Matthew P. Martens
Issues associated with athletics, alcohol abuse, and drug use continue to be salient aspects of popular culture. These issues include high-profile athletes experiencing public incidents as a direct or indirect result of alcohol and/or drug use, the role that performance-enhancing drugs play in impacting outcomes across a variety of professional and amateur contests, and the public-health effects alcohol abuse and drug use can have among athletes at all competitive levels. For some substances, like alcohol abuse, certain groups of athletes may be particularly at-risk relative to peers who are not athletes. For other substances, participating in athletics may serve as a protective factor. Unique considerations are associated with understanding alcohol abuse and drug use in sport. These include performance considerations (e.g., choosing to use or not use a certain substance due to concerns about its impact on athletic ability), the cultural context of different types of sporting environments that might facilitate or inhibit alcohol and/or drug use, and various internal personality characteristics and traits that may draw one toward both athletic activity and substance use. Fortunately, there are several effective strategies for preventing and reducing alcohol abuse and drug use, some of which have been tested specifically among athlete populations. If such strategies were widely disseminated, they would have the potential to make a significant impact on problems associated with alcohol abuse and drug use in sport and athletics.
There is no doubt that exercise, a vital health-promoting activity, regardless of health status, produces numerous well-established physical, functional, and mental health benefits. Many people, however, do not adhere to medical recommendations to exercise consistently, especially if they have chronic illnesses. Put forth to explain this conundrum are numerous potential explanatory factors. Among these are mental health correlates such as anxiety, fear, fatigue, pain, motivation, and depression, as well as various self-efficacy perceptions related to exercise behaviors, which may be important factors to identify and intervene upon in the context of promoting adherence to physical activity recommendations along with efforts to reduce the cumulative health and economic burden of exercise non-adherence among the chronically ill and those at risk for chronic illnesses.
This article aims to provide a narrative overview on injury prevention in sport and performance psychology. Research and applied interest in psychological injury prevention in sport and performance psychology has risen in popularity over the past few decades. To date, existing theoretical models, pure and applied research, and practice-based evidence has focused on conceptualizing and examining psychological injury occurrence and prevention through stress-injury mechanisms, and predominantly in sport injury settings. However, given the inherited similarities across the different performance domains however, it is the authors’ belief that existing injury prevention knowledge can be transferable beyond sport but should be done with caution. A range of cognitive-affective-behavioral strategies such as goal setting, imagery, relaxation strategies, self-talk, and social support have been found beneficial in reducing injuries, particularly when used systematically (a) prior to injury occurrence as part of performance enhancement program and/or as a specific injury prevention measure, (b) during injury rehabilitation, and (c) as part of a return-to-activity process to minimize the risk of secondary injuries and reinjuries. Existing theoretical and empirical evidence also indicates that using cognitive-affective-behavioral strategies for injury prevention are effective when used as part of a wider, multi-modal intervention. Equally, such interventions may also need to address possible behavioral modifications required in sleep, rest, and recovery. Considering the existing empirical and anecdotal evidence to date, this paper argues that injury prevention efforts in sport and performance psychology should be cyclical, biopsychosocial, and person-centered in nature. In short, injury prevention should be underpinned by recognition of the interplay between personal (both physical and psychological), environmental, and contextual characteristics, and how they affect the persons’ cognitive-affective-behavioral processes before, during, and after injury occurrence, at different phases of rehabilitation, and during the return to activity or retirement from activity process. Moreover, these holistic injury prevention efforts should be underpinned by a philosophy that injury prevention is inherently intertwined with performance enhancement, with the focus being on the individual and their overall well-being.
Sayaka Aritake-Okada and Sunao Uchida
Research indicates that both acute and chronic physical activity improve sleep. Effects on sleep include prolongation of total sleep time, slow wave sleep increase, rapid eye movement sleep decrease, wake after sleep onset reduction, and shortened sleep latency. However, detailed biological mechanisms of these effects have not been well elucidated.
Past studies strongly suggest that the sleep-promoting effect of exercise could be multifactorial. Increase of slow wave sleep, which has been repeatedly reported, strongly suggests physical activity effects on central nervous system function. Physical activity also elevates body temperature, alters glucose, and impacts other metabolic regulations. Habitual exercise also alters autonomic nervous system predominance measured by heart rate variability.
Stephen H. Boutcher
Cardiovascular disease has been estimated to be responsible for over 30% of deaths worldwide. The traditional cardiovascular risk factors of smoking, obesity, diabetes, physical inactivity, and family history predict about 50% of the variance of new cardiovascular disease cases; therefore, a number of other risk factors must contribute to cardiovascular disease development. One such factor is psychological stress, which has been identified as playing a role in the development of cardiovascular disease. The major research strategy for assessing the impact of psychological stress on cardiovascular disease development is to measure cardiovascular reactivity to laboratory mental stressors. Exaggerated mental stress-induced cardiovascular reactivity and slow stressor recovery have been associated with the development of cardiovascular disease.
In contrast to exposure to psychological stress, there is strong evidence that participation in aerobic exercise leads to a reduction in cardiovascular disease. Participation in regular aerobic exercise generally reduces the cardiovascular response to acute exercise; therefore, researchers have hypothesized that the ability of aerobic exercise to enhance cardiovascular health works partly by modifying the cardiovascular reactivity response to mental stressors. There is mixed evidence to suggest that chronic aerobic exercise decreases or increases cardiovascular reactivity to mental challenge in normotensive, healthy individuals. A decrease in reactivity, however, has been found in those studies that have examined individuals at risk of disease or diseased adults. The optimal volume and intensity of aerobic exercise that brings about maximum decreases in cardiovascular reactivity has yet to be determined. The impact of other forms of exercise on reactivity such as resistance exercise and interval sprinting exercise is starting to be assessed. The challenge for researchers in this area is to identify the mode of exercise that takes the least amount of time but brings about the greatest reduction of levels of stress-induced cardiovascular disease.
Steven J. Petruzzello
A historically popular research topic in exercise psychology has been the examination of the exercise-anxiety relationship, with an ever-growing literature exploring the link between exercise and anxiety. In addition to its potential for preventing anxiety and anxiety disorders, an increasing number of studies have examined the utility of physical activity and exercise interventions for the treatment of elevated anxiety and clinical anxiety disorders. A National Institute of Mental Health “state-of-the-art workshop” in 1984 was the first significant call put forth that understanding the anxiety-reducing potential of exercise was important and required further investigation. Since the publication of the evidence that came out of that NIMH workshop in Morgan and Goldston’s 1987 book, “Exercise and Mental Health,” a great deal more has been learned yet key aspects of the relationship between exercise and anxiety remain unknown. There is a great deal of work that remains to make good on the “potential efficacy of exercise.”
Brian C. Focht and Ciaran M. Fairman
Health-related quality of life (HRQL) is a multidimensional subcomponent of quality of life involving subjective appraisal of various dimensions of one’s life that can be affected by health or health-related interventions. There is considerable evidence demonstrating that exercise consistently results in meaningful improvements in an array of HRQL outcomes. Advances in the conceptualization of HRQL and recent evidence identifying select moderators and mediators of the effects of upon HRQL outcomes have important implications for the design and delivery of exercise interventions. Taken collectively, contemporary findings support the utility of adopting a hierarchical, bottom-up approach to the investigation of the effects of exercise upon HRQL.
Trent A. Petrie
Although the specific prevalence rates may vary, eating disorders (ED) affect male and female athletes regardless of sport type and competitive level. Generally, rates of subclinical disorders are much higher than clinical ones, with the most frequent clinical classification being Eating Disorders Not Otherwise Specified. Further, EDs occur not only among active athletes, but are also found in samples of retired athletes as well. Existing research on the prevalence of EDs in athletes, however, has been limited due to its reliance on out-of-date diagnostic criteria, sometimes small samples, and a focus on point prevalence to the exclusion of examining how rates might change over time. Central to prevalence research and clinical assessments is the ability to accurately assess EDs in athletes. Although structured clinical interviews represent the most valid approach, they are time consuming and not often used in determining prevalence. Researchers have relied on self-report measures instead. Such measures include those developed initially in nonathletes, but used to study athletes (e.g., Questionnaire for Eating Disorder Diagnosis; Mintz, O’Halloran, Mulholland, & Schneider, 1997), and those specifically for athletes (e.g., Athletic Milieu Direct Questionnaire; Nagel, Black, Leverenz, & Coster, 2000). Most of these measures, though having adequate psychometric properties, are based on diagnostic criteria that are no longer in use, so additional research that employs prevalence measures that reflect DSM-5 criteria is needed with athletes. Most ED research in sport has used samples of active athletes; few studies have considered how the transition out of sport might affect athletes’ perceptions of their bodies, their relationship to food, and their approaches to exercise and being physically active. Retirement from sport generally is considered to be a developmental stressor and thus may exacerbate ED symptoms and body image concerns in some athletes. Yet, for other athletes, retirement may represent a positive transition in which they emerge from a sport culture, focused on weight and appearance, to reclaim themselves and their bodies. Initial qualitative findings appear to support each hypothesis in part, though longitudinal quantitative studies that track athletes from active competition through retirement are needed to understand the changes athletes experience in relation to their bodies, food, and exercise, and when such changes are most likely to occur.
Mary Fry and Candace M. Hogue
There is a large literature base within the field of sport psychology that provides tremendous direction to coaches and parents on how to structure youth sport so that young athletes develop sport skills and concurrently reap psychological benefits from their sport participation. Much of this research has employed Nicholls’ Achievement Goal Perspective Theory and a Caring Framework to (a) identity the processes children undergo as their cognitive development matures across the elementary years, allowing them to accurately judge their ability by adolescence, (b) formulate their personal definitions of success in sport (develop their goal orientations), and (c) note features of the team and overall sport climate created by coaches and parents. Of particular importance is athletes’ perceptions of the motivational climate prevailing on their teams. Athletes can perceive a caring and task-involving climate where coaches reward effort, improvement, and cooperation among teammates, make everyone feel they play an important role on the team, and treat mistakes as part of the learning process. In contrast, athletes can also perceive an ego-involving climate where the coach rewards ability and performance outcome, fosters rivalry among teammates, punishes mistakes, and gives most of the recognition to a few “stars.”
When athletes perceive a caring and task-involving climate on their teams, they are more likely to have fun, exert high effort, experience intrinsic motivation, have better interpersonal relationships with coaches and athletes, display better sportsperson-like values and behaviors, have better psychological well-being, and even perform better. In contrast, when athletes perceive an ego-involving climate on their teams they experience fewer adaptive and positive motivational outcomes and greater problematic outcomes (e.g., increased cortisol; greater endorsement of unsportsperson-like behaviors). Research has clearly identified the benefits of coaches and parents creating a caring and task-involving climate for young athletes, yet there are still many ego-involving climates in the youth sport world. A number of organizations are committed to helping coaches and parents transform youth sport culture into a positive arena where young people can develop their athletic skills and have a rewarding sport experience.
Britton W. Brewer
In addition to the disruptive impact of sport injury on physical functioning, injury can have psychological effects on athletes. Consistent with contemporary models of psychological response to sport injury, aspects of psychological functioning that can be affected by sport injury include pain, cognition, emotion, and behavior. Part of the fabric of sport and ubiquitous even among “healthy” athletes, pain is a common consequence of sport injury. Postinjury pain is typically of the acute variety and can be exacerbated, at least temporarily, by surgery and some rehabilitation activities. Cognitive responses to sport injury include appraising the implications of the injury for one’s well-being and ability to manage the injury, making attributions for injury occurrence, using cognitive coping strategies, perceiving benefits of injury, and experiencing intrusive injury-related thoughts and images, increased perception of injury risk, reduced self-esteem and self-confidence, and diminished neurocognitive performance. Emotional responses to sport injury tend to progress from a preponderance of negative emotions (e.g., anger, confusion, depression, disappointment, fear, frustration) shortly after injury occurrence to a more positive emotional profile over the course of rehabilitation. A wide variety of personal and situational factors have been found to predict postinjury emotions. In terms of postinjury behavior, athletes have reported initiating coping strategies such as living their lives as normally as possible, distracting themselves, seeking social support, isolating themselves from others, learning about their injuries, adhering to the rehabilitation program, pursuing interests outside sport, consuming alcohol, taking recreational and/or performance-enhancing substances, and, in rare cases, attempting suicide. Psychological readiness to return to sport after injury is an emerging concept that cuts across cognitive, emotional, and behavioral responses to sport injury.
Maximilian Pelka and Michael Kellmann
The sport and performance environment is highly demanding for its actors. Therefore, recovery from work and sports requires special attention. Without adequate recovery, optimal performance is not attainable. It depends, however, on the individual what adequate recovery actually is. An extremely demanding event for someone may not be as demanding for someone else. Every individual perceives his or her environment differently and therefore has to choose his or her response or prevention strategy accordingly. Monitoring one’s recovery-stress states might be a promising starting point to establish individual baselines and further regulate training or work intensities. Relaxation in terms of implementing systematic relaxation techniques seems to be an adequate approach. These techniques can be divided into muscle-to-mind and mind-to-muscle techniques focusing either on the training of one’s sensitivity to muscle tension or on the cognitive processes involved in relaxation. Whether the recovery process is finally successful depends on if the chosen methods fit the purpose of recovery (i.e., response to cognitive or physical demands), the setting/circumstance (i.e., time and place), and how comfortable one feels with the specific recovery strategy.
The Roles of Psychological Stress, Physical Activity, and Dietary Modifications on Cardiovascular Health Implications
Chun-Jung Huang, Matthew J. McAllister, and Aaron L. Slusher
Psychological stress disorders, such as depression and chronic anxiety contribute to increased risk of cardiovascular disease and mortality. Acute psychological and physical stress exacerbate the activity of sympathetic-adrenal-medullary system, resulting in the elevation of cardiovascular responses (i.e., heart rate and blood pressure), along with augmented inflammation and oxidative stress as major causes of endothelial and metabolic dysfunction. The potential health benefits of regular physical activity mitigate excessive inflammation and oxidative stress. Along with physical exercise, complementary interventions, such as dietary modification are needed to enhance exercise effectiveness in improving these outcomes. Specifically, dietary modification reduces sympathetic nervous system activity, improve mitochondrial redox function, and minimize oxidative stress as well as chronic inflammation.
Diane M. Wiese-Bjornstal
The sociocultural aspects of sport injury and recovery include the broad landscape of social beliefs, climates, processes, cultures, institutions, and societies that surround the full chronological spectrum of sport injury outcomes, ranging from risk through to rehabilitation and retirement. A social ecological view of research on this topic demonstrates that sociocultural influences affect sport injury outcomes via interrelated sport systems extending from the intrasystem (i.e., within sports persons) through the microsystem (i.e., sport relationships), mesosystem (i.e., sport organizations), exosystem (i.e., sport governing bodies), and macrosystem (i.e., sport cultures). Affected sport injury outcomes include sport injury risks and responses during rehabilitation, return to play, and retirement from sport.
Some specific examples of sociocultural themes evident in research literature include personal conformity to the cultural expectation to play hurt, social conventions of behavior when sport injuries occur, institutional character or ethics when making return to play decisions, guidelines for the care of athletes prescribed by sport governing bodies, and the economic costs to society for sport injuries. Many elements of sport injury are affected by these sociocultural influences, such as the risk of injuries, rehabilitation processes, and career terminations. Continuing debates and discussions include advocacy for sport rule changes, bans on dangerous sports, institutional responsibility, and global sport safety efforts. These form the basis for recommendations about sociocultural interventions designed to reduce sport injury risks and optimize effective injury recoveries through social and cultural best practices.
Nikos Ntoumanis, Cecile Thørgersen-Ntoumani, Eleanor Quested, and Nikos Chatzisarantis
Compelling evidence worldwide suggests that the number of physically inactive individuals is high, and it is increasing. Given that lack of physical activity has been linked to a number of physical and mental health problems, identifying sustainable, cost-effective, and scalable initiatives to increase physical activity has become a priority for researchers, health practitioners, and policymakers. One way to identify such initiatives is to use knowledge derived from psychological theories of motivation and behavior change. There is a plethora of such theories and models that describe a variety of cognitive, affective, and behavioral mechanisms that can target behavior at a conscious or an unconscious level. Such theories have been applied, with varying degrees of success, to inform exercise and physical activity interventions in different life settings (e.g., schools, hospitals, and workplaces) using both traditional (e.g., face-to-face counseling and printed material) and digital technology platforms (e.g., smartphone applications and customized websites). This work has offered important insights into how to create optimal motivational conditions, both within individuals and in the social environments in which they operate, to facilitate long-term engagement in exercise and physical activity. However, we need to identify overlap and synergies across different theoretical frameworks in an effort to develop more comprehensive, and at the same time more distinct, theoretical accounts of behavior change with reference to physical activity promotion. It is also important that researchers and practitioners utilize such theories in interdisciplinary research endeavors that take into account the enabling or restrictive role of cultural norms, the built environment, and national policies on physical activity.
Nicola D. Ridgers and Samuel K. Lai
Commercially available wearable activity trackers are small, non-invasive electronic devices that are worn on the body for the purposes of monitoring a range of outcomes including steps, energy expenditure, and sleep. These devices utilize sensors to track movement, and these recorded data are provided to the user via a visual display on the device itself and/or by syncing the device with an accompanying app or web-based program. Combined together, these devices and accompanying apps incorporate a broad range of behavior change techniques that are known to change behavior, including self-monitoring, goal setting, and social support. In recent years, wearable activity trackers have become increasingly popular, and the growth in ownership within different populations has occurred at an exponential rate. This growth in appeal has led to researchers and practitioners examining the validity and reliability of wearable activity trackers for measuring a range of outcomes and integrating the results into physical activity promotion strategies. Acceptable validity has been reported for steps and moderate validity for measuring energy expenditure. However, little research has examined whether wearable activity trackers are a feasible and effective method for changing physical activity behaviors in the short- and longer-term, either alone or in combination with additional strategies. Some initial results are promising, though concerns have been raised over longer-term use and impacts on motivation for physical activity. There is a need for research examining the longer-term use of wearable activity trackers in different population groups, and establishing whether this technology has any positive effects on physical activity levels.