The hidden dangers of competitive bodybuilding

When you picture bodybuilding, chances are you imagine chiseled physiques, gleaming muscles under bright stage lights, and a celebration of human strength taken to its most extreme form. Bodybuilders are often admired as paragons of discipline and physical perfection. But behind the glossy photos and trophy smiles lies a far more dangerous reality: bodybuilding, especially at the professional level, comes with serious, and sometimes deadly, health risks.

A new study published in the European Heart Journal pulls back the curtain on these dangers. Researchers from the University of Padova in Italy, along with an international team spanning the United States, Austria, and beyond, assessed mortality in male bodybuilding athletes in the most comprehensive fashion. And the findings are startling.

The team tracked over 20,000 male bodybuilders who competed in official International Federation of Bodybuilding and Fitness (IFBB) events between 2005 and 2020. Using meticulous searches across multiple languages and media sources, they followed these athletes for an average of eight years.

During that time, 121 deaths were confirmed. Nearly two out of five were sudden cardiac deaths (SCD), instances where seemingly healthy men collapsed unexpectedly, often during training or competition. Some key numbers stand out. For example, the sudden cardiac death rate among active competitors is high: 33 cases per 100,000 athlete-years. Professional bodybuilders were more than five times more likely than amateurs to die of sudden cardiac death. Nearly 7% Mr. Olympia competitors (the sport’s pinnacle) had died during the study window, most from heart-related causes, at an average age of just 36. Autopsies of several athletes revealed a consistent pattern: enlarged hearts with thickened walls (cardiomegaly and ventricular hypertrophy), warning signs of dangerous strain. Many also showed evidence of anabolic steroid use.

Why is this happening?

The study doesn’t claim bodybuilding is inherently deadly. After all, strength training and exercise are beneficial when done in moderation. The problem lies in the extremes of professional bodybuilding, a culture that pushes the human body well beyond its natural limits.

Several factors play into the elevated risks. First, Performance-enhancing drugs such as anabolic steroids and other substances are rampant in bodybuilding. They help pack on muscle, but at a heavy cost: they raise blood pressure, thicken the heart, disrupt cholesterol, and increase the risk of fatal arrhythmias. Psychiatric side effects, ranging from aggression to depression, may also contribute to the suicides and overdoses noted among athletes. Second, to achieve the razor-sharp “stage look,” bodybuilders often cut water weight and manipulate salt intake. Extreme dieting practices and dehydration can destabilize the heart’s electrical system and stress the kidneys. Third, the relentless drive for muscular perfection can fuel 3. psychological pressure, body dysmorphia, anxiety, and risk-taking behaviors. Tragically, mental health struggles may explain some of the suicides and violent deaths documented. Fourth, unlike athletes in many other sports, bodybuilders often compete without standardized heart checks, despite the intense physical demands of preparation.

Until now, most knowledge about bodybuilding deaths came from scattered case reports, individual stories of athletes who died young. This study is the first large-scale, systematic look at the problem. The implications extend beyond the stage. Competitive bodybuilders are highly visible role models. Their training methods, supplement use, and appearance ideals influence millions of gym-goers worldwide. If elite competitors are dying young, what does that mean for the countless amateurs mimicking their routines?

What needs to change

The authors don’t suggest banning bodybuilding. Instead, they call for a cultural shift that balances aesthetics and ambition with genuine health and safety. They recommend stronger anti-doping efforts. Despite official policies, the IFBB has been criticized for lax drug testing. In one recent year, only 80 samples were tested out of thousands of competitions. That’s a fraction compared to other sports. Also, the authors encourage routine medical checks, including simple screenings like ECGs or echocardiograms, which could catch early warning signs of heart enlargement or arrhythmias. Indeed, education plays a key role. Athletes and fans alike need candid conversations about the risks of performance-enhancing drugs, extreme dieting, and mental health strain. Finally, competitions should ensure ready access to defibrillators and trained responders.

Bodybuilding occupies a unique space in the athletic world. Unlike runners, swimmers, or football players, bodybuilders don’t compete by testing endurance, speed, or skill. They compete on appearance, an aesthetic judged by size, symmetry, and definition. That distinction shapes everything: the training, the drug culture, the risks.

For decades, fans have celebrated bodybuilders as superheroes come to life. But even superheroes are human, and improved preventive measures can help make a difference: if the price of the dream of being a superhero is a shorter life, maybe it’s time to rethink definitions. Perhaps the real triumph lies not in pushing muscles to their breaking point but in building a body, and a lifestyle, that can carry us healthily through the decades.

If you want to learn more, read the original article titled "Mortality in male bodybuilding athletes" on European Heart Journal at http://dx.doi.org/10.1093/eurheartj/ehaf285.