Assessing the efficacy of the Stop OsteoARthritis (SOAR) program: A randomized delayed-controlled trial in persons at increased risk of early onset post-traumatic knee osteoarthritis

OBJECTIVE

Assess the efficacy of an 8-week virtual, physiotherapist (PT)-guided knee health program (Stop OsteoARthritis (SOAR)) to improve knee extensor strength in individuals at risk of post-traumatic knee osteoarthritis (PTOA).

METHOD

In this superiority, randomized delayed-control trial, persons aged 16-35 years, 1-4 years after a self-reported knee joint injury were randomly assigned (1:1) to receive the SOAR program immediately (experimental group) or after a 9-week delay (control group). SOAR includes 1) one-time Knee Camp (virtual PT-guided group education, knee assessment, 1:1 exercise and physical activity (PA) goal-setting); 2) Weekly personalized home-based exercise and PA program with tracking; 3) Weekly 1:1 PT counseling (virtual). The primary outcome was a change in isokinetic knee extensor strength (baseline to 9-weeks). Additional outcomes included change in self-reported knee-related quality-of-life (QOL), self-efficacy, self-management and kinesiophobia, and PA (accelerometer) at 9 and 18-weeks. Linear regression models estimated the effect of the 8-week intervention at the primary endpoint (9-week).

RESULTS

49 of 54 randomized participants completed the study (91%). Participants were a mean ± standard deviation age of 27 ± 5.0 years, and 2.4 ± 0.9 years post-injury. No mean between group differences for the primary (0.05; 95% confidence interval (CI): -0.10, 0.19) or other outcomes were seen at 9 weeks except for greater improvements in perceived self-management (Partner in Health Scale; 11.3/96, 95%CI: 5.5, 17.1) and kinesiophobia (Tampa Scale of Kinesiophobia; -4.4/33, 95%CI: -7.0, -1.8).

CONCLUSION

For active persons with elevated risk of PTOA, an 8-week SOAR program did not change knee-related strength, QOL, self-efficacy, or PA, on average, but may benefit the ability to self-manage knee health and kinesiophobia.

A grounded theory of personal development in high-performance sport environments

OBJECTIVES

The purpose of this study was to develop a grounded theory of how to promote personal development in high-performance sport environments.

METHODOLOGY

Individual interviews were conducted with 32 members of the Canadian junior and senior national biathlon teams, including 18 athletes (9 women, 9 men, Mage = 20.8 years, SD = 2.9), 5 coaches (1 woman, 4 men), 3 technical leaders (2 women, 1 man), and 6 parents (3 mothers, 3 fathers). Follow-up interviews were conducted with five key participants. Straussian grounded theory methodology was used. Analytic techniques included open coding, constant comparison, questioning, memoing, diagramming, and theoretical integration.

RESULTS

The grounded theory is based on the core category that personal development is a continual and individualized process. Three propositions represent how to promote athletes' personal development process. Proposition 1: Athletes use realistic self-evaluation and goal setting. Proposition 2: Athletes experience different situations and reflect on their areas for personal development. Proposition 3: Athletes perceive and receive social support.

CONCLUSION

The grounded theory portrays propositions that can be used to promote athletes' personal development in high-performance sport environments. It may inform future applied research and the delivery of sport psychology support to high-performance athletes.

Social support and therapeutic relationships intertwine to influence exercise behavior in people with sport-related knee injuries

OBJECTIVE

Explore how social support influences exercise therapy participation and adherence before and after enrolling in an education and exercise therapy intervention (Stop OsteoARthritis, SOAR).

METHODS

Study design: Interpretative description. We sampled participants with sport-related knee injuries from the SOAR randomized controlled trial. SOAR is a virtual, physiotherapist-guided, education and exercise therapy-based knee health program that targets individuals at risk of early osteoarthritis. One-on-one semi-structured interviews were completed, and an inductive approach was guided by Braun & Clarke's reflexive thematic analysis.

RESULTS

Fifteen participants (67% female, median age 26 [19-35] years) were interviewed. Three themes were generated that encapsulated participants' social support experiences that fostered exercise participation: 1) Treat me as a whole person represented the value of social support that went beyond participants' physical needs, 2) Work with me highlighted the working partnership between the clinician and the participant, and 3) Journey with me indicated a need for on-going support is necessary for the long-term management of participants' knee health. A theme of the therapeutic relationship was evident across the findings.

CONCLUSIONS

Insight was gained into how and why perceived support may be linked to exercise behavior, with the therapeutic relationship being potentially linked to perceived support. Social support strategies embedded within an education and exercise therapy program may boost exercise adherence after sport-related knee injuries.

Collegiate Athletes' Cognitive Beliefs Related to Setback Anxiety and Rumination in Sport

Setbacks are common occurrences in sport. Recently, setbacks such as injuries and deselection have been accompanied, and confounded, by setbacks related to COVID-19. How students manage a setback may depend on the interaction of two control beliefs: primary control (PC) to directly influence the setback and secondary control (SC) to adjust to it. Purpose: This study investigates the relationships between athletes' PC and SC and two important sport setback-related outcomes-anxiety and rumination. Method: We employed a cross-sectional design examining collegiate athletes in the USA and Canada (N = 200; Mage = 20.9 years, 143 women, 52 men, 3 non-binary, 2 did not disclose). Using regression tests controlling for setback severity, we examined the interaction effects of athletes' PC and SC beliefs relative to setbacks, on the anxiety and rumination variables. Results: We found SC beliefs were beneficial to setback-related anxiety and rumination. A significant interaction indicated that particularly when PC was low, SC had negative associations with setback-related anxieties about letting others down (β = -.45, p < .001) and experiencing pain (β = -.37, p < .001). Conclusion: The findings suggest SC beliefs are important for managing setbacks-specifically for attenuating harmful rumination, and specific setback anxieties. We discuss the possibility of enhancing SC beliefs for combatting sport setbacks through control-enhancing interventions as a direction for future research.

A longitudinal interpretative phenomenological analysis study of athletes' lived experiences in elite disc golf competitions

Gaining the inside perspective of an elite athlete throughout the competitive season provides a unique approach to understand the lived experience during multiple competitive events. The purpose of the present study was to investigate how elite disc golf athletes perceive and interpret their experiences of performing during various training and competitive events over the course of an elite disc golf season. Two elite disc golf athletes, one man and one woman, were recruited using homogeneous purposive sampling. The participants were interviewed three times and observed during three competitive events, as well as before and after a training session. A longitudinal interpretative phenomenological analysis (LIPA) was adopted to capture temporal and dynamic changes of the participants' lived experiences. The findings illustrated the athletes' personal experiences of performing during competitive disc golf events, with both athletes' experiences of competition changing during the season. Their competitive experiences appear to relate to the meaning disc golf has for the athletes, which in this study had both an experiential and existential level of meaning over time. Such a finding illustrates the importance of honoring athletes' unique experiences in making sense of their performances during an elite disc golf season. Taking the time to understand athletes' perceptions of their personal experiences appear important in attempting to understand their sense-making of their hot cognition before, during, and after competitions.

A quantitative assessment of the predictive utility of grit in sport

In high-performance sport, an athlete's ability to overcome setbacks and sustain their pursuit of long-term goals is essential for success. Grit (i.e., passion and perseverance over long-terms) has been linked to success in a variety of domains but is often critiqued for its limited predictive utility when compared to other psychological variables including self-control, conscientiousness, and mental toughness. The purpose of this study was to examine whether grit predicted important athlete outcomes (i.e., various measures of sport performance and athlete well-being) beyond other determinants of success. Data from 214 collegiate student-athletes (111 women, 103 men; Mage = 21.02, SD = 2.26) from Western Canadian universities were analysed. When predicting performance, the addition of the grit subscales (i.e., consistency of interests, perseverance of effort, adaptability to situations) explained an additional 11% of variance (R2 = 0.37, F[7, 203] = 7.16, p < .001) beyond self-control, conscientiousness, and mental toughness in subjective sport performance perceptions; however, grit did not add unique variance when entered into models predicting athlete goal achievement perceptions or highest level of competition. When predicting well-being, addition of the grit subscales added 18% of unique variance (R2 = 0.43, F[7, 203] = 21.43, p < .001) beyond other determinants of success in eudaimonic well-being, and 5% (R2 = 0.17, F[7, 203] = 6.95, p < .001) in satisfaction with sport, but did not add any unique variance to the model predicting mood. The partial support of the predictive utility of grit illustrates the complexity of forecasting success in sport and offers evidence that grit should continue to be studied as a motivational disposition in the domain of sport.

"I think the best athletes use it": Masculinities and self-compassion among men varsity athletes

We examined how men varsity athletes' embodiments of masculinities shaped their perceptions and experiences of self-compassion to manage sport-related challenges. Two semi-structured interviews were conducted with 11 men varsity athletes (20 interviews total). Vignettes depiciting athletes low and high in self-compassion were used as talk elicitation tools during interviews. Data were analyzed using reflexive thematic analysis and four themes were identified from the mens' accounts. Participants utilized self-compassion as a coping strategy in sport and other life-domains to maintain well-being. Self-compassion was used to balance self-criticism to support achievement striving efforts. The experience of contrasting masculine ideologies (hegemonic and inclusive) promoted and constrained the men's implementation of self-compassion. Traditional masculine narratives created tensions for participants who at times embodied the (mis)belief that self-compassion promotes complacency in the pursuit of athletic achievement. Findings contribute to understandings of men athletes' experiences of self-compassion and masculinities in relation to sport-related challenges and performance.

Resilience and Enhancement in Sport, Exercise, & Training (RESET): A brief self-compassion intervention with NCAA student-athletes

Athletes often believe that self-criticism is necessary to avoid complacency, but this attitude can lead to anxiety and stress. Research shows that self-compassion is an adaptive way to relate to mistakes and challenges. Although there are many benefits of self-compassion, fear that self-compassion harms performance may discourage athletes from adopting this approach. This study developed and tested an online self-compassion intervention for athletes called RESET (Resilience and Enhancement in Sport, Exercise, & Training), adapted from the Mindful Self-Compassion program. Between-group analyses (multilevel modeling; MLM) and within-group analyses (paired t-tests) were used to assess the effectiveness of the intervention on athletes' ability to respond compassionately to failure, improve well-being, and increase perceived sport performance. Compared to the waitlist control (n = 102, 71% women), the intervention group (n = 148, 90% women) experienced greater increases in self-compassion, decreases in self-criticism and fear of self-compassion, and greater improvements in perceived performance. In general, the intervention was more effective for those who had the most room for growth. Within-group analyses supported the MLM findings while also showing that athletes who participated in the RESET program experienced reduced levels of depression, anxiety, and stress. Program evaluation measures, including participant testimonials, extend the quantitative findings and demonstrate that RESET was engaging, well-liked, and effective.

"I feel I'm leading the charge." Experiences of a virtual physiotherapist-guided knee health program for persons at-risk of osteoarthritis after a sport-related knee injury

Objective

Describe participants' perspectives about the feasibility of a virtual, physiotherapist-guided knee health program for people at risk of post-traumatic osteoarthritis after a sport-related knee injury.

Design

Qualitative description study nested within a quasi-experimental study evaluating the feasibility of the Stop OsteoARthritis (SOAR) with persons with sport-related knee injuries. SOAR includes: 1) one-time Knee Camp (group education, 1:1 exercise/activity goal-setting); 2) weekly home-based exercise/activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning. Upon program completion, semi-structured 1:1 interviews were conducted with participants identified by convenience and maximum variation sampling (age, gender, program satisfaction). Open-ended questions elicited participants' experiences with the program. Content analysis was conducted.

Results

12 women and 4 men [median (min-max) age; 30 (19-46) years] were interviewed. Four categories depicted participants' experiences: 1) 'SOAR satisfies an unmet need' portrayed the perceived relevance and need for a program that promotes knowledge about knee health and self-efficacy for independent exercise behaviour, 2) 'Regaining control of knee health' described how SOAR empowered participants and fostered a sense of 'leading the charge' to their own knee health, 3) 'Social support encourages exercise participation' highlighted that weekly physiotherapy interactions provided accountability for achieving exercise goals, and that relating to other participants was inspirational, 4) 'Program refinements and barriers' suggested enhancements to meet the needs of future participants.

Conclusions

Participants report the SOAR program to be acceptable, relevant, and empowering. Improved knowledge about one's knee health, self-efficacy, autonomy, and social support may encourage exercise adherence and self-management of future knee OA risk.

Balance, reframe, and overcome: The attitudes, priorities, and perceptions of exercise-based activities in youth 12-24 months after a sport-related ACL injury

Attitudes, priorities, and perceptions of exercise directly influence exercise behaviors. Despite the benefits of exercise-based activities for future health, little is known about how youth who experience an ACL injury view exercise-based activity beyond the immediate recovery period. A qualitative (interpretative description) approach with one-to-one semistructured interviews was used to probe the current attitudes, priorities, and perceptions of exercise-therapy, physical activity, and sport participation with a purposive sample of youth from an ongoing inception cohort study who experienced an ACL tear or reconstruction in the past 12-24 months. Analyses followed an inductive approach guided by an analytic interpretative description process. Reflexive journaling, memoing, and a detailed audit trail promoted data trustworthiness. A patient-partner was involved throughout. Ten youth (six women, four men), 15-19 years of age, and a median of 20-months (16-26) from injury were interviewed. Three overarching themes were identified. 'Balancing physical activity and future knee health' highlighted ongoing negotiations between what were perceived to be competing priorities for return-to-sport and future knee health. 'Reframing the value of exercise-therapy and physical activity' reflected the importance of reshaping attitudes toward exercise as positive and was linked to exercise adherence. 'Overcoming unforeseen exercise challenges' encompassed persisting psychological and physical challenges perceived to limit exercise-based activities. Clinical significance: reframing exercise-based activities in a positive light and leveraging motivation for return-to-sport and life-long knee health may be important strategies for encouraging ongoing exercise therapy and physical activity following a youth ACL injury.

Reasons why older adults play sport: A systematic review

BACKGROUND

Despite the known contribution of sport to health and well-being, sport participation declines in older age. However, for some people, sport continues to play an important role in older age and may contribute to improved health and well-being in older years. Although the health-related benefits of participating in sport are commonly reported, the reasons why some older adults continue to play sport are not well understood. This systematic review aimed to (1) identify studies from the literature that evaluated the reasons why older adults (aged 55 years and older) participate in sport and (2) synthesize and discuss the reasons for their participation reported in the literature.

METHODS

Searches of the electronic databases Embase, Medline, PsycInfo, PubMed, and SPORTDiscus were performed. Studies were included that evaluated reasons for sport participation in adults aged 55 years and older because this is the age at which sport participation has been reported to begin declining. The studies included in this review used qualitative, quantitative, or mixed methods designs, were peer reviewed, and were published in the English language before the search date (20 January 2019).

RESULTS

A total of 1732 studies were identified. After exclusions, 30 studies were included in the review (16 qualitative, 10 quantitative, and 4 mixed methods). The review presents several features and findings from the studies, including a description and systematization of the reasons for participating in sport and the main reasons that participants gave for participating in sport (maintaining health, feeling and being part of a community, and taking advantage of opportunities to develop relationships). Other reasons included competing and attaining a feeling of achievement, taking advantage of opportunities for travel, and being part of a team. Sport was identified as contributing to the overall experience of successful ageing. There were few comparative differences for participating in sport, and there were only small differences between genders for the reasons given for participation. Generally, the quality of the studies was good; however, mixed methods studies lacked appropriate data analysis procedures.

CONCLUSION

Older adults play sport for a range of health-related and social reasons that can contribute to the experience of successful ageing. Strategies to increase sport participation by older adults should focus on promoting these aspects.

Why Do Older Adults Play Golf? An Evaluation of Factors Related to Golf Participation by Older Adults

Golf is a popular sport for older adults, and is therefore an important source of physical activity. This study investigated the reasons for golf participation in an older population using the Golf Participation Questionnaire for Older Adults. The participants (N = 3,262, 82.5% male) completed the questionnaire online. The most important reasons for participation were fun, a pleasant playing environment, and competition, with reasons related to health being relatively less important. The female participants rated fun, a pleasant playing environment, and a feeling that participation made them part of a community as more important reasons for participating than males. Although health-related factors were identified as important reasons for golf participation in older adults, non-health-related factors were also more important. Strategies to promote golf participation by older adults, as a means of increasing physical activity, should emphasize aspects related to fun, a pleasant playing environment, and engagement in competition.

Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review

Objective

To explore the role of psychological, social and contextual factors across the recovery stages (ie, acute, rehabilitation or return to sport (RTS)) following a traumatic time-loss sport-related knee injury.

Material and methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and Arksey and O’Malley framework. Six databases were searched using predetermined search terms. Included studies consisted of original data written in English that identified or described a psychological, social or contextual factor related to recovery after a traumatic time-loss sport-related knee injury. Two authors independently conducted title–abstract and full-text reviews. Study quality was assessed using the Mixed Methods Appraisal Tool. Thematic analysis was undertaken.

Results

Of 7289 records, 77 studies representing 5540 participants (37% women, 84% anterior cruciate ligament tears, aged 14–60 years) were included. Psychological factors were investigated across all studies, while social and contextual factors were assessed in 39% and 21% of included studies, respectively. A cross-cutting concept of individualisation was present across four psychological (barriers to progress, active coping, independence and recovery expectations), two social (social support and engagement in care) and two contextual (environmental influences and sport culture) themes. Athletes report multiple barriers to recovery and valued their autonomy, having an active role in their recovery and diverse social support.

Conclusion

Diverse psychological, social and contextual factors are present and influence all stages of recovery following a traumatic sport-related knee injury. A better understanding of these factors at the time of injury and throughout rehabilitation could assist with optimising injury management, promoting RTS, and long-term health-related quality-of-life.

Exploring Self-Compassion and Versions of Masculinity in Men Athletes

Despite a growing emphasis on self-compassion in sport, little research has focused exclusively on men athletes. The purpose of this research was to explore the interaction of self-compassion and diverse versions of masculinity on the psychosocial well-being of men athletes. The authors sampled 172 men athletes (Mage = 22.8 yr) from a variety of sports, using descriptive methodology with self-report questionnaires. Self-compassion was related to most variables (e.g., psychological well-being, fear of negative evaluation, state self-criticism, internalized shame, reactions to a hypothetical sport-specific scenario) in hypothesized directions and predicted unique variance beyond self-esteem across most of those variables, as well as moderated relationships between masculinity and both autonomy and attitudes toward gay men. In addition, self-compassion was differentially related to inclusive and hegemonic masculinity. Our findings support self-compassion as a promising resource for men athletes to buffer emotionally difficult sport experiences.

Associations between markers of health and playing golf in an Australian population

OBJECTIVE

To investigate associations between markers of health and playing golf in an Australian population.

METHODS

Secondary analysis of data from the Australian National Nutrition and Physical Activity Survey to compare selected health outcomes between golfers (n=128) and non-golfers (n=4999).

RESULTS

Golfers were older than non-golfers (mean±SD 57.7±14.2 years, 48.5±17.6 years, p<0.05). A higher proportion of golfers were overweight or obese compared with non-golfers (76% vs 64%, p<0.05), and golfers were more likely to have been diagnosed with ischaemic heart disease (IHD) at some time in their life (OR 2.8, 95% CI 1.0 to 7.8). However, neither the risk of being overweight or obese (OR 1.4, 95% CI 0.9 to 2.2) or having been diagnosed with IHD (OR 2.1, 95% CI 0.8 to 5.8), were significant after controlling for age. Golfers were more physically active than non-golfers (8870±3810 steps/day vs 7320±3640 steps/day, p<0.05) and more likely to report high health-related quality of life (HRQoL) than non-golfers (OR 1.8; 95% CI 1.0 to 3.3), but not after adjusting for physical activity (OR 1.4, 95% CI 0.9 to 2.2).

CONCLUSION

Compared with non-golfers, golfers were more likely to be overweight or obese and to have been diagnosed with IHD, but not after adjusting for golfers being older. Golfers were more likely to report a higher HRQoL, but not after adjusting for golfers being more physically active. There may be an association between golfers being more physically active than non-golfers and reporting a higher HRQoL.

Applying self-compassion in sport: an intervention with women athletes

This study investigated the effects of a self-compassion intervention on negative cognitive states and self-compassion in varsity women athletes. Athletes who self-identified as being self-critical were randomly assigned to a self-compassion intervention (n = 29) or attention control group (n = 22). The self-compassion intervention consisted of a psychoeducation session and writing components completed over a 7-day period. Measures of self-compassion, state self-criticism, state rumination, and concern over mistakes were collected pretreatment, at 1 week posttreatment, and at a 4-week follow-up. A mixed factorial MANOVA with follow-up post hoc tests demonstrated moderate-to-strong effects for the intervention at posttest and follow-up (Wilks's Λ = .566, F (8, 42) = 4.03, p < .01, η2 = .43). The findings demonstrate the effectiveness of the self-compassion intervention in managing self-criticism, rumination, and concern over mistakes. Fostering self-compassionate mind frames is a potential coping resource for women athletes dealing with negative events in sport.

Self-compassion: a potential resource for young women athletes

Self-compassion has demonstrated many psychological benefits (Neff, 2009). In an effort to explore self-compassion as a potential resource for young women athletes, we explored relations among self-compassion, proneness to self-conscious emotions (i.e., shame, guilt-free shame, guilt, shame-free guilt, authentic pride, and hubristic pride), and potentially unhealthy self-evaluative thoughts and behaviors (i.e., social physique anxiety, obligatory exercise, objectified body consciousness, fear of failure, and fear of negative evaluation). Young women athletes (N = 151; Mage = 15.1 years) participated in this study. Self-compassion was negatively related to shame proneness, guilt-free shame proneness, social physique anxiety, objectified body consciousness, fear of failure, and fear of negative evaluation. In support of theoretical propositions, self-compassion explained variance beyond self-esteem on shame proneness, guilt-free shame proneness, shame-free guilt proneness, objectified body consciousness, fear of failure, and fear of negative evaluation. Results suggest that, in addition to self-esteem promotion, self-compassion development may be beneficial in cultivating positive sport experiences for young women.