Football linemen work diligently in the weight room with strength coaches during their competitive years to put on muscle mass and become bigger, stronger, and more powerful. As a result, in the past 20 years, the body weight of college football lineman has increased at an alarming rate (11). For example, at the University of Kansas, the average weight of the starting offensive line was 260 pounds in 1985. In the 2007 season, the offensive linemen weighed an average of 293 pounds, an increase of 33 pounds in just 2 decades (7). A closer evaluation of these large athletes for potential health risks may be warranted.
Football training programs are aimed at improving athletic strength and power. To accomplish this goal, training typically has been designed to emphasize anaerobic training and provide high-calorie diets aimed at body mass gains. This type of training does add lean body mass, but the high-calorie diet often results in a substantial increase in fat mass (8,23) and that gain can lead to pathogenic chronic health consequences later in life as a result of obesity-related illnesses. An additional factor compounding the problem is that athletes may continue to consume a huge amount of calories even though their activity level is drastically reduced once they stop competing. Because the large stature and body mass of college football lineman can be associated with future health problems, it is important to provide athletes with a reconditioning plan they can use to reduce and/or avoid this problem in the future. The purpose of this article is to define the magnitude of the problem in active National Collegiate Athletic Association (NCAA) collegiate linemen.
OBESITY AND METABOLIC SYNDROME
Although competitive collegiate student-athletes might be assumed to be sheltered from risks of cardiovascular disease, a recent study by Buell et al. (5) found a high incidence of metabolic syndrome and other associated adverse biomarkers for heart disease in current collegiate football linemen. Of the 70 athletes participating in the study, 34 were identified as having metabolic syndrome according to measures of blood pressure, waist circumference, fasting glucose, high-density lipoprotein, and triglycerides. If the present physical activity of current football linemen does not seem to give enough protective benefit to avoid metabolic syndrome, this creates an even greater concern for these athletes when they retire from football. The findings of Buell et al. (5) should generate significant doubt about the presumed health of current and postcompetitive collegiate football linemen.
Metabolic syndrome is a name given to a cluster of interrelated metabolic risk factors that are frequent among those who have a high potential to develop or who already have coronary heart disease (14). Metabolic syndrome is diagnosed when a patient exhibits 3 of the following: elevated waist circumference (>40 inches), elevated triglycerides (>150 mg/dL), low high-density lipoprotein cholesterol (<40 mg/dL), elevated blood pressure (130/85 or higher), and elevated fasting glucose (fasting glucose >100 mg/dL) (10). Although the players having an abnormal lipid profile were not identified (11), they did indicate that offensive linemen had the highest total cholesterol (TC) levels: the TC of offensive linemen being 185 mg/dL, whereas kickers, punters, and quarterbacks averaged 145 mg/dL.
Unhealthy eating habits can increase the magnitude of the body weight problem and add to potential future problems with health. Individuals with more abdominal fat tend to have a more adverse metabolic profile and an increased risk for diabetes and coronary heart disease (14). In a study assessing body fat percentages of Division I collegiate football players, offensive and defensive lineman averaged body fat percentages that places them in the obese range (>25%) (18). A significant amount of fat carried by these players was deposited in the abdominal region (18). Centrally located fat is termed visceral fat and is an important measure to consider because the relationship between this form of fat distribution to metabolic abnormalities and disease is well recognized (18). Individuals with more visceral fat tend to have a more adverse metabolic profile and an increased risk for diabetes and coronary heart disease (14). Although the eating habits of the players in the study by Noel et al. (18) were not examined, poor food choices (and likely large amounts of food consumed) by their subjects could have attributed to the higher percentage of fat they had. In a study evaluating the eating habits of 31 freshman football players, researchers found that players ate out 4.8 times per week with fast food as the most popular choice when eating away from home (11). In fact, 1 in 4 athletes (24%) was found to have abnormal plasma lipid profiles, a major risk factor for the development of coronary heart disease (11).
Although the “bigger is better” philosophy of training may be the accepted norm for improving football performance, it can lead to an increase in abdominal obesity (18) and higher body fat percentages (23) among athletes. Players who have adopted these habits to gain weight for football do not always shake them postcompetitively, and in most cases, greatly reduce or cease training once they quit playing. The combination of high-calorie intake with low training levels can eventually result in their placement in the high-health risk category (14).
To help prevent these problems, a reconditioning process is needed that can help the athlete return to their preconditioned state (13). The reconditioning process starts with the exit physical/interview, identifies potential psychological problems, and requires the structuring of a team of professionals to make up the reconditioning team.
THE RECONDITIONING PROCESS
THE EXIT PHYSICAL
The exit physical can be a crucial tool for assessing the health and wellness of postcompetitive athletes as the first step of the reconditioning process. The areas of assessment we recommend are given in the Table. Ultimately, a risk factor analysis should be developed and performed on all players finishing their eligibility. The inclusion of some additional tests would help screen for athletes who are at risk and could serve as baseline tests for long-term follow-up.
Part of the exit physical testing procedure should include an exit body weight and should be compared with the athlete's program entry body weight to determine how much weight gain occurred. The inclusion of pre- and postbody composition tests, such as skinfolds and girth measurements, would provide a more complete picture of health (1). As noted earlier, visceral fat is located inside the abdominal wall and contributes more to the risk of cardiovascular disease and diabetes than does fat located in any other area (2). One simple way to measure the risk of too much visceral fat is through a waist circumference measurement. This measurement has been shown to be a good predictor of disease risk (21). A cardiovascular fitness test would also be a beneficial addition to the exit physical because it would give a more complete picture of an athlete's health at the end of their competitive years. Although cardiorespiratory problems are rare in this group of athletes, this test would give a reliable baseline for long-term follow-up. An exercise treadmill stress test that includes a 12-lead electrocardiogram is an ideal exit test for college football lineman (1,13), but it requires a physician or exercise physiologist with the appropriate testing equipment and maybe too expensive to be practical for some programs. However, costs should not be a concern when it relates to the future health and well-being of a student-athlete.
The Harvard Step Test is a health-related field test that also measures cardiorespiratory fitness and is a good indicator of the athlete's ability to recover after strenuous exercise. It could be more easily administered than the treadmill stress test, it could be conducted in the training room, and the costs would be much lower. Cardiovascular fitness can be lost quickly as the athlete detrains, and these baseline values would help them realize the importance of maintaining some form of training. The Young Men's Christian Association (YMCA) sit and reach test is easily administered (26) and comparisons can be made with the athlete's initial evaluation/health screening as well as normative data.
The results of these additional tests will enable strength and conditioning/sports nutrition staff to put together a reconditioning action plan that will establish the best approach for the individual. It will also provide the athlete with a training/nutrition strategy that will enable them to return to a noncompetitive lifestyle without endangering their health.
The reconditioning process is more complicated than a simple change in the exercise routine. The literature indicates that athletic retirement can also result in psychological and emotional difficulties (3,19,24). Blinde and Streatta (3) documented the overpowering identity loss and despair that collegiate athletes suffered when they were cut or their programs were terminated. The identity alterations that can be developed along with the commitment crucial for athletic excellence generally come at the cost of the exploration of and investment in other age-appropriate or available roles or activities. This neglect or atrophy of other roles as an outcome of the ascendancy of a single role may expose the individual to subsequent identity issues.
Counseling can help fight postcompetition depression (24). However, researchers have shown that student-athletes are often hesitant to seek help from a counselor (4). Therefore, in dealing with college student-athletes, it is often necessary for the strength and conditioning/sports nutrition staff to be proactive. To help the postcompetitive athlete with their transition as they negotiate their new sense of self, the strength and conditioning coach and other members of the reconditioning team can be very important to the athletes' emotional stability. The diversified role of the recovery team during the transition period can be divided into several areas, which are all inclusive in the reconditioning process (9):
- Communication with the athletic trainers, sport psychologists, and sport nutritionists.
- Constant interaction with the postcompetitive athlete.
- Training directed toward body mass reduction and maintenance, and fitness for health.
It may be prudent to establish a specialized position for a strength and conditioning coach in charge of reconditioning. This may be difficult for some programs but football programs that compete in the bowl championship series could dedicate budgetary resources to institute this important position.
THE RECONDITIONING TEAM
There must be a strong partnership among athletic trainers, counselors, sport nutritionists, sport psychologists, and strength and conditioning specialists to collaborate and formulate an initial screening program for players after the completion of their eligibility. Thus, a group or team of postathletic career specialists could be formed, having a responsibility to assist the athlete in “reconditioning for life,” particularly as it applies to football lineman and other large athletes such as track and field throwing athletes. Having a “reconditioning process” including a risk factor analysis and reconditioning team will provide the necessary tools to address health risks for oversized football players.
Research indicates that communication involving a number of professionals is important (15). The roles of all the team players except the athletic trainer have been discussed. In most sport settings, the athletic trainer is often the first member of the health care team with whom the athlete interacts (25). Studies reflect that of all the individuals comprising the reconditioning team, athletic trainers usually have the most influential relationship with the athlete relating to issues like health and wellness (6). Athletes identified athletic trainers as the primary source of nutrition information over strength and conditioning coaches and nutritionists (6). Most importantly, athletic trainers are involved in pre- and postparticipation health evaluations (12). Athletic trainers typically perform what is termed an exit physical following the completion of the playing season to evaluate an athlete's overall health. While athletic trainers reported that they did not necessarily feel qualified to attend to all athlete issues, they also perceive that their own roles as caregivers go beyond prevention and rehabilitation of athletic injuries (15). Thus, part of the responsibility for athletic trainers should be aimed at helping the athlete work with his or her strength and conditioning coach and other members of the reconditioning team.
THE NEED TO ESTABLISH A NEW NATIONAL COLLEGIATE ATHLETIC ASSOCIATION POLICY
The NCAA has made strides within its legislation to protect the health of intercollegiate athletes: drug tests condemn the misuse of harmful legal and illegal substance abuse, and educational program implementation gives both athletes and coaches the knowledge to prevent health-related problems (17). In fact, it were safety concerns about the early game of football and its notorious “flying wedge” formation that led to the establishment of the NCAA during the first decade of the 20th century (16). Although much of the attention from the NCAA has been directed toward sports that require lower body masses such as gymnastics or wrestling, protecting at-risk football players from a lifetime of health complications has become more of an NCAA priority. The 2001 ruling that restricted member institutions from providing athletes with supplements such as creatine and protein (17) is a good example of this policy shift. Although the NCAA change in policy does not appear to be based on sound evidence (20,22), it does point out the NCAA concern for the well-being of athletes. Similar concerns for postcollegiate lifestyle alterations should arguably be part of the policy of the NCAA.
Because the lifestyle habits adopted while in the sport can put athletes at risk on completion of collegiate eligibility, a program to educate and retrain them should be initiated (13). Making a reconditioning program part of mandated NCAA legislation would go a long way in ensuring that football athletes and other power athletes who graduate from college are better informed when it comes to developing lifelong healthy habits. Unfortunately, it does not appear that the passage of such legislation will occur in the foreseeable future because there has not been a strong enough push for the development of NCAA legislation in the area of reconditioning linemen in football. One plausible reason for the seemly slow development of NCAA and member institution policy to deal with the super-sized football players is that the health risks posed to the athlete seemingly arise after eligibility. In contrast, of more immediate concern to NCAA policy makers has been athletes facing acute health risks associated with rapid reduction of body weight in sports like cross country, gymnastics, and wrestling. Until a reconditioning program becomes legislated as official policy, we propose that universities take the initiative and create a reconditioning program and place the program under the combined supervision of strength and conditioning professionals, sport medicine staff, sport nutritionists, and sport psychologists with the strength and conditioning staff, leading the administration of the program. Early screening, awareness, and intervention may have positive effects on the overall future health outcomes of football linemen (5).
The future health of football linemen warrants more preventive consideration than it may be receiving. There is no reason for a football lineman to emerge from collegiate athletics participation to be overweight and so out of shape that he is out of breath walking up a flight of stairs. As early as 1983, Kraemer (13) formulated 10 components for a reconditioning program for athletes finishing their competitive career in high-performance sport, which have lost nothing of their importance with the passage of time. In fact, they are more important than ever in 2010. After the final game of the season, colleges and universities have a responsibility to initiate a reconditioning program and prepare the exiting lineman for a healthy life after football. This program must be initiated during the spring semester, and the lineman should begin to be reconditioned before he or she leaves campus. Once the athlete leaves campus, it would be his responsibility to continue the process and take responsibility for his or her future health and wellness.
Athletes at risk for metabolic syndrome must be counseled about the related risks and educated about lifestyle alternatives that may decrease this risk (5). A detraining booklet should be developed and given to the athlete when they leave campus for future reference (13). This booklet should contain prepared materials including reading lists and other important information that will help lead the athlete toward a healthy lifestyle in the future. After the reconditioning/retraining program, it is then up to the individual to choose the sporting activity that suits him best. The responsibility of the university stops once they provide the guidance and the student leaves the university on track for a healthy future. The postcompetitive athlete can then embark into a new training program in the activity of his or her choice. The key is to stay active and have a plan.
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