Increased risk and early onset of ALS in professional players from Italian Soccer Teams

Abstract

Objective: Since the observation of several deaths from amyotrophic lateral sclerosis (ALS) among Italian professional soccer players, an association between ALS and soccer has been postulated. The objective of the study is to investigate the association between professional soccer and the risk of ALS in a large cohort of former professional soccer players with prolonged follow-up.Methods: All professional soccer players practicing in the period 1959-2000 were identified through the archives of an Italian soccer cards publisher. For each player, date and place of birth, playing role and team history were recorded. Each player was followed since 15 years of age.Incident ALS cases were all soccer players first diagnosed during the period 1959-2018. The expected incidence rate was the number of ALS cases/100,000 person-years expected in the cohort. SIR was the ratio between observed and expected incidence rate.Results: 34 ALS cases were detected. The number of expected cases was 17.8. The SIR was 1.91 (95% CI 1.32-2.67) in the entire sample and 4.66 (95% CI 2.66-7.57) in subjects aged less than 45 years. The mean age at diagnosis was 45.0 years. Compared to the mean age of onset of ALS in the general population (65.2 years), the disease in former soccer players occurred 20.2 years earlier.Conclusions: Professional soccer players are at higher risk of developing ALS than the general population. Soccer players with ALS develop the disease at a younger than expected age.

Occupation and amyotrophic lateral sclerosis risk: a case-control study in the isolated island population of Malta

“…In a Dutch cohort, ALS patients had significantly higher levels of leisure-time PA compared to controls (23). In corroboration, Italian professional footballers were found to have a higher risk of developing ALS compared to the general population (7,9) and triathlon athletes were over-represented in Israeli patients with ALS (35). Interestingly, both triathletes and footballers with ALS had a higher frequency of bulbar-onset ALS compared to other patients (6,35), a result that resonates with our findings.…”

“…Occupational risks have long been addressed with a classical study, published more than 50 years ago, presenting evidence indicating a trend for ALS to occur among persons engaged in physical labor (5). More recently, several studies are supportive of an increased ALS risk in professions associated with strenuous physical exertion and/or sustained physical activity (PA) including professional European and American football players (6)(7)(8)(9), elite long-distance cross-country skiers (10), military personnel (11)(12)(13), and manual workers comprising mechanics, painters, and employees in the agriculture and construction industry (14)(15)(16)(17)(18). Small and large-scale case-control studies have further confirmed an association between risk of developing ALS and a history of PA in occupation-related activities (19)(20)(21).…”

Association of Field Position and Career Length With Risk of Neurodegenerative Disease in Male Former Professional Soccer Players

“…Specifically, neurodegenerative mortality was reported at higher-than-expected rates among former professional US football players in the National Football League 3,15 and former professional soccer players. [4][5][6][7][8] Mirroring experience from autopsy observations, these studies document higher neurodegenerative disease risk across a range of diagnoses. Thus, while overall neurodegenerative disease mortality was approximately 3.5-fold higher in former professional soccer players than in matched general population control individuals, risk varied from a 2-fold increase in deaths with Parkinson disease to a 5-fold increase in deaths with Alzheimer disease.…”

The Skeletal Muscle Emerges as a New Disease Target in Amyotrophic Lateral Sclerosis

“…Although ALS shares several pathological traits with other neurodegenerative conditions, such as proteinopathic inclusions of TDP-43 or ubiquitin, in contrast to the rest of neurological conditions, exercise might be a risk factor for the development of ALS. Various prospective cohort and case-control studies support the association between frequent physical activity and the risk of developing ALS [ 78 , 175 , 176 , 177 ], and other longitudinal and cross-sectional observational studies have found over-representation of athletes and professional soccer players among populations of ALS patients [ 178 , 179 , 180 ]. However, this relationship has not been replicated in all studies [ 181 ], and, therefore, it remains controversial.…”