Table 1.
Summary of current epidemiological evidence investigating the association between physical activity and Amyotrophic Lateral Sclerosis
| References | Setting Study design |
Sample | Main association | Confounders |
|---|---|---|---|---|
| Pupillo et al. [14] | Europe Population-based case–control study |
652 ALS cases and 1166 controls | Total PA OR 0.65 (0.48–0.89) |
Models adjusted for age, education, BMI, register, interview, traumatic events, coffee, alcohol, smoking, and work-related PA |
| Yu et al. [15]a | Michigan (USA) Case–control study (controls recruited through health-related website) |
66 ALS cases and 66 matched controls (sex and age) | High PA intensity in the past 30 years OR 5.98 (0.38–93.3) | |
| Gotkine et al. [16]b | Jerusalem, Israel Comparison of self-reported exposure to Triathlon in a case series with nationwide number of participants in the total population |
185 cases of ALS and total Israeli population in 2011 (3,493,700) | OR for participation in triathlon 16.2 (5.6–36.4) | – |
| Huisman et al. [10]c | The Netherlands Population-based case–control study |
636 ALS cases and 2166 controls | Total PA adjusted OR 1.02 (0.98–1.06) Leisure time PA OR 1.08 (1.02–1.14) Occupational PA OR 1.00 (0.96–1.04) Vigorous PA OR 1.24 (0.96–1.61) |
Models adjusted for gender, age, BMI, current smoking, current alcohol consumption, and level of education |
| Lehman et al. [7] | USA Standardised mortality ratios among professional American Football players |
7 ALS deaths among 3439 American football players | SMR 4.31 (1.73–8.87) | |
| Vanacore et al. [17] | USA Case–control study on the US mortality dataset |
14,628 ALS deaths and 58,512 matched controls (age, gender and geographic area) | OR for intense PA at work 0.95 (99 % CI 0.86–1.04) in men and 1.00 (99 % CI 0.82–1.20) in women | |
| Chio’ et al. [18]d | Italy Standardised mortality ratios among football, basketball player and road cyclist |
8 ALS cases among 7325 football players; no ALS cases among 1973 basketball players and 1701 road cyclists | SMR for football players 6.45 (95 % CI 2.78–12.70) | |
| Okamoto et al. [11] | Japan Population-based case control study |
183 ALS cases and 366 matched controls (age and gender) | Vigorous physical activity OR 2.0 (95 % CI 1.0–4.0) | Age, sex, bone fracture, “hate to lose personality”, self-reported stress, type A personality, smoking, alcohol, intake of green/yellow vegetables |
| Chio’ et al. [6] | Italy Standardised mortality ratios among football players |
5 ALS cases among 7325 football players | SMR 6.5 (95 % CI 2.1–15.1) | |
| Valenti et al. [19] | Italy Population-based case–control study |
300 ALS cases and 300 matched controls (age and sex) | Any sport OR 0.38 (95 % CI 0.25–0.58) | |
| Veldink et al. [12] | Netherlands Case–control study (cases chose their own controls) |
219 ALS cases and 254 controls | Cumulative occupational PA OR 4th versus 1st quartile 1.07 (estimated 95 % CI 0.9–4.0) Cumulative leisure PA OR 4th versus 1st quartile 0.8 (estimated 95 % CI 0.6–1.8) |
Sex, age, level of education, smoking, alcohol use, and premorbid body mass index (BMI) |
| Scarmeas et al. [20] | New York (USA) Hospital-based case–control study (controls with other neurological diseases) |
431 ALS cases and 152 controls (but analyses based on smaller numbers) | Varsity athlete OR 1.89 (95 % CI 1.05–3.40) Based on 232 cases and 121 controls |
Age, sex, always slim, BMI |
| Longstreth et al. [8] | Washington (USA) Washington state Population-based case–control study |
174 ALS cases and 348 matched controls (sex and age) | Lifetime PA in the workplace OR 3rd versus 1st tertile 1.07 (95 % CI 0.57–2.03) Lifetime leisure PA OR 3rd versus 1st tertile 1.46 (95 % CI 0.89–2.39) Participation in organised sports during high school OR 1.52 (95 % CI 1.03–2.25) |
Education |
| Strickland et al. [9] | Minnesota (USA) Semi-population-based semi-hospital-based case–control study |
25 ALS cases and 50 controls: 25 hospital-based and 25 population-based | Having received recognition for organised sport participation at school OR 30 (95 % CI 1.04–9.30) How often did PA case you to sweat at work in your twenties OR for trend across 5 categories 1.60 (95 % CI 1.1–2.4) How often did you sweat during leisure time PA in your twenties OR for trend across 5 categories 1.60 (95 % CI 1.1–2.5) |
aSingle sports (jogging/running, cycling, swimming, aerobic dancing, recreational dancing, calisthenics, gardening, weightlifting, soccer, football, baseball, field hockey, golf, ice hockey, tennis, boxing, wrestling) also tested yielding to non-significant differences between cases and controls
bSevere flaws in the study as the study design is not appropriate and prevalence of triathlon in the general population is likely to be overestimated (ever registered with the triathlon association)
cNone of the variables were associated with ALS survival
dData on football players are an update of the study published on Brain 2005; 128: 472–476