Bodybuilders face high risk of sudden cardiac death, especially those who compete professionally, study finds

Pumping iron could leave you at greater risk of suddenly falling to your death, a major study of 20,000 bodybuilders has revealed.

Researchers found those who had built extreme levels of muscle over their lifetime were twice as likely to die from sudden cardiac death, compared to the general population. 

Meanwhile, those who took part in regular bodybuilding competitions such as ‘Mr Olympia’ titleholders like Arnold Schwarzenegger, saw the risk of shock death increase five-fold, compared to their amateur counterparts.  

Alarmingly, some 40 per cent of the deaths among all bodybuilders studied were sudden and heart-related. 

The authors suggested their figures could be an underestimation, as many deaths were listed as ‘ unknown’.

Dr Marco Vecchiato, an expert in sports medicine from the University of Padova and author of the study, said analysis of autopsy reports suggested a combination of factors were to blame. 

‘Bodybuilding involves several practices that could have an impact on health, such as extreme strength training, rapid weight loss strategies including severe dietary restrictions and dehydration.’

He also flagged the dangers of the ‘widespread use of different performance-enhancing substances’.

‘These approaches can place significant strain on the cardiovascular system, increase the risk of irregular heart rhythm, and may lead to structural heart changes over time.’

Previous studies have suggested up to three in four bodybuilders have used performance enhancing drugs, such as steroids—known to place extra strain on the heart.

‘While striving for physical excellence is admirable, the pursuit of extreme body transformation at any cost can carry significant health risks, particularly for the heart,’ said Dr Vecchiato.

‘Awareness of these risks should encourage safer training practices, improved medical supervision, and a different cultural approach that firmly rejects the use of performance enhancing substances.’

He also encouraged stronger anti-doping rules for competitions, as well as campaigns among the sporting community about the hazards of using performance-enhancing substances. 

Dr Vecchiato added the research was a reminder that no matter how healthy someone looked, they could be engaging in behaviour that puts them at risk.  

‘The research challenges the idea that appearance alone is an indicator of health and highlights the hidden risks that can exist behind even the most sculpted physiques,’ he said.

However, he added the findings should not be taken as evidence that bodybuilding, or any other type of fitness, was inherently harmful.

‘Regular physical activity and strength training can be extremely beneficial for health, quality of life and mortality risk.’

A sudden cardiac death isn’t a specific medical condition but rather a description of  unexpected demise due to a hidden heart issue.

This could be a sudden heart attack with no prior symptoms or a congenital heart defect that had gone undetected since someone was born.

The impact of steroids on bodybuilders and gym goers was recently highlighted by the case of 32-year-old Zak Wilkinson.

Mr Wilkinson, like a growing number of young men, turned to steroids, which mimic the role of the natural hormone testosterone, to boost his muscle growth. 

But this came at massive cost to his health, and he started having seizures, vomiting and sweating profusely and at one point needed to be put in an induced coma. 

Medics have told the father-of-one he likely suffer complications for the rest of his days.

Anabolic-androgenic steroids are the most common type of image and performance enhancing drug.

They are typically injected directly into the muscle, though can also be taken orally in tablet form or even as a cream.

Common side effects include severe acne, kidney failure, high cholesterol and even stroke.

Another finding of the new study was that a significant number of fatalities among bodybuilders were what researchers classified ‘sudden traumatic deaths’.

This included incidents like car crashes, suicides, murders and overdoses.

Dr Vecchiato said this data suggested there was need for greater mental health awareness and support among the bodybuilding community.

‘These findings underline the need to address the psychological impact of bodybuilding culture,’ he said. 

‘These mental health challenges, sometimes worsen with substance abuse and can elevate the risk of impulsive or self-destructive behaviours.’

In the study, published in the European Heart Journal, researchers examined the records of 20,286 bodybuilders who had been active in at least one official event between 2005 and 2020. 

After analysing the data, they found a total of 121 athletes had died, with an average age at death of 45.

The team are now planning a similar study on female bodybuilders to examine if they also experience an increased risk of sudden cardiac death.