Healthy behaviors may counteract the long-term effects of concussions

When it comes to football, concussion, and long-term health, many people have already made up their minds: They believe that repeat concussions condemn athletes to a future of mental illness and cognitive decline.

Such beliefs instill fear and helplessness in many professional athletes and their families. “There’s a thought that former NFL players are all broken and there’s nothing they can do about it,” says William Meehan, MD, of the Sports Medicine Division at Boston Children’s Hospital.

Fear of traumatic brain injury affects younger athletes as well. “Some of these athletes develop generalized anxiety, and some of them crippling anxiety, convinced they’ve done long-term damage to their brains,” says Meehan. 

A study conducted as part of a research project called the NFL-Long study gives athletes reason for hope. While a history of sports-related concussions correlated to worse cognitive and emotional function in former NFL players, exercise, diet, and sleep were significantly associated with better outcomes — with stronger associations than concussion history in many areas.

Mood, emotional control, cognitive function, and concussion

The study, published in the British Journal of Sports Medicine, compares the effects of sport-related concussions and health-promoting behaviors on symptoms of depression, anxiety, emotional-behavioral control, and cognitive function among 1,784 former NFL players with an average age of 52 years.

Researchers used two tools, the Patient-Reported Outcomes Measurement Information System (PROMIS) and the Neuro-QOL Emotional-Behavioral Dyscontrol measurement system, to gather and analyze players’ responses to a self-administered questionnaire.

Most respondents reported more than three sports-related concussions in their lifetimes and one quarter reported 10 or more. The results revealed a significant association between a higher number of sports-related concussions and worse outcomes in each of the areas studied. However, diet, regular exercise, and sleep largely — and in some cases completely — counteracted these effects.

Key findings

Diet and exercise: Players who ate a healthy diet and regularly engaged in moderate-to-vigorous aerobic exercise or resistance training had significantly better scores in cognition, depression, anxiety, and emotional-behavioral control.

Sleep: Players who slept six to nine hours a night had better outcomes in depression, anxiety, and emotional-behavioral control. Sleep did not appear to affect cognition.

Depression, anxiety, emotional control: Taken together, the positive effects of regular exercise, a high-quality diet, and sleep completely outweigh the negative effects of concussion on depression, anxiety, and emotional control.

Cognition: While health-promoting behaviors did not fully counterbalance the negative effects of concussion on cognition, they had a significant positive impact.

Hope for athletes

The results offer hope for former NFL players concerned about their histories of concussion. “If you sustained a number of concussions in your career, you are not doomed,” says Meehan.

While players cannot change their concussion history, they can modify many other aspects of their lives with positive effects. “If you exercise a little more, improve your diet, and improve your sleep habits, you can counteract the potential effects of concussion.”

And while the study focused on former NFL players, the results could help younger, non-professional athletes as they weigh the risks and benefits of playing the game. Concussion is one of several common injuries sustained in football, but there are concrete steps athletes can take to boost recovery.

For athletes who would either play football or no sport at all, Meehan points to the many proven benefits of sports participation such as better psychological well-being, better health-related quality of life, higher self-esteem, and improved memory and learning, to name a few. “If we’re steering an athlete away from sports altogether, we’re steering them away from a great opportunity.”

Learn more about NFL-Long study findings and Boston Children’s Sports Medicine Division.