Osteoarthritis is associated with symptoms of common mental disorders among former elite athletes

Foot Strike Run Retraining for Patients With Patellofemoral Chondral Defects: A Case Series

Military service members (SMs) demonstrate high rates of patellofemoral chondral defects (PFCDs) that are difficult to diagnosis and, if untreated, result in a cascade of events eventually leading to osteoarthritis. Running is an essential occupational task for SMs; however, there is little evidence regarding techniques to maintain running ability in individuals with cartilage defects. The purpose of this case series was to assess the clinical application of foot strike run retraining in patients with PFCDs. This case series included two active duty U.S. Marine Corps SMs who presented to outpatient physical therapy with PFCD, diagnosed via MRI. Both patients attended eight foot strike run retraining sessions. Running mechanics and patient-reported outcomes were recorded pre-training, post-training, and at a 1-month follow-up visit. Both patients successfully converted their strike pattern from a rearfoot to a non-rearfoot strike pattern with training and retained this strategy at 1-month follow-up. Post-intervention, both patients demonstrated increased running tolerance, and improvements in Numeric Pain Rating Scale and Lower Extremity Functional Scale scores. Biomechanical analysis showed that both patients demonstrated a 63% to 70% reduction in average and peak vertical ground reaction force loading rates post-treatment. Modification of foot strike pattern from rear to non-rearfoot strike during running for individuals with PFCD can reduce the magnitude of impact loading, which potentially limits disease progression. These findings suggest that foot strike run retraining may be a feasible strategy to reduce pain and improve function in SMs with PFCD who are required to run for occupational responsibilities.

Longitudinal trajectory of depression symptom severity and the influence of concussion history and physical function over a 19-year period among former National Football League (NFL) players: an NFL-LONG Study

OBJECTIVE

This study investigated the longitudinal course of depressive symptom severity over 19 years in former American football players and the influence of concussion history, contact sport participation and physical function on observed trajectories.

METHODS

Former American football players completed a general health questionnaire involving demographic information, medical/psychiatric history, concussion/football history and validated measures of depression and physical function at three time points (2001, 2010 and 2019). Parallel process latent growth curve modelling tested associations between concussion history, years of football participation, and overall and change in physical function on the overall level and trajectory of depressive symptoms.

RESULTS

Among the 333 participants (mean(SD) age, 48.95 (9.37) at enrolment), there was a statistically significant, but small increase in depressive symptom severity from 2001 (48.34 (7.75)) to 2019 (49.77 (9.52)), slope=0.079 (SE=0.11), p=0.007. Those with greater concussion history endorsed greater overall depressive symptom severity, B=1.38 (SE=0.33), p<0.001. Concussion history, B<0.001 (SE=0.02), p=0.997 and years of participation, B<0.001 (SE=0.01), p=0.980, were not associated with rate of change (slope factor) over 19 years. Greater decline in physical function, B=-0.71 (SE=0.16), p<0.001, was predictive of a faster growth rate (ie, steeper increase) of depression symptom endorsement over time.

CONCLUSIONS

Concussion history, not years of participation, was associated with greater depressive symptom severity. Neither factor was predictive of changes over a 19-year period. Decline in physical function was a significant predictor of a steeper trajectory of increased depressive symptoms, independent of concussion effects. This represents one viable target for preventative intervention to mitigate long-term neuropsychiatric difficulties associated with concussion across subsequent decades of life.

NZ-RugbyHealth Study: Self-reported Injury Experience and Current Health of Former Rugby Union and Non-contact Sport Players

Background

There is limited research on associations between playing rugby union and player health post-retirement.

Objective

This study investigated differences in self-reported sport injury history and current self-reported health characteristics between former New Zealand rugby and non-contact sport players with a view to identifying issues to be further investigated with stronger epidemiological research designs.

Methods

Using a cross-sectional design, the NZ-RugbyHealth study surveyed 470 former rugby and non-contact sport players (43.8 ± 8.1 years; 127 elite rugby, 271 community rugby, 72 non-contact sport) recruited from October 2012 to April 2014. Demographic information, engagement in sport, sport injuries, medical conditions, mood, alcohol and substance use and ratings of current health status were obtained from a self-report 58-item general health e-questionnaire. We highlighted standardised differences in means of > 0.6 and differences in relative percentages of > 1.43 for variables between groups as representing at least moderate effect sizes, and of being worthy of follow-up studies.

Results

Higher percentages of the elite rugby player group had sustained injuries of a given body-site type (e.g. neck sprain/strain, thigh bruising, hamstring strain) combination than the non-contact sports players. Higher percentages of the rugby groups reported having sustained concussion (94% for elite, 82% for community, 26% for non-contact), injuries requiring hospitalisation (73%, 46%, 25%), injuries that stopped participation in sport permanently (28%, 28%, 11%) and sport-related surgery (72%, 46%, 32%) during their playing career. Both rugby groups had a higher prevalence of osteoarthritis (37%, 18%, 6%) than non-contact athletes and community rugby players had higher levels of hazardous alcohol consumption (38%, 40%, 25%) in retirement than non-contact athletes. There was little difference between rugby players and non-contact sports athletes in self-reported mood, substance use and current physical or psychological health ratings.

Conclusions

Former rugby player groups were at higher risk than the non-contact player group for most injuries during their playing careers, and in retirement had greater prevalence of osteoarthritis and hazardous alcohol consumption. The relative youth of the groups (43.8 years on average) means that health issues that typically do not emerge until later life may not have yet manifested.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01630-7.

A Systematic Review of the Prevalence of Mental Health Symptoms and Disorders in Rugby Players

The aim of this systematic review was to investigate the prevalence of mental health symptoms and disorders in rugby players. Six electronic databases were searched in December 2020. Studies were included if they provided quantitative data on mental health symptoms and disorders and consisted of adult rugby players. Eight studies were included, covering symptoms of anxiety, depression, alcohol use/misuse, distress, sleeping/sleep disturbance, and eating disorders/adverse nutrition behaviors. Prevalence of mental health symptoms ranged from 6% (depression) to 68.8% (alcohol use/misuse). Most rates were similar to the general population, while symptoms of sleeping/sleep disturbance were lower, and symptoms of eating disorders/adverse nutrition behaviors and alcohol use/misuse were higher than the general population. One study included female rugby players. Epidemiological evidence comprising of rigorous diagnostic data and inclusive of gender, race, ethnicity, sexuality, and other protected characteristics is needed to inform future mental health support in this population.

The relationship between cricket participation, health and wellbeing: A scoping review

Summarising and synthesising the evidence on cricket health and wellbeing can help inform cricket stakeholders and navigate future research directions. The purpose of this study was to investigate the relationship between cricket participation, health and wellbeing at all ages and playing standards, and identify research gaps in the existing literature. A scoping review was performed from inception to March, 2020. Studies were included if they assessed a construct related to health and/or wellbeing in cricketers, available in English. 219 articles were eligible. Injury incidence per 1,000 player exposures ranged from 1.8-5.7 injuries. 48% of former cricketers experienced persistent joint pain. However, former cricketers reported greater physical activity levels and mental-components of quality of life compared to the general population. Heat injury/illness and skin cancer are concerns and require further research. Cricket participation is associated with an inherent injury risk, which may have negative implications for musculoskeletal health in later life. However, cricket participation is associated with high quality of life which can persist after retirement. Gaps in the literature include prospective studies on health and wellbeing of cricketers, female cricketers, injury prevention strategies, and the impact of cricket participation on metabolic health and lifetime physical activity.

Inflammatory Arthropathy in the Elite Sports Athlete

ABSTRACT

Elite athletes commonly present with joint pains that are attributed to overuse injuries though on occasion it can be due to an inflammatory arthropathy. The diagnostic challenge is that presenting symptoms of benign injuries are similar to inflammatory arthropathies. A holistic review of the athlete can provide clues suggestive of inflammatory arthropathy, before requesting further investigations to confirm the diagnosis. Current imaging modalities are not specific in differentiating inflammatory arthritis with other causes of joint inflammation. Prompt treatment is required to restore the athlete to an optimum level of activity and prevent career ending disability, all in adherence to the regulations of the sporting governing bodies. This review aims to highlight the importance of inflammatory arthropathy in the differentials for an athlete presenting with joint pains.

Depression Assessment: Challenges and Treatment Strategies in the Athlete

Major depressive disorder and other related disturbances in mood account for the highest proportion of psychiatric illnesses in the general population and are a leading cause of disability around the world. Despite belief to the contrary, athletes are vulnerable to the same mental illnesses as the general population. Unique circumstances experienced by athletes create challenges that are exclusive to that population, which can place them at greater risk for depression and other mental illnesses. This chapter explores the incidence of depression and related mood disturbances in athletes, risk factors for illness, obstacles to assessment and management, and treatment strategies.

The association between alcohol consumption and osteoarthritis: a meta-analysis and meta-regression of observational studies

There is conflicting evidence for the association between alcohol consumption and common joint conditions such as Osteoarthritis (OA), which affects millions of people. We sought to determine the true association between alcohol intake and OA. We conducted a PRISMA systematic review and meta-analysis of observational studies that reported associations between alcohol consumption and OA. Pooled estimates of association were represented through odds ratios (ORs). Publication bias was assessed with Funnel and Galbraith plots, and risk of bias was assessed with the Newcastle Ottawa Scale. We included 29 studies and 25,192 subjects with OA and reported an OR between any alcohol consumption and OA of 0.79 (0.68–0.93), suggesting a protective effect. OR of weekly or more frequent use was 0.79 (0.65–0.97). When grouped by covariates, alcohol consumption was negatively associated with radiographic (0.83, 0.70–0.98), hand (0.80, 0.66–0.95) and knee OA (0.85, 0.72–0.99), North American ethnicity and female gender. Subgroup analysis of unadjusted data resulted in an OR of 0.70 (0.55–0.89) but this disappeared upon analysis of studies with data adjusted for any covariate (0.93, 0.78–1.10). Whilst our pooled analysis suggest that weekly or more frequent alcohol consumption was negatively associated with OA, this was not observed when adjusted for confounding factors. Reasons for this include selection bias and lack of longitudinal exposure and adjustment for confounding variables. Therefore, this meta-analysis provides evidence to dispel notions that alcohol use may be protective against OA.

Clinical Hip Osteoarthritis in Current and Former Professional Footballers and Its Effect on Hip Function and Quality of Life

The objective of the study was to establish the prevalence of clinical hip osteoarthritis in current and former professional footballers and to explore its consequences on hip function and health-related quality of life (HRQoL). A cross-sectional study by means of questionnaire was conducted among current and former professional footballers fulfilling the following inclusion criteria: (1) male (2) active or retired professional footballer (3) member of FIFPRO (Football Players Worldwide) (4) between 18 and 50 years old (5) could read and understand texts in French, Spanish, or English. Controls (matched for: gender, age, body weight and height) were also recruited. The main outcome measures were clinical hip osteoarthritis, hip function and HRQoL. Questionnaires were sent to 2,500 members of which 1,401 participated (1,000 current and 401 former professional footballers). Fifty-two controls were recruited. Prevalence of hip osteoarthritis was 2% among current and 8% among former professional footballers. Hip function was significantly (p ≤ 0.001) lower in both types of footballers with hip osteoarthritis than in footballers without hip osteoarthritis and controls. Current and former professional footballers with hip osteoarthritis reported significantly lower physical health scores (p = 0.032, p = 0.002) than those without. Hip osteoarthritis led to a significantly lower score in the physical (p = 0.004) and mental (p = 0.014) component of HRQoL in former footballers compared to the controls, while in current footballers only the physical component was significantly (p = 0.012) lower compared to the controls. Hip osteoarthritis has a higher prevalence in former than in current professional footballers and impacts hip function and HRQoL negatively.

Retirement of professional soccer players - A systematic review from social sciences perspectives

Retiring professional athletes face multifaceted changes and potential issues of adjustment, occupational development, and well-being, which raises concerns around the world. The study systematically reviewed the available research investigating professional soccer players' sport retirement from social sciences perspectives. The literature search in electronic databases and a "snowballing" procedure yielded 17 eligible studies investigating > 2,200 retired professional soccer players. The review followed the PRISMA statement. Nine studies focused on an early transition phase to retirement period; four studies investigated later periods of ten years or longer after retirement. Around half of the players reported involuntary retirement, often associated with declining performance and/or injury. Studies suggest issues of adjustment and mental health during early years after retirement, while psychological issues had apparently declined around 1-2 decades after retirement. However, available studies had notable limitations including lack of evidenced representative samples, report of measures' reliability, and control for confounders. Furthermore, while theoretical models emphasise a holistic perspective, quantitative research often took a narrow rather than holistic perspective. In summary, available knowledge is fraught with some uncertainty regarding reliability and representativeness of the population of retired professional soccer players. We offer future directions to advance the development of a theory of sport retirement.

Specific manifestations of knee osteoarthritis predict depression and anxiety years in the future: Vancouver Longitudinal Study of Early Knee Osteoarthritis

Background

To evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models.

Methods

A population-based cohort (n = 122) with knee pain, aged 40–79, was evaluated at baseline, 3 and 7 years. Baseline predictors were: age decade; sex; BMI ≥ 25; physical exam knee effusion; crepitus; malalignment; quadriceps atrophy; flexion; flexion contracture; Kellgren-Lawrence (KL) x-ray grade (0/1/2/3+); WOMAC pain ≥25; WOMAC stiffness ≥25; self-reported knee swelling; and knee OA diagnosis (no/probable/definite). Depression and anxiety, cutoffs 5+ and 7+ respectively, were measured via the Hospital Anxiety and Depression Scale. We fit logistic models at each cycle using multivariable models selected via lowest Akaike’s information criterion.

Results

Baseline depression model: sex (female OR = 0.27; 0.10, 0.76) and KL grade (KL 1 OR = 4.21; 1.31, 13.48). Three-year depression model: KL grade (KL 1 OR = 18.92; 1.73, 206.25). Seven-year depression model: WOMAC stiffness ≥25 (OR = 3.49; 1.02, 11.94) and flexion contracture ≥1 degree (OR = 0.23; 0.07, 0.81). Baseline anxiety model: knee swelling (OR = 4.11; 1.51, 11.13) and age (50–59 vs. 40–49 OR = 0.31 [0.11, 0.85]; 60–69 OR = 0.07 [0.01, 0.42]). Three-year anxiety model: WOMAC stiffness ≥25 (OR = 5.80; 1.23, 27.29) and KL grade (KL 1 OR = 6.25; 1.04, 37.65). Seven-year anxiety model: sex (female OR = 2.71; 0.87, 8.46).

Conclusion

Specific knee OA-related manifestations predict depression and anxiety cross-sectionally, 3 years in the future, and for depression, 7 years in the future. This information may prove useful to clinicians in helping to identify patients most at risk of present or future depression and anxiety, thus facilitating preemptive discussions that may help counter that risk.

Ankle osteoarthritis and its association with severe ankle injuries, ankle surgeries and health-related quality of life in recently retired professional male football and rugby players: a cross-sectional observational study

OBJECTIVES

To determine (1) the prevalence of ankle osteoarthritis (OA) among former professional football and rugby players, (2) assess the association between ankle injuries or ankle surgeries with ankle OA, and (3) compare the mental and physical quality of life (QoL) between former professional football and rugby players with and without OA.

METHODS

We conducted a questionnaire-based observational study with a cross-sectional design. Former professional football and rugby players were recruited by the Football Players Worldwide and the International Rugby Players. Information concerning ankle OA, sustained ankle injuries and ankle surgeries was gathered (medical record or most recent medical professional). Health-related QoL was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) physical and mental health scores.

RESULTS

Overall, 553 former professional football (n=401) and rugby (n=152) players were enrolled in the study (response rate of 56%). Ankle OA prevalence among former professional football and rugby players was 9.2% and 4.6%, respectively. Football players were more likely to suffer from ankle OA following every ankle injury and/or surgery. Football and rugby players with ankle OA had similar PROMIS physical and mental health scores to the norm for the general population.

CONCLUSION

Former professional football and rugby players had higher ankle OA prevalence than the general population (3.4%). Football players are more likely to suffer from ankle OA following every ankle injury and/or surgery. No clinically relevant difference was seen for physical or mental health-related QoL among football and rugby players. Preventive measures for ankle injuries are recommended.

Monitoring the health of transitioning professional footballers: protocol of an observational prospective cohort study

INTRODUCTION

Transitioning out of professional football is a challenging time in most players' lives. During these preretirement and postretirement years, professional footballers may struggle with their mental, musculoskeletal, neurocognitive and cardiovascular health. Currently, longitudinal data about these health conditions are lacking. This article presents the design of a prospective cohort study with the primary aim of gathering epidemiological evidence about the onset and course of mental, musculoskeletal, neurocognitive and cardiovascular health conditions in professional footballers during their preretirement and postretirement years and evaluating the associations between risk indicators and the health conditions under study in these players.

METHODS AND ANALYSIS

An observational prospective cohort study with repeated measurements over a follow-up period of 10 years will be conducted among at least 200 professional footballers (male; 27 (±1) years old). Mental health will be explored by assessing symptoms of distress, anxiety, depression, sleep disturbance, alcohol misuse, drug misuse and disordered eating. Musculoskeletal health will be explored by assessing severe joint injury and related surgery, clinical and radiological osteoarthritis, and joint function (hips, knees and ankles). Neurocognitive health will be explored by assessing the concussion, brain structure and functioning, and neurocognitive functioning. Cardiovascular health will be explored by assessing blood pressure, lipid profile and ECG abnormalities.

ETHICS AND DISSEMINATION

Ethical approval for the study was provided by the Medical Ethics Review Committee of the Amsterdam University Medical Centers. The results of the study will be submitted to peer-reviewed journals, will be presented at scientific conferences and will be released in the media (postpublication).

TRIAL REGISTRATION NUMBER

The Dutch Trial Registry (Drake Football Study NL7999).

Relationship between cricket participation, health and well-being: scoping review protocol

INTRODUCTION

Cricket is a popular sport played by 2.5 billion people of all ages and abilities. However, cricket participation is decreasing in the UK, despite an increased focus of governments on increasing sport participation to enhance public health. Understanding the health benefits and mitigating the health risks of cricket participation may help cricket organisations promote cricket participation while optimising the long-term health of cricket participants. Currently, there is no literature review on the relationship between cricket participation, health and well-being; thus, this relationship remains unclear. Therefore, the aims of this scoping review were (1) to investigate the relationship between cricket participation, health and well-being and (ii) to identify the research gaps related to cricket, health and well-being.

METHODS AND ANALYSIS

Due to the broad nature of our research question and the large number of health outcomes assessed within the cricket literature and to facilitate identification of research gaps, a scoping review methodology was used. The methodology of this paper was informed by previous scoping review protocols and best practice methodological frameworks. MEDLINE, CINAHL, Embase, Scopus, PsycINFO, SPORTDiscus, Cochrane Library, EBSCO, Web of Science and PEDro and grey literature sources (Google Scholar, ClinicalTrials.gov, ISRCTN Registry and ProQuest) will be systematically searched. Studies that assess a construct related to health and/or well-being in current and/or former cricketers from all ages and standards of play will be eligible. Two reviewers will independently screen full texts of identified studies for eligibility and will perform data extraction. Results will be presented in tabular and graphical forms and will be reported descriptively.

ETHICS AND DISSEMINATION

This research is exempt from ethics approval due to the data being available through published and public available resources. Results will be published in a peer-reviewed sports and exercise medicine journal regardless of positive or negative findings. In addition, results will be disseminated through multiple platforms, including conference presentations and social media using multimedia resources (eg, infographics, animations, videos, podcasts and blogs), to engage stakeholder groups, including cricketers, cricket coaches, sporting bodies, sports medicine professionals and policy makers. There findings will inform clinical decision making, policy changes and future research agendas.

Quality of Life and Life Satisfaction in Former Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

Sport participation has many physical and psychosocial benefits, but there is also an inherent risk of injury, subsequent osteoarthritis and psychological challenges that can negatively impact quality of life (QOL). Considering the multifaceted impacts of sport participation on QOL across the lifespan, there is a need to consolidate and present the evidence on QOL in former sport participants.

OBJECTIVE

To evaluate QOL and life satisfaction in former sport participants, and determine what factors are associated with QOL and life satisfaction in this population.

METHODS

Eight electronic databases were systematically searched in July 2018 to retrieve all articles that evaluated QOL or life satisfaction in former sport participants. Two authors independently screened titles/abstracts and full texts, extracted data, and appraised methodological quality using a modified Downs and Black Checklist. Random-effects meta-analysis estimated pooled mean and 95% confidence intervals (Cis) for Mental Component Scores (MCS) and Physical Component Scores (PCS) derived from the SF-12, SF-36, VR-12 and VR-36 measures. MCS and PCS were pooled for all former sport participants, as well as professional- and collegiate-athlete subgroups. Data that were inappropriate for meta-analysis (i.e. EQ-5D, PROMIS and life-satisfaction outcomes) were collated and reported descriptively.

RESULTS

Seventeen articles evaluated QOL or life satisfaction in a total of 6692 former athletes [eight studies (n = 4255) former professional athletes; six studies (n = 1946) former collegiate athletes; two studies (n = 491) included both] with a mean age ranging from 21 to 66 years. Most studies were cross-sectional (15 of 17 articles) and 12 studies had a moderate risk of bias (n = 1 high-risk, n = 4 low-risk). Unpublished data were provided for five studies. Meta-analysis of seven studies resulted in a pooled PCS mean (95% CI) of 50.0 (46.6-53.3) [former professional athletes from two studies: 46.7 (42.1-51.2), former collegiate athletes from five studies: 51.2 (48.4-53.9)] and a pooled MCS of 51.4 (50.5-52.2) [former professional athletes: 52.7 (51.3-54.2), former collegiate athletes: 50.9 (50.0-51.8)]. Factors associated with worse QOL or life satisfaction in former athletes included involuntary retirement from sport (three studies), collision/high-contact sport compared with low/no-contact sport (three studies), three or more concussions compared with no/fewer concussions (two studies), increased body mass index (BMI) (worse PCS, three studies), and osteoarthritis or musculoskeletal issues (worse PCS and MCS, three studies; worse PCS but not MCS, two studies).

CONCLUSIONS

Former athletes had similar PCS and better MCS, compared to general-population norms. Former athletes with impaired PCS reported better MCS than population norms, highlighting the need to use an instrument that differentiates between physical and mental components of QOL in former sport participants. Factors associated with worse QOL that may explain between-study variation include involuntary retirement, collision/high contact sports, concussion, BMI and osteoarthritis.

PROSPERO

CRD42018104319.

Determinants of anxiety in elite athletes: a systematic review and meta-analysis

Objective

To identify and quantify determinants of anxiety symptoms and disorders experienced by elite athletes.

Design

Systematic review and meta-analysis.

Data sources

Five online databases (PubMed, SportDiscus, PsycINFO, Scopus and Cochrane) were searched up to November 2018 to identify eligible citations.

Eligibility criteria for selecting studies

Articles were included if they were published in English, were quantitative studies and measured a symptom-level anxiety outcome in competing or retired athletes at the professional (including professional youth), Olympic or collegiate/university levels.

Results and summary

We screened 1163 articles; 61 studies were included in the systematic review and 27 of them were suitable for meta-analysis. Overall risk of bias for included studies was low. Athletes and non-athletes had no differences in anxiety profiles (d=−0.11, p=0.28). Pooled effect sizes, demonstrating moderate effects, were identified for (1) career dissatisfaction (d=0.45; higher anxiety in dissatisfied athletes), (2) gender (d=0.38; higher anxiety in female athletes), (3) age (d=−0.34; higher anxiety for younger athletes) and (4) musculoskeletal injury (d=0.31; higher anxiety for injured athletes). A small pooled effect was found for recent adverse life events (d=0.26)—higher anxiety in athletes who had experienced one or more recent adverse life events.

Conclusion

Determinants of anxiety in elite populations broadly reflect those experienced by the general population. Clinicians should be aware of these general and athlete-specific determinants of anxiety among elite athletes.

Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis

Objectives

To present an overview of the existing epidemiological evidence regarding the occurrence of mental health symptoms and disorders among current and former elite athletes.

Design

Systematic review and meta-analysis.

Data sources

Five electronic databases were searched from inception to November 2018: PubMed (MEDLINE), SportDiscus via EBSCO, PSycINFO via ProQuest, Scopus and Cochrane.

Eligibility criteria for selecting studies

We included original quantitative studies that were written in English, were conducted exclusively among current or former elite athletes, and presented incidence or prevalence rates of symptoms of mental disorders.

Results

Twenty-two relevant original studies about mental health symptoms and disorders among current elite athletes were included: they presented data especially on symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 2895 to 5555 current elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression. Fifteen relevant original studies about mental health symptoms and disorders among former elite athletes were included: they similarly presented data especially about symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 1579 to 1686 former elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 16% for distress to 26% for anxiety/depression.

Conclusions

Our meta-analyses showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression for current elite athletes, and from 16% for distress to 26% for anxiety/depression for former elite athletes.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Empowering the health of retired professional footballers: the systematic development of an After Career Consultation and its feasibility

Objectives

This article describes (1) the systematic development of the intervention and (2) the assessment of its feasibility (in terms of relevancy, suitability, satisfaction and added value).

Methods

The intervention was developed based on the first four steps of the Intervention Mapping and Knowledge Transfer Scheme processes. Subsequently, a qualitative research based on a one-group post-test cross-sectional design was conducted. Eight retired professional footballers underwent the developed intervention and its feasibility (operationalised in relevancy, suitability, satisfaction and added value) was assessed by means of a questionnaire and interview.

Results

An After Career Consultation (ACC) was developed with a focus on five main domains: (1) detraining from professional football; (2) remission of osteoarthritis; (3) promotion of healthy lifestyle; (4) preventing mental and cognitive health problems; and (5) employment and education. The ACC relies on three components: (1) raising self-awareness about potential physical, mental and social health problems after a career in professional football; (2) medical examination (60 min) with thorough medical history and general physical examination; and (3) follow-up during 3 months (if necessary) about optimal skills and strategies to empower physical, mental and social health and quality of life. The relevancy, suitability, satisfaction and added value of the ACC were positively evaluated by the retired professional footballers.

Conclusion

The ACC was developed with a focus on five main health-related domains. The feasibility of the ACC was positively assessed by retired professional footballers, while the suggestion was made to repeat the ACC in the initial years after football retirement.

Lower extremity osteoarthritis is associated with lower health-related quality of life among retired professional footballers

OBJECTIVE

The objective of the current study was to explore whether retired professional footballers suffering from lower extremity OA have a lower health-related quality of life than those without OA or current professional footballers.

METHODS

An observational study based on a cross-sectional design by means of questionnaires was conducted. Participants were retired and current professional footballers recruited by the World Players' Union (FIFPro). Information about lower extremity OA (clinically diagnosed by a medical professional) was gathered, while health-related quality of life (Global Physical Health and Global Mental Health scores) was assessed through a validated scale.

RESULTS

A total of 396 retired and 361 current professional footballers were included in the analyses (response rate of 54%). The group of retired professional footballers was on average 36 years old, and they had competed in professional football for 11 years (retired for 5 years). The group of current professional footballers was on average 25 years old, and they had been active in professional football for 7 years. Within the group of retired professional footballers, prevalence of lower extremity OA was 33%. Both Global Physical Health and Global Mental Health scores among retired professional footballers with lower extremity OA were significantly lower than among retired players without OA and current players, but these scores were nearly similar to the norm for the general population (regardless the presence of OA or not).

CONCLUSIONS

Health-related quality of life among retired professional footballers with lower extremity OA was significantly lower than among retired players without OA and current players but nearly similar to the norm for the general population (regardless the presence of OA or not). A rational recommendation is that a support measure such as the After Career Consultation should be introduced among retired professional footballers in order to empower their sustainable health and quality of life, focussing especially on the prevention of the occurrence or worsening of lower extremity OA.

Knee osteoarthritis in professional football is related to severe knee injury and knee surgery

BACKGROUND

As a consequence of severe knee injuries, knee osteoarthritis (OA) seems prevalent in retired professional footballers. However, some epidemiological data remain missing, for instance whether knee OA is also prevalent in current professional footballers, whether knee OA is associated with knee injuries and surgeries, and whether knee OA leads to a lower level of functioning. Therefore, three research questions were answered: (i) what is the prevalence of knee osteoarthritis (OA) among current and retired professional footballers? (ii) is severe knee injury or knee surgery associated with knee OA among current and retired professional footballers? (iii) what are the consequences of knee OA on physical knee function among current and retired professional footballers?

METHODS

An observational study based on a cross-sectional design by means of questionnaires was conducted. Participants were current and retired professional footballers recruited by the World Players' Union (FIFPro). Information about severe knee injury and knee OA was gathered (medical record or team doctor), while physical knee function was assessed through a validated scale.

RESULTS

A total of 1360 participants (964 current and 396 retired professional footballers) were enrolled in the study (response rate of 54%). Prevalence of knee OA was 13% among current players and 28% among retired players (p < 0.01), being higher among older players. Current and retired professional footballers were nearly twice as likely to suffer from knee OA by every additional severe knee injury and by every additional knee surgery (risk ratio: 1.72-1.96; p < 0.01). Current and retired professional footballers with knee OA reported a lower level of physical knee function than current and retired players without OA (p < 0.01), their physical knee function being also lower than reference values (adult population, young athletic population and amateur footballers).

CONCLUSION

The prevalence of knee OA was higher among retired than among current professional footballers and reached up to 40%, leading to negative consequences for their physical knee function. Current and retired professional footballers were nearly twice as likely to suffer from knee OA by every additional severe knee injury and by every additional knee surgery incurred during their career. Management of knee OA should be prioritized among professional footballers, especially to prevent the worsening of the condition during their retirement years.

Prevalence and Correlates of Psychological Distress among Retired Elite Athletes: A Systematic Review

This article presents results of a systematic review of the literature (2000-2017) examining the prevalence and correlates of psychological distress among retired elite athletes. Forty articles were selected and included. Our review suggests the prevalence of psychological distress among retired athletes is similar to that found in the general population. However, subgroups reporting medical comorbidities, significant pain, a greater number of concussions, less social support, and adverse psychosocial factors were at greater risk for psychological distress. Additionally, athletes experiencing psychological distress in retirement often do not seek treatment for their distress. Based on the existing literature, there is a need for greater standardization and use of reliable measures, as well as use of diagnostic interviews in order to assess the most accurate prevalence of psychological distress among these athletes. Longitudinal designs, matched control groups, more heterogeneous samples, and use of multivariate analyses would also help to more accurately determine the prevalence and risk factors of psychological distress in this population. This review suggests a number of different clinical implications and highlights directions for future research to enhance our understanding of the long-term psychological health of former elite athletes.

The mental wellbeing of current and retired professional cricketers: an observational prospective cohort study

OBJECTIVE

Scientific knowledge about symptoms of common mental disorders in professional cricket is non-existent. Consequently, the aims of the study were to determine the prevalence and the 6 months incidence of symptoms of common mental disorders (CMD: distress, anxiety/depression, sleep disturbance, adverse alcohol use) among current and former professional cricketers and to explore the association of potential stressors (significant injury, surgery, adverse life events, career dissatisfaction) and CMD.

METHODS

An observational prospective cohort study with a follow-up period of 6 months was conducted among current and former professional cricketers from South Africa. Using validated questionnaires to assess symptoms of common mental disorders as well as several stressors, an electronic questionnaire was set up and distributed by the South African Cricketers Association (SACA).

RESULTS

A total of 116 participants enrolled at baseline (overall response rate of 33%) and 76 of those participants completed the 6 month follow-up (follow up rate of 66%). The prevalence of symptoms of CMD in current professional cricketers was 38% for distress, 38% for sleep disturbance, 37% for anxiety/depression and 26% for adverse alcohol use. Among former professional cricketers, baseline prevalence as was 26% for distress, 24% for anxiety/depression, 21% for sleep disturbance and 22% for adverse alcohol use. Career dissatisfaction led to an increased risk of distress, anxiety/depression and sleep disturbance in current professional cricketers. Surgeries and adverse life events led to an increase in reported symptoms of distress and anxiety/depression in current professional cricketers.

CONCLUSIONS

It was concluded that symptoms of CMD are prevalent in both current and former professional cricketers and the association with surgery, adverse life events and cricket career dissatisfaction may provide some insight into possible mechanisms.

A history of concussions is associated with symptoms of common mental disorders in former male professional athletes across a range of sports

OBJECTIVE

Recent reports suggest that exposure to repetitive concussions in sports is associated with an increased risk of symptoms of distress, anxiety and depression, sleep disturbance or substance abuse/dependence (typically referred as symptoms of common mental disorders[CMD]) and of later development of neurodegenerative disease, in particular chronic traumatic encephalopathy (CTE). The primary aim of this study was to explore the relationship between sports career-related concussions and the subsequent occurrence of symptoms of CMD among former male professional athletes retired from football (soccer), ice hockey and rugby (union).

METHODS

Cross-sectional analyses were performed on baseline electronic questionnaires from three prospective cohort studies among former male professional athletes retired from football (soccer), ice hockey and rugby (union). The number of confirmed concussions was examined through a single question, while symptoms of distress, anxiety and depression, sleep disturbance and adverse alcohol use were assessed using validated questionnaires.

RESULTS

From 1,957 former professional athletes contacted, a total of 576 (29%) completed the questionnaire. Of these, 23% had not incurred a concussion during their career, 34% had two or three, 18% four or five, and 11% six or more concussions. The number of sports career-related concussions was a predictor for all outcome measures (β = 0.072-0.109; P ≤ 0.040). Specifically, former professional athletes who reported a history of four or five concussions were approximately 1.5 times more likely to report symptoms of CMD, rising to a two- to five-fold increase in those reporting a history of six or more sports career-related concussions.

CONCLUSIONS

These data demonstrate an association between exposure to sports concussion and subsequent risk of symptoms of CMD in former professional athletes across a range of contact sports. Further work to explore the association between sports concussion and symptoms of CMD is required; in the meanwhile, strategies for effective risk reduction and improved management appear indicated.

Osteoarthritis and other long-term health conditions in former elite cricketers

OBJECTIVES

This study aimed to describe the prevalence and risk of chronic conditions in former elite cricketers compared to a normal population, and describe wellbeing in former elite cricketers.

DESIGN

Cross-sectional study.

METHODS

Former elite cricketers, recruited from the Professional Cricketers' Association, completed a self-report cross-sectional questionnaire. The English Longitudinal Study of Ageing (ELSA) served as the normal population. The prevalence of self-reported, GP-diagnosed conditions (heart problems, hypertension, stroke, diabetes, asthma, dementia, osteoarthritis (OA), total hip replacement (THR), total knee replacement (TKR), anxiety, depression) were reported for both population samples. Standardised morbidity ratios (SMRs) compared chronic conditions in sex-, age- and BMI-matched former cricketers (n=113) and normal population (n=4496).

RESULTS

Heart problems were reported by 13.3% of former cricketers, significantly lower than the normal population, SMR 0.55 (0.33-0.91). Former cricketers reported 31.9% hypertension, 1.8% stroke, 6.2% diabetes, 15.0% asthma, and no dementia, none significantly different to the normal population. OA, THR, and TKR were reported by 51.3%, 14.7% and 10.7% of former cricketers, respectively, significantly higher than the normal population, SMRs 3.64 (2.81-4.71), 3.99 (2.21-7.20) and 3.84 (1.92-7.68). Anxiety and depression were reported by 12.4% and 8.8% of former cricketers, respectively, SMRs 3.95 (2.34-6.67) and 2.22 (1.20-4.14). 97% of former cricketers reflected they would undertake their cricket career again, 98% agreed that cricket enriched their lives.

CONCLUSIONS

Heart problems were significantly lower, while OA, THR, TKR, anxiety, and depression were significantly higher in the former cricketers compared to the normal population (ELSA). Most former cricketers reflected positively on their career.