A few weeks ago, Stuart McMillan, the sprint coach from Altis, put up a very thought-provoking social media post. Stu made the point that elite performance was not healthy, and it stimulated a great discussion, with many good points made by a variety of contributors. The idea of whether elite sport is healthy or not is something that I’ve been thinking about for a long time, and so, prompted by Stu’s thoughts, I’ve finally gotten around to collate mine.
What Is ‘Health’?
To determine whether athletes are healthy, we first need to define health. The most commonly cited definition comes from the World Health Organization, which says that health is “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” This indicates that we can’t just focus on the physical aspect of health, but must also include the psychological and social aspects—both of which I will consider in this article.
Another key point to consider is how we define elite athletes. This is important when it comes to interpreting the research for several reasons. First, there are precious few elite athletes in the world, so true elites don’t tend be found in great numbers in research. This is problematic, because to discover population-wide trends in health, we need large numbers of people.
A second issue is that there isn’t really a consensus as to what an elite athlete is. In athletics, we might consider an Olympian elite, or perhaps someone who has competed at the World Championships. But what about non-Olympic sports, such as American football? How do we define an elite athlete within that realm? The most common workaround is that elite athletes are those that compete internationally, although some sports (NFL, AFL) don’t really have true international competitions, so it’s not a catchall.
Physical Health: Short-Term and Long-Term
Let’s begin with physical health. Overall, former elite athletes are likely to live five to six years longer than non-athletes, and are less likely to develop cardiovascular disease and suffer from strokes (although this is true only for endurance and team-sport athletes). “Power” athletes, especially boxers, are more likely to die from dementia than non-athletes. Other studies have similar findings, although they do illustrate that statistical anomalies occur when you analyze large amounts of data. For instance, baseball players whose name began with the letter D had shorter life spans than those whose name began with the letters E through Z.
One of the protective causes is that athletes are much less likely to smoke, indicating that a potential reason athletes are healthier is that taking part in elite sport promotes behaviors commonly thought of as healthful. An obvious protective cause is that of exercise; athletes are more likely to exercise more than non-athletes. Indeed, many athletes train for at least 20 hours per week, far in excess of the typical recommendations on physical activity. In turn, this can protect them from a number of metabolic diseases, such as type 2 diabetes, with rates lower in athletes than non-athletes, even after retirement.
This is less clear-cut in power-based sports such as sprinting, with at least one study suggesting that obesity rates could be higher within this population. However, it is apparent that, overall, athletes are typically at lower risk of developing the majority of activity-preventable and diet-related diseases and, as such, tend to live longer. In terms of long-term physical health, athletes are indeed “healthy.”
But what about in the short term? It seems logical that taking part in sports increases the risk of musculoskeletal injuries—nobody pulls a hamstring sitting on the sofa. What isn’t clear is how this differs between elite athletes and non-elite athletes.
On the one hand, elite athletes spend greater amounts of time participating in their sport, increasing their injury risk. However, on the other hand, they are likely better conditioned, which may protect them from injury. Again, this probably differs from sport to sport, so we would expect injury rates in contact sports such as rugby to be higher than in track and field. Similarly, we might expect hamstring injury rates to be greater in sprinters than in distance runners, who might have a greater prevalence of stress fractures.
I’m not aware of any studies examining long-term health in athletes forced to retire due to injury. However, as I am such an athlete, I can offer an anecdotal standpoint. I retired because of a back injury that doesn’t give me many problems at all day to day—and certainly fewer issues than many non-athletes I know. In addition to this, I know of many people who were not elite athletes but suffered long-term damage from sports-related accidents. It appears that sport/exercise itself contains an inherent injury risk, which is not necessarily increased in elite athletes compared to the general population.
While exercise is certainly healthy, it is entirely possible that elite performers will take it too far, developing symptoms of overtraining and/or unexplained underperformance. This occurs in roughly 10-20% of athletes over the course of their careers, and is more common in endurance athletes than speed-power athletes. However, this overtraining is fairly rare, and the best coaches will guard against it.While exercise is certainly healthy, it is entirely possible elite performers will take it too far. Click To Tweet
There isn’t really a comparable syndrome in non-athletes, although it’s worth pointing out that work-related stress and burnout are high in the general public, especially in stressful jobs such as a doctor or pilot. The good news is that, in most cases, the symptoms of overtraining appear to resolve within six to 12 weeks after diagnosis. Long-term, excessive strenuous exercise appears to be associated with ill health, but again, sensible athletes and coaches will avoid this.
On the physical side then, it is difficult to conclude that elite performance is unhealthy. Overall, it likely promotes healthful behaviors, such as getting sufficient sleep, consuming a nutritious diet, and getting plenty of exercise. Rates of diseases, especially metabolic diseases, appear much less often in elite athletes than other populations. In the short term, athletes may be unhealthy occasionally due to exercise-induced injuries, and in some sports —particularly contact sports—these may continue throughout their lifespan (although the same is true for non-elite athletes competing in these sports).
Considering Mental Health
The other side of the health paradigm may be where athletes might be considered “unhealthy.” Let’s first look at the mental side of health. Mental health was a dirty prospect in elite sport for a long time, especially among males. However, more attention has recently focused on this area, and so professional sports people can hopefully get the support they require. Mental health issues are not uncommon in elite athletes, but it’s not clear whether they are more common than in the general population (elite athletes may be less likely to report symptoms of depression or anxiety, for instance). Eating disorders are potentially more common in athletes than non-athletes; in females, this can lead to the female athlete triad, which can seriously impact long-term health and well-being.
Elite athletes are especially susceptible to mental health issues when they have to retire, either voluntarily or involuntarily (i.e., through injury). This represents a difficult transition for these athletes to make, and can create a lot of stress as the athlete moves from an income-producing, familiar position into a sea of unknown.
Overall, it doesn’t appear that athletes are at an increased risk of psychological ill-health, aside from eating disorders. Athletes will no doubt have periods of increased stress, such as around major competitions or retirement, but these stressors are also present in the general population in the form of job interviews, family illness, redundancy, etc. Athletes may also be better at tolerating stress through learned behaviors attained over the course of their career. This is especially true if they have worked closely with a sports psychologist, which is something that may improve their health throughout their life.
Perceptions of Social Health
Finally, we have the social aspect of health. The typical perception of an athlete is someone who never has a night out, is extremely strict with their diet, and overall has no social life. This isn’t the case. Athletes tend to train in groups, and they tend to spend a lot of time with their training partners. This gives them a social group aligned with their goals, which can be very useful.
When I was at university, I lived with three other athletes, and was in a training group of 10 people. We had lunch together every day, and would often have social events together. We even—gasp! —had nights out, although only occasionally, and never before training. Overall, I’m not convinced that athletes are socially unhealthy; they have the opportunity to spend plenty of time in social situations with teammates.
However, athletes are certainly not normal, and I think this is where a lot of the confusion comes from. Overall, athletes are healthy—or, at least, they’re certainly not unhealthy. But they aren’t normal, which may be the reason they sometimes get tagged as unhealthy.
Athletes become obsessed with performance. I could probably tell you what more than 50 different supplements do; I’ve tried a number of different diets, training regimens, and sports science practices; I’ve worked with a sports psychologist; I have a good working knowledge of biomechanics; and through experience, I even understand some sports medicine. So, I’m not normal. But I can’t see this as unhealthy, especially when it promotes healthful behaviors.
Athletes may also be seen as unbalanced; again, this is true—and is an extension of the “not normal” perception. But is it unhealthy? If I don’t want to go to a night club and drink alcohol, and follow it up with a greasy kebab and two hours of fitful sleep because I’d rather get nine hours of sleep and then wake up and do some exercise, is that an unhealthy choice? I don’t think so, but it’s certainly not normal, at least in the sphere of university students. We equate balance, or normality, with health, whereas many of the normal, balanced behaviors are not associated with optimal health.
’Normal’ Doesn’t Apply to Elite Athletes
Overall, I can’t conclude that elite performance is inherently unhealthy. This is not to say that there shouldn’t be a focus on athlete health, because there absolutely should be. Elite athletes likely do develop some unhealthy behaviors over time, as do many non-athletes.While athletes may be healthier than “normal,” it doesn’t mean they are necessarily healthy. Click To Tweet
Some unhealthy behaviors may be more prevalent in athletes, especially acutely—playing with an injury, for example—and care should be taken by athletes and support staff to guard against these behaviors where possible. Normal rules do not apply to non-normal people, so we can’t judge athletes by normal standards—but overall, their behaviors don’t appear to be particularly unhealthy.
The one final confounder is that, overall, populations tend to be somewhat unhealthy: The number of obese and overweight people is higher than ever, as are disease rates such as type 1 diabetes. It’s possible that just because athletes are healthier than “normal” doesn’t mean they are necessarily healthy. This is a good reminder to everyone involved in sport to prioritize athlete health as much as possible.
Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF