Can an 86-year-old woman with advanced lung disease be a world class athlete?

We describe the case of an 86-year-old woman with advanced obstructive lung disease (forced expiratory volume in 1 s/forced vital capacity ratio (FEV(1)/FVC)=34%) who remains capable of superior athletic performance. Detailed pulmonary function testing was performed to characterize this patient's baseline respiratory impairment. An incremental symptom limited cycle exercise test was performed to characterize her sensory, ventilatory, cardiovascular and respiratory mechanical responses to exercise. Despite significant respiratory mechanical constraints, her peak cycle work rate and oxygen uptake were 177 and 175% predicted, respectively, and she achieved this while experiencing only moderate exertional dyspnea. She holds numerous world and national masters swim records despite her substantial objective respiratory impairment and continues to compete and set records to this day. We propose that lifelong participation in rigorous endurance training resulted in desensitization to dyspnea and has led to important cardiorespiratory adaptations that may have counterbalanced the known negative effects of obstructive lung disease on exercise performance and dyspnea.