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Tan CO, Grashow R, Thorpe R, Miller KK, Nathan DM, Izzy S, Radmanesh F, Kim JH, Weisskopf MG, Taylor HA, Zafonte RD, Baggish AL. Concussion burden and later-life cardiovascular risk factors in former professional American-style football players. Ann Clin Transl Neurol 2024. [PMID: 38808967 DOI: 10.1002/acn3.52045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Mid-life cardiovascular risk factors are associated with later cognitive decline. Whether repetitive head injury among professional athletes impacts cardiovascular risk is unknown. We investigated associations between concussion burden and postcareer hypertension, high cholesterol, and diabetes among former professional American-style football (ASF) players. METHODS In a cross-sectional study of 4080 professional ASF players conducted between January 2015 and March 2022, we used an mulitsymptom concussion symptom score (CSS) and the number of loss-of-consciousness (LOC) episodes as a single severe symptom to quantify football-related concussion exposure. Primary outcomes were hypertension, dyslipidemia, and diabetes, defined by current or recommended prescription medication use. RESULTS The prevalence of hypertension, high cholesterol, and diabetes among former players (52 ± 14 years of age) was 37%, 34%, and 9%. Concussion burden was significantly associated with hypertension (lowest vs. highest CSS quartile, odds ratio (OR) = 1.99; 95%CI: 1.33-2.98; p < 0.01) and high cholesterol (lowest vs. moderate CSS, OR = 1.46, 95%CI, 1.11-1.91; p < 0.01), but not diabetes. In fully adjusted models, the prevalence of multiple CVD was associated with CSS. These results were driven by younger former players (≤ 40 year of age) in which the odds of hypertension were over three times higher in those in the highest CSS quartile (OR = 3.29, 95%CI: 1.39-7.61; p = 0.01). Results were similar for LOC analyses. INTERPRETATION Prior concussion burden is associated with postcareer atherogenic cardiovascular risk profiles among former professional American football players.
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Affiliation(s)
- Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Roland Thorpe
- Program of Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, Maryland, USA
| | - Karen K Miller
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, Massachusetts, USA
| | - David M Nathan
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Diabetes Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, Massachusetts, USA
| | - Saef Izzy
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Farid Radmanesh
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neurocritical Care, Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marc G Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Herman A Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ross D Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiology, University of Lausanne, Lausanne, Switzerland
- Department of Sports Science, University of Lausanne, Lausanne, Switzerland
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Hodzic A, Gendron P, Baron E, Éthier A, Bonnefous O, Saloux E, Milliez P, Normand H, Tournoux F. Inter-season training effects on cardiovascular health in American-style football players. BMC Sports Sci Med Rehabil 2024; 16:108. [PMID: 38741116 DOI: 10.1186/s13102-024-00888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Recent studies on American-style football (ASF) athletes raised questions about the impact of training on the cardiovascular phenotype, particularly among linemen players who engage mostly in static exercise during competition and who exhibit concentric cardiac remodeling, often considered maladaptive. We aimed to examine the cardiovascular adaptation to the inter-season mixed-team training program among ASF players. METHODS A prospective, longitudinal, cohort study was conducted among competitive male ASF players from the University of Montreal before and after an inter-season training, which lasted 7 months. This program includes, for all players, combined dynamic and static exercises. Clinical and echocardiographic examinations were performed at both steps. Left atrial (LA) and ventricular (LV) morphological and functional changes were assessed using a multiparametric echocardiographic approach (2D and 3D-echo, Doppler, and speckle tracking). Two-way ANOVA was performed to analyze the impacts of time and field position (linemen versus non-linemen). RESULTS Fifty-nine players (20 linemen and 39 non-linemen) were included. At baseline, linemen had higher blood pressure (65% were prehypertensive and 10% were hypertensive), thicker LV walls, lower LV systolic and diastolic functions, lower LA-reservoir and conduit functions than non-linemen. After training, linemen significantly reduced weight (Δ-3.4%, P < 0.001) and systolic blood pressure (Δ-4.5%, P < 0.001), whereas non-linemen maintained their weight and significantly increased their systolic (Δ+4.2%, P = 0.037) and diastolic (Δ+16%, P < 0.001) blood pressure ). Mixed training was associated with significant increases in 2D-LA volume (P < 0.001), 3D-LV end-diastolic volume (P < 0.001), 3D-LV mass (P < 0.001), and an improvement in LV systolic function, independently of the field position. Non-linemen remodeled their LV in a more concentric fashion and showed reductions in LV diastolic and LA reservoir functions. CONCLUSIONS Our study underscored the influence of field position on cardiovascular adaptation among university-level ASF players, and emphasized the potential of inter-season training to modulate cardiovascular risk factors, particularly among linemen.
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Affiliation(s)
- Amir Hodzic
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Inserm Comete, GIP Cyceron, Caen, 14000, France.
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France.
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France.
| | - Patrick Gendron
- Clinique de Médecine du Sport, University of Montreal, Montreal, Canada
| | - Emmanuelle Baron
- Clinique de Médecine du Sport, University of Montreal, Montreal, Canada
| | - Amélie Éthier
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de L'Université de Montréal), Montreal, Canada
| | - Odile Bonnefous
- Philips Research, Medical Imaging (Medisys), Suresnes, France
| | - Eric Saloux
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France
| | - Paul Milliez
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, 14000, France
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France
| | - Hervé Normand
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Inserm Comete, GIP Cyceron, Caen, 14000, France
- Université Caen Normandie, UMR 1075 COMETE UNICAEN/INSERM, 2 Rue Des Rochambelles, Caen, 14032, France
| | - François Tournoux
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de L'Université de Montréal), Montreal, Canada
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Sisk M, Medawar N, McClure M, Cooke B, Cannon R, Kufner D, D'Almeida S, Jardaly A, Asif I, Momaya A, Ponce B. Cardiovascular disease in retired NFL players: a systematic review. PHYSICIAN SPORTSMED 2024:1-8. [PMID: 38318675 DOI: 10.1080/00913847.2024.2315929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/05/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Despite robust research endeavors exploring post-play health implications in former NFL players, the impact of former-player status on long-term cardiovascular health has not yet been elucidated. The purpose of this systematic review is to describe the available research on the cardiovascular health in former NFL players. METHODS Relevant studies were included from the PubMed, Scopus, and Embase databases. Studies were evaluated in accordance with PRISMA guidelines. Two independent reviewers conducted the title/abstract screenings and risk of bias determinations. The results of the studies were extracted for inclusion in the review. RESULTS Sixteen studies met inclusion criteria. Though evidence was discordant among studies, former NFL players appeared to possess more favorable metabolic profiles and decreased mortality compared to community controls. Of note, 90% of former players were found to be overweight or obese. CONCLUSION Though cardiovascular disease is the leading cause of death among former NFL players, they possess comparable metabolic and cardiovascular profiles to community controls. Further research is necessary to ascertain the impact of NFL play on cardiovascular health and develop tailored preventative care strategies for former players.
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Affiliation(s)
- Morgan Sisk
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Nicholas Medawar
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Mark McClure
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Brett Cooke
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Reily Cannon
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
| | - David Kufner
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
| | - Stacey D'Almeida
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
| | - Achraf Jardaly
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
| | - Irfan Asif
- Department of Family and Community Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amit Momaya
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent Ponce
- Department of Orthopaedic Surgery, Hughston Orthopaedic Clinic, Columbus, GA, USA
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Warren JR, Rumore G. The association between playing professional American football and longevity. Proc Natl Acad Sci U S A 2023; 120:e2308867120. [PMID: 37903248 PMCID: PMC10636321 DOI: 10.1073/pnas.2308867120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023] Open
Abstract
Recent research concludes that professional American football players (hereafter, "football players") live longer than American men in general, despite experiencing higher rates of chronic traumatic encephalopathy (CTE) and cardiovascular disease (CVD). This suggests that the longevity-enhancing benefits of playing football (e.g., physical fitness, money) outweigh the costs associated with CTE, CVD, and other longevity detriments of playing football. However, these surprising results may be the consequence of flawed research design. To investigate, we conducted two analyses. In analysis 1, we compared a) all professional American football players whose first season was 1986 or between 1988 and 1995 to b) a random sample of same-age American men observed as part of the National Health Interview Surveys in those same years selected on good health, at least 3 y of college, and not being poor. The exposure consists of playing one or more games of professional football; the outcome is risk of death within 25 y. In analysis 2, we use data on 1,365 men drafted to play in the (American) National Football League in the 1950s-906 of whom ultimately played professional football, and 459 of whom never played a game in any professional league. We estimate the association between playing football and survival through early 2023. In both analyses, we investigate differences between linemen and other position players. In contrast to most prior research, in both analyses, we find that linemen died earlier than otherwise similar men; men who played other positions died no earlier (or later).
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Affiliation(s)
- John Robert Warren
- Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN55455
| | - Gina Rumore
- Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN55455
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Edwards RR, Tan CO, Dairi I, Whittington AJ, Thomas JD, Campbell CM, Ross E, Taylor HA, Weisskopf M, Baggish AL, Zafonte R, Grashow R. Race differences in pain and pain-related risk factors among former professional American-style football players. Pain 2023; 164:2370-2379. [PMID: 37314441 PMCID: PMC10502895 DOI: 10.1097/j.pain.0000000000002948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/17/2023] [Accepted: 04/03/2023] [Indexed: 06/15/2023]
Abstract
ABSTRACT The burden of pain is unequal across demographic groups, with broad and persisting race differences in pain-related outcomes in the United States. Members of racial and ethnic minorities frequently report more pervasive and severe pain compared with those in the majority, with at least some disparity attributable to differences in socioeconomic status. Whether race disparities in pain-related health outcomes exist among former professional football players is unknown. We examined the association of race with pain outcomes among 3995 former professional American-style football players who self-identified as either Black or White. Black players reported more intense pain and higher levels of pain interference relative to White players, even after controlling for age, football history, comorbidities, and psychosocial factors. Race moderated associations between several biopsychosocial factors and pain; higher body mass index was associated with more pain among White but not among Black players. Fatigue and psychosocial factors were more strongly related to pain among Black players relative to White players. Collectively, the substantial social and economic advantages of working as a professional athlete did not seem to erase race-related disparities in pain. We highlight an increased burden of pain among elite Black professional football players and identify race-specific patterns of association between pain and biopsychosocial pain risk factors. These findings illuminate potential future targets of interventions that may serve to reduce persistent disparities in the experience and impact of pain.
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Affiliation(s)
- Robert R. Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Alicia J. Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Julius Dewayne Thomas
- Department of Clinical Psychology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Claudia M. Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Edgar Ross
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Marc Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
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6
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Pain Acceptance Among Retired National Football League Athletes: Implications for Clinical Intervention. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2023; 17:27-40. [PMID: 36919031 PMCID: PMC10010661 DOI: 10.1123/jcsp.2020-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Over 80% of National Football League (NFL) retirees experience daily pain. Pain acceptance is an important psychological construct implicated in the intensity of chronic pain, though these findings have not been extended to NFL retirees. Therefore, the current study examined the association between pain acceptance and pain intensity among former NFL athletes. NFL retirees (N = 90) recruited from 2018 to 2019 completed questionnaires that assessed pain, substance use, and NFL career information. Multiple linear regression examined the association between current pain acceptance and pain intensity while adjusting for other risk factors of pain. NFL retirees reported average scores of 33.31 (SD = 10.00), and 2.18 (SD = 2.40) on measures of pain acceptance and pain intensity, respectively. After covariate adjustment, greater pain acceptance (β = -0.538, p < .001) was associated with lower pain intensity. These findings can further inform the behavioral and mental health care of retired NFL athletes.
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Grashow R, Shaffer-Pancyzk TV, Dairi I, Lee H, Marengi D, Baker J, Weisskopf MG, Speizer FE, Whittington AJ, Taylor HA, Keating D, Tenforde A, Guseh JS, Wasfy MM, Zafonte R, Baggish A. Healthspan and chronic disease burden among young adult and middle-aged male former American-style professional football players. Br J Sports Med 2022; 57:bjsports-2022-106021. [PMID: 36588423 PMCID: PMC9887383 DOI: 10.1136/bjsports-2022-106021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the relationships between age, healthspan and chronic illness among former professional American-style football (ASF) players. METHODS We compared age-specific race-standardised and body mass index-standardised prevalence ratios of arthritis, dementia/Alzheimer's disease, hypertension and diabetes among early adult and middle-aged (range 25-59 years) male former professional ASF players (n=2864) with a comparator cohort from the National Health and Nutrition Examination Survey and National Health Interview Survey, two representative samples of the US general population. Age was stratified into 25-29, 30-39, 40-49 and 50-59 years. RESULTS Arthritis and dementia/Alzheimer's disease were more prevalent among ASF players across all study age ranges (all p<0.001). In contrast, hypertension and diabetes were more prevalent among ASF players in the youngest age stratum only (p<0.001 and p<0.01, respectively). ASF players were less likely to demonstrate intact healthspan (ie, absence of chronic disease) than the general population across all age ranges. CONCLUSION These data suggest the emergence of a maladaptive early ageing phenotype among former professional ASF players characterised by premature burden of chronic disease and reduced healthspan. Additional study is needed to investigate these findings and their impact on morbidity and mortality in former ASF players and other athlete groups.
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Affiliation(s)
- Rachel Grashow
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Hang Lee
- Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Dean Marengi
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jillian Baker
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank E Speizer
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alicia J Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Herman A Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Dylan Keating
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
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Lambert V, Carbuhn A, Culp A, Ketterly J, Twombley B, White D. Interassociation Consensus Statement on Sports Nutrition Models for the Provision of Nutrition Services From Registered Dietitian Nutritionists in Collegiate Athletics. J Athl Train 2022; 57:717-732. [PMID: 36356618 PMCID: PMC9661935 DOI: 10.4085/1062-6050-0157.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Collegiate athletic programs are increasingly adding nutrition services to interdisciplinary sports medicine and sports performance departments in response to scientific evidence highlighting nutrition's integral role in supporting athletic performance and overall health. Registered Dietitian Nutritionists (RDNs) specializing in sports dietetics (ie, sports RDNs) and credentialed Board-certified Specialists in Sports Dietetics (CSSDs) are the preferred nutrition service providers for these programs. Their extensive training and proficiency in medical nutrition therapy, education and behavioral counseling, food-service management, exercise physiology, physical performance, and administration, as defined by the "Standards of Practice and "Standards of Professional Performance" for Registered Dietitian Nutritionists in Sports Nutrition and Human Performance," make these practitioners uniquely qualified to deliver the breadth of care required in the collegiate setting. Therefore, this document, guided by a multidisciplinary panel, introduces 4 sports nutrition models through which any collegiate athletic program can deliver sports RDN-directed nutrition services. In each model, the most effective staffing and scope of service are indicated and reviewed. In addition, recommended organizational structures for sports RDNs are provided that best support the delivery of the model's nutrition services in a variety of collegiate athletic programs and organizational settings. Lastly, future research initiatives and nutrition interventions to help improve the standard of care through these sport nutrition models are explored.
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Affiliation(s)
| | - Aaron Carbuhn
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City
| | - Amy Culp
- Intercollegiate Athletics, University of Texas at Austin
| | - Jennifer Ketterly
- Duke Sports Sciences Institute, Duke University School of Medicine, Durham, NC
| | | | - Dana White
- Athletic Training & Sports Medicine, Quinnipiac University, Hamden, CT
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Montero A, Stevens D, Adams R, Drummond M. Sleep and Mental Health Issues in Current and Former Athletes: A Mini Review. Front Psychol 2022; 13:868614. [PMID: 35465516 PMCID: PMC9023010 DOI: 10.3389/fpsyg.2022.868614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep and mental health are important aspects of human health that work concurrently. However, sleep and mental health disorders are often overlooked and undiagnosed in sport due to the negative stigma associated with them. Evidence suggests that athletes are disproportionately affected by mental health issues and sleep problems. Internal and external pressures contribute to psychological distress. Variable competition times, travel and stress are detrimental to sleep quality. Retirement from sport can deteriorate sleep and psychological wellbeing, particularly for those who retired involuntarily and identify strongly with their athletic role. When untreated, these issues can manifest into a range of clinical disorders. This is concerning, not only for compromised athletic performance, but for general health and wellbeing beyond sport. Previous research has focussed on sleep and health independently among currently competing, or former, athletes. To date, no research has comprehensively assessed and compared sleep complaints and mental health issues between these two cohorts. Moreover, research has failed to obtain data across a variety of different competition levels, sports, and genders, leaving the current scope of the literature narrow. Comorbid conditions (e.g., concussion history, obesity), ex-college athletes, and mental health has been the focus of existing literature post-retirement. Future research would benefit from employing both quantitative and qualitative methodologies to comprehensively assess the prevalence and severity of sleep and mental health disorders across current and retired athletes. Research outcomes would inform education strategies, safeguarding athletes from these issues by reducing negative stigmas associated with help-seeking in sport and ultimately increase self-guided treatment.
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Affiliation(s)
- Ashley Montero
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - David Stevens
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Murray Drummond
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
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Cortez B, Valdivia C, Keating D, Marengi D, Bates T, Brown C, Dairi I, Doyle M, Keske R, Connor A, Grashow R, Tenforde A, Wasfy MM, Weisskopf MG, Speizer F, Zafonte R, Baggish A. Multi-modality human phenotyping to examine subjective and objective health afflictions in former professional American-style football players: The In-Person Assessment (IPA) protocol. PLoS One 2022; 17:e0265737. [PMID: 35358242 PMCID: PMC8970522 DOI: 10.1371/journal.pone.0265737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Participation in American-style football (ASF), one of the most popular sports worldwide, has been associated with adverse health outcomes. However, prior clinical studies of former ASF players have been limited by reliance on subjective self-reported data, inadequate sample size, or focus on a single disease process in isolation.
Objective
To determine the burden of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Methods
The In-Person Assessment is a case-control, multi-day, deep human phenotyping protocol designed to characterize and quantify pathology among former professional ASF players. Participants, recruited from an on-going large-scale longitudinal cohort study, will include 120 men who report either no health conditions, a single health condition, or multiple health conditions across the key domains of cardiometabolic disease, disordered sleep, chronic pain, and cognitive impairment. Data will be collected from validated questionnaires, structured interviews, physical examinations, multi-modality imaging, and functional assessments over a 3-day study period. A pilot study was conducted to assess feasibility and to obtain participant feedback which was used to shape the final protocol.
Results
This study provides a comprehensive assessment of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Conclusion
The study will determine whether subjective health complaints among former professional ASF players are explained by objective explanatory pathology and will provide novel opportunities to examine the interrelatedness of co-morbidities. It is anticipated that this protocol will be applicable to other clinical and occupational populations.
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Affiliation(s)
- Bryan Cortez
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chelsea Valdivia
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dylan Keating
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dean Marengi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Trevor Bates
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael Doyle
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robyn Keske
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann Connor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Berenson Allen Center and Division for Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Adam Tenforde
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Meagan M. Wasfy
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Frank Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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11
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Tso JV, Turner CG, Liu C, Ahmad S, Ali A, Selvaraj S, Galante A, Gilson CR, Clark C, Williams BR, Quyyumi AA, Baggish AL, Kim JH. Hypertension and Ventricular-Arterial Uncoupling in Collegiate American Football Athletes. J Am Heart Assoc 2022; 11:e023430. [PMID: 35199554 PMCID: PMC9075286 DOI: 10.1161/jaha.121.023430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ventricular–arterial (VA) coupling is defined as the ratio between arterial elastance (EA) and left ventricular elastance (ELV). VA uncoupling, as occurs in hypertensive heart disease, is associated with adverse outcomes. This study sought to determine the relationship between American football (AF)–associated hypertension and VA uncoupling. Methods and Results This was a multicenter, longitudinal, and repeated measures observational study of collegiate AF athletes across 3 years of AF participation. Of 200 freshman athletes initially enrolled, 142 (67 Black [47%]/75 White [53%], 58 linemen [41%]/84 nonlinemen [59%]) were prospectively studied with echocardiography and applanation tonometry. Primary echocardiographic VA coupling outcome measures were EA/ELV and ΔEA/ELV, with increased EA/ELV indicating VA uncoupling. Adjusting for race and player position, AF athletes demonstrated increased EA/ELV (mean [95% CI]Δ, 0.10 [0.04–0.15]; P=0.001) and systolic blood pressure (SBP) (mean [95% CI]Δ, 11.4 [8.3–14.5] mm Hg, P<0.001) over their collegiate AF careers. In combination with longitudinal VA uncoupling, hypertension prevalence (including both stage 1 and 2) increased from 54% at baseline to 77% (44% stage 2) at the end of the study period (P<0.001). In multivariable mixed‐effects linear regression analysis, higher SBP (β=0.021, P=0.02), lower E′ (β=−0.010, P=0.03), and worse global longitudinal strain (β=0.036, P<0.001) were associated with higher EA/ELV. Increased SBP (ΔSBP, β=0.029, P=0.02) and worsened global longitudinal strain (Δglobal longitudinal strain, β=0.045, P<0.001) also predicted increased ΔEA/ELV. Conclusions VA uncoupling is associated with pathologically increased SBP and subclinical impairments in left ventricular systolic function in collegiate AF athletes, indicating a key mechanism underlying maladaptive cardiovascular phenotypes observed in this population. Future studies analyzing whether targeted clinical interventions improve VA coupling and health outcomes are warranted.
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Affiliation(s)
- Jason V Tso
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Casey G Turner
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Chang Liu
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Syed Ahmad
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Abbas Ali
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Steve Selvaraj
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Angelo Galante
- Sports Medicine Georgia Institute of Technology Atlanta GA
| | - Carla R Gilson
- Sports Medicine Georgia Institute of Technology Atlanta GA
| | - Craig Clark
- Sports Medicine Furman University Greenville SC
| | - B Robinson Williams
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Arshed A Quyyumi
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Aaron L Baggish
- Cardiovascular Performance Program Massachusetts General Hospital Boston MA
| | - Jonathan H Kim
- Division of Cardiology Emory Clinical Cardiovascular Research Institute Atlanta GA.,Sports Medicine Georgia Institute of Technology Atlanta GA
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12
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Shikora SA, Edgerton C, Harris D, Buchwald H. Metabolic surgery. Curr Probl Surg 2021; 59:101059. [DOI: 10.1016/j.cpsurg.2021.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
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13
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Tso JV, Turner CG, Liu C, Galante A, Gilson CR, Clark C, Taylor HA, Quyyumi AA, Baggish AL, Kim JH. Association between race and maladaptive concentric left ventricular hypertrophy in American-style football athletes. Br J Sports Med 2021; 56:151-157. [PMID: 34389546 DOI: 10.1136/bjsports-2021-104333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES American-style football (ASF) athletes are at risk for the development of concentric left ventricular hypertrophy (C-LVH), an established cardiovascular risk factor in the general population. We sought to address whether black race is associated with acquired C-LVH in collegiate ASF athletes. METHODS Collegiate ASF athletes from two National Collegiate Athletic Association Division-I programmes were recruited as freshmen between 2014 and 2019 and analysed over 3 years. Demographics (neighbourhood family income) and repeated clinical characteristics and echocardiography were recorded longitudinally at multiple timepoints. A mixed-modelling approach was performed to evaluate acquired C-LVH in black versus white athletes controlling for playing position (linemen (LM) and non-linemen (NLM)), family income, body weight and blood pressure. RESULTS At baseline, black athletes (N=124) were more often NLM (72% vs 54%, p=0.005) and had lower median neighbourhood family income ($54 119 vs $63 146, p=0.006) compared with white athletes (N=125). While both black and white LM demonstrated similar increases in C-LVH over time, among NLM acquired C-LVH was more common in black versus white athletes (postseason year-1: N=14/89 (16%) vs N=2/68 (3%); postseason year-2: N=9/50 (18%) vs N=2/32 (6%); postseason year-3: N=8/33 (24%) vs N=1/13 (8%), p=0.005 change over time). In stratified models, black race was associated with acquired C-LVH in NLM (OR: 3.70, 95% CI 1.12 to 12.21, p=0.03) and LM was associated with acquired C-LVH in white athletes (OR: 3.40, 95% CI 1.03 to 11.27, p=0.048). CONCLUSIONS Independent of family income and changes in weight and blood pressure, black race was associated with acquired C-LVH among collegiate ASF NLM and LM was associated with acquired C-LVH in white athletes.
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Affiliation(s)
- Jason V Tso
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Casey G Turner
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Angelo Galante
- Sports Medicine, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Carla R Gilson
- Sports Medicine, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Craig Clark
- Sports Medicine, Furman University, Greenville, South Carolina, USA
| | - Herman A Taylor
- Department of Medicine, Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan H Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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14
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Blue MNM, Hirsch KR, Brewer GJ, Smith-Ryan AE. Abdominal Adiposity in Collegiate Football Linemen: A Study of Race and Position. Int J Sports Med 2021; 43:41-45. [PMID: 34255323 DOI: 10.1055/a-1518-8003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
American football linemen are at an increased risk for developing obesity-related diseases. This study evaluated the impact of race and position on abdominal fat (visceral adipose tissue and android fat percentage) in football linemen. Thirty-four offensive and defensive linemen (%fat: 27.1±7.2%) completed a total body dual-energy X-ray absorptiometry scan to estimate visceral fat and android fat percentage. Participants were stratified by race [Black: n=23; White: n=11] and position (Offense: n=18; Defense: n=16). Two separate two-way ANOVA tests [race × position] were completed. For visceral adipose tissue, there was no interaction (p=0.056), but there was an effect of race (Black: 0.57±0.34 kg; White: 1.51±0.56 kg; p <0.001) and position (Offense: 1.22±0.60 kg; Defense: 0.49±0.34 kg; p<0.001). For android fat percentage, there was no interaction (p=0.855) or race effect (Black: 31.5±11.3%; White: 40.9±8.6%; p=0.123); there was a position effect (Offense: 42.1±5.6%; Defense: 26.0±9.9%; p<0.001). Offensive linemen, regardless of race, had greater visceral adipose tissue and android fat percent compared to defensive linemen. White linemen had greater visceral adipose tissue, regardless of position. These results suggest football linemen, especially offensive linemen with increased abdominal adiposity, may benefit from tracking metabolic health during their collegiate career to mitigate obesity-related disease risk once retired from sport.
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Affiliation(s)
- Malia N M Blue
- Department of Exercise Science, High Point University, High Point, United States
| | - Katie R Hirsch
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Gabrielle J Brewer
- Korey Stringer Institute, University of Connecticut, Storrs, United States
| | - Abbie E Smith-Ryan
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, United States
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15
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Grashow R, Weisskopf MG, Miller KK, Nathan DM, Zafonte R, Speizer FE, Courtney TK, Baggish A, Taylor HA, Pascual-Leone A, Nadler LM, Roberts AL. Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction in Former Professional US-Style Football Players. JAMA Neurol 2021; 76:1428-1438. [PMID: 31449296 PMCID: PMC6714010 DOI: 10.1001/jamaneurol.2019.2664] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Question Are professional US-style football players with a history of multiple concussion symptoms more likely to report indicators of low testosterone levels or erectile dysfunction (ED)? Findings In this cross-sectional study of 3409 former players, a monotonically increasing association was found between the number of concussion symptoms and the odds of reporting an indicator of low testosterone level and ED. Meaning Concussion symptoms among former football players were associated with low testosterone levels and ED indicators, suggesting that men with a history of head injury may benefit from discussions with their health care clinicians regarding these treatable outcomes. Importance Small studies suggest that head trauma in men may be associated with low testosterone levels and sexual dysfunction through mechanisms that likely include hypopituitarism secondary to ischemic injury and pituitary axonal tract damage. Athletes in contact sports may be at risk for pituitary insufficiencies or erectile dysfunction (ED) because of the high number of head traumas experienced during their careers. Whether multiple symptomatic concussive events are associated with later indicators of low testosterone levels and ED is unknown. Objective To explore the associations between concussion symptom history and participant-reported indicators of low testosterone levels and ED. Design, Setting, and Participants This cross-sectional study of former professional US-style football players was conducted in Boston, Massachusetts, from January 2015 to March 2017. Surveys on past football exposures, demographic factors, and current health conditions were sent via electronic and postal mail to participants within and outside of the United States. Analyses were conducted in Boston, Massachusetts; the data analysis began in March 2018 and additional analyses were performed through June 2019. Of the 13 720 male former players eligible to enroll who were contacted, 3506 (25.6%) responded. Exposures Concussion symptom score was calculated by summing the frequency with which participants reported 10 symptoms, such as loss of consciousness, disorientation, nausea, memory problems, and dizziness, at the time of football-related head injury. Main Outcomes and Measures Self-reported recommendations or prescriptions for low testosterone or ED medication served as indicators for testosterone insufficiency and ED. Results In 3409 former players (mean [SD] age, 52.5 [14.1] years), the prevalence of indicators of low testosterone levels and ED was 18.3% and 22.7%, respectively. The odds of reporting low testosterone levels or ED indicators were elevated for previously established risk factors (eg, diabetes, sleep apnea, and mood disorders). Models adjusted for demographic characteristics, football exposures, and current health factors showed a significant monotonically increasing association of concussion symptom score with the odds of reporting the low testosterone indicator (highest vs lowest quartile, odds ratio, 2.39; 95% CI, 1.79-3.19; P < .001). The ED indicator showed a similar association (highest quartile vs lowest, odds ratio, 1.72; 95% CI, 1.30-2.27; P < .001). Conclusions and Relevance Concussion symptoms at the time of injury among former football players were associated with current participant-reported low testosterone levels and ED indicators. These findings suggest that men with a history of head injury may benefit from discussions with their health care clinicians regarding testosterone deficiency and sexual dysfunction.
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Affiliation(s)
- Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Karen K Miller
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - David M Nathan
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital Diabetes Center, Boston.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ross Zafonte
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Massachusetts General Hospital, Harvard Medical School, Boston.,Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank E Speizer
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theodore K Courtney
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Aaron Baggish
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Herman A Taylor
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Alvaro Pascual-Leone
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lee M Nadler
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts.,Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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16
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Tenforde AS, Cortez B, Coughlan-Gifford E, Grashow R, Baker J, Baggish AL, Pascual-Leone A, Nadler LM, Speizer FE, Taylor HA, Weisskopf MG, Zafonte R. Individual and cumulative health afflictions are associated with greater impairment in physical and mental function in former professional American style football players. PM R 2021; 14:30-39. [PMID: 33644969 PMCID: PMC9292914 DOI: 10.1002/pmrj.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Former American style football players (ASF players) have recognized health concerns associated with prior sport participation. It remains unknown whether categorizations of current health conditions, referred to in this report as afflictions (conceptually framed as neurocognitive, cardiovascular, cardiometabolic, sleep apnea, and chronic pain) are associated with physical and mental function. OBJECTIVE To evaluate the association of afflictions to physical and mental function. It was hypothesized that former National Football League players with any affliction would have worse function compared to unafflicted participants. It was anticipated that multiple afflictions would result in cumulative loss of function. DESIGN Cross-sectional retrospective design. SETTING Academic medical multisite hospital system. PARTICIPANTS A total of 3913 of 15,611 former ASF players who played professionally from 1960 to 2019 (response rate 25%). Assessment of Risk Factors Self-report survey. MAIN OUTCOME MEASURES Each participant completed the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale and Physical Function questionnaires. Responses were used to generate two physical function and one mental function subscale scores. Raw scores were converted to T-scores categorized as impaired (T-score < 40) or unimpaired (T-score ≥ 40). Primary analyses measured the association of affliction to function (impaired or unimpaired). RESULTS After adjusting for confounders (age, race, position, number of seasons, age of first exposure to football, alcohol use, smoking history, and current body mass index), each affliction was associated with reduced physical function on the Global physical function subscale (risk ratio [RR] = 1.23-2.45, all P < .005), physical function scale (RR = 1.24-2.75, all P < .01), and mental function scale (RR = 1.34-2.87, all P < .001), except that cardiovascular affliction was not associated with mental function (RR = 1.15, P = .15). The lowest functional measures were observed in those afflicted by chronic pain. Cumulative afflictions were associated with worse function. CONCLUSIONS Afflictions are associated with cumulative reduction of function. Research evaluating how afflictions interact may help elucidate mechanisms for illness and develop interventions to optimize function.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Bryan Cortez
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Elaine Coughlan-Gifford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jillian Baker
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, Boston, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.,Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Camí de Can Ruti, Barcelona, Spain
| | - Lee M Nadler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Frank E Speizer
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Herman A Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
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17
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Tenforde AS, Cortez B, Baker J, Borg-Stein J, Wasfy M, Baggish AL, Zafonte R. Prevalence of total hip and knee arthroplasty in former National Football League players: comparison with the general US population and other populations of professional athletes. BMJ Open Sport Exerc Med 2020; 6:e000833. [PMID: 33062305 PMCID: PMC7520548 DOI: 10.1136/bmjsem-2020-000833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: To evaluate the prevalence of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a population of former National Football League (NFL) players. Methods: Participants were 3913 former NFL players (participation in years 1960–2019) who completed either an online or mailed survey that included self-reported TKA and THA, year(s) of surgery and date of birth. The prevalence of TKA and THA was reported by age category and compared to published cohorts of athlete populations and general population of non-athletes in the USA. Results: 12.3% and 8.1% of sample reported TKA and THA, respectively. The prevalence of both TKA and THA was higher in former NFL players compared to US non-athletes across all ages. Prevalence of TKA was not statistically higher than in other former athlete cohorts but performed at younger ages. The prevalence of TKA and THA was higher than in other cohorts of former NFL players. Conclusion: Former NFL players had higher prevalence of arthroplasty than the general population, suggesting prior participation in American-style football may contribute to elevated risk for arthroplasty at younger ages. Understanding risk factors in style of play, lifestyle and other contributors is important to improve joint health of this population.
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Affiliation(s)
- Adam S Tenforde
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Football Player Health Study, Harvard Medical School, Boston, Massachusetts, USA
| | - Bryan Cortez
- Football Player Health Study, Harvard Medical School, Boston, Massachusetts, USA
| | - Jillian Baker
- Football Player Health Study, Harvard Medical School, Boston, Massachusetts, USA
| | - Joanne Borg-Stein
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Football Player Health Study, Harvard Medical School, Boston, Massachusetts, USA
| | - Meagan Wasfy
- Football Player Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts General Hospital, Cardiovascular Research Program, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Football Player Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts General Hospital, Cardiovascular Research Program, Boston, Massachusetts, USA
| | - Ross Zafonte
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Football Player Health Study, Harvard Medical School, Boston, Massachusetts, USA
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18
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Kim JH, Hollowed C, Liu C, Al-Badri A, Alkhoder A, Dommisse M, Gowani Z, Miller A, Nguyen P, Prabakaran G, Sidoti A, Wehbe M, Galante A, Gilson CL, Clark C, Ko YA, Quyyumi AA, Baggish AL. Weight Gain, Hypertension, and the Emergence of a Maladaptive Cardiovascular Phenotype Among US Football Players. JAMA Cardiol 2020; 4:1221-1229. [PMID: 31617867 DOI: 10.1001/jamacardio.2019.3909] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Former US football athletes are at increased risk of cardiovascular (CV) morbidity and mortality compared with the general population and other professional athletes. However, responsible maladaptive CV phenotypes have not been fully characterized. Objective To address the emergence and progression of multiple independent factors associated with CV risk across serial years of collegiate US football participation. Design, Setting, and Participants Collegiate US football athletes from 2 National Collegiate Athletic Association Division I programs were recruited as freshmen between June 2014 and June 2017 and analyzed at multiple points throughout 3 complete years of collegiate US football participation (until January 2019). Excluded athletes were those who did not complete any season of US football training because of injury, illness, or leaving the team. Factors associated with CV risk assessed clinically, by transthoracic echocardiography, and by vascular applanation tonometry were recorded. Exposures The exposure of interest was seasonal US football exposure, including training, competition, and the training environment. Main Outcomes and Measures Primary outcome measures were left ventricular mass index and geometry (cardiac structure), early diastolic myocardial relaxation velocity (E'; diastolic function), and pulse-wave velocity (arterial stiffness). Results Of 186 individuals recruited as freshmen, 126 athletes were included in analyzed data. Collegiate US football athletes (62 white individuals [49%]; 63 black individuals [50%]; 77 nonlinemen [61%]; 49 linemen [39%]; 126 male individuals [100%]) weighed a mean (SD) of 101.1 (21.0) kg, with a mean systolic blood pressure of 129.1 (11.6) mm Hg at baseline of the freshman season. Adjusting for race, height, and player position, there were significant increases in weight (mean [SE] Δ, 4.74 [0.6] kg; P < .001), systolic blood pressure (mean [SE] Δ, 11.6 [1.6] mm Hg; P < .001), and pulse-wave velocity (mean [SE] Δ, 0.24 [0.09] m/s; P = .007), and significant declines in E' (mean [SE] Δ, -1.7 [0.3] cm/s; P < .001) across 3 years of US football participation. Weight gain was associated with both arterial stiffening (increased pulse-wave velocity, β = 0.01 [SE, 0.004]; P = .003) and the development of concentric left ventricular hypertrophy (odds ratio, 1.09 [95% CI, 1.05-1.14]; P < .001); increased systolic blood pressure was also associated with arterial stiffening (β = 0.01 [SE, 0.003]; P = .007) and the development of concentric left ventricular hypertrophy (odds ratio, 1.04 [95% CI, 1.01-1.07]; P = .02). Conclusions and Relevance Collegiate US football athletes who gain weight and develop increased systolic blood pressure levels are at risk for the development of a pathologic CV phenotype characterized by concentric left ventricular hypertrophy, arterial stiffening, and reduced left ventricular diastolic function. Future work aimed at optimizing CV health in this population, who are young but uniquely at risk, is warranted.
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Affiliation(s)
- Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia.,Sports Medicine, Georgia Institute of Technology, Atlanta
| | - Casey Hollowed
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Chang Liu
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Ahmed Al-Badri
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Ayman Alkhoder
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Morgan Dommisse
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Zaina Gowani
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Arthur Miller
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Parker Nguyen
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Ganesh Prabakaran
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Arianna Sidoti
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Mohamad Wehbe
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Angelo Galante
- Sports Medicine, Georgia Institute of Technology, Atlanta
| | - Carla L Gilson
- Sports Medicine, Georgia Institute of Technology, Atlanta
| | - Craig Clark
- Sports Medicine, Furman University, Greenville, South Carolina
| | - Yi-An Ko
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
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19
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Tso J, Hollowed C, Liu C, Alkhoder A, Dommisse M, Gowani Z, Miller A, Nguyen G, Nguyen P, Prabakaran G, Wehbe M, Galante A, Gilson CR, Clark C, Marshall T, Patterson G, Quyyumi AA, Baggish AL, Kim JH. Nonsteroidal Anti-inflammatory Drugs and Cardiovascular Risk in American Football. Med Sci Sports Exerc 2020; 52:2522-2528. [PMID: 32520869 DOI: 10.1249/mss.0000000000002404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with adverse cardiovascular outcomes and reportedly overused in American-style football (ASF). However, assessment of ASF NSAID use in the context of cardiovascular risk has not been performed. We sought to characterize NSAID use patterns and the association with cardiovascular risk in a diverse cohort of high school and collegiate ASF athletes. METHODS A total of 226 ASF athletes, 60 endurance athletes, and 63 nonathletic controls were studied pre- and postseason with echocardiography, vascular applanation tonometry, and clinical data assessment. Qualitative NSAID use throughout the season was recorded at postseason. RESULTS ASF athletes gained weight (Δ0.86 ± 3.9 kg, P < 0.001), increased systolic blood pressure (SBP, Δ3.1 ± 12 mm Hg, P < 0.001) and pulse wave velocity (Δ0.2 ± 0.6 m·s, P < 0.001), and decreased E' (Δ-1.4 ± 2.8 cm·s, P < 0.001) across one athletic season. Seventy-seven percent (n = 173) of ASF athletes reported that sport-specific NSAID use began in middle school. ASF NSAID use was more frequent with "weekly" (n = 42.19%) and "daily" (n = 32.14%) use compared with endurance athletes (P < 0.001) and controls (P = 0.02). ASF NSAID use increased in parallel with postseason SBP and weights. "Daily" ASF NSAID users demonstrated the highest postseason SBP (137 ± 13 vs 128 ± 13 mm Hg, P = 0.002) and weight (109.0 ± 18.6 vs 95.8 ± 20.5 kg, P = 0.002) compared with "never/rare" users. Adjusting for player position, SBP, pulse wave velocity, and E', increased weight (odds ratio = 1.04, 95% confidence interval = 1.0-1.08, P = 0.037) was associated with more frequent NSAID use. CONCLUSIONS Habitual NSAID use commonly begins during adolescence, before full physical maturation, and is associated with cardiovascular risk, particularly increased weight, in ASF athletes. NSAID use frequency should be considered when risk stratifying high-risk ASF athletes.
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Affiliation(s)
- Jason Tso
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Casey Hollowed
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Chang Liu
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Ayman Alkhoder
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Morgan Dommisse
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Zaina Gowani
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Arthur Miller
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Grace Nguyen
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Parker Nguyen
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Ganesh Prabakaran
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Mohamad Wehbe
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Angelo Galante
- Sports Medicine, Georgia Institute of Technology, Atlanta, GA
| | - Carla R Gilson
- Sports Medicine, Georgia Institute of Technology, Atlanta, GA
| | - Craig Clark
- Sports Medicine, Furman University, Greenville, SC
| | | | | | - Arshed A Quyyumi
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
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20
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Gaulton TG, Deshpande SK, Small DS, Neuman MD. Observational Study of the Associations of Participation in High School Football With Self-Rated Health, Obesity, and Pain in Adulthood. Am J Epidemiol 2020; 189:592-601. [PMID: 31781744 DOI: 10.1093/aje/kwz260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 11/12/2022] Open
Abstract
American football is the most popular high school sport in the United States, yet its association with health in adulthood has not been widely studied. We investigated the association between high school football and self-rated health, obesity, and pain in adulthood in a retrospective cohort study of data from the Wisconsin Longitudinal Study (1957-2004). We matched 925 males who played varsity football in high school with 1,521 males who did not play football. After matching, playing football was not associated with poor or fair self-rated health (odds ratio (OR) = 0.88, 95% confidence interval (CI): 0.63, 1.24; P = 0.48) or pain that limited activities (OR = 0.86, 95% CI: 0.59, 1.25; P = 0.42) at age 65 years. Football was associated with obesity (body mass index (weight (kg)height (m)2) ≥30) in adulthood (OR = 1.32, 95% CI: 1.06, 1.64; P = 0.01). The findings suggest that playing football in high school was not significantly associated with poor or fair self-related health at age 65 years, but it was associated with the risk of being obese as an adult in comparison with not playing football in high school. Our findings provide needed information about the risk of playing football with regard to a broader set of health outcomes.
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Affiliation(s)
- Timothy G Gaulton
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sameer K Deshpande
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Dylan S Small
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark D Neuman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Grashow R, Weisskopf MG, Baggish A, Speizer FE, Whittington AJ, Nadler L, Connor A, Keske R, Taylor H, Zafonte R, Pascual-Leone A. Premortem Chronic Traumatic Encephalopathy Diagnoses in Professional Football. Ann Neurol 2020; 88:106-112. [PMID: 32281676 PMCID: PMC7383807 DOI: 10.1002/ana.25747] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE American-style football (ASF) has gained attention because of possible links between repetitive head injury and neurodegenerative diseases. Although postmortem pathologic changes consistent with chronic traumatic encephalopathy (CTE) have been reported in ASF players, there are currently no established premortem diagnostic criteria for CTE. Nevertheless, presented with symptoms of cognitive impairment, clinicians treating former players may be inclined to suggest CTE without a thorough exploration of comorbid factors that demonstrate similar clinical phenotypes to putative CTE. METHODS A survey of 3,913 former ASF players aged 24 to 89 was conducted for those who responded by March 2019. RESULTS Despite being a postmortem diagnosis, 108 players (2.8%) self-reported clinician-diagnosed CTE. The percentage of players under age 60 years reporting a CTE diagnosis was 2.3% versus 3.7% in participants age 60 or older. Comorbidities in participants self-reporting CTE were significantly more common, including sleep apnea, hypercholesterolemia, obesity, indicators of past or current depression, hypertension, prescription pain medication use, heart conditions, and low testosterone when compared to non-CTE respondents. Patterns of reporting for obesity, hypertension, heart conditions, or hypercholesterolemia differed between older and younger participants. Cognitive impairment symptoms were significantly higher in participants self-reporting CTE. INTERPRETATION Some former professional football players have been clinically diagnosed with CTE, a postmortem condition. Comorbidities that can affect cognition were associated with CTE diagnoses in both older and younger players. Although underlying neuropathology cannot be ruled out, treatable conditions should be explored in former athletes demonstrating CTE-linked clinical phenotypes or symptoms as a means of improving cognitive health in these patients. ANN NEUROL 2020 ANN NEUROL 2020;88:106-112.
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Affiliation(s)
- Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Marc G Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Frank E Speizer
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alicia J Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Lee Nadler
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Dana Farber Cancer Institute, Boston, MA
| | - Ann Connor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Neurology, Harvard Medical School, Boston, MA
| | - Robyn Keske
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Herman Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School Boston, Boston, MA
| | - Alvaro Pascual-Leone
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.,Department of Neurology, Harvard Medical School, Boston, MA.,Center for Memory Health and Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, MA.,Institut Guttmann, Universitat Autónoma, Barcelona, Spain
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22
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Cookinham B, Swank C. Concussion History and Career Status Influence Performance on Baseline Assessments in Elite Football Players. Arch Clin Neuropsychol 2020; 35:257-264. [PMID: 30927353 DOI: 10.1093/arclin/acz012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/17/2019] [Accepted: 02/23/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine if concussion history and career status is associated with neurocognitive performance in elite football players. METHODS The study design was a cross-sectional single assessment. Fifty-seven elite football players (age 29.39 ± 7.49 years) categorized as draft prospects, active professional players, and retired professional players were assessed on the Sport Concussion Assessment Tool - third edition (SCAT-3), in an outpatient therapy setting. RESULTS Common symptoms were the following: fatigue (45.6%), trouble falling asleep (35.1%), difficulty remembering (33.3%) and irritability (22.8%); 36.8% reported no symptoms. The low concussion (0-1) group reported fewer symptoms (U = 608.50, p < .001), less symptom severity (U = 598.00, p = -.001), and produced greater scores on the Standardized Assessment of Concussion (SAC) total scores compared to the multiple concussion (2+) group (U = 253.00, p = .024), but no differences were observed on modified Balance Error Scoring System (m-BESS) scores (U = 501.50, p = .066) on the Mann-Whitney U test. The Kruskal-Wallis test and post-hoc analysis indicated retired players were significantly different from draft prospects and current professional players for total symptom scores (p < .001), total symptom severity (p < .001), SAC total scores (p = .030), and m-BESS (p < .001). CONCLUSIONS Concussion history and career status appear associated with total symptoms, symptom severity, performance on the SAC, and the m-BESS in elite football players. With this in mind, future research is recommended to determine longitudinal impact for elite football players.
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Affiliation(s)
| | - Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
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23
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Mannes ZL, Ferguson EG, Perlstein WM, Waxenberg LB, Cottler LB, Ennis N. Negative health consequences of pain catastrophizing among retired National Football League athletes. Health Psychol 2020; 39:452-462. [PMID: 31999177 DOI: 10.1037/hea0000847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study examined the association between pain catastrophizing with pain interference, depressive symptoms, and health-related quality of life (HRQoL) among National Football League (NFL) retirees. METHOD Former NFL athletes from the Retired NFL Players Association (N = 90) were recruited from 2018 to 2019 via telephone and were administered measures of pain, substance use, depressive symptoms, and HRQoL. Multiple linear and binomial regression analyses examined the association of pain catastrophizing with pain interference, depressive symptoms, and HRQoL while controlling for covariates (i.e., pain intensity, concussions, opioid use, binge alcohol use, years since NFL retirement, and marital status). RESULTS Many retired NFL athletes reported moderate-severe depressive symptoms as well as poorer perceived physical health compared with general medical patients. Greater pain catastrophizing was associated with more severe pain interference, greater odds of reporting moderate-severe depressive symptoms, and lower odds of reporting average and above physical and mental HRQoL after adjusting for relevant covariates. Concussions were not associated with any of the study outcomes. CONCLUSIONS Given the findings from this study, health care professionals should monitor symptoms of catastrophizing among current and retired NFL athletes. Assessment and requisite treatment of pain catastrophizing may assist these elite athletes in reducing depressive symptoms, while improving pain interference and HRQoL in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine
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24
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Plessow F, Pascual-Leone A, McCracken CM, Baker J, Krishnan S, Baggish A, Connor A, Courtney TK, Nadler LM, Speizer FE, Taylor HA, Weisskopf MG, Zafonte RD, Meehan WP. Self-Reported Cognitive Function and Mental Health Diagnoses among Former Professional American-Style Football Players. J Neurotrauma 2019; 37:1021-1028. [PMID: 31672091 PMCID: PMC7185350 DOI: 10.1089/neu.2019.6661] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Clinical practice strongly relies on patients' self-report. Former professional American-style football players are hesitant to seek help for mental health problems, but may be more willing to report cognitive symptoms. We sought to assess the association between cognitive symptoms and diagnosed mental health problems and quality of life among a cohort of former professional players. In a cross-sectional design, we assessed self-reported cognitive function using items from the Quality of Life in Neurological Disorders (Neuro-QOL) Item Bank. We then compared mental health diagnoses and quality of life, assessed by items from the Patient-Reported Outcome Measurement Information System (PROMIS®), between former professional players reporting daily problems in cognitive function and former players not reporting daily cognitive problems. Of the 3758 former professional players included in the analysis, 40.0% reported daily problems due to cognitive dysfunction. Former players who reported daily cognitive problems were more likely to also report depression (18.0% vs. 3.3%, odds ratio [OR] = 6.42, 95% confidence interval [CI] [4.90–8.40]) and anxiety (19.1% vs. 4.3%, OR = 5.29, 95% CI [4.14–6.75]) than those without daily cognitive problems. Further, former players reporting daily cognitive problems were more likely to report memory loss and attention deficit(/hyperactivity) disorder and poorer general mental health, lower quality of life, less satisfaction with social activities and relationships, and more emotional problems. These findings highlight the potential of an assessment of cognitive symptoms for identifying former players with mental health, social, and emotional problems.
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Affiliation(s)
- Franziska Plessow
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alvaro Pascual-Leone
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Department of Neurology, Hebrew SeniorLife and Harvard Medical School, Boston, Massachusetts.,Guttmann Brain Health Institut, Institut Guttmann, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Caitlin M McCracken
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,College of Pharmacy, Oregon State University/Oregon Health Science University, Portland, Oregon
| | - Jillian Baker
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Supriya Krishnan
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Aaron Baggish
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Performance Program, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ann Connor
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division for Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Theodore K Courtney
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Lee M Nadler
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Frank E Speizer
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Herman A Taylor
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Cardiovascular Research Institute, Morehouse Medical School, Atlanta, Georgia
| | - Marc G Weisskopf
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ross D Zafonte
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, and Harvard Medical School, Boston, Massachusetts
| | - William P Meehan
- Football Players' Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics and Orthopedics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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25
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Zafonte R, Pascual‐Leone A, Baggish A, Weisskopf MG, Taylor HA, Connor A, Baker J, Cohan S, Valdivia C, Courtney TK, Cohen IG, Speizer FE, Nadler LM. The Football Players' Health Study at Harvard University: Design and objectives. Am J Ind Med 2019; 62:643-654. [PMID: 31210374 PMCID: PMC6772014 DOI: 10.1002/ajim.22991] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 12/13/2022]
Abstract
The Football Players Health Study at Harvard University (FPHS) is a unique transdisciplinary, strategic initiative addressing the challenges of former players’ health after having participated in American style football (ASF). The whole player focused FPHS is designed to deepen understanding of the benefits and risks of participation in ASF, identify risks that are potentially reversible or preventable, and develop interventions or approaches to improve the health and wellbeing of former players. We are recruiting and following a cohort of former professional ASF players who played since 1960 (current n = 3785). At baseline, participants complete a self‐administered standardized questionnaire, including initial reporting of exposure history and physician‐diagnosed health conditions. Additional arms of the initiative are addressing targeted studies, including promising primary, secondary, and tertiary interventions; extensive in‐person clinical phenotyping, and legal and ethical concerns of the play. This paper describes the components of the FPHS studies undertaken and completed thus far, as well as those studies currently underway or planned for the near future. We present our initiatives herein as a potential paradigm of one way to proceed (acknowledging that it is not the only way). We share what we have learned so that it may be useful to others, particularly in regard to trying to make professional sports meet the needs of multiple stakeholders ranging from players to owners, to fans, and possibly even to parents making decisions for their children.
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Affiliation(s)
- Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts
| | - Alvaro Pascual‐Leone
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Berenson‐Allen Center and Division for Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Cardiovascular Performance Program, Department of Medicine, Massachusetts General Hospital Harvard Medical School Boston Massachusetts
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Department of Environmental Health Harvard TH Chan School of Public Health Boston Massachusetts
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Department of Medicine, Cardiovascular Research Institute Morehouse Medical School Atlanta Georgia
| | - Ann Connor
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Berenson‐Allen Center and Division for Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts
| | - Jillian Baker
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
| | - Sarah Cohan
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
| | - Chelsea Valdivia
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
| | - Theodore K. Courtney
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Department of Environmental Health Harvard TH Chan School of Public Health Boston Massachusetts
| | - I. Glenn Cohen
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Harvard Law School Cambridge Massachusetts
| | - Frank E. Speizer
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Department of Environmental Health Harvard TH Chan School of Public Health Boston Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts
| | - Lee M. Nadler
- Football Players Health Study at Harvard University, Harvard Medical School Boston Massachusetts
- Dana Farber Cancer Center Harvard Medical School Boston Massachusetts
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26
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Morris TP, McCracken C, Baggish A, Weisskopf M, Zafonte R, Taylor HA, Nadler LM, Speizer FE, Pascual‐Leone A. Multisystem afflictions in former National Football League players. Am J Ind Med 2019; 62:655-662. [PMID: 31134638 PMCID: PMC6640629 DOI: 10.1002/ajim.22992] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 12/16/2022]
Abstract
Background The long‐term health consequences of participation in American style football (ASF) are not well understood. Methods We conducted a retrospective cohort study of men who had played in the NFL after 1960. Participants were studied using a standardized self‐administered questionnaire designed to determine both the exposure history to ASF and the prevalence of chronic pain, sleep apnea, cardiometabolic disease, and neurocognitive impairment. Logistic regression and negative binomial regression models were used to assess associations between age, ethnicity, body‐mass index during professional football career, field position, and football career duration with individual and multiple afflictions. Results In this cohort of former NFL players (n = 3745), approximately one quarter of the eligible former players (27%) reported two or more medical afflictions (chronic pain, cardiometabolic disease, sleep apnea, or neurocognitive impairment). Career duration was significantly associated with an increase in the number of comorbidities. Age, race, and body‐mass index were associated with all affliction categories, other than neurocognitive impairment, which was similarly prevalent in middle‐aged players and older players. Earlier age when first playing the sport was protective against cardiometabolic affliction. Conclusions Former NFL players report significant combinations of cross‐system afflictions. Future work will be required to determine mechanistic underpinnings. However, attention to the whole player, rather than specific organ systems seems critical to improve long‐term health outcomes in former ASF professional athletes.
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Affiliation(s)
- Timothy P. Morris
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBoston Massachusetts
| | - Caitlin McCracken
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBoston Massachusetts
| | - Aaron Baggish
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBoston Massachusetts
- Cardiovascular Performance ProgramMassachusetts General Hospital and Harvard Medical SchoolBoston Massachusetts
| | - Marc Weisskopf
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBoston Massachusetts
- Department of Environmental Health and EpidemiologyHarvard TH Chan School of Public HealthBoston Massachusetts
| | - Ross Zafonte
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBoston Massachusetts
- Department of Physical Medicine and RehabilitationSpaulding Rehabilitation HospitalBoston Massachusetts
| | - Herman A. Taylor
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBoston Massachusetts
- Department of Medicine, Morehouse School of MedicineCardiovascular Research InstituteAtlanta Georgia
| | - Lee M. Nadler
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBoston Massachusetts
- Department of MedicineHarvard Medical SchoolBoston Massachusetts
| | - Frank E. Speizer
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBoston Massachusetts
- Cardiovascular Performance ProgramMassachusetts General Hospital and Harvard Medical SchoolBoston Massachusetts
- Channing Division of Network Medicine, Department of MedicineBrigham and Women's Hospital and Harvard Medical SchoolBoston Massachusetts
| | - Alvaro Pascual‐Leone
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBoston Massachusetts
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBoston Massachusetts
- Institut GuttmannUniversitat Autònoma de BarcelonaBadalona Spain
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Nguyen VT, Zafonte RD, Chen JT, Kponee-Shovein KZ, Paganoni S, Pascual-Leone A, Speizer FE, Baggish AL, Taylor HA, Nadler LM, Courtney TK, Connor A, Weisskopf MG. Mortality Among Professional American-Style Football Players and Professional American Baseball Players. JAMA Netw Open 2019; 2:e194223. [PMID: 31125098 PMCID: PMC6632140 DOI: 10.1001/jamanetworkopen.2019.4223] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022] Open
Abstract
Importance Studies of American-style football players have suggested lower overall mortality rates compared with general populations, but with possibly increased neurodegenerative mortality. However, comparisons with general populations can introduce bias. This study compared mortality between US National Football League (NFL) and US Major League Baseball (MLB) players, a more appropriate comparison group of professional athletes. Objective To compare all-cause and cause-specific mortality between NFL and MLB players. Design, Setting, and Participants In this retrospective cohort study, the setting was US mortality from January 1, 1979, through December 31, 2013. The dates of analysis were January 2016 to April 2019. Participants were 3419 NFL and 2708 MLB players with at least 5 playing seasons. Exposures Participation in the NFL compared with the MLB. Main Outcomes and Measures Vital status and causes of death from the National Death Index from 1979 through 2013 were obtained. Cox proportional hazards regression models using age as the timescale were used to calculate hazard ratios (HRs) and 95% CIs to examine all-cause and cause-specific mortality among NFL players compared with MLB players, adjusted for race and decade of birth. Results By the end of follow-up, there were 517 deaths (mean [SD] age, 59.6 [13.2] years) in the NFL cohort and 431 deaths (mean [SD] age, 66.7 [12.3] years) in the MLB cohort. Cardiovascular and neurodegenerative conditions, respectively, were noted as underlying or contributing causes in 498 and 39 deaths in the NFL and 225 and 16 deaths in the MLB. Compared with MLB players, NFL players had significantly elevated rates of all-cause (HR, 1.26; 95% CI, 1.10-1.44), cardiovascular disease (HR, 2.40; 95% CI, 2.03-2.84), and neurodegenerative disease (HR, 2.99; 95% CI, 1.64-5.45) mortality. Comparing hypothetical populations of 1000 NFL and 1000 MLB players followed up to age 75 years, there would be an excess 21 all-cause deaths among NFL players, as well as 77 and 11 more deaths with underlying or contributing causes that included cardiovascular and neurodegenerative conditions, respectively. Conclusions and Relevance This study found that NFL players had elevated all-cause, cardiovascular, and neurodegenerative mortality rates compared with MLB players, although the absolute number of excess neurodegenerative deaths was still small. Factors that vary across these sports (eg, body habitus and head trauma) as opposed to those common across sports (eg, physical activity) could underlie the differences.
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Affiliation(s)
- Vy T. Nguyen
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ross D. Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Jarvis T. Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kalé Z. Kponee-Shovein
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sabrina Paganoni
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Frank E. Speizer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Herman A. Taylor
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Cardiovascular Research Institute, School of Medicine, Morehouse University, Atlanta, Georgia
| | - Lee M. Nadler
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Theodore K. Courtney
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ann Connor
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Marc G. Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Grashow RG, Roberts AL, Zafonte R, Pascual-Leone A, Taylor H, Baggish A, Nadler L, Courtney TK, Connor A, Weisskopf MG. Defining Exposures in Professional Football: Professional American-Style Football Players as an Occupational Cohort. Orthop J Sports Med 2019; 7:2325967119829212. [PMID: 30746383 PMCID: PMC6360475 DOI: 10.1177/2325967119829212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Studies of professional American football players have shown that football-related activities lead to acute injuries and may have long-term adverse health outcomes including osteoarthritis, neurocognitive impairment, and cardiovascular disease. However, the full complement of what constitutes professional football exposure has yet to be effectively articulated. Most likely, professional football exposure encompasses a multifaceted array of experiences including head impacts and joint stresses, long-term pain medication use, dietary restrictions, and strenuous training regimens. To study the health of professional American football players, characterizing the group as an occupational cohort and taking advantage of methods established within the discipline of occupational epidemiology may be beneficial. We conducted a narrative review of existing football research, occupational epidemiological methods papers, and occupational medicine studies. Here we describe the traditional occupational epidemiological approach to assessing exposure in a novel cohort and show how this framework could be implemented in studies of professional football players. In addition, we identify the specific challenges associated with studying an elite athletic occupational group, including the healthy worker effect and other types of selection and information biases, and explore these in the context of existing studies of football-related health. The application of well-established occupational epidemiological methods to professional football players may yield new insights into the effects of playing exposure and may provide opportunities for interventions to reduce harm.
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Affiliation(s)
- Rachel G Grashow
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ross Zafonte
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alvaro Pascual-Leone
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Herman Taylor
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Aaron Baggish
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee Nadler
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Theodore K Courtney
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ann Connor
- Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Football Players Health Study, Harvard Medical School, Boston, Massachusetts, USA.,Environmental and Occupational Medicine and Epidemiology Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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