To achieve the unachievable-Patients' experiences of opting for delayed anterior cruciate ligament reconstruction after trying rehabilitation alone as primary treatment: A qualitative study

INTRODUCTION

About 50% of patients who sustain an anterior cruciate ligament (ACL) injury are treated without ACL reconstruction (ACL-R). A significant proportion of these patients opt for late ACL-R. Patients' experience of changing treatment has not yet been investigated and presented in the scientific literature.

AIM

To explore patients' experiences before and after changing treatment from ACL rehabilitation alone to ACL-R.

METHOD

Fifteen patients were interviewed in semi-structured interviews, which were recorded, transcribed, and analyzed with qualitative content analysis, based on the method described by Graneheim and Lundman. Patients were between 26 and 58 years old, and had tried rehabilitation for a minimum of 9 months prior to ACL-R.

RESULTS

Two themes, "Expecting what could not be achieved: the struggle to recover and not becoming stable", and "Internal completeness: expectations can be achieved", emerged from the analysis. Each theme was supported by three main categories and 5-6 subcategories. The first theme represents the journey before ACL-R, where patients experienced getting stronger, but perceived the knee as unstable. The second theme represents the journey after ACL-R, where patients expressed that they felt whole after their ACL-R, and where able to achieve their expections. Patients experienced a greater support from the healthcare system, and ultimately expressed a feeling of having achieved the unachievable after ACL-R.

SUMMARY

Patients who cross over from ACL rehabilitation to ACL-R experienced rehabilitation alone as insufficient to achieve the desired outcomes, which resulted in a need to opt for delayed ACL-R. Healthcare providers need to support patients, who primarily choose to undergo rehabilitation alone and later opt for ACL-R, throughout the whole rehabilitation process.

Dropout from exercise trials among cancer survivors-An individual patient data meta-analysis from the POLARIS study

INTRODUCTION

The number of randomized controlled trials (RCTs) investigating the effects of exercise among cancer survivors has increased in recent years; however, participants dropping out of the trials are rarely described. The objective of the present study was to assess which combinations of participant and exercise program characteristics were associated with dropout from the exercise arms of RCTs among cancer survivors.

METHODS

This study used data collected in the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) study, an international database of RCTs investigating the effects of exercise among cancer survivors. Thirty-four exercise trials, with a total of 2467 patients without metastatic disease randomized to an exercise arm were included. Harmonized studies included a pre and a posttest, and participants were classified as dropouts when missing all assessments at the post-intervention test. Subgroups were identified with a conditional inference tree.

RESULTS

Overall, 9.6% of the participants dropped out. Five subgroups were identified in the conditional inference tree based on four significant associations with dropout. Most dropout was observed for participants with BMI >28.4 kg/m2 , performing supervised resistance or unsupervised mixed exercise (19.8% dropout) or had low-medium education and performed aerobic or supervised mixed exercise (13.5%). The lowest dropout was found for participants with BMI >28.4 kg/m2 and high education performing aerobic or supervised mixed exercise (5.1%), and participants with BMI ≤28.4 kg/m2 exercising during (5.2%) or post (9.5%) treatment.

CONCLUSIONS

There are several systematic differences between cancer survivors completing and dropping out from exercise trials, possibly affecting the external validity of exercise effects.

The intensity paradox: A systematic review and meta-analysis of its impact on the cardiorespiratory fitness of older adults

AIM

The present systematic review and meta-analysis aimed to compare the effect of moderate- versus high-intensity aerobic exercise on cardiorespiratory fitness (CRF) in older adults, taking into account the volume of exercise completed.

METHODS

The databases MEDLINE (Ovid), EMBASE (Ovid), and CENTRAL (Cochrane Library) were searched to identify randomized controlled trials (RCTs). Two reviewers extracted data and assessed bias. Comprehensive Meta-Analysis software calculated overall effect size, intensity differences, and performed meta-regression analyses using pre-to-post intervention or change scores of peak oxygen uptake (V̇O2 peak). The review included 23 RCTs with 1332 older adults (intervention group: n = 932; control group: n = 400), divided into moderate-intensity (435 older adults) and high-intensity (476 older adults) groups.

RESULTS

Meta-regression analysis showed a moderate, but not significant, relationship between exercise intensity and improvements in V̇O2 peak after accounting for the completed exercise volume (β = 0.31, 95% CI = [-0.04; 0.67]). Additionally, studies comparing moderate- versus high-intensity revealed a small, but not significant, effect in favor of high-intensity (Hedges' g = 0.20, 95% CI = [-0.02; 0.41]). Finally, no significant differences in V̇O2 peak improvements were found across exercise groups employing various methods, modalities, and intensity monitoring strategies.

CONCLUSION

Findings challenge the notion that high-intensity exercise is inherently superior and indicate that regular aerobic exercise, irrespective of the specific approach and intensity, provides the primary benefits to CRF in older adults. Future RCTs should prioritize valid and reliable methodologies for monitoring and reporting exercise volume and adherence among older adults.

The effects of interpersonal development programmes with sport coaches and parents on youth athlete outcomes: A systematic review and meta-analysis

Interpersonal coach-and parent development programmes (CDP and PDP, respectively), have the goal to foster positive youth sport experiences through high-quality relations between coaches, parents, and youth athletes. In this paper we systematically reviewed the extant literature and estimate the overall magnitude of such programmes and how they can inform future interventions. Specifically, we aimed to: (a) conduct a systematic review on the literature of interpersonal CDPs and PDPs within the youth sport context; (b) examine the effects of such interventions on youth athlete outcomes via a meta-analysis. English written peer-reviewed publications and grey literature was identified through electronic search in databases and manual searches of reference lists. By utilising a priori criteria for inclusion and exclusion, 33 studies describing interpersonal CDPs, and PDPs were identified in the systematic review. Studies that presented required data for estimation of Hedge's g effect sizes were included in the meta-analysis (k = 27). By and large, the included studies used a quasi-experimental design (58%), sampled from team sports (79%), and reported several delivery methods (e.g., workshops, audio feedback, observations, peer group discussions) and outcome measures (e.g., anxiety, autonomous motivation, self-confidence). Some interventions were based on the same delivery protocols (e.g., Coach Effectiveness Training, Mastery Approach to Coaching) or theoretical frameworks (e.g., Achievement Goal Theory, Self-Determination Theory). The meta-analysis showed statistically significant small, and medium, effect sizes on a subsample of youth athlete outcomes (e.g., task-related climate, fun and enjoyment, anxiety), indicating that coach interpersonal skills can contribute to positive youth sport experiences. Theory-based interpersonal CDPs and PDPs are recommended to expand the knowledge in this field of research.

Short-term effects and long-term changes of FUEL-a digital sports nutrition intervention on REDs related symptoms in female athletes

Female endurance athletes are at high risk for developing Relative Energy Deficiency in Sport (REDs), resulting in symptoms such as menstrual dysfunction and gastrointestinal (GI) problems. The primary aim of this study was to investigate effects of the FUEL (Food and nUtrition for Endurance athletes-a Learning program) intervention consisting of weekly online lectures combined with individual athlete-centered nutrition counseling every other week for sixteen weeks on REDs related symptoms in female endurance athletes at risk of low energy availability [Low Energy Availability in Females Questionnaire (LEAF-Q) score ≥8]. Female endurance athletes from Norway (n = 60), Sweden (n = 84), Ireland (n = 17), and Germany (n = 47) were recruited. Fifty athletes with risk of REDs (LEAF-Q score ≥8) and with low risk of eating disorders [Eating Disorder Examination Questionnaire (EDE-Q) global score <2.5], with no use of hormonal contraceptives and no chronic diseases, were allocated to either the FUEL intervention (n = 32) (FUEL) or a sixteen-week control period (n = 18) (CON). All but one completed FUEL and n = 15 completed CON. While no evidence for difference in change in LEAF-Q total or subscale scores between groups was detected post-intervention (BFincl < 1), the 6- and 12-months follow-up revealed strong evidence for improved LEAF-Q total (BFincl = 123) and menstrual score (BFincl = 840) and weak evidence for improved GI-score (BFincl = 2.3) among FUEL athletes. In addition, differences in change between groups was found for EDE-Q global score post-intervention (BFincl = 1.9). The reduction in EDE-Q score remained at 6- and 12- months follow-up among FUEL athletes. Therefore, the FUEL intervention may improve REDs related symptoms in female endurance athletes.

Clinical Trial Registration

www.clinicaltrials.gov (NCT04959565).

Psychology research in women's soccer: a scoping review

Previous research suggests that psychological factors play an important role in trying to explain and predict the participation, performance, and health of player and practitioners in soccer. However, most previous works have focused on specific research questions and included samples from male populations. As part of a larger Fédération Internationale de Football Association (FIFA) project aiming to steer women's soccer research, our purpose with this scoping review was to give an overview of the current state of psychology-related research within women's soccer. We searched five electronic databases up to April 2023, from which 280 original peer-reviewed articles met the inclusion criteria. Included records were inductively coded into 75 specific research topics and nine broader research categories. Population characteristics within each topic and category, and overall publication trends, were identified. The results revealed a growth in research attention, with notable increases in publication rates around the international competitions years, over the last two decades. While a notable number of abstracts did not report sufficient details about population age and/or playing levels, senior elite players were identified as the most common population studied. Most studies examined several topics from different research categories, with research focusing on emotions, moods and/or environmental factors, and the specific the topics of anxiety, stress, and coach behavior, receiving most research attention. Our study provides an informative mapping of all psychology-related research activity within women's soccer, which will enhance researchers' understanding of the current quantity of literature within this complex, heterogeneous, and growing area of research.

School-based physical activity in relation to active travel - a cluster randomized controlled trial among adolescents enrolled in the school in motion study in Norway

BACKGROUND

Active travel and school settings are considered ideal for promoting physical activity. However, previous research suggests limited effect of school-based interventions on overall physical activity levels among adolescents. The relationship between physical activity in different domains remains inconclusive. In this study, we examined the effects of adding two weekly hours of school-based physical activity on active travel rates.

METHOD

We analyzed data from 1370 pupils in the 9th-grade participating in the cluster RCT; the School In Motion (ScIM) project. Intervention schools (n = 19) implemented 120 min of class-scheduled physical activity and physical education, in addition to the normal 2 hours of weekly physical education in the control schools (n = 9), for 9 months. Active travel was defined as pupils who reported walking or cycling to school, while motorized travel was defined as pupils who commuted by bus or car, during the spring/summer half of the year (April-September), or autumn/winter (October-February). The participants were categorized based on their travel mode from pretest to posttest as; maintained active or motorized travel ("No change"), changing to active travel (motorized-active), or changing to motorized travel (active-motorized). Multilevel logistic regression was used to analyze the intervention effect on travel mode.

RESULTS

During the intervention period, most participants maintained their travel habits. In total, 91% of pupils maintained their travel mode to school. Only 6% of pupils switched to motorized travel and 3% switched to active travel, with small variations according to season and trip direction. The intervention did not seem to influence the likelihood of changing travel mode. The odds ratios for changing travel habits in spring/summer season were from active to motorized travel 1.19 [95%CI: 0.53-2.15] and changing from motorized to active travel 1.18 [0.30-2.62], compared to the "No change" group. These findings were consistent to and from school, and for the autumn/winter season.

CONCLUSION

The extra school-based physical activity does not seem to affect rates of active travel among adolescents in the ScIM project.

TRIAL REGISTRATION

Clinicaltrials.gov ID nr: NCT03817047. Registered 01/25/2019' retrospectively registered'.

Skating on thin ice? Mental health and well-being in women's ice hockey

Objectives

First, to map the prevalence of symptoms of positive mental health, anxiety, depression and sleep difficulties, along with the coexistence of these symptoms, among players in the Swedish Women's Hockey League (SDHL). Second, to investigate relationships between these mental health symptoms and demographic variables (ie, age, injuries, dual careers), social support and psychological flexibility.

Methods

Players from nine teams in SDHL (n=182; mean age 22.3±SD 4.8, range 16-35) participated in this cross-sectional study. An online survey, including validated self-assessment questionnaires, conducted data collection. The questionnaires were distributed just before the play-offs started in the 2022-2023 season. Mental health variables were presented as descriptive statistics, and associations were investigated through multivariate binary logistic regression analyses.

Results

The response rate was 91%. Moderate or severe symptoms were reported among 29.7% for sleep difficulties, 20.9% for anxiety and 18.1% for depression. Nineteen per cent reported comorbidities. Sixty percent reported flourishing mental health. Lower psychological flexibility was associated with lower odds of flourishing mental health and higher odds of symptoms of anxiety, depression and sleep difficulties. Social support was associated with higher odds of flourishing mental health and lower odds of sleep difficulties.

Conclusion

6 of every 10 players reported not reaching the ideal state of mental health (ie, flourishing mental health without mental illness). Mental health symptoms were statistically significantly associated with psychological flexibility and social support, suggesting that these factors will be beneficial to consider when preventing mental illness and promoting mental health in this population.

Examination of the validity of the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale in male professional football players: A worldwide study of 29 professional teams

Perceived confidence is an important dimension of an athlete's psychological readiness to return-to-play. However, there is no established and validated tool to evaluate confidence in professional football. This study aimed to provide preliminary evaluation of the internal structure of the Injury-Psychological Readiness to Return-to-Sport scale (I-PRRS) in a cohort of injured male professional footballers. Over an 18-month period, 29 teams from 17 leagues participated. Players sustaining injuries eliciting ≥ 3 weeks' time-loss were recruited. Cross culturally adapted to 4 further languages, the I-PRRS was administered on two occasions: 1) day before returning-to-training and 2) day before returning-to-match-play. In total, 113 injuries were recorded with 96 completed I-PRRS data sets collected. Confirmatory factor analysis indicated the I-PRRS was a unidimensional scale, with all items measuring the same construct. The scale demonstrated good internal consistency (ω = .88). When examining longitudinal invariance of the I-PRRS across administration time-points, indices of model fit supported scalar invariance. There was preliminary evidence of good internal structure for the I-PRRS in professional male footballers. However, before further research involving the I-PRRS can be endorsed, efforts to confirm or refute empirical developments pertaining to psychological readiness are necessary.

Injury incidence in male elite youth football players is associated with preceding levels and changes in training load

Objectives

Elite youth football players miss out on a large part of seasonal training due to injury. Limited research suggests an association between external and internal training load (TL) and injury incidence in elite youth football. This study analysed external and internal TL variables and their association with injury incidence in a group of male elite youth football players over four seasons.

Methods

Measures of external and internal TL and injury incidence of 56 male elite youth football players (age 17-19 years) were collected throughout four seasons. Heart rate, session rating of perceived exertion andGlobal Positioning System (GPS) variables were analysed. Individual players' TL during the 30 days leading up to injury was compared with 30-day injury-free control periods. Change in TL through the periods was also analysed.

Results

Eighty-five injuries were included for analysis, showing that for most TL variables, the average levels were significantly lower during the period leading up to injury. Significant increases for the majority of TL variables were also found during the periods leading up to injury, while the control periods did not show any significant change.

Conclusion

A lower and/or increasing average TL volume over 30 days might increase the risk of injury in male elite youth football players. Avoiding long-term drops in TL and balance increases in TL might be beneficial to reduce injury risk.

Self-determination theory and the smoking cessation process: Daily electronic self-reports can identify the initiation of quit attempts

OBJECTIVES

To examine the motivational predictors of the smoking cessation process at the between-persons and within-persons levels.

METHODS

Mediation analyses were conducted on self-report data (N = 236) that were collected using interval contingent sampling over a 39-day study period.

RESULTS

There was a high rate of attrition, as nearly 50% of participants were lost to follow-up. There were credible indirect effects of autonomous self-regulation on smoking behavior on the next day and seven-day abstinence through perceived competence and medication use. At the between-persons level, these models explained 17% of the variance in smoking behavior on the next day and 31% of the variance in seven-day abstinence; at the within-persons level, these estimates were 39% and 57%, respectively.

CONCLUSIONS

Day-to-day changes in autonomous self-regulation, perceived competence, and medication use are important initiators of the smoking cessation process.

PRACTICE IMPLICATIONS

Smokers might be more likely to make a quit attempt if practitioners "tune into" the day-to-day fluctuations of their patients' motivation for stopping smoking, perhaps using an electronic platform to assess and compare smokers' current reports to their previous experiences. Such "motivational attunement" can afford practitioners an opportunity to provide need support when patients are willing and able to initiate a quit attempt.

Mental health problems in elite sport: the difference in the distribution of mental distress and mental disorders among a sample of Norwegian elite athletes

Objectives

To, based on diagnostic interviews, investigate the distribution of mental disorders among a sample of Norwegian elite athletes with 'at-risk scores' on a self-report questionnaire measuring symptoms of mental health problems. Then, to investigate the relationship between 'at-risk scores' and diagnosed mental disorders.

Methods

A two-phase, cross-sectional design was used. In phase 1, 378 elite athletes completed a questionnaire, including validated self-report psychiatric instruments assessing symptoms of mental disorders. In phase 2, we assessed the 30-day presence of the same disorders through diagnostic interviews with the athletes with 'at-risk scores' using the fifth version of the Composite International Diagnostic Interview.

Results

Two hundred and eighty athletes (74.1%) had an 'at-risk score,' and 106 of these athletes (37.9%) completed diagnostic interviews. Forty-seven athletes (44.3%) were diagnosed with a mental disorder. Sleep problems (24.5%) and obsessive-compulsive disorder (OCD) and OCD-related disorders (18.9%), mainly represented by body dysmorphic disorder (BDD), were most common. Anxiety disorders (6.6%), eating disorders (5.7%) and alcohol use disorder (≤4.7%) were less frequent. Affective disorders, gambling and drug use disorder were not present. Results from self-report questionnaires did not, in most cases, adequately mirror the number of mental disorders identified using diagnostic interviews.

Conclusions

Using self-report questionnaires to map mental distress among elite athletes can be beneficial. If the aim, however, is to investigate mental disorders, one should move beyond self-report questionnaires and use diagnostic interviews and diagnostic instruments. In our study, sleep problems and BDD were the most prevalent. Longitudinal studies are needed to investigate these findings further.

Are they all born to score? The relationship between throwing arm and scoring from the 7-meter line in semi-professional handball

ABSTRACTIndications of laterall biases favouring left-handers have been found in various sports; especially interactive sports where the athletes have limited time to react to incoming objects. The aim of this study was therefore to explore whether any lateral biases exist in handball by examining 7-meter shots. A total of 6846 7-meter throws from 240 7-meter shooters across four seasons in the semi-professional Icelandic elite handball division (male and female) were analyzed. Out of the 240 7-meter shooters, of which 151 were male and 89 were female, 22% were left-handed (22% of the males and 20% of the females). The left-handed 7-meter shooters took a disproportionate number of the 7-meter shots, with left-handed shooters performing 29% of the 7-meter shots (27% in the male league and 33% in the female league). The results of a Bayesian two-level analysis indicated that left-handedness is not associated with greater success from the 7-meter line at the semi-professional level.

Identity leadership and cohesion in elite sport: The mediating role of intra-team communication

One perspective on leadership that has recently gained increased attention in sport is identity leadership; however, research on elite sport teams is still in its infancy. Thus, the main purpose of this research is to investigate identity leadership in elite team sports in relation to task cohesion, and subsequently to explore the mediating role of the intra-team communication dimensions of acceptance and distinctiveness. A cross-sectional design was employed and 441 elite athletes from division 1 and division 2 in handball and ice hockey participated in the present study. Structural equation modeling was used to assess relationships between identity leadership and task cohesion, and the mediating role of acceptance and distinctiveness. Results revealed that identity leadership positively predicted task cohesion, and that this relationship was mediated by intra-team communication acceptance. In conclusion, findings in the present study expand our understanding of performance-related benefits of identity leadership in elite sport.

Relationship between Physical Activity and Health Outcomes in Persons with Psychotic Disorders after Participation in a 2-Year Individualized Lifestyle Intervention

People with psychotic disorders have a significantly increased risk of physical diseases and excessive mortality rates. The aim of the study was to investigate relationships between changes in physical activity, levels of salutogenic health, and glycated hemoglobin among people with psychotic disorders after participation in an individualized lifestyle intervention. The results from analyses showed that self-reported increased physical activity was positively associated with the level of salutogenic health and negatively associated with the level of HbA1c on an individual level. The results indicate that coordinated, individualized, holistic and health-promoting nursing care is crucial to enabling enhanced lifestyle within this vulnerable target group.

In-season autoregulation of one weekly strength training session maintains physical and external load match performance in professional male football players

The aim of this study was to compare the effects of autoregulating strength training volume based on an objective (external load match performance) versus a subjective (self-selected) method in professional male football players. Sixteen players completed a 10-week strength training programme where the number of sets was regulated based on football match high-intensity running distance (HIR >19.8 km/h, AUTO, n = 7), or self-selected (SELF, n = 9). In addition to traditional physical performance assessments (30-m sprint, countermovement jump, leg-strength, and body composition), external load match performance was assessed with five matches in the beginning and in the end of the study period. Both groups performed ~ 1 weekly bout of ~ 6 sets in leg extensor exercises during the 10-week period, and maintained physical performance during the competitive season, with no group differences detected after the training period. Non-overlap of all pairs (NAP) analysis showed weak-to-moderate effects in external load match performance from before to after the study period, suggesting that players maintained or improved their performance. In conclusion, no group differences were observed, suggesting that both external load autoregulated and self-selected, low-volume in-season strength training maintained physical, and external load match performance in professional male football players.

The Effects of an Equine-Assisted Therapeutic Intervention on Well-Being in Persons Diagnosed with Schizophrenia. A Pilot Study

The process of personal recovery among persons diagnosed with schizophrenia may be facilitated through innovative health promotion interventions targeting multidimensional aspects of subjective well-being. The current pilot study aims to test the use of self-rated questionnaires as a means of evaluation of the effects of an equine-assisted intervention for persons diagnosed with schizophrenia. Twenty adults diagnosed with schizophrenia were offered a 12-week EAT intervention performed six times once every 14 days by a licensed mental health nurse. Two validated self-rated questionnaires, HSCL-25 and SHIS were used as outcome measurements at baseline and at post-treatment, additionally the self-rated questionnaire PANAS was completed twice a week starting 1 week before the 12 week-EAT intervention. Only six of the 20 participants managed to complete the validated questionnaires. Despite the low response rate of approximately 30%, a significant difference was found between pre and post scores for positive affect and well-being. Effect sizes, ranging from small to large for pre-to-post treatment scores indicated less depression and anxiety, more positive affect, less negative affect, and reinforced well-being. Results suggest that EAT interventions may have beneficial effects among persons diagnosed with schizophrenia and that a varied range of research methods are needed to create a solid evidence base for EAT interventions intended for the target group.

When context creates uncertainty: experiences of patients who choose rehabilitation as a treatment after an ACL injury

Up to 50% of patients who suffer an anterior cruciate ligament (ACL) injury receive or opt for rehabilitation alone as initial treatment in Scandinavia. Knowledge of whether patients treated with rehabilitation alone after ACL injury are satisfied is lacking. This study aimed to explore the experiences of patients treated with rehabilitation alone after an ACL injury. Fourteen patients (35.9 (19-56) years old) who suffered an ACL injury treated with rehabilitation alone, a mean of 32 months before inclusion, were interviewed. The interview transcripts were analysed using qualitative content analysis with an inductive approach. The experiences of patients treated with rehabilitation after an ACL injury were summarised in one theme: 'Is the grass greener on the other side? Context characterised by uncertainty', supported by three main categories and nine subcategories. Uncertainty permeated the context of all levels of knee-related life following ACL injury: (1) in the past, patients felt uncertainty regarding treatment choices, (2) in the present, patients felt uncertainty regarding their physical capacity and knee self-efficacy, and (3) for the future, patients felt uncertainty regarding what might happen. With few exceptions, patients' experiences after an ACL injury treated with rehabilitation alone are characterised by uncertainty regarding their physical function, psychological impairments and possible future limitation of knee function. Uncertainty is experienced by patients in the past, the present and the future. Patients experience the knee as a symptomatic obstacle and need to adapt the physical activity to the presence of symptoms.

Motivational predictors of children's involvement in out-of-school activities: An application of a football program

The "11 for Health in Denmark" in-school educational football program has shown to have numerous positive physiological and psychological effects in 10- to 12-year-old schoolchildren. A key part of the successful application of the program, however, has not yet been examined, namely the motivational processes underlying participation and behavioral changes. This study examined such motivational processes (i.e., autonomous motivation, beliefs, and intentions) using the trans-contextual model (TCM) and investigated if the 11 for Health in Denmark program increased intentions to participate in physical activity (PA) outside of school in 10- to 12-year-old schoolchildren. Using a web-based questionnaire, Danish-speaking schoolchildren (N = 276 [boys, 50.4%]; M_age  = 10.44, SD = 0.35) from three schools and seven classes completed TCM-based questionnaires at three time-points (weeks 0, 1, and 5) while participating in the 11 for Health in Denmark program. Single-indicator structural equation modeling was performed to examine goodness-of-fit and parameter estimates. A path analysis using maximum likelihood estimation was used to test the direct and indirect effects of the TCM model. The results partly supported a mediation sequence, as we found significant direct effects in eight of 13 motivational variables (β = -0.25-0.83, p < 0.05), indirect effects in one of nine variables (β = 0.15, p < 0.01), but no effects with regard to PA behavior. Findings provide evidence for a motivational link between Danish-speaking schoolchildren's autonomous and controlled motivation from in school to out of school, and may inform future interventions promoting motivation and participation in out of school PA.

Empowerment-Based Physical Activity Intervention for People with Advanced Dry Age-Related Macular Degeneration: Mixed-Methods Protocol

Age-related macular degeneration (AMD) is the most common cause of incurable visual impairment and impacts daily life. These impacts include loss of social activities, decreased functional independence, and reduced physical activity. This protocol aims to describe a prospective, mixed-methodology for studying a population with AMD before, during, and after an empowerment-based physical activity intervention (EPI). A study framework was also developed for EPI. The intervention will include 20 older individuals (age 65+ years) with AMD recruited in Sweden. The intervention period is six months and comprises adapted physical activity and social activities in a group twice a week and individual health coaching on three occasions. The quantitative pre-test and three follow-ups include physical functional tests, an accelerometer that monitors physical activity continuously for one week, and questionnaires. Individual and focus-group interviews and ethnographic observations will explore the experience of living with AMD and what it means to participate in the EPI for individuals with AMD. The chosen methodology offers a structured way for researchers to explore the experiences and factors that may provide insights into the potential of creative supervised, adapted physical activity in groups, health coaching, and socialising that are significant to enable well-being among older individuals with AMD.

Psychosocial Predictors of Drop-Out from Organised Sport: A Prospective Study in Adolescent Soccer

In recent years an increased drop-out rate in adolescents' soccer participation has been observed. Given the potentially adverse consequences of drop-out from soccer, more information about risk factors for drop-out is warranted. In the current study, Classification and Regression Tree (CRT) analysis was used to investigate demographic and motivational factors associated with an increased risk of drop-out from adolescent soccer. The results of this study indicate that older age, experiencing less autonomy support from the coach, less intrinsic motivation, being female, and lower socioeconomic status are factors associated with an increased risk of drop-out. An interpretation of the results of this study is that coaches play a central part in creating a sports context that facilitates motivation and continued soccer participation. Based on the findings of the current study we propose that soccer clubs implement theoretically informed coach education programs to help coaches adopt autonomy-supportive coaching strategies.

Exploring psychosocial risk factors for dropout in adolescent female soccer

OBJECTIVES

We examined the manner in which age, participation in other sports, socioeconomic status, perceived sport competence, achievement goal orientations, and perceived motivational climate may interact to predict the risk of dropout among adolescent female soccer players.

METHODS

Self-reported data from 519 female soccer players between 10 and 19 years of age (M = 13.41, SD = 1.77) were analysed using a person-centred approach to uncover the interactions among risk factors and their relative predictability of dropout.

RESULTS

Perceived motivational climate was identified as the main predictor, where relatively lower levels of mastery climate were associated with a higher dropout tendency (absolute risk reduction [ARR] = 12.2% ±6.1% [95% CL]). If combined with relatively lower levels of mastery climate, then relatively lower levels of perceived sport competence were related to higher dropout risks (ARR = 16.5% ±9.5%), whereas, in combination with relatively higher levels of mastery climate, then relatively lower levels of ego-orientated achievement goals were associated with higher dropout rates (ARR = 10.8% ±12.6%).

CONCLUSIONS

Our findings afford novel insights into the interactions between, and the relative importance of, various risk factors for dropout in adolescent female soccer. This knowledge may be useful for soccer associations, clubs, and coaches when developing guidelines and strategies that aim to foster young females' sustained participation in organised soccer.

Evaluation of a universal early intervention for parents and children from birth to age five

Background

This study aimed to investigate the health and economic outcomes of a universal early intervention for parents and children, the Salut Programme, from birth to when the child completed five years of age.

Methods

This study adopted a retrospective observational design using routinely collected register data with respect to both exposures and outcomes from a county in northern Sweden. Areas that received care-as-usual (non-Salut area) were compared to areas where the Programme was implemented after 2006 (Salut area) in terms of: i) health outcomes, healthcare resource use and related costs around pregnancy, delivery and birth, and ii) healthcare resource use and related costs, as well as costs related to care of sick child. Costs were estimated for inpatient care and specialised outpatient care for mothers and children. Two analyses were conducted: a matched difference-in difference analysis using the total sample and an analysis including a longitudinal subsample.

Results

The longitudinal analysis on mothers who had given birth in both the pre- and post-measure periods showed that those that had been exposed to the Salut Programme, had on average 6% (95% CI 3-9%) more full-term pregnancies and 2% (95% CI 0.03-3%) more babies born within normal weight range, compared to mothers who had only care-as-usual. Savings were incurred in terms of outpatient care related costs for children of mothers in the Salut area ($826). The difference-in-difference analysis using the total sample did not result in any significant differences in health outcomes or cumulative resource use over time.

Conclusions

The Salut Programme achieved health gains at a reasonable cost for children and parents, and may lead to lower usage of outpatient care. Other indicators point towards positive effects but the small sample size may have led to underestimation of true differences. The current findings support the continuous investment in this early childhood programme.

Key messages

• The Salut Programme improves the health of children and parents at a low cost.

• The Salut Programme as a health promotion early intervention is value for money and should be included in the local policy investment agenda.

Favorable Adaptation during SARS-CoV-2-Pandemic as Told by Student-Athletes-A Longitudinal and Behavioral Study

(1) Background: The aim was to explore the impact of adaptive responses (resilience factors) on student-athletes' behaviors during a stressful period of life during the SARS-CoV-2-pandemic of 2020 and 2021. (2) Methods: A constructivist-based grounded theory (CGT) was used guided by a biopsychosocial approach. Based on purposeful sampling, 22 male and female student-athletes were divided into four focus group interviews (FGI) seven months after the outbreak of the SARS-CoV-2-pandemic (October 2020) and 18 of these were followed up by FGI seven months later (May 2021). The mean age was 17.65 and they represented golf and handball. (3) Results: The CGT contained four main categories seven months after the SARS-CoV-2-pandemic outbreak: Social support, Self-discipline, Physical practice and recovery and Management of everyday life. Fourteen months after the SARS-CoV-2-pandemic outbreak, four additional main categories emerged: More extensive social support, Belief in the future, Self-awareness and Responsibility and problem-solving. (4) Conclusions: The CTG suggests that student-athletes' favorable adaptations to the stressful SARS-CoV-2-pandemic period 2020-2021 are based on a gradually developed ability to take responsibility for one's own actions, insight into the importance of deepened social interaction, belief in a positive post-COVID future and increased awareness of physical activity and its relation to perceived health.

'I was young, I wanted to return to sport, and re-ruptured my ACL' - young active female patients' voices on the experience of sustaining an ACL re-rupture, a qualitative study

Background

Despite anterior cruciate ligament (ACL) re-ruptures being common, research on patient experiences after knee trauma has primarily focused on the time after primary ACL reconstruction. Integrating qualitative research and patient experiences can facilitate researchers and clinicians in understanding the burden of an ACL re-rupture. The aim of the study was to explore the experiences of an ACL re-rupture journey in young active females aiming to return to knee-strenuous sports after primary ACL reconstruction.

Method

Fifteen young (19[range 16–23] years old) active females who suffered an ACL re-rupture were interviewed with semi-structured interviews. Qualitative content analysis using deductive approach based on Wiese-Bjornstal’s ‘integrated model of response to sport injury’ was used.

Results

The results are presented in two timelines 1) from first ACL injury to ACL re-rupture, and 2) from ACL re-rupture to present day, and further stratified according to the domains of the ‘integrated model of psychological response to injury’. Results in the first timeline are summarised into seven categories: Finding hope for the journey; Accepting my ACL injury; I succeeded; What matters now? Who am I?; Where will this end? What is going to happen? In the second timeline, eight categories were identified: Fighting spirit; A helping hand; Working hard; I am a new me; I am destroyed; Loneliness; Painful changes; and, I could have made it to the pro´s.

Conclusion

Young active females who suffered an ACL re-rupture did not express any positive experience following their first ACL injury, however, in contrast, expressed positive experiences and personal growth after going through the ACL re-rupture journey, characterized by a lot of struggling, and ultimately led to the experience of becoming a new, stronger person.

Weighted Blankets' Effect on the Health of Older People Living in Nursing Homes

Background: An increasingly aging population is a global phenomenon. While considered a positive step forward, vulnerability to age-related health problems increases along with the ageing population. The aim of the study was to investigate weighted blankets’ effect on health regarding quality of life (QoL), sleep, nutrition, cognition, activities of daily living ADL and medication in older people living in nursing homes. Methods: In total, 110 older people were involved in an intervention with weighted blankets, and 68 older people completed the intervention. Measures before and after were performed regarding quality of life; QoL-AD, EQ-VAS, sleep; MISS, nutrition; MNA, cognition; S -MMSE (ADL) and medication. Comparative statistical analyses were applied. Results: After intervention with weighted blankets, health in general, such as QoL, improved. Sleep also improved significantly, especially with respect to waking up during the night. Nutrition was enhanced, health as a cognitive ability improved, and medication in the psychoanaleptic group decreased. The effect size varied between small and large. Conclusions: A weighted blanket seems to be an effective and safe intervention for older people in nursing homes, as several improvements were made regarding the health of older people.

Moderate-to-vigorous group aerobic exercise versus group leisure activities for mild-to-moderate depression in adolescents: study protocol for a multicentre randomised controlled trial

INTRODUCTION

Depression is common, increasing among adolescents and carries risk of disability, lower educational achievements, cardiovascular disease, substance abuse, self-harm and suicide. The effects of evidence-based treatments with medication or psychotherapy are modest. Aerobic exercise is a promising intervention for adolescents with depression, but available studies are hampered by methodological shortcomings. This study aims to evaluate aerobic group exercise versus an active comparator of leisure group activities in adolescents from clinical services with mild-to-moderate depression.

METHODS AND ANALYSIS

This study is a multicentre randomised controlled trial at four psychiatric clinics in Sweden. Participants (n=122) will be randomised 1:1 to group exercise delivered by exercise professionals and supported by mental health (MH) workers or leisure activities lead by the same MH workers for 1 hour three times a week for 12 weeks. Participants will be assessed at baseline, single blind after 13 weeks and 26 weeks and openly after 1 year. Participants randomised to the leisure group will be offered exercise in the open phase. The primary outcome is clinician-rated Children's Depression Rating Scale-Revised. Secondary outcomes are self-rated Quick Inventory of Depressive Symptomatology, self-rated functioning; clinician-rated improvement and functioning; objectively measured aerobic capacity, muscular strength, muscular endurance, body composition and presence or activity of selected biological markers of neuroprotection and neuroinflammation in blood samples. Further outcomes are cost-effectiveness and adolescents', parents' and coaches' experiences of the interventions and an exploration of how the adolescents' health and lifestyle are influenced by the interventions through qualitative interviews.

ETHICS AND DISSEMINATION

The study is approved by the Swedish Ethical Review Authority (Ref. 2021-05307-01). Informed consent in writing will be provided from patients and parents of participants below 15 years of age. The results of this study will be communicated to the included participants and healthcare providers and also submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05076214.

The Healthy Body Image Intervention and Reduction in Eating Disorder Symptomatology and Muscle Building Supplement Use in High School Students: A Study of Mediating Factors

Background

Mediation analysis is important to test the theoretical framework underpinning an intervention. We therefore aimed to investigate if the healthy body image (HBI) intervention's effect on eating disorder (ED) symptomatology and use of muscle building supplements was mediated by the change in risk and protective factors for ED development and muscle building supplement use.

Methods

This study used data from the HBI intervention: a cluster randomized controlled universal intervention aiming to promote positive body image and embodiment and reduce the risk for ED development including 30 schools in Norway. A total of 1,713 (37% boys) participants were included in the analyses. Conditional latent growth curve analyses were performed to test for indirect effects on ED symptomatology and weekly frequency of protein and creatine supplement use measured at the 12-month follow-up via change in the proposed mediators.

Results

In girls, the reduction in ED symptomatology was mediated by positive changes in protective factors (self-esteem and body image flexibility) and reductions in risk factor scores (perceived media pressure and thin appearance internalization). Comparable changes in protective and risk factors among boys played no mediating role.

Conclusion

Interventions aiming to reduce the risk of ED development in girls may benefit from aiming to enhance self-esteem and body image flexibility and reduce perceived media pressure and thin appearance internalization. Future studies should investigate the casual relationship between muscle building supplement use and risk and protective factors for ED development in both girls and boys.

Simulated Game-Based Ice Hockey Match Design (Scrimmage) Elicits Greater Intensity in External Load Parameters Compared With Official Matches

Objective

A limited number of studies have explored the external load experienced in indoor sports such as ice hockey, and few the link between training and match performance. As a paucity exists within this topic, this study explored whether a simulated match design (i.e., scrimmage) could be representative of official match demands and elicit similar external loads as in official matches in a group of elite youth male ice hockey players.

Methods

A total of 26 players were monitored during eight official and four simulation matches using a Local Positioning System. Total distance, max velocity, slow (0–10.9 km/h), moderate (11–16.9 km/h), high (17.0–23.9 km/h), and sprint (>24 km/h) speed skating distance, distance per min, PlayerLoad^TM, PlayerLoad^TM per min, high-intensity events (HIEs) (>2.5 m/s⁻²), acceleration (ACCs), decelerations (DECs), and change of directions (CODs) were extracted from the tracking devices. A two-level regression analysis was conducted to compare the difference between match types when controlling for time on ice, match day, and position.

Results

Between match-type results showed a credible difference in all variables except max velocity and ACCs. Distance per min was 27.3% higher during simulation matches and was explained by a 21.3, 24.1, and 14.8% higher distance in sprint-, high-, and moderate speed skating distance, while slow speed-skating distance was 49.2% lower and total distance only trivially different from official to simulation matches. Total PlayerLoad^TM was 11.2% lower, while PlayerLoad^TM per min was 8.5% higher during simulation matches. HIEs, CODs, and DECs were 10.0, 11.9, and 22.3% higher during simulation matches.

Conclusion

The simulated match design is related to official match demands with comparable match-time, playing time, number of shifts, and shift duration. However, simulation matches provoked a higher external load output compared with official matches, possibly explained by a more continuous movement design. A game-based simulation match design can therefore be utilized when match-related actions at high intensity are warranted.

Mental health and well-being during COVID-19 lockdown: A survey case report of high-level male and female players of an Italian Serie A football club

OBJECTIVES

To describe high-level footballers' levels and changes in mental health and well-being throughout a 8-week period of lockdown and restricted training during the COVID-19 pandemic.

METHOD

One-hundred and one players belonging to four teams (women's and men's, first and U19 teams) of the same Italian Serie A club participated in the study. Data were collected through an online questionnaire, and administered at 2, 3, 5, 7 and 9 weeks after the start of the lockdown . Well-being, positive and negative affects measurements were examined.

RESULTS

Across the five measures, 36% of players reported clinical levels in depressive symptoms (scores ≤50) on at least one occasion. Thirteen percent of the players reported clinical levels on > 50% of the occasions. There was a decrease in depressive symptoms and negative affects over the period. No change was found in positive affects.

CONCLUSIONS

High number of players reportedclinical levels of depressive symptoms compared to what was found previously in high-level athletes. The number decrease during the 8-week period. A similar trend was found for negative affects.Despite a higher prevalence in depressive symptoms earlier during lockdown, this improved as players progressed towards fewer restrictions.

Dental Hygienists' BioPsychoSocial Beliefs and Giving Autonomy Support in Treatment of Patients: A Self-Determination Theory Perspective

OBJECTIVES

Self-Determination Theory posits that managers' autonomy-supportive behavior and employees' autonomy causality orientation, are motivation constructs to explain internalization of values, functioning, and wellness at work. Hypothesis 1 tested whether profiles comprising perceived dental clinic managers' autonomy-supportive, as opposed to their controlling interpersonal style, and dental hygienists' autonomy, as opposed to their control and impersonal, causality orientations at baseline, would be positively related to dental hygienists' biopsychosocial (BPS) beliefs and giving autonomy support in treatment of patients after 18 months. Hypothesis 2 tested whether dental hygienists' BPS beliefs in treatment of patients will be positively associated with their autonomy-supportive behavior given to patients after 18 months.

MATERIAL AND METHODS

A prospective cohort design with 299 (M_age = 42.71; SD_age = 12.62) dental hygienists completed an online survey at baseline and after 18 months.

RESULTS

Latent profile and correlational analyses supported the hypotheses. Effect sizes were moderate to large.

CONCLUSIONS

Both perceived managerial styles and dental hygienists' causality orientations are important for dental hygienists' BPS beliefs and autonomy-supportive behaviors when working with dental patients.

Resilience as a protective factor for well-being and emotional stability in elite-level football players during the first wave of the COVID-19 pandemic

Background: In Denmark, the first COVID-19 pandemic lockdown resulted in a compact season finisher for elite footballers, potentially impacting their mental health.Purpose: This study aimed to investigate the protective role of resilience and the impeding role of trait anxiety on elite footballers' level and variability of well-being and emotional stability.Material and Methods: One hundred and twenty-five male elite-level players (M_age = 25.04 ± 4.82) completed baseline measures on trait anxiety and resilience. Additionally, well-being and positive and negative affect were assessed before games (n = 24) over 62 days. Separate two-level regression analysis using Bayesian statistics was conducted to test potential relationships. Results: Results show a credible positive relationship between the average level of well-being and within-person variability over time as well as the average level in positive affect. This indicates that resilience might be a protector for mental health. In addition, higher levels of trait anxiety (i.e., subscale concentration disruption) were associated with higher levels of negative affect and higher variability over time. This indicates that trait anxiety might facilitate negative affect. No other credible relationships were found. Conclusion: High resilience and low trait anxiety are identified as relevant factors for mental health within elite footballers during COVID-19. Implications for practice are discussed.

The Role of the Results of Functional Tests and Psychological Factors on Prediction of Injuries in Adolescent Female Football Players

Football is a popular sport among adolescent females. Given the rate of injuries in female footballers, identifying factors that can predict injuries are important. These injuries are often caused by complex reasons. The aim of this study was to investigate if the combination of demographic (age, number of training and match play hours/week), psychosocial (perceived stress, adaptive coping strategies) and physiological factors (functional performance) can predict a traumatic injury in adolescent female footballers. A cohort consisting of 419 female football players aged 13-16 years was established. Baseline questionnaires covered potential risk factors for sport injuries, and measurements included football-related functional performance tests. Data were collected prospectively with a weekly online questionnaire for 52 weeks covering, e.g., injuries, training, and match play hours/week. A total of 62% of the players reported at least one traumatic injury during the 52 weeks. The coping strategy "positive reframing" had the strongest association with the risk of traumatic injuries. The combination of more frequent use of the coping strategy, positive reframing, and high levels of physical performance capacity may prevent a traumatic injury in adolescent female footballers. Coaches are encouraged to adopt both physiological and psychological factors when preventing injuries in young female footballers.

Profiles of psychosocial factors: Can they be used to predict injury risk?

The creation of risk profiles using the model of stress and athletic injury (J Appl Sport Psychol. 1998;10(1):5) represents a proposed shift from the reductionism paradigm to the complex sport approach in an attempt to formulate prevention strategies to combat the increasing number of injuries being reported in sporting populations. As a result, the primary purpose of this study was to: (a) identify different risk profiles based on psychosocial factors associated with the Williams and Andersen's model of stress and athletic injury model; and (b) examine potential differences in the frequency of injuries across these risk profiles. A prospective research design was utilized with a sample of 117 competitive soccer players (81 males and 36 females) from Sweden and the United States of America. Data was collected at two time points over the course of three months. At time 1 (beginning of the season) - a demographic information sheet, the Life Event Survey for Collegiate Athletes (LESCA), Sport Competitive Anxiety Test (SCAT), and Brief Cope were administered. At time two (T2), three months after the initial data collection, participants' traumatic injuries were recorded. Latent profile analysis (LPA) showed that 3 profiles solution showed best fit to data. Players in profile 1 and 2 reported fewer injuries compared to players in profile 3. However, whereas individuals in profile 1 had a lower predictive risk of sustaining an injury when compared to those in profile 3, both profiles had similar anxiety levels and use of coping strategies with differing stress levels. These findings suggest that the interaction between different proposed risk factors might influence injury risk.

Relating Competitive Golfers' Perceived Emotions and Performance

The present study examined relationships between golfers' self-perceived emotions (e.g., irritability, nervousness, tension), task-oriented coping, perceived control, and performance during a golf competition. We implemented a process-oriented golf analysis in which competitors rated these variables hole-by-hole in a competitive golf round. Within a two-level Bayesian multivariate autoregressive model, we showed that (a) within persons, emotions and task-oriented coping were reactions that stemmed from performance on the previous hole; and (b) between persons, player skill level predicted both better scores and the ability to limit the influence of negative affect on performance. These findings highlight the complex nature of the relationship between emotions and performance. Future studies might use a similarly ecologically valid research design to more precisely measure aspects of time and potentially moderating effects of player skill level and personality. An increased understanding of the dynamic relationship between emotions and performance can promote the development of effective psychological interventions for optimal performance outcomes.

Risk factors for overuse injuries in a cohort of elite Swedish track and field athletes

BACKGROUND

Most injuries in track and field are caused by overuse with conflicting reports concerning the underlying mechanisms. The purpose of this study was to evaluate how biomechanical and clinical factors relate to the risk of overuse injuries, and to investigate whether the relationships between potential risk factors and injury become stronger if injuries are grouped by location.

METHODS

The study is a prospective cohort study conducted during a Swedish track and field season over eleven months, from October to August. The cohort consisted of elite male and female track and field athletes competing in either middle- and long-distance running, sprinting, jumping, or throwing events (n = 96). Athletes performed a baseline screening at enrollment consisting of a clinical examination, running, and strength tests. Injury data was collected during the season by medical professionals and divided according to their anatomical location into upper-body, thigh/hip, knee, or foot/shank injuries.

RESULTS

Thirty-four (54.8%) injuries where located at the foot/shank, followed by sixteen injuries at the thigh/hip (25.8%). Only eight knee (12.9%) and four upper-body (6.5%) injuries were registered during the season and therefore not analysed. Effect sizes were calculated for all test variables. Small effect sizes (rpb = .10-.23) were found for eleven risk factors between the overall injured (all injuries combined) and non-injured athletes. By further sub-grouping the injured group into thigh/hip injuries, effect size increased in hip adduction range of motion knee flexion velocity and the muscle flexibility of the iliopsoas. For foot/shank injuries, only the hamstring:quadriceps strength ratios increased for the right side to a small effect size.

CONCLUSIONS

Injury grouping appears to increase effect size for certain risk factors. Athletes with a slower knee flexion velocity during stance phase were more likely to become injured (p-value <.03, rpb = .37). An increased cohort size to further sub-divide injuries into specific diagnoses is needed.

Exploring risk factors for developing occupational ill health - departing from an occupational perspective

BACKGROUND

Sick leave due to stress-related mental ill health increases in society. In occupational therapy, occupational balance is considered important for experiencing health and well-being. Thus, knowledge regarding occupational balance and occupational value constitute essential parts of occupational therapists' work with people suffering from occupational ill health.

OBJECTIVE

The aim of this study is to analyse the relationships between sociodemographic factors, occupational value, occupational balance and perceived health in people suffering from occupational ill health.

METHODS

In a quantitative cross-sectional study data from a total of 218 individuals were included, 192 women, 22 men and 4 individuals who did not specify their gender. Data were collected by means of surveys prior to an occupational therapy intervention. The instruments used included OVal-pd, OBQ, EQ5D and a sociodemographic questionnaire. Data were analysed using regression and decision tree analysis.

RESULTS

The results show that individuals who experience an imbalance in their everyday life and who have few or no experiences of daily occupations imprinted by socio-symbolic occupational value experienced lower perceived health.

CONCLUSIONS

Low level of experiences of balance in daily life and occupational value seems to be the main risk factors for the development of occupational ill health, rather than sociodemographic factors.

Psychological risk profile for overuse injuries in sport: An exploratory study

Overuse injuries account for a substantial part of sport injury incidence among athletes of various sports and levels. Despite the gradual onset of symptoms, athletes often persevere in training and competing. The present exploratory study aimed to identify a psychological risk profile for overuse injury. One hundred and forty-nine athletes competing in various sports responded to a range of questionnaires measuring the following psychological variables: negative life stress, perfectionistic concerns, perfectionistic strivings, athletic identity, and the coach-athlete relationship. Participants subsequently answered the OSTRC Overuse Injury Questionnaire on a weekly basis during a 10-week period. Using a latent profile analysis, athletes were classified into three latent profiles regarding their psychological characteristics. Athletes in the second profile, characterized by a combination of high athletic identity, perfectionistic concerns and negative life stress and poor coach-athlete relationship, were found to be significantly more often affected by overuse injuries (74% of the time) than individuals in the two other profiles (52% and 48% of the time, respectively). In conclusion, psychological factors may contribute to the risk of overuse injuries through complex interactions (i.e. accounting for interdependencies within a specific configuration of variables) rather than through their independent influences.

Is Perceived Autonomy Support Provided by a Coach Related to the Intention of Injury Preventative Behavior Among National and International Level Golfers?

The successful implementation of injury prevention programs is reliant on athletes and coaches accepting, adopting, and complying with behaviors that reduce injury risk. Exploring factors, such as motivation and planned behavior, that might increase the frequency of these behaviors warrants investigation. The aim of the study was to investigate the complex interaction between perceived autonomy support, self-determined motivation, planned behavior, and how this relates to golfers self-reported intention injury preventative behavior. A total of 60 golfers completed questions on psychological measures of perceived autonomy support from coaches, autonomous motivation, and intentions of injury preventative behavior. A neural network model analysis was performed to investigate the strength of connection between covariates and construct a network structure. Analysis of results was performed by assessing edge strengths and node centrality to guide inference of the network topology. The most central node was autonomous regulation and the results showed one cluster comprising positive interactions between perceived autonomy support, effort of injury preventative behavior, and frequency of injury preventative behavior. When aiming to encourage injury preventative behavior, coaches should consider giving feedback that supports autonomous motivation since it is positively associated with effort and frequency of injury preventative behavior among high-level golfers. Injury prevention programs should include strategies to improve the athlete's autonomous motivation to carry out preventive activities.

Mental health among elite athletes in Norway during a selected period of the COVID-19 pandemic

Objective

To investigate the prevalence of mental health problems and satisfaction with life among different groups of elite athletes during a selected period of the COVID-19 pandemic and examine how COVID-19 related consequences were associated with these variables.

Design

Cross-sectional data collection during a selected period of the COVID-19 pandemic in Norway.

Participants

378 elite athletes, mean age 26.86 (range 18–59), 159 females and 219 males, divided into Olympic-level and Paralympic-level athletes (n=194) and elite and semielite athletes (n=184).

Main outcome measures

Hopkins Symptoms Check List − 10; symptoms of anxiety and depression; Bergen Insomnia Scale; Eating Disorder Examination Questionnaire Short; Canadian Problem Gambling Index and Satisfaction with Life Scale. In addition, we included specific COVID-19 questions (eg, financial concern, keeping daily routines, perceived coping and motivation).

Results

Symptoms of insomnia (38.3%) and depression (22.3%) were most prevalent within the sample. Symptoms of eating disorders more prevalent among female athletes (8.8% vs 1.4%) while symptoms of gambling problems were higher among male athletes (8.6% vs 1.3%). Olympic and Paralympic athletes reported lower levels of anxiety and depression symptoms than elite and semielite athletes. Financial concerns were associated with an increased risk of mental health problems, while daily routines and perception of coping were associated with less mental health problems and higher satisfaction with life.

Conclusion

Symptoms of insomnia and depression were the two most common mental health problems reported during this selected phase of the COVID-19 pandemic. Elite and semielite athletes reported financial concerns as a risk factor for mental health problems at a larger degree than Olympic and Paralympic athletes.

The Temporal Relations of Adolescents' Basic Need Satisfaction in Physical Education and Global Self-Worth

This study investigated the temporal relations of adolescents' basic need satisfaction in physical education (PE) and global self-worth in a sample of 3,398 lower and upper secondary school students (49% boys, 51% girls, average age T1 = 15.00, SD = 1.79). Four models and competing hypotheses were tested, and the model with bidirectional paths specified showed the best fit to the data. The bidirectional effect estimates suggest not only that basic need satisfaction in PE predicts global self-worth development but also that adolescents' perceptions of global self-worth predict the degree to which they experience basic need satisfaction in PE. Findings could suggest that students with low global self-worth are less sensitive to basic need support in PE. These students may need personally tailored need-supportive initiatives in order to develop basic need satisfaction in PE and, thus, global self-worth through PE.

Scanning, Contextual Factors, and Association With Performance in English Premier League Footballers: An Investigation Across a Season

Scanning in football (soccer) denotes an active head movement where a player's face is temporarily directed away from the ball to gather information in preparation for subsequently engaging with the ball. The aim of this study was to learn more about the ways that 27 elite professional football players in an English Premier League club use scanning in competitive matches, the conditions under which this behavior is exhibited, and the relationships between these behaviors and performance. Players were filmed across 21 matches, producing a total number of 9,574 individual ball possessions for analysis. Close-up video analyses of scanning show positional differences (with central midfielders and central defenders scanning most frequently, forwards least) and contextual differences (with relatively lower scanning frequency in situations with tight opponent pressure, in positions wide in the field and closer to the opponent's goal, and under certain game state conditions). Players scan more frequently prior to giving passes than when they dribble, shoot, or only receive it, as well as prior to more long/forward passes compared to short/backward ones, although these differences are small. A Bayesian hierarchical model, which accounts for individual player differences and pass difficulty, suggests that the more a player scans, the higher the probability of completing a pass. In conclusion, match demands are likely to constrain the extent to which highly elite players scan, and scanning seems to have a small, but positive role in elite football players' performance.

The influence of initial selection age, relative age effect and country long-term performance on the re-selection process in European basketball youth national teams

The aims of the study were to: (a) analyse the re-selection patterns in European youth basketball national teams, and (b) investigate how the chance of re-selection is influenced by the initial selection age and relative age of the players, as well as the long-term performance of the country at the youth level. The sample consisted of 8362 basketball players (5038 men, 3324 women) born 1988-1997 who have participated in at least one U16, U18 or U20 European youth basketball championship between 2004 and 2017. The results from the survival analysis showed that around 75% of male and 80% of female players participating in a championship were re-selected the following year. Also, initial selection age, relative age effect, and the country long-term performance influenced the re-selection rates, with relationships being different between men and women. To conclude, the results of the present study show that the re-selection process by which players progress in European youth national basketball teams is complex and influenced by several different factors.

Mindfulness and shooting performance in biathlon. A prospective study

The aim of the study was to examine the temporal relationship between facets of sport-specific dispositional mindfulness (i e., Awareness, Refocusing, Nonjudgemental attitude) and shooting performance in actual competitions, in a population of 25 elite biathlon athletes. Findings indicated that mindfulness facets were positively associated with shooting performance, with higher levels of Awareness, Refocusing, and Awareness being related to better shooting performance in competitions. In spite of the fact that the explained variance was quite small, even a minor shooting performance enhancement may increase an athlete's chance of winning a biathlon competition.

Somali-Swedish Research Cooperation for Health (SSRCH) - a joint initiative by Somali and Swedish Universities to guide the Somali health system recovery process

In the fragile Somali state, there is a research imperative to effectively guide health systems recovery, which is crucial in the national rebuilding process for societal stability and peace. Our collaboration has its roots in the early 1980's, was cut short by the civil war and revived in 2014 to meet the need for health research capacity in Somalia today. Somali universities, representing different regions (East Africa University, University of Hargeisa, Galkayo University, Benadir University, Puntland Health Science University, Amoud University, and recently Somali National University) formed a consortium with Swedish universities (Umeå, Lund, Uppsala, Karolinska Institutet and Dalarna) and Somali diaspora professionals. Most recently we joined forces with the Public Health Agency of Sweden, linking us to the National Institute of Health Somalia (NIHS). A joint action programme for capacity building in health research has been developed, as outlined in the article “Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative” (Glob Health Action, 2017;10:1;1348693). We have a model for working collaboratively across regions and cultural barriers, creating hope for real change. As a first step, priority was given to research capacity development of faculty staff at the Somali universities' health faculties and Ministries of Health. A 'training of trainers' course in health research methodology was carried out during 2016-2018, supported by WHO-based Alliance for Health Policy and Systems Research. This has fostered health research as an integral component of these universities' academic development process. Institutional and research capacity in public health has a key role in rebuilding national health services for better health and wellbeing and to reach the SDGs (goals 3, 5, 10, 16).

Athlete availability and incidence of overuse injuries over an athletics season in a cohort of elite Swedish athletics athletes - a prospective study

Background

Athletics is a sport with a high incidence of injury, where most injuries are caused by overuse. Research on injury incidence and the occurrence of overuse injuries during a season in athletics is scarce. An athlete availability (unrestricted ability to participate in training or competition) of less than 80% has been linked with athletes being less likely to reach their performance goals. The purpose of this study was to estimate the monthly injury incidence rates, athlete availability, and the overuse injury incidence rate per 1000 athletics-hours of training in a cohort of Swedish elite athletics athletes.

Methods

The cohort consisted of 59 male and female elite athletes competing in either middle or long-distance running, sprint, or jumping events. Injury and training data were collected during one athletics season, from October to the end of August. All injury data were collected by medical professionals. Training data were collected monthly, and consisted of event-specific training diaries covering training sessions, training days, and non-training or non-competition days. Monthly injury incidence rates were based on the number of new injuries per month in relation to the number of exposed (injury-free) athletes.

Results

The overall injury incidence rate for all athletes was highest in October (22.0%). Monthly injury incidence rate for middle and long-distance runners was highest in October (26.1%), for sprinters in April (19.0%), and for jumpers in October (21.4%). The overall athlete availability was 78.0% for the cohort. Sprinters had the lowest athlete availability (71.4%), followed by jumpers (77.3%), and middle-distance and long-distance runners (82.7%). Female athletes (76.5%) had a lower athlete availability than male athletes (79.7%). The injury incidence rate was 1.81 injuries per 1000 athletics hours of training. Middle and long-distance runners had the highest injury incidence rate (2.38), followed by jumpers (1.62), and sprinters (1.34).

Conclusion

Monthly injury incidence rates during a season appears to correspond to periods of high training volume (conditioning phases and training camps). The low overall athlete availability (> 80%) indicates that many Swedish elite athletes are less likely to reach their full potential.