Bodybuilding is a sport of extremes where athletes push the absolute boundaries of human capability. As such, just like with any elite sport, the toll that this then takes on the body can often put the individual at risk. It is hoped, however, that a new study highlighting the startling stats linking bodybuilding with sudden cardio death could lead to positive changes in the pumping iron industry—If promoters and participants take note.

This brand new study, published in the European Heart Journal gathered the names of more than 20,000 bodybuilders who had competed for the International Fitness and Bodybuilding Federation between 2005 and 2020. Researchers then cross-referenced reported deaths, and where possible, verified the individual causes.

While sudden cardiac death is rare among young healthy males in the general population, the resulting data showed that of the 121 deaths in pro bodybuilders averaging 45 years of age, 38% of these deaths were due to cardiac events. This risk to pro bodybuilders was found to be far greater than in standard society, and a massive 5-times higher than that of even amateur bodybuilders. Potential precursors to these critical cardio events include enlargement of the heart, potentially as a result of anabolic substance abuse.

Experts Hope to Balance the Positive and Negative Aspects of Bodybuilding

“As a sports and exercise physician, I have come close to the bodybuilding world, and this has given me the opportunity to see not only its many positive aspects, such as the promotion of fitness and self-discipline, but also some of the challenges and risks that are inherently part of this discipline,” said Dr Marco Vecchiato, who led the study from the University of Padova, Italy.

Indeed, bodybuilding offers a multi-faceted community aimed at inspiring dreams and chasing brilliance, but those who take the sport to the extreme should do all they can to protect themselves. And, it’s not just steroids themselves that carry risk. Other behaviors such as sharing needles are very dangerous, too.

The official word from the IFBB is that steroids are banned unless there is a therapeutic exemption already agreed. “Anti-doping programs are founded on the intrinsic value of sport,” stated a policy document released by the organization in 2023. “This intrinsic value is often referred to as ‘the spirit of sport’: the ethical pursuit of human excellence through the dedicated perfection of each athlete’s natural talents.”

Still, IFBB Pro events aren’t generally subjected to the testing of unnatural substances, leaving the responsibility to play fair and stay safe with the athletes themselves.

How Bodybuilders Can Lower Their Risk of Cardiac Events

This latest study builds on previous work in elite sports, where the European Society of Cardiology has advocated for athletes to undergo regular and comprehensive cardio screening. This is certainly great advice for bodybuilders, too. “For clinicians, our findings suggest the importance of proactive cardiovascular screening and counseling in (the bodybuilding) population, even in young and apparently healthy athletes,” added Dr. Vecchiato.

The findings of this latest bodybuilding specific study also calls for federations to engage in ways that educate and keep athletes safe. “Based on this data, the medical associations cannot ignore this health problem anymore and should collaborate with the respective federations and policy makers to promote safer participation,” says Dr Vecchiato. “Particularly as the approach of famous athletes can also influence many other people who are engaged in strength training in gyms around the world.”

There is no doubt that bodybuilding is enjoying immense popularity right now, so the need to protect the sport and its athletes is as essential as ever. If improved education and preventative measures by both the promoter and the participant can lead to the greater longevity of bodybuilders, then we all win.

After nine weeks out, Toone was back with a bang.

She scored six goals in her first five games back for United, including a stunning hat-trick against rivals Manchester City.

“When I was back on the grass and around the girls I was like ‘I miss it’ and that’s when I knew I was ready to kick on,” Toone said.

“I came back and started playing well and scoring goals. Then my love for the game really grew and I wasn’t putting as much pressure on myself as I was before in wanting to do everything and wanting to score for dad, thinking I’m never going to score again.

“It was perfect timing and now it’s about not falling again. It’s hard in football because you are up and down all the time anyway.”

Toone is currently on international duty as England prepare to face Portugal and Spain in the Nations League.

Her former United team-mate, best friend and podcast partner Alessia Russo, who now plays for Arsenal, drove to Manchester when she heard of Nick’s passing.

“From living together to then being so far away down in London was hard anyway,” Russo said. “When something as heavy as that happens, all I wanted to do was be there.

“Whether she wanted me there or not I didn’t really care. I just wanted to be there, to sit with her, to cry with her, to eat with her, to try and make her laugh and to help with anything she needed.

“It’s so hard being away from someone at a time like that. As soon as I could I wanted to go and see her. I know Tooney would drop anything to help me if I needed her, big or small.”