OBJECTIVE: To compare the long term survival of a group of athletes taking 
prolonged vigorous physical exercise to that of the general population.
DESIGN: Follow up of a cohort of participants in the Dutch eleven cities ice 
skating tour (a race and recreational tour) over a distance of 200 kilometers.
SETTING: Data on participation from the organising committee and data on 
mortality from all municipalities in The Netherlands.
SUBJECTS: 2259 Male athletes.
MAIN OUTCOME MEASURES: Comparison of all cause mortality in male participants in 
the tour with that in the general population of The Netherlands.
RESULTS: The standardised mortality ratio for all participants during 32 years 
of follow up was 0.76 (95% confidence interval 0.68 to 0.85), and 0.90 (0.48 to 
1.44) for participants in the race, and 0.72 (0.60 to 0.86) for participants in 
the recreational tour who finished within the time limit.
CONCLUSIONS: The capacity for prolonged and vigorous physical exercise, 
particularly if the exercise is recreational, is a strong indicator of 
longevity.