A groundbreaking global study of over 20,000 male bodybuilders has revealed a concerning trend: a higher incidence of sudden cardiac deaths (SCDs) among those who participate in the sport, especially at competitive levels. The research, published in the European Heart Journal, emphasizes that the aim isn't to condemn bodybuilding but to advocate for safer practices within the community.
Bodybuilding, unlike traditional sports, focuses on sculpting the body for aesthetic appeal rather than athletic performance. This often involves intense training and very specific dietary regimens.
Researchers tracked 20,286 men who competed in International Fitness and Bodybuilding Federation (IFBB) events between 2005 and 2020. Over an average of 8.1 years, 121 deaths were recorded. Of the 99 cases with known causes, 73 were sudden. The average age at death was 45. When excluding traumatic deaths (like accidents or suicide), 46 of the 55 non-traumatic sudden deaths were classified as SCDs.
The overall death rate was 63.61 per 100,000 person-years. This rate jumped to 80.58 among active competitors who died within a year of their last IFBB event. For sudden cardiac deaths specifically, the rate was 24.18 for the entire group, rising to 32.83 for competing athletes, who were on average only 35 years old at the time of death. Professional bodybuilders faced a five times higher risk of SCD compared to recreational bodybuilders. Autopsies in most cases (4 out of 5) showed an enlarged heart and severe thickening of the heart's pumping chambers.
Why the Increased Risk? Unpacking the Potential Factors
While the study aimed to identify the incidence of deaths, not the direct causes, Dr. Marco Vecchiato, a specialist and researcher in Sports and Exercise Medicine at the University of Padua and the study's coordinator, points to several plausible factors based on existing research:
Intense Training: High-intensity workouts put significant stress on the heart and muscles.
Extreme Diets: High protein intake and rapid weight changes between "off-season" and "on-season" periods can strain the body's metabolism and heart.
Dangerous Dehydration: Methods used to quickly shed fluids before competitions, like specific fluid and salt protocols or diuretics, can be very risky.
Doping Substances: The use of performance-enhancing drugs, particularly anabolic steroids, can severely damage the heart, kidneys, liver, and nervous system.
The Shadow of Doping
Dr. Vecchiato highlights that there are no studies specifically on bodybuilders who are guaranteed not to have used doping substances. However, he notes that recent evidence strongly suggests a clear difference in death rates between athletes who have and haven't abused anabolic steroids.
He believes that performance-enhancing drug use is likely widespread at the highest levels of competition. While some athletes in the US openly discuss using these drugs due to intense competitive and aesthetic pressures, in Italy, Dr. Vecchiato observes that the issue is largely hidden and often seen as a "necessary means" to achieve a desired physique rather than a medical risk.
A Patchwork of Medical Requirements
One significant concern raised by the study is the inconsistent medical oversight for bodybuilders. In Italy, various bodybuilding federations have different rules regarding medical check-ups. Some require a competitive sports medical certificate, while others have no specific medical requirements, allowing participation even without a health assessment. This is often because the activity isn't formally classified as a "sport" but rather an "aesthetic activity," which allows them to bypass certain regulations.
Even if not formally required, some gyms might ask for a non-competitive medical certificate, often for insurance. However, Italian law doesn't make this mandatory for individuals doing non-competitive physical activity unless they are affiliated with specific national sports bodies.
This varied regulatory landscape means some athletes receive thorough annual medical check-ups, including heart tests and lung function tests, while others only get a basic electrocardiogram. Disturbingly, a significant number of bodybuilders may never undergo any structured medical evaluation at all.
Dr. Vecchiato warns that this lack of oversight means the first contact with a doctor might only happen when advanced symptoms appear, potentially indicating already significant heart or metabolic damage.
Early Warning Signs and Mental Health
General practitioners have a crucial role to play in identifying warning signs in bodybuilders, such as excessive muscle growth, extreme weight fluctuations, suspected illicit substance use, sudden mood changes, adult acne, or male breast enlargement. These signs should prompt referrals for cardiac or psychological evaluations.
The study also noted that 15% of sudden deaths in this population were traumatic. Dr. Vecchiato suggests that obsessive body transformation goals, extreme practices, and substance misuse can increase the risk of impulsive or self-harming behavior, underscoring the vital need to prioritize the mental health of these athletes.
Ultimately, Dr. Vecchiato concludes that a combination of intensified anti-doping efforts, targeted heart screenings, and educational campaigns could significantly reduce the risks associated with bodybuilding, encouraging athletes to adopt safer training and nutrition practices and seek medical supervision. The story is from Medscape Medical News.