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This case study utilized the holistic ecological approach (HEA) to explore a successful athletic talent development environment (ATDE) in China. As a case, we selected a basketball team in one Shanghai sport-friendly high school with outstanding individual and team achievements and aimed at (a) describing the ATDE, and (b) identifying environmental success factors (ESF). Using participant observations, document analysis, informal talks, and formal interviews with key stakeholders, including coaches, teachers, athletes, and administrators from sports and education departments, we derived the ATDE and ESF empirical models. The findings showed that (a) the ATDE demonstrated effective interactions between macro- and micro-levels, and (b) the experienced head coach, dedicated assistant coach, and support from athletes' parents contributed to overcoming barriers of preconditions (e.g., limited financial and human resources) within the environment. Further, a coherent and robust cultural paradigm led by the head coach helped the environment maintain its success for a long period. Although some features are similar to successful ATDEs in other countries, unique characteristics (e.g., not prioritizing athletes' autonomy) specific to this ATDE within the Chinese cultural context have been identified. Our findings supplement current studies on ATDEs using the HEA and reflect the environment within Chinese context, offering insights for researchers and practitioners., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To examine whether a "letter to my future self" analyzed using structural topic modeling (STM) represents a useful technique in revealing how participants integrate educational content into planned future behaviors., Methods: 453 club-sports athletes in a concussion-education randomized control study wrote two-paragraph letters describing what they hoped to remember after viewing one of three randomly assigned educational interventions., Results: A six-topic solution revealed three topics related to the content of the education and three topics related to the participant behavioral takeaways. The content-related topics reflected the educational content viewed. The behavioral takeaway topics indicated that the Consequence-based education was more likely to generate the Concussion Seriousness[CS:23%] topic while Traditional(24%) and Consequence-based(20%) interventions were more likely to generate the Responsibility for Brain Health[BH] topic. Traditional(21%) and Revised-symptom(17%) interventions were more likely to generate the Awareness and Action topics., Conclusion: Unstructured user-generated data in the form of a "letter to my future self" analyzed using structural topic modeling provides a novel evaluation of the present and likely future impact of educational interventions., Practice Implications: Patient educators can enhance the effectiveness of education through the application of these methods to the evaluation of and innovation in programs., Competing Interests: Declaration of Competing Interest The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. No author received an honorarium or other compensation for the completion or submission of this manuscript., (Copyright © 2024 Elsevier B.V. All rights reserved.)

We revisit an agenda that was outlined in a previous paper in this journal focusing on the importance of skill acquisition research in enhancing practice and instruction in sport. In this current narrative review, we reflect on progress made since our original attempt to highlight several potential myths that appeared to exist in coaching, implying the existence of a theory-practice divide. Most notably, we present five action points that would impact positively on coaches and practitioners working to improve skill learning across sports, as well as suggesting directions for research. We discuss the importance of practice quality in enhancing learning and relate this concept to notions of optimising challenge. We discuss how best to assess learning, the right balance between repetition and practice that is specific to competition, the relationship between practice conditions, instructions, and individual differences, and why a more "hands-off" approach to instruction may have advantages over more "hands-on" methods. These action points are considered as a broad framework for advancing skill acquisition for excellence (SAFE) in applied practice. We conclude by arguing the need for increased collaboration between researchers, coaches, and other sport practitioners.

The National Collegiate Athletic Association (NCAA) Summit on Gender Identity and Student-Athlete Participation was convened to identify institutional/athletic department strategies that may support the well-being of trans and gender nonconforming (TGNC) collegiate student-athletes in the USA. The Summit's purview did not include policy-level changes to eligibility rules. A modified Delphi consensus process was used to identify strategies for supporting collegiate TGNC student-athlete well-being. Key steps included an exploration phase (learning, generating ideas), and an evaluation phase (rating ideas in terms of their utility and feasibility). Summit participants (n=60) included individuals meeting at least one of the following criteria: current or former TGNC athlete, academic or healthcare professional with topical expertise, collegiate athletics stakeholder who would be involved in implementing potential strategies, representative from leading sports medicine organisation, or representative from relevant NCAA membership committee. Summit participants identified strategies in the following domains: healthcare practices (patient-centred care and culturally sensitive care); education for all stakeholders involved in athletics; and administration (inclusive language, quality improvement processes). Summit participants also proposed ways that the NCAA, through its existing committee and governance structures, could help support the well-being of TGNC athletes. NCAA-focused concepts were in the following domains: policy making processes; eligibility and transfer processes; resource development and dissemination; and visibility and support for TGNC athletes. The strategies developed represent important and relevant approaches that member institutions, athletic departments, NCAA committees, governance bodies and other stakeholders might consider in their efforts to support TGNC student-athlete well-being., Competing Interests: Competing interests: KEA is a member of the World Rowing Gender Advisory Panel and the US Rowing Gender Identity Policy Working Group. EK is a paid consultant of the NCAA., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: Concussion underreporting leads to delays in diagnosis and treatment, prolonging recovery time. Athletes' self-reporting of concussion symptoms, therefore, reduces risk., Objective: To evaluate the effectiveness of 3 concussion-education programs in improving concussion-reporting intention., Design: Randomized controlled clinical trial., Setting: Three high schools in California., Patients or Other Participants: A total of 118 male football players (age = 14.88 ± 1.19 years)., Intervention(s): Participants were randomly assigned to receive concussion education via CrashCourse (CC), Centers for Disease Control and Prevention (CDC) video education materials (CDC-Vi), or CDC written education materials (CDC-Wr)., Main Outcome Measure(s): The primary outcome was concussion-reporting intention, which was assessed at baseline, immediately after education, and at 1-month follow-up. Secondary outcomes were concussion knowledge, concussion-reporting attitudes, perceived concussion-reporting norms, and perceived behavioral control., Results: Across all education formats, a total sample of athletes improved in concussion-reporting intention at immediate and 1-month follow-ups (mean improvements = 6.8% and 11.4%, respectively; F4,224 = 11.1, P < .001). Similar findings were observed across all education formats in secondary analyses examining knowledge, attitudes, and perceived behavioral control. However, we noted differences in concussion-reporting intention by education format and time (F4,224 = 2.8, P = .03). Post hoc analysis showed that athletes who received CC had increased concussion-reporting intentions at immediate and 1-month follow-ups (baseline = 4.7, immediate follow-up = 6.1, 1-month follow-up = 6.0; F16,61.1 = 6.1, P = .007) compared with increases only at 1-month follow-up for CDC-Vi (baseline = 4.3, immediate follow-up = 5.2, 1-month follow-up = 5.8; F1.6,61.6 = 8.4, P = .001) and no improvement for CDC-Wr (P = .10). Secondary analyses indicated differences between CC and both CDC interventions in concussion knowledge and attitudes at immediate and 1-month follow-ups. We identified no differences in perceived behavioral control among interventions (F4,216 = 0.2, P = .93) or perceived concussion-reporting norms across (F4,224 = 0.3, P = .73) or among (F4,224 = 1.7, P = .15) interventions., Conclusions: All athletes exhibited an improved intent to report concussions, increased concussion knowledge, better concussion attitudes, and more perceived behavioral control at both immediate and 1-month follow-ups. However, athletes randomized to receive CC reported a greater intent to report concussion, more knowledge, and improved concussion-reporting attitudes when compared with those who received CDC-Vi and CDC-Wr., (© by the National Athletic Trainers' Association, Inc.)

The aim of this study was to evaluate the effects of a seven-week nutrition education intervention on the sports nutrition knowledge (SNK) of highly trained UK adolescent swimmers. Fifteen national and international adolescent swimmers (males = 5; females = 10, 15.5 ± 1.1 years, 170.2 ± 7.5 cm, 60.3 ± 5.7 kg) participated in the study during seven consecutive weeks of the competitive swimming season. The participants received 30 min of nutrition education once per week in a classroom-based setting after they had completed their regular swim training. An undergraduate sports nutrition student delivered all nutrition education sessions and SNK questionnaires were administered to the participants pre- and post-intervention. The mean total SNK score improved by 8.3% (SD = 8.4%, 95% CI = 4.1-12.6; p = 0.006; ES = 1.0) following the nutrition education sessions. On an individual basis, ten swimmers significantly improved their total SNK score, whereas four swimmers did not improve, and one swimmer performed significantly worse after the intervention. Moreover, the swimmers' knowledge of hydration improved by 22.2% (SD = 20.6%, 95% CI = 11.8-32.6, p = 0.004, ES = 1.1) over the seven-week timeframe, which was the only nutrition topic to have a significantly increased knowledge score. The current study therefore suggests that a nutrition education intervention can positively influence the SNK of highly trained adolescent swimmers.

The purpose of this paper is to present a player-centred performance analysis method as an effective mechanism to enhance expert players' performance in professional soccer. Data were collected through an application of a developed performance analysis method and subsequent unstructured interviews to explore participants' experience of the applied methodology. Grounded by an enactive perspective of human activity, the applied methodology foregrounds the player's intrinsic experience and places the player at the centre of the analysis and interpretation process. The sample included thirty professional soccer players with professional playing experience ranging from 2 years to 19 years and representing three professional teams. Using an interpretive data analysis approach results were considered from a methodological perspective concerning the core functions of a performance analysis method. Categories regarding performance analysis and performance development were highlighted. Findings demonstrate that adopting a player-centred approach to performance analysis in professional soccer provides advancement of the understanding of the collective performance of the expert player and may increase the opportunity for sustained learning.

Context: The transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation., Objective: To better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs., Design: Qualitative study., Setting: Telephone interviews., Patients or Other Participants: Fourteen professional master's athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs., Data Collection and Analysis: Participants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach., Results: We developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies., Conclusions: The model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors., (© by the National Athletic Trainers' Association, Inc.)

Objectives: The authors aimed to develop a moral intervention and to determine whether it was more effective in preventing doping than an educational (i.e., knowledge-based) intervention; their primary outcome was doping likelihood, and the secondary outcomes were moral identity, moral disengagement, moral atmosphere, and anticipated guilt., Methods: Eligible athletes (N = 303) in the United Kingdom and Greece took part in the study. The authors randomly assigned 33 clubs to either the moral or the educational intervention. They measured outcomes pre- and postintervention and at 3- and 6-month follow-up., Results: Athletes in both interventions in both countries reported lower doping likelihood and moral disengagement and higher guilt from pre- to postintervention. These effects were maintained at the 3- and 6-month follow-ups. There were no effects on moral identity or moral atmosphere., Conclusions: In addition to disseminating information about doping, doping prevention programs should include content that focuses on moral variables.

Educational interventions aimed at increasing concussion knowledge and attitudes are designed according to different frameworks. The aim of this systematic review of the literature was to determine the effects of educational interventions on concussion knowledge and attitudes, while providing recommendations for future research in the area of concussion education interventions. Data were extracted from 25 papers following a systematic search of the CINAHL, PubMed/Medline, Science Direct, SPORTDiscus and Web of Science scientific databases. Interventions were designed according to expert opinion and recommendations from previous research, such as knowledge transfer frameworks, the Health Belief Model, Theory of Planned Behaviour or by unknown means. Interventions were presented using PowerPoint presentations, videos, interactive computer modules, tool-kits, games and as guidelines. Interventions designed according to expert opinion increased concussion knowledge during post-intervention testing up to 2 weeks after intervention administration, and occasionally increased attitudes, with both knowledge and attitude improvements tending to return to baseline levels over-time. Interventions designed according to recommendations from previous research tend to increase both knowledge and attitudes with lack of follow-up data to determine long-term effects. Future concussion educational interventions should be designed according to expert opinion and using a knowledge transfer framework. The long-term effects of interventions require more research in order to design more effective educational tools.

Objectives: Coach-centred antidoping education is scarce. We tested the efficacy of a motivationally informed antidoping intervention for coaches, with their athletes' willingness to dope as the primary outcome., Methods: We delivered a cluster randomised controlled trial in Australia, the UK and Greece. This study was a parallel group, two-condition, superiority trial. Participants were 130 coaches and 919 athletes. Coaches in the intervention group attended two workshops and received supplementary information to support them in adopting a motivationally supportive communication style when discussing doping-related issues with their athletes. Coaches in the control condition attended a standard antidoping workshop that provided up-to-date information on antidoping issues yet excluded any motivation-related content. Assessments of willingness to dope (primary outcome) and other secondary outcomes were taken at baseline, postintervention (3 months) and at a 2-month follow up., Results: Compared with athletes in the control group, athletes in the intervention group reported greater reductions in willingness to take prohibited substances (effect size g=0.17) and psychological need frustration (g=0.23) at postintervention, and greater increases in antidoping knowledge (g=0.27) at follow-up. Coaches in the intervention group reported at postintervention greater increases in efficacy to create an antidoping culture (g=0.40) and in perceived effectiveness of need supporting behaviours (g=0.45) to deal with doping-related situations. They also reported greater decreases in doping attitudes (g=0.24) and perceived effectiveness of need thwarting behaviours (g=0.35)., Conclusions: Antidoping education programmes should consider incorporating principles of motivation, as these could be beneficial to coaches and their athletes. We offer suggestions to strengthen these programmes, as most of the effects we observed were not sustained at follow-up., Trial Registration Number: This trial has been registered with the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371465&isReview=true)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes., Competing Interests: Competing interests: EK reports funding from the National Collegiate Athletic Association during the conduct of the study and research funding to institution in past 3 years from the Pac-12 Athletic Conference. KC reports grants from National Collegiate Athletic Association and US Department of Defense during the conduct of the study, book royalties from Springer, and membership on the NATA Foundation Board of Directors. JDS reports grants from National Collegiate Athletic Association and US Department of Defense during the conduct of the study. CD’L reports grants from the National Collegiate Athletic Association and US Department of Defense during the conduct of the study. JKR-M reports grants from the National Collegiate Athletic Association and US Department of Defense during the conduct of the study, research funding to institution in past 3 years from: National Football League, National Athletic Trainers Association Foundation, Centers for Disease Control, National Operating Committee on Standards for Athletic Equipment, and current membership on USA Football's Football Development Council. RS reports funding from the National Collegiate Athletic Association during conduct of the study., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: A growing number of high-school-aged athletes participate on club sport teams. Some, but not all, state concussion laws apply to both interscholastic and private sport organizations. However, concussion education, management plans, and knowledge have not been examined in club coaches who coach high school-aged athletes., Objective: To determine if differences in concussion education, management plans, and knowledge exist between high school coaches and coaches of club sport teams., Design: Cross-sectional study., Setting: Online survey., Patients or Other Participants: A total of 769 coaches (497 high school coaches, 272 club coaches coaching high school-aged athletes; 266 women [34.6%], 503 men [65.4%]) completed an anonymous online questionnaire., Main Outcome Measure(s): The questionnaire consisted of demographic and team information, requirements for concussion-education and -management plans, and concussion knowledge., Results: High school coaches were more likely than club coaches to report that their organizing bodies or leagues required them to receive concussion-education information (97.4% versus 80.4%; P < .001) and that their organizing bodies or leagues had a concussion-management plan (94.0% versus 70.2%; P < .001). High school coaches were more likely than club coaches to correctly agree that most concussions resolve in 7 to 10 days (48.6% versus 40.1%; P = .02) and disagree that loss of consciousness is required to diagnose a concussion (87.1% versus 80.9%; P = .02)., Conclusions: Club coaches were less likely to be aware of requirements for concussion-education and -management plans from their parent organizations and scored lower on specific concussion-knowledge questions than high school coaches despite the same education requirements across groups under their state concussion laws. These results raise concerns regarding the proper management of concussions in club sports and suggest a need for greater oversight and enforcement of state laws in the club sport setting., (© by the National Athletic Trainers' Association, Inc.)

Context: Concussion-symptom education remains the primary approach used by athletic trainers to address underreporting of possible sport-related concussions. Social marketing represents an untapped approach to promote concussion reporting by communicating the benefits or consequences of reporting or not reporting, respectively., Objective: To apply expectancy value theory and identify how marketing the possible consequences of concealing concussion symptoms influenced young adults' concussion-reporting beliefs to increase the likelihood of reporting., Design: Randomized controlled clinical trial., Setting: Laboratory., Patients or Other Participants: A total of 468 competitive collegiate club sport athletes at a large US university who engaged in 1 of 46 sports with various levels of concussion risk., Intervention(s): Participants were randomly assigned by team to 1 of 3 conditions. The treatment condition was a social-marketing program focused on the possible consequences of the reporting decision. The control condition was traditional concussion-symptom education based on the National Collegiate Athletic Association's publication, "Concussion: A Fact Sheet for Student-Athletes." An additional condition mirrored the traditional symptom education but included a less clinical delivery., Main Outcome Measure(s): Positive and negative beliefs regarding concussion reporting were assessed. We applied expectancy value theory, which posits that changing beliefs in the short term will produce greater reporting intentions in the long term., Results: Club sport athletes exposed to consequence-based social marketing showed higher levels of positive reporting beliefs and lower levels of negative reporting beliefs than athletes exposed to traditional or revised symptom education. We observed no differences between the traditional and revised symptom-education programs. Exposure to consequence-based marketing decreased negative beliefs about reporting (B = -0.165, P = .01) and increased positive beliefs about reporting (B = 0.165, P = .01)., Conclusions: Social marketing offers athletic trainers another strategic tool for motivating athletes to report concussion symptoms by translating scientific findings into marketable statements and then communicating the benefits of reporting or the negative consequences of concealing concussion symptoms., (© by the National Athletic Trainers' Association, Inc.)

Several studies have examined the efficacy of behavior analytic coaching strategies in sports to increase performance fluency. Rock climbing is a multifaceted sport requiring mastery of several complex behavior chains in order to successfully navigate climbing surfaces. To date, most investigations have focused on the physiological aspects of rock climbing, as opposed to training specific rock-climbing movements. In this replication and extension, researchers used a multiple baseline design across skills to examine an expert video modeling plus video and verbal feedback training package on foundational rock-climbing skills of novice adult climbers. Results demonstrated that all participants showed an increase in accurate performance for all three skills that were targeted in the intervention., (© 2020 Society for the Experimental Analysis of Behavior.)

Periodized nutrition is necessary to optimize training and enhance performance through the season. The Athlete's Plate (AP) is a nutrition education tool developed to teach athletes how to design their plates depending on training load (e.g., volume × intensity), from easy (E), moderate (M) to hard (H). The AP was validated, confirming its recommendations according to international sports nutrition guidelines. However, the AP had significantly higher protein content than recommended (up to 2.9 ± 0.5 g·kg -1 ·d -1 ; p < 0.001 for H male). The aim of this study was to quantify the environmental impact (EnvI) of the AP and to evaluate the influence of meal type, training load, sex and registered dietitian (RD). The nutritional contents of 216 APs created by 12 sport RDs were evaluated using Computrition Software (Hospitality Suite, v. 18.1, Chatsworth, CA, USA). The EnvI of the AP was analyzed by life cycle assessment (LCA) expressed by the total amount of food on the AP, kg, and kcal, according to the Swiss Agricultural Life Cycle Assessment (SALCA) methodology. Higher EnvI is directly associated with higher training load when the total amount of food on the plate is considered for E (5.7 ± 2.9 kg CO 2 eq/day); M (6.4 ± 1.5 kg CO 2 eq/day); and H (8.0 ± 2.1 kg CO 2 eq/day). Global warming potential, exergy and eutrophication are driven by animal protein and mainly beef, while ecotoxicity is influenced by vegetable content on the AP. The EnvI is influenced by the amount of food, training load and sex. This study is the first to report the degree of EnvI in sports nutrition. These results not only raise the need for sustainability education in sports nutrition in general, but also the urgency to modify the AP nutrition education tool to ensure sports nutrition recommendations are met, while not compromising the environment.

Coccia, C, Fernandes, SM, and Altiti, J. Tweeting for nutrition: feasibility and efficacy outcomes of a 6-week social media-based nutrition education intervention for student-athletes. J Strength Cond Res 34(7): 2084-2092, 2020-The main objective of this study was to determine the feasibility and efficacy of a social media-based nutrition intervention using Twitter on nutrition knowledge, dietary practices, body mass index (BMI), self-efficacy, and social support among student-athletes. Participants included 50 male and female National Collegiate Athletic Association Division I student-athletes between the ages of 18 and 24 years. Data were collected in October 2014. The study design employed a 6-week social media intervention using Twitter, to increase nutrition knowledge, self-efficacy, social support, and dietary adherence to the recommendations from the Dietary Guidelines for Americans. Descriptive statistics were calculated for all study variables and pre-post differences were assessed using paired t-tests. The results indicate a 6-week nutrition intervention delivered solely through social media resulted in increased nutrition knowledge (t = -2.23; p = 0.035), reduced fat intake (t = -1.57; p = 0.13), and decreased BMI (t = 2.32; p = 0.027) in student-athletes. In conclusion, social media-based nutrition education may provide university-based strength and conditioning coaches and other sports practitioners with a tool for widespread and timely access to students to facilitate healthy dietary behaviors.

Context: A novel peer concussion-education program (PCEP) was developed to enhance concussion knowledge and reporting among collegiate student-athletes., Objective: To describe the PCEP and its development and implementation., Design: Program development consisting of a literature review, focus group, and pilot implementation., Setting: Athletics department at a college participating at the National Collegiate Athletic Association Division II-sanctioned competition level., Patients or Other Participants: Fifteen student-athletes from the women's soccer and men's lacrosse teams participated in the focus group. Four peer concussion educators (PCEs) were debriefed after the pilot implementation of the PCEP with the women's soccer and men's lacrosse teams., Data Collection and Analysis: Focus-group data were analyzed qualitatively. The PCEs were debriefed, and responses were organized into recommendation types., Results: The literature review contributed information that supported the development of the PCEP's conceptual model. Focus-group results provided information used to train the PCEs and refine the PCEP's education modules. The pilot implementation and PCE debriefing supplied information used to further revise the education modules, PCE training, and PCEP implementation procedure., Conclusions: The PCEP was developed based on the Theory of Reasoned Action and Planned Behavior and uses a peer-mediated, cognitive-behavioral, and interdisciplinary model to enhance concussion knowledge of and reporting by collegiate student-athletes. After a focus-group discussion and pilot implementation, we revised the PCEP and its education modules and developed an online manual to facilitate broad dissemination.

Context: The National Collegiate Athletic Association and US Department of Defense have called for educational programs to change the culture of concussion reporting, increase reporting behavior, and enhance the safety of players and service members., Objective: To evaluate the effects of a novel peer concussion-education program (PCEP) in changing knowledge, attitudes, and norms about concussion reporting among collegiate student-athletes and assess program implementation., Design: Randomized controlled trial and qualitative analysis of interviews., Setting: National Collegiate Athletic Association athletic teams from randomly selected colleges or universities., Patients or Other Participants: A total of 1614 male and female student-athletes from 60 teams at 10 colleges and universities and 8 athletic trainers., Intervention(s): The PCEP intervention trains 2 peer concussion educators to provide 2 education modules to their teammates. Knowledge, attitudes (oneself and teammates), and concussion occurrence or reporting were assessed at baseline, postintervention, and 1 month later. Eight athletic trainers were interviewed about program implementation., Results: Compared with the control group, the intervention group showed greater increases occurred postintervention and at 1 month in concussion knowledge ( F 1,2648 = 51.3, P < .0001), intention to report (oneself, F 2,2633 = 82.3, P < .0001; teammates, F 2,2624 = 53.9, P < .0001), return-to-play protocol knowledge, ( F 2,2632 = 28.4, P < .0001), direct subjective norms (oneself, F 2,2625 = 51.7, P < .0001; teammates, F 2,2644 = 40.6, P < .0001), direct perceived behavioral control (oneself, F 2,2628 = 53.7, P < .0001; teammates, F 2,2615 = 68.2, P < .0001), and indirect attitudes (oneself, F 2,2626 = 47.1, P < .001; teammates, F 2,2623 = 40.9, P < .0001). Peer concussion-education program participants discussed concussion more often with a teammate ( F 1,1396 = 13.96, P < .0001) or athletic staff ( F 1,1396 = 6.62, P < .001). Qualitative program analysis revealed both positive aspects of the PCEP and areas for improvement., Conclusions: The PCEP showed promise in increasing concussion knowledge, intention to report concussion, reporting a teammate's concussion, and facilitating attitudinal changes that support reporting among student-athletes.

Context: Postconcussion, student-athletes should return to the classroom using a gradual, stepwise process to ensure that symptoms are not exacerbated by cognitive activities. The National Collegiate Athletic Association (NCAA) has mandated that its affiliated institutions develop return-to-learn (RTL) policies to support the return to the classroom., Objective: To investigate athletic trainers' (ATs') perceptions of their role in the RTL policy development and implementation at NCAA Division II and III institutions., Design: Qualitative study., Setting: Individual phone interviews., Patients or Other Participants: Fifteen ATs (age = 40 ± 11 years, clinical practice experience = 16 ± 9 years, employment term = 9 ± 9 years) representing NCAA Division II (n = 6) or III (n = 9) institutions., Data Collection and Analysis: Interviews were transcribed verbatim and checked for accuracy by the principal investigator. A 2-member data-analysis team independently coded a portion of the transcripts and then met to discuss the codebook. The codebook was applied to the remaining transcripts, confirmed, and externally reviewed., Results: Five themes emerged: (1) approach, (2) collaborative practice, (3) patient advocacy, (4) institutional autonomy, and (5) barriers. Policies must allow for an individualized, evidence-based approach through facilitated, active communication among members of the RTL team and the student-athlete. Collaborative practice was described as key to successful policy implementation and should include interprofessional collaboration beyond health care providers (eg, educating academicians about the purpose of RTL). The RTL process was triggered by a specific member of the RTL team, usually a medical doctor or the head AT. Participants noted that the purpose of the RTL policy was to advocate for the student-athlete's successful postconcussion outcomes., Conclusions: For the development and implementation of a successful RTL policy, strong communication and interprofessional practice must extend beyond health care professionals. Members of the health care team must establish a network with academic partners to develop a policy that is appropriate for the institution's available resources and the needs of its student-athletes.

The objective of this study was to analyse the sun exposure habits of elite aquatics athletes, together with their sunburn history and skin examination habits, taking into account differences by sex and between sports. A cross-sectional health survey was conducted at world championship events during which elite surfers, windsurfers and Olympic sailors from 30 different countries were invited to participate. The athletes were asked to complete a self-administered questionnaire focused on sun protection habits, sun exposure and sports practices. The survey was completed by 240 athletes, 171 men (71.3%) and 69 women (28.8%), with a mean age of 22 years (SD 5.86) and skin phototypes I (6.3%), II (3.3%), III (22.0%), IV (32.5%), V (9.2%) and VI (1.7%). There were significant differences between male and female athletes in skin self-examination (p < 0.001) and in the use of sunglasses (p < 0.001). In sunburn history during the last season, there were significant differences (p < 0.001) among the three sports analysed, in both sexes. The mean rate of sunburn during the previous season was 76.7%, and 27.5% of participants reported having experienced three or more sunburns that lasted at least 1 day. This type of athlete is at high risk of sunburn and hence of future skin cancer. However, there is a general lack of awareness of this risk. This study highlights the need to inform such athletes and to raise awareness of the dangers, through educational interventions on the importance of protecting against sunburn in order to reduce the future incidence of skin cancer.

Objective: To evaluate the influences of sociodemographic factors, estimated head impact exposure, and academic aptitude on ImPACT scores in college athletes. Methods: Data were reported on 18,886 participants (58% male) from the NCAA/DoD CARE Consortium. Race, SES, concussion history, estimated repetitive head impact exposure (eRHIE), and academic aptitude (SAT or ACT score) were our predictors of interest. Cognition was measured using ImPACT composite scores. We evaluated the mediating effects of academic aptitude on sociodemographic predictors and eRHIE on ImPACT scores. We then evaluated a football-only subsample and added age of first exposure to football (AFE) to the model. Males, females, and football players were analyzed separately using structural equation modeling. Results: Academic aptitude was associated with Black/African American race, SES, and each of the ImPACT composite scores. There were significant indirect effects of Black/African American race and SES on all ImPACT composite scores. Academic aptitude fully mediated SES effects and either fully or partially mediated race effects. Contrary to expectation, greater concussion history and eRHIE predicted better ImPACT scores. Conclusions: Academic aptitude, a stable indicator of premorbid cognitive function, consistently and most strongly predicted baseline ImPACT scores in collegiate student-athletes. Concussion and eRHIE history demonstrated a small positive, but non-significant, relationship with cognitive scores at the time of college athletic participation. This study suggests that attempts to characterize cognitive ability across the lifespan must consider premorbid functioning and sociodemographic variables.

Importance: Adolescent relationship abuse (ARA) and sexual violence (SV) reported among adolescents point to the need for prevention among middle school-age youths., Objective: To test an athletic coach-delivered relationship abuse and sexual violence prevention program among middle school male athletes., Design, Setting, and Participants: An unblinded cluster randomized clinical trial from spring 2015 to fall 2017 at 41 middle schools (38 clusters). The study included 973 male middle school athletes (ages 11-14 years; grades 6-8; participation rate 50%) followed up for 1 year (retention 86%)., Interventions: Coaching Boys Into Men (CBIM) is a prevention program that trains athletic coaches to talk to male athletes about (1) respectful relationship behaviors, (2) promoting more gender-equitable attitudes, and (3) positive bystander intervention when harmful behaviors among peers are witnessed., Main Outcomes and Measures: The primary outcome was change in positive bystander behaviors (ie, intervening in peers' disrespectful or harmful behaviors); secondary outcomes were changes in recognition of what constitutes abusive behavior, intentions to intervene, gender-equitable attitudes, and reduction in recent ARA/SV perpetration (at end of sports season and 1-year follow up)., Results: Of the 973 participants, 530 were white (54.5%), 282 were black (29.0%), 14 were Hispanic (1.4%), and the remainder were multiracial, other race/ethnicity, or not reported. Positive bystander behaviors increased at end of sports season and at 1-year follow-up (relative risk, 1.51; 95% CI, 1.06-2.16 and 1.53; 95% CI, 1.10-2.12, respectively) as did recognition of abuse (mean risk difference, 0.14; 95% CI, 0.01-0.27 and 0.14; 95% CI, 0.00-0.28, respectively). At 1-year follow-up, among those who ever dated, athletes on teams receiving CBIM had lower odds of reporting recent ARA/SV perpetration (odds ratio, 0.24; 95% CI, 0.09-0.65). Gender attitudes and intentions to intervene did not differ between study arms. In exploratory intensity-adjusted and per protocol analyses, athletes on teams receiving CBIM were more likely to report positive bystander behaviors and to endorse equitable gender attitudes and less likely to report ARA and sexual harassment perpetration 1 year later., Conclusions and Relevance: An athletic coach-delivered program for middle school male athletes is an effective strategy for reducing relationship abuse among younger adolescents., Trial Registration: ClinicalTrials.gov Identifier: NCT02331238.

The aim of the current study was to evaluate the effect of personalized sleep hygiene education on sleep indices in elite athletes. Nine elite male cricket players performed 3 weeks of baseline sleep monitoring (PRE), followed by group and individualized sleep hygiene education and a further 3 weeks of sleep monitoring (POST). Subjective sleep questionnaires included the Athlete Sleep Behaviour Questionnaire (ASBQ), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). Objective sleep indices were monitored via wrist actigraphy. There were significant improvements (p < 0.05) in two of the sleep questionnaires (ESS and PSQI) and in sleep efficiency (+5%), sleep latency (-29 min) and sleep onset variance (-28 min) following the intervention, all associated with large or very large effect sizes ( d = 1.38, -0.85 and -0.88, respectively). The current study reports that personalized sleep hygiene education using the ASBQ to target maladaptive sleep behaviours may be effective in acutely improving sleep indices in elite male athletes.

Context: Current evidence suggests that a low percentage of athletic trainers (ATs) routinely use patient-reported outcome measures (PROMs). An understanding of the perceptions of ATs who use (AT-USE) and who do not use (AT-NON) PROMs as well as any differences due to demographic characteristics (eg, use for patient care or research, job setting, highest education level) may help facilitate the use of PROMs in athletic training., Objective: To describe commonly used PROMs by AT-USE, the criteria by which AT-USE select PROMs, and reasons for non-use by AT-NON., Design: Cross-sectional study., Setting: Online survey., Patients or Other Participants: A convenience sample of 1784 ATs (response rate = 10.7% [1784/17972]; completion rate = 92.2% [1784/1935]) who worked in a variety of settings., Main Outcome Measure(s): Participants completed an anonymous electronic online survey. Descriptive statistics were used to describe commonly used PROMs, PROM selection criteria, and reasons for PROM non-use., Results: Participants were classified as AT-USE (n = 370, 20.7%) or AT-NON (n = 1414, 79.3%). For the AT-USE group, the most common type of PROMs used were specific (eg, region, joint; n = 328, 88.6%), followed by single-item (n = 258, 69.7%) and generic (n = 232, 62.7%). Overall, the PROMs most frequently endorsed by the AT-USE group were the Numeric Pain Rating Scale (n = 128, 34.6%); Lower Extremity Functional Scale (n = 108, 29.2%); Disability of the Arm, Shoulder and Hand (n = 96, 25.9%); Owestry Disability Index (n = 80, 21.6%); and Foot and Ankle Ability Measure (n = 78, 21.1%). The most important criteria reported by AT-USE for selecting PROMs were that the measure was valid and reliable, easy for patients to understand, and easy for clinicians to understand and interpret. Common reasons for non-use were that PROMs were too time consuming for the clinician, too time consuming for the patient, and more effort than they were worth., Conclusions: The Numeric Pain Rating Scale; Lower Extremity Functional Scale; Disability of the Arm, Shoulder and Hand; Owestry Disability Index; and Foot and Ankle Ability Measure were the PROMs most commonly endorsed by AT-USE and should be considered for athletic training use. To further facilitate the use of PROMs in athletic training, future authors should identify strategies to address organizational and time-constraint obstacles. Interpretation of our study findings may require caution due to a relatively low response rate and because "routine use" was not operationalized.

Concussion education is an important aspect of concussion prevention. The purpose of this study was to investigate the effect of a novel, theory of planned behavior (TPB)-driven concussion education program on secondary school athletes' concussion-reporting relevant cognitions immediately post-intervention and at 3 months follow-up. Data were collected from 428 secondary school athletes during the 2016-2017 academic year: 229 were assigned to an intervention group of which 59 (25.76%) completed assessments at all timepoints; 199 were assigned to a control group of which 153 (76.88%) completed assessments at all timepoints. Using repeated measures ANOVAs, we examined differences in athletes' concussion-reporting cognitions, by group and gender. The program had a significant positive effect on athletes' knowledge (P < 0.01), perceived behavioral control over concussion recognition and reporting (P < 0.01), and reporting intention (P < 0.01). These results were maintained at 3 months follow-up, with the exception of perceived behavioral control. The program did not have a significant effect on athletes' attitudes toward concussion reporting and subjective reporting norms. Results suggest that the TPB may be a useful framework to inform the development of more effective educational programs. There is a need for multi-layered interventions that aim to create sporting environments that encourage positive concussion care seeking behaviors.

The intent of this article is to describe the process of creating a dual-purpose athlete nutrition advising program at the collegiate level. The first goal was to help student athletes enhance their performance through optimal fuel and hydration. The second goal was to provide experiential learning for nutrition students. This program provided a platform for nutrition students to gain hands-on experience assessing, monitoring, and educating athletes in relation to nutrition for performance. The implication for practice is based on recent growth and increased interest in the performance nutrition field that drives the need for more formal training programs., (Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Violence against women and girls is an important global health concern. Numerous health organizations highlight engaging men and boys in preventing violence against women as a potentially impactful public health prevention strategy. Adapted from an international setting for use in the US, "Manhood 2.0" is a "gender transformative" program that involves challenging harmful gender and sexuality norms that foster violence against women while promoting bystander intervention (i.e., giving boys skills to interrupt abusive behaviors they witness among peers) to reduce the perpetration of sexual violence (SV) and adolescent relationship abuse (ARA). Manhood 2.0 is being rigorously evaluated in a community-based cluster-randomized trial in 21 lower resource Pittsburgh neighborhoods with 866 adolescent males ages 13-19. The comparison intervention is a job readiness training program which focuses on the skills needed to prepare youth for entering the workforce, including goal setting, accountability, resume building, and interview preparation. This study will provide urgently needed information about the effectiveness of a gender transformative program, which combines healthy sexuality education, gender norms change, and bystander skills to interrupt peers' disrespectful and harmful behaviors to reduce SV/ARA perpetration among adolescent males. In this manuscript, we outline the rationale for and evaluation design of Manhood 2.0. Clinical Trials #: NCT02427061., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Background/aim: Rugby union ('rugby') presents an above-average risk of injury to participants. BokSmart is a South African nationwide intervention that aims to reduce rugby-related injuries in players. This is achieved by educating coaches and referees to improve injury behaviour of players. Thus, the aim of this study was to assess if the receipt of injury-prevention education was associated with player behaviour., Methods: Junior (n=2279) and senior (n=1642) players, who attended merit-based South African Rugby tournaments (2008-2012), completed an anonymous questionnaire. Logistic regressions investigated if player injury-prevention behaviours were associated with the receipt of education on the same topic. Additionally, players' preferred sources of education were explored through frequency and χ 2 analyses., Results: Of the 16 injury-prevention behaviours, 12 (75%) were associated with receiving education on that topic. The four behaviours not associated with education were: warming-up (before training and matches), and avoiding heat and massage post injury. Of the seven possible sources of this education, the majority of players chose either coaches or physiotherapists as their preferred media. In comparison with junior players, more senior players chose physiotherapists instead of coaches for warming-up and cooling-down education., Conclusions: The results of this study support, to a large degree, the strategy of BokSmart -influence of player behaviour through coach education. However, these findings also suggest that BokSmart could target team physiotherapists in addition to coaches and referees with their safety education. Also, players might have different preferences for this education depending on their age., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Context:   The female athlete triad (Triad) and relative energy deficiency in sport (RED-S) specify the consequences of energy imbalance. Athletic trainers (ATs) are positioned to identify athletes who are fueling themselves inadequately and experiencing related health and performance consequences., Objective:   To assess the knowledge of collegiate ATs about the Triad and RED-S and to examine variability in related screening and referral behaviors among National Collegiate Athletic Association divisions., Design:   Cross-sectional study., Setting:   Collegiate athletic training departments., Patients or Other Participants:   Head ATs at National Collegiate Athletic Association member institutions (n = 285, response rate = 33%)., Main Outcome Measure(s):   An electronic survey was administered. The number of Triad components that were correctly identified and screening and referral behaviors related to Triad components were measured., Results:   Nearly all respondents (98.61% [n = 281]) had heard of the Triad; a smaller proportion (32.98% [n = 94]) had heard of RED-S. On average, respondents correctly identified 2 components of the Triad. We observed differences by sex, with women correctly identifying more components than men ( U = 12.426, P = .003). More than half (59.93% [n = 163]) indicated that athletes at their institutions were screened for eating disorders. Nearly three-quarters (70.55% [n = 115]) of respondents indicated that all female athletes at their institutions were screened annually for menstrual dysfunction. More comprehensive referral behaviors for athletes identified as experiencing menstrual dysfunction or a bone injury (eg, athlete referred to a nutritionist, dietitian, or counselor) occurred at Division I institutions than at Division II and III institutions., Conclusions:   Continuing education for ATs about the Triad and RED-S may encourage a more comprehensive approach to referral and screening after a diagnosis of menstrual dysfunction or bone-stress injury. Using institutional opportunities, such as preparticipation screening, for identifying components of the Triad or RED-S and specifying protocols for referring athletes who screen positive for 1 of these components should also be explored.

Objective:   To provide certified athletic trainers, physicians, and other health care and fitness professionals with recommendations based on current evidence regarding the prevention of noncontact and indirect-contact anterior cruciate ligament (ACL) injuries in athletes and physically active individuals., Background:   Preventing ACL injuries during sport and physical activity may dramatically decrease medical costs and long-term disability. Implementing ACL injury-prevention training programs may improve an individual's neuromuscular control and lower extremity biomechanics and thereby reduce the risk of injury. Recent evidence indicates that ACL injuries may be prevented through the use of multicomponent neuromuscular-training programs., Recommendations:   Multicomponent injury-prevention training programs are recommended for reducing noncontact and indirect-contact ACL injuries and strongly recommended for reducing noncontact and indirect-contact knee injuries during physical activity. These programs are advocated for improving balance, lower extremity biomechanics, muscle activation, functional performance, strength, and power, as well as decreasing landing impact forces. A multicomponent injury-prevention training program should, at minimum, provide feedback on movement technique in at least 3 of the following exercise categories: strength, plyometrics, agility, balance, and flexibility. Further guidance on training dosage, intensity, and implementation recommendations is offered in this statement.

Context:   An estimated 40 million school-aged children (age range = 5-18 years) participate annually in sports in the United States, generating approximately 4 million sport-related injuries and requiring 2.6 million emergency department visits at a cost of nearly $2 billion., Objective:   To determine the effects of a school-based neuromuscular training (NMT) program on sport-related injury incidence across 3 sports at the high school and middle school levels, focusing particularly on knee and ankle injuries., Design:   Randomized controlled clinical trial., Setting:   A total of 5 middle schools and 4 high schools in a single-county public school district., Patients or Other Participants:   A total of 474 girls (222 middle school, 252 high school; age = 14.0 ± 1.7 years, height = 161.0 ± 8.1 cm, mass = 55.4 ± 12.2 kg) were cluster randomized to an NMT (CORE; n = 259 athletes) or sham (SHAM; n = 215 athletes) intervention group by team within each sport (basketball, soccer, and volleyball)., Intervention(s):   The CORE intervention consisted of exercises focused on the trunk and lower extremity, whereas the SHAM protocol consisted of resisted running using elastic bands. Each intervention was implemented at the start of the season and continued until the last competition. An athletic trainer evaluated athletes weekly for sport-related injuries. The coach recorded each athlete-exposure (AE), which was defined as 1 athlete participating in 1 coach-directed session (game or practice)., Main Outcome Measure(s):   Injury rates were calculated overall, by sport, and by competition level. We also calculated rates of specific knee and ankle injuries. A mixed-model approach was used to account for multiple injuries per athlete., Results:   Overall, the CORE group reported 107 injuries (rate = 5.34 injuries/1000 AEs), and the SHAM group reported 134 injuries (rate = 8.54 injuries/1000 AEs; F 1,578 = 18.65, P < .001). Basketball (rate = 4.99 injuries/1000 AEs) and volleyball (rate = 5.74 injuries/1000 AEs) athletes in the CORE group demonstrated lower injury incidences than basketball (rate = 7.72 injuries/1000 AEs) and volleyball (rate = 11.63 injuries/1000 AEs; F 1,275 = 9.46, P = .002 and F 1,149 = 11.36, P = .001, respectively) athletes in the SHAM group. The CORE intervention appeared to have a greater protective effect on knee injuries at the middle school level (knee-injury incidence rate = 4.16 injuries/1000 AEs) than the SHAM intervention (knee-injury incidence rate = 7.04 injuries/1000 AEs; F 1,261 = 5.36, P = .02). We did not observe differences between groups for ankle injuries ( F 1,578 = 1.02, P = .31)., Conclusions:   Participation in an NMT intervention program resulted in a reduced injury incidence relative to participation in a SHAM intervention. This protective benefit of NMT was demonstrated at both the high school and middle school levels.

Context:   Organizational factors have been identified as barriers to finding work-life balance (WLB) in athletic training. Despite the existence of organizational policies to address WLB, little is known about athletic trainers' (ATs') awareness of these policies that could assist them., Objective:   To better understand the perceptions of ATs regarding the workplace practices available to them, which may help them achieve WLB., Design:   Phenomenologic study., Setting:   Collegiate practice setting., Patients or Other Participants:   Twenty-one ATs (women = 10, men = 11) employed at the collegiate level (National Collegiate Athletic Association Division I = 12, Division II = 5, Division III = 4) volunteered for our study. The average age of the participants was 33 ± 9 years. Saturation of the data was met at n = 21., Data Collection and Analysis:   Participants completed an in-depth, 1-on-1 phone interview, which was then transcribed verbatim. Data were analyzed using a phenomenologic approach. Credibility was determined by member checks, peer review, and researcher triangulation., Results:   Our analyses revealed that participants (1) had a limited awareness of formal policies that were offered within their university or collegiate infrastructure; (2) used informal policies to manage their personal, family, and work obligations; and (3) thought that more formal policies, such as adherence to adequate staffing patterns and work schedules, could help establish WLB within collegiate athletic training settings., Conclusions:   Informal workplace policies were more commonly used by our participants and were viewed as a means of creating a supportive atmosphere. Administrators and supervisors should consider creating or endorsing more formal policies specific to the demands of an AT in the collegiate setting to help with WLB.

Introduction: High rates of adolescent relationship abuse (ARA) and sexual violence (SV) reported among adolescents point to the need for prevention among middle school-age youth. This is a cluster randomized controlled trial to test an athletic coach-delivered ARA/SV prevention program in 41 middle schools (38 clusters). Trained coaches talk to their male athletes about 1) what constitutes harmful vs. respectful relationship behaviors, 2) dispelling myths that glorify male sexual aggression and promoting more gender-equitable attitudes, and 3) positive bystander intervention when aggressive male behaviors toward females are witnessed., Methods: A total of 973 male athletes (ages 11-14, grades 6-8) are participating. Athletes complete surveys at the beginning and end of sports season (Time 2), and one year later (Time 3). The primary outcome is an increase in positive bystander behaviors (i.e., intervening in peers' disrespectful or harmful behaviors); secondary outcomes are changes in recognition of what constitutes abusive behavior, intentions to intervene, and gender equitable attitudes (Time 2 and 3) as well as reduction in abuse perpetration (Time 3)., Results: Participating schools have a greater proportion of non-White students and students on free/reduced lunch compared to schools that declined participation. Participants' self-reported ethnicities are 54.5% White, 29.0% Black, 1.4% Hispanic and the remainder, multi-racial, other, or not reported., Conclusions: This study will evaluate the effectiveness of a coach-delivered ARA/SV prevention program for middle school male athletes. Findings will add to the evidence base regarding developmentally appropriate violence prevention programs as well as the role of coaches in adolescent health promotion. Clinical Trials #: NCT02331238., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Sports dietary supplements are available for sale in public places including sports clubs. Although there is uncertainty regarding their safety, many gym members who regularly work out consume them. The present study aimed to identify the approaches and perspectives of the public who work out in gyms and take dietary supplements. It examined how professionals view sports dietary supplement consumption, and how they communicate this issue to gym members. The literature discusses the prevalence of SDS use among athletes, but rarely discusses or compares between the risk perceptions of gym members, trainers, and dietitians, who represent the physically-active general public, regarding SDS., Methods: We conducted constructivist qualitative research in semi-structured one-on-one interviews ( n  = 34). We held in-depth interviews ( n  = 20) with a heterogeneous population of adult gym members who take dietary supplements, and ( n  = 14) with dietitians and fitness trainers., Results: The main finding was a gap in risk perception of dietary supplement use between dietitians, gym members and fitness trainers. There was low risk perception among dietary supplements consumers. Trainers believed that benefits of supplement consumption exceeded risk, and therefore they did not convey a message to their clients about risk. In contrast, dietitians interviewed for this study renounced general use of sports dietary supplements and doubted whether trainers had proper nutritional knowledge to support it., Conclusion: Lack of awareness of risks suggests that there is a need for communication on this issue. We recommend that professionals (physicians and dietitians) be present in sports clubs that sell such products in an uncontrolled way.

Background: Concussion education for children early in their participation in organized sport may help shape lasting attitudes about concussion safety. However, existing programming and research focus on older ages., Methods: Qualitative interviews about concussions were conducted with twenty children between the ages of six and eight. Structural, descriptive and pattern coding were used to organize the transcribed interviews and identify emergent themes., Results: Eighteen of the participants indicated that they had heard of the word concussion, with 12 describing the injury as related to the brain or head. The most frequently described mechanisms of injury were impacts to the head or falls, and symptoms tended to be somatic, such as generalized pain. The most frequently endorsed strategy to avoid sustaining a concussion was to 'follow the rules.' Multiple participants referenced parents as an informal source of information about concussions., Conclusions: While most participants demonstrated some awareness about concussions, there were clear knowledge gaps that can be addressed with developmentally appropriate concussion education programming. Consistent with their developmental stage, interventions targeted at children in this age range may be most successful if they use basic logic, concrete ideas, provide rules to be followed and engage parents in dissemination., (© 2016 John Wiley & Sons Ltd.)

Although the cardiovascular benefits of moderate exercise are well established, there is growing epidemiological support for the notion that high-intensity endurance athletics increases the risk of atrial fibrillation (AF). There are many gaps in evidence related to epidemiology and mechanisms of AF in endurance athletes. The proposed pathophysiological mechanisms include alterations of autonomic tone, electrical remodeling, anatomical remodeling, fibrosis, and inflammation. Clinical management of the athlete with AF often includes a period of decreased frequency, intensity, and duration of exercise with assessment for improvement in AF recurrence. Based on symptoms, a strategy of rate or rhythm control should be selected; however, due to side effects and intolerance of medications, ablation may be a preferred approach. The risks and benefits of anticoagulation for stroke prevention must be carefully assessed in the athlete with AF. All patients should be encouraged to be physically active with moderation; however, men should be advised of the higher risk of AF with long-term, high-intensity endurance training., (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Context:   Concussions in student-athletes are a serious problem. Most states have enacted legislation mandating concussion education for student-athletes, under the assumption that education leads to better self-reporting of concussions and improved knowledge of symptoms., Objectives:   (1) To determine the effect of state-based concussion legislation on the proportion of student-athletes receiving concussion education and to assess the moderation of this effect by gender and sport and (2) to assess the effect of concussion education on student-athletes' knowledge of concussion symptoms and likelihood of seeking treatment after a concussion., Design:   Cross-sectional study., Setting:   Private university., Patients or Other Participants:   A total of 249 National Association of Intercollegiate Athletics collegiate athletes attending St Xavier University; 160 were surveyed prelegislation and 89 were surveyed postlegislation., Main Outcome Measure(s):   Participants completed an anonymous survey that assessed previous involvement in concussion-education programs, degree of self-reporting after a concussion, and ability to enumerate symptoms., Results:   The number of athletes who reported having received education increased after the implementation of concussion legislation; however, almost 25% still reported not having received education. Athletes who played football were more likely to report having received education than those who played volleyball. The student-athletes' ability to name a diversity of concussion symptoms or to report seeking medical attention after a concussion did not improve in the postlegislation period relative to the prelegislation period., Conclusions:   Legislation has been passed in all 50 states to address concussions in student-athletes; however, improvements are still needed. Concussion education must be delivered in a uniform, effective manner to all student-athletes across sports and genders. Concussion education should emphasize the diversity of symptoms, especially cognitive and behavioral symptoms. We must develop and disseminate evidence-based educational programs that are clinically proven to be effective in improving athletes' knowledge and behaviors.

Sports nutrition professionals aim to influence nutrition knowledge, dietary intake and body composition to improve athletic performance. Understanding the interrelationships between these factors and how they vary across sports has the potential to facilitate better-informed and targeted sports nutrition practice. This observational study assessed body composition (DXA), dietary intake (multiple-pass 24-hr recall) and nutrition knowledge (two previously validated tools) of elite and subelite male players involved in two team-based sports; Australian football (AF) and soccer. Differences in, and relationships between, nutrition knowledge, dietary intake and body composition between elite AF, subelite AF and elite soccer players were assessed. A total of 66 (23 ± 4 years, 82.0 ± 9.2 kg, 184.7 ± 7.7 cm) players participated. Areas of weaknesses in nutrition knowledge are evident (57% mean score obtained) yet nutrition knowledge was not different between elite and subelite AF and soccer players (58%, 57% and 56%, respectively, p > .05). Dietary intake was not consistent with recommendations in some areas; carbohydrate intake was lower (4.6 ± 1.5 g/kg/day, 4.5 ± 1.2 g/kg/day and 2.9 ± 1.1 g/kg/day for elite and subelite AF and elite soccer players, respectively) and protein intake was higher (3.4 ± 1.1 g/kg/day, 2.1 ± 0.7 g/kg/day and 1.9 ± 0.5 g/kg/day for elite and subelite AF and elite soccer players, respectively) than recommendations. Nutrition knowledge was positively correlated with fat-free soft tissue mass (n = 66; r 2 = .051, p = .039). This insight into known modifiable factors may assist sports nutrition professionals to be more specific and targeted in their approach to supporting players to achieve enhanced performance.

Although dehydration of ≥ 2% body weight (BW) loss significantly impairs endurance performance, dehydration remains prevalent among athletes and may be owing to a lack of knowledge in relation to fluid requirements. The aim of this study was to assess the hydration status of university/club level athletes (n = 430) from a range of sports/activities (army officer cadet training; bootcamp training; cycling; Gaelic Athletic Association camogie, football and hurling; golf; hockey; netball; rugby; running (sprinting and endurance); Shotokan karate and soccer) immediately before and after training/competition and to assess their nutritional knowledge. Urine specific gravity (USG) was measured immediately before and after exercise and BW loss during exercise was assessed. Nutritional knowledge was assessed using a validated questionnaire. 31.9% of athletes commenced exercise in a dehydrated state (USG >1.020) with 43.6% of participants dehydrated posttraining/competition. Dehydration was particularly prevalent (>40% of cohort) among karateka, female netball players, army officer cadets, and golfers. Golfers that commenced a competitive 18 hole round dehydrated took a significantly higher number of strokes to complete the round in comparison with their euhydrated counterparts (79.5 ± 2.1 vs. 75.7 ± 3.9 strokes, p = .049). Nutritional knowledge was poor among participants (median total score [IQR]; 52.9% [46.0, 59.8]), albeit athletes who were euhydrated at the start of exercise had a higher overall score in comparison with dehydrated athletes (55.2% vs. 50.6%, p = .001). Findings from the current study, therefore, have significant implications for the education of athletes in relation to their individual fluid requirements around exercise.

Context:  Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models., Objective:  To investigate the perceived benefits of and barriers in the medical and academic models., Design:  Qualitative study., Setting:  National Collegiate Athletic Association Divisions I, II, and III., Patients or Other Participants:  A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models., Data Collection and Analysis:  We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility., Results:  In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative)., Conclusions:  The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties.

The pillars of anti-doping are detection, deterrence, and prevention. Detection takes the form of testing for banned substances. Deterrence builds on testing and gathering evidence. Athletes who test positive are exposed to penalties. The main tool of prevention is education. Education takes many forms and can be implemented in many ways. This chapter addresses the nature and challenges of current anti-doping education. Firstly, general goals of education and their connection to sport are discussed. Secondly, three normative interpretations of sport are presented, and their implications for anti-doping education are examined. Instrumentalist interpretations and interpretations with emphasis on performance and enhancement challenge the anti-doping campaign. A human excellence interpretation is advocated in which anti-doping is considered a consistent and integral part of sport. Thirdly, future challenges for anti-doping education are reflected upon., (© 2017 S. Karger AG, Basel.)

'Coaching Boys into Men' is an evidence-based dating violence prevention program for coaches to implement with male athletes. A common adaptation of this program is delivery by domestic violence and sexual violence prevention advocates instead of coaches. We explored how this implementer adaptation may influence athlete uptake of program messages and outcomes. Randomly, one school received the program delivered by an advocate while another school received the program delivered by coaches. Athletes completed baseline and follow-up surveys (n = 148), and a subset who received the advocate-led program participated in focus groups (four groups; n = 26). We compared changes in athlete attitudes and behaviors and conducted thematic analyses with qualitative data. We found no significant differences between athletes who received the program from the advocate versus their coaches. Athletes highlighted the advocate's delivery and role as a non-judgmental adult ally as qualities that influenced their uptake of program messages. The acceptability of the advocate-led program may be related to the implementer type along with specific implementer characteristics and delivery methods. Using advocates together with coaches as implementers could increase the reach of this program. Further study of best practices for Coaching Boys into Men adaptation is needed to guide program dissemination and sustainability., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of load-including rapid changes in training and competition load, competition calendar congestion, psychological load and travel-and health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

The purpose of this article is to provide a framework for developing a sports nutrition education program in a collegiate athletic department. A review of literature on student-athlete nutrition behaviors is combined with practical suggestions from personnel who wrote a sports nutrition curriculum at a large Midwestern university. There are 2 primary implications for practice. First, maintaining a written curriculum and conducting periodic evaluation are fundamental aspects of sports nutrition education programs. Second, better documentation of program outcomes is needed to establish best practices in collegiate sports nutrition education and demonstrate the value of full-time sports registered dietitians., (Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)