Confidence to Return to Play After Concussion.

CONTEXT: The sequelae of concussion may have psychological consequences that affect an athlete's ability to return to play (RTP). However, confidence of RTP readiness is rarely monitored after a concussion. DESIGN: This study examined the acute and longitudinal implications of concussion on an athlete's confidence to RTP, the relationship between self-reported symptoms and athlete confidence to RTP, and interactions between concussion symptoms, sex, sport type (contact vs noncontact), and confidence to RTP. METHODS: Forty-six college athletes (65% female) sustained a concussion and completed the Injury Psychological Readiness to Return to Sport (I-PRRS) scale at 3 timepoints: within 72 hours of injury (acute), within 72 hours of beginning the RTP protocol (pre-RTP), and within 72 hours of being fully cleared to RTP (post-RTP). RESULTS: Athletes reported acute low confidence after concussion (I-PRRS mean [SD] = 32.59 [18.45]), which improved over time (pre-RTP mean [SD] = 52.11 [9.60]; post-RTP mean [SD] = 57.45 [5.96]). Some athletes returned to competition (post-RTP) with lingering confidence concerns (ie, I-PRRS < 50; 95% CI = 0.03-0.26). Acute symptom severity was associated with worse confidence (P < .001). Sex and sport type (contact vs noncontact) had no relationship with confidence (P = .406, P = .3314, respectively). These results indicate that athletes lack confidence acutely (within 72 h) following concussion. CONCLUSIONS: Although confidence improves over time, those who report greater acute symptoms also exhibit decreased confidence, and some athletes are returning to play with lingering concerns about their confidence (I-PRRS < 50). This preliminary evidence of heterogeneous confidence following concussion encourages the assessment and monitoring of confidence throughout concussion rehabilitation.

An examination of relationships between transdiagnostic psychological processes and mental health disorders in athletes.

INTRODUCTION: The aims of this study were (a) to identify links between transdiagnostic psychological processes and mental health disorder (MHD) symptoms, and (b) to examine differences in MHD and transdiagnostic psychological processes as a function of demographic variables, including, gender, status as an athlete (elite vs. non-elite), number of training sessions per week, previous severe injuries, and use of medical care following severe injuries. METHODS: A total of 159 competitive athletes aged between 18 and 40 years old (44 % female; mean age = 24.20 ± 4.88 years) participated in this cross-sectional study. Participants completed a demographic questionnaire along with validated questionnaires evaluating MHD symptoms and transdiagnostic processes including: motivation to practice sport, emotional competencies, self-efficacy, repetitive negative thinking, meta-cognitive beliefs, and impulsive and perfectionist behaviors. RESULTS: MHD symptoms were positively correlated with controlled forms of motivation, repetitive negative thinking, meta-cognitive beliefs, and impulsive and perfectionistic behaviors; and negatively correlated with emotional competencies and self-efficacy. Gender differences showed that women were more likely to experience MHD, higher levels of repetitive negative thinking, meta-cognitive beliefs, and lower levels of emotional competencies and self-efficacy than men. Finally, elite athletes showed higher personal standards than their non-elite counterparts and those training more than four times per week showed significantly higher perfectionistic behaviors. DISCUSSION: These results are in line with previous findings in clinical psychology and shed light on the role of transdiagnostic processes and the risk of MHD in a sample of French athletes. Further research on the identification of key risk factors for MHD in competitive athletes is needed.

50 Years of Research on the Psychology of Sport Injury: A Consensus Statement.

Factors influencing sport injury risk, rehabilitation outcomes, and return to sport processes have been the focus in various research disciplines (sports medicine, psychology and sociology). One discipline, with over 50 years of scholarship, is the psychology of sport injury. Despite the research in this field, there is no evidence-based consensus to inform professional practice. The aim of this original and timely consensus statement is to summarise psychological sport injury research and provide consensus recommendations for sport practitioners seeking to implement psychological principles into clinical practice. A total of seven experts with extensive experience outlined the consensus objectives and identified three psychology of sport injury sub-domains: risk, rehabilitation and return to sport. The researchers, grouped in pairs, prepared initial drafts of assigned sub-domains. The group met in Stockholm, and the three texts were merged into a draft and revised in an iterative process. Stress responses are the strongest psychological risk factor for acute injuries. Intra- and interpersonal factors, as well as sociocultural factors, are demonstrated psychosocial risk factors for overuse injuries. Stress management and mindfulness interventions to prevent injuries have been successfully implemented. The rehabilitation process may influence athlete's cognitive, emotional, and behavioural responses. Social support, mindfulness, acceptance-based practices, and cognitive-behavioural based intervention programs reduce negative reactions. Return to sport includes various stages and different trajectories. Returning athletes typically experience concerns regarding competence, autonomy, and relatedness. It is recommended that athletes focus on the physical, technical, and psychological demands of their sport as they progress to increasingly intense activities. Interdisciplinary collaboration (e.g., sports medicine and psychology) would be beneficial in enhancing clinical practice and improving athlete outcomes.

An examination of changes in psychological status across four phases of injury recovery and return to sport: A prospective weekly study of competitive athletes from acute care to return to sport.

While ample research has shown that sport injuries are associated with poor psychological status, scant attention has been given to changes in injured athletes' psychological status over the full course of recovery and return to sport. The aim of the present study was to prospectively investigate potential changes in injured athletes' psychological status across four phases of recovery and return to sport. A total of 38 severely injured adult competitive athletes (58% female; mean age 24.1 ± 7.18 years) participated in this prospective weekly investigation (n = 319 observations). Athletes' were asked to indicate their current phase of recovery or return to sport (acute care, rehabilitation, adapted training, or full return to sport) after which they responded to visual analog scales assessing post-injury psychological status, including: perceived pain (frequency and intensity), emotions (positive and negative), anxiety (cognitive and physiological), motivation, self-efficacy, and satisfaction. During the acute care phase, participants showed higher scores of perceived pain, and physiological anxiety compared to the other phases. During the adapted training phase, amotivation was higher than in the acute care phase, and self-efficacy was lower than in other phases. At full return to sport, athletes showed less perceived pain, cognitive anxiety, and more satisfaction than during other phases. The present study provides a deeper prospective understanding of changes in athlete's psychological status over the course of injury recovery and return to sport and highlight the importance of monitoring psychological status.

Experiences participating in a telehealth exercise program among older adults with cancer: a qualitative study.

PURPOSE: Telehealth delivery of exercise programs has rapidly increased in recent years; yet, little is known regarding older cancer survivors' (OCS) experiences participating in telehealth exercise. The purpose of this study was to determine OCS barriers and facilitators to participation in telehealth-delivered exercise. METHODS: OCS who participated in a 12-week, one-on-one telehealth exercise program were recruited to participate in one of three focus groups. Focus groups were conducted virtually using a semi-structured interview guide. Focus groups were audio recorded, transcribed verbatim, and analyzed utilizing thematic analysis with Atlas.ti. RESULTS: Fourteen OCS (age range 65-79 years) participated in the focus groups, five (35.7%) of which had not completed a telehealth follow-up assessment. The most common cancer type was breast (n = 6, 42.9%), and all cancer stages were represented. Three overall themes were identified: having adequate space to exercise, meeting OCS physical and psychosocial needs, and OCS learning throughout the exercise program. Within these themes, five facilitators and two barriers were identified. Facilitators included the individualization of the exercise program, no travel, accountability, learning to exercise, and support from staff and family. The barriers identified were having limited space to exercise and a learning curve with technology. CONCLUSION: OCS viewed telehealth exercise positively. Identified barriers aligned with those in younger cancer survivors (≥18 years), indicating that OCS are able to engage with telehealth exercise programs alongside their younger counterparts. IMPLICATIONS FOR CANCER SURVIVORS: Telehealth exercise mitigates exercise barriers in OCS and should be used as a strategy to support exercise participation among cancer survivors, regardless of age.

Examination of the validity of the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale in male professional football players: A worldwide study of 29 professional teams.

Perceived confidence is an important dimension of an athlete's psychological readiness to return-to-play. However, there is no established and validated tool to evaluate confidence in professional football. This study aimed to provide preliminary evaluation of the internal structure of the Injury-Psychological Readiness to Return-to-Sport scale (I-PRRS) in a cohort of injured male professional footballers. Over an 18-month period, 29 teams from 17 leagues participated. Players sustaining injuries eliciting ≥ 3 weeks' time-loss were recruited. Cross culturally adapted to 4 further languages, the I-PRRS was administered on two occasions: 1) day before returning-to-training and 2) day before returning-to-match-play. In total, 113 injuries were recorded with 96 completed I-PRRS data sets collected. Confirmatory factor analysis indicated the I-PRRS was a unidimensional scale, with all items measuring the same construct. The scale demonstrated good internal consistency (ω = .88). When examining longitudinal invariance of the I-PRRS across administration time-points, indices of model fit supported scalar invariance. There was preliminary evidence of good internal structure for the I-PRRS in professional male footballers. However, before further research involving the I-PRRS can be endorsed, efforts to confirm or refute empirical developments pertaining to psychological readiness are necessary.

Enjoyment Mediates Associations of the Physical and Family Environment With Adolescent Physical Activity: A Structural Equation Modeling Approach.

PURPOSE: The purpose of this study was to examine the direct effects and mediating effect of physical activity (PA) enjoyment on the associations of the physical environment and family environment with adolescent PA behavior. METHODS: Participants were US high school students who participated in the National Youth Physical Activity and Nutrition Study (N = 11,429; 49.4% female). The dependent variable was a latent variable from 3 survey items indicating adolescent PA behavior. One set of independent variables were items of the physical environment and a second set of independent variables were items of the family environment. A latent PA enjoyment mediating variable was constructed within a weighted structural equation model to examine the standardized direct and indirect effects (IEs) of the physical and family environment variables with adolescent PA controlling for demographic covariates. RESULTS: Significant PA enjoyment mediating effects on adolescent PA were observed for the physical environment variables (IE range = 0.015-0.040) and adult transportation (IE = 0.013, 95% confidence interval [CI]: 0.006-0.020). The strongest direct effects were the associations between the family environment variables of adult PA encouragement (ß = 0.11, 95% CI: 0.08-0.14), transportation (ß = 0.14, 95% CI: 0.10-0.17), and watching (ß = 0.12, 95% CI: 0.09-0.15) with adolescent PA. DISCUSSION: Stronger PA enjoyment mediating effects on adolescent PA were observed for variables of the physical environment compared to the family environment but the strongest direct effects on adolescent PA were observed for family environment variables. Interventions that provide equipment, improve neighborhood safety, and educate parents on how to support PA may both indirectly and directly improve adolescent PA.

Clinical and Demographic Factors Associated With Follow-Up in a Hospital-Based Exercise Oncology Program.

OBJECTIVE: Despite the numerous benefits of regular exercise participation for cancer survivors, nearly 60% of survivors do not meet current guidelines. Hospital-based exercise oncology programs may be one strategy to promote exercise engagement as survivors have expressed a preference for exercise programs associated with a cancer hospital. However, follow-up rates in hospital-based exercise oncology programs can be low. Follow-up assessments are a critical component of exercise oncology programs as they determine survivor progress, allow for revision of exercise prescriptions, and demonstrate the effectiveness of the exercise program. Therefore, the purpose of this study was to identify clinical and demographic factors associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. METHODS: We analyzed data collected from 2016 to 2019 (n = 849) from the Huntsman Cancer Institute's hospital-based exercise oncology program, the Personal Optimism with Exercise Recovery (POWER) program. Cancer survivors completed an assessment at the start of POWER and were encouraged to attend a 12-week follow-up assessment. Factors associated with not attending a 12-week follow-up assessment were identified using logistic regression. RESULTS: Multiple myeloma cancer survivors were more likely (OR 2.33; 95% CI 1.09, 4.98) to not attend a 12-week follow-up assessment, whereas endometrial cancer survivors were less likely (OR 0.39; 95% CI 0.18, 0.87). Greater travel time (OR 2.69; 95% CI: 1.83, 3.96) and distance (OR 2.37; 95% CI: 1.61, 3.49) were associated with not attending a 12-week follow-up assessment. Immunotherapy (OR 1.66; 95% CI 1.02, 2.72), waist circumference (OR 1.01; 95% CI 1.00, 1.02), overweight status per body mass index (OR 1.62; 95% CI 1.11, 2.38), and male sex (OR 1.70; 95% CI 1.23, 2.35) were associated with an increased likelihood of not attending a 12-week follow-up assessment. Survivors with a higher baseline quality of life (OR 0.96; 95% CI 0.93, 0.99) and peak oxygen consumption (OR 0.97; 95% CI 0.95, 0.99) were less likely not to attend a 12-week follow-up assessment. CONCLUSIONS: Both clinical and demographic factors were associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. Understanding factors related to follow-up assessment attendance in exercise oncology programs can inform the development of targeted interventions to improve follow-up rate thus maximizing exercise support for cancer survivors.

Exploring the Factors Involved in Being "Ready" to Return to Sport Following a Concussion.

OBJECTIVE: To explore the factors involved in athletes being ready (or not) to return to sport (RTS) after sport-related concussion (SRC). DESIGN: Qualitative, semistructured interviews.Setting: Videoconference.Participants: Twenty-two sport-injury stakeholders involved in contact and collision sports at various levels of competition (high school, university, professional), including: formerly concussed athletes (n = 4), coaches (n = 5), athletic therapists (n = 5), physiotherapists (n = 4), nurse practitioner (n = 1), and sports medicine physicians (n = 3). INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: We included questions in the interview guide regarding factors participants believed were involved in athletes being ready (or not ready) to RTS after a concussion. RESULTS: Participants described physical (concussion symptoms, return to pre-injury fitness), behavioral (changes in behavior, avoidance, malingering), psychological (individual factors, cognitive appraisals, mental health), and social (isolation, social support, communication, pressure) factors that they believed were involved in athletes being ready to RTS after SRC. CONCLUSIONS: The graduated RTS strategy outlined in the most recent Concussion in Sport Group consensus statement focuses on physical aspects involved in being ready to RTS, which does not address behavioral, psychological, and social factors, which were identified by participants as being related to returning to sport post-SRC. More research is needed to determine whether the additional factors outlined in this study are relevant among larger samples of athletes, coaches, and healthcare professionals.

Patient and practitioner perspectives of psychological need support in physical therapy.

PURPOSE: To examine strategies utilized by physical therapists that contributed to patient perceptions of basic psychological needs support articulated within Self-Determination Theory (SDT). METHODS: Semi-structured interviews were conducted with physical therapists (n = 9) and physical therapy patients (n = 9) undergoing rehabilitation for a variety of musculoskeletal injuries. RESULTS: Both patients and practitioners articulated the value of specific competence (e.g. matching rehabilitation challenges with patient abilities) and autonomy support strategies (e.g. active decision-making). Interestingly, both patients and therapists emphasized the salience of relatedness need support, a finding indicative of the potential importance of this need in a rehabilitation environment. The possibility that relatedness need support may be of equal - or potentially greater - importance than the other two needs in a rehabilitation setting, is however, antithetical to SDT contentions. Whether the primacy of relatedness need support is an artifact of the sample used in the current study or a reflection of a broader rehabilitation trend, is uncertain and remains a topic for further investigation. CONCLUSIONS: Understanding the strategies physical therapists use to support patients' psychological needs may have substantial implications for patient motivation and rehabilitation adherence, such as, improved psychological well-being, enhanced function, and increased adherence to physical therapists' recommendations.

The basic psychological need support in physical therapy questionnaire.

Given the limitations of current inventories of basic psychological need measurement, and the importance of psychological need support within an injury rehabilitation context, there is an evident need to develop the present inventory. Utilizing Self-Determination Theory (SDT) as a theoretical framework, two studies were conducted to develop and psychometrically test a measure of patients' perceptions of basic psychological needs support in physical therapy: The Basic Psychological Needs Support in Physical Therapy Questionnaire (BPNS-PT). In study 1, a panel of Self-Determination Theory academics assessed a pool of items for content relevance, representativeness, and item clarity. In study 2, responses from 199 physical therapy patients were used to identify the best fitting model through confirmatory factor analysis. A 3-factor 10-item measure displayed good fit to the data and illustrated evidence of internal consistency. Findings from these studies provide initial psychometric support (i.e. internal consistency and evidence of construct validity) for the BPNSPT as a measure of patient perceptions of basic psychological needs support in a physical therapy context.

Does motivation mediate the relationship between competence perceptions and patient outcomes among individuals with chronic low back pain? A multiple mediation analysis.

PURPOSE: The aim of this study was to examine: (1) motivations of patients with chronic low back pain to attend physical therapy; (2) relationships between competence perceptions, motivational regulations, and pain/disability; and (3) whether patient motivations to attend physical therapy mediate the relationship between competence perceptions and pain/disability. METHODS: A sample of 64 participants completed baseline assessment (1-week prior to initiation of physical therapy) and 6-week follow-up assessment. Differences between motivation variables at baseline were examined using one-way within-person ANOVA. Relationships between competence perceptions, motivation subscales, and pain/disability were calculated using bivariate correlations and multiple mediation analyses. RESULTS: Participants reported significantly higher levels of autonomous versus controlled motivation (mean difference = 3.5, p < 0.001, d = 2.3) and amotivation (mean difference = 3.6, p < 0.001, d = 2.4). Competence was positively associated with autonomous motivation (r = 0.45, p ≤ 0.05) and negatively associated with controlled motivation (r = -0.26, p ≤ 0.05), amotivation (r = -0.57, p ≤ 0.05), pain (r = -0.35, p ≤ 0.05), and disability (r = -0.34, p ≤ 0.05). Amotivation significantly mediated the competence-pain relationship (Amotivation IE = -0.19, 95% CI (-0.44, -0.06), p < 0.05) and the competence-disability relationship (Amotivation IE = -0.07, 95% CI (-0.17, -0.01), p < 0.05). CONCLUSION: Findings highlight the role of competence perceptions in mitigating amotivation for physical therapy and the deleterious implications of amotivation for patient-centered outcomes.Implications for rehabilitationWhile it is normal for patients to experience periods where they lack motivation for rehabilitation exercises, practitioners can encourage patients to assume responsibility for their recovery by informing them that amotivated states may increase the likelihood of increased pain perceptions and disability.Health-care practitioners should seek to foster competence perceptions in patients about to undergo physical therapy.Competence building strategies such as patient education, goal setting, and role modeling may be valuable in facilitating autonomous motivation and reducing amotivation for physical therapy.

Understanding the dimensions of sport-injury related growth: A DELPHI method approach.

Despite the multitude of adverse physical and psychosocial consequences of sports injury, evidence also highlights the potential for positive benefits in the injury aftermath. The purpose of this study is to address this gap by exploring the dimensions of personal growth following a severe sports injury. A 3-rounds e-Delphi method was utilized to develop a consensual understanding of the dimensions of sport-injury related growth. A panel of 24 psychology of sport injury experts participated in the process. The final list of items obtained was subjected to conventional content analysis to identify general themes. The process led to the development of a 5-dimension model capable of describing athletes' experiences of personal growth following a severe sports-related injury: personal strength, improved social life, health benefits, sport benefits, and social support and recognition. The domains of sport-injury related growth identified here are consistent with growth-domains identified in previous personal growth literature. However, they also highlight the importance of contextualizing the experience of growth. We have captured key elements of sport-injury related growth, domains that can be used as the basis for further psychometric testing and for further interventions to increase adjustment and well-being during the rehabilitation process.

Perceived Competence, Achievement Goals, and Return-To-Sport Outcomes: A Mediation Analysis.

The purpose of this study was to explore the potential mediating effect of achievement goals on perceived competence and return-to-sport outcomes among college athletes sustaining a sport injury. Altogether, 75 male and female college athletes from the United States who returned to sport after having missed competition for an average of 3 weeks due to injury, completed valid and reliable inventories measuring perceived competence, achievement goals, and return-to-sport outcomes. Results indicated that task-approach goals significantly mediated the relationship between perceived competence and a renewed sport perspective. These data suggest the importance of promoting competence beliefs and a task-oriented focus among athletes returning to sport following athletic injury. From a practical standpoint, clinicians can foster competence perceptions by integrating progressive physical tests assessing functionality and sport-specific skills/abilities. Furthermore, these data suggest that coaches, physical therapists, and significant others may do well to use language that orients injured athletes towards attaining success as opposed to avoiding failure, to emphasize effort, task completion, and correct form, and to avoid comments that compare athletes to others or to their preinjury standards of performance. From a theoretical standpoint, our mediation findings extend previous achievement goal research into the sport injury domain, further highlighting the importance of task-approach goals.

Not All Promotion Is Good Promotion: The Pitfalls of Overexaggerated Claims and Controlling Language in Exercise Messaging.

Across 2 studies, the authors explored reactance effects to overexaggerated claims and controlling language in exercise messaging. In Study 1, participants received either a message exaggerating the benefits of an upcoming exercise session or no message. They subsequently undertook a mundane exercise session led by an instructor, which was either need supportive or "realistically controlling." Relative to no-message participants, those who had read the message reported less positive evaluations of the session. These results were observed despite participants in the message condition holding more positive presession expectations, and the effect was apparent even for those who received need-supportive instruction. In Study 2, participants read an advertisement that was written in either autonomy-supportive language or controlling language. Despite reporting comparable expectations, participants who received a controlling-language message reported significantly greater anger and freedom threat-factors commonly linked to contrast effects. These studies highlight the operation of message-driven contrast effects in exercise.

Caring Rehabilitation Climate, the Tripartite Efficacy Framework, and Adherence to Rehabilitation Programs Among Individuals With Parkinson's Disease: A Multiple Mediation Analysis.

BACKGROUND AND PURPOSE: Adherence to physical therapy (PT) and secondary prevention programs (SPPs) is particularly low for individuals with Parkinson's disease. Preliminary research has linked perceptions of caring climates as well as enhanced tripartite efficacy perceptions to adherence during rehabilitation programs. In light of such preliminary research, the purpose of this study was threefold: (1) to examine relationships between perceptions of a caring climate and the 3 efficacy constructs within the tripartite model, (2) to examine the relationship between the tripartite efficacy constructs and adherence to PT/SPP exercises, and (3) to determine whether tripartite efficacy beliefs mediated the relationship between caring climate perceptions and adherence. METHOD: A total of 77 individuals with Parkinson's disease who were currently or recently enrolled in PT or an SPP were recruited and surveyed about their perceptions of the caring climate of their rehabilitation clinic, their tripartite efficacy perceptions, and their adherence to rehabilitation. Correlations and a multiple mediation analysis were conducted to address the purposes of this study. RESULTS AND DISCUSSION: Results showed significant positive associations between all variables; however, all paths within the proposed mediation model were not significant. Specifically, the c paths linking the tripartite efficacy constructs with adherence were not significant. A follow-up analysis was undertaken to address potential suppression effects within the mediating variables, and this analysis revealed a statistically significant model with relation-inferred self-efficacy (RISE) as a sole mediator of the relationship between caring perceptions and adherence to rehabilitation. CONCLUSIONS: Several practical implications can be gleaned from the current study. First, practitioners should strive to enhance the caring climate of their clinic by employing techniques reported in previous literature, such as creating a supportive atmosphere, displaying benevolence, and paying attention. In addition, the results suggest that individuals' RISE perceptions, in particular, could be a viable target for enhancing adherence.

Cognitive processing following acquired disability for para sport athletes: a serial mediation model.

Purpose: To understand the cognitive processing that occurs in relation to a disabling life event among para sport athletes, as well as the role of para sport participation in shaping these cognitions, and subsequent perceptions of posttraumatic growth or distress.Methods: Participants were 75 para sport athletes with acquired disability. Serial multiple mediation analysis was conducted to identify the various pathways through which posttraumatic growth or distress is experienced.Results: Findings suggested that a disabling event initiated challenges to one's core beliefs which influenced subsequent perceptions of posttraumatic growth and distress through cognitive processing at two separate time frames. Moreover, the utility of deliberate rumination (at both time points) was evident in experiencing posttraumatic growth, while intrusive rumination only appeared beneficial if it prompted deliberate ruminations.Conclusions: As several unique paths to posttraumatic growth were found, results suggest that a multitude of paths to growth may be possible. Para sport participation may have utility in facilitating deliberate ruminations and subsequent posttraumatic growth for those unable to deliberately ruminate in the immediate disability aftermath.Implications for rehabilitationAs challenges to core beliefs triggered ruminative thoughts that ultimately facilitated PTG, practitioners are encouraged to explicitly ask patients about how the adverse event might have influenced patients' self-perceptions and views about the meaning of life. Such questions may be revisited from injury onset throughout recovery and rehabilitation.Rehabilitation specialists should inform patients that intrusive ruminations may be salient in the post-trauma aftermath, but that such rumination may be facilitative if it gives way to more deliberate forms of rumination.Attempts to understand the meaning of a traumatic event may be instrumental in alleviating distress.Health practitioners should encourage individuals suffering physically disabling events to engage in activities such as para sport, given its potential to facilitate deliberate rumination and subsequent posttraumatic growth.

Acute Exercise and Academic Achievement in Middle School Students.

(1) The purpose of this study was to examine the acute effects of aerobic exercise, resistance exercise, and non-exercise on measures of academic achievement and cognition in pre-adolescent students. (2) In a randomized crossover design, sixty-three participants with a mean age of 13.7 ± 0.47 years completed 20 min of aerobic exercise, resistance exercise, or non-exercise with a period of seven days between each bout. Immediately after each bout, participants were tested for academic achievement and cognitive performance. Academic achievement was assessed using standardized, age-appropriate mathematics tests. Cognition was measured using the Dot, Word, and Color tasks of the Stroop Test (Victoria version). (3) Participants scored significantly higher on the mathematics tests (F1,62 = 4.50, p = 0.038) and all elements of the Stroop Test (Dot: F1,62 = 8.14, p = 0.006; Word: F1,62 = 9.90, p = 0.003; Color: F1,62 = 7.57, p = 0.008) following acute resistance exercise as compared to non-exercise. Math test performance was not statistically different between the aerobic and resistance exercise treatments (F1,62 = 0.214, p = 0.645), but participants did perform significantly better on all elements of the Stroop Test following resistance exercise as compared to aerobic exercise (Dot: F1,61 = 25.82, p < 0.001; Word: F1,62 = 14.73, p < 0.001; Color: F1,62 = 20.14, p < 0.001). (4) Resistance exercise acutely influenced academic achievement and cognition in a positive manner. Such results add to the growing body of research that may support an increase in the prescription of varied exercise modalities within school settings for the purposes of improving academic performance and student health.

Well-Come Back! Professional Basketball Players Perceptions of Psychosocial and Behavioral Factors Influencing a Return to Pre-injury Levels.

The psychological factors influencing a return to sport has gained increased research attention. In the current investigation, we explored professional basketball players' perceptions of the psychosocial and behavioral factors facilitating a return to performance equal to or exceeding previous performance standards. We also sought to describe athletes' experiences - both positive and negative - of returning to sport following injury recovery. Ten Italian professional male basketball players (age range 22-36 years), were retrospectively interviewed in relation to three time-periods: (1) from the commencement of rehabilitation to their first official competition, (2) the first official competition, and (3) the 6-months following the initial competition. Qualitative content analysis of the data revealed numerous themes across the three time periods. In regards to Period 1, participants indicated that social support, investment in rehabilitation and training programs, coping skills and motivation were fundamental in reaching pre-injury performance levels. During their first official game (i.e., Period 2), athletes reported that realistic performance expectations, focusing on the performance, positive emotions, motivation, arousal and social support facilitated their return to sport. Athletes, however, also described a predominance of factors that hindered their return to pre- injury levels (i.e., low confidence in personal abilities, decrements in skill execution and dysfunctional physical sensations). Moreover, participants typically described a substandard level of performance during their first competition back following injury. In recounting experiences during the 6 months following their first official game, basketballers reported improvements in skill execution and highlighted the importance of coping skills, motivation and social support. The process of restoring self-confidence in one's ability to successfully perform was perceived as crucial in enabling participants to move beyond a mere return to sport to a return to high performance - that is, to reach a level of proficiency equal to or exceeding previous performance standards. Findings support the relevance of cognitive, emotional and behavioral responses highlighted in the Integrated Model and suggest the importance of addressing psychological factors throughout the return-to-sport process. Finally, results from the present study hold a number of practical implications for athletes' aiming to achieve a return to pre-injury levels.