FIELD research study findings

What the findings mean from a medical perspective

By Dr. Charlotte Cowie - FA Head of Medicine

Dr Charlotte Cowie, Head of Performance Medicine at The FA

The FIELD study is a much-needed piece of research and it’s an important step in helping football to understand any potential risks in our game. 

Dr William Stewart and the University of Glasgow have made ground-breaking progress and a crucial first step in building a greater understanding of where the game can focus further research in the future. 

We felt it was important that The FA helped to support and fund the study, partnering with the PFA, and the publication of this paper in the New England Journal of Medicine, one of the most highly respected medical journals in the world, demonstrates the quality and importance of the study.

Until this point it was hard to imagine how such a significant study could be produced in such a short space of time and the quality of data means we are very sure that the results are accurate.

We’ve known all along that playing football brings a number of significant health benefits, and I was very pleased to see the research confirm that the former professional footballers in this study lived longer and were less likely to die of conditions such as heart disease or lung cancer than those who were not professional footballers. However, the results also showed us that the former professional footballers assessed in this study were 3.5 times more likely to die of dementia than the matched population and this is important new information. 

One difficult aspect of interpreting the paper is that the former professional footballers studied in the FIELD study were born between 1900 and 1976. Since that time there have been various changes to the game, so we can’t know what the results would be for professional footballers today.

Whether you're a former or current player, a coach or a parent, it's understandable that people may feel worried and also wonder what the results mean for them. The fact is that this piece of research was always going to give an initial indication of where more research, if any, was required. We'll now need to see more research in a number of areas before anyone can determine what the overall implications are for the game we all love. 

The next steps must be for football to conduct further research that's specifically designed to identify exactly what might cause this link between the former professional footballers in the FIELD study and dementia. It was important to play a role in commissioning this research and I know The FA are committed to working with football governing bodies in the future, including FIFA and UEFA, to help seek a greater understanding of the issue.

We've taken the findings of the research very seriously. Although the findings are very recent, we've already consulted with a group of experts we assembled as soon as we were aware of the results. Our independently chaired Medical & Football Advisory Group is a team of both medical and football experts who have expertise in areas like neurology, dementia and football coaching. 

One of their immediate concerns was that although the former professional footballers lived longer than the control group, and we don’t know what the effect of football is in modern day or non-professional football, people may see the headlines and become concerned about playing football. However, any decrease in physical activity could actually put people at more risk, not less risk, of dementia and other medical conditions. 

The Medical & Football Advisory Group have made three main recommendations, and these are very helpful in ensuring we address known risk factors for dementia and take a measured approach towards heading, which many people will have queries about. 

The three recommendations are:

1. That concussion, a known risk factor for dementia, is managed according to The FA’s Concussion guidelines, with a very clear main message of ‘If In Doubt, Sit Them Out’. The group have also supported UEFA’s stance in encouraging FIFA to review its own concussion regulations.

2. That heading practice follows guidelines and that children only practice heading in proportion to the very infrequent number of times the ball is actually headed in youth games [which is around 1.5 headers per game in youth football].

3. That professional and recreational footballers alike should be reminded that there are other known risk factors for dementia which are more relevant to the public overall. Key to this is not smoking, moderating alcohol intake, being physically active and maintaining a healthy weight, blood pressure and cholesterol levels.

This Medical & Football Advisory Group also agreed that more research was needed into why players had been affected, but that there is currently not enough evidence to make other changes to the way the modern-day game is played.

It's crucially important that we don’t speculate or jump to conclusions that these increased rates of dementia may be caused by on-field concussions, heading, or any other factor linked with the game. This detail is simply not available currently.

The FA’s next step in pushing the research agenda forward is to ask a group of experts and stakeholders to form a Research Taskforce.  This group will meet at the end of October 2019 to consider how we can identify and action further research to complement the FIELD study findings and our other ongoing work in this area. 

I think we're all very aware that although The FA and other football bodies, such as FIFA and UEFA, could commission further research, any further studies may be quite long and complex. It's therefore crucially important that we take advice and think carefully about how to make any future research as robust and informative as the FIELD study has been.

On a personal note, I also want to extend my thanks to Dawn Astle and the Astle family for their unwavering commitment to supporting this research and for the time they've spent helping me to understand the importance of this issue to themselves and the other families they support through the Astle Foundation.