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Mortality of French Participants in the Tour de France (1947–2012)
Study Questions:
Over an extended time interval, was mortality different among French participants in the endurance cycling event Tour de France compared to the male general population?
Methods:
Characteristics and vital status of all French participants in the Tour de France were collected for the period 1947–2012. Causes of death were obtained from 1968. Overall and disease-specific mortalities were compared with the French male general population using overall and specific standardized mortality ratios (SMRs) with their 95% confidence intervals (CIs).
Results:
Among the 786 French cyclists who participated in the Tour de France at least once between 1947 and 2012, 208 (26%) died by September 1, 2012. Neoplasms and cardiovascular diseases accounted for 61% of deaths. There was a 41% lower mortality among French cyclists compared to the male general population (SMR: 0.59; 95% CI, 0.51-0.68; p < 0.0001), which did not change over time (p = 0.70). Lower mortality among participants was observed for neoplasms (SMR: 0.56; 95% CI, 0.42-0.72; p < 0.0001) and for cardiovascular death (SMR: 0.67; 95% CI, 0.50-0.88; p = 0.004), but not for mortality related to external (mainly trauma-related) causes (SMR: 1.06; 95% CI, 0.71-1.53; p = 0.80).
Conclusions:
A substantially and significantly lower mortality was observed among participants in the Tour de France compared with the general male population. However, the authors noted that these results do not allow for the detailed assessment of the positive effects of high-level sports activity, the subselection of healthy elite athletes, and any potential deleterious effects of excessive physical exercise or alleged doping.
Perspective:
This long-term observational study suggests that ultra-endurance French athletes who participated in the Tour de France enjoyed an additional mean 6.3-year life span compared to the male general population. Lower mortality was evident across different time periods, for all ages except for those <30 years (in whom external/traumatic causes of death prevailed), and for overall as well as for cardiovascular and cancer-related deaths. Although this study supports overwhelming data that regular exercise reduces cardiovascular and overall mortality, it adds fuel to the current debate of whether endurance and ultra-endurance sports might actually increase cardiovascular risk. The control group of the male general population leaves open to debate whether exercise associated with participation in the Tour de France was the cause of lower observed mortality among this group; or whether Tour de France riders are a subselected group that is inherently healthier than the general population, including many people with already known diseases.
Keywords: Athletes, Cause of Death, France, Cardiology, Exercise, Physical Endurance, Sports, Cardiovascular Diseases, Risk Factors
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