Abstract

We investigated if Brazilian Olympic athletes live longer than the general population, and if there are differences between the types of sport. This is a retrospective cohort study with secondary data analysis. Data from Brazilian athletes of both sexes were included, from the 7^th edition (1920) to the 25^th edition (1992) of the Modern Olympic Games. Details of sex, date of birth, date of death, and sport competed were recorded when available. Comparisons were made between athletes vs. age-matched controls from the general population; and between sport types (strength/power [SP] vs. endurance/mixed [EM]). Brazilian Olympic athletes live approx. 8 years longer than expected for the age matched general population. However, there were no differences in lifespan between SP (68.8 years) vs. EM (68.9 years) athletes (p>0.05). Brazilian Olympic athletes live longer than expected for the general population. However, there are no differences between athletes from different sport types.

Key words:
Athletes; Longevity; Life expectancy; Physical activity; Sports

Resumo

Investigamos se os atletas olímpicos brasileiros vivem mais que a população em geral e se existem diferenças entre os tipos de esporte. Trata-se de um estudo de coorte retrospectivo com análise de dados secundários. Foram incluídos dados de atletas brasileiros de ambos os sexos, desde a 7ª edição (1920) até a 25ª edição (1992) dos Jogos Olímpicos Modernos. Detalhes sobre o sexo, data de nascimento, data de falecimento e esporte praticado foram registrados quando disponíveis. Foram feitas comparações entre atletas e controles de mesma idade da população em geral; e entre tipos de esporte (força/potência [SP] vs. resistência/misto [EM]). Os atletas olímpicos brasileiros vivem aprox. 8 anos a mais do que o esperado para a população geral correspondente à idade. No entanto, não houve diferenças na expectativa de vida entre atletas SP (68,8 anos) vs. EM (68,9 anos) (p>0,05). Os atletas olímpicos brasileiros vivem mais que o esperado pela população em geral. No entanto, não há diferenças entre atletas de diferentes modalidades esportivas.

Palavras-chave:
Atletas; Longevidade; Expectativa de vida; Atividade física; Esportes

Introduction

A dichotomous perspective exists between the beneficial effects of physical exercise and the risks of strenuous efforts. Prospective studies have demonstrated that additional increases in exercise, starting from moderate levels i.e., 3600 metabolic equivalents (MET) per minutes/week¹1 Kyu HH, Bachman VF, Alexander LT, Mumford JE, Afshin A, Estep K, Veerman JL, Delwiche K, Iannarone ML, Moyer ML, Cercy K, Vos T, Murray CJ, Forouzanfar MH. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: Systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ 2016; 354:i3857. can be beneficial for health and longevity, thus suggesting that the more physical activity practiced, the better these outcomes²2 Al-Mallah MH, Sakr S, Al-Qunaibet A. Cardiorespiratory Fitness and Cardiovascular Disease Prevention: an Update. Curr Atheroscler Rep 2018; 20(1):1. However, other studies have identified a greater cardiac risk related to frequent strenuous efforts³3 Andersen K, Farahmand B, Ahlbom A, Held C, Ljunghall S, Michaëlsson K, Sundström J. Risk of arrhythmias in 52 755 long-distance cross-country skiers: A cohort study. Eur Heart J 2013; 34(47):3624-3631..

Athletes are a select population who may yield insights into the associations between high levels of physical training over time and longevity. In the last two decades, an increasing number of studies have addressed the question of whether elite athletes live longer than the general population⁴4 Takeuchi T, Kitamura Y, Sado J, Hattori S, Kanemura Y, Naito Y, Nakajima K, Okuwaki T, Nakata K, Kawahara T, Sobue T. Mortality of Japanese Olympic athletes: 1952-2017 cohort study. BMJ Open Sport Exerc Med 2019; 5(1):e000653.

5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902.

6 Garatachea N, Santos-Lozano A, Sanchis-Gomar F, Fiuza-Luces C, Pareja-Galeano H, Emanuele E, Emanuele E, Lucia A. Elite Athletes Live Longer Than the General. Mayo Clin Proc 2014; 89(9):1195-1200.

7 Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. Sport Med Open 2015; 1(1):16.

8 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301.

9 Teramoto M, Bungum TJ. Mortality and longevity of elite athletes. J Sci Med Sport 2010; 13(4):410-416.^-1010 Orchard JW, Orchard JJ, Semsarian C, La Gerche A, Driscoll T. Reduced death rates of elite Australian Rules footballers compared to age-matched general population. J Sci Med Sport 2022; 25(9):710-714.. The results from the majority of previous studies⁴4 Takeuchi T, Kitamura Y, Sado J, Hattori S, Kanemura Y, Naito Y, Nakajima K, Okuwaki T, Nakata K, Kawahara T, Sobue T. Mortality of Japanese Olympic athletes: 1952-2017 cohort study. BMJ Open Sport Exerc Med 2019; 5(1):e000653.^,66 Garatachea N, Santos-Lozano A, Sanchis-Gomar F, Fiuza-Luces C, Pareja-Galeano H, Emanuele E, Emanuele E, Lucia A. Elite Athletes Live Longer Than the General. Mayo Clin Proc 2014; 89(9):1195-1200.

7 Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. Sport Med Open 2015; 1(1):16.

8 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301.

9 Teramoto M, Bungum TJ. Mortality and longevity of elite athletes. J Sci Med Sport 2010; 13(4):410-416.^-1010 Orchard JW, Orchard JJ, Semsarian C, La Gerche A, Driscoll T. Reduced death rates of elite Australian Rules footballers compared to age-matched general population. J Sci Med Sport 2022; 25(9):710-714. confirmed the survival advantage of being an Olympic athlete, regardless of country and sex.

However, it may be premature to make conclusions about the survival advantage of being an Olympic athlete in all countries, since the majority of studies on this topic were conducted with athletes from developed countries⁵5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902.^,66 Garatachea N, Santos-Lozano A, Sanchis-Gomar F, Fiuza-Luces C, Pareja-Galeano H, Emanuele E, Emanuele E, Lucia A. Elite Athletes Live Longer Than the General. Mayo Clin Proc 2014; 89(9):1195-1200.. The four reviews on this topic Teramoto and Bungum⁹9 Teramoto M, Bungum TJ. Mortality and longevity of elite athletes. J Sci Med Sport 2010; 13(4):410-416., Garatachea et al.⁶6 Garatachea N, Santos-Lozano A, Sanchis-Gomar F, Fiuza-Luces C, Pareja-Galeano H, Emanuele E, Emanuele E, Lucia A. Elite Athletes Live Longer Than the General. Mayo Clin Proc 2014; 89(9):1195-1200., Lemez and Baker⁷7 Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. Sport Med Open 2015; 1(1):16., and Runacres et al.⁸8 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301., all included studies that analyzed samples of Olympians from Europe, North America, Oceania, and Asia, such as the United States (US), France, Italy, Belgium, Norway, Sweden, Finland, New Zealand, the Netherlands, Germany, Japan, Poland, and the United Kingdom (UK). As far as we know, no studies have been performed on this topic with athletes from developing countries. Despite being the 12^th largest economy in the World in 2020 (according to the Austin Rating), Brazil has a lower socioeconomic profile and life expectancy when compared to countries from Europe and the US¹¹11 World Health Organization (WHO). Life expectancy and Healthy life expectancy Data by country [Internet]. [cited 2021 set 3]. Available from: https://apps.who.int/gho/athena/data/GHO/WHOSIS_000001,WHOSIS_000015,WHOSIS_000002,WHOSIS_000007.html?profile=ztable&filter=COUNTRY:*
https://apps.who.int/gho/athena/data/GHO... . This could be an important consideration, as studies performed in Brazil may clarify whether the expected advantage of being an Olympian is influenced by the social, economic, geographical, and cultural factors of the country, when compared to developed countries.

On the other hand, it should be noted that lower mortality rates were observed for endurance but not for power athletes in some previous studies⁷7 Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. Sport Med Open 2015; 1(1):16.

8 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301.

9 Teramoto M, Bungum TJ. Mortality and longevity of elite athletes. J Sci Med Sport 2010; 13(4):410-416.^-1010 Orchard JW, Orchard JJ, Semsarian C, La Gerche A, Driscoll T. Reduced death rates of elite Australian Rules footballers compared to age-matched general population. J Sci Med Sport 2022; 25(9):710-714., and it is unknown whether this pattern will be observed in Brazilian Olympians, given the important differences in sports training methods and cultures between countries. Therefore, differences in longevity in terms of sport modality remain to be elucidated in developing countries with different socioeconomic and cultural contexts.

Thus, the aims of this study were: (1) to investigate whether former Brazilian Olympic athletes live longer than an age matched sample of the general population; and (2) to describe whether the sport type is related to greater longevity.

Methods

This is a retrospective cohort study of Brazilian male and female Olympic athletes. We used publicly available data from the Brazilian Olympic Committee (COB) website (https://www.cob.org.br/) to identify all the Brazilian women and men who participated, at least once, in the Summer Olympic Games between 1920 (Antwerp, Belgium) and 1992 (Barcelona, Spain). The sex, dates of birth and death, date(s) of Olympic Games participation, and sports competed in of all the athletes were obtained from both the COB website and the book: “Atletas Olímpicos Brasileiros”¹²12 Rubio K. Atletas Olímpicos Brasileiros. São Paulo: SESI-SP; 2015.. Athletes with a missing date of birth were excluded from the analyses (Figure 1).

No ethical approval was needed. According to the National Health Council (CNS, acronym in Portuguese), Resolution No. 466/2012 (https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf), no approval or ethical review by the CEP-CONEP system (Research Ethics Committee - National Research Ethics Commission) was needed as all data are available in the scientific literature and on the COB site. All data were anonymized before use.

The data from the Brazilian population were obtained from the Brazilian Institute of Geography and Statistics (IBGE) life tables (https://doi.org/10.48331/scielodata.13JWWJ).

In our study the athletes were matched by year of birth and age when they participated in the Summer Olympic Games.

For the sport type comparison, the athletes were categorized into two distinct groups: Strength/Power and Endurance/Mixed. The two types of sports are described in Chart 1. A similar criterion has previously been used⁸8 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301., in which Strength and Power (SP) athletes were those from predominantly anaerobic or technical sports; and Endurance and Mixed (EM) athletes were those from continuous or intermittent sports lasting ≥10 min.

Data were inserted into an Excel spreadsheet and statistical analyses were performed using R software. As the main interest is the years lived by the athlete (T_i), we defined T_i = F_i−N_i / 365 as the years lived of the i-th athlete (in years), where N_i is the birth date and F_i is the death date for dead athletes; we set F_i = 31/05/2020 for the living athletes, for i = 1, ..., n.

For the analyses, we considered descriptive analysis and an adjusted survival model. In this context, we present the summary measures referring to the athletes’ lifetime using a boxplot. With the aid of the Akaike Information criterion (AIC) selection criteria, in addition to the Kaplan-Meier curve, a model was formulated to adjust the lifetime of the athletes under analysis. Considering the adjusted model, we calculated how much longer an athlete lives in relation to their compatriots.

As the database is composed of the years lived of dead and alive athletes, for the adjustment of the survival model, we assumed that the longevity of living athletes are right-censored observations of type I¹³13 Louzada-Neto F, Pereira BB. Modelos em análise de sobrevivência. Cad Saude Colet 2000; 1:9-26., which means that our study had a set number of athletes and ended on 31/05/2020 (i.e., before the death of many athletes had occurred). Additionally, we considered that the years lived (T_i) came from a weibull distribution, which showed the lowest value of the AIC criterion. To estimate the parameters, we considered the maximum likelihood method¹⁴14 Casella G, Berger RL. Statistical inference Second Edition. Encyclopedia of Ecology; 2018..

For comparisons of the life expectancy of Olympic athletes and the general population we present two approaches:

Results

A total of 523 (465 men) Olympian athletes were included in this study, among which 167 had died (32%; 159 men, 8 women) and 354 were alive (68%; 306 men) on May, 31^th, 2020 (the study end point). Figure 2 presents the boxplot of the lifetime of deceased and alive athletes. Among the deceased athletes, the shortest lifetime recorded was 28 years and the longest was 104 years, with a median lifetime of 73 years, ranging from 50y (1^st Quartile) to 82y (3^rd Quartile). Among the living athletes, the shortest and longest lifetimes were 46 and 100 years, respectively, with a median lifetime of 65 years, ranging from 57y (1^st Quartile) to 80y (3^rd Quartile). The median lifetime of dead female athletes was greater than that of male athletes. For living athletes, the median lifetime of male athletes was significantly greater than that of female athletes.

Figure 3A shows the Kaplan-Meier survival models with confidence intervals, while Figure 3B shows the survival curves of the Weibull model. There was no difference between the survival of the two groups, according to the log rank test, that is, the estimation indicates a consistently equal survival function between EM and SP athletes.

The average lifespans of SP and EM athletes were 68.8 and 68.9 years, respectively. However, the life expectancies of the population in the year of their respective competitions were 60.5 and 60.2 years, which shows that SP and EM athletes live 8.38±2.16 years and 8.82±1.67 respectively longer than their compatriots, as shown in Figure 4.

Discussion

This study is the first to investigate longevity among Brazilian athletes. The results suggest that Brazilian Olympic athletes live nearly 8 years longer than the expected lifespan for the age matched general population. Additionally, in our sample, the longevity of SP athletes was not significantly different to that of EM athletes, which differs from previous reports in studies from developed countries.

Our findings confirm previous reports that elite athletes live longer than the general population⁵5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902.^,1010 Orchard JW, Orchard JJ, Semsarian C, La Gerche A, Driscoll T. Reduced death rates of elite Australian Rules footballers compared to age-matched general population. J Sci Med Sport 2022; 25(9):710-714.

11 World Health Organization (WHO). Life expectancy and Healthy life expectancy Data by country [Internet]. [cited 2021 set 3]. Available from: https://apps.who.int/gho/athena/data/GHO/WHOSIS_000001,WHOSIS_000015,WHOSIS_000002,WHOSIS_000007.html?profile=ztable&filter=COUNTRY:*
https://apps.who.int/gho/athena/data/GHO...

12 Rubio K. Atletas Olímpicos Brasileiros. São Paulo: SESI-SP; 2015.^-1313 Louzada-Neto F, Pereira BB. Modelos em análise de sobrevivência. Cad Saude Colet 2000; 1:9-26.^,1515 Coate D, Sun R. Survival estimates for elite male and female Olympic athletes and tennis championship competitors. Scand J Med Sci Sport 2013; 23(6):722-727.. Specifically, two previous studies⁵5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902.^,88 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301. provide strong evidence of the greater longevity of Olympic athletes compared to the general population. Clarke et al.⁵5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902. examined 15,174 Olympic medalists from 9 developed countries and showed that athletes lived ~2.8 years longer than the general population. In a recent meta-analysis including nearly 165,000 former elite athletes of both sexes from different sport types, Runacres et al.⁸8 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301. confirmed the current knowledge, while refuting the ‘J’ shaped hypothesis for vigorous exercise and mortality by showing greater longevity for the athletes when compared to the general population.

To achieve Olympic status, an athlete invests in many years of physical training, thus it is expected that some physiological mechanisms associated with cardiovascular, neuromuscular, and immune systems triggered by systematic vigorous physical exercise can influence physical and psychological health and, consequently, increase longevity by decelerating the aging process¹⁶16 Gremeaux V, Gayda M, Lepers R, Sosner P, Juneau M, Nigam A. Exercise and longevity. Maturitas 2012; 73(4):312-317.. For instance, maximum oxygen consumption (VO2max) during adulthood has previously been associated with lower mortality rates. This association may be explained by the higher starting point of individuals with higher VO2max values at younger ages, which may lead to greater health and functional capacity when they become older¹⁶16 Gremeaux V, Gayda M, Lepers R, Sosner P, Juneau M, Nigam A. Exercise and longevity. Maturitas 2012; 73(4):312-317..

Unfortunately, we were not able to record the cause of death of most of the athletes in the current sample. The reduction in mortality from chronic non-communicable diseases may be the main explanatory factor for the greater longevity of Olympians observed in our study, in accordance with recent findings from 8,124 US athletes¹⁷17 Antero J, Tanaka H, Larochelambert Q, Pohar-Perme M, Toussaint JF. Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. Br J Sports Med 2021; 55(4):206-212.. Antero et al.¹⁷17 Antero J, Tanaka H, Larochelambert Q, Pohar-Perme M, Toussaint JF. Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. Br J Sports Med 2021; 55(4):206-212. showed that the longevity advantage for US athletes compared to the general population was primarily attributed to the lower risk of death from cardiovascular diseases followed by cancer, respiratory diseases, external causes, endocrine and metabolic diseases, and digestive system diseases. However, mortality rates due to nervous system disorders and mental illnesses were not different from the general population¹⁷17 Antero J, Tanaka H, Larochelambert Q, Pohar-Perme M, Toussaint JF. Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. Br J Sports Med 2021; 55(4):206-212..

When we consider the epidemiological transition that Brazil experienced in the middle of the 20^th century, with important changes in the mortality profile, moving from infectious diseases to non-communicable diseases as the main causes of death¹⁸18 Silva Junior JB, Gomes FBC, Cezário AC ML. Doenças e agravos não transmissíveis: bases epidemiológicas. In: Rouquayrol MZ, Almeida Filho N. Epidemiologia & Saúde. 6ª ed. Rio Janeiro: Medsi. 2003. p. 289-311., we can suggest that the deaths in our sample were mainly due to non-communicable diseases and senility, as most Olympians died after 1970.

It is noteworthy that the positive effects of vigorous systematic exercise are reversible after a period of detraining, depending on physiological adaptations, with different rates of decline¹⁹19 Lambert MI. General adaptations to exercise: Acute versus chronic and strength versus endurance training. In: Vaamonde D, Plessis SS, Agarwal A, editors. Exercise and Human Reproduction: Induced Fertility Disorders and Possible Therapies. New York: Springer; 2016. p. 93-100.. In this regard, little is known about the potential “legacy” effect of systematic vigorous exercise during young adulthood on the morbidity and mortality of athletes after retirement. The majority of studies with longevity as the outcome did not assess lifestyle habits after the end of the athletic career⁵5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902.^,99 Teramoto M, Bungum TJ. Mortality and longevity of elite athletes. J Sci Med Sport 2010; 13(4):410-416.^,2020 Antero-Jacquemin J, Rey G, Marc A, Dor F, Haïda A, Marck A, Berthelot G, Calmat A, Latouche A, Toussaint JF. Mortality in Female and Male French Olympians: A 1948-2013 Cohort Study. Am J Sports Med 2015; 43(6):1505-1512., thus, the question on how much exercise and its characteristics before retirement influence athletes’ longevity remains largely unknown, as part of this outcome may be due to positive behavioral facets of lifestyle after retirement.

It has been reported that former athletes who later adopt a sedentary lifestyle present an increased risk of developing chronic diseases, such as diabetes and cardiovascular disease²¹21 Witkowski S, Spangenburg EE. Reduced physical activity and the retired athlete: a dangerous combination? Br J Sports Med 2008; 42(12):952-953.. On the other hand, former athletes with a physically active lifestyle after retirement have better body composition and a lower risk for cardiovascular disease, metabolic syndrome, and non-alcoholic fatty liver disease²²22 Kujala UM, Tikkanen HO, Sarna S, Pukkala E, Kaprio J, Koskenvuo M. Disease-specific mortality among elite athletes. JAMA 2001; 285(1):44-45.. These findings highlight the impact of an athlete’s post-retirement lifestyle on morbidity and mortality. However, longevity also has other environmental (e.g., access to health services, nutrition, socioeconomic characteristics and wealth) and genetic⁵5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902. components. Socioeconomic status - measured as a combination of education, income, and occupation - is a well-known factor that may influence human longevity. For former athletes with a higher income for example, medical care and technology accessibility, healthier nutrition, and physical activity facilities are probably more easily available⁷7 Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. Sport Med Open 2015; 1(1):16.. Higher socioeconomic status could also expose athletes to a lower risk of violence and homicide¹⁷17 Antero J, Tanaka H, Larochelambert Q, Pohar-Perme M, Toussaint JF. Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. Br J Sports Med 2021; 55(4):206-212.. Despite these “potential” but speculative relationships between socioeconomic status and longevity in athletes, mortality remains lower in athletes compared to controls, even after accounting for socioeconomic status²³23 Kettunen JA, Kujala UM, Kaprio J, Bäckmand H, Peltonen M, Eriksson JG, Sarna S. All-cause and disease-specific mortality among male, former elite athletes: An average 50-year follow-up. Br J Sports Med 2015; 49(13):893-897., highlighting the influence of other factors in longevity. We cannot exclude the hypothesis that our athletes are part of a select group of individuals genetically predisposed to live longer. However, this hypothesis has not been confirmed²⁴24 Gómez-Gallego F, Ruiz JR, Buxens A, Altmäe S, Artieda M, Santiago C, González-Freire M, Verde Z, Arteta D, Martínez A, Tejedor D, Lao JI, Arenas J, Lucia A. Are elite endurance athletes genetically predisposed to lower disease risk? Physiol Genomics 2010; 41(1):82-90.. Meanwhile, different to our hypothesis, the expected negative effect of being a citizen of a developing country on the aforementioned environmental factors does not seem to play a role.

Interestingly, there was no statistically significant difference in longevity between the SP and EM groups, which is a different outcome from previous studies⁵5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902.^,77 Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. Sport Med Open 2015; 1(1):16.

8 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301.^-99 Teramoto M, Bungum TJ. Mortality and longevity of elite athletes. J Sci Med Sport 2010; 13(4):410-416.^,2525 Lee-Heidenreich J, Lee-Heidenreich D, Myers J. Differences in life expectancy between Olympic high jumpers, discus throwers, marathon and 100 meter runners. BMC Sports Sci Med Rehabil 2017; 9:3.^,2626 Keller K. Life Expectancy of Olympic Wrestling Champions in Comparison to the General Population. J Community Health 2019; 44(1):61-67.. The literature more frequently shows greater longevity for endurance athletes (e.g., marathon runners, cyclists), with gains of 4 to 8 years of lifespan when compared to the general population⁵5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902.^,88 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301.^,2222 Kujala UM, Tikkanen HO, Sarna S, Pukkala E, Kaprio J, Koskenvuo M. Disease-specific mortality among elite athletes. JAMA 2001; 285(1):44-45.^,2727 Sanchis-Gomar F, Olaso-Gonzalez G, Corella D, Gomez-Cabrera MC, Vina J. Increased average longevity among the Tour de France cyclists. Int J Sports Med 2011; 32(8):644-647.. However, other previous evidence¹⁷17 Antero J, Tanaka H, Larochelambert Q, Pohar-Perme M, Toussaint JF. Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. Br J Sports Med 2021; 55(4):206-212., does not confirm differences between sport types, except for some specific sports (i.e., fencing, shooting) which present a similar risk of death to the general population.

Some explanations for the greater survival of EM athletes have been previously suggested, including more vigorous physical activity levels²²22 Kujala UM, Tikkanen HO, Sarna S, Pukkala E, Kaprio J, Koskenvuo M. Disease-specific mortality among elite athletes. JAMA 2001; 285(1):44-45.^,2828 Laine MK, Eriksson JG, Kujala UM, Kaprio J, Loo BM, Sundvall J, Bäckmand HM, Peltonen M, Jula A, Sarna S. Former male elite athletes have better metabolic health in late life than their controls. Scand J Med Sci Sport 2016; 26(3):284-290. a higher proportion of slow-twitch fibers conferring metabolic and cardiovascular protection⁹9 Teramoto M, Bungum TJ. Mortality and longevity of elite athletes. J Sci Med Sport 2010; 13(4):410-416.^,2222 Kujala UM, Tikkanen HO, Sarna S, Pukkala E, Kaprio J, Koskenvuo M. Disease-specific mortality among elite athletes. JAMA 2001; 285(1):44-45. and higher aerobic fitness associated with a lower risk of several cardiovascular, inflammatory, and pulmonary diseases and some types of cancer⁷7 Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. Sport Med Open 2015; 1(1):16.^,99 Teramoto M, Bungum TJ. Mortality and longevity of elite athletes. J Sci Med Sport 2010; 13(4):410-416..

Meanwhile, SP athletes tend to have a higher body mass and body mass index (BMI), both factors independently associated with mortality⁷7 Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. Sport Med Open 2015; 1(1):16.^,2525 Lee-Heidenreich J, Lee-Heidenreich D, Myers J. Differences in life expectancy between Olympic high jumpers, discus throwers, marathon and 100 meter runners. BMC Sports Sci Med Rehabil 2017; 9:3.. Furthermore, the use of anabolic steroids is more frequent in SP athletes making them more vulnerable to mental disorders, suicide²⁹29 Lindqvist A, Moberg T, Ehrnborg C, Eriksson BO, Fahlke C, Rosén T. Increased mortality rate and suicide in Swedish former elite male athletes in power sports. Scand J Med Sci Sports 2014; 24(6):1000-1005., and cardiovascular and liver diseases³⁰30 Sjöqvist F, Garle M, Rane A. Use of doping agents, particularly anabolic steroids, in sports and society. Lancet 2008; 371(9627):1872-1882.. Thus, it could be speculated that, in our sample, some of these factors did not exert their influence.

Alternatively, it is possible that the low number of athletes and the limited statistical power of our study did not allow other comparisons between SP and EM⁸8 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301.. Moreover, the differences between studies for sport type classification also deserve consideration. For example, the study by Kujala et al.²²22 Kujala UM, Tikkanen HO, Sarna S, Pukkala E, Kaprio J, Koskenvuo M. Disease-specific mortality among elite athletes. JAMA 2001; 285(1):44-45. assigned endurance runners and cross country skiers to the “endurance” athlete group; sprinters, weightlifters, and track and field throwers were assigned to the “power/speed” group; while a third group named “other” comprised soccer, ice hockey, basketball players, boxers, wrestlers, and other track and field subdisciplines. Meanwhile, in our study, we grouped endurance and team sport athletes into the EM group, thus including athletes from different sports with diverse aerobic fitness levels. This is an important aspect that should be considered when comparing studies on this topic. We decided to create only two groups with apparently different metabolic demands because of the reduced sample available for comparisons. Of note, we initially assigned volleyball athletes to the EM and later to the SP group because of the reduced levels of intense activity during matches. The non-significant difference between groups was maintained in both analyses, thus confirming the consistency of our criteria.

Interestingly, the study by Lee-Heidenreich et al.²⁵25 Lee-Heidenreich J, Lee-Heidenreich D, Myers J. Differences in life expectancy between Olympic high jumpers, discus throwers, marathon and 100 meter runners. BMC Sports Sci Med Rehabil 2017; 9:3. including the top 20 former male and female Olympic high jumpers, discus throwers, and marathon and 100-m runners showed that life-expectancy of high-jumpers and marathon runners was longer than that of throwers and sprinters, which may be explained by the lower body mass of the first group. These findings suggest that differences in athletes’ longevity may be attributed to factors (e.g., body mass) other than the metabolic profile of the sport. Further studies should verify the relative effect of different facets of physical fitness, including aerobic fitness and body composition.

This is the first study to assess the longevity of Brazilian Olympic athletes. However, some limitations should be highlighted: (1) We were unable to find information about the date of birth of some athletes, and thus, 165 athletes were excluded from our sample, which may have implied less statistical power. However, most previous studies have exhibited similar limitations⁵5 Clarke PM, Walter SJ, Hayen A, Mallon WJ, Heijmans J, Studdert DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br J Sports Med 2015; 49(13):898-902.^,1717 Antero J, Tanaka H, Larochelambert Q, Pohar-Perme M, Toussaint JF. Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. Br J Sports Med 2021; 55(4):206-212. although in our study these 165 would represent 23.98% of the total sample. (2) Since socioeconomic characteristics of most Brazilian athletes were not available, we did not control our analysis for these factors. However, as we believe Brazilian Olympians have a similar ethnic and social profile to the general population, we can disregard this potential influence. In contrast, this may represent an important difference with other studies with diverse socioeconomic characteristics of samples from developed countries. (3) Given the low representation of female athletes in this study when compared to previous studies⁶6 Garatachea N, Santos-Lozano A, Sanchis-Gomar F, Fiuza-Luces C, Pareja-Galeano H, Emanuele E, Emanuele E, Lucia A. Elite Athletes Live Longer Than the General. Mayo Clin Proc 2014; 89(9):1195-1200.^,88 Runacres A, Mackintosh KA, Mcnarry MA. Health Consequences of an Elite Sporting Career: Long Term Detriment or Long Term Gain? A Meta Analysis of 165,000 Former Athletes. Sport Med 2021; 51:289-301., the analyses were not performed by sex. Assuming that male and female elite athletes share common determinants for greater longevity¹⁷17 Antero J, Tanaka H, Larochelambert Q, Pohar-Perme M, Toussaint JF. Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. Br J Sports Med 2021; 55(4):206-212., this may not represent a limitation.

Conclusion

Brazilian Olympic athletes live about 8 years longer than expected for the general population matched for sex and age. However, there are no differences in longevity between athletes in strength and power sports when compared to those in endurance and mixed sports.

Acknowledgements

The source of this data (IBGE, COB) and Dr. Kátia Rubio (author of the book Brazilian Olympic Athletes). The Olympic Athletes. Universidade Federal de Mato Grosso do Sul. CAPES. The PENSARE study group (Research on Exercise and Nutrition in Health and Sports Performance). And Ph.D. Erlandson Ferreira Saraiva for his help with the statistical analysis. Daniel Boullosa was supported by Grant RYC2021-031098-I funded by MCIN/AEI/10.13039/501100011033, by “European Union NextGenerationEU/PRTR”, and by a productivity research grant PQ1-D (317126/2021-0) by CNPq (Brazil).

References

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