The lifespan health of elite, competitive athletes has received increasing attention in recent years, becoming a focal point of public discourse, legal action, and healthrelated policy. However, supporting scientific data are sparse and fail to reflect the diversity of today’s athletes, especially the participation of women. A comprehensive, descriptive understanding of modern competitive sports’ influence on lifetime health and well-being is absent. Investigations reflecting progressive health science and evidencebased medicine, oriented toward the practical translatability and clinical impact of research findings, and embracing a holistic model of physical, mental, social, and psychological health, are needed.

National Collegiate Athletic Association (NCAA) intercollegiate sports comprise one of the most diverse and rapidly growing populations of modern athletes. No study to date has examined lifespan health and exercise outcomes in this group. Therefore, this dissertation evaluated holistic health, exercise, and health-related quality-of-life (HRQL) among current and alumni NCAA student-athletes (SA), alongside an age- and gender-matched control group of non-athletes (NA).

496 participants (aged 17-84 years) completed a novel health and exercise questionnaire (the TLC Survey). A robust validation of the survey's psychometric properties was conducted, including test-retest reliability, concurrent validity (i.e. equivalence) between paper and electronic forms, and evaluation of error magnitudes in relation to clinically relevant thresholds. Age-stratified, cross-sectional analyses were conducted to evaluate lifespan health and exercise outcomes.

The TLC Survey demonstrated strong evidence of content, criterion, and convergent validity, feasibility, and test-retest reliability. Typical error was significantly less than thresholds of clinical interest, and there was minimal evidence of systematic test-retest error. SA demonstrated a substantially higher risk of joint health concerns later in life, comparable cardiopulmonary health, and differences in lifespan psychosocial health and HRQL profiles compared to NA. A relative parity of joint, cardiopulmonary, and psychosocial health concerns was observed. While current SA were more interested and involved in exercise than their peers, alumni SA and NA displayed similar exercise outcomes. Compliance with American College of Sports Medicine exercise guidelines was associated with significant attenuation of age-dependent cardiopulmonary health concerns, independent of intercollegiate athletic participation.

These findings were robust, using both traditional statistical methods and magnitude-based inferences of clinical effect. They are distinct from those of earlier investigations, and suggest important differences in the experience of modern athletes compared to previous generations. They provide timely scientific evidence on a compelling public issue, and have important implications for health care, policy, and education. Future, larger-scale studies should enhance generalizability among diverse populations, explore sport-specific effects, inform targeted mechanistic research, and further direct related interventions that promote lifetime health and well-being among elite, competitive athletes.