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A new study of college football players suggests that repeated blows to the head cause “abnormal regulation of inflammation, less coordinated movement and abnormalities in how cells produce energy,” according to a press release.

The study, published yesterday in iScience, was conducted by researchers at Northwestern Medicine, Pennsylvania State University, Purdue University, Orlando Regional Medical Center, the University of Cincinnati, the University of Rochester and Indiana University. Research was conducted on 23 college athletes who had their blood drawn and took part in coordination testing before and after the football season. Researchers also attached sensors to players’ helmets for all practices throughout the season to monitor and record impact to the athletes’ heads.

Of the players tested, all had at least a decade of football experience, including their time in college. The press release noted that “regardless of history of concussion,” athletes playing impact sports, such as football, “have chronic problems” due to repeated head trauma.

“These findings support over a decade of reports about the negative effects of repetitive head impacts along with studies of animal brain injury,” co-senior author Dr. Hans Breiter, professor of psychiatry and behavioral sciences at the Northwestern University Feinberg School of Medicine, said in a news release. “At this point, it appears the canary is dead in the coal mine.”

Scientists aim to expand the study in the future with a larger cohort.

“Ultimately, the goal is to develop preventative interventions that minimize abnormal changes in the brain that have been observed in studies of contact sport athletes time and time again,” co-lead author Nicole Vike, a postdoctoral fellow at the department of psychiatry and behavioral sciences at Northwestern, said in the press release. “Collectively, we need to use interdisciplinary approaches, like those used here, to better quantify the unseen damage of contact sports.”