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Centenary of the Tour de France Group: Mortality of French Participants from the Tour de France 1947-2012


Presenter abstract
Discussant report
All the Scientific resources on ESC Congress 365


By Xavier Jouven
Other authors: Muriel Tafflet, France; Eloi Marijon, France; Juliana Antero-Jacquemin, France; Nour El Helou, France; Geoffroy Berthelot, France; Nicolas Combes, France; Wulfran Bougouin, France; Grégoire Rey, France; David S Celermajer, Australia; Jean-François Toussaint, France
The Tour de France is the world’s most celebrated endurance cycling event and will celebrate its 100th anniversary race this year. Especially in the context of recent concerns regarding performance enhancing techniques and potential negative effects of excessive high-level physical activity, data on the long-term outcomes in elite endurance cyclists is of particular interest. We therefore undertook a study aiming to evaluate and compare overall mortality and specific causes of death among French participants in the Tour de France from 1947–2012 versus the community average. 

Data were collected using the National Institute of Statistics Economical Studies (INSEE) as well as other independent sources for the 1947–2012 period. Causes of death were given by the Epidemiologic French Center on Medical Causes of Death (CépiDc). Overall mortality and specific causes of death mortalities were compared to the French male population in calculating the overall Standard Mortality Ratio (SMR). Additional sensitivity analyses were carried out through the three 20-year time periods. There was no loss to follow-up.

Among the 786 French cyclists who participated at least once in the Tour, 208 (26%) were known to have died by Sept 01, 2012. Compared to the general population, the overall SMR was 0.59 (95% CI, 0.51–0.68, P<0.0001), with highly similar results over time. The mean additional life expectancy, compared to the general population, was estimated at 6.3±2 years. We observed a significant reduction in cardiovascular (SMR=0.68, 95% CI, 0.51–0.89, P=0.006) and cancer (0.51, 95% CI, 0.38–0.66, P<0.0001) deaths, whereas mortality related to accidents was similar (1.02, 95% CI, 0.67–1.49, P=0.90).

We have been surprised to observe a substantial and significant increase in longevity in participants in the Tour de France, compared to the general population. We suspect that regular and high-level practice is more beneficial than any potential deleterious effects of alleged doping or excessive physical activity.
Jouven, Figure 1

Discussant Report

Sanjay Sharma
The cardiovascular benefits of moderate exercise are established, however, there is emerging data suggesting that participation in chronic intensive exercise may have detrimental effects on the heart.
Furthermore, there has been a tremendous amount of controversy relating to the issue of performance enhancing agents amongst athletes who undertake gruelling exercise.  Reduced mortality amongst athletes participating in gruelling endurance events may serve to nullify claims that too much exercise is deleterious.
The authors examined mortality in 786 French participants of the Tour de France race over 63 years. Mortality data gathered from websites was used to calculate standardised mortality ratios (SMR) for Tour participants, using male, age-matched members of the French population as referents. During the study 208 (26%) died. Mortality was 41% lower among cyclists than the general population.  The SMR was low for almost all conditions causing death.
The authors conclude that endurance exercise is associated with reduced mortality, apparently outweighing any deleterious effects of exercise or doping. However, the most elite former athletes in the world were compared to the general population; the latter including individuals with pre-existing chronic diseases or unhealthy life habits. Indeed the ability to compete in the most arduous endurance sports may in itself indicate a superior genetic composition with lower disease susceptibility. Furthermore, since it is recognised that former athletes continue to lead a healthier lifestyle and smoke less than the general population, reduced mortality in later life cannot be attributed simply to the effects of a decade of intense sport.





Centenary of the Tour de France Group: Mortality of French Participants from the Tour de France 1947-2012

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.