In recent decades, there has been a significant increase in the number of men and women over the age of 40 participating in high-intensity endurance sports, often referred to as “master athletes.” The “State of the Running 2019” report by RunRepeat.com and the International Association of Athletics Federation covers 96% of US recreational race results, 91% of the race results from the EU, Canada, and Australia, and a big portion from Asian, Africa, and South America. According to this study, more than a million people finished a marathon in 2018 (compared to less than half million in 2001): of those, more than 40% were over 40 years old [1] (Fig. 1). Other endurance sports, such as cycling, also show a large number of adult and senior competitors. This trend towards a higher mean age of participants in strenuous sport disciplines obliges the sports cardiology community to confront new challenges.The majority of scientific studies and public health initiatives have historically focused

In recent decades, there has been a significant increase in the number of men and women over the age of 40 participating in high-intensity endurance sports, often referred to as “master athletes.” The “State of the Running 2019” report by RunRepeat.com and the International Association of Athletics Federation covers 96% of US recreational race results, 91% of the race results from the EU, Canada, and Australia, and a big portion from Asian, Africa, and South America. According to this study, more than a million people finished a marathon in 2018 (compared to less than half million in 2001): of those, more than 40% were over 40 years old [1] (Fig. 1). Other endurance sports, such as cycling, also show a large number of adult and senior competitors. This trend towards a higher mean age of participants in strenuous sport disciplines obliges the sports cardiology community to confront new challenges.The majority of scientific studies and public health initiatives have historically focused