The Drake Football Study: observational cohort protocol now published

The Drake Football Study’s protocol has now been published, providing insight into how the team of collaborative researchers plan to assess the health challenges experienced by professional football players before, during and after retirement.

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Following the launch of The Drake Football Study at The Health Challenges in Professional Football symposium (Emirates Stadium, London, UK; 16 October 2019), the study’s protocol has now been published in BMJ Open Sport and Exercise Medicine.

The pre- and post-retirement years in a footballer’s career can be quite challenging for many players, as transitioning out of the sport has been associated with various health issues.

As there is a lack of longitudinal data about these health conditions in football, The Drake Football Study aims to gain epidemiological evidence about the onset and course of the health conditions present in elite players both before and after retirement. The team of collaborative researchers hope to associate the risk indicators with the health conditions of the participants in the study.

“The current epidemiological evidence shows that during and after their career, professional footballers are likely to experience problems with their mental, musculoskeletal, neurocognitive and cardiovascular health. However, this available evidence has been established principally from cross-sectional studies focusing on a specific health domain in either active or retired players,” explained Vincent Gouttebarge, Chief Medical Officer at FIFPRO. “The Drake Football Study is the first prospective cohort study that monitors the health of professional footballers across domains (mental, musculoskeletal, neurocognitive, cardiovascular) before, through and after their transition out of sport. It will allow us to get a better understanding about when and how adverse adaptations might occur and when support measures should be offered.”

The observational prospective cohort study with repeated measures will explore the health of at least 200 professional footballers (male; 27 (±1) years old) every second year during a 10 year follow-up period.

The health variables that will be explored are:

  • Mental health, which will be assessed by looking for symptoms of distress, anxiety depression, sleep disturbance, alcohol misuse and disordered eating.
  • Musculoskeletal health,which will be assessed by examining severe joint injuries and related surgery, clinical and radiological osteoarthritis, plus joint function.
  • Cardiovascular health,which will be assessed by examining blood pressure, lipid profile and ECG abnormalities.
  • Neurocognitive health, which will be assessed by examining concussion, brain structure and functioning, and neurocognitive functioning.

“The Drake Football Study is the first of its kind. Not only will the study measure a range of variables across cardiovascular, musculoskeletal, cognitive and mental health, but we will also track players over at least 10 years, thus hopefully filling the gaps in our knowledge around the onset and progression of several health conditions previously associated with a career in football,” commented Lauren Pulling, Programme Manager at The Drake Foundation. “We hope the study will result in some powerful data that will equip clubs and medical teams to support future players both in their careers and throughout retirement.”

When it comes to neurocognitive health, previous studies have discovered that recently retired professional players might have impairments in their attention, memory and concentration when compared with age-matched controls, however, the clinical significance of this remains unclear

In the current study concussion is defined as a blow to the head resulting in symptoms such as nausea, dizziness, fatigue and blurred vision. The number of sport-related and non-sport-related concussions both pre- and post-retirement are assessed through a simple question.

In the case of concussion, additional information, such as loss of consciousness, duration of recovery and hospitalization, will be requested. To answer these questions players are recommended to consult their medical records and career timeline.

Further, MRI sequences will be used to review brain volume, microstructural white matter integrity and functional connectivity.

The main expected challenges of the study related to the enrollment of participants, recruitment of matched controls, potential unexpected costs and retention of the cohort during the 10 year follow-up period.

Ethical approval for the study was provided by the Medical Ethics Review Committee of the Amsterdam University Medical Centers.  

Source: Gouttebarge V, Anderson TE, Cowie C et al. Monitoring the health of transitioning professional footballers: protocol of an observational prospective cohort study. BMJ Open Sport Exerc. Med. doi:10.1136/bmjsem-2019-000680 (2019) (Epub ahead of print)

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