First international consensus statement on sports psychiatry.

Sports psychiatry is a young field of medicine and psychiatry that focuses on mental health among athletes, and sports and exercise within psychiatry and mental disorders. However, the development of sports psychiatry and its fields of activity vary from region to region and are not uniform yet. Sports psychiatry and the role of sports psychiatrists have also already been discussed in the field of sports and exercise medicine, and within medical teams in competitive and elite sports. A uniform definition on sports psychiatry, its fields of activity, sports psychiatrist, and the essential knowledge, skills, and abilities (plus attitudes, eKSA+A) of the sports psychiatrist were developed as part of an International Society for Sports Psychiatry (ISSP) Summit, as well as First International Consensus Statement on Sports Psychiatry. Three fields of activity can be distinguished within sports psychiatry: (i) mental health and disorders in competitive and elite sports, (ii) sports and exercise in prevention of and treatment for mental disorders, and (iii) mental health and sport-specific mental disorders in recreational sports. Each of these fields have its own eKSA+A. The definitions on sports psychiatry and sports psychiatrists, as well as the framework of eKSA+A in the different fields of activity of sports psychiatrists will help to unify and standardize the future development of sports psychiatry, establish a standard of service within sports psychiatry and together with the neighboring disciplines, and should be included into current, and future sports psychiatry education and training.

Modified defense reaction reduces biomechanical and myoelectrical ACL injury risk factors in elite Judo.

In judo, an anterior cruciate ligament (ACL) injury is the most severe injury an athlete could experience. Most ACL ruptures occur when defending against an osoto-gari attack. This study aims to identify ACL risk factors during osoto-gari defence and implement a modified osoto-gari defence reaction, which is assumed to improve myoelectric patterns and ameliorate critical biomechanical risk factors for ACL injuries. Twenty-six elite judokas were enrolled in the cross-over trial (female: 6; male: 20). 3D kinematics and force dynamometrics were combined with electromyographical recordings to assess the effects of the common and the modified osoto-gari defence reaction. Compared to the common osoto-gari defence reaction (maximal knee flexion: 29 ± 12°; maximal valgus: 10 ± 5°; maximal valgus moment: 58 ± 17 Nm; peak internal rotation: 9 ± 5°), the modified osoto-gari defence reaction showed significantly reduced knee angles (31 ± 10° p < 0.05; 1 ± 0° p < 0.05; 31 ± 9 Nm p < 0.05; 3 ± 0° p < 0.05). The myoelectric activity of the hamstring increased (+5±% to +27±%, p < 0.05) in the modified compared to common defence reaction. The modified osoto-gari defence reaction reduced critical biomechanical risk factors and increased hamstring myoelectric activity. We recommend the implementation of the modified osoto-gari defence reaction in judo practice and seek to evaluate its long-term effectiveness in decreasing ACL injury incidences in elite judo.

Nutritional intake when cycling under racing and training conditions in professional male cyclists with type 1 diabetes.

This study sought to detail and compare the in-ride nutritional practices of a group of professional cyclists with type 1 diabetes (T1D) under training and racing conditions. We observed seven male professional road cyclists with T1D (Age: 28 ± 4 years, HbA1c: 6.4 ± 0.4% [46 ± 4 mmol.mol-1], VO2max: 73.9 ± 4.3 ml.kg -1.min-1) during pre-season training and during a Union Cycliste Internationale multi-stage road cycling race (Tour of Slovenia). In-ride nutritional, interstitial glucose, and performance variables were quantified and compared between the two events.    The in-ride energy intake was similar between training and racing conditions     (p = 0.909), with carbohydrates being the major source of fuel in both events during exercise at a rate of 41.9 ± 6.8 g.h-1 and 45.4 ± 15.5 g.h-1 (p = 0.548), respectively. Protein consumption was higher during training (2.6 ± 0.6 g.h-1) than race rides (1.9 ± 0.9 g.h-1; p = 0.051).   A similar amount of time was spent within the euglycaemic range (≥70-≤180 mg.dL-1): training 77.1 ± 32.8% vs racing 73.4 ± 3.9%; p = 0.818. These data provide new information on the in-ride nutritional intake in professional cyclists with T1D during different stages of the competitive season.

[Sports psychiatry and psychotherapy]. / Sportpsychiatrie und -psychotherapie.

Sports psychiatry and psychotherapy is a relatively young field and is comprised of two key segments: the special features of the diagnostics and therapy of mental disorders in elite athletes and the use of exercise and sports in the development and treatment of mental disorders. Although all mental disorders can in principle also occur in (elite) athletes, there are additionally sport-specific mental disorders, such as anorexia athletica and other eating disorders, chronic traumatic encephalopathy, misuse of and dependency on performance-enhancing substances (doping) and muscle dysmorphia. Many high-quality clinical trials over the past two decades have been able to demonstrate a therapeutic efficacy of physical activity and sport in the treatment of various mental disorders. All clinicians active in psychiatry and psychotherapy should possess a basic knowledge of sports psychiatry.

Self-reported sleep quantity, quality and sleep hygiene in elite athletes.

Sleep is essential for recovery and performance in elite athletes. While actigraphy-based studies revealed suboptimal sleep in athletes, information on their subjective experience of sleep is scarce. Relatively unexplored is also the extent to which athletes' sleep is adversely affected by environmental conditions and daytime behaviours, that is sleep hygiene. This study aimed to provide insight in sleep quantity, quality and its putative association with sleep hygiene. Participants were 98 elite (youth) athletes competing at the highest (inter-)national level. Sleep quantity, quality and sleep hygiene were assessed once covering a 1-month period by using established (sub)clinical questionnaires, and repeatedly during 7 consecutive days. Sleep quality was generally healthy, although 41% of all athletes could be classified as 'poor sleeper', and 12% were identified as having a sleep disorder. Daily self-monitoring revealed sleep durations of 8:11 ± 0:45 h, but elevated wake after sleep onset of 13 ± 19 min. Sleep quality, feeling refreshed, and morning vigor were moderate at best. Regarding sleep hygiene, general measures revealed irregular sleep-wake patterns, psychological strain and activating pre-sleep behaviours. At the daily level, blue-light exposure and late-evening consumption of heavy meals were frequently reported. General sleep hygiene revealed significant associations with sleep quality (0.45 < r > 0.50; P < 0.001). Results indicate that there is ample room for optimization, specifically in onset latency and in wake after sleep onset. Subtle improvements in sleep seem possible, and optimizing sleep hygiene, such as regular sleep-wake patterns and reducing psychological strain, may facilitate this sleep upgrading process.

Effects of Natural Between-Days Variation in Sleep on Elite Athletes' Psychomotor Vigilance and Sport-Specific Measures of Performance.

Performance capacity in athletes depends on the ability to recover from past exercise. While evidence suggests that athletic performance decreases following (partial) sleep deprivation and increases following sleep extension, it is unclear to which extent natural variation in sleep impacts performance. Sleep quantity and, for the first time, sleep stages were assessed among 98 elite athletes on three non-consecutive nights within a 7-day monitoring period, along with performance tests that were taken on standardized times each following morning. Performance assessment included psychomotor performance (10-minute psychomotor vigilance task) and sport-specific tests of fine (e.g., accuracy) and gross motor skills (e.g., endurance, power). Mixed-effects models were employed to assess the effect of sleep quantity (total sleep time (TST), sleep onset latency (SOL), wake after sleep onset, sleep efficiency) and sleep stage duration (light, deep, REM) on performance. Average TST was 7:30 ± 1:05 hours, with a mean variation of 57 minutes across days. Longer TSTs were associated with faster reaction times (p = 0.04). Analyses indicated small and inconsistent effects of sleep quantity (TST, SOL) and sleep staging (light sleep) on gross motor performance, and no effects on fine motor skill performance. Results indicate that natural variation in sleep quantity impacts psychomotor vigilance to a greater extent than athletic performance. Small or absent effects can be a consequence of the rather small variation in non-manipulated sleep. It is suggested that one night of compromised sleep may not be immediately problematic, but that more extreme sleep loss or accumulated sleep debt may have more severe consequences.

Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes.

Little is known about health variables and if these variables could increase the risk of injuries among adolescent elite athletes. The primary aim was to present overall data on self-perceived stress, nutrition intake, self-esteem, and sleep, as well as gender and age differences, on two occasions among adolescent elite athletes. A secondary aim was to study these health variables as potential risk factors on injury incidence. A questionnaire was e-mailed to 340 adolescent elite athletes on two occasions during a single school year: autumn semester and spring semester. The results show that during autumn semester, the recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Multiple logistic regression showed that athletes sleeping more than 8 h of sleep during weekdays reduced the odds of injury with 61% (OR, 0.39; 95% CI, 0.16-0.99) and athletes reaching the recommended nutrition intake reduced the odds with 64% (OR, 0.36; 95% CI, 0.14-0.91). Our findings suggest that nutrition intake and sleep volume are of importance in understanding injury incidence.

Fear of failure, psychological stress, and burnout among adolescent athletes competing in high level sport.

The purpose of this study was to investigate fear of failure in highly competitive junior athletes and the association with psychological stress and burnout. In total 258 athletes (152 males and 108 females) ranged in age from 15 to 19 years (M = 17.4 years, SD = 1.08) participated. Athletes competed in variety of sports including both team and individual sports. Results showed in a variable-oriented approach using regression analyses that one dimension, fear of experiencing shame and embarrassment had a statistically significant effect on perceived psychological stress and one dimension of burnout, reduced sense of accomplishment. However, adopting a person-oriented approach using latent class analysis, we found that athletes with high levels of fear failure on all dimensions scored high on burnout. We also found another class with high scores on burnout. These athletes had high scores on the individual-oriented dimensions of fear of failure and low scores on the other oriented fear of failure dimensions. The findings indicate that fear of failure is related to burnout and psychological stress in athletes and that this association is mainly associated with the individual-oriented dimensions of fear of failure.

The effect of westward travel across five time zones on sleep and subjective jet-lag ratings in athletes before and during the 2015's World Rowing Junior Championships.

This study examined sleep-wake habits and subjective jet-lag ratings of 55 German junior rowers (n = 30 male, 17.8 ± 0.5 years) before and during the World Rowing Junior Championships 2015 in Rio de Janeiro, Brazil. Athletes answered sleep logs every morning, and Liverpool John Moore's University Jet-Lag Questionnaires each evening and morning. Following an 11-h westward flight with 5-h time shift, advanced bedtimes (-1 h, P < .001, ηp2 = 0.68), reduced sleep onset latency (P = .002, ηp2 = 0.53) and increased sleep duration (P < .001, ηp2 = 0.60) were reported for the first two nights. Jet-lag symptoms peaked upon arrival but were still present after 6 days. Sleep quality improved (P < .001, ηp2 = 0.31) as well as some scales of the Recovery-Stress Questionnaire for Athletes. Participation was successful as indicated by 11 of 13 top 3 placings. Overall, the initial desynchronisation did not indicate negative impacts on competition performance. As travel fatigue probably had a major effect on perceptual decrements, sleep during travel and time to recover upon arrival should be emphasised. Coaches and practitioners should consider higher sleep propensity in the early evening by scheduling training sessions and meetings until the late afternoon.

Neuromuscular and athletic performance following core strength training in elite youth soccer: Role of instability.

Cross-sectional studies revealed that inclusion of unstable elements in core-strengthening exercises produced increases in trunk muscle activity and thus potential extra stimuli to induce more pronounced performance enhancements in youth athletes. Thus, the purpose of the study was to investigate changes in neuromuscular and athletic performance following core strength training performed on unstable (CSTU) compared with stable surfaces (CSTS) in youth soccer players. Thirty-nine male elite soccer players (age: 17 ± 1 years) were assigned to two groups performing a progressive core strength-training program for 9 weeks (2-3 times/week) in addition to regular in-season soccer training. CSTS group conducted core exercises on stable (i.e., floor, bench) and CSTU group on unstable (e.g., Thera-Band® Stability Trainer, Togu© Swiss ball) surfaces. Measurements included tests for assessing trunk muscle strength/activation, countermovement jump height, sprint time, agility time, and kicking performance. Statistical analysis revealed significant main effects of test (pre vs post) for trunk extensor strength (5%, P < 0.05, d = 0.86), 10-20-m sprint time (3%, P < 0.05, d = 2.56), and kicking performance (1%, P < 0.01, d = 1.28). No significant Group × test interactions were observed for any variable. In conclusion, trunk muscle strength, sprint, and kicking performance improved following CSTU and CSTS when conducted in combination with regular soccer training.