Promoting lifelong brain health: A review of risk factors and protective opportunities for athletes.

OBJECTIVES: Brain health is an emerging public health priority, with dementia now among the leading causes of death in many high-income countries. The long-term brain health of current and former athletes has attracted increasing public and scientific attention in recent years, with attention largely focussed on risks such as sport-related concussion. This review aimed to increase awareness among the sports sector of the multi-factorial nature of brain health, presenting evidence on risk and protective factors alongside recommendations for individuals, sporting organisations, and regulatory agencies. DESIGN: A systematic search strategy was employed across three stages. The search protocol was pre-registered on the Open Science Framework. METHODS: First, position statements from global organisations were used to identify established risk and protective factors for brain health. Second, systematic reviews and meta-analyses from general populations were examined to build understanding of the current evidence base for each of these factors, including recent evidence not captured in stage 1. Third, an athlete-specific search was conducted to identify what is known about the factors within sporting contexts and cohorts. Limited evidence was identified specific to athlete populations; findings from the general population were therefore extrapolated where relevant. Factors considered most relevant to athletic populations were prioritised. RESULTS: Recommendations are presented for different roles within the sporting sector. CONCLUSIONS: Individual athletes are encouraged to address modifiable lifestyle risks; sporting organisations should create environments that actively support brain health during and beyond a sporting career; and regulatory agencies are encouraged to reduce harmful commercial influences on athletes.