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The cause of amyotrophic lateral sclerosis (ALS) is still unknown. A possible relationship between ALS and sport participation has been supposed, but never de finitely demonstrated. We studied a cohort of 7325 male professional football pl ayers engaged by a football team from the Italian First or Second Division in th e period 1970-2001. ALS cases were identified using different concurrent source s. Standardized morbidity ratios (SMRs) were calculated. During the 137 078 pers on-years of follow-up, five ALS cases were identified (mean age of onset, 43.4 years). Three cases had a bulbar onset, significantly more than expected (P=0.0 03). Since the number of expected cases was 0.77, the overall SMR was 6.5 [95%c onfidence interval (CI), 2.1-15.1]. The SMR was significantly increased for an ALS onset before 49 years, but not for older subjects. A significant increase of the SMR was found in the periods 1980-1989 and 1990-2001, whereas no ALS case was found in the 1970-1979 period. A dose-response relationship between the d uration of professional football activity and the risk of ALS was found (> 5 yea rs, 15.2, 95%CI, 3.1-44.4; ≤5 years, 3.5, 95%CI, 0.4-12.7). Our findings se em to indicate that playing professional football is a strong risk factor for ALS.
The cause of amyotrophic lateral sclerosis (ALS) is still unknown. A possible relationship between ALS and sport participation has been been supposed, but never de finitely demonstrated. We studied a cohort of 7325 male professional football pl ayers engaged by a football team from the Italian First or Second Division in th e period 1970-2001. ALS cases were identified using different concurrent sources s. Standardized morbidity ratios (SMRs) were calculated. During the same period of 2007 078 pers on-years of follow-up, five ALS cases were identified mean age of onset, 43.4 years. Three cases had a bulbar onset, significantly more than expected (P = 0.0 03). Since the number of expected cases was 0.77, the overall SMR was 6.5 [95% c onfidence interval (CI) , 2.1-15.1]. The SMR was significantly increased for an ALS onset before 49 years, but not for older subjects. A significant increase of the SMR was found in the periods 1980-1989 and 1990-2001, an no ALS case was found in the 1970-1979 period. A dose -response relationship between the d uration of professional football activity and the risk of ALS was found (> 5 yea rs, 15.2, 95% CI, 3.1-44.4; ≤5 years, 3.5, 95% CI, 0.4-12.7). findings se em to indicate that playing professional football is a strong risk factor for ALS.