Review
Mortality and longevity of elite athletes

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Abstract

The health benefits of leisure-time physical activity are well known, however the effects of engaging in competitive sports on health are uncertain. This literature review examines mortality and longevity of elite athletes and attempts to understand the association between long-term vigorous exercise training and survival rates. Fourteen articles of epidemiological studies were identified and classified by type of sport. Life expectancy, standardised mortality ratio, standardised proportionate mortality ratio, mortality rate, and mortality odds ratio for all causes of death were used to analyse mortality and longevity of elite athletes. It appears that elite endurance (aerobic) athletes and mixed-sports (aerobic and anaerobic) athletes survive longer than the general population, as indicated by lower mortality and higher longevity. Lower cardiovascular disease mortality is likely the primary reason for their better survival rates. On the other hand, there are inconsistent results among studies of power (anaerobic) athletes. When elite athletes engaging in various sports are analysed together, their mortality is lower than that of the general population. In conclusion, long-term vigorous exercise training is associated with increased survival rates of specific groups of athletes.

Introduction

Physical activity performed at moderate intensity during leisure time is associated with the reduced risk of all-cause mortality in the general population.1 Specifically, moderate-intensity physical activity helps to prevent cardiovascular disease, hypertension and some types of cancers (e.g., colon, breast, and lung cancers).1 In addition, engaging in regular physical activity reduces the risk of overweight and obesity and promotes maintaining a healthy body weight,1 whereas excess body fat could cause various diseases, including hypertension, high blood cholesterol, type 2 diabetes mellitus and coronary heart disease.2 Moderate-intensity physical activity is generally defined as activity completed at an intensity of 3.0–5.9 metabolic equivalents (METs), such as brisk walking (i.e., walking at 3.0 mph [80.4 m/min] or faster).3 According to the 2008 Physical Activity Guidelines for Americans,3 adults in the general population should accumulate at least 150 min of moderate-intensity physical activity per week to gain substantial health benefits. Despite this recommendation, Healthy People 20104 reported that 40% of adults aged 18 years and older engage in no leisure-time physical activity.

Although the health benefits of leisure-time physical activity are well documented, the association between vigorous exercise training and mortality/longevity of elite athletes is not fully understood. Longitudinal observations showed that vigorous exercise and sports play had an additional benefit on lowering mortality among former Harvard College students and athletes.5 On the other hand, Wannamethee and Shaper6 suggest that moderate physical activity is sufficient to reduce the risk of cardiovascular disease and all-cause mortality, whereas engaging in vigorous physical activity and competitive sports may increase the risk of heart attack.7, 8 According to the American College of Sports Medicine and the American Heart Association, vigorous exercise can transiently increase the risk of sudden cardiac death and acute myocardial infarction, particularly among those with structural cardiac disease (e.g., hereditary or congenital cardiovascular abnormalities, atherosclerotic disease).9 Because of the lack of understandings, we believed that a comprehensive analysis was necessary on this topic. In particular, the following questions were formulated: (1) do elite athletes live longer than the general population and (2) are survival rates of elite athletes related to specific types of sports? The purpose of this literature review is to examine mortality and longevity of elite athletes who participated in different types of sports and to determine whether long-term vigorous exercise training is associated with higher survival rates.

Section snippets

Methods

The inclusion criteria for this review were: (1) the study examined athletes who had experience of competing nationally, internationally, or professionally and (2) the study measured mortality and/or longevity of athletes by comparing them with the general population. If studies followed athletes other than described above (e.g., college athletes, master athletes, and recreational athletes) or did not compare mortality or longevity of athletes with general population controls, they were

Results

Among the 14 articles reviewed, Sarna et al.10 examined endurance, mixed-sports and power athletes separately. Consequently, we identified 2 studies for endurance athletes, 3 studies for mixed-sports athletes, 8 studies for power athletes, and 3 studies for all-sports athletes. The main findings of the studies are presented in Table 1. A majority of the studies examined male athletes, whereas two studies included both male and female athletes.

Both studies in Table 1 indicated that long-distance

Discussion

The purpose of this review is to examine the role of long-term vigorous exercise training on mortality and longevity of elite athletes. The findings across the epidemiological studies indicate that long-term vigorous exercise training can positively impact mortality and longevity. Specifically, endurance and mixed-sports athletes tend to survive longer than the general population. Lower cardiovascular disease mortality among these athletes seems to play a major role in their better survival

Practical implications

  • Similar to leisure-time physical activity, engaging in competitive sports and vigorous exercise training is generally beneficial to improving mortality and longevity.

  • Elite endurance athletes (e.g., distance runners and cross-country skiers) tend to survive longer than people in the general population.

  • Elite mixed-sports athletes who perform both endurance and power activities (e.g., soccer, ice hockey, basketball and short- to moderate-term events in track and field) are also likely to live

Acknowledgment

There was no external financial support for this project.

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