World Rugby and New Zealand Rugby have welcomed the results of a wide-ranging independent study, researching the long-term physical and psychological health effects of playing elite rugby, community rugby and non-contact sports.
The three-year study, conducted by the Auckland University of Technology (AUT), funded by World Rugby and AUT and supported by New Zealand Rugby, does not provide definitive links between rugby and long-term cognitive health issues and further research is required in this priority player welfare area.
The study set out to assess the general health, neuropsychological function, balance capability and brain corticomotor excitability in retired professional and community level rugby union players from New Zealand playing from the 1980s through to the 2000s in comparison with age-matched control groups.
The research aimed to show associations and identify areas of importance for further investigation.
The study showed that rugby players performed above average in some tests compared to non-contact sports players and less well in others.
It is therefore difficult to draw robust conclusions about the links between rugby and long-term cognitive health issues and highlights the need for further in-depth research.
Concussion education, prevention, management and research continues to be World Rugby's number-one player welfare priority and with rugby participation experiencing record growth around the world, the governing body is committed to commissioning and funding research to drive forward medical and player welfare knowledge and enhancements to protect and support participants at all levels of the sport.
It is currently supporting a number of global player welfare studies.
In its recommendations, the study endorsed World Rugby’s concussion strategy of prevention, management, education and research and the continued need to educate participants in all levels of sport about the risks associated with concussion.
The key recommendations made by AUT were:
1. Further targeted research is needed to assess the impact of concussion on long-term balance and cognitive brain function. Arthritis and cardiovascular health in retired athletes also requires further investigation.
2. Sports should focus on improving concussion awareness, management (immediate and follow-up) and prevention programmes.
3. Injury prevention and injury management programmes should target not only acute injuries during participation but also long-term injuries associated with the greatest morbidity such as arthritis.
4. Education on the harmful effects of excessive alcohol ingestion should be a core inclusion in all sports education programmes.
5. Sports should identify and highlight not only the injury risk associated with sport but also the potential benefits to general and neuropsychological health that are associated with sports participation.
Impact of sport
When looking at the results across all participants (rugby and non-contact sport athletes):
1. Ex-sportsmen, when compared to New Zealand males in general reported better health, were more likely to be in long-term relationships, generally had higher incomes, and were less likely to smoke cigarettes.
2. Ex-sportsmen, irrespective of the number of concussions reported, had no differences in marital status, hours worked per week, income, arthritis, medication use, mental health issues, sleeping patterns, frequency of alcohol use, current smoking levels, and current physical activity levels.
3. Ex-sportsmen, irrespective of the number of concussions reported, showed no differences in brain excitability assessment (i.e. efficiency of connection between brain cells).
4. Ex-sportsmen who reported four or more concussions during their sporting career
– Performed worse on some, but not all, measures in the neuropsychological test used in this research
– Reported more injuries during sport
– Had more hospitalisations for injury
– Rated their current health lower
5. Ex-sportsmen who reported one to three concussions during their sporting career (but not four or more) had a worse result in one of the five balance tests.
Retired rugby players (both elite and community) compared with non-contact sports people reported:
1. More injuries during their career.
2. Current higher levels of osteoarthritis and cardiovascular issues.
3. Fewer alcohol drinking sessions in a week but higher alcohol intake during a drinking session.
4. Retired elite rugby players performed marginally worse on some, but not all, of the neuropsychological tests used in this research.
"World Rugby’s number-one priority is player welfare and our strategies regarding concussion education, management, prevention and research are at the very top of our agenda," said World Rugby's Chief Executive Officer Brett Gosper.
"We welcome the findings of this study, and while the study does not provide any definitive conclusions, we are alive to all potential risks and, as such, we will continue to prioritise research in this very important area."
World Rugby Chief Medical Officer Dr Martin Raftery said the study was an important exercise.
"Concussion impacts all sports and World Rugby continues to take a proactive approach to educating and protecting our players at all levels and studies like this are important to informing our evidence-based approach," he explained.
"Guided by leading independent experts and based on increased scientific understanding, rugby is being proactive in this important area. We are changing culture within the sport, our extensive education and management initiatives are working and players have never been so informed and supported when it comes to concussion.
"We continue to collaborate with other international sporting federations and bodies to share knowledge and move towards a common cross-sport approach to educating and supporting athletes at all levels of recreation and competition."
New Zealand Rugby Senior Scientist Dr Ken Quarrie reiterated that the study provided a valuable starting point for future research.
"We are doing all the right things currently through our RugbySmart programmes and other initiatives to make the game as safe as possible and we will continue to evolve our approach as new information comes to hand to ensure we remain on top of the issue," he said.
"In particular, managing concussion remains front and centre of our injury prevention focus. We believe the message is getting through. Coaches understand that to get the best from players, they need to deal with concussion promptly, remove players from the field and give them time to recover before they resume playing. Likewise players are more aware of the steps they need to take to recover from concussion."
International Rugby Players' Association (IRPA) CEO Rob Nichol welcomed the study.
"IRPA is pleased to see research being undertaken in this area," he said.
"Whilst not conclusive hopefully the learnings will allow for more targeted research in the future.
"Concussion education and management is a priority for the game and without doubt Rugby is experiencing a culture change for the good in this respect.
"All stakeholders must take responsibility for ensuring the welfare of players at all levels of the game and evidenced-based research and information is crucial in that respect."
In 2014 World Rugby delivered face to face or online concussion education to more than 13,000 players, coaches, referees and medics (sport and GPs) and launched its #RecogniseAndRemove campaign, centered on public concussion guidance – a resource that is being adopted by other bodies and authorities.
With thanks to World Rugby