The DOI matches its Crossref record; 30 of the 30 references it cites were found in a registry or an index.
ALS in Italian professional soccer players: The risk is still present and could be soccer-specific
Abstract
We previously found an increased risk for ALS in Italian professional soccer players actively engaged between 1970 and 2001 (n =7325). The present study extends previous work with a prospective follow-up of the original cohort to 2006 and investigates the risk of ALS in two other cohorts of professional athletes, basketball players (n =1973) and road cyclists (n =1701). Standardized morbidity ratios (SMRs) were calculated. Among soccer players three new cases of ALS were identified, reaching a total of eight ALS cases (mean age of onset, 41.6 years). The number of expected cases was 1.24, with an SMR of 6.45 (95% CI 2.78-12.70; p<0.00001). The risk of ALS was higher for careers lasting >5 years, for midfielders, and for players engaged after 1980. No basketball player and no cyclist developed ALS. This prospective extension of the Italian soccer players cohort survey confirms the highly significant risk of developing ALS, the young age of onset, the dose-effect risk and a predilection for midfielders. The absence of ALS cases in professional road cyclists and basketball players indicates that ALS is not related to physical activity per se.
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“Chio et al. reanalyzed this cohort in 2009 and confirmed a higher rate of ALS in Italian professional soccer players (standardized morbidity ratio [SMR] 6.45, 95% CI 2.78‐12.70, P < .00001), but not in professional basketball players or road cyclists, who in general do not suffer frequent head injuries.”
From Risk factors for amyotrophic lateral sclerosis: A regional United States case‐control study (2021) · cites this paper as [15]
In the citing paper
“Some data suggests that trauma and athletic exposure are risk factors for developing ALS [30, 31, 166], although there are conflicting reports regarding single versus repetitive head injury [24].”
From The neuropathology of sport (2014) · cites this paper as [31]
In the citing paper
“ALS incidence and mortality are also reported to be unusually high among professional soccer players in Italy [30, 31].”
From The neuropathology of sport (2014) · cites this paper as [31]
Citations
Cites
Talent identification and development in soccer
Williams, A. M., & Reilly, T. P. (2000) · Journal of Sports Sciences · doi:10.1080/02640410050120041 · Cited by 1,127
The Human Gene Map for Performance and Health-Related Fitness Phenotypes
Rankinen, T., Bray, M. S., Hagberg, J. M., Përusse, L., Roth, S. M., Wolfarth, B., & Bouchard, C. (2006) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000233789.01164.4f · Cited by 734
Mitchell, J. D., & Borasio, G. D. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60944-1 · Cited by 606
Strength and endurance of elite soccer players
Wisløff, U., Helgerud, J., & Hoff, J. (1998) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199803000-00019 · Cited by 495
Severely increased risk of amyotrophic lateral sclerosis among Italian professional football players
Chio, A. (2005) · Brain · doi:10.1093/brain/awh373 · Cited by 484
Self-citationIncidence and prevalence of ALS in Ireland, 1995–1997: A population-based study
Traynor, B. J., Codd, M. B., Corr, B., Forde, C., Frost, E., & Hardiman, O. (1999) · Neurology · doi:10.1212/wnl.52.3.504 · Cited by 292
Profiling in Basketball: Physical and Physiological Characteristics of Elite Players
Ostojić, S. M., Mazic, S. D., & Dikic, N. V. (2006) · The Journal of Strength and Conditioning Research · doi:10.1519/r-15944.1 · Cited by 291
Occurrence of amyotrophic lateral sclerosis among Gulf War veterans
Horner, R. D., Kamins, K. G., Feussner, J. R., Grambow, S. C., Hoff-Lindquist, J., Harati, Y., Mitsumoto, H., Pascuzzi, R., Spencer, P. S., Tim, R., et al. (2003) · Neurology · doi:10.1212/01.wnl.0000069922.32557.ca · Cited by 277
Physiological and Performance Characteristics of Male Professional Road Cyclists
Mujika, I., & Padilla, S. (2001) · Sports Medicine · doi:10.2165/00007256-200131070-00003 · Cited by 223
Occurrence of amyotrophic lateral sclerosis among Gulf War veterans
Armon, C. (2007) · Neurology · doi:10.1212/01.wnl.0000260429.80237.c0 · Cited by 223
Research works printed but not linked: 3
- Al-Hazzaa HM, 2001, J Sports Med Phys Fitness., 41, 54
- Sallet P, 2005, J Sports Med Phys Fitness., 45, 291
- Ostojic SM, 2006, J Strenght Cond Res., 20, 740
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Ramsay, D. S. C., Miller, A., Baykeens, B., Hassan, H., & Gentleman, S. (2023) · Cureus · doi:10.7759/cureus.34279 · Cited by 8
Trojsi, F., Sagnelli, A., Vanacore, N., Piccirillo, G., Daniele, L., Izzo, F., Laiola, A., Costanzo, A. D., Savettieri, G., Monsurrò, M. R., et al. (2012) · Annali dell Istituto Superiore di Sanità · doi:10.4415/ann_12_03_09 · Cited by 8
Pradat, P., Attarian, S., Camdessanché, J.-P., Carluer, L., Cintas, P., Corcia, P., Echaniz‐Laguna, A., Gonzalez‐Bermejo, J., Guy, N., Nicolas, G., et al. (2010) · Revue Neurologique · doi:10.1016/j.neurol.2010.03.006 · Cited by 9
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Physical activity and amyotrophic lateral sclerosis: a Mendelian randomization study
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Association of the practice of contact sports with the development of amyotrophic lateral sclerosis
Henriques, A. R., Gromicho, M., Großkreutz, J., Kuźma‐Kozakiewicz, M., Petri, S., Uysal, H., Pinto, S., Antunes, M. C. D. S., de Carvalho, M. A., & Ribeiro, R. M. (2023) · Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · doi:10.1080/21678421.2023.2189911 · Cited by 8
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Luisetto, M., AL-Mukhtar, N. J., Rafa, A. Y., Nili-Ahmadabadi, B., Mashori, G. R., Khan, F. A., Sahu, R. K., Hamid, G. A., & Edbey, K. (2019) · Journal of Neuroscience and Neurological Disorders · doi:10.29328/journal.jnnd.1001019 · Cited by 6
Stipa, G., Ancidoni, A., Mazzola, M., Testai, E., Funari, E., Spera, C., Fanelli, C., Mancini, A., & Vanacore, N. (2021) · Brain Sciences · doi:10.3390/brainsci11020193 · Cited by 5
Chronisch Traumatische Enzephalopathie: Wie Sportverletzungen das Gehirn schädigen können
Gänsslen, A., Krutsch, W., Schmehl, I., & Rickels, E. (2016) · Deutsches Ärzteblatt · doi:10.3238/persneuro.2016.09.16.03 · Cited by 5
Common genetic basis of ALS patients and soccer players may contribute to disease risk
Ben‐Zaken, S., Nefussy, B., Meckel, Y., Eliakim, A., Nemet, D., Gotkine, M., Lorber, D., Zeev, A., & Drory, V. E. (2022) · Neurological Sciences · doi:10.1007/s10072-022-05990-4 · Cited by 5
Shaw, C. A. (2017) · Wiley eBooks · doi:10.1002/9781118634523.refs · Cited by 9
Schwartzenburg, J., Cruise, S. C., Reed, R. E., Hutchinson, C. M., Mirzalieva, O., Edwards, K. N., Edwards, S., Gilpin, N. W., Molina, P. E., & Desai, S. D. (2023) · Journal of Neurotrauma · doi:10.1089/neu.2023.0074 · Cited by 4
Mukhamedyarov, M. A., Khabibrakhmanov, A. N., & Zefirov, A. L. (2020) · Biochemistry (Moscow) Supplement Series A Membrane and Cell Biology · doi:10.1134/s1990747820030113 · Cited by 3
Golini, E., Marinelli, S., Pisu, S., Angelis, F. D., Vacca, V., Rava, A., Casola, I., Laurenzi, G., Rizzuto, E., Giuliani, A., et al. (2023) · Current Neurovascular Research · doi:10.2174/1567202620666230823095922 · Cited by 3
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Maggio, R., Fasciani, I., Coppolino, M. F., Petragnano, F., & Rossi, M. (2025) · Medical Hypotheses · doi:10.1016/j.mehy.2025.111732 · Cited by 2
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Lotti, F., & Przedborski, S. (2022) · Advances in neurobiology · doi:10.1007/978-3-031-07167-6_13 · Cited by 2
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Lotti, M., & Moretto, A. (2017) · Archives of Toxicology · doi:10.1007/s00204-017-1992-z · Cited by 2
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[A case report of FOLFOX treatment for primary duodenal carcinoma with multiple liver metastases].
Fujiwara, Y., Naomoto, Y., Tanabe, S., Sakurama, K., Noma, K., Nishikawa, T., Motoki, T., Takaoka, M., Shirakawa, Y., Yamatsuji, T., et al. (2009) · PubMed · Cited by 1
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Factor-Litvak, P. R. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-800228-5.00016-9 · Cited by 1
Joshua, A. M., Misri, Z., Prabhakar, A. J., Pai, S., & Nayak, P. (2022) · Medical Hypotheses · doi:10.1016/j.mehy.2022.110912 · Cited by 1
Federated sport activity in amyotrophic lateral sclerosis: a case-control study
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Gänsslen, A., & Rickels, E. (2016) · Trauma und Berufskrankheit · doi:10.1007/s10039-016-0150-9 · Cited by 1
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Chiò, A. (2016) · Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · doi:10.3109/21678421.2016.1172824 · Cited by 1
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Zetterström, P. (2011) · DiVA at Umeå University (Umeå University)
Exogenous risk factors for amyotrophic lateral sclerosis
Huisman, M. (2015) · Utrecht University Repository (Utrecht University)
Is there a link between physical activity and Amyotrophic Lateral Sclerosis?
Torre, G. L., & Masala, D. (2022) · Epidemiology Biostatistics and Public Health · doi:10.2427/11648
Harati, Y. (2009) · Journal of Clinical Neuromuscular Disease · doi:10.1097/cnd.0b013e3181c75e35
Baldwin, K. R. (2015) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York)
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Acosta‐Saltos, A. (2016) · UCL Discovery (University College London)
Wang, M. (2014) · uO Research (University of Ottawa) · doi:10.20381/ruor-3755
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Göricke, B., Frank, T., Schmidt, J., & Bähr, M. (2015) · Elsevier eBooks · doi:10.1016/b978-3-437-24265-6.00010-x
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Veronese, S., & Calvo, A. (2020) · Springer eBooks · doi:10.1007/978-981-15-5840-5_11
Self-citationHarati, Y. (2009) · Journal of Clinical Neuromuscular Disease · doi:10.1097/cnd.0b013e31819c7418
Nefussy, B., & Drory, V. E. (2012) · Advances in predictive, preventive and personalised medicine · doi:10.1007/978-94-007-5866-7_10
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Sghirlanzoni, A., & Genovese, U. R. (2012) · Springer eBooks · doi:10.1007/978-88-470-2074-0_13
Preece, A. (2009) · British Journal of Neuroscience Nursing · doi:10.12968/bjnn.2009.5.12.45653
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Gänsslen, A., Schmehl, I., Wieckhorst, B., & Kringler, W. (2023) · Springer eBooks · doi:10.1007/978-3-662-65600-6_38
Garzillo, E. M., Miraglia, N., Pedata, P., Feola, D., Sannolo, N., & Lamberti, M. (2025) · Giornale italiano di medicina del lavoro ed ergonomia · doi:10.4081/gimle.673 · Cited by 3
Bigard, X. A., & Vital, J.-M. (2025) · Bulletin de l Académie Nationale de Médecine · doi:10.1016/j.banm.2025.04.013
Malik, M., Bhatti, T., Hodson-Tole, E. F., Onambélé-Pearson, G. L., & Chaouch, A. (2025) · Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · doi:10.1080/21678421.2025.2488298
Age-period-cohort effect on motor neuron disease mortality in the United States, 2001–2020
Raymond, J. S., Larson, T. C., III, Nair, T., Kaufman, J., Horton, D. K., Weisskopf, M. G., Mohidul, S., & Mehta, P. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2025.1751690
Comprendre et modéliser la Sclérose Latérale Amyotrophique à début précoce
Muratet, F. (2022) · theses.fr (ABES) · doi:10.70675/9a7778aaz88c7z40b1z92d3zaf5699b86a09
Hergesheimer, R. C. (2021) · theses.fr (ABES) · doi:10.70675/89c77c60z44efz4d20z9890z4c8df03030ad
Basinas, I., Copsey, H., Carson, F., Brooker, F., Robertson, S., van Hoecke, Y., Kemp, S. P. T., Seghezzo, G., Pearce, N. E., Gallo, V., et al. (2026) · Annals of Work Exposures and Health · doi:10.1093/annweh/wxag032
Stipa, G., Colosimo, C., & Vanacore, N. (2026) · Journal of Neural Transmission · doi:10.1007/s00702-026-03202-3
Kennedy, J., Khleifat, A. A., King, A. P., Al-Sarraj, S., Al‐Chalabi, A., Mitchell, J. C., & Troakes, C. (2026) · Brain Communications · doi:10.1093/braincomms/fcag272
Metadata
- Authors
- Chiò, A., Calvo, A., Dossena, M., Ghiglione, P., Mutani, R., & Mora, G.
- Affiliations
- University of Turin (IT)
- University of Pavia (IT)
- Istituti Clinici Scientifici Maugeri (IT)
- Corresponding author
- Chiò, Adriano
- Venue
- Amyotrophic Lateral Sclerosis
- Publisher
- Informa UK Limited
- Published
- 2009-01
- Volume
- 10
- Issue
- 4
- Pages
- 205-209
- ISSN
- 1471-180X (ISSN-L)
- 1748-2968
- OpenAlex
- W2162616806
- Cited by
- 180
- References
- 30
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 4 · 2023: 12 · 2022: 14 · 2021: 14 · 2020: 5 · 2019: 12 · 2018: 9 · 2017: 13 · 2016: 14 · 2015: 17 · 2014: 8 · 2013: 10 · 2012: 11
- FWCI
- 7.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Amyotrophic Lateral Sclerosis (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- Ministero della Salute
- Topics
- Health Sciences › Medicine › Clinical Neurology › Amyotrophic Lateral Sclerosis Research
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- professional football players, basketball players, road cyclists, standardized morbidity ratio, dose-response relationship, age of onset, career length, physical activity
- MeSH terms
- Adult, Aged, Aged, 80 and over, Amyotrophic Lateral Sclerosis, Basketball, Bicycling, Humans, Italy, Male, Middle Aged, Occupational Diseases, Risk Factors, Soccer, Age of Onset, Young Adult
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