Introduction
Many older adults have an increased likelihood of living longer with multiple comorbidities (e.g., arthritis, high blood pressure, injury) that can require continual financial and medical care [
1‐
3]. Additionally, because many health care systems were designed to provide acute, episodic care for a relatively young population, these systems are ill equipped to manage the complex health care needs of this population (~ 75–80% reporting one or more chronic diseases) [
4‐
6]. Fortunately, modifiable lifestyle factors such as participating in physically and cognitively challenging activities can be useful for mitigating and managing many health-related issues among older adults [
3,
7]. Engagement in diverse forms of activities has been shown to provide a wide range of physical [
8,
9], cognitive [
10,
11] and psychosocial benefits [
12‐
15]. Different types of activities may also provide different health benefits, which can be crucial in maintaining overall well-being to age successfully [
16‐
19].
Interestingly, while there is considerable evidence emphasizing the benefits of maintaining an active lifestyle irrespective of age [
7,
20], most studies of older adults have focused on activities of low to moderate exercise intensity (i.e., walking, dancing, fitness classes) [
14], and, as a result, we have little information on the health outcomes associated with older adults who regularly participate in more intensive activities such as competitive sport [
21,
22]. However, the growing number of baby boomers competing in sport has recently caught the attention of researchers interested in optimizing the health and function of older adults [
23,
24]. Moreover, there is increasing momentum for participation in competitive sport. For example, participation in the World Masters Games has increased from 8305 competitors in 1985 to 28,905 in 2017 [
25]. In Canada, a 2 to 3-fold increase has been observed in the number of sport participants aged 55 and above [
26]. This proliferation has motivated researchers to examine
Masters Athletes, defined as individuals generally above the age of 35 who continually maintain a high intensity of exercise by competing in Master sport [
23].
Despite having little information on the health and functional benefits of competitive sport [
22,
24], some researchers have proposed older (i.e., Masters) athletes as the ideal model of successful aging [
27]. A large body of evidence with this group has focused on areas such as maintaining performance despite declines in physical function or modulating the factors responsible for age-related decline [
28‐
31]. Interestingly, research on the health and function of Masters Athletes, suggest continual participation in sport is associated with lower risk of certain chronic diseases (e.g., chronic chest pain, asthma, heart attack and diabetes) [
12,
32]. In addition, while there is some information on sport-related injury among older athletes [
26,
31,
33‐
35], little is known on the prevalence of injury in older Masters Athletes in comparison to non-athletes [
36,
37]. This could be important, since regular sport participation can accelerate the onset of conditions such as osteoarthritis as a result of overuse [
38], whereas some chronic diseases (e.g., osteoporosis) can increase the risk of severe injury [
32,
39].
Furthermore, the literature on healthy aging in older adults has primarily focused on the benefits of physical engagement, with much less attention dedicated to other types of engagement [
40]. This is surprising since physical activity (i.e., sport) represents only one of the many types of active engagement older adults may experience and other types of activities may be beneficial for maintaining other components of health [
13,
40]. For example, previous research suggests cognitive engagement has many associated mental health benefits (e.g., improvement of memory or delaying dementia) and is useful for maintaining cognitive function [
11,
41‐
43]. This type of active engagement is especially important to help manage the 66% rise in older adults with dementia expected to occur in the next few years [
2]. Furthermore, in relation to physical health, previous studies have found older adults with some chronic diseases (e.g., hypertension, heart disease, chronic obstructive pulmonary disorder) score significantly lower on cognitive performance tasks (e.g., block design, object assembly, word recall, visuospatial tests) compared to older adults without these diseases [
44‐
46].
Interestingly, none of the studies of Masters Athletes has considered them relative to other forms of engagement. To this end, we compared the physical health of older adults, who participated in competitive sport with similar aged older adults (i.e., 50 years and above) who competed in chess competitions during the time of data collection. This activity was chosen because of its popularity, objective performance measure (i.e., Elo score), and the intense practice required to become an expert competitive participant [
47,
48]. This allows for an intriguing comparison between older adults who are highly physically active with those who are highly cognitively active. Moreover, exploring competitive chess may increase our understanding on the health outcomes associated with older adults who are actively engaged in a sedentary activity. Based on limited past research [
32,
49], we hypothesized Master Athletes would have the highest rates of injury and the lowest prevalence of chronic disease when compared to chess players and normative groups, due to their continual participation in vigorous activity.
Results
Descriptively, the Masters Athletes reported the highest prevalence (69.6%) of injuries compared to chess players (24%), moderately active (14.1%) and inactive adults (14.5%). They also reported the lowest prevalence of chronic diseases (15.9%), followed by the chess players (30%), inactive (64.5%) and moderately active (67.2%) older adults (Table
1).
Table 1
Background information on athletes, chess players, moderately and inactive older adults (N = 245)
Age |
50–59 years | 33 (49%) | 20 (40%) | 27 (42%) | 28 (45%) |
60–69 years | 21 (30.4%) | 17 (34%) | 21 (32.8%) | 21 (33.9%) |
70–79 years | 10 (14.5%) | 8 (16%) | 10 (15.6%) | 9 (14.5%) |
80 and above | 5 (7.2%) | 5 (10%) | 6 (9.4%) | 4 (6.5%) |
Marital Status |
Married/Domestic relationship | 33 (47.8%) | 30 (60%) | 48 (75%) | 44 (71%) |
Divorced/Widowed/Separated | 9 (13.0%) | 11 (22%) | 12 (18.8%) | 12 (19.4%) |
Single/Never married | 27 (39.1%) | 9 (18%) | 4 (6.3%) | 6 (9.7%) |
Income |
<$60,000 | 15 (21.7%) | 22 (44%) | 11 (17.2%) | 9 (14.5%) |
$60,000 - $79,000 | 6 (8.7%) | 4 (8%) | 6 (9.4%) | 8 (12.9%) |
$80,000 or more | 48 (69.6%) | 24 (48%) | 47 (73.4%) | 45 (72.6%) |
Education |
< Secondary school | 6 (8.7%) | 3 (6%) | 9 (14.1%) | 11 (17.7%) |
Secondary graduate | 6 (8.7%) | 5 (10%) | 8 (12.5%) | 14 (22.6%) |
Other post-secondary | 9 (13.0%) | 14 (28%) | 3 (4.7%) | 3 (4.8%) |
Post-secondary graduate | 48 (69.6%) | 28 (56%) | 44 (68.8%) | 34 (54.8%) |
Years competing |
< 5 years | 19 (27.9%) | 2 (4.4%) | | |
6 to 15 years | 24 (35.3%) | 2 (4.4%) | | |
16 to 20 years | 6 (8.8%) | 2 (4.4%) | | |
21 or more years | 19 (27.9%) | 39 (86.7%) | | |
Practice for activity (hrs/week) |
< 5 h | 22 (32.4%) | 20 (44.4%) | | |
6 to 15 h | 45 (66.2%) | 18 (40%) | | |
16 to 20 h | 0 | 2 (4.4%) | | |
21 or more hours | 1 (1.5%) | 5 (11.1%) | | |
Injury |
Yes | 48 (69.6%) | 12 (24%) | 9 (14.1%) | 9 (14.5%) |
No | 21 (30.4%) | 38 (76%) | 55 (85.9%) | 53 (85.5%) |
Chronic Disease |
Yes | 11 (15.9%) | 15 (30%) | 43 (67.2%) | 40 (64.5%) |
No | 58 (84.1%) | 35 (70%) | 21 (32.8%) | 22 (35.5%) |
Total (N = 245) | 69 | 50 | 64 | 62 |
The Kruskal-Wallis (K-W) tests indicated a statistically significant difference for rate of injury,
H(3) = 73.2,
p < 0.001, and prevalence of chronic disease among the activity groups,
H(3) = 53.5,
p < 0.001. Further exploration using a one-way ANCOVA indicated a significant effect for type of activity on the number of injuries reported, F(3, 236) = 28.39,
p < 0.0001, partial η
2 = 0.27, and observed power = 1.0 for
α < 0.0125. Bonferroni post hoc tests indicated Masters Athletes were significantly different (
p < 0.0001) than all activity groups, while no significant difference was found between chess players and the normative groups for incidence of injury (see Table
2). Interestingly, Chi-square analyses suggested a sprain or strain (52.1%) was the most common type of injury reported among injured Masters Athletes (
n = 48), followed by multiple injuries (31.3%). In contrast, injured chess players (
n = 12) primarily reported multiple injuries (41.7%) and/or a scrape or bruise (25%). Moderately active (
n = 9) most commonly experienced a cut or puncture (33.3%) and/or a scrap or bruise (33.3%), whereas inactive older adults (
n = 9) reported experiencing a broken or fractured bone (33.3%) and/or a sprain or strain (33.3%) (see Tables
2 and
3).
Table 2
Prevalence of injuries reported by athletes, chess players, moderately activity and inactive older adults
(A) Masters Athletes | 69 | 1.46 (1.24) | AxB*, AxC*, AxD* |
(B) Chess | 50 | 0.58 (1.18) | AxB* |
(C) Moderately activity | 64 | 0.17 (0.46) | AxC* |
(D) Inactive | 62 | 0.16 (0.41) | AxD* |
Total | 245 | 0.62 (1.06) | |
Table 3
Prevalence of chronic diseases reported by athletes, chess players, moderately activity and inactive older adults
(A) Masters Athletes | 69 | 0.20 (0.53) | AxC*, AxD* |
(B) Chess | 50 | 0.48 (0.84) | BxC*, BxD* |
(C) Moderately activity | 64 | 1.33 (1.27) | CxA*, CxB* |
(D) Inactive | 62 | 1.31 (1.46) | DxA*, DxB* |
Total | 245 | 0.83 (1.19) | |
Similarly, the chronic disease analyses indicated a significant effect for type of activity on the prevalence of chronic disease reported by older adults, F(3, 236) = 20.01,
p < 0.0001, partial η
2 = 0.20, and observed power = 1.0 for
α < 0.0125. Interestingly, post hoc tests suggested Masters Athletes and chess players were not significantly different in the prevalence of chronic disease (
p = 1.00), but were significantly different from both normative groups (
p < 0.0001). In addition, no significant difference (
p = 1.00) was found between the normative groups (Table
3). According to the Chi-square analyses, moderately active and inactive groups reported arthritis (29.7, 22.6%), high-blood pressure (28.1, 24.7%) and back problems (26.6, 25.8%) as the most prevalent types of chronic diseases, respectively. In contrast, chess players experienced, high-blood pressure (10%), back problems (8%) and diabetes (8%), while Masters Athletes commonly reported arthritis (5.8%) and high blood pressure (4.3%) (see Tables
4 and
5).
Table 4
Types of injuries experienced by athletes, chess players, moderately activity and inactive older adults
Multiple Injuries | 15 (31.3%) | 5 (41.7%) | 0 | 0 | 20 (25.6%) |
Broken or fractured bones | 0 | 0 | 1 (11.1%) | 3 (33.3%) | 4 (5.10%) |
Sprain or Strain | 25 (52%) | 2 (16.7%) | 0 | 3 (33.3%) | 30 (38.5%) |
Cut or puncture | 0 | 0 | 3 (33.3%) | 0 | 3 (3.8%) |
Scrap, Bruise | 3 (6.3%) | 3 (25%) | 3 (33.3%) | 1 (11.1%) | 10 (12.8%) |
Other | 5 (10.4%) | 2 (16.7%) | 2 (22.2%) | 2 (22.2%) | 11 (14.1%) |
Total | 48 | 12 | 9 | 9 | 78 |
Table 5
Types of chronic diseases experienced by athletes, chess players, moderately activity and inactive older adults
Asthma | 2 (2.9%) | 1 (2%) | 4 (6.3%) | 3 (4.8%) |
Arthritis | 4 (5.8%) | 3 (6%) | 19 (29.7%) | 14 (22.6%) |
Back problems | 1 (1.4%) | 4 (8%) | 17 (26.6%) | 16 (25.8%) |
High-blood pressure | 3 (4.3%) | 5 (10%) | 18 (28.1%) | 17 (27.4%) |
Migraine headaches | 0 | 0 | 3 (4.7%) | 5 (8.1%) |
Chronic bronchitis | 0 | 0 | 0 | 1 (1.6%) |
Emphysema | 0 | 0 | 0 | 2 (3.2%) |
COPD | 0 | 0 | 1 (1.6%) | 3 (4.8%) |
Diabetes | 0 | 4 (8%) | 7 (10.9%) | 7 (11.3%) |
Heart disease | 1 (1.4%) | 2 (4%) | 3 (4.7%) | 6 (9.7%) |
Cancer | 2 (2.9%) | 0 | 1 (1.6%) | 1 (1.6%) |
Stomach or intestinal ulcers | 0 | 0 | 2 (3.1%) | 2 (3.2%) |
Stroke | 0 | 0 | 2 (3.1%) | 1 (1.6%) |
Urinary incontinence | 0 | 2 (4%) | 4 (6.3%) | 1 (1.6%) |
Bowel disorder | 1 (1.4%) | 3 (6%) | 4 (6.3%) | 2 (3.2%) |
Total (N = 109) | 11 | 15 | 43 | 40 |
Discussion
Advancing age is a unique constraint on health and function. It acts as both a risk factor for many health outcomes and a barrier to participation in physical or cognitive activities as well as other preventive behaviours such as medical physical examinations [
52]. With this in mind, the current study compared injury and chronic disease rates among groups of older adults who maintained competitive involvement in a physically or cognitively challenging activity – namely, Masters Athletes and chess players. In addition, these two primary groups were compared to normative data from moderately active and inactive older adults [
50].
In congruence with previous research [
26,
49,
51], Masters Athletes reported significantly higher rate of injuries compared to all activity groups in the study; however, the partial η
2 value (0.27) corresponded to a small effect size, perhaps due to the small samples [
53]. Results from this study also reinforce findings from previous literature suggesting risk of injury can be higher in vigorous forms of physical activity such as competitive sport [
32,
49]. Interestingly, the most common types of injuries among athletes were a sprain/strain and multiple injuries. In line with our findings, previous literature on Masters sport [
32,
54,
55] suggests track and field athletes primarily experience minor orthopedic injuries in the lower extremities. Specifically, runners commonly sustain overuse injuries, knee pain, Achilles tendon issues, plantar fasciitis and shin splints [
55]. In contrast, chess players primarily sustained multiple injuries and/or a scrape/bruise, while inactive older adults were found to be the only group to report broken bones.
In terms of chronic disease, type of activity significantly influenced the prevalence of chronic disease reported by older adults, although, once again, the effect size was small. Masters Athletes were significantly different to the normative groups on chronic disease prevalence, but not the chess players. Previous studies indicate sport participants have a significantly lower prevalence of chronic diseases compared to non-athletes [
32,
56]. In addition to participation in often vigorous competition, lower prevalence of chronic disease could be contributed by additional lifestyle behaviors such as eating a healthy diet or limiting alcohol intake, cigarette smoking or sedentary time to a greater extent than the ‘average’ older adult [
56]. As a result, increased participation in these various positive lifestyle behaviors may have improved the health outcomes of athletes.
Interestingly, chess players were also associated with a lower prevalence of chronic disease than the normative groups, even though increased sedentary time is recognized as an independent contributor for the decline in physical health [
57]. Although chess is a sedentary activity, the competitive nature of the game can elicit certain physiological responses [
47] that may encourage players to practice positive health behaviours (e.g., reduce smoking, healthy eating, regular medical examinations and positive expectations regarding aging) to advance in their level of competition [
40,
52]. This is congruent with reports of chess grandmasters and championship competitors employing nutritionists and/or exercise trainers to prepare for the physical endurance required for matches [
58]. Furthermore, similar to elite sport players, chess grandmasters are associated with a significantly greater life expectancy than the general population [
40] suggesting competitive chess provides similar physical health benefits (i.e., mitigate chronic diseases) to competitive sport. In contrast, older adults who avoid cognitive engagement may find it challenging to manage not only cognitive and mental health [
44‐
46,
59] but also physical health.
While considerable additional work is necessary to validate and replicate these results, they suggest competitive chess could be a viable option for older adults who are unable to participate in sport, since prevalence of a chronic disease was 3–4 times higher in the inactive group than Masters Athletes and chess players. Both normative groups reported increased prevalence of arthritis, high-blood pressure and back problems. Furthermore, future work is needed to determine whether these differences are due to participation in the activity itself (e.g., competition in a cognitively or physically challenging task) or to variables that might be related to these relatively unique groups (e.g., greater involvement in preventive health activities). These studies will extend our knowledge of the level and type of activity required to optimize health and function, as well as confirm whether participation in an intense cognitive activity alone can mitigate chronic disease amongst older adults. Given that chess players reported lower incident of injuries than Masters Athletes as well as a lower prevalence of chronic diseases compared to moderately active and inactive groups, it begs the question ‘why is the gold standard for successful aging only associated with those who participate in competitive sport?’ as suggested by Hawkins et al. [
27]. Perhaps this label could be expanded to include other forms of competitive activity. Moreover, our lack of understanding regarding the consequences of competitive sport [
24,
60], highlights the need to refrain from labeling Masters Athletes as the ideal model for successful aging, at least until additional work has been conducted. Furthermore, from a health promotion standpoint, advocating sport as a preventive health strategy may be problematic, particularly for individuals who have a) debilitating chronic diseases and/or socio-demographic barriers that can limit participation in sport [
7,
61] or b) internalized the pervasive old age stereotypes in North American society and likely avoid participation in competitive sport [
22]. Our study suggests older adults may have other options, such as competitive chess, to gain similar health benefits to sport participation. Moreover, it is possible older adults who participate in a variety of activities (e.g., chess
and sport) may gain a combination of physical and cognitive health benefits [
13,
62]. For that reason, advocating programs designed to cognitively and physically engage older persons may be a pragmatic response from both a health and an economic standpoint.
Limitations
While this study had its strengths, by including a nationally representative dataset to generate normative data for group-based comparisons, as well as two unique activity groups, there were some limitations. For instance, Masters Athletes and chess players resided in the province of Ontario, whereas the normative groups were from Nova Scotia and British Columbia,
4 which limits generalizations to other provinces or countries outside of Canada. Findings should also not be generalized to females, since all participants in this study were males. In addition, a cross-sectional study design limits our ability to test causal relationships between sport and chess participation and the physical health of older adults, since other genetic or environmental factors may be involved. Although not a limitation, this study did not compare ‘active’ older adults (i.e., the most active group in the CCHS) with Masters Athletes due to concerns about overlap between these groups. As a result, this limits what we can say about the value of high levels of sport participation compared to high levels of exercise involvement. It was also difficult to capture the nuances of socioeconomic status and its influence on the health of older adults, especially between the chess players and athletes, which would seem to be privileged groups. In addition, creating a more homogenous sub-sample may have concealed the effects of socio-demographic factors on the physical health of moderately active and inactive older adults, where the prevalence of chronic disease may have actually been higher among normative groups. Lastly, injured athletes and chess players who were unable to compete during the time of data collection may have led to an underestimation of injury and chronic disease.