On peut faire du sport pour plein de raisons : pour se dépasser, pour l’amour de la compétition, pour oublier des soucis, pour le lien social, etc. Beaucoup font du sport pour rester en forme.
Avoir une activité physique régulière est très positif en matière de santé physique et mentale. Le sport peut jouer un rôle dans l’amélioration et la prévention de nombreuses pathologies. Une équipe de chercheurs taïwanais a mis en évidence dans une énorme cohorte de plus de 400 000 personnes suivis sur 8 ans que 15 minutes d’activité physique modéré par jour conférait une baisse de 14% de la mortzalité toutes causes confondues . Ainsi il devient difficile aux couch potatoes de se défendre derrière l’argument churchillien que l’activité physique serait dangereux pour la santé.

On ne peut pas non plus nier qu’il existe des morts traumatiques au cours d’activités sportives . Je suis assez aventurier pour en avoir conscience… Plus pernicieux il existe aussi des phénomènes d’addiction pathologique au sport comme la bigorexie. L’addiction à l’activité sportive peut nuire fortement en détériorant les rapports humains… Je suis conscient de tout ça mais je ne connaissais pas l’hypothèse d’un effet de l’excès de sport d’endurance sur la santé des vaisseaux. J’ai découvert ça avec la lecture des éditos de John O’Keefe et Carl Lavie .
Ces éditos m’ont marqué en citant des travaux qui vont dans le sens d’une perte de la qualité des vaisseaux avec l’augmentation des volumes d’entrainement que ça soit chez des sujets déjà atteints d’une pathologie coronarienne ou chez des sportifs très expérimentés . (je souligne que je n’ai pas retrouvé une étude qu’ils citent à propos d’une augmentation des plaques coronaires chez des marathoniens très expérimentés, faut toujours creuser et vérifier… on en parle aussi içi) Ils citent aussi des travaux qui montrent des cicatrices myocardiques chez des sportifs de longue date. Ces zones de fibrose pourraient être des zones de démarrage de troubles du rythme .
Ces données anatomiques appellent à la prudence et une grande cohorte danoise vient enfoncer le clou. Plus de 17 000 danois ont été suivis depuis 1976. Il apparait que les joggers vivent en moyenne 6 ans de plus que les non-joggers. Les coureurs-loisirs ont un risque abaissé de 44% de mourir durant le suivi de la cohorte. Après ajustement pour les facteurs confondants (tabac, poids, etc) le risque relatif (hazard ratio) est moins favorable mais reste statistiquement significatif pour les hommes (cf table 2 ci dessous). Rassurant pour la majorité des coureurs.

Mais la cohorte montre aussi que ceux qui semble le mieux protégés sont les coureurs modérés qui pratiquent 2H30 par semaine à une allure modérée. En courant beaucoup il semble que l’on perde le bénéfice de l’activité physique modérée.

Ainsi ce travail appelle à la méfiance. Le sportif compétiteur que je suis était rassuré par les travaux de suivi des plus grands sportifs qui montraient que les athlètes de très haut niveaux dans les sports d’endurance ont souvent une longévité améliorée par rapport à leur concitoyens . Je tiens à rappeler que ces études épidémiologiques démontre une association mais non un lien de causalité, il faudrait pour celà suivre des gens au hasard sur de longues années et les attribuer au hasard dans un groupe « course à pied intensive » ou « footing tranquille », ça semble difficile à concevoir… Mais ces articles me font réfléchir. Un homme averti en vaut deux. La voie du milieu semble encore la meilleure solution à long terme.
Post-scriptum 4 avril 2014 : une excellente analyse d’Alex Hutchinson qui écrit régulièrement dans Runner’s world fait le point sur tout ça. Il souligne le fait que l’étude danoise est la plus solide (la seule ?) pour réfléchir sur le sujet mais qu’elle souffre d’un défaut : les auteurs ont commencé à s’intéresser à du qualitatif (allure) après le début de l’étude. Les effectifs sont donc minces et leur impact réel peut être discuté. Lisez cet article, il est bien mieux écrit que le mien et donne des rappels de stats super intéressants
Will Running Too Much Kill You?
Ma conclusion dans ce billet…
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