Weight Gain, Hypertension, and the Emergence of a Maladaptive Cardiovascular Phenotype Among US Football Players
Kim JH, Hollowed C, Liu C, Al-Badri A, Alkhoder A, Dommisse M, Gowani Z, Miller A, Nguyen P, Prabakaran G, Sidoti A, Wehbe M, Galante A, Gilson CL, Clark C, Ko YA, Quyyumi AA, Baggish AL. JAMA Cardiology. 2019 October 16. doi:10.1001/jamacardio.2019.3909.
https://jamanetwork.com/journals/jamacardiology/article-abstract/2752890
Take-Home Message
Cardiovascular health declines in collegiate American football athletes.
Summary
Competitive sports participation increases health and wellness, but it is unclear if this applies to American football. A former football player has a greater risk of cardiovascular mortality, especially if his body mass index was > 35 kg/m2 or he played as a lineman. Poor long-term outcomes may be influenced by cardiovascular changes during the transition to college football or weight gain in college. Unfortunately, we know very little about how college football participation alters cardiovascular heath because most studies are limited to a short amount of time or focus on only one aspect of cardiovascular health. These authors conducted a three year (June 2014 – June 2017) prospective study to examine the onset and changes in cardiovascular risk factors during a collegiate career in football. The authors assessed weight, height, and blood pressure. Furthermore, they completed transthoracic echocardiography to assess changes in heart structure/function and vascular applanation tonometry to evaluate arterial stiffness. Freshman athletes completed baseline assessments during preseason. The authors then reassessed the athletes at the beginning of freshmen postseason (approximately 5-6 months later), at the beginning of sophomore postseason (about one year later), and finally at the beginning of junior postseason (another year later).
A total of 126 football athletes qualified for the study. However, only 55 of the 126 athletes completed the full study. Lineman typically started with greater systolic blood pressure as well as poorer arterial stiffness and cardiac structure/function. However, regardless of position, football players developed increases in systolic blood pressure and weight, declines in cardiac structure/function, and worsening arterial stiffness. After the authors accounted for various risk factors they found that greater blood pressure and weight related to worse arterial stiffness and undesirable cardiac adaptations (concentric left ventricular hypertrophy, impaired diastolic function) over time.
Viewpoints
Overall, this study was interesting because it was the first longitudinal study to examine football players over 3 years. The authors found that some collegiate football athletes develop high blood pressure, undesirable cardiac changes in structure and function, as well as arterial stiffness. The authors also noted that weight gain and increased systolic blood pressure were key factors related to these poor outcomes. Young adults who participate in football should be aware of the potential adverse health effects. It would have been interesting to see if the researchers monitored for fat mass and fat-free mass changes to see if the increase in systolic blood pressure related to gains in fat or fat-free mass. Patient education may be key in trying to avoid negative outcomes like excess weight gain or cardiovascular pathologies. Furthermore, it is unclear if football is the only sport that puts the heart at risk for pathology and conducting further studies on a broader population would provide valuable information. It would be interesting to know if proactively treating hypertension in collegiate football players could help reduce the risk of poor outcomes. Clinicians should be sure to educate their athletes who may be at risk for weight gain and increased blood pressure to emphasize long-term health and wellness. Furthermore, clinicians should monitor changes in blood pressure during an athlete’s collegiate career.
Questions for Discussion
Is football the only sport that puts young athletes at risk for cardiovascular issues later in life? Do you think if lean body mass increased, would there still be an increase in systolic blood pressure? How can we prevent cardiovascular pathology in collegiate football athletes?
Written by: Daniel Webb
Reviewed by: Jeffrey Driban
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Hi Daniel,
This article is really interesting because it is contradictory of how we see athletes and overall fitness. I am a Student Athletic Trainer, but I also work in the Personal Training world. I’ve seen hypertension and cardio a weakness in bodybuilders and powerlifters. These men and women put on a ludicrous amount of weight but ignore the conditioning factor that balances out their fitness level. Being a former linemen back in high school I do remember training just for strength and size, and conditioning was barely part of our practice. Seeing the similarities of training in Football players and Bodybuilders, this article makes a lot of sense.
However, even though cardiovascular pathologies may come with this kind of training does not mean that it is not preventable. As stated in your writing, education is key. By educating coaches and athletes the importance of conditioning, it can be integrated in a workout. And for those individuals that think that adding cardio into their training will decrease power and strength, we should tell that it’s not true. By following a highly dense nutrition plan, cardio can be performed without causing atrophy.
Again great piece of writing,
Khalif
I have no doubt that football is not the only sport where athletes suffer from cardiovascular issues. Often, in high school sports these athletes, and athletes alike (in body mass) transfer to track & field and throw during the spring season. From personal experience working with these athletes they often focus on “bulking up” but not on their endurance and cardiovascular health.
I think that if the athletes’ lean body mass was increasing that their systolic blood pressure would decrease. This would be based on the fact that I would attribute an increase in lean body mass to an increase in cardio activity.
I think that we can work to prevent cardiovascular problems through education. As previously mentioned, often we assume that our athletes are healthy based on the fact that they are playing sports. However, this is not always the case. I think that we need to not just educate the athletes, but their coaches as well.
I found this very interesting because it is not something I have considered being a risk factor in my athletes. As Khalif stated we can often view the populations we treat as fit, therefore it is not something to consider, but it definitely goes back to patient education as stated. A lot of these athletes, especially being D1 may not even know they are at risk long term with factor long term effects high blood pressure and weight gain. They also may not aware of all the resources available to them to prevent this. Overall nutrition, education, and fitness should be our focus so these athletes, especially high school or institutions that don’t have as many resources as a D1 school. I have not seen many other sports as a student but I do know a few former wrestlers and a shot putter struggle with these same issues as adults so those may be populations to consider.