How Much Do Psychological Factors Affect Lack of Return to Play After Anterior Cruciate Ligament Reconstruction? A Systematic Review

Background:

Variables affecting return to sport after anterior cruciate ligament reconstruction (ACLR) are multifactorial. The nonphysical factors germane to successful return to play (RTP) are being increasingly recognized.

Purpose:

To (1) evaluate the available evidence base for psychological factors relating to RTP after ACLR, (2) identify psychological factors affecting RTP after ACLR, and (3) understand currently available metrics used to assess psychological RTP readiness.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A review of the MEDLINE database was performed for studies reporting RTP after ACLR. Studies reporting on the psychological determinants of RTP were included. Demographic, methodological, and psychometric properties of the included studies were extracted. Weighted analysis was performed after patients were pooled across included studies.

Results:

Of 999 studies identified in the initial search, 28 (2.8%) studies, comprising 2918 patients, were included; 19 studies (n = 2175 patients) reported RTP rates. The mean time for RTP was 17.2 months. There was a 63.4% rate of RTP, and 36.6% of patients returning to sport were not able to perform at their prior level of play. Of the 795 patients who did not achieve RTP, 514 (64.7%) cited a psychological reason for not returning. Fear of reinjury was the most common reason (n = 394; 76.7%); other psychological factors included lack of confidence in the treated knee (n = 76; 14.8%), depression (n = 29; 5.6%), and lack of interest/motivation (n = 13; 2.5%). The Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the ACL–Return to Sport after Injury scale, and the Knee Self-Efficacy Scale were reported measures for assessing the influence of psychology on RTP.

Conclusion:

Psychological factors play an important role in RTP after ACLR. Among studies evaluating the impact of psychology on RTP, there was a delay in returning as well as lower RTP rates compared with the previously reported normative literature. Fear of reinjury was the most commonly reported impediment to RTP. The psychosocial measures identified in this review may have a role in RTP protocols for assessing mental resiliency; however, their roles need to be further investigated and validated in patients who have undergone ACLR.

Anterior Cruciate Ligament Reconstruction-Not Exactly a One-Way Ticket Back to the Preinjury Level: A Review of Contextual Factors Affecting Return to Sport After Surgery

CONTEXT

A recently updated meta-analysis of return-to-sport rates after anterior cruciate ligament (ACL) reconstruction demonstrated that 65% of athletes returned to their preinjury level of sport after surgery. The aim of this clinical review was to explore contextual factors associated with returning or not returning to the preinjury level after ACL reconstruction.

EVIDENCE ACQUISITION

Data were obtained from peer-reviewed literature via a search of the electronic databases Medline, Embase, CINAHL, and SPORTDiscus from database inception to January 2015. The keywords anterior cruciate ligament and return to sport were used. Additional literature was identified via hand-searching of the reference lists of relevant articles and the ePublication lists of key scientific journals. Random effects meta-analyses were used to pool the results of modifiable contextual factors and to examine their association with returning or not returning to the preinjury level of sport after surgery.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 2.

RESULTS

Lower fear of reinjury (standardized mean difference, 0.7), greater psychological readiness to return to sport (standardized mean difference, 1.0), and a more positive subjective assessment of knee function (standardized mean difference, 0.9) favored return to the preinjury level after surgery.

CONCLUSION

Returning or not returning to the preinjury level after ACL reconstruction is complex and multifactorial. Screening for potentially modifiable contextual factors, particularly psychological factors, early after ACL injury may help clinicians identify athletes who could be at risk of not returning to the preinjury level of sport and institute interventions that could improve returning to sport.

Psychosocial responses during different phases of sport-injury rehabilitation: a qualitative study

CONTEXT

Athletic trainers have traditionally conceptualized rehabilitation programs in terms of 3 distinct physiologic phases; however, these phases appear to neglect athletes' psychosocial responses to their injuries.

OBJECTIVE

To document injured athletes' psychosocial responses during the different phases of injury rehabilitation.

DESIGN

Qualitative study.

SETTING

National Collegiate Athletic Association Division II university in the mid-Atlantic region of the United States.

PATIENTS OR OTHER PARTICIPANTS

A total of 8 previously injured athletes (4 men and 4 women) participated in the study.

DATA COLLECTION AND ANALYSIS

We collected participant data by using semistructured interviews, transcribed verbatim and analyzed by directed content analysis. Established themes were triangulated to determine trustworthiness.

RESULTS

Initially, athletes' cognitive appraisals were predominantly negative in nature, leading to negative emotions. These appraisals changed after diagnosis and when moving to the reaction-to-rehabilitation phase and the reaction-to-sport phase. During the reaction-to-rehabilitation phase, athletes reported mixed cognitive appraisals and identified frustration as the main emotional response. When returning to sport, athletes reflected on the lessons learned, yet they expressed some doubts related to their ability to return to play. These cognitive appraisals served as a precursor to the resulting emotional responses of nervousness and reinjury anxiety, as well as excitement. Throughout the various phases of rehabilitation, athletes reported seeking out social support: initially from significant others and then from their athletic trainers during the reaction-to-rehabilitation phase.

CONCLUSIONS

The results appear to support the use of the integrated model of psychological response to sport injury and the rehabilitation process and the 3 phases of rehabilitation as a framework for understanding how physical and psychosocial factors may interact during sport-injury rehabilitation. Understanding this interaction may help athletic trainers provide better care to their injured athletes.

Adolescent Sport Participation and Symptoms of Anxiety and Depression: A Systematic Review and Meta-Analysis

Sport may protect against symptoms of mental disorders that are increasingly prevalent among adolescents. This systematic review explores the relationship between adolescent organized sport participation and self-reported symptoms of anxiety and depression. From 9,955 records screened, 29 unique articles were selected that included 61 effect sizes and 122,056 participants. Effects were clustered into four categories based on the operationalization of sport involvement: absence or presence of involvement, frequency of involvement, volume of involvement, and duration of participation. Results from the random-effects meta-analyses indicated that symptoms of anxiety and depression were significantly lower among sport-involved adolescents than in those not involved in sport, although this effect size was small in magnitude. Meta-regression was used to identify how age and sex explained heterogeneity in effects. Although these results do not signify a causal effect, they do support theorizing that sport participation during adolescence may be a protective environment against anxiety and depressive symptoms.

Video modeling by experts with video feedback to enhance gymnastics skills

The effects of combining video modeling by experts with video feedback were analyzed with 4 female competitive gymnasts (7 to 10 years old) in a multiple baseline design across behaviors. During the intervention, after the gymnast performed a specific gymnastics skill, she viewed a video segment showing an expert gymnast performing the same skill and then viewed a video replay of her own performance of the skill. The results showed that all gymnasts demonstrated improved performance across three gymnastics skills following exposure to the intervention.

Sport-related anxiety: current insights

To date, much research has been devoted to understanding how anxiety can affect sport performance, both in practice and in competitive settings. It is well known that sport has the potential for high levels of stress and anxiety, and that practicing and employing a range of psychological strategies can be beneficial in anxiety management. Equally, growing evidence also suggests that anxiety can play a role in sport injury prevention, occurrence, rehabilitation, and the return to sport process. The purpose of this paper is to provide current insights into sport-related anxiety. More specifically, it will provide the reader with definitions and theoretical conceptualizations of sport-related anxiety. This will be followed by making a case for considering the term “performance” to be broader than activities associated with sport-related performance in practice and competition, by including performance activities associated with sport injury prevention, rehabilitation, and the return to sport process. The paper will then highlight the importance of recognizing early signs and symptoms of anxiety, and the potential need for referral. Finally, the conclusions will emphasize the need for appropriate, client-specific, and practitioner competent care for athletes experiencing sport-related anxiety.

Rational Emotive Behavior Therapy (REBT), Irrational and Rational Beliefs, and the Mental Health of Athletes

In this article Rational Emotive Behavior Therapy (REBT) is proposed as a potentially important framework for the understanding and promotion of mental health in athletes. Cognitive-behavioral approaches predominate in the provision of sport psychology, and often form the backbone of psychological skills training for performance enhancement and maintenance. But far from being solely performance-focused, the cognitive-behavioral approach to sport psychology can restore, promote, and maintain mental health. This review article presents REBT (Ellis, 1957), the original cognitive behavioral therapy, as a valuable approach to addressing mental health issues in sport. REBT holds that it is not events that directly cause emotions and behaviors. Rather, it is one's beliefs about the events that lead to emotional and behavioral reactivity. Further, REBT distinguishes between rational and irrational beliefs, and suggests that in response to failure, maltreatment, and misfortune, people can react with either healthy or unhealthy emotional and behavioral responses. The extant research indicates that irrational beliefs lead to unhealthy negative emotions, a range of pathological conditions, and a host of maladaptive behaviors that undermine mental health. Therefore, REBT proposes a process for the reduction of irrational beliefs and the promotion of rational beliefs. The use of REBT in sport is seldom reported in literature, but research is growing. This review article proposes three important areas of investigation that will aid the understanding of irrational beliefs and the application of REBT within sport. These areas are: (1) the influence of irrational beliefs and REBT on the mental health of athletes, (2) the influence of irrational beliefs and REBT on athletic performance, (3) the origins and development of irrational beliefs in athletes. Each area is discussed in turn, offering a critical and progressive review of the literature as well as highlighting research deficits, and recommendations to address each of the three areas of investigation.

Smaller Change in Psychological Readiness to Return to Sport Is Associated With Second Anterior Cruciate Ligament Injury Among Younger Patients

BACKGROUND

Lower psychological readiness to return to sport has been reported for younger patients (≤20 years) who go on to a second anterior cruciate ligament (ACL) injury. However, changes in psychological readiness and specific psychological responses associated with second injury have not been identified.

PURPOSE/HYPOTHESIS

To identify changes in psychological readiness over time associated with a second ACL injury. It was hypothesized that younger patients who suffered a second injury would have smaller changes in psychological readiness to return to sport when compared with those who did not have a second injury.

STUDY DESIGN

Case-control study; Level of evidence, 2.

METHODS

Patients ≤20 years old at the time of surgery who had a primary ACL reconstruction procedure between June 2014 and June 2016 were recruited for this study. The short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale was completed by patients before their ACL reconstruction and repeated at 12 months after surgery to assess psychological readiness to return to sport. The primary outcome of interest was the relationship between the change in psychological readiness and second ACL injuries.

RESULTS

Among 115 young patients who returned to sport after ACL reconstruction, 21 (18%) experienced a second ACL injury. Injured patients did not show improvement in their ACL-RSI score between the preoperative assessment and 12-month time point (58.5 vs 60.8 points, P = .60) and had a significantly smaller change when compared with noninjured patients (9.2 vs 24.9 points, P = .01). When compared with the noninjured group, the injured group reported they were more nervous about playing sport, less confident in playing sport without concern for the knee, more frustrated with having to consider the knee with respect to sport, and more fearful of reinjuring the knee by playing sport ( P≤ .05).

CONCLUSION

Injured patients exhibited less improvement in psychological readiness at a group level and reported different psychological characteristics with regard to return to sport at 12 months after ACL reconstruction as monitored by the ACL-RSI scale.

The Psychosocial Implications of Sport Specialization in Pediatric Athletes

Data on the psychosocial implications of sport specialization in pediatric athletes are lacking. Sport specialization often requires increased training hours and may predispose young athletes to social isolation, poor academic performance, increased anxiety, greater stress, inadequate sleep, decreased family time, and burnout. Sport specialization frequently introduces multiple stressors that could be expected to adversely affect mental health and function in young athletes and may increase the risk for burnout. This may be confounded by altered sleep duration and quality, increased drive for elite status, and perfectionistic personality types. The signs and symptoms of burnout in young athletes can be difficult to detect. It is important to be aware of the possible diagnosis of burnout in young athletes who display vague symptoms and a decrease in academic performance. The purpose of this review was to survey the available literature on sport specialization in young athletes and its association with mental health, sleep, the drive for success in sport, and burnout.

Role of sport medicine professionals in addressing psychosocial aspects of sport-injury rehabilitation: professional athletes' views

CONTEXT

Research from the sport medicine professional's (SMP's) perspective indicates that SMPs are often required to address psychosocial aspects of injuries during treatment. However, only a few authors have investigated injured athletes' experiences with these concerns.

OBJECTIVE

To explore injured professional athletes' views on the role of SMPs in the psychosocial aspects of sport-injury rehabilitation. Design : Qualitative study.

SETTING

Professional association football and rugby union clubs.

PATIENTS OR OTHER PARTICIPANTS

Ten professional, male football (n = 4; 40%) and rugby union (n = 6; 60%) players (age = 22.4 ± 3.4 years). Data Collection and Analysis : We collected data using a semistructured interview guide, and the data were then transcribed and analyzed following the interpretative phenomenological analysis guidelines. We peer reviewed and triangulated the established emergent themes to establish trustworthiness.

RESULTS

Athletes in our study viewed injuries as "part and parcel" of their sports. Despite normalizing sport injuries, athletes reported frequent feelings of frustration and self-doubt throughout the rehabilitation process. However, athletes' perceived the role of SMPs in injury rehabilitation as addressing physical concerns; any intervention aimed at psychosocial outcomes (eg, motivation, confidence) needed to be subtle and indirect.

CONCLUSIONS

The SMPs working with injured athletes need to understand the psychosocial principles that underpin athletes' sport-injury processes and the effect psychosocial reactions can have on athletes. Moreover, SMPs must understand the self-regulatory processes that may take place throughout injury rehabilitation and be able to apply psychological principles in natural and subtle ways to aid athletes' self-regulatory abilities.

From fan to fat? Vicarious losing increases unhealthy eating, but self-affirmation is an effective remedy

Using archival and experimental data, we showed that vicarious defeats experienced by fans when their favorite football team loses lead them to consume less healthy food. On the Mondays following a Sunday National Football League (NFL) game, saturated-fat and food-calorie intake increase significantly in cities with losing teams, decrease in cities with winning teams, and remain at their usual levels in comparable cities without an NFL team or with an NFL team that did not play. These effects are greater in cities with the most committed fans, when the opponents are more evenly matched, and when the defeats are narrow. We found similar results when measuring the actual or intended food consumption of French soccer fans who had previously been asked to write about or watch highlights from victories or defeats of soccer teams. However, these unhealthy consequences of vicarious defeats disappear when supporters spontaneously self-affirm or are given the opportunity to do so.

Psychological interventions used to reduce sports injuries: a systematic review of real-world effectiveness

OBJECTIVE

To systematically review studies examining the role of psychological interventions in injury prevention. The primary research question was: What is the real-world effectiveness of psychological intervention in preventing sports injuries?

DESIGN

Mixed methods systematic review with best evidence synthesis.

DATA SOURCES

CINAHL, MEDLINE, PsycARTICLES, PsycINFO, SPORTDiscus, Science Direct and PubMed.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials (RCT), non-RCTs that included a comparison group, before and after study designs and qualitative methods. Studies were required to outline specific unimodal or multimodal psychological interventions used in relation to injury prevention in the real-world setting.

OUTCOME MEASURE

Studies were independently appraised with the Mixed Methods Appraisal Tool.

RESULTS

Thirteen papers (incorporating 14 studies) met the eligibility criteria, of which 93% (13/14) reported a decrease in injury rates (effect size range=0.2-1.21). There was an overall moderate risk of bias in reporting (52%). There is a dominance of stress management-based interventions in literature due to the prominence of the model of stress and athletic injury within the area.

SUMMARY/CONCLUSIONS

Psychological interventions demonstrate small (0.2) to large (1.21) effects on sports injury rates. The research area demonstrates a cumulative moderate risk in reporting bias (52%).

PROSPERO REGISTRATION NUMBER

CRD42016035879.

Suicidal thoughts (ideation) among elite athletics (track and field) athletes: associations with sports participation, psychological resourcefulness and having been a victim of sexual and/or physical abuse

OBJECTIVE

To examine associations between suicidal ideation and sexual and physical abuse among active and recently retired elite athletics (track and field) athletes.

METHODS

The study population consisted of all athletes (n=402) selected for a Swedish Athletics team between 2011 and 2017. Data on suicidal ideation, suicidal events (estimated through the 1 year non-sports injury prevalence), lifetime abuse experiences, sociodemographics, sense of coherence and coping strategies were collected using a cross-sectional survey. The data were analysed using binary logistic regression with suicidal ideation and non-sports injury as outcomes.

RESULTS

192 athletes (47.8%) returned data. The prevalence of suicidal ideation was 15.6% (men 17.4%; women 14.2%) and the non-sports injury prevalence was 8.0% (men 11.6%; women 5.7%). Among women, suicidal ideation was associated with having been sexually abused (OR 5.94, 95% CI 1.42 to 24.90; p=0.015) and lower sense of coherence (OR 0.90, 95% CI 0.85 to 0.96; p=0.001) (Nagelkerke R²=0.33). Among men, suicidal ideation was only associated with use of behavioural disengagement for coping (OR 1.51, 95% CI 1.18 to 1.95; p=0.001) (R² =0.25). Among women, non-sports injury prevalence was associated with having been sexually abused (OR 8.61, 95% CI 1.34 to 55.1; p=0.023) and participating in an endurance event (OR 7.37, 95% CI 1.11 to 48.9; p=0.039 (R² =0.23), while among men, having immigrant parents (OR 5.67, 95% CI 1.31 to 24.5; p=0.020) (R² =0.11) was associated with injury outside sports.

CONCLUSIONS

About one out of six international athletics athletes reported having experienced suicidal ideation. World Athletics and National Olympic Committees need to include suicide prevention in their athlete protection programmes.

Assessment of Personality Traits Influencing the Performance of Men in Team Sports in Terms of the Big Five

The purpose of this article is to define the perspective from which a coach should analyze and evaluate personality traits that influence sports performance in team sports. The subjects of the research are Polish players (N = 300) in senior age (20–29 years) from 10 team sports (each n = 30). A sample of champions (n = 13) was selected from the study population, and the Big Five model was applied to examine their personality with the use of the NEO Five-Factor Inventory questionnaire. Statistical analyses were performed with the IBM SPSS Statistics software, version 25. The study revealed statistically significant differences between team sports in four personality traits: neuroticism, extraversion, agreeableness, and conscientiousness. Champions of team sports were characterized by a lower level of neuroticism, a higher level of extraversion, and openness to experiences in relation to other sportsmen. It was also confirmed that the personality traits distribution levels depend on the sport discipline. Therefore, an important role must be assigned to those mental training techniques that favor emotional balance, team communication, and tactical thinking skills and are manifested in triggering start-up readiness.

Metacognition and action: a new pathway to understanding social and cognitive aspects of expertise in sport

For over a century, psychologists have investigated the mental processes of expert performers – people who display exceptional knowledge and/or skills in specific fields of human achievement. Since the 1960s, expertise researchers have made considerable progress in understanding the cognitive and neural mechanisms that underlie such exceptional performance. Whereas the first modern studies of expertise were conducted in relatively formal knowledge domains such as chess, more recent investigations have explored elite performance in dynamic perceptual-motor activities such as sport. Unfortunately, although these studies have led to the identification of certain domain-free generalizations about expert-novice differences, they shed little light on an important issue: namely, experts’ metacognitive activities or their insights into, and regulation of, their own mental processes. In an effort to rectify this oversight, the present paper argues that metacognitive processes and inferences play an important if neglected role in expertise. In particular, we suggest that metacognition (including such processes as “meta-attention,” “meta-imagery” and “meta-memory,” as well as social aspects of this construct) provides a window on the genesis of expert performance. Following a critique of the standard empirical approach to expertise, we explore some research on “metacognition” and “metacognitive inference” among experts in sport. After that, we provide a brief evaluation of the relationship between psychological skills training and metacognition and comment on the measurement of metacognitive processes. Finally, we summarize our conclusions and outline some potentially new directions for research on metacognition in action.

Parental Physical Activity Associates With Offspring's Physical Activity Until Middle Age: A 30-Year Study

BACKGROUND

Parents' physical activity associates with their children's physical activity. Prospective designs assessing this association are rare. This study examined how parents' physical activity was associated with their children's physical activity from childhood to middle adulthood in a 30-year prospective, population-based setting.

METHODS

Participants (n = 3596) were from the ongoing Cardiovascular Risk in Young Finns study started in 1980. Participants' physical activity was self-reported at 8 phases from 1980 to 2011, and their parents' physical activity at 1980. Analyses were adjusted for a set of health-related covariates assessed from 1980 to 2007.

RESULTS

High levels of mothers' and fathers' physical activity were systematically associated with increased levels of their children's physical activity until offspring's age of 24. Longitudinal analyses conducted from 1980 to 2011 showed that higher levels of parents' physical activity were associated with increased levels of physical activity within their offspring until midlife, but the association between parents' and their children's physical activity weakened when participants aged (P < .05). Covariate adjustment did not attenuate the association.

CONCLUSIONS

This study suggests that parents' physical activity assessed in their offspring's childhood contributes favorably to offspring's physical activity from childhood to middle age.

Evaluation of the Responsiveness of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale

Background

The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale is a reliable and valid tool for evaluation of psychological readiness to return to sport after ACL injury, but its responsiveness to change has not been extensively evaluated.

Purpose

To determine the responsiveness of the ACL-RSI scale.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

The ACL-RSI scale and the knee confidence question from the Knee injury and Osteoarthritis Outcome Score-Quality of Life subscale was completed at 6 and 12 months after ACL reconstruction surgery. Responsiveness was assessed using distribution and anchor-based methods for the full- and short-form versions of the scale and subgroup analyzed for sex. From distribution statistics, the standardized response mean (SRM) and the smallest detectable change (SDC) were calculated. Using the anchor-based method, the minimally important change (MIC) that was associated with an improvement in knee confidence was determined using receiver operating characteristic analysis.

Results

A total of 441 patients (257 men, 184 women; mean age of 25 years) were included in this study. An SRM of 0.7 was found for both versions, indicating a moderate level of responsiveness. The MIC was 13.4 points for the full-form version and 15.1 points for the short-form version. These values were larger than SDC values at the group level but not at the individual patient level. Responsiveness was similar between male and female patients.

Conclusion

The ACL-RSI scale had sufficient responsiveness to investigate the efficacy of an intervention at a group level, but it may be more limited at an individual patient level.

Young Soccer Players With Higher Tactical Knowledge Display Lower Cognitive Effort

The present study aimed to investigate whether the form and amount of declarative tactical knowledge (DTK) and procedural tactical knowledge (PTK) influence cognitive effort during soccer performance among young players. We assessed 36 male players from a Brazilian first-division soccer club; participants averaged 14.89 ( SD = 1.42) years of age. We evaluated DTK from video simulation tests and PTK through the System of Tactical Assessment in Soccer. We assessed cognitive effort by measures of pupil diameter using Mobile Eye Tracking-XG while players viewed soccer video scenes and made game-related play decisions. After the assessment of tactical knowledge, we categorized the sample according to players' tactical knowledge into participants with higher and lower PTK and higher and lower DTK. Subsequently, we examined the both PTK and DTK groups on cognitive effort. Our results suggest that tactical knowledge influences cognitive effort in that players with higher PTK and DTK displayed less cognitive effort during soccer performance tasks. In conclusion, we observed that PTK and DTK influenced the cognitive effort younger soccer players expended while viewing soccer scenes and making soccer performance decisions.

Weight Regain, but not Weight Loss, Is Related to Competitive Success in Real-Life Mixed Martial Arts Competition

We aimed to describe the nutritional and behavioral strategies for rapid weight loss (RWL), investigate the effects of RWL and weight regain in winners and losers, and verify mood state and technical-tactical/time-motion parameters in mixed martial arts. The sample consisted of mixed martial arts athletes after a single real match and was separated into two groups: winners (n = 8; age: 25.4 ± 6.1 years, height: 173.9 ± 0.2 cm, habitual body mass: 89.9 ± 17.3 kg) and losers (n = 7; age: 24.4 ± 6.8 years, height: 178.4 ± 0.9 cm, habitual body mass: 90.8 ± 19.5 kg). Both groups exhibited RWL and weight regain, verified their macronutrient intake, underwent weight and height assessments, and completed two questionnaires (Profile of Mood States and RWL) at (a) 24 hr before weigh-in, (b) weigh-in, (c) postbout, and (d) during a validated time-motion and technical-tactical analysis during the bout. Variance analysis, repeated measures, and a logistic regression analysis were used. The main results showed significant differences between the time points in terms of total caloric intake as well as carbohydrate, protein, and lipid ingestion. Statistical differences in combat analysis were observed between the winners and losers in terms of high-intensity relative time (58 [10-98] s and 32 [1-60] s, respectively), lower limb sequences (3.5 [1.0-7.5] sequences and 1.0 [0.0-1.0] sequences, respectively), and ground and pound actions (2.5 [0.0-4.5] actions and 0.0 [0.0-0.5] actions, respectively), and logistic regression confirmed the importance of high-intensity relative time and lower limb sequences on mixed martial arts performance. RWL and weight regain strategies were related to technical-tactical and time-motion patterns as well as match outcomes. Weight management should be carefully supervised by specialized professionals to reduce health risks and raise competitive performance.

Mindfulness training enhances flow state and mental health among baseball players in Taiwan

Objective

To examine the effect of mindfulness-based training on performance and mental health among a group of elite athletes.

Methods

This study aimed to evaluate the effect of mindful sport performance enhancement (MSPE) on mental health, flow state, and competitive state anxiety using a 4-week workshop. We recruited an amateur baseball team (N=21) in Taiwan, and collected information by self-reported questionnaires administered before, immediately after, and at a 4-week follow-up. The primary outcome was to evaluate sports performance by flow state and competitive state anxiety, which included self-confidence, somatic anxiety, and cognitive anxiety. The secondary outcome was to explore whether MSPE intervention can improve anxiety, depression, sleep disturbance, and eating disorders.

Result

After the workshop and follow-up 1 month later, we found improvements in flow state (P=0.001; P=0.045), cognitive anxiety in competitive anxiety (P=0.056; P=0.008), global eating disorder (P=0.009; P<0.001), marked shape concern (P=0.005; P<0.001), and weight concern (P=0.007; P<0.001). Scores of sleep disturbance (P=0.047) showed significant improvement at follow-up. We also found significant association between flow state and mindfulness ability (P<0.001).

Conclusion

This is the first mindfulness intervention to enhance athletes’ performance in Taiwan, and also the first application of MSPE for team sports. Our study results suggested that mindfulness ability is associated with flow state, and that MSPE is a promising training program for strengthening flow state and mental health.

Perceived and Received Dimensional Support: Main and Stress-Buffering Effects on Dimensions of Burnout

Social support is an adaptive resource associated with lower levels of burnout in sport. The effects of social support on burnout have typically been demonstrated through (1) a main effects model (direct negative associations between social support and burnout) and (2) a stress-buffering model (social support buffering the negative effects of stress on burnout). While both models provide insights into functional adaptations to burnout and stress in sport, evidence for significant main and stress-buffering effects are inconsistent. Reasons for this is include: (1) testing of a singular perspective of support in empirical research, and (2) a lack of specificity when analyzing social support and burnout (e.g., adoption of global-level analyses). To address this, the purpose of the study was to test differing perspectives of social support (perceived availability of support and received support) in regards to the main and stress-buffering effects of dimensions of social support (emotional, esteem, informational, and tangible) on dimensions of burnout (reduced sense of accomplishment, devaluation, emotional and physical exhaustion). Cross-sectional data were collected from 222 athletes. Moderated hierarchical regression analyses revealed that: (1) higher levels of stress were associated with higher levels of burnout (all dimensions); (2) higher levels of perceived availability of support were associated with lower levels of reduced sense of accomplishment and devaluation (with the exception of perceived availability of emotional support upon devaluation), and (3) perceived availability of emotional support buffered the negative effects of high stress upon devaluation. There were no significant main or interactive effects for any dimensions of received support. The significant interaction suggests that higher levels of perceived availability of emotional support may result in a functional adaptation to higher stress such that individuals may be protected from higher levels of devaluation of sport.

Students' Emotional Experience in Physical Education-A Qualitative Study for New Theoretical Insights

Physical education (PE) can be the starting point for many students to be physically active throughout their lives. Positive emotional experiences in PE are discussed as beneficial for long-term physical activity, however, triggers of students’ emotions are still unclear. The purpose of this study is to explore, from a student’s perspective, emotions and their triggers, which occur in PE classes. N = 12 students (male: six, female: six, ø-age: 15.6 ± 1.2 years) have been interviewed using a focused semi-structured interview to identify their emotions in PE and to explore the situations in which they occurred. An inductive approach with elements of the Grounded Theory Method was implemented to analyze the data. Students reported a wide range of positive and negative emotions. Furthermore, four crucial triggers were identified: (I) Attractiveness of the task, (II) social belonging, (III) competence and (IV) autonomy. Parallels to existing theories, especially the Self-Determination Theory (SDT), will be discussed. These results can be used to improve teachers’ knowledge about students’ emotions in PE in order to build a basis for lifelong physical activity.

Perceived hotness affects behavior of basketball players and coaches

Although "hot hands" in basketball are illusory, the belief in them is so robust that it not only has sparked many debates but may also affect the behavior of players and coaches. On the basis of an entire National Basketball Association season's worth of data, the research reported here shows that even a single successful shot suffices to increase a player's likelihood of taking the next team shot, increase the average distance from which this next shot is taken, decrease the probability that this next shot is successful, and decrease the probability that the coach will replace the player.

Practicing What We Preach: Investigating the Role of Social Support in Sport Psychologists' Well-Being

Well-being and mental health of psychologists and their clients can be strongly linked to the psychologists’ experience of work. We know from general theories of occupational health psychology that certain work factors will have a greater impact on well-being than others. Work engagement is positively related with occupational health, while burnout and workaholic tendencies relate negatively. An individual’s resources can buffer against these negative effects. Specifically, the environmental resource of social support can impede the impact and instance of workaholism and has a positive influence on burnout. Social support is often encouraged by sport psychologists in protecting an athlete’s well-being. Drawing on theory and research from work and organizational, health and social psychology we explore the lived experiences of burnout and work engagement among applied sport psychologists, investigating their perceptions of how these experiences impact their well-being. Thirty participants from five countries were asked, using semi-structured interviews, to recall specific incidents when feelings of work engagement and burnout occurred. We examined the influence of social support and its impact on these incidents. Thematic analysis revealed that burnout is frequently experienced despite high levels of work engagement. Sources of social support differ between groups of high burnout versus low burnout, as does reference to the dimensions of work engagement. Avenues for future research including investigating the role of mindfulness and therapeutic lifestyle changes for practitioners are outlined.

Is team confidence the key to success? The reciprocal relation between collective efficacy, team outcome confidence, and perceptions of team performance during soccer games

The present manuscript extends previous research on the reciprocal relation between team confidence and perceived team performance in two ways. First, we distinguished between two types of team confidence; process-oriented collective efficacy and outcome-oriented team outcome confidence. Second, we assessed both types not only before and after the game, but for the first time also during half-time, thereby providing deeper insight into their dynamic relation with perceived team performance. Two field studies were conducted, each with 10 male soccer teams (N = 134 in Study 1; N = 125 in Study 2). Our findings provide partial support for the reciprocal relation between players' team confidence (both collective efficacy and team outcome confidence) and players' perceptions of the team's performance. Although both types of players' team confidence before the game were not significantly related to perceived team performance in the first half, players' team confidence during half-time was positively related to perceived team performance in the second half. Additionally, our findings consistently demonstrated a relation between perceived team performance and players' subsequent team confidence. Considering that team confidence is a dynamical process, which can be affected by coaches and players, our findings open new avenues to optimise team performance.