Narrative review: Comprehensive health assessment of retired martial arts athletes

Why this study matters

The authors write that most studies look at active athletes and that little is known about health after an athletic career ends, particularly in the Middle East. They note earlier findings that former athletes still have stronger bones than inactive people many years after retiring, and that retirement can bring less physical activity, weight gain, stress and insomnia. The study compared retired martial arts athletes with non-athletes of the same age on bone density, weight, diet, physical activity and wellbeing.

What the researchers did

The authors call the design a descriptive case-control study: two groups were measured once and compared. The first was 30 retired Jordanian male elite athletes from taekwondo, boxing, judo, karate and kickboxing, recruited through Jordanian martial arts federations. All were aged 40 to 50 and had not competed for at least 10 years. The second was 20 Jordanian men of the same age who were not athletes.

Each participant had a dual-energy X-ray absorptiometry (DEXA) scan, an X-ray scan that measures bone density, body fat and lean mass. For men under 50, bone results were given as Z-scores, which compare a person’s bone density with what is expected at their age. Participants also kept a food record for 3 days and completed questionnaires on physical activity, quality of life, happiness, perceived stress and insomnia. Weight change was worked out differently in the two groups: athletes’ current weight was compared with the weight category they used to compete in, and non-athletes’ with their weight 10 years earlier.

What they found

Bone density was higher in the retired athletes. Their mean Z-score at the neck of the left thigh bone was 0.32, against -0.56 in non-athletes. At the lower spine it was -0.15, against -1.15. All 30 retired athletes had bone density in the normal range. Among non-athletes, 65% were in the normal range, 20% had abnormal bone density and 15% had osteopenia, meaning bone density below normal but not as low as osteoporosis.

Current weight was similar in the two groups: 88.03 kg in retired athletes and 90.3 kg in non-athletes. The change over time was not. Retired athletes weighed on average 18.55 kg more than at their last competition, and non-athletes 4.3 kg more than 10 years earlier. Retired athletes had less body fat (24.11 kg against 30.04 kg). On the activity questionnaire, all non-athletes and 30% of retired athletes were classed as insufficiently active, and 20% of retired athletes as highly active. Food records showed higher intakes of energy, protein and carbohydrate in retired athletes, and both groups fell short of recommended intakes for most vitamins and minerals.

The mean perceived stress score was higher in retired athletes (2.36 against 2.15), a statistically significant difference, meaning one unlikely to be due to chance alone. Insomnia scores were nearly the same (1.17 in retired athletes and 1.22 in non-athletes). The authors report that 30% of each group had a low level of insomnia, and that 10% of retired athletes and 25% of non-athletes had a moderate level. Quality of life and happiness scores did not differ significantly.

Strengths and limits

The study measured bone and body composition with a scanner and did not rely on questionnaires alone. It also compared the retired athletes with men of the same age from the same country.

The authors, who describe the study as preliminary, state several limits. The sample was small, which makes real differences harder to detect, and it was too small to look at each martial art separately. Vitamin D deficiency and thyroid problems were asked about, not tested with blood samples. Diet, activity and wellbeing were self-reported, and the authors note that people may overstate or understate their own behaviour.

Other limits follow from the design. Each person was measured once, so the study cannot show that a sports career caused the differences. All participants were men aged 40 to 50 in Jordan. Weight change had a different starting point in each group. The article is also not always consistent: for one bone measure, its text and its table give different values for non-athletes.

What it adds to research on fighter health

The study gives measurements in men who left combat sports at least 10 years earlier, a group the authors say has had little research. On sleep, it found no statistically significant difference in insomnia scores between the groups. Other results pointed in different directions: higher bone density and less body fat in the retired athletes, and more weight gain and higher perceived stress. The study pooled five martial arts and gives no separate results for boxers or kickboxers. The authors call for more research, including studies of retired female athletes.