The effect of strenuous, competitive exercise on the human heart and life expectancy has long been a subject of debate. For centuries, the general belief was that vigorous, competitive exercise was harmful and decreased life expectancy. However, a number of studies of the early 20th century, together with more recent data in elite athletes, strongly support the notion that participation in competitive sports is associated with normal or increased life expectancy, with a special beneficial effect of aerobic type of activities. In terms of genetics, current humans are citizens of the Paleolithic era living in the 21st century, so that those who better match with an active lifestyle will likely have a longer life expectancy and a reduced risk of chronic diseases. Endurance athletes might be such an example.

The effect of strenuous, competitive exercise on human life expectancy has long been a subject of debate. Since the classical antiquity, the prevailing belief has been that vigorous, competitive exercise is harmful. Hippocrates wrote about athletes that ‘…the truth is, however, that no one is in a more risky state of health than they….’1 Similar was the opinion of the Greek physician–philosopher Galen. Galen's beliefs were that ‘Athletes live a life quite contrary to the precepts of hygiene…when they give up their profession, they fall into a dangerous condition; as a fact, some die shortly afterwards, others live for some little time but do not arrive at old age..’2 The belief that vigorous exercise was harmful remained for centuries. In 1968, Moorstein3 stated that all members of the 1948 Harvard rowing crew had died early from ‘various cardiac diseases.’ A number of studies of the early 20th century and thereafter, however, showed that participation in endurance competitive sports increased life expectancy (table 1).