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Aim of the study: to draw an epidemiological panorama of the link between elite athletes and chronic diseases. Method: literature review conducted between June and Decembre 2008. Databases used: Medline Pubmed, Pascal, Cochrane Library, BDSP. Results: apart from traumatology, there are very few epidemiological studies the topic. The incidence of many current chronic diseases, such as coronary artery disease or type 2 diabetes, is lower in elite athletes, especially endurance athlete, than in the general population, excepted for asthma and, undoubtedly, osteoarthritis. Moreover, their standardized mortality ratios are lower too, which results in a lengthened life expectancy. Discussion: elite athletes naturally have a physiological and genetic profile, which is different from the rest of the population. Beyond physical activity, these elements have to be taken into account for the interpretation of results evoked above. Moreover, may be that the modifications of practice observed recently, such as professionalism, training techniques, or doping behaviors, will have, a few years from here, an impact on the morbidity of these athletes. Lastly, it should be stressed that certain results would deserve to be confirmed, either because the number of study, or the number of participant involved, is reduced, or because the method employed provides a low level of scientific proof (i.e: cohort studies). Conclusion: it would be advisable to realize prospective epidemiological studies aiming to describe chronic diseases among active or former high level athletes, set up the influence of high level sport practice on health, and evaluate the health-related effects of a regular physical activity in retired high level athletes. Key-words: elite athletes, health, chronic diseases, epidemiology Introduction The beneficial effects of a regular physical activity on health are largely admitted. An active way of life enables prevention of many chronic diseases, like diabetes mellitus, breast cancer or colon cancer, coronary artery diseases, anxiety, etc. For people already chronically ill, physical activity, which then constitutes a very part of the medical treatment, can involve a reduction of the amounts of drugs, complications of the disease, number of hospitalizations and an improvement of the quality of life (1-3). These effects appear at a threshold of intensity and duration of physical activity, which vary with the individuals, chronically ill or not (4-6). This means that, for a given person, a physical activity will have to reach determined intensity and duration to generate benefits on health. On a population scale, the usually admitted average values for this threshold are 60% of maximum heart rate, approximately 4 MET, for the intensity and 30 minutes per day 5 days per week for the duration (7). However, if there is a threshold of benefit, one can also describe a threshold of damage for health: intensity, duration or methods of practice beyond of which occur physical activity-induced pathologies, like traumatic lesions, overuse pathologies or medical pathologies. If any physically active person is likely to exceed this second threshold, high level or professionals athletes are especially concerned. Thus, sport traumatology is the topic of an abundant medical literature and of numerous specialized congresses. This is not the case for other health subjects, such as chronic diseases, life expectancy or quality of life. However, these areas constitute common topics in the field of public health. In addition, high level athletes’ health is often a subject of interest for the general public, at least through the link between health and physical performance or enhancement. This interest is expressed in mass-media via opinions like: “High level athletes, such as cyclists, live less longer than the general population” or “Elite sport practice involves pathology, but anti-doping texts often foreclose athletes from medical treatment” (8, 9). The purpose of this study is to carry out an epidemiological panorama of morbidity and mortality related to high level or professional sports, traumatology excluded. Methods Data were collected between June and December 2008 from: Electronic databases: Medline Pubmed, Pascal, Cochrane and the French Database in Public Health 246 Laure P., Binsinger C. / Medicina Sportiva 13 (4): 245-250, 2009 (BDSP). The main searched keywords were: “epidemiology”, “elite sports”, “high level sports”, “elite athletes”, “morbidity”, mortality”, “life expectancy”, “health expectancy”, “quality of life”, associated with “cardiovascular disease”, “lung disease”, etc. The search was limited, when possible, to paper with abstract, humans, all adults 19 + years and adolescent 13-18 years. The same keywords were used to investigate all the electronic databases (but translated in French for BDSP). Internet sites of various organizations of sports medicine, public health and epidemiology, and sporting federations, for example: American College of Sports Medicine (www.acsm.org), Centers for Disease Control and Prevention (www.cdc.gov), International Amateur Athletic Foundation, (www. iaaf.org), Federal Office of Sport Macolin (www. baspo.admin.ch), Public Health Agency of Canada (www.phac-aspc.gc.ca), etc. This procedure was supplemented by manual searches of previous reviews. The principal papers selected satisfied the following criteria: Design: epidemiological study, reviews, meta-analysis, original articles, and reports (provided that they were dated and that they indicated the authors name) Population: high level (involved in national level competitions at least) or professionals athletes; Method: randomized controlled studies, prospective studies. Grids of reading allowed a fast and homogeneous analysis of the preselected articles. Results 1) General A Medline search, with the key words epidemiology elite sports found 346 papers, which represents only 0.03% of the articles on epidemiology (293/1173667). To compare, the part of epidemiology of diabetes mellitus is 3.50%. According to the same data base, but now considering the sole field of sport, epidemiology in high level sport accounts for approximately 0.3% of the whole publications related to sport. The large majority of epidemiological works in high level sport concerns traumatology. |
