Not All Former Athletes Age the Same

Longevity · 8 min read · For Athletes

The limitation to hold onto: twelve of the twenty studies in that review evaluated males only, and the major endurance-cardiac study was entirely male.

Why “former athlete” is not one thing

If you competed seriously and then stopped, you have probably been reassured at least once on the strength of that history. You have a base. You know how to train. You will be fine.

The trouble is that the phrase covers a rower, a lineman, a gymnast and a powerlifter, and those four people spent their twenties doing almost nothing in common. One accumulated tens of thousands of aerobic hours. One accumulated repeated collisions and a deliberate weight gain. One accumulated loading impact alongside, very often, chronic under-fuelling. One accumulated maximal loads and, sometimes, pharmacology.

Twenty-five years later those are not variations on a theme. They are different exposures, and they leave different marks.

A 2023 scoping review in BMJ Open Sport & Exercise Medicine looked specifically at midlife — ages 40 to 65 — and pulled together twenty studies published between 2000 and 2022 on function, body composition and cardiometabolic health in former athletes. It is the most useful single source we have on this population, and its central finding is a division rather than a verdict.

What the endurance history tends to leave behind

In that review, former endurance athletes generally compared favourably with non-athlete controls: leaner body composition, higher aerobic capacity, and lower total cholesterol, triglycerides and glucose. Broadly the picture you would hope for, and broadly what most former endurance athletes assume about themselves.

The complication sits somewhere the metabolic panel does not look.

The MASTER@HEART study compared 191 lifelong endurance athletes, 191 athletes who took up endurance training after thirty, and 176 healthy non-athletic controls — all men, median age 55. It found that the lifelong endurance group had more coronary plaque, not less — more calcified, more non-calcified, more mixed, more lesions in the proximal segments, and more lesions producing significant narrowing.

This finding is easy to misread, so we will be careful with it. It does not show that endurance training causes coronary disease. Aerobic fitness remains one of the most robustly protective things a person can have, and the study was not designed to overturn that. What it does show is that a lifetime of high training volume does not confer the immunity many endurance athletes assume it does — and that the specific belief I did the miles, so my heart is fine is a hypothesis rather than a fact.

Two further things about the endurance profile. Leanness is not automatically a good sign in isolation — a long history of energy intake below training demand can suppress hormones in ways that persist, and a low testosterone result in a lean former runner may reflect fuelling rather than a primary hormone problem. And bone is protected less well by non-impact endurance sports like cycling and swimming than by loading sports.

What a collision-sport history tends to leave behind

The other half of the review's picture is less flattering, and it is worth being precise about what it actually says. The clearest signal is functional: former team-sport athletes may perform worse on functional testing than recreationally active controls.

On blood pressure the evidence splits. Two of the studies in the review found a lower prevalence of hypertension among former athletes; one, in former NFL players specifically, found a higher prevalence and higher systolic pressure. Anyone telling you flatly that team-sport athletes end up hypertensive is reporting one study and omitting two. What is fair to say is that the team-sport picture is not the reassuring one, and that it is not settled.

Work from the Football Players Health Study at Harvard adds a dimension that most people find genuinely surprising. Weight gained across a playing career appears to carry forward: every ten pounds gained between college and professional play was associated with meaningfully higher later risk of sleep apnoea, heart disease and cardiometabolic conditions — independent of body weight at the point of assessment.

That is worth sitting with if your sport required you to get big on purpose. The number on the scale today is not the whole story, and a normal current weight is not evidence that the exposure did not happen.

The same research programme found that former players with ACL tears carried increased later risk not only of knee replacement and arthritis but of heart attack — a link that most plausibly runs through decades of reduced activity rather than anything cardiac about the knee itself. An old injury is a cardiovascular exposure if it quietly stops you moving for twenty years.

Strength and power sports

This group is the least studied of the three, and what can be said is more limited.

The clear asset is peak muscle mass. Years of heavy loading bank more of it than almost any other activity, and muscle in midlife is metabolically and functionally valuable in ways that go well beyond appearance.

The complication is that a high starting point does not slow the rate of decline that follows — it changes where the decline starts from. And a high baseline is very effective at hiding a steep loss, because you continue to look and feel strong relative to everyone around you long after something has begun to slip. Comparing yourself to your peer group is not measurement.

There is also a history in this group that goes undisclosed more often than any other. Past anabolic steroid use is far more common than clinical records suggest, and it changes the interpretation of hormone results substantially. We ask about it directly and without judgment, because reading a testosterone result without it is guesswork.

Where all three converge

Two things apply across every athletic history.

Bone protection is site-specific and conditional. Loading builds bone durably, and former gymnasts have been followed well over a decade after retirement with benefits still measurable. But the benefit accrues to the parts of the skeleton that were loaded, not to the skeleton in general — which is why a swimming or cycling history protects bone far less than a running or lifting one. And it can be undercut: research in retired elite gymnasts found that a history of amenorrhoea compromised the bone advantage the loading should have produced, in both cortical and trabecular bone.

The habits are the shared risk. Every athletic culture teaches you to work through discomfort, to treat fatigue as a discipline problem, and to distrust the impulse to stop. Those habits are why you were good. They are also why former athletes reliably arrive late — filing symptoms under getting older for years before mentioning them to anyone.

What this changes about what we measure

Everyone gets the same starting point: a full panel covering metabolic markers, lipids, liver and kidney function, thyroid, inflammatory markers, nutrient status and hormones. What your history changes is how we read it and what we add.

• Endurance history: cardiovascular risk gets a serious conversation rather than an assumption, and a lean patient with low testosterone gets a fuelling conversation before a hormone one.
• Collision-sport history: blood pressure, metabolic markers and sleep — particularly sleep. Screening for sleep-disordered breathing is one of the highest-yield things we can do in this group.
• Strength and power history: body composition and function rather than weight, and an open question about past substance use that we ask without judgment.
• Any history involving under-fuelling or lost periods: bone and hormones, in both sexes.

One boundary worth stating plainly. We are a telehealth practice. We can measure and we can treat, but we cannot perform imaging — a coronary calcium scan or a DEXA scan is a referral, not something we provide. Where that is the right next step, we say so.

An honest word on the evidence

This research base is real and it is thinner than the confidence of most writing about it.

Most of the studies are cross-sectional, comparing groups at a single point in time, which supports association rather than causation. Prior injury is rarely controlled for. Populations skew heavily toward elite and professional athletes, when the far larger group is people who competed seriously at school or club level. And the review flags its own most serious limitation: twelve of the twenty studies evaluated males only, with four including female participants exclusively — two of those with fewer than fifty people counting controls. The MASTER@HEART cohort was entirely male.

So the sensible use of this material is as a guide to what to examine, not as a prediction about any individual. If you competed and you are now in your forties or fifties, none of this tells you what is true of you. It tells you which questions are worth actually answering.

Where this fits in your plan

The reason to know which profile you fit is not the label. It is that it changes what gets looked at first. If you have an athletic history, the useful starting point is a baseline panel read by someone who asks what your sport was, how long you did it, and what it cost you at the time — rather than someone who hears “I used to be an athlete” and moves on. The athlete hub sets out the whole picture.

Frequently asked questions

I played two sports. Which profile applies to me?

Usually the one you did for longest and at the highest volume, but this is exactly the kind of thing worth talking through rather than sorting into a category. Mixed histories are common and the interpretation is individual.

Does a good metabolic panel mean my heart is fine?

No. Lipids and glucose are useful and they are not a picture of your coronary arteries. The MASTER@HEART finding is specifically that a favourable metabolic and fitness profile can coexist with more plaque, not less.

I stopped competing twenty-five years ago. Is this still relevant?

Several of the findings concern exposures during the career that appear to persist independently of current fitness or weight. Twenty-five years is not long enough for training load, weight trajectory, injury history or a period of under-fuelling to stop being part of your picture.

Should I get a coronary calcium scan?

That is a conversation to have with a clinician who knows your full history and risk profile, and it is not something we can perform. Where the history and the risk picture suggest it is worth doing, we say so and refer.

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