The Legacy of Olympic Sport: A Cross-Sectional Comparison of the Musculoskeletal and General Health of 1488 Retired Female Summer and Winter Olympians and 998 Female General Population Controls

BACKGROUND: Little is known about the long-term health outcomes associated with sustained elite performance once female Olympians retire from their Olympic careers. OBJECTIVE: The aim of this study was to determine and compare (1) musculoskeletal health, (2) general health and (3) current physical activity (PA) behaviours between a global sample of female retired Olympians and general population controls. METHODS: A cross-sectional survey comprised four sections: (1) background information, (2) injury history, (3) current musculoskeletal health and (4) general health. A total of 1488 retired female Olympians and 998 female controls completed the survey. Poisson regression analysis was used to determine prevalence ratios (aPR) with 95% confidence intervals (CI) adjusted for age, body mass index (BMI) and/or previous significant injury or current persistent pain. RESULTS: Adjusting for age, BMI and previous significant injury, more retired female Olympians reported stiffness, pain and/or osteoarthritis (OA) (aPR [95% CI]) in the cervical spine (stiffness 1.42 [1.08-1.86]; OA 1.85 [1.01-3.39]), lumbar spine (stiffness 1.41 [1.18-1.67], pain 1.41 [1.15-1.73]) and hip (OA 1.82 [1.08-3.06]) compared with controls. Stiffness, pain and OA at the knee were also higher for Olympians, but not when adjusting for prior injury. No differences were observed between groups for self-reported disease states, however the prevalence of most health conditions increased among Olympians following retirement, except for depression which decreased. Both groups rated their health-related quality of life (retired female Olympians: 88/100; Controls: 89/100) and mental health similarly, while the prevalence of participation in weekly sport (aPR: 0.75 [0.66-0.85]) and physical activity (aPR: 0.91 [0.87-0.95]) was slightly lower in retired Olympians when adjusted for age, BMI and current persistent musculoskeletal pain. CONCLUSIONS: Retired female Olympians report poorer musculoskeletal health than the general population, a difference only partly attributable to previous significant injury, which suggests elements of elite athletic exposure may underlie some of these outcomes. Primary and secondary prevention of shoulder, hip and knee injuries remains a priority with consideration to long-term outcomes. Future research should broaden our understanding of retired female athlete health by exploring the largely under-researched domains of cognitive, reproductive, breast and pelvic floor health.