Skip to main content
SpringerLink
Log in

Amyotrophic lateral sclerosis among cross-country skiers in Sweden

  • NEURO-EPIDEMIOLOGY
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

A highly increased risk of amyotrophic lateral sclerosis (ALS) has been suggested among professional athletes. We aimed to examine whether long distance cross-country skiers have also a higher risk of ALS and whether the increased risk was modified by skiing performance. We followed 212,246 cross-country skiers in the Swedish Vasaloppet cohort and a random selection of 508,176 general Swedes not participating in the Vasaloppet during 1989–2010. The associations between cross-country skiing as well as skiing performance (i.e., type of race, finishing time and number of races) and the consequent risk of ALS were estimated through hazard ratios (HRs) derived from Cox model. During the study, 39 cases of ALS were ascertained among the skiers. The fastest skiers (100–150 % of winner time) had more than fourfold risk of ALS (HR 4.31, 95 % confidence interval [CI] 1.78–10.4), as compared to skiers that finished at >180 % of winner time. Skiers who participated >4 races during this period had also a higher risk (HR 3.13, 95 % CI 1.37–7.17) than those participated only one race. When compared to the non-skiers, the fastest skiers still had a higher risk (HR 2.08, 95 % CI 1.12–3.84), as skiers who had >4 races (HR 1.88, 95 % CI 1.05–3.35), but those finishing at >180 % of winner time had a lower risk (HR 0.46, 95 % CI 0.24–0.87). In conclusion, long distance cross-country skiing is associated with a higher risk of ALS, but only among the best skiers; recreational skiers appear to have a largely reduced risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chio A, Benzi G, Dossena M, Mutani R, Mora G. Severely increased risk of amyotrophic lateral sclerosis among Italian professional football players. Brain. 2005;128:472–6.

    Article  PubMed  Google Scholar 

  2. Abel EL. Football increases the risk for Lou Gehrig’s disease, amyotrophic lateral sclerosis. Percept Mot Skills. 2007;104:1251–4.

    PubMed  Google Scholar 

  3. Chio A, Calvo A, Dossena M, Ghiglione P, Mutani R, Mora G. ALS in Italian professional soccer players: the risk is still present and could be soccer-specific. Amyotroph Lateral Scler. 2009;10:205–9.

    Article  PubMed  Google Scholar 

  4. Lehman EJ, Hein MJ, Baron SL, Gersic CM. Neurodegenerative causes of death among retired National Football League players. Neurology. 2012;79:1970–4.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Al-Chalabi A, Leigh PN. Trouble on the pitch: are professional football players at increased risk of developing amyotrophic lateral sclerosis? Brain. 2005;128:451–3.

    Article  PubMed  Google Scholar 

  6. Bassini A, Cameron LC. Sportomics: building a new concept in metabolic studies and exercise science. Biochem Biophys Res Commun. 2014;445:708–16.

    Article  CAS  PubMed  Google Scholar 

  7. Dupuis L, Pradat PF, Ludolph AC, Loeffler JP. Energy metabolism in amyotrophic lateral sclerosis. Lancet Neurol. 2011;10:75–82.

    Article  CAS  PubMed  Google Scholar 

  8. McKee AC, Gavett BE, Stern RA, et al. TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J Neuropathol Exp Neurol. 2010;69:918–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Hazrati LN, Tartaglia MC, Diamandis P, et al. Absence of chronic traumatic encephalopathy in retired football players with multiple concussions and neurological symptomatology. Front Hum Neurosci. 2013;7:222.

    Article  PubMed  PubMed Central  Google Scholar 

  10. McKee AC, Cantu RC, Nowinski CJ, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68:709–35.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jordan BD, Relkin NR, Ravdin LD, Jacobs AR, Bennett A, Gandy S. Apolipoprotein E epsilon4 associated with chronic traumatic brain injury in boxing. JAMA. 1997;278:136–40.

    Article  CAS  PubMed  Google Scholar 

  12. Jordan BD. Chronic traumatic brain injury associated with boxing. Semin Neurol. 2000;20:179–85.

    Article  CAS  PubMed  Google Scholar 

  13. Farahmand BY, Ahlbom A, Ekblom O, et al. Mortality amongst participants in Vasaloppet: a classical long-distance ski race in Sweden. J Intern Med. 2003;253:276–83.

    Article  CAS  PubMed  Google Scholar 

  14. Ludvigsson JF, Andersson E, Ekbom A, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Chio A, Ciccone G, Calvo A, et al. Validity of hospital morbidity records for amyotrophic lateral sclerosis. A population-based study. J Clin Epidemiol. 2002;55:723–7.

    Article  PubMed  Google Scholar 

  16. Felmus MT, Patten BM, Swanke L. Antecedent events in amyotrophic lateral sclerosis. Neurology. 1976;26:167–72.

    Article  CAS  PubMed  Google Scholar 

  17. Granieri E, Carreras M, Tola R, et al. Motor neuron disease in the province of Ferrara, Italy, in 1964–1982. Neurology. 1988;38:1604–8.

    Article  CAS  PubMed  Google Scholar 

  18. Roelofs-Iverson RA, Mulder DW, Elveback LR, Kurland LT, Molgaard CA. ALS and heavy metals: a pilot case-control study. Neurology. 1984;34:393–5.

    Article  CAS  PubMed  Google Scholar 

  19. Gregoire N, Serratrice G. Risk factors in amyotrophic lateral sclerosis. Initial results apropos of 35 cases. Rev Neurol (Paris). 1991;147:706–13.

    CAS  PubMed  Google Scholar 

  20. Savica R, Parisi JE, Wold LE, Josephs KA, Ahlskog JE. High school football and risk of neurodegeneration: a community-based study. Mayo Clin Proc. 2012;87:335–40.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Huisman MH, Seelen M, de Jong SW, et al. Lifetime physical activity and the risk of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry. 2013;84:976–81.

    Article  PubMed  Google Scholar 

  22. Haley RW. Excess incidence of ALS in young Gulf War veterans. Neurology. 2003;61:750–6.

    Article  PubMed  Google Scholar 

  23. Horner RD, Kamins KG, Feussner JR, et al. Occurrence of amyotrophic lateral sclerosis among Gulf War veterans. Neurology. 2003;61:742–9.

    Article  CAS  PubMed  Google Scholar 

  24. Weisskopf MG, O’Reilly EJ, McCullough ML, et al. Prospective study of military service and mortality from ALS. Neurology. 2005;64:32–7.

    Article  CAS  PubMed  Google Scholar 

  25. Blennow K, Hardy J, Zetterberg H. The neuropathology and neurobiology of traumatic brain injury. Neuron. 2012;76:886–99.

    Article  CAS  PubMed  Google Scholar 

  26. Carlsson S, Olsson L, Farahmand BY, Hallmarker U, Ahlbom A. Skiers in the long-distance ski race invest in their health. Lakartidningen. 2007;104:670–1.

    PubMed  Google Scholar 

  27. Kirkinezos IG, Hernandez D, Bradley WG, Moraes CT. Regular exercise is beneficial to a mouse model of amyotrophic lateral sclerosis. Ann Neurol. 2003;53:804–7.

    Article  PubMed  Google Scholar 

  28. Pupillo E, Messina P, Giussani G, et al. Physical activity and ALS. A European population-based, case-control study. Ann Neurol. 2014;75:708–16.

    Article  PubMed  Google Scholar 

  29. del Aguila MA, Longstreth WT Jr, McGuire V, Koepsell TD, van Belle G. Prognosis in amyotrophic lateral sclerosis: a population-based study. Neurology. 2003;60:813–9.

    Article  PubMed  Google Scholar 

  30. Fang F, Chen H, Wirdefeldt K, et al. Infection of the central nervous system, sepsis and amyotrophic lateral sclerosis. PLoS One. 2011;6:e29749.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Peters TL, Fang F, Weibull CE, Sandler DP, Kamel F, Ye W. Severe head injury and amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2013;14:267–72.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the Swedish Research Council, the Swedish Society for Medical Research and the Karolinska Institutet.

Author information

Authors and Affiliations

  1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77, Stockholm, Sweden

    Fang Fang

  2. Department of Internal Medicine, Mora Hospital, Mora, Sweden

    Ulf Hållmarker

  3. Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden

    Ulf Hållmarker & Stefan James

  4. Department of Neurology, Karolinska University Hospital, Stockholm, Sweden

    Caroline Ingre

  5. Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden

    Caroline Ingre

  6. Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden

    Karl Michaëlsson

  7. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Anders Ahlbom & Maria Feychting

Authors
  1. Fang Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulf Hållmarker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan James
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Caroline Ingre
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karl Michaëlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anders Ahlbom
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria Feychting
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fang Fang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fang, F., Hållmarker, U., James, S. et al. Amyotrophic lateral sclerosis among cross-country skiers in Sweden. Eur J Epidemiol 31, 247–253 (2016). https://doi.org/10.1007/s10654-015-0077-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-015-0077-7

Keywords

Search

Navigation