research paper of sport

• Systematic review update
• Open access
• Published: 21 June 2023

The impact of sports participation on mental health and social outcomes in adults: a systematic review and the ‘Mental Health through Sport’ conceptual model

• Narelle Eather   ORCID: orcid.org/0000-0002-6320-4540 1 , 2 ,
• Levi Wade   ORCID: orcid.org/0000-0002-4007-5336 1 , 3 ,
• Aurélie Pankowiak   ORCID: orcid.org/0000-0003-0178-513X 4 &
• Rochelle Eime   ORCID: orcid.org/0000-0002-8614-2813 4 , 5  

Systematic Reviews volume  12 , Article number:  102 ( 2023 ) Cite this article

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Sport is a subset of physical activity that can be particularly beneficial for short-and-long-term physical and mental health, and social outcomes in adults. This study presents the results of an updated systematic review of the mental health and social outcomes of community and elite-level sport participation for adults. The findings have informed the development of the ‘Mental Health through Sport’ conceptual model for adults.

Nine electronic databases were searched, with studies published between 2012 and March 2020 screened for inclusion. Eligible qualitative and quantitative studies reported on the relationship between sport participation and mental health and/or social outcomes in adult populations. Risk of bias (ROB) was determined using the Quality Assessment Tool (quantitative studies) or Critical Appraisal Skills Programme (qualitative studies).

The search strategy located 8528 articles, of which, 29 involving adults 18–84 years were included for analysis. Data was extracted for demographics, methodology, and study outcomes, and results presented according to study design. The evidence indicates that participation in sport (community and elite) is related to better mental health, including improved psychological well-being (for example, higher self-esteem and life satisfaction) and lower psychological ill-being (for example, reduced levels of depression, anxiety, and stress), and improved social outcomes (for example, improved self-control, pro-social behavior, interpersonal communication, and fostering a sense of belonging). Overall, adults participating in team sport had more favorable health outcomes than those participating in individual sport, and those participating in sports more often generally report the greatest benefits; however, some evidence suggests that adults in elite sport may experience higher levels of psychological distress. Low ROB was observed for qualitative studies, but quantitative studies demonstrated inconsistencies in methodological quality.

Conclusions

The findings of this review confirm that participation in sport of any form (team or individual) is beneficial for improving mental health and social outcomes amongst adults. Team sports, however, may provide more potent and additional benefits for mental and social outcomes across adulthood. This review also provides preliminary evidence for the Mental Health through Sport model, though further experimental and longitudinal evidence is needed to establish the mechanisms responsible for sports effect on mental health and moderators of intervention effects. Additional qualitative work is also required to gain a better understanding of the relationship between specific elements of the sporting environment and mental health and social outcomes in adult participants.

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Introduction

The organizational structure of sport and the performance demands characteristic of sport training and competition provide a unique opportunity for participants to engage in health-enhancing physical activity of varied intensity, duration, and mode; and the opportunity to do so with other people as part of a team and/or club. Participation in individual and team sports have shown to be beneficial to physical, social, psychological, and cognitive health outcomes [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Often, the social and mental health benefits facilitated through participation in sport exceed those achieved through participation in other leisure-time or recreational activities [ 8 , 9 , 10 ]. Notably, these benefits are observed across different sports and sub-populations (including youth, adults, older adults, males, and females) [ 11 ]. However, the evidence regarding sports participation at the elite level is limited, with available research indicating that elite athletes may be more susceptible to mental health problems, potentially due to the intense mental and physical demands placed on elite athletes [ 12 ].

Participation in sport varies across the lifespan, with children representing the largest cohort to engage in organized community sport [ 13 ]. Across adolescence and into young adulthood, dropout from organized sport is common, and especially for females [ 14 , 15 , 16 ], and adults are shifting from organized sports towards leisure and fitness activities, where individual activities (including swimming, walking, and cycling) are the most popular [ 13 , 17 , 18 , 19 ]. Despite the general decline in sport participation with age [ 13 ], the most recent (pre-COVID) global data highlights that a range of organized team sports (such as, basketball, netball volleyball, and tennis) continue to rank highly amongst adult sport participants, with soccer remaining a popular choice across all regions of the world [ 13 ]. It is encouraging many adults continue to participate in sport and physical activities throughout their lives; however, high rates of dropout in youth sport and non-participation amongst adults means that many individuals may be missing the opportunity to reap the potential health benefits associated with participation in sport.

According to the World Health Organization, mental health refers to a state of well-being and effective functioning in which an individual realizes his or her own abilities, is resilient to the stresses of life, and is able to make a positive contribution to his or her community [ 20 ]. Mental health covers three main components, including psychological, emotional and social health [ 21 ]. Further, psychological health has two distinct indicators, psychological well-being (e.g., self-esteem and quality of life) and psychological ill-being (e.g., pre-clinical psychological states such as psychological difficulties and high levels of stress) [ 22 ]. Emotional well-being describes how an individual feels about themselves (including life satisfaction, interest in life, loneliness, and happiness); and social well–being includes an individual’s contribution to, and integration in society [ 23 ].

Mental illnesses are common among adults and incidence rates have remained consistently high over the past 25 years (~ 10% of people affected globally) [ 24 ]. Recent statistics released by the World Health Organization indicate that depression and anxiety are the most common mental disorders, affecting an estimated 264 million people, ranking as one of the main causes of disability worldwide [ 25 , 26 ]. Specific elements of social health, including high levels of isolation and loneliness among adults, are now also considered a serious public health concern due to the strong connections with ill-health [ 27 ]. Participation in sport has shown to positively impact mental and social health status, with a previous systematic review by Eime et al. (2013) indicated that sports participation was associated with lower levels of perceived stress, and improved vitality, social functioning, mental health, and life satisfaction [ 1 ]. Based on their findings, the authors developed a conceptual model (health through sport) depicting the relationship between determinants of adult sports participation and physical, psychological, and social health benefits of participation. In support of Eime’s review findings, Malm and colleagues (2019) recently described how sport aids in preventing or alleviating mental illness, including depressive symptoms and anxiety or stress-related disease [ 7 ]. Andersen (2019) also highlighted that team sports participation is associated with decreased rates of depression and anxiety [ 11 ]. In general, these reviews report stronger effects for sports participation compared to other types of physical activity, and a dose–response relationship between sports participation and mental health outcomes (i.e., higher volume and/or intensity of participation being associated with greater health benefits) when adults participate in sports they enjoy and choose [ 1 , 7 ]. Sport is typically more social than other forms of physical activity, including enhanced social connectedness, social support, peer bonding, and club support, which may provide some explanation as to why sport appears to be especially beneficial to mental and social health [ 28 ].

Thoits (2011) proposed several potential mechanisms through which social relationships and social support improve physical and psychological well-being [ 29 ]; however, these mechanisms have yet to be explored in the context of sports participation at any level in adults. The identification of the mechanisms responsible for such effects may direct future research in this area and help inform future policy and practice in the delivery of sport to enhance mental health and social outcomes amongst adult participants. Therefore, the primary objective of this review was to examine and synthesize all research findings regarding the relationship between sports participation, mental health and social outcomes at the community and elite level in adults. Based on the review findings, the secondary objective was to develop the ‘Mental Health through Sport’ conceptual model.

This review has been registered in the PROSPERO systematic review database and assigned the identifier: CRD42020185412. The conduct and reporting of this systematic review also follows the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 30 ] (PRISMA flow diagram and PRISMA Checklist available in supplementary files ). This review is an update of a previous review of the same topic [ 31 ], published in 2012.

Identification of studies

Nine electronic databases (CINAHL, Cochrane Library, Google Scholar, Informit, Medline, PsychINFO, Psychology and Behavioural Sciences Collection, Scopus, and SPORTDiscus) were systematically searched for relevant records published from 2012 to March 10, 2020. The following key terms were developed by all members of the research team (and guided by previous reviews) and entered into these databases by author LW: sport* AND health AND value OR benefit* OR effect* OR outcome* OR impact* AND psych* OR depress* OR stress OR anxiety OR happiness OR mood OR ‘quality of life’ OR ‘social health’ OR ‘social relation*’ OR well* OR ‘social connect*’ OR ‘social functioning’ OR ‘life satisfac*’ OR ‘mental health’ OR social OR sociolog* OR affect* OR enjoy* OR fun. Where possible, Medical Subject Headings (MeSH) were also used.

Criteria for inclusion/exclusion

The titles of studies identified using this method were screened by LW. Abstract and full text of the articles were reviewed independently by LW and NE. To be included in the current review, each study needed to meet each of the following criteria: (1) published in English from 2012 to 2020; (2) full-text available online; (3) original research or report published in a peer-reviewed journal; (4) provides data on the psychological or social effects of participation in sport (with sport defined as a subset of exercise that can be undertaken individually or as a part of a team, where participants adhere to a common set of rules or expectations, and a defined goal exists); (5) the population of interest were adults (18 years and older) and were apparently healthy. All papers retrieved in the initial search were assessed for eligibility by title and abstract. In cases where a study could not be included or excluded via their title and abstract, the full text of the article was reviewed independently by two of the authors.

Data extraction

For the included studies, the following data was extracted independently by LW and checked by NE using a customized Google Docs spreadsheet: author name, year of publication, country, study design, aim, type of sport (e.g., tennis, hockey, team, individual), study conditions/comparisons, sample size, where participants were recruited from, mean age of participants, measure of sports participation, measure of physical activity, psychological and/or social outcome/s, measure of psychological and/or social outcome/s, statistical method of analysis, changes in physical activity or sports participation, and the psychological and/or social results.

Risk of bias (ROB) assessment

A risk of bias was performed by LW and AP independently using the ‘Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies’ OR the ‘Quality Assessment of Controlled Intervention Studies’ for the included quantitative studies, and the ‘Critical Appraisal Skills Programme (CASP) Checklist for the included qualitative studies [ 32 , 33 ]. Any discrepancies in the ROB assessments were discussed between the two reviewers, and a consensus reached.

The search yielded 8528 studies, with a total of 29 studies included in the systematic review (Fig.  1 ). Tables  1 and 2 provide a summary of the included studies. The research included adults from 18 to 84 years old, with most of the evidence coming from studies targeting young adults (18–25 years). Study samples ranged from 14 to 131, 962, with the most reported psychological outcomes being self-rated mental health ( n  = 5) and depression ( n  = 5). Most studies did not investigate or report the link between a particular sport and a specific mental health or social outcome; instead, the authors’ focused on comparing the impact of sport to physical activity, and/or individual sports compared to team sports. The results of this review are summarized in the following section, with findings presented by study design (cross-sectional, experimental, and longitudinal).

Flow of studies through the review process

Effects of sports participation on psychological well-being, ill-being, and social outcomes

Cross-sectional evidence.

This review included 14 studies reporting on the cross-sectional relationship between sports participation and psychological and/or social outcomes. Sample sizes range from n  = 414 to n  = 131,962 with a total of n  = 239,394 adults included across the cross-sectional studies.

The cross-sectional evidence generally supports that participation in sport, and especially team sports, is associated with greater mental health and psychological wellbeing in adults compared to non-participants [ 36 , 59 ]; and that higher frequency of sports participation and/or sport played at a higher level of competition, are also linked to lower levels of mental distress in adults . This was not the case for one specific study involving ice hockey players aged 35 and over, with Kitchen and Chowhan (2016) Kitchen and Chowhan (2016) reporting no relationship between participation in ice hockey and either mental health, or perceived life stress [ 54 ]. There is also some evidence to support that previous participation in sports (e.g., during childhood or young adulthood) is linked to better mental health outcomes later in life, including improved mental well-being and lower mental distress [ 59 ], even after controlling for age and current physical activity.

Compared to published community data for adults, elite or high-performance adult athletes demonstrated higher levels of body satisfaction, self-esteem, and overall life satisfaction [ 39 ]; and reported reduced tendency to respond to distress with anger and depression. However, rates of psychological distress were higher in the elite sport cohort (compared to community norms), with nearly 1 in 5 athletes reporting ‘high to very high’ distress, and 1 in 3 reporting poor mental health symptoms at a level warranting treatment by a health professional in one study ( n  = 749) [ 39 ].

Four studies focused on the associations between physical activity and sports participation and mental health outcomes in older adults. Physical activity was associated with greater quality of life [ 56 ], with the relationship strongest for those participating in sport in middle age, and for those who cycled in later life (> 65) [ 56 ]. Group physical activities (e.g., walking groups) and sports (e.g., golf) were also significantly related to excellent self-rated health, low depressive symptoms, high health-related quality of life (HRQoL) and a high frequency of laughter in males and females [ 60 , 61 ]. No participation or irregular participation in sport was associated with symptoms of mild to severe depression in older adults [ 62 ].

Several cross-sectional studies examined whether the effects of physical activity varied by type (e.g., total physical activity vs. sports participation). In an analysis of 1446 young adults (mean age = 18), total physical activity, moderate-to-vigorous physical activity, and team sport were independently associated with mental health [ 46 ]. Relative to individual physical activity, after adjusting for covariates and moderate-to-vigorous physical activity (MVPA), only team sport was significantly associated with improved mental health. Similarly, in a cross-sectional analysis of Australian women, Eime, Harvey, Payne (2014) reported that women who engaged in club and team-based sports (tennis or netball) reported better mental health and life satisfaction than those who engaged in individual types of physical activity [ 47 ]. Interestingly, there was no relationship between the amount of physical activity and either of these outcomes, suggesting that other qualities of sports participation contribute to its relationship to mental health and life satisfaction. There was also some evidence to support a relationship between exercise type (ball sports, aerobic activity, weightlifting, and dancing), and mental health amongst young adults (mean age 22 years) [ 48 ], with ball sports and dancing related to fewer symptoms of depression in students with high stress; and weightlifting related to fewer depressive symptoms in weightlifters exhibiting low stress.

Longitudinal evidence

Eight studies examined the longitudinal relationship between sports participation and either mental health and/or social outcomes. Sample sizes range from n  = 113 to n  = 1679 with a total of n  = 7022 adults included across the longitudinal studies.

Five of the included longitudinal studies focused on the relationship between sports participation in childhood or adolescence and mental health in young adulthood. There is evidence that participation in sport in high-school is protective of future symptoms of anxiety (including panic disorder, generalised anxiety disorder, social phobia, and agoraphobia) [ 42 ]. Specifically, after controlling for covariates (including current physical activity), the number of years of sports participation in high school was shown to be protective of symptoms of panic and agoraphobia in young adulthood, but not protective of symptoms of social phobia or generalized anxiety disorder [ 42 ]. A comparison of individual or team sports participation also revealed that participation in either context was protective of panic disorder symptoms, while only team sport was protective of agoraphobia symptoms, and only individual sport was protective of social phobia symptoms. Furthermore, current and past sports team participation was shown to negatively relate to adult depressive symptoms [ 43 ]; drop out of sport was linked to higher depressive symptoms in adulthood compared to those with maintained participation [ 9 , 22 , 63 ]; and consistent participation in team sports (but not individual sport) in adolescence was linked to higher self-rated mental health, lower perceived stress and depressive symptoms, and lower depression scores in early adulthood [ 53 , 58 ].

Two longitudinal studies [ 35 , 55 ], also investigated the association between team and individual playing context and mental health. Dore and colleagues [ 35 ] reported that compared to individual activities, being active in informal groups (e.g., yoga, running groups) or team sports was associated with better mental health, fewer depressive symptoms and higher social connectedness – and that involvement in team sports was related to better mental health regardless of physical activity volume. Kim and James [ 55 ] discovered that sports participation led to both short and long-term improvements in positive affect and life satisfaction.

A study on social outcomes related to mixed martial-arts (MMA) and Brazilian jiu-jitsu (BJJ) showed that both sports improved practitioners’ self-control and pro-social behavior, with greater improvements seen in the BJJ group [ 62 ]. Notably, while BJJ reduced participants’ reported aggression, there was a slight increase in MMA practitioners, though it is worth mentioning that individuals who sought out MMA had higher levels of baseline aggression.

Experimental evidence

Six of the included studies were experimental or quasi-experimental. Sample sizes ranged from n  = 28 to n  = 55 with a total of n  = 239 adults included across six longitudinal studies. Three studies involved a form of martial arts (such as judo and karate) [ 45 , 51 , 52 ], one involved a variety of team sports (such as netball, soccer, and cricket) [ 34 ], and the remaining two focused on badminton [ 57 ] and handball [ 49 ].

Brinkley and colleagues [ 34 ] reported significant effects on interpersonal communication (but not vitality, social cohesion, quality of life, stress, or interpersonal relationships) for participants ( n  = 40) engaging in a 12-week workplace team sports intervention. Also using a 12-week intervention, Hornstrup et al. [ 49 ] reported a significant improvement in mental energy (but not well-being or anxiety) in young women (mean age = 24; n  = 28) playing in a handball program. Patterns et al. [ 57 ] showed that in comparison to no exercise, participation in an 8-week badminton or running program had no significant improvement on self-esteem, despite improvements in perceived and actual fitness levels.

Three studies examined the effect of martial arts on the mental health of older adults (mean ages 79 [ 52 ], 64 [ 51 ], and 70 [ 45 ] years). Participation in Karate-Do had positive effects on overall mental health, emotional wellbeing, depression and anxiety when compared to other activities (physical, cognitive, mindfulness) and a control group [ 51 , 52 ]. Ciaccioni et al. [ 45 ] found that a Judo program did not affect either the participants’ mental health or their body satisfaction, citing a small sample size, and the limited length of the intervention as possible contributors to the findings.

Qualitative evidence

Three studies interviewed current or former sports players regarding their experiences with sport. Chinkov and Holt [ 41 ] reported that jiu-jitsu practitioners (mean age 35 years) were more self-confident in their lives outside of the gym, including improved self-confidence in their interactions with others because of their training. McGraw and colleagues [ 37 ] interviewed former and current National Football League (NFL) players and their families about its impact on the emotional and mental health of the players. Most of the players reported that their NFL career provided them with social and emotional benefits, as well as improvements to their self-esteem even after retiring. Though, despite these benefits, almost all the players experienced at least one mental health challenge during their career, including depression, anxiety, or difficulty controlling their temper. Some of the players and their families reported that they felt socially isolated from people outside of the national football league.

Through a series of semi-structured interviews and focus groups, Thorpe, Anders [ 40 ] investigated the impact of an Aboriginal male community sporting team on the health of its players. The players reported they felt a sense of belonging when playing in the team, further noting that the social and community aspects were as important as the physical health benefits. Participating in the club strengthened the cultural identity of the players, enhancing their well-being. The players further noted that participation provided them with enjoyment, stress relief, a sense of purpose, peer support, and improved self-esteem. Though they also noted challenges, including the presence of racism, community conflict, and peer-pressure.

Quality of studies

Full details of our risk of bias (ROB) results are provided in Supplementary Material A . Of the three qualitative studies assessed using the Critical Appraisal Skills Program (CASP), all three were deemed to have utilised and reported appropriate methodological standards on at least 8 of the 10 criteria. Twenty studies were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with all studies clearly reporting the research question/s or objective/s and study population. However, only four studies provided a justification for sample size, and less than half of the studies met quality criteria for items 6, 7, 9, or 10 (and items 12 and 13 were largely not applicable). Of concern, only four of the observational or cohort studies were deemed to have used clearly defined, valid, and reliable exposure measures (independent variables) and implemented them consistently across all study participants. Six studies were assessed using the Quality Assessment of Controlled Intervention Studies, with three studies described as a randomized trial (but none of the three reported a suitable method of randomization, concealment of treatment allocation, or blinding to treatment group assignment). Three studies showed evidence that study groups were similar at baseline for important characteristics and an overall drop-out rate from the study < 20%. Four studies reported high adherence to intervention protocols (with two not reporting) and five demonstrated that.study outcomes were assessed using valid and reliable measures and implemented consistently across all study participants. Importantly, researchers did not report or have access to validated instruments for assessing sport participation or physical activity amongst adults, though most studies provided psychometrics for their mental health outcome measure/s. Only one study reported that the sample size was sufficiently powered to detect a difference in the main outcome between groups (with ≥ 80% power) and that all participants were included in the analysis of results (intention-to-treat analysis). In general, the methodological quality of the six randomised studies was deemed low.

Initially, our discussion will focus on the review findings regarding sports participation and well-being, ill-being, and psychological health. However, the heterogeneity and methodological quality of the included research (especially controlled trials) should be considered during the interpretation of our results. Considering our findings, the Mental Health through Sport conceptual model for adults will then be presented and discussed and study limitations outlined.

Sports participation and psychological well-being

In summary, the evidence presented here indicates that for adults, sports participation is associated with better overall mental health [ 36 , 46 , 47 , 59 ], mood [ 56 ], higher life satisfaction [ 39 , 47 ], self-esteem [ 39 ], body satisfaction [ 39 ], HRQoL [ 60 ], self-rated health [ 61 ], and frequency of laughter [ 61 ]. Sports participation has also shown to be predictive of better psychological wellbeing over time [ 35 , 53 ], higher positive affect [ 55 ], and greater life satisfaction [ 55 ]. Furthermore, higher frequency of sports participation and/or sport played at a higher level of competition, have been linked to lower levels of mental distress, higher levels of body satisfaction, self-esteem, and overall life satisfaction in adults [ 39 ].

Despite considerable heterogeneity of sports type, cross-sectional and experimental research indicate that team-based sports participation, compared to individual sports and informal group physical activity, has a more positive effect on mental energy [ 49 ], physical self-perception [ 57 ], and overall psychological health and well-being in adults, regardless of physical activity volume [ 35 , 46 , 47 ]. And, karate-do benefits the subjective well-being of elderly practitioners [ 51 , 52 ]. Qualitative research in this area has queried participants’ experiences of jiu-jitsu, Australian football, and former and current American footballers. Participants in these sports reported that their participation was beneficial for psychological well-being [ 37 , 40 , 41 ], improved self-esteem [ 37 , 40 , 41 ], and enjoyment [ 37 ].

Sports participation and psychological ill-being

Of the included studies, n  = 19 examined the relationship between participating in sport and psychological ill-being. In summary, there is consistent evidence that sports participation is related to lower depression scores [ 43 , 48 , 61 , 62 ]. There were mixed findings regarding psychological stress, where participation in childhood (retrospectively assessed) was related to lower stress in young adulthood [ 41 ], but no relationship was identified between recreational hockey in adulthood and stress [ 54 ]. Concerning the potential impact of competing at an elite level, there is evidence of higher stress in elite athletes compared to community norms [ 39 ]. Further, there is qualitative evidence that many current or former national football league players experienced at least one mental health challenge, including depression, anxiety, difficulty controlling their temper, during their career [ 37 ].

Evidence from longitudinal research provided consistent evidence that participating in sport in adolescence is protective of symptoms of depression in young adulthood [ 43 , 53 , 58 , 63 ], and further evidence that participating in young adulthood is related to lower depressive symptoms over time (6 months) [ 35 ]. Participation in adolescence was also protective of manifestations of anxiety (panic disorder and agoraphobia) and stress in young adulthood [ 42 ], though participation in young adulthood was not related to a more general measure of anxiety [ 35 ] nor to changes in negative affect [ 55 ]). The findings from experimental research were mixed. Two studies examined the effect of karate-do on markers of psychological ill-being, demonstrating its capacity to reduce anxiety [ 52 ], with some evidence of its effectiveness on depression [ 51 ]. The other studies examined small-sided team-based games but showed no effect on stress or anxiety [ 34 , 49 ]. Most studies did not differentiate between team and individual sports, though one study found that adolescents who participated in team sports (not individual sports) in secondary school has lower depression scores in young adulthood [ 58 ].

Sports participation and social outcomes

Seven of the included studies examined the relationship between sports participation and social outcomes. However, very few studies examined social outcomes or tested a social outcome as a potential mediator of the relationship between sport and mental health. It should also be noted that this body of evidence comes from a wide range of sport types, including martial arts, professional football, and workplace team-sport, as well as different methodologies. Taken as a whole, the evidence shows that participating in sport is beneficial for several social outcomes, including self-control [ 50 ], pro-social behavior [ 50 ], interpersonal communication [ 34 ], and fostering a sense of belonging [ 40 ]. Further, there is evidence that group activity, for example team sport or informal group activity, is related to higher social connectedness over time, though analyses showed that social connectedness was not a mediator for mental health [ 35 ].

There were conflicting findings regarding social effects at the elite level, with current and former NFL players reporting that they felt socially isolated during their career [ 37 ], whilst another study reported no relationship between participation at the elite level and social dysfunction [ 39 ]. Conversely, interviews with a group of indigenous men revealed that they felt as though participating in an all-indigenous Australian football team provided them with a sense of purpose, and they felt as though the social aspect of the game was as important as the physical benefits it provides [ 40 ].

Mental health through sport conceptual model for adults

The ‘Health through Sport’ model provides a depiction of the determinants and benefits of sports participation [ 31 ]. The model recognises that the physical, mental, and social benefits of sports participation vary by the context of sport (e.g., individual vs. team, organized vs. informal). To identify the elements of sport which contribute to its effect on mental health outcomes, we describe the ‘Mental Health through Sport’ model (Fig.  2 ). The model proposes that the social and physical elements of sport each provide independent, and likely synergistic contributions to its overall influence on mental health.

The Mental Health through Sport conceptual model

The model describes two key pathways through which sport may influence mental health: physical activity, and social relationships and support. Several likely moderators of this effect are also provided, including sport type, intensity, frequency, context (team vs. individual), environment (e.g., indoor vs. outdoor), as well as the level of competition (e.g., elite vs. amateur).

The means by which the physical activity component of sport may influence mental health stems from the work of Lubans et al., who propose three key groups of mechanisms: neurobiological, psychosocial, and behavioral [ 64 ]. Processes whereby physical activity may enhance psychological outcomes via changes in the structural and functional composition of the brain are referred to as neurobiological mechanisms [ 65 , 66 ]. Processes whereby physical activity provides opportunities for the development of self-efficacy, opportunity for mastery, changes in self-perceptions, the development of independence, and for interaction with the environment are considered psychosocial mechanisms. Lastly, processes by which physical activity may influence behaviors which ultimately affect psychological health, including changes in sleep duration, self-regulation, and coping skills, are described as behavioral mechanisms.

Playing sport offers the opportunity to form relationships and to develop a social support network, both of which are likely to influence mental health. Thoits [ 29 ] describes 7 key mechanisms by which social relationships and support may influence mental health: social influence/social comparison; social control; role-based purpose and meaning (mattering); self-esteem; sense of control; belonging and companionship; and perceived support availability [ 29 ]. These mechanisms and their presence within a sporting context are elaborated below.

Subjective to the attitudes and behaviors of individuals in a group, social influence and comparison may facilitate protective or harmful effects on mental health. Participants in individual or team sport will be influenced and perhaps steered by the behaviors, expectations, and norms of other players and teams. When individual’s compare their capabilities, attitudes, and values to those of other participants, their own behaviors and subsequent health outcomes may be affected. When others attempt to encourage or discourage an individual to adopt or reject certain health practices, social control is displayed [ 29 ]. This may evolve as strategies between players (or between players and coach) are discussion and implemented. Likewise, teammates may try to motivate each another during a match to work harder, or to engage in specific events or routines off-field (fitness programs, after game celebrations, attending club events) which may impact current and future physical and mental health.

Sport may also provide behavioral guidance, purpose, and meaning to its participants. Role identities (positions within a social structure that come with reciprocal obligations), often formed as a consequence of social ties formed through sport. Particularly in team sports, participants come to understand they form an integral part of the larger whole, and consequently, they hold certain responsibility in ensuring the team’s success. They have a commitment to the team to, train and play, communicate with the team and a potential responsibility to maintain a high level of health, perform to their capacity, and support other players. As a source of behavioral guidance and of purpose and meaning in life, these identities are likely to influence mental health outcomes amongst sport participants.

An individual’s level of self-esteem may be affected by the social relationships and social support provided through sport; with improved perceptions of capability (or value within a team) in the sporting domain likely to have positive impact on global self-esteem and sense of worth [ 64 ]. The unique opportunities provided through participation in sport, also allow individuals to develop new skills, overcome challenges, and develop their sense of self-control or mastery . Working towards and finding creative solutions to challenges in sport facilitates a sense of mastery in participants. This sense of mastery may translate to other areas of life, with individual’s developing the confidence to cope with varied life challenges. For example, developing a sense of mastery regarding capacity to formulate new / creative solutions when taking on an opponent in sport may result in greater confidence to be creative at work. Social relationships and social support provided through sport may also provide participants with a source of belonging and companionship. The development of connections (on and off the field) to others who share common interests, can build a sense of belonging that may mediate improvements in mental health outcomes. Social support is often provided emotionally during expressions of trust and care; instrumentally via tangible assistance; through information such as advice and suggestions; or as appraisal such feedback. All forms of social support provided on and off the field contribute to a more generalised sense of perceived support that may mediate the effect of social interaction on mental health outcomes.

Participation in sport may influence mental health via some combination of the social mechanisms identified by Thoits, and the neurobiological, psychosocial, and behavioral mechanisms stemming from physical activity identified by Lubans [ 29 , 64 ]. The exact mechanisms through which sport may confer psychological benefit is likely to vary between sports, as each sport varies in its physical and social requirements. One must also consider the social effects of sports participation both on and off the field. For instance, membership of a sporting team and/or club may provide a sense of identity and belonging—an effect that persists beyond the immediacy of playing the sport and may have a persistent effect on their psychological health. Furthermore, the potential for team-based activity to provide additional benefit to psychological outcomes may not just be attributable to the differences in social interactions, there are also physiological differences in the requirements for sport both within (team vs. team) and between (team vs. individual) categories that may elicit additional improvements in psychological outcomes. For example, evidence supports that exercise intensity moderates the relationship between physical activity and several psychological outcomes—supporting that sports performed at higher intensity will be more beneficial for psychological health.

Limitations and recommendations

There are several limitations of this review worthy of consideration. Firstly, amongst the included studies there was considerable heterogeneity in study outcomes and study methodology, and self-selection bias (especially in non-experimental studies) is likely to influence study findings and reduce the likelihood that study participants and results are representative of the overall population. Secondly, the predominately observational evidence included in this and Eime’s prior review enabled us to identify the positive relationship between sports participation and social and psychological health (and examine directionality)—but more experimental and longitudinal research is required to determine causality and explore potential mechanisms responsible for the effect of sports participation on participant outcomes. Additional qualitative work would also help researchers gain a better understanding of the relationship between specific elements of the sporting environment and mental health and social outcomes in adult participants. Thirdly, there were no studies identified in the literature where sports participation involved animals (such as equestrian sports) or guns (such as shooting sports). Such studies may present novel and important variables in the assessment of mental health benefits for participants when compared to non-participants or participants in sports not involving animals/guns—further research is needed in this area. Our proposed conceptual model also identifies several pathways through which sport may lead to improvements in mental health—but excludes some potentially negative influences (such as poor coaching behaviors and injury). And our model is not designed to capture all possible mechanisms, creating the likelihood that other mechanisms exist but are not included in this review. Additionally, an interrelationship exits between physical activity, mental health, and social relationships, whereby changes in one area may facilitate changes in the other/s; but for the purpose of this study, we have focused on how the physical and social elements of sport may mediate improvements in psychological outcomes. Consequently, our conceptual model is not all-encompassing, but designed to inform and guide future research investigating the impact of sport participation on mental health.

The findings of this review endorse that participation in sport is beneficial for psychological well-being, indicators of psychological ill-being, and social outcomes in adults. Furthermore, participation in team sports is associated with better psychological and social outcomes compared to individual sports or other physical activities. Our findings support and add to previous review findings [ 1 ]; and have informed the development of our ‘Mental Health through Sport’ conceptual model for adults which presents the potential mechanisms by which participation in sport may affect mental health.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Eime RM, Young JA, Harvey JT, Charity MJ, Payne WR. A systematic review of the psychological and social benefits of participation in sport for adults: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10:135.

Article   PubMed   PubMed Central   Google Scholar  

Ishihara T, Nakajima T, Yamatsu K, Okita K, Sagawa M, Morita N. Relationship of participation in specific sports to academic performance in adolescents: a 2-year longitudinal study. Scand J Med Sci Sports. 2020.

Cope E, Bailey R, Pearce G. Why do children take part in, and remain involved in sport?: implications for children’s sport coaches. Int J Coach Sci. 2013;7:55–74.

Google Scholar  

Harrison PA, Narayan G. Differences in behavior, psychological factors, and environmental factors associated with participation in school sports and other activities in adolescence. J Sch Health. 2003;73(3):113–20.

Article   PubMed   Google Scholar  

Allender S, Cowburn G, Foster C. Understanding particpation in sport and physical activity among children and adults: a review of qualitative studies. Health Educ Res. 2006;21(6):826–35.

Adachi P, Willoughby T. It’s not how much you play, but how much you enjoy the game: The longitudinal associations between adolescents’ self-esteem and the frequency versus enjoyment of involvement in sports. J Youth Adolesc. 2014;43(1):137–45.

Malm C, Jakobsson J, Isaksson A. Physical activity and sports-real health benefits: a review with insight into the public health of Sweden. Sports (Basel, Switzerland). 2019;7(5):127.

PubMed   Google Scholar  

Mills K, Dudley D, Collins NJ. Do the benefits of participation in sport and exercise outweigh the negatives? An academic review. Best Pract Res Clin Rheumatol. 2019;33(1):172–87.

Howie EK, Guagliano JM, Milton K, Vella SA, Gomersall SR,Kolbe-Alexander TL, et al. Ten research priorities related to youth sport, physical activity, and health. 2020;17(9):920.

Vella SA, Swann C, Allen MS, Schweickle MJ, Magee CA. Bidirectional associations between sport involvement and mental health in adolescence. Med Sci Sports Exerc. 2017;49(4):687–94.

Andersen MH, Ottesen L, Thing LF. The social and psychological health outcomes of team sport participation in adults: An integrative review of research. Scand J Public Health. 2019;47(8):832–50.

Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The mental health of elite athletes: a narrative systematic review. Sports medicine (Auckland, NZ). 2016;46(9):1333–53.

Article   Google Scholar  

Hulteen RM, Smith JJ, Morgan PJ, Barnett LM, Hallal PC, Colyvas K, et al. Global participation in sport and leisure-time physical activities: a systematic review and meta-analysis. Prev Med. 2017;95:14–25.

Eime RM, Harvey J, Charity M, Westerbeek H. Longitudinal Trends in Sport Participation and Retention of Women and Girls. Front Sports Act Living. 2020;2:39.

Brooke HL, Corder K, Griffin SJ, van Sluijs EMF. Physical activity maintenance in the transition to adolescence: a longitudinal study of the roles of sport and lifestyle activities in british youth. PLoS ONE. 2014;9(2): e89028.

Coll CVN, Knuth AG, Bastos JP, Hallal PC, Bertoldi AD. Time trends of physical activity among Brazilian adolescents over a 7-year period. J Adolesc Health. 2014;54:209–13.

Klostermann C, Nagel S. Changes in German sport participation: Historical trends in individual sports. Int Rev Sociol Sport. 2012;49:609–34.

Eime RM, Harvey J, Charity M. Sport participation settings: where and “how” do Australians play sport? BMC Public Health. 2020;20(1):1344.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Lim SY, Warner S, Dixon M, Berg B, Kim C, Newhouse-Bailey M. Sport Participation Across National Contexts: A Multilevel Investigation of Individual and Systemic Influences on Adult Sport Participation. Eur Sport Manag Q. 2011;11(3):197–224.

World Health Organisation. Mental Health Action Plan 2013–2020. Geneva: World Health Orgnaisation; 2013.

Keyes C. Bridging Occupational, Organizational and Public Health. Netherlands: Springer Dordrecht; 2014.

Ryff C, Love G, Urry H, Muller D, Rosenkranz M, Friedman E, et al. Psychological well-being and ill-being: Do they have distinct or mirrored biological correlates? Psychother Psychosom. 2006;75:85–95.

Australian Government. Social and emotional wellbeing: Development of a children’s headline indicator information paper. Canberra: Australian Institute of Health and Welfare; 2013.

Global Burden of Disease Injury IP. Collaborators, Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858.

World Health Organisation. Mental disorders: Fact sheet 2019 [Available from: https://www.who.int/news-room/fact-sheets/detail/mental-disorders .

Mental Health [Internet]. 2018 [cited 12 March 2021]. Available from: https://ourworldindata.org/mental-health ' [Online Resource].

Newman MG, Zainal NH. The value of maintaining social connections for mental health in older people. The Lancet Public Health. 2020;5(1):e12–3.

Eime RM, Harvey JT, Brown WJ, Payne WR. Does sports club participation contribute to health-related quality of life? Med Sci Sports Exerc. 2010;42(5):1022–8.

Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLoS Med. 2021;18(3): e1003583.

Eime RM, Young JA, Harvey JT, Charity MJ, Payne WR. A systematic review of the psychological and social benefits of participation in sport for adults: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10(1):135.

Critical Appraisal Skills Programme. CASP Qualitative Studies Checklist2019 1/12/2021]. Available from: https://casp-uk.b-cdn.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf .

National Institutes from Health. Quality assessment tool for observational cohort and cross-sectional studies 2014 [Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools .

Brinkley A, McDermott H, Grenfell-Essam R. It’s time to start changing the game: a 12-week workplace team sport intervention study. Sports Med Open. 2017;3(1):30–41.

Doré I, O’Loughlin JL, Schnitzer ME, Datta GD, Fournier L. The longitudinal association between the context of physical activity and mental health in early adulthood. Ment Health Phys Act. 2018;14:121–30.

Marlier M, Van Dyck D, Cardon G, De Bourdeaudhuij I, Babiak K, Willem A. Interrelation of sport participation, physical activity, social capital and mental health in disadvantaged communities: A sem-analysis. PLoS ONE [Internet]. 2015; 10(10):[e0140196 p.]. Available from: http://ezproxy.newcastle.edu.au/login?url=http://ezproxy.newcastle.edu.au/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med12&AN=26451731 .

McGraw SA, Deubert CR, Lynch HF, Nozzolillo A, Taylor L, Cohen I. Life on an emotional roller coaster: NFL players and their family members’ perspectives on player mental health. J Clin Sport Psychol. 2018;12(3):404–31.

Mickelsson T. Modern unexplored martial arts – what can mixed martial arts and Brazilian Jiu-Jitsu do for youth development?. Eur J Sport Sci. 2020;20(3):386–93. https://doi.org/10.1080/17461391.2019.1629180 .

Purcell R, Rice S, Butterworth M, Clements M. Rates and Correlates of Mental Health Symptoms in Currently Competing Elite Athletes from the Australian National High-Performance Sports System. Sports Med. 2020.

Thorpe A, Anders W, Rowley K. The community network: an Aboriginal community football club bringing people together. Aust J Prim Health. 2014;20(4):356–64.

Appelqvist-Schmidlechner K, Vaara J, Hakkinen A, Vasankari T, Makinen J, Mantysaari M, et al. Relationships between youth sports participation and mental health in young adulthood among Finnish males. Am J Health Promot. 2018;32(7):1502–9.

Ashdown-Franks G, Sabiston CM, Solomon-Krakus S, O’Loughlin JL. Sport participation in high school and anxiety symptoms in young adulthood. Ment Health Phys Act. 2017;12:19–24.

Brunet J, Sabiston CM, Chaiton M, Barnett TA, O’Loughlin E, Low NC, et al. The association between past and current physical activity and depressive symptoms in young adults: a 10-year prospective study. Ann Epidemiol. 2013;23(1):25–30.

Chinkov AE, Holt NL. Implicit transfer of life skills through participation in Brazilian Jiu-jitsu. J Appl Sport Psychol. 2016;28(2):139–53. https://doi.org/10.1080/10413200.2015.1086447 .

Ciaccioni S, Capranica L, Forte R, Chaabene H, Pesce C, Condello G. Effects of a judo training on functional fitness, anthropometric, and psychological variables in old novice practitioners. J Aging Phys Act. 2019;27(6):831–42.

Doré I, O’Loughlin JL, Beauchamp G, Martineau M, Fournier L. Volume and social context of physical activity in association with mental health, anxiety and depression among youth. Prev Med. 2016;91:344–50.

Eime R, Harvey J, Payne W. Dose-response of women’s health-related quality of life (HRQoL) and life satisfaction to physical activity. J Phys Act Health. 2014;11(2):330–8.

Gerber M, Brand S, Elliot C, Holsboer-Trachsler E, Pühse U. Aerobic exercise, ball sports, dancing, and weight Lifting as moderators of the relationship between Stress and depressive symptoms: an exploratory cross-sectional study with Swiss university students. Percept Mot Skills. 2014;119(3):679–97.

Hornstrup T, Wikman JM, Fristrup B, Póvoas S, Helge EW, Nielsen SH, et al. Fitness and health benefits of team handball training for young untrained women—a cross-disciplinary RCT on physiological adaptations and motivational aspects. J Sport Health Sci. 2018;7(2):139–48.

Mickelsson T. Modern unexplored martial arts–what can mixed martial arts and Brazilian Jiu-Jiutsu do for youth development? Eur J Sport Sci. 2019.

Jansen P, Dahmen-Zimmer K. Effects of cognitive, motor, and karate training on cognitive functioning and emotional well-being of elderly people. Front Psychol. 2012;3:40.

Jansen P, Dahmen-Zimmer K, Kudielka BM, Schulz A. Effects of karate training versus mindfulness training on emotional well-being and cognitive performance in later life. Res Aging. 2017;39(10):1118–44.

Jewett R, Sabiston CM, Brunet J, O’Loughlin EK, Scarapicchia T, O’Loughlin J. School sport participation during adolescence and mental health in early adulthood. J Adolesc Health. 2014;55(5):640–4.

Kitchen P, Chowhan J. Forecheck, backcheck, health check: the benefits of playing recreational ice hockey for adults in Canada. J Sports Sci. 2016;34(21):2121–9.

Kim J, James JD. Sport and happiness: Understanding the relations among sport consumption activities, long-and short-term subjective well-being, and psychological need fulfillment. J Sport Manage. 2019.

Koolhaas CH, Dhana K, Van Rooij FJA, Schoufour JD, Hofman A, Franco OH. Physical activity types and health-related quality of life among middle-aged and elderly adults: the Rotterdam study. J Nutr Health Aging. 2018;22(2):246–53.

Article   CAS   PubMed   Google Scholar  

Patterson S, Pattison J, Legg H, Gibson AM, Brown N. The impact of badminton on health markers in untrained females. J Sports Sci. 2017;35(11):1098–106.

Sabiston CM, Jewett R, Ashdown-Franks G, Belanger M, Brunet J, O’Loughlin E, et al. Number of years of team and individual sport participation during adolescence and depressive symptoms in early adulthood. J Sport Exerc Psychol. 2016;38(1):105–10.

Sorenson SC, Romano R, Scholefield RM, Martin BE, Gordon JE, Azen SP, et al. Holistic life-span health outcomes among elite intercollegiate student-athletes. J Athl Train. 2014;49(5):684–95.

Stenner B, Mosewich AD, Buckley JD, Buckley ES. Associations between markers of health and playing golf in an Australian population. BMJ Open Sport Exerc Med. 2019;5(1).

Tsuji T, Kanamori S, Saito M, Watanabe R, Miyaguni Y, Kondo K. Specific types of sports and exercise group participation and socio-psychological health in older people. J Sports Sci. 2020;38(4):422–9.

Yamakita M, Kanamori S, Kondo N, Kondo K. Correlates of regular participation in sports groups among Japanese older adults: JAGES cross–sectional study. PLoS ONE. 2015;10(10):e0141638.

Howie EK, McVeigh JA, Smith AJ, Straker LM. Organized sport trajectories from childhood to adolescence and health associations. Med Sci Sports Exerc. 2016;48(7):1331–9.

Chinkov AE, Holt NL. Implicit transfer of life skills through participation in Brazilian Jiu-Jitsu. J Appl Sport Psychol. 2016;28(2):139–53.

Lubans D, Richards J, Hillman C, Faulkner G, Beauchamp M, Nilsson M, et al. Physical activity for cognitive and mental health in youth: a systematic review of mechanisms. Pediatrics. 2016;138(3):e20161642.

Lin TW, Kuo YM. Exercise benefits brain function: the monoamine connection. Brain Sci. 2013;3(1):39–53.

Dishman RK, O’Connor PJ. Lessons in exercise neurobiology: the case of endorphins. Ment Health Phys Act. 2009;2(1):4–9.

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Acknowledgements

We would like to acknowledge the work of the original systematic review conducted by Eime, R. M., Young, J. A., Harvey, J. T., Charity, M. J., and Payne, W. R. (2013).

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All authors contributed to the conducting of this study and reporting the findings. The titles of studies identified were screened by LW, and abstracts and full text articles reviewed independently by LW and NE. For the included studies, data was extracted independently by LW and checked by NE, and the risk of bias assessment was performed by LW and AP independently. All authors have read and approved the final version of the manuscript and agree with the order of presentation of the authors.

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Eather, N., Wade, L., Pankowiak, A. et al. The impact of sports participation on mental health and social outcomes in adults: a systematic review and the ‘Mental Health through Sport’ conceptual model. Syst Rev 12 , 102 (2023). https://doi.org/10.1186/s13643-023-02264-8

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Article Contents

Introduction, literature search, physeal injuries and growth disturbance, residual problems after injury in athletes, outcomes of operative management of common sports injuries, conclusions.

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Sport injuries: a review of outcomes

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Nicola Maffulli, Umile Giuseppe Longo, Nikolaos Gougoulias, Dennis Caine, Vincenzo Denaro, Sport injuries: a review of outcomes, British Medical Bulletin , Volume 97, Issue 1, March 2011, Pages 47–80, https://doi.org/10.1093/bmb/ldq026

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Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wresting, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.

Participation in sports is widespread all over the world, 1 with well-described physical, psychological and social consequences for involved athletes. 2–5 The benefits associated with physical activity in both youth and elderly are well documented. 2 , 6–8 Regular participation in sports is associated with a better quality of life and reduced risk of several diseases, 1 , 9 allowing people involved to improve cardiovascular health. 10 , 11 Both individual and team sports are associated with favourable physical and physiological changes consisting of decreased percentage of body fat 12 and increased muscular strength, endurance and power. 13 , 14 Moreover, regular participation in high-volume impact-loading and running-based sports (such as basketball, gymnastics, tennis, soccer and distance running) is associated with enhanced whole-body and regional bone mineral content and density, 14 , 15 whereas physical inactivity is associated with obesity and coronary heart disease. 16 Sports are associated with several psychological and emotional benefits. 7 , 17 , 18 First of all, there is a strong relationship between the development of positive self-esteem, due to testing of self in a context of sport competition, 19 reduced stress, anxiety and depression. 20 Physical activities also contribute to social development of athletes, prosocial behaviour, fair play and sportspersonship 21 and personal responsibility. 22

Engaging in sports activities has numerous health benefits, but also carries the risk of injury. 7 , 23 , 24 At every age, competitive and recreational athletes sustain a wide variety of soft tissue, bone, ligament, tendon and nerve injuries, caused by direct trauma or repetitive stress. 25–35 Different sports are associated with different patterns and types of injuries, whereas age, gender and type of activity (e.g. competitive versus practice) influence the prevalence of injuries. 7 , 36 , 37

Injuries in children and adolescents, who often tend to focus on high performance in certain disciplines and sports, 24 include susceptibility to growth plate injury, nonlinearity of growth, limited thermoregulatory capacity and maturity-associated variation. 9 In the immature skeleton, growth plate injury is possible 38 and apophysitis is common. The most common sites are at the knee (Osgood-Schlatter lesion), the heel (Sever's lesion) and the elbow. 39 Certain contact sports, such as rugby, for example, are associated with 5.2 injuries per 1000 total athletic exposures in high school children (usually boys). These were more common during competition compared with training and fractures accounted for 16% of these injuries, whereas concussions (15.8%) and ligament sprains (15.7%) were almost as common. 40

Sports trauma commonly affects joints of the extremities (knee, ankle, hip, shoulder, elbow, wrist) or the spine. Knee injuries are among the most common. Knee trauma can result in meniscal and chondral lesions, sometimes in combination with cruciate ligament injuries. 37 Ankle injuries constitute 21% of all sports injuries. 41 Ankle ligament injuries are more commonly (83%) diagnosed as ligament sprains (incomplete tears), and are common in sports such as basketball and volleyball. Ankle injuries occur usually during competition and in the majority of cases, athletes can return to sports within a week. 42 Hip labral injuries have drawn attention in recent years with the advent of hip arthroscopy. 43 , 44 Upper extremity syndromes caused by a single stress or by repetitive microtrauma occur in a variety of sports. Overhead throwing, long-distance swimming, bowling, golf, gymnastics, basketball, volleyball and field events can repetitively stress the hand, wrist, elbow and shoulder. Shoulder and elbow problems are common in the overhead throwing athlete whereas elbow injuries remain often unrecognized in certain sports. 45 Hand and wrist trauma accounts for 3–9% of all athletic injuries. 46 Wrist trauma can affect the triangular fibrocartilage complex 47 or cause scaphoid fractures, 48 whereas overuse problems (e.g. tenosynovitis) are not uncommon. 49 Spinal problems can range from lumbar disc herniation, 39–42 to fatigue fractures of the pars interarticularis, 50 and ‘catastrophic’ cervical spine injuries. 51

Thus, in addition to the beneficial aspects related to sports activities, injuries can counter these if an athlete is unable to continue to participate because of residual effects of injury. Do injuries in children, adolescents and young adults have long-term consequences? What are the outcomes of the most commonly performed surgical procedures? The aim of this review is to provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries.

An initial pilot Pubmed search using the keywords ‘sports’, ‘injury’, ‘injuries’, ‘athletes’, ‘outcome’, ‘long term’, was performed. From 1467 abstracts that were retrieved and scanned we identified the thematic topics (types of injury, management, area of the body involved) of the current review, listed below:

Then a more detailed search of PubMed, Medline, Cochrane, CINAHL and Embase databases followed. We used combinations of the keywords: ‘sport’, ‘sports’, ‘youth sports’, ‘young athletes’, ‘former athletes’, ‘children’, ‘skeletally immature’, ‘adolescent’, ‘paediatric’, ‘pediatric’, ‘physeal’, ‘epiphysis’, ‘epiphyseal injuries’, ‘hip’, ‘knee’, ‘ankle’, ‘spine’, ‘spinal’, ‘shoulder’, ‘elbow’, ‘wrist’, ‘football players’, ‘football’, ‘soccer’, ‘tennis’, ‘swimmers’, ‘swimming’, ‘divers’, ‘wrestlers’, ‘wrestling’, ‘cricket’, ‘gymnastics’, ‘skiers’, ‘baseball’, ‘basketball’, ‘osteoarthritis’, ‘former athletes’, ‘strain’, ‘contusion’, ‘distortion’, ‘injury’, ‘injuries’, ‘trauma’, ‘drop out’, ‘dropping out’, ‘attrition’, ‘young’, ‘ youth’, ‘sprain’, ‘ligament’, ‘ACL’, ‘cruciate ligament’, ‘meniscus’, ‘meniscal’, ‘chondral’, ‘labrum’, ‘labral’, ‘reconstruction’, ‘arthroscopy’, ‘throwing’, ‘overhead’, ‘rotator cuff’, ‘TFCC’, ‘scaphoid’, ‘osteoarthritis’, ‘arthritis’, ‘long term’, ‘follow-up’ and ‘athlete’. The most recent search was performed during the second week of November 2009.

Osteoarthritis (OA) in former athletes

Spine problems in former athletes

Knee injury and OA

Ankle ligament injury and OA

Residual upper limb symptoms in the ‘overhead’ athlete

Meniscectomy and oa, meniscal repair in athletes.

Anterior cruciate ligament (ACL) reconstruction and OA

ACL reconstruction in children

Ankle arthroscopy in athletes, hip arthroscopy in athletes.

Operative management of shoulder injuries in athletes (focusing on surgery for instability and labral tears)

Operative management of wrist injuries in athletes (focusing on triquetral fibrocartilage complex, TFCC, injuries and scaphoid fractures)

Given the different types of sports injuries in terms of location in the body, several searches were carried out. The search was limited to articles published in peer-reviewed journals.

From a total of 2596 abstracts that were scanned, 1247 studies were irrelevant to the subject and were excluded. The remaining studies were categorized in the topics identified earlier. We excluded from our investigation case reports, letter to editors and articles not specifically reporting outcomes, as well as ‘kin’ studies (studies reporting on the same patients' population). The most recent study or the study with the longest follow-up was included. In some topics of particular importance, such as the effect of knee injuries (given their frequency), we included long-term studies reporting not only on athletes, but also on the general population (usually in these studies a very high proportion on sports injuries is included). Regarding knee injuries in adults, we included articles with follow-up more than 10 years.

Given the linguistic capabilities of the research team, we considered publications in English, Italian, French, German, Spanish and Portuguese.

A concern regarding children's participation in sports is that the tolerance limits of the physis may be exceeded by the mechanical stresses of sports such as football and hockey or by the repetitive physical loading required in sports such as baseball, gymnastics and distance running. 52 Unfortunately, what is known about the frequency of acute sport-related physeal injuries is derived primarily from case reports and case series data. In a previous systematic review on the frequency and characteristics of sports-related growth plate injuries affecting children and youth, we found that 38.3% of 2157 acute cases were sport related and among these 14.9% were associated with growth disturbance. 24 These injuries were incurred in a variety of sports, although football is the sport most often reported. 53

There are accumulating reports of stress-related physeal injuries affecting young athletes in a variety of sports, including baseball, basketball, climbing, cricket, distance running, American football, soccer, gymnastics, rugby, swimming, tennis. 24 Although most of these stress-related conditions resolved without growth complication during short-term follow-up, there are several reports of stress-related premature partial or complete distal radius physeal closure of young gymnasts. 25–29 These data indicate that sport training, if of sufficient duration and intensity, may precipitate pathological changes of the growth plate and, in extreme cases, produce growth disturbance. 24 , 32

Disturbed physeal growth as a result of injury can result in length discrepancy, angular deformity or altered joint mechanics and may cause significant long-term disability. 33 However, the incidence of long-term health outcome of physeal injuries in children's and youth sports is largely unknown.

Based on the previously selection criteria, 20 studies 54–73 were retained for analysis (Table  1 ). Injury to the physis can result in limb deformities and leg-length discrepancy, the latter being more common after motor vehicle accidents, rather than sports participation.

Evidence on acute physeal injury with subsequent adverse affects on growth.

OA in former athletes

Two studies investigated former top-level female gymnasts for residual symptoms (back pain) and radiographical changes. 74 , 75 Both studies reported no significant differences in back pain between gymnast and control groups; however, the prevalence of radiographical abnormalities was greater in gymnasts than controls in one study. 74

Lower limb weight-bearing joints such as the hip and the knee are at risk of developing OA after injury or in the presence of malalignment, especially in association with high impact sport. 76 Varus alignment was present in 65 knees (81%) in 81 former professional footballers (age 44–70 years), whereas radiographic OA in 45 (56%). 77 Others showed that prevalence of knee OA in soccer players and weight lifters was 26% (eight athletes) and 31% (nine athletes), respectively, whereas it was only 14% in runners (four athletes). 78 By stepwise logistic regression analysis, the increased risk is explained by knee injuries in soccer players and by high body mass in weight lifters. A survey in English former professional soccer players revealed that 47% retired because of an injury. The knee was most commonly involved (46%), followed by the ankle (21%). Of all respondents, 32% had OA in at least one lower limb joint and 80% reported joint pain. 79 Another study examined the incidence of knee and ankle arthritis in injured and uninjured elite football players. The mean time from injury was 25 years. 80 Arthritis was present in 63% of the injured knees and in 33% of the injured ankles, whereas the incidence of arthritis in uninjured players was 26% in the knee and 18% in the ankle. Obviously, it should be kept in mind that radiographic studies can only ascertain the presence of degenerative joint disease, which is just one of the features of OA. Clinical examination is always necessary to clarify the diagnosis, and formulate a management plan.

Ex-footballers also had high prevalence of hip OA (odds ratio: 10.2), 81 whereas in another study the incidence of hip arthritis was 5.6% among former soccer players (mean age: 55 years) compared with 2.8% in an age-matched control group. In 71 elite players it was higher (14%). Female ex-elite athletes (runners, tennis players) were compared with an age-matched population of women, and were found to have higher rates (2–3 fold increase) of radiographic OA (particularly the presence of osteophytes) of the hip and knee. 82 The risk was similar in ex-elite athletes and in a subgroup from the general population who reported long-term sports activity, suggesting that duration rather than frequency of training is important. An older study 83 is runners associated degenerative changes with genu varum and history of injury. A cohort of 27 Swiss long-distance runners was at increased risk of developing ankle arthritis compared with a control group. 84 Similarly elite tennis players were at risk of developing glenohumeral OA, 85 whereas handball players of developing premature hip OA, 86 and former elite volleyball players had marginally increased risk for ankle OA. 87 Interestingly a study that investigated the health-related quality of life (HRQL) in 284 former professional players in the UK found that medical treatment for football-related injuries was a common feature, as was arthritis, with the knee being most commonly affected. Respondents with arthritis reported poorer outcomes in all aspects of HRQL. 88

In summary, OA is more common among former athletes, compared with the general population. The lower limb joints are commonly affected, in association with high impact and injury.

Evidence from follow-up studies on spine of former athletes

Heavy physical work and activity lead to degenerative changes in the spine. Studies on different athletic disciplines and heavy workers have given variable degenerative changes and abnormalities in the lumbar spine. Even though sporting activity is regarded as an important predisposing factor in the development of spinal pathologies, 89–99 there are few studies on the late spinal sequelae of competitive youth sport. Any comparison in terms of back pain between top athletes and the general population is difficult. Experience of pain may be influenced by factors such as susceptibility, motivation and physical activity. Minor pain may be provoked by vigorous body movements that hamper athletic performance, thereby ascribing the pain a greater impact than in the general population. On the other hand, a well-motivated athlete may ignore even severe pain to maintain or improve his/her athletic performance. Also, varying rate/prevalence of osteophytosis has been reported in players associated with various disciplines of sports.

Efforts should be made to understand the aetiology of injuries to the intervertebral discs during athletic performance and thereby prevent them. 74

Based on the previously selection criteria, seven studies 74 , 89 , 98 , 100–103 were retained for analysis (Table  2 ). In summary, spine pathologies are associated more commonly with certain sports (e.g. wresting, heavy-weight lifting, gymnastics, tennis, soccer). Degenerative changes in the athlete's spine can occur, but they are not necessarily associated with clinically relevant symptoms of OA. Therefore, it cannot be determined whether it threatens the athlete's career, or whether it has a worse impact on athletes compared with the general population.

Evidence from follow-up studies on spine of former athletes.

Knee injury and OA in athletes

A population-based case-control study investigated the risk of knee OA with respect to sports activity and previous knee injuries of 825 athletes competing in different sports. They were matched with 825 controls. After confounding factors were adjusted, the sports-related increase risk of OA was explained by knee injuries. 104 Another study leads to the same conclusion: 23 American football high-school players were compared with 11 age-matched controls, 20 years after high-school competition. No significant increase in OA could be demonstrated clinically or radiographically. However, a significant increase in knee joint OA was found in the subgroup of football players who had sustained a knee injury. 105

A cohort of 286 former soccer players (71 elite, 215 non-elite) with a mean age of 55 years was compared with 572 age-matched controls, regarding the prevalence of radiographic features of knee arthritis. Arthritis in elite players, non-elite players and controls was 15%, 4.2% and 1.6%, respectively. In non-elite players, absence of history of knee injury was associated with arthritis prevalence similar to the controls. 106

An interesting study involved a cohort of 19 high-level athletes of the Olympic program of former East Germany. They sustained an ACL tear between 1963 and 1965. None were reconstructed, and all were able to return to sports within 14 weeks. Subsequent meniscectomies were necessary in 15/19 (79%) athletes at 10 years and 18/19 (95%) at 20 years, when in 18 of the 19 knees, arthroscopy was performed, 13 patients (68%) had a grade four chondral lesion. By year 2000 (more than 35 years after ACL rupture), 10/19 knees required a joint replacement. 107

The incidence of radiographic advanced degeneration (Kellgren–Lawrence grade 2 or higher) was 41% in a cohort of 122 Swedish male soccer players (from a total of 154) who consented to radiographic follow-up, 14 years after an ACL rupture. No difference was found between players treated with or without surgery for their ACL rupture. The prevalence of Kellgren–Lawrence grade 2 or higher knee OA was 4% in the uninjured knees. 108

Similar results were evident among Swedish female soccer players who were injured before the age of 20. The prevalence of radiographic OA was 51%, compared with 8% only in the uninjured knee, 12 years later. The presence of symptoms was documented in 63 of 84 (75%) athletes who answered the questionnaire, and was similar ( P = 0.2) in the two management groups (operative versus non-operative). The presence of symptoms did not necessarily correlate with radiographic OA ( P = 0.4). 109

In summary, knee injury is a recognized risk factor for OA. Injured athletes develop OA more commonly than the general population in the long term. Approximately half of the injured knees could have radiographic changes 10–15 years later. It is not clear whether radiographic changes correspond to presence of symptoms.

Ankle ligament injuries and OA in athletes

Ankle sprains are common sporting injuries generally believed to be benign and self-limiting. However, some studies report a significant proportion of patients with ankle sprains having persistent symptoms for months or even years. Nineteen patients with a mean age of 20 years (range: 13–28), who were referred to a sports medicine clinic after an ankle inversion injury, were followed for 29 months (average), and compared with matched controls. Only five (26%) injured patients had recovered fully, whereas 74% had symptoms 1.5–4 years after the injury. Assessments of quality of life using the short form-36 questionnaires revealed a difference in the general health subscale between the two groups, favouring the controls ( P < 0.05). 110

Similar conclusions were drawn from another study, regarding ankle injuries in a young (age range: 17–24 years) athletic population. 111 There were 104 ankle injuries (96 sprains, 7 fractures and 1 contusion), accounting for 23% of all injuries seen. Of the 96 sprains, 4 were predominately medial injuries, 76 lateral and 16 syndesmosis sprains. Although 95% had returned to sports at 6 weeks, 55% reported pain or loss of function. At 6 months, 40% had not fully recovered, reporting residual symptoms. Syndesmosis injuries were associated with prolonged recovery.

The association between ligamentous ankle injuries has been highlighted in a study that, retrospectively, reviewed data from 30 patients (mean age: 59 years, 33 ankles) with ankle osteoarthritis. 112 They found that 55% had a history of sports injuries (33% from soccer), and 85% had a lateral ankle ligament injury. The mean latency time between injury and OA was 34.3 years. The latency period for acute severe injuries was significantly lower (25.7 years), compared with chronic instability (38 years). Varus malalignment and persistent instability were present in 52% of those patients.

In summary, ankle ligamentous injuries in athletes can result in considerable morbidity, residual symptoms and arthritis 25–30 years later.

Shoulder injuries account for 7% of sports injuries and often limit the athlete in his or her ability to continue with their chosen sport. 113 Repetitive overhead throwing imparts high valgus and extension loads to the athlete's shoulder and elbow, often leading to either acute or chronic injury or progressive structural change and long-term problems in the overhead athlete. 45

Schmitt et al . 102 examined 21 elite javelin throwing athletes at an average of 19 years after the end of their high-performance phase (mean age at follow-up was 50 years). Five athletes (24%) complained about transient shoulder pain and three (16%) about elbow pain in their throwing arm affecting activities of daily living. All dominant elbows had advanced degeneration (osteophytes).

Elbow intra-articular lesions are recognized as consequences of repetitive stress and overuse. Shanmugam and Maffulli 9 reported follow-up (mean 3.6 years) of lesions of the articular surface of the elbow joint in a group of 12 gymnasts (six females and six males). This group showed a high frequency of osteochondritic lesions, intra-articular loose bodies and precocious signs of joint ageing. Residual mild pain in the elbow at full extension occurring after activity was present in 10 patients and all patients showed marked loss of elbow extension compared with their first visit.

Glenoid labral tears require repair, and shoulder instability is currently approached operatively more often. A review article found that conservative management of traumatic shoulder dislocations in adolescents was associated with high rates of recurrent instability (up to 100%). Therefore, surgical shoulder stabilization is recommended. The outcomes of surgical management are presented in the next section.

A distinct clinical entity is the ‘little league shoulder’, which is characterized by progressive upper arm pain with throwing and is more commonly seen in male baseball pitchers between ages 11 and 14 years. It is thought to be Salter-Harris type I stress fracture. Activity modification, education to improve throwing mechanics and core muscle training are recommended. It is not known how this condition behaves in the long term, regarding structural damage and development of degenerative changes.

Overhead athletes are plagued by shoulder and elbow injuries or overuse syndromes that can affect their performance and cause degeneration and pain in the long term.

The association between knee OA and meniscectomy has been well documented. In former athletes 114 – 116 it is associated with OA (Table  3 ). Meniscectomy in children and adolescents 117 – 123 has been associated with unfavourable results and radiographic arthritic changes in the long term (Table  4 ). However, radiographic criteria were not always clearly defined. To assess the long-term outcomes of meniscectomy, we also evaluated studies with a minimum follow-up of 10 years in the adult general population 106 , 124 – 129 (Table  5 ). Many of the ‘older’ studies providing the long-term outcomes represent results of open total meniscectomies. The overall message is that radiographic degeneration is common in meniscectomized knees, and patients are at risk of developing OA. The condition of the articular cartilage is a prognostic factor. However, clinical and radiographic findings do not always correlate. Resection should be limited to the torn part of the meniscus.

Menicectomy and osteoarthritis in athletes.

Menicectomy in children and adolescents.

Meniscectomy in adults / general popaltion—long-term outcomes.

Given the long-term problems associated with meniscectomies, preservation of the substance of the meniscus after injury is currently advocated. Based on this concept, arthroscopic meniscal repair techniques have been developed. 125 In the general population, encouraging clinical results with failure rates of 27–30% at 6–7 years follow-up have been reported. 130–132 One study 133 evaluated 45 meniscal repairs in 42 elite athletes followed for an average of 8.5 years. In 83% of them an ACL reconstruction was performed as well. Return to their sport was possible in 81% at an average of 10 months after surgery. They identified 11 failures (24%), seven of which were associated with a new injury. The medial meniscus re-ruptured more frequently compared with the lateral (36.4 versus 5.6%, respectively).

Mintzer et al . 134 retrospectively reviewed the outcome of meniscal repair in 26 young athletes involved in several sports at an average follow-up of 5 years (range: 2–13.5). No failures were reported, with 85% of patients performing high level of sports activities.

In general, the results of meniscal repairs in the general population, as well as in athletes, are encouraging.

ACL reconstruction and OA

Knee injuries can result in ligament ruptures and/or meniscal tears and are recognized as a risk factor of OA. A systematic review on studies published until 2006 135 reported on the prognosis of conservatively managed ACL injuries showed that there was an average reduction of 21% at the level of activities (Tegner score evaluation). ACL reconstruction is therefore a procedure frequently performed in athletic individuals, as they desire to maintain a high level of activities. However, does ACL reconstruction affect the incidence of knee degeneration and symptoms in the long term? We identified three studies 108 , 109 , 136 comparing operative versus non-operative management of ACL ruptures specifically in athletes, in regard to OA.

Two studies from Sweden investigating the prevalence of OA after ACL rupture in male 108 and female 109 soccer players were discussed earlier. Both found no difference in the incidence of radiographic arthritis between surgically and conservatively treated players, more than 10 years after their injury.

A comparative study 136 on high-level athletes with ACL injury showed no statistical difference between the patients treated conservatively or operatively (patella tendon graft) with respect to OA or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.

Several studies present outcomes of ACL injuries in the general population. A recent systematic review included 31 studies (seven were prospective) reporting radiographic outcomes regarding OA, with more than 10 years follow-up after ACL injury. 137 The prevalence of OA in the injured knee varied from 1 to 100%, whereas in the contralateral knee it was 0–38%. Isolated ACL tears were associated with low OA incidence between 0 and 13%, whereas in the presence of additional meniscal injury, it was 21–48%. Meniscal injury and meniscectomy were the most frequently reported risk factors for OA. The authors scored the quality of the studies and found that studies scoring high reported low incidence of OA. Data extraction indicated that ACL reconstruction as a single factor did not prevent the development of knee OA. 137

There is lack of evidence to support a protective role of reconstructive surgery of the ACL against OA, both in athletes as well as in the general population.

ACL reconstruction in skeletally immature patients is a relatively new trend. 138 The concern is intra-operative epiphysis damage and growth disturbance, a complication which has been avoided in several studies. 139–143

The earliest published study 144 compared non-operative versus operative management of ACL ruptures in 42 skeletally immature athletes (age range: 4–17 years) followed for a mean of 5.3 years. They used a composite knee score based on clinical examination and a patient questionnaire and found superior results in the operatively treated patients. Age and growth plate maturity did not influence results. They recommended ACL reconstruction for active athletic children.

One of the early reports showed that there were no growth disturbances at a mean of 3.3 years after surgery in 9 children, however, with two re-ruptures. Those children could not return to athletic activities. 139

In a series of 57 ACL reconstructions, 15 patients had reached completion of growth when examined at follow-up, none had signs of growth disturbance, whereas clinical scoring was good or excellent in all patients. 142

Another study compared the outcomes of two management strategies in 56 children with ACL ruptures, namely ligament reconstruction in the presence of open physis, or delayed reconstruction after skeletal maturity. The ‘early’ reconstruction group had evidence of less medial meniscal tears (16 versus 41%), and no evidence of growth disturbances, at 27 months mean follow-up. 140

After 1.5–7.5 years follow-up of 19 ACL reconstructions in 20 athletic teenagers (age range: 11.8–15.6 years), all but one had returned to sports, none had tibiofemoral malalignment or a leg-length discrepancy of more than 1 cm, and the modified Lysholm score was 93 out of 95. 143

Finally, 55 children (ages 8 to 16 years, mean 13 years) were followed for a mean of 3.2 years (range: 1–7.5 years) after ACL reconstruction, with no evidence of growth disturbances. Clinical scores showed normal or almost normal values (higher than 90 out of 100 possible points) and 88% of the patients went back to normal or almost normal sports according to the Tegner score. 141

Overall, the clinical results are encouraging and iatrogenic epiphysis damage does not seem to be a problem, possibly because physeal sparing procedures were used. The study designs, however, are inadequate to answer the question of whether early or delayed ACL reconstruction results in the best possible outcome in skeletally immature patients.

Anterior impingement syndrome is a generally accepted diagnosis for a condition characterized by anterior ankle pain with limited and painful dorsiflexion. The cause can be either soft tissue or bony obstruction. Arthroscopic debridement is currently considered a routine procedure, and chondral lesions are now more frequently identified as causes of ankle pain. Few reports specifically in athletes are available 145–149 (Table  6 ). Short-term outcomes only are available. It is not known whether arthritis is a long-term consequence.

Ankle arthroscopy in athletes.

Only recently has the hip received attention as a recognized site of sports injuries, possibly as a result of the evolution of hip arthroscopy which allowed recognition of intra-articular pathology. 150 Acetabular labrum and chondral lesions can be addressed arthroscopically, and patients' satisfaction rates up to 75% have been reported. 44 One study evaluated the outcome of hip arthroscopy in 15 athletes (mean age: 32 years, range: 14–70) followed for 10 years. Nine were recreational athletes, four high school and two intercollegiate athletes. Diagnoses included cartilage lesion (8), labral tear (7), arthritis (5), avascular necrosis (1), loose body (1) and synovitis (1). The median improvement in the modified Harris hip score was 45 points (from 51 preoperatively to 96, on the 100-point scale), with 13 patients (87%) returning to their sport. All five athletes with arthritis eventually underwent total hip arthroplasty at an average of 6 years. 43 Long-term outcomes regarding progression of joint degeneration after traumatic chondral or labral damage are not available.

Operative management of shoulder injuries in athletes

Labral tears require repair, whereas shoulder instability is currently approached operatively more often. Conservative management of traumatic shoulder dislocations in adolescents is associated with high rates of recurrent instability (up to 100%), whereas recurrent dislocations were reported in up to 12%, at an average of 3 years after arthroscopic stabilization. Shoulder dislocations are particularly common in rugby, the characteristic mechanism of injury being tackling, whereas labral tears are common in the ‘overhead’ athlete'. Published results in athletes 151 – 162 (Table  7 ) show that operative stabilization of the shoulder is initially successful, but instability and pain can recur in the long term. Results of arthroscopic techniques in the management of intra-articular pathologies are promising, but long-term outcomes are unknown (Table  7 ).

RCT, randomized controlled trial; VAS, visual analogue scale.

Operative management of elbow injuries in athletes

Elbow ulnar collateral ligament (UCL) insufficiency is one of the frequently recognized injuries in the overhead athlete, as a result of excessive valgus stress. It constitutes a potentially career threatening injury and requires surgical repair. 163 The use of a muscle-splitting approach, avoiding handling of the ulnar nerve, and the use of the docking technique for stabilization is recommended 164 , 165 (Table  8 ). Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for highly motivated athletes. The results of arthroscopic debridement 150 , 166 (Table  7 ) need to be evaluated in the long term.

Operative management of elbow injuries in athletes.

UCL, ulnar collateral ligament.

Operative management of wrist injuries in athletes

A review of the literature shows that 3–9% of all athletic injuries occur in the hand or wrist, and are more common in adolescent athletes than adults. 46 In this article, we focused on TFCC injuries and acute scaphoid fractures in athletes.

TFCC injuries are an increasingly recognized cause of ulnar-sided wrist pain, and can be particularly disabling in the competitive athlete. Advances in wrist arthroscopy made endoscopic debridement and repair of the TFCC possible. McAdams et al . 47 treated arthroscopically TFCC tears in 16 competitive athletes (mean age: 23.4 years). Repair of unstable tears was performed in 11 (69%) and debridement only in 5 (31%). Return to play averaged 3.3 months (range: 3–7 months). The mean duration of follow-up was 2.8 years (range: 2–4.2 years). Clinical scores (mini-DASH and mini-DASH sports module) improved significantly. No long-term outcomes are available.

Operative management of scaphoid fractures in athletes, even if undisplaced, is recommended if early return to sports is desired. One study followed 12 athletes treated operatively for a scaphoid fracture. They were able to return to sports at 6 weeks. At an average follow-up of 2.9 years, 9 of 12 athletes had range of motion equal to the uninjured side, and grip strength was equal to the unaffected side in 10 of 12 athletes. 49

Participation in sports offers potential benefits for individuals of all ages, such as combating obesity and enhancing cardiovascular fitness. 1 On the other hand, negative consequences of musculoskeletal injuries sustained during sports may compromise function in later life, limiting the ability to experience pain-free mobility and engage in fitness-enhancing activity. 167 Increasingly, successful management of sports-related injuries has allowed more athletes to return to participation. The knee is the joint most commonly associated with sports injuries, and therefore is most at risk of developing degenerative changes. It is not clear whether radiographic OA always correlates with symptoms and reduced quality of life. Furthermore, even effective management of meniscal or ACL injury does not reduce the risk of developing subsequent OA. 137 , 168 OA in an injured joint is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcomes involves not only the exact type of injury (e.g. ACL rupture with or without meniscal damage), 137 but also additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity and reinjury. A better understanding of these variables may improve future prevention and treatment strategies. 169

In many of the long-term studies (the majority being retrospective case series), several methodological flaws have to be highlighted. A recent systematic review on OA after ACL injuries 137 suggested that some studies may overestimate the prevalence of long-term OA. The authors in several studies mention that a proportion of the index group of injured athletes were available for follow-up or consented for radiographic examination. One can argue that these patients were the ones with symptoms, therefore the prevalence of OA (after ACL rupture for example) may appear higher than it really is. Presentation of outcomes was not always based on robust criteria. Different clinical scores and radiographic classifications have been used, and therefore results between studies are not directly comparable. In the majority of the studies, it was not clarified whether radiographic appearance correlated with symptoms, and how important these were for the quality of life of the patients. Disabling arthritis requiring intervention may actually be delayed for more than 20–30 years. 107 , 112 Furthermore, long-term studies present outcomes of older techniques, not used any more in clinical practice (e.g. primary ACL repair or total meniscectomy). Evolution in surgical or rehabilitation techniques might have improved outcomes of certain injuries. Therefore, currently known ‘long-term outcomes’ may only reflect the results of techniques used in the past and not what we should expect in the future. Increasing awareness of athletes and trainers, new diagnostic and musculoskeletal imaging modalities, improved surgical and rehabilitation methods, but also analysis of injury patterns in different sports and development of injury prevention strategies might be beneficial to minimize the effects of sports injuries in the years to come.

What is the true incidence of arthritis in the long term? Will it be a disabling condition for the former athlete, in the coming decades? Currently, joint preserving procedures (e.g. microfractures, 145 mosaicplaty, 170 autologous chondrocyte implantation, 171 , 172 realignment osteotomies 173 and implant arthroplasties 174 ) have evolved and allow middle aged or older patients to live without pain and maintain an active life style. Meniscal transplantation shows encouraging results. 175 Should therefore an increased risk for developing musculoskeletal problems prevent children and adults from being active in sports? 176 Do the benefits of participating in sports outweigh the risks?

A survey in Sweden showed that 80% of former track and field athletes with an age range of 50–80 years felt they were in good health, compared with 61% of the referents, despite higher prevalence of hip arthritis in former athletes. Low back disorders were similar in the two groups, shoulder and neck problems were lower in former athletes, and knee arthritis was similar in the two groups. 177

No definite answer can be given to the previously addressed questions, based on available evidence. Future research should involve questionnaires assessing the HRQL in former athletes, to be compared with the general population. 27 , 178–181

Physical injury is an inherent risk in sports participation and, to a certain extent, must be considered an inevitable cost of athletic training and competition. Injury may lead to incomplete recovery and residual symptoms, drop out from sports, and can cause joint degeneration in the long term. Few well-conducted studies are available on the long-term follow-up of former athletes, and, in general, we lack studies reporting on the HRQL to be compared with the general population. Advances in arthroscopic techniques allow operative management of most intra-articular post-traumatic pathologies in the lower and upper limb joints, but long-term outcomes are not available yet. It is important to balance the negative effects of sports injuries with the many social, psychological and health benefits that a serious commitment to sport brings. 9

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Peer-reviewed

Research Article

Sport psychology and performance meta-analyses: A systematic review of the literature

Roles Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, United States of America, Education Academy, Vytautas Magnus University, Kaunas, Lithuania

Roles Data curation, Methodology, Writing – original draft

Affiliation Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, United States of America

Roles Data curation, Methodology

Roles Writing – original draft, Writing – review & editing

Affiliation Department of Kinesiology and Sport Management, Honors College, Texas Tech University, Lubbock, Texas, United States of America

Roles Data curation, Methodology, Writing – original draft, Writing – review & editing

Affiliation Faculty of Education, Health and Well-Being, University of Wolverhampton, Walsall, West Midlands, United Kingdom

Roles Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

Affiliation Division of Research & Innovation, University of Southern Queensland, Toowoomba, Queensland, Australia

• Marc Lochbaum, 
• Elisabeth Stoner, 
• Tristen Hefner, 
• Sydney Cooper, 
• Andrew M. Lane, 
• Peter C. Terry

• Published: February 16, 2022
• https://doi.org/10.1371/journal.pone.0263408
• Peer Review
• Reader Comments

Sport psychology as an academic pursuit is nearly two centuries old. An enduring goal since inception has been to understand how psychological techniques can improve athletic performance. Although much evidence exists in the form of meta-analytic reviews related to sport psychology and performance, a systematic review of these meta-analyses is absent from the literature. We aimed to synthesize the extant literature to gain insights into the overall impact of sport psychology on athletic performance. Guided by the PRISMA statement for systematic reviews, we reviewed relevant articles identified via the EBSCOhost interface. Thirty meta-analyses published between 1983 and 2021 met the inclusion criteria, covering 16 distinct sport psychology constructs. Overall, sport psychology interventions/variables hypothesized to enhance performance (e.g., cohesion, confidence, mindfulness) were shown to have a moderate beneficial effect ( d = 0.51), whereas variables hypothesized to be detrimental to performance (e.g., cognitive anxiety, depression, ego climate) had a small negative effect ( d = -0.21). The quality rating of meta-analyses did not significantly moderate the magnitude of observed effects, nor did the research design (i.e., intervention vs. correlation) of the primary studies included in the meta-analyses. Our review strengthens the evidence base for sport psychology techniques and may be of great practical value to practitioners. We provide recommendations for future research in the area.

Citation: Lochbaum M, Stoner E, Hefner T, Cooper S, Lane AM, Terry PC (2022) Sport psychology and performance meta-analyses: A systematic review of the literature. PLoS ONE 17(2): e0263408. https://doi.org/10.1371/journal.pone.0263408

Editor: Claudio Imperatori, European University of Rome, ITALY

Received: September 28, 2021; Accepted: January 18, 2022; Published: February 16, 2022

Copyright: © 2022 Lochbaum et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Sport performance matters. Verifying its global importance requires no more than opening a newspaper to the sports section, browsing the internet, looking at social media outlets, or scanning abundant sources of sport information. Sport psychology is an important avenue through which to better understand and improve sport performance. To date, a systematic review of published sport psychology and performance meta-analyses is absent from the literature. Given the undeniable importance of sport, the history of sport psychology in academics since 1830, and the global rise of sport psychology journals and organizations, a comprehensive systematic review of the meta-analytic literature seems overdue. Thus, we aimed to consolidate the existing literature and provide recommendations for future research.

The development of sport psychology

The history of sport psychology dates back nearly 200 years. Terry [ 1 ] cites Carl Friedrich Koch’s (1830) publication titled [in translation] Calisthenics from the Viewpoint of Dietetics and Psychology [ 2 ] as perhaps the earliest publication in the field, and multiple commentators have noted that sport psychology experiments occurred in the world’s first psychology laboratory, established by Wilhelm Wundt at the University of Leipzig in 1879 [ 1 , 3 ]. Konrad Rieger’s research on hypnosis and muscular endurance, published in 1884 [ 4 ] and Angelo Mosso’s investigations of the effects of mental fatigue on physical performance, published in 1891 [ 5 ] were other early landmarks in the development of applied sport psychology research. Following the efforts of Koch, Wundt, Rieger, and Mosso, sport psychology works appeared with increasing regularity, including Philippe Tissié’s publications in 1894 [ 6 , 7 ] on psychology and physical training, and Pierre de Coubertin’s first use of the term sport psychology in his La Psychologie du Sport paper in 1900 [ 8 ]. In short, the history of sport psychology and performance research began as early as 1830 and picked up pace in the latter part of the 19 th century. Early pioneers, who helped shape sport psychology include Wundt, recognized as the “father of experimental psychology”, Tissié, the founder of French physical education and Legion of Honor awardee in 1932, and de Coubertin who became the father of the modern Olympic movement and founder of the International Olympic Committee.

Sport psychology flourished in the early 20 th century [see 1, 3 for extensive historic details]. For instance, independent laboratories emerged in Berlin, Germany, established by Carl Diem in 1920; in St. Petersburg and Moscow, Russia, established respectively by Avksenty Puni and Piotr Roudik in 1925; and in Champaign, Illinois USA, established by Coleman Griffith, also in 1925. The period from 1950–1980 saw rapid strides in sport psychology, with Franklin Henry establishing this field of study as independent of physical education in the landscape of American and eventually global sport science and kinesiology graduate programs [ 1 ]. In addition, of great importance in the 1960s, three international sport psychology organizations were established: namely, the International Society for Sport Psychology (1965), the North American Society for the Psychology of Sport and Physical Activity (1966), and the European Federation of Sport Psychology (1969). Since that time, the Association of Applied Sport Psychology (1986), the South American Society for Sport Psychology (1986), and the Asian-South Pacific Association of Sport Psychology (1989) have also been established.

The global growth in academic sport psychology has seen a large number of specialist publications launched, including the following journals: International Journal of Sport Psychology (1970), Journal of Sport & Exercise Psychology (1979), The Sport Psychologist (1987), Journal of Applied Sport Psychology (1989), Psychology of Sport and Exercise (2000), International Journal of Sport and Exercise Psychology (2003), Journal of Clinical Sport Psychology (2007), International Review of Sport and Exercise Psychology (2008), Journal of Sport Psychology in Action (2010), Sport , Exercise , and Performance Psychology (2014), and the Asian Journal of Sport & Exercise Psychology (2021).

In turn, the growth in journal outlets has seen sport psychology publications burgeon. Indicative of the scale of the contemporary literature on sport psychology, searches completed in May 2021 within the Web of Science Core Collection, identified 1,415 publications on goal setting and sport since 1985; 5,303 publications on confidence and sport since 1961; and 3,421 publications on anxiety and sport since 1980. In addition to academic journals, several comprehensive edited textbooks have been produced detailing sport psychology developments across the world, such as Hanrahan and Andersen’s (2010) Handbook of Applied Sport Psychology [ 9 ], Schinke, McGannon, and Smith’s (2016) International Handbook of Sport Psychology [ 10 ], and Bertollo, Filho, and Terry’s (2021) Advancements in Mental Skills Training [ 11 ] to name just a few. In short, sport psychology is global in both academic study and professional practice.

Meta-analysis in sport psychology

Several meta-analysis guides, computer programs, and sport psychology domain-specific primers have been popularized in the social sciences [ 12 , 13 ]. Sport psychology academics have conducted quantitative reviews on much studied constructs since the 1980s, with the first two appearing in 1983 in the form of Feltz and Landers’ meta-analysis on mental practice [ 14 ], which included 98 articles dating from 1934, and Bond and Titus’ cross-disciplinary meta-analysis on social facilitation [ 15 ], which summarized 241 studies including Triplett’s (1898) often-cited study of social facilitation in cycling [ 16 ]. Although much meta-analytic evidence exists for various constructs in sport and exercise psychology [ 12 ] including several related to performance [ 17 ], the evidence is inconsistent. For example, two meta-analyses, both ostensibly summarizing evidence of the benefits to performance of task cohesion [ 18 , 19 ], produced very different mean effects ( d = .24 vs d = 1.00) indicating that the true benefit lies somewhere in a wide range from small to large. Thus, the lack of a reliable evidence base for the use of sport psychology techniques represents a significant gap in the knowledge base for practitioners and researchers alike. A comprehensive systematic review of all published meta-analyses in the field of sport psychology has yet to be published.

Purpose and aim

We consider this review to be both necessary and long overdue for the following reasons: (a) the extensive history of sport psychology and performance research; (b) the prior publication of many meta-analyses summarizing various aspects of sport psychology research in a piecemeal fashion [ 12 , 17 ] but not its totality; and (c) the importance of better understanding and hopefully improving sport performance via the use of interventions based on solid evidence of their efficacy. Hence, we aimed to collate and evaluate this literature in a systematic way to gain improved understanding of the impact of sport psychology variables on sport performance by construct, research design, and meta-analysis quality, to enhance practical knowledge of sport psychology techniques and identify future lines of research inquiry. By systematically reviewing all identifiable meta-analytic reviews linking sport psychology techniques with sport performance, we aimed to evaluate the strength of the evidence base underpinning sport psychology interventions.

Materials and methods

This systematic review of meta-analyses followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 20 ]. We did not register our systematic review protocol in a database. However, we specified our search strategy, inclusion criteria, data extraction, and data analyses in advance of writing our manuscript. All details of our work are available from the lead author. Concerning ethics, this systematic review received a waiver from Texas Tech University Human Subject Review Board as it concerned archival data (i.e., published meta-analyses).

Eligibility criteria

Published meta-analyses were retained for extensive examination if they met the following inclusion criteria: (a) included meta-analytic data such as mean group, between or within-group differences or correlates; (b) published prior to January 31, 2021; (c) published in a peer-reviewed journal; (d) investigated a recognized sport psychology construct; and (e) meta-analyzed data concerned with sport performance. There was no language of publication restriction. To align with our systematic review objectives, we gave much consideration to study participants and performance outcomes. Across multiple checks, all authors confirmed study eligibility. Three authors (ML, AL, and PT) completed the final inclusion assessments.

Information sources

Authors searched electronic databases, personal meta-analysis history, and checked with personal research contacts. Electronic database searches occurred in EBSCOhost with the following individual databases selected: APA PsycINFO, ERIC, Psychology and Behavioral Sciences Collection, and SPORTDiscus. An initial search concluded October 1, 2020. ML, AL, and PT rechecked the identified studies during the February–March, 2021 period, which resulted in the identification of two additional meta-analyses [ 21 , 22 ].

Search protocol

ML and ES initially conducted independent database searches. For the first search, ML used the following search terms: sport psychology with meta-analysis or quantitative review and sport and performance or sport* performance. For the second search, ES utilized a sport psychology textbook and used the chapter title terms (e.g., goal setting). In EBSCOhost, both searches used the advanced search option that provided three separate boxes for search terms such as box 1 (sport psychology), box 2 (meta-analysis), and box 3 (performance). Specific details of our search strategy were:

Search by ML:

• sport psychology, meta-analysis, sport and performance
• sport psychology, meta-analysis or quantitative review, sport* performance
• sport psychology, quantitative review, sport and performance
• sport psychology, quantitative review, sport* performance

Search by ES:

• mental practice or mental imagery or mental rehearsal and sports performance and meta-analysis
• goal setting and sports performance and meta-analysis
• anxiety and stress and sports performance and meta-analysis
• competition and sports performance and meta-analysis
• diversity and sports performance and meta-analysis
• cohesion and sports performance and meta-analysis
• imagery and sports performance and meta-analysis
• self-confidence and sports performance and meta-analysis
• concentration and sports performance and meta-analysis
• athletic injuries and sports performance and meta-analysis
• overtraining and sports performance and meta-analysis
• children and sports performance and meta-analysis

The following specific search of the EBSCOhost with SPORTDiscus, APA PsycINFO, Psychology and Behavioral Sciences Collection, and ERIC databases, returned six results from 2002–2020, of which three were included [ 18 , 19 , 23 ] and three were excluded because they were not meta-analyses.

• Box 1 cohesion
• Box 2 sports performance
• Box 3 meta-analysis

Study selection

As detailed in the PRISMA flow chart ( Fig 1 ) and the specified inclusion criteria, a thorough study selection process was used. As mentioned in the search protocol, two authors (ML and ES) engaged independently with two separate searches and then worked together to verify the selected studies. Next, AL and PT examined the selected study list for accuracy. ML, AL, and PT, whilst rating the quality of included meta-analyses, also re-examined all selected studies to verify that each met the predetermined study inclusion criteria. Throughout the study selection process, disagreements were resolved through discussion until consensus was reached.

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Data extraction process

Initially, ML, TH, and ES extracted data items 1, 2, 3 and 8 (see Data items). Subsequently, ML, AL, and PT extracted the remaining data (items 4–7, 9, 10). Checks occurred during the extraction process for potential discrepancies (e.g., checking the number of primary studies in a meta-analysis). It was unnecessary to contact any meta-analysis authors for missing information or clarification during the data extraction process because all studies reported the required information. Across the search for meta-analyses, all identified studies were reported in English. Thus, no translation software or searching out a native speaker occurred. All data extraction forms (e.g., data items and individual meta-analysis quality) are available from the first author.

To help address our main aim, we extracted the following information from each meta-analysis: (1) author(s); (2) publication year; (3) construct(s); (4) intervention based meta-analysis (yes, no, mix); (5) performance outcome(s) description; (6) number of studies for the performance outcomes; (7) participant description; (8) main findings; (9) bias correction method/results; and (10) author(s) stated conclusions. For all information sought, we coded missing information as not reported.

Individual meta-analysis quality

ML, AL, and PT independently rated the quality of individual meta-analysis on the following 25 points found in the PRISMA checklist [ 20 ]: title; abstract structured summary; introduction rationale, objectives, and protocol and registration; methods eligibility criteria, information sources, search, study selection, data collection process, data items, risk of bias of individual studies, summary measures, synthesis of results, and risk of bias across studies; results study selection, study characteristics, risk of bias within studies, results of individual studies, synthesis of results, and risk of bias across studies; discussion summary of evidence, limitations, and conclusions; and funding. All meta-analyses were rated for quality by two coders to facilitate inter-coder reliability checks, and the mean quality ratings were used in subsequent analyses. One author (PT), having completed his own ratings, received the incoming ratings from ML and AL and ran the inter-coder analysis. Two rounds of ratings occurred due to discrepancies for seven meta-analyses, mainly between ML and AL. As no objective quality categorizations (i.e., a point system for grouping meta-analyses as poor, medium, good) currently exist, each meta-analysis was allocated a quality score of up to a maximum of 25 points. All coding records are available upon request.

Planned methods of analysis

Several preplanned methods of analysis occurred. We first assessed the mean quality rating of each meta-analysis based on our 25-point PRISMA-based rating system. Next, we used a median split of quality ratings to determine whether standardized mean effects (SMDs) differed by the two formed categories, higher and lower quality meta-analyses. Meta-analysis authors reported either of two different effect size metrics (i.e., r and SMD); hence we converted all correlational effects to SMD (i.e., Cohen’s d ) values using an online effect size calculator ( www.polyu.edu.hk/mm/effectsizefaqs/calculator/calculator.html ). We interpreted the meaningfulness of effects based on Cohen’s interpretation [ 24 ] with 0.20 as small, 0.50 as medium, 0.80 as large, and 1.30 as very large. As some psychological variables associate negatively with performance (e.g., confusion [ 25 ], cognitive anxiety [ 26 ]) whereas others associate positively (e.g., cohesion [ 23 ], mental practice [ 14 ]), we grouped meta-analyses according to whether the hypothesized effect with performance was positive or negative, and summarized the overall effects separately. By doing so, we avoided a scenario whereby the demonstrated positive and negative effects canceled one another out when combined. The effect of somatic anxiety on performance, which is hypothesized to follow an inverted-U relationship, was categorized as neutral [ 35 ]. Last, we grouped the included meta-analyses according to whether the primary studies were correlational in nature or involved an intervention and summarized these two groups of meta-analyses separately.

Study characteristics

Table 1 contains extracted data from 30 meta-analyses meeting the inclusion criteria, dating from 1983 [ 14 ] to 2021 [ 21 ]. The number of primary studies within the meta-analyses ranged from three [ 27 ] to 109 [ 28 ]. In terms of the description of participants included in the meta-analyses, 13 included participants described simply as athletes, whereas other meta-analyses identified a mix of elite athletes (e.g., professional, Olympic), recreational athletes, college-aged volunteers (many from sport science departments), younger children to adolescents, and adult exercisers. Of the 30 included meta-analyses, the majority ( n = 18) were published since 2010. The decadal breakdown of meta-analyses was 1980–1989 ( n = 1 [ 14 ]), 1990–1999 ( n = 6 [ 29 – 34 ]), 2000–2009 ( n = 5 [ 23 , 25 , 26 , 35 , 36 ]), 2010–2019 ( n = 12 [ 18 , 19 , 22 , 27 , 37 – 43 , 48 ]), and 2020–2021 ( n = 6 [ 21 , 28 , 44 – 47 ]).

https://doi.org/10.1371/journal.pone.0263408.t001

As for the constructs covered, we categorized the 30 meta-analyses into the following areas: mental practice/imagery [ 14 , 29 , 30 , 42 , 46 , 47 ], anxiety [ 26 , 31 , 32 , 35 ], confidence [ 26 , 35 , 36 ], cohesion [ 18 , 19 , 23 ], goal orientation [ 22 , 44 , 48 ], mood [ 21 , 25 , 34 ], emotional intelligence [ 40 ], goal setting [ 33 ], interventions [ 37 ], mindfulness [ 27 ], music [ 28 ], neurofeedback training [ 43 ], perfectionism [ 39 ], pressure training [ 45 ], quiet eye training [ 41 ], and self-talk [ 38 ]. Multiple effects were generated from meta-analyses that included more than one construct (e.g., tension, depression, etc. [ 21 ]; anxiety and confidence [ 26 ]). In relation to whether the meta-analyses included in our review assessed the effects of a sport psychology intervention on performance or relationships between psychological constructs and performance, 13 were intervention-based, 14 were correlational, two included a mix of study types, and one included a large majority of cross-sectional studies ( Table 1 ).

A wide variety of performance outcomes across many sports was evident, such as golf putting, dart throwing, maximal strength, and juggling; or categorical outcomes such as win/loss and Olympic team selection. Given the extensive list of performance outcomes and the incomplete descriptions provided in some meta-analyses, a clear categorization or count of performance types was not possible. Sufficient to conclude, researchers utilized many performance outcomes across a wide range of team and individual sports, motor skills, and strength and aerobic tasks.

Effect size data and bias correction

To best summarize the effects, we transformed all correlations to SMD values (i.e., Cohen’s d ). Across all included meta-analyses shown in Table 2 and depicted in Fig 2 , we identified 61 effects. Having corrected for bias, effect size values were assessed for meaningfulness [ 24 ], which resulted in 15 categorized as negligible (< ±0.20), 29 as small (±0.20 to < 0.50), 13 as moderate (±0.50 to < 0.80), 2 as large (±0.80 to < 1.30), and 1 as very large (≥ 1.30).

https://doi.org/10.1371/journal.pone.0263408.g002

https://doi.org/10.1371/journal.pone.0263408.t002

Study quality rating results and summary analyses

Following our PRISMA quality ratings, intercoder reliability coefficients were initially .83 (ML, AL), .95 (ML, PT), and .90 (AL, PT), with a mean intercoder reliability coefficient of .89. To achieve improved reliability (i.e., r mean > .90), ML and AL re-examined their ratings. As a result, intercoder reliability increased to .98 (ML, AL), .96 (ML, PT), and .92 (AL, PT); a mean intercoder reliability coefficient of .95. Final quality ratings (i.e., the mean of two coders) ranged from 13 to 25 ( M = 19.03 ± 4.15). Our median split into higher ( M = 22.83 ± 1.08, range 21.5–25, n = 15) and lower ( M = 15.47 ± 2.42, range 13–20.5, n = 15) quality groups produced significant between-group differences in quality ( F 1,28 = 115.62, p < .001); hence, the median split met our intended purpose. The higher quality group of meta-analyses were published from 2015–2021 (median 2018) and the lower quality group from 1983–2014 (median 2000). It appears that meta-analysis standards have risen over the years since the PRISMA criteria were first introduced in 2009. All data for our analyses are shown in Table 2 .

Table 3 contains summary statistics with bias-corrected values used in the analyses. The overall mean effect for sport psychology constructs hypothesized to have a positive impact on performance was of moderate magnitude ( d = 0.51, 95% CI = 0.42, 0.58, n = 36). The overall mean effect for sport psychology constructs hypothesized to have a negative impact on performance was small in magnitude ( d = -0.21, 95% CI -0.31, -0.11, n = 24). In both instances, effects were larger, although not significantly so, among meta-analyses of higher quality compared to those of lower quality. Similarly, mean effects were larger but not significantly so, where reported effects in the original studies were based on interventional rather than correlational designs. This trend only applied to hypothesized positive effects because none of the original studies in the meta-analyses related to hypothesized negative effects used interventional designs.

https://doi.org/10.1371/journal.pone.0263408.t003

In this systematic review of meta-analyses, we synthesized the available evidence regarding effects of sport psychology interventions/constructs on sport performance. We aimed to consolidate the literature, evaluate the potential for meta-analysis quality to influence the results, and suggest recommendations for future research at both the single study and quantitative review stages. During the systematic review process, several meta-analysis characteristics came to light, such as the number of meta-analyses of sport psychology interventions (experimental designs) compared to those summarizing the effects of psychological constructs (correlation designs) on performance, the number of meta-analyses with exclusively athletes as participants, and constructs featuring in multiple meta-analyses, some of which (e.g., cohesion) produced very different effect size values. Thus, although our overall aim was to evaluate the strength of the evidence base for use of psychological interventions in sport, we also discuss the impact of these meta-analysis characteristics on the reliability of the evidence.

When seen collectively, results of our review are supportive of using sport psychology techniques to help improve performance and confirm that variations in psychological constructs relate to variations in performance. For constructs hypothesized to have a positive effect on performance, the mean effect strength was moderate ( d = 0.51) although there was substantial variation between constructs. For example, the beneficial effects on performance of task cohesion ( d = 1.00) and self-efficacy ( d = 0.82) are large, and the available evidence base for use of mindfulness interventions suggests a very large beneficial effect on performance ( d = 1.35). Conversely, some hypothetically beneficial effects (2 of 36; 5.6%) were in the negligible-to-small range (0.15–0.20) and most beneficial effects (19 of 36; 52.8%) were in the small-to-moderate range (0.22–0.49). It should be noted that in the world of sport, especially at the elite level, even a small beneficial effect on performance derived from a psychological intervention may prove the difference between success and failure and hence small effects may be of great practical value. To put the scale of the benefits into perspective, an authoritative and extensively cited review of healthy eating and physical activity interventions [ 49 ] produced an overall pooled effect size of 0.31 (compared to 0.51 for our study), suggesting sport psychology interventions designed to improve performance are generally more effective than interventions designed to promote healthy living.

Among hypothetically negative effects (e.g., ego climate, cognitive anxiety, depression), the mean detrimental effect was small ( d = -0.21) although again substantial variation among constructs was evident. Some hypothetically negative constructs (5 of 24; 20.8%) were found to actually provide benefits to performance, albeit in the negligible range (0.02–0.12) and only two constructs (8.3%), both from Lochbaum and colleagues’ POMS meta-analysis [ 21 ], were shown to negatively affect performance above a moderate level (depression: d = -0.64; total mood disturbance, which incorporates the depression subscale: d = -0.84). Readers should note that the POMS and its derivatives assess six specific mood dimensions rather than the mood construct more broadly, and therefore results should not be extrapolated to other dimensions of mood [ 50 ].

Mean effects were larger among higher quality than lower quality meta-analyses for both hypothetically positive ( d = 0.54 vs d = 0.45) and negative effects ( d = -0.25 vs d = 0.17), but in neither case were the differences significant. It is reasonable to assume that the true effects were derived from the higher quality meta-analyses, although our conclusions remain the same regardless of study quality. Overall, our findings provide a more rigorous evidence base for the use of sport psychology techniques by practitioners than was previously available, representing a significant contribution to knowledge. Moreover, our systematic scrutiny of 30 meta-analyses published between 1983 and 2021 has facilitated a series of recommendations to improve the quality of future investigations in the sport psychology area.

Recommendations

The development of sport psychology as an academic discipline and area of professional practice relies on using evidence and theory to guide practice. Hence, a strong evidence base for the applied work of sport psychologists is of paramount importance. Although the beneficial effects of some sport psychology techniques are small, it is important to note the larger performance benefits for other techniques, which may be extremely meaningful for applied practice. Overall, however, especially given the heterogeneity of the observed effects, it would be wise for applied practitioners to avoid overpromising the benefits of sport psychology services to clients and perhaps underdelivering as a result [ 1 ].

The results of our systematic review can be used to generate recommendations for how the profession might conduct improved research to better inform applied practice. Much of the early research in sport psychology was exploratory and potential moderating variables were not always sufficiently controlled. Terry [ 51 ] outlined this in relation to the study of mood-performance relationships, identifying that physical and skills factors will very likely exert a greater influence on performance than psychological factors. Further, type of sport (e.g., individual vs. team), duration of activity (e.g., short vs. long duration), level of competition (e.g., elite vs. recreational), and performance measure (e.g., norm-referenced vs. self-referenced) have all been implicated as potential moderators of the relationship between psychological variables and sport performance [ 51 ]. To detect the relatively subtle effects of psychological effects on performance, research designs need to be sufficiently sensitive to such potential confounds. Several specific methodological issues are worth discussing.

The first issue relates to measurement. Investigating the strength of a relationship requires the measured variables to be valid, accurate and reliable. Psychological variables in the meta-analyses we reviewed relied primarily on self-report outcome measures. The accuracy of self-report data requires detailed inner knowledge of thoughts, emotions, and behavior. Research shows that the accuracy of self-report information is subject to substantial individual differences [ 52 , 53 ]. Therefore, self-report data, at best, are an estimate of the measure. Measurement issues are especially relevant to the assessment of performance, and considerable measurement variation was evident between meta-analyses. Some performance measures were more sensitive, especially those assessing physical performance relative to what is normal for the individual performer (i.e., self-referenced performance). Hence, having multiple baseline indicators of performance increases the probability of identifying genuine performance enhancement derived from a psychological intervention [ 54 ].

A second issue relates to clarifying the rationale for how and why specific psychological variables might influence performance. A comprehensive review of prerequisites and precursors of athletic talent [ 55 ] concluded that the superiority of Olympic champions over other elite athletes is determined in part by a range of psychological variables, including high intrinsic motivation, determination, dedication, persistence, and creativity, thereby identifying performance-related variables that might benefit from a psychological intervention. Identifying variables that influence the effectiveness of interventions is a challenging but essential issue for researchers seeking to control and assess factors that might influence results [ 49 ]. A key part of this process is to use theory to propose the mechanism(s) by which an intervention might affect performance and to hypothesize how large the effect might be.

A third issue relates to the characteristics of the research participants involved. Out of convenience, it is not uncommon for researchers to use undergraduate student participants for research projects, which may bias results and restrict the generalization of findings to the population of primary interest, often elite athletes. The level of training and physical conditioning of participants will clearly influence their performance. Highly trained athletes will typically make smaller gains in performance over time than novice athletes, due to a ceiling effect (i.e., they have less room for improvement). For example, consider runner A, who takes 20 minutes to run 5km one week but 19 minutes the next week, and Runner B who takes 30 minutes one week and 25 minutes the next. If we compare the two, Runner A runs faster than Runner B on both occasions, but Runner B improved more, so whose performance was better? If we also consider Runner C, a highly trained athlete with a personal best of 14 minutes, to run 1 minute quicker the following week would almost require a world record time, which is clearly unlikely. For this runner, an improvement of a few seconds would represent an excellent performance. Evidence shows that trained, highly motivated athletes may reach performance plateaus and as such are good candidates for psychological skills training. They are less likely to make performance gains due to increased training volume and therefore the impact of psychological skills interventions may emerge more clearly. Therefore, both test-retest and cross-sectional research designs should account for individual difference variables. Further, the range of individual difference factors will be context specific; for example, individual differences in strength will be more important in a study that uses weightlifting as the performance measure than one that uses darts as the performance measure, where individual differences in skill would be more important.

A fourth factor that has not been investigated extensively relates to the variables involved in learning sport psychology techniques. Techniques such as imagery, self-talk and goal setting all require cognitive processing and as such some people will learn them faster than others [ 56 ]. Further, some people are intuitive self-taught users of, for example, mood regulation strategies such as abdominal breathing or listening to music who, if recruited to participate in a study investigating the effects of learning such techniques on performance, would respond differently to novice users. Hence, a major challenge when testing the effects of a psychological intervention is to establish suitable controls. A traditional non-treatment group offers one option, but such an approach does not consider the influence of belief effects (i.e., placebo/nocebo), which can either add or detract from the effectiveness of performance interventions [ 57 ]. If an individual believes that, an intervention will be effective, this provides a motivating effect for engagement and so performance may improve via increased effort rather than the effect of the intervention per se.

When there are positive beliefs that an intervention will work, it becomes important to distinguish belief effects from the proposed mechanism through which the intervention should be successful. Research has shown that field studies often report larger effects than laboratory studies, a finding attributed to higher motivation among participants in field studies [ 58 ]. If participants are motivated to improve, being part of an active training condition should be associated with improved performance regardless of any intervention. In a large online study of over 44,000 participants, active training in sport psychology interventions was associated with improved performance, but only marginally more than for an active control condition [ 59 ]. The study involved 4-time Olympic champion Michael Johnson narrating both the intervention and active control using motivational encouragement in both conditions. Researchers should establish not only the expected size of an effect but also to specify and assess why the intervention worked. Where researchers report performance improvement, it is fundamental to explain the proposed mechanism by which performance was enhanced and to test the extent to which the improvement can be explained by the proposed mechanism(s).

Limitations

Systematic reviews are inherently limited by the quality of the primary studies included. Our review was also limited by the quality of the meta-analyses that had summarized the primary studies. We identified the following specific limitations; (1) only 12 meta-analyses summarized primary studies that were exclusively intervention-based, (2) the lack of detail regarding control groups in the intervention meta-analyses, (3) cross-sectional and correlation-based meta-analyses by definition do not test causation, and therefore provide limited direct evidence of the efficacy of interventions, (4) the extensive array of performance measures even within a single meta-analysis, (5) the absence of mechanistic explanations for the observed effects, and (6) an absence of detail across intervention-based meta-analyses regarding number of sessions, participants’ motivation to participate, level of expertise, and how the intervention was delivered. To ameliorate these concerns, we included a quality rating for all included meta-analyses. Having created higher and lower quality groups using a median split of quality ratings, we showed that effects were larger, although not significantly so, in the higher quality group of meta-analyses, all of which were published since 2015.

Conclusions

Journals are full of studies that investigate relationships between psychological variables and sport performance. Since 1983, researchers have utilized meta-analytic methods to summarize these single studies, and the pace is accelerating, with six relevant meta-analyses published since 2020. Unquestionably, sport psychology and performance research is fraught with limitations related to unsophisticated experimental designs. In our aggregation of the effect size values, most were small-to-moderate in meaningfulness with a handful of large values. Whether these moderate and large values could be replicated using more sophisticated research designs is unknown. We encourage use of improved research designs, at the minimum the use of control conditions. Likewise, we encourage researchers to adhere to meta-analytic guidelines such as PRISMA and for journals to insist on such adherence as a prerequisite for the acceptance of reviews. Although such guidelines can appear as a ‘painting by numbers’ approach, while reviewing the meta-analyses, we encountered difficulty in assessing and finding pertinent information for our study characteristics and quality ratings. In conclusion, much research exists in the form of quantitative reviews of studies published since 1934, almost 100 years after the very first publication about sport psychology and performance [ 2 ]. Sport psychology is now truly global in terms of academic pursuits and professional practice and the need for best practice information plus a strong evidence base for the efficacy of interventions is paramount. We should strive as a profession to research and provide best practices to athletes and the general community of those seeking performance improvements.

Supporting information

S1 checklist..

https://doi.org/10.1371/journal.pone.0263408.s001

Acknowledgments

We acknowledge the work of all academics since Koch in 1830 [ 2 ] for their efforts to research and promote the practice of applied sport psychology.

• 1. Terry PC. Applied Sport Psychology. IAAP Handbook of Applied Psychol. Wiley-Blackwell; 2011 Apr 20;386–410.
• 2. Koch CF. Die Gymnastik aus dem Gesichtspunkte der Diätetik und Psychologie [Callisthenics from the Viewpoint of Dietetics and Psychology]. Magdeburg, Germany: Creutz; 1830.
• 3. Chroni S, Abrahamsen F. History of Sport, Exercise, and Performance Psychology in Europe. Oxford Research Encyclopedia of Psychology. Oxford: Oxford University Press; 2017 Dec 19. https://doi.org/10.1093/acrefore/9780190236557.013.135
• 4. Rieger K. Der Hypnotismus: Psychiatrische Beiträge zur Kenntniss der Sogenannten Hypnotischen Zustände [Hypnotism: Psychiatric Contributions to the Knowledge of the So-called Hypnotic States]. Würzburg, Germany: University of Würzburg; 1884.
• 5. Mosso, A. La fatica [Fatigue]. Milan, Italy: Treves; 1891 [trans. 1904].
• View Article
• Google Scholar
• 9. Hanrahan SJ, Andersen MB, editors. Routledge Handbook of Applied Sport Psychology. London: Routledge; 2010.
• 10. Schinke RJ, McGannon KR, Smith B, editors. Routledge International Handbook of Sport Psychology. London: Routledge; 2016.
• 11. Bertollo M, Filho E, Terry PC. Advancements in Mental Skills Training: International Perspectives on Key Issues in Sport and Exercise Psychology. London: Routledge; 2021.
• PubMed/NCBI
• 17. Lochbaum M. Understanding the meaningfulness and potential impact of sports psychology on performance. In: Milanović D, Sporiš G, Šalaj S, Škegro D, editors, Proceedings book of 8th International Scientific Conference on Kinesiology, Opatija. Zagreb, Croatia: University of Zagreb, Faculty of Kinesiology; 2017. pp. 486–489.
• 24. Cohen J. Statistical Power Analysis for the Behavioral Sciences. New York: Routledge Academic; 1988.
• 50. Ekkekakis P. The Measurement of Affect, Mood, and Emotion. Cambridge: Cambridge University Press; 2013.

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Corresponding Author:

Stig Arve Sæther Department of Sociology and Political Science Norwegian University of Science and Technology, NTNU, Dragvoll, 7491 Trondheim, Norway E-mail: [email protected], https://orcid.org/0000-0002-1429-4746

Mads Røgen Noesgaard is educated as a physiotherapist and holds a master’s degree in sport science from the Norwegian University of Science and Technology. He has an extent experience as a physiotherapist from professional sports especially related to football and handball.

Stig Arve Sæther is an associate professor in sport science at the Norwegian University of Science and Technology, with an extensive research portfolio in talent development within sports and especially football. Sæther is head of the sport science staff, head of education at the department of Sociology and Political science and head of the research group Skill and Performance Development in Sports and School (SPDSS).

Purpose The aim of this study is to research how the decision-making on RTP from the medical staff impact on the perceived short- and long-term performance of the player and the team, from a coach, medical staff, and player perspective. Methods: Two professional football players, one physical coach, one physiotherapist and one assistant coach were interviewed in-depth and recruited because of their insight, experience, and expertise from one Norwegian premiere league club. Results: The decision-making process on RTP in the club were partly based on the hierarchy in the club, where the coach was on the top among these actors. Despite that the actor´s describes the process as a natural dynamic, and felt a shared responsibility in the process, their different roles impact on the decisions. The RTP decision was affected by aspects such as the period in the season, earlier injury experience of the player and the medical staff and coach collaboration. Conclusions: Even though the medical staff and the injury prevention could mean that the player could have a longer career, the choices made in the process of RTP is often based on short term player and team performance. Applications in sport: Professional football players have competition as a living and are expected to enjoy and embrace competing against both other teams related to winning trophies and teammates related to a place on the team in matches. This degree of competition was also seen as a part of the RTP process since the competition with teammates gave the players motivation to overcome their injury situation and get back to compete for their “spot” on the team. Even though this study only includes experiences from one professional football club, it gives insight into how the RTP process is done in a professional football context. Future studies should consider recruiting representatives from the club management, which also could give insight on how the macro aspects of a club impact on the RTP decisions in the coaching team of a professional football club.

Keywords : return-to-play, professional sports, communication

INTRODUCTION

The development of professional football player is complex and consist of a myriad of factors, including injury prevention and rehabilitation through the return to play (RTP) (38). Even though the development of injuries in European professional football has decreased over the last two decades (10), the impact of injuries still plays a major role in both team and individual player development and success (7). Time loss in on field training and matches may have a negative impact on the players development, which makes it vital to minimize the duration of rehabilitation and RTP process. The responsibility of injury prevention, treatment and following RTP has in the literature been described as the responsibility of the medical staff, even though a strong coach and player involvement has been recommended (10). Even so, lack of needed authority in this process, have been highlighted as a challenge since both the coaching team and especially the head coach, and the players are expected to be a part of the decision process, hereby creating a dilemma (26). The need for a high performing medical team is thereby indicated crucial for the present success, but also future accomplishments (7).

Knowing that the major predictor in future injury being previous injury (13, 27-28, 35, 45), it has become standard procedure in European professional football clubs to screen and evaluate both in-squad players and potential investments even though research points to a lack of predictive capabilities (29, 46). Hereby the screening process is arguably/potentially increasing the consequences of previous injuries and treatment of such and the importance of injury preventive measures. In the pursuit of securing the best possible squad at all times injury preventive programmes such as FIFA11+, seems common but often adjusted based on either screening results or coaches’ preferences and hereby losing its evidence-based merits (29-30, 34, 46). Another promising preventive strategy is tracking and managing of load and restitution of the individual player and indicated to both increase the “here and now” short-term performance and the long-term performance. The main aim is to reduce the risk of injuries and illness (19, 24, 36), but it also presents a risk of withdrawing players from training and matches unnecessary.

The rehabilitation process of a player must address and manage the psychological and sociological health of the player (12). Though the general plan and goals of the rehabilitation is clear there is a lack of gold-standard and consensus for RTP which complicates the last steps before returning to training and competition (22). The literature advocates a shared-decision-making process to optimize this process. Coaches, medical staff, physical coaches, and the individual player all possess insight about the state of the player seen in a bio-psycho-social framework (5-6, 8, 47). A process as such is nonetheless challenged by the different profession’s confidence in their own decision, but also potentially with a lack of trust in others, hereby creating a dilemma where authority and power becomes more important than teamwork (9-10, 20). To increase the overall medical effort, the literature advocates an SDM-approach to minimize injuries and rehabilitation periods and improve RTP (1). Still, Paul et al. newly published editorial are highlighting that there has been identified concerns surrounding the social complexities of elite sports and the difficulties of truly applying this concept in practice (37).

Most of the research on this subject and in professional football have used a quantitative approach (7) and there seems to be a need of qualitative insight on how this process unfolds in practice, and how and by whom the decisions are made. An exception is Law and Bloyce (25) who interviewed professional football managers behavior towards injured players. The results indicated that managers at the lower levels felt more constrained to take certain risks related to injured players. The aim of this study is to research how the decision-making on RTP from the medical staff impact on the perceived short- and long-term performance of the player and the team, from a coach, medical staff, and player perspective.

Participants 

Two professional football players, one physical coach, one physiotherapist and one assistant coach were interviewed in-depth and chosen based on strategic selection because of their insight, experience, and expertise in the field and their long-term involvement within one Norwegian premiere league club. The two players have in total more than 15 years in the club, while the physiotherapist and the physical coach has been in the club’s medical team for more than five years and altogether more than 20 years of experience in the field. The assistant coach has more than seven years of coaching experience. The participants are described in table 1.

All interviews were conducted in person and the location chosen by the interviewee. The length of each interview varied from 50 to 90 minutes with a mean at 70 minutes. Each interview was initiated with general questions to start the conversation and to get more background information on each participant. Prior to the interviews the questions were largely prepared to facilitate the conversation into different themes and topics of interest, with prepared follow up questions when depth and more context was needed. The questions varied specificity from general questions about the interviewee’s thoughts on the injury-period (e.g. “How do you think a player can develop while injured”) to more defined questions about the different actors’ actual role in the decision-making process about RTP (e.g. What role does the player has in the RTP-decisions). With these types of specific questions, the former mentioned extensive experience and expertise in the field was highly prioritized in the selection of participants. This made the insight in the specific club more extensive and gave the answers more depth. In addition, all participants were giving the opportunity to read through the transcript and afterwards able to withdraw parts or the interview in full, which none of the participants did. None of the participants neither wanted to alter the transcription. All interviews were audio-recorded and transcribed verbatim. By using pseudonyms for each participant, the transcriptions ensured the interviewee’ confidentiality and furthermore, ethical approval was in accordance with and approved by the Norwegian Social Sciences Data Services (number: 678375).          

Analysis The analysis of data was done with the six steps of theme-centred approach as described by Braun and Clarke (2-3). The process was initiated by the transcription by the first author who afterwards read and reread the data twice. This was followed by initial coding, phase two of the chosen method. In this process the transcription was revisited multiple times until the final codes were discovered and presented to the second writer for discussion. The total of 47 codes were structed using a mind-map, which visualised the third phase of the process and used to structure the data into nine higher-order themes. Phase four was a back-and-forth process rereading the transcript, revising the raw material for clarifying questions, reviewing the codes all in all to elaborate the emerged themes. Through dialog and discussion within the research group the final three/four themes were identified, and subgroups reviewed and hereby phase five concluded. Finally, phase 6 was a detailed process and highly interwoven with the analysis of data. To present the findings in an argumentation related to research question and to illustrate the story of the data it was important to revise the extracts and go back to the both the higher order themes and the final themes in the writing of the report to ensure that the essence of the data was captured and presented. The final report presents the experienced everyday life of the participants in this specific Norwegian Premier League football club, how they perceive the decision-making process in the context of both development and performance and how the structure and reality of modern football plays and important role in both injury prevention and RTP after injury.

The actors in the RTP process – the club hierarchy According to the actors (medical staff, coach and players), the prevention of injury and RTP practice has changed throughout the last decades, from a collective focus to a more specific and individual practice, described as a positive change by all the actors. RTP was described as a process, with benchmarks which was considered a motivational factor in the overall rehabilitation process. The decision-making process in the professional football club related to decisions on injured players and their capacity to play were affected to some degree by a hierarchy in the club. Even though the actor´s in the present study describes the process as a natural dynamic, and that they agree on their shared responsibility of the process, the different roles impact on the decisions.

Highest in the hierarchy are the coaches, and even though they highlight that the medical staff has an impact on their decision, the coaches seem to be the final decision maker in the process. This is indicated as a natural order because the coach is the one to take the ”fall” when the decisions shows to be wrong or more precisely have a negative output and also the final responsibility for the team performance. The coach described therefor a need to keep the medical staff on their toes, which the medical staff described as a challenge of their decisions, often based on what they considered external pressure on performance and results. This again meant that the medical staff had to make the “right” decision to keep their authority in the collaboration with the coaches.

The players felt in this regard that the medical staff had a two-sided role or responsibility both towards the coaches and the players, but that they still according to the players weigh the perspective of the player the heaviest. This double role was considered challenging and could mean lack of support in cases of doubt, while the medical staff considered that the final decision was taken by the coaches and the player. From the player perspective the trust was described as essential in this process. So even though trust, communication and collaboration are fundamental elements to keep a squad of players performing, there is also a need for a trust in the actors’ competencies and loyalty, both highlighted by the coach Lars: “Despite thinking about the result, first and foremost, we of course think: “The best for the player”. Because the player performs best when he is 100% healthy, both physically and mentally.” The physical coach Thomas stated this on the matter:

Thomas: “Because the vast majority of players understand deep down what the point is. They know when they shouldn’t go out there. They want to have hope, that: “yeah, it’s allright” and so sometimes our job is actually just to say: “Yes, it’s actually allright”, even if it’s 50/50, if it’s the last match on the season and they wanna take the chance anyways. Okay, then we have to see that and then just say: “This is allright”.

Thomas argued that their role in the process was to inform the coaches and even though the decision was not always in line with their suggestions, they felt that their opinions was considered vital for the final decision-making.

The factors that impact the decision process

Because of the complexity and uncertainty of who decides which players could play, the medical staff experience situations where at times they felt pressured to clear a player for playing, which in their experience often leads to a longer injury period. And despite the open communication, the pressure got more intense especially before important matches and at the end of the season, as this conversation and the following quotes indicates: Physiotherapist Hans: “You get a player who runs at 60%?”, Coach Lars: “Yes, but he is so important for us in set-pieces, so we have to have him”. This becomes even more prominent at the end of the season as physical coach Thomas highlights: “The fewer matches left, the greater chances you are willing to take with the athlete’s health”.

The decision to deny a player to train or play a match based on the risk of injury, was considered difficult for the medical staff because of uncertainty of the outcome. The coach describes how they in some cases start the player and see how it goes. Even though this was described as happening seldom and especially since this could be considered treating the players differently, which potentially could impact the team dynamic:

Lars: “If you and I play in the same position, and you train 3 times a week but you are a little better than me. I’m training every single day, and then you get to play matches. I train more than you, twice a week, and then arrangements will be made for you to play. That could become a conflict.”

The medical staff points out how this load-management strategy is potentially positive for RTP, the coach argument furthermore how this might add pressure for the next matches both for the player and the medical staff. If the team loses, one could consider that being in minus and that means that the next match must be won. This adds on to the earlier statement that an injury might be a heavy process for a player:

David: “From the moment you feel that you are a part of something, then you will show up the day after you have been injured, then you show up for work. You eat breakfast, you go to the locker room and then the rest of the team go out on field and do what you love the most, they play football. But you wander into a dark gym alone and do what all footballers think is the most boring job, cycling and doing rehab training. As boring as it gets. But you have to do it. You go into such a lonely and confined, empty mental phase, it’s really hard.”

What was considered the “right” decision depended on the perspective, even though obviously the most impacted part is the player:

Niels: “Perhaps I have been lucky in that I have not had so many major injuries, but at the same time the one injury I have had, where it was done the way it was done, that was enough for me to think: “yes, I lost some good matches that year”, then you can think of those who have been injured longer and have had more injuries, how much it has affected them.”

Injuries are however also described by all actors as a natural part of professional football, and that this often means taking risks to be able to perform on the highest level. One of the players, David, describes it as following:

David: “At the top level, you are balancing on a knife’s edge much more often, because you are pushing boundaries all the time and then the need for medical help is all the greater than when you operate at a not so fully professional level.”

It could seem from a professional players perspective that the players consider their everyday life as a footballer as finding the optimal balance to be able to stay fit and avoid injuries, and that this situation is difficult and that they need help from the medical staff to be able to keep staying “in the game”. Even so, the physical coach Lars highlights the difference between pain and injury:

Lars: “I think when you play football and it’s one-on-one, it’s dueling, you can get a knee in the side, you can get hit by an elbow, so after a football match, you might have a bruise here and a little bit of swelling there and you can have, stiffness in generel. That doesn’t mean you need 2-3 days to recover because that pain you feel”.

Protecting the players

The coach stated that it was important to protect the players and not introduce them for unnecessary risk, even though he pointed out that there is a limit in terms of how much consideration one could do for each player. In this regard did the physical coach acknowledges that there had not been a reduction in the number of injuries despite the heavy number of added resources to prevent them. The injuries have changed but one has not been able to eliminate the incident rate:

Thomas: “There is much less ankel rolls, but there are more hamstring injuries and groin injuries because there is more sprinting in the matches and the matches are closer schedueled. And you can’t quite solve that. Even with sufficient sleep, enough nutrition, tablets in the fusion of plasma, i.e. “you name it”, game ready – the player still breaks down and then you see that if you train very well, then maybe you will go through the season with very little damage.”

This was also something the players describes as problematic in certain situations, as stated by Niels: “Coach, physio and they, they really push you back in and then it’s difficult as a player to sit there and say: “I’m not healthy”, it’s difficult!”

The physical coach recons it is all about the time spent on the pitch to improve RTP and the high amount of matches impact on the possibilities for the medical staff to schedule and complete the injury preventions and rehabilitation. One example mentioned are an away match where the travel time is the reason for the player not attending enough training sessions, even though he is ready to train.  Furthermore, the game importance is an important factor because of the impact on the results sportingly and economically and has been found to be the reason as to why players play partly injured, or at least adding on to the pressure on the medical staff and their decision on every player potentially injured.

          Also, one of the players described how he perceived that the players are at their best when the get to train and play matches as much as possible:

David: “All footballers perform at their best when they get the opportunity to play football every day. Play every match. That’s when you get into a rhythm, where you act on intuition in battle and in that moment. In order to do that, you have to have continuity in your training and to have that, you have to be good at taking care of your body, to manage and last through a tough week of training, to perform in every match. So it’s definitely important. You profit from doing a good job (ed. injury prevention) in order to be able to perform in the best possible way. It is absolutely indisputable.”

Both the players and the medical staff highlights that the injury prevention is important for the players to be able to train more.  The physical coach highlights that this injury prevention training has a direct impact on the player opportunity to run faster and develop more power.

One of the players mentions how each club and their culture try to maximise the development and that the club culture is impacting the performance. This was also mentioned by the coach who stated that building the club is one of the most important tasks for the club, which is considered difficult since both players and coaches comes and goes. Another challenge is the impact the head coaches have on how the club perceive injury and development. The physiotherapist describes how the many changes also impact on the medical staff and their way of working:

Hans: “I think that, the biggest challenge in all of this is the constant change in player material, the constant change, at least as it has been in X, that coaches change, and therefore you constantly have different routines. It is natural that a coach who comes in and is boss wants to have it his way, and then a new coach comes in who wants it his way. Then there will always be changes and that means that what you tested on last year will be tested in a different way this year.”

Both players and the physical coach add on to this position, even though they also see positive outputs when new people are trying to collaborate:

Thomas: “Things that work well can also be diluted by poor execution. I think we make it work. I think so. that’s how it is when you bring new things to the table. Basically, it should be a good thing and if you manage to get best out of it, then it will be beneficial.”

The injury situation as an opportunity for development

All the actors thought of the injury period as a period for potential development of performance level of the player. So even though the players considered it as a tough and challenging period, it also contains opportunities. The coach highlighted that this motivation and opportunity had to come from within, and that he medical staff and the coach’s role was to facilitate and further motivate. In that way the injury period can be effective and also an opportunity, which could be considered a win-win situation both for the player and the team. 

Still, at times the players felt pressured to play, and sometimes felt alone and “naked” in the discussion between them, the medical staff and the coaches. This was partly confirmed by the physiotherapist, who described football as being black or white at times, and that he felt the need to protect the player:

Hans: “A player who is out several times and often… It can very quickly become black and white in a football club, “This player is always injured. No, we’ll give up on him a little”, and then it’s challenging to say: “You mustn’t give up on him, even if he’s a bit injured now. There are several factors that cause him to be injured and we have to look at ourselves as well, all of us.” What we have often done is to look at the coach and say: “If we are going to get him out of this, we’ll have to make a change. What we are doing now is not good enough. So we have to take him out of training and have to do this instead of that. He can’t play every game and at the moment”.

However, at other times the medical staff also feel the need to push the players to return to ordinary training or playing matches. They feel the need to be careful since they might misstep. Some players might get pushed back to soon, while others need a push.

Lars: “Sometimes where you have to push a little, and we really do that for the sake of the player, not because we absolutely have to. We don’t take any chances with players, that is. But if we see that he has done what he is supposed to and at the same time it is a player who is a bit more careful with himself. Because that too, you have to know the group, you have to know the player, because there are some who can be too tough too early, and then there are some who are actually ready, but holding back. So you can say that sometimes we have to try and push them in a positive way too, I think. Without us doing anything wrong.”

One of the players Niels stated that for some of the players, they need to be more included in the decision-making-process. One example mentioned by one of the players was the importance to get into the pre-season together with the squad, to be able to compete about his playing position.

The medical staff clearly stated that they did not consider themselves having the definitive solution in every case. They also mentioned the fact that holding a player back from a match based on the fear of being injured might deprive the player from development and potentially economic gain (e.g. club transfer, bonuses etc.) or the team’s performance or the club’s economic gains. Many of the actors highlighted that if the player felt ready to play, and the coaches meant that he would have an impact on the game, the medical staff would take that into consideration. This position of taking a decision which is good for all the actors both in a short-term and long-term perspective was considered a difficult dilemma for the medical staff, since they feel an extra responsibility related to the players health.

Keeping the players on their toes but still together

The coach also highlighted that the competition between players could challenge the individuals in the club. Internal competition is essential and when a player is injured, that could create an opportunity for other players. This competition was also highlighted by the two players, however as a stressor for the injured player. The coach however stated that this type of competition must be present and that it makes the players push each other, and fight for a place on the team. This type of pressure, trying to withhold your place on the team, having the right attitudes, frequent changes in the coaching staff, and short-term results, was describes from all the actors as impacting the medical staff’s opportunity to impact the decision for players to play matches and their development. Both the coach and the medical staff highlighted that this might impact the decision, but never determined the RTP, while the players could consider this as a weighty stressor

The players point out a potential isolation of the injured players by dividing the players into two groups: those who are injured and those who are not, but this division is described differently based on the perspective. They also describe the rehabilitation as lonely, heavy, and boring, especially the acute phase, and experience that the injured players not to be a part of the community in the club, which the player Niels described in the following: “But I want to put it this way, you are down in hell and then you start the ascent from there, and then it becomes a bit like tunnel vision. You don’t see the light at the start, but you see it eventually”. The coach, however, does not describe this as an isolation or division of the team, but rather a natural part of the everyday life in a club, but highlight the importance of joint meals and meeting schedules. The medical staff have another nuance of this division, since an injury might be challenging and create a sense of exclusion, while this could also be good for the team, since the negativity which often comes with an injury does not get spread among the other team members. The physical coach highlights the same and furthermore that it should be attractive not to be injured.

All the actors describe the deprivation from matches in times of doubt about a player’s availability have both sportingly and economic negative impact on the player’s career:

David: “Football can be so simpel that if you, how should I put it , score a hat-trick in the right match against the right team, you can be like… And the salaries are so high, so if you end up in the right place then you, then you can in a way support the whole family for the rest of your life. So it’s quite clear that injuries affect the course of a career.”

Injuries means less time to train, and the actors agree that the time for the specific football training and matches are essential for a player’s individual development. Both the coach and the physiotherapist highlighted however the importance of making the most of the injury period, which could be considered as a window of opportunity to focus on individual skill development, which normally one does not have time for. The physical coach stated however that it might be difficult for a player to develop largely during the rehabilitation process. And this could be related to the somewhat black-white perspective the medical staff and the coach has on injuries. The physiotherapist meant that this approach might have a positive consequence for a player who have experienced an injury. They often work harder than before to be able to get back to football. At the same time Hans also pointed to the fact that the players could be “forgotten” by the coaches if they achieve a “bad” reputation: “But if you first get a reputation of being.. that the coach gets the feeling that he is not available, then it can often be difficult. A fight really. That is my experience”. The coach Lars partly confirmed this by stating that the coaches are aware of players who have a history of injuries, which often mean that they cannot play all matches during a season:

Lars: “In other words, injury follows injury. It’s a bit like that. So there are certain players that you know more or less that he is not going to play 100% of the games. Let’s say there is an exclusive player who often gets hamstring issues, then you know that during the season he will play 70% of the games. It may happen that we have players, who we know are like that.”

In a long-term perspective and focusing on the players career, the coach also highlighted that the players are screened and assessed by clubs if a club transfer is in motion, that a player with a large injury history would be considered as less interesting to recruit:

Lars: “[…] But the more players who don’t have an injury history.. So if you’re going to build a team then you have to get as few players as possible with an injury history, because often you see that those type of issues, especially if it’s the groin or hamstring or those types of injuries, they often come back.”

The coach described players’ injury history as essential when clubs assess which player they could recruit, and that injured players must convince the coaches to become relevant for a club transfer. These types of assessment are important for coaches in their process of building a squad both in a short-term and long-term perspective.

The aim of this study is to research how the decision-making on RTP from the medical staff impact on the perceived short- and long-term performance of the player and the team, from a coach, medical staff, and player perspective. The decision-making process on RTP in this professional football club were partly based on the hierarchy in the club (40). So, despite that the actor´s in the present study describes the process as a natural dynamic, and felt a shared responsibility in the process, their different roles impact on the decisions. The coaches were described highest in the hierarchy and related to them being responsible for the sportingly results and the performance of the team. The players were described as having a say in the decision of his availability, even though they often highlighted an experience of being pressured to play in certain situations (9). The medical staff was considered to have a two-sided role, since they were employed and a part of the coaching team and naturally felt a responsibility on behalf of the coaches and the club, they also felt the need to protect the players and their health as professional health workers (20). Their decisions would often mean that they had to “disappoint” the coaches or the player, by denying the player to play or the availability of a player in a match.

Responsibility was a term especially the medical staff used to describe how they felt about their role, but also when taking part in the final decision in the RTP process. This responsibility became important in the process of making “the right” call based on the information available while trying to account for the interests of all the actors. This might mean that they let a player play, with a “let´s see how it goes” approach, and that the outcome of the decision was described as “right” if the player played the whole game. A dilemma in the process was also related to the natural part of pain and injury as part of professional football described by all the actors in the process (31). So even if protecting the players was important, time spent on the pitch is the main goal for both the individual players and the team’s development and performance. Even so, earlier research (41) has indicated that elite sports have a pain culture where pain is a natural and expected part of elite sports, which could have a negative impact on the players development, if this means that the players do not communicate when feeling injured or unavailable for training and matches.

Professional football is all about results and performance (32). So, a characteristic off successful environments is their constant search of areas to develop further (14). This seemed to be the case in this club as well since a period of injury was considered an opportunity for the player to develop. The players are competing about a place in the starting line-up and need to pick up the glow to get back into the team. Still, there was also a mutual understanding that each RTP case might be different and had to be considered individually. So, in some cases both the medical staff and the coaches felt that some players needed a push to get back. This may in many cases also be in the best interest of the player since it could mean that they in example get identified by scouts, impacting their career by a club transfer. Furthermore, this pressure could mean that the players are willing to take a higher risk by playing while injured. The players in this study described being injured as lonely and feeling isolated from the team, as found in earlier studies (32), which could be perceived as an increased motivation to RTP potentially even before the mind or body are ready.

In accordance with the focus on results and performance in professional football are also the high degree of uncertainty in this professional context (15). This could be related to the small margins between success and failure. This is also related to the RTP process, since all actors in the process of RTP must make the best decision for both the individual and teams’ performance. Still, there is a lack of knowledge related to the potential outcome of the decision. This means that the actors must “take risks” to be able to maximize the opportunity to succeed. While it was not a part of the study, the obvious economically benefits of decreasing time loss in training and competition on both an individually (players, medical team, and coaching team) and club level (potential sale of players), also makes both the rehabilitation and preventive strategies important. The club perspective might conflict with the individual actors in the RTP process, with the example of the club winning the league, while a player got injured because of the overload and hereby potentially ending his career.

CONCLUSIONS

All the actors in this study highlight that football is a sport where you must expect to feel pain regularly and that injury is a part of being a professional football player. So even though the medical staff and the injury prevention could mean that the player could have a longer career, the choices made in the process of RTP is often based on short term player and team performance. Professional football players have competition as a living and are expected to enjoy and embrace competing against both other teams related to winning trophies and teammates related to a place on the team in matches. This degree of competition was also seen as a part of the RTP process since the competition with teammates gave the players motivation to overcome their injury situation and get back to compete for their “spot” on the team. Even though this study only includes experiences from one professional football club, it gives insight into howe the RTP process is done in a professional football context. Future studies should consider recruiting representatives from the club management, which also could give insight on how the macro aspects of a club impact on the RTP decisions in the coaching team of a professional football club.

• Bizzini, M., Hancock, D., & Impellizzeri, F. (2012). Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: soccer. journal of orthopaedic & sports physical therapy, 42(4), 304-312.
• Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.
• Braun, V., Clarke, V., & P. Weate (2016) Using thematic analysis in sport and exercise research. In B. Smith & A. C. Sparkes (Eds.), Routledge handbook of qualitative research in sport and exercise (pp. 191-205). New York, NY: Routledge.
• Della Villa, S., Boldrini, L., Ricci, M., Danelon, F., Snyder-Mackler, L., Nanni, G., & Roi, G. S. (2012). Clinical outcomes and return-to-sports participation of 50 soccer players after anterior cruciate ligament reconstruction through a sport-specific rehabilitation protocol. Sports health, 4(1), 17-24.
• Dijkstra, H. P., Pollock, N., Chakraverty, R., & Ardern, C. L. (2016). Return to play in elite sport: a shared decision-making process. British Journal of Sports Medicine 51(5), 419-420.
• Dingenen, B., & Gokeler, A. (2017). Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: a critical step back to move forward. Sports Medicine, 47(8), 1487-1500.
• Drew, M. K., Raysmith, B. P., & Charlton, P. C. (2017). Injuries impair the chance of successful performance by sportspeople: a systematic review. British journal of sports medicine, 51(16), 1209-1214.
• Dunlop, G., Ardern, C. L., Andersen, T. E., Lewin, C., Dupont, G., Ashworth, B., . . . McCall, A. (2019). Return-to-Play Practices Following Hamstring Injury: A Worldwide Survey of 131 Premier League Football Teams. Sports Medicine, 1-12.
• Ekstrand, J., Lundqvist, D., Davison, M., D’Hooghe, M., & Pensgaard, A. M. (2019). Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs. British journal of sports medicine, 53(5), 304-308.
• Ekstrand, J., Lundqvist, D., Lagerbäck, L., Vouillamoz, M., Papadimitiou, N., & Karlsson, J. (2018). Is there a correlation between coaches’ leadership styles and injuries in elite football teams? A study of 36 elite teams in 17 countries. British journal of sports medicine, 52(8), 527-531.
• Ekstrand, J., Spreco, A., Bengtsson, H., & Bahr, R. (2021). Injury rates decreased in men’s professional football: an 18-year prospective cohort study of almost 12 000 injuries sustained during 1.8 million hours of play. British journal of sports medicine, 55(19), 1084-1091.
• Erickson, L. N., & Sherry, M. A. (2017). Rehabilitation and return to sport after hamstring strain injury. Journal of sport and health science, 6(3), 262-270.
• Esmaeili, A., Hopkins, W. G., Stewart, A. M., Elias, G. P., Lazarus, B. H., & Aughey, R. J. (2018). The individual and combined effects of multiple factors on the risk of soft tissue non-contact injuries in elite team sport athletes. Frontiers in Physiology, 9, 1280.
• Eubank, M., Nesti, M., & A. Cruickshank. (2014) Understanding high performance sport environments: Impact for the professional training and supervision of sport psychologists. Sport and Exercise Psychology Review 10(2), 30-37.
• Fasey, K.J., Sarkar, M., Wagstaff, C.R.D. & Johnston, J. (2022) Understanding organizational resilience in elite sport: An exploration of psychosocial processes. Psychology of Sport and Exercise, 62, 2022.
• Faude, O., Rommers, N., & Rössler, R. (2018). Exercise-based injury prevention in football. German Journal of Exercise and Sport Research, 48(2), 157-168.
• Faude, O., Rössler, R., Petushek, E. J., Roth, R., Zahner, L., & Donath, L. (2017). Neuromuscular adaptations to multimodal injury prevention programs in youth sports: a systematic review with meta-analysis of randomized controlled trials. Frontiers in Physiology, 8, 791.
• Fuller, C. W. (2019). Assessing the return on investment of injury prevention procedures in professional football. Sports Medicine, 49(4), 621-629.
• Gabbett, T. J., & Whiteley, R. (2017). Two training-load paradoxes: can we work harder and smarter, can physical preparation and medical be teammates? International journal of sports physiology and performance, 12(2), 250-254.
• Ghrairi, M., Loney, T., Pruna, R., Malliaropoulos, N., & Valle, X. (2019). Effect of poor cooperation between coaching and medical staff on muscle re-injury in professional football over 15 seasons. Open access journal of sports medicine, 10, 107.
• Gokeler, A., Benjaminse, A., & Dingenen, B. (2020). Return to Play After Sport Injuries. i W. Krutsch, H. O. Mayr, V. Musahl, F. Della Villa, P. M. Tscholl, & H. Jones (Red.), Injury and Health Risk Management in Sports (s. 91-96). Berlin: Springer.
• Hickey, J. T., Timmins, R. G., Maniar, N., Williams, M. D., & Opar, D. A. (2017). Criteria for progressing rehabilitation and determining return-to-play clearance following hamstring strain injury: a systematic review. Sports Medicine, 47(7), 1375-1387.
• Jones, A., Jones, G., Greig, N., Bower, P., Brown, J., Hind, K., & Francis, P. (2019). Epidemiology of injury in English Professional Football players: A cohort study. Physical therapy in sport, 35, 18-22.
• ones, C. M., Griffiths, P. C., & Mellalieu, S. D. (2017). Training load and fatigue marker associations with injury and illness: a systematic review of longitudinal studies. Sports Medicine, 47(5), 943-974.
• Law, G. & Bloyce, D. (2019) ‘Pressure to play?’ A sociological analysis of professional football managers’ behaviour towards injured players, Soccer & Society 20(3), 387-407, DOI: 10.1080/14660970.2017.1321540
• Loose, O., Achenbach, L., Fellner, B., Lehmann, J., Jansen, P., Nerlich, M., Angele P. & Krutsch, W. (2018). Injury prevention and return to play strategies in elite football: no consent between players and team coaches. Archives of orthopaedic and trauma surgery, 138(7), 985-992.
• McCall, A., Carling, C., Davison, M., Nedelec, M., Le Gall, F., Berthoin, S., & Dupont, G. (2015). Injury risk factors, screening tests and preventative strategies: a systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues. British journal of sports medicine, 49(9), 583-589.
• McCall, A., Carling, C., Nedelec, M., Davison, M., Le Gall, F., Berthoin, S., & Dupont, G. (2014). Risk factors, testing and preventative strategies for non-contact injuries in professional football: current perceptions and practices of 44 teams from various premier leagues. British journal of sports medicine, 48(18), 1352-1357.
• McCall, A., Davison, M., Andersen, T. E., Beasley, I., Bizzini, M., Dupont, G., . . . Dvorak, J. (2015). Injury prevention strategies at the FIFA 2014 World Cup: perceptions and practices of the physicians from the 32 participating national teams. British journal of sports medicine, 49(9), 603-608.
• McCall, A., Dupont, G., & Ekstrand, J. (2016). Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams’ head medical officers. British journal of sports medicine, 50(12), 725-730.
• Murphy, P. & Waddington, I. (2007) Are Elite Athletes Exploited?. Sport in Society 10,(2), 239-255, DOI: 10.1080/17430430601147096
• Nesti, M. (2010) Psychology in football: Working with elite and professional players. Routledge.
• Niederer, D., Wilke, J., Vogt, L., & Banzer, W. (2018). Return to play after injuries: A survey on the helpfulness of various forms of assistance in the shared decision-making process in semiprofessional athletes in germany. Archives of physical medicine and rehabilitation, 99(4), 690-698.
• O’Brien, J., Young, W., & Finch, C. (2017). The use and modification of injury prevention exercises by professional youth soccer teams. Scandinavian journal of medicine & science in sports, 27(11), 1337-1346.
• Orchard, J. W. (2001). Intrinsic and extrinsic risk factors for muscle strains in Australian football. The American journal of sports medicine, 29(3), 300-303.
• Owen, A. L., Dunlop, G., Rouissi, M., Haddad, M., Mendes, B., & Chamari, K. (2016). Analysis of positional training loads (ratings of perceived exertion) during various-sided games in European professional soccer players. International journal of sports science & coaching, 11(3), 374-381.
• Paul, D.J., Jones, L. & Read, P. (2022) Shared Decision-Making: Some cautionary observations in the context of elite sport”. Sports Medicine – Open 8(44). https://doi.org/10.1186/s40798-022-00413-2.
• Raysmith, B. P., & Drew, M. K. (2016). Performance success or failure is influenced by weeks lost to injury and illness in elite Australian track and field athletes: a 5-year prospective study. Journal of Science and Medicine in Sport, 19(10), 778-783.
• Read, P. J., Jimenez, P., Oliver, J. L., & Lloyd, R. S. (2018). Injury prevention in male youth soccer: current practices and perceptions of practitioners working at elite English academies. Journal of sports sciences, 36(12), 1423-1431.
• Relvas, H., Littlewood, M., Nesti, M., Gilbourne, D. & Richardson, D. (2010) Organizational Structures and Working Practices in Elite European Professional Football Clubs: Understanding the Relationship between Youth and Professional Domains. European Sport Management Quarterly, 10(2), 165-187, DOI: 10.1080/16184740903559891
• Roderick, M., Waddington, I., & Parker, G. (2000) PLAYING HURT: Managing Injuries in English Professional Football. International Review for the Sociology of Sport 35(2), 165–180. https://doi.org/10.1177/101269000035002003
• Shrier, I., Safai, P., & Charland, L. (2014). Return to play following injury: whose decision should it be? British journal of sports medicine, 48(5), 394-401.
• Shultz, R., Bido, J., Shrier, I., Meeuwisse, W. H., Garza, D., & Matheson, G. O. (2013). Team clinician variability in return-to-play decisions. Clinical journal of sport medicine, 23(6), 456-461.
• Silvers-Granelli, H. J., Bizzini, M., Arundale, A., Mandelbaum, B. R., & Snyder-Mackler, L. (2017). Does the FIFA 11+ injury prevention program reduce the incidence of ACL injury in male soccer players? Clinical Orthopaedics and Related Research, 475(10), 2447-2455.
• Toohey, L. A., Drew, M. K., Cook, J. L., Finch, C. F., & Gaida, J. E. (2017). Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis. Br J Sports Med, 51(23), 1670-1678.
• Van Crombrugge, G., Duvivier, B. M., Van Crombrugge, K., Bellemans, J., & Peers, K. (2019). Hamstring injury prevention in Belgian and English elite football teams. Acta orthopaedica Belgica, 85(3), 373-380.
• Van Der Horst, N., Backx, F., Goedhart, E. A., & Huisstede, B. M. (2017). Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making. British journal of sports medicine, 51(22), 1583-1591.
• Waldén, M., Hägglund, M., Magnusson, H., & Ekstrand, J. (2016). ACL injuries in men’s professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. British journal of sports medicine, 50(12), 744-750.
• Zaffagnini, S., Grassi, A., Muccioli, G. M., Tsapralis, K., Ricci, M., Bragonzoni, L., . . . Marcacci, M. (2014). Return to sport after anterior cruciate ligament reconstruction in professional soccer players. The Knee, 21(3), 731-735.

Comparing Public vs. Private High School Sports-Related Concussions from a Countywide Concussion Injury Surveillance System

George Minoso 2024-03-18T11:04:24-05:00 April 5th, 2024 | General , Research , Sport Training |

Authors: Gillian Hotz 1 , Jacob R. Griffin 2 , Hengyi Ke 3 , Raymond Crittenden IV 4 , Abraham Chileuitt 5

1 Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA 2 KiDZ Neuroscience Center, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA 3 Department of Public Health, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA 4 Department of Neurology, University of Miami Miller School of Medicine, Miami, FL

Gillian Hotz, Ph.D. 1095 NW 14th Ter Miami, FL 33136 [email protected] 305-243-2074

Gillian A. Hotz, PhD is a research professor at the University of Miami Miller School of Medicine and a nationally recognized behavioral neuroscientist and expert in pediatric and adult neurotrauma, concussion management, and neurorehabilitation. Dr. Hotz is the director of the KiDZ Neuroscience Center, WalkSafe, and BikeSafe programs.

Purpose Largely, research on adolescent sports-related concussion (SRC) has focused on public school athletes. SRCs of private school athletes have been studied less and may differ due to differences between school types.

Methods SRCs between Miami-Dade County high school athletes at trained public (n = 1088), trained private (n = 272), and untrained private (n = 79) were compared. Outcomes included days between date of injury (DOI) and clinic date, days between DOI and post-injury ImPACT retest, days withheld, return to play (RTP), ImPACT baseline and post-injury retest completion, and academic accommodation status.

Results Trained public and trained private groups had similar days between DOI and clinic date, days withheld, and percentage who RTP. Differences between the trained public and untrained private groups existed for RTP but not for days between DOI and clinic date or days withheld. Private group athletes were more likely to receive academic accommodations.

Conclusions Public and private high schools trained on the same SRC protocol did not have significantly different outcomes. The untrained private schools, however, had worse outcomes compared to the public group.

Application In Sports SRC outcomes in both public and private high schools may benefit from SRC education, training, an established protocol, and use of a management system.

Keywords : youth athletes, concussion recognition, concussion management, private schools, sports

Each year, an estimated 1.6 to 3.8 million sports-related concussions (SRCs) occur in the United States (1). While the nearly 8 million high school athletes participating in sports annually benefit from the improved social, psychological, and physical health gained from playing sports (2, 3), there is also an ongoing risk of injury due to consistent athlete-exposure (4). SRCs are understandably a concern for high school aged athletes due to the short-term and potentially lifelong behavioral, cognitive, emotional, physical, and psychological effects they can produce (1, 5). These consequences can be particularly worrisome as this population is already experiencing their own ongoing physical and cognitive development changes that can negatively be affected by an SRC (6). Understanding risk factors contributing to adolescent SRCs and what may lead to differences in outcomes is therefore imperative for identifying those most at risk and ensuring the proper management and treatment resources are in place.

Thus far, an overwhelming majority of research on SRCs has focused on or included samples of public high school athletes as opposed to private high school athletes. One example is the High School Sports-Related Injury Surveillance Study, Reporting Information Online (RIO) (7). The High School RIO is an internet-based data collection tool that captures athletic exposures and injury events through athletic trainers (ATs) that report data. It is often used as a source of SRC data for research (4). In the most recent report, nearly 80% of the participating high schools were public with the rest being private (7). Additionally, other studies on SRC incidence and trends have included only athletes from public high schools (8.) The lack of private high school inclusion in adolescent SRC research is an important consideration because known distinctions between public and private high schools possibly lead to differences in SRC incidence and outcomes (4). These include differences in school size, support services and resources, student racial/ethnic backgrounds, rigorous academic programs, and socioeconomics (9).

While there has been recent research that details private high school athlete SRC experiences and reporting behavior (4, 10), there is still a need for continued research into private high school SRC outcomes. Specifically, it would be important to examine how SRC outcomes differ between public and private high schools. Therefore, the purpose of this study was to compare SRC outcomes between public high schools who received specific concussion training and education to private high schools who received the same training and private high schools who did not receive training on the same SRC protocol. The goal of using these three distinct groups was to examine whether differences in SRC outcomes would be a result of differences in SRC education, training, and protocol.

Participants and Procedures

This study included Miami-Dade County (MDC) public and private high school athletes with an SRC that occurred in a practice or game between August 1 st , 2012, and July 31 st , 2022. All athletes were treated at the University of Miami Miller School of Medicine’s Concussion Clinic, UConcussion (UCC). Athletes that sustained an SRC outside of the study period were excluded as well as those with an SRC that did not occur during an MDC public or private high school practice or competition. If an athlete was treated at a provider other than the UCC, they were also excluded. 

 The UCC clinical team hosts an annual SRC training and educational workshop for MDC public high school ATs and athletic directors (ADs). In these workshops, ATs and ADs are trained on how to use the Six Steps to Play Safe protocol (11) and how to administer ImPACT (12) concussion tests. The UCC also makes available specialty concussion clinics where athletes with a suspected SRC can be referred to for management and treatment. The UCC similarly partners with and provides training and education to 8 private high schools within MDC. While athletes at other private high schools within MDC can still be referred to and receive treatment at the UCC, ATs and ADs at these high schools are not provided with the same educational workshops and training on the Six Steps to Play Safe protocol (11). In this study, there were 35 trained public, 8 trained private, and 29 untrained private high schools that were grouped as either “trained public,” “trained private,” or “untrained private,” respectively.              

The Six Steps to Play Safe (11) is a standardized protocol that can be used to manage an athlete’s SRC and safe return to play (RTP) and return to school during recovery (Figure 1). Included in this protocol are, in order, pre-season ImPACT (12) baseline testing, AT sideline testing, post-injury ImPACT testing, SRC clinic follow-up, gradual RTP and return to learn protocols, and SRC injury surveillance form completion.

Variables Reported variables were collected during UCC visits and from surveillance reporting by ATs. Athlete information in the study included demographics and the sport played when the injury occurred. SRC specific information was also reported and included date of injury (DOI), days between DOI and first clinic date, days between DOI and post-injury ImPACT retest, RTP status (yes/no), and days between DOI and RTP (days withheld). To eliminate the few extreme outliers, athletes were only included in days between DOI and first clinic date as well as days withheld mean calculations if the value for these variables was < 120 days. For similar reasons, only athletes with days between DOI and post-injury ImPACT retest < 30 days were included in the calculation. Whether an athlete received academic accommodations was included as a variable because previous research (13) suggests that private high school students experience particularly high levels of stress due to concerns about academic performance and school requests, which potentially impacts whether academic accommodations are prescribed. The percentage of athletes who experienced loss of consciousness (LOC) was also reported because LOC indicates a potentially more severe SRC and is associated with longer recovery than SRCs without LOC (14). Athlete ImPACT (12) baseline testing and post-injury data from the ImPACT test online database was included and used to determine whether athletes had completed a baseline ImPACT test and/or a post-injury ImPACT retest. ImPACT testing comparisons were only included for the trained public and trained private high schools since untrained private high schools either did not use ImPACT or did not grant the UCC access to their records.

Data Analysis Data analysis was performed using R 4.2.2. Athletes sustaining an SRC from MDC public high schools were compared with athletes from private schools between 2012-2022. The eight private schools were particularly selected because they followed a similar protocol and received the same SRC education as the public schools. The other 29 private schools did not receive the training or follow the protocol. For continuous data in the normal distribution like “Age”, mean and standard deviation were reported. For categorical data, such as “Gender”, data was presented as frequency and percentage. For those variables with important clinical significance, such as “Days withheld”, data was reported as median and interquartile range. Propensity score matching was performed to match the public schools with the eight private schools who received similar SRC training. SRC outcomes were therefore compared between trained public and trained private schools before and after matching. This was done to confirm whether one hypothesis, that public and private schools trained on the same SRC protocol would not differ in SRC outcomes, would be true when baseline covariates were and were not controlled for between the groups. Sample T-test was used to detect the significant difference for quantitative data in the normal distribution. The Wilcoxon test was used for quantitative data in non-normal distribution. The Chi-Square test was used to detect significant differences in categorical data. Statistical significance was set at < 0.05.

Participant Demographics A total of 1,088 public, 272 trained private, and 79 untrained private athletes were treated at the UCC during the study period and are included in this study. The average age was similar for each group (16.5 and 16.2). While there were more male than female athletes in all three groups, the percentage of athletes that were female was greater in the trained (38.6%) and untrained (38.0%) private groups than the public group (25.9%). In both the trained and untrained private groups, a greater percentage of athletes were White (28.5% and 25.3%) or Hispanic (62.6% and 68.0%) compared to public athletes (8.0% White, 56.4% Hispanic). The public group instead had a greater percentage of Black athletes (30.9%) than the trained (24.7%) and untrained (6.7%) private groups. Across all three groups, football accounted for the greatest percentage of SRCs but was more prevalent in the public (58.3%) than both private groups (36.4% and 39.2%) (Table 1).

Comparing Trained Public and Trained Private High Schools SRCs Data from trained public and trained private high schools was compared to determine if there were any differences in outcomes between public and private high schools that were trained using the same protocol and program. There were no differences between the groups for days between DOI and first clinic date (P = 0.1), days withheld (P = 0.83), post-injury retest completion (P = 0.06), and RTP (P = 0.30). The average days between DOI and post-injury ImPACT retesting was smaller (P < 0.001) for the public (3 days) than trained private (6 days) group. The public group also had a greater percentage of athletes who completed ImPACT baseline testing (88.5% vs. 80.1%; P < 0.001). The trained private group had a significantly greater percentage of athletes who had academic accommodations (P < 0.001) and experienced LOC (P < 0.001) (Table 2).

After matching, groups had similar demographic characteristics for age, sex, race, grade, and sport (Table 3). Outcomes between the matched groups were also compared, and there were no differences for days between DOI and first clinic date, days withheld, percentage of athletes who completed ImPACT baseline testing and post-injury retesting, and RTP (Table 4). However, average days between DOI and post-injury ImPACT retest was smaller for the public group (4 vs. 6 days, P < 0.001). The public-school group was also more likely to have experienced LOC (P < 0.001) and not receive academic accommodations (P < 0.001).

Comparing Trained Public and Untrained Private High School SRCs Trained public and untrained private groups did not differ in average days between DOI and first clinic date (P = 0.40) or days withheld (P = 0.40). A significantly greater percentage of the public group did RTP (91.9% vs. 81.0%; P = 0.002). More of the athletes in the untrained private group received academic accommodations (P < 0.001) and experienced LOC (P < 0.001) than did the trained public group (Table 5).

Understanding risk factors, whether demographical (e.g., sex, age) or injury event-related (e.g., sport, mechanism of injury), that are associated with differences in SRC outcomes are important for ensuring that those most at risk receive proper SRC treatment and resources. One potential risk factor that was explored in this study was whether an athlete was from a public or private high school. Historically, most research on SRC risk and outcomes has been conducted using public high school athletes (4). This study provides further insight into how SRC outcomes between high school athletes differ based on the type of school attended and if a dedicated SRC protocol and education can help mitigate any differences.

While football accounted for the greatest percentage of SRCs in all three groups, its contribution was roughly 20% percent more in the public group than both private groups. Other sports, including soccer, basketball, and volleyball, were more prevalent in both private school groups. The distribution of sport played during the SRC injury event likely differed between public and private groups because private schools offer a variety of sport options, like crew and sailing, that were not available at public schools. This availability may have impacted the popularity of sports and participation numbers as private school athletes had a greater number of sports to choose from.

To our knowledge, there is only one other study (15) that directly compares SRC experiences between public and private schools. In that study, private school athletes were twice as likely to report a history of SRC compared to public school athletes, but there was no difference in RTP timelines between athletes at the different types of school (15). While the current study did not compare history of SRC between school types, analysis was performed to compare rates of RTP. There was no significant difference between the trained public and trained private school groups for RTP percentage or days withheld (Table 2), similar to the other study that concluded no difference in RTP. After matching, there was still no difference in RTP percentage or days withheld between these groups (Table 4). The untrained private group, however, had significantly less athletes RTP than the trained public group (Table 5). The UCC is a specialized concussion program that provides comprehensive SRC management and treatment, but the program also provides continuing education and a standardized protocol to the trained public and private high schools to better identify, manage, and treat athletes with an SRC (11). Athletes at these participating trained high schools potentially benefited from the coordinated and structured care they receive as a result of these trainings and partnerships, which may have led to better RTP outcomes compared to the untrained private group. These results also suggest that SRC outcomes do not necessarily depend on school type and the systematic differences between public and private schools (4, 9), but instead on AT and AD SRC education and if an SRC protocol is in place and being followed. Additionally, these results also indicate the positive effect an available and established SRC program and protocol with clinicians trained on SRC management and treatment can have on SRC outcomes. Another finding was that the trained public and untrained private groups did not differ in average days between DOI and first clinic date (Table 5). Systematic differences in socioeconomics between public and private high schools (9) may explain why the trained public group did not have significantly fewer average days between DOI and first clinic date than the untrained private group, which was the initial hypothesized result. There is well established evidence (16) that supports a relationship between socioeconomics and access to healthcare, and socioeconomic differences between school type may have led to barriers, including transportation, time, and costs, that delayed public athletes from getting into the UCC (17). Yet, there was also no difference between trained public and trained private groups for average days between DOI and first clinic date in both unmatched and matched comparisons (Tables 2 and 4), suggesting that UCC’s partnership with these schools and the flexibility it provides by offering both on-site and virtual appointments may have alleviated any potential differences. These findings also indicate that educating ATs and ADs on the risks of SRCs leads to quicker identification and subsequent appointments.

The percentage of athletes who received academic accommodations after an SRC was significantly greater for both the trained (unmatched and matched) and untrained private school groups compared to the trained public school group. During recovery from an SRC, athletes may have post SRC symptoms that can interfere with their ability to participate and function in the classroom setting (18). Consequently, return to learn protocols and academic accommodations are often provided to the athlete to help reintegrate them into classes but also prevent worsening symptoms (19, 20). Previous research (13) shows that private school students face a particularly high level of academic pressure, potentially due to more rigorous academic programs (9), which could explain why a greater percentage of private groups in this study received more academic accommodations. These additional academic accommodations may have been provided to reduce the burden private group athletes felt about their academic responsibilities or at the request of academic advisors employed at these schools. However, it is important to ensure that all athletes with a sustained SRC receive any appropriate and necessary academic accommodation, regardless of school type attended, to prevent further symptom development.

Limitations This study is not without limitations. All participants in this study were athletes that attended a public or private high school in MDC. Results may not be generalizable to other playing levels, like youth, middle schools, and college, nor to public or private high schools in other counties. Additionally, while other counties may have their own SRC surveillance system, they may not have a program, such as the UConcussion program, that provides ATs with additional SRC training and encourages timely, accurate reporting. A larger sample population in all three groups would have also been beneficial and provided more evidence on the impact of SRC education and protocol on SRC outcomes in the high school setting.

Public and private high school groups trained on the same SRC protocol did not have significantly different SRC outcomes. The untrained private high school group, however, had worse SRC outcomes compared to the public school group, suggesting that SRC outcomes in the high school setting may benefit from education, training, and an established SRC protocol and program and not on whether the school is public or private.

Applications In Sport

An inherent risk of playing sports is injuries, and SRCs are a particularly concerning injury for high school athletes, especially those playing contact sports. Ensuring those responsible for helping to manage SRCs in high schools are educated about SRCs is important, and a collaborative approach to treating and managing SRCs has been recommended (20). As suggested by this study, all high school personnel involved with athletics should be offered SRC management training and education to help improve outcomes of those that sustain an SRC. Additionally, an SRC protocol, like the Six Steps to Play Safe (11), should be established and can include:

• Pre-season baseline testing, using computer-based tests such as ImPACT (12)
• Sideline testing after a potential SRC injury (SCAT5, Balance Error Scoring System (BESS), etc.)
• Post-testing after a suspected SRC (to compare neurocognitive scores to pre-season baseline tests)
• Clinic appointments with a healthcare professional trained in SRC who can evaluate tests and make recommendations
• Gradual RTP and return to learn protocol after the athlete has been examined by a professional and is asymptomatic
• Injury surveillance system reporting by ATs

ACKNOWLEDGEMENTS The authors would like to thank: Dr. Kaplan and the UHealth Sports Medicine Clinic and Staff, the Division of Athletics and Activities for the Miami-Dade County Public Schools, all Miami-Dade County High School Certified Athletic Trainers, previous UConcussion team members, Dr Kester Nedd who served as medical director of the program from 2012 to 2019, current medical director Dr. Abraham Chileuitt, and The Miami Dolphin Foundation for supporting countywide ImPACT testing and educational workshops. We also want to thank David Goldstein and the Goldstein Family for the development of the Countywide Concussion Care Program and their initial and continued support. The project was supported by the University of Miami Clinical and Translational Science Institute.

• Langlois, J. A., Rutland-Brown, W., & Wald, M. M. (2006). The epidemiology and impact of traumatic brain injury: A brief overview. The Journal of Head Trauma Rehabilitation, 21(5), 375-378. 10.1097/00001199-200609000-00001
• Participation in high school sports registers first decline in 30 years. (n.d.). https://www.nfhs.org/articles/participation-in-high-school-sports-registers-first-decline-in-30-years/
• Eime, R. M., Young, J. A., Harvey, J. T., Charity, M. J., & Payne, W. R. (2013). Systematic review of the psychological and social benefits of participation in sport for adults: Informing development of a conceptual model of health through sport. International Journal of Behavioral Nutrition and Physical Activity, 10(1), 135. 10.1186/1479-5868-10-135
• Daugherty, J., Waltzman, D., Snedaker, K. P., Bouton, J., Zhang, X., & Wang, D. (2020). Concussion experiences in new england private preparatory high school students who played sports or recreational activities. The Journal of School Health, 90(7), 527-537. 10.1111/josh.12899
• Tator, C. H. (2013). Concussions and their consequences: Current diagnosis, management and prevention. Canadian Medical Association Journal (CMAJ), 185(11), 975-979. 10.1503/cmaj.120039
• Daneshvar, D. H., MA, Riley, D. O., SB, Nowinski, C. J., AB, McKee, A. C., MD, Stern, R. A., PhD, & Cantu, R. C., MD. (2011). Long-term consequences: Effects on normal development profile after concussion. Physical Medicine and Rehabilitation Clinics of North America, 22(4), 683-700. 10.1016/j.pmr.2011.08.009
• Injury & amp; violence prevention center (IVPC). University of Colorado Denver | Anschutz Medical Campus. Accessed June 9, 2023. https://coloradosph.cuanschutz.edu/research-and-practice/centers-programs/ivpc/research-practice/research-projects#ac-rio-study-reports-1.
• Lincoln, A. E., Caswell, S. V., Almquist, J. L., Dunn, R. E., Norris, J. B., & Hinton, R. Y. (2011). Trends in concussion incidence in high school sports. The American Journal of Sports Medicine, 39(5), 958-963. 10.1177/0363546510392326
• Choy SP. Public and Private Schools: How Do They Differ? National Center for Education Statistics, U.S. Dept. of Education, Office of Educational Research and Improvement; 1997.
• Waltzman, D., Daugherty, J., Snedaker, K., Bouton, J., & Wang, D. (2020). Concussion reporting, return to learn, and return to play experiences in a sample of private preparatory high school students. Brain Injury, 34(9), 1193-1201. 10.1080/02699052.2020.1793388
• Lopez AD, Schnayder M, Pomares B, Siegel J, Nedd K, Hotz G. Academic Accommodations for a Countywide Concussion High School Program. The Sport Journal. 2017.
• Impact concussion test: Impact applications. ImPACT Concussion. January 3, 2023. Accessed June 9, 2023. https://impactconcussion.com/.
• Leonard, N. R., Gwadz, M. V., Ritchie, A., Linick, J. L., Cleland, C. M., Elliott, L., & Grethel, M. (2015). A multi-method exploratory study of stress, coping, and substance use among high school youth in private schools. Frontiers in Psychology, 6, 1028. 10.3389/fpsyg.2015.01028
• Kelly, J. P. (2001). Loss of consciousness: Pathophysiology and implications in grading and safe return to play. Journal of Athletic Training, 36(3), 249-252. https://www.ncbi.nlm.nih.gov/pubmed/12937492
• Post, E. G., Snedden, T. R., Snedaker, K., Bouton, J., & Wang, D. (2021). Differences in sport-related concussion history, reporting behavior, and return to learn and sport timelines in public versus private high school student athletes. Brain Injury, 35(5), 596-603. 10.1080/02699052.2021.1890217
• McMaughan, D. J., Oloruntoba, O., & Smith, M. L. (2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health, 8, 231. 10.3389/fpubh.2020.00231
• Love, H., Panchal, N., Schlitt, J., Behr, C., & Soleimanpour, S. (2019). The use of telehealth in school-based health centers. Global Pediatric Health, 6, 2333794-2333794X19884194. 10.1177/2333794X19884194
• McGrath, N. (2010). Supporting the student-athlete’s return to the classroom after a sport-related concussion. Journal of Athletic Training, 45(5), 492-498. 10.4085/1062-6050-45.5.492
• Carson, J. D., Lawrence, D. W., Kraft, S. A., Garel, A., Snow, C. L., Chatterjee, A., Libfeld, P., MacKenzie, H. M., Thornton, J. S., Moineddin, R., & Frémont, P. (2014). Premature return to play and return to learn after a sport-related concussion: Physician’s chart review. Canadian Family Physician, 60(6), e310, e312-e310. https://www.ncbi.nlm.nih.gov/pubmed/24925965
• McCrory, P., Meeuwisse, W., Dvořák, J., Aubry, M., Bailes, J., Broglio, S., Cantu, R. C., Cassidy, D., Echemendia, R. J., Castellani, R. J., Davis, G. A., Ellenbogen, R., Emery, C., Engebretsen, L., Feddermann-Demont, N., Giza, C. C., Guskiewicz, K. M., Herring, S., Iverson, G. L., . . . Vos, P. E. (2017). Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in berlin, october 2016. British Journal of Sports Medicine, 51(11), 838-847. 10.1136/bjsports-2017-097699

An analysis of the factors impacting win percentage and change in win percentage in women’s Division 1 college lacrosse

George Minoso 2024-04-01T07:01:38-05:00 March 22nd, 2024 | General , Research , Sport Training , Sports Management |

Authors: Christiana E. Hilmer 1

1 Department of Economics, San Diego State University, San Diego, CA

Christiana Hilmer, PhD 5500 Campanile Drive San Diego, CA 92182-4485 [email protected] 619-301-9388

Christiana E. Hilmer, PhD, is a Professor of Economics at San Diego State University in San Diego, CA. Her research interests include the economics of sports, applied econometrics, labor economics, and resource and environmental economics.

What factors in women’s NCAA Division 1 college lacrosse led to an increase in win percentage in a single season and a change in win percentage across two consecutive seasons? Do these factors differ between teams at the top and the bottom ends of the win distributions? Using data from the 2023 and 2022 lacrosse seasons, we find that goals, assists, unassisted goals, and participation in the NCAA Championship tournament have a positive impact on win percentage, while opponent’s goals and if the team was new in 2023 have a negative impact on win percentage. The most crucial factor that explains the change in win percentage between the 2022 and 2023 lacrosse seasons is an improvement in the change in total shots ratio, while changes in attacking efficiency and defending efficiency are also important, all together explaining 58% of the variation. Teams at the bottom of the distributions have similar characteristics for both win percentage and change in win percentage as those teams in the middle and the top of the distributions, although there are some slight differences in the magnitudes of the statistically significant variables. These results suggest that lacrosse players and coaches should focus on obtaining additional goals and assists while concurrently minimizing the opponent’s goals to increase win percentage and changes in win percentage.

Keywords : distributional impacts, quantile regression, women’s college lacrosse

Since the advent of sabermetrics pioneered by Bill James and the popularity of Lewis’s (5) Moneyball, the use of statistics to analyze sports has exploded in popularity. Reep and Benjamin (7) applied statistical analysis to team-wide factors in soccer where they investigated how the passing skill and position of a player on the field impacts goals. When analyzing a team’s performance, it is essential to determine which factors lead to a team’s success. Most research in this field has focused on professional sports. Busca et al. (1) examine eleven high-stakes international soccer tournaments to determine where a penalty kick is most likely to be struck. Pelechrinis and Winston (6) develop a framework that is comprised of publicly available data to determine the expected contribution of an individual professional soccer player to the probability of his team winning the game. Alberti et. al. (1) examine goal-scoring patterns in four different professional soccer leagues and find that the majority of goals are scored in the second half of the game with the most goals being scored in the last fifteen minutes of play. Castellano et. al. (3) analyze professional soccer match statistics to determine which factors impact winning, drawing, and losing a game and find that shots, shots on goal, and ball possession are important on the offensive end of the field, while total shots received and shots on target received are important on the defensive end of the field. A notable departure from research that focuses on professional soccer is Joslyn et al. (4), who examines the factors that improve the change in win percentage in men’s Division 1 (D1) college soccer. They find that improving shots, attacking, and defending positively impact the change in win percentage between two consecutive seasons.

This research utilizes the tools found in the team-focused literature from soccer and extends it to lacrosse. Soccer and lacrosse have many similarities, especially regarding possession, assists, goals, and defense. There are also marked differences between the two sports in addition to the obvious one: in soccer the ball is kicked while in lacrosse the ball is played with a net attached to a stick. Lacrosse is a higher-scoring game due to the presence of a 90-second shot clock and defending a women’s lacrosse player is more difficult in lacrosse than it is in soccer. One reason for this is that in lacrosse it is a foul to “move into the path of an opponent without giving the opponent a chance to stop or change direction, and causing contact” (page 51, 2022 and 2023 NCAA Women’s Lacrosse Rules Book (6)), while there is no such rule in soccer. Another reason is due to a rule in women’s lacrosse called shooting space (page 54, NCAA 2022 and 2023 Women’s Lacrosse Rules Book (6)), which states that “with any part of one’s body, guarding the goal outside or inside the goal circle so as to obstruct the free space to goal, between the ball and the goal circle, which denies the attack the opportunity to shoot safely and encourages shooting at a player” while soccer does not have a comparable rule. According to NCAA Statistics (7), the average number of goals per game scored in D1 women’s college lacrosse in 2023 was 12, while the average number of goals per game scored in D1 women’s college soccer in 2023 was 1.39. Another notable difference between lacrosse and soccer is that the offside rules are very different. The offsides rule in lacrosse states that there must be at least five defenders behind their defensive restraining line and at least four offensive players behind their offensive restraining line (page 61, NCAA 2022 and 2023 Women’s Lacrosse Rules Book (6)). The offsides rule in soccer is much less stringent and it states that when in the opponent’s half of the field “the player is not closer to the opponent’s end line than at least two opponents” (page 52, NCAA 2022 and 2023 Soccer Rules Book (7)). These disparities between lacrosse and soccer may result in differences in which factors impact win percentages and changes in win percentages.

This research examines which factors lead to an increase in win percentage and change in win percentage for women’s Division 1 college lacrosse teams. We also seek to determine if these factors differ among teams in the 25th, 50th, and 75th percentiles for win percentage and the change in win percentage. Using data from the 2023 women’s D1 college lacrosse season, we explain 86% of the variation in win percentage. Goals, unassisted goals, and participation in the NCAA Championship tournament have a statistically significant positive impact on win percentage, while opponent’s goals and if the team was new in 2023 have a statistically significant negative impact on win percentage. The most crucial factor explaining the change in win percentage between the 2022 and 2023 lacrosse seasons is an improvement in the change in total shots ratio, while changes in attacking efficiency and defending efficiency are also statistically significant, all together explaining 58% of the variation. The variables that explain both win percentage in a single season and the change in win percentage between seasons are similar between the 25th, 50th, and 75th percentiles. This suggests that teams at the bottom of the distributions should focus on the same factors as those at the top when they seek to improve during a season and between seasons.

Data Source Win percentage was collected from the National Collegiate Athletic Association (NCAA) archives for the 2023 and 2022 seasons. A win was awarded one point while a loss was awarded zero points. Offensive and defensive statistics for the 2023 and 2022 seasons were collected from each University’s women’s lacrosse website housed in the season’s cumulative statistics. It is important to note that these data are provided by individual institutions and therefore the statistical findings of this research is dependent on the accuracy of the information provided by each school. In addition to winning percentage, data was collected on goals, assists, shots, opponent’s goals, opponent’s shots, unassisted goals, ground balls, turnovers, caused turnovers, draw controls, whether the team was new to NCAA D1 lacrosse in the 2023 season, and if the team made the NCAA Championship tournament in 2023. Of the 126 D1 women’s lacrosse teams, 123 had information on every variable listed above.

Variables and Distributions

This analysis aims to determine what factors impact a single season winning percentage and which factors impact the change in win percentage across two consecutive seasons. Figure 1 is a histogram of win percentage for the 2023 women’s lacrosse season. The average win percentage was close to 50% at 48.27%; the minimum win percentage was 0 for the two teams that lost every game during the season, while the maximum win percentage was from a team that won 95.65% of their games. The team with the second-highest win percentage won the 2023 NCAA National Championship tournament.

Summary statistics for the 2023 D1 women’s lacrosse 2023 season are found in table 1. The average number of goals and opponent’s goals nearly offset each other at 211 and 210, respectively. There was an average of 495 shots with a large standard deviation of 105. Below half the goals were aided by an average of 92 assists, while over half of the goals resulted from an average of 119 unassisted goals. There were nearly twice as many turnovers as there were caused turnovers, 7% or a total of 8 teams were new D1 lacrosse teams in 2023, and 24% of the D1 lacrosse teams made the NCAA end-of-season tournament.

Figure 2 contains a histogram of win percentage change, which is constructed by taking the win percentage in the 2023 lacrosse season and subtracting the win percentage in the 2022 lacrosse season. There are fewer observations in the change in win percentage because the seven teams who were new in the 2023 season did not have any statistics for the 2022 season. On average, most teams had a similar win percentage in 2023 as they did in 2022, with an average change in the win percentage of .16. The team with the lowest change in win percentage between the two seasons of -51.47 had a win percentage of 75% in 2022, dropping to 24% in 2023. At the other end of the spectrum, the team with the highest change in win percentage won 12% of their games in 2022 and improved to winning 50% of their games in 2023.

Following Joyce et al. (4), we construct three measures of team success to explain the change in winning percentage: total shots ratio, attaching scoring efficiency, and defending scoring efficiency. The first measure, total shots ratio, is constructed as

The total shots ratio in both 2022 and 2023 is .5, which means, on average, teams are matching their opponent’s shots with their own shots with a range in values from .23 to .7 in 2023 and .3 to .63 in 2022.  This finding for lacrosse compares favorably to what Joyce et al. (4) found for D1 college soccer, where the total shots ratio ranged from .24 to .69 in D1 men’s soccer.

            The second measure of team success is attacking scoring efficiently or goals to shots ratio.

The average attaching scoring efficiency for 2023 and 2022 was .42. This measure had a relatively smaller variability than the total shots ratio, with a minimum of around .3 for both years and a maximum of .5 in 2023 to .58 in 2023. This maximum means that the teams with the highest attacking scoring efficiency earn an average of one goal for every two shots. Being able to convert shots into goals is an essential aspect of winning games. Lacrosse teams are much more likely to convert shots into goals, as Joyce et al. (4) found an average attacking scoring efficiency of .1 or 1 goal for every ten shots in D1 men’s soccer.

The third measure of team success is the defending scoring efficiency, which is contracted as

This final measure determines if teams can prevent opponents from turning shots into goals. The average values for defending scoring efficiency are slightly higher than attaching scoring efficiency, with an average of .43 in 2023 and .44 in 2022. The variability is higher for defending scoring efficiency than attacking scoring efficiency, with a minimum of .31 in 2023 and .34 in 2022 and a maximum of .66 in 2023 and .77 in 2022. Teams that are better at preventing shots from being converted into goals typically have a higher win percentage.

Regression Model The first step in our regression analysis is to empirically estimate the degree to which offensive and defensive statistics impact the win percentage for the 2023 lacrosse season. The win percentage regression model takes the form:

            The second part of the analysis follows Joyce et. al. (4) to determine what factors impact the change in win percentage between the 2023 and 2022 lacrosse seasons.  The regression model is as follows

where ε_i is the error term and i is the individual women’s lacrosse team. As with the individual season analysis, this model is estimated using ordinary linear regression and quantile regression at the 50th, 25th, and 75th percentiles.

Table 3 contains the results for the estimation of equation (4) from the 2023 lacrosse season with robust standard errors in parentheses. Looking first at the results from the ordinary least squares model, 86% of the variation in win percentage is explained by the 11 independent variables. Turning to the variables that are statistically significant, each additional goal results in an increase of .18 in win percentage, while each opponent’s goal results in a decrease of .2 in win percentage, with goals and opponent’s goals nearly offsetting each other. On average, one additional unassisted goal results in an increase of .13 in win percentage. Being a new D1 women’s lacrosse team in 2023 results in a 9 point marginally statistically significant decrease in win percentage relative to teams that have been in the league in previous years. This result suggests that new D1 teams have a difficult time navigating their first year likely due to players and coaches lacking experience and chemistry, making obtaining wins more difficult. Women’s lacrosse teams who participated in the 2023 NCAA Championship Tournament have a statistically significant almost 5 point higher win percentage than those who did not participate in the tournament. This finding is not surprising given that the two ways to get a team into the tournament are to either receive an automatic bid by winning their conference tournament or earn an at-large bid by having a compelling enough record during the regular season and conference playoffs.

The last three columns of table 3 contain quantile regression results at the 50th, 25th, and 75th percentiles of the win percentage distribution. Opponent’s goals are the only statistically significant factor to explain wins across all three percentiles. The magnitude of opponent’s goals is largest at the 25th percentile at -.24 and is -.20 for both the 50th and 75th percentile. Teams at the 25th and 50th percentiles of the win percentage distribution that participates in the NCAA end-of-season tournament has a statistically significant 7 point and 6 point higher win percentage, respectively, relative to those who did not participate, while this variable is not statistically significant at the 75th percentile. This may be because most, 73%, of the tournament participants come from the teams at the top 25% of the win percentage distribution, while most teams at the middle and bottom of the distribution did not participate in the tournament. Aside from this difference, the results are similar between the models at the three points in the win percentage distribution.

Table 4 contains the second part of the regression analysis which estimates equation (5) that attempts to determine what factors impact the change in win percentage between the 2023 and 2022 seasons. The variables contained in this analysis mimic those in Joyce et. al. (4) for men’s D1 college soccer. Looking at the OLS results, teams that had a one unit increase in the change in total shots ratio between the two seasons had a 2.4 increase in the change in win percentage. Teams with a 1 unit increase in the change in attacking efficiency had a 1 unit increase in the change in win percentage, and teams with a one unit increase in the change in defending efficiency decreased the change in win percentage by 1.2 points. The statistical significance between these lacrosse results and those found for soccer by Joslyn et al. (4) are identical, suggesting that even though there are many differences between the two sports, the same factors are important in explaining the change in win percentage between consecutive years. Comparing magnitudes between the two applications is not possible because the estimation methods differed. The statistical significance of the variables included in the quantile regression evaluated at the 50th, 25th, and 75th percentiles were the same as in the OLS regression. The quantile regression performed at the 25th percentile of the change in win percentage had the highest impact for the change in total shots ratio and the change in attacking efficiency, while the change in defending efficiency had the smallest impact. The change in total shots ratio and the change in attacking efficiency had the smallest impact for those teams at the 75th percentile, while the change in defending efficiency had the largest impact for those teams at the 50th percentile. These results suggest that the factors that impact the change in win percentage are similar across teams at the bottom and the top of the change in win percentage distribution, although the marginal impacts differed slightly between the percentiles.

It is not surprising that additional goals led to an increase in win percentage and an increase in opponent’s goals led to a decrease in win percentage. However, it was unanticipated that many of the other offensive and defensive statistics included in the regression were not statistically significant. It is likely that these other factors either lead to the team’s ability to score goals, such as shots, ground balls, and caused turnovers, or lead to the opponent’s goals, such as turnovers. One drawback of this research is that it does not investigate how these other factors impact goals and opponent’s goals. One adage in lacrosse is “win the draw, win the game.” Even though draw controls are not statistically significant in explaining win percentage, there was no information contained in the box scores on how many goals were obtained when the team won the draw control or how many goals were conceded when the team lost the draw control. More detailed information would be needed to investigate this relationship further. Other factors that likely explain win percentage and changes in win percentage such as team chemistry, the presence of a star player, the experience of the players and the coaches, and how different game management strategies, such as the usage of substitutes and quickness of play, are not included because they are difficult to measure, not included in the box scores, or both.

For a lacrosse coach or lacrosse player who is looking to improve win percentage between seasons, it is comforting to note that focusing on improving the changes in total shots ratio, attacking scoring efficiency, and becoming better at defending by decreasing the opponent’s goal-to-shot ratio will lead to an increase in the change in win percentage. One major drawback of this research is that it does not point to the factors that cause improvements in these variables and how they feed into additional goals or fewer conceded goals.

This study is the first to analyze which factors impact win percentage and changes in win percentage for NCAA D1 women’s lacrosse. The regression results suggest that goals, unassisted goals, and those who competed in the NCAA tournament had a positive impact on win percentage, while opponent’s goals and teams that were new in 2023 had a negative impact on win percentage. These factors were similar across the distribution of win percentage at the 25th, 50th, and 75th percentiles. Changes in win percentage between the 2023 and 2022 seasons are positively impacted by the change in the total shots ratio and attacking scoring efficiency and negatively impacted by the change in defending scoring efficiency. Even though there are many differences between lacrosse and soccer, the findings of this research and those of Joyce et. al. (4) that focus on college soccer suggest that the factors that explain changes in win percentage are similar between the two sports. These results also suggest that the statistics that explain win percentage and change in win percentage are similar between teams at the bottom, at the middle, and at the top of the distributions.

Women’s lacrosse programs at the collegiate level as well as at the national level can use these results to determine which factors to focus on when attempting to improve their win percentage within a specific year or over the course of several years. This research suggests that teams should emphasize their efforts in practice and in games on factors that increase goals as well as those factors that prevent goals. The lack of empirical analysis at the collegiate level, especially for women’s sports, can be rectified using available data. Additional publicly available information would make individual game analysis more informative such as how winning a draw control impacts goals as well as how focusing on specific factors such as caused turnovers or increasing assists increases goals and therefore positively impacts a team’s chances of winning.

• (1) Alberti, G., Iaia, F. M., Arcelli, E., Cavaggioni, L., Rampinini, E. (2013). Goal scoring patterns in major European soccer leagues. Sport Sciences for Heath, 9(3), 151-153.
• (2) Buscà, B., Hileno, R., Nadal, B., & Serna, J. (2022). Prediction of the penalty kick direction in men’s soccer. International Journal of Performance Analysis in Sport, 22(4), 571–582.
• (3) Castellano, J., Casamichana, D., Penas, C. (2012). The use of match statistics that discriminate between successful and unsuccessful soccer teams, Journal of Hunan Kinetics, 31, 137-147.
• (4) Joslyn, M.R., Joslyn, N. J. & Joslyn, M. R. (2017). What delivers an improved season in men’s college soccer? The relative effects of shots, attacking and defending scoring efficiency on year-to-year change in season win percentage. The Sport Journal, 24, 1-12.
• (5) Lewis, M. (2004). Moneyball: The art of winning an unfair game. WW Norton & Company.
• (6) NCAA 2022 and 2023 Women’s Lacrosse Rule Book. https://www.usalacrosse.com/sites/default/files/documents/Rules/WLC23.pdf
• (7) NCAA 2022 and 2022 Soccer Rules Book. https://www.ncaapublications.com/productdownloads/SO23.pdf
• (8) NCAA Statistics, Women’s Lacrosse and Women’s Soccer http://stats.ncaa.org/rankings/conference_trends
• (9) Pelechrinis, K., & Winston, W. (2021). A Skellam regression model for quantifying positional value in soccer. Journal of Quantitative Analysis in Sports, 17(3), 187–201.
• (10) Reep, C., & Benjamin, B. (1968). Skill and chance in association football. Journal of the Royal Statistical Society. Series A (General), 131(4), 581-585.
• (11) Waldmann E. (2018). Quantile regression: A short story on how and why. Statistical Modelling. 18(3-4): 203-218.

Can there be two speeds in a clean peloton? Performance strategies in modern road cycling

George Minoso 2024-02-22T11:24:51-06:00 February 23rd, 2024 | Research , Sport Education , Sport Training , Sports Coaching , Sports Health & Fitness , Sports Medicine , Sports Nutrition |

Authors: Karsten Øvretveit 1

1 K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing,

K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway, PB 8905, N-7491 Trondheim, Norway [email protected]

Karsten Øvretveit, MSc3, is a physiologist and PhD candidate at the Norwegian University of Science and Technology (NTNU). His research areas include genetic disease risk, physical performance, motivational dynamics, and human nutrition.

In the history of professional cycling, riders have always sought competitive advantages. Throughout 20th century, many relied on performance-enhancing drugs (PEDs) which gave rise to a phenomenon called “two-speed cycling”. Throughout its modern era, professional cycling has seen anti-doping efforts repeatedly intensify on the heels of several large doping scandals. Over the past decade, the sport appears to have transitioned away from large-scale systematic doping and towards novel, legal performance-enhancing strategies, facilitated by a close relationship with scientific, technological, and engineering communities. The tools and technologies available to assess the demands of the sport, the capabilities of the riders, and the role of environmental factors such as wind resistance, altitude, and heat are more refined and comprehensive than ever. Teams and riders are now able to leverage these to improve training, recovery, equipment, race tactics and more, often from a very early age. This review explores several key developments in road cycling and their implications for the modern professional peloton.

Key Words: professional cycling; performance-enhancing drugs; marginal gains; performance analysis

The main pack of riders navigating the road in a cycling race, known as the peloton, comprises a wide range of physiological, anthropometrical, technical, and strategical attributes. The role of each rider in a given race is typically based on strengths, weaknesses, and objectives, and can be modified by injuries, fitness level, personal goals, and unexpected in-race developments. The concept of “cycling at two speeds”, cyclisme à deux vitesses, has historically been used to distinguish between chemically enhanced riders and those who ride clean (134). However, despite increasingly stringent doping controls in professional cycling along with a clear shift in doping culture, the concept of two-speed cycling remains. Given the well-documented benefits of performance-enhancing drugs (PEDs), there is an expectation that the intensification of anti-doping measures in professional cycling leads to more homogeneous performance levels in the peloton by reducing the number of artificially enhanced riders. Although this may be a reasonable assumption, it discounts the many substantial advances made in training, nutrition, technology, and strategy, as well as the growing talent pool of potential professionals and the early age at which they begin to seriously structure their training, racing, and recovery. These factors can differ greatly between teams and individual riders and thus help maintain the two-speed phenomenon. This review provides a brief history of the PED culture and use in professional cycling, followed by an examination of some of the key developments in the sport that has helped preserve the two-speed phenomenon in a peloton riding within an increasingly strict anti-doping framework.

The performance-enhanced past of the peloton

Drugs have been used to enhance athletic performance for millennia, stretching back to at least the ancient Olympic Games (16). Cycling as a profession emerged among working-class men who likened endurance sports to physically demanding jobs where the use of drugs to aid performance was considered the right thing to do (58). Indeed, doping has been pervasive in professional cycling for over 150 years, throughout most of which it was either legal or not subject to testing (34). For decades, riders doped to simply be able to do the job – faire le métier (33). Then, athlete health became a concern and a major driving force to regulate, if not outright ban the use of certain substances. Drug testing in the Tour de France (TdF), the most prestigious event on the race calendar, began in 1966. Despite this, amphetamines, cortisone, and steroids remained widespread in the professional peloton. It was also around this time that rumors about the use of blood transfusions in athletes began (60). The year after Raymond Poulidor underwent the first drug test in the TdF, Tom Simpson collapsed on the ascent of Mount Ventoux and later passed away due to an unfortunate combination of alcohol, amphetamines, intense heat, and extreme physical exertion. Although this event brought more attention to the use of stimulants and other drugs in cycling and in sports in general (69), doping would persist for decades to follow. Based on interviews with riders on a professional cycling team at the turn of the millennium, psychiatrist Jean-Christophe Seznec (115) asserted that professional cyclists are not only prone to develop an addiction to PEDs, but also recreational drugs, noting the importance of explicitly acknowledging this risk in order to mitigate it.

When professional cycling entered the 90s, the banned yet at that time undetectable erythropoiesis-stimulating agent (ESA) recombinant human erythropoietin (rHuEPO) arrived in the peloton (101), and performances hit a new level. Increasing circulating erythropoietin (EPO) by illegal means has been perceived by some riders and coaches to give an estimated performance boost, without the term “performance” being strictly defined, of 3% to 20% (31, 100, 134, 138). Interestingly, despite its popularity in the peloton, the research literature on the effects of ESAs such as rHuEPO on endurance performance is equivocal. Its effects on hematological values like hemoglobin concentration ([Hb]) and clinical measurements of power and maximal oxygen uptake (V̇O2max) are well-established, but the real-world benefits are not always clear (116, 123).

There are several aspects of professional cycling that are difficult to account for in experimental studies on exogenous EPO, such as the extremely high fitness level of a peaked professional cyclist and the physiological impact of training and racing on parameters such as Hb . A recent randomized controlled trial found no apparent benefit of EPO on relevant performance markers has sometimes been cited to shed doubt on the true effects of the drug (47). However, this study was done in cyclists with an average V̇O2max of 55.6 mL/kg/min, which is substantially lower than their professional counterparts (124). By his own account, former professional Michael Rasmussen saw his hematocrit (Hct) drop from 41% to 36% following the 2002 Giro d’Italia (98), illustrating how blood composition can be severely perturbed by training and racing. Similar values have been observed in other professionals following participation in Grand Tours (17, 89). Using Rasmussen as an example, using rHuEPO to bring this up to 49%, just below the old 50% limit, would represent a relative Hct increase of 36% and result in improved ability to maintain a much higher intensity in training and racing, and consequently greater exercise-induced adaptations.

Throughout the 90s, Grand Tour riders with supraphysiological Hct would traverse France, Italy, and Spain at impressive speeds until it all seemingly came to an end in 1998. Three days before the start of the 85th edition of the TdF, a Festina team car carrying various PEDs was stopped by customs agents at the French-Belgian border. This event marked the start of what later became known as the Festina affair, a major catalyst in cycling’s transition to a cleaner sport. The wake of this scandal saw an increasing number of calls to action against doping, including by the driver of the Festina car (132), with claims of the sport dying unless drastic action is taken. Subsequent large-scale doping cases such as Operación Puerto and the contents of the USADA’s Reasoned Decision Report (10) served as reminders that PEDs were still present in the peloton and strengthened the resolve of those fighting for a cleaner sport. Although riders are often blamed for the pervasive drug use in cycling, most entered a sport with a lack of top-down anti-doping efforts, leaving them with the difficult choice of either conforming to the culture or competing on unequal terms. One of the most crucial steps towards a cleaner sport is a change in culture among teams and riders. Much, if not most, of the credit should go to the riders themselves, many of which have actively pushed against the use of PEDs for years (46, 50, 59, 85, 130). Today, most doping cases in cycling are among semi-professional riders, whereas the number of riders testing positive at the highest level is approaching zero (88).

Although absence of evidence is not evidence of absence, fewer doping cases at the highest level of cycling suggests that overt, systematic drug use is a thing of the past. Given professional cycling’s checkered history, it would be naïve to think that doping has been eliminated entirely, but the sport does appear to have evolved beyond doping being perceived as all but necessary to gain entry into the professional peloton. Generational shifts not only among riders, but also among governing bodies and team leadership have contributed to an overall firmer stance against doping, removing potentially significant contributors to anti-doping violations (6). There is also indications that the post-Armstrong generation, especially those who started their careers young, are less likely to use PEDs (5), although the evidence is equivocal (64). Additionally, anti-doping technology continues to improve, with recent advances such as gene expression analysis being able to extend the detection window of blood manipulations (28, 133).

Conceptual approaches to legal performance development

It could be argued that the extraordinary performances regularly being on display by the current generation of riders suggest that the dismantling of systematic doping practices has led to progression rather than regression of the sport of cycling. The transition away from prevalent PED use has forced teams and riders to seek out other areas of improvement, some with barely measurable effects, to keep up. Although seeking improvements in many areas is not a new phenomenon in professional cycling, it has received increasing attention over the past decade with the success of Team Sky, now INEOS Grenadiers, and team director, Dave Brailsford, who called this concept “marginal gains”. Brailsford and his team set out to win the TdF within five years with a clean British rider (29). To achieve this, he brought with him the approach he used as a performance director for British Cycling, which had led to considerable success in track cycling. Team Sky was established on the back of British dominance in the Laoshan velodrome during the 2008 Beijing Olympics, where they took home seven gold medals. As he transitioned from the track to the road, Brailsford brought the idea that compiling enough marginal gains could provide a greater performance advantage than PEDs (87).

Although the marginal gain concept came to prominence with Team Sky during one of professional cycling’s most recent avowed shift from banned to legal performance-enhancing strategies, it has been practiced by cyclists since at least the mid-1900s. Italian Fausto Coppi, who rode to multiple victories in the TdF and Giro d’Italia, as well as in one-day classics throughout the 40s and early 50s, was an early adopter of novel diet and training approaches. After World War II, the sport of cycling was anything but advanced and Coppi set out to change that. He worked with Bianchi to develop bikes and other equipment; he adapted his diet to better fuel his riding – not only its contents, but also the timing and amount; and he explored strategies for how to best race as a team (37). Some of these developments would later influence other greats, such as Eddie Merckx, who, among other things, was obsessed with proper bike fit (38). Current director of the French national team, Cyrille Guimard, has also long been known for his application of cutting-edge technology and training methods. One of his former riders, Laurent Fignon, described him as being “right up-to-date. He had files for everything. He was interested in all the lates training methods. Where his protégés were concerned, he would look at the very last detail and even the slightest defect would be corrected. He knew how to ensure everyone had the very best equipment that was on the market: made-to-measure bikes, the newest gadgets.” (32, p. 56).

  The notion that modern riders can surpass past performances solely through legal performance strategies rests on the assumption that these strategies, particularly when combined, are highly effective. Furthermore, a larger pool of athletes and an earlier onset of structured athletic development might amplify these effects. The following section explores the degree of improvement that can be made in the areas of training, nutrition, and technology.

There is not a single anthropometric or physiological characteristic that is completely uniform across high-level cyclists (65, 111). Those with elite potential tend to have stand-out absolute measurements of aerobic fitness and power, but these are attributes that can also be found in cyclists of lower caliber. Elite riders also possess very high power-to-weigh ratios, typically expressed as watts per kilogram (W/kg). An emerging concept that may also distinguish riders of different caliber is durability, i.e., the point and degree of physiological decline during extended exercise (66, 79, 80). Laboratory measurements of key performance determinants such as power-to-weigh ratio, V̇O 2max , cycling economy, critical power, and peak power output provide a detailed physiological profile of each individual rider but cannot accurately predict real-life performance.

Training Strategies

Aided by technology, experience, and insights from a growing body of research, training is more refined, structured, and supervised than before, with most, if not all, training sessions serving a specific purpose. Each rider typically follows an individualized training plan that is carried out under comprehensive monitoring of variables such as heart rate, power output, climate, and terrain. These data, along with laboratory measurements, race outcomes, and even psychological variables, are used to adjust volume, frequency, intensity, and/or modality throughout the season. This allows each rider to absorb as much recoverable training volume as possible to optimize physiological adaptations and peak repeatedly for competition while avoiding overtraining. Whereas virtually every single pedal stroke of the modern rider is quantified and analyzed to guide training, racing, and recovery, riders of the past relied more on “feel”, often opting for subjective rather than objective measurements of output. During the 1987 TdF, Laurent Fignon declared his legs to be “functioning again, more or less”, but did not see the value in monitoring his heart rate, explaining that “I lost my temper with those blasted pulse monitors: I handed mine back so that it wouldn’t tell me anything anymore” (32, p. 182).

Although W/kg is often favored as an indicator of riding capacity and a way to quantify cycling performances, a large V̇O 2max has long been considered a basic requirement of entry into the professional peloton. Values reported for GC contenders are generally comparable between generations, with the lowest value found in the most dominant TdF rider of all time, albeit with an asterisk ( table 1 ). There are a few caveats to these numbers, such as the validity of the actual measurement, most of which are not described in the research literature but rather in media. Moreover, oxygen uptake does not increase in proportion to body mass and scaling V̇O 2max to whole body mass is thus not appropriate when comparing athletes of different body sizes (71). Although some of these values may be exacerbated by PED use, both the baseline level and plasticity of V̇O 2max are under considerable genetic influence (15, 86, 135), and WorldTour levels can be reached without doping in those with sufficient genetic predisposition and appropriate stimulus.

Interestingly, there seems to be a physiological trade-off between efficiency and power, where adaptations towards the latter may attenuate the former (72, 113). This phenomenon was observed in Norwegian cyclist, Oskar Svendsen, who once had the highest V̇O2max ever recorded. Svendsen showed promise early by becoming junior time trial champion with less than three years of training and placing high in Tour de l’Avenir. However, despite an incredible V̇O2max of 96.7 ml/kg/min at 18 years of age, Svendsen never became a WorldTour rider. Although his early retirement at age 20 left his potential at the elite level largely unexplored, the reduction in cycling economy he experienced with increased training load could have been resolved as he matured as a rider, as cyclists appear to become more efficient over the span of their careers with little change in V̇O2max (112). If he remained active, Svendsen may eventually have been able to exploit his incredible baseline to reach the proverbial second speed in the modern peloton without chemical assistance. These insights into Svendsen’s physiological profile not only reveal some of the physiological complexities involved in high-level endurance performance, but also serve as an example of the scientific resources available to modern teams and riders that allows for a level of detail in the assessment and follow-up of athletes never seen before at that level of the sport.

Among the many training-related advances in the modern era is a more systematic approach to altitude training. Altitude-mediated erythropoiesis has long been recognized as an exposure that can produce adaptations that improves performance at sea level, as well as acclimatize athletes to sustain performance in hypobaric conditions. There are several ways to approach altitude training and care should be taken to avoid carrying the detrimental effects of prolonged hypoxic exposure, such as reduced cardiac output (Q̇) due to hypovolemia (117), into competition. Today, professional cycling teams rely on both experience as well as past and emerging research to use altitude as an important preparatory measure in various parts of the season. As the individual responses to hypoxic conditions can vary greatly (93), a large hematological response following real or simulated altitude exposure is an important attribute in modern riders. If done properly, altitude training can induce comparable hematological changes to rHuEPO use (table 2), making it a crucial performance-enhancing strategy in the modern peloton. Increasing [Hb] not only improves V̇O2max by improving the oxygen-carrying capacity of blood (43), it also enables sustained work at a higher fraction of maximal capacity (40) and faster V̇O2 kinetics (18), which can be hugely influential in a peloton with limited interindividual difference in V̇O2max.

A more recent strategy to legally induce hematological adaptations is heat acclimation. Prolonged exposure to heat is associated with both increased plasma volume, which can improve stroke volume and consequently Q̇ and V̇O2max, as well as an expansion of total hemoglobin mass (Hbmass) (91). In fact, light exercise in a heated environment five times per week has been shown to increase Hbmass by 3% – 11% in endurance athletes (90, 103, 107). Due to the logistical challenges and cost related to with altitude camp designs such as live high-train low, heat acclimation training may offer a more accessible strategy for riders and teams with less resources, or an additional stimulus to regular stays at altitude. The mechanistic similarities between synthetic and natural causes of erythropoiesis makes it physiologically possible to harness the benefits of EPO without doping. Voet (132) recounts that pre-scandal Festina riders did not even bring EPO to altitude camps because it was going to be “useless”. Describing his first stay at altitude, formerly enhanced rider, Thomas Dekker, wrote that “[t]he altitude works its magic: the thin air jolts my body into producing extra red blood cells and the Swiss Tour is the first race in ages where I can stay with the pace on the climbs” (25, p. 135), expressing relief that he could hang with the peloton without PEDs. Michele Ferrari, Lance Armstrong’s coach during the height of his career, argues that the effects of EPO on hemoglobin concentration can be achieved through proper altitude training alone (31).

Every rider in the professional peloton possesses rare abilities as cyclists. Given that the sport selects for individuals with above average baseline values of [Hb] and Hct, it may not take much stimulus to maintain a high level. However, compared to simply administering rHuEPO, strategies such as altitude training and heat acclimation are more complex undertakings, partly because of potential drawbacks with that must be accounted for, such as transiently reduced Q̇ and altered dietary requirements. The financial cost associated with prolonged exposure to altitude and/or heat for a professional team is also a considerable barrier, as the finances of teams can differ greatly. In some cases, PED use might simply just be more practical than legal strategies, and not necessarily more powerful.

Improving oxygen delivery and utilization have been main training targets for cyclists throughout most of its history, while resistance training (RT) has been largely neglected. As the impact of both power output and oxygen consumption on cycling performance is intrinsically related to rider weight, maintaining a low body mass has been, and still is, imperative. However, RT with an emphasis on neural adaptations can substantially improve force-generating capacity and reduce the oxygen cost of exercise in athletes without adding unnecessary bulk (51-53, 140). It also helps maintain bone mineral density, which elite cyclists are prone to lose (48, 110). A recent study found that RT with traditional movements and individualized load improved bone mineral density and endurance performance in professional cyclists (126). Moreover, it appeared to improve strength, power, and body composition to a greater degree than short sprint training, a more traditional power training modality for cyclists, supporting the role of structured RT as a part of a professional cyclists overall training program. Indeed, evidence for the benefit of RT on cycling performance has been mounting over the past years (table 3) (62, 102, 104-106, 108, 109, 120, 131, 141). This has contributed to changing the way RT is perceived and applied in the.

An elite physiology is easier to perturb than improve. At the highest level of cycling, large adaptations to training are unlikely to occur in the short term. The full, natural potential of a rider can only be reached via the cumulative effects of proper training and recovery, both of which are highly dependent on proper fueling. Nutrition, body composition, and supplementation

In Jørgen Leth’s classic documentary, “A Sunday in Hell”, Roger De Vlaeminck can be seen consuming a plate of meat with his team before setting out to defend his multiple Paris–Roubaix victories from the previous years in the 1976 edition, with the narrator explaining that “a rare steak is a good breakfast for what lies ahead” (67). This is in stark contrast to the low-residue diet often consumed by riders in the modern peloton (39). A low-residue diet is characterized by a very low fiber content, which can reduce rider weight and consequently improve race performance (36). This diet is usually combined with a very high carbohydrate intake throughout a race to ensure constant glucose availability, and the reduced satiety that can be associated with low-residue diets may even help a rider maintain energy intake during a race. The exact amount differs between riders, with numbers around 100 g of carbohydrate per hour being a rough estimate that may be exceeded considerably on hard days. The recognition of the added performance benefit of increased carbohydrate intake has given rise to the concept of gut training for athletes (56, 78). Racing hard for hours on end for multiple consecutive days with limited glucose availability is guaranteed to hamper performance compared to a well-fueled athlete; as red blood cells do not convert to adenosine triphosphate; blood doping cannot replace bioenergetic fuel.

There are some examples of riders that leveraged nutrition to increase their performance throughout history, such as Fausto Coppi (37), but in the modern era, all riders pay attention and have access to both nutritionists and chefs, both of which are roles that have become integral parts of professional teams. Riders also have access to more knowledge and tools, such as food apps powered by machine learning (121). The days of training hard during the day following by alcohol consumption in the evening and racing on the weekends are gone, but were reportedly common until fairly recently (25, 54). The culmination of evidence- and experience-based diets in professional cycling has led to better fueling strategies and lower body mass in the peloton and perhaps especially among the best riders.

Although described as “thin as rakes” (132, p. 63), the riders of the 90s were heavy by today’s standard. Laurent Fignon (32) explains that the importance of power-to-weight ratio did not become known among the riders before the mid-80s and that he, until that point, paid little attention to diet. Looking at the top 10 finishers of the TdF for the past four decades, starting with the latest edition, suggest that it is becoming more and more of a requirement for the overall GC placing (table 4). Notably, between 1992 and 2022, the average BMI of the top 10 decreased by 8.1%. This trend seems to generally hold across all Grand Tours for the past decades (118).

Supplements such as creatine and beta-alanine have been shown to improve endurance performance, including in cycling (7, 12, 21, 49, 127, 128). Creatine was introduced to the peloton in the mid-90s but was very expensive at the time. Riders who had access to it could consume up to 30 g the day before a long time trial or a mountain stage in hopes of a performance boost (132). Creatine and beta-alanine are now both affordable and widely used, alongside other supplements such as caffeine, electrolytes, nitrates, various vitamins, and minerals, as well as macronutrient supplements such as protein and carbohydrate.

In recent years, a lot of attention has been devoted to exogenous ketones. It is a contentious supplement that has been embraced some of the strongest teams while being recommended against by the Union Cycliste Internationale (UCI) and the Movement for Credible Cycling (MPCC). Ketones, or ketone bodies, are acetyl-CoA-derived metabolites that are produced by the liver under conditions with reduced glucose availability, such as low-carbohydrate diets, fasting, and during or after hard exercise. Ketone bodies such as β-hydroxybutyrate can spare glycogen by inhibiting glycolysis and acting as an alternative fuel in oxidative phosphorylation, which in turn can improve endurance (19). As with the research on other legal and illegal enhancement strategies, the degree to which exogenous ketones translates to improved exercise performance remains to be fully elucidated (24, 92, 94, 96, 125, 139). Although there may be potential drawbacks with isolated ketone supplementation (82), in conjunction with sodium bicarbonate, which is a weak base that has been used for some time in endurance sports (45), ketone supplementation has been shown to improve power output towards the end of a race simulation by 5% (95), although this effect may be unreliable and warrants further study (97).

Much of the hype surrounding some of the proposed effect of ketones as an energy substrate appears unwarranted, but emerging evidence suggest that it may have intriguing properties as a signaling molecule. A few years ago, it was shown that infusion of ketone bodies increased circulating EPO levels in healthy adults (63). The impact of ketones on EPO is supported by the observation that adherence to a ketogenic diet can increase [Hb] and Hct by ~3%, with the caveat this effect is within the biological variation of these markers (83). Recently, Evans et al. (30) found that ingestion of ketone monoester after cycling exercise increased serum EPO concentration, providing further evidence that it may be the signaling effects rather than nutritional value of ketone supplements confers the greatest performance benefit for professional cyclists.

Technology and equipment Science tends to be reductionistic by necessity, whereas a cycling race is much more open-ended. There is, however, a certain cycling event that is performed in highly controlled conditions and relies heavily on technological advances that can serves as a good example of marginal gains in modern road cycling: the hour record. In 1972, Eddy Merckx, perhaps the greatest cyclist of all time, rode a distance of 49.431 km to set a new hour record for the first time since the 1950s. Twelve years later, Francesco Moser breached 50 km with an effort totaling 51.151 km, aided by disc wheels and a skin suit. The following years would see various innovative approaches by riders such as Graeme Obree and Chris Boardman, until the UCI decided to revise the rules in 1994 and again in 2014 (table 5). To set his records, Boardman worked closely with Brailsford’s predecessor in British Cycling, Peter Keen, and then later with Brailsford himself after his retirement, on what would be the beginning of British riders’ marginal gains on the track and later in the peloton (14).

From Voigt’s first attempt to Ganna’s latest, the modern hour record has been improved by over 11%. Although Ganna is a multiple World Time Trial champion and likely one of the most suitable riders to attempt the record, the last person to hold the record before him was Daniel Bigham, the only rider on the list that was never a WorldTour rider. Although an accomplished cyclist in his own right, Bigham’s record is a prime example of how far and fast you can get by maximizing the margins, with his record being set at an average power output approximately 100 watts less than Wiggins. Bigham himself puts his performance down to 50% physiology and 50% equipment (137). One of the main aspects Bigham exploited was aerodynamics; his coefficient of aerodynamic drag (CdA) was ~0.15, which is considerably below what is commonly seen in cyclists, including professionals (41).

Aerodynamics is not only relevant when riding fast around a velodrome for an hour, but also one of the most important things to consider when trying to ride fast on a bike in general. At a riding speed of about 54 km/h, close to the average on a flat TdF stage, approximately 90% of the total resistance is aerodynamic resistance (13, 44). Most of the resistance is caused by the rider himself, with common estimates ranging from 60-82% (74), and the rest by other factors such as equipment (22, 73, 77). The importance of minimizing CdA underlies much of the development of modern bike frames, wheels, handlebars, helmets, clothing, and more. In recent years, there has been less emphasis from manufacturers on getting their bikes down to the UCI weight limit of 6.8 kg in favor of more aerodynamic optimizations. This approach is supported by findings showing that simply opting for aerodynamic rather than light wheels will reduce climbing time on 3% – 6% grade hills (57). Steeper hills favor lighter wheels and WorldTour riders often make specific selections of wheelset, gear ratio, and even frameset based on race or stage profile. Some teams take it a step further, such as Jumbo-Visma, who use a portable aero sensor to measure exact wind conditions on race day and make equipment selections accordingly (81).

Since the inception of professional cycling there have been numerous technological advances and there is still a steady flow of innovations reaching the peloton. Some of these become widely adopted, such as aero-optimized gear; some are providing new alternatives without replacing old ones, such as tubeless tires (riders still use a variety of tubed, tubeless, and tubular tires); and others are replacing without immediately improving a function, such as disc brakes. Technology has also enabled more extensive monitoring of athletes, both on and more recently off the bike. For instance, several teams are now measuring body temperature and hydration status, and by analyzing the individual sodium composition sweat, can select the appropriate supplementary amount of sodium for each rider. During very hot days, riders are often seen wearing cooling gear to keep body temperature down. This can not only keep the riders comfortable, but may also benefit their performance in the race by lowering thermal strain (75).

Although professional cycling continues to benefit from science, technology, and engineering, the UCI have rules and regulations in place that ensures that cycling does not, for better or worse, stray too far away from its origins. Although these are subject to change based on new developments, they sometimes can become more restrictive, such as the recent ban on handlebars narrower than 350mm. Riders with the ability and resources to combine effective performance strategies from training, nutrition, recovery, and technology – perhaps especially strategies with small effects that are more likely to be ignored by others – may find themselves able to ride at a different speed than the rest of the peloton.

Merging the margins

Imagine a gifted and durable athlete with an exceptional ability to consume oxygen across all intensity domains, maintain a low body mass, effectively utilize lactate, absorb and recover from a high training load without injury or illness, handle training and race nutrition, thermoregulate in various climates, and respond well to altitude and heat exposure finding his or her way into cycling early in life. Suppose this young cyclist learns to maintain an aerodynamic position on the bike, pedal with an efficient cadence, move seamlessly through the peloton, avoid accidents, calmly handle the pressure of competition, and execute winning moves. Professional cycling selects for individuals with supraphysiological potential from environments that have allowed this potential to be expressed. Then, it awards those who have made it to the starting line and are able make as many performance determinants as possible come together on race day.

Increased professionalism at the highest level of the sport trickles down to the amateur and junior ranks, exposing up-and-coming cyclists to favorable conditions at an earlier age, leading to greater improvements in physiology, psychology, and race craft. Some riders may show incredible promise in some aspects of racing and struggle with others. Oskar Svendsen, V̇O2max world record holder, undoubtedly had one of the greatest physiological potentials ever seen in a rider. However, he admittedly also had technical and tactical challenges: “Cycling is a monotonous sport, yet so complex and driven by tactics that you won’t win races unless you deliver on all those qualities. I came into the sport with good physical qualities, but I struggled most with the tactics and patterns. I did learn a lot in my senior years on Team Joker though, even if I still had a long way to go. Descending down hills was also something I struggled a lot with, and it sapped much of my energy in races.” (99) Svendsen’s career serves as an example of how cycling is not only a physiological sport, but also technical, tactical, and psychological. Recently retired rider, Richie Porte, described former TdF GC winners Chris Froome and Tadej Pogačar as “psychological beasts” and noted that cycling has become increasingly scientific, which does not suit all riders (35). Modern riders are more methodical, data driven, and regimented than before. This reduces the human element of the sport, to the dismay of those claiming that this will increase predictability. Some researchers in the field have also warned against measuring just for the sake of measuring, and advise that rider data should serve a specific purpose (55).

The widely established routine of constant fueling during training and racing not only acutely increase work capacity but also improves subsequent recovery by preventing the rider from becoming completely depleted. This is in stark contrast to the days when reaching for your bottle during a hard training ride, even if it only contained water, was considered a weakness. Paul Köchli, former coach of riders such as Bernard Hinault and Greg Lemond, once said that the art of cycling is to do the right thing at the right moment (27). This is true not only in the context of a race, but indeed for the professional cyclist’s career as a whole. The effects of proper training, nutrition, and recovery accumulate not only throughout a season, but a whole career, benefitting those who consistently do the right things from early on.

Conclusion and future perspectives

In some ways, modern approaches to improving cycling performance represent a first principles approach to cycling and a fundamental challenge of conventions, within the rules and regulations of UCI. It seems to have restored some of the faith in the sport that was once lost with various doping scandals. Given the measurable impacts of legal performance-enhancing strategies, many of which were previously unknown or overlooked, it could be argued that combining these effects can bring a clean rider’s performance close to, or even surpass, that of an enhanced cyclist, assuming a gifted baseline and sufficient degree of adaptability.

Suggesting that it is possible to win at the highest level in cycling without the use of PEDs is not the same as claiming that the sport is completely clean. As others have pointed out, periods that have previously been perceived as clean have later been shown to be anything but (26). This paper covers some of the key legal advances in road cycling that has contributed to elite performances in the modern peloton, while at the same time acknowledging that illegal strategies may still be present.

Much of what was once considered “marginal gains” have now become common in all professional cycling teams. This represents a shift from a culture of doping to a culture of exhaustive continuous improvement, a lot of which is kept under wraps and some that may even be considered a grey area. Effective anti-doping measures contribute to a more level playing field, but not entirely level. The teams with the most resources often get the most talented riders, allowing them to combine the greatest potential with the best strategies. And even still, there are some who favor optimizing riders and their equipment for weight rather than aerodynamics, ignoring the latter to the extent that it becomes a considerable detriment. In an era of professional cycling where individual performances are influenced by a multitude of human and nonhuman factors, which in combination can have profound effects, the existence of two-speed cycling in a clean peloton is not only logical – it should be expected.

Acknowledgments

This work was supported by the Norwegian University of Science and Technology (NTNU). The author would like to thank Dr. Endre T. Nesse and Dr. Fabio G. Laginestra for their comments and feedback on the manuscript.

• Annaheim, S., Jacob, M., Krafft, A., Breymann, C., Rehm, M., & Boutellier, U. (2016). RhEPO improves time to exhaustion by non-hematopoietic factors in humans. European Journal of Applied Physiology, 116(3), 623-633. https://doi.org/10.1007/s00421-015-3322-6
• Arnold, R. (2018, 18 January 2018). Egan Bernal: A VO2max of 91… “it’s just a number”. Ride Media. Retrieved 10 January 2023 from https://www.ridemedia.com.au/features/egan-bernal-vo2max-91-just-number
• Astolfi, T., Crettaz von Roten, F., Kayser, B., Saugy, M., & Faiss, R. (2021). The Influence of Training Load on Hematological Athlete Biological Passport Variables in Elite Cyclists. Frontiers in Sports and Active Living, 3. https://doi.org/10.3389/fspor.2021.618285
• Attia, P., & San-Millán, I. (2022, 1 April 2022). How often should you be doing Zone 5 training? | Iñigo San-Millán, Ph.D. & Peter Attia, M.D. YouTube. Retrieved 10 January 2023 from https://www.youtube.com/watch?v=xuqURs4auc8
• Aubel, O., Lefèvre, B., Le Goff, J.-M., & Taverna, N. (2018). Doping risk and career turning points in male elite road cycling (2005–2016). Journal of Science and Medicine in Sport, 21(10), 994-998. https://doi.org/10.1016/j.jsams.2018.03.003
• Aubel, O., Lefèvre, B., Le Goff, J. M., & Taverna, N. (2019). The team effect on doping in professional male road cycling (2005-2016). Scandinavian Journal of Medicine & Science in Sports, 29(4), 615-622. https://doi.org/10.1111/sms.13384
• Baguet, A., Koppo, K., Pottier, A., & Derave, W. (2010). Beta-alanine supplementation reduces acidosis but not oxygen uptake response during high-intensity cycling exercise. Eur J Appl Physiol, 108(3), 495-503. https://doi.org/10.1007/s00421-009-1225-0
• Bailey, M. (2016, 6 May 2016). Greg LeMond: Interview. Cyclist. Retrieved 10 January 2023 from https://www.cyclist.co.uk/in-depth/115/greg-lemond-interview
• Bailey, M. (2016, 31 May 2016). Miguel Indurain: the record Tour winner. Cyclist. Retrieved 10 January 2023 from https://www.cyclist.co.uk/in-depth/423/miguel-indurain-the-record-tour-winner
• Bell, P., Ten Have, C., & Lauchs, M. (2016). A case study analysis of a sophisticated sports doping network: Lance Armstrong and the USPS Team. International Journal of Law, Crime and Justice, 46, 57-68. https://doi.org/10.1016/j.ijlcj.2016.03.001
• Bell, P. G., Furber, M. J., van Someren, K. A., Antón-Solanas, A., & Swart, J. (2017). The Physiological Profile of a Multiple Tour de France Winning Cyclist. Med Sci Sports Exerc, 49(1), 115-123. https://doi.org/10.1249/mss.0000000000001068
• Bemben, M. G., & Lamont, H. S. (2005). Creatine supplementation and exercise performance: recent findings. Sports Med, 35(2), 107-125. https://doi.org/10.2165/00007256-200535020-00002
• Blocken, B., van Druenen, T., Toparlar, Y., & Andrianne, T. (2018). Aerodynamic analysis of different cyclist hill descent positions. Journal of Wind Engineering and Industrial Aerodynamics, 181, 27-45. https://doi.org/10.1016/j.jweia.2018.08.010
• Boardman, C. (2017). Triumphs and Turbulence: My Autobiography. Ebury Press.
• Bouchard, C., An, P., Rice, T., Skinner, J. S., Wilmore, J. H., Gagnon, J., Pérusse, L., Leon, A. S., & Rao, D. C. (1999). Familial aggregation of VO(2max) response to exercise training: results from the HERITAGE Family Study. J Appl Physiol (1985), 87(3), 1003-1008. https://doi.org/10.1152/jappl.1999.87.3.1003
• Bowers, L. D. (1998). Athletic drug testing. Clin Sports Med, 17(2), 299-318. https://doi.org/10.1016/s0278-5919(05)70082-x
• Chicharro, J. L., Hoyos, J., Bandrés, F., Terrados, N., Fernández, B., & Lucía, A. (2001). Thyroid hormone levels during a 3-week professional road cycling competition. Horm Res, 56(5-6), 159-164. https://doi.org/10.1159/000048112
• Connes, P., Perrey, S., Varray, A., Préfaut, C., & Caillaud, C. (2003). Faster oxygen uptake kinetics at the onset of submaximal cycling exercise following 4 weeks recombinant human erythropoietin (r-HuEPO) treatment. Pflugers Arch, 447(2), 231-238. https://doi.org/10.1007/s00424-003-1174-0
• Cox, Pete J., Kirk, T., Ashmore, T., Willerton, K., Evans, R., Smith, A., Murray, Andrew J., Stubbs, B., West, J., McLure, Stewart W., King, M. T., Dodd, Michael S., Holloway, C., Neubauer, S., Drawer, S., Veech, Richard L., Griffin, Julian L., & Clarke, K. (2016). Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes. Cell Metabolism, 24(2), 256-268. https://doi.org/10.1016/j.cmet.2016.07.010
• Coyle, E. F. (2005). Improved muscular efficiency displayed as Tour de France champion matures. J Appl Physiol (1985), 98(6), 2191-2196. https://doi.org/10.1152/japplphysiol.00216.2005
• Crisafulli, D. L., Buddhadev, H. H., Brilla, L. R., Chalmers, G. R., Suprak, D. N., & San Juan, J. G. (2018). Creatine-electrolyte supplementation improves repeated sprint cycling performance: A double blind randomized control study. J Int Soc Sports Nutr, 15, 21. https://doi.org/10.1186/s12970-018-0226-y
• Crouch, T. N., Burton, D., LaBry, Z. A., & Blair, K. B. (2017). Riding against the wind: a review of competition cycling aerodynamics. Sports Engineering, 20(2), 81-110. https://doi.org/10.1007/s12283-017-0234-1
• CyclingTips. (2016, 15 August 2016). Chris Froome’s lab results analysed: just how good is the three-time Tour de France champion? CyclingTips. Retrieved 10 January 2023 from https://cyclingtips.com/2016/08/chris-froomes-lab-results-analysed-just-how-good-is-the-three-time-tour-de-france-champion
• Dearlove, D. J., Harrison, O. K., Hodson, L., Jefferson, A., Clarke, K., & Cox, P. J. (2021). The Effect of Blood Ketone Concentration and Exercise Intensity on Exogenous Ketone Oxidation Rates in Athletes. Medicine & Science in Sports & Exercise, 53(3). https://doi.org/10.1249/MSS.0000000000002502
• Dekker, T. (2018). The Descent. Ebury Press.
• Dimeo, P. (2014). Why Lance Armstrong? Historical Context and Key Turning Points in the ‘Cleaning Up’ of Professional Cycling. The International Journal of the History of Sport, 31(8), 951-968. https://doi.org/10.1080/09523367.2013.879858
• Dower, J. (2014). Slaying the Badger ESPN.
• Durussel, J., Haile, D. W., Mooses, K., Daskalaki, E., Beattie, W., Mooses, M., Mekonen, W., Ongaro, N., Anjila, E., Patel, R. K., Padmanabhan, N., McBride, M. W., McClure, J. D., & Pitsiladis, Y. P. (2016). Blood transcriptional signature of recombinant human erythropoietin administration and implications for antidoping strategies. Physiological Genomics, 48(3), 202-209. https://doi.org/10.1152/physiolgenomics.00108.2015
• Edworthy, S., & Brailsford, D. (2012). 21 Days to Glory: The Official Team Sky Book of the 2012 Tour de France. HarperSport.
• Evans, E., Walhin, J.-P., Hengist, A., Betts, J. A., Dearlove, D. J., & Gonzalez, J. T. (2022). Ketone monoester ingestion increases post-exercise serum erythropoietin concentrations in healthy men. American Journal of Physiology-Endocrinology and Metabolism. https://doi.org/10.1152/ajpendo.00264.2022
• Ferrari, M. (2013, 22 January 2013). A bit of history. 53×12. Retrieved 27 December 2022 from https://www.53×12.com/a-bit-of-history
• Fignon, L. (2010). We Were Young and Carefree. Yellow Jersey Press.
• Fincoeur, B. (2009). Lutte antidopage et cyclisme à deux vitesses: Évolution du rapport au dopage chez les cyclistes belges depuis l’affaire Festina. Revue internationale de criminologie et de police technique, 62.
• Fincoeur, B., Gleaves, J., & Ohl, F. (2019). Doping in Cycling: Interdisciplinary Perspectives. Routledge.
• Fletcher, P. (2022, 23 December 2022). Richie Porte: Pogacar and Froome are psychological beasts. Cyclingnews. Retrieved 18 January 2023 from https://www.cyclingnews.com/news/richie-porte-pogacar-and-froome-are-psychological-beasts
• Foo, W. L., Harrison, J. D., Mhizha, F. T., Langan-Evans, C., Morton, J. P., Pugh, J. N., & Areta, J. L. (2022). A Short-Term Low-Fiber Diet Reduces Body Mass in Healthy Young Men: Implications for Weight-Sensitive Sports. Int J Sport Nutr Exerc Metab, 32(4), 256-264. https://doi.org/10.1123/ijsnem.2021-0324
• Fotheringham, W. (2010). Fallen Angel: The Passion of Fausto Coppi. Yellow Jersey Press.
• Fotheringham, W. (2013). Half Man, Half Bike: The Life of Eddy Merckx, Cycling’s Greatest Champion. Yellow Jersey Press.
• Freeman, R. (2018). The Line: Where Medicine and Sport Collide. Wildfire.
• Fritsch, J., Winter, U. J., Reupke, I., Gitt, A. K., Berge, P. G., & Hilger, H. H. (1993). [Effect of a single blood donation on ergo-spirometrically determined cardiopulmonary performance capacity of young healthy probands]. Z Kardiol, 82(7), 425-431. (Einfluss einer einmaligen Blutspende auf die ergospirometrisch bestimmte kardiopulmonale Leistungsfähigkeit bei jungen gesunden Probanden.)
• García-López, J., Rodríguez-Marroyo, J. A., Juneau, C.-E., Peleteiro, J., Martínez, A. C., & Villa, J. G. (2008). Reference values and improvement of aerodynamic drag in professional cyclists. Journal of Sports Sciences, 26(3), 277-286. https://doi.org/10.1080/02640410701501697
• Gifford, B. (July 2008). Greg LeMond vs. The World. Men’s Journal. Retrieved 10 January 2023 from https://www.mensjournal.com/health-fitness/greg-lemond-vs-the-world-20130318
• Gledhill, N., Warburton, D., & Jamnik, V. (1999). Haemoglobin, blood volume, cardiac function, and aerobic power. Can J Appl Physiol, 24(1), 54-65. https://doi.org/10.1139/h99-006
• Grappe, F., Candau, R., Belli, A., & Rouillon, J. (1298). Aerodynamic drag in field cycling with special reference to the Obree’s position. Ergonomics, December 1, 1299-1311. https://doi.org/10.1080/001401397187388
• Grgic, J., Pedisic, Z., Saunders, B., Artioli, G. G., Schoenfeld, B. J., McKenna, M. J., Bishop, D. J., Kreider, R. B., Stout, J. R., Kalman, D. S., Arent, S. M., VanDusseldorp, T. A., Lopez, H. L., Ziegenfuss, T. N., Burke, L. M., Antonio, J., & Campbell, B. I. (2021). International Society of Sports Nutrition position stand: sodium bicarbonate and exercise performance. J Int Soc Sports Nutr, 18(1), 61. https://doi.org/10.1186/s12970-021-00458-w
• Hamilton, T., & Coyle, D. (2012). The Secret Race: Inside the Hidden World of the Tour de France. Bantam Press.
• Heuberger, J. A. A. C., Rotmans, J. I., Gal, P., Stuurman, F. E., van ‘t Westende, J., Post, T. E., Daniels, J. M. A., Moerland, M., van Veldhoven, P. L. J., de Kam, M. L., Ram, H., de Hon, O., Posthuma, J. J., Burggraaf, J., & Cohen, A. F. (2017). Effects of erythropoietin on cycling performance of well trained cyclists: a double-blind, randomised, placebo-controlled trial. The Lancet Haematology, 4(8), e374-e386. https://doi.org/10.1016/S2352-3026(17)30105-9
• Hilkens, L., van Schijndel, N., Weijer, V., Boerboom, M., van der Burg, E., Peters, V., Kempers, R., Bons, J., van Loon, L. J. C., & van Dijk, J.-W. (2022). Low Bone Mineral Density and Associated Risk Factors in Elite Cyclists at Different Stages of a Professional Cycling Career. Medicine & Science in Sports & Exercise. https://doi.org/10.1249/MSS.0000000000003113
• Hill, C. A., Harris, R. C., Kim, H. J., Harris, B. D., Sale, C., Boobis, L. H., Kim, C. K., & Wise, J. A. (2007). Influence of beta-alanine supplementation on skeletal muscle carnosine concentrations and high intensity cycling capacity. Amino Acids, 32(2), 225-233. https://doi.org/10.1007/s00726-006-0364-4
• Hincapie, G., & Hummer, C. (2014). The Loyal Lieutenant: Leading Out Lance and Pushing Through the Pain on the Rocky Road to Paris. HarperCollins.
• Hoff, J., Berdahl, G. O., & Bråten, S. (2001). Jumping height development and body weight considerations in ski jumping. In Science and skiing II : Second International Congress on Science and Skiing ; St. Christoph a. Arlberg, Austria, January 9-15, 2000. Hamburg: Kovač (Verlag), 2001, S. 403-412, Lit.
• Hoff, J., Gran, A., & Helgerud, J. (2002). Maximal strength training improves aerobic endurance performance. Scand J Med Sci Sports, 12(5), 288-295. https://doi.org/10.1034/j.1600-0838.2002.01140.x
• Hoff, J., Helgerud, J., & Wisløff, U. (1999). Maximal strength training improves work economy in trained female cross-country skiers. Med Sci Sports Exerc, 31(6), 870-877. https://doi.org/10.1097/00005768-199906000-00016
• Hushovd, T., & Ravnåsen, J. (2014). Thor. Schibsted Forlag AS.
• Javaloyes, A., & Mateo-March, M. (2022). Only what is necessary: The use of technology in cycling and concerns with its selection and use. Journal of Science & Cycling, 11(3), 1-2. https://doi.org/10.28985/1322.jsc.16
• Jeukendrup, A. E. (2017). Training the Gut for Athletes. Sports Med, 47(Suppl 1), 101-110. https://doi.org/10.1007/s40279-017-0690-6
• Jeukendrup, A. E., & Martin, J. (2001). Improving Cycling Performance. Sports Medicine, 31(7), 559-569. https://doi.org/10.2165/00007256-200131070-00009
• Johnson, M. (2016). Spitting in the Soup: Inside the Dirty Game of Doping in Sports. VeloPress
• Kimmage, P. (2007). Rough Ride. Yellow Jersey Press.
• Klein, H. G. (1985). Blood transfusion and athletics. Games people play. N Engl J Med, 312(13), 854-856. https://doi.org/10.1056/nejm198503283121311
• Kolata, G. (2005, 24 July 2005). Super, Sure, but Not More Than Human. The New York Times. Retrieved 10 January 2023 from https://www.nytimes.com/2005/07/24/weekinreview/super-sure-but-not-more-than-human.html
• Kordi, M., Folland, J. P., Goodall, S., Menzies, C., Patel, T. S., Evans, M., Thomas, K., & Howatson, G. (2020). Cycling-specific isometric resistance training improves peak power output in elite sprint cyclists. Scand J Med Sci Sports, 30(9), 1594-1604. https://doi.org/10.1111/sms.13742
• Lauritsen, K. M., Søndergaard, E., Svart, M., Møller, N., & Gormsen, L. C. (2018). Ketone Body Infusion Increases Circulating Erythropoietin and Bone Marrow Glucose Uptake. Diabetes Care, 41(12), e152-e154. https://doi.org/10.2337/dc18-1421
• Lentillon-Kaestner, V., Hagger, M., & Hardcastle, S. (2011). Health and doping in elite-level cycling. Scandinavian Journal of Medicine & Science in Sports, 22, 596-606. https://doi.org/10.1111/j.1600-0838.2010.01281.x
• Leo, P., Simon, D., Hovorka, M., Lawley, J., & Mujika, I. (2022). Elite versus non-elite cyclist – Stepping up to the international/elite ranks from U23 cycling. Journal of Sports Sciences, 40(16), 1874-1884. https://doi.org/10.1080/02640414.2022.2117394
• Leo, P., Spragg, J., Mujika, I., Giorgi, A., Lorang, D., Simon, D., & Lawley, J. S. (2021). Power Profiling, Workload Characteristics, and Race Performance of U23 and Professional Cyclists During the Multistage Race Tour of the Alps. International Journal of Sports Physiology and Performance, 16(8), 1089-1095. https://doi.org/10.1123/ijspp.2020-0381
• Leth, J. (1977). A Sunday in Hell Steen Herdel Filmproduktion.
• Levine, B. D., & Stray-Gundersen, J. (1997). “Living high-training low”: effect of moderate-altitude acclimatization with low-altitude training on performance. J Appl Physiol (1985), 83(1), 102-112. https://doi.org/10.1152/jappl.1997.83.1.102
• Ljungqvist, A. (2017). Brief History of Anti-Doping. Med Sport Sci, 62, 1-10. https://doi.org/10.1159/000460680
• Llamas, F. (2016, 24 January 2016). La ‘bestia’ que viene. Marca. Retrieved 10 January 2023 from https://www.marca.com/ciclismo/2016/01/24/56a4fa71ca474159048b45c4.html
• Lolli, L., Batterham, A. M., Weston, K. L., & Atkinson, G. (2017). Size Exponents for Scaling Maximal Oxygen Uptake in Over 6500 Humans: A Systematic Review and Meta-Analysis. Sports Med, 47(7), 1405-1419. https://doi.org/10.1007/s40279-016-0655-1
• Lucía, A., Hoyos, J., Pérez, M., Santalla, A., & Chicharro, J. L. (2002). Inverse relationship between V̇O2max and economy/efficiency in world-class cyclists. Medicine & Science in Sports & Exercise, 34(12). https://doi.org/10.1249/01.MSS.0000039306.92778.DF
• Lukes, R. A., Chin, S. B., & Haake, S. J. (2005). The understanding and development of cycling aerodynamics. Sports Engineering, 8(2), 59-74. https://doi.org/10.1007/BF02844004
• Malizia, F., Druenen, T., & Blocken, B. (2021). Impact of wheel rotation on the aerodynamic drag of a time trial cyclist. Sports Engineering, 24. https://doi.org/10.1007/s12283-021-00341-6
• Marino, F. E. (2002). Methods, advantages, and limitations of body cooling for exercise performance. British Journal of Sports Medicine, 36(2), 89. https://doi.org/10.1136/bjsm.36.2.89
• Martin, D. T., Quod, M. J., & Gore, C. J. (2005). Has Armstrong’s cycle efficiency improved? Journal of Applied Physiology, 99(4), 1628-1629. https://doi.org/10.1152/japplphysiol.00507.2005
• Martin, J. C., Milliken, D. L., Cobb, J. E., McFadden, K. L., & Coggan, A. R. (1998). Validation of a Mathematical Model for Road Cycling Power. Journal of Applied Biomechanics, 14(3), 276-291. https://doi.org/10.1123/jab.14.3.276
• Martinez, I. G., Mika, A. S., Biesiekierski, J. R., & Costa, R. J. S. (2023). The Effect of Gut-Training and Feeding-Challenge on Markers of Gastrointestinal Status in Response to Endurance Exercise: A Systematic Literature Review. Sports Med, 53(6), 1175-1200. https://doi.org/10.1007/s40279-023-01841-0
• Mateo-March, M., Valenzuela, P. L., Muriel, X., Gandia-Soriano, A., Zabala, M., Lucia, A., Pallarés, J., & Barranco-Gil, D. (2022). The Record Power Profile of Male Professional Cyclists: Fatigue Matters. International Journal of Sports Physiology and Performance, 17, 1-6. https://doi.org/10.1123/ijspp.2021-0403
• Maunder, E., Seiler, S., Mildenhall, M. J., Kilding, A. E., & Plews, D. J. (2021). The Importance of ‘Durability’ in the Physiological Profiling of Endurance Athletes. Sports Medicine, 51(8), 1619-1628. https://doi.org/10.1007/s40279-021-01459-0
• Mc Laughlin, R. (2022, 3 August 2022). Has Aerosensor finally cracked at-home aero testing? CyclingTips. Retrieved 17 January 2023 from https://cyclingtips.com/2022/08/has-aerosensor-finally-cracked-at-home-aero-testing
• McCarthy, D. G., Bostad, W., Powley, F. J., Little, J. P., Richards, D. L., & Gibala, M. J. (2021). Increased cardiorespiratory stress during submaximal cycling after ketone monoester ingestion in endurance-trained adults. Appl Physiol Nutr Metab, 46(8), 986-993. https://doi.org/10.1139/apnm-2020-0999
• McKay, A. K. A., Peeling, P., Pyne, D. B., Welvaert, M., Tee, N., Leckey, J. J., Sharma, A. P., Ross, M. L. R., Garvican-Lewis, L. A., Swinkels, D. W., Laarakkers, C. M., & Burke, L. M. (2019). Chronic Adherence to a Ketogenic Diet Modifies Iron Metabolism in Elite Athletes. Medicine & Science in Sports & Exercise, 51(3). https://doi.org/10.1249/MSS.0000000000001816
• Meeuwsen, T., Hendriksen, I. J. M., & Holewijn, M. (2001). Training-induced increases in sea-level performance are enhanced by acute intermittent hypobaric hypoxia. European Journal of Applied Physiology, 84(4), 283-290. https://doi.org/10.1007/s004210000363
• Millar, D. (2012). Racing Through the Dark. Orion Publishing Group.
• Miyamoto-Mikami, E., Zempo, H., Fuku, N., Kikuchi, N., Miyachi, M., & Murakami, H. (2018). Heritability estimates of endurance-related phenotypes: A systematic review and meta-analysis. Scandinavian Journal of Medicine & Science in Sports, 28(3), 834-845. https://doi.org/10.1111/sms.12958
• Moore, R. (2012). Sky’s the Limit: British Cycling’s Quest to Conquer the Tour de France. HarperSport.
• Movement for Credible Cycling. (2022). Credibility figures: Continental teams tarnished [Internet; cited 2023 August 2]. Retrieved from: https://www.mpcc.fr/en/credibility-figures-continental-teams-tarnished/.
• Mørkeberg, J. S., Belhage, B., & Damsgaard, R. (2009). Changes in blood values in elite cyclist. Int J Sports Med, 30(2), 130-138. https://doi.org/10.1055/s-2008-1038842
• Nybo, L., Rønnestad, B., & Lundby, C. (2022). High or hot-Perspectives on altitude camps and heat-acclimation training as preparation for prolonged stage races. Scand J Med Sci Sports. https://doi.org/10.1111/sms.14268
• Oberholzer, L., Siebenmann, C., Mikkelsen, C. J., Junge, N., Piil, J. F., Morris, N. B., Goetze, J. P., Meinild Lundby, A.-K., Nybo, L., & Lundby, C. (2019). Hematological Adaptations to Prolonged Heat Acclimation in Endurance-Trained Males. Frontiers in Physiology, 10. https://doi.org/10.3389/fphys.2019.01379
• Pinckaers, P. J., Churchward-Venne, T. A., Bailey, D., & van Loon, L. J. (2017). Ketone Bodies and Exercise Performance: The Next Magic Bullet or Merely Hype? Sports Med, 47(3), 383-391. https://doi.org/10.1007/s40279-016-0577-y
• Płoszczyca, K., Langfort, J., & Czuba, M. (2018). The Effects of Altitude Training on Erythropoietic Response and Hematological Variables in Adult Athletes: A Narrative Review. Frontiers in Physiology, 9. https://doi.org/10.3389/fphys.2018.00375
• Poffé, C., Ramaekers, M., Bogaerts, S., & Hespel, P. (2020). Exogenous ketosis impacts neither performance nor muscle glycogen breakdown in prolonged endurance exercise. Journal of Applied Physiology, 128(6), 1643-1653. https://doi.org/10.1152/japplphysiol.00092.2020
• Poffé, C., Ramaekers, M., Bogaerts, S., & Hespel, P. (2021). Bicarbonate Unlocks the Ergogenic Action of Ketone Monoester Intake in Endurance Exercise. Medicine & Science in Sports & Exercise, 53(2). https://doi.org/10.1249/MSS.0000000000002467
• Poffé, C., Robberechts, R., Podlogar, T., Kusters, M., Debevec, T., & Hespel, P. (2021). Exogenous ketosis increases blood and muscle oxygenation but not performance during exercise in hypoxia. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 321(6), R844-R857. https://doi.org/10.1152/ajpregu.00198.2021
• Poffé, C., Wyns, F., Ramaekers, M., & Hespel, P. (2021). Exogenous Ketosis Impairs 30-min Time-Trial Performance Independent of Bicarbonate Supplementation. Med Sci Sports Exerc, 53(5), 1068-1078. https://doi.org/10.1249/mss.0000000000002552
• Rasmussen, M., & Wivel, K. (2013). Gul Feber. People’sPress.
• Redford, P. (2018, 2 April 2018). The Fittest Human Ever Quit Sports, Found Happiness. Deadspin Retrieved 10 January 2023 from https://deadspin.com/the-fittest-human-ever-quit-sports-found-happiness-1823998288
• Riis, B., & Pedersen, L. S. (2012). Riis: Stages Of Light And Dark. Vision Sports Publishing.
• Robinson, N., Giraud, S., Saudan, C., Baume, N., Avois, L., Mangin, P., & Saugy, M. (2006). Erythropoietin and blood doping. Br J Sports Med, 40 Suppl 1(Suppl 1), i30-34. https://doi.org/10.1136/bjsm.2006.027532
• Rønnestad, B. (2022). Case Report: Effects of Multiple Seasons of Heavy Strength Training on Muscle Strength and Cycling Sprint Power in Elite Cyclists. Front Sports Act Living, 4, 860685. https://doi.org/10.3389/fspor.2022.860685
• Rønnestad, B., Hamarsland, H., Hansen, J., Holen, E., Montero, D., Whist, J. E., & Lundby, C. (2021). Five weeks of heat training increases haemoglobin mass in elite cyclists. Exp Physiol, 106(1), 316-327. https://doi.org/10.1113/ep088544
• Rønnestad, B., Hansen, E. A., & Raastad, T. (2010). Effect of heavy strength training on thigh muscle cross-sectional area, performance determinants, and performance in well-trained cyclists. Eur J Appl Physiol, 108(5), 965-975. https://doi.org/10.1007/s00421-009-1307-z
• Rønnestad, B., Hansen, E. A., & Raastad, T. (2010). In-season strength maintenance training increases well-trained cyclists’ performance. Eur J Appl Physiol, 110(6), 1269-1282. https://doi.org/10.1007/s00421-010-1622-4
• Rønnestad, B., Hansen, E. A., & Raastad, T. (2011). Strength training improves 5-min all-out performance following 185 min of cycling. Scandinavian Journal of Medicine & Science in Sports, 21(2), 250-259. https://doi.org/10.1111/j.1600-0838.2009.01035.x
• Rønnestad, B., Hansen, J., Bonne, T., & Lundby, C. (2021). Case Report: Heat Suit Training May Increase Hemoglobin Mass in Elite Athletes. International Journal of Sports Physiology and Performance, 17, 1-5. https://doi.org/10.1123/ijspp.2021-0033
• Rønnestad, B., Hansen, J., Hollan, I., & Ellefsen, S. (2015). Strength training improves performance and pedaling characteristics in elite cyclists. Scand J Med Sci Sports, 25(1), e89-98. https://doi.org/10.1111/sms.12257
• Rønnestad, B., Hansen, J., & Nygaard, H. (2017). 10 weeks of heavy strength training improves performance-related measurements in elite cyclists. J Sports Sci, 35(14), 1435-1441. https://doi.org/10.1080/02640414.2016.1215499
• Sabo, D., Reiter, A., Pfeil, J., Güssbacher, A., & Niethard, F. U. (1996). [Modification of bone quality by extreme physical stress. Bone density measurements in high-performance athletes using dual-energy x-ray absorptiometry]. Z Orthop Ihre Grenzgeb, 134(1), 1-6. https://doi.org/10.1055/s-2008-1037409 (Beeinflussung der Knochenqualität durch extreme körperliche Belastung. Knochendichtemessungen bei Hochleistungssportlern mit der Dual-Energie-Röntgen-Absorptionmetrie.)
• Sánchez-Muñoz, C., Mateo-March, M., Muros, J. J., Javaloyes, A., & Zabala, M. (2022). Anthropometric characteristics according to the role performed by World Tour road cyclists for their team. European Journal of Sport Science, 1-8. https://doi.org/10.1080/17461391.2022.2132879
• Santalla, A., Naranjo, J., & Terrados, N. (2009). Muscle efficiency improves over time in world-class cyclists. Med Sci Sports Exerc, 41(5), 1096-1101. https://doi.org/10.1249/MSS.0b013e318191c802
• Schiffer, T. A., Ekblom, B., Lundberg, J. O., Weitzberg, E., & Larsen, F. J. (2014). Dynamic regulation of metabolic efficiency explains tolerance to acute hypoxia in humans. The FASEB Journal, 28(10), 4303-4311. https://doi.org/10.1096/fj.14-251710
• Schuler, B., Thomsen, J. J., Gassmann, M., & Lundby, C. (2007). Timing the arrival at 2340 m altitude for aerobic performance. Scand J Med Sci Sports, 17(5), 588-594. https://doi.org/10.1111/j.1600-0838.2006.00611.x
• Seznec, J. C. (2002). Toxicomanie et cyclisme professionnel. Annales Médico-psychologiques, revue psychiatrique, 160(1), 72-76. https://doi.org/10.1016/S0003-4487(01)00133-0
• Sgrò, P., Sansone, M., Sansone, A., Romanelli, F., & Di Luigi, L. (2018). Effects of erythropoietin abuse on exercise performance. The Physician and Sportsmedicine, 46(1), 105-115. https://doi.org/10.1080/00913847.2018.1402663
• Siebenmann, C., Hug, M., Keiser, S., Müller, A., van Lieshout, J., Rasmussen, P., & Lundby, C. (2013). Hypovolemia explains the reduced stroke volume at altitude. Physiol Rep, 1(5), e00094. https://doi.org/10.1002/phy2.94
• Smith, A., Wijnkoop, M. v., Colangelo, J., Buadze, A., & Liebrenz, M. (2023). Body Mass Index trends in men’s Grand Tour cycling events from 1992-2022: Implications for athlete wellbeing and regulatory frameworks. Research Square. https://doi.org/10.21203/rs.3.rs-2568920/v1
• Stray-Gundersen, J., Chapman, R. F., & Levine, B. D. (2001). “Living high-training low” altitude training improves sea level performance in male and female elite runners. J Appl Physiol (1985), 91(3), 1113-1120. https://doi.org/10.1152/jappl.2001.91.3.1113
• Sunde, A., Støren, Ø., Bjerkaas, M., Larsen, M. H., Hoff, J., & Helgerud, J. (2010). Maximal Strength Training Improves Cycling Economy in Competitive Cyclists. The Journal of Strength & Conditioning Research, 24(8). https://doi.org/10.1519/JSC.0b013e3181aeb16a
• Team Jumbo-Visma. (2021, 21 January 2021). Must-have for all riders: the Jumbo Foodcoach app. TeamJumboVisma.com. Retrieved 16 January 2023 from https://www.teamjumbovisma.com/article/material/must-have-for-all-riders-the-jumbo-foodcoach-app/
• Thewlis, T. (2023). Chords to cols: How Jonas Vingegaard went from guitars to Grand Tours [Internet]. 2023 July 6 [cited 2023 August 2]; Retrieved from: https://www.cyclingweekly.com/racing/holidays-in-the-mountains-to-hard-graft-in-hantsholm-harbour-the-making-of-jonas-vingegaard.
• Trinh, K. V., Diep, D., Chen, K. J. Q., Huang, L., & Gulenko, O. (2020). Effect of erythropoietin on athletic performance: a systematic review and meta-analysis. BMJ Open Sport Exerc Med, 6(1), e000716. https://doi.org/10.1136/bmjsem-2019-000716
• Valenzuela, P. L., Alejo, L. B., Ozcoidi, L. M., Lucia, A., Santalla, A., & Barranco-Gil, D. (2023). Durability in Professional Cyclists: A Field Study. Int J Sports Physiol Perform, 18(1), 99-103. https://doi.org/10.1123/ijspp.2022-0202
• Valenzuela, P. L., Castillo-García, A., Morales, J. S., & Lucia, A. (2021). Perspective: Ketone Supplementation in Sports-Does It Work? Adv Nutr, 12(2), 305-315. https://doi.org/10.1093/advances/nmaa130
• Valenzuela, P. L., Gil-Cabrera, J., Talavera, E., Alejo, L. B., Montalvo-Pérez, A., Rincón-Castanedo, C., Rodríguez-Hernández, I., Lucia, A., & Barranco-Gil, D. (2021). On- Versus Off-Bike Power Training in Professional Cyclists: A Randomized Controlled Trial. Int J Sports Physiol Perform, 16(5), 674-681. https://doi.org/10.1123/ijspp.2020-0305
• Van Thienen, R., Van Proeyen, K., Vanden Eynde, B., Puype, J., Lefere, T., & Hespel, P. (2009). Beta-alanine improves sprint performance in endurance cycling. Med Sci Sports Exerc, 41(4), 898-903. https://doi.org/10.1249/MSS.0b013e31818db708
• Vandebuerie, F., Vanden Eynde, B., Vandenberghe, K., & Hespel, P. (1998). Effect of creatine loading on endurance capacity and sprint power in cyclists. Int J Sports Med, 19(7), 490-495. https://doi.org/10.1055/s-2007-971950
• Vandecapelle, B. (2023). FACTCHECK. “Toen hij 17 was, had hij VO₂max van 97”: waanzinnige cijfers doen de ronde over Vingegaard, maar kloppen ze wel? [Internet]. 2023 July 19 [cited 2023 August 2]; Retrieved from: https://www.hln.be/tour-de-france/factcheck-toen-hij-17-was-had-hij-vomax-van-97-waanzinnige-cijfers-doen-de-ronde-over-vingegaard-maar-kloppen-ze-wel~a340e8a6/.
• Vaughters, J. (2019). One-Way Ticket: Nine Lives on Two Wheels. Quercus Editions Ltd.
• Vikmoen, O., Ellefsen, S., Trøen, Ø., Hollan, I., Hanestadhaugen, M., Raastad, T., & Rønnestad, B. (2016). Strength training improves cycling performance, fractional utilization of VO2max and cycling economy in female cyclists. Scand J Med Sci Sports, 26(4), 384-396. https://doi.org/10.1111/sms.12468
• Voet, W. (2002). Breaking the Chain: Drugs and Cycling: The True Story. Random House.
• Wang, G., Durussel, J., Shurlock, J., Mooses, M., Fuku, N., Bruinvels, G., Pedlar, C., Burden, R., Murray, A., Yee, B., Keenan, A., McClure, J. D., Sottas, P.-E., & Pitsiladis, Y. P. (2017). Validation of whole-blood transcriptome signature during microdose recombinant human erythropoietin (rHuEpo) administration. BMC Genomics, 18(8), 817. https://doi.org/10.1186/s12864-017-4191-7
• Whittle, J. (2009). Bad Blood: The Secret Life of the Tour de France. Yellow Jersey Press.
• Williams, C. J., Williams, M. G., Eynon, N., Ashton, K. J., Little, J. P., Wisloff, U., & Coombes, J. S. (2017). Genes to predict VO2max trainability: a systematic review. BMC Genomics, 18(Suppl 8), 831. https://doi.org/10.1186/s12864-017-4192-6
• Witts, J. (2022, 1 August 2022). Rouleur Retrieved 10 January 2023 from https://www.rouleur.cc/blogs/rouleur-performance/recover-like-a-grand-tour-rider
• Witts, J. (2022, 1 September 2022). Behind the scenes of Dan Bigham’s Hour Record: Part one Rouleur. Retrieved 17 January 2023 from https://www.rouleur.cc/blogs/the-rouleur-journal/behind-the-scenes-of-dan-bighams-hour-record-part-one
• Zenovich, M. (2020). Lance Part 1 ESPN.
• Øvretveit, K. (2023). Metabolic and moral effects of exogenous ketones. Norwegian journal of nutrition, 21(2), 33-36. https://doi.org/10.18261/ntfe.21.2.6
• Øvretveit, K., & Tøien, T. (2018). Maximal Strength Training Improves Strength Performance in Grapplers. J Strength Cond Res, 32(12), 3326-3332. https://doi.org/10.1519/jsc.0000000000002863
• Aagaard, P., Andersen, J. L., Bennekou, M., Larsson, B., Olesen, J. L., Crameri, R., Magnusson, S. P., & Kjær, M. (2011). Effects of resistance training on endurance capacity and muscle fiber composition in young top-level cyclists. Scandinavian Journal of Medicine & Science in Sports, 21(6), e298-e307. https://doi.org/10.1111/j.1600-0838.2010.01283.x

The Real Cause of Losing Sports Officials

George Minoso 2024-02-15T12:01:06-06:00 February 16th, 2024 | Contemporary Sports Issues , General , Sports Coaching , Sports Management , Sports Studies |

Authors: Matthew J Williams D.S.M., M.B.A. M.S.

Department of Education, The University of Virginia’s College at Wise, Wise, VA, USA

Dr. Matthew Williams The University of Virginia’s College at Wise 2001 Greenbriar Drive Bristol, VA 24202

Matthew J. Williams D.S.M., M.B.A., M.S., is an Associate Professor of Sport Management at The University of Virginia’s College at Wise. His areas of research interest include NASCAR, COVID-19, college athletics, professional sports, and sport management issues..

Recreational Sports, Junior Highschool Sports, and Highschool Sports are witnessing across all types of sports a decline in sports officials. Athletic directors in all three levels have seen a steadily declined in sports officials in the last twenty years. But since the COVID-19 Pandemic, the lack of sports officials has increased so rapidly that it could eventually become a nationwide crisis. The pandemic may have caused the decline of sports officials but it was not the only cause. The age of the sports officials has played a role in the decline of the sport’s officials. But the true main cause of losing sports officials has been the lack of respect for the sport’s officials through the behavior of players, coaches, family members, and sports fans.

Keywords Sports Officials, Players, Coaches, Fans, COVID-19 Pandemic, Respect.

Introduction

Recreational Sports, Junior High School Sports, and High School Sports are all witnessing a lack of sports officials all across the United States. There are so many theories out there on why we are losing sports officials so rapidly. If you have attended a sporting event lately and looked at the sports officials, a constant trend you will witness is the sports officials’ increasing ages and the lack of sports officials that are able to cover the sporting events. The repercussions of the lack of sports officials are already being felt. What is the true reason we are losing sports officials? Did COVID-19 Pandemic play a role in the loss of sports officials, the current age of sports officials, or the constant verbal abuse or threats to sports officials?

Even before the 2020 COVID-19 Pandemic Virus, it was apparent to recreational athletic directors, and athletic directors at both junior high and high school that they were already seeing a steady decline in sports officials across the United States over the past decade. The scarcity of officials is a long-running problem in high school sports. (6) From the 2018-19 school year to 2021-22, 32 of 38 states reporting statistics have seen registration numbers of officials drop, according to the National Federation of State High School Associations data. (1) Over the last decade, there has been a steady decline in the amount of referees available. In 2018, the Michigan High School Athletic Association reported that amount of referees available dropped from 12,400 to around 10,000 over the previous decade. (11)

The start of the COVID-19 Pandemic in the spring of 2020 forced a majority of recreational sports, junior high and high school sports across the United States to cease operations and shut down all games until further notice. This action of shutting down all games caused some officials to walk away from officiating. Simply because there were no games for the sports officials to work. As a result of the shutdown, officials had a chance to evaluate if they wanted to return to officiating. So many sports officials did not return to officiate games because of numerous reasons in the fall of 2020 or the spring of 2021. The Alabama High School Athletic Association is working hard to recruit and retain officials in all sports after losing more than 1,000 after the COVID-19 shutdown in the spring of 2020. (2) Washington said the association lost more than 1,100 officials after the COVID-19 shutdown. (2)

In the fall of 2020 and spring of 2021, some of the COVID-19 Pandemic restrictions were lifted and sports returned to somewhat normalcy. However, some officials decided not to return to officiating simply because of their age. There is a concern by some the impact of COVID-19 might hasten the retirement of older officials. (8)

The average age of the sports official was between 45 and 60 and it played a major role in the sports officials’ decision either to continue to be sports officials or not to be a sports official. Officials tend to be near or beyond retirement age the median age for a football referee is 56, according to the National Association of Sports Officials survey. (6) 77% of current officials are over the age of 45, with slightly more than half over the age of 55. (12)

The average age of the sports officials was at least 45 or older during the COVID-19 Pandemic. The COVID-19 Pandemic forced some older sports officials to choose not to return to officiating because simply of the underlying healthcare issues from the COVID-19 Pandemic. Some officials chose not to work during the pandemic because of health/safety concerns, and some of them chose not to return at all. (17) “In talking to some of the state directors, many of these losses are people who were probably on the brink of retirement, and then COVID kind of forced the issue,” explains Dana Pappas, NFHS director of officiating services. (15) The pandemic has also pushed a growing number of referees out, with officials leaving out of fear of getting sick. (16)

During the fall of 2021, some governors across the United States mandated that state employees must be fully vaccinated to prevent and/or limit the spread of the COVID-19 virus. This mandate forced many officials to choose whether to get the COVID-19 vaccination or not get the COVID-19 vaccination. If the sport’s official chose not to take the COVID-19 vaccination due to fears of the side effects of the COVID-19 vaccination or for religious beliefs, they would be banned from officiating junior high school and/or high school games. This mandate forced many officials to stop officiating resulting in a smaller pool of available officials to officiate games. “We already have a shortage of officials, not just in football but other sports,” Weber said”. “That (vaccine requirement) will reduce our numbers, based on what we’re hearing from our officials.” (3) The COVID-19 Pandemic resulted in some officials deciding not to return to officiating, creating an already smaller pool of available officials to officiate games. COVID-19 accelerated the problem, without question. (9)

Today’s parents are more invested financially than ever in their children’s sports careers. Parents are financially supporting their children’s sports careers through travel teams, summer leagues, specialized camps, personal training, and individual lessons. In the hopes that their child will either be drafted into professional sports or earn a college scholarship. Parents being so financially invested has caused an explosion of verbal abuse or threats toward officials from parents. Parents want the best outcomes for their children and are not afraid to voice their opinion to officials either by verbal abuse or threatening officials. Barrett theorized that the rise of travel teams in baseball —not to mention AAU teams in basketball and specialized camps for young football players — has caused parents to feel much more invested in their kids’ athletic careers, both financially and emotionally. (9) The parents feel more emboldened now than ever and are not afraid to voice their opinion verbally toward officials due to the fact they are so financially invested in their children’s sports careers. The parents feel strongly that they deserve the best officials to call the games because they have invested so much financially. “Parents have this sense of entitlement,” Barrett said. “They’re paying so much money, they think they should have better umpires.” (9) “These parents have this mentality of. ‘We pay all this money and travel all this way we expect the best, and referees can’t make mistakes.’ It’s based on society saying it’s okay to yell at people in public if they’re not giving you what they want. It’s asinine.” (13) “The problem is that, as parents spend more time and money on children’s sports, families are “coming to these sporting events with professional-level expectations,” said Jerry Reynolds, a professor of social work at Ball State University who studies the dynamics of youth sports and parent behavior. (7)

Aggressive behavior of abuse toward officials from coaches, players, parents, and fans started well before the COVID-19 Pandemic of 2020. “Before COVID, I felt like this behavior was reaching its peak,” Barlow said. (13) The aggressive behavior toward officials did not stop after the COVID-19 Pandemic was over. But some feel that the abuse of officials has increased resulting in the loss of more officials. Society of today has now become a custom of unruly behavior toward officials, players, and fans. The old saying, I paid my general admission ticket, gives me the right to berate an official, an opposing player, or a coach. This mentality has allowed more aggressiveness toward officials. Parents, coaches, and fans are increasingly aggressive toward officials. (4) People have had seemingly free license to scream, taunt and hurl insults at sporting events — acting out in ways they never would at work, the grocery store, or the dentists office. (14)

Officials have had enough of this type of abusive behavior, which is a major reason why we are losing officials so quickly. No official wants to be verbally abused, harassed, or threatened. Such unruly behavior is the driving force, referees say, behind a nationwide shortage of youth sports officials. (7) We have had the problem of losing officials because of the lack of respect toward officials from parents, family members, and fans well before the COVID-19 Pandemic. The shortfall has persisted for years, as rowdy parents, coaches, and players have created a toxic environment that has driven referees away and hampered the recruitment of new ones, referees say. (7)

The coaches, athletes, parents, family members, and fans of today no longer value or demand sportsmanlike behavior. We now accept unsportsmanlike behavior. Which consists of disrespect or lack of respect for officials through verbal abuse, threats, or harassment. Because we are accepting and allowing this type of behavior from coaches, athletes, parents family members, and fans. This is one of the main reasons why we are losing so many sports officials. “The un-sportsman like conduct of coaches, as well as some parents put people off and they don’t want to come back, they don’t want to return. They get yelled at during their days at work,” added Gittelson. (5) The shortage of officials in high school – and middle school – sports has been a growing concern for several years – in large part due to unsportsmanlike behavior by parents and other adult fans. (10)

Conclusions

The lack of sports officials is becoming a critical situation that recreational athletic directors, junior high school, and high school athletic directors will be facing in the coming years. Some sports officials are deciding to retire because of their age or knowing that their bodies can no longer keep pace with the speed of the game that they are officiating. This is creating a smaller pool of officials from the standpoint that the average age of the sport’s official is at least 45.

The COVID-19 pandemic did play somewhat of a role in reducing of sports officials that we are in right now. The pandemic brought health scares and mandatory COVID-19 vaccinations to some sports officials resulting in these officials making the decision to not return to officiating. But the real cause of the shortage of sports officials is simply the respect that is not given to the sports official by coaches, parents, family members, and fans. The behavior from coaches, parents, family members, and fans of yelling at sports officials, questioning sports officials’ calls, threats of violence towards sports officials, cursing at sports events, and even battery towards sports officials is out of control. No sports official wants to deal with this type of behavior at all nor should this type of behavior be allowed. This is the main reason why we are seeing the pool of sports officials becoming smaller. State legislation, superintendents of schools, principals of schools, and county commissioners need to address this issue of out-of-control behavior toward sports officials. If they do not, we will witness games being canceled, cancellation of seasons, and drastic pay increases that will be demanded by sports officials for the abuse.

• Aldam, W. (2022, July 30). Why number of high school officials is declining in Connecticut and what’s being done to fix it. Retrieved from CT Insider: https://www.ctinsider.com/gametimect/article/Why-number-of-high-school-officials-is-declining-17339698.php#:~:text=The%20primary%20contributing%20factor%20to,abuse%20from%20fans%20and%20coaches.%E2%80%9D
• Anonymous. (2022, August 16). AHSAA trying to replace more than 1,000 high school sports officials. Retrieved from Al.com: https://www.al.com/sports/2022/08/ahsaa-trying-to-replace-more-than-1000-high-school-sports-officials.html
• Arnold, G. C. (2021, September 21). Shortage of high school sports officials expected to worsen as Oregon’s vaccination mandate approaches. Retrieved from The Oregonian: https://www.oregonlive.com/highschoolsports/2021/09/shortage-of-high-school-sports-officials-expected-to-worsen-as-oregons-vaccination-mandate-approaches.html
• Davis Jr., M. A. (2021, November 5). No refs, no games: Can people play nice? Retrieved from The Christian Science Monitor: https://www.csmonitor.com/USA/Society/2021/1105/No-refs-no-games-Can-people-play-nice
• De La Fe, R. (2022, August 20). Nationwide referee shortage impacting hgh school and youth sports. Retrieved from CBS8: https://www.cbs8.com/article/news/local/nationwide-referee-shortage-impacting-high-schools/509-ce465d36-7a4a-419c-8671-a19711ca1cd9#:~:text=According%20to%20the%20National%20Federation,moved%20to%20Thursdays%20and%20Saturdays.
• Keilman, J. (2021, August 10). Friday night slights: referees, feeling unappreciated, underpaid and unnerved by COVID-19, are fleeing high school football and other youth sports. Retrieved from gmtoday: https://www.gmtoday.com/news/illinois/friday-night-slights-referees-feeling-unappreciated-underpaid-and-unnerved-by-covid-19-are-fleeing-high/article_bf377e00-010a-11ec-8f40-cf2c2f39f0d2.html
• Medina, E. (2022, April 21). Bad Behavior Drove a Referee Shortage. Covid Made It Worse. . Retrieved from New York Times: https://www.nytimes.com/2022/04/21/sports/referee-shortage-youth-sports.html
• Miller, M. (2023, June 2). Return to Play Concerns for Youth and High School Sports Officials. Retrieved from SportsEngine: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwi3uJqCxqCAAxW3l2oFHSYSAiMQFnoECBwQAQ&url=https%3A%2F%2Fwww.sportsengine.com%2Freturn-to-play%2Freturn-play-concerns-youth-and-high-school-sports-officials&usg=AOvVaw0
• Newberry, P. (2022, April 23). Column: Amid increasing abuse, officials flee youth sports. Retrieved from The Bulletin: https://www.bendbulletin.com/ap/column-amid-increasing-abuse-officials-flee-youth-sports/article_eb67df8f-5782-5e4b-8fba-1dc3cd756bde.html
• Niehoff, K. (2021, September 1). Poor Sportsmanship, Pandemic Contributing to Shortage of Officials . Retrieved from National Federation of State High School Associations: https://www.nfhs.org/articles/poor-sportsmanship-pandemic-contributing-to-shortage-of-officials/#:~:text=Poor%20Sportsmanship%2C%20Pandemic%20Contributing%20to%20Shortage%20of%20Officials,-By%20Dr.&text=As%20high%20schools%20begin%20a,to%20officiate%20all
• Purcell, J. (2022, January 10). High school referee shortage ‘as bad as it’s been’ as COVID-19 continues to impact Metro Detroit. Retrieved from Michigan Live: https://www.mlive.com/highschoolsports/2022/01/high-school-referee-shortage-as-bad-as-its-been-as-covid-19-continues-to-impact-metro-detroit.html
• Saunders, C. (2023, February 2). Shortage of local sports officials in ‘a crisis mode’. Retrieved from The Outer Banks Voice: https://www.outerbanksvoice.com/2023/02/02/shortage-of-local-sports-officials-in-a-crisis-mode/#:~:text=Local%20referees%20and%20officials%20say,dealing%20with%20increasingly%20bad%20behavior.
• Solomon, J. (2022, April 15). Roughing Up the Refs: Abusive Behavior is Driving Youth Sports Officials Away From the Game. Retrieved from Global Sports Matter: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiFi8L5wKCAAxWnmmoFHSdIAVQQFnoECBsQAQ&url=https%3A%2F%2Fglobalsportmatters.com%2Fbusiness%2F2022%2F04%2F15%2Fabusive-behavior-driving-youth-sports-officials-away%2F&us
• Stanmyre, M. (2022, March 29). It’s never been uglier on N.J. sports fields as bad behavior explodes. Retrieved from Nj.com: https://www.nj.com/sports/2022/03/its-never-been-uglier-on-nj-sports-fields-as-bad-behavior-explodes.html
• Thiede, D. (2022, August 18). SportsLife: Officials shortage impacting youth, high school sports. Retrieved from Kare 11: https://www.kare11.com/article/sports/local-sports/sportslife/sportslife-official-shortage-impacting-youth-high-school-sports/89-61bde5cf-6dcd-4d76-92e5-722bed0ac53a#:~:text=A%20recent%20survey%20by%20the,year%20unaffected%20by%20the%20pandemic.
• Voigt, K. (2021, December 5). Youth sports referees are quitting in droves due to a toxic combination of abuse from coaches and parents, low salaries, and COVID-19. Retrieved from iSport360: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwich4n_vKCAAxWqk2oFHfO2DF0QFnoECBMQAQ&url=https%3A%2F%2Fisport360.com%2Fyouth-sports-referees-are-quitting-in-droves%2F&usg=AOvVaw0UL4DhXYHn35R0v1Ek0ISO&cshid=16899659
• Woelfel, R. (2022, July 15). Why is there a Shortage of Officials? Retrieved from Stack: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwj5i_K_y6CAAxVBk2oFHUOkAAsQFnoECA0QAw&url=https%3A%2F%2Fwww.stack.com%2Fa%2Fwhy-is-there-a-shortage-of-officials%2F%23%3A~%3Atext%3DThe%2520Covid%252019%2520pandemic%2

Tracing the state of sport management research: a bibliometric analysis

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• Published: 24 February 2023

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• Jonas Hammerschmidt 1 ,
• Ferran Calabuig 2 ,
• Sascha Kraus   ORCID: orcid.org/0000-0003-4886-7482 3 , 4 &
• Sebastian Uhrich 5  

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This article presents a state-of-the-art overview of the sport management research discipline through a bibliometric analysis of publication data from the top five sport management journals in the decade 2011–2020. The analysis includes citation and productivity analysis of journals, institutions, countries, and articles, author citation and output analysis, and title and abstract (co-)word analysis. The data identifies the Sport Management Review as the most prolific journal of the last decade. Institutions and authors from the US are dominating the sport management research, which has increased its attractiveness in other disciplines. Co-word analysis shows recent and frequently discussed topics related to management of sport organizations and events, team and game, sport marketing and sponsorship, and behaviour and identification of the spectator. The article serves the ongoing debate on sport management as an academic field with deep insights into the publication structure and thematic dynamics of the last decade.

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1 Introduction

Sport has become a weighty player embedded in the context of economic development (Ratten 2010 ). The growing economic relevance of sport created an organizational need for operational and managerial structure. Research at the intersection of sport and management has established a discipline that tackles the complexity of managerial activity in the sport environment. In the slipstream of the increasing influence of sport, sport management research has developed into an attractive and exponentially growing discipline (Funk 2019 ). However, the rapid and proliferating growth of sport management research, especially in the last decade (Pellegrini et al. 2020 ), has led to seemingly uncoordinated progress. As a result, it is difficult to assess the current status quo of the research discipline, as well as uncertainty about the prevailing dynamics that have influenced the development of the field in recent years.

In the period from 1990 to 2000, sport management was dominated by topics related to athletic training and athlete programs with less focus on the commercial potential of sport (Ciomaga 2013 ). In the penultimate decade, from 2000 to 2010, the thematic landscape of sport management has evolved in the opposite direction, with the focus of the field on commercial issues and becoming more oriented towards management disciplines (Ciomaga 2013 ). Ciomaga ( 2013 ) and Shilbury ( 2011a , b ) noted that marketing had the greatest impact on sport management research during these years, and that influence appeared to increase over time. This development was viewed with suspicion because the extensive commercial view of the multifaceted world of sport could lead to a neglect of its special qualities (Ciomaga 2013 ; Zeigler 2007 ). Almost as a logical consequence, Gammelsæter ( 2021 ) criticizes the prevailing conceptualization of sport as an industry or a business, which ignores natural features of sport such as its sociality. In the current conceptualization of sport entrepreneurship, a sub-area of sport management, Hammerschmidt et al. ( 2022 ) has recognized that ‘sport is social by nature and thus is sport entrepreneurship’ (p. 9), which apparently is the case for sport management. However, the discussion about the lack of conceptual clarity in sport management research was initiated early on, accompanied by recommendations that subsequent research addresses this deficit of clarity through systematic analyses (Chalip 2006 ).

To take a first step towards a better understanding of the status quo of a scientific discipline, a bibliometric analysis is a well-established method (Deyanova et al. 2022 ; Kraus et al. 2022 ; Martínez-López et al. 2018 ; Tiberius et al. 2020 , 2021 ). In recent years, few reviews have been conducted in the sport management discipline. Ciomaga ( 2013 ) combined a content-related review with a quantitative analysis of three leading sport management journals for the period 1987–2010. The study examines how sport management research strives for legitimacy and asserts that sport management research is still strongly influenced by its reference disciplines (e.g., marketing and organizational studies). To assess the state of development of the research field and its influence on generic disciplines, Shilbury ( 2011a ) examined citations of sport management and marketing journals in management and marketing journals. Results show that sport management and especially sport marketing literature has gained traction in top tier generic journals. In addition, Shilbury ( 2011a ) observed that it takes just over six years after a sport management journal’s creation until it’s expected to generate citations in journals outside the field. However, six of the seven analyzed journals were then not yet listed in the Social Science Citation Index (SSCI), which makes it difficult to draw a real picture of journal usage and consequently impact. Moreover, Shilbury ( 2011b ) analyzed citations of reference lists of manuscripts published in the Journal of Sport Management (JSM), Sport Marketing Quarterly (SMQ), European Sport Management Quarterly (ESMQ) and Sport Management Review (SMR). JSM is the journal with the longest history and was the most frequently cited journal, highlighting its role as the leading journal in the discipline. It is followed by SMQ with the second most citations, which is correspondingly the journal with the second-longest history. Apparently, the time factor played an important role because influence, citations, number of citable items, and reputation have developed over time (Budler et al. 2021 ).

Previous studies were important for a better understanding of the publishing behavior of sport management journals and provided a comprehensive overview of the fields’ development. However, the discipline has had the greatest growth in the last decade (Pellegrini et al. 2020 ) and the diffusion of new theories can take several years (Funk 2019 ). For example, when the analysis of Shilbury ( 2011a ) was conducted, only one sport management journal was listed in the SSCI, indicating that it may have been too early to obtain conclusive results from bibliometric analysis. Since then, many sport management and marketing journals have been listed in the SSCI for numerous years. It is particularly interesting to see how the sport management journals have performed in comparison since the analyses of Ciomaga ( 2013 ) and Shilbury ( 2011a , b ).

The aim of this bibliometric analysis is therefore to quantitatively structure the field using bibliometric indicators, and to assess the thematic dynamics of the last ten years with bibliometric coupling to contribute to the debate on the path that sport management is taking. To achieve this, a holistic bibliometric analysis is required due to the high demands on an integrated view of the complex scientific field (Gammelsæter 2021 ). This is mainly due to the multi-faceted nature of sport management, which can be easily illustrated by the role of a sport manager who takes care of issues in the organizational environment such as the desire to win, business, sport for development, professional marketing or social welfare (Hammerschmidt et al. 2021 ). Consequently, the methodological approach to achieve the research aim goes beyond related previous work.

A bibliometric analysis is a capable tool to identify the most influential journals based on publication and citation trends (Baumgartner and Pieters 2003 ; Martínez-López et al. 2018 ). In doing so, the study identifies important aspects in terms of citations, authors, articles, institutions, and countries. Ciomaga ( 2013 ) calls for studies to be conducted with more and particularly specialized journals. In response to this call, we conduct a bibliometric analysis that goes further than what has been done so far and analyses five of the leading sport management and marketing journals: Journal of Sport Management, Sport Management Review, European Sport Management Quarterly, International Journal of Sport Marketing & Sponsorship, and Sport Marketing Quarterly. The rationale for our selection of these five journals is their appearance in the SSCI. Whatever delimitations are set, bibliometric analyses can never provide a complete picture of the field, as recent work may not have reached its full bibliometric impact (Budler et al. 2021 ), but boundaries need to be set to manage the data, and given the work that has pre-dated this study, delimiting the scope of this work to a ten-year period since 2011 is logical.

The study is structured as follows. The next section explains in detail the methodology used for bibliometric analysis and data collection. The results of the bibliometric analysis are then presented, including basic bibliometric indicators, as well as leading institutions, countries, authors, and articles of the five journals. The bibliometric coupling and the analysis of the themes is then presented. Subsequently, the main findings are discussed, followed by the limitations and the conclusion in the last section.

2.1 Procedure

The method of bibliometric analysis aims to statistically and objectively map the current state of a scientific field and to quantitatively structure its publications (Merigó et al. 2018 ; Mukherjee et al. 2022 ). To obtain a holistic picture of the sport management scholarship, we performed several bibliometric procedures. Specifically, basic bibliometric indicators were calculated to analyze the top five sport management journals: publication behavior of specific institutions, citation measures of different countries, scientific productivity of authors within the field, and most cited articles in the field.

Quantitative numbers of publications indicate the scientific productivity and citation frequency reveals the influence of research (Luther et al. 2020 ; Shilbury 2011b ). In this context, the quantitative analysis offers a high level of objectivity (Zupic and Čater 2015 ). To measure the influence of journals in this study, the Impact Factor is used because compared to other metrics, such as CiteScore, the Impact Factor is still the more widely used and recognized metric and is more likely to reflect current developments because it is based on a smaller time frame (Kurmis 2003 ). Institutional and country data is collected to provide a potential basis for alternative explanations of thematic dynamics and trends (Ciomaga 2013 ). The results on authorship provide a useful basis for the interpretation of possible social influences within the scientific community (Small 2011 ). The analysis of the most cited articles offers information about what type of research can generate the most interest in the discipline (Ciomaga 2013 ).

The quantitative analysis includes additional metrics to evaluate the authors' research output: the h-index and the g-index. The h-index metric presents a balance between individual articles that achieve high citations, older articles, and articles with average citation counts (Alonso et al. 2009 ; Hirsch 2005 ). “A researcher has index h if h of his/her N p papers have at least h citations each, and the other ( N p  −  h ) papers have no more than h citations each” (Alonso et al. 2010 , p. 3). Thus, a h-index of 10 means that at least 10 articles have achieved 10 citations each. In addition, we present the g-index, which is intended to extend the h-index. Here, the threshold of achieved citations are exponentiated and aggregated (Egghe 2006 ). “A set of papers has a g -index g if g is the highest rank such that the top g papers have, together, at least g 2 citations. This also means that the top + 1 papers have less than ( g  + 1) 2 cites” (Alonso et al. 2010 , p. 4). Hence, a g-index of 10 means that the top 10 articles of an author have collected at least 100 citations. Taken together, these two metrics give a sharper picture of the correlations between productivity figures and the influence of authors. Since the data base for these metrics is limited to sport management publications, the h- and g-indexes correspond to their sport management publications.

The data retrieved from the Social Science Citation Index (SSCI) is decisive to build networks of co-occurrences. Although there is no standard approach of a bibliometric analysis, the most common methodologies include the investigation of citations, co-citations and co-occurrences (Ferreira et al. 2015 ). In this study, the VOSviewer software is used to perform bibliometric coupling by means of a co-word analysis of titles and abstracts. This method processes the bibliometric data and then visualizes the relationships in a distance-based map. The representation simplifies the illustration of the bibliometric data and helps with the subsequent interpretation of the results (Luther et al. 2020 ). The aim of this work is not to synthesize the entire literature of the discipline, but rather the most mentioned themes. This inheres the danger of neglecting current trends and topics with little influence. Considering the research question, however, this is by no means a disadvantage, but provides clarity on the themes that were frequently discussed in the period under study.

To increase the depth of the results, this study performs a co-word density map. The density of a term depends on the number of nearby items and the number of citations they have. The density map shows how dense the research on a topic is. The denser the color, the more research is being done on that topic (van Eck and Waltman 2010 ). By combining a co-word map and a co-word density map, we get a more complete picture, because this shows which terms are mentioned the most and which ones gather the most science around them. The unified approach sheds more light on the underlying structure of bibliometric networks and therefore adds value compared to the isolated use of either approach (Waltman et al. 2010 ).

2.2 Data collection

The data were collected from the Social Science Citation Index (SSCI) using the Web of Science Core Collection™ (WoS). To be included, journals need to be directly related to either sport management or sport marketing, or both. Second, the journals need to be assigned with an Impact Factor in the journal citation report (JCR) at the time of the search. Table 1 provides an overview of the selected journals. The study is limited to published research between 2011 and 2020 that is labelled as either original or review articles, and excludes other types of articles. The search string was carried out on February 15, 2021.

This research contributes to the sport management discipline by providing a systematization of literature from the last decade. From 2011 to 2020, a total of 1516 articles (1417 articles and 79 reviews) were published in these five sport management journals by 1951 authors, belonging to 845 institutions from 49 countries.

3.1 Basic bibliometric indicators of the journals

The discipline of sport management and marketing is still a young area, as can be seen in Table 1 . The first sport management journal to be indexed in the WoS was the Journal of Sport Management, which first appeared in 1993. In 2007, a second journal was added, the International Journal of Sports Marketing & Sponsorship. The European Sport Management Quarterly was introduced one year later. There is an important quantitative leap until 2011 when the Sport Management Review was included in the index. Finally, the Sport Marketing Quarterly was indexed in 2014 and received the first Impact Factor in 2017.

The journal that contributes the most articles to the analysis is the Sport Management Review with 462 original articles or reviews, followed by the Journal of Sport Management with 410 articles or reviews.

The local citation score (LCS) indicates the number of citations the journal has received in the analyzed database of 1516 articles. The global citation score (GCS) indicates the number of citations that the journals’ articles have received throughout the WoS database. The LCS and GCS are aggregate data on the amount of citations and therefore, whether the variables are calculated for articles or journals, can be an indicator of influence (Mehri et al. 2014 ). On a general level, SMR is the most influential journal outside the discipline during the last decade, receiving 7557 citations (Table 1 ). It is followed at a large distance by JSM with 5985 citations and the European Sport Management Quarterly, which has 3719 citations in the general database of the WoS. The great influence of SMR is particularly notable considering that it is a very young journal in the WoS since it entered this index not until 2011. In addition, SMR received the highest Impact Factor (i.e., 6.577) in the field in 2020.

Figure  1 shows the development of published articles over the years. As more journals have been introduced into the WoS, the number of published articles has increased. However, the journals’ strategy of increasing the frequency of issues published per year to improve visibility and citation opportunities influenced the results. Growth has been steady, reaching the highest level in the historical series in 2020.

Total number of publications of the top five sport management journals

As far as the development of the number of published articles and reviews per journal is concerned, there is an upward trend for all of them (Fig.  2 ). In general, these journals have increased the number of their publications over the past decade. The journal that published the most articles in 2020 is SMR (72), followed by JSM (45) and IJSMS (38). In contrast, the journals that published the smallest number of articles in 2020 are ESMQ (28) and SMQ (17).

Number of publications of the top five sport management journals

As can be observed, there is a general increase in the IF, especially in the last year (Fig.  3 ). The IF of JSM shows an upward trend (IF 2011–IF 2019 = 1.55) and presented the highest improvement in 2017. Regarding SMR, the IF also showed a positive trend from 2014 (first year with IF) to 2019 (IF 2011–IF 2019 = 2.13), reaching the highest value of the top five journals in 2019 (IF = 3.34). ESMQ has also shown a positive trend in IF in recent years (IF 2011–IF 2019 = 1.01). The highest growth of its IF was between 2015 and 2016 and the highest value was reached in 2018 with 2.27. However, in 2019, its Impact Factor decreased to 1.89.

Impact Factor of the top five sport management journals

For the IJSMS, there was a positive trend in IF from 2011 to 2020. Though, it had no IF in 2012 and 2013. Since then, its highest IF was reached in 2020 with 2.93. Finally, SMQ received its IF recently, in 2017, and it increased sharply in 2018 (IF = 1.14), but decreased in 2019 (IF = 0.74), showing similar values to 2017 (IF = 0.69).

3.2 Institutions and countries

Slightly more than half of the contributing authors (814) come from the US, followed by Australia (252) and the UK (173). The European country with the highest number of contributing authors is Germany (105).

Figure  4 provides an overview of the most cited countries in the last decade. Darker colors indicate a higher number of citations. The US and Australia are the countries that have received the largest number of citations (> 2000 citations). However, it is important to highlight that the US is by far the country that has received the most citations (9834). The European country with the most citations is Germany (1589).

Number of articles published per country

Regarding the institutions, Griffith University ranks first by citation count in the WoS (1717), followed by Temple University, which is the second most cited university (1432). The University of Florida ranks third (1270). In addition, these three universities are also the most cited in searches within these five journals (LCS). The most productive institutions are Temple University with 96 articles, followed by Griffith University with 81, and the University of Florida with 79 published articles.

In terms of number of citations per article published in the WoS (GCS/Nb. Articles), the University of Technology Sydney ranks first (25.47), followed by Griffith University (21.20) in second, and Deakin University in third (20.72). University of Technology Sydney also ranked first in the number of citations per document published in these five journals (7.17) (see Table 2 ).

3.3 Authorship of published articles

We ranked the number of citations by author based on the date of data collection (February 15, 2021). The most outstanding authors are Funk with 850, Wicker with 618 and Breuer with a total of 581 citations in the WoS. Highly cited researchers are also highly productive. There is evidence that the number of publications is highly correlated with the number of citations (Parker et al. 2013 ). Looking at the number of publications of these authors, Funk stands out as the author of the field with the highest number of publications (39) in the mentioned sport management journals during the last ten years. In addition, Funk has the highest h-index with 19 and the highest g-index with 29. Both metrics indicate that his high number of publications is matched by a high number of citations. Therefore, he can be considered the most influential author in the discipline in absolute terms. Table 3 shows the most productive authors in sport management and marketing research. An additional way to determine the influence of authors is the number of citations received based on the number of articles published (Kostoff 2007 ). The GCS/Nb. index shows that Kaplanidou has the most global citations per published article with 35.55. The scholar is followed by Schulenkorf (31.20) and in third position is Lock with 30.35 citations per article.

Considering only the citations received in these five journals over the past ten years, the LCS/Nb. index shows that Lock has the most citations per article with 11.94. He is followed by Doherty with 10.57 and Yoshida with 10 citations per article.

The ten most cited articles in the WoS are displayed in Table 4 . It is noteworthy that the three most frequently cited articles are relatively recent literature reviews. SMR contributes seven articles and JSM contributes two articles, one is from ESMQ.

3.4 Co-word analysis

Figure  5 clusters the co-occurrence of words within titles and abstracts. The generated terms reflect frequently discussed topics in the literature. The relationships of the topics show four recurring thematic groups of the five sport management journals. Each color (blue, red, yellow, and green) corresponds to a theme and signals its group membership.

Co-word analysis of terms gathered in clusters

Figure  6 is a density map. A topic is denser if it has more terms nearby. Thus, the figure shows the interconnections and proximity of the themes to each other (van Eck and Waltman 2010 ). The range is displayed from yellow (most intense) to green, and blue (least intense).

Density map of co-word analysis

The co-word analysis revealed four thematic clusters. The red cluster (1) belongs to the management of sport organizations and events, the blue cluster (2) is about the team, fan and the game, the green cluster (3) is the sport marketing and sponsorship cluster, and the yellow cluster (4) is about the behavior and identification of the sport spectators.

3.4.1 Red: Examining the management of sport organizations

The red cluster is relatively diverse and appears to contain another subgroup. In principle, this thematic field is about the management of sport organizations, which are the origin of sport participation (Misener and Doherty 2009 ). This field is predestined to benefit from the knowledge of other disciplines. Thus, the principle of organizational capacity, a concept from the management discipline, can be a key determinant for the success of sport organizations (Hoeber and Hoeber 2012 ; Misener and Doherty 2009 ). However, sport organizations are exposed to unique circumstances and, therefore, a potential subject for research emanating from inside the field. An example of this is the research of volunteerism, which is currently in the conceptualization phase (Wicker 2017 ), but can be one of the most pressing issues of sport organizations in the future (Wicker et al. 2014 ).

3.4.2 Blue: the sport cluster about the team, the fan and the game

The blue cluster is much clearer and is dominated by only a few terms. It is somewhat surprising that team and identification appear in separate clusters, since team identification is one of the most developed concepts of sport management, especially within the last decade (Katz and Heere 2016 ; Lock and Heere 2017 ). This is probably due to the fact that the terms fan, team, game, and league create a kind of cluster of their own since they are typically mentioned together. They have apparently also connections to other topics (which can be observed at their central position) but should be seen more as a platform for gaining knowledge, rather than as a separate thematic field. The connection of the word pairs is also interesting because in the blue cluster, the fan, and fan attendance are connected, whereas the terms customer, spectator, and behavior appear in the yellow cluster. The blue cluster seems to have evolved out of sport because of the terminology, whereas the yellow cluster is obviously characterized by commercial concepts (consumer, spectator, behavior, identification). The blue cluster is also the only cluster that includes a specific sport, namely major league baseball and especially football (soccer).

3.4.3 Green: developing marketing and sponsorship in sports

Marketing is part of the green cluster, however, neither the co-word analysis nor the density map reveals an increased appearance or influence of the term marketing. However, this refers only to the term in the analysis, not to the influence of the marketing topic in general. The way in which sport is consumed is of great value for practitioners. They try to provide pleasurable sport experiences by focusing on service quality and customer satisfaction, which is based on knowledge about how sport is consumed (Funk et al. 2016 ). Sport consumer research is a popular and growing sub-discipline of sport marketing research (Funk 2017 ; Yoshida 2017 ). Sponsorships most prominent context is sport, and generated insights have the potential to impact generic disciplines. For example, sport management research is discussing whether a consumer can identify non-congruent messages in sport marketing more easily than congruent, consistent information (Alonso Dos Santos and Calabuig 2018 ).

3.4.4 Yellow: investigating the commercial aspect of the spectator

Research within the yellow cluster focuses on diverse aspects related to spectator identification, loyalty, and behavior with sport (Lock et al. 2012 ). The terms of the yellow cluster are strongly linked to the concept of team identification, which in turn is strongly linked to marketing research (Heere et al. 2011 ; Katz et al. 2018 ). Psychology also has a great influence on the yellow cluster. Chang et al. ( 2018 ) used the approach of cognitive psychology to create the concept of implicit team identification (iTeam ID). By integrating the unconscious nature of consumption, iTeam ID may provide sport marketers with new insights for understanding fans’ identification with teams.

The density map (Fig.  6 ) shows that the term ‘team’ has the highest density in the field, indicating that more researchers are conducting research related to topics that mention the term team. The terms sport club, sport management, and sport organization are also presented with a high degree of density and would likely overtake the term ‘team’ if more consistent terminology were used. Terms such as league, game, fan, behavior, consumer, identification, participation, sponsorship, and sponsor also have a high density and are all presented in a more concentrated color than the term marketing.

4 Discussion

4.1 productivity and citations.

Despite its relative newness to the WoS, SMR is the most influential journal in the sport management discipline in our analysis of the last decade. During this period, it published the most articles, collected the most local and global citations, and had the highest Impact Factor among the top 5 journals in sport management. In addition, 7 of the 10 most cited articles, including the one with the most citations, were published in SMR. Hence, our study reveals a potential shift from the Journal of Sport Management as the most influential journal in sport management to SMR.

Productivity in the analyzed journals has been dominated by the US. The majority of authors come from the US, indeed the number is eight times higher compared to the European country with the most contributing authors: Germany. However, among the 3 most cited authors in the field are two Germans (Wicker and Breuer), which, by the way, count for 76% of all German citations with 1199 out of 1589 citations. The most cited article comes from an Australian university. The dominance of the US therefore seems to be less due to the quality (what can be derived from the values of LCS and GCS per article), but much more due to the quantity of researchers from the US contributing to sport management. The high number of researchers from the US seems to have an influence on the topics discussed. Sport in the US is more commercial in its basic concept, and community-sport organizations have less influence than is the case in Canada or Europe (Misener and Doherty 2009 ), which in turn may be part of the explanation why commercial logic has taken over in the sport management literature. It is further surprising that the term football is so prominently represented, even though football is called soccer in the US and plays a minor role. Conversely, this indicates that the scholarship of other nations focuses all the more on football.

In terms of authorship, a two-sided picture emerges. On the one hand, there are authors like Kaplanidou and Schulenkorf who have achieved high GCS scores and thus many citations outside the sport management journals. The articles by Kaplanidou were focused on the field of sport events and sport tourism. The most influential articles by Schulenkorf belong to sport for development literature and the most influential article is a review on sport for development, which accounts for a good quarter of the total global citations. Without this article, the value would fall back to the midfield. Research in these areas thus seems well suited to be cited by disciplines outside the field, but less suited to generate traction within the field. In terms of local citations, however, research on consumer satisfaction/behavior and sport organizations, respectively done by Yoshida and Doherty, are leading the scoring board. Lock is the only one whose research on team identification is frequently cited, both within and outside the sport management discipline. This possibly stems from the fact that Lock is also a co-author in other areas, such as sport and social media, eSports or sport consumption, and therefore has a very diverse research portfolio. Whether these findings about the choice of a topic and its influence on citation generation can be systematically replicated remains unclear. It can, however, support academics in choosing future projects and contributes to Funk's ( 2019 ) findings that on the one hand the ‘How?’ influences the diffusion of knowledge and on the other hand the ‘What?’ influences where knowledge can generate impact.

In Ciomaga's ( 2013 ) analysis, the papers with the most citations were reviews. Likewise, the three most cited articles in this analysis are reviews, a phenomenon that can also be observed in other disciplines (Vallaster et al. 2019 ). Surprisingly, the three authors with the most citations do not have an article in the top cited article list. However, the authors also have high scores in the h- and g-indexes, which means that they are highly productive, but also able to gain traction in terms of citations.

4.2 Exploring the thematic complexity of sport management research

In the results section, the thematic clusters were presented and their content discussed. In this section, we link our results to the ongoing debate in some substantive areas within sport management research.

The most obvious finding when looking at the visualization of co-occurrences is also the most influential: the thematic map of sport management research has become more diverse. The thematic complexity of the discipline that we present in our study contrasts significantly with the previous one-dimensionality of issues. Previous reflections mentioned that the focus of sport management research was characterized by a lack of systematic management strategies (Slack 1998 ) and then oscillated to an over-representation of commercial logic (Chalip 2006 ; Ciomaga 2013 ; Gammelsæter 2021 ). Our findings have carved out four thematic clusters and two of them, namely the green cluster on sport marketing and sponsorship and the red cluster on the management of sport organizations and events, are noticeably influenced by management disciplines and commercial thinking. However, both also show research streams that intend only to apply theories from other disciplines in the sport context, but to develop their own theories concerning, for example, the voluntary work of sport clubs, the management of community-sport-organizations or the peculiarities of sport sponsorship. The yellow cluster remains vague in this respect. On the one hand, this thematic group is also dominated by a commercial perspective and deals with the fundamental question of what motivates a spectator to consume sport. In this context, spectators are also referred to as customers, a term normally used in business. On the other hand, sport management scholars managed to establish a firm basis of evidence around the team identification topic. This thematic area, while based on identity theory and the social identity approach, has subsequently built up a sport-specific and data-based knowledge base step by step, rather than accumulating theories through the constant introduction of new general management theories.

The blue cluster in this analysis is a novelty and represents a dominant thematic field of sport management that deals with sport specific characteristics: the team, the fan, the league, and the game. This cluster represents a thematic development of the last decade in sport management research, which is in line with the demand to put sport back into the center of sport management (Gammelsæter 2021 ). It is also important to note that the term ‘team’ is the term on which most research has been conducted. However, this conclusion may also be deceptive, as other thematic fields have greater diversity in the use of terms and, cumulatively, would likely yield more influential scores.

In general, commercial research areas continue to dominate the field. A common characteristic of these topics is that they are related to important sources of income and, hence, the findings are relevant from the perspective of practitioners as well. Sport has its grassroots in voluntary, community-based sport clubs. Despite the ongoing professionalization of sport, most sport organizations have a social background and are non-profit (Misener and Doherty 2009 ). As Morrow ( 2013 ) notes, sport ‘has always been and continues to be […] economic in basis, but social in nature’ (p. 297). In contrast, the term ‘social’ was not represented in our analysis and therefore future research could take a more holistic approach and engage in distinct social aspects of managing sport.

Football (soccer) is the only sport besides major league baseball that appears in the co-word analysis. Moreover, both terms, i.e., soccer and football, are still represented and together their influence would be mapped even more strongly. Nevertheless, football is the most represented sport in the sport management journals in our analysis, thus underlining its significant and leading role in research.

Looking at the development of sport management topics in the past, it is interesting to note that these have grown mainly within sport management journals. Shilbury ( 2011a ) noted that only 25 sport management related papers were published in generic management journals. In contrast, sport entrepreneurship, a young and emerging sub stream of management research in sport, has originated from the field of entrepreneurship and mainly grown up outside the major sport management and marketing journals. Sport entrepreneurship attaches great importance to the specifics of sport (Hammerschmidt et al. 2020 , 2022 ) and can therefore help to support the missing distinctiveness of sport management (Shilbury 2011b ). It remains open whether it is a trend or an exception that new sub streams arise outside the discipline.

4.3 Bridging sport management facets: an integrative view

The integrated view of sport management is a holistic approach that considers the various aspects of sport managements research. This approach recognizes that, for example, the success of a sport organization is not solely dependent on one aspect, such as management or marketing, but rather on the interrelationship of all elements.

In our analysis, we were able to depict the multi-faceted landscape of topics in sport management over the past decade. As described above, the dominant themes and ultimately the concepts and theories that emerged from them can be traced back to a strong influence of commercially oriented generic management research. This commercial focus runs throughout the discipline of sport management. Interestingly, however, the inherent tasks of managing sport lead to a much more diverse landscape of topics. Therefore, the integrative view of sport management does not refer to focused topics, but attempts to point out the multi-faceted nature of sport management through a holistic approach.

An integrated view of sport management considers the management of sport organizations, including the development of unique and sport-specific theories that address the unique challenges and opportunities presented by the sport industry. This approach also includes the marketing and sponsorship of sport events and the spectator sport experience. In addition, an integrated view of sport management considers the volunteerism and community engagement aspect of sport organizations, recognizing the important role that volunteers play in the sport management discipline. This approach also embraces the role of sport in promoting social development, for example, through the use of sport as a means of education and promoting healthy lifestyles. The integrated view of sport management thus allows for a better understanding of the sport industry as a whole and the interactions between the different elements of the industry. This can lead to better prediction of industry trends and a more accurate understanding of the competitive landscape. The integrated view of sport management is a holistic approach that considers all aspects of sport organizations and events. Therefore, the integrative view offers opportunities for unique and sport-specific theories, and allows for more effective strategies and decision-making by recognizing the interrelatedness of the sport management elements.

4.4 Sport management research on the rise: a sport-specific perspective

The results of the study underline that sport management research has been attractive outside the field over the last decade. Many of the papers published in sport management and marketing journals are cited in journals from other fields. The ten most cited articles presented in this study show high citation indicators in the general WoS database and are good proof that research in sport management attracts the interest of the larger scientific community. This underlines the findings of Ciomaga ( 2013 ) who analyzed sport management research following the direction of a reference discipline as a trend.

One possible explanation for the increased influence of sport management research is provided by the assumption of Ciomaga ( 2013 ) that sport management research has increasingly shown the ability to build unique theories and thus may become a reference discipline. In this study, we presented the main thematic clusters of sport management research and showed that there are research areas characterized by a gradual development of unique theories. One of these areas is volunteer management in sport, the theories of which are well-developed due to their great relevance for sport clubs and sport events and thus play a leading role in volunteerism research. Another topic is sport for development, of which two articles appear in the ten most cited articles. The term already indicates that these are developed findings from a sport management sub stream that focuses primarily on sport-specific contexts. In addition, the development within the topic area of team identification is noteworthy. The articles we analyzed showed a steady theoretical development because they built on each other stepwise with a high degree of consistency. Although the number of articles in the field of team identification is comparatively small, well-researched and advanced theories and concepts have been developed. Moreover, it has been shown that sport management research has grown and the topics of the discipline have become more diverse, which logically has increased the number and possibilities of theories to be used for other disciplines. In addition, the blue cluster presented in this study (terms: team, fan, league, game) shows a greater cohesion to sport-specific topics compared to the dominant topics presented so far, suggesting that more unique sport management theory is emerging. However, the methods presented in this study cannot answer the question of how sport management research has increased its attractiveness in other disciplines and whether this is related to the emergence of unique theories.

In essence, a reference discipline states its progress of knowledge by getting cited by other disciplines (Shilbury 2011b ). Being a reference discipline is strongly linked to the fundamental debate on conceptual clarity of sport management. The ability to create theories reinforces the view that sport has a special quality (Gammelsæter 2021 ), whereas the application of theory from broader disciplines to sport management suggests that it is rather a sub-discipline of management (Ciomaga 2013 ). Regardless of which way is chosen to generate knowledge in sport management, it should be considered that the diffusion of new theories in sport management proves to be a slow and uncomfortable process (Funk 2019 ). The ongoing debate shows that sport management is still in its discovery phase.

5 Conclusion

This study applied the bibliometric method to analyze the five leading journals in sport management and marketing literature (Journal of Sport Management, Sport Management Review, European Sport Management Quarterly, International Journal of Sport Marketing & Sponsorship, and Sport Marketing Quarterly). The analysis covers data of 1516 articles in the period from 2011 to 2020 and leads to theoretical and practical contributions in several ways.

The bibliometric analysis allowed us to identify key authors, institutions and journals in the field, as well as the mapping of research trends and patterns over time. Our analysis shows that authors from the US dominate, not qualitatively but quantitatively, and suggests that their focus may be part of the explanation why the theoretical structure of the sport management field is highly commercialized. Despite the US dominance, the term football is prominently represented suggesting that football (soccer) is a popular empirical setting for sport management research. In terms of thematic development, commercial thinking in sport management has become firmly entrenched within the discipline and an abrupt change in the prevailing paradigms seems naïve, even if it neglects sport-specific idiosyncrasies as a result. One of these idiosyncrasies is the inherent social nature of sport (Morrow 2013 ), which receives hardly any attention in sport management. The result of our co-word analysis showed that there are four dominant thematic clusters in the field (management of sport organizations and events; team, fan and the game; marketing and sponsorship; behavior and identification of the spectator). Despite the dominance of commercial topics, the cluster around the team, fan and game seems to have evolved out of sport with a focus on the sporting aspect. Moreover, Ciomaga ( 2013 ) predicted that research within sport management will ‘follow lines of research on sport that have been legitimized by reference disciplines’ (p. 572). The analyses of this study indicate that the influence of sport management literature on other disciplines is growing. In addition, developments in substantive areas and the introduction of sport-specific theories in several contexts, including volunteerism, sport for development, or team identification are emerging within the discipline. This enriches the field in diversity and has the potential to (a) drive a paradigm shift to put sport back in the spotlight and (b) increase the legitimacy of the field through growing influence on other disciplines.

On the practical side, our analysis showed that SMR is, in the period under study, the leading journal in almost every productivity category which can be a useful information for authors looking to publish their work, or for organizations and institutions to identify potential partners or competitors. In addition, the analysis of citation data support authors in future articles by showing what research achieved high popularity. Within the study period, reviews in particular achieved high citation scores. Articles in the field of sport for developments, sport events and sport tourism were cited remarkably often outside the discipline. Within sport management, articles in the thematic area of consumer behavior and sport organization in particular achieved high citation values.

The presented findings in this study are constrained by various limitations. Quantitative data were collected from the Social Sciences Citation Index (SSCI) of the Web of Science database. Hence, the limitations of the database also limit the results of this study. Therefore, future studies may select other sport management and marketing journals indexed in other databases (e.g. Scopus) and perform a bibliometric analysis to compare the themes and trends with the results obtained in this study. Further, recognizing scientific contributions and developing academic impact takes time (Xi et al. 2015 ). As a result, recently published articles were yet not able to unfold their full potential and have relatively lower impact than well-established papers in the field. In addition, the journals’ impact was measured based on their scientific productivity, which is influenced by the time period of being indexed in the WoS. As a consequence, we created indexes by putting absolute numbers in relation, like citations per article or global citation score per year. Further, our approach mainly rests on quantitative metrics and the results should therefore not be used to evaluate the research quality of countries, journals, or individual articles and authors. The results can contribute to making such assessments, but we suggest to refrain from using any of the rankings presented here as a direct measure of research quality.

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Alonso S, Cabrerizo FJ, Herrera-Viedma E, Herrera F (2009) h-Index: a review focused in its variants, computation and standardization for different scientific fields. J Informetr 3(4):273–289. https://doi.org/10.1016/j.joi.2009.04.001

Article   Google Scholar  

Alonso S, Cabrerizo F, Herrera-Viedma E, Herrera F (2010) hg-index: a new index to characterize the scientific output of researchers based on the h-and g-indices. Scientometrics 82(2):391–400

Alonso Dos Santos M, Calabuig F (2018) Assessing the effectiveness of sponsorship messaging: measuring the impact of congruence through electroencephalogram. Int J Sports Mark Spons 19(1):25–40. https://doi.org/10.1108/IJSMS-09-2016-0067

Baumgartner H, Pieters R (2003) The structural influence of marketing journals: a citation analysis of the discipline and its subareas over time. J Mark 67(2):123–139. https://doi.org/10.1509/jmkg.67.2.123.18610

Budler M, Župič I, Trkman P (2021) The development of business model research: a bibliometric review. J Bus Res 135:480–495. https://doi.org/10.1016/j.jbusres.2021.06.045

Chalip L (2006) Toward a distinctive sport management discipline. J Sport Manag 20(1):1–21. https://doi.org/10.1123/jsm.20.1.1

Chang Y, Wann DL, Inoue Y (2018) The effects of implicit team identification (iTeam ID) on revisit and WOM intentions: a moderated mediation of emotions and flow. J Sport Manag 32(4):334–347. https://doi.org/10.1123/jsm.2017-0249

Ciomaga B (2013) Sport management: a bibliometric study on central themes and trends. Eur Sport Manag Q 13(5):557–578. https://doi.org/10.1080/16184742.2013.838283

Deyanova K, Brehmer N, Lapidus A, Tiberius V, Walsh S (2022) Hatching start-ups for sustainable growth: a bibliometric review on business incubators. Rev Manag Sci 16:2083–2109

Egghe L (2006) Theory and practise of the g-index. Scientometrics 69(1):131–152. https://doi.org/10.1007/s11192-006-0144-7

Ferreira MP, Reis NR, Miranda R (2015) Thirty years of entrepreneurship research published in top journals: analysis of citations, co-citations and themes. J Glob Entrep Res. https://doi.org/10.1186/s40497-015-0035-6

Funk DC (2017) Introducing a Sport Experience Design (SX) framework for sport consumer behaviour research. Sport Manag Rev 20(2):145–158. https://doi.org/10.1016/j.smr.2016.11.006

Funk DC (2019) Spreading research uncomfortably slow: insight for emerging sport management scholars. J Sport Manag 33(1):1–11. https://doi.org/10.1123/jsm.2018-0315

Funk DC, Lock D, Karg A, Pritchard M (2016) Sport consumer behavior research: improving our game. J Sport Manag 30(2):113–116. https://doi.org/10.1123/jsm.2016-0028

Gammelsæter H (2021) Sport is not industry: bringing sport back to sport management. Eur Sport Manag Q 21(2):257–279. https://doi.org/10.1080/16184742.2020.1741013

Hammerschmidt J, Eggers F, Kraus S, Jones P, Filser M (2020) Entrepreneurial orientation in sports entrepreneurship—a mixed methods analysis of professional soccer clubs in the German-speaking countries. Int Entrep Manag J 16(3):839–857. https://doi.org/10.1007/s11365-019-00594-5

Hammerschmidt J, Durst S, Kraus S, Puumalainen K (2021) Professional football clubs and empirical evidence from the COVID-19 crisis: time for sport entrepreneurship? Technol Forecast Soc Change 165:120572. https://doi.org/10.1016/j.techfore.2021.120572

Hammerschmidt J, Kraus S, Jones P (2022) Sport entrepreneurship: defnition and conceptualization. J Small Bus Strategy. https://doi.org/10.5370/001c.31718

Heere B, James J, Yoshida M, Scremin G (2011) The effect of associated group identities on team identity. J Sport Manag 25(6):606–621. https://doi.org/10.1123/jsm.25.6.606

Hirsch JE (2005) An index to quantify an individual’s scientific research output. Proc Natl Acad Sci 102(46):16569–16572. https://doi.org/10.1073/pnas.0507655102

Hoeber L, Hoeber O (2012) Determinants of an innovation process: a case study of technological innovation in a community sport organization. J Sport Manag 26(3):213–223. https://doi.org/10.1123/jsm.26.3.213

Katz M, Heere B (2016) New team, new fans: a longitudinal examination of team identification as a driver of university identification. J Sport Manag 30(2):135–148. https://doi.org/10.1123/jsm.2014-0258

Katz M, Ward RM, Heere B (2018) Explaining attendance through the brand community triad: integrating network theory and team identification. Sport Manag Rev 21(2):176–188. https://doi.org/10.1016/j.smr.2017.06.004

Kostoff RN (2007) The difference between highly and poorly cited medical articles in the journal Lancet. Scientometrics 72(3):513–520. https://doi.org/10.1007/s11192-007-1573-7

Kraus S, Breier M, Lim WM, Dabić M, Kumar S, Kanbach D, Mukherjee D, Corvello V, Piñeiro-Chousa J, Liguori E, Palacios-Marqués D, Schiavone F, Ferraris A, Fernandes C, Ferreira JJ (2022) Literature reviews as independent studies: guidelines for academic practice. Rev Manag Sci 16(8):2577–2595. https://doi.org/10.1007/s11846-022-00588-8

Kurmis AP (2003) Understanding the limitations of the journal impact factor. J Bone Joint Surg 85(12):2449–2454

Lock D, Heere B (2017) Identity crisis: a theoretical analysis of ‘team identification’research. Eur Sport Manag Q 17(4):413–435. https://doi.org/10.1080/16184742.2017.1306872

Lock D, Taylor T, Funk DC, Darcy S (2012) Exploring the development of team identification. J Sport Manag 26(4):283–294. https://doi.org/10.1123/jsm.26.4.283

Luther L, Tiberius V, Brem A (2020) User experience (UX) in business, management, and psychology: a bibliometric mapping of the current state of research. Multimodal Technol Interact 4(2):18. https://doi.org/10.3390/mti4020018

Martínez-López FJ, Merigó JM, Valenzuela-Fernández L, Nicolás C (2018) Fifty years of the European Journal of Marketing: a bibliometric analysis. Eur J Mark 52(1/2):439–468. https://doi.org/10.1108/EJM-11-2017-0853

Mehri S, Ammar J, Sedighi M, Jalalimanesh A (2014) Mapping research trends in the field of knowledge management. Malays J Libr Inf Sci 19(1):71–85

Google Scholar  

Merigó JM, Pedrycz W, Weber R, de la Sotta C (2018) Fifty years of Information Sciences: a bibliometric overview. Inf Sci 432:245–268. https://doi.org/10.1016/j.ins.2017.11.054

Misener K, Doherty AH (2009) A case study of organizational capacity in nonprofit community sport. J Sport Manag 23(4):457–482. https://doi.org/10.1123/jsm.23.4.457

Morrow S (2013) Football club financial reporting: time for a new model? Sport Bus Manag Int J 3(4):297–311. https://doi.org/10.1108/SBM-06-2013-0014

Mukherjee D, Lim WM, Kumar S, Donthu N (2022) Guidelines for advancing theory and practice through bibliometric research. J Bus Res 148:101–115

Parker JN, Allesina S, Lortie CJ (2013) Characterizing a scientific elite (B): publication and citation patterns of the most highly cited scientists in environmental science and ecology. Scientometrics 94(2):469–480. https://doi.org/10.1007/s11192-012-0859-6

Pellegrini MM, Rialti R, Marzi G, Caputo A (2020) Sport entrepreneurship: a synthesis of existing literature and future perspectives. Int Entrep Manag J. https://doi.org/10.1007/s11365-020-00650-5

Ratten V (2010) Developing a theory of sport-based entrepreneurship. J Manag Organ 16(4):557–565

Shilbury D (2011a) A bibliometric study of citations to sport management and marketing journals. J Sport Manag 25(5):423–444. https://doi.org/10.1123/jsm.25.5.423

Shilbury D (2011b) A bibliometric analysis of four sport management journals. Sport Manag Rev 14(4):434–452. https://doi.org/10.1016/j.smr.2010.11.005

Slack T (1998) Is there anything unique about sport management? Eur J Sport Manag 5:21–29

Small H (2011) Interpreting maps of science using citation context sentiments: a preliminary investigation. Scientometrics 87(2):373–388. https://doi.org/10.1007/s11192-011-0349-2

Tiberius V, Siglow C, Sendra-García J (2020) Scenarios in business and management: the current stock and research opportunities. J Bus Res 121:235–242

Tiberius V, Schwarzer H, Roig-Dobón S (2021) Radical innovations: between established knowledge and future research opportunities. J Innov Knowl 6(3):145–153

Vallaster C, Kraus S, Lindahl JMM, Nielsen A (2019) Ethics and entrepreneurship: a bibliometric study and literature review. J Bus Res 99:226–237. https://doi.org/10.1016/j.jbusres.2019.02.050

van Eck NJ, Waltman L (2010) Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics 84(2):523–538. https://doi.org/10.1007/s11192-009-0146-3

Waltman L, van Eck NJ, Noyons ECM (2010) A unified approach to mapping and clustering of bibliometric networks. J Informetr 4(4):629–635. https://doi.org/10.1016/j.joi.2010.07.002

Wicker P (2017) Volunteerism and volunteer management in sport. Sport Manag Rev 20(4):325–337. https://doi.org/10.1016/j.smr.2017.01.001

Wicker P, Breuer C, Lamprecht M, Fischer A (2014) Does club size matter: an examination of economies of scale, economies of scope, and organizational problems. J Sport Manag 28(3):266–280. https://doi.org/10.1123/jsm.2013-0051

Xi JM, Kraus S, Filser M, Kellermanns FW (2015) Mapping the field of family business research: past trends and future directions. Int Entrep Manag J 11(1):113–132. https://doi.org/10.1007/s11365-013-0286-z

Yoshida M (2017) Consumer experience quality: a review and extension of the sport management literature. Sport Manag Rev 20(5):427–442. https://doi.org/10.1016/j.smr.2017.01.002

Zeigler EF (2007) Sport management must show social concern as it develops tenable theory. J Sport Manag 21(3):297–318. https://doi.org/10.1123/jsm.21.3.297

Zupic I, Čater T (2015) Bibliometric methods in management and organization. Organ Res Methods 18(3):429–472. https://doi.org/10.1177/1094428114562629

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The joy of sports: How watching sports can boost well-being

Researchers explore in depth the positive psychological and neurophysiological benefits of watching sports.

For many individuals, sports have long served as a source of enjoyment and relaxation. Watching sports, particularly at large gatherings, goes beyond entertainment. It fosters a sense of community and belonging among audiences. This sense of connection not only makes individuals feel good but also benefits society by improving health, enhancing productivity, and reducing crime. Although it is popularly recognized for its positive effects, existing studies on the relationship between watching sports and well-being offer only limited evidence.

Recognizing this gap, a team of researchers led by Associate Professor Shintaro Sato from the Faculty of Sport Sciences, Waseda University, Japan, embarked on a groundbreaking study. Prof. Sato, alongside Assistant Professor Keita Kinoshita from Nanyang Technological University and Dr. Kento Nakagawa from the Faculty of Human Sciences, Waseda University, used a multi-method approach, combining secondary data analysis, self-reports, and neuroimaging measures to understand the connection between sports viewing and well-being in the general population. "A significant challenge in well-being research is the subjective nature of measurement procedures, potentially leading to biased findings. Therefore, our studies focused on both subjective and objective measures of well-being," explains Prof. Sato. Their research was published online on 22 March 2024 in Sports Management Review .

In the first study, the researchers analyzed large-scale publicly available data on the influence of watching sports on 20,000 Japanese residents. The results of this study confirmed the ongoing pattern of elevated reported well-being associated with regular sports viewing. However, this study was limited by its inability to provide deeper insight into the relationship between sports consumption and well-being.

The second study, an online survey aimed at investigating whether the connection between sports viewing and well-being varied depending on the type of sport observed, involved 208 participants. The experiment exposed them to various sports videos, assessing their well-being both before and after viewing. The findings underscored that widely embraced sports, like baseball, exerted a more significant impact on enhancing well-being compared to less popular sports, such as golf.

However, the most groundbreaking aspect of this research emerged in the third study. Here, the team employed neuroimaging techniques to scrutinize alterations in brain activity following sports viewing. Utilizing multimodal MRI neuroimaging measurement procedures, the brain activity of fourteen able-bodied Japanese participants was analyzed while they watched sports clips. The results of this investigation illuminated that, sports viewing triggered activation in the brain's reward circuits, indicative of feelings of happiness or pleasure. Additionally, a noteworthy finding surfaced in the structural image analysis. It revealed that individuals who reported watching sports more frequently exhibited greater gray matter volume in regions associated with reward circuits, suggesting that regular sports viewing may gradually induce changes in brain structures. "Both subjective and objective measures of well-being were found to be positively influenced by engaging in sports viewing. By inducing structural changes in the brain's reward system over time, it fosters long-term benefits for individuals. For those seeking to enhance their overall well-being, regularly watching sports, particularly popular ones such as baseball or soccer, can serve as an effective remedy," comments Prof. Sato.

The study has profound implications and theoretical contributions to sports management literature. Existing literature has primarily focused on sports fans; however, this study has taken into consideration a larger general population irrespective of their relationship to sports consumption. This research can contribute significantly to sports management practices and policymaking for public health.

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• Keita Kinoshita, Kento Nakagawa, Shintaro Sato. Watching sport enhances well-being: evidence from a multi-method approach . Sport Management Review , 2024; 1 DOI: 10.1080/14413523.2024.2329831

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The joy of sports: How watching sports can boost well-being

Researchers explore in depth the positive psychological and neurophysiological benefits of watching sports

Waseda University

Researchers investigate the impact of watching sports on well-being, utilizing diverse methods including data analysis, surveys, and neuro-imaging experiments, revealing positive psychological and neurological effects.

Credit: Shintaro Sato from Waseda University

For many individuals, sports have long served as a source of enjoyment and relaxation. Watching sports, particularly at large gatherings, goes beyond entertainment. It fosters a sense of community and belonging among audiences. This sense of connection not only makes individuals feel good but also benefits society by improving health, enhancing productivity, and reducing crime. Although it is popularly recognized for its positive effects, existing studies on the relationship between watching sports and well-being offer only limited evidence.

Recognizing this gap, a team of researchers led by Associate Professor Shintaro Sato from the Faculty of Sport Sciences, Waseda University, Japan, embarked on a groundbreaking study. Prof. Sato, alongside Assistant Professor Keita Kinoshita from Nanyang Technological University and Dr. Kento Nakagawa from the Faculty of Human Sciences, Waseda University, used a multi-method approach, combining secondary data analysis, self-reports, and neuroimaging measures to understand the connection between sports viewing and well-being in the general population.  “ A significant challenge in well-being research is the subjective nature of measurement procedures, potentially leading to biased findings. Therefore, our studies focused on both subjective and objective measures of well-being," explains Prof. Sato. Their research was published online on 22 March 2024 in Sports Management Review .

In the first study, the researchers analyzed large-scale publicly available data on the influence of watching sports on 20,000 Japanese residents. The results of this study confirmed the ongoing pattern of elevated reported well-being associated with regular sports viewing. However, this study was limited by its inability to provide deeper insight into the relationship between sports consumption and well-being.

The second study, an online survey aimed at investigating whether the connection between sports viewing and well-being varied depending on the type of sport observed, involved 208 participants. The experiment exposed them to various sports videos, assessing their well-being both before and after viewing. The findings underscored that widely embraced sports, like baseball, exerted a more significant impact on enhancing well-being compared to less popular sports, such as golf.

However, the most groundbreaking aspect of this research emerged in the third study. Here, the team employed neuroimaging techniques to scrutinize alterations in brain activity following sports viewing. Utilizing multimodal MRI neuroimaging measurement procedures, the brain activity of fourteen able-bodied Japanese participants was analyzed while they watched sports clips. The results of this investigation illuminated that, sports viewing triggered activation in the brain's reward circuits, indicative of feelings of happiness or pleasure. Additionally, a noteworthy finding surfaced in the structural image analysis. It revealed that individuals who reported watching sports more frequently exhibited greater gray matter volume in regions associated with reward circuits, suggesting that regular sports viewing may gradually induce changes in brain structures. “ Both subjective and objective measures of well-being were found to be positively influenced by engaging in sports viewing. By inducing structural changes in the brain's reward system over time, it fosters long-term benefits for individuals. For those seeking to enhance their overall well-being, regularly watching sports, particularly popular ones such as baseball or soccer, can serve as an effective remedy ,” comments Prof. Sato.

The study has profound implications and theoretical contributions to sports management literature. Existing literature has primarily focused on sports fans; however, this study has taken into consideration a larger general population irrespective of their relationship to sports consumption. This research can contribute significantly to sports management practices and policymaking for public health.

DOI: https://doi.org/10.1080/14413523.2024.2329831

1 Keita Kinoshita (Nanyang Technological University)

2 Kento Nakagawa (Waseda University)

3 Shintaro Sato (Waseda University)

Affiliations      

• Physical Education and Sports Science, Nanyang Technological University, Singapore
• Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
• Faculty of Sport Sciences, Waseda University, Nishitokyo, Japan

About Waseda University

Located in the heart of Tokyo, Waseda University is a leading private research university that has long been dedicated to academic excellence, innovative research, and civic engagement at both the local and global levels since 1882. The University has produced many changemakers in its history, including nine prime ministers and many leaders in business, science and technology, literature, sports, and film. Waseda has strong collaborations with overseas research institutions and is committed to advancing cutting-edge research and developing leaders who can contribute to the resolution of complex, global social issues. The University has set a target of achieving a zero-carbon campus by 2032, in line with the Sustainable Development Goals (SDGs) adopted by the United Nations in 2015. 

To learn more about Waseda University, visit https://www.waseda.jp/top/en  

About Professor Shintaro Sato

Shintaro Sato, Ph.D., currently serves as an Associate Professor at Waseda University's Faculty of Sport Sciences and directs the Sport & Entertainment Management Lab. He earned his doctoral degree from the University of Florida and has held academic positions at institutions including Georgia Southern University and Feliciano School of Business, Montclair State University. Additionally, he served as a visiting researcher at the Baruch College, Zicklin School of Business and City University of New York, and as a Ph.D. supervisor at the University of Ottawa. With a strong commitment to leveraging the potential of sports, Prof. Sato has spearheaded numerous research endeavors and authored several papers in esteemed international academic journals.

Sport Management Review

10.1080/14413523.2024.2329831

Method of Research

Experimental study

Subject of Research

Article title.

Watching Sport Enhances Well-Being: Evidence from a Multi-Method Approach

Article Publication Date

22-Mar-2024

COI Statement

No potential conflict of interest was reported by the author(s)

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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Effects of psychological interventions on high sports performance: A systematic review

Mario reyes-bossio.

1 Facultad de Psicología, Universidad Peruana de Ciencias Aplicadas, Lima, Peru

Santiago Corcuera-Bustamante

Giancarlo veliz-salinas, marcelo villas boas junior.

2 Universidade São Judas Tadeu, São Paulo, Brazil

Mariel Delgado-Campusano

Paul brocca-alvarado.

3 Universidad Científica del Sur, Lima, Peru

Tomás Caycho-Rodríguez

4 Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru

Leslie Casas-Apayco

Veronica tutte-vallarino.

5 Departamento de Bienestar y Salud, Universidad Católica del Uruguay, Montevideo, Uruguay

Carlos Carbajal-León

6 South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru

Regina Brandão

Associated data.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Introduction

Intervention programs in sports psychology aid to modify the thoughts and behaviors of athletes in order to improve their performance in sports settings. For high-performance athletes, these interventions are very relevant, given that they constantly face pressure towards obtaining sporting achievements.

This systematic review aims to analyze the scientific articles between 2010 and 2020 that evaluated the effect of psychological interventions on high-performance athletes. In the search procedure, nine studies were selected, the most studied variables were psychological skills, psychological flexibility, and stress.

The 44% of the interventions were designed by the research authors themselves, while the remaining 56% were replicated programs, which already had scientific evidence.

Psychological interventions have a positive impact on sports performance. This review allows sports institutions and professionals to have more knowledge and resources at their disposal to implement these types of programs in their sports planning.

The psychology of sports and physical exercise is a scientific discipline that focuses on the study of people behaviors in the context of sports and physical activities (Gill, 2000 ). In addition, it includes the application of psychological theories to understand and optimize the performance, mental processes, and wellbeing of these people (Moran and Toner, 2017 ). In particular, the discoveries linking mental aspects and athletic performance were originated almost simultaneously with those of psychology (Kornspan, 2011 ; Kremer et al., 2012 ). Nevertheless, since decades ago this discipline has been consolidated and has experienced a considerable growth, accompanied by greater activity and relevance in scientific production (Weinberg and Gould, 2010 ; Berengüi and López-Walle, 2018 ). This increase has allowed sports agents to have at their disposal multiple scientifically validated knowledge and resources to solve daily practical questions related to sports performance (Moran and Toner, 2017 ). However, one of the great challenges for sports psychology is to continue updating the knowledge obtained and to be in constant search of new subfields that answer its main questions (Cantón, 2016 ). A convenient way to do this is through the development of intervention programs with a specific methodology that includes evaluation instruments, techniques, and strategies, both direct and indirect (Cantón, 2010 ).

An intervention program can be defined as an action or process that affects the functioning and/or performance of a person through changes in their thinking and behavior (American Psychological Associaton, 2002 ). In the specific case of sports psychology and physical exercise, this is achieved through psychological factors related to the sports context.

Sports psychological interventions have proven to be important over the years given the positive impact that they have on wellbeing and the optimization of sports performance (Greenspan and Feltz, 1989 ; Weinberg and Comar, 1994 ; Martin et al., 2005 ; Brown and Fletcher, 2017 ). In addition, the training and/or learning of strategies and techniques acquired in these interventions, allow the development of psychological skills such as concentration, activation level, motivation and other cognitive skills required for the most demanding sports scenarios (Craig, 2011 ; Olmedilla et al., 2011 , 2018 ; Escolano et al., 2014 ; Olmedilla and Domínguez-Igual, 2016 ; Larkin et al., 2018 ; McCromick et al., 2018 ).

Previous literature on other systematic reviews have emphasized the impact of psychological variables on sports performance. For instance, Brown and Fletcher ( 2017 ) carried out a meta-analysis that aimed to synthesize all the studies, without a defined range of years, that evaluated the psychological, social, and psychosocial interventions with athletes and the relationship they had with their athletic performance. On the other hand, Ursino and Barrios ( 2019 ) described how sports performance associated with psychological variables has been studied, although it focused on all empirical studies in general. These scientific evidences have become known thanks to the fact that these and other sports science professionals have undergone very rigorous research processes, in which they conceptualized, developed, intervened, and evaluated the impact of certain psychological skills on athletes' performance. Therefore, to continue contributing to the spread and growth of this discipline, the purpose is to carry out a systematic review of the most recent studies that have evaluated the effects of psychological interventions on the performance of professional athletes in sports settings, high competition, or high-performance athletes.

The Instituto Peruano del Deporte ( 2019 ) groups these people into the category called high-level qualified athlete, which means that they represent the country in official international events and obtain results in them. However, for the purposes of this research, the high-performance athlete has been defined as an athlete who can also represent a professional club through competitive tournaments, regardless of their category.

It should be noted that other recent systematic investigations have been carried out, which emphasized the impact of psychological variables on sports performance. On the one hand, Brown and Fletcher ( 2017 ) carried out a meta-analysis that aimed to synthesize all the studies, without a defined range of years, that evaluated the psychological, social, and psychosocial interventions with athletes and the relationship they had with their athletic performance. On the other hand, Ursino and Barrios ( 2019 ) described how sports performance associated with psychological variables has been studied, although it focused on all empirical studies in general.

In this sense, the purpose of this review was to synthesize and analyze the scientific studies between the period 2010–2020 that have evaluated the effects of psychological interventions on the performance of professional athletes who perform in highly competitive settings.

This systematic review followed the guidelines of the methodology proposed in the PRISMA statement (Preferred Reporting Items for Systematic reviews and Meta-Analyses) (Moher et al., 2009 ).

Search strategy

The studies were identified in electronic databases with scientific relevance and good contribution to the spread of research in the psychology of sports and physical exercise. The search was carried out in WEB OF SCIENCE, SCOPUS, SCIELO and PSICODOC using the following keywords: “sport psychology” AND “intervention program,” including the Boolean operators “AND” between these keywords and the concept “high performance” and excluding through “NOT” recreational sport, physical exercise, case and/or single case studies and interventions that delve into physiological aspects. We considered the use of keywords in English because the results were more numerous with this search, finding research in other languages as well, such as Spanish and Portuguese. In relation to time limiters we selected a 10-year period, between 2010 and 2020. Finally, we chose full-text publications, leaving aside abstracts, as specified in the PRISMA system.

Inclusion criteria

The articles were selected with the following inclusion criteria: (1) intervention programs that contemplate a pre-test, intervention, and post-test in their analysis; (2) investigations that evaluate the effect on psychological variables related to the optimization of sports performance; (3) sample in high-performance athletes who participate in professional categories in sports and indistinct ages; (4) the years between publication of the studies is from 2010 to 2020; and (5) the evaluation of interventions can be both quantitative and qualitative. It should be noted that the language or origin country did not compromise the inclusion of any study in the subsequent analyzes because greater cultural diversity was search among the articles searched.

Study selection

The details of the research compilation strategy and its different phases are shown in the PRISMA flow diagram ( Figure 1 ), while the references and the most relevant data were also rigorously reviewed through databases at Microsoft Excel. In the first phase, 632 articles were identified, using the keywords described above and in the selected electronic databases. Of this total, 13 duplicate articles were detected, so that in the second phase they were erased. In this same study, other 590 investigations were also excluded because, through the reading of titles and abstracts, they did not belong to the discipline of sports psychology, they did not present any type of intervention (correlational, comparative designs, reviews, etc.), their sample was not with athletes (coaches, parents, referees, etc.), and finally, others who did not have free access. In this way, 603 investigations were excluded, which, subtracted from the 632 found, result in 29 research that were maintained in the present systematic review.

PRISMA flow chart for study selection.

In the third phase, the authors read the full text of the 29 selected articles to analyze and decide their eligibility. From this, 16 works were eliminated because they did not meet the established criteria. In most cases, these were excluded because the participant athletes were not considered as high-performance athletes (e.g., university, school, training academy athletes, etc.). In addition, other articles only reported or described an intervention, without evaluating it (pre-test and post-test). Also, some works selected nutritional, physical, or biomechanical variables to evaluate the impact on sports performance. Finally, four of the 13 remaining articles were eliminated to obtain greater uniformity in the discussion of results. Therefore, two studies with a qualitative design and two with single case studies were deleted. As a result of this, in the fifth phase, nine articles were included in the systematic review for further analyzes shown in the results (Reyes-Bossio et al., 2012 ; García-Naveira, 2016 ; Sallen et al., 2018 ; Campo et al., 2019 ; Carraça et al., 2019 ; Holguín-Ramírez et al., 2020 ; Lundgren et al., 2020 ; Tutte Vallarino et al., 2020 ; Vidarte et al., 2020 ).

Quality assessment

The quality assessment was carried out based on the STROBE statement for observational methodological designs (Von et al., 2014 ). It comprehends a checklist of items that should be included in the case study and control reports. This format is made up of 31 variables assigned to sections (a) title and summary, (b) introduction, (c) method, (d) results, (e) discussion and (f) financing information, answered dichotomously among themselves or does not meet the quality attribute ( Table 1 ).

STROBE statement—checklist of items that should be included in reports of case-control studies.

In the first place, emphasizing the formal aspects, of the nine articles analyzed, we find that six were published between 2019 and 2020. It is evident that three of them belong to Latin America within this period (Colombia, Uruguay and Mexico) and three to Europe (Portugal, France and Sweden). Two of them use Spanish and the remaining four use English.

According to the introduction section, all articles except one defined and explained the variables they were investigating. It was found that two articles evaluated psychological abilities, two psychological flexibility and two stress; while psychological wellbeing, emotional intelligence and cognitive abilities completed all findings. Regarding the programs used to measure these variables, it was found that four were developed by the authors themselves, while the other five were replicated programs. Likewise, only one article omitted the mention of research objectives. Besides, three studies presented specific objectives. Finally, it was found that in five of the nine articles the authors mentioned hypotheses.

Regarding the aspects found in the method, four opted for a quasi-experimental design, followed by two experimental studies, a case series study and a couple of articles that did not specify any design. However, only four studies were able to explain the design. Additionally, it was confirmed that all had a pre and post intervention evaluation. According to the participants, it was found that five articles had only men as a sample, two exclusively women, and two other studies participated both genders. Regarding age, it should be noted that only four articles showed their basic measures (range, mean, standard deviation). For their part, it was found that two articles selected practitioners of various sports, while another two chose football as the sports practice to be investigated. The remaining sports were Ice Hockey, Field Hockey, Volleyball, Rugby, and Artistic Gymnastics. Regarding the instruments, seven studies showed evidence of validity and reliability. Finally, in relation to the procedure, all the articles except one described or made a design of the sessions of the applied program.

Regarding the results section of these nine selected articles, it was found that four of them presented descriptive statistics, only one presented correlations between the investigated variables, and another five articles made comparisons. Additionally, six studies worked out the effect size, while the remaining ones were limited to comparing the results obtained from the pre and post-test.

Finally, referring to the discussion section, the five studies that presented hypotheses were able to confirm it and give a logical explanation. In addition, the results they obtained were analyzed and compared with other research in all articles. Finally, the nine selected studies concluded that the applied program had a positive impact on one or more of the psychological variables investigated ( Tables 2 , ​ ,3 3 ).

Descriptive summary of the analyzed studies.

Summary of analysis of selected studies.

V, Variables in the title; D, Variable's definition; R, Replicated program; E, Own elaboration program; O, Mention of objectives in introduction; C, Hypothesis confirmed; P, Pre and post-test; Ed, Design explication; VC, Validity and Reliability; Ds, Sessions' description; Rd, Descriptive results; Rr, Correlational results; Rc, Comparative results; T, Effect size; Ci, Comparison between investigations Ip, Program positive program.

The purpose of this review was to synthesize and analyze the scientific studies between the period 2010-2020 that have evaluated the effects of psychological interventions on the performance of professional athletes who perform in highly competitive settings. In particular, nine studies were selected from a total of 632 identified in the corresponding databases. This number found within a large universe of studies makes us reflect on intervention designs in scientific research. Based on the filters developed and the literature found, it is evident that, in sports psychology, non-experimental studies predominate over those that study the effects of programs (quasi-experimental or experimental). Regarding this, a review that analyzed the current state of research on sports psychology in Spanish between 2010 and 2016, found that the trend was non-experimental designs with a total of 60% of selected articles; although between quasi-experimental and experimental investigations accounted for 24% of the total (Calderón and Lesmes, 2016 ). It leads us to reflect on whether the scope of the applied psychological intervention programs.

A second important finding was regarding the year of publication of the articles, because only in the last couple of years (2019 and 2020) more studies were found than in the previous nine (2010–2018). This could represent the possible lack of psychological intervention work in the last decade; or we could deduce that there are not many records of this type of investigation o there are great difficulties in systematizing and drafting such intervention. In this way, it would not necessarily mean that interventions of this nature have not been carried out in the sports field, but rather that they are not reflected in high-impact magazines; and only in recent years could they be published by these media. The dissemination of research in sports psychology is very important because it provides valuable information and knowledge based on evidence that allows solving multiple relevant practical questions to optimize the sports performance of athletes (Moran and Toner, 2017 ). Additionally, this finding evidences that there is a growth in the publication of sports psychological interventions in high impact magazines, improving the visibility of the results related to the improvement of the performance of elite athletes. On the other hand, it is important to emphasize that, according to the search period of the Ursino and Barrios ( 2019 ) review carried out from 2008 to 2018, it was found that the highest concentration of studies that associated sports performance with psychological variables was between 2015 and 2018, repeating the pattern that there is more research in the last years of the search period, although not exclusively in experimental or quasi-experimental designs, but in empirical studies in general.

As a third finding, the most investigated variables in these nine articles were: psychological abilities, psychological flexibility, and stress. However, it is relevant to consider that, in one of the studies, psychological flexibility was not the only variable investigated, but was shared by others (psychological distress, thought suppression and Flow). In addition, with respect to stress, it was evaluated in different dimensions, because one article emphasized resistance to stress and the other on the stress-recovery balance. In this way, it is evident that the evaluation of psychological abilities had a greater role among the others. It is likely that this is due to the fact that psychological abilities group several constructs that have been scientifically proven over the years that directly intervene in sports performance, such as motivation, attention, coping, attitude, anxiety, imaginative visual control, among other (Getz and McConnell, 2014 ; León et al., 2014 ; Ramos-Cabal et al., 2018 ). Furthermore, the importance of psychological skills in sports performance has been demonstrated by many researchers (MacNamara et al., 2010 ; López-Gullón et al., 2011 ; Weinberg and Gould, 2014 ; Abdullah et al., 2016 ; Ramírez-Muñoz and Prieto-Andreu, 2021 ). Not only psychological skills may provide you a general psychological profile of high-performance athletes, but also to know which the variables are to work on according to the extent to which they influence their competitive performance (Loehr, 1986 ; Raimundi et al., 2016 ).

Regarding the programs implemented in the different research, the use of already established programs predominates (55%), compared to those elaborated for the purposes of the studies; understanding that there are highly recognized psychological techniques used in the construction of programs, such as Mindfulness.

This type of psychological interventions within the sports field have been described as emerging third generation therapies with high levels of efficacy. Demonstrating improvements in athletes who favored different states of anxiety and concentration (Hoja and Jansen, 2019 ). A similarity found in two replicated programs was the use of this technique to address psychological skills such as flexibility, thought suppression, flow, and stress. The continuous investigation of this psychological technique is what has allowed us to know and verify its multiple benefits. Therefore, intervening with this type of (replicated) programs that already have a long history and scientific support, allows to obtain greater security with respect to the development of the psychological skills investigated; unlike what it could mean to implement a program with its own design that does not have the necessary evidence to know whether it can generate a positive impact. However, it is known that one of the main objectives of the research is not only to clarify and expand the knowledge that already exists, but also to generate new ones (Ato et al., 2013 ). This would be achieved through the implementation of self-made programs because it would be creating a new opportunity to investigate other options. In turn, improvements have also been observed with more classical second generation treatments or strategies, based on cognitive-behavioral therapies (Olmedilla et al., 2010 ). Therefore, the remaining 45% of the selected interventions could respond to designs developed by the researchers but using techniques that respond to theoretical models already consolidated in different contexts over time, allowing them to be adapted to the sports environment (Reyes-Bossio et al., 2012 ) y a otros niveles deportivos (Trujillo-Torrealva and Reyes-Bossio, 2019 ; Cárcamo-La Torre and Reyes-Bossio, 2022 ).

Another relevant finding was the great variety in terms of the age range of the athletes considering all the studies, since the youngest was 13 years old and the oldest 40 years old. This finding can have several explanations. The first is defined according to the category of athletes, because they may have selected juniors from the national teams they represent, such as a volleyball sub-17. There are other athletes who, instead of representing a youth category, play in professional teams or clubs of the first/second division of their national leagues, in which it is known that there is a greater variety in age groups. Also, it is important to consider the sport practiced, since there is a recognized age and average start and end of a career in each one (López de Subijana and Equiza, 2018 ). As was previously known, of the nine studies selected, six different sports were found, which is why in some the age of the athletes may be dispersed. Finally, it should be noted that, in addition to the six sports found, two studies evaluated athletes from various sports, which could also explain the variance in age. Additionally, regarding the sex of the athletes, it was found that more than half of the studies intervened only with men, coinciding with the systematic review by Brown and Fletcher ( 2017 ). However, 44% of the articles had the presence of women in their samples. Although these findings appear to be encouraging in the field of scientific research, there is still a large gap in the resources allocated to sportsmen and women, especially financial ones, generating inequity (López, 2017 ).

Following the line of sports, soccer was the sport with the greatest presence in the different studies. Although the magnitude and beauty of this sport around the world is known, from a total of nine studies, five other sports disciplines were found. This may reflect the increasing awareness, research, and psychological intervention in various sports. Added to this, it is worth mentioning that all the sports presented were collective, except for artistic gymnastics, which has a mixed modality. Within the search process of the present review, several psychological interventions were found on individual sports, such as table tennis, sailing, taekwondo, among others; but they were logically investigated under a single case design, falling outside of our inclusion criteria. However, this type of research, which seeks to understand the behavior of an individual in response to an intervention program, is progressively increasing in the psychology of sport and exercise (Kratochwill and Levin, 2010 ; Moran and Toner, 2017 ). For more detail, you can examine the review by Barker et al. ( 2011 ), who investigated the nature and applications of single case designs in that discipline.

A sixth finding was that three studies chose to implement their psychological training program to their entire sample, understanding that they only had one intervention group. Therefore, it is logical that they have chosen to make comparisons between the evaluations applied before and after the program to determine their impact. In contrast, the other six studies divided their sample into an experimental and control group, applying their program only and obviously to the first of the groups. Unlike the other three studies, these six had and made effective the possibility of using the effect size statistic, not only to assess whether there was improvement in the psychological variables evaluated after the intervention, but also in what extent. This means a very relevant result considering that it allows to know how much the findings can be adjusted to reality (Castillo and Bravo, 2015 ).

Finally, in order to evaluate the psychological work resulting from these interventions, it is important to focus on the improvement of the psychological functioning of athletes, assessing their adaptive progress, their relationship with performance and their psychological wellbeing (Olmedilla and Domínguez-Igual, 2016 ; Kosendiak and Ptak, 2017 ). All articles concluded that their psychological training programs had a positive impact on high-performance athletes, regardless of the type of program, intervention strategy or technique used, as well as without discriminating in the distribution or characterization of each sample, coinciding with the findings of the Brown and Fletcher ( 2017 ) review. Perhaps this level of improvement as a consequence of the different interventions selected may be due to the level of satisfaction with the psychological training by both the athletes and the technical staff, as they were able to find time to reflect, share, enjoy and learn techniques such as relaxation, mindfulness and visualization. We could think that generating spaces for exchange and experimentation have effects on the improvement of skills and sense of wellbeing. Similar results were found with Polish Olympic athletes (Kosendiak and Ptak, 2017 ) alluding to their enjoyment of the choice of relaxation and visualization techniques, within a psychological intervention program. However, it is important to clarify, as mentioned above, that some studies evaluated several psychological variables at the same time, so this finding is focused on the overall effectiveness of the program, but not necessarily on the significant improvement of all the psychological constructs addressed. Therefore, the authors culminated their studies with the request and recommendation to continue researching on these topics in order to clarify the panorama and obtain new discoveries that contribute to the growth of sport psychology. At the end of the day, it is the publications of this type of research that allow society to have more knowledge and resources at its disposal for its interventions.

Limitations

A first limitation of the study was to discriminate and define the characteristics of a high-performance athlete over one who is not. This is because several aspects are involved, such as age, category, representativeness in a national team and participation in a professional team. In this way, it was difficult to select the studies that presented the characteristics of the required sample.

Added to this, in the beginning it had been planned to select all kinds of research that would demonstrate the effects of psychological training, including qualitative ones and case studies. However, in order to obtain greater uniformity in the results and analysis, it was decided to select only the quantitative studies. It happens that qualitative studies have other elements that could be discussed and analyzed. Such information, together with what was found in quantitative research, was going to mean more extension, diseños y posibles confusiones metodológicas.

Another limitation is found in the predominance of non-experimental descriptive cross-sectional designs. There are even studies that make mental or psychological training programs available, but a scientific evaluation of the impact generated on athletes is not observed. This is connected with the lack of rigor in the results supported by scientific evidence, understanding that there may be a large number of sports psychological interventions, but that they do not necessarily go through the rigorous process of scientific research, and this causes that ultimately there is no support for a positive impact.

Practical implications

The present study will clarify and have relevant information available on the impact of psychological interventions on sports performance. In this way, it can contribute to different sports institutions having knowledge and providing themselves with various resources and activities that favor the development of psychological skills related to improving their performance. They will have a wide range of effective interventions to apply with their own athletes according to the required needs.

Recommendations

In the first place, based on the objective of promoting the continuous obtaining of new discoveries based on scientific evidence, especially in sports psychology, we recommend continuing research on this discipline in the process of consolidation. The results and analysis that we do cannot be taken as absolute truths because our investigations are framed in a specific sample and context, so it would be a mistake to generalize to large magnitudes. Therefore, to approximate reality, there needs to be a series of studies to support it, and this will only be achieved if there is continuous scientific research.

It is recommended that the inclusion criteria be fairly clear and free of interpretation, because given the large amount of research to be analyzed, some may go unnoticed due to a doubtful inclusion criterion. Furthermore, it makes it difficult for the funnel process, shown in the PRISMA diagram, to be fast and effective.

Finally, it is suggested to analyze and investigate the challenges framed in sports psychology after the Covid-19 pandemic. Because possibly the needs and demands of athletes have mutated and now the psychological variables to work on could be different from what they were a couple of years ago. Athletes and society in general are in constant readjustment processes due to the new competition conditions and sports psychology professionals must consider them in their new interventions both face-to-face and virtual, which has come to stay and be enhanced with technology.

Conclusions

There has been a recent and accelerated growth in the research of interventions in sports psychology, which shows that both professionals in this discipline and sports institutions are opting for their work to have a greater reach in society and form part of the required scientific evidence to be replicated with sustenance. Additionally, it is relevant to evaluate the psychological abilities in high-performance athletes, because by grouping a series of (proven) variables that influence their performance, you obtain a psychological profile of the athlete that will allow you to know what aspects could be worked on to have the maximum potential. Finally, from all the information collected and analyzed, it is concluded that interventions on psychological variables have a positive impact on the performance of highly competitive athletes.

Data availability statement

Author contributions.

MR-B conceived the original idea of the study. MR-B, GV-S, MD-C, PB-A, and LC-A selected the references and contributed to data selecting and processing. MR-B, SC-B, and MV analyzed and presented the data. MR-B, TC-R, VT-V, CC-L, and RB wrote and organized the manuscript. All authors have read and agreed to the published version of the manuscript.

This work was supported by the Dirección de Investigación de la Universidad Peruana de Ciencias Aplicadas (C-032-2021).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

• Abdullah M., Musa R., Maliki A. B., Musawi H., Kosni N. and K., et al.. (2016). Role of psychological factors on the performance of elite soccer players . J. Physic. Educ. Sport . 16 , 170–176. 10.7752/jpes.2016.01027 [ CrossRef ] [ Google Scholar ]
• American Psychological Associaton . (2002). Criteria for evaluating treatment guidelines . Am. Psychol . 57 , 1052–2059. 10.1037/0003-066X.57.12.1052 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ato M., López-García J. J., Benavente A. (2013). Un sistema de clasificación de los diseños de investigación en psicología . Anales de Psicología . 29 , 1038–1059. 10.6018/analesps.29.3.178511 [ CrossRef ] [ Google Scholar ]
• Barker J., McCarthy P., Jones M., Moran A. (2011). Single-Case Research Methods in Sport and Exercise Psychology (1st ed.) . London: Routledge. [ Google Scholar ]
• Berengüi R., López-Walle J. M. (2018). Introducción a la Psicología del Deporte . Editorial EOS: España [ Google Scholar ]
• Brown D., Fletcher D. (2017). Effects of psychological and psychosocial interventions on sport performance: a meta-analysis . Sports Med . 47 , 77–99. 10.1007/s40279-016-0552-7 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Calderón L. C., Lesmes L. P. (2016). Revisión teórica: el estado actual de las investigaciones sobre psicología del deporte en habla hispana, entre los años 2010 a 2016 (Doctoral dissertation, Corporación Universitaria Minuto de Dios). [ Google Scholar ]
• Campo M., Laborde S., Martinent G., Louvet B., Nicolas M. (2019). Emotional intelligence (EI) training adapted to the international preparation constraints in rugby: influence of EI trainer status on EI training effectiveness . Front. Psychol . 10 , 1939. 10.3389/fpsyg.2019.01939 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cantón E. (2010). La psicología del deporte como profesión especializada . Pap. Psicól . 31 , 237–245. Avalaible online at: https://www.papelesdelpsicologo.es/pdf/1852.pdf [ Google Scholar ]
• Cantón E. (2016). La especialidad profesional en Psicología del Deporte . Revista de Psicología aplicada al Deporte y al Ejercicio Físico . 1 , 1–12. 10.5093/rpadef2016a2 [ CrossRef ] [ Google Scholar ]
• Cárcamo-La Torre F., Reyes-Bossio M. (2022). Influencia del programa “Pateando Alto” sobre la empatía en niíos de 4to y 5to grado . J. Sport Health Res . 14 , 405–418. Available online at: https://recyt.fecyt.es/index.php/JSHR/article/view/96642 [ Google Scholar ]
• Carraça B., Serpa S., Rosado A., Palmi J., Magalhaes C. (2019). Mindfull compassion training on elite soccer: effects, roles and associations on flow, psychological distress and thought suppression . Rev. Iberoamericana Psicol. Ejercicio Deporte 14 , 141–149. Avalilable online at: https://www.riped-online.com/articles/mindfull-compassion-training-on-elite-soccer-effects-roles-and-associations-on-flow-psychological-distress-and-thought-s.pdf [ Google Scholar ]
• Castillo R., Bravo A. A. (2015). Importancia del tamaño del efecto en el análisis de datos de investigación en psicología . Persona: Revista de la Facultad de Psicología. 137–148. [ Google Scholar ]
• Craig M. C. (2011). New approaches to studying decision making in sport . Rev. Psicol. Deporte 20 , 689–708. Avalaible online at: https://archives.rpd-online.com/article/download/871/871-2693-1-PB.pdf [ Google Scholar ]
• Escolano E., Herrero M. L., Echeverría R. (2014). La resolución de problemas como estrategia de enseñanza para el aprendizaje de la táctica ofensiva en la categoría pre-benjamín de fútbol 8 . Rev. Psicol. Deporte 23 , 209–217. Avalaible online at: https://archives.rpd-online.com/article/download/v23-n1-escolano-herrero-echeverria/1422-4907-1-PB.pdf [ Google Scholar ]
• García-Naveira A. (2016). Percepción del bienestar y de la salud psicológica, y la eficacia de un programa de intervención en coaching en deportistas de rendimiento . Rev. Iberoamericana Psicol. Ejercicio Deporte 11 , 211–219. [ Google Scholar ]
• Getz D., McConnell A. (2014). Comparing trail runners and mountain bikers: Motivation, involvement, portfolios, and event-tourist careers . J. Conven. Event Tour . 15 , 69–100. 10.1080/15470148.2013.834807 [ CrossRef ] [ Google Scholar ]
• Gill D. L. (2000). Psychological Dynamics of Sport and Exercise . Champaign, IL: Human Kinetics. [ Google Scholar ]
• Greenspan M. J., Feltz D. L. (1989). Psychological interventions with athletes in competitive situations: a review . Sport Psychol . 3 , 219–236. 10.1123/tsp.3.3.219 [ CrossRef ] [ Google Scholar ]
• Hoja S., Jansen P. (2019). Mindfulness-based intervention for tennis players: a quasi-experimental pilot study . BMJ Open Sport Exer. Med . 5 , e000584. 10.1136/bmjsem-2019-000584 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Holguín-Ramírez J., Ramos-Jiménez A., Quezada-Chacón J. T., Cervantes-Borunda M. S., Hernández-Torres R. P. (2020). Effect of mindfulness on the stress–recovery balance in professional soccer players during the competitive season . Sustainability . 12 , 7091. 10.3390/su12177091 [ CrossRef ] [ Google Scholar ]
• Instituto Peruano del Deporte (2019). Ley del Deportista de Alto Nivel . Avalaible online at: https://busquedas.elperuano.pe/download/url/ley-del-deportista-de-alto-nivel-ley-n-30994-1798195-1 (accessed 16 de agosto de 2019).
• Kornspan A. (2011). A history of sport psychology, in Handbook of Sport and Performance Psychology , ed Murphy S. M. (Oxford: Oxford University Press; ). [ Google Scholar ]
• Kosendiak J., Ptak E. (2017). Psychological support as a factor of the training process quality improvement . J. Educat. Health Sport . 7 , 807–818. 10.12775/QS.2017.006 [ CrossRef ] [ Google Scholar ]
• Kratochwill T. R., Levin J. R. (2010). Enhancing the scientific credibility of single-case intervention research: Randomization to the rescue . Psychologic. Methods . 15 , 124–144. 10.1037/a0017736 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kremer J., Moran A., Walker G., Craig C. (2012). Key concepts in sport psychology. The SAGE Key Concepts. London: SAGE Publications Ltd. [ Google Scholar ]
• Larkin P., Mesagno C., Berry J., Spittle M., Harvey J. (2018). Video-based training to improve perceptual-cognitive decision-making performance of australian football umpires . J. Sports Sci . 36 , 239–246. 10.1080/02640414.2017.1298827 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• León J. A., Fuentes I., Calvo A. (2014). Relationship between anxiety state, selfconfidence and performance in basketball . Rev. Int. Med. Cienc. Activ . Física Deporte 14, 527–543. Avalaible online at: Http://cdeporte.rediris.es/revista/revista55/artrelacion487.htm
• Loehr J. (1986). Mental Toughness Training for Sports. Achieving Athletic Excellence . Lexington, MA: Stephen Greene Press. [ Google Scholar ]
• López de Subijana C., Equiza X. (2018). La retirada en natación: La vida fuera del agua . Rev. Española Educ. Física Deportes 421 , 101–121. 10.55166/reefd.vi421.670 [ CrossRef ] [ Google Scholar ]
• López M. J. (2017). Mujer, discriminación y deporte . Editorial Reus: Zaragoza. [ Google Scholar ]
• López-Gullón J., García-Pallares J., Berengüi Gil R., Martínez-Moreno A., Morales-Baños V., Torres-Bonete M., et al.. (2011). Physical and psychological factors in predictingolympic wrestling performance . Rev. Psicol. Deporte 20 , 573–588. Avalaible online at: https://www.rpd-online.com/article/view/817/789 [ Google Scholar ]
• Lundgren T., Reinebo G., Näslund M., Parling T. (2020). Acceptance and commitment training to promote psychological flexibility in ice hockey performance: a controlled group feasibility study . J. Clin. Sport Psychol . 14 , 170–181. 10.1123/jcsp.2018-0081 [ CrossRef ] [ Google Scholar ]
• MacNamara A., Button A., Collins D. (2010). The role of psychological characteristics in facilitating the pathway toelite performance part 1: identifying mental skills and behaviors . Sport Psychol . 24 , 52–73. 10.1123/tsp.24.1.52 [ CrossRef ] [ Google Scholar ]
• Martin G. L., Vause T., Schwartzman L. H. (2005). Experimental studies of psychological interventions with athletes in competitions: why so few? Behav. Modificat . 29 , 616–41. 3259394 10.1177/0145445503259394 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McCromick A., Meijen C., Marcora S. (2018). Effects of a motivational self-talk intervention for endurance athletes completing an ultramarathon . Sport Psychol . 32 , 42–50. 10.1123/tsp.2017-0018 [ CrossRef ] [ Google Scholar ]
• Moher D. Liberati A. Tetzlaff J. Altman D. G. Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement . PLoS medicine . 6 , e1000097. 10.1371/journal.pmed.1000097 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Moran A., Toner J. (2017). A Critical Introduction to Sport Psychology: A Critical Introduction . New York: Taylor and Francis. [ Google Scholar ]
• Olmedilla A., Bazaco M. J., Ortega E., Boladeras A. (2011). Formación psicológica en futbolistas jóvenes. Relación con el bienestar psicológico percibido, la ansiedad y la satisfacción . Revista Científica Electrónica de Psicología . 12 , 221–237. [ Google Scholar ]
• Olmedilla A., Domínguez-Igual J. J. (2016). Entrenamiento psicológico para la mejora de la atención y la autoconfianza en un futbolista . Revista de Psicología Aplicada al Deporte y al Ejercicio Físico. 16 :4. 10.5093/rpadef2016a4 [ CrossRef ] [ Google Scholar ]
• Olmedilla A., Ortega E., Candel N. (2010). Ansiedad, depresión y práctica de ejercicio físico en estudiantes universitarias . Apunts. Medicina de L'Esport . 45 , 175–180. 10.1016/j.apunts.2010.03.001 [ CrossRef ] [ Google Scholar ]
• Olmedilla A., Torres-Luque G., García-Mas A., Rubio V. J., Ducoing E., Ortega E. (2018). Psycological profiling of triathlon and road cycling athletes . Front. Psychol . 9 , 825. 10.3389/fpsyg.2018.00825 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Raimundi M. J., Reigal R., Hernández-Mendo A. (2016). Adaptación argentina del Inventario Psicológico de Ejecución Deportiva (IPED): Validez, fiabilidad y precisión . Cuadernos Psicol. Deporte . 16 , 211–222. [ Google Scholar ]
• Ramírez-Muñoz A., Prieto-Andreu J. M. (2021). Análisis de las habilidades psicológicas en los deportistas promesas y talentos guipuzcoanos . Retos: nuevas tendencias en educación física, deporte y recreación . 39 , 465–470. 10.47197/retos.v0i39.74861 [ CrossRef ] [ Google Scholar ]
• Ramos-Cabal H., Salguero del Valle A., González-Diñeiro A., Molinero-González O., Marquéz-Rosa S. (2018). Adaptación para deportes de montaña (CPRD-M) del cuestionario “Características Psicológicas Relacionadas con el Rendimiento Deportivo” (CPRD) . Revista Iberoamericana de Diagnóstico y Evaluación Psicológica . 2 , 185–196. 10.21865/RIDEP47.2.13 [ CrossRef ] [ Google Scholar ]
• Reyes-Bossio M., Raimundi M. J., Correa L. G. (2012). Programa de entrenamiento en habilidades psicológicas en jugadoras de voleibol de alto rendimiento . Cuadernos de Psicología del Deporte . 12 , 9–16. 10.4321/S1578-84232012000100001 [ CrossRef ] [ Google Scholar ]
• Sallen J., Hemming K., Richartz A. (2018). Facilitating dual careers by improving resistance to chronic stress: effects of an intervention programme for elite student athletes . Euro. J. Sport Sci . 18 , 112–122. 10.1080/17461391.2017.1407363 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Trujillo-Torrealva D., Reyes-Bossio M. A. (2019). Programa de mindfulness para la reducción de la ansiedad precompetitiva en deportistas de artes marciales . Retos . 36 , 418–426. 10.47197/retos.v36i36.66589 [ CrossRef ] [ Google Scholar ]
• Tutte Vallarino V., Reche García C., Álvarez Zecchini V. (2020). Evaluación e intervención psicológica en jugadoras de hockey sobre hierba femenino . Cuadernos de Psicología del Deporte . 20 , 62–74. 10.6018/cpd.406651 [ CrossRef ] [ Google Scholar ]
• Ursino D., Barrios R. M. (2019). El estudio del rendimiento deportivo: Una revisión sistemática. In XI Congreso Internacional de Investigación y Práctica Profesional en Psicología. XXVI Jornadas de Investigación. XV Encuentro de Investigadores en Psicología del MERCOSUR. I Encuentro de Investigación de Terapia Ocupacional. I Encuentro de Musicoterapia. Facultad de Psicología-Universidad de Buenos Aires. [ Google Scholar ]
• Vidarte J. A., Gutiérrez C. A., Ortega A. J., Caicedo S. A., Parra J. H. (2020). Programa de entrenamiento deportivo sobre variables cognitivas en deportistas de selección colombiana de gimnasia artística . Serie de casos. Sportis 6 , 204–227. 10.17979/sportis.2020.6.2.5737 [ CrossRef ] [ Google Scholar ]
• Von E. Altman D. G. Egger M. Pocock S. J. Gøtzsche P. C. Vandenbroucke J. P. STROBE Initiative. (2014). The Strengthening the Reporting ofObservational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies . Int. J. Surg . 12 , 1495–1499. 10.1016/j.ijsu.2014.07.013 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Weinberg R. S., Comar W. (1994). The effectiveness of psychological interventions in competitive sport . Sports Med . 18 , 406–418. 10.2165/00007256-199418060-00005 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Weinberg R. S., Gould D. (2010). Fundamentals of Sport Psychology and Physical Exercise . Ed. Médica Panamericana. [ Google Scholar ]
• Weinberg R. S., Gould D. (2014). Foundations of Sport and Exercise Psychology, 6E. Human Kinetics. [ Google Scholar ]

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U of T research team hits bullseye with strategy to improve fairness in darts

(photo by Zac Goodwin/PA Images via Getty Images)

Published: April 11, 2024

By Safa Jinje

A research team from the University of Toronto is rethinking how darts can be played more fairly.

The team, led by  Timothy Chan , a professor in the department of mechanical and industrial engineering in the Faculty of Applied Science & Engineering, recently took home first place in the 2024 MIT Sloan Sports Analytics Conference Research Papers Competition by designing a new framework to level the playing field in dart games. 

“Winning this competition, at the world’s most prominent and competitive sports analytics conference, is a testament to the excellence and ingenuity of our students here at the University of Toronto,” says Chan, who is also U of T’s associate vice-president and vice-provost, strategic initiatives.  

With millions of players around the world, including an estimated 17 million in the United States, according to the National Sporting Goods Association, the game of darts continues to grow in popularity.   

“Darts is a great sport because almost anyone can play and it doubles as a fun mental puzzle,” says  Rachael Walker , an alumna who is a co-author of the conference paper  along with PhD candidate Craig Fernandes  and Chan. 

The research, which expands on work Walker did for her undergraduate thesis, focuses on the game of 501 darts, where players begin with a score of 501 and take turns throwing darts at the dartboard. Points are deducted from their total depending on where the darts land. The first player to reach zero wins.   

“We looked at 501 darts played in recreational and professional settings,” says Fernandes. “In a recreational setting, the game is often played amongst players that have different skill sets – and when that happens, the stronger player often wins, which can lead to unexciting matches.”  

As in golf, the imbalance is often addressed by introducing a system that gives the less-skilled players an advantage so that all players have an equal chance at winning.  

“[But] our research first proved that the current approach of giving the weaker player a head start doesn’t actually give all players a fair chance at victory,” says Fernandes. “Instead, we used a Markov decision process to understand the nuances of the game and then come up with a new system that actually leads to mathematical fairness.”  

The new framework first determines a player’s skill level by having them throw several darts at the centre of the board before the start of a game. Players are then assigned a skill level based on where their darts land – players who get most of their darts in the centre are determined to be higher skilled, while those whose darts are spread out across the board are deemed less-skilled players who would benefit from an advantage.   

The new system gives the lesser-skilled player credits that they can cash in at any point in the game. The credits can be used to claim the outcome of a throw – that is, the region of the board they intend the dart to land in – without physically throwing the dart.   

The researchers found that credits create fairness by using a Markov decision process, a mathematical framework that models scenarios where the outcomes are partly in control of the decision-maker and partly random. However, the number of possible decisions and outcomes in darts made the model difficult to implement and solve at scale.    

“To accurately model a dart game that assigns an advantage to a single player, we needed to consider over half a million possible game states and hundreds of possible actions at each state,” says Walker.  

“In a traditional implementation, you optimize across all states simultaneously, which may require considering billions, or even trillions, of possible outcomes.”  

The researchers overcame the challenge of scale by starting simply and slowly adding complexity to the model. The first version did not consider the fact that darts is played in turns of three throws for each player; this helped build intuition and develop implementation tricks that later allowed them to solve the true model.   

The first-place finish at the MIT Sloan Sports Analytics Conference was affirming for the researchers.  

“It was a very strong competition featuring many major North American sports such as football, baseball and basketball, and a lot of research was focused on generative artificial intelligence and machine learning,” says Fernandes, who presented the research at the Sloan conference.   

“Winning with our operations research and optimization approach was exciting for us.”  

The team is now looking to implement the framework with collaborators, including local dart leagues, to see it work in practice.   

“My lab tackles complex decision-making problems in health care and sports using techniques from operations research,” says Chan.  

“The tools we develop are general, so the insights we obtain from solving a problem in darts may then be applied towards solutions in patient scheduling or medical decision-making.” 

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Research into ACL injuries in women's sport 'disparate and slow,' finds select committee report

The Women and Equalities Committee (WEC) found "systemic gender inequality" in how sports and exercise research is conducted and called on the Government to convene a task force to develop a long-term strategy to tackle sportswomen's health and physiology-related issues

Tuesday 5 March 2024 08:53, UK

Sport's response to the prevalence of anterior cruciate ligament (ACL) injuries among women has been "disparate and slow", a select committee report has concluded.

Several top female footballers, including England captain Leah Williamson and her Lionesses team-mate Beth Mead, have suffered ACL injuries, with Arsenal star Williamson sidelined for nine months before she returned to action in January.

The Women and Equalities Committee (WEC) found "systemic gender inequality" in how sports and exercise research is conducted and called on the government to convene a task force to develop a long-term strategy to tackle sportswomen's health and physiology-related issues.

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"Scrutiny of the ongoing anterior cruciate ligament (ACL) knee injury issue in women's football has shown that there is systemic gender inequality in sports and exercise research, which is still overwhelmingly conducted by men, looking at issues affecting men," the report summary stated.

"The sports science sector's response to the ACL issue has been disparate and slow. We have no doubt that a health issue of similar magnitude affecting elite male footballers would have received a faster, more thorough, and better co-ordinated response."

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European football's governing body UEFA has set up a women's health expert panel which is looking at ACL injuries, with the long-term goal being to produce a consensus on prevention and management by the summer, plus an updated ACL injury prevention programme.

A paper published last year in the British Editorial Society of Bone and Joint Surgery found females were up to eight times more likely to suffer an ACL injury than males. Hormonal factors were cited in the paper as a modifier in the increased risk of injury but the paper's authors accepted data on this topic remained "limited".

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Tuesday's WEC report pointed to the specific example of football boot design as an example of the inequality between men and women participating in sport.

"While female footballers in the UK have enjoyed great success at club and national level, they have done so wearing ill-fitting footwear," the report said.

"Few football boots designed for women are available, and those that do exist are rarely stocked or promoted by the UK's leading high street sports retailers."

The WEC recommended the Department for Culture, Media and Sport (DCMS) and the Department for Education (DfE) should convene a taskforce to also include representatives from elite sport funding body UK Sport, the UK Sports Institute, women's health and fitness experts, sport and exercise research institutes and the UK divisions of leading sportswear brands.

A DCMS spokesperson said: "Later this month, the Government will establish a Board of Women's Sport to share best practices and research across women's sport, including on issues such as ACL injuries.

"We are supporting women's sport at every opportunity, from ensuring girls' equal access to sport in school to investing £325m in grassroots football and multi-sport facilities across the UK by 2025.

"In December, Culture Secretary Lucy Frazer supported the recommendations from Karen Carney MBE's review of women's football in full, including holding others to account for action on player welfare."

The report also called for a "drastic" improvement in how schools teach about girls' health and physiology, including the menstrual cycle and periods in the context of sport and physical exercise.

The report found "overwhelming evidence" that sports kit can have a "devastating impact" on girls' confidence to participate in and enjoy school sport, and said focus needed to be on the enjoyment girls derive from sport, not solely on increasing participation.

The report also called for mandatory qualifications for coaches to ensure they are fully educated around female health. It highlighted "deplorable" instances of harmful coaching practices such as public weighing, fat-shaming and bullying in swimming and sport more widely which had "damaged trust" in sports governing bodies.

A sector-wide working group should be established to ensure equal access to maternity pay and leave, and how pregnant women and mothers are supported, the report said.

It also called for the Government's 'Get Active' strategy to be updated to include an analysis of the barriers to participation faced by women in midlife, including perimenopausal and menopausal symptoms.

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Softball: Probability of competing beyond high school

When we survey NCAA student-athletes about their expectations of moving on to professional athletics careers, the results indicate surprising confidence in that possibility. The reality is that very few go pro.

Estimated probability of competing in college baseball

Sources: High school figures come from the 2022-23 High School Athletics Participation Survey conducted by the National Federation of State High School Associations. College numbers are from the NCAA’s 2022-23 Sports Sponsorship and Participation Rates Report . These college numbers account for participation in college athletics at NCAA-member schools only.

High school-to-NCAA percentages were calculated by dividing the number of NCAA participants in 2022-23 by the number of HS participants in that same year. This assumes that high school and college rosters are turning over at roughly the same rate (e.g., both HS and college participation numbers include four classes of students, and both sets of teams turn over roughly one-quarter of their rosters each year). In prior versions of this table, more complex calculations were used to estimate the number of HS departures and open college roster slots each year; however, these more involved calculations did not lead to substantially different percentages than the simple calculation used currently. Given several potential confounds (e.g., multi-sport participation in high school, frequency of redshirt in NCAA Division I football that would lead to a 5-year rather than 4-year college track), these calculations should be considered approximations and not exact accounting.

The high school-to-NCAA divisional percentages were calculated by dividing the number of 2022-23 participants within each NCAA division by the total number of HS participants. For example, we estimate that approximately 3.6% of HS boys basketball participants go on to play at an NCAA school (Divisions I, II or III), but only 1.0% of HS participants do so at the Division I level.

As the high school figures account only for participants on high school teams and not those competing exclusively on club teams or similar, the true pre-college to NCAA percentages could be lower in some sports (e.g., ice hockey, tennis); see this page for sport-specific information regarding club and high school sport participation). Data for several sports (e.g., rowing, skiing, gymnastics) is not shown due to the low number of high school programs in those sports relative to non-scholastic pre-college participation opportunities.

Estimated probability of competing in professional baseball

• Women’s Fastpitch Softball draft data from 2023 (source: wprofastpitch.com ). There were 24 draft slots in the 2023 WPF draft, all of which went to athletes from Division I schools. Percentage NCAA to Major Pro calculated using the 24 NCAA selections (calculated as 24 / 4,810 = 0.5%).
• We estimate that 1.6% of draft-eligible Division I players were chosen in the 2023 WPF draft (24 / 1,497), while approximately 7.7% of draft-eligible players from the five Division I conferences with autonomous governance (ACC, Big Ten, Big 12, Pac-12 and SEC) were drafted by the WFP in 2023 (23 / 299).

Last updated: April 1, 2024

Competing Beyond High School Links

• Probability of Competing Beyond High School
• Estimated probability of competing in college athletics
• Estimated probability of competing in professional athletics
• 2023 Probability of Competing Beyond High School Figures and Methodology
• Did NCAA Student-Athletes Compete on High School or Club Teams?

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The Five Players to Watch at the Masters

Among them are golfers who have won the event before and have a good chance to do it again.

By Michael Arkush

No golfer has repeated as the champion of the Masters Tournament, which begins on Thursday at Augusta National Golf Club, since Tiger Woods successfully defended his crown in 2002.

Such is the challenge facing Spain’s Jon Rahm, who closed with a 69 last year to secure his second major title. He also won the 2021 United States Open.

Rahm, who signed with LIV Golf in late 2023, will be one of the favorites.

Here are five other players to watch:

Scottie Scheffler

The strong favorite will be Scheffler, who is so precise from tee to green. When he is making putts, as he’s been doing lately, he seems unbeatable.

Ranked No. 1 in the world, Scheffler turned in a six-under 66 in the final round to capture the Arnold Palmer Invitational last month. One week later, he shot an eight-under 64 to rally to win his second consecutive Players Championship, which no player had done since the tournament — considered the unofficial fifth major — began in 1974.

The true test of his greatness, however, will depend on how he fares in the official majors. Scheffler, 27, who tied for second in March at the Texas Children’s Houston Open, has one major title, the Masters in 2022 .

Brooks Koepka

Koepka , 33, made a run at the green jacket last year before faltering with a final-round 75 to tie for second, four strokes behind Rahm.

The next month, he took the P.G.A. Championship, his fifth major. One more and he’ll match the total of Phil Mickelson, Lee Trevino and Nick Faldo.

Koepka said his inability to close the deal at Augusta National last year helped pave the way for his win at the P.G.A.

“I think failure is how you learn,” he told reporters at the P.G.A. “You get better from it. You realize what mistakes you’ve made.”

Phil Mickelson

It wouldn’t be a shock if three-time Masters champion Mickelson, 53, were to miss the cut. He missed the cut in last year’s U.S. and British Opens and tied for 58th in the P.G.A. Championship.

It also wouldn’t be a shock if his name popped up on the leaderboard late Sunday afternoon.

That’s what happened last year when he fired a 65 to tie for second behind Rahm. In 2021, Mickelson won the P.G.A. Championship at age 50, becoming the oldest golfer to win a major.

Could there be another week of magic in Mickelson on a course he knows so well?

Hideki Matsuyama

For one thing, Matsuyama , 32, is a former Masters champion. In 2021, he became the first Japanese man to win a golf major, edging Will Zalatoris by a stroke.

For another, he has been playing extremely well in recent months.

In February, he recorded a 62 on Sunday to capture the Genesis Invitational by three.

In March, he tied for 12th at the Arnold Palmer Invitational. Then, Matsuyama, who has nine tour victories, tied for sixth in the Players Championship. And on Sunday, he tied for seventh in the Valero Texas Open.

Jordan Spieth

Put aside how he has performed recently — he hadn’t cracked the top 25 for nearly two months, until tying for 10th in the Valero Texas Open — and keep in mind that Spieth , still only 30, often comes to life when he tees it up at Augusta National.

Last year was no exception.

Spieth, now ranked No. 18, closed with a 66 to end up in a tie for fourth. In 2021, he tied for third. In 10 appearances at Augusta since his Masters debut in 2014, Spieth, the winner in 2015, has notched six top five finishes.

“From the moment I got here,” the three-time major champion told Golf Digest in 2023. “I was always very excited, and I wanted to learn it and fall in love with it.”

Inside the World of Sports

Dive deeper into the people, issues and trends shaping professional, collegiate and amateur athletics..

What We Saw at Augusta: Golf enthusiasts regard a trip to the Masters as the stuff of dreams. Here are photos from this year’s tournament .

A Dizzying 3 Weeks: At times, Shohei Ohtani, baseball’s biggest star, seemed in danger of being tainted by a gambling scandal , before his longtime interpreter was charged with fraud.

A Soccer Team With Free Matches: When Paris F.C. made its tickets free, it began an experiment into the connection between fans and teams , and posed a question about the value of big crowds to televised sports.

Minor League Baseball’s Real Estate: The fight over a new stadium for the Eugene Emeralds  highlights a wider challenge for cheaper alternatives to big-league live sports.

New York’s Favorite Soccer Team: Some people splurge on vacations, fancy shoes and motorcycles. A group of dozens of friends, neighbors and co-workers decided to try something better (or maybe worse): They bought a middling soccer team in Denmark .

Here Comes Padel: The sport is played with a racket on a court with a net, but watch out for those bouncing shots from the back wall. Reporters take a look at the padel scene in New York City .

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• 15 April 2024

Revealed: the ten research papers that policy documents cite most

• Dalmeet Singh Chawla 0

Dalmeet Singh Chawla is a freelance science journalist based in London.

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Policymakers often work behind closed doors — but the documents they produce offer clues about the research that influences them. Credit: Stefan Rousseau/Getty

When David Autor co-wrote a paper on how computerization affects job skill demands more than 20 years ago, a journal took 18 months to consider it — only to reject it after review. He went on to submit it to The Quarterly Journal of Economics , which eventually published the work 1 in November 2003.

Autor’s paper is now the third most cited in policy documents worldwide, according to an analysis of data provided exclusively to Nature . It has accumulated around 1,100 citations in policy documents, show figures from the London-based firm Overton (see ‘The most-cited papers in policy’), which maintains a database of more than 12 million policy documents, think-tank papers, white papers and guidelines.

“I thought it was destined to be quite an obscure paper,” recalls Autor, a public-policy scholar and economist at the Massachusetts Institute of Technology in Cambridge. “I’m excited that a lot of people are citing it.”

The most-cited papers in policy

Economics papers dominate the top ten papers that policy documents reference most.

Data from Sage Policy Profiles as of 15 April 2024

The top ten most cited papers in policy documents are dominated by economics research. When economics studies are excluded, a 1997 Nature paper 2 about Earth’s ecosystem services and natural capital is second on the list, with more than 900 policy citations. The paper has also garnered more than 32,000 references from other studies, according to Google Scholar. Other highly cited non-economics studies include works on planetary boundaries, sustainable foods and the future of employment (see ‘Most-cited papers — excluding economics research’).

These lists provide insight into the types of research that politicians pay attention to, but policy citations don’t necessarily imply impact or influence, and Overton’s database has a bias towards documents published in English.

Interdisciplinary impact

Overton usually charges a licence fee to access its citation data. But last year, the firm worked with the London-based publisher Sage to release a free web-based tool that allows any researcher to find out how many times policy documents have cited their papers or mention their names. Overton and Sage said they created the tool, called Sage Policy Profiles, to help researchers to demonstrate the impact or influence their work might be having on policy. This can be useful for researchers during promotion or tenure interviews and in grant applications.

Autor thinks his study stands out because his paper was different from what other economists were writing at the time. It suggested that ‘middle-skill’ work, typically done in offices or factories by people who haven’t attended university, was going to be largely automated, leaving workers with either highly skilled jobs or manual work. “It has stood the test of time,” he says, “and it got people to focus on what I think is the right problem.” That topic is just as relevant today, Autor says, especially with the rise of artificial intelligence.

Most-cited papers — excluding economics research

When economics studies are excluded, the research papers that policy documents most commonly reference cover topics including climate change and nutrition.

Walter Willett, an epidemiologist and food scientist at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, thinks that interdisciplinary teams are most likely to gain a lot of policy citations. He co-authored a paper on the list of most cited non-economics studies: a 2019 work 3 that was part of a Lancet commission to investigate how to feed the global population a healthy and environmentally sustainable diet by 2050 and has accumulated more than 600 policy citations.

“I think it had an impact because it was clearly a multidisciplinary effort,” says Willett. The work was co-authored by 37 scientists from 17 countries. The team included researchers from disciplines including food science, health metrics, climate change, ecology and evolution and bioethics. “None of us could have done this on our own. It really did require working with people outside our fields.”

Sverker Sörlin, an environmental historian at the KTH Royal Institute of Technology in Stockholm, agrees that papers with a diverse set of authors often attract more policy citations. “It’s the combined effect that is often the key to getting more influence,” he says.

Has your research influenced policy? Use this free tool to check

Sörlin co-authored two papers in the list of top ten non-economics papers. One of those is a 2015 Science paper 4 on planetary boundaries — a concept defining the environmental limits in which humanity can develop and thrive — which has attracted more than 750 policy citations. Sörlin thinks one reason it has been popular is that it’s a sequel to a 2009 Nature paper 5 he co-authored on the same topic, which has been cited by policy documents 575 times.

Although policy citations don’t necessarily imply influence, Willett has seen evidence that his paper is prompting changes in policy. He points to Denmark as an example, noting that the nation is reformatting its dietary guidelines in line with the study’s recommendations. “I certainly can’t say that this document is the only thing that’s changing their guidelines,” he says. But “this gave it the support and credibility that allowed them to go forward”.

Broad brush

Peter Gluckman, who was the chief science adviser to the prime minister of New Zealand between 2009 and 2018, is not surprised by the lists. He expects policymakers to refer to broad-brush papers rather than those reporting on incremental advances in a field.

Gluckman, a paediatrician and biomedical scientist at the University of Auckland in New Zealand, notes that it’s important to consider the context in which papers are being cited, because studies reporting controversial findings sometimes attract many citations. He also warns that the list is probably not comprehensive: many policy papers are not easily accessible to tools such as Overton, which uses text mining to compile data, and so will not be included in the database.

The top 100 papers

“The thing that worries me most is the age of the papers that are involved,” Gluckman says. “Does that tell us something about just the way the analysis is done or that relatively few papers get heavily used in policymaking?”

Gluckman says it’s strange that some recent work on climate change, food security, social cohesion and similar areas hasn’t made it to the non-economics list. “Maybe it’s just because they’re not being referred to,” he says, or perhaps that work is cited, in turn, in the broad-scope papers that are most heavily referenced in policy documents.

As for Sage Policy Profiles, Gluckman says it’s always useful to get an idea of which studies are attracting attention from policymakers, but he notes that studies often take years to influence policy. “Yet the average academic is trying to make a claim here and now that their current work is having an impact,” he adds. “So there’s a disconnect there.”

Willett thinks policy citations are probably more important than scholarly citations in other papers. “In the end, we don’t want this to just sit on an academic shelf.”

doi: https://doi.org/10.1038/d41586-024-00660-1

Autor, D. H., Levy, F. & Murnane, R. J. Q. J. Econ. 118 , 1279–1333 (2003).

Article   Google Scholar  

Costanza, R. et al. Nature 387 , 253–260 (1997).

Willett, W. et al. Lancet 393 , 447–492 (2019).

Article   PubMed   Google Scholar  

Steffen, W. et al. Science 347 , 1259855 (2015).

Rockström, J. et al. Nature 461 , 472–475 (2009).

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IOC accused of new low by funding study that claims trans women have physical disadvantage

T he International Olympic Committee has been accused of sinking to a new low after funding research into transgender athletes that claims they are at a physical disadvantage to biological females.

The research paper, which has been published in the British Journal of Sports Medicine, reported that physically active transgender women performed worse in certain cardiovascular tests and had less lower-body strength than cisgender females. Researchers at the University of Brighton also found that, contrary to previous claims, transgender women’s bone density was equivalent to cisgender females, which has links to muscle strength.

The findings, published on Thursday morning, could have a significant effect on the debate around gender-inclusion in sport ahead of the Paris Olympics as the research was the first relating to the issue that the IOC has funded and is the first scientific study of “athletes” who have undergone gender-affirming hormone therapy.

The authors, who included a member of the IOC’s medical and scientific commission, said their results showed that sporting federations should caution against banning transgender women from the female category without further research into their individual sports.

“While longitudinal transitioning studies of transgender athletes are urgently needed, these results should caution against precautionary bans and sport eligibility exclusions that are not based on sport-specific (or sport-relevant) research,” the paper said in its conclusions.

Trans women ‘don’t jump as high’

The study collected data from 69 volunteers, who had responded to social-media adverts seeking participants in the research. The cohort comprised 19 transgender women, 20 cisgender women, 19 cisgender men and 11 transgender men. To qualify for the study, they had to be taking part in competitive sport or physical training at least three times a week, and the transgender volunteers needed to have undergone hormonal therapy for at least a year. None of the subjects were competing in national or international sport.

Researchers found that transgender women performed worse than cisgender women in the countermovement jump that tests lower-body strength. It involves jumping vertically with hands on hips. Transgender women’s average jump was 36.4cm with a standard deviation (SD) of 7.9cm. Cisgender women’s average was 40.7cm with a SD of 5.8cm.

Cisgender women also performed worse in an important test of lung function called the FEV1/FVC ratio, which compares subjects’ Forced Expiratory Volume (the maximum amount of air that is expelled during the first second following a deep inhalation) with their Forced Vital Capacity (the volume of air that can be exhaled following a deep inhalation and a measurement of lung size). It added that there was no meaningful difference between the two groups’ haemoglobin profiles and bone density – both of which are related to athletic performance – even though, the researchers noted, previous studies of sedentary subjects found that transgender women performed better in both.

‘Unfair comparisons’

The findings produced a strong backlash from women’s sport campaigners, who described the research as unreliable and “like giving someone the answers to an exam.”

Dr Ross Tucker, a sports scientist and high performance sports expert currently working as a research scientist for World Rugby, questioned the reliability of comparing groups of women and transgender women from such a small pool and with varying fitness levels.

“I have to say, I think it is a poor study, and It’s amazing that it’s being described as ‘a landmark study’ by anyone,” Dr Tucker told Telegraph Sport. “This study is a comparison, one moment in time, between transgender women and a group of female athletes, and then they are using it as though it gives us insights into what happens when a person suppresses testosterone.

“When I first read it, it made me think that the IOC and their researchers simply could not find enough transgender athletes to study over time, and so instead, they’ve just taken whatever they could find, and then compared to them a group of whatever females they could find, and tried to portray it as a valid comparison.”

Dr Tucker explained that the pool of transgender women displayed V02max (the maximum level of oxygen a body can use during exercise) put them in a “mid-range of untrained or moderately trained adults”, whereas the group of females were in “a significantly higher category of training status”.

“One of those groups would be described as overweight, and the other athletic,” Dr Tucker added. “The transgender women have a body fat percentage of 31.6 per cent, the females 26.6 per cent.

“These demographic characteristics should already make us pause – these groups may not be comparable for reasons that really matter. We have a group of females who are on the higher end of cardiovascular capacity along the female spectrum, and there is a group of transgender women in the middle of that range, even the lower side of it. One group is overweight, the other is not.

“I would not be comparing these groups with any expectation that the comparison is like for like. The females are fit and well trained, and the transgender women are well below the same standard. Their physiological capacity suggests untrained.”

Professor Yannis Pitsiladis, who led the research and who sits on the IOC’s medical and scientific commission, said that such discrepancies should prevent anyone viewing the two groups as synonymous when addressing the issue of gender inclusion.

‘Trying to justify a ludicrous position’

Sharron Davies, the former British swimmer who was cheated out of a gold medal at the 1980 Olympics after East Germany’s Petra Schneider admitted doping her way to first place, took aim directly at the IOC. 

“The IOC, as far as I’m concerned, can’t get any lower than they are. They really are just unbelievable,” Davies told Telegraph Sport. “It’s them trying to justify their ludicrous position, which has been ludicrous since 2015.

“I don’t believe that you can turn around and ask a trans athlete who will benefit by not performing in tests to do their own testing. That’s crazy. That’s like giving someone the answers to an exam. It’s stupid, isn’t it?

“That’s exactly what happened with the Emily Bridges stuff up in Loughborough. Emily Bridges [a transgender women’s cyclist] is trying to prove that Emily Bridges has lost power so Emily Bridges can race women . That’s insane.

“All the other studies that we have – all 19 of them – are over longer periods of time with people who had nothing to gain by warping the results.”

Bridges, who set a national junior men’s record over 25 miles in 2018 before undergoing hormone therapy in 2021 to reduce her testosterone levels, was one of those impacted by British Cycling’s decision last July to ban transgender athletes from women’s events. Athletics and swimming are among those to have done the same.

But the IOC currently allows an individual sporting federation to designate its own rulings on transgender inclusion for the Olympics.

Fiona McAnena, director of campaigns at human rights charity Sex Matters, said: “It’s disappointing that the IOC is still looking at how to allow males to access women’s sport when that can only disadvantage women, who already get less funding and less access to sport.

“Some trans-identifying males were asked to prove that they can’t jump very high or blow into a tube for long. Why would they try their hardest when trying less hard gets them into women’s sport? The objective measures like height and weight show male advantage. But even if these males have lost some strength over time, that is not a licence to compete in women’s events and take women’s places.”

Mara Yamauchi, the third-fastest British female in Olympic marathon history, added: “This study has numerous problems, including self-selection of participants, wide variation in ages of the participants, and no control over hormone treatment of its transgender participants. Rather than fund research like this, and make nonsense claims like ‘no presumption of advantage’, the IOC could simply look at its own archives to know the undeniable fact that males as a sex class have massive physical advantages compared to females as a sex class.

“Therefore, males do not belong in the female category under any circumstances.”

Telegraph Sport has contacted the IOC for a response.

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