Objective Self-reported concussion history (SR-CHx) is often associated with adverse daily functioning. We hypothesized that greater SR-CHx would relate to worse cognitive, behavioral, and emotional function; and that health-promoting behaviors of regular physical activity, adequate sleep, and diet quality would relate to better function in former National Football League (NFL) players with varying SR-CHx.

Design Cross-sectional.

Setting A paper/web-based survey.

Participants Former NFL players (n=1784; age=52.3±16.3years; years since retirement (YSR)=24.0±15.6; total years playing football (TYP)=17.5±4.5).

Independent Variables SR-CHx (5-groups: 0, 1–2, 3–5, 6–9, 10+), combined sessions/week participating in moderate-vigorous cardiovascular exercise and resistance-training (no session duration specified), average nightly hours of sleep, and diet quality (Rapid Eating Assessment for Participants-Shortened).

Outcome Measures Primary outcomes were: Cognitive Function (CF; higher=better), Emotional-Behavioral Dyscontrol (EBD; higher=worse), and Depression (higher=worse) from validated PROMIS measures. Multivariable linear regressions were employed for each outcome and adjusted R²-values, p-values, and standardized beta-values (b) were calculated. Predictors entered in each model were: SR-CHx, exercise frequency, sleep duration, and diet quality. Covariates included YSR and TYP.

Main Results SR-CHx was associated with worse CF, EBD, and depression (b’s=-0.35, 0.28, 0.28, respectively; p’s<0.001). Conversely, exercise (b’s=0.15, -0.13, -0.16, respectively), sleep duration (b’s=0.11, -0.16, -0.14, respectively), and diet quality (b’s=0.10, -0.14, -0.15, respectively) were all associated with better function (all p’s<0.001). Adjusted R²-values were 0.20 (CF), 0.17 (EBD), and 0.18 (depression).

Conclusions Health-promoting behaviors such as exercise, sleep and diet may help improve the reported declines in cognitive function associated with SR-CHx.