Health-Related Quality of Life in Former National Collegiate Athletic Association Division I Collegiate Athletes Compared With Noncollegiate Athletes: A 5-Year Follow-Up

Simon JE, Lorence M, Docherty CL. J Athl Train. 2021 Feb 18.  doi: 10.4085/1062-6050-0107.20.  Online ahead of print.

Full Text Freely Available

Take-Home Message

Former Division I athletes report worse health outcomes and greater declines in quality of life than peers who were recreationally active during college.


Collegiate athletes benefit from participating in physical activity (e.g., enhanced cardiorespiratory fitness, muscular strength, team building). Unfortunately, they may also over train, develop musculoskeletal injuries, and experience stress, which could negatively impact their short- and long-term well-being. In part, this may explain why former collegiate athletes report a lower quality of life and become more inactive later in life. Unfortunately, these findings come from cross-sectional studies, which cannot explain if former athletes report a consistently low quality of life and less physical activity or if they are getting worse over time.

Study Goal

The authors conducted a 5-year prospective study to assess health-related quality of life of former NCAA Division I collegiate athletes and peers who were recreationally active during college (45 to 70 years of age).


Athletes that responded to the original cross-sectional study were eligible to complete the 5-year follow-up study. Therefore, the researchers contacted 457 former Division I collegiate athletes and their peers 5 years after the initial study to determine how health-related quality of life changed. All collegiate athletes competed at least one season in an NCAA Division 1 sport. In contrast, their peers never participated in a Division 1 sport. Instead, they regularly participated in intramural, club, or other recreational activities. Overall, 193 former Division I college athletes (34% female; ~58 years of age) and 169 former recreationally active peers (53% female; ~58 years of age) completed PROMIS questionnaires. The authors assessed the same 7 PROMIS subscales at each timepoint: sleep, depression, fatigue, pain interference, physical function, and social.


Former Division I athletes weighed more and performed less aerobic and anaerobic activity than their peers. Additionally, more Division I collegiate athletes indicated that they were diagnosed with osteoarthritis (46%) than their peers (27%). Forty-four percent of Division I athletes also reported feeling limited in their daily life compared to 20% from other alumni. Former Division I athletes reported worsening depression, sleep disturbance, fatigue, pain, and physical function on the PROMIS from baseline to 5-year follow-up. In contrast, their peers experienced minimal, if any, any changes in these measures of health. 


The authors confirmed their original findings that former Division 1 athletes report diminished health-related quality of life compared with their peers who were recreationally active during college. Furthermore, they found Division I athletes experience worsening sleep disturbance, depression, fatigue, pain, and function over just 5 years. In contrast, their peers remained stable over time. One of the more alarming findings yet not surprising findings was that former Division I athletes were almost twice as likely to be diagnosed with osteoarthritis while also reporting less physical activity than their peers. This finding could represent a vicious cycle where osteoarthritis-related pain impedes physical activity, leading to worsening osteoarthritis-related symptoms. While this study offers important insights into the long-term wellness of former college athletes, it is important to note that these athletes competed over 25 years ago, and collegiate sports have changed over the past few decades. We urgently need more research to understand if these results apply to more recent collegiate athletes. Furthermore, we need to follow our current student athletes from active sports participation through adulthood to understand how things change as our patients age.

Clinical Implications

Medical professionals should be aware of the difficulties former collegiate athletes face. They should teach student athletes strategies to preserve long-term wellness and when to report concerns to a healthcare provider. Furthermore, clinicians that see former collegiate athletes should screen these patients for diminished quality of life and reduced physical activity to ensure they receive appropriate education/interventions.

Questions for Discussion

What do you do as a clinician to help educate athletes about long-term health? If you do, when do you do this? If not, is this something you may start to think about implementing into your clinical practice?

Related Posts

  1. Former Division III Female Collegiate Athletes Report Better Overall Long-Term Health
  2. Retired Athletes May Be Set Up for Unhealthy Lifestyles
  3. Does your Level of Exercise Match Up Against Retired Elite Athletes?…Probably!
  4. Stop! In the Name of Long-Term Joint Health
  5. Looking in The Crystal Ball: Life After College Sports

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

7 evidence-based practice courses