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Peek K, Franchi M, Lemmink K, Balsom P, Meyer T. Quality Criteria for Studies Assessing the Acute Effects of Heading: Results from a UEFA Expert Panel. Sports Med 2024; 54:1089-1095. [PMID: 38150166 PMCID: PMC11127840 DOI: 10.1007/s40279-023-01977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
There is increasing concern regarding the effects of heading in football on brain health including cognitive, behavioural and neuromotor function, with research suggesting an association between repeated ball-head impacts and neurodegenerative disease. While longitudinal studies to determine the long-term consequences of heading are challenging, there have been short-term 'acute' studies conducted, with some studies lacking appropriate methodology to ensure valid results. The Union of European Football Associations (UEFA) established a panel of experts to determine methodological recommendations for the conduct of studies that explore the acute effects of heading (defined as a single session of heading conducted either in a laboratory setting or following match play or a training session). The aim of this panel was to create quality criteria for acute heading studies that will form part of the eligibility assessment when applying for UEFA research funding (although the criteria can be applied to the conduct of acute heading research more widely). This process was deemed necessary to counter studies with poor methodological quality that used heading trials that did not accurately represent player exposure to ball-head impacts through football practice and match play (such as small sample sizes, unrealistically high heading exposure, and a lack of consideration of confounding variables). The panel identified core design decisions that authors should consider when designing and conducting acute heading research, with key methodological requirements for each domain pertaining to participants, heading trials, confounding variables, statistics and dependent/target variables and their measurement. After two rounds of reviews, the final list of quality criteria was agreed by the panel and will be applied to the next round of UEFA grant applications.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Martino Franchi
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Koen Lemmink
- Department of Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Paul Balsom
- Swedish Football Association, Solna, Stockholm, Sweden
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarland, Germany
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Smirl JD, Peacock D, Burma JS, Wright AD, Bouliane KJ, Dierijck J, van Donkelaar P. Repetitive bout of controlled soccer heading does not alter heart rate variability metrics: A preliminary investigation. Front Neurol 2022; 13:980938. [PMID: 36504654 PMCID: PMC9732532 DOI: 10.3389/fneur.2022.980938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives There is elevated unease regarding how repetitive head impacts, such as those associated with soccer heading, contribute to alterations in brain function. This study examined the extent heart rate variability (HRV) and cardiac baroreceptor sensitivity (BRS) metrics are altered immediately following an acute bout of soccer heading. Methods Seven male elite soccer players (24.1 ± 1.5 years) completed 40 successful soccer headers in 20-min. The headers were performed under controlled circumstances using a soccer ball launcher located 25 meters away and using an initial ball velocity of 77.5 ± 3.7 km/h (heading condition). An accelerometer (xPatch) on the right mastoid process quantified linear/rotational head accelerations. Participants also completed sham (body contact) and control (non-contact) sessions. A three-lead ECG and finger photoplethysmography characterized short-term spontaneous HRV/cardiac BRS, before and after each condition. The SCAT3 indexed symptom scores pre-post exposures to all three conditions. Results During the heading condition, cumulative linear and rotational accelerations experienced were 1,574 ± 97.9 g and 313,761 ± 23,966 rad/s2, respectively. Heart rate trended toward an increase from pre- to post-heading (p = 0.063), however HRV metrics in the time-domain (ps > 0.260) and frequency-domain (ps > 0.327) as well as cardiac BRS (ps > 0.144) were not significantly changed following all three conditions. Following the heading condition, SCAT3 symptom severity increased (p = 0.030) with a trend for symptom score augmentation (p = 0.078) compared to control and sham. Conclusion Whereas, symptoms as measured by the SCAT3 were induced following an acute bout of controlled soccer heading, these preliminary findings indicate they were not accompanied by alterations to autonomic function. Ultimately, this demonstrates further research is needed to understand the physiological underpinnings of alterations in brain function occurring immediately after a bout of soccer heading and how these may, over time, contribute to long-term neurological impairments.
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Affiliation(s)
- Jonathan David Smirl
- Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada,Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada,Human Performance Laboratory, University of Calgary, Calgary, AB, Canada,Faculty of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada,*Correspondence: Jonathan David Smirl
| | - Dakota Peacock
- Southern Medical Program, University of British Columbia, Kelowna, BC, Canada,Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Joel Stephen Burma
- Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada,Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada,Human Performance Laboratory, University of Calgary, Calgary, AB, Canada,Faculty of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Alexander D. Wright
- Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada,Southern Medical Program, University of British Columbia, Kelowna, BC, Canada,University of British Columbia, Vancouver, BC, Canada,Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kevin J. Bouliane
- Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada
| | - Jill Dierijck
- Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada,School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Paul van Donkelaar
- Concussion Research Lab, University of British Columbia, Kelowna, BC, Canada
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McCunn R, Beaudouin F, Stewart K, Meyer T, MacLean J. Heading in Football: Incidence, Biomechanical Characteristics and the Association with Acute Cognitive Function-A Three-Part Systematic Review. Sports Med 2021; 51:2147-2163. [PMID: 34129222 DOI: 10.1007/s40279-021-01492-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is growing concern surrounding the role of repetitive sub-concussive head impacts, such as football heading, on brain health. OBJECTIVES Three questions were addressed while only considering studies that observed heading exposure directly: (1) how frequently does heading occur within football training and matches, (2) what are the biomechanical characteristics of heading, and (3) is cognitive function affected by heading? METHODS This review followed the steps described in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including MEDLINE and SPORTDiscus were searched from the earliest entry to July 2020. Studies that reported independently quantified heading exposure, biomechanical characteristics of heading or the relationship between heading and cognitive function were included. Data were extracted and used to populate summary tables with reference to each research question. RESULTS Heading incidence ranged between one to nine headers per player per match. The number of headers observed in small-sided games during training varied depending on the exact format used but generally speaking ranged between zero to one per player per game. The three most commonly reported biomechanical variables were head acceleration, head rotational velocity and overall movement kinematics during the heading action. Average head acceleration ranged from approximately four to 50 g. Nine out of 12 included studies did not observe a negative impact on cognitive test performance following exposure to heading and while three did, these negative effects were limited to specific outcome measures: reaction time and memory function. CONCLUSION The current weight of evidence summarised herein does not support the notion that heading is deleterious to cognitive performance in the short term; however, this conclusion is tentative due to methodological shortcomings in the existing evidence base.
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Affiliation(s)
- Robert McCunn
- Heart of Midlothian Football Club, Tynecastle Park , Edinburgh, EH11 2NL, UK.
| | - Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Katy Stewart
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Glasgow, UK
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - John MacLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Glasgow, UK
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Bonn MM, Harriss AB, Thompson JWG, Dickey JP. Performing more than 20 purposeful gameplay headers in a soccer season may alter autonomic function in female youth soccer players. Res Sports Med 2021; 29:440-448. [PMID: 33596738 DOI: 10.1080/15438627.2021.1888098] [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: 10/22/2022]
Abstract
This study evaluated the effects of cumulative purposeful soccer heading on autonomic nervous system function in 22 female youth soccer players (13.3 ± 0.9 years). A 10 minute electrocardiogram recording was collected at baseline and following the 20 game season (post-season) to calculate measures of heart rate variability (HRV), including standard deviation of the normal-normal intervals, total power, high frequency (HF), low frequency (LF), LF:HF, normalized HF and normalized LF. Participants were categorized into low- (<20 headers per season; n = 13) and high- (>20 headers per season; n = 9) exposure groups. Mann-Whitney U tests demonstrated no significant differences between groups for any HRV metric. However, the increased normalized LF power (low exposure 8.67 and high exposure -31.17, respectively; r = 0.35) and LF:HF power (-6.39 and 15.80, respectively; r = 0.35), between groups had moderate practical significance. Therefore, female youth players who perform more than 20 purposeful headers during a soccer season may exhibit altered autonomic function.
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Affiliation(s)
- Marquise M Bonn
- Health and Rehabilitation Sciences, Western University, London, Canada
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Snowden T, Reid H, Kennedy S, Kenny R, McQuarrie A, Stuart-Hill L, Garcia-Barrera MA, Gawryluk J, Christie BR. Heading in the Right Direction: A Critical Review of Studies Examining the Effects of Heading in Soccer Players. J Neurotrauma 2020; 38:169-188. [PMID: 32883162 DOI: 10.1089/neu.2020.7130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The practice of heading in soccer has become a public concern because of the potential for subconcussive impacts to cause cumulative concussive-like effects; however, experimental evidence for this hypothesis has been mixed. This systematic review used pre-defined search parameters to assess primary literature that examined changes in cognitive, behavioral, structural, and/or biological processes after acute heading exposure in youth and young adult soccer players. The findings were synthesized into a concise and comprehensive summary of the research following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) format, and suggestions for standardization of acute heading protocols are described. A total of 1189 articles were considered for this review, with 19 articles meeting all of the inclusion criteria for full analysis. An attempt was made to identify methods with significant sensitivity and reliability by grouping studies based on their outcome measures. Because of lack of standardization across intervention types and data collection protocols, no sensitive and reliable methods could be identified conclusively to assess the effects of acute heading exposure in soccer players. Based on this review, there is not enough evidence to either support or refute the potential of effects of subconcussive events from acute soccer heading exposure. Recommendations for standardization of acute heading exposure studies based on the included literature are discussed. Standardization is required to better understand the impact of acute heading exposure in soccer players, while allowing for the development of guidelines that mitigate any potential risks and allowing athletes to remain active and develop their skills.
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Affiliation(s)
- Taylor Snowden
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Hannah Reid
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Samantha Kennedy
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada.,Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - Rebecca Kenny
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Amanda McQuarrie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Lynneth Stuart-Hill
- School of Exercise Science, Physical and Health Education, and University of Victoria, Victoria, British Columbia, Canada
| | | | - Jodie Gawryluk
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Brian R Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada.,Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada.,School of Exercise Science, Physical and Health Education, and University of Victoria, Victoria, British Columbia, Canada
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