Brain Health and Sport

Sport plays a vital role in promoting overall health and well-being. Although some sports carry certain risks to the brain, the physical and mental benefits of engaging in sports far outweigh the potential drawbacks.. 

Sport, Life And Brain Health

 

“We don’t stop playing because we grow old. We grow old because we stop playing.”

Bernard Shaw

 

For a moment, I want you to imagine life without sport. What would it look like?  I remember many years ago while travelling on the subway in New York, I saw an ad for the sports channel ESPN that said, ‘Without sport, Saturday and Sunday would be just like any other day of the week.’ It struck a note of resonance for me because sport is an important part of my life.  Without sport, life might be more predictable but certainly less exciting.

 

Seamus Heaney, in his poem ‘Harvest Bow’, said that ‘the end [purpose] of art is peace’. What then is the purpose of sport?  Sport, and participation in sport, can mean so many things to different people. For a community, sport, either playing or following it, is a very special place where emotions are expressed, and people connect. Think back to the ‘Italia 90' World Cup when a whole country’s mood and emotions were determined by Ireland’s games and winning and losing. For young people who participate in sports, there are major emotional benefits; they have fewer psychological problems and better peer relationships, and as young adults, they are less likely to experience loneliness.  From a health perspective, participation in sport decreases overall death rates, particularly deaths due to heart disease, and improves our cardiometabolic profile, and from a mental health point of view, it lowers stress and decreases depression and anxiety.

 

The scientific evidence suggests that another advantage of playing sports at the recreational or elite level is that you live longer. In the Copenhagen City Heart Study, recreational tennis players topped the scoreboard, living on average 9.7 years longer, with soccer players gaining 4.7 years compared to those with a sedentary lifestyle. At the elite level, most athletes, except those in martial arts, boxing and sumo wrestling, live longer, and once again racket sports, including tennis, and track and field showed the highest benefits. For elite rugby and soccer, there are smaller gains in longevity, and it may be that improved cardiovascular health in athletes playing these contact sports is offset by the increased risk of death due to neurodegenerative disease secondary to concussions. Taking a closer look at the differences between sports, we can see there are 36% more Wimbledon finalists alive today than would be expected, compared with 16% more England rugby captains, 14% cricket captains, 9% British Open champions, 3% Derby winners, 2% football captains but 7% fewer heavyweight boxing champions. We can attribute longevity to the effect of exercise, but of course, there are many other factors, including social and educational, that may have contributed to this dividend. 

 

Billie Jean King, the famous Grand Slam tennis champion, wisely once said, “Sport teaches you character; it teaches you to play by the rules; it teaches you to know what it feels like to win and lose; it teaches you about life.”  Sport is a microcosm of life, and you can tell a lot about a person by the way they play their sport. It promotes resilience, passion and determination, and respect for an opponent, and when it comes to team sports, it helps develop trust in other people and a spirit of collaboration that is key to relationship building.

 

Sport is a gift that keeps giving to individuals and society. Sport promotes social connection, provides meaning in people's lives, increases physical activity, improves physical and mental health and increases our life span.  And very importantly, sport is good for our brains and our brain health.  Brain health does not simply mean the absence of brain diseases. Brain health is the highest level of cognitive, emotional, psychological and behavioural functioning that you can achieve. It's the best brain fitness that you can attain by protecting the brain, reducing risks to it and building up the brain’s reserve so that the brain is better able to deal with the wear and tear of ageing and the effects of the pathology that build up over time.  You can increase your brain health and reserve through activities that promote the brain’s nerve cells or neuronal connections. Exercise and social and cognitive stimulation (e.g., learning new languages, getting involved in creative activities) all build your brain’s reserve.

 

There are several important determinants of brain health: environmental (e.g., pollution); physical health (e.g., significant kidney disease, liver disease, heart disease or respiratory disease); emotional (e.g., depression, anxiety and loneliness); social (e.g., relationships); and cognitive (e.g., the presence of brain diseases such as epilepsy, different types of dementia, Parkinson's disease, multiple sclerosis and motor neurone disease).

 

We know that over your life course, there are at least 14 major risk factors that affect brain health and increase the risk of developing dementia.  Early in life, less education impacts your brain’s plasticity and health.  In midlife, age-related hearing loss, high cholesterol, depression, traumatic brain injury (including repetitive concussion), a sedentary lifestyle, diabetes, smoking, hypertension, obesity, and excessive alcohol have negative effects on your brain health.  Finally, later in life, social isolation, air pollution and visual loss impact brain health. If we were to successfully address all these risk factors across the life course, we could potentially reduce people's risks of developing dementia at a population level by up to 45%, a huge benefit to individuals and society.  The important point about these factors is that they can be modified, reduced or even prevented.

 

So, what protects our brains?  Physical exercise, both endurance and strengthening, activates and protects our brains. Likewise, a healthy diet with plenty of colourful fruit and vegetables is good for your brain health and is associated with a decreased risk of developing dementia.  Activities that stimulate your brain, such as arts, creativity, and learning a new language, can improve the brain’s plasticity and promote your brain health. Social connection has a powerful effect on brain health, as does having purpose and meaning in life. And, finally, education enhances brain plasticity, particularly in life, but importantly, education can have benefits to the brain’s structure and function at all stages of life.

 

Where does sport fit into the brain health story? Sport has several protective elements, such as physical activity, social connection, inclusion, meaning and purpose and stress reduction. Participation in sports addresses several of the 14 big risk factors for brain health. Although contact sports have some level of risk to the brain, notably concussion, it’s a question of balance. Participation in sports overall has huge benefits to our brain health.  While there is a risk of concussion in all contact sports, a history of concussion is not a determining factor for neurodegeneration, but it does increase the overall risk, particularly if there have been many episodes. And there is more that we can do to reduce risks and protect the brain when playing contact sports. When it comes to concussion and repetitive head injury, an ounce of prevention is better than a pound of cure.  At the primary prevention level, we need to increase education and awareness around how to protect the brain and reduce risk to the brain, particularly in young people who are engaged in contact sports.  Head injury and collisions should be minimised, and sports rules changed or adapted to prevent and reduce the number of concussions. When a concussion has already happened, we should think about secondary prevention, amplifying and promoting the many other brain health protective factors to build up the brain’s reserve to counter the risk of any damage that may have occurred. And when concussion happens, regarding tertiary prevention, we must ensure that concussion protocols are implemented and strictly adhered to.

 

To understand the importance of policy to protect brains and take individual decision-making out of the equation, we need to go back to rush hour in Hanoi before and after 2007.  In Vietnam the main form of transport is by motorcycle, and before 2007 nobody wore helmets.  Consequently, there was a high rate of death and serious brain injuries from accidents.  In 2007, with the help of Chuck Feeney's Atlantic Philanthropies, a new law was passed whereby people had to wear motorcycle helmets.  This had a significant impact on reducing brain injuries and deaths from motorcycle accidents. This does not mean that helmets should be recommended for contact sports, as they do not protect the brain from concussion.  The important point, though, is that we need effective policies to be implemented to change people's behaviour. We cannot leave the decisions about how to protect the brain in sports or elsewhere to people themselves, as we know that individuals can make poor health decisions in sports and life.

 

Sport is not just a ‘nice to have’ but a ‘must’ for health. Participation in sports contributes significantly to our brain health and should be encouraged not just for its joy, meaning and connection but also for its positive value for the brain.  For contact sports, there are significant benefits to health and our brains, but there are risks. Greater efforts need to be made to protect brains in contact sports across the life course. If we protect brains in contact sports, we promote health and protect the future of the sport.

Concussion, Sport and Brain Health

 

 

Brain health is influenced by a variety of factors, including:

  • Physical health: Conditions such as hypertension, diabetes, and hearing loss
  • Mental health: Issues like depression, and alcohol or substance use
  • Environmental and lifestyle factors: Regular exercise, time spent in nature, mental stimulation, reducing exposure to pollution, and access to well-designed spaces for walking and relaxation
  • Stress and security: Experiences of chronic stress and trauma
  • Lifelong learning: Continuous education and intellectual engagement
  • Social connections: Building strong relationships, maintaining social activity, finding purpose, and addressing feelings of loneliness
  • Social determinants: Factors like poverty, housing quality, and access to essential services

Sports can significantly impact many of these factors, acting as a contributor, amplifier, catalyst, or even a mitigator. While sports generally promote better brain health and can drive positive change, it’s crucial to balance their benefits with potential risks, such as concussions.

Repetitive head trauma, commonly referred to as a concussion in contact sports, has been identified as a notable risk factor for developing dementia later in life.

This has raised understandable concerns among rugby and soccer players across all age groups, particularly those who have played at elite levels for prolonged periods.

Research involving over 7,500 male Scottish professional football players born between 1900 and 1976, compared to 23,000 matched individuals, uncovered some significant findings:

  • A fivefold increase in Alzheimer’s disease cases
  • A fourfold increase in motor neurone disease (MND) cases
  • Double the number of Parkinson’s disease cases

The research also highlighted that the position played on the field and frequent heading of the ball were key contributing factors. On a positive note, elite football players were found to be less likely to die from heart disease and lung cancer, suggesting some protective benefits of sports.

Remember, head injuries are just one of 14 modifiable risk factors for dementia. While concussions increase risk, they are not a determining factor.

What should we recommend?

Emerging evidence suggests that lifestyle changes and addressing other risk factors can help protect brain health and reduce the likelihood of dementia. To effectively minimise dementia risk, head injuries must be addressed as part of a comprehensive approach that considers multiple factors throughout life.

The brain health approach emphasises early intervention, prevention, and maintaining cognitive health across the lifespan. Currently, many retired players have limited awareness of other mid-life risk factors for dementia or the steps they can take to reduce their overall risk.

Prevention strategies fall into three main categories:

  • Primary prevention: Raising awareness and education about the importance of protecting the brain in sport. This includes reducing physical contact and limiting heading practices during training. 
  • Secondary prevention: Where there is a history of concussions, prioritise brain health by proactively addressing and reducing other risk factors and implementing pathways to safeguard long-term cognitive function.
  • Tertiary prevention: Enforcing strict concussion protocols and ensuring appropriate medical management for affected players.

 

Brain Health and Sport: Rugby, The Way Forward

Some of the most vivid moments in Irish life have come through sport: Italia '90, when Irish people everywhere came together, as Mick McCarthy put it, "in a spirit of joy, hope, and possibility." Munster beating the All Blacks 12–0 at Thomond Park in 1978. These aren't just results. They're shared meaning, and meaning matters for brain health as much as any biological factor does.

That's not just sentiment — it's backed by real evidence. Young people who take part in sport report less loneliness and fewer emotional problems like worry and sadness; those who play team sports specifically show even greater benefits for wellbeing, anxiety, and depression than those who don't. The physical health payoff can be substantial too: the Copenhagen City Heart Study found that recreational tennis players lived, on average, 9.7 years longer than sedentary people, and footballers gained 4.7 years. At the elite end, there are 36% more Wimbledon finalists alive today than statistically expected for men their age, and 16% more England rugby captains — likely reflecting a mix of fitness, social connection, and the educational and economic advantages that often accompany elite sporting careers, not just exercise alone.

Brain health isn't the absence of brain disease — it's protecting the brain, reducing its risks, and building cognitive reserve over a lifetime so it can better withstand the wear and tear ageing brings. Many of the factors that raise dementia risk later in life — high blood pressure, high cholesterol, diabetes, hearing loss, traumatic brain injury, physical inactivity — sit on what's now recognised as a list of roughly 14 modifiable risk factors across the life course, and most of them can genuinely be reduced or prevented. Sport touches several of these directly and positively: physical activity, social connection, a sense of inclusion and purpose, and stress reduction are all protective. But for a contact sport like rugby specifically, there's a countervailing risk that has to be named honestly: concussion, and the disruption of early or forced retirement.

The retirement problem is real, and predictable. Elite rugby careers often build a singular identity — playing rugby becomes the focus above everything else, with total commitment to the team. When that ends, especially when it ends early and involuntarily rather than on the player's own terms, the loss of that institutional connection can bring disorientation, a loss of purpose, and real isolation. Around half of elite rugby players retire early because of injury, and a meaningful share specifically because of concussion. Forced retirement carries roughly double the psychological distress of voluntary retirement, and some studies have found higher rates of depression and alcohol use among retired players compared to those who chose their own exit. A recent Oscar-nominated animated short film, Retirement Plan, voiced by Domhnall Gleeson, captures exactly this — the story of a retired player, Ray, grappling with what's left once the identity that structured his whole life is gone.

The point isn't that this is unavoidable. It's that it's predictable, which means it can be planned for. Retirement — especially forced retirement — needs to be treated as a known risk factor for players' brain health and wellbeing, not something addressed only after the fact.

This is a question of balance, not prohibition. The right response to concussion risk in rugby isn't to abandon the sport, any more than the right response to a road safety crisis is to abandon cars. When Vietnam made motorcycle helmets mandatory in 2007, compliance and safety improved dramatically almost overnight — not because every individual rider suddenly decided helmets were a good idea, but because a policy-level, multilevel solution addressed a problem that individual choices alone hadn't solved. Sport and brain health work the same way: reduce the risk factors, increase the protective ones, and remember that a risk is not the same as a certainty. An ounce of prevention — education, awareness, and the right policies, thought through ahead of time rather than reacted to afterward — is worth far more than a pound of cure.

There's no health without brain health, and sport remains one of the most powerful, evidence-backed contributors to it that we have. Protecting that means protecting the brains of the people who play it too.

Create Your Own Website With Webador