They’ve really thought it through
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didn’t tick them as I’ve retired 
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Agree its multi-faceted, just sharing some thoughts on the supposed U-curve. I don’t think we’ll ever have a solid answer as to whether there actually is a uplift in mortality at extreme exercise levels. All studies will be heavily confounded as to what came first. But that does at least suggest that any potential detrimental effect of endurance exercise is tiny in terms of signal:noise of study design and reassure people they can continue to push themselves if we don’t have good individual reasoning to suggest otherwise.
Confounders like Doon mentions:
When compared to life expectancy at birth, elite athletes have already outsurvived everyone already dead by performance age.
Even if comparing standardised rates for say 20 year olds, elite athletes are unlikely to have impairing conditions (eg cystic fibrosis, Duchennes muscular dystrophy etc etc), or have suffered but survived significant childhood illnesses (cancers, polio)
They’re also more likely to have been more financially affluent before exercise, given they had access to training and facilities, with the knock on effects that has.
As well as potential increased success using their Olympic fame. Although this could be through intelligence/skills gained through the pursuit of exercise which would benefit us mere mortals. The LA marathon project I mentioned last week repeatedly shows high school kids who complete the marathon get better grades, but again which came first in terms of the ability to focus on achieving a long term goal?
Some other findings:
8000 US Olympians between 1912-2012 lived an average of 5 years longer than the average American, mostly due to less CVD and cancer (possibly suggesting exercise benefit?)
Commonwealth Games medalists since 1930 live 4-5 years longer than average, depending on sport, with endurance sports conveying more benefit. Other similar studies have typically shown endurance exercise to have better benefits than power sports for life expectancy.
American NFL players have better life expectancies than general (American) public, but worse compared to baseball players, with higher rates of cardiovascular and neurodegenerative disease
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I suspect the relative wealth is the primary causal factor. Should be lots of data to support that somewhere.
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Agree it has to be huge. But likewise it’s felt that exercise is still a beneficial additive.
Yes there’s a ton of data linking affluence to longevity.
Just like there’s studies linking exercise to longevity
A perfect retrospective study on exercise levels that truly accounts for the confounding affect of wealth/education between them will never exist.
An RCT would be the only way to do it, which can’t be done over the long enough time frame to show that effects were because of study protocol rather than peoples own choices outside of that.
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Wealth before health? Yep, Gap Minder…
Aged 76.