Studies have shown that staying active throughout your entire life is a very big deal when it comes to your health, so the math geek who takes up running after college and keeps at it will probably live longer than the football hero who hangs up his cleats and hits the recliner once his glory days are over [source: Paffenbarger ]. Don't count team sports and resistance training out, either. They may not boost longevity quite as much as endurance sports, but they are an important part of the picture.
Team sports can teach youth about discipline, camaraderie and sportsmanship, and are a healthy way to bond with friends. Resistance training helps prevent muscle wasting that happens with aging and reduces strength, coordination and quality of life during a person's golden years [source: Johnston et al.
Resistance training also strengthens bones for a healthy life [source: Kravitz ]. Cross-training helps prevent overuse. Varying your workout will keep you from getting bored and let you tap into the unique benefits of different types of exercise. A runner who regularly covers long distances can trot along comfortably while the novice runner next to the regular gasps for breath.
Is it just good genes? No, all that training has, among other things, made the more experienced runner's body better at transporting oxygen to the muscles, so the lungs don't have to work as hard. All sports have their health benefits, but those benefits come with risks, too. Sports injuries sometimes require surgeries and can lead to lifelong pain for some athletes. Repetitive motion injuries are a serious risk in some sports, and can have life-changing consequences.
Scientists in England found that professional soccer players are 10 times more likely to develop arthritis in the hip than the general public. Surprisingly, most of the players who developed arthritis did not realize they were injuring their hips -- the arthritis was caused by repetitive motion.
Many professional soccer players require total hip replacements in their 30s or 40s, which is much younger than most hip replacement patients in the general population. Another significant danger in some sports is traumatic brain injury TBI. TBI can be disabling or even life-threatening -- actress Natasha Richardson died in after she hit her head while skiing , and world-class halfpipe snowboarder Kevin Pearce was critically injured during training late that same year.
Pearce was rushed to the hospital in critical condition and placed on a respirator after he hit his head on the ice; he spent over three months in the hospital and many more months in rehabilitation.
He was wearing a helmet at the time of the accident [source: Branch ]. Athletes who suffer brain injuries can continue to get sicker even years after they stop playing their sport. Dementia pugilistica is a degenerative brain disorder caused by repeated blows to the head that was first diagnosed in boxers. This disease causes severe mental and physical disabilities; it can mimic Parkinson's disease or Alzheimer's disease, and it continues to get worse until the patient dies.
The risk of dementia pugilistica makes boxing less than a sure bet for living longer. Approximately , sports-related concussions happen each year in the U. The sports with the most player concussions are:. Even mild concussions can cause memory problems, confusion, depression and personality changes, and medical experts still don't know the long-term effects of repeated mild concussions.
College football players with a history of three or more concussions are three times more likely to suffer another concussion than their teammates, so repeated concussions are a concern for football players [source: Guskiewicz ].
Besides injuries, some competitive athletes do things to their bodies in their efforts to win that can shorten their lives. Anabolic steroid abuse can cause heart damage and suicidal behavior. Competitive wrestlers have died of dehydration and heatstroke from trying to lose water weight by abusing laxatives or trying to "sweat out" pounds before meets so they can compete in a lower weight category.
Sub-group analyses revealed male all-cause mortality was reported in 23 studies [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 , 51 , 52 , 53 ] , athletes; There was insufficient data to calculate a meta-SMR for either CVD or cancer mortality in females, therefore, this was only performed in male athletes. Overall, male CVD mortality was reported in 15 studies [ 30 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 45 , 46 , 47 , 49 , 50 , 53 ] , athletes, Overall cancer mortality was reported in 17 studies [ 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 45 , 46 , 47 , 49 , 51 , 53 ], with a pooled-SMR of 0.
Sensitivity analyses revealed that when 1 the four-lowest quality studies were removed; 2 only studies incorporating athletes actively competing after ; or 3 only studies published after were included, the pooled SMR remained similar to the overall SMR 0.
Indeed, meta-regressions demonstrated no significant interaction with SMR for any of the three data constraints. This was the first systematic review and meta-analysis to examine sport-specific all-cause mortality in former elite athletes and to consider CVD- and cancer-specific mortality, the two most prevalent diseases worldwide.
The key findings from this review are: 1 male and female elite athletes live longer than the general population; 2 male athletes have a lower incidence of CVD and cancer mortality than the general population; 3 power sport athletes all-cause and CVD mortality were not significantly different to the general population; 4 endurance athletes cancer mortality was not significantly different to the general population and 5 increased follow-up length increased the SMR for all-cause and cancer mortality, but not CVD.
Furthermore, there is currently insufficient data to allow sport-level comparisons for female athletes. Over recent years, an argument has been made that chronic, intensive exercise may be harmful to health [ 10 , 11 , 12 ] and lead to a greater chance of premature mortality, or an increased incidence cardiovascular events [ 14 , 15 , 54 ]. This seems to indicate that the female survival advantage females are expected to live 6—8 years longer than males at birth [ 55 ] persists, and is even extended, after a career in elite sport.
However, female mortality was only explored in 25, athletes, 24, Therefore, more research in female athletes is needed to confirm the survival benefit in highly active female athletes. Given that the standardised mortality ratio was the most common method of reporting the risk of mortality in elite athletes, this method was chosen for the meta-analysis.
However, life expectancy and age at death in male athletes has also been explored. Specifically, Clarke et al. These results are, therefore, largely in accord with those of the current meta-analysis, as the lowered SMR risk indicates a longer survival in former elite athletes compared to the general population. Despite the apparent survival benefit of elite athletes, one common and important criticism of the literature is the applicability of comparing former elite athletes to the general population.
Elite athletes may be characterised by healthier lifestyles post-retirement than the general population and engage in more leisure-time physical activity LTPA , both of which predict all-cause mortality [ 31 , 44 , 57 , 58 ]. It is, therefore, not currently possible to distinguish the influence of intensive training per se from overall lifestyle factors.
Indeed, it may be worth noting that when Sarna et al. Additionally, some studies have only reported survival benefits up to a specific age, rather than across the whole lifespan [ 40 , 46 , 49 ]. Specifically, Schnohr [ 46 ] found that athletes up to 50 years had a SMR of 0.
Similarly, former Scottish footballers only had a survival benefit up to the age of 60 years [ 40 ], with Polish footballers having a benefit until 75 years [ 49 ], after which the mortality was the same or greater than the general population.
Conversely, Antero-Jacquemin [ 29 ] reported an increased longevity in French Olympians after 50 years of age, thus, it is unknown why this apparent loss of survival advantage occurs, in some, but not all, athletes. Further work is needed to elucidate the potential mechanisms. Male END athletes had the most favourable all-cause mortality rate and lived significantly longer than the general population SMR 0.
Indeed, Clarke et al. Endurance athletes have consistently been shown to have favourable mortality compared to the general population, attributed to an increased cardiorespiratory fitness CRF and subsequent maintenance of CRF throughout the lifespan. Furthermore, the difference is unlikely to be explained by genetic factors as it has recently been shown that elite athletes who undertake strenuous aerobic exercise exhibit similar disease-trait-related genotypes to the general population [ 61 ].
Thus, endurance athletes are still predisposed to similar levels of disease to the general population. Male team sport athletes, the biggest sub-group within the meta-analysis including 78, This may be explained, at least in part, by two studies in the team sport meta-analysis including athletes competing before [ 46 , 51 ].
Specifically, sporting practices, training demands, athlete welfare and advances in health care make it difficult to directly compare across such a large time-span and gain reliable results.
It should be acknowledged, however, that three of these studies, conducted by Abel and Kruger [ 62 , 63 , 65 ], also involved athletes who made their professional debuts before , so the applicability of their findings to a modern population is questionable.
Furthermore, Kuss et al. Nevertheless, despite these methodological limitations, they advance our understanding, although the generalisability of their results remains questionable and conclusions must be drawn with caution. In contrast, Clarke et al. Former Olympic male wrestlers have also been reported to live However, contradicting the negative associations of all-cause mortality and power sports, Antero-Jacquemin et al.
Given the disparity of results across the literature and the small statistical power within this meta-analysis, more research is needed to fully elucidate the long-term effects of competing in power sports. Specifically, men in the highest quintile of fitness, compared to those in the lowest, had a relative risk of 0. However, more research is needed to confirm this hypothesis and to establish whether intensive training lowers the specific risk profile and aetiologies of individual CV diseases.
Nevertheless, American football linemen, who share a lot of characteristics with power sport athletes, had a two to threefold increase in CVD mortality compared to counterparts in other positions [ 33 , 41 ]. One possible explanation is the increased likelihood of hypertension in power athletes [ 32 , 73 , 74 ], a long-established independent CVD risk factor.
This risk could be further exacerbated as over a year period power athletes reportedly gained an average of So, a question remains as to whether playing-time BMI is the primary risk factor of CVD or subsequent weight-gain post-retirement is a greater indicator of CVD mortality in power athletes.
Cancer mortality SMR 0. Likewise, elite French athletes had a significantly lower incidence of cancer mortality, gaining an average of 2. One possible explanation is that former athletes smoke less, drink less, and engage in more LTPA than the general population [ 31 , 57 , 58 , 76 ], all of which significantly contribute to cancer risk and mortality. Indeed, Sourmunen et al.
Moreover, Pukkala et al. This may explain, at least in part, why some populations of footballers [ 40 , 49 , 53 , 78 ], Olympians [ 39 , 46 ] and baseballers [ 51 ] all have similar rates of cancer incidence and mortality to the general population, whilst others demonstrate a reduced risk [ 33 , 34 , 42 , 45 ]. Despite this, END athletes have consistently been found to have favourable longevity compared to the general population and, indeed, other athletes [ 29 , 37 , 41 , 42 , 47 , 52 ].
Thus, it is worth considering whether the non-protective effect on cancer mortality derives from END training, or simply that athletes are living longer and, therefore, have a greater chance of developing cancer.
Whilst distinguishing these factors may be challenging, it deserves consideration given that it could alter the interpretation of the results presented and future study directions.
Regardless of their increased longevity, however, END athletes are still at a decreased risk of CVD mortality, suggesting the benefit of training is maintained throughout the life-span.
Whilst there are numerous strengths, there are limitations to this review that require consideration. Specifically, not all the athletes within these studies were elite and of national standard, although they were all considered to be highly trained. Moreover, inferences are not able to be made about the specific training that athletes should undertake as such data was rarely reported. As such, conclusions regarding the long-term effects of participating in specific types of training regimes, such as HIIT, resistance or strength training, are precluded.
Furthermore, the small number of studies included within the POW athlete sub-group, and female athletes potentially limits the generalisability of these results.
It is also noteworthy that some sports may have been mis-classified in previous research for example, Sarna et al. Finally, no inferences can be made as to the relative contribution of lifestyle on overall mortality.
Thus, it is hard to distinguish whether any survival benefit observed is because of training, lifestyle choices, or most likely, a combination of both.
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Our World in Data [cited Accessed 1 Aug Cardiorespiratory fitness and cardiovascular disease prevention: an update. Curr Atheroscler Rep. Nystoriak MA, Bhatnagar A. Cardiovascular effects and benefits of exercise. Front Cardiovasc Med. Sarna S, et al. Health status of former elite athletes. The Finnish experience. Aging Clin Exp Res. CAS Google Scholar.
Laukkanen JA, et al. Cardiorespiratory fitness, lifestyle factors and cancer risk and mortality in Finnish men. Eur J Cancer. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin Proc. Part 1: potential dangers of extreme endurance exercise: how much is too much? Part 2: screening of school-age athletes.
Prog Cardiovasc Dis. The goldilocks zone for exercise: not too little, not too much. Missouri Med. Armstrong MEG, et al. Frequent physical activity may not reduce vascular disease risk as much as moderate activity: large prospective study of women in the United Kingdom. Schnohr P, et al. Dose of jogging and long-term mortality: the Copenhagen city heart study. J Am Coll Cardiol. Running the risk of coronary events: prevalence and prognostic relevance of coronary atherosclerosis in marathon runners.
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The number of months of life until death, or the key date of the examination, is used as the dependent variable. The time of first-time participation in the Olympic Games is included in the models as a regressor and is used as a proxy for the general increase in life expectancy within the Cox regression.
The procedures applied are standard procedures used in medical statistics for survival analyses Altman, ; Klein and Moeschberger, ; Bland, Our analysis strategy is based on the variables currently available.
It does not yet allow for any causal conclusions, confounder analyses, or sensitivity analyses. It can only be a first step toward a causal analysis, disturbance variable analysis, and sensitivity analysis. The knowledge gained from the results of our analysis, in addition to the current state of research, will be used below to propose a model of impact factors on the life span of elite athletes.
The data in Table 1 shows the number of all German Olympic participants between and and the three sub-risk groups analyzed German Olympic participants —, FRG Olympic participants —, GDR Olympic participants — In order to compare the mortality risk of West FRG and East German GDR Olympic participants with the general population aged 15 and over, the mortality risks of the general population were aggregated across the observation periods —; —; — and age groups 15—34; 35—64; 65 and older and multiplied by the number of associated groups of Olympic participants.
The resulting expected number of deaths was compared to the observed number of deaths. The observed and expected number of deaths determined for the three time periods and the three age groups and the resulting SMRs are shown in Table 2. Instead of the expected 7. Female athletes are more affected by the increased mortality risk of the 15—year-old West German Olympians between and and between and than male athletes.
The mortality risk of athletes aged 65 years and above decreases over the three time ranges. An increased mortality risk was also determined for the East German Olympians between 15 and 34 years old in comparison with the GDR population or the East German federal states see Table 2.
For the three time ranges analyzed, the entire group of Olympians between and from East and West Germany shows higher standardized mortality rates in the age groups 15—34 and 35—64, and a lower mortality rate for athletes aged 65 and above see Figure 1. Figure 1. Development of the standardized mortality rates SMR by age group and time range. Analyzing the development of the SMR over time in age groups of 10 years each, starting from the age of 15, for the time ranges —, —, etc.
This indicates that athletes' mortality risk for younger age groups develops negatively compared to the general population, while it converges toward the general population for older age groups. Due to the low number of deaths of athletes participating in the Olympic Games or later for their first time, no conclusions can be drawn yet with respect to mortality rates of reunified Germany.
In summary: the better the Olympic result, the higher the mortality risk in this cohort. Non-significant factors within the Cox regression were the age at first Olympic participation, the differentiation between winter and summer games, the number of Olympic participations, and the differentiation between team, individual, and mixed sports. In a separate Cox regression, we also included prototypical aerobic and anaerobic sports as independent factors but did not detect any significant effects on life span.
We obtained the same result when using doping-related sports as an additional explanatory factor. An exposure group's mortality rates always show the sum of positive and negative factors effective at a specific measurement point in time in comparison to a control group Kalwij, ; Nguyen et al.
This means that the results are always preliminary. Nevertheless, since , the sum of positive and negative effects of elite sports on the mortality of German Olympic participants appears to have been negative in comparison to the general population over 14 years old.
What is surprising is that we did not find any evidence in our data set and analysis that assumed risk factors such as being part of the East German Olympic team or sports-specific risks indeed impact the mortality rate. The analysis by Nguyen et al.
This is also indicated by the findings of Wicker et al. Lower mortality rates of athletes with high metabolism contradict theories of aging Prinzinger, In contrast, the here presented study shows a negative influence on life span when participating in the Olympic Games several times and thus developing a high metabolism for a longer time.
It also appears to be the case that previous studies compared the mortality of elite athletes with the total population, including infants. The higher infant mortality may, however, make the results appear more favorable for Olympic participants. It is, of course, also possible that elite sports act as a selection factor: people whose genetic predisposition leads them to living a riskier life may be more likely to choose elite sports, so that they as a group have a different life expectancy than the general population.
This would mean that elite sports represent a variant of different lifestyles in which people with specific dispositions prevail. The findings on the Goldman-Dilemma Gonzalez et al.
We call this the endogeneity problem. The findings from previous research and the newly presented findings on German Olympic participants can be combined into a research strategy that aims to causally explain the effects of extensive elite sports on mortality risk, and to isolate the effect factors. Particular attention is paid to the risk factors tobacco use, alcohol abuse, salt intake, obesity, raised blood pressure, raised blood glucose, and diabetes Kontis et al.
These two general risk factors socioeconomic status and WHO risk factors have not been controlled in any study of the mortality of elite athletes. In a model to explain the life span of elite athletes, both factors must be considered.
Since men in the general population have a riskier lifestyle, this should also apply to male athletes after the end of their career. On the other hand, elite athletes, especially women, behave in a more risk-averse manner with regard to the general risks listed above in order to not jeopardize their sporting career.
Our analysis of German Olympic participants' mortality strengthens the evidence that sports have lost their positive effect on the life span of elite athletes and that sports can be considered a risk factor.
Gender and the type of sport determine the exercise workload. In case of moderate training load, positive effects on the life span should occur. For elite athletes, however, negative effects such as sports accidents, heart failure, suicide, or doping may outweigh the positive effects.
Other risk factors specific to competitive sports have not been widely observed to date but cannot be ruled out. Our analysis indicates that negative effects are stronger for male elite athletes than for female athletes and increase with higher training loads. Gender and sport-specific workload also determine the level of sporting success. The strong evidence for gender-specific influences on mortality risk suggests that gender is a moderator for the effect of athletic success on socioeconomic status.
In addition, gender might also influence the effect of exercise load on both general risk factors and factors specific to the type of sport. It can also be assumed that gender directly influences the general risk factors after the end of a sporting career. This results in four groups of effect factors, which are influenced in different ways by sporting success, training load, type of sport, and gender.
Compared to a life without a competitive sports career, a higher socioeconomic status and the avoidance of general risks during the sports career lead to a longer life span.
In contrast, with increasing training load, sport-specific risk factors reduce the life span. It remains to be seen whether a sports career leads to a healthier lifestyle after its end than would have been the case without a sports career.
There is still a lack of research in this area, so that the direction of the effect cannot be stated at present. The above considerations lead to a model which aims to explain the life span of elite athletes and postulates the influencing variables and effects, which are summarized in Figure 3. The current state of research, enriched by the results of our analysis, now allows a first proposal for a training impact model on the life span of athletes at the international top level.
However, the evidence gathered has not yet reached a quality that would allow further insights into causal relationships. In summary, the assumption of a higher survival rate of Olympians compared to the general population was not confirmed. While different types of sport do not exhibit any differences, gender and origin FRG vs. Based on our results and the current state of research, we have proposed an impact model that integrates all of the results to date but also identifies the missing impact factors.
As for all survival analyses, the results presented are limited due to the usage of censored data. Furthermore, it is possible that due to data limitations, certain deaths were not taken into account in our analysis, and thus actual mortality risk for elite athletes may be even higher than currently stated.
However, overall, we do not believe a systematic distortion in favor of one of the comparison categories e. Also due to data limitations, only sports-specific risk factors were controlled. Data on suicide and risk factors that are usually very influential in general survival analyses, such as socioeconomic status income, property, professional position, reputation of the profession , and educational risk factors had to be neglected.
Also, it is questionable whether comparisons of official causes of death would be appropriate as they would not allow conclusions to be drawn about competitive sports-induced reasons for a risky lifestyle.
Moreover, the unsolved endogeneity problem discussed above represents a limitation to the results presented. However, the proposed model could address the endogeneity problem if it withstands further validation and falsification. The partially contradictory results call for a repeat of the analysis with a larger data set. The groups of Olympians analyzed could also be specified in more detail and extended to further countries in order to expand the reach of the results presented.
In a next step, the proposed model should be tested and developed further. The results may contribute to the validity of general theories of aging. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Abel, E. Longevity of major league baseball players. Sports Med. Altman, D. Practical Statistics for Medical Research. Google Scholar.
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