Elite cyclists participating in the Tour de France have significantly lower mortality compared to the general male population in France, according to study results released on Sept. 3 as part of the ESC Congress 2013 in Amsterdam and published in the European Heart Journal. However, the results are inconclusive as to whether the benefits of high-level sport activities outweigh the risks of regular, strenuous exercise and/or performance-enhancing drug use.

The study, based on 786 French cyclists who participated in the Tour de France between 1947 and 2012, found a 41 percent lower mortality rate among the cyclists, as compared to the general French male population. Specifically, of the cyclists in the study, 208 had died as of Sept. 1, 2012, with neoplasms and cardiovascular diseases accounting for 61 percent of deaths. There was also a high frequency of "external," or trauma-related, deaths (15.8 percent) in the group. The cyclists had participated in a median of 2.5 Tour de France races and were followed for a median of 37.4 years. Their median age at the first race was 25 years.

The study authors, however, suggest that their findings should be treated with caution for a number of reasons. First, they note that only the healthiest and fittest individuals are able to compete in the tour, making it difficult to fairly compare them with the broader French community in which there are many men with prevalent chronic disease and illness. Second, participation in the Tour de France represents only a small time period in a cyclists' lifespan, limiting the ability to conclusively link participation in the tour with decreased mortality. Finally, the study authors were not able to directly estimate any effects of doping on cyclists.

"Due to a multitude of confounding factors, it is difficult to draw concrete and meaningful conclusions regarding the effects of endurance exercise itself on mortality from the data presented," said Abbas Zaidi, MD, and Sanjay Sharma, Department of Cardiovascular Sciences, St. George's University of London, UK, in a related commentary. Although providing food for thought, the study … ultimately leaves key questions on the optimal exercise dose and risk-benefit ratio of endurance sport unanswered."

Keywords: Athletes, Neoplasms, France, Chronic Disease, Doping in Sports, Performance-Enhancing Substances, Exercise, Sports, Cardiovascular Diseases, Risk Factors