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Older People Running in the park with bumbers on their chest

Dr Nicola Keay – Health and Hormones in the Master’s Athlete Age Group – Injury Rehab Network

The March Injury Rehab Network event with BASRaT featured a presentation from Dr Nicola Keay. The online event took place on the evening of Monday, 24th March, with 275 sports rehabilitation practitioners in attendance.

Nicky discussed health and hormones in the master’s athlete age group, including menopause. The recording is available to watch here.

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Dr Nicola Keay – Hormone Health Expert

Nicky Keay is the author of “Health Hormones and Human Potential: A Guide to Understanding Your Hormones to Optimise Your Health and Performance.” Her latest book explores “The Myths of Menopause.”

Nicky is an Honorary Clinical Lecturer at the Division of Medicine, University College London. She lectures and conducts research in exercise endocrinology and has published in this field. Nicky’s clinical endocrine work is mainly with active women, exercisers, dancers, and athletes, with a focus on relative energy deficiency in sports (REDs) and those navigating perimenopause/menopause.

Nicky works to provide a more personalised approach to female hormone health for all ages. Nicky is a medical advisor to Scottish Ballet and a keen dancer herself, taking four ballet classes per week.

Health and hormones in the Master’s Athlete Age Group

Nicky’s presentation considered health and hormones in the master’s athlete age group, including menopause.

Dr Keay summarised her qualifications and current roles as an Exercise Endocrinologist, including Honorary Clinical Lecturer in the Division of Medicine at UCL and member of the British Association of Sport and Exercise Medicine.

Older Woman Running in the Park

Master’s Athletic Performance Matters

Nicky considered hormones in the context of “setting in motion” the path to health and performance, with hormones as determinants of health and performance. Nicky described the interaction between hormones and how hormones adapt to athlete behaviours, including age-related hormone changes, recovery, training, fuelling for the work required and female hormones.

Hormone Definition and Hormone Effects on Performance

Nicky provided a definition of hormone “setting in motion” and the relationship between hormones and physical and mental health.

The hormone network has many effects on performance, including:

  • Cardiovascular
  • Psychological
  • Bone
  • Body composition
  • Metabolism
  • Strength
  • Endurance
  • Cognitive

Harnessing Hormones to Optimise Health and Performance

Dr Keay described the importance of balanced exercise, nutrition, and recovery to optimise health and performance over your lifespan.

Nicky presented the external and internal factors associated with the periodisation of an athlete, including:

  • External: Training cycles, training type, nutrition, and recovery
  • Internal: Physiological response to exercise/ training, menstrual cycle, life stage

Decline of Anabolic Hormones with Age

Nicky described how anabolic (“bodybuilding”) hormones decline with age. In men and women, growth hormone steadily declines from the teenage years. In men, testosterone increases throughout the teenage years and maintains during adult life until around the age of 50, when there is a gradual, slight decline. Oestrogen increases from the teenage years and maintains during the menstruating years before a rapid decline during menopause at around the age of 50.

Challenges of Decline of Anabolic Hormones

Dr Keay considered the challenges associated with the decline in anabolic hormones with response to training decreased, changes to cardiometabolic health, changes to body composition (decline in lean body mass and increase in fat deposition), and quality of tissues in the musculoskeletal system changes. These challenges/ changes can lead to a potential increased risk of injury in master athletes.

Three older ladies doing yoga on yoga mats on grass

Model of Ageing, Hormones and Physical Function

Nicky presented a model of ageing that depicted a combination of factors that can lead to frailty. The factors are linked to any pre-existing conditions. Reduced hormonal function, together with lower levels of physical activity and illness, can lead to less muscle and bone mass, reduced strength, increased fat mass, reduced mobility, and lower exercise capacity.

Energy Availability Consequences Health and Performance

Dr Keay discussed energy availability with factors under athlete’s control including training load, nutritional intake, and recovery. If these factors are well balanced, a fully functioning hormone network will drive adaptations to exercise leading to positive health and performance outcomes.

Sleep

Nicky considered the role of sleep in health and performance, and sleep was described as the “chief nourisher in life’s great feast.”

Dr Keay described how sleep impacts hormone health, with good sleep leading to circadian alignment and release of anabolic hormones: you get fitter when you are asleep! Nicky discussed metabolic factors, including sleep, that contribute to increased insulin and leptin sensitivity and the regulation of appetite hormones.

Nicky discussed links between sleep and MSK health, with good sleep contributing to greater bone density and muscle mass.

Sleep hygiene is therefore important to maximise the benefits of sleep, and Dr Keay considered practicalities such as a bedtime milk drink. Milk contains casein protein for muscle repair and precursor tryptophan for the synthesis of the sleep hormone melatonin.

Exercise Training Schedule

Dr Keay discussed the requirements of an exercise/ training schedule for master’ s-age athletes, including a longer dynamic warm and the importance of focusing on exercise quality rather than quantity. Nicky described the importance of strength work in optimising body composition and preventing muscle decline.

Recovery is important for training response, but older adults should aim to reduce sedentary time.

Woman squeezing lemon onto a plate of fruit, veg and salmon

Fuel for the Work Required

Dr Keay considered whether carbohydrates are friends or foes, with carbohydrates essential for intense exercise. Anaerobic respiration leads to the production of lactic acid, and Nicky described strategies that can be used to delay this.

Good nutrition is required to fuel training and performance. Dr Keay recommends regular meals of roughly equal size, including complex carbohydrates and protein. Fuelling around training is important before, during, and after (within 20 minutes, complex carbohydrate and protein ratio 3:1).

Fueling consistently is necessary to avoid mini-energy deficits during the day. Athletes should also consider other energy demands outside of training.

Dr Keay presented a forward-looking schedule for the nutritional requirements before, during and after training for recovery.

Energy Availability and Hormone Function

Dr Keay described how both energy deficiency and surplus energy can lead to hormone dysregulation. Optimal hormone function is achieved when energy intake is matched/ balanced with energy demand.

Nicky considered the implications of intentional and unintentional low energy availability. When energy intake is matched with energy demand, sufficient energy is available for life processes. Low energy availability forces the body to trigger hormonal responses that adversely affect normal life processes, leading to negative health and performance consequences.

Dr Keay described how cumulative energy deficits are like draining the battery on a device, leading to cumulative endocrine dysfunction, which Nicky likened to a car in limp/ safe mode. Nicky discussed the significance of Relative Energy Deficiency in Sport (REDs), with adverse effects on health and performance caused by chronic low energy availability.

Nutrition and Protein

Nicky recommends all food groups be consumed but with an emphasis on protein. To prevent sarcopenia, protein intake and anabolic training stimulus are required.

Dr Keay discussed protein intake, with around 1.2-1.5 g/kg/day required. This equates to approximately 40% of energy intake. Nicky considered how timing is crucial and recommends daily intake split into 20-25g portions of protein every 3-4 hours, ideally after an anabolic signal/ training. Pre-sleep protein is also essential for recovery.

Older man tending to an older woman who seems to have hurt her ankle. They are both sat on a bench

Bone Turnover

Dr Keay discussed bone turnover (formation and resorption) with age. Bone mineral density increases rapidly during the teenage years and peaks at around the age of twenty before declining gradually. Bone mineral density is lower in women, and the decline accelerates around the time of menopause.

Nicky described how multi-directional loading of the skeleton and good nutrition help to mitigate bone loss.

Adapting to Declining Anabolic Hormones

Dr Keay discussed strategies for master’s athletes to adapt to declining anabolic hormones:

>> Strength exercises + protein + sleep = Maintain muscle

>> Strength exercises + carbohydrates + sleep = Avoid fat deposition

>> Strength exercises + vitamin D + sleep = Bone strength

Masters Athletic Performance Matters

Nicky considered the role of hormones in setting in motion health and performance. Dr Keay described hormones as determinants of health and performance and discussed the interaction between hormones and athlete behaviours.

In relation to female hormones, Nicky described Horme as the Goddess of effort, energy, and action. Nicky presented a graph showing how hormone levels change throughout the menstrual cycle.

What’s so Good About Ovarian Hormones?

Dr Keay considered the many benefits of ovarian hormones, including bone and soft tissue health, cardiometabolic health, neurological function, gastrointestinal function, and response to exercise.

Female Hormone Odyssey

Nicky described the changes in regular hormonal changes in women as an odyssey from adolescence to perimenopause. The menstrual cycle and associated hormones may stop due to physiological amenorrhoea (pregnancy) or hypothalamic amenorrhoea (hormonal contraception).

Middle aged people exercising

Perimenopause and Menopause

Dr Keay discussed perimenopause and menopause. Menopause occurs on average at age 51 but is usually around the age of 45-55. During perimenopause (the lead-up to menopause), women may experience initial symptoms with variable menstrual cycles. Menopause is confirmed after a woman has had 12 months without periods.

Nicky described ovarian fluxes around the times of puberty and perimenopause, which show similarities.

Menopausal symptoms are multifaceted. Dr. Keay described these symptoms and their impact on health and well-being. Symptoms include hot flushes, palpitations, disrupted sleep, low energy, and cognitive issues. During perimenopause, women may have vasomotor symptoms and in postmenopause; urogenital symptoms may occur alongside other health issues.

Hormone Replacement Therapy

Dr Keay considered the need to treat women as individuals, not statistics. Nicky described the main indication for HRT as the quality of life with long-term health outcomes leading to decreased overall mortality. Nicky explained that HRT is the primary support for poor bone health and reduces the risk of cardiovascular disease (CVD).

Dr Keay discussed the risks and perceived issues associated with HRT. In relation to breast cancer, the extra cases per 1,000 increase by 4 in women with HRT, which is the same as drinking more than 2 units of alcohol per day. There are 24 extra cases of breast cancer if overweight and 7 fewer cases if taking 2+ hours of moderate-intensity exercise. Nicky stated that there is no increased risk if women take HRT pre-menopause up until the physiological age of menopause.

Dr Keay advised that it is best to start HRT asap during menopause and that transdermal oestradiol and micronised progesterone have the lowest risk profile.

The Foundations of Optimal Performance

Nicky discussed the foundations of optimal performance, which are built on a social setting, the quality and timing of recovery and nutrition, and the quality and timing of training.

Competitive Sprint Finish – 30-year age gap

Nicky presented a personal case study of her husband and son, who have a 30-year age gap, competing together in a two-hour off-road duathlon. The result was a competitive sprint finish, showing that optimal performance can be achieved at any age!

Follow Dr Nicola Keay

Follow Dr Nicky Keay via the channels and links below. Nicky is also available for private appointments to discuss health and hormones.

Books

Nicky Keay is the author of “Health Hormones and Human Potential: A Guide to Understanding Your Hormones to Optimise Your Health and Performance.” Her latest book explores “The Myths of Menopause.”

Q&A

Nicky kindly answered questions put forward by practitioners who attended the session. Please see the presentation recording for the insights from Dr Keay to the questions.

Presentation Recording

The recording of Nicky’s presentation is available to watch here

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