Bodybuilding and the risk of sudden death: the experts' warning

More checks, medical and anti-doping, and more awareness, both among athletes and in the world of bodybuilding. This is what a group of researchers are asking today in the pages of the European Heart Journal , after having observed a high risk of sudden death in male bodybuilders. A risk higher than that reported for other sports disciplines, especially in the category of professional bodybuilders.

The study of over 20 thousand bodybuilders online

The data emerges from an analysis of over 20,000 athletes, carried out by fishing information entirely online, explains Marco Vecchiato of the University of Padua, first author of the study, to Salute . The athletes monitored by the study were identified within two databases, that of the International Federation of Bodybuilding and Fitness (IFBB) and that of MuscleMemory. Specifically, the researchers selected male athletes who had participated in at least one IFBB event between 2005 and 2020, and combined this data with that present on MuscleMemory, a database that contains different data, from the type of competitions participated in by an athlete to his age and physical measurements.

How to estimate cases of sudden death

In this way, the researchers identified 20,286,000 male athletes, on whom the research focused. “For each of these, online searches were done, associating the athlete's full name with keywords related to death, sudden death, sudden cardiac death, and so on, in five languages: English, Italian, German, French and Spanish - explains Vecchiato - we consulted newspapers, social media, forums and in the end we found 121 deaths in our population. At this point we classified, based on the available information, the different types of death”. For about 80% of these, the researchers were in fact able to trace the circumstances of death, continues the expert, therefore divided into sudden deaths (traumatic or not, including accidents as well as suicides in traumatic ones) or not (that is, attributable to other causes, such as oncological diseases, Covid infections or surgical interventions).

By sifting through the information in this way, the researchers identified 46 sudden cardiac deaths. “We used a standard definition to identify what is considered sudden cardiac death,” Vecchiato continues, “such as the case of a person who was found dead in his sleep at home or who fell ill during training, or who simply had a cardiac arrest and did not survive treatment by health workers.” The athletes were analyzed in the period from their first participation in a race until mid-2023. By proceeding in this way, the researchers estimated the rate of sudden cardiac death, calculating that it is equal to 33 cases per 100,000 athletes per year currently active (i.e. in the last considered), about ten times higher than that observed in other sports, the expert admits.

But Vecchiato himself urges us to be cautious in making comparisons: "We cannot speak of a lower life expectancy, because monitoring has not been so extensive. At the same time, it is necessary to consider, even in comparison with other athletes, that bodybuilding has some peculiarities: the average athlete is older than the average athlete of other disciplines. But not only that. Bodybuilding, unlike other sports, brings the athlete to competitions in less than optimal conditions: he arrives at the competition, at the moment of posing, in conditions of hydro-saline deprivation, sometimes even food, in psychophysical conditions of strong stress". That said, and considering the limitations of the study - the accuracy of the data, as well as their completeness, coming from web sources, cannot be guaranteed - the signal is there, the experts point out. Especially when looking at some categories (worse for Men's Bodybuilding than Classic), and at the population of professional bodybuilders, Vecchiato specifies, for which a risk of sudden cardiac death five times higher is observed: "Narrowing the analysis to the athletes who participated in the Mr. Olympia, considered the elite competition in bodybuilding, in the monitored period there were 100 athletes, and 7 died, and of these at least 5 from sudden cardiac death: data that are practically not comparable to any other sport".

Possible causes

Paraphysiological training, excessive protein intake, alternation between on-season and off-season phases, with related changes in eating habits and water and salt consumption, and the use of substances of abuse, from diuretics to anabolics, are the main suspects of the potential risks associated with bodybuilding, Vecchiato explains. These behaviors can in fact alter human physiology, for example by compromising the functioning of the kidneys or the heart, with arrhythmias and thickening or swelling, as observed in four autopsies examined by the study. "Strength training, the gym, fitness are not harmful, in fact we know that not only do they improve the quality of life and well-being, but they can also influence longevity - comments Vecchiato - consequently this must not be a disincentive to practice strength activity". While waiting for further studies, including on female bodybuilders, the message from the researcher and colleagues is rather an invitation to greater awareness and caution, on multiple levels: more anti-doping controls, more educational campaigns on the potential risks associated with the activity and especially with substances of abuse, more medical checks, more regular. Not only to protect against heart risks, concludes the expert, but also from other problems, including those of a psychological nature.