Mortality in male bodybuilding athletes

Premature deaths of bodybuilders have raised questions about the safety and associated risks of this discipline. The main objective of this study was to analyse mortality risk in a large international population of bodybuilders.

Male athletes who performed International Federation of Bodybuilding and Fitness (IFBB) competitions between 2005 and 2020 were identified and classified according to age, division and level. A standardized web-search, tailored to detect deaths, was performed for each athlete using specific keywords, with follow-up through July 2023. Mortality rates have been calculated both as the overall incidence rate during the monitored period as well as the annual incidence rate of those who participated in at least one competition within the previous year, i.e. currently competing athletes.

A total of 20 286 athletes competing in 730 IFBB events were identified with an average follow-up of 8.1 ± 3.8 years (i.e. 190 211 athlete-years of surveillance). During the study period, 121 deaths were identified: 73 were considered sudden deaths, of which 46 were classified as sudden cardiac deaths (SCD), including 11 currently competing athletes (mean age 34.7 ± 6.1 years). The incidence of SCD in currently competing athletes was 32.83 cases per 100 000 athlete-years. Available autopsies of SCD cases consistently showed cardiomegaly and ventricular hypertrophy. Professional bodybuilders had a higher risk of SCD than amateurs (HR 5.23 [3.58-7.64]).

The results of this study should alert the bodybuilding and medical communities to the need for improved preventive measures to promote safer sports participation.