Everyone could enjoy the “survival advantage” of elite athletesBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8338 (Published 13 December 2012) Cite this as: BMJ 2012;345:e8338
- 1School of Public Health, Sydney University, 2006 NSW, Australia
- 2Arnold School of Public Health, University of South Carolina, USA
Two linked papers examine longevity in former Olympic athletes and reach different conclusions.1 2 Clark and colleagues (doi:10.1136/bmj.e8308) analysed data on 15 174 Olympic medallists from nine countries that have enjoyed success in Olympic Games. The athletes had participated in at least one Olympic Games between 1896 and 2010.1 The study found that Olympic medallists had a relative survival advantage of 8% compared with matched controls, which translates into 2.8 extra years of life. The second and smaller study by Zwiers and colleagues (doi:10.1136/bmj.e7456) examined data on 9989 people who competed in Olympic Games between 1896 and 1936.2 They reported no increase in survival among those who competed in aerobic sports and higher mortality in those who participated in collision and contact sports, including power sports. Indeed, mixed epidemiological evidence pervades this literature, with many studies identifying a lower risk of mortality in previously elite athletes, especially those competing in aerobic events.3 By contrast, those who compete in power events tend to show less evidence of a survival advantage.3 What drives these differences?
The differences in the findings of the two current studies could be attributed to different mortality datasets, different study periods, differential loss to follow-up (or different statistical methods being used to deal with loss to follow-up1), or differences in the characteristics of athletes (for example, Zwiers and colleagues examined all Olympic participants, not just medal winners).2
Some elite sportspeople may be influenced by fame and glory, which could confer longevity through increased affluence unless undermined by excessive partying and hazardous risk taking behaviours.4
Nonetheless, the epidemiological research shows a slight survival advantage in elite athletes compared with the general population.3 However, more than four decades of epidemiological data show that people who do at least 150 minutes a week of moderate to vigorous intensity physical activity also have a survival advantage compared with the inactive general population. Conservative estimates put the survival advantage at just under a year,5 but the range extends to several years of added survival for physically active people.6 Interestingly, the upper threshold for benefit seems to be around 300 minutes of exercise a week (about an hour a day), beyond which negligible additional benefit is accrued.7 Furthermore, recent reviews suggest that excessive endurance training may be associated with harms, particularly in terms of cardiac structure, function, and biomarkers.6 8
The athletes’ survival advantage may not be due only to their elite athletic performance. Epidemiological studies have shown that US college alumni were protected only if they maintained their physical activity for decades after their time of sporting prowess.9 Other researchers have found that Finnish Olympians maintained their physical activity and other aspects of a healthy lifestyle, and that this extended their lives by as much as five years.10 This health advantage is similar to the life years gained by those in the general population who maintain a healthy active lifestyle,11 with physical activity being the most important health enhancing habit in older people.
Meeting recommended levels of physical activity is as important to global health as not smoking, and inactivity contributes to more than five million deaths a year, more than obesity.5 Compared with the successes that have been achieved in tobacco control, our inability to improve physical activity is a public health failure, and it is not yet taken seriously enough by many in government and in the medical establishment.12
The direct population effect of Olympic medal winners is small—the 448 medal winners in London 2012 studied by Clarke and colleagues comprise about 0.00008% of the adult populations of their countries. Community-wide participation in physical activity needs to be fostered. Olympic athletes could act as role models in organised and integrated efforts to increase physical activity before and after Olympic Games. However, rhetoric and not action abounds. In 2002, planners proposed that the London Olympics might increase the proportion of adults meeting the current guidelines of 150 minutes of physical activity a week from 35% to 70%, an anticipated population effect large on enthusiasm but well beyond credibility.13 Studies of previous Olympic Games have found no effect on physical activity levels in the general population,14 15 probably because of insufficient investment and non-sustained policy and programmatic efforts aimed at tackling inactivity.
Paffenbarger and colleagues cautioned against the mesmerising effects of celebrity athleticism in 2004, suggesting that “Today’s interest in sport is more often vicarious than participatory. We idolize the elite athlete who performs for us, rather than the everyday athlete we could and should become.”16 Even Hippocrates recognised that “Everything in excess is opposed to nature” and observed that “Walking is man’s best medicine.” Although the evidence points to a small survival effect of being an Olympian, careful reflection suggests that similar health benefits and longevity could be achieved by all of us through regular physical activity. We could and should all award ourselves that personal “gold medal.”
Cite this as: BMJ 2012;345:e8338
Competing interests: Both authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.