环法自行车赛运动员寿命长于普通人

阿姆斯特丹——在环法自行车赛创办100周年之际完成的一项新颖的研究显示，能够骑完整个赛段的法国自行车运动员的死亡率比年龄匹配的普通法国男性降低了41%。

法国巴黎乔治蓬皮杜医院的Xavier Jouven医生在欧洲心脏病学会(ESC)年会上报告称，具体到各项死亡原因，这些精英运动员的情况均优于一般人群：心血管疾病所致死亡的风险降低33%，致死性肿瘤的风险降低44%，呼吸疾病所致死亡的风险降低72%，死于消化疾病的风险降低78%。唯一一项运动员不占优势的死亡原因是创伤，主要与自行车或汽车撞击有关。


Xavier Jouven医生

这项研究纳入了1947~2012年间完成全部赛程的所有786名法国职业自行车手。他们人均参加了2.5次环法自行车赛。截至2012年，其中已有208人死亡。

这些精英自行车运动员在全部5个年龄段中均显示出生存优势。据估计，参加该赛事的运动员的寿命平均比其他法国男性延长了6~7年。

Jouven医生承认自己对上述研究结果感到意外。他原本预料会发现精英运动员的死亡率会高于一般人群的平均值，原因是数十年来环法自行车赛参赛者常常服用各种对身体有害的兴奋剂来提高成绩，而且运动员在比赛期间的运动量相当于在近3周时间内每天跑1场马拉松，还常常遭遇碰撞等意外。“假如高强度运动的确是危险的，那么我们就应该会观察到死亡率升高，我们原本以为会得出这样的结果。”

研究者指出，在不同的年代，这些精英运动员的死亡率降低程度相当一致：安非他命被普遍使用的20世纪50和60年代；合成类固醇常被使用的20世纪70和80年代；以及促红细胞生成素和人类生长激素流行的最近20年。

研究者之所以仅对法国自行车运动员开展研究，是由于可利用法国登记资料确保掌握每一例死亡。

英国伦敦圣乔治医院的Sanjay Sharma医生对于Jouven医生的数据解读持保留意见，认为上述结果并未真正解决大家最关心的问题：运动过度是否对心脏有害？“我想知道，有多少运动员患有合并症，有多少仍健在的运动员患有心房颤动，与一般人群相比处于什么水平？有多少运动员植入了起搏器？我希望研究者对仍健在的运动员开展进一步研究，提供这些极为重要的数据。”

Sharma医生还补充道，研究者在对照组方面的选择并不令人印象深刻。“精英运动员很可能从呱呱坠地开始在遗传、生理和心理等方面就已领先于其他人，因此合并症负担、心血管疾病危险因素负担、不良生活方式负担以及社会经济地位偏低的情况均较少。所以我不认为参加环法自行车赛本身可以延长寿命，这项研究恐怕只能证明，能够完成环法自行车赛的运动员的寿命可能比普通人长6~7年。”

每周分5~6次进行40代谢当量(MET)的体育锻炼的益处已得到确证。这种强度的运动可使心血管死亡风险降低40%~50%。然而，高水平耐力性竞技运动的强度高达上述体育锻炼的10~20倍之多。“越来越多的证据提示，锻炼过度可能对心脏有害。我们知道，马拉松运动员血液中的心脏损伤标志物水平较高。动物实验显示，心肌内的炎症和纤维化增多。近期心脏MRI研究显示，退役运动员心肌纤维化增多，而且电生理专家们仍在讨论退役运动员中较高的房颤患病率。”

Jouven医生的报告在自行车运动风靡的欧洲立刻成为了各大媒体竞相报道的新闻。这项研究同时发表在《欧洲心脏杂志》在线版上(Eur. Heart J. 2013 [doi:10.1093/eurheartj/eht347])，并配发了Sharma医生的随刊述评(Eur. Heart J. 2013 [doi:10.1093/eurheartj/eht373])。

这两位心脏病医生均无相关利益冲突披露。这项研究获得了巴黎猝死专科中心的拨款资助。

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By: BRUCE JANCIN, Cardiology News Digital Network

AMSTERDAM – French bicyclists who have competed in the Tour de France have a 41% lower mortality rate, compared with the age-matched male French general population, according to a first-of-its-kind study carried out on the 100th anniversary of the world’s most venerable professional bike race.

Causes of death were consistently lower across the board among the ex-racers. They had a 33% reduction in mortality owing to cardiovascular diseases, a 44% decrease in fatal cancers, a 72% reduction in deaths from respiratory disease, and a 78% decrease in deaths from digestive diseases, compared with controls. The sole cause-of-death category that was not significantly less common among the former Tour de France athletes was trauma, mostly from bike or auto crashes, Dr. Xavier Jouven reported at the annual congress of the European Society of Cardiology.

The study included all 786 French professional bike racers who competed in the Tour de France during 1947-2012. They participated in a mean 2.5 tours. By 2012, there had been 208 deaths.

The mortality advantage favoring the ex-racers was consistent across all 5-year age groups. It’s estimated that the Tour de France participants are averaging a 6- to 7-year greater longevity than do other Frenchmen, according to Dr. Jouven of Georges Pompidou Hospital, Paris.

He confessed to being surprised by the study results. He had anticipated finding an above-average mortality rate in the ex-racers because of the deleterious long-term effects of the various performance-enhancing drugs widely used over the decades, coupled with the sheer physical grind of participating in an event described as similar to racing a marathon per day for nearly 3 weeks and the crashes that are part of the job description.

"If there was really a danger in doing high-level exercise, then we should have observed an increased mortality rate. That’s actually what we’d expected to find," the cardiologist said.

The cyclists’ mortality reduction was consistent across all eras of the race: the 1950s and 1960s, when the use of amphetamines was common; the 1970s and 1980s, when anabolic steroids were the performance-enhancing drugs of choice; and most recently, the era of erythropoietin and human growth hormone, he noted.

The study was restricted to French cyclists because the investigators knew they could capture every single death through French registries.

Discussant Sanjay Sharma took issue with Dr. Jouven’s interpretation of the Tour de France data, which he said do not really address one of the hottest controversies in all of sports medicine: Is too much exercise cardiotoxic?

"I would like to have some data on comorbidities. I would like to have known how many of the surviving individuals have atrial fibrillation, compared with the general population. How many have implanted pacemakers? I would urge the investigators to go back and look at the survivors and produce [these] very important data," said Dr. Sharma of St. George’s Hospital, London.

He added that he was unimpressed by the investigators’ choice of a comparison group.

"They have compared possibly the fittest human beings in the world, people who are probably genetically, physically, physiologically, and psychologically superior to the general population, in which there is of course a much higher burden of comorbidities, a higher burden of risk factors for cardiovascular disease, a higher burden of adverse lifestyle, as well as a lower socioeconomic class. So I don’t believe that the Tour de France per se increases longevity of life; what I believe they have shown is, if you are capable of doing the Tour de France, then you may live 6-7 years longer than the average individual in the community," the cardiologist continued.

The benefits of physical exercise in the range of 40 metabolic equivalents (METs) per week spread over five or six workouts are well established. This level of exercise confers a 40%-50% reduction in cardiovascular mortality. But elite endurance athletes exercise at intensities 10- to 20-fold greater than that.

"There is emerging evidence that too much exercise may be deleterious to the heart," according to Dr. Sharma. "We know that marathon runners have high circulating markers of cardiac damage. Animal studies show increased inflammation and fibrosis within the myocardium. Recent cardiac magnetic resonance imaging studies have shown fibrosis in veteran athletes, and [electrophysiologists] continue to talk about the high prevalence of atrial fibrillation amongst veteran athletes."

Dr. Jouven’s presentation was big news in daily newspapers across cycling-crazy Europe. Simultaneous with his report on the Tour de France study in Amsterdam, the findings were published online (Eur. Heart J. 2013 [doi:10.1093/eurheartj/eht347]) with an accompanying editorial coauthored by Dr. Sharma (Eur. Heart J. 2013 [doi:10.1093/eurheartj/eht373]).

Neither cardiologist had any relevant financial interests. The study was funded by a research grant from the Sudden Death Expertise Center in Paris.