Individual and cumulative health afflictions are associated with greater impairment in physical and mental function in former professional American style football players

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 FactorsSelf‐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.

A systematic review on the risk of neurodegenerative diseases and neurocognitive disorders in professional and varsity athletes

“…After selection based on the pertinence and relevance to the topic of the review, 11,191 records were excluded, leaving 47 articles meeting the selection criteria. The full texts of the selected articles were assessed for inclusion, and 30 further articles were excluded as 3 were case reports [17,19,45], 1 review [46], 1 reported participation in sports as a leisure activity [47] 2 reported data only on an overall measure of physical activity [48,49] 2 included only athletes who had ≥ 1 head/brain injury [50,51] 8 did not report any measure of risk of NDs and/or NCDs [20,[52][53][54][55][56][57][58] and 13 were already included in the 2016 review [59][60][61][62][63][64][65][66][67][68][69][70][71].…”

A Case Report of Reversible Cognitive Decline in a Former Professional American-Style Football Player: Findings from the Football Players Health Study In-Person Assessments

“…Research from the Football Player Health Study has explored multiple aspects of health and impairments that are observed in former ASF players that include neurocognitive impairments and other domains, including cardiometabolic, sleep apnea, and chronic pain. For example, using questionnaires in more than 4100 former players, we have observed that multiple health domains may be associated with impairments in physical and mental health (22). History of concussion may be associated with depression, anxiety, and impaired quality of life in this cohort (23).…”

Incorporation of concussion history as part of the LIfestyle for BRAin Health (LIBRA) modifiable factors risk score and associations with cognition in older former National Football League players

“…For example, numerous studies have independently reported relatively high rates of these modifiable risk factors in former professional American football players, including hypertension and prehypertension (64.5%), excessive alcohol use, and obesity/body mass index (BMI) > 30 (52%). 10,11 Conversely, lower rates of select modifiable risk factors have also been reported within former professional American football players (e.g., lower rates of impaired fasting glucose, cigarette smoking, and sedentary lifestyle). 11,12 While cumulative risk scores have the potential to comprehensively quantify risk of adverse long-term outcomes, history of TBI/head trauma has not been incorporated as part of the overall weighted risk calculation to date.…”

“…Evidence suggests that other modifiable risk factors may play a significant role in risk of neurodegenerative disease in former elite‐level contact sport athletes and that a more comprehensive approach is needed to truly understand and address the risk of long‐term adverse outcomes later in life. For example, numerous studies have independently reported relatively high rates of these modifiable risk factors in former professional American football players, including hypertension and prehypertension (64.5%), excessive alcohol use, and obesity/body mass index (BMI) > 30 (52%) 10,11 . Conversely, lower rates of select modifiable risk factors have also been reported within former professional American football players (e.g., lower rates of impaired fasting glucose, cigarette smoking, and sedentary lifestyle) 11,12 …”