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Sports Medicine Research

Fair Play rules make ice hockey safer

Fair Play (PDF) is an initiative developed and implemented by Mayo Clinic Sports Medicine Research to reduce the incidence of concussions and make hockey a safer sport.

Research improves all aspects of sports mechanics

Mayo Clinic Sports Medicine Research is using research discoveries to improve strength, power, agility and speed and prevent common injuries such as ACL tears in athletes.

Biomechanics breaks down movement to prevent injury

Mayo Clinic Sports Medicine Research is using biomechanics research to show how pitching and swing mechanics can put an athlete at risk for injury.

Striving to improve athletic performance

Mayo Clinic Sports Medicine Research: Preventing and treating sports injuries to improve and enhance athletic performance.

Mayo Clinic Sports Medicine Research performs leading-edge research to define the mechanism of injury and utilizes these findings to implement educational programs and therapeutic interventions. This work helps prevent injuries, enhances athletic performance and increases injury prevention during play.

Sports Medicine Research investigates all aspects of sports injury evaluation, treatment and prevention to provide optimal care to those involved in sports- or fitness-related activities. Recent work has addressed neuromuscular interventions to prevent anterior cruciate ligament (ACL) injuries, the use of subsymptom exercise to return athletes who've had concussions to a pre-head-trauma state and the modeling of lower extremity athletic joint injuries.

Research focus areas

Mayo Clinic Sports Medicine Research focuses on the following areas for optimal care and results for athletes:

• Mechanisms that may identify the anatomical and structural causes of injuries
• Screening using algorithms to identify athletes at a high risk of injury
• Intervention and prevention through neuromuscular training protocols
• Treatment strategies (surgical and nonsurgical) to optimize outcomes after injury

Comprehensive care comes from bringing research directly into practice. A complete team of surgeons, physicians, researchers, specialists and therapists work together to return people to physical activity as soon as possible.

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Research is focused into specialized areas to diagnose, treat and prevent diseases or conditions that affect athletic performance for the professional and recreational athlete.

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Clinical research areas in ACL, concussion, hip, knee and shoulder apply scientific discoveries to diagnose and treat athletes for the best outcomes.

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The American Journal of Sports Medicine (AJSM) is the official peer-reviewed scientific journal of the American Orthopaedic Society for Sports Medicine (AOSSM). Founded in 1972, AJSM is an essential forum for independent orthopaedic sports medicine research and education, allowing clinical practitioners the ability to make decisions based on sound scientific information. AJSM is published 14 times a year and contains original articles addressed to orthopaedic surgeons, team physicians, athletic trainers, and physical therapists focusing on the treatment and prevention of athletic injuries.

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• v.48(1); 2020 Jan

The increasing importance of sports science and medicine

The notion that exercise has a multitude of benefits, especially for health, has been around for millennia. 1 Physicians’ traditional focus on the prevention of disease and the maintenance of health requires them to find interventions that will help patients, with as few adverse effects and reactions as possible. Only lately has the focus shifted towards acute illnesses and treating patients according to their complaints. 1 In any case, diet and exercise have almost always been part of the regimen emphasised by physicians. 1 Even ancient physicians recognised the importance of these two aspects of care in the formulation of their treatments. 2 This understanding suggests that maintaining health in a preventative manner may be a more appropriate medical approach than treating patients at the doorway of disease.

Most modern diseases can be said to be preventable. 2 Almost half of the mortality rate in the United States can be traced to behavioural causes. 2 The main causes of early death in the country are smoking and diseases attributable to physical inactivity linked to obesity. 2 Physicians should consider returning to an approach of prescribing lifestyle changes before prescribing medication. Prescribing exercise can indeed maximise the health of patients. 1 Clearly, exercise is relatively inexpensive yet massively effective for multiple bodily systems. Exercise can be considered a medication, and physicians should be encouraged to start treating physical activity as a prescription that they can recommend to their patients. As more people are beginning to recognise, the benefits of exercise will usually outweigh the risks, and each person should be able to perform at least a minimum amount of exercise. 2

There is a growing opinion that, in the near future, lack of exercise may be the most important public health problem. 2 Physicians should consider it their duty to modify patients’ lifestyles in ways that lead to the health benefits that science has now confirmed are clear and undeniable. Many conditions, such as depression, osteoarthritis, hypertension, obesity, cancer, and diabetes mellitus have outcomes that are obviously ameliorated by increased physical activity. 3

The United States is in love with sports, with 60% of Americans describing themselves as sports fans. 4 Billions of dollars are generated every year by various US-based sports leagues, such as the National Hockey League, the National Basketball Association, Major League Baseball, and the National Football League. 4 Collegiate sports are a multimillion-dollar business as well. 4 As the earnings increase, so do the investments that these leagues make in the best players. Because of the financial impact of these various sports, it has become a priority for the leagues to keep their players healthy. As such, optimising performance, improving the best players’ availability, and decreasing the risk of injury have become the main thrusts of sports science and sports medicine when tied to high-performance teams. 5

Sports science research can help lead to evidence-based approaches that will allow athletes and active individuals to exercise in optimal ways. There is a continuing gap between current practices in athletics and the latest scientific evidence, compounded by an era of anti-intellectualism and ‘fake news’, as well as a burgeoning disbelief in fact and science. 4 Non-peer-reviewed articles are proliferating, as are so-called ‘predatory’ journals and conferences, which can contribute to the dilution of good science that could be used for the benefit of athletes, active individuals, and indeed, all patients who are trying to exercise more.

Coaches and athletes need to listen more carefully and more often to sports scientists, whose findings can be supported and dispersed by sports medicine physicians. Widespread support for the use of unproven supplements in sports, or wearing specific bracelets or anklets to supposedly improve athletic ability, are but a few of the pseudoscientific practices that coaches and athletes need to discuss further with scientists and physicians. Conversely, those engaged in the science of sports medicine and the provision of health care need to improve their ability to translate terms and ideas that may not be easily understood by those engaged or about to engage in sports and exercise activities.

Knowledge transfer is key, and sports communities all over the world should be able to engage with sports scientists and medical providers more directly. We now have the ability to leverage social media, application software, and other forms of technology to achieve this. Our use of these evolving tools should focus on sports physicians and athletes being proactive, using exercise as prevention, rather than reactive, treating maladies as needed. The idea that ‘exercise is medicine’ should become second nature in the world of primary care and sports medicine. 1

Declaration of conflicting interest

The authors declare that there is no conflict of interest.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

George G.A. Pujalte https://orcid.org/0000-0002-7537-7457

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The American Sports Medicine Institute (ASMI) is a national and international leader in sports medicine research related to clinical and surgical outcomes, biomechanics, and rehabilitation. The foci of ongoing studies at ASMI includes both clinical and biomechanical research, and our team includes researchers with expertise in motion capture biomechanics, cadaver joint biomechanics, outcomes research, clinical trials, biostatistics, and human anatomy.

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• What is sports medicine? Sports medicine is a field of medicine concerned with the prevention and treatment of injuries and disorders that are related to participation in sports.
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• What is the difference between biomechanical research and clinical research? ASMI’s biomechanics studies the motions and forces to minimize injury risk and maximize performance in sports. Other biomechanical studies at ASMI investigate the strength of human joints after surgery compared to their natural, undamaged state. Clinical research at ASMI involves both observational studies and clinical trials. Observational studies generally include examination of what is already occurring (no intervention), whereas clinical trials are carefully designed experiments that involve a specific treatment or intervention. Specifically, our clinical team works to evaluate surgical outcomes, rehabilitation efficacy, as well as injury mechanisms and prevention to improve treatment of sports-related and orthopaedic injuries. Importantly, our biomechanical and clinical research teams work closely together to fulfill the mission of ASMI.
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• Volume 58, Issue 11
• Research in specialist sport and exercise medicine training
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• Bruce Hamilton 1 , 2 ,
• http://orcid.org/0000-0002-8413-2814 Larissa Trease 3 , 4 ,
• Corey Cunningham 4 , 5
• 1 Sports Medicine , High Performance Sport New Zealand AUT Millennium Institute of Sport and Health , Auckland , New Zealand
• 2 SPRINZ , Auckland University of Technology , Auckland , New Zealand
• 3 La Trobe Sport and Exercise Medicine Research Centre (LASEM) , La Trobe University , Bundoora , Victoria , Australia
• 4 Australasian College of Sport and Exercise Physicians , Melbourne , Victoria , Australia
• 5 New South Wales Institute of Sport , Sydney Olympic Park , New South Wales , Australia
• Correspondence to Dr Bruce Hamilton, Sports Medicine, High Performance Sport New Zealand AUT Millennium Institute of Sport and Health, Auckland, New Zealand; bruce.hamilton{at}hpsnz.org.nz

https://doi.org/10.1136/bjsports-2024-108554

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• Sports medicine

Over 20 years ago, Thomas Best and Domhnall MacAuley rhetorically posited that evidence-based sports medicine was potentially a ‘contradiction in terms’. 1 In 2010, Evert Verhagen and Willem van Mechelen stated that ‘most individuals involved in sports medicine are not thoroughly trained in epidemiological and methodological rigour’. 2 Despite these somewhat disparaging views, research has long been recognised as an important component of specialist training in sport and exercise medicine, 3 4 at least in part as a result of academic medical centres demonstrating better patient outcomes. 5 Indeed, the Australasian College of Sport and Exercise Physicians (ACSEP) has centralised the role of research in sports medicine training since its inception in 1985, incorporating a requirement to complete original research as part of fellowship training. 6 Until 2023, in order to graduate from the training programme, registrars were required to complete a series of mandatory research modules and undertake ‘an original research project, and [be] published as first author in an international refereed journal’. 7

As part of an internal 2022 review of the college’s research requirements, several limitations with this research approach were identified including:

A focus on publication in a high-level journal as a binary outcome, rather than the process of research.

Inconsistency with the research requirements with other specialist training programmes in Australia and New Zealand. 8

A reliance on the nuances and publication imperatives of academic journals to determine registrar research outcomes, with resultant delays, difficulties in publishing and an inability to complete the fellowship requirements.

A lack of focus on identifying and developing research competencies.

A lack of access for registrars to research environments, resources and technical capability.

Registrar dissatisfaction, frustration and disengagement with research activities.

The review highlighted a conflict between the desirability of incorporating research requirements into specialist sports medicine training, and the unavoidable challenges of performing quality research. Reflecting this, the Medical Council of New Zealand specifically highlights the importance of ‘enquiry, intellectual curiosity and evidence-based practice’ in specialist training, but also acknowledges that ‘not all trainees will have the inclination, opportunity or aptitude for an extended period of research activity’. 9

Following the 2022 review, the ACSEP ‘doubled down’ on its desire to develop specialists who were competent in critically interpreting, applying and undertaking sports medicine research. While recognising that trainee approaches to research engagement may vary, all trainees are required to contribute to or lead a research study. 8 In essence, the college recognised that while not all specialist sport and exercise registrars were destined to be researchers, all specialists must be able to engage positively in research activity. One size does not fit all. Subsequently, the college overhauled the training programme approach to research with the goal of achieving greater research engagement from both registrars and fellows.

In 2023, the ACSEP formally evolved its training requirements to a competency-based assessment with the removal of the singular publication outcome requirement and providing a range of means by which registrars could complete their individualised ‘research-based activity (RBA)’. While the participation in original research remained a requirement, evidence of developing research competencies such as the formulation of research questions and hypotheses, literature reviews and the development of a research methodology allowed registrars to establish a broad research portfolio in order to complete the training requirements. Furthermore, evidence of ongoing involvement in research and the demonstration of the translation of novel research in sporting or clinical environments can contribute to a registrar’s RBA portfolio.

In recognition of the constraints many registrars face in linking with effective research environments and supervisors, the ACSEP has recruited a technical advisor to support registrars in developing appropriate projects and to guide them towards national and international research support networks. Finally, the college has committed to promoting research from its registrars and fellows with a view to ensuring the ongoing involvement in research is seen as a viable and rewarding professional pathway for sport and exercise physicians.

For the specialty of sport and exercise medicine to thrive requires highly skilled and informed clinicians who are able to interpret and use a broad range of 21st century research techniques. In modernising its research curriculum, the ACSEP hopes to be at the forefront of clinical and evidence-based sports medicine in the decades to come. Evidence-based sports medicine should not be a contradiction.

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Patient consent for publication.

Not applicable.

Ethics approval

• MacAuley D ,
• Verhagen E ,
• van Mechelen W
• Humphries D ,
• Dijkstra HP , et al
• Khullar D ,
• Orav EJ , et al
• Brukner PD ,
• Crichton KJ ,
• Stehlik P ,
• Brandenburg C , et al

X @DrLarissaTrease

Contributors All authors contributed to the development of this editorial.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests CC is the president of the Australasian College of Sport and Exercise Physicians (ACSEP) and BH is the chair of the Research Committee of ACSEP.

Provenance and peer review Not commissioned; externally peer reviewed.

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• Open access
• Published: 24 May 2024

Investigation of the effects of an 8-week cross-country skiing exercise program on various reaction time parameters, selective attention and academic achievement in adolescents

• Musab Çağın   ORCID: orcid.org/0000-0001-8882-5506 1 ,
• Sezen Çimen Polat   ORCID: orcid.org/0000-0002-2143-8402 2 ,
• Halil Sarol   ORCID: orcid.org/0000-0002-1678-3244 3 ,
• Amador García Ramos   ORCID: orcid.org/0000-0003-0608-8755 4 &
• Abdulkerim Çeviker   ORCID: orcid.org/0000-0002-6566-1251 5  

BMC Sports Science, Medicine and Rehabilitation volume  16 , Article number:  116 ( 2024 ) Cite this article

211 Accesses

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Exercise slows or helps reverse the shrinkage of key cognitive brain regions such as the hippocampus, which is important for information processing, learning, reasoning and planning. For this reason, it is thought that regular exercise of individuals, especially during adolescence, which is considered one of the most important processes of development, can increase their performance in areas where cognitive activities are at the forefront. Cross-country skiing, one of the leading branches of winter sports, has a much more complex structure, unlike the branches that are widely preferred today (football, basketball, volleyball, etc.) and is a branch where many motor skills are exhibited at the same time For this reason, the effect of cross-country skiing, which is defined as more complex and difficult in terms of biomotor than other branches, on cognitive activities is a matter of curiosity. Therefore, the aim of the research is; to examine the cognitive effects of cross-country skiing exercise. The study involved 54 (26 male, 28 female) adolescents who had no prior experience in any licensed sports. The average age of the participants was determined as 12.61 ± 1.32. The participants were divided in experimental and control groups. Reaction performances were determined using the ÇAĞIN Hand and Foot Reaction Tests, selective attention performances were evaluated using the Flanker Test and academic achievement was determined using the e-Okul system. Two-way ANOVA revealed significant group × time interactions for hand and foot simple, selective, discriminative reaction time, selective attention and academic achievement ( p  < 0.05) due to improved values at post-test for the experimental group but not for the control groups. No significant group × time interactions were observed for correct reaction rate for all reaction parameters ( p  > 0.05). The study concludes that the cross-country skiing exercise, which was applied to adolescents for eight weeks, had a positive impact on the parameters of reaction, selective attention and academic achievement. Therefore, parents are suggested to encourage their children to exercise and engage in sports practices like cross-country skiing to improve cognitive and academic performance during adolescence.

Peer Review reports

Introduction

Sports is an important tool for the physical, spiritual and social development of especially adolescent individuals. Research shows that individuals who start sports at an early age have better physical fitness than their peers, have a higher level of self-confidence, and are more aware of obeying the rules, respecting the rights of others, and communicating with people. Therefore, sports play a key role in raising a healthy generation [ 1 , 2 , 3 , 4 ]. If we examine the sports individually, it can be said that the skills required to be displayed in each branch have differed. For example, while explosive strength and endurance are at the forefront in athletics, it can be said that coordination and decision-making skills are at the forefront in archery. At the same time, it can be said that the more stimuli and variables an athlete is exposed to in a branch, the more skills the athlete must demonstrate at the same time. For this reason, performing complex branches in which more than one skill is at the forefront can bring a cognitive burden to the athletes. The athlete’s constant exposure to this cognitive load causes; It can lead to the development of decision-making, selective attention, cognitive flexibility and reaction skills [ 5 ]. For this reason, it is thought that directing individuals in adolescence to more complex branches may also contribute to their cognitive development.

If we classify the branches according to the stimuli and variables they contain, it can be said that winter sports have a more complex structure. In addition to the performance they must demonstrate, athletes must also cope with weather conditions, ground, altitude and difficulties specific to the winter season. Otherwise, the athlete may not be able to perform as desired, but may also face serious injuries [ 6 ]. For this reason, it can be said that doing winter sports involves having a serious level of attention. When we examine winter sports in terms of branches, it is observed that cross-country skiing is widely preferred.

Cross-country skiing is the origin of all skiing branches and is considered the predecessor of winter sports. It is a sport that uses all major muscle groups in a harmonious way. Cross-country skiing requires strength, endurance, coordination, balance, and flexibility. Athletes who can exhibit good skiing technique are able to use their energy more efficiently, giving them an advantage. In order to perform well in cross-country skiing, the athlete must have both technical and motoric skills at a certain level [ 7 ].

Neuroplasticity refers to the change in function and structure of neurons in the brain and synapses formed by these neurons due to certain environmental stimuli [ 8 , 9 ]. Exercise is a process that activates cellular and molecular steps that support and help maintain brain plasticity [ 10 ]. Regular exercise has been found to facilitate the neuroplasticity of various brain structures and the hippocampus in both humans and animals. This supports cognitive functions and behavioral responses [ 11 , 12 ]. Additionally, exercise can slow down or even reverse the shrinkage of basic cognitive brain regions such as the hippocampus that are important for information processing, learning, reasoning and planning [ 13 ]. Various studies have demonstrated that aerobic-based exercises increase cerebral blood volume and the number of hippocampus neurons [ 14 , 15 ]. Furthermore, studies have shown that regular exercise has a positive impact on academic achievement, cognitive flexibility, and problem-solving skills [ 16 , 17 , 18 ]. This suggests that individuals who exercise regularly are likely to have better cognitive performance than those who do not exercise or lead a sedentary lifestyle.

When the studies examining the effects of exercise on cognitive activities are examined, it is observed that similar exercises are generally performed under the same environmental conditions. The fact that there have been no previous studies examining the effects of winter sports on cognitive activities makes the research even more important. Because cross-country skiing is very different from conventional branches in terms of the way it is practiced, the season, the weather conditions and the equipment used. Although the effects of winter sports on physical performance are known, more research is needed to determine their effects on cognitive performance.

In light of this information; It is thought that cross-country skiing, which includes instant decision-making and implementation, fast and accurate reaction to incoming stimuli, high level of attention to avoid obstacles, and being successful by displaying these components together, can improve reaction time, selective attention and decision-making skills in adolescent individuals. Therefore, the hypothesis of the research is that cross-country skiing exercise will positively affect cognitive activities in adolescent individuals. To investigate these effects, this study aims to examine the impact of an 8-week cross-country skiing exercise program on various reaction time parameters, selective attention and academic achievement in adolescents.

Materials and method

Participant.

A total of 54 (26 male, 28 female) adolescents who had no previous licensed sports experience were included in the study. The participants were randomly divided into two even groups; experimental (26) and control (28). To be eligible for the study, participants had to meet the following criteria: no prior history of licensed sports, no cognitive impairment, no acute injury, and no school absenteeism. Experimental group had a mean age of 12.62 ± 1.16 years, mean height 153.85 ± 9.54 cm, and mean body mass 44.92 ± 7.49 kg. The control group had a mean age of 12.61 ± 1.47 years, mean height 155.07 ± 10.83 cm, and mean body mass 49.11 ± 7.74 kg.

Study design

The necessary permissions and approvals were obtained from the Ethics Commission of Gazi University (Code: 2023-168) and the study was conducted in accordance with the Declaration of Helsinki. Participation in the study was voluntary, and the parents of the students signed a consent form, which informed them about all details of the study. The students were randomly divided into two groups; experimental and control groups. Both groups took reaction, selective attention, and academic achievement pretests. The tests were administered under similar conditions for both groups. The experimental group underwent eight weeks of cross-country skiing exercise while the control group continued their routine physical education classes. These exercises were applied to the experimental group during January and February. At the end of eight weeks, the post-tests were conducted for both groups, and the measurements of the study were completed. The study collected data on the age, body weight, and height of the participants through a personal information form. The reaction performance of the subjects was evaluated using the ÇAĞIN Hand and Foot Reaction Tests, while selective attention performance was measured through the Flanker Test. Additionally, the academic achievement of the participants was determined by using the E-Okul system.

Exercise applications

The experimental group did cross-country skiing exercises twice a week (Tuesday and Friday) in addition to physical education for 8 weeks, while the control group attended only physical education classes twice a week. The exercises for the experimental group were conducted in December and January, at an altitude of 1838 m and a temperature range of -10 to -1 degrees Celsius. During the 8-week period, the skiing exercises began with a 10-min warm-up, followed by instruction on the proper technique according to the exercise program, application of the exercise, and ended with a 10-min cool-down period. As the weeks progressed, the time spent on technique instruction was gradually decreased, and the duration of the exercises was increased. By the 7th and 8th weeks, repetition exercises were performed, which included a combination of all the techniques taught over the previous six weeks (Table  1 ).

Data collection tools

ÇAĞIN hand and foot reaction tests

The study measured the reaction performances of participants using the ÇAĞIN Hand and Foot Reaction Tests [ 19 ], which involved the use of a FitLight Trainer (CA/Ontario) device. Prior to conducting the reaction tests, individuals were assessed using the ÇAĞIN Color Blindness Test to ensure they met the inclusion criteria. The protocol involved administering simple, selective and discriminative reaction tests for hand and foot reactions to the participants (Fig.  1 ). Participants were asked to turn off the lights that were on for 20 s as quickly as possible, according to the specified reaction test. At the end of the test, the participants’ average reaction time and correct reaction rate were recorded. The test was repeated twice and the best scores were evaluated.

Flanker test

The Flanker test is a type of psychophysical test measures selective attention performance. It was administered in a computerized environment using version 2.1 of the PEBL cognitive test battery [ 20 ]. During the test, arrows arranged horizontally side by side in groups of fives or singles appear in the center of the computer screen (Fig.  2 ). If the arrows appeared in singles, the subject was asked to press either the “Right Shift” or “Left Shift” key on the keyboard according to the direction indicated by the arrow. If the arrows were displayed in groups of five, the subject was asked to press either the “Right Shift” or “Left Shift” key on the keyboard according to the direction indicated by the arrow in the middle of the group. A total of 120 stimuli were given during the test, with each stimulus displayed on the screen for 500 ms. The stimulus was displayed on the screen for 500 ms following the subject’s response. A preliminary test consisting of 12 stimuli was administered prior to the actual test. The test lasted approximately five minutes. At the end of the test, the participants' total selective attention correct rate was recorded and evaluated.

Descriptive visual representing the stimuli applied during the Flanker Test and the keyboard keys to be pressed by the subjects

• Academic achievement

To evaluate the academic performance of the participants, the Ministry of National Education of the Republic of Turkey used the e-Okul system, which is a student grade tracking module. Participants' scores were graded according to the 100-point system. Higher scores mean that participants have better academic success. The study considered the semester grade point averages of the subjects before and after they participated in cross-country skiing exercise.

Data analysis

Analysis of the data obtained from the study was performed with the SPSS program (version 26.0; IBM Corp., Armonk, NY). In the study, mean and standard deviation values were taken as descriptive statistics. Two-way repeated measures analysis of variance (ANOVA) with group (control vs. experimental) as between-subject factor and time (pretest and posttest) as within subject factor were used to compare the different dependent variables. The confidence interval was chosen as 95% and values below p  < 0.05 were considered statistically significant.

The interaction ANOVAs were significant for both hand and foot reaction parameters ( p  < 0.05). After the experiment, better improvements were detected in the experimental group compared to the control group (Table  2 ).

The interaction ANOVAs were not significant for any reaction parameters ( p  > 0.05). After the experiment, similar results were detected in the experimental and control groups (Table  3 ).

The interaction of ANOVAs was significant for the selective attention parameter ( p  < 0.05). After the experiment, better improvements were detected in the experimental group compared to the control group (Table  4 ).

The interaction of ANOVAs was significant for the academic achievement parameter. After the experiment, better improvements were detected in the experimental group compared to the control group (Table  5 ).

This research was conducted on a total of 54 individuals divided in experimental ( n  = 26) and control ( n  = 28) groups. ANOVA interaction results show that the hand and foot simple, selective and discrimination reaction times of the experimental group are better than the control group. In this context, it is observed that cross-country exercise positively affects reaction time. There was no significant difference between the two groups in terms of correct reaction rate. After examining the literature, researchers discovered that implementing an exercise program for adolescent subjects over a 12-week period had a positive impact on their visual and auditory reaction time [ 21 ]. Additionally, it was observed that 8-10 year old male children who participated in judo technical training and games for 12 weeks showed improvement in their reaction performance [ 22 ]. Another study was conducted on sedentary individuals aged 18-25 years, which found that moderate intensity aerobic exercise can acutely shorten reaction time [ 23 ]. Therefore, it can be concluded that the findings of the present study are consistent with the existing literature on this subject.

ANOVA interaction results show that the selective attention performance of the experimental group is better than the control group. In this context, it is observed that cross-country skiing exercise positively affects selective attention. Research shows that short-term, high-intensity intermittent exercise is effective in developing selective attention among university students [ 24 ]. Another study found that acute aerobic exercise significantly improved selective attention in low-income children [ 25 ]. Additionally, selective attention and concentration levels increased as physical fitness levels increased in a study conducted on adolescents [ 26 ]. According to a study conducted on 14–15-year-old adolescents, it was observed that those who exercised regularly had a relatively better level of selective attention [ 27 ]. Therefore, it can be inferred that the study’s findings align with the existing literature on the topic.

ANOVA interaction results show that the academic achievement performance of the experimental group is better than the control group. In this context, it is observed that cross-country exercise positively affects academic success. According to Yıldız’s study, middle school male students who engaged in physical activity regularly had better academic achievement [ 28 ]. However, İşgüder’s study on high school students showed that academic achievement decreased as physical activity and sports participation increased [ 29 ]. According to a study involving university students, their academic performance was found to be positively correlated with their level of physical activity [ 30 ]. Another study also found that regular engagement in sports activities had a positive impact on academic achievement [ 31 ].

When the research results are evaluated holistically; It appears that cross-country skiing exercise positively affects all cognitive activities tested in the study. In addition, it is observed that the findings obtained in the research are supported by the literature. In light of these findings, it is observed that cross-country skiing exercise may be an important tool for adolescent individuals in improving cognitive functions.

Studies in the literature largely support the findings of a recent study that found that eight weeks of cross-country skiing exercise had a positive effect on the parameters of reaction, selective attention and academic achievement in adolescents. The study suggests that promoting exercise applications such as cross-country skiing, which requires complex and varied motoric skills, and making them a habit among adolescents, who are in the most critical stage of development, is essential for cognitive performance. The study recommends that parents’ guide their children towards exercise and sports applications, such as cross-country skiing, to improve cognitive and academic performance during adolescence. In addition, the research reveals the positive effects of cross-country skiing, one of the winter sports, on cognitive activities; This raises the question of whether winter sports or summer sports are more effective cognitive tools for adolescent athletes. When the branches commonly preferred by adolescent individuals or their families are examined today, it is observed that branches such as football, basketball, volleyball, handball, tennis and wrestling are at the forefront. It is thought that comparing adolescent individuals doing winter and summer sports in terms of cognitive activities in future studies will contribute to the field in terms of deepening the cognitive dimension of sports. It is thought that the findings resulting from such a comparison may provide a way for parents to direct their children to branches that will have a more positive cognitive impact. It is also thought that examining the positive effects of cross-country skiing on cognitive activities through similar studies may increase the tendency towards winter sports. It is thought that the research conducted in this context will contribute to the field in terms of making the positive effects of winter sports visible.

Limitations

The sample group of the research was limited to adolescent individuals who had not done sports before. In addition, the cross-country skiing exercise program applied to the sample group was limited to 8 weeks. Cognitive parameters examined in the study; limited by reaction time, selective attention, and academic achievement.

Availability of data and materials

Data are available for research purposes upon reasonable request to the corresponding author.

Abbreviations

Reaction Time

Reaction Correct Rate

Correct Rate

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Musab Çağın

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Conceptualization, M.C. and S.C.P.; methodology, M.C. and S.C.P.; analysis, M.C. and H.S.; sources, H. S and A.Ç.; data curation, H.S. and A.G.R.; writing of original draft, M.Ç., S.Ç.P., H.S., A.G.R. and A.C.; manuscript review and editing, M.Ç., S.Ç.P., H.S., A.G.R. and A.C. All authors read and accepted the published version of the manuscript.

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Çağın, M., Çimen Polat, S., Sarol, H. et al. Investigation of the effects of an 8-week cross-country skiing exercise program on various reaction time parameters, selective attention and academic achievement in adolescents. BMC Sports Sci Med Rehabil 16 , 116 (2024). https://doi.org/10.1186/s13102-024-00908-3

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Consideration of Mental Health and Well-Being in High-Level Sport: When Will a Coach-Centred Approach Be Introduced?

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Coverage of problems relating to mental health and well-being is gaining ground in the sports sector today, both in the media and in the scientific literature. Despite exposure to numerous stressors and suffering from poor mental health, coaches have in general been largely overlooked in the scientific literature. Previous studies have mainly focused upon athlete populations. The absence of research means that there are real shortcomings in both understanding the mechanisms involved in the deterioration of coaches’ mental health and well-being and in the lack of specific support systems available. This paper first describes findings from the recent, albeit quite scarce, research investigating mental health and well-being in coaches. It then proposes a number of avenues for research and support protocols, both of which are currently ongoing at the French Football Federation Research Centre. The aim is to help support these key participants in the sports sector who arguably have not been given sufficient consideration until now.

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1 Introduction

Concerns relating to mental health and well-being in sport have received wide attention in recent years although scientific research has arguably focused upon athletes [ 1 , 2 ]. Indeed, two recent reviews have highlighted a limited amount of research investigations on these key issues in coaching populations [ 3 , 4 ]. This observation implies that coaches are often omitted from the psychological monitoring and support programmes available in high-performance systems. Yet given their level of responsibility and exposure levels, this population is particularly at risk of a range of problems relating to their mental health and well-being. Apart from the recent, albeit quite scarce, research that highlights the difficulties encountered by coaches and their psychopathological effects [ 5 , 6 , 7 , 8 ], a comprehensive understanding of the mechanisms that cause, go together with, or are a consequence of the deterioration in their mental health and well-being is lacking [ 9 ]. Perhaps more importantly, few practical recommendations to help support coaches have been made [ 4 , 10 ]. Indeed, support programmes for athletes are now much more developed and widely accepted than in coaching circles. In the face of the deterioration in coaching conditions and particularly in the context of association football (56.9% of football coaches were notably dismissed worldwide last season according to a 2023 CIES study [ 11 ]), it is arguably time to provide better support for this population regarding their mental health and well-being. Through developing research programmes related to this specific issue, our research group at the French Football Federation (FFF) Research Centre has made football coaches the focus of its work and support with the aim of helping them to perform optimally while benefiting from appropriate support programmes.

This paper first describes the results of the recent, albeit rare, research focusing upon the mental health and well-being of coaches. It then suggests a number of research avenues for reflection whilst also discussing the support protocols, together with the different tools, that the FFF Research Centre is currently rolling out for its coaches.

2 Stressors and the Mental Health of Coaches: A Startling Observation

2.1 chronic exposure to stressors.

Coaches particularly at elite standards encounter multiple stressors in their daily lives, which have already received attention in the scientific literature [ 12 , 13 , 14 ]. In a previous review, Norris et al. [ 14 ] identified various categories of stressors for coaches involved in a wide variety of sports. These are related to their own performance, that of their athletes, and other organisational, contextual, interpersonal, and intrapersonal factors (see Table  1 for more details). These stressors can resemble those experienced by athletes, such as the need to perform, or their expectations of others [ 14 , 15 ], but also differ significantly, with stressors specifically related to athlete and team management (e.g. commitment, conflicts, player selection), job insecurity, and relations with organisational stakeholders. Among the numerous stressors identified, organisational ones (e.g. work overload, difficulties in striking a work–life balance, quality of the work environment) were identified as having a large impact on coaches, since these are cumulative and chronic, and lead to some long-term negative consequences [ 7 ]. Organisational stressors are also the most difficult to manage as coaches have less control over these when compared to others, such as personal ones [ 6 ]. Faced with exposure to multiple stressors, coaches may try to adapt by adopting coping strategies. Unfortunately, a recent study among football coaches showed that the numerous demands they face are generally perceived as negative and threatening, and many of the strategies subsequently applied to deal with stressful experiences are deemed ineffective [ 6 ]. The repeated confrontation with stressors deemed to exceed a coach’s self-resources can subsequently have negative consequences affecting, for example, their ability to achieve their objectives, the quality of their daily life, and their well-being [ 6 ].

2.2 Mental Health and Well-Being of Coaches Compromised by Stressors

Among the few studies that have examined coaches’ well-being, Bentzen et al. [ 16 ] showed that a coach’s level of well-being decreases during a sporting season while exhaustion increases. Declining levels of well-being and greater exhaustion may be linked to a perceived lack of control in their professional activity [ 16 ]. This perception can be explained by numerous stressors that are, in part, uncontrollable (e.g. coaches cannot, by definition, train or perform in place of their athletes) [ 17 , 18 ]. Job insecurity during the season also seems to contribute significantly to this deterioration since it is associated with a decrease in well-being and an increase in ill-being [ 19 ]. This insecurity, which is particularly high among coaches, is linked not only to expectations around results, but also to the low, precarious, and often short-term employment possibilities in this profession, as it is not always easy to find a comparable role at a similar standard of play following dismissal [ 19 ]. Confronting these stressors and their effects are fraught with consequences. For example, a coach who mismanages, feels overwhelmed by, or is unable to cope with difficult stress-related well-being problems can negatively impact their own performance. This in turn can negatively impact the coach–athlete relationship and the mental state of athletes, and subsequently harm their competitive performances [ 20 ].

Beyond their impact on well-being, coaches who have difficulty coping with the numerous stressors that they encounter can experience a deterioration in their mental health [ 5 , 7 ]. Stressors and, specifically, dissatisfaction with social support and life balance are robust correlates of psychological distress [ 5 ]. While the literature has focused heavily on the mental health of athletes, it should be noted that coaches have similar prevalence rates for mental health disorders [ 21 ]. Research has shown that 55% of coaches from all sports and at all levels report that they have previously suffered from a mental illness [ 22 ]. The consequences can be worrying for coaches, as research reports high-risk alcohol consumption [ 5 , 7 ], moderate to severe sleep disturbance [ 5 ], and anxiety and depressive disorders, which are the most common issues [ 7 , 22 , 23 ]. Given the close link between daily stress, which can be chronic and potentially unmanageable, and the probability of developing depressive symptoms [ 24 ], it appears necessary to account for and subsequently make attempts to attenuate the effects of these stressors through interventional measures to enhance coach support programmes.

2.3 Rare and Mostly Non-specific Interventional Studies

In view of the difficulties encountered by coaches and their related consequences, several research proposals have been forwarded to help promote their mental health and well-being. These include support focused on the quality of professional relationships [ 22 ], work–life balance [ 22 , 25 ], avoidance of ambiguity in roles [ 22 ], resilience [ 7 ], the ability to self-manage one’s workload [ 26 ], and autonomy in tasks [ 26 , 27 ]. Regrettably, few interventional studies have been conducted in coach populations. Indeed, in their recent review, Breslin et al. [ 3 ] identified only six papers covering interventions in coaches (Table  2 ). In addition, the main aim identified by the authors across these six studies was, indirectly, to improve the well-being of athletes rather than that of the coaches themselves. It has been suggested that the early implementation of intervention programmes is necessary to detect and treat the onset of symptoms of mental health disorders in coaches, help them minimise stressors, facilitate positive assessments and emotions, and, ultimately, assist promotion of their well-being [ 5 , 8 , 28 ].

In general, interventional studies concerning coaches’ mental health have been shown to increase their knowledge of mental health disorders, make them more confident in helping others with a mental disorder, and bring about change in attitudes that stigmatise those with mental health disorders [ 29 , 30 , 31 , 32 ]. However, none of this research appears to have specifically targeted the coaches’ own well-being, and to what extent they could improve their ability to care for their own mental health. Longshore and Sachs [ 33 ] for example, demonstrated that a 6-week mindfulness programme can have positive effects in coaches. Improved emotional control, lower levels of anxiety and unproductive emotional states, and greater curiosity were notably observed. This sport-specific intervention can help lead to positive adjustments, balance, and psychological well-being in all areas of a coach’s life, through better work–life balance among other factors [ 33 ]. A programme of conscious self-reflection has also shown positive effects, with greater commitment in coaches towards their well-being and improved self-awareness and self-compassion [ 34 ]. Despite some encouraging research, there are very few studies in proportion to the magnitude of the issues at stake (described above) regarding the well-being and mental health of coaches. As such, additional research is required to test and roll out instruments and protocols adapted to coaches’ lifestyles, and ultimately help them deal with these largely unresolved issues.

3 Ongoing Research at the FFF to Improve Overall Understanding of the Mechanisms Involved in the Deterioration of Mental Health and Well-Being of Coaches

The recent aforementioned studies have mainly highlighted the stressors that coaches encounter in their professional activities and the possible consequences on their mental health and/or well-being. These studies have nevertheless produced essential findings that have shed light on these issues, which have frequently been overlooked until recently. However, there are limitations, which will be discussed below (Sects.  3.1 and 3.2 ), that do not enable a comprehensive understanding of the mechanisms underlying the deterioration of coaches’ mental health, and additional research is warranted. The FFF Research Centre study group has developed a structured programme to explore several lines of research based upon (1) recommendations to conduct longitudinal studies to track changes in mental health and well-being throughout a season [ 9 ], and (2) collection and analysis of a range of variables to enable the most comprehensive understanding possible of the mechanisms underpinning deterioration in the mental health and well-being of coaches.

3.1 Longitudinal Experimental Designs to Monitor Coaches Throughout the Season

Among previous studies conducted on the mental health and well-being of coaches, few have utilised longitudinal designs [ 35 ] to monitor changes in levels of mental health and well-being over time [ 36 ], which is a major limitation [ 7 , 8 ]. Furthermore, the variables and disorders associated with the mental health and well-being of coaches, such as sleep [ 5 ], at-risk alcohol consumption [ 5 , 7 ], eating disorders, and psychoactive substance disorders [ 23 ], are typically measured in isolation and transversally, thereby limiting a holistic understanding of the influence and cause–effect relationships of the various interacting factors. The level of social support, an important stressor [ 14 ] and a robust correlate of the psychological distress of coaches [ 5 ], has also been investigated [ 37 , 38 ]. Unfortunately, up to now, this support has again been studied in isolation to the other factors mentioned above. To overcome these limitations and improve understanding of the challenges of the mental health and well-being of coaches, the FFF Research Centre is currently conducting several studies in professional and amateur football coaches. These investigations are employing longitudinal methodologies, making it possible to monitor coaches systematically over the entire course of a competitive season. The tracking begins before the summer break, when the coach returns from vacation, then every month until the end of the season. This longitudinal experimental design also utilises a pragmatic mixed methods combination [ 39 ]. Quantitative data derived from questionnaires (described in Sect.  3.2 ) and analyses of context across the competition season (notably the results of their team) in combination with qualitative data from interviews are used to investigate and identify in greater depth the coaches’ “key” moments across the season and their personal experiences.

3.2 Holistic Consideration of the Various Influencing Factors to Ensure a Greater Understanding of Mental Health and Well-Being of Coaches

The need to explore the environmental, personal, and relational factors that influence the well-being of coaches has been highlighted [ 40 ]. As such, the studies conducted by the FFF Research Centre are currently investigating a range of variables to help decipher the mechanisms via which these different factors can affect mental health and well-being over the course of a season. Variables such as vitality, defined as “positive feeling of having energy available to the self” [ 41 ]), sleep, diet, social support, and personal practices (the time coaches devote to rest and recover) are measured concomitantly alongside mental health and well-being to help understand the roles of various factors when a deterioration is observed. Finally, dispositional measurements are also being used to identify profiles that may potentially be more at risk than others (e.g. personality traits [ 42 ], type of passion [ 43 ], emotional competences [ 44 ]). Through the various methodologies used and variables investigated, our research group aims to pinpoint the dynamics by which coaches observe a decline in their mental health and well-being over the course of a season, as well as the protective or degrading role of certain factors.

4 Suggestions for Practical Applications: An Example of Support Offered to Coaches

Pending the scientific results from its aforementioned longitudinal monitoring that aims to enrich coach support programmes, the FFF’s research group runs both individual and collective sessions with coaches to raise their awareness of the importance of mental health and well-being regarding the effectiveness of their own performance. These sessions are notably built into the federation’s coach education pathways to avoid any possible stigma that such topics may potentially raise when coaches need to seek help [ 28 ]. Psychologists and researchers from our research group consequently intervene during coaching education courses to address the question of mental health and well-being in this population. In addition, as coaches have prominent leadership roles and play a key role in cultivating their organizational or team environment, any positive effects on them may in turn influence the system in which they evolve, notably by shaping cultural and institutional attitudes towards mental health [ 10 ].

4.1 An Approach Designed to Optimise Personal Resources

Working on mental health and well-being via research and coach education programmes requires a posture and objectives that are both clear and consistent within these contexts. The objectives of the FFF Research Centre are not the analysis of symptoms or therapeutic care but rather the optimisation of personal resources to help develop growth processes [ 45 , 46 ]. This objective coincides with the precepts of positive psychology, defined as the scientific study of factors promoting the well-being and development of individuals and groups [ 47 ]. In this theory, mental health is described based on the World Health Organization (WHO) definition [ 48 ], which addresses this concept as a state of well-being in which a person can realise their abilities, cope with the normal stresses of life, perform productive work, and contribute to the life of their community. Well-being is studied in its subjective (hedonic well-being associated with pleasure) and psychological (eudemonic well-being associated with meaning) dimensions [ 49 ].

Thus, the aim of our support programmes is to help coaches identify the factors underpinning the improvement of their mental health and well-being and to improve awareness of the resources at their disposal to cope with the demands inherent to their personal and professional environments. Furthermore, the concept of “restoration”, as described by Hartig [ 50 ] in the context of restorative environments, is central to this support for coaches. These restorative environments are described as having therapeutic potential, enabling the renewal of the cognitive, emotional, physical, and social resources that are naturally depleted during an individual’s adaptive efforts [ 50 ]. Our work is thus positioned downstream of the adaptive efforts inherent in the professional and personal life of coaches, by aiding them to renew their resources to help them to cope, in the long term, with the pressures associated with their profession (e.g. media pressure, performance challenges, organisational stressors), which they themselves cannot always influence directly. Consequently, our support for coaches encompasses three areas: (1) exposure to restorative environments, (2) restorative experiences, and (3) restorative interactions. These are discussed in turn.

4.2 Exposure to Restorative Environments

Humans have always been aware of the impact of their environment on the way they live and act. In recent years, however, several scientific studies have increased understanding of the role of the environment. As a result, the concept of the restorative environment [ 50 ] has emerged in the literature. This is described as environments with therapeutic potential that contribute to increased mental health, well-being, and performance. In sport contexts, several studies have highlighted the importance and benefits of natural environments for the mental health and well-being of athletes [ 51 , 52 ] and inferences can be made for coaching populations. Indeed, the FFF Research Centre has set up its own restorative environment. Surrounded by nature (an environment with very high restorative powers – see Ohly et al. [ 53 ] for a meta-analysis), the research centre facility was also carefully designed regarding the choice of colours, materials, sounds, shapes, and smells (i.e. positive distractors [ 54 ]). The aim is to ensure coaches benefit from a “restorative environment experience” to make them aware of the impact that the places in which they live, work, hold meetings, participate in seminars, and so on has on them and on their athletes. This experience can then eventually be employed as a model to inspire coaches to develop the restorative power of their own work environments.

4.3 Restorative Experiences

Exposure to restorative environments can only have a limited effect if coaching practitioners do not benefit from restorative experiences within those environments. We consider as “restorative” any experience set up by the coach to replenish their resources, give them pleasure, nourish their enthusiasm, and reconnect them to their physical and emotional sensations. In this respect, our research centre offers several activities including mind–body practices such as Garuda [ 55 ], breathing techniques [ 56 ], meditation techniques [ 57 ], music-based digital therapies [ 58 ], and even movement through sports and fun activities such as trampolining [ 59 ]. The research centre’s aim and role is to determine which of these instruments and techniques are best suited to a coach’s personal needs, and how to support them with their day-to-day application (when, in which combination, at what frequency, for which purpose, and how to deal with and adapt these to the time constraints specific to their profession, etc.).

4.4 Restorative Interactions

The final factor conducive to renewing a coach’s resources is the quality of their interpersonal relationships that develop within the restorative environments. Given the importance of relationship factors in coaching and the role of social support frequently cited in studies dealing with coaches’ mental health and well-being [ 5 , 7 , 14 , 22 ], it seems important to specifically account for interpersonal aspects, both professionally (optimising communication and the general atmosphere within a team or a group of players) and personally (maintaining a good life balance and high-quality relationships with friends and family).

Didymus et al. [ 60 ] highlighted the importance of empowering coaches to ensure that they consider their own mental health and well-being. As such, the support programmes proposed by the FFF Research Centre aim to help coaches become more self-reliant by increasing their self-awareness through identification of their needs and how they function. By raising their awareness and providing them with a “toolkit” to help them learn how to take care of themselves (through their environment, experiences, and restorative interactions), the research centre’s support policies encourage coaches to draw upon their personal and external resources. The aim is to help coaches to “replenish themselves” daily, and to help ready them to cope with the short-, medium-, and long-term challenges that will shape their coaching career.

5 Conclusion

Mental health and well-being have received an ever-increasing amount of attention in sport. However, up to now, studies have largely been confined to athlete populations and coaches have frequently been overlooked. Given the complexity of their occupation and the findings that have nevertheless recently emerged regarding its impact on their mental health and well-being, additional research is necessary to help understand and elucidate the reasons and mechanisms underpinning any deterioration. The results of these explanatory studies could then be used to deploy more targeted, and potentially more effective, interventional studies to help promote the mental health and well-being of coaches over the short, medium, and long term. The FFF Research Centre has opted for this scientific approach and is currently conducting studies in coaches that aim to increase understanding of, and subsequently help confront, these problems and ultimately optimise support programmes to aid personal and professional performance.

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Leprince, C., Maurin, M. & Carling, C. Consideration of Mental Health and Well-Being in High-Level Sport: When Will a Coach-Centred Approach Be Introduced?. Sports Med (2024). https://doi.org/10.1007/s40279-024-02044-x

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• 39 Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.
• 40 School of Engineering and Materials Science, Queen Mary University of London, London, UK.
• 41 School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
• 42 University Hospital Southampton, Southampton, UK.
• 43 Brighton and Sussex University Hospitals, Brighton, UK.
• 44 Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.
• 45 Murdoch Children's Research Institute, Melbourne, VIC, Australia.
• 46 Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia.
• 47 Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, VA, USA.
• 48 Faculty of Educational Sciences and Sports, University of Vigo, Galicia, Spain.
• 49 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Center for Health and Performance, Goteborg University, Göteborg, Sweden.
• 50 Sahlgrenska University Hospital/Ostra, Region of Western Sweden, Göteborg, Sweden.
• 51 Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
• 52 Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan.
• 53 UCT Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa.
• 54 Department for Health, University of Bath, Bath, UK.
• 55 I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation.
• 56 Moscow Research and Practical Center for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation.
• 57 Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany.
• 58 Institute of Sports Science, University of Vienna, Vienna, Austria.
• 59 Austrian Institute of Sports Medicine, Vienna, Austria.
• 60 Unit of International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Salzburg, Austria.
• 61 Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
• 62 School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK.
• 63 School of Sport and Service Management, University of Brighton, Eastbourne, UK.
• 64 Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, 06100, Ankara, Turkey.
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• PMID: 33761127
• PMCID: PMC7988249
• DOI: 10.1007/s40279-021-01451-8

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

Publication types

• Athletic Performance*
• Sexual Development
• Testosterone

Collaborative effort at WMU supports health and safety of firefighters

Igor Lapa, a on-call firefighter for Cooper Township, has his hearing tested at Sindecuse Health Center as part of his annual physical.

Dr. Mike Miller measures Igor Laba's grip strength during his fitness test.

KALAMAZOO, Mich.—Western Michigan University's Department of Human Performance and Health Education (HPHE) and WMU Sports Medicine Clinic joined Sindecuse Health Center to conduct annual physical examinations for  108  firefighters. Between  May 14-17 , firefighters from the Mattawan, Oshtemo, Cooper and Texas Township fire departments traveled to the health center for physical screenings. Firefighters also completed chest x-rays, diagnostic ultrasounds and fitness testing. 

Required annually, the purpose of the physicals is to reduce the risk of injury, illness or death to firefighters and to insure they are medically fit for duty. By assessing a firefighter's overall health and fitness, potential health problems can be identified and addressed before they lead to complications during fire emergencies. Additionally, the physicals establish baseline health reading for future comparisons. 

"Firefighters have demanding physical and mental stresses associated with their profession," says  Dr. Mike Miller , chair of HPHE and a former firefighter. "In addition, the firefighter gear is heavy and cumbersome, and difficult to move efficiently, and add the heat from a fire, the exertion extolled on them can be extreme on the body. Annual physical and fitness testing can identify potential risk factors or medical conditions that can be addressed, to keep them healthy and ready for their jobs."

Using x-rays, medical staff at Sindecuse can detect abnormalities in organs.

The collaboration between the fire departments and Western was made possible by  Kristen   Smith , a former athletic trainer at WMU. As part of her current involvement with the Texas Township fire department, she along with other area firefighting departments and townships decided to write a proposal to find local skilled providers that could provide resources and services necessary to help meet their safety culture needs. Reaching out to Sindecuse and having the proposal approved to provide exams, she then contacted the WMU Sports Medicine Clinic, HPHE and Miller given his background, to assist in conducting fitness tests. 

"Kristen approached us about it and asked if we would be interested because firefighter physicals have been partial out to different places and wanted to do everything under one roof," says  William   Arbogast , director of the WMU Sports Medicine Clinic. "We primarily focus on having employees and students, so we looked at what they (fire departments) needed and brought those things to Sindecuse."

Dr. Gayle Ruggiero , medical director of Sindecuse Health Center, adds "first responders always have a special place in the hearts of health care providers and building this program was as much about giving back to our community as it was about the gratitude and camaraderie that we feel towards those that take on risks daily selflessly for others." 

FUTURE RESEARCH

Igor Lapa, a on-call firefighter for Cooper Township, had his annual physical done at Sindecuse Health Center.

Hosting the physical examinations at WMU will also provide faculty and students the opportunity to conduct research on the health impacts of the profession. By collecting data from physical screenings and fitness tests, they'll be able to compare firefighter's health each year.

While similar research has been conducted before, Miller says they'll be looking at the data from a unique perspective.  

"Most of firefighter health information in the research/literature is based upon full-time firefighters and while we do have full-time firefighters part of these fire departments, we have more paid-on-call firefighters, and this type of firefighter actually constitutes the majority of firefighters in the country," explains Miller. "Examining potential differences in the health and physical attributes of those who are full versus part-time will provide us with new research perspectives." 

Dr. Timothy Michael , professor of exercise science, adds, "for someone to participate and be a firefighter, they're putting themselves at risk and putting other people at risk if they can't physically do the job. Once we start looking at the data there might be a big discrepancy between the fitness levels of the on-call versus the full time and then you have to start asking the questions whether that impacts their ability to do the job."

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