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DOI: 10.1055/a-2684-8925
Clinical Outcomes Related to the After-Career Consultation in Retired Male Footballers

Abstract
The After-Career Consultation (ACC) was developed to empower the physical, mental and social health of retired professional footballers and effectively address their specific health challenges. The objective of this study was to describe the clinical outcomes (e.g., prevalence of health conditions) and recommendations to retired professional footballers who undertook the ACC. A quasi-experimental study was conducted. Forty-seven retired male professional footballers underwent ACCs. Ten participants had a diagnosis of osteoarthritis (21.3%), 4 (8.5%) met the criteria for a diagnosis of generalised anxiety disorder, 7 (14.9%) met the criteria for a diagnosis of depression and 7 (14.9%) met the criteria for Stage 1 hypertension. Health-related quality of life scores among retired footballers undergoing the ACC were above average compared to the general population. Clinical recommendations were made to participants in relation to their musculoskeletal (n=12, 25.5%), cardiovascular (n=12, 25.5%), mental (n=10, 21.3%) and lifestyle (n=20, 42.6%) health. Eleven participants (23.4%) were referred for further investigations, and secondary referral to other specialists was arranged for 4 (8.5%). Participants reported high satisfaction with the ACC. The ACC could complement existing player welfare strategies to provide a well-rounded approach to managing the long-term health of professional footballers throughout the lifespan.
Publication History
Received: 25 September 2024
Accepted after revision: 15 August 2025
Accepted Manuscript online:
15 August 2025
Article published online:
03 September 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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References
- 1 Carmody S, Jones C, Malhotra A, Gouttebarge V, Ahmad I. Put out to pasture: what is our duty of care to the retiring professional footballer? Promoting the concept of the ‘exit health examination’ (EHE). Br J Sports Med 2019; 53: 788-789
- 2 Zafonte R, Pascual-Leone A, Baggish A. et al. The Football Players’ Health Study at Harvard University: Design and objectives. Am J Ind Med 2019; 62: 643-654
- 3 Graham NS, Zimmerman K, Parker TD. et al. 165 The advanced BRAIN health clinic and study of long-term neurological outcomes in retired elite athletes. J Neurol Neurosurg Psychiatry 2022; 93: e2
- 4 World Olympians Association. WOA medical Committee launched to support retired Olympians 2015 https://olympians.org/news/293/woa-medical-committee-launched-to-support-retired-olympians/
- 5 Fernandes GS, Parekh SM, Moses J. et al. Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study. Br J Sports Med 2018; 52: 678-683
- 6 Carmody S, Anemaat K, Massey A, Kerkhoffs G, Gouttebarge V. Health conditions among retired professional footballers: a scoping review. BMJ Open Sport Exerc Med 2022; 8: e001196
- 7 Gouttebarge V, Aoki H, Kerkhoffs GMMJ. Knee osteoarthritis in professional football is related to severe knee injury and knee surgery. Inj Epidemiol 2018; 5: 26 http://www.ncbi.nlm.nih.gov/pubmed/29911282
- 8 Gouttebarge V, Aoki H, Ekstrand J, Verhagen EA, Kerkhoffs GM. Are severe musculoskeletal injuries associated with symptoms of common mental disorders among male European professional footballers. Knee Surg Sports Traumatol Arthrosc 2016; 24: 3934-3942
- 9 Gouttebarge V, Aoki H, Kerkhoffs GMMJ. Lower extremity osteoarthritis is associated with lower health-related quality of life among retired professional footballers. Phys Sportsmed 2018; 46: 471-476 http://www.ncbi.nlm.nih.gov/pubmed/29527975
- 10 van Ramele S, Aoki H, Kerkhoffs GMMJ, Gouttebarge V. Mental health in retired professional football players: 12-month incidence, adverse life events and support. Psychol Sport Exerc 2017; 28: 85-90
- 11 Mackay DF, Russell ER, Stewart K, MacLean JA, Pell JP, Stewart W. Neurodegenerative disease mortality among former professional soccer players. N Engl J Med 2019; 381: 1801-1808 http://www.ncbi.nlm.nih.gov/pubmed/31633894
- 12 Macnab TP, Espahbodi S, Hogervorst E. et al. Cognitive Impairment and Self-Reported Dementia in UK Retired Professional Soccer Players: A Cross Sectional Comparative Study. Sports Med Open 9: 43 2023;
- 13 Ueda P, Pasternak B, Lim CE. et al. Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study. Lancet Public Health 2023; 8 (04) e256
- 14 Espahbodi S, Hogervorst E, Macnab TP. et al. Heading frequency and risk of cognitive impairment in retired male professional soccer players. JAMA Netw Open 2023; 6 (07) e2323822
- 15 Gouttebarge V, Goedhart E, Kerkhoffs G. Empowering the health of retired professional footballers: the systematic development of an After Career Consultation and its feasibility. BMJ Open Sport Exerc Med 2018; 4: e000466
- 16 FIFPRO and FIFA to provide health support to recently retired football players. May 2021 https://www.fifa.com/football-development/media-releases/fifpro-and-fifa-to-provide-health-support-to-recently-retired-football-players [Accessed 31st October 2022]
- 17 TREND Group. Des Jarlais DC, Lyles C, Crepaz N. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health 2004; 94 (03) 361-366 PMID: 14998794; PMCID: PMC1448256
- 18 Harris AD, McGregor JC, Perencevich EN. et al. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inf Assoc 2006; 13: 16-23
- 19 World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA 2013; 310 (20) 2191-2194
- 20 McKay AKA, Stellingwerff T, Smith ES. et al Defining Training and Performance Caliber: A Participant Classification Framework. Int J Sports Physiol Perform 2022; 17 (02) 317-331 Epub 2022 Dec 29. PMID: 34965513
- 21 Fuller CW, Ekstrand J, Junge A. et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 2006; 40: 193-201
- 22 Waldén M, Mountjoy M, McCall A. et al. Football-specific extension of the IOC consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020. Br J Sports Med 2023; 57: 1341-1350
- 23 National Institute for Health and Care Excellence. 2022 Osteoarthritis https://cks.nice.org.uk/topics/osteoarthritis/ [Last Accessed: 4th Dec 2022]
- 24 Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder. Arch Intern Med 2006; 166: 1092-1097
- 25 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-613
- 26 Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. primary care evaluation of mental disorders. patient health questionnaire. JAMA 1999; 282: 1737-1744
- 27 Dawson DA, Grant BF, Stinson FS, Zhou Y. Effectiveness of the derived alcohol use disorders identification test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcohol Clin Exp Res 2005; 29: 844-854
- 28 de Meneses-Gaya C, Zuardi AW, Loureiro SR, Crippa JAS. Alcohol use disorders identification test (audit): an updated systematic review of psychometric properties. Psychol Neurosci 2009; 2: 83-97
- 29 Bender AM, Lawson D, Werthner P, Samuels CH. The clinical validation of the athlete sleep screening questionnaire: an instrument to identify athletes that need further sleep assessment. Sports Med Open 2018; 4: 23
- 30 Samuels C, James L, Lawson D, Meeuwisse W. The athlete sleep screening questionnaire: a new tool for assessing and managing sleep in elite athletes. Br J Sports Med 2016; 50: 418-422
- 31 Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 2009; 18: 873-880 PMID: 19543809]
- 32 McCrory P, Meeuwisse W, Dvořák J. et al. Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017; 51: 838-847
- 33 Williams B, Mancia G, Spiering W. et al. 2018; 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 39 (33) 3021-3104
- 34 Drezner JA, Sharma S, Baggish A. et al. International criteria for electrocardiographic interpretation in athletes: consensus statement. Br J Sports Med 2017; 51: 704-31
- 35 SPSS. IBM Corp. IBM SPSS Statistics for Macintosh, Version 28.0 2021 Armonk, NY: IBM Corp.
- 36 Myers L, Sirois MJ. Spearman correlation coefficients, differences between. Encyclopedia of statistical sciences Hoboken, NJ: Wiley; 2006
- 37 National Institute for Health and Care Excellence. Hypertension https://cks.nice.org.uk/topics/hypertension/ [Last Accessed: 1st May 2024]
- 38 Blakelock DJ, Chen MA, Prescott T. Psychological distress in elite adolescent soccer players following deselection. J Clin Sport Psychol 2016; 10: 59-77
- 39 Fernandes GS, Parekh SM, Moses J. et al. Depressive symptoms and the general health of retired professional footballers compared with the general population in the UK: a case-control study. BMJ Open 2019; 9: e030056
- 40 Koch M, Klügl M, Frankewycz B. et al. Football-related injuries are the major reason for the career end of professional male football players. Knee Surg Sports Traumatol Arthrosc 2021; 29: 3560-3568
- 41 Klünder KB, Rud B, Hansen J. Osteoarthritis of the hip and knee joint in retired football players. Acta Orthop Scand 1980; 51: 925-927
- 42 Armenis E, Pefanis N, Tsiganos G, Karagounis P, Baltopoulos P. Osteoarthritis of the ankle and foot complex in former Greek soccer players. Foot Ankle Spec 2011; 4: 338-343
- 43 Iosifidis MI, Tsarouhas A, Fylaktou A. Lower limb clinical and radiographic osteoarthritis in former elite male athletes. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2528-2535
- 44 Gouttebarge V, Frings-Dresen MH, Sluiter JK. Mental and psychosocial health among current and former professional footballers. Occup Med 2015; 65: 190-196
- 45 Gouttebarge V, Aoki H, Kerkhoffs GM. Prevalence and determinants of symptoms related to mental disorders in retired male professional footballers. J Sports Med Phys Fit 2016; 56: 648-654
- 46 Kilic Ö, Carmody S, Upmeijer J. et al. Prevalence of mental health symptoms among male and female Australian professional footballers. BMJ Open Sport Exerc Med 2021; 7: e001043
- 47 Gouttebarge V, Aoki H, Verhagen E, Kerkhoffs G. Are level of education and employment related to symptoms of common mental disorders in current and retired professional footballers?. Asian J Sports Med 2016; 7: 1-6
- 48 Office for Health Improvement & Disparities. Smoking profile for England: statistical commentary, March 2024 update Published 5 March 2024. 2024. https://www.gov.uk/government/statistics/smoking-profile-march-2024-update/smoking-profile-for-england-statistical-commentary-march-2024-update#:~:text=in%202022%20to%202023%2C%20the,13.6%25%20in%20the%20general%20population [Last accessed: 2nd August 2024]
- 49 Anstey KJ, von Sanden C, Salim A, O'Kearney R. Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. Am J Epidemiol 2007; 166 (04) 367-378
- 50 Luchsinger JA, Tang MX, Siddiqui M, Shea S, Mayeux R. Alcohol intake and risk of dementia. J Am Geriatr Soc 2004; 52 (04) 540-546
- 51 Byers AL, Yaffe K. Depression and risk of developing dementia. Nat Rev Neurol 2011; 7 (06) 323-331 PMID: 21537355; PMCID: PMC3327554
- 52 Gouttebarge V, Aoki H, Lambert M, Stewart W, Kerkhoffs G. A history of concussions is associated with symptoms of common mental disorders in former male professional athletes across a range of sports. Phys Sportsmed 2017; 45: 443-449
- 53 Carmody S, Ranson J, Iqbal Z, Massey A, Kerkhoffs G, Gouttebarge V. Evaluation of a medical after-care intervention among deselected elite male Academy football players: a pilot study. BMJ Open Sport Exerc Med 2024; 10: e001891
- 54 Carmody S, den Hollander S, Elliott-Sale K. et al. Self-reported reproductive health of retired elite women’s footballers: a cross-sectional study. BMJ Open Sport Exerc Med 2024; 10: e002028