Physical activity reduces many major mortality risk factors including arterial hypertension, diabetes mellitus type 2, dyslipidemia, coronary heart disease, stroke, and cancer. All-cause mortality is decreased by about 30% to 35% in physically active as compared to inactive subjects. The purpose of this paper was to synthesize the literature on life expectancy in relation to physical activity. A systematic PubMed search on life expectancy in physically active and inactive individuals was performed. In addition, articles comparing life expectancy of athletes compared to that of nonathletes were reviewed. Results of 13 studies describing eight different cohorts suggest that regular physical activity is associated with an increase of life expectancy by 0.4 to 6.9 years. Eleven studies included confounding risk factors for mortality and revealed an increase in life expectancy by 0.4 to 4.2 years with regular physical activity. Eleven case control studies on life expectancy in former athletes revealed consistently greater life expectancy in aerobic endurance athletes but inconsistent results for other athletes. None of these studies considered confounding risk factors for mortality. In conclusion, while regular physical activity increases life expectancy, it remains unclear if high-intensity sports activities further increase life expectancy.
The most important causes of death in Western industrialized countries are cardio- and cerebrovascular diseases and malignancies. For instance, in Germany in 2008, 68.6% of all women and 65.9% of all men died from these diseases. In contrast, the third most frequent cause of death are respiratory diseases which cause less than 10% of deaths each year (Table
Number of deaths (percentage of total number of deaths) for the three most frequent causes of death for women and men in Germany in 2008 [
Women (per 100,000 persons/y) | Men (per 100,000 persons/y) | |
---|---|---|
Total | 467.3 (100.0%) | 720.5 (100.0%) |
| ||
Vascular diseases | 186.4 (39.9%) | 263.6 (36.6%) |
Coronary heart disease | 61.8 (13.2%) | 117.4 (16.3%) |
Strokes | 35.8 (7.7%) | 41.6 (5.8%) |
Malignant tumors | 134.0 (28.7%) | 210.9 (29.3%) |
Respiratory diseases | 27.7 (5.9%) | 53.3 (7.4%) |
Regular physical activity reduces the risk of and/or improves many diseases and conditions including arterial hypertension, diabetes mellitus type 2, dyslipidemia, obesity, coronary heart disease, chronic heart failure [
Preventive effects of regular physical activity on major risk factors for cardio- and cerebrovascular diseases and cancer.
Author(s) | Risk factor | Effect of regular physical activity on the risk factor in healthy subjects |
---|---|---|
Adami et al. [ |
Colon cancer | Incidence −30% to −40% |
Adami et al. [ |
Breast cancer | Incidence −20% to −50% |
Walker et al. [ |
Type 2 diabetes mellitus | Incidence −28% to −59% |
G. A. Kelley and K. S. Kelley [ |
Dyslipidemia | HDL cholesterol +11% |
Pedersen and Saltin [ |
Arterial hypertension | Systolic and diastolic blood pressure −3.84/−2.58 mmHg |
Pedersen and Saltin [ |
Obesity | Increased chance to maintain body weight |
Warburton et al. [ |
Stroke | Incidence −27% to −40% |
The relative risk of death is approximately 20% to 35% lower in physically active and fit persons compared to that in inactive and unfit persons [
The purpose of this review was to synthesize the literature on life expectancy in relation to physical activity. Specifically, cohort studies on physically active and inactive subjects were reviewed to detect a possible difference in life expectancy between these subject groups. In addition, cohort studies on athletes and non-athletes were reviewed to detect a possible difference in life expectancy between these subject groups.
To identify all relevant articles about cohort studies investigating the life expectancy of physically active versus inactive persons, a systematic literature search was conducted in the electronic bibliographical database PubMed (
Subsequently, a search was performed using the terms “(life expectancy OR longevity) AND athlete” to find articles on life expectancy in (former) athletes. Sixty-six articles were found. Additional publications were identified using the search term “(life expectancy OR longevity) AND (physical activity OR exercise OR sport).” Of all these articles, 21 articles investigated mortality and/or life expectancy of (former) athletes. Eleven of these articles presented detailed data on life expectancy of athletes compared to that of a control group.
The remaining life expectancy for physically active and inactive individuals or the difference in remaining life expectancy between the two groups, respectively, were reported in the articles. However, the attained ages of subject groups differed between studies. Because the differences of remaining life expectancies cannot be assumed to be independent from the attained age, we report the results stratified for attained age. Within each stratum of attained age, the results were presented for both sexes.
Only five articles [
Because a meta-analysis model was not appropriate, all data found in the literature search were reported despite some overlaps between the cohort studies. For instance, Jonker et al. [
Thirteen cohort studies presented data on life expectancy in physically active individuals compared to that in physically inactive control subjects (Table
Cohort studies comparing the life expectancy of physically active and inactive persons.
Sex | Age (class) at start of followup | Authors | Country | Number of individuals, duration of followup | Estimate additional years of life (95% CI) (years) | Activity of the “active” group | Activity of the “inactive” group | Confounding factors |
---|---|---|---|---|---|---|---|---|
Women | 30 | Fraser and Shavlik [ |
USA | #12 y | 2.19 |
At least 3 times per week vigorous all-day or sports activities ≥15 min. | Less than 3 times per week intensive all-day and sportive activities ≥15 min. | Vegetarian/nonvegetarian, high/low nut consumption, body mass index, never/past smoker, hormone replacement therapy |
30 | Wen et al. [ |
Taiwan | 216.910 |
3.67 |
Very vigorous physical activity (≥25.5 MET·h/week) during leisure time | Inactivity (<3.75 MET·h/week) during leisure time | Age, sex, education, physical work, smoking, alcohol consumption, diabetes mellitus, arterial hypertension, cancer, fasting glucose, systolic blood pressure, total cholesterol, body mass index | |
45 | Bélanger et al. [ |
Canada | #2 y | 6.9 |
≥1.5 kcal/kg/d |
<1.5 kcal/kg/d |
||
50 | Jonker et al. [ |
USA |
2.813 |
3.7 |
High physical activity level (>33 METs/d) | Low physical activity level (<30 METs/d) | Age, education, smoking, marital status, cardiovascular and lung diseases, cancer, left ventricular hypertrophy, arthritis, ankle edema, total cholesterol, familial history of diabetes mellitus | |
50 | Nusselder et al. [ |
The Netherlands | 1.447 |
1.8 |
Walking, biking, gardening, sports >17.33 METs/week | Walking, biking, gardening, sports <12 METs/week | Age, sex, education, cardiovascular disease, cancer, COPD, arthritis, back complaints, neurological diseases | |
50 | Nusselder et al. [ |
USA (Framingham Heart Study) | 2.873 |
3.4 |
High physical activity level (>33 METs/d) | Low physical activity level (<30 METs/d) | Age, sex, education, marital status, smoking, body mass index, blood pressure, cancer, diabetes mellitus, left ventricular hypertrophy, ankle edema, any pulmonary disease, smoking | |
65 | Ferrucci et al. [ |
USA | 5.215 |
Nonsmoker: 5.7 |
High physical activity (gardening, walking, vigorous exercise) each once per week or several times per month |
Activities as in the active group at most once per month | ||
| ||||||||
Men | 30 | Fraser and Shavlik [ |
USA | #12 y | 2.1 |
At least 3 times per week vigorous all-day or sports activities ≥15 min. | Less than 3 times per week intense all-day and sportive activities ≥15 min. | Vegetarian/nonvegetarian, high/low nut consumption, body mass index, never/past smoker, hormone replacement therapy |
30 | Wen et al. [ |
Taiwan | 199.265 |
4.21 |
Very vigorous physical activities (≥25.5 MET·h/week) during leisure time | Inactivity (<3.75 MET·h/week) during leisure time | Age, sex, education, physical work, smoking, drinking, diabetes mellitus, arterial hypertension, history of cancer, fasting blood glucose, systolic blood pressure, total cholesterol, body mass index | |
35–39 | Paffenbarger et al. [ |
USA (Harvard Alumni) | 16.936 |
1.5* | Physical activities (walking, climbing stairs, sports) ≥2.000 kcal/week | Physical activities (walking, climbing stairs, sports) <2.000 kcal/week | Age, cigarette smoking, arterial hypertension, body mass index, age of parental death | |
35–39 | Paffenbarger et al. [ |
USA (Harvard Alumni) | 16.936 |
2.51* | Physical activities (walking, climbing stairs, sports) ≥2.000 kcal/week | Physical activities (walking, climbing stairs, sports) <500 kcal/week | Age, cigarette smoking, arterial hypertension, body mass index, age of parental death | |
40–59 | Menotti et al. [ |
Italy | 1.712 |
1.6* | Physically active | Sedentary | Age, family history of both parents, mean blood pressure, serum cholesterol, mid-arm circumference, forced exspiratory volume, chronic diseases (cardiovascular, diabetes mellitus, cancer), corneal arcus, xanthelasma, body mass index | |
45 | Bélanger et al. [ |
Canada | #2 y | 3.9 |
≥1.5 kcal/kg/d energy expenditure during leisure time | <1.5 kcal/kg/d energy expenditure during leisure time | ||
45–54 | Paffenbarger et al. [ |
USA (Harvard Alumni) | 10.269 |
0.43* | Physical activities ≥2.000 kcal/week | Physical activities <2.000 kcal/week | Age, cigarette smoking, arterial hypertension, overweight, early parental death | |
45–54 | Paffenbarger et al. [ |
USA (Harvard Alumni) | 14.785 |
1.78* | Physical activity (walking, stair climbing, sports, or recreational activities) increased from <1.500 to ≥1.500 kcal/week | Physical activity (walking, stair climbing, sports, or recreational activities) continuing <1.500 kcal/week | Age, cigarette smoking, arterial hypertension, overweight, alcohol consumption, early parental death, chronic diseases | |
50 | Jonker et al. [ |
USA (Framingham Heart Study) | 2.396 |
4.1 |
High physical activity level (>30 METs/d) | Low physical activity level (<30 METs/d) | Age, education, smoking, marital status, cardiovascular and lung diseases, cancer, left ventricular hypertrophy, arthritis, ankle edema, total cholesterol, familial history of diabetes mellitus | |
50 | Nusselder et al. [ |
The Netherlands | 1.519 |
2.9 |
Walking, biking, gardening, sports >17.33 METs/week | Walking, biking, gardening, sports <12 METs/week | Age, sex, education, cardiovascular disease, cancer, chronic obstructive pulmonary disease, arthritis, back complaints, neurological diseases | |
50 | Nusselder et al. [ |
USA (Framingham Heart Study) | 2.336 |
3.5 |
High physical activity level (>33 METs/d) | Low physical activity level (<30 METs/d) | Age, sex, education, marital status, body mass index, blood pressure, cancer, diabetes mellitus, left ventricular hypertrophy, ankle edema, any pulmonary disease, smoking | |
50 | Byberg et al. [ |
Sweden | 2.205 |
2.3 |
Regularly hard physical training or competitive sport or any active recreational sports or heavy gardening at least 3 hours every week | Spending most of the time reading, watching TV, going to the cinema, or engaging in other, mostly sedentary activities | Smoking, weight and height, alcohol use, obesity, diabetes mellitus, musculoskeletal, neurological, or psychiatric disorders, blood pressure, antihypertensive drugs, total serum cholesterol, educational level, socioeconomic group | |
65 | Ferrucci et al. [ |
USA | 3.389 |
Nonsmoker: 5.2 |
High physical activity (gardening, walking, vigorous exercise) each once per week or several times per month |
Activities as in the active group maximally once per month |
*Total life expectancy not presented, #number of individuals not differentiated between men and women.
The median increase of life expectancy of men and women in the eight studies presenting data on both sexes amounted to 3.7 years each. Physical activity during leisure time seems to increase life expectancy more effectively than total physical activity (all-day, professional, or leisure time activity altogether; professional physical activity alone has not been studied): 3.4 added years due to total activities and 4.7 added years (median values) due to leisure time activities in women, 1.9 and 3.9 added years, respectively, in men. The number of studies, however, is too low for a statistical analysis. Furthermore, the description of the amount of physical activity in the active and inactive groups are too heterogeneous for any statistical correlation between the amount of activity and the added years of life.
The eleven case control studies on life expectancy of athletes, mostly elite athletes (Table
Case control studies presenting life expectancy of (former) athletes compared to that of control subjects.
Author(s) | Type of sports | Reduction/increase in life expectancy (y) |
---|---|---|
Prout [ |
Endurance sports (college rowers from Harvard and Yale) | +6.3 |
| ||
Sarna et al. [ |
Endurance sports (long distance running, cross-country skiing) | +5.7 |
| ||
Karvonen [ |
Endurance sports (cross-country skiing) | +2.8 to +4.3 |
| ||
Sanchis-Gomar et al. [ |
Endurance sports (Tour de France cyclists) | +8.0 |
| ||
Sarna et al. [ |
Power sports (throwing sports, wrestling, weight lifting, boxing) | +1.6 |
| ||
Sarna et al. [ |
Team sports (ice hockey, soccer, basketball, other outdoor sports) | +4.0 |
| ||
Abel and Kruger [ |
Team sports (baseball) | −5.0 |
| ||
Abel and Kruger [ |
Team sports (baseball) | +4 to 5 |
| ||
Kuss et al. [ |
Team sports (German international soccer players) | −1.9 J. (+0.6 to −3.2) |
| ||
Hudec et al. [ |
Various sports disciplines | −0.38 |
| ||
Rook [ |
Various sports disciplines | +1.03 |
The purpose of this review was to synthesize the literature on life expectancy in relation to physical activity. Being physically active indeed appears to be associated with a higher life expectancy. Samitz et al. [
The studies that standardized extended life estimates for confounding factors [
The mechanisms underlying the net effect of physical activity are speculative and include reduction of triglyceride and apolipoprotein B concentrations, increase of high-density lipoproteins and tissue plasminogen activator activity, and reduction of coronary artery calcium resulting in reduced risks of vascular diseases, which carry the strongest mortality risk [
According to the results of the meta-analysis on all-cause mortality in relation to physical activity performed by Samitz et al. [
A greater life expectancy is not associated with more years of being frail and depending on assistance. In contrary, Nusselder et al. [
The few data available on life expectancy in athletes who were much more physically active than the average individual are inconclusive. All studies proved an increased life expectancy in endurance athletes ranging between 2.8 to 8.0 added years. This gain is probably higher than that found for persons performing vigorous physical activity in the cohort studies. In team sports and other sports disciplines, life expectancy may fall below or be above that of the control groups. However, data on health behaviors of these athletes other than their physical activity during their active sports career such as smoking, food, and alcohol consumption are not available. Thus, the effect of elite sports activities on life expectancy warrants further investigation.
In summary, as expected from numerous prospective cohort studies on all-cause mortality in physically active and physically inactive persons, estimates on life expectancy in relation to physical activity indicate additional years of life in active subjects: the conservative estimate of the net increase in life expectancy with physical activity is about 2–4 years but presumably even greater because of the positive influence of physical activity on major risk factors for mortality.
Confidence interval
Chronic obstructive pulmanry disease
Day
Hour(s)
Metabolic equivalent value (1 MET = 1 kcal per h per kg of bodyweight)
Minute(s)
Television
Versus
Year(s).