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.
Interesting discussion on VO2 Max vs longevity, seems pretty obvious but the numbers are pretty stark.
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its interesting, the least fit 25% of 53 year olds have by far the greatest risk of dying early.
Although I wonder how much if this is that some have low vo2max because they already have a serious illness. Say, cystic fibrosis or cancer or some form of heart disease.
(Maybe this is addressed in the full article, I just skimmed the notes)
But yeah, pays to be fit
Apparently quad strength is directly linked with longevity too in the elderly
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Only because any marker of fitness/strength is linked with longevity, because most end stage disease brings systemic atrophy and frailty, so those with the least reserve will suffer more.
I used to see influencer arguments for training grip strength after studies showed that was clearly linked to less cardiovascular disease/all cause mortality, when obviously it’s not actually really to do with someone’s forearm flexors, but that people with higher grip strength also likely have higher total lean body mass, VO2, and less systemic disease.
Sorry, lifting steins of fosters all day won’t save anyone.
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there’s always some exception isn’t there though?
if that was an MCQ true or false you’d have to plump for false surely
eg. it might save the guy who is suffocating under a shed load of tinnies 
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I had similar thoughts, obvs an elite athlete is not suffering a long term illness but the biggest gain was moving form the lowest to the next lowest level of fitness too.
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Touché. Touché indeed.
Lesson 1 of gaming medicine exams, any option with a definite is false 
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