Monitoring Readiness to Train and Perform in Female Football: Current Evidence and Recommendations for Practitioners

PURPOSE

Monitoring player readiness to train and perform is an important practical concept in football. Despite an abundance of research in this area in the male game, to date, research is limited in female football. The aims of this study were, first, to summarize the current literature on the monitoring of readiness in female football; second, to summarize the current evidence regarding the monitoring of the menstrual cycle and its potential impact on physical preparation and performance in female footballers; and third, to offer practical recommendations based on the current evidence for practitioners working with female football players.

CONCLUSIONS

Practitioners should include both objective (eg, heart rate and countermovement jump) and subjective measures (eg, athlete-reported outcome measures) in their monitoring practices. This would allow them to have a better picture of female players' readiness. Practitioners should assess the reliability of their monitoring (objective and subjective) tools before adopting them with their players. The use of athlete-reported outcome measures could play a key role in contexts where technology is not available (eg, in semiprofessional and amateur clubs); however, practitioners need to be aware that many single-item athlete-reported outcome measures instruments have not been properly validated. Finally, tracking the menstrual cycle can identify menstrual dysfunction (eg, infrequent or irregular menstruation) that can indicate a state of low energy availability or an underlying gynecological issue, both of which warrant further investigation by medical practitioners.

Monitoring load, wellness, and psychological variables in female and male youth national team football players during international and domestic playing periods

Aim

To study differences in total load exposure, wellness, and psychological variables in youth female (N = 19) and male (N = 20) national team football players during domestic and international playing periods, respectively.

Procedures

The players filled out questionnaires on well-being, stress, and resilience before and after both playing periods lasting 8 days each. The Hooper index was used to monitor daily wellness levels during both playing periods. The number of training sessions and matches were recorded, and the session rating of perceived exertion was collected. Training load, monotony, and strain were calculated. Daily measurements were used to evaluate in-period changes, and composite scores were used to describe differences between periods.

Results

The international compared to the domestic playing period was for both groups characterized by more matches played, longer field training session durations, and of fewer gym-based sessions (P < 0.05). The male players increased total exposure time (25%; P < 0.05), monotony (P < 0.001), and strain (P < 0.001), which was not changed in the female players. Well-being decreased (P < 0.05) during the international playing period in male players. Stress levels were higher (P < 0.05) for both genders during the international compared to the domestic playing period. During the international playing period, positive correlations were found between the initial levels of stress, and the change in stress (P = 0.03; r2 = 0.12), and between the changes in total load and changes in well-being (P = 0.02; r2 = 0.12), whereas a negative correlation was found between the changes in wellness and stress (P = 0.03; r2 = 0.14).

Conclusion

A playing period characterized by increased match focus, longer field training sessions, and fewer gym-based training activities may lead to changes in the physical and mental profiles of youth national team football players. Alterations to load exposure and wellness may influence mental health. Players with high initial stress levels may be subjected to greater changes compared to other players. Sports scientists and medical staff may benefit from initiating structured monitoring systems to track alterations in physical load and mental health in youth national team players.

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.

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.

Well-being, physical fitness and health profile of 10-12 years old boys in relation to leisure-time sports club activities: a cross-sectional study

OBJECTIVES

This study investigated the correlation between sports club activities and well-being and physical health parameters in 10-12 years old boys.

DESIGN

Cross sectional.

SETTING

Danish schools.

PARTICIPANTS

2293 boys took part in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Questionnaires on participation in sports clubs and well-being and testing of physical health profile through measurement of body composition, resting heart rate (RHR), blood pressure and postural balance, jump and Yo-Yo IR1C performance. Data were analysed by participation in sport and according to the five most frequently reported sports.

RESULTS

Boys enrolled in sports clubs had higher physical well-being (51.7±9.7 vs 45.9±8.7) and psychological well-being (53.3±9.6 vs 51.4±10.0), experienced more peers and social support (50.9±9.9 vs 48.0±11.6), and had a more positive perception of the school environment (48.6±7.5 vs 45.9±8.1) than boys not involved in sports clubs. In addition, they showed better Yo-Yo IR1C (+46%), long jump (9%) and balance test performance (+20%). The boys active in sports clubs had higher relative muscle mass (+6%) and lower fat percentage (-3%), body mass index (-6%) and RHR (-5%) compared with boys not involved in sports clubs (p<0.05). Boys enrolled in football clubs had higher aerobic fitness compared with boys not active in clubs (+11%), handball players (+5%), swimmers (+8%) and badminton players (+7%). Moreover, the boys enrolled in football clubs had lower fat percentage (-17%) and higher relative muscle mass (+4%) than swimmers.

CONCLUSION

Boys participating in club-based sports showed markedly higher levels of well-being and better physical health profiles than boys not involved in sports club activities. Footballers had superior aerobic fitness and body composition compared with those active in other sports. Results suggest that sports club activities seem to be beneficial for young boys' well-being, fitness and physical health profile, with the greatest benefits achieved by boys involved in football.

Implementation facilitation of the "11 for Health in Denmark": A case study in a Danish 5th grade class

The “11 for Health in Denmark” concept aims to enhance 10–12‐year‐old schoolchildren's physical activity levels and health knowledge through an 11‐week football intervention and has been shown to induce positive effects in numerous areas. However, little is known about the implementation facilitation of this concept in schools. This case study therefore aims to gain a deeper understanding of the implementation facilitation of “11 for Health” in a Danish 5^th grade class comprising 22 schoolchildren (12 boys and 10 girls, M_age 11.86±) and one teacher. Data were derived from multiple school situations using photographs and videos, observations, and informal interviews. Five themes were identified: (1) environmental and organizational factors impacting on the implementation; (2) familiarization with the concept for the teacher and schoolchildren; (3) previous clique formation; (4) the central role of the teacher; and (5) the importance of how praise partners are allocated. We found high adherence to the “11 for Health” concept, in which the teacher played a key role by applying an autonomy‐supportive style of teaching and using the praise partner concept in a suitable manner. A clique of football‐playing boys was a resource, as their praising of classmates encouraged adherence. However, familiarization with the “11 for Health” concept was a challenge and the clique's competitive nature occasionally built barriers to other schoolchildren without football experience, potentially leading to a more controlled form of motivation. Based on the results, we encourage teachers to apply autonomy‐supportive teaching when applying the “11 for Health” concept.

The Danish "11 for Health" program raises health knowledge, well-being, and fitness in ethnic minority 10- to 12-year-olds

OBJECTIVES

This study investigated the effects of the health promotion intervention "11 for Health in Denmark" program on 10- to 12-year-old ethnic minority schoolchildren's enjoyment, health knowledge, well-being, and fitness.

METHODS

1122 Danish 5th grade schoolchildren with ethnic minority background from 154 schools were randomized (5:1) to an intervention group (IG, n = 944) or a control group (CG, n = 178). The IG and CG were also divided into subgroups of children active in a sports club (IGPA: n = 644; CGPA: n = 122) and not active in a sports club (IGPI: n = 300, CGPI: n = 56). IG participated in the "11 for Health in Denmark" 11-week program, consisting of 2 × 45 min per week of football drills, small-sided games, and health education, whereas CG continued their regular activities. Pre-post physical testing and questionnaires were applied (short version of the multidimensional well-being questionnaire KIDSCREEN-27, and a 34-item health knowledge questionnaire).

RESULTS

The "11 for Health in Denmark" program was rated moderate-to-high on a 1-5 scale for enjoyment by girls (3.57) and boys (3.65). The intervention had positive between-group effect on health knowledge in relation to hygiene (IG vs GC: 10.6% points (CI95%: 6.9:14.3), p < 0.05), nutrition (9.6% point (CI95%: 7.4:11.8), p < 0.01) and physical activity 4.4% points (CI95%: 2.2:6.6) as well as overall health knowledge (5.7% points, (CI95%: 4.3;7.1), p < 0.05), with similar effects for girls and boys. The IGPI subgroup showed a positive effect on well-being (p = 0.04, school and learning) and also fitness effects on performance and VO₂  max (p = 0.02: p = 0.01). The IGPA subgroup showed a positive effect on fitness scores (p = 0.02, BMI).

CONCLUSION

The intervention program was enjoyable and had a positive impact on health knowledge of ethnic minority background schoolchildren. In addition, the intervention program had the strongest positive effects on well-being and fitness scores for the non-sports club-active children.

Physical performance and loading for six playing positions in elite female football: full-game, end-game, and peak periods

The present study investigated the position-specific match demands and heart rate response of female elite footballers, with special focus on the full-game, end-game, and peak-intensity periods. In total, 217 match observations were performed in 94 players from all eight teams of the best Danish Women's League, that is, goalkeepers (GK, n = 10), central defenders (CD, n = 23), full-backs (FB, n = 18), central midfielders (CM, n = 28), external midfielders (EM, n = 18), and forwards (FW, n = 11). Positional data (GPS; 10 Hz Polar Team Pro) and HR responses were collected. HR_mean and HR_peak were 87%-89% and 98%-99% of HR_max , for outfield players, with no positional differences. CM, EM, and FB covered 8%-14% greater (P < .001) match distances than CD. EM, FW, FB, and CM performed 40%-64% more (P < .05) high-speed running and 41%-95% more (P < .01) very-high-speed running (VHSR) than CD. From the first to the last 15-minute period, total distance, except for FW, number of VHSR, except FB, peak speed and sum of accelerations and sum of decelerations decreased (P < .05) for all outfield positions. In the most intense 5-minute period, EM, FB, and CM performed 25%-34% more (P < .01) HSR than CD, whereas EM, FW, and FB performed 36%-49% more (P < .01) VHSR than CD. In conclusion, competitive elite female matches impose high physical demands on all outfield playing positions, with high aerobic loading throughout matches and marked declines in high-speed running and intense accelerations and decelerations toward the end of games. Overall physical match demands are much lower for central defenders than for the other outfield playing positions, albeit this difference is minimized in peak-intensity periods.

An 11-week school-based 'health education through football programme' improves health knowledge related to hygiene, nutrition, physical activity and well-being-and it's fun! A scaled-up, cluster-RCT with over 3000 Danish school children aged 10-12 years old

ObjectivesOur large-scale cluster randomised controlled trial aimed to investigate the effects on health knowledge and enjoyment of an 11 week 'health education through football' programme for children aged 10-12 years old. Methods 3127 Danish school children (49% girls) aged 10-12 years from a total of 154 schools located in 63% of the Danish municipalities (69 of 98) took part in the analysis. A 5:1 cluster randomisation was performed at school level for the intervention group (IG) or the control group (CG). The twice-weekly 45 min intervention was the '11 for Health in Denmark' programme, which includes health education, football drills and small-sided games. The health education element focused on hygiene, nutrition, physical activity and well-being. Outcomes: The participants completed a 34-item multiple-choice computer-based health knowledge questionnaire preintervention and postintervention. IG also evaluated whether the programme was enjoyable. Results Between-group differences (p<0.05) were observed in overall health knowledge in favour of IG (+7.2% points, 95% CI 6.1% to 8.4%, effect size, ES:0.59), with similar effects for girls (+7.4% points, 95% CI 5.9% to 9.0%, ES:0.57) and for boys (+7.0% points, 95% CI 5.3% to 8.7%, p<0.05, ES:0.51). Marked between-group differences were observed in favour of IG, for health knowledge related to hygiene (IG vs CG:+13.9% points, 95% CI 11.1% to 16.7%, ES:0.53), nutrition (+10.3% points, 95% CI 8.5% to 12.1%, ES:0.53), physical activity (+5.9% points, 95% CI 4.1% to 7.7%, ES:0.36) and well-being (+4.4% points, 95% CI 2.7% to 6.1%, ES:0.28). Both girls and boys gave the programme moderate to high scores for enjoyment (3.6±1.0 and 3.7±1.1, respectively). Conclusion Health education through sport, using the '11 for Health' model, was enjoyable for girls and boys aged 10-12 years old, and improved health knowledge related to hygiene, nutrition, physical activity and well-being.

Can psychological characteristics, football experience, and player status predict state anxiety before important matches in Danish elite-level female football players?

Elite football can make players feel nervous, and personality characteristics, as well as experience, affect how well pressure is handled before important games. Studying the psychological characteristics of female football players can provide information on how well psychological pressure is handled and generate knowledge on how to support players in order to improve performance. Based on a sample of 128 female elite football players from 8 top-level teams, the present study investigates whether psychological characteristics and football experience/player stus in elite female football players can predict state anxiety before important matches. Our results outline that high age and national team experience negatively predicted most of the trait anxiety subscales. In line with previous research, no psychological differences were found between goalkeepers, defenders, midfielders, and strikers while starting players revealed to have significantly lower trait anxiety. When measuring before important matches, we found that somatic state anxiety was negatively associated with senior national team experience and positively associated with worry trait anxiety and fear of failure. Cognitive state anxiety was negatively associated with hope for success and positively associated with somatic and worry trait anxiety. Self-confidence was positively associated with youth national team experience and negatively associated with worry trait anxiety. It can be concluded that psychological characteristics and national team experience are both important for optimal state anxiety before important matches in elite-level women's football. Implications for practice and future research are discussed.

The "11 for Health in Denmark" intervention in 10- to 12-year-old Danish girls and boys and its effects on well-being-A large-scale cluster RCT

BACKGROUND

The present study investigates the well-being effects for 10- to 12-year-old children  who participated in the school-based intervention "11 for Health in Denmark," which comprises physical activity (PA) and health education. Subgroup analyses were carried out for boys and girls.

METHOD

Three thousand sixty-one children were randomly assigned to an intervention group (IG) or a control group (CG) by 5:1 cluster randomization by school. 2533 children (mean age 11.5 ± 0.4; 49.7% boys) were assigned to IG and 528 children (mean age 11.4 ± 0.5; 50.8% boys) were assigned to CG. IG participated in the "11 for Health in Denmark" 11-week program, consisting of 2 × 45 min per week of football drills, small-sided games, and health education. CG did not participate in any intervention and continued with their regular education. Before and after the intervention period, both groups answered a shortened version of the multidimensional well-being questionnaire KIDSCREEN-27.

RESULTS

The "11 for Health in Denmark" intervention program had a positive effect on physical well-being in girls (IG: 48.6 ± 8.5 to 50.2 ± 9.3), whereas the improvement was not significant in boys. The program also had a positive impact on well-being scores for peers and social support (IG: 50.2 ± 10.2 to 50.8 ± 10.1), though when analyzed separately in the subgroups of boys and girls the changes were not significant. No between-group differences were found for psychological well-being or school environment.

CONCLUSION

The intervention program had a positive between-group effect on physical well-being in girls, whereas the change was not significant in boys. The overall scores for peers and social support improved during the intervention period, but no subgroup differences were found.

Is therapeutic judgement influenced by the patient's socio-economic status? A factorial vignette survey

Background In Denmark patients are entitled to rehabilitation regardless of socio-economic status (SES). During this process therapists have to balance cost effectiveness with providing equal treatment. Aim To investigate whether occupational therapists and physiotherapists were influenced by the patient's SES. Material and method An experimental factorial vignette survey was used. Four different vignettes describing fictitious patient cases with different SES variables were randomly allocated to therapists working in somatic hospitals. Thereafter, the therapists judged specific clinical situations and general attitudes in relation to the patient's SES. Chi-square was used to test the statistical association between the variables. Results No statistically significant associations were found between the specific clinical situations and the patient's SES. A statistical significant association was found between general attitudes and the patient's SES. Subgroup analysis revealed a statistically significant association between the therapist's gender, age, and the therapeutic judgement in relation to SES. Conclusion In the specific clinical situations, Danish therapists seem to maintain their professional ethical principles, although they might face ethical dilemmas during their clinical decision-making. In order to prevent and resolve these dilemmas, they have to be made explicit. However, further research on how SES influences the health care professional's judgement is warranted.

The effect of rater training on scoring performance and scale-specific expertise amongst occupational therapists participating in a multicentre study: a single-group pre-post-test study

PURPOSE

In order to enhance the quality of the data collected in a multicentre validation study of a revised Danish version of the McGill Ingestive Skills Assessment (MISA), the authors developed a rater training programme. The purpose of the present study was to evaluate the effect of the training on scoring performance and scale-specific expertise amongst raters.

METHOD

During 2 days of rater training, 81 occupational therapists (OTs) were qualified to observe and score dysphagic clients' mealtime performance according to the criteria of 36 MISA-items. The training effects were evaluated pre- to post-training using percentage exact agreement (PA) of scored MISA items of a case-vignette and a Likert scale self-report of scale-specific expertise.

RESULTS

PA increased significantly from pre- to post-training (Z = -4.404, p < 0.001), although items for which the case-vignette reflected deficient mealtime performance appeared most difficult to score. The OTs scale-specific expertise improved significantly (knowledge: Z = -7.857, p < 0.001 and confidence: Z = -7.838, p < 0.001).

CONCLUSION

Rater training improved OTs scoring performance when using the Danish MISA as well as their perceived scale-specific expertise. Future rater training should emphasis the items identified as those most difficult to score. Additionally, further studies addressing different training approaches and durations are warranted.

IMPLICATIONS FOR REHABILITATION

When occupational therapists (OTs) use the McGill Ingestive Skills Assessment (MISA) they observe, interpret and record occupational performance of dysphagic clients participating in a meal. This is a highly complex task, which might introduce unwanted variability in measurement scores. A 2-day rater training programme was developed and this builds on the findings of several studies. These suggest that combinations of different training methods tend to yield the most effective results. Participation in the newly developed training programme on how to administer the MISA significantly reduces unwanted variability in measurement scores and improves OTs' competency. The training programme could be used in undergraduate and postgraduate dysphagia education initiatives to help OTs understanding of the content and the scoring criteria for each aspect of occupational performance during a meal, thus developing observation skills as well as recognizing and avoiding the most common errors in measurement scores.