Why do elite athletes live longer than those less gifted at sport?

Athlete mortality statistics are often compared with data from the general population. Finnish male former elite athletes outlived matched controls who were healthy at the age of 20.1 In former endurance athletes, the risk of type 2 diabetes (OR adjusted for age, socioeconomic status, body mass index and smoking 0.24, 95% CI 0.07 to 0.81) and ischaemic heart disease (adjusted OR 0.33, 95% CI 0.18 to 0.61) were dramatically lower than in matched controls. These partly genetically determined1 3 health advantages, combined with a lower rate of smoking, were likely major mediating pathways that explain the association between endurance-type sports and a longer life expectancy.1

Athletes follow active rehabilitation protocols and maintain good physical function in later life

In middle age and later life, the Finnish male former elite athletes mentioned above were more physically active, had fewer disabilities, better self-rated health1 and decreased overall need of hospital care (for different disease categories and types of sports, see table 1).4 This finding is important for the individual and also provides important economic benefits to social and healthcare systems. While the quality of life of former athletes is usually good,1 5 there are factors, such as involuntary retirement, collisions/high contact sports, high body mass index and osteoarthritis, which are associated with low quality of life.⁵ The new data from three-time Olympian Dr Debbie Palmer and colleagues provides novel insights into self-reported health of the largest cohort of former Olympians yet studied.6

Athletes’ potential health risks change with time

Use of doping has severe consequences such as increased risk of suicide after using anabolic agents,7 8 and sudden cardiac death due to non-specific cardiac hypertrophy and related arrhythmia, possibly induced by anabolic agents.8 The IOC deserves kudos for its anti-doping activities.9 The doping control system is not perfect but it has surely prevented a large number of sudden deaths among young ambitious athletes. However, doping practices are just one factor that has changed during the professionalisation of sports.

In the Finnish former athlete cohort, compared with the controls, the need for hospital care among former elite athletes was low for most of the disease categories except for musculoskeletal diseases (table 1).4 High training volume and an intense competition calendar increase the risk of injuries. The risk of developing premature osteoarthritis is most strongly associated with athletes having suffered joint injuries in certain sports. In most sports, the risk of injuries is increased in competitions compared with training sessions. Injury prevention programmes should be tailored according to sports discipline, and there is a need to consider the possibility of rule changes in order to prevent injuries. There are also efforts by the IOC to improve monitoring of training, competition and psychological load, to improve athletes’ health.10

In many sports, athletes now reach peak performance at a young age. Knowledge about the specific mental and musculoskeletal characteristics of growing athletes is important. Some athletes do not reach the top because of injuries or other health-related problems during growth. Therefore, good education of both athletes and their coaches is an important component of athletes’ long-term health and well-being in many ways. Alongside parents, sport coaches also have an important role in an athlete’s development. Good education of coaches helps to prevent mental, physical or sexual maltreatment of young athletes. Good education of athletes includes information about how to adopt healthy lifestyle habits and how to find motivating professional careers after retirement from sport. Education of athletes, coaches and sports-leaders should also include information about how to prevent the distribution of infections.