition and functional capacity, J. Nutr., 123, 465, 1993.
27. Sial, S., Coggan, A. R., Hickner, R. C., and Klein, S., Training-induced alterations in fat and carbo- hydrate metabolism during exercise in elderly subjects, Am. J. Physiol., 274, E785, 1998.
28. Calles-Escandon, J. and Poehlman, E. T., Aging, fat oxidation, and exercise, Aging (Milano), 9, 57, 1997.
29. American College of Sports Medicine Position Stand. Exercise and physical activity for older adults, Med. Sci. Sports Exerc., 30, 992, 1998.
30. Evans, W. J., Exercise, nutrition, and aging, Clin. Geriatr. Med., 11, 725, 1995.
31. Chandler, J. M. and Hadley, E. C., Exercise to improve physiologic and functional performance in old age, Clin. Geriatr. Med., 12, 761, 1996.
32. Whipple, R. H., Wolfson, L. I., and Amerman, P. M., The relationship of knee and ankle weakness to falls in nursing home residents, J. Am. Geriatr. Soc., 35, 13, 1987.
33. Blair, S. N., Physical activity, physical fitness, and health, Res. Q. Exerc. Sport, 64, 365, 1993.
34. McArdle, W. D., Katch, F. I., and Katch, V. L., Physical activity, health, and aging, in Exercise Physiology: Energy, Nutrition, and Human Performance, 4th ed., Williams and Wilkins, Baltimore, 1996, pp. 634-668.
35. Sipila, S., Viitsalo, J., Era, P., and Suominen, H., Muscle strength in male athletes aged 70-81 years and a population sample, Eur. J. Appl. Physiol., 63, 399, 1991.
8199/C05/frame Page 92 Thursday, August 10, 2000 3:44 AM
NUTRITIONAL CONCERNS OF ELDERLY ATHLETES 93
36. Brooks, S. V. and Faulkner, J. A., Skeletal muscle weakness in old age: underlying mechanisms, Med.
Sci. Sports Exerc., 26, 432, 1994.
37. Grimby, G., Muscle performance and structure in the elderly as studied cross-sectionally and longi- tudinally, J. Gerontol. A Biol. Sci. Med. Sci., 50, 17, 1995.
38. Monemi, M., Eriksson, P. O., Eriksson, A., and Thornell, L. E., Adverse changes in fibre-type composition of the human masseter versus biceps brachii muscle during aging, J. Neurol. Sci., 154, 35, 1998.
39. Doherty, T. J., Vandervoort, A. A., Taylor, A. W., and Brown, W. F., Effects of motor unit losses on strength in older men and women, J. Appl. Physiol., 74, 868, 1993.
40. Booth F. W., Weeden, S. H., and Tseng, B. S., Effect of aging on human skeletal muscle and motor function, Med. Sci. Sports Exerc., 26, 556, 1994.
41. Brown, A. B., McCartney, N., and Sale, D. G., Positive adaptations to weight-lifting training in the elderly, J. Appl. Physiol., 69, 1725, 1990.
42. Aniansson, A., Grimby, G., and Hedberg, M., Compensatory muscle fiber hypertrophy in elderly men, J. Appl. Physiol., 73, 812, 1992.
43. Roman, W. J., Fleckenstein, J., Stray-Gundersen, J., Alway, S. E., Peshock, R., and Gonyea, W. J., Adaptations in the elbow flexors of elderly males after heavy-resistance training, J. Appl. Physiol., 74, 750, 1993.
44. Treuth, M. S., Ryan, A. S., Pratley, R. E., Rubin, M. A., Miller, J. P., Nicklas, B. J., Sorkin, J., Harman, S. M., Goldberg, A. P., and Hurley, B. F., Effects of strength training on total and regional body composition in older men, J. Appl. Physiol., 77, 614, 1994.
45. Meredith, C. N., Frontera, W. R., and Evans, W. J., Body composition in elderly men: effect of dietary modification during strength training, J. Am. Geriatr. Soc., 40, 155, 1992.
46. Fiatarone, M. A., O’Neill, E. F., Ryan, N. D., Clements, K. M., Solares, G. R., Nelson, M. E., Roberts, S. B., Kehayias, J. J., Lipsitz, L. A., and Evans, W. J., Exercise training and nutritional supplementation for physical frailty in very elderly people, New Engl. J. Med., 330, 1769, 1994.
47. Campbell, W. W., Joseph, L. J., Davey, S. L., Cyr-Campbell, D., Anderson, R. A., and Evans, W. J., Effects of resistance training and chromium picolinate on body composition and skeletal muscle in older men, J. Appl. Physiol., 86, 29, 1999.
48. Bermon, S., Venembre, P., Sachet, C., Valour, S., and Dolisi, C., Effects of creatine monohydrate ingestion in sedentary and weight-trained older individuals, Acta Physiol. Scand., 164, 147, 1998.
49. Brown, M., Special considerations during rehabilitation of the aged athlete, Clin. Sports Med., 8, 893, 1989.
50. Seto, J. L. and Brewster, C. E., Musculoskeletal conditioning of the older athlete, Clin. Sports Med., 10, 401, 1991.
51. Aniansson, A. and Gustafsson, E., Physical training in elderly men with special reference to quadriceps muscle strength and morphology, Clin. Physiol., 1, 87, 1981.
52. Lowenthal, D. T., Kirschner, D. A., Scarpace, N. T., Pollock, M., and Graves, J., Effects of exercise on age and disease, South. Med. J., 87, S5, 1994.
53. Frontera, W. R., Meredith, C. N., O’Reilly, K. P., Knuttgen, H. G., and Evans, W. J., Strength conditioning in older men: skeletal muscle hypertrophy and improved function, J. Appl. Physiol., 64, 1038, 1988.
54. Stamford, B. A., Exercise and the elderly, Exerc. Sport Sci. Rev., 16, 341, 1988.
55. Lowenthal, D. T., Kendrick, Z. V., and Powers, S., The effects of exercise training on skeletal muscle in humans and aging Fischer 344 rats, in Musculoskeletal Soft-Tissue Aging: Impact on Mobility, Buckwalter, J. A., Goldberg, V. M., and Woo, S. L.-Y., Eds., American Academy of Orthopaedic Surgeons, Rosemont, IL, 1993, 201.
56. Durnin, J. V. and Wormersley, J., Body fat assessed from total body density and its estimation from skinfold thickness: measurements of 481 men and women aged from 16 to 72 years, Br. J. Nutr., 32, 77, 1974.
57. Voorrips, L. E., Lemmink, K. A., van Heuvelen, M. J., Bult, P., and van Staveren, W. A., The physical condition of elderly women differing in habitual physical activity, Med. Sci. Sports Exerc., 25, 1152, 1993.
58. Schlienger, J. L., Pradignac, A., and Grunenberger, F., Nutrition of the elderly: a challenge between facts and needs, Horm. Res., 43, 46, 1995.
8199/C05/frame Page 93 Thursday, August 10, 2000 3:44 AM
94 NUTRITIONAL APPLICATIONS IN EXERCISE AND SPORT
59. Seim, H. C. and Holtmeier, K. B., Treatment of obesity in the elderly, Am. Fam. Physician, 47, 1183, 1993.
60. Ortega, R. M. and Andres, P., Is obesity worth treating in the elderly? Drugs and Aging, 12, 97, 1998.
61. Bidlack, W. R., Interrelationships of food, nutrition, diet and health: the National Association of State Universities and Land Grant Colleges White Paper, J. Am. Coll. Nutr., 15, 422, 1996.
62. Carek, P. J., Sherer, J. T., and Carson, D. S., Management of obesity: medical treatment options, Am.
Fam. Physician, 55, 551, 1997.
63. Ortega, R. M., Fernandez-Azuela, M., Encinas-Sotillos, A., Andres, P., and Lopez-Sobaler, A. M., Differences in diet and food habits between patients with gallstones and controls, J. Am. Coll. Nutr., 16, 88, 1997.
64. Westerterp, K. R., Alterations in energy balance with exercise, Am. J. Clin. Nutr., 68, 970S, 1998.
65. Hoyert, D. L., Kochanek, K. D., and Murphy, S. L., Deaths: final data for 1997, Nat. Vital Stats. Rep., 47, 8, 1999.
66. Weisfeldt, M., Aging, changes in the cardiovascular system, and responses to stress, Am. J. Hypertens., 11, 41S, 1998.
67. Salmasi, A. M. and Dore, C., Variation of aortic blood velocity with age at rest and during exercise in normal subjects, Clin. Auton. Res., 5, 19, 1995.
68. Lindeman, R. D., Tobin, J., and Shock, N. W., Longitudinal studies on the rate of decline in renal function with age, J. Am. Geriatr. Soc., 33, 278, 1985.
69. Marin, J., Age-related changes in vascular responses: a review, Mech. Aging Dev., 79, 71, 1995.
70. Pickering, G. P., Fellmann, N., Morio, B., Ritz, P., Amonchot, A., Vermorel, M., and Coudert, J., Effects of endurance training on the cardiovascular system and water compartments in elderly subjects, J. Appl. Physiol., 83, 1300, 1997.
71. Siscovick, D. S., Fried, L., Mittelmark, M., Rutan, G., Bild, D., and O’Leary, D. H., Exercise intensity and subclinical cardiovascular disease in the elderly. The Cardiovascular Health Study, Am. J. Epide- miol., 145, 977, 1997.
72. Yataco, A. R., Fleisher, L. A., and Katzel, L. I., Heart rate variability and cardiovascular fitness in senior athletes, Am. J. Cardiol., 80, 1389, 1997.
73. Public health focus: physical activity and the prevention of coronary heart disease, Morb. Mortal.
Wkly. Rep., 42, 669, 1993.
74. Blair, S. N., Physical activity, fitness, and coronary heart disease, in Physical Activity, Fitness, and Health. International Proceedings and Consensus Statement, Bouchard, C., Shephard, R. J., and Stephens, T., Eds., Human Kinetics Publishers, Champaign, IL, 1994, pp. 579-590.
75. Whaley, M. H. and Blair, S. N., Epidemiology of physical activity, physical fitness and coronary heart disease, J. Cardiovasc. Risk, 2, 289, 1995.
76. Leon, A. S., Myers, M. J., and Connett, J., Leisure time physical activity and the 16-year risks of mortality from coronary heart disease and all causes in the Multiple Risk Factor Intervention Trial (MRFIT), Int. J. Sports Med., 18, S208, 1997.
77. De Backer, G., Physical activity and psychosocial variables in atherosclerosis, Acta Cardiol. Suppl., 29, 107, 1988.
78. Moore, S., Physical activity, fitness, and atherosclerosis, in Physical Activity, Fitness, and Health.
International Proceedings and Consensus Statement, Bouchard, C., Shephard, R. J., and Stephens, T., Eds., Human Kinetics Publishers, Champaign, IL, 1994, pp. 570-578.
79. Bernadet, P., Benefits of physical activity in the prevention of cardiovascular diseases, J. Cardiovasc.
Pharmacol., 25, S3, 1995.
80. Fletcher, G. F., The antiatherosclerotic effect of exercise and development of an exercise prescription, Cardiol. Clin., 14, 85, 1996.
81. Niebauer, J. and Cooke, J. P., Cardiovascular effects of exercise: role of endothelial shear stress, J.
Am. Coll. Cardiol., 28, 1652, 1996.
82. American College of Sports Medicine. Position Stand. Physical activity, physical fitness, and hyper- tension, Med. Sci. Sports Exerc., 25, i, 1993.
83. Fagard, R. H. and Tipton, C. M., Physical activity, fitness, and hypertension, in Physical Activity, Fitness, and Health. International Proceedings and Consensus Statement, Bouchard, C., Shephard, R. J., and Stephens, T., Eds., Human Kinetics Publishers, Champaign, IL, 1994, pp. 633-655.
8199/C05/frame Page 94 Thursday, August 10, 2000 3:44 AM
NUTRITIONAL CONCERNS OF ELDERLY ATHLETES 95
84. Miller, N. H., Physical activity: one approach to the primary prevention of hypertension, Am. Assoc.
Occupat. Health Nurs. J., 43, 319, 1995.
85. Borhani, N. O., Significance of physical activity for prevention and control of hypertension, J. Hum.
Hypertens., 10, S7, 1996.
86. Yang, Y. C., Huang, S. C., Wu, J. S., and Chang, C. J., Community-based study on the relationship between physical activity and hypertension, J. Formos. Med. Assoc., 95, 110, 1996.
87. Folsom, A. R., Arnett, D. K., Hutchinson, R. G., Liao, F., Clegg, L. X., and Cooper, L. S., Physical activity and incidence of coronary heart disease in middle-aged women and men, Med. Sci. Sports Exerc., 29, 901, 1997.
88. Garber, C. E., The benefits of physical activity on coronary heart disease and coronary heart disease risk factors in women, Women’s Health Issues, 7, 17, 1997.
89. Haapanen, N., Miilunpalo, S., Vuori, I., Oja, P., and Pasanen, M., Association of leisure time physical activity with the risk of coronary heart disease, hypertension and diabetes in middle-aged men and women, Int. J. Epidemiol., 26, 739, 1997.
90. Lip, G. Y., Luscombe, C., McCarry, M., Malik, I., and Beevers, G., Ethnic differences in public health awareness, health perceptions and physical exercise: implications for heart disease prevention, Ethn.
Health., 1, 47, 1996.
91. Pereira, M. A., Folsom, A. R., McGovern, P. G., Carpenter, M., Arnett, D. K., Liao, D., Szklo, M., and Hutchinson, R. G., Physical activity and incident hypertension in black and white adults: the Atherosclerosis Risk in Communities Study, Prev. Med., 28, 304, 1999.
92. Lewis, R. D. and Modlesky, C. M., Nutrition, physical activity, and bone health in women, Int. J.
Sports Nutr., 8, 250, 1998.
93. Wolinsky, I., Taylor, P. N., Klimis-Tavantzis, D. J., and Arnaud, S. B., Calcium nutrition in the elderly, in Handbook of Nutrition in the Aged, 2nd ed., Watson, R. R., Ed., CRC Press, Boca Raton, FL, 1994, pp. 355-362.
94. Fahey, P. J., Boltri, J. M., and Monk, J. S., Key issues in nutrition. Supplementation through adulthood and old age, Postgrad. Med., 81, 123, 1987.
95. Rosen, C. J., Morrison, A., Zhou, H., Storm, D., Hunter, S. J., Musgrave, K., Chen, T., Wei, W., and Holick, M. F., Elderly women in northern New England exhibit seasonal changes in bone mineral density and calciotropic hormones, Bone Miner., 25, 83, 1994.
96. Boucher, B. J., Inadequate vitamin D status: does it contribute to the disorders composing syndrome
‘X’?, Br. J. Nutr., 79, 315, 1998.
97. Mosekilde, L., Minisymposium, osteoporosis, and calcium, J. Intern. Med., 231, 145, 1992.
98. Singh, M. A., Combined exercise and dietary intervention to optimize body composition in aging, Ann. N. Y. Acad. Sci., 854, 378, 1998.
99. Storm, D., Eslin, R., Porter, E. S., Musgrave, K., Vereault, D., Patton, C., Kessenich, C., Mohan, S., Chen, T., Holick, M. F., and Rosen, C. J., Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo-controlled trial, J. Clin. Endocrinol. Metab., 83, 3817, 1998.
100. Lane, J. M. and Nydick, M., Osteoporosis: current modes of prevention and treatment, J. Am. Acad.
Orthop. Surg., 7, 19, 1999.
101. O’Connell, M. B., Prevention and treatment of osteoporosis in the elderly, Pharmacotherapy, 19, 7S, 1999.
102. Butler, R. N., Davis, R., Lewis, C. B., Nelson, M. E., and Strauss, E., Physical fitness: benefits of exercise for the older patient. 2, Geriatrics, 53, 46, 1998.
103. Burckhardt, P., Are hip fractures preventable with nutrition measures and exercise in the elderly?, Osteoporosis Int., 3, S56, 1996.
104. Nelson, M. E., Fiatarone, M. A., Morganti, C. M., Trice, I., Greenberg, R. A., and Evans, W. J., Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures, J. Am. Med.
Assoc., 272, 1909, 1994.
105. Iwamoto, J., Takeda, T., Otani, T., and Yabe, Y., Effect of increased physical activity on bone mineral density in postmenopausal osteoporotic women, Keio J. Med., 47, 157, 1998.
106. Layne, J. E. and Nelson, M. E., The effects of progressive resistance training on bone density: a review, Med. Sci. Sports Exerc., 31, 25, 1999.
8199/C05/frame Page 95 Thursday, August 10, 2000 3:44 AM
96 NUTRITIONAL APPLICATIONS IN EXERCISE AND SPORT
107. Bassey, E. J., Rothwell, M. C., Littlewood, J. J., and Pye, D. W., Pre- and postmenopausal women have different bone mineral density responses to the same high-impact exercise, J. Bone Miner. Res., 13, 1805, 1998.
108. Bemben, D. A., Exercise interventions for osteoporosis prevention in postmenopausal women, J. Okla.
State Med. Assoc., 92, 66, 1999.
109. Kelley, G. A., Aerobic exercise and bone density at the hip in postmenopausal women: a meta-analysis, Prev. Med., 27, 798, 1998.
110. Voss, L. A., Fadale, P. D., and Hulstyn, M. J., Exercise-induced loss of bone density in athletes, J.
Am. Acad. Orthop. Surg., 6, 349, 1998.
111. Crespo, R., Revilla, M., Villa, L. F., Usabiaga, J., Leibar, X., and Rico, H., Transient dissociation of bone metabolism induced by high performance exercise: a study in elite marathon runners, Calcif.
Tissue Int., 64, 287, 1999.
112. Grisso, J. A., Kelsey, J. L., O’Brien, L. A., Miles, C. G., Sidney, S., Maislin, G., LaPann, K., Moritz, D., and Peters, B., Risk factors for hip fracture in men. Hip Fracture Study Group, Am. J. Epidemiol., 145, 786, 1997.
113. Schwartz, A. V., Kelsey, J. L., Sidney, S., and Grisso, J. A., Characteristics of falls and risk of hip fracture in elderly men, Osteoporos. Int., 8, 240, 1998.
114. Slemenda, C., Prevention of hip fractures: risk factor modification, Am. J. Med., 103, 65S, 1997.
115. Dargent-Molina, P., Risk factors and prevention of fractures in the elderly, Curr. Opin. Rheumatol., 10, 357, 1998.
116. Hill, K., Schwarz, J., Flicker, L., and Carroll, S., Falls among healthy, community-dwelling, older women: a prospective study of frequency, circumstances, consequences and prediction accuracy, Aust.
N. Z. J. Pub. Hlth., 23, 41, 1999.
117. Joakimsen, R. M., Magnus, J. H., and Fnneb, V., Physical activity and predisposition for hip fractures:
a review, Osteoporos. Int., 7, 503, 1997.
118. Henderson, N. K., White, C. P., and Eisman, J. A., The roles of exercise and fall risk reduction in the prevention of osteoporosis, Endocrinol. Metab. Clin. North Am., 27, 369, 1998.
119. Kovar, P. A., Allegrante, J. P., MacKenzie, C. R., Peterson, M. G., Gutin, B., and Charlson, M. E., Supervised fitness walking in patients with osteoarthritis of the knee: a randomized controlled trial, Ann. Intern. Med., 116, 529, 1992.
120. Sinaki, M., Fitzpatrick, L. A., Ritchie, C. K., Montesano, A., and Wahner, H. W., Site-specificity of bone mineral density and muscle strength in women: job-related physical activity, Am. J. Phys. Med.
Rehabil., 77, 470, 1998.
121. Casper, R. C., Nutrition and its relationship to aging, Exp. Gerontol., 30, 299, 1995.
122. Saltzman, J. R. and Russell, R. M., The aging gut. Nutritional issues, Gastroenterol. Clin. North Am., 27, 309, 1998.
123. Clarkston, W. K., Pantano, M. M., Morley, J. E., Horowitz, M., Littlefield, J. M., and Burton, F. R., Evidence for the anorexia of aging: gastrointestinal transit and hunger in healthy elderly vs. young adults, Am. J. Physiol., 272, R243, 1997.
124. Kay, L. and Avlund, K., Abdominal syndromes and functional ability in the elderly, Aging (Milano), 6, 420, 1994.
125. O’Keefe, E. A., Talley, N. J., Zinsmeister, A. R., and Jacobsen, S. J., Bowel disorders impair functional status and quality of life in the elderly: a population-based study, J. Gerontol. A Biol. Sci. Med. Sci., 50, M184, 1995.
126. Webster, S. G. P. and Leeming, J. T., Assessment of small-bowel function in the elderly using a modified xylose tolerance test, Gut, 16, 109, 1975.
127. Castleden, C. M., Volans, C. N., and Raymond, K., The effect of aging on drug absorption from the gut, Age Aging, 6, 138, 1977.
128. Webster, S. G., Wilkinson, E. M., and Gowland, E., A comparison of fat absorption in young and old subjects, Age Aging, 6, 113, 1977.
129. Montgomery, R. D., Heaney, M. R., Ross, I. N., Sammons, H. G., Barford, A. V., Balakrishnan, S., Mayer, P. P., Culank, L. S., Field, J., and Gosling, P., The aging gut: a study of intestinal absorption in relation to nutrition in the elderly, Q. J. Med., 47, 197, 1978.
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