Supporting athletes during a challenging situation: recommendations from a global insight of COVID-19 home-based training experience

BACKGROUND

For athletes, overcoming obstacles in challenging situations like pandemic home training is crucial. Strategies and approaches in this context are not well-documented. Our study aims to investigate such a scenario from a performance standpoint, based on a major global crisis: the COVID-19 pandemic and lockdown.

METHODS

This cross-sectional study surveyed athletes without disabilities using online questionnaires (35 languages) from May to July 2020. Questions included aspects of alternative routines, training monitoring, recovery, sleep patterns, injury occurrence/prevention based on structured answers, and an open-ended question on lockdown training experiences.

RESULTS

Of the 11,762 athletes from 142 countries, 63% were male, including at World-Class, International, National, State and Recreational levels. During lockdown, 25% athletes used innovative or modern ways to maintain or improve fitness e.g., virtual reality and tracking devices (favoring World-Class level, 30%). Many athletes, regardless of gender (43%) watched video competitions to improve/maintain their mental skills and performance [World-Class (47%) and International (51%)]. Contact frequency between athletes and their coaches was mainly at least once a week (36%), more among higher-level (World-Class/International) than lower-level athletes (27 vs. 16%). Higher-level athletes (≥ 54%) monitored training load and were assisted by their coaches (21%). During lockdown, stretching (67%) was considered one of the primary means of recovery, especially for higher-level athletes (> 70%). Compared to pre-lockdown, about two-thirds of athletes reported "normal" or "improved" sleep quality and quantity, suggesting a low sleep quality pre-lockdown. On average, 40% utilized injury prevention exercises (at least) once a week [World-Class (51%) and International (39%)]. Most injury occurrences during lockdown involved the knee (18%), ankle (16%), and back (9%). Four key themes emerged regarding lockdown experiences: remote training adaptation (e.g., shifting training focus), training creativity (e.g., using household items), performance enhancement opportunities (e.g., refocusing neglected aspects), and mental and motivation challenges.

CONCLUSIONS

Both male and female athletes, particularly those of higher levels, displayed some adaptalibity during the COVID-19 lockdown, employing innovative approaches and technology for training. Many athletes implemented load monitoring, recovery, and attentive of injury prevention, while optimizing their sleep quality and quantity. Athletes demonstrated their abilities to navigate challenges, and utilized different coping strategies in response to the lockdown's constraints.

Evolution of 1500-m Olympic Running Performance

PURPOSE

This study determined the evolution of performance and pacing for each winner of the men's Olympic 1500-m running track final from 1924 to 2020.

METHODS

Data were obtained from publicly available sources. When official splits were unavailable, times from sources such as YouTube were included and interpolated from video records. Final times, lap splits, and position in the peloton were included. The data are presented relative to 0 to 400 m, 400 to 800 m, 800 to 1200 m, and 1200 to 1500 m. Critical speed and D' were calculated using athletes' season's best times.

RESULTS

Performance improved ∼25 seconds from 1924 to 2020, with most improvement (∼19 s) occurring in the first 10 finals. However, only 2 performances were world records, and only one runner won the event twice. Pacing evolved from a fast start-slow middle-fast finish pattern (reverse J-shaped) to a slower start with steady acceleration in the second half (J-shaped). The coefficient of variation for lap speeds ranged from 1.4% to 15.3%, consistent with a highly tactical pacing pattern. With few exceptions, the eventual winners were near the front throughout, although rarely in the leading position. There is evidence of a general increase in both critical speed and D' that parallels performance.

CONCLUSIONS

An evolution in the pacing pattern occurred across several "eras" in the history of Olympic 1500-m racing, consistent with better trained athletes and improved technology. There has been a consistent tactical approach of following opponents until the latter stages, and athletes should develop tactical flexibility, related to their critical speed and D', in planning prerace strategy.

Ball possessions and game rhythm in basketball games involving players with and without intellectual impairments

BACKGROUND

Ball possessions and game rhythm are promising variables to better understand teams' collective behaviour during a basketball game. However, the role of these variables is not well documented in teams with intellectual impairments (II). This study aimed to explore ball possession and game rhythm differences between II and non-II basketball games.

METHODS

Data were obtained through video observations (53 II games) and the International Basketball Federation records (53 non-II games).

RESULTS

Independent t-tests (P ≤ 0.05) revealed that the number of ball possessions was higher and game rhythm was faster in II games. Two-way repeated-measures analysis of variance (P ≤ 0.05) showed that ball possessions and game rhythm developed differently throughout the II games compared with the non-II games.

CONCLUSIONS

The differences may be due to the decision-making, tactical and self-regulatory limitations of players with II. These limitations adequately explain why players with II respond differently to the environmental cues and monitor insufficiently their actions compared with players without II. Additionally, the higher number of ball possessions and the faster game rhythm in II games could be an indicator of more intuitive, and thus faster, game-related decision-making. In conclusion, the study provides further understanding of the role of cognition in basketball and contributes to better explain the differences between II and non-II games.

Exploring experiences of people with stroke and health professionals on post-stroke fatigue guidance: getting the right people to the right care at the right time

PURPOSE

This focus group study aimed to explore experiences and perceptions on post-stroke fatigue guidance in Dutch rehabilitation and follow-up care among people/patients with stroke and health professionals.

METHODS

Ten persons with stroke and twelve health professionals with different professions within stroke rehabilitation or follow-up care in the Netherlands were purposively sampled and included. Eight online focus group interviews were conducted. We analysed the data using reflexive thematic analysis.

RESULTS

Three themes were identified. Guidance in fatigue management did not always match the needs of people/patients with stroke. Professionals were positive about the provided fatigue guidance (e.g. advice on activity pacing), but found it could be better tailored to the situation of people/patients with stroke. Professionals believe the right time for post-stroke fatigue guidance is when people/patients with stroke are motivated to change physical activity behaviour to manage fatigue - mostly several months after stroke - while people/patients with stroke preferred information on post-stroke fatigue well before discharge. Follow-up care and suggestions for improvement described that follow-up support after rehabilitation by a stroke coach is not implemented nationwide, while people/patients with stroke and professionals expressed a need for it.

CONCLUSIONS

The study findings will help guide improvement of fatigue guidance in stroke rehabilitation programmes and stroke follow-up care aiming to improve physical activity, functioning, participation, and health.

Be Aware of the Benefits of Drafting in Sports and Take Your Advantage: A Meta-Analysis

Purpose

In competitive sports, optimizing performance is the key. An interesting venue to explore is to consider drafting as a pacing strategy. The purpose of this study is to identify the magnitude of drafting benefits for biomechanical, physiological, and psychobiological parameters in and between athletes in cycling, kayaking, running, skating, skiing, and swimming.

Design

A systematic review and meta-analysis.

Methods

Systematic searches were performed in PubMed, Web of Science, and Embase databases.

Results

In total, 205 studies were found, from which 22 were relevant (including 232 participants and 548 observations). Methodological quality was high for all the included articles. The meta-analyses for all parameters indicated strong evidence for a benefit of drafting, with moderate effects between leading and drafting athletes found for the heart rate (3.9%), VO2 (8.9%), power output (11.3%), and rating of perceived exertion (10.4%). Large effect sizes were found for blood lactate (24.2%), VE (16.2%), and EMG (56.4%). A moderator analysis showed differences between sports on the effect of drafting with most benefits in cycling. Discussion. Based on the observed effects of drafting in the biomechanical, physiological, and psychobiological parameters, it can be considered as an element of pacing, a strategy to conserve energy and optimize performance.

Conclusion

There is strong evidence that drafting benefits athletes, with varying levels of effect for athletes in different sports. Knowledge about the magnitude of benefits can be used to improve training sessions, race strategies, and performance in competition.

Measurement properties of device-based physical activity instruments in ambulatory adults with physical disabilities and/or chronic diseases: a scoping review

BACKGROUND

People with physical disabilities and/or chronic diseases tend to have an inactive lifestyle. Monitoring physical activity levels is important to provide insight on how much and what types of activities people with physical disabilities and/or chronic diseases engage in. This information can be used as input for interventions to promote a physically active lifestyle. Therefore, valid and reliable physical activity measurement instruments are needed. This scoping review aims 1) to provide a critical mapping of the existing literature and 2) directions for future research on measurement properties of device-based instruments assessing physical activity behavior in ambulant adults with physical disabilities and/or chronic diseases.

METHODS

Four databases (MEDLINE, CINAHL, Web of Science, Embase) were systematically searched from 2015 to April 16th 2023 for articles investigating measurement properties of device-based instruments assessing physical activity in ambulatory adults with physical disabilities and/or chronic diseases. For the majority, screening and selection of eligible studies were done in duplicate. Extracted data were publication data, study data, study population, device, studied measurement properties and study outcome. Data were synthesized per device.

RESULTS

One hundred three of 21566 Studies were included. 55 Consumer-grade and 23 research-grade devices were studied on measurement properties, using 14 different physical activity outcomes, in 23 different physical disabilities and/or chronic diseases. ActiGraph (n = 28) and Fitbit (n = 39) devices were most frequently studied. Steps (n = 68) was the most common used physical activity outcome. 97 studies determined validity, 11 studies reliability and 6 studies responsiveness.

CONCLUSION

This scoping review shows a large variability in research on measurement properties of device-based instruments in ambulatory adults with physical disabilities and/or chronic diseases. The variability highlights a need for standardization of and consensus on research in this field. The review provides directions for future research.

Drafting in long-track speed skating team pursuit on the ice rink

Drafting is distinctive for team pursuit races in long-track speed skating. This study aims to compare the impact of drafting on physical intensity (heart rate [HR]) and perceived intensity (ratings of perceived exertion [RPE]) per drafting position. Eighteen skilled male (n = 9) and female (n = 9) skaters (20.0 ± 4.8 years) skated three trials, in first, second or third position, with consistent average velocity (F_2,10 = 2.30, p = 0.15, η_p² = 0.32). Differences in HR and RPE (Borg CR-10 scale) were compared within-subjects (three positions) using a repeated-measures ANOVA (p < 0.05). Compared to the first position, HR was lower in the second (benefit 3.2%) and third (benefit 4.7%) position and lower in third compared to second position (benefit 1.5%), observed in 10 skaters (F_2,28 = 28.9, p < 0.001, η_p²= 0.67). RPE was lower when comparing second (benefit 18.5%) and third (benefit 16.8%) position to first (F_1.3,22.1 = 7.02, p < 0.05, η_p²= 0.29) and similar for third and second positions., observed in 8 skaters. Even though the physical intensity was lower when drafting in third versus second position, the perceived intensity was equal. There were large interindividual differences between skaters. Coaches are advised to adopt a multidimensional, tailored approach when selecting and training skaters for a team pursuit.

Biomechanics of wheelchair turning manoeuvres: novel insights into wheelchair propulsion

Introduction

Wheelchair turning biomechanics is an under researched area despite its obvious relevance to functional mobility of wheelchair users. Wheelchair turns might be linked to a higher risk of upper limb injuries due to the increased forces and torques potentially associated with asymmetric movement. Our aim was to obtain a better theoretical understanding of wheelchair turning by biomechanically analyzing turns compared to steady-state straightforward propulsion (SSSFP).

Methods

Ten able-bodied men received 12-min familiarization and 10 trials (in a random order) of SSSFP and multiple left and right turns around a rectangular course. A Smart^wheel was mounted at the right wheel of a standard wheelchair to measure kinetic parameters during SSSFP and of the inner hand during right turns and the outer hand during left turns. A repeated measures ANOVA was used to detect differences across tasks.

Results

Two strategies were identified: 3% demonstrated roll turns and 97% spin turns. Spin turns consisted of three phases: approach, turning and depart phase. The turning phase was accomplished by increasing peak force (72.9 ± 25.1 N vs. 43.38 ± 15.9 N in SSSFP) of the inner hand, while maintaining high push frequency of the outer hand (1.09 ± 0.20 push/s vs. 0.95 ± 0.13 push/s in SSSFP). Peak negative force and force impulse during the turning phase were much higher than SSSFP, 15.3 ± 15.7 and 4.5 ± 1.7 times higher, respectively.

Conclusion

The spin turn strategy might carry an increased risk of upper limb injuries due to higher braking force and requires particular attention by rehabilitation professionals to preserve upper limb function of long-term wheelchair users.

Psychosocial factors of physical activity among people with disabilities: Prospective cohort study

PURPOSE/OBJECTIVE

This study aimed to (a) explore the associations between psychosocial factors and physical activity behavior in people with physical disabilities and/or chronic diseases, both between and within persons over time; and (b) examine whether these associations differ for people initiating and people maintaining physical activity behavior.

RESEARCH METHOD/DESIGN

Data of 1,256 adults with physical disabilities and/or chronic diseases enrolled in the prospective cohort study Rehabilitation, Sports, and Active lifestyle (ReSpAct) were analyzed. Self-reported physical activity and four main psychosocial factors (i.e., self-efficacy, attitude, motivation, social support) were measured with questionnaires 3-6 weeks before discharge (T0) and 14 (T1), 33 (T2), and 52 (T3) weeks after discharge from rehabilitation. Hybrid multilevel regression models (corrected for age, sex, education level, diagnosis, counseling support) were used.

RESULTS

Multivariable significant between-subject associations were found for self-efficacy (std β = .094; 95% CI [0.035, 0.153]) and intrinsic motivation (std β = .114; [0.036, 0.192]). Multivariable significant within-subject associations were found for identified regulation (std β = -.038; [-0.072, -0.005]) and intrinsic motivation (std β = .049; [0.016, 0.082]). Effect modification of initiating or maintaining physical activity was found for the between-subject association of attitude (p = .035). No significant associations were found for social support, amotivation, external regulation, and introjected regulation.

CONCLUSION/IMPLICATIONS

This study is the first that explored the between- and within-subject associations between psychosocial factors and physical activity over time in a large cohort of adults with physical disabilities and/or chronic diseases. The findings indicate the importance of intrinsic motivation, identified regulation, and self-efficacy in initiating and maintaining physical activity behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Music Alters Conscious Distance Monitoring without Changing Pacing and Performance during a Cycling Time Trial

Athletes use their own perception to monitor distance and regulate their pace during exercise, avoiding premature fatigue before the endpoint. On the other hand, they may also listen to music while training and exercising. Given the potential role of music as a distractor, we verified if music influenced the athletes' ability to monitor the distance covered during a 20-km cycling time trial (TT20km). We hypothesized that music would elongate cyclists' perceived distance due to reduced attentional focus on exercise-derived signals, which would also change their ratings of perceived exertion (RPE). We also expected that the motivational role of music would also be beneficial in pacing and performance. After familiarization sessions, ten recreational cyclists performed an in-laboratory TT20km while either listening to music or not (control). They reported their RPE, associative thoughts to exercise (ATE), and motivation when they each perceived they had completed 2-km. Power output and heart rate (HR) were continuously recorded. Cyclists elongated their distance perception with music, increasing the distance covered for each perceived 2 km (p = 0.003). However, music reduced the error of conscious distance monitoring (p = 0.021), pushing the perceived distance towards the actual distance. Music increased the actual distance-RPE relationship (p = 0.004) and reduced ATE (p < 0.001). However, music affected neither performance assessed as mean power output (p = 0.564) and time (p = 0.524) nor psychophysiological responses such as HR (p = 0.066), RPE (p = 0.069), and motivation (p = 0.515). Cyclists elongated their distance perception during the TT20km and changed the actual distance-RPE relationship, which is likely due to a music-distractive effect. Although there was a reduced error of conscious distance monitoring, music affected neither pacing nor performance.

Differentiated ratings of perceived exertion in upper body exercise

This study examined whether differentiated ratings of perceived exertion (RPE) (local; RPEL and central; RPEC) and overall RPE (RPEO) were different between exercise modes (upper- versus lower body) and/or changed after upper body training, providing relevant input for upper body exercise prescription/regulation. Eight rowers completed an incremental cycling test (CY), and incremental handcycle (HC) tests before (HCpre) and after three weeks of handcycle training (HCpost). RPEc was higher during CY (17.4±2.4) compared to HCpost (15.9±1.9). However, RPEo was higher during HCpost (9.1±0.6) compared to CY (8.3±1.1). During the HC tests, RPEL was consistently higher than RPEO at the same PO. Training resulted in higher RPEc (HCpre: 14.6±2.6; HCpost: 15.9±1.9) and RPEo (HCpre: 7.9±0.9; HCpost: 9.1±0.6). No differences were found for RPEL between CY and HCpost (8.7±1.1; 9.3±0.4) and after HC training (HCpre: 9.1±1.0; HCpost: 9.3±0.4). At the point of exhaustion, RPEc was higher in CY than during HCpre and HCpost, suggesting RPEC is not causing exercise termination in HC. Furthermore, RPEL is perceived higher than RPEO during all stages of the incremental HC tests compared to CY. This suggests that in contrast to cycling, local factors during arm work are perceived more strongly than central or overall cues of exertion.

Physical activity behaviour up to 1 year post-rehabilitation among adults with physical disabilities and/or chronic diseases: results of the prospective cohort study ReSpAct

BACKGROUND

Little is known of physical activity behaviour among adults with a disability and/or chronic disease during and up to 1 year post-rehabilitation. We aimed to explore (1) dose characteristics of physical activity behaviour among adults with physical disabilities and/or chronic diseases during that period, and (2) the effects of personal characteristics and diagnosis on the development of physical activity over time.

METHODS

Adults with physical disabilities and/or chronic diseases (N=1256), enrolled in the Rehabilitation, Sports and Active lifestyle study, were followed with questionnaires: 3-6 weeks before (T0) and 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. Physical activity was assessed with the adapted version of the Short Questionnaire to ASsess Health enhancing physical activity. Dose characteristics of physical activity were descriptively analysed. Multilevel regression models were performed to assess physical activity over time and the effect of personal and diagnosis characteristics on physical activity over time.

RESULTS

Median total physical activity ranged from 1545 (IQR: 853-2453) at T0 to 1710 (IQR: 960-2730) at T3 min/week. Household (495-600 min/week) and light-intensity (900-998 min/week) activities accrued the most minutes. Analyses showed a significant increase in total physical activity moderate-intensity to vigorous-intensity physical activity and work/commuting physical activity for all time points (T1-T3) compared with baseline (T0). Diagnosis, age, sex and body mass index had a significant effect on baseline total physical activity.

CONCLUSION

Physical activity is highly diverse among adults with physical disabilities and/or chronic diseases. Understanding this diversity in physical activity can help improve physical activity promotion activities.

Objectively-assessed physical activity and self-reported activity pacing in adults with multiple sclerosis: A pilot study

OBJECTIVE

To examine the association between self-reported activity pacing (a strategy to manage fatigue symptoms) and objectively-measured physical activity behaviours in adults with multiple sclerosis.

DESIGN

Single cross-sectional study.

SETTING

Multiple sclerosis rehabilitation centre in Colchester, United Kingdom.

SUBJECTS

Twenty-one adults (59 ± 9 years) with multiple sclerosis.

MAIN MEASURES

Physical activity behaviours (activity level: activity counts per minute; activity variability: highest activity counts per minute each day divided by activity counts per minute on that day) were measured with accelerometers. Self-reported activity pacing (Activity Pacing and Risk of Overactivity Questionnaire), fatigue severity (Fatigue Severity Scale) and health-related quality of life (RAND-12-Item Short-Form Health Survey) were measured. Scatter plots were used to explore associations between measures.

RESULTS

Activity level was 258 ± 133 counts per minutes, activity variability was 4 ± 1, self-reported activity pacing was 3 ± 1, fatigue severity was 5 ± 2 and health-related quality of life was 43 ± 8. Increased self-reported activity pacing was associated with lower activity levels and less variability in daily activities.

CONCLUSION

This investigation suggests that people with multiple sclerosis who have low physical activity levels could be inappropriately using activity pacing as a reactionary response to their multiple sclerosis symptoms.

Assessment of Activity Pacing in Relation to Physical Activity and Health-Related Quality of Life in Adults with Multiple Sclerosis: A Foundation for Further Intervention Development

BACKGROUND

Activity pacing is a behavioral strategy for coping with fatigue, optimizing physical activity (PA) levels, and achieving a paced approach to lifestyle and sustainable self-regulated exercise practice to optimize health and well-being. Yet little is known about how activity pacing affects PA and health-related quality of life (HRQOL) while controlling for fatigue and demographic characteristics over time in adults with multiple sclerosis (MS). This study examined the natural use of activity pacing and how it is associated with PA and HRQOL over time in adults with MS.

METHODS

Sixty-eight adults with MS (mean ± SD age, 45.2 ± 10.9 years) completed questionnaires on their activity pacing, fatigue, PA, and HRQOL 14, 33, and 52 weeks after rehabilitation. Associations between the variables were examined using multilevel models.

RESULTS

No associations were found between activity pacing and PA (β = -0.01, P = .89) or between activity pacing and HRQOL (β = -0.15, P = .09).

CONCLUSIONS

This study provides an initial understanding of how activity pacing relates to PA and HRQOL in people with MS over time and indicates that there is no clear strategy among adults with MS that is successful in improving PA and HRQOL in the short or long term. Persons with MS may benefit from goal-directed activity pacing interventions to improve longitudinal engagement in PA, and the present study provides a foundation for further intervention development.

Meso-pacing in Olympic and World Championship sprints and hurdles: Medallists save their best for the final

The aim of this novel study was to analyse performance changes across qualifying heats, semi-finals and finals in world-class sprinters and hurdlers. Finalists' finishing positions, times and rankings at the Olympic Games and IAAF World Championships (2012-2019) were obtained. 78% of gold, 67% of silver and 38% of bronze medallists won their qualifying heat and semi-final, and in most events final placings were associated with finishing positions in the qualifying heats (P ≤ 0.006), but not with finishing times. Medallists ran faster in each successive round (P < 0.001), whereas those finishing between 4^th-6^th did not improve on their semi-final times. Most athletes finishing last and second-last ran the final slower than both their semi-final and qualifying heats. The short hurdles events, with fixed barrier heights and distances, differed from the other races as the medallists were faster than most rivals in the qualifying rounds (P < 0.05), and their race times did not improve from the semi-final to the final. Coaches should note that the world's best athletes were able to conserve energy for the final within a meso-pacing strategy throughout the championships, which was more important in the short hurdles, and requires preparation within their training regimens.

Physical Activity, Sedentary Behavior and Well-Being of Adults with Physical Disabilities and/or Chronic Diseases during the First Wave of the COVID-19 Pandemic: A Rapid Review

Background: People with physical disabilities and/or chronic diseases report lower levels of physical activity and well-being than the general population, which potentially is exacerbated through the COVID-19 pandemic. This study explored the international literature on physical activity, sedentary behavior and well-being in adults with physical disabilities and/or chronic diseases during the first wave of the pandemic. Method: In a rapid review, we included studies reporting on physical activity, sedentary behavior and/or well-being in adults with physical disabilities and/or chronic diseases. Four databases (Pubmed, CINAHL, PsycInfo, Embase) were searched for studies published until 30 September 2020. Results: We included twenty-nine studies involving eleven different types of disabilities or health conditions from twenty-one different countries. Twenty-six studies reported on physical activity, of which one reported an increase during the COVID-19 pandemic, four studies reported no difference, and twenty-one studies reported a decrease. Thirteen studies reported a decline in well-being. Only one study measured sedentary behavior, reporting an increase. Conclusion: Despite the variety in methods used, almost all studies reported negative impacts on physical activity and well-being in people with physical disabilities and/or chronic disease during the first wave of the pandemic. These findings highlight the importance of supporting this population, especially in times of crisis.

Practical and Clinical Approaches Using Pacing to Improve Selfregulation in Special Populations such as Children and People with Mental Health or Learning Disabilities

For special populations such as people with a mental health issue or learning disability, a disconnect between the ability to accurately monitor and regulate exercise behaviour can lead to reduced levels of physical activity, which, in turn, is associated with additional physical or mental health problems. Activity pacing is a strategy used in clinical settings to address issues of pain amelioration, while self-pacing research is now well addressed in sport and exercise science literature. It has been proposed recently that these overlapping areas of investigation collectively support the development of self-regulatory, lifestyle exercise skills across broad population groups. Activity pacing appears to have substantial application in numerous development and rehabilitation settings and, therefore, the purpose of this short communication is to articulate how an activity pacing approach could be utilized among population groups in whom self-regulatory skills may require development. This paper provides specific examples of exercise practice across 2 discrete populations: children, and people with mental health and learning difficulties. In these cases, homeostatic regulatory processes may either be altered, or the individual may require extrinsic support to appropriately self-regulate exercise performance. A support-based exercise environment or approach such as programmatic activity (lifestyle) pacing would be beneficial to facilitate supervised and education-based self-regulation until such time as fully self-regulated exercise is feasible.

The importance of pacing in basketball players with intellectual impairment: Input for evidence-based classification

Pacing places a high demand on intellectual functioning and has been found useful for classification of athletes with intellectual impairments (II). This may also be true in open-loop sports like basketball. The current study aimed to investigate the pacing behaviour of basketball players with and without II. Using time-motion analysis, the activity of elite basketball players with II (n = 37) and amateur players without II (n = 34) was coded into four movement categories over eight periods of each game: standing, walking, running and jumping. Following two-way ANOVA, an effect of group showed differences between groups in duration and frequency of the movement categories within each period of the games. Additionally, an effect of time suggested that players in both groups paced their performances. However, no interaction was found, indicating that pacing may not be different between groups. In conclusion, the results suggest that due to the dynamic nature of basketball, the included players paced more intuitively by responding to environmental cues and using less deliberate planning. The players with II demonstrated slower games, which may be due to an impaired ability to make quick moment-to-moment deliberate decisions. These skills should be further studied in the context of evidence-based classification.

Effect of a Tailored Activity Pacing Intervention on Fatigue and Physical Activity Behaviours in Adults with Multiple Sclerosis

Tailored activity pacing could help manage fatigue and improve physical activity. However, little is known about how to tailor activity pacing for people with multiple sclerosis. This study aims to evaluate the effect of a tailored activity pacing intervention on fatigue and physical activity behaviours in adults with multiple sclerosis. Twenty-one adults with multiple sclerosis, stratified by age and gender, are randomly allocated to either a tailored pacing or control group. Participants wear an accelerometer for seven days that measures physical activity behaviours, and self-report fatigue at the baseline and four-week follow-up. Physical activity behaviours are assessed by examining activity level (seven-day average activity counts per minute) and activity variability (seven-day average highest activity counts each day divided by activity counts on that day). The intervention improves activity levels (Mean difference = 40.91; 95% Confidence Interval [CI] (3.84-77.96); p = 0.03) and lessens activity variability (Mean difference = -0.63; 95% CI (-1.25-0.02); p = 0.04). No significant effect is found for fatigue (Mean difference = -0.36; 95% CI (-1.02-0.30); p = 0.27). This investigation shows that tailoring activity pacing based on physical activity behaviours and fatigue is effective in improving physical activity levels, without exacerbating fatigue symptoms.

The Impact of Sex and Performance Level on Pacing Behavior in a 24-h Ultramarathon

Purpose: We analyzed the impact of sex, performance level and substantial speed reductions (SSR) on pacing in the VI Rio 24-h Marines Ultramarathon. This will provide insights into the importance of minimizing speed variations in relation to optimal pacing in endurance events.

Methods: Runners (30 males and 21 females), classified as high- (HP) and low-performance (LP) ran the race while having their time recorded every 400 m. The pacing was analyzed as the first 10% (initial epoch), the following 80% (intermediate epoch) and the last 10% of the race (final epoch). The time percentage spent at speeds <3.5 km·h⁻¹ (SSR), 3.5 to 5.9 km·h⁻¹ (walking speed), 6.0 to 8.0 km·h⁻¹ (walk-to-running transition speed) and > 8.0 km·h⁻¹ (running speed) was calculated.

Results: Runners showed a reverse J-shaped pacing (P < 0.001) regardless of sex and performance level, although male (P < 0.004) and HP runners (P < 0.001) have preserved a higher mean speed throughout the race. Male and HP runners spent more time at running speed (P < 0.001) and less time at SSR (P < 0.001) than female and LP runners. Total distance was inversely correlated with the number of SSR and speed CV in male (r = −0.47 and r = −0.64, respectively) and female (r = −0.61 and r = −0.47, respectively).

Conclusion: Male, HP runners showed less SSR, conserving a higher mean speed with less variation throughout the race. Results suggest that conservative pacing strategies, with lower speeds in the beginning and higher speeds toward the end, may be the most adequate for different endurance running disciplines. Results also show different competition dynamics between men and women, which warrants further exploration in ultramarathons as well as other IAAF events.

Preexercise Cycling Protocol Alters Pacing Behavior in Competitive Time Trials

PURPOSE

The behavior of an opponent has been shown to alter pacing and performance. To advance our understanding of the impact of perceptual stimuli such as an opponent on pacing and performance, this study examined the effect of a preexercise cycling protocol on exercise regulation with and without an opponent.

METHODS

Twelve trained cyclists performed 4 experimental, self-paced 4-km time-trial conditions on an advanced cycle ergometer in a randomized, counterbalanced order. Participants started the time trial in rested state (RS) or performed a 10-min cycling protocol at 67% peak power output (CP) before the time trial. During the time trials, participants had to ride alone (NO) or against a virtual opponent (OP). The experimental conditions were (1) RS-NO, (2) RS-OP, (3) CP-NO, and (4) CP-OP. Repeated-measures analyses of variance (P < .05) were used to examine differences in pacing and performance in terms of power output.

RESULTS

A faster pace was adopted in the first kilometer during RS-OP (318 [72] W) compared with RS-NO (291 [81] W; P = .03), leading to an improved finishing time during RS-OP compared with RS-NO (P = .046). No differences in either pacing or performance were found between CP-NO and CP-OP.

CONCLUSIONS

The evoked response by the opponent to adopt a faster initial pace in the 4-km time trial disappeared when cyclists had to perform a preceding cycling protocol. The outcomes of this study highlight that perceived exertion alters the responsiveness to perceptual stimuli of cyclists during competition.

Factors Influencing Walking and Exercise Adherence in Healthy Older Adults Using Monitoring and Interfacing Technology: Preliminary Evidence

BACKGROUND

Monitoring and interfacing technologies may increase physical activity (PA) program adherence in older adults, but they should account for aspects influencing older adults' PA behavior. This study aimed at gathering preliminary wrist-based PA adherence data in free-living and relate these to the influencing factors.

METHODS

Ten healthy older adults (4 females, aged 70-78 years) provided health, fatigue, activity levels, attitude towards pacing, and self-efficacy information and performed a 6 min-walk test to assess their fitness. After a baseline week they followed a two-week walking and exercise intervention. Participants saw their progress via a purposely designed mobile application.

RESULTS

Walking and exercise adherence did not increase during the intervention (p = 0.38, p = 0.65). Self-efficacy decreased (p = 0.024). The baseline physical component of the Short Form Health Survey was the most predictive variable of walking adherence. Baseline perceived risk of over-activity and resting heart rate (HRrest) were the most predictive variables of exercise adherence. When the latter two were used to cluster participants according to their exercise adherence, the fitness gap between exercise-adherent and non-adherent increased after the intervention (p = 0.004).

CONCLUSIONS

Risk of over-activity and HRrest profiled short-term exercise adherence in older adults. If confirmed in a larger and longer study, these could personalize interventions aimed at increasing adherence.

Changes in technique throughout a 1500-m speed skating time-trial in junior elite athletes: Differences between sexes, performance levels and competitive seasons

Speed skating is a technical endurance sport. Still, little is known about technical changes in junior speed skaters. Therefore, changes in technique throughout a 1500-m time-trial of elite junior speed skaters is investigated to explore differences between sexes, performance levels and competitive seasons. At (inter)national 1500-m competitions, knee and push-off angles were obtained for 120 elite junior speed skaters (56 female, 64 male, age 17.6±1.1 years) per lap at 250m (lap 1), 650m (lap 2), 1050m (lap 3) and 1450m (lap 4). Additionally, 1500m end-times and lap-times were obtained to divide skaters in faster and slower performance groups and to analyze pacing behavior. Fifteen skaters (8 female, 7 male, age 17.3±1.5 years) were measured again after 1.6±0.6 years. (Repeated measures) ANOVAs were used for statistical analyses (p<0.05). ICC, determined in a pilot study, was 0.55 for knee and 0.76 for push-off angles. Elite junior speed skaters increased their knee angles throughout the race (p<0.005), regardless of sex (p = 0.110) or performance level (p = 0.714). Push-off angles increased from lap 1–3 (p<0.001), in which men showed a larger decay than female skaters (p<0.05), this holds for both performance groups (p = 0.103). Faster skaters had smaller knee and push-off angles than slower skaters (p<0.05). Males showed smaller body angles than females (p<0.001). Faster male and female skaters showed a relative slower start and faster lap 3 compared to slower skaters (p<0.05). Development over competitive seasons showed a shift towards smaller push-off angles (p = 0.038) and less decay in knee angles from lap 2–3 (p = 0.026). The present study shows that technique throughout the 1500m deteriorates. Deterioration in technique is regardless of performance level, even with different pacing behaviors. Differences between sexes were found for push-off angles. The longitudinal development suggests changes in technique towards senior level and highlights the importance of studying juniors separate from seniors.

Associations between Activity Pacing, Fatigue, and Physical Activity in Adults with Multiple Sclerosis: A Cross Sectional Study

Fatigue is common in people with multiple sclerosis (MS). Activity pacing is a behavioral way to cope with fatigue and limited energy resources. However, little is known about how people with MS naturally pace activities to manage their fatigue and optimize daily activities. This study explored how activity pacing relates to fatigue and physical activity in people with MS. Participants were 80 individuals (60 females, 20 males) with a diagnosis of MS. The participants filled in questionnaires on their activity pacing, fatigue, physical activity, and health-related quality of life, 3-6 weeks before discharge from rehabilitation. The relationships between the variables were examined using hierarchical regression. After controlling for demographics, health-related quality of life, and perceived risk of overactivity, no associations were found between activity pacing and fatigue (β = 0.20; t = 1.43, p = 0.16) or between activity pacing and physical activity (β = -0.24; t = -1.61, p = 0.12). The lack of significant associations between activity pacing and fatigue or physical activity suggests that without interventions, there appears to be no clear strategy amongst people with MS to manage fatigue and improve physical activity. People with MS may benefit from interventions to manage fatigue and optimize engagement in physical activity.

The implementation of a physical activity counseling program in rehabilitation care: findings from the ReSpAct study

PURPOSE

This study aimed to evaluate the implementation of a physical activity counseling program in rehabilitation and to study heterogeneity in received counseling and investigate its association with changes in patients' physical activity outcomes.

METHODS

This prospective cohort study was conducted in 18 rehabilitation institutions. Data were collected using surveys completed by professionals (n= ±70) and patients (n = 1719). Implementation was evaluated using different process outcomes: reach, dosage, satisfaction, maintenance. Patients' physical activity outcomes included changes in total minutes/week of physical activity. Latent class analyses were conducted to identify profiles of received counseling characteristics and multilevel models were used to investigate associations with physical activity outcomes.

RESULTS

5873 Patients were provided with motivational interviewing-based counseling after rehabilitation. Professionals and patients were positive about the program. Sixteen institutions (89%) formally agreed to continue the program. The four identified profiles of counseling characteristics illustrate a large variation in received counseling among patients. No substantial differences in physical activity outcomes were found between profiles.

CONCLUSION

After a three-year program period, the physical activity counseling centers were sustainably implemented in Dutch rehabilitation care. This study illustrated an innovative approach to assess heterogeneity in implementation outcomes (e.g., counseling profiles) in relation to program outcomes (e.g., physical activity).Implications for rehabilitationPhysical activity counseling after rehabilitation is important to support people with disabilities in making the step from rehabilitation-based physical activities to community-based physical activities.Establishing "Physical Activity Counseling Centers" is a promising "disability-overarching" strategy to promote physical activity after rehabilitation.Although the actual received counseling (dosage) varied among patients, this did not coincide with large differences in physical activity outcomes.The training in Motivational Interviewing, the financial incentives, and the advisory support were considered as important or essential ingredients for a successful implementation of the counseling program in rehabilitation practice.

Head-to-head competition does not affect pacing or performance in 1 km cycling time trials

Previous research has shown enhanced performance and altered pacing behaviour in the presence of a virtual opponent during middle-distance cycling time trials with a duration of 2 min and longer. The purpose of this study was to determine whether these effects are also present in cycling time trials of shorter duration. Twelve physically active men completed three 1-km time trials. After a familiarisation trial (FAM), participants performed two experimental conditions: one without opponent (NO) and one with a virtual opponent (OP). Repeated-measures ANOVAs were used to assess differences in pacing and performance using power output and duration (p<0.05). No differences in mean finishing times (FAM: 91.5 ± 7.7 s; NO: 91.6 ± 6.4 s; OP: 90.9 ± 4.9 s; p=0.907) or power output (FAM: 382 ± 111 W; NO: 363 ± 80 W; OP: 367 ± 67; p=0.564) were found between experimental conditions. Furthermore, no differences in pacing profiles between experimental conditions were found (p=0.199). Similarly, rate of perceived exertion did not differ between experimental conditions at any moment (p=0.831). In conclusion, unlike events of a more prolonged duration (>2 min), the presence of an opponent did not affect participants' pacing behaviour in short duration 1-km time trials.

The Role of Technology in Adherence to Physical Activity Programs in Patients with Chronic Diseases Experiencing Fatigue: a Systematic Review

Background

The beneficial role of physical activity (PA) to manage the health condition of patients with chronic diseases is well known. However, adherence to PA guidelines in this group is still low. Monitoring and user-interface technology could represent a significant tool to increase exercise adherence to those particular groups who experience difficulties in adhering to regular and substantial physical activity, and could be supportive in increasing the success of PA programs and interventions. This systematic review aimed at evaluating the effect of physical activity monitoring technology in improving adherence to a PA program in patients with chronic diseases experiencing fatigue.

Methods

This systematic review was conducted according to PRISMA guidelines. The literature search was performed in Embase, Medline, Biosis, Scopus, and SPORTDiscus. We filtered the literature according to the question: “Does monitoring technology affect adherence to physical activity and exercise programs in patients with chronic diseases perceiving fatigue?”.

Results

The search resulted in 1790 hits; finally, eight studies were included, with a total number of 205 patients. Study quality was moderate except for one study of high quality. Only three disease types emerged, COPD, HF, and cancer. PA programs were rather short (from 8 to 13 weeks) except for one 3-year-long study. Five studies employed pedometers and two an activity monitor. Three studies based their adherence on steps, the remaining studies focused on active minutes. Adherence was explicitly reported in two studies, and otherwise derived. Four studies showed high adherence levels (85% week-10, 89% week-8, 81% week-13, 105% week-13, 83% average week-1–12) and three low levels (56% week-12, 41% year-2, 14 year-3).

Conclusion

The small number of studies identified did not allow to establish whether the use of monitoring technology could improve adherence to PA programs in patients with chronic diseases experiencing fatigue, but the current evidence seems to suggest that this is a field warranting further study, particularly into how monitoring technology can help to engage patients to adhere to PA programs.

Optimal Development of Youth Athletes Toward Elite Athletic Performance: How to Coach Their Motivation, Plan Exercise Training, and Pace the Race

Elite athletes have invested many years in training and competition to reach the elite level. One very important factor on the road to elite performance is the decision-making process regarding the regulation of effort over time, termed as pacing behavior. The regulation of effort is vital for optimal athletic performance during a single race and over a longer period of time (e.g., a competitive season) as an inadequate regulation could result in a higher risk of injuries, overtraining, and drop-out. Despite this, there is limited knowledge on how young athletes learn and develop the abilities related to pacing. Pacing behavior of athletes develops from childhood throughout adolescence and is thought to be closely connected to physical maturation, the development of pre-frontal cortical related (meta-) cognitive functions, as well as the gathering of experience with exercise tasks. The motivation of an athlete can critically influence how an athlete paces a single race, but also how they distribute their effort over a longer period of time. Coaches are advised to closely monitor the development of pacing behavior during adolescence (e.g., by gathering split times, and related physiological measurement, during training and competition), as well as the underlying factors including physical maturation (meta-) cognitive development and the motivation of young athletes. Furthermore, pacing behavior development could be aided by providing training in which the task, individual, and environment are manipulated. Hereby, presenting athletes with the opportunity to gain experience in situations which closely resemble the perceptual-motor conditions of upcoming competitions.

The Science Behind Competition and Winning in Athletics: Using World-Level Competition Data to Explore Pacing and Tactics

The purpose of this study was to examine whether World Championship and Olympic medallist endurance athletes pace similarly to their race opponents, where and when critical differences in intra-race pacing occur, and the tactical strategies employed to optimally manage energy resources. We analyzed pacing and tactics across the 800, 1,500, 5,000, 10,000 m, marathon and racewalk events, providing a broad overview for optimal preparation for racing and pacing. Official electronic splits from men's (n = 275 performances) and women's (n = 232 performances) distance races between 2013 and 2017 were analyzed. Athletes were grouped for the purposes of analysis and comparison. For the 800 m, these groups were the medalists and those finishing 4th to 8th ("Top 8"). For the 1,500 m, the medalists and Top 8 were joined by those finishing 9th to 12th ("Top 12"), whereas for all other races, the Top 15 were analyzed (those finishing 9th to 15th). One-way repeated measures analysis of variance was conducted on the segment speeds (p < 0.05), with effect sizes for differences calculated using Cohen's d. Positive pacing profiles were common to most 800 m athletes, whereas negative pacing was more common over longer distances. In the 1,500 m, male medalists separated from their rivals in the last 100 m, whereas for women it was after 1,200 m. Similarly, over 5,000 m, male medalists separated from the slowest pack members later (4,200 m; 84% of duration) than women (2,500 m; 50% of duration). In the 10,000 m race, the effect was very pronounced with men packing until 8,000 m, with the Top 8 athletes only dropped at 9,600 m (96% of duration). For women, the slowest pack begin to run slower at only 1,700 m, with the Top 8 finishers dropped at 5,300 m (53% of duration). Such profiles and patterns were seen across all events. It is possible the earlier separation in pacing for women between the medalists and the other runners was because of tactical racing factors such as an early realization of being unable to sustain the required speed, or perhaps because of greater variation in performance abilities.

Athlete-Opponent Interdependency Alters Pacing and Information-Seeking Behavior

PURPOSE

The influence of interdependency between competitors on pacing decision-making and information-seeking behavior has been explored. This has been done by only altering instructions, and thereby action possibilities, while controlling environment (i.e., competitor behavior) and exercise task.

METHODS

Twelve participants performed a 4-km time trial on a Velotron cycle ergometer in a randomized, counterbalanced order alone with no virtual opponent (NO), against a virtual opponent with no restrictions (low athlete-opponent interdependency [OP-IND]), or against a virtual opponent who the participant was permitted to overtake only once during the trial (high athlete-opponent interdependency [OP-DEP]). Information-seeking behavior was evaluated using an SMI eye tracker. Differences in pacing, performance, and information-seeking behavior were examined using repeated-measures ANOVA (P < 0.05).

RESULTS

Neither mean power output (NO, 298 ± 35 W; OP-IND, 297 ± 38 W; OP-DEP, 296 ± 37 W) nor finishing time (NO, 377.7 ± 17.4 s; OP-IND, 379.3 ± 19.5 s; OP-DEP, 378.5 ± 17.7 s) differed between experimental conditions. However, power output was lower in the first kilometer of OP-DEP compared with the other experimental conditions (NO, 332 ± 59 W; OP-IND, 325 ± 62 W; OP-DEP, 316 ± 58 W; both P < 0.05), and participants decided to wait longer before they overtook their opponent (OP-IND, 137 ± 130 s; OP-DEP, 255 ± 107 s; P = 0.040). Moreover, total fixation time spent on the avatar of the virtual opponent increased when participants were only allowed to overtake once (OP-IND, 23.3 ± 16.6 s; OP-DEP, 55.8 ± 32.7 s; P = 0.002).

CONCLUSION

A higher interdependency between athlete and opponent altered pacing behavior in terms of in-race adaptations based on opponent's behavior, and it induced an increased attentional focus on the virtual opponent. Thus, in the context of exercise regulation, attentional cues are likely to be used in an adaptive way according to their availability and situational relevance, consistent with a decision-making framework based on the interdependence of perception and action.

Pacing Decision Making in Sport and the Effects of Interpersonal Competition: A Critical Review

An athlete's pacing strategy is widely recognised as an essential determinant for performance during individual events. Previous research focussed on the importance of internal bodily state feedback, revealed optimal pacing strategies in time-trial exercise, and explored concepts such as teleoanticipation and template formation. Recently, human-environment interactions have additionally been emphasized as a crucial determinant for pacing, yet how they affect pacing is not well understood. Therefore, this literature review focussed on exploring one of the most important human-environment interactions in sport competitions: the interaction among competitors. The existing literature regarding the regulation of exercise intensity and the effect of competition on pacing and performance is critically reviewed in this paper. The PubMed, CINAHL and Web of Science electronic databases were searched for studies about pacing in sports and (interpersonal) competition between January 2000 to October 2017, using the following combination of terms: (1) Sports AND (2) Pacing, resulting in 75 included papers. The behaviour of opponents was shown to be an essential determinant in the regulation of exercise intensity, based on both observational (N = 59) and experimental (N = 16) studies. However, adjustment in the pacing response related to other competitors appears to depend on the competitive situation and the current internal state of the athlete. The findings of this review emphasize the importance of what is happening around the athlete for the outcome of the decision-making process involved in pacing, and highlight the necessity to incorporate human-environment interactions into models that attempt to explain the regulation of exercise intensity in sports and exercise.

Drive in Sports: How Mental Fatigue Affects Endurance Performance

Performance in endurance sports relies on athletes' drive, which is the sum of all factors pushing athletes to exert effort during exercise. Mental fatigue can influence endurance performance by decreasing athletes' drive to exercise. From a psychological point of view, mental fatigue has two separate components: it can affect drive by increasing the perceived effort necessary for a given task ("I cannot do this, I am too exhausted"), or by decreasing the perceived value of the reward that can be obtained ("I do not want to do this, it is not worth it"). Neurophysiological theories confirm this dual nature of mental fatigue. It is suggested that mental fatigue can activate the inhibition centers of the brain, increasing perceived effort for a given task, hence decreasing drive and willingness to act. On the other hand, it may also deactivate facilitative brain centers (normally responsible for motivated behavior and increased drive toward a reward), also resulting in decreased drive. In this Perspective we will adopt a multidimensional approach, describing how mental fatigue interacts with drive and performance in endurance exercise. We aim to show how mental fatigue affects endurance performance via two main mechanisms: perceived effort and reward. We will study the interaction between mental fatigue and other factors impacting on drive, such as perceived exertion and motivation, and examine how these factors combined result in athletes' exercise behavior (such as pacing) and performance. This will provide researchers, coaches, and athletes with useful tools in order to understand, influence and enhance athletes' drive in exercise, which is of high relevance in elite endurance sports, where mental fatigue, motivation, and stakes all are of the highest level.

Sex differences in wheelchair propulsion biomechanics and mechanical efficiency in novice young able-bodied adults

An awareness of sex differences in gait can be beneficial for detecting the early stages of gait abnormalities that may lead to pathology. The same may be true for wheelchair propulsion. The aim of this study was to determine the effect of sex on wheelchair biomechanics and mechanical efficiency in novice young able-bodied wheelchair propulsion. Thirty men and 30 women received 12  min of familiarisation training. Subsequently, they performed two 10-m propulsion tests to evaluate comfortable speed (CS). Additionally, they performed a 4-min submaximal propulsion test on a treadmill at CS, 125% and 145% of CS. Propulsion kinetics (via Smart^wheel) and oxygen uptake were continuously measured in all tests and were used to determine gross mechanical efficiency (GE), net efficiency (NE) and fraction of effective force (FEF). Ratings of perceived exertion (RPE) were assessed directly after each trial. Results indicated that CS for men was faster (0.98 ± 0.24 m/s) compared to women (0.71 ± 0.18 m/s). A lower GE was found in women compared to men. Push percentage, push angle and local RPE were different across the three speeds and between men and women. NE and FEF were not different between groups. Thus, even though their CS was lower, women demonstrated a higher locally perceived exertion than men. The results suggest sex differences in propulsion characteristics and GE. These insights may aid in optimising wheelchair propulsion through proper training and advice to prevent injuries and improve performance. This is relevant in stimulating an active lifestyle for those with a disability.

Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care

BACKGROUND

Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior.

METHODS

This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes.

RESULTS

Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p < .05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613) = - 1032, p = .303).

CONCLUSIONS

Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization's conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program's standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations' starting position, size, and circumstances.

TRIAL REGISTRATION

The Netherlands National Trial Register NTR3961 . Registered 18 April 2013.