Do elite athletes live longer?
Regular physical activity, such as walking and jogging, is well-documented to significantly improve health outcomes and reduce the risk of numerous diseases. Epidemiological evidence strongly supports its role in managing and rehabilitating conditions like cardiovascular disease (CVD), hypertension, stroke, metabolic syndrome, type 2 diabetes, breast and colon cancer, depression, and fall-related injuries. Additionally, regular physical activity is associated with a lower risk of all-cause mortality (Garatachea et al., 2014).
However, the effects of extreme levels of physical activity, as seen in professional sports, on human longevity and disease risk are still a topic of debate. This article explores the current literature to understand whether elite athletes experience different mortality and health outcomes compared to the general population.
Media Perception vs. Reality: Elite Athlete Mortality
Popular media often shapes public perceptions of elite athletes' health and mortality, sometimes creating a misleading image of early death among athletes. A comprehensive review by Lemez and Baker (2015) examined mortality risk in elite athletes compared to other athletes and the general population. This review included 54 peer-reviewed publications and three online articles, focusing on sports like baseball, football, soccer, basketball, and cycling.
Key Findings:
- Longevity in Elite Athletes:
- Most studies reported that elite athletes have favourable lifespan longevities compared to the general population.
- For example, Tour de France cyclists from France, Italy, and Belgium showed greater lifespan longevity compared to the general population of their respective countries.
- Conversely, Finnish powerlifters had shorter lifespans compared to the Finnish general population.
- Sport-Specific Trends:
- Aerobic and mixed-sport athletes exhibited superior longevity outcomes compared to those in anaerobic sports.
- Factors such as playing position, weight, education, and race were consistent indicators of mortality risk, suggesting that elite athletes are a heterogeneous group with varied mortality trends.
- Increased Survival Factors:
- Higher volumes of exercise training leading to greater physical fitness.
- Elite athletes are often among the healthiest and fittest individuals.
- Many elite athletes maintain active and healthy lifestyles even after their sports careers.
Meta-Analyses and Longitudinal Studies
Garatachea et al. (2014) conducted a meta-analysis of cohort studies comparing mortality in elite athletes with the general population. This analysis included data from 42,807 athletes across ten studies. The findings indicated that elite athletes tend to live longer than the general population and have a lower risk of CVD and cancer. Moreover, these athletes also had a reduced need for medications for chronic diseases.
Endurance Exercise and Cardiac Health
There is growing evidence that intense endurance exercise might lead to cardiac alterations, particularly an increased risk of atrial fibrillation. Despite this, studies by Garatachea et al. (2014) and Fyyaz and Papadakis (2022) found that the incidence of life-threatening arrhythmias in endurance athletes is low, typically linked to hereditary or congenital cardiac issues, rather than the exercise itself.
Olympic Athletes and Longevity
A study by Antero et al. (2020) compared the longevity of US Olympic athletes to the general population. The study included 8,124 US Olympians (2,301 women and 5,823 men). Results showed that US Olympians lived approximately five years longer than the general population, primarily due to lower risks of CVD and cancer. Interestingly, there were no significant differences in the incidence of nervous system disorders and mental illness between Olympians and the general population.
Challenging the 'J' Shape Hypothesis
Runacres et al. (2020) challenged the 'J' shaped exercise-longevity relationship, which posits that the health benefits of exercise plateau and then diminish at high levels of physical activity and can even be detrimental to health.
As the above-mentioned studies already looked at the positive findings of elite athletes and mortality rate, this study wanted to go one step further and compare different sport groups (endurance athletes, power athletes, team-athlete) to the general population. 38,047 English language articles were retrieved from Web of Science, PubMed and SportDiscus databases published after 1970, of which 44 were included in the systematic review and meta-analysis. In total 165 000 former athletes were included in this study.
Findings:
- Endurance and Team-Sport Athletes:
- These athletes lived longer and had a reduced incidence of CVD compared to the general population.
- The risk of cancer mortality was not significantly different, possibly due to athletes living longer and thus having a higher chance of developing cancer.
- Power Athletes:
- They had a reduced all-cause mortality and similar CVD mortality risk compared to the general population.
- Gender Differences:
- Female athletes had a 49% lower risk of all-cause mortality than the general population, while male athletes had a 31% lower risk, indicating that the female survival advantage persists and even extends after a career in elite sports.
- ‚J‘ – Relationship:
- Overall, endurance and team-sport athletes live longer and have a reduced incidence of CVD compared to the general population, debunking the ‘J’ shape hypothesis.
Conclusion
The body of evidence suggests that elite athletes generally experience greater longevity and better health outcomes compared to the general population. Factors contributing to these benefits include high levels of physical fitness and a healthy lifestyle. However, variations exist across different sports and within subgroups of athletes, indicating the need for better understanding and personalized health strategies for athletes post-retirement.
Literature:
Antero, J., Tanaka, H., De Larochelambert, Q., Pohar-Perme, M. & Toussaint, J. (2020). Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. British Journal Of Sports Medicine, 55(4), 206–212. https://doi.org/10.1136/bjsports-2019-101696
Fogelholm, M., Kaprio, J. & Sarna, S. (1994). Healthy lifestyles of former Finnish world class athletes. Medicine & Science in Sports & Exercise, 26(2), 224–229. https://doi.org/10.1249/00005768-199402000-00013
Fyyaz, S. & Papadakis, M. (2022). Arrhythmogenesis of Sports: Myth or Reality? Arrhythmia & Electrophysiology Review, 11. https://doi.org/10.15420/aer.2021.68
Garatachea, N., Santos-Lozano, A., Sanchis-Gomar, F., Fiuza-Luces, C., Pareja-Galeano, H., Emanuele, E. & Lucia, A. (2014). Elite Athletes Live Longer Than the General Population: A Meta-Analysis. Mayo Clinic Proceedings, 89(9), 1195–1200. https://doi.org/10.1016/j.mayocp.2014.06.004
Lemez, S. & Baker, J. (2015). Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. Sports Medicine - Open/Sports Medicine - Open, 1(1). https://doi.org/10.1186/s40798-015-0024-x
Runacres, A., Mackintosh, K. A. & McNarry, M. A. (2020). Health Consequences of an Elite Sporting Career: Long-Term Detriment or Long-Term Gain? A Meta-Analysis of 165,000 Former Athletes. Sports Medicine, 51(2), 289–301. https://doi.org/10.1007/s40279-020-01379-5
Teramoto, M. & Bungum, T. J. (2010). Mortality and longevity of elite athletes. Journal Of Science And Medicine in Sport, 13(4), 410–416. https://doi.org/10.1016/j.jsams.2009.04.010