Challenges athletes can face looking after brain health

I’m Dr. Fiona Wilson, Chartered Physiotherapist and Associate Professor. In this video, I’ll be discussing some of the physical, mental, and emotional challenges that athletes face in looking after their brain health, particularly when they’re approaching or entering a retirement phase. There’s been a lot of discussion in recent years regarding the potential influence of taking part in contact sports on brain health in later life. This information can be worrying, especially if you or someone you know played a sport where concussions (brain injuries) were sustained. And it can be difficult to get a clear understanding of how concerned we should be.

It’s not possible to reverse time, but it can be helpful to put the risks into perspective by understanding some more about the area. We know that risk of dementia is complicated and is influenced by many factors throughout the course of life. Traumatic brain injury is a known modifiable risk factor that plays a role in 3% to 15% of dementia cases in the community. But the contribution here is complex. The link between brain injury, multiple head impacts in sport was first noticed in boxers as “punch-drunk syndrome” or “dementia pugilistica,” now called Chronic Traumatic Encephalopathy, or CTE. We now recognise that evidence of CTE has been reported in the brains of some former contact sport athletes.

We also know that CTE pathology has been found in people who have had a single or moderate severe TBI outside the sport setting. As a result of the recognition in sport, there are huge efforts to reduce athletes’ exposure to brain injuries through better prevention– for example with rule changes and better education and management procedures. For current athletes at any level, now is the time to start thinking proactively. Throughout the course of life, the goal should be to do everything possible to maximise brain health. Two areas which you can address positively are to protect and support positive mental health and to engage in consistent exercise and physical activity.

Many athletes can find that retiring from sport can be a huge transition for them. And mental health challenges are not uncommon. We talk about athletic identity, which means someone may see being an athlete as who they are as a person and may struggle to think of themselves differently. This can be particularly difficult if retirement is forced through injury and this happens quickly. One may struggle at first to see where they fit in in the world. It’s important to recognise that this can be normal, and to discuss these feelings with someone who will understand. This might even be another athlete in the same situation.

It can be easy to turn to alcohol or drugs to try and feel better and manage pain. But we know this can negatively affect short and long term mental health, which links to overall brain health. Drinking may increase if someone is less constricted by training or competing and there’s more freedom to socialise. So it’s worthwhile checking in on habits around alcohol use. The same can be true for drug misuse. For some retired athletes who exit their sport with chronic pain and injury, abuse of prescription or even over-the-counter drugs can be a real problem. Discuss medication use or drug-taking with a health care provider.

One of the hardest things to do as a retired athlete is to start to engage in exercise for health rather than performance. It’s not uncommon for athletes to be performance-literate but not actually know how to exercise just to stay healthy– physically, mentally, and emotionally. An individual may feel that people are looking at them and judging them against past performances. As an athlete, exercise prescription may have been provided for many years during training sessions. And the individual may have been used to competing against themselves and others. Being very competitive can be a positive, but also a negative, as sometimes it makes exercise a burden.

A challenge athletes face as they approach retirement is that it is now time to take a different approach and make sure that they enjoy whatever exercise they do and that they’ll maintain it. This may take some time to work out. You may be someone who loves challenges, as this is what works for you. That’s OK, especially if it means you stay engaged with the programme. Athletes can be their own toughest critics and set very high standards for themselves. Transitioning from exercising for performance to exercising for health can be a time to focus on participation and enjoyment for the long-term benefit of the brain. Pain and injury are two other important areas to be aware of.

Our research has told us that pain and injury caused from sport can restrict athletes’ ability to exercise when retired. This is because sport-related injuries can be carried into retirement, that were not managed properly or are severe enough to cause ongoing problems, sometimes being the very reason for retirement. For example, in our retired athlete study, some athletes told us that they could no longer run because of knee pain. It’s critical to get some help in dealing with this. But it’s also helpful to use this time in life to explore different types of exercise programmes. There’s usually an exercise modality that can work around limitations. For pain and injury, referral to physiotherapists who specialise in this area can be really helpful.

Dealing with pain and old injuries will improve mental health but also allow the individual to take part in a variety of exercise programmes and support the physical well-being of fitness, all the while supporting brain health. Changes in diet and nutrition are also relevant here. Part of being an athlete is making sure enough calories are consumed for all the energy that’s being burned. It can be really hard to change the habit of eating large volumes of food when retired, as for many athletes this is associated with weight gain. Not training as much or as often means that the body composition can change, too. Muscle mass can reduce and the amount of fat carried increases.

Sometimes it’s hard to notice, as weight may not change dramatically. The combination of increased body fat, especially around the middle section, and decreased exercise can be a poor combination, especially as it’s often associated with an increase in blood pressure. Raised blood pressure, or hypertension, increases the risk of developing dementia. Hypertension can be changed. So this risk is what we call modifiable. Our study of former professional athletes showed that many in midlife had hypertension, which they did not even know about. Most also did not know it increased their dementia risk.

Whilst I’ve discussed a number of physical, mental, and emotional challenges or risks associated with retirements in sport that have a direct link to brain health, it’s important to focus on the fact that there are many positive things that can be done to be proactive in managing this process. For example, 1– stay actively engaged in regular exercise that you enjoy. 2– manage mental health. 3– monitor the use of alcohol and prescription drugs. And seek support from a doctor or health care provider if needed. 4– stay on top of pain and injuries before they worsen. 5– check weight and blood pressure regularly, and seek medical help if these metrics are raised or you’re concerned.