Nutrition for Older Athletes: Focus on Sex-Differences

TL;DR

This narrative review summarizes physiological, endocrine, bone, performance, and nutritional changes in older masters athletes, with emphasis on sex differences. It concludes that chronic exercise and adequate nutrition can favorably modify many age-related declines, but evidence specific to masters athletes remains limited and recommendations are often extrapolated from younger athletes and older non-athletes.

Key findings

• Aging reduces VO2max by approximately 10% per decade after the third decade, but training modulates this; examples include 81-year-old male endurance athletes with VO2max 38 (±1) vs. 21 (±1) mL/min/kg in age-matched untrained persons, an 83-year-old female masters runner with VO2max 42.3 mL/min/kg, and a 101-year-old athlete improving VO2max from 31 to 35 mL/min/kg over 2 years.
• Masters athletes often show better body composition than non-athletes: among 156 masters athletes aged 40–79, none were categorized as sarcopenic, and individuals aged 40–81 training 4–5 times/week showed no decline in lean muscle mass or strength. Still, decline occurs: 71 track-and-field masters had calf muscle cross-section decrease of 0.6%/year in men but no significant change in women; 256 track-and-field masters had whole-body skeletal muscle mass reduction of 3.2% per decade in women and 2.8% in men, offset by fat gain. In bone, male power athletes preserved or increased tibia bone mass/strength, while male endurance athletes and female track-and-field masters lost tibia epiphyseal bone mass at approximately 5% per decade.
• Nutrition risks and targets: low energy availability is <30 kcal/kg lean body mass/day; masters triathletes’ post-exercise energy and protein intakes were −40% (22.7 kJ/kg) and −25% (19.6 g) below younger-athlete recommendations, and female masters consumed 0.7 g/kg carbohydrate post-exercise vs. 1.0–1.2 g/kg recommended. Protein recommendations include ≥30 g/meal or ≥1.2 g/kg/day for older adults, 35–40 g/meal and ~1.5–1.6 g/kg/day for masters athletes, and 1.6–2.5 g/kg/day during injury. Vitamin D insufficiency is <50 nmol/L, deficiency <30 nmol/L, and optimal 75 nmol/L, with daily 1000 IU vitamin D3 suggested in winter. Probiotic supplementation with 1 × 10^10 CFUs for 12 weeks limited exercise-induced drops in tryptophan and reduced upper respiratory tract infection incidence.
• Sex differences: relative VO2max differs by about 10% between male and female athletes; performance sex differences were 12% for running, swimming, and cycling and 17% for cross-country skiing. Ages at which performance declined to 50% of the 30–35-year maximum were walking 90/84, swimming 87/84, jumping 78/72, and weightlifting 74/60 years (male/female); 200-m sprint cycling performance halved at 80 years in men vs. 59 years in women. Strength differences between sexes are largely explained by muscle size, with similar relative strength and hypertrophy changes after resistance training.

Methods

• Narrative review; the authors state they collate relevant information to provide recommendations where evidence is available and to flag open questions, rather than conducting a systematic review or meta-analysis.
• Synthesizes cited literature across oxygen delivery/utilization, body composition and metabolism, endocrine aging, bone metabolism, performance/trainability, and nutrition/immune/microbiota in masters athletes and older adults, including human cross-sectional, longitudinal, and intervention studies plus rodent mitochondria studies.
• No primary data collection, and no systematic search strategy, inclusion criteria, or formal quality appraisal is described.

Limitations

• The authors state that limited evidence exists on nutritional requirements for masters athletes and that many open questions remain; future longitudinal studies are needed on diet and specific nutrients across the athletic lifespan.
• The authors note that some findings cannot be directly extrapolated to masters athletes, e.g., probiotic/immune results from young athletes due to age-related immune changes; GH/IGF-1 findings may be biased by short study duration, training motivation, inability to achieve sufficient absolute exercise intensity in the elderly, and sex-bias toward male participants; one bone study could not discern aging from menopause; and robust data on nutritional interventions in injured athletes are lacking.
• Evident from the text: as a narrative review, it lacks a systematic search, formal quality assessment, and meta-analytic synthesis, and recommendations often extrapolate from younger athletes and older non-athletic populations.