FPHS Publications

Sustaining concussions has been linked to health issues later in life, yet evidence for associations between contact sports exposure and long-term cognitive performance is mixed. This cross-sectional study of former professional American-style football players tested the association of several measures of football exposure with later life cognitive performance, while also comparing the cognitive performance of former players to nonplayers.

The study found that future investigations of the long-term outcomes of contact sports exposure should include measures of sports-related concussion symptoms, which were more sensitive to objective cognitive performance than other football exposure measures, including self-reported diagnosed concussions.

This study assessed the relationship between concussion history and the development of late-life hypertension among 4,168 participants who played professional American-style football. There was a significant association between concussion symptom burden during years of active play and the odds of post-career hypertension, even after adjusting for established risk factors such as smoking history, race, the presence of diabetes, age, and BMI. The results of this study suggest that repetitive early-life brain injury may have late-life implications for cardiovascular health in former professional American-style football players.

High blood pressure or hypertension is a common condition in American men as well as in former NFL players. While we know there are several risk factors for hypertension, including smoking, weight gain, diabetes, aging, and identifying as Black, the link between concussion during NFL play and later-life hypertension is unknown.

• Among 4,168 former NFL players, those reporting high numbers of concussion symptoms during playing years were almost twice as likely to report high blood pressure post-career.
• The risk of high blood pressure gradually increased with more concussion symptoms, even after taking into account smoking, older age, diabetes, race, and elevated BMI.

Previous research has shown that former professional football players live as long or longer than men in the general population. However, former players have reported that they feel older than their actual age. Despite their long lifespans, are football players experiencing early aging and living with illness and disability for more years than non-football players? Our researchers and health practitioners examined the occurrence of four chronic diseases in 2,864 former players under the age of 60, including arthritis, dementia/Alzheimer’s Disease, hypertension, and diabetes.

• As expected, our research confirmed that hypertension, diabetes, arthritis, and dementia all increased with age in both football and general populations.
• However, the proportion of players who experienced these conditions was different from non-players. For both arthritis and Alzheimer’s disease/dementia, we found an increase in self-reported diagnoses across all ages.
• For hypertension and diabetes, a higher proportion of former players reported these conditions only in the youngest age group (25–29).
  Our findings showed that players, on average, had 10 fewer years of healthspan, meaning they were without hypertension, arthritis, Alzheimer’s/dementia, and/or diabetes (as shown in the graphic below). This means that former players reported “loss of health” (reporting at least one of the four conditions of interest) appropriately ten years earlier than non-football American men.
• Among football players, linemen were more likely to report at least one of the conditions studied compared to non-linemen under the age of 50.

Please read our results return for more information and action items for former players.

Anterior cruciate ligament (ACL) revision surgery is challenging for both patients and surgeons. Understanding the risk factors for failure after bridge-enhanced ACL restoration (BEAR) may help with patient selection for ACL restoration versus ACL reconstruction. The purpose of this paper was to identify the preoperative risk factors for ACL revision surgery within the first two years after BEAR. They found that gounger age and higher MTS were predictors of ipsilateral ACL revision surgery after the BEAR procedure. Younger patients with higher tibial slopes should be aware of the increased risk for revision surgery when deciding to undergo ACL restoration.

Insomnia is highly prevalent among persons with chronic pain. Although cognitive behavioral therapy for insomnia is recommended as first-line treatment for insomnia, it is underutilized. We tested the feasibility of a potentially scalable alternative – Brief Behavioral Therapy for Insomnia (BBTI) for former National Football League (NFL) players, a group with a high prevalence of chronic pain. We assessed changes in sleep, pain, and psychological health, and found that an adapted telephone-delivered BBTI is acceptable and feasible among retired players with a range of insomnia symptoms. It shows promise for improving sleep and pain. These data support the need for future trials assessing BBTI’s effect on both sleep and pain outcomes.

In this cohort study including 4351 patients, each with mild or moderate to severe traumatic brain injury (TBI), and 4351 frequency-matched unexposed patients without TBI, the rates of cardiovascular and endocrine comorbidities after TBI were significantly higher in patients with mild or moderate to severe TBI compared with patients without TBI. The risk of post-TBI comorbidities was higher in all age groups compared with age-matched unexposed patients, particularly in patients younger than 40 years, and post-TBI comorbidities were associated with higher mortality over a 10-year follow-up period.

These findings suggest that patients with TBI in all age groups may benefit from a proactive targeted screening program for chronic multisystem diseases, particularly cardiometabolic diseases, after injury.

The Football Players Health Study In-Person Assessment (IPA) was designed to evaluate the relationship between subjective health affliction and objective clinical pathology in former American Style Football (ASF) players. Utilizing a novel, multi-day, deep phenotyping protocol, the IPA collects objective data defining health, wellness, and pathology with an emphasis on the key domains of cardiometabolic disease, sleep quality, chronic pain, and cognitive impairment. Importantly, simultaneous assessment of multiple health domains provides an opportunity to explore the interrelated nature of concurrent co-morbidities with an ultimate goal of defining previously unidentified causal mediators of health and affliction.

This paper presents a study design and methodology for validating subjective self-reported health data with objective clinical assessments in a population susceptible to substantial workplace hazards.

Instances of childhood adversity were strongly associated with concussion symptoms and should be investigated among professional football players and other populations as a possible indicator of persons at high concussion risk. The research was based on surveys of 1,755 former NFL players ages 28 to 92, comparing outcomes between players who reported a history of family dysfunction and childhood adversity and those who did not.

The key findings include:

• The frequency with which former NFL players experience of childhood adversities was similar to this of the general populations in the United States.
• Former NFL players who reported having four or more adverse experiences in childhood were 48% more likely to screen positive for dementia and had a markedly greater risk for cognitive problems in later life.
• Players who reported childhood adversity were more likely to also report depression and problems with pain in their daily life.
• Players with four or more adverse childhood experiences were 60% more likely to suffer high concussion symptoms during their football career.

Previous clinical studies have shown that psychological factors have significant effects on an athlete’s readiness to return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). This study hypothesized that patients who underwent bridge-enhanced ACL restoration (BEAR) would have higher levels of psychological readiness to return to sport compared with patients who underwent ACLR. It found that patients who underwent the BEAR procedure had higher ACL-RSI scores at 6 months postoperatively. Better ACLRSI scores at 6 months were related most strongly to higher IKDC scores at 6 months and were also associated with lower pain levels, better muscle recovery, and less knee laxity at 6 months.