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Research Christmas 2012: Sport

Mortality in former Olympic athletes: retrospective cohort analysis

BMJ 2012; 345 doi: (Published 13 December 2012) Cite this as: BMJ 2012;345:e7456
  1. R Zwiers, PhD candidate1,
  2. F W A Zantvoord, medical student1,
  3. F M Engelaer, PhD candidate12,
  4. D van Bodegom, assistant professor of medicine12,
  5. F J G van der Ouderaa, chief scientific officer1,
  6. R G J Westendorp, professor of old age medicine12
  1. 1Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA Leiden, Netherlands
  2. 2Leiden University Medical Centre, Leiden
  1. Correspondence to: F Engelaer Engelaer{at}
  • Accepted 14 September 2012


Objective To assess the mortality risk in subsequent years (adjusted for year of birth, nationality, and sex) of former Olympic athletes from disciplines with different levels of exercise intensity.

Design Retrospective cohort study.

Setting Former Olympic athletes.

Participants 9889 athletes (with a known age at death) who participated in the Olympic Games between 1896 and 1936, representing 43 types of disciplines with different levels of cardiovascular, static, and dynamic intensity exercise; high or low risk of bodily collision; and different levels of physical contact.

Main outcome measure All cause mortality.

Results Hazard ratios for mortality among athletes from disciplines with moderate cardiovascular intensity (1.01, 95% confidence interval 0.96 to 1.07) or high cardiovascular intensity (0.98, 0.92 to 1.04) were similar to those in athletes from disciplines with low cardiovascular intensity. The underlying static and dynamic components in exercise intensity showed similar non-significant results. Increased mortality was seen among athletes from disciplines with a high risk of bodily collision (hazard ratio 1.11, 1.06 to 1.15) and with high levels of physical contact (1.16, 1.11 to 1.22). In a multivariate analysis, the effect of high cardiovascular intensity remained similar (hazard ratio 1.05, 0.89 to 1.25); the increased mortality associated with high physical contact persisted (hazard ratio 1.13, 1.06 to 1.21), but that for bodily collision became non-significant (1.03, 0.98 to 1.09) as a consequence of its close relation with physical contact.

Conclusions Among former Olympic athletes, engagement in disciplines with high intensity exercise did not bring a survival benefit compared with disciplines with low intensity exercise. Those who engaged in disciplines with high levels of physical contact had higher mortality than other Olympians later in life.


  • Contributors: RZ and FWAZ contributed equally to this work; they collected and analysed the data with assistance from FE and DvB. All authors contributed to writing the article and participated in the scientific debate. FE is the guarantor.

  • Funding: None.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (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.

  • Ethical approval: Not needed. All calculations used publicly available data.

  • Data sharing: No additional data available.

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