Sport-related concussion research agenda beyond medical science: culture, ethics, science, policy.

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes.

DEBATE: Do interventions based on behavioral theory work in the real world?

BACKGROUND: Behavioral scientists suggest that for behavior change interventions to work effectively, and deliver population-level health outcomes, they must be underpinned by behavioral theory. However, despite implementation of such interventions, population levels of both health outcomes and linked behaviors have remained relatively static. We debate the extent to which interventions based on behavioral theory work in the real world to address population health outcomes. DISCUSSION: Hagger argues there is substantive evidence supporting the efficacy and effectiveness of interventions based on behavioral theory in promoting population-level health behavior change in the 'real world'. However, large-scale effectiveness trials within existing networks are relatively scarce, and more are needed leveraging insights from implementation science. Importantly, sustained investment in effective behavioral interventions is needed, and behavioral scientists should engage in greater advocacy to persuade gatekeepers to invest in behavioral interventions. Weed argues there is no evidence to demonstrate behavioral theory interventions are genuinely effective in real world settings in populations that are offered them: they are merely efficacious for those that receive them. Despite behavioral volatility that is a normal part of maintaining steady-state population behavior levels creating the illusion of effectiveness, interventions fail in shifting the curve of population behaviors because they focus on individuals rather than populations. Hagger responds that behavioral interventions work in the 'real world' in spite of, not because of, flux in health behaviors, and that the contention that behavioral theory focuses solely on individual behavior change is inaccurate. Weed responds that the focus on extending the controls of efficacy trials into implementation is impractical, uneconomic and futile, and this has squandered opportunities to conduct genuine effectiveness trials in naturalistic settings. Hagger contends that interventions based on behavioral theory are effective in changing population-level behavior in 'real world' contexts, but more evidence on how best to implement them and how to engage policymakers and practitioners to provide sustained funding is needed. Weed argues for a paradigm shift, away from aggregative attempts to effect individual behavior change towards a focus on disrupting social practices, underpinned by understanding social and economic causation of the distribution and acceptance of behaviors in a population.

Developing a physical activity legacy from the London 2012 Olympic and Paralympic Games: a policy-led systematic review.

AIMS: There is no evidence that previous Olympic Games have raised physical activity levels in adult populations. However, it may be premature to assume that this lack of previous evidence for an inherent effect is an indication that there is no potential to proactively harness the Games to generate a physical activity or sport legacy. Given that the political goal of achieving a physical activity legacy had already been set, the policy-led aim of this systematic review was to examine the processes by which the London 2012 Olympic and Paralympic Games might deliver a physical activity (as opposed to sport) legacy. METHODS: Searches were conducted on five databases: SPORTS DISCUS, CINAHL, PsychLNFO, MEDLINE and Web of Knowledge. RESULTS: There are two key findings: first, that communities that are not positively engaged with hosting the 2012 Games in London are likely to be beyond the reach of any initiatives seeking to harness the Games to develop legacies in any area; second, major events such as London 2012 can, if promoted in the right way, generate a 'festival effect' that may have the potential to be harnessed to promote physical activity among the least active. The 'festival effect' derives from the promotion of the 2012 Games as a national festival that is bigger than and beyond sport, but that is also rooted in the lives of local and cultural communities, thus creating a strong desire to participate in some way in an event that is both nationally significant and locally or culturally relevant. CONCLUSIONS: Physical activity policy makers and professionals should seek to satisfy this desire to participate through providing physical activity (rather than sport) opportunities presented as fun community events or programmes. The key to generating a physical activity legacy among the least active adults through this process is to de-emphasise the sporting element of the 2012 Games and promote the festival element.