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Tanous DR, Motevalli M, Leitzmann C, Wirnitzer G, Rosemann T, Knechtle B, Wirnitzer K. Dietary Habits and Race Day Strategies among Flexitarian, Vegetarian, and Vegan Recreational Endurance Runners: A Cross-Sectional Investigation from The NURMI Study (Step 2). Nutrients 2024; 16:1647. [PMID: 38892580 PMCID: PMC11174902 DOI: 10.3390/nu16111647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Many of today's recreational runners have changed their diet from omnivorous to vegetarian or vegan for reasons like better sport performance, animal ethics, positive health, eco-aspects, or male infertility. Others have constructed the flexitarian diet due to current trends in sustainable eating. The aim of this investigation was to analyze the dietary habits and race day strategies of recreational endurance runners following current sustainable dietary trends. Recreational endurance runners (18+ years) were invited to complete the standardized online survey on socio-demography/anthropometry, motivations, running/racing history, food frequency, and race day dietary strategy. Chi-squared tests and Wilcoxon tests were used for the statistical analysis. In total, 289 participants submitted the survey; 146 subjects following flexitarian (n = 34), vegetarian (n = 50), or vegan (n = 62) diets were included in the final sample. Significant differences were found across the diet types: BMI (p = 0.018), fruit/vegetable consumption (p < 0.001), and the dietary motive of performance (p = 0.045). The findings suggest that the flexitarian diet may be appropriate for health- and environmentally conscious populations living in a meat-centered society and lacking social support to eat completely vegetarian/vegan. Following a plant-based diet is perceived as easy for health-conscious, athletic populations, and the vegan diet does not require a particularly effortful/complex race day strategy for endurance runners.
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Affiliation(s)
- Derrick R. Tanous
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Department of Secondary Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
| | - Mohamad Motevalli
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Department of Secondary Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
| | - Claus Leitzmann
- Institute of Nutrition, University of Gießen, 35390 Gießen, Germany
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8006 Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8006 Zurich, Switzerland
- Medbase St. Gallen, Am Vadianplatz, 9000 St. Gallen, Switzerland
| | - Katharina Wirnitzer
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Department of Secondary Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
- Research Center Medical Humanities, University of Innsbruck, 6020 Innsbruck, Austria
- Department of Pediatric Oncology and Hematology, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
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Engelbrecht L, Rawlins M, Kohn TA, Wilson RL, Eksteen GJ, Myburgh KH. Physiological and muscle histochemical assessment of men and women 10 km runners matched for race performance or training volume. J Appl Physiol (1985) 2024; 136:1133-1143. [PMID: 38357724 DOI: 10.1152/japplphysiol.00707.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/30/2024] [Accepted: 02/11/2024] [Indexed: 02/16/2024] Open
Abstract
Women have a disadvantage for performance in long-distance running compared with men. To elaborate on inherent characteristics, 12 subelite women were matched with 12 men for training volume (M-Tm) (56.6 ± 18 vs. 55.7 ± 17 km/wk). The women were also matched to other men for a 10 km staged outdoor time trial (M-Pm) (42:36 min:s) to determine which factors could explain equal running performance. Anthropometry and treadmill tests were done. Fiber type (% Type I and Type IIA) and citrate synthase activities were analyzed in muscle biopsy samples. Consistent sex differences for both comparisons included height, weight, % body fat (P < 0.01), and hematocrit (P < 0.05). Women had lower V̇o2max and peak treadmill speed (PTS) compared with both M-Tm and M-Pm (P < 0.01). Training matched pairs had no sex difference in % PTS at race pace but compared with M-Pm women ran at a higher % PTS (P < 0.05) and %HRmax (P < 0.01) at race pace. On average, the women trained 22.9 km/wk more than M-Pm (+67.5%, P < 0.01). This training was not associated with higher V̇o2max or better running economy. Muscle morphology and oxidative capacity did not differ between groups. Percentage body fat remained significantly higher in women. In conclusion, women matched to men for training volume had slower 10 km performance (-10.5% P < 0.05). Higher training volume, more high-intensity sessions/wk, and time spent training in the 95%-100% HRmax zone may explain the higher % PTS and %HRmax at race pace in women compared with performance-matched men.NEW & NOTEWORTHY When subelite women 10 km runners were matched with male counterparts for 10 km race performance, inherent differences in % body fat, V̇o2max, Hct, and peak treadmill speed were counteracted by significantly higher training volume, more time training at higher %HRmax and consequently, higher %HRmax and %PTS at race pace. Citrate synthase activity and muscle fiber types did not differ. When women and men matched for training, 10 km performance of men was 10.5% faster.
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Affiliation(s)
- Lize Engelbrecht
- Department of Physiological Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Maia Rawlins
- Department of Physiological Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Tertius A Kohn
- Department of Physiological Sciences, University of Stellenbosch, Stellenbosch, South Africa
- Department of Medical Biosciences, University of the Western Cape, Bellville, South Africa
| | - Robyn L Wilson
- Department of Physiological Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Gabriël J Eksteen
- Department of Physiological Sciences, University of Stellenbosch, Stellenbosch, South Africa
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Kathryn H Myburgh
- Department of Physiological Sciences, University of Stellenbosch, Stellenbosch, South Africa
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Knechtle B, Tanous D, Thuany M, Motevalli M, Wirnitzer G, Leitzmann C, Weiss K, Rosemann T, Wirnitzer K. Differences in training characteristics of recreational endurance runners by race distance - results from the NURMI Study (Step 2). Front Psychol 2024; 14:1269374. [PMID: 38264416 PMCID: PMC10805148 DOI: 10.3389/fpsyg.2023.1269374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/07/2023] [Indexed: 01/25/2024] Open
Abstract
Background Although runner's profiles were previously investigated, information on the training frequency and training distance for short (5 km, 10 km) and long-distance (>21 km) running is absent. The present study aimed to investigate the associations between training routines and exercise habits of recreational endurance runners considering self-reported preferred race distance [10 km, half-marathon (HM), and marathon/ultra-marathon (M/UM)] subgroups. Methods This is a cross-sectional study, sampling 154 recreational runners of both sexes. A web survey was used for data collection regarding age, sex, preferred distance (10-km, HM, M/UM), training routines, exercise habits, and periodized training routines. The Chi-square test (Cramer's V) and Kruskal-Wallis test (Eta-Squared η2) with effect sizes were used for comparisons between race distances. Results Significant differences were shown for anthropometric, training, and periodization characteristics. Highly significant differences were found between subgroups for the number of sessions, running kilometers, and training hours at all periods and within all four preparation conditions. M/UM runners were training more frequently, for longer durations, and ran greater distances each week. Conclusion This finding supports the notion that training habits and periodization characteristics are different for different race distances (10-km, half marathon, marathon, and ultramarathon).
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Affiliation(s)
- Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Derrick Tanous
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education, Innsbruck, Tyrol, Austria
| | | | - Mohamad Motevalli
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education, Innsbruck, Tyrol, Austria
| | | | - Claus Leitzmann
- Institute of Nutrition, University of Gießen, Gießen, Germany
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Katharina Wirnitzer
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education, Innsbruck, Tyrol, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, Innsbruck, Austria
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Günaşti O, Özdemir C, Özgünen KT, Korkmaz-Eryilmaz S, Gezgin E, Boyraz C, Kilci A, Adaş Ü, Özmen C, Rahiomova H, Akilli R, Demirtaş M, Kurdak SS. Effects of Sixty-Minute Race-Pace Running on Cardiac Stress Biomarkers in Recreational Distance Runners. Physiol Res 2023; 72:707-717. [PMID: 38224040 PMCID: PMC10805261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/08/2023] [Indexed: 01/16/2024] Open
Abstract
Sudden cardiac death (SCD) in athletes is generally rare, but a serious complication of cardiovascular events during exercise. Although regular intensive physical exercise is thought to be a key to a healthy life, unsuspected pathologies might lead to SCD during or after physical activity. Cardiac dysfunction and elevated cardiac markers have been reported after prolonged exercise. We sought to clarify the cardiac marker levels and hydration status in healthy, middle-aged male subjects for 24 hours after running sixty-minute at race-pace. The participants were 47.4±1.7 years old, had peak oxygen consumption of 47.1±1.2ml/kg/min, and regularly running 70.5±6.4km/week. Blood biomarkers were performed before, immediately after, at the fourth and twenty-fourth hours after running. Compared to initial values, creatine kinase (before:161.2±22.5U/L, 24 hours after:411.9±139.7U/L, p<0.001) and CK-MB (before:4.3±0.7ng/ml, 24 hours after:10.1±3.0ng/ml, p<0.001) were significantly elevated immediately after running and remained significantly high for 24 hours. In addition, Troponin-I (before:5.0±1.1ng/l, 4 hours after:81.5±29.9ng/l, p<0.001) and NT-proBNP (before: 31.2±5.3pg/ml, immediately after: 64.4±8.5pg/ml, p<0.01) were significantly elevated immediately after running and returned to baseline levels in 24 hours. The sixty-minute running caused significant dehydration, but athletes were rehydrated at the 4th hour in their voluntary hydration behavior. As the individual data were analyzed, it was interesting to see that some of the athletes had critical biomarker levels without any cardiac symptom. Our findings indicate that race-pace sixty-minute running may induce a possible transient silent myocardial injury in apparently healthy master runners. Detailed pre-participation screening of these athletes may be necessary to reduce the risk of SCD.
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Affiliation(s)
- O Günaşti
- Çukurova University, Medical Faculty, Department of Physiology, Division of Sports Physiology, Balcali, Sariçam, Adana, Turkey.
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Knechtle B, Tanous D, Thuany M, Motevalli M, Wirnitzer G, Leitzmann C, Weiss K, Rosemann T, Wirnitzer K. Differences in race history by distance of recreational endurance runners from The NURMI Study (Step 2). Sci Rep 2023; 13:18083. [PMID: 37872366 PMCID: PMC10593817 DOI: 10.1038/s41598-023-45055-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 10/15/2023] [Indexed: 10/25/2023] Open
Abstract
Few studies were developed to understand the relationship between running characteristics and motivation. The purpose of this study was to assess the relationship between running event history, running experience, and best race performances in recreational distance runners. We used a web survey to obtain information regarding running experience, racing history, and periodization training routines/exercise habits, including weekly volumes and daily mileage and duration across periods and conditions. Associations between variables were conducted with the Chi-square test (χ2; nominal scale) and Wilcoxon test. Multiple linear regression analysis and multivariate linear regression were performed. Concerning the participants' motive for exercising, a significant difference was identified between the race distance subgroups (p < 0.001), where 58% of M/UM runners exercised for performance (n = 38) and 64% of HM runners (n = 57) and 57% of 10 km runners (n = 52) exercised for recreational purposes. A significant difference was found in the number of years of running completed without taking a break (p = 0.004), with marathoners/ultramarathoners reporting the most years. Runners competing in different race distances such as 10 km, half-marathon, marathon, and ultra-marathon presented differences in training background and habits according to the distance of preference.
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Affiliation(s)
- Beat Knechtle
- Institute of Primary Care, University of Zurich, 8000, Zurich, Switzerland.
- Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9000, St. Gallen, Switzerland.
| | - Derrick Tanous
- Department of Sport Science, University of Innsbruck, 6020, Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education, Tyrol, 6020, Innsbruck, Austria
| | | | - Mohamad Motevalli
- Department of Sport Science, University of Innsbruck, 6020, Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education, Tyrol, 6020, Innsbruck, Austria
| | | | - Claus Leitzmann
- Institute of Nutrition, University of Gießen, 35390, Gießen, Germany
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, 8000, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8000, Zurich, Switzerland
| | - Katharina Wirnitzer
- Department of Sport Science, University of Innsbruck, 6020, Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education, Tyrol, 6020, Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, 6020, Innsbruck, Austria
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Wirnitzer K, Tanous D, Motevalli M, Wagner KH, Raschner C, Wirnitzer G, Leitzmann C, Rosemann T, Knechtle B. Racing Experiences of Recreational Distance Runners following Omnivorous, Vegetarian, and Vegan Diets (Part B)-Results from the NURMI Study (Step 2). Nutrients 2023; 15:nu15102243. [PMID: 37242128 DOI: 10.3390/nu15102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
The potential running or endurance performance difference based on following different general types of diets, such as omnivorous, vegetarian, or vegan, remains questionable. Several underlying modifiable factors of long-distance running performance, especially runner training behaviors and experience, diminish the clarity of results when analyzing dietary subgroups. Based on the cross-sectional design (survey), the NURMI Study Step 2 aimed to investigate a plethora of training behaviors among recreational long-distance running athletes and the relationship of general diet types with best time race performance. The statistical analysis was based on Chi-squared and Wilcoxon tests. The final sample (n = 245) included fit recreational long-distance runners following an omnivorous diet (n = 109), a vegetarian diet (n = 45), or a vegan diet (n = 91). Significant differences were found between the dietary subgroups in body mass index (p = 0.001), sex (p = 0.004), marital status (p = 0.029), and running-related motivations for well-being (p < 0.05) but not in age (p = 0.054). No significant difference was found for best time half-marathon, marathon, and/or ultra-marathon race performance based on diet type (p > 0.05). Whether the vegan diet is associated with enhanced endurance performance remains unclear. Although, the present results are suggestive that 100% plant-based (vegan) nutrition is compatible with distance running performance at the least.
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Affiliation(s)
- Katharina Wirnitzer
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol (PH Tirol), 6010 Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Research Center Medical Humanities, University of Innsbruck, 6020 Innsbruck, Austria
| | - Derrick Tanous
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol (PH Tirol), 6010 Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Mohamad Motevalli
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol (PH Tirol), 6010 Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Karl-Heinz Wagner
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria
| | - Christian Raschner
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Claus Leitzmann
- Institute of Nutrition, University of Gießen, 35390 Gießen, Germany
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
- Medbase St. Gallen, Am Vadianplatz, 9001 St. Gallen, Switzerland
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Wirnitzer K, Tanous D, Motevalli M, Raschner C, Wagner KH, Wirnitzer G, Leitzmann C, Rosemann T, Knechtle B. Training Behaviors and Periodization Outline of Omnivorous, Vegetarian, and Vegan Recreational Runners (Part A)-Results from the NURMI Study (Step 2). Nutrients 2023; 15:1796. [PMID: 37049635 PMCID: PMC10096545 DOI: 10.3390/nu15071796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Runners train for long-distance competitions based on underlying motivations, which may be similar to individual dietary motivations (e.g., well-being and performance). Fundamental training differences may arise in recreational runners following different diet types (omnivore, vegetarian, vegan) considering possible motive variations. Following a cross-sectional design, distance runners completed a survey (online), including a thorough assessment of training behaviors with generic training details and periodization specifics in three phases: 1. an intermediary and rebound stage, 2. a main preparatory stage, and 3. a main event stage (tapering or interim event level/s). Kruskal-Wallis and chi-squared tests were used in the statistical analysis. A total of 245 fit recreational runners following omnivore (n = 109), vegetarian (n = 45), and vegan diets (n = 91) were included. Significant differences in the initial running motivation were found across dietary subgroups (p = 0.033) as well as for current motivations (p = 0.038), with vegetarians being the least health motivated (27% and 9%, respectively). No differences in each of the specific periods were found between diet types across the outline (p > 0.05). The present evidence shows that there is a lack of fundamental training differences based on recreational runners following different generic types of diets. The results of the present investigation may be especially relevant for future studies on safety, sustainability, and performance-enhancing dietary practices among athletes.
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Affiliation(s)
- Katharina Wirnitzer
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Research Center Medical Humanities, University of Innsbruck, 6020 Innsbruck, Austria
| | - Derrick Tanous
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Mohamad Motevalli
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Christian Raschner
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Karl-Heinz Wagner
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria
| | | | - Claus Leitzmann
- Institute of Nutrition, University of Gießen, 35390 Gießen, Germany
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
- Medbase St. Gallen, Am Vadianplatz, 9001 St. Gallen, Switzerland
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Motevalli M, Tanous D, Wirnitzer G, Leitzmann C, Rosemann T, Knechtle B, Wirnitzer K. Sex Differences in Racing History of Recreational 10 km to Ultra Runners (Part B)-Results from the NURMI Study (Step 2). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13291. [PMID: 36293872 PMCID: PMC9602481 DOI: 10.3390/ijerph192013291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 06/01/2023]
Abstract
Sex differences in anatomy and physiology are the primary underlying factor for distinctions in running performance. Overall participation in recreational running events has been dominated by males, although increasing female participation has been reported in recent years. The NURMI study participants filled in a survey following the cross-sectional study design with questions on sociodemographic data, running and racing motivations, training behaviors, and racing history and experience. Data analysis included 141 female and 104 male participants aged 39 (IQR 17) with a healthy median BMI (21.7 kg/m²; IQR 3.5). Statistical analyses revealed sex differences with the males performing faster at half-marathon (p < 0.001) and marathon (p < 0.001) events but no difference at ultra-marathons (p = 0.760). Mediation analyses revealed no significant sex differences in the performance of half-marathon and marathon when considering training behaviors (p > 0.05), racing history (p > 0.05), or racing experience (p > 0.05). Differences in recreational performance may be more closely related to social constraints and expectations of females rather than the physiological advantages of the male athlete. Health professionals who guide and support recreational runners as well as the runners themselves and their coaches may benefit from this study's results in order to improve the best time performance through a deeper understanding of the areas that mediate sex differences.
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Affiliation(s)
- Mohamad Motevalli
- Department of Sport Science, Leopold-Franzens University of Innsbruck, 6020 Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education, Tyrol, 6010 Innsbruck, Austria
| | - Derrick Tanous
- Department of Sport Science, Leopold-Franzens University of Innsbruck, 6020 Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education, Tyrol, 6010 Innsbruck, Austria
| | | | - Claus Leitzmann
- Institute of Nutrition, University of Gießen, 35390 Gießen, Germany
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8000 Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8000 Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, 9000 St. Gallen, Switzerland
| | - Katharina Wirnitzer
- Department of Sport Science, Leopold-Franzens University of Innsbruck, 6020 Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education, Tyrol, 6010 Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, 6020 Innsbruck, Austria
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