The fact that regular balanced physical activity – i.e. sport – has innumerable positive health effects may be regarded as well known. It was also convincingly shown that the effort required to achieve a noticeable effect can be quite modest. But what about when you increase the intensity and play elite sports? Do the health-promoting effects develop linearly?
Again and again it is reported that athlete X, at an age when others are still fully active, has to stop his sport, for example because of hip arthrosis, or that athlete Y can only be brought into action by means of injections. Is it really the case that sports can only be played at the highest level at the expense of health? If one were to rely on enumerations of the various injuries and damages suffered by famous competitive athletes, the answer to the aforementioned question would have to be “yes.” Or, to put it another way, the way top-level sport is practiced today is not healthy.
But what do we mean by top-class sport?
A competitive athlete is one who trains systematically, individually or as part of a team, and frequently pushes himself to his personal physical limits. In most cases, the competitive athlete competes. With this definition, we cover many more people than just the famous professionals, because, as we know, there are countless people who exercise almost every day – and sometimes to an impressive extent.
Sudden cardiac death – famous and feared
Probably the worst things that can happen during sports activities are deaths and spinal cord injuries, probably because they usually strike young (supposedly) healthy athletes. In recent years, there has been a great deal of reporting of sports-associated sudden deaths-the unexpected death of cardiac origin that occurs during exercise or within an hour of exercise. The causes of this tragic event have become better understood over time (in individuals under 35 years of age, it is mainly cardiomyopathies, and after that, it is mainly coronary heart disease). Fortunately, the incidence is quite low at 0.3-3/100,000 athletes per year, also thanks to effective preventive measures (sports medical examinations).
Death in sport
There is sometimes conflicting information on all-cause mortality associated with intensive sport. Not long ago, French authors reported in a much-cited paper that French participants in the Tour de France live longer than their compatriots (high-performance sports and doping notwithstanding). The authors compared a total of 768 French cyclists who had participated in the Tour de France at least once between 1947 and 2012 with the normal population of the same age. By the end of the study, 26% of the observed racers had died, a mortality rate significantly lower than that of the normal population (namely, approximately 41%).
At first glance, the results are reassuring, but they do not allow any direct conclusions to be drawn about the harmfulness of doping. Moreover, an excellent expert on the French cycling scene was able to demonstrate the opposite in a similar paper where the data collection of fatalities was done much more carefully!
Footballer and ALS
The phenomenon of doping is also suspected in the following observation: it seems that professional soccer players have an increased risk of developing amyotrophic lateral sclerosis (ALS). This finding has been known for years, but the causes are obscure. What has been shown again and again on the basis of individual cases has recently been confirmed by a large study. An Italian group examined the medical records of 7325 professional soccer players who played in the Italian first or second division between 1970 and 2001. Statistically, there is an incidence of 0.77 ALS cases per 100,000 persons. In fact, however, the researchers identified a total of 34 former Italian professionals, 30 of whom have since died. This would result in an incidence of no less than 465/100,000. A cluster of ALS cases has also been observed in U.S. football players, as well as in professional soccer players in the British Premier League and the German Bundesliga.
But what are the causes of this mysterious accumulation? Some researchers suspect a connection with the use of doping preparations, but there is no evidence for this thesis. Since footballers are often affected and not cyclists, some scientists believe that the many headers during the game are the cause of the diseases. But they also do not rule out environmental toxins used in the maintenance of soccer turf as a cause.
Acute injuries and chronic overloads
Probably the greatest risk for the competitive athlete, however, lies in the various acute injuries and chronic overuse symptoms that predominantly affect the musculo-skeletal system. In recent years, epidemiologists have worked diligently and collected a lot of reliable data on the numbers of sports traumatology at major events (Olympic Games, summer, winter and world championships in various sports).
But probably the most revealing source of information is provided by a publication of the medical experts of UEFA, the European Football Association. For eleven years, 24 top teams recorded, with astonishing meticulousness, all injuries and signs of overuse that led to absence from training or matches. The conclusion of this study is that with a squad of 25 players, approximately 50 injuries per season are to be expected – in other words, 12% of the squad is consistently unable to play or train. Imagine a similar situation in “normal” professional life! A similar study from the UK even claimed that the injury rate in professional football was 1000 times higher than in high-risk occupations. Even if many of these health impairments do not seem dramatic a priori, they have a high disability potential, with all the inconveniences (including economic ones).
These traumatic events will emphasize the consequences of head injuries as they occur in various team sports. In recent years, the so-called chronic traumatic encephalopathy (formerly dementia pugilistica) with early cognitive disorders up to dementia has been increasingly mentioned. In fact, concussions are all too often downplayed – certain reports see repeated head impacts, such as those seen in football, as a potential risk of harm.
What would have to change in top-level sport?
So from that point of view, elite sports are not healthy in any way. But this could also be different. There are known reasons why so many injuries and damages occur. Sports physicians, those who work in this field, know these reasons. Prevention would therefore be possible, even proven. But unfortunately, there are too few sports physicians, and they do not make much headway in the clubs and in the associations. If this circumstance could be changed, it would be quite conceivable to design the training in such a way that it would not be dangerous but beneficial for the athlete. In the case of unavoidable minor injuries, people would go to the trouble of immediately making a proper diagnosis and arranging for professional treatment. Proper nutrition and recovery advice could be given to the athlete, and sports officials would come up with smarter competition programs. More sensible competition rules could be enforced that do not force athletes to constantly perform above their performance limits.
It is permissible to dream a little – but also quite realistically, top-level sport, practiced under optimal conditions, could become an even more fascinating thing, because it would no longer be so dangerous. It would then be easier to believe studies that have well documented that, true to the motto “LLL = long runners live longer,” large cohorts of Olympic athletes actually have a longer life expectancy than non-athletes.
HAUSARZT PRAXIS 2015; 10(7): 6-7
