Do elite athletes live longer?

Most of us aren’t elite athletes, of course.  But most any athlete is interested in the answer to the question.

In the past year, there have been two scientific reports on this issue–one examining longevity of Olympic medalists in the modern area and another examining longevity of riders in the Tour de France.

The Olympians

The first study was undertaken by Dr. David Studdert and colleagues from the Melbourne (Australia) School of Population Health.  They asked the question:  Do Olympic medalists live longer than the general population?  These investigators estimated that since the birth of the modern Olympic movement in 1896, some 25,000 individuals from 136 different countries had won medals.  Their report, though, focused on 15,174 medalists at the Games from 1896-2010 who hailed from a subset of 9 country groups that accounted for the majority of medals won  (United States, Germany, the Nordic countries as a group, Russia, the United Kingdom, Frane, Italy, Canada, Australia, and New Zealand).  For the purpose of comparison, each medalist was paired with a control subject, matched by country, age, sex, and year of birth.

A comparison was made of the survival at up to 30 years for the Olympians and the control subjects.  The most important findings were:

• Olympic medalists lived, on average, 2.8 years longer than controls,
• Gold, silver, and bronze medallists had similar survival rates, and
• Endurance athletes enjoyed a larger survival advantage than athletes in the power sports.

The investigators suggested several possible explanations.  The Olympians might:

• be healthier, due to exercise and better nutrition, and/or
• enjoy higher socioeconomic status, that is known to be associated with improved mortality rates, and/or
• improved social status, independent of wealth, which might also be associated with improved mortality rates.

So, as Dr. Studdert notes, the ancient Greek warrior, Achilles, had to choose between a short glorious life and a long obscure one,….modern Olympic medalists fare somewhat better!

The Grand Tour Cyclists

The second study received a fair bit of media attention when the results were reported at this fall’s meeting of the European Society of Cardiology meeting.  A complete report by Dr. Eloi Marijon and his colleagues from Paris Descartes University was published in last week’s edition of the European Heart Journal.

As many readers will know, the Tour de France is a 3-week cycling race, a so-called Grand Tour, that is is held each July.  The race is exceptionally arduous, covering upwards of 2,500 miles and many mountainous ascents, with only 2 days of rest during the event.  Moreover, the cyclists who participate in the Tour are typically in their 20’s and 30’s, and have trained many 10’s of thousands of miles of cycling over many years to reach the level of ability to qualify for one of the Tour teams.

We also know now that for a couple decades, at least, there was widespread doping among the elite Tour-level cyclists.  The list of doping agents is long and raises the question about long-term harm that might come to riders as a result.

This study focused on 786 French cyclists who participated in at least 1 Tour de France between 1947 and 2012.  This group accounted for just about 30% of all riders in the Tour over that time period.  The median period of follow-up for the riders was 37.4 years.  The cyclists were compared to male individuals in the French general population.  The main findings were:

• overall, a 41% lower mortality rate than controls,
• a survival benefit independent of when (1947-1970 vs. 1971-1990 vs. 1991-2010) the riders raced,
• major causes of death since 1968 being cancer, cardiovascular disease, or trauma, but
• interestingly, a higher mortality for young (<30 years old) cyclists compared to the controls.

The authors acknowledge several possibilities for the cyclists’ survival advantage, in addition to the healthy effects of exercise:

• a selection bias, where only healthy individuals could become elite cyclists, and/or
• the advantage may be due to aspects of the cyclists’ lifetimes outside of their short elite cycling career, and/or
• other, unmeasured factors (eg, smoking history, nutrition) that might not be similar between the cyclists and the control group.

My Thoughts

I’m not surprised by the findings.

I’ve only met one Olympic medalist and I don’t know any Tour riders.  These are very small groups of athletes, for sure.

What can the rest of us learn from these studies?

In the case of the Olympic medalists, there was a small survival benefit of 2.8 years.  We know that for many sports, an Olympic career is short.  I haven’t seen any epidemiological accounting, but I’d bet that the majority of Olympic medalists lead a healthy lifestyle long after their competing days are over.  And certainly, whatever survival advantage they gain must be due not only to their elite sporting career, but also to factors related to their lives afterward.  Do they continue to exercise?  Do they continue to eat well?  Not smoke?  There are probably countless factors that are important.

But remember, too, what we’ve learned from studies focused on the question:  How little exercise is needed to produce a longevity benefit?  We know a lot.  And we certainly know that a survival advantage of 2.8 years is easily gained over the general population by making exercise a part of one’s life.  This is the basis for the recommendations of 150 minutes of aerobic exercise per week by organizations such as the American Heart Association.  You certainly don’t need to be an Olympic medalist.  Just get out there and exercise.

In the case of the Tour de France cyclists, it’s interesting that the youngest (<30 years old) riders did not enjoy a survival advantage.  What’s different for the youngest riders?  In my mind, this raises the possibility of a greater prevalence of underlying heart conditions such as hypertrophic cardiomyopathy or long Q-T syndrome and suggests to me that there is value to cardiac screening programs for young competitive athletes.  The finding of an overall 41% reduction in mortality for the cylists is quite large.  The benefit is certainly not due solely to competing in the Tour.  It probably reflects decades of rather healthy behaviors in general, including exercise, leading up to participating….and then a variety of factors, both health-wise and socioeconomically, after participating in the Tour.

On the bright side, it’s good to see that Grand Tour cyclists don’t have reduced longevity!

Related Posts:

1.  Do cyclists (and perhaps triathletes) live longer?

2.  Exercise is Good!

3.  23 1/2 Hours:  What is the single best thing we can do for our health?  A great video by Doc Mike Evans.