Choose Your Sport Wisely

An investigation into the health benefits of various sports

Having spent a good portion of my life talking to people in the health realm, I have often answered questions around sport (as opposed to exercise) and it’s role in the physical activity regime of people trying to be healthy or increase their healthspan (confused about the difference between exercise, physical activity and sport, see here). In short, people want to know if their sport ‘counts’ as exercise and/or how to classify it (is it HIIT or Zone 2 or something else?).

A recent article permeated across my social media channels piquing my interest in writing this piece, it touched on the longevity of international elite athletes from various sports, looking to quantify it compared to the rest of the population. For context, there is quite a bit of evidence that, as a group, elite athletes live longer than the general public but this is the first article I have seen really dig into the details of sport specifics for elite athletes. The two main figures that tell the bulk of the story are below, the first for male athletes and the second for female athletes. Don’t be scared by the technicality of the graph. The TLDR is if the thing that looks like a Star Wars Tie Fighter is to the right, they lived longer (and the further over to the right it is the longer the athletes lived) and vice versa. And if you don’t know what a Tie Fighter is, you’re probably close enough to your education that you’ll be able to read the figures.

Change in Years of Life in Male Athletes Based on Sport from Altulea et al

Change in Years of Life in Female Athletes Based on Sport from Altulea et al

Some notes on the figures; the broader the lines, the greater the range of data (most likely reflecting less certainly but also in the case of the female athletes likely smaller sample sizes.

How Much Exercise is Enough?

Before we start, I will reiterate quickly: everything is better than nothing, the most potent/beneficial effects are seen going from nothing to slightly more and yes you can do these numbers broken up across the day, week etc.

Almost all guidelines world over align (it’s a rarity we can agree this widely) and are to the effect of:

• 75-150 mins of vigorous physical activity or 150-300 mins of moderate physical activity or a mixture of the two

• Strengthening activities on at least 2 days a week

• Minimise sedentary time (this is the part most people struggle with)

To be honest, for optimal health (and certainly when we examine performance) the low end of this range is probably the floor (maybe basement for performance). When it comes to health, the ceiling is hard to be sure about, I’ve certainly heard cardiologists talking about observational data suggesting somewhere in the vicinity of 7 hours a week is where the diminishing returns may turn into a detriment - but let’s remember that even some detriment that we see in high levels of activity (there is an association with some arrhythmias) still have a significantly lower all cause mortality than folks exercising less than this.

When it comes to performance, endurance athletes are mostly energy limited; they cannot intake enough nutrients to sustain more training, and they cap out somewhere around 30 hours a week (remembering that this may be more if they do less intensity, but the intensity is where sport happens). In non-endurance sports athletes obviously do much less, but their sport is more chaotic and less endurance dependant. All of this of course is balanced with injury risk, and in skill sports like golf, injury becomes significantly more risky if we go north of 30hrs a week due to the repetitive nature of the movements (though I’ve had nothing to do with golfers I would infer this - but please comment below if I am off the mark I would love to learn more).

How Should we Classify Sport?

Firstly, it is worth noting that the guidelines do not delineate into ‘training zones’, mostly to keep things simple (these are more advocacy than exact prescription). In the context of the physical activity guidelines, sport usually falls into the vigorous realm, but there’s an enormous difference to something like very social tennis with a parent of yours, where you perhaps don’t break a sweat and playing your local club championship. Similarly the vigorousness of my old olympic weightlifting training sessions where I’d do a set every 5 mins, across around 2 hours, accumulating somewhere in the vicinity of 75 reps total are in stark contrast to something like a “Fran” workout from Crossfit or German Volume Training (which I mentioned here).

When it comes to things like zone 2 vs HIIT vs other the answer is probably ‘it depends’ again (as always). That said, with enough intensity sport usually falls into an extended HIIT type of realm, that is, it is high intensity but intermittent. Again, this will vary between sports, level of play etc etc but this is both helpful enough and good enough for these purposes.

Why do Athletes Live Longer?

There are many reasons for athletes living longer, and the real answer is probably some mixture of all of these and perhaps some that we aren’t sure of. It is also worth noting, the thesis of this whole newsletter’s existence is that some aspects of performance (the thing athletes care about) are not healthy, so it is worth considering that whilst as a group athletes live longer, the “magic wand” experiment where we get their twins and train them to a high level but don’t let them compete at an elite level hasn’t been done, and probably won’t be (never say never).
That said, some reasons that likely play a role in athletes living longer are:

• Genetics - these folks won the genetic lottery in many ways from a physical standpoint, don’t underestimate this.

• Exercise - generally, these folks are more active and for longer than the bulk of society (and this is getting more stark)

• Diet - depending on the sport, athletes are generally at least aware of diet and eating healthy (though the genetic lottery applies here too; I’ve met some of these individuals who could eat a diet that would make most sick and still look unbelievable and perform as such too)

• Fitness - I use this term intentionally as a catch all, these folks would likely outperform most of society on a number of metrics related to longevity. These include strength, power and endurance metrics.

• Smoking - there are notable exceptions as always, but the prevalence of smoking in athletes not called Jai Taurima, is significantly lower than the general population

• Socioeconomic Status (SES) - not all athletes end up with a high SES, in fact it’s well publicised that many end up broke. That said, if we compare the complete cross section of athletes to the complete cross section of society, it COULD be that athletes have a high SES. This is of importance because SES is a significant factor in longevity.

Should you Include Sport into your Health and Longevity Regime?

In answering this question it is helpful to have a hierarchy of how to think about physical activity with respect to health (aka organising your thinking). In this case, the pyramid would have the base (and thus most important portion) being enjoyment: ensuring that for the most part you are enjoying the activity is what will ensure sustainability and thus consistency (which is key to success here). Of course, this is a continuum but if it’s absolutely dreadful at all times it’s gonna be a tough hill to keep climbing, and starting with more enjoyable is a good way to go to ensure you can build the rest of the pyramid. The second layer of the pyramid is volume: doing enough physical activity and exercise should be the priority. Following this, the third level, is type and intensity: doing enough of both strength training and endurance training as well as ensure some of the training is high enough intensity (the pure volume will likely dictate some needs to be at a lower intensity). The final layer, at the top of the pyramid, is the ‘what’: in this case we can talk about exact modalities, whether sport is part of the regime etc.

With this in mind, the answer of whether or not to include sport becomes quite an easy question to answer (hence the value in organising thinking - the questions largely answer themselves). If enjoyment is the unlock to habit formation, sustainability and consistency or indeed the “foot in the door” so to speak, then let’s go right ahead and do that. From there building out the rest of the pyramid can become easier. As an example I recently spoke to a friend who was not particularly active but started playing padel. Following this, the enjoyment increased their activity significantly and a will to improve saw their padel further them start strength training. From there the discussion of increasing some endurance training isn’t particularly difficult, especially if using the hook of improved padel performance.

What Other Value May Sport Have in Health and Longevity?

Beyond being a ‘gateway’ of sorts, or being something people enjoy, there are other reasons why sport may be a valuable inclusion into what can otherwise be a quite sterile prescription of gym based exercise. Factors that sport has as core that are important for health and longevity:

• Social interaction - as we age we can increasingly have smaller social circles, in fact many folks may not see that many people day to day if they are working from home. Social interaction is key to health and longevity, as is a sense of community (which may be around your sporting team).

• Skill - Continuing to challenge yourself to develop and hone skills is a key part of keeping your brain healthy. This is the genesis of Dr Tommy Wood (an expert in the space) regularly suggesting dancing for brain health.

• Competition - This may sound strange to some, some may even find this confronting (whereas the athletes reading this may be nodding) but hear me out. The competitive nature of sport often means we will work a little bit harder, but the deadline and goal of competition may also be the carrot (or stick) we need to motivate us at times. I know a good number of folks who are dedicated athletes training hard, provided they have something they are training towards - so you now see my point.

• Outdoors - There’s a good chance sport will be outdoors, though to be fair it may not be and exercise that is not sport related may be. That said, being outdoor is important for health as I covered here. Interestingly, generally exercising outdoors feels easier (at the same intensity) too, so there’s another good reason to do so.

Of course some of these aspects are not quite specific to sport, some of them could well be achieved in an exercise setting (and sometimes the lines are pretty blurry with things like Hyrox and Crossfit). But the principles remain, so apply them as they suit your situation.

The take home message here is that sport can form a great part of any health or longevity regime, but it should be kept in the context of doing enough exercise total and ensure you are getting the right stimuli needed ideally. That is to say, 10 hours a week of golf is probably not quite what we are after. The counter to this is to not hyperoptimise everything and cut a sport you enjoy to get some zone 2 which you hate just to make sure you get some zone 2 (remember the enemy of good is better sometimes).

References

1. Oja, P., Memon, A.R., Titze, S. et al. Health Benefits of Different Sports: a Systematic Review and Meta-Analysis of Longitudinal and Intervention Studies Including 2.6 Million Adult Participants. Sports Med - Open 10, 46 (2024). https://doi.org/10.1186/s40798-024-00692-x

2. Oja P, Kelly P, Pedisic Z, et al Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80306 British adults. British Journal of Sports Medicine 2017;51:812-817.

3. Schnohr P, O'Keefe JH, Holtermann A, Lavie CJ, Lange P, Jensen GB, Marott JL. Various Leisure-Time Physical Activities Associated With Widely Divergent Life Expectancies: The Copenhagen City Heart Study. Mayo Clin Proc. 2018 Dec;93(12):1775-1785. doi: 10.1016/j.mayocp.2018.06.025. Epub 2018 Sep 4. PMID: 30193744.

4. Spring KE, Holmes ME, Smith JW. Long-term Tennis Participation and Health Outcomes: An Investigation of "Lifetime" Activities. Int J Exerc Sci. 2020 Sep 1;13(7):1251-1261. PMID: 33042385; PMCID: PMC7523898.

5. Altulea, A., Rutten, M.G.S., Verdijk, L.B. et al. Sport and longevity: an observational study of international athletes. GeroScience (2024). https://doi.org/10.1007/s11357-024-01307-9

6. Ceci R, Hassmén P. Self-monitored exercise at three different RPE intensities in treadmill vs field running. Med Sci Sports Exerc. 1991 Jun;23(6):732-8. PMID: 1886482.

7. Gladwell VF, Brown DK, Wood C, Sandercock GR, Barton JL. The great outdoors: how a green exercise environment can benefit all. Extrem Physiol Med. 2013 Jan 3;2(1):3. doi: 10.1186/2046-7648-2-3. PMID: 23849478; PMCID: PMC3710158.

8. Olsson KSE, Ceci R, Wahlgren L, Rosdahl H, Schantz P. Perceived exertion can be lower when exercising in field versus indoors. PLoS One. 2024 May 29;19(5):e0300776. doi: 10.1371/journal.pone.0300776. PMID: 38809815; PMCID: PMC11135770.