quantitative research paper about sports

• 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.

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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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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
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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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https://doi.org/10.1371/journal.pone.0263408.g001

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.

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Home » 500+ Sports Research Topics

500+ Sports Research Topics

Sports research topics cover a vast array of areas in the world of athletics, from the physical and psychological impacts of sport on athletes to the social and cultural implications of sports on society. Sports research can include studies on training techniques, nutrition, injury prevention, performance enhancement, and much more. It can also explore the societal impact of sports, such as the role of sports in shaping national identities, gender roles, and cultural values. As a result, the field of sports research provides a unique lens through which to understand the complex relationship between sports and society, and offers insights that can benefit athletes, coaches, and sports enthusiasts alike. In this post, we will explore some of the most fascinating and important sports research topics that are currently being investigated.

Sports Research Topics

Sports Research Topics are as follows:

• The psychological benefits of participating in team sports
• The impact of sports on academic achievement
• The role of sports in promoting physical health and fitness
• The impact of sports on mental health and well-being
• The benefits and drawbacks of early specialization in youth sports
• The relationship between sports and character development
• The role of sports in building social capital and community cohesion
• The impact of technology on sports training and performance
• The influence of gender on sports participation and achievement
• The impact of culture on sports participation and achievement
• The economics of professional sports: salaries, revenue, and team valuations
• The role of sports in promoting diversity and inclusion
• The impact of sports on political and social change
• The impact of sports sponsorship on consumer behavior
• The impact of doping in sports on athlete health and performance
• The role of nutrition in sports performance
• The impact of weather conditions on sports performance
• The influence of crowd behavior on sports performance and player behavior
• The impact of sports injuries on athlete health and career longevity
• The impact of sports on tourism and local economies
• The role of sports in promoting peace and conflict resolution
• The impact of globalization on sports and their respective cultures
• The impact of sports on national identity and patriotism
• The impact of sports media on fan behavior and athlete performance
• The impact of sports on the environment
• The influence of sports fans on team strategy and decision-making
• The impact of sports gambling on sports integrity and athlete health
• The impact of sports specialization on long-term athlete development
• The influence of sports referees and officials on game outcomes
• The role of technology in sports officiating and decision-making
• The impact of sports on youth development and socialization
• The role of sports in promoting gender equality and women’s empowerment
• The impact of sports on personal identity and self-esteem
• The role of sports in promoting physical literacy and lifelong physical activity
• The impact of fan behavior on athlete mental health and well-being
• The influence of sports broadcasters on fan behavior and attitudes
• The role of sports in promoting healthy competition and fair play
• The impact of sports participation on academic performance in children
• The influence of social media on athlete behavior and fan engagement
• The impact of sports on international diplomacy and political relations
• The influence of coach behavior on athlete mental health and performance
• The role of sports in promoting cultural understanding and awareness
• The impact of sports science on athlete training and performance
• The impact of youth sports on parent-child relationships
• The influence of sports team culture on athlete behavior and performance
• The role of sports in promoting environmental sustainability
• The impact of sports on social mobility and economic inequality
• The influence of sports on global health issues
• The impact of sports on regional and national identity
• The role of sports in promoting positive youth development and resilience.
• The impact of technology on sports performance
• The effects of altitude on ball flight in sports like golf and tennis
• The effects of sports on stress management
• The impact of COVID-19 on the sports industry
• The impact of technology on sports officiating and rule enforcement
• The role of sports in promoting cultural heritage and preservation
• The impact of sports on mental toughness and resilience among athletes
• The effects of different types of recovery interventions on sports injury rehabilitation
• The role of sports in promoting intergenerational connections and social capital
• The effects of different types of sports psychology interventions on team dynamics and performance in professional sports
• The role of sports in promoting peacebuilding and conflict resolution in divided societies
• The impact of sports on career development and job satisfaction among sports journalists
• The effects of different types of recovery interventions on injury prevention and performance in powerlifting
• The role of sports in promoting social innovation and entrepreneurship among youth
• The impact of sports on social identity and community building among refugees and immigrants
• The effects of different types of sports nutrition interventions on brain health and cognitive function in older adults
• The role of sports in promoting sustainable urban development and active transportation
• The impact of sports on social capital and political engagement among LGBTQ+ athletes
• The effects of different types of training interventions on injury prevention and recovery in equestrian sports.
• The impact of sports on body image and self-esteem among female athletes
• The effects of different types of sports equipment on performance and injury risk in extreme sports
• The role of sports in promoting cultural diplomacy and international relations
• The impact of sports on emotional regulation and mental health among adolescent athletes
• The effects of different types of nutrition interventions on injury prevention and recovery in team sports
• The role of sports in promoting civic engagement and political participation among athletes
• The impact of sports on cognitive development and academic achievement in early childhood
• The effects of different types of sports psychology interventions on sports performance and mental health
• The role of sports in promoting environmental education and sustainability in schools
• The impact of sports on career development and employability among retired athletes
• The effects of different types of mindfulness interventions on sports performance and well-being
• The role of sports in promoting intercultural dialogue and understanding
• The impact of sports on emotional intelligence and leadership development among coaches
• The effects of different types of sports supplements on performance and health outcomes
• The role of sports in promoting disaster risk reduction and resilience in coastal communities
• The impact of sports on social identity and group dynamics in fan communities
• The effects of different types of sports training on injury prevention and recovery in power sports
• The role of sports in promoting digital literacy and technological innovation in youth
• The impact of sports on social-emotional learning and character development in schools
• The effects of different types of nutrition interventions on sports performance and cognitive function in older adults
• The role of sports in promoting gender equity and empowerment in sports organizations
• The impact of sports on cultural identity and community building among Indigenous peoples
• The effects of different types of training interventions on injury prevention and recovery in para-athletes
• The role of sports in promoting global health and disease prevention
• The impact of sports on social support and mental health among parents of youth athletes
• The effects of different types of recovery interventions on sports performance and injury prevention in master athletes
• The role of sports in promoting community-based health education and behavior change
• The impact of sports on identity development and socialization among adolescent girls
• The effects of different types of sports nutrition interventions on gut microbiota and health outcomes
• The role of sports in promoting intercultural communication and language learning
• The impact of sports on psychological well-being and job satisfaction among sports officials
• The effects of different types of mindfulness interventions on injury prevention and recovery in endurance sports
• The role of sports in promoting sustainable tourism and economic development in rural areas
• The impact of sports on social integration and inclusion among individuals with disabilities
• The effects of different types of sports equipment on biomechanics and performance in precision sports
• The role of sports in promoting community resilience and disaster risk reduction in urban areas
• The impact of sports on social-emotional development and academic achievement among at-risk youth
• The effects of different types of sports nutrition interventions on immune function and health outcomes
• The role of sports in promoting social justice and human rights in sport governance
• The impact of sports on community development and social capital in post-conflict areas
• The effects of different types of resistance training on injury prevention and recovery in endurance athletes
• The role of sports in promoting intergenerational relationships and aging well-being
• The impact of sports on social support and mental health among retired athletes
• The role of sports in promoting civic activism and social change
• The impact of sports on sleep quality and quantity in professional athletes
• The effects of different types of stretching on recovery and injury prevention
• The role of sports in promoting environmental justice and sustainability
• The impact of sports on emotional intelligence and social skills among youth athletes
• The effects of different types of resistance training on sports performance
• The role of sports in promoting peace and conflict resolution in divided societies
• The impact of sports on academic achievement and career success among athletes
• The effects of different types of endurance training on injury prevention and recovery
• The role of sports in promoting cultural diversity and inclusion
• The impact of sports on team cohesion and communication
• The effects of different types of dietary interventions on sports performance and recovery
• The role of sports in promoting mental health and well-being in marginalized communities
• The impact of sports on cognitive function and academic achievement in children
• The effects of different types of cooling interventions on sports performance and recovery
• The role of sports in promoting community resilience and disaster preparedness
• The impact of sports on social capital and social mobility in low-income communities
• The effects of different types of sports nutrition interventions on bone health and injury prevention
• The role of sports in promoting global citizenship and intercultural competence
• The impact of sports on personal and professional development among athletes
• The effects of different types of training programs on sports performance and injury prevention in older adults
• The role of sports in promoting human rights and social justice
• The impact of sports on decision-making and risk-taking behavior in adolescents
• The effects of different types of aerobic exercise on cognitive function and brain health
• The role of sports in promoting sustainable development and social innovation
• The impact of sports on social integration and belonging among refugees and immigrants
• The effects of different types of sports equipment on injury risk and performance
• The role of sports in promoting gender equality and empowerment in developing countries
• The impact of sports on academic engagement and achievement among middle school students
• The effects of different types of hydration interventions on sports performance and recovery
• The role of sports in promoting community-based tourism and economic development
• The impact of sports on identity formation and self-concept among athletes
• The effects of different types of sports training on bone health and injury prevention in female athletes
• The role of sports in promoting environmental conservation and climate action
• The impact of sports on personal values and character development among athletes
• The effects of different types of sports nutrition interventions on cardiovascular health and performance
• The role of sports in promoting community-based disaster response and recovery
• The impact of sports on social support and well-being among LGBTQ+ athletes
• The effects of different types of recovery interventions on injury rehabilitation and return to play in professional athletes
• The role of sports in promoting social entrepreneurship and innovation
• The impact of sports on moral reasoning and ethical decision-making among athletes
• The effects of different types of training programs on cognitive function and academic achievement in children
• The role of sports in promoting social inclusion and equality in urban settings
• The impact of sports on social identity and collective action among fans
• The effects of different types of recovery interventions on sports performance and injury prevention in adolescent athletes
• The effects of different types of recovery modalities on injury prevention in sports
• The role of sports in promoting cultural diplomacy
• The impact of sports participation on academic achievement among college students
• The effects of different types of hydration strategies on sports performance
• The role of sports in promoting social cohesion and community building
• The impact of sports on physical and cognitive aging
• The effects of different types of warm-down on sports performance and injury prevention
• The role of sports in promoting positive youth development
• The impact of sports on crime and delinquency among youth
• The effects of different types of endurance training on sports performance
• The role of sports in promoting gender equity and empowerment
• The impact of sports on mental health among athletes
• The effects of different types of carbohydrate intake on sports performance
• The role of sports in promoting international relations and diplomacy
• The impact of sports on body image and self-esteem among adolescents
• The effects of different types of sports drinks on sports performance
• The role of sports in promoting environmental sustainability and conservation
• The impact of sports on cognitive function and brain health
• The effects of different types of sports psychology interventions on sports performance
• The role of sports in promoting social justice and human rights
• The impact of sports on physical activity levels and sedentary behavior
• The effects of different types of pre-game nutrition on sports performance
• The role of sports in promoting economic development and tourism
• The impact of sports on cultural and national identity
• The effects of different types of footwear on injury risk in sports
• The role of sports in promoting civic engagement and democracy
• The impact of sports on sleep quality and quantity
• The effects of different types of anaerobic training on sports performance
• The role of sports in promoting intergenerational relationships and socialization
• The impact of sports on body composition and weight management
• The effects of different types of sports psychology interventions on injury prevention and recovery
• The role of sports in promoting peacebuilding and conflict resolution
• The impact of sports on self-efficacy and self-esteem among athletes
• The effects of different types of protein intake on sports performance
• The role of sports in promoting health equity and reducing health disparities
• The impact of sports on social capital and community resilience
• The effects of different types of high-intensity interval training on sports performance
• The impact of sports on stress and stress-related disorders
• The effects of different types of dietary supplements on sports performance
• The role of sports in promoting human development and well-being
• The impact of sports on emotional regulation and mental health
• The effects of different types of strength training on sports performance
• The role of sports in promoting social innovation and entrepreneurship
• The impact of sports on social identity and belonging
• The effects of different types of cognitive training on sports performance
• The role of sports in promoting disaster resilience and preparedness
• The impact of sports on academic engagement and achievement among high school students
• The effects of different types of stretching on injury prevention and sports performance.
• The effects of different types of training on athletic performance
• The effectiveness of different coaching styles in sports
• The role of nutrition in athletic performance
• The psychology of injury rehabilitation in sports
• The use of performance-enhancing drugs in sports
• The role of sports in promoting physical and mental health
• The impact of social media on sports marketing
• The effectiveness of sports marketing campaigns
• The effects of gender and ethnicity on sports participation and performance
• The impact of sports sponsorship on athlete performance
• The role of sports in promoting teamwork and leadership
• The effects of environmental conditions on sports performance
• The impact of sports on community development
• The psychology of winning and losing in sports
• The effects of sleep on sports performance
• The use of virtual reality in sports training
• The impact of sports injuries on athletes’ careers
• The effects of altitude on athletic performance
• The use of data analysis in sports performance assessment
• The role of sports in reducing stress and anxiety
• The impact of sports on academic performance
• The effects of different sports on cardiovascular health
• The use of cryotherapy in sports recovery
• The impact of social media on sports fans and fandom
• The effects of different types of footwear on sports performance
• The role of sports in promoting physical activity among children and adolescents
• The effects of different types of stretching on sports performance
• The impact of sports on social and cultural values
• The effects of hydration on sports performance
• The role of sports in promoting global understanding and diplomacy
• The effects of different types of surfaces on sports performance
• The impact of sports on economic development
• The impact of sports on mental toughness and resilience
• The effects of different types of recovery methods on sports performance
• The use of mindfulness in sports performance and injury recovery
• The impact of sports on environmental sustainability
• The effects of different types of warm-up on sports performance
• The role of sports in promoting tourism and travel
• The impact of sports on crime reduction and community safety
• The effects of different types of sports equipment on performance
• The impact of sports on job creation and employment opportunities
• The effects of different types of physical activity on mental health
• The role of sports in promoting social mobility and equality
• The impact of sports on identity formation and socialization
• The effects of different types of pre-game rituals on sports performance.
• The role of sports in promoting healthy aging
• The impact of sports on conflict resolution among youth
• The effects of sports on job satisfaction and productivity
• The role of sports in promoting environmental conservation
• The impact of sports on language proficiency and communication skills
• The effects of sports on the development of social skills
• The role of sports in promoting peaceful coexistence and tolerance
• The impact of sports on community building and cohesion
• The effects of different types of sports on hand-eye coordination
• The impact of sports on personal growth and self-discovery
• The effects of sports on cultural competency
• The role of sports in promoting social and emotional learning
• The impact of sports on community health
• The effects of different types of sports on reaction time
• The role of sports in promoting social justice and equity
• The impact of sports on academic motivation and achievement
• The effects of sports on the development of grit and resilience
• The role of sports in promoting civic engagement and social responsibility.
• The impact of sports on tourism
• The role of sports in promoting physical activity
• The effects of playing sports on cognitive development
• The impact of sports on political identity
• The effects of sports on self-esteem and body image
• The role of sports in promoting teamwork and collaboration
• The effects of different coaching styles on athlete performance
• The impact of sports on national security
• The role of sports in promoting cultural exchange and diplomacy
• The effects of sports on language acquisition
• The impact of sports on family dynamics
• The role of sports in promoting conflict resolution
• The impact of sports on social mobility
• The effects of different types of training on injury prevention
• The role of sports in promoting global health
• The effects of sports on decision-making and risk-taking behavior
• The role of sports in promoting physical and mental well-being
• The impact of sports on social justice
• The effects of sports on academic achievement among at-risk youth
• The role of sports in promoting cultural heritage
• The impact of sports on personal identity
• The effects of sports on emotional intelligence and empathy
• The role of sports in promoting gender equality
• The impact of sports on identity formation
• The effects of different types of sports on balance and coordination
• The role of sports in promoting social capital
• The impact of sports on social integration and inclusion
• The effects of training at high altitudes on athletic performance
• The psychological factors that contribute to athlete burnout
• The relationship between sleep and athletic performance
• The effects of music on sports performance
• The effects of caffeine on sports performance
• The impact of climate on sports performance
• The use of supplements in sports performance
• The role of genetics in sports performance
• The effects of aging on sports performance
• The impact of sports injuries on athlete’s careers
• The relationship between sports and mental health
• The effects of gender on sports performance
• The impact of social media on sports
• The effects of sports fandom on mental health
• The use of technology in sports coaching
• The impact of team culture on sports performance
• The effects of sports specialization on athlete development
• The role of sports psychology in athlete performance
• The effects of plyometric training on athletic performance
• The impact of climate change on outdoor sports
• The effects of team dynamics on sports performance
• The impact of sports participation on academic achievement
• The effects of sports sponsorship on athlete performance
• The role of biomechanics in sports performance
• The effects of stretching on sports performance
• The impact of sports equipment on performance
• The effects of altitude training on endurance sports performance
• The effects of different types of training on sports performance
• The role of nutrition in injury prevention
• The effects of mental preparation on sports performance
• The effects of climate on indoor sports performance
• The role of sports in cultural identity
• The impact of sports participation on youth development
• The effects of strength training on sports performance
• The role of coaches in athlete development
• The impact of sports on national identity
• The effects of different playing surfaces on sports performance
• The role of recovery in sports performance
• The impact of sports on local economies
• The impact of sports on gender and racial equality
• The effects of team size on sports performance
• The role of sports in promoting social inclusion
• The effects of sports on personal development
• The impact of sports on conflict resolution
• The effects of sports on leadership development

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Journal of Quantitative Analysis in Sports

An official journal of the american statistical association.

• Online ISSN: 1559-0410
• Print ISSN: 2194-6388
• Type: Journal
• Language: English
• Publisher: De Gruyter
• First published: January 1, 2005
• Publication Frequency: 4 Issues per Year

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• BMJ Open Sport Exerc Med
• v.7(1); 2021

Youth sport injury research: a narrative review and the potential of interdisciplinarity

Solveig elisabeth hausken-sutter.

1 Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden

Richard Pringle

2 Faculty of Education, Monash University, Melbourne, Victoria, Australia

Astrid Schubring

Stefan grau, natalie barker-ruchti.

3 School of Health Sciences, Örebro University, Örebro, Sweden

To prevent sports injuries, researchers have aimed to understand injury aetiology from both the natural and social sciences and through applying different methodologies. This research has produced strong disciplinary knowledge and a number of injury prevention programmes. Yet, the injury rate continues to be high, especially in youth sport and youth football. A key reason for the continued high injury rate is the development of injury prevention programmes based on monodisciplinary knowledge that does not account for the complex nature of sport injury aetiology. The purpose of this paper is to consider and outline an interdisciplinary research process to research the complex nature of sport injury aetiology. To support our proposition, we first present a narrative review of existing youth football and youth sport injury research demonstrating an absence of paradigmatic integration across the research areas’ main disciplines of biomedicine, psychology and sociology. We then demonstrate how interdisciplinary research can address the complexity of youth sport injury aetiology. Finally, we introduce the interdisciplinary process we have recently followed in a youth football injury research project. While further research is necessary, particularly regarding the integration of qualitative and quantitative sport injury data, we propose that the pragmatic interdisciplinary research process can be useful for researchers who aim to work across disciplines and paradigms and aim to employ methodological pluralism in their research.

What is already known?

• Youth athletes sustain injuries.
• Youth sport injuries have been researched from multiple scientific disciplines.
• There is growing support for the application of a complexity approach to sport injury research.

What are the new findings?

• An overview of youth football and youth sport injury research from the scientific disciplines of biomedicine, psychology and sociology.
• Paradigmatic distinctions in youth football and youth sport injury research create scientific differences between bodies of injury research.
• Youth football and youth sport injury research lacks integration across disciplines and paradigms.
• Our proposed interdisciplinary research process consists of five phases that demonstrates the working process of a project researching youth football injuries.
• The five-phase process can be considered a response to the call for interdisciplinarity in sport injury research as well as a practical guide.

Introduction

Youth sport injury research has during the past years produced important knowledge concerning injury aetiology and injury prevention. Most of this scholarship has emerged from research conducted in specific scientific disciplines, primarily biomechanics, sport medicine, exercise physiology, sport psychology and sport sociology. 1 Broadly speaking, researchers of these disciplines follow distinctive assumptions of what an injury is and what research questions, ethical stances, research methods and interpretations and explanations of results are most appropriate to study this phenomenon. 2 3 These constellations of beliefs, values and methodologies are referred to as scientific paradigms . Existing youth sport injury research can be categorised by three paradigms: positivism, postpositivism and interpretivism. The positivist paradigm is closely related to reductionism, and reality and truth are understood as singular and identifiable. Positivist sport injury research has specifically focused on identifying and separating risk factors. 4 Methodologically, objectivity is paramount, which requires researchers to detach themselves from the study object. In analysis, the identified risk factors are used to generalise causality. 3 5 In the postpositivist paradigm, reality and truth are understood alike positivism. However, researchers adopt diverse research methods to establish causality, including through qualitative methodology. 3 In the interpretivist paradigm, reality and truth are understood as multiple and relative. 2 3 Researcher objectivity is not considered possible as it is assumed that truth is constructed between researchers and the researched. The overall aim is to gain a deeper understanding of what an injury means, and how it is experienced and made sense of.

Scientific paradigms guide researchers and research, 2 3 5 and they have shaped research on youth sport injury aetiology. The existing body of knowledge is comprehensive, however, seldom brought together to understand sport injury and sport injury aetiology from the perspectives presently adopted. Thus, an interdisciplinary understanding that is interparadigmatic is missing. Recently, a number of sport injury researchers have critiqued the reductionist methodology that characterises most research on sport injury aetiology and suggested a turn to complexity to account for the multidimensional nature of sport injury aetiology. 4 6–9 At present, however, relatively few researchers adopt a complexity approach and scholarship is only at the conceptual level. Moreover, current discussions have not included ways to integrate the influence socio-cultural context has.

The purpose of this paper is to advance existing youth sport injury aetiology scholarship by considering and outlining an interdisciplinary research process to research the complex nature of youth sport injury aetiology. In our view, an interdisciplinary approach that is interparadigmatic has potential to generate data that can address the complexity of an injury. To support our proposition for interdisciplinarity, the paper aims to: (1) present the results of a narrative review that examined multidisciplinary literature on youth sport injury aetiology; (2) discuss interdisciplinary research to consider how such an approach can address the complexity of youth sport injury aetiology and (3) introduce an interdisciplinary research process that we have adopted in a research project on youth football injury aetiology.

To achieve the above aims, we draw on the research context of the ongoing project ‘Injury free children and adolescents: towards best practice in Swedish football’ (FIT project). 10 The purpose of the FIT project is to provide evidence-based interdisciplinary injury prevention strategies. To achieve this, the project aims to produce a comprehensive picture of injury aetiology in a sample of male and female Swedish football players aged 10–19 years through integrating natural and social science and producing quantitative and qualitative data. The research team includes scholars from biomechanics, sport medicine, sociology and sport coaching. The project started in January 2017 and involved a prospective questionnaire to record incidence and prevalence of injuries over a 5-month period, one-time biomedical testing (clinical examination, isometric strength measurements, running analysis and knee stability), a 5-month analysis of training protocols, observation of training sessions of players and their coaches and interviews with players and coaches. At present, the project is working towards the integration of collected quantitative and qualitative data.

Narrative review of youth football and sport injury research

We conducted a narrative review of literature relevant to youth football injury aetiology to provide a critical synthesis of existing literature and to specifically identify paradigmatic and methodological assumptions, research approaches, research methods and data analysis procedures. The focus on existing literature’s paradigmatic distinctions is an important first step in interdisciplinary work. 3 According to Phoenix et al 3  (p. 220), a ‘step back’ to understand underlying assumptions can advance knowledge and awareness of the respective research field as a way to ‘move beyond debates about right or wrong ways of approaching research’.

The first author has from January 2017 to May 2020 searched for literature on youth football injuries in the databases PubMed, Scopus, PsycINFO and Web of Science. Search terms included various combinations of ‘youth’, ‘soccer’, ‘football’, ‘injury’, ‘aetiology‘ and ‘risk’. Inclusion criteria were set to youth football players aged approximately 10–19 years and injury aetiology, injury prevention and/or injury risk factors. The search revealed a paucity of sociological youth football injury research. Thus, the search was broadened to sociological injury research in different sports and age groups, which identified research in biathlon, figure skating, rhythmic gymnastics, rugby and softball. To identify assumptions underlying paradigmatic distinctions, we predefined three analytic areas: body and injury perspective (state of the art regarding how an injury is explained and defined); paradigmatic assumptions (reality/truth/knowledge) and research approaches (methodology). Based on how these categories were approached in the literature included in the review, as well as discussions in the FIT project team and a presentation at a scientific conference, 11 we placed the literature in the three paradigms dominant for youth sport injury research: positivism, postpositivism and interpretivism. Furthermore, five dominant disciplines of youth sport injury research were identified based on the reviewed literature; biomedicine (biomechanics, sport medicine and exercise physiology), sport psychology and sport sociology. Table 1 summarises key findings of the narrative review.

Distinctions of youth football and sport injury aetiology research

Table 1 summarises the key findings of a narrative review of existing youth football and youth sport injury research, which demonstrates an absence of paradigmatic integration across the research areas’ main disciplines of biomedicine, psychology and sociology.

Biomedical research

Biomedical research on injuries in youth football has mostly focused on individual injury risk factors relating to kinematics, kinetics and spatiotemporal variables, physical development and amount of training and competitions. Key findings from our literature search show that age, growth and biological maturation contribute to an increased risk of injuries, especially during the year of peak height velocity. 12–14 Possible risk factor for injuries in youth football players during this period include muscle strength, 15 familial disposition, 16 previous injury, 17 physical stress (ie, training and match duration and perceived exertion) 18 and match playing. 12 16 Furthermore, external factors such as playing turf and type of shoes are associated with injuries among youth football players. 19 Findings from the biomedical discipline have resulted in the development of injury prevention interventions applied to youth through programmes such as the Nordic hamstring strengthening exercise, 20 the FIFA 11+ exercise programme 21 and a neuromuscular warm-up programme called ‘Knee control’. 22 These exercise-based programmes include multiple training components, such as agility, balance, mobility, running and strength activities.

In addition to identifying risk factors, biomedical research has contributed with a number of sport-general models on injury causation, including the Sequence of Prevention model, 23 and the Multifactorial Model of Athletic Injury Aetiology, 24 which was later revised and updated to a more dynamic model. 25 McIntosh 26 also proposed a multifactorial model of injury causation but with a biomechanical focus on tissue properties and injury. Furthermore, sport injury research frameworks such as the Translating Research into Injury Prevention Practice framework, 27 and the extension of the Reach; Effectiveness; Adoption; Implementation; Maintenance framework 28 have been developed in order to close the gap between research and implementation of interventions. These models and frameworks have, in general, been used by youth football injury aetiology researchers.

Biomedical youth football injury research reviewed in this paper is situated in the positivist paradigm. Given its assumptions of a singular and identifiable reality and truth, an injury is objectively defined as a specified damage to the physical body. Injury aetiology is often linear and related to identifiable individual physical factors. Methodologically, researchers are required to stay objective and abstain from interacting with research participants. A hypothetic-deductive reasoning leads the research from broad hypotheses to testing using quantitative methods (eg, physical testing, questionnaires), often in isolation and through manipulation of typical risk factors, often in a laboratory setting.

Psychological research

Psychological research on injuries in youth football players has mainly focused on psychosocial dimensions. Main risk factors identified in this research are personality traits (eg, high level of trait anxiety; low level of mistrust; ineffective coping), 29 history of stressors (eg, negative life event, daily hassles), 30 mental and physical fatigue 31 and team climate (eg, lack of support from coach and teammates). 31 32

Findings from the psychological discipline have resulted in prevention and research focusing on stress management techniques and goal setting skills. 33–35 Furthermore, the Model of Stress and Athletic Injury, 36 37 which demonstrates how the magnitude of stress and athletes’ appraisal of the situation may be influenced by the interplay between various psychosocial factors (eg, personality, history of stressors, coping resources), has become one of the most cited research models. In extending this model through the Biopsychosocial Model of Stress Athletic Injury and Health, the authors suggest that behavioural mechanisms associated with stress response (eg, impaired self-care; poor sleep quality) should also be addressed. 38 Moreover, emotions and environmental factors have been included in the Biopsychosocial Sport Injury Risk Profile, 39 as important risk factors related to sport injury.

Psychological youth football injury research reviewed in this paper is mainly situated in the positivist paradigm, with some research fitting into the postpositivist paradigm. Like the positivist paradigm, injury and injury aetiology definition is specific and related to the physical body, but adds the mind. Methodologically, researchers keep interaction with athletes to a minimum, and similar to positivist researchers, tend to follow a hypothetic-deductive reasoning as a method to gain knowledge. Assuming that establishing truth requires diverse sets of data, some researchers test the hypotheses by using qualitative methods, such as questionnaires and in-depth interviews.

Sociological research

Sociological research on youth sport injury has examined injuries from the perspective of athletes and by analysing the sporting culture athletes are immersed in. Key findings from our search show that sociocultural values (eg, sporting success; discipline and striving for perfection), social norms (eg, femininity; masculinity; power; being on time; respecting the coach), 40–43 pressure to play through injury and pain (especially socialisation to accept training/competing with pain; silence around pain and injury), 41 44 45 medical support (eg, lack of medical support; information being withheld) 44 46 and coach-athlete relationships, 42 47 can influence injury aetiology among athletes.

Sociological injury researchers do not use models to conceptualise injury aetiology, but employ theoretical frameworks such as sport ethic (a set of ideas and beliefs that together comprise norms of traditional athleticism), 42 narratives of self, 47 culture of risk, 48 social control (eg, individuals become inscribed and normalised by particular dominant standards) and masculinity theories, 49 in order to understand and explain sport injury aetiology.

Sociological youth sport injury research reviewed in this paper tends to be situated in the interpretivist paradigm. An injury and its aetiology are interpreted by athletes and researchers and can be explained or understood by examining athletes’ sociocultural context. To examine injury aetiology, researchers interact with athletes and the context. Methodologically, sociological researchers sometimes use deductive reasoning as described above, but they also use inductive reasoning, where the process of creating insight develops from empirical data towards a theory (ie, patterns, themes and categories of analysis emerge out of the data). Researchers in the interpretivist paradigm apply qualitative methods such as observation and interviews, and interpretive analysis techniques such as thematic, content, discourse and narrative analysis.

Reflections on distinctions of youth football and youth sport injury research

The narratively reviewed literature on youth football and youth sport injury research shows two paradigmatic distinctions. First, the literature is monoparadigmatic and tends to focus on one subdiscipline of sport science. Most of the literature is biomedical, sport psychological and sport sociological, and often based on either quantitative or qualitative research techniques. The French philosopher and sociologist Edgar Morin 50 argues that by approaching research from single disciplines, complexity becomes invisible. The disintegration of complexity through monodisciplinarity is not due to the discipline in itself, but as Morin 50  (p. 2) emphasises, because ‘of the discipline as it is conceived, non-communicating with the other disciplines, closed to itself’. Monodisciplinarity in research reduces the phenomenon into separate parts, thus making the whole as well as interactions between parts and between parts and the whole, invisible. 7 50 Second, and related to monodisciplinarity, there is no integration of research across the three paradigms.

These limitations can be clearly seen in our narratively reviewed literature included in table 1 . Thus, current youth sport injury research can be seen to shield off—or in other words leave out—possibly important aspects, creating a picture that is not actually representative of the complex phenomenon under study (eg, injury aetiology). 51 For example, biomedical and psychological disciplines, by mainly focusing on athletes’ physical bodies and minds, leave out their interaction with and in the larger sociocultural context the athletes participate in. Similarly, sociological research, by focusing on sociocultural context, often ignores how the physical body and mind interact with and influence athletes.

Researchers operating in these paradigms and disciplines can and do apply different research approaches and methods, thus, paradigms do not confine. Indeed, researchers have adopted approaches to be more inclusive, such as an ‘ecological’, ‘integrated’ or more ‘real-world’ approach to sport injuries. 52–54 However, these approaches either miss to account for multiple and complex interactions between different ‘parts of the whole’, 7 or do not attempt to integrate disciplines across paradigms or use multiple quantitative and qualitative research methods.

The complexity approach to sport injury research

The recognition that sport injury aetiology involves numerous interactions between various variables across multiple dimensions has led some researchers to explore the potential of a complex systems approach for understanding and researching sport injury aetiology. 4 6–9 Although researchers understand and apply complexity to sport injury research differently, three elements characterise current discussions. First, a complexity approach embraces an understanding of context as open systems consisting of components that are actively connected through mostly non-linear relationships. 4 7 8 A non-linear relationship between components in the system implies that A plus B does not necessarily equal C. For example, a weak muscle plus psychological stress does not necessarily result in an injury. Second, these non-linear relationships between the components can induce dramatic new effects giving rise to unexpected structures and events, also known as emergence. 55 56 Emergence can, for example, be certain tendencies, powers or complex phenomena such as a sport injury. Emergence, or the injury and its aetiology is constantly evolving, and not strictly predictable. 55 In other words, emergence is self-organising, meaning a complex system can transform over time, either growing or shrinking. 55 Emergence should be accounted for when researching sport injury aetiology, for example, through longitudinal studies. Finally, and what Newell 55 argues is typically overlooked in the understanding of complex systems, is the importance of ‘local knowledge’, or knowledge of specific parts of the system. An athlete can, for example, be stressed over an upcoming exam at school and is injured right before the exam. The athlete might believe exam stress caused the injury. A closer examination may, however, show that it was the way the coach had changed behaviour towards the athlete that affected the injury aetiology. When applying a complex systems approach to injury research, the focus moves from identifying single risk factors for injuries to recognising patterns of interaction among multilevel components, acknowledging that these components interact in unpredictable ways and may be moderated by a number of individual and contextual factors. 4 6 8

Researchers are currently discussing how the implementation of complex systems thinking can advance sport injury research, specifically through statistical mathematical models and computer-based simulations guided by equations, rules and laws. Complex models 4 and statistical procedures such as the Agent-Based Modelling (ABM) and Systems Dynamics (SD) modelling 9 are recent examples. According to Bekker 6  (p. 80), however, this development represents an “overemphasis on the epistemological question of how multifactorialism is accounted for in research and a corresponding underemphasis on the ontological considerations and assumptions we make about the world”, which reflects a dissonance in how complexity is understood and applied to sport injury research. The current argument for complexity assumes a reductionist positivist/postpositivist view where complexity is understood as emerging from the rule-based interactions of simple agents/elements and explored through agent-based modelling. 56 Consequently, it tends to ignore that there is more to emergence than the product of interactions of agents; athletes are themselves complex systems, and more complex than agents in agent-based simulations. 56 Thus, the current argument for complexity is limited in recognising the importance of understanding athletes’ interactions with and in a certain context; hence, it is ignoring the significance of incorporating sociocultural conditions that researchers from the interpretivist paradigm have identified as relevant. Bekker further argues that injury researchers’ focus should not be on methodological preferences, but rather on ‘understanding system goal behaviour using methodological pluralism’ 6 (p. 81). We agree. A complexity approach requires alternative research methodologies. One such approach, which we have found to have potential in the FIT project to account for the multiple dimensions of injury aetiology, is an interdisciplinary research process that includes scientific disciplines from different paradigms and integrates qualitative and quantitative research methods.

The potential of interdisciplinary sport injury research

Drawing on research by Klein and Newell, 57 we understand interdisciplinarity as a research process aiming to address a topic that is too broad or complex to be dealt with adequately by a single discipline. Furthermore, an interdisciplinary research process integrates disciplinary perspectives through construction of a more comprehensive perspective. 57 Both Newell 55 and sports researchers such as Buekers et al 58 argue that complex systems and phenomena are a necessary condition for interdisciplinary studies. The rationale for this argument lies in the way complex phenomena can be understood and studied. If an injury is to be understood as complex, then this would mean, as argued earlier, that the phenomenon is multidimensional. Seeing it from one single angle, such as from biomedicine or sociology, only, the phenomenon appears different than from another angle. Since the overall pattern of behaviour is non-linear and dynamic, an effective method for modelling such a phenomenon must offer insight into the separate parts as well as the complex pattern produced by their overall interactions. 55 An interdisciplinary research process, which draws insights from relevant disciplines and integrates these insights into a more comprehensive understanding, is thus proposed to have potential to study sport injury aetiology. 1

The benefits of interdisciplinarity have been pointed out in a recent Nature editorial. 59 The editor specifically endorsed the incorporation of social sciences, cautioning that ‘[i]f social, economic and/or cultural factors are not included in the framing of the questions’ then ‘a great deal of creativity can be wasted’. Recently, sports sociologists Pringle and Falcous 60 have also advocated a collaboration between the social and natural sciences. They argue that a collaboration between biomedical researchers and sport sociologists, which they refer to as methodological border crossing, could improve the political impact of research from the sociology of sport. Regarding sport injury research, Burwitz et al 1 argued for the benefits of interdisciplinarity over two decades ago. Despite their call, however, very little empirical work has been conducted to this end. Reasons provided for this reservation have been related to various obstacles that prevent high quality, truly integrated interdisciplinary work, as well as practical difficulties relating to gaining funding and publishing. 1 58 Philosophical obstacles relating to paradigmatic differences may also result in a lack of shared understandings, research approaches and methods, 61–63 preventing researchers from adopting such an approach. Nevertheless, our research in the FIT project has demonstrated that interdisciplinarity has potential for sport injury research.

The interdisciplinary research process of the FIT project

The interdisciplinary research process of the FIT project consisted of five phases depicted in figure 1 . The five-phase research process was developed based on key interdisciplinary research steps outlined by interdisciplinary researchers such as Alan Repko, Rick Szostak and William H. Newell. 55 64 While presented sequentially, the five-phase research process is an iterative and non-linear process. At times it was necessary to move back to an earlier phase or forward towards later phases, which is common and reflects the complexity of the interdisciplinary research process. 55 64

The interdisciplinary research process of the FIT project. The figure illustrates the five-phase interdisciplinary research process adopted for the study of youth football injury aetiology. 10 The blue boxes present the main theme of each of the five phases of the process. The green boxes entail research actions. The interdisciplinary research process was not linear, but involved the researchers moving back to an earlier phase or forward towards later phases during the process.

In the first phase of the process, the FIT project research group came together from multiple scientific disciplines and agreed on researching injury aetiology in youth football using an interdisciplinary approach. In the second phase, the project team members decided which scientific disciplines to draw on to study the problem, a process that took place through meetings, discussions, reviewing literature and presentations of research within and outside of the project group. In phase III, we conducted research applying the following research methods to study youth football injury aetiology: questionnaire; measures of weight and height; injury diagnostics; clinical examinations; strength testing; running analyses; knee laxity measurements; examination of training protocols; field observations and interviews. Research methods were chosen based on knowledge gained from project team members’ disciplinary expertise, existing literature, internal meetings and discussions with experts outside of the research group. Additionally, phase III entailed recruitment of research participants.

In the final two phases, data were analysed through measurement-specific analyses (eg, three-dimensional kinematics to analyse movement-specific characteristics; isometric strength to analyse muscle weakness and/or muscle imbalance; content analysis of field notes and interview transcripts) and an analytic procedure was prepared that makes integrated analysis of measurement-specific analysis possible.

During the FIT project’s five-phase interdisciplinary research process, the research group encountered paradigmatic challenges typical of working interdisciplinarily. 61 One example is sample size and recruitment. Where positivist paradigmatic distinctions require a statistically powerful sample size, the interpretivist paradigm demands possibilities for in-depth and detailed examination of one or a few cases. A further challenge was the lack of an integrated data analysis procedure that would allow us to integrate the measurement-specific analysis referred to above. As we could not locate a suitable analytical procedure, we needed to spend time and effort to develop and test such a procedure. Finally, we have found that presenting the FIT project research in multiple cases resulted in misunderstanding and scientific criticism. As a result, we had to place extra effort in considering the communication of the FIT project’s scientific rationale, methodology and results. Indeed, while we have not struggled to respect our different paradigmatic worldviews and demands, it has been challenging to find and communicate what interdisciplinary researchers like Repko and Szostak 64 and Welch 65 call the ‘space in between’ scientific paradigms and disciplines we have been trying to create. The key measure that helped us to move forward in the interdisciplinary research process was a negotiation process that entailed regular meetings.

The purpose of this paper was to consider and outline an interdisciplinary research process to research the complex nature of youth sport injury aetiology. To facilitate this proposal, our narrative review of existing biomedical, sport psychological and sociological literature summarised youth football and youth sport injury research and demonstrated paradigmatic distinctions and methodological assumptions, research approaches, research methods and data analysis procedures. The narrative review has shown a paucity on youth football injury research in the sociological discipline as well as a dominance of monodisciplinary research and a lack of integration across research disciplines and paradigms.

Our paper has further shown that to advance youth sport injury research, specifically considering complexity, an interdisciplinary research process, such as proposed in figure 1 , has potential to integrate disciplinary knowledge and measurement-specific data across research paradigms. The integrated potential is particularly promising for research aiming to examine the interactions of components proposed vital to understand the complexity of injury aetiology. We recognise, however, that to advance this potential, additional research is necessary. We particularly see a need to develop and trial analytical procedures that integrate qualitative and quantitative injury aetiology data to produce complex injury aetiology findings, and to explore interdisciplinary research teams’ pragmatic negotiation of the challenges of melding seemingly opposing paradigms in the interests of better understanding the complexities of sport injury processes.

Contributors: NB-R and SG conceptualised the FIT project, which is the basis for this paper. NB-R acquired the funding. AS, NB-R, SG and SEH-S contributed with the preparation of tools and data production for the FIT project. SEH-S is the PhD student in the FIT project. NB-R and SEH-S were responsible for the initial preparation and writing of the manuscript. RP, AS and SG contributed to the accurate and critical revision of the manuscript as well as approval of the final version. All authors were involved in the preparation and editing of the manuscript.

Funding: This study was funded by The Swedish Research Council for Sport Science.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

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