Experiences of a controlled early exercise intervention following a sport-related concussion: A qualitative study of rugby union student-athletes.

BACKGROUND: Early aerobic exercise is associated with improved outcomes following recovery from sport-related concussion (SRC) and is now recommended in guidance for clinicians managing athletes return-to-play. OBJECTIVES: To explore student-athlete experiences of a novel early aerobic exercise intervention. DESIGN: Qualitative study using semi-structured interviews. SETTING: Loughborough University, UK. PARTICIPANTS: Ten rugby union university aged student-athletes (6 men) that had been medically diagnosed with an SRC sustained playing rugby. RESULTS: Three themes divided into eight supporting subthemes were generated. Main findings were: 1) Experience: despite some apprehension over the novel approach, most had a positive experience, 2) Adherence: Participants suggested reasonably good overall adherence to the prescribed exercises but intrinsic and extrinsic factors for non-adherence were identified, 3) Outcomes: the intervention was perceived to help rehabilitation, improve confidence, support retention of athletic identity and, for some, influenced more cautious attitudes toward brain health. CONCLUSIONS: The novel early exercise intervention was reasonably well received and adhered to. Unintended benefits included supporting retainment of athletic identity and encouraging precautious health behaviours. As early exercise protocols are refined, these findings will help inform the design and delivery of future interventions, particularly in relation to intensity and diversity of exercises and supporting education.

Delapré Walk project: Are signposted walking routes an effective intervention to increase engagement in urban parks? -Natural experimental study.

Spatial education interventions in the built environment may increase engagement with urban greenspace. This research was a natural experimental study with mixed-method evaluation and repeated cross-sectional design. Twenty-four directional wayfinding signs were installed within an urban park to create a 3 km signposted walking route through the park's amenities in a clockwise direction. Manual counts on one path and bi-directional automated active infrared counts on six paths along the intervention route were conducted at baseline and 12-month follow-up. A QR code accessed intercept survey was open throughout the follow-up phase to capture user experiences, views, and attitudes toward the intervention. There was no consistent difference in manual counts at baseline or 12-month follow-up between intervention and control parks. Automated counts showed no consistent significant change in clockwise footfall between baseline (median automated count range across six counters: 10-130 clockwise counts per day) and follow-up (Autumn to Winter follow-up median automated count range across six counters: 13-103 clockwise counts per day; Spring to Summer follow-up median automated count range across six counters: 13-124 clockwise counts per day). However, 23% (11 out of 48 people) of clockwise travelling route users reported they were following the signs at 12-month follow-up. Intercept survey respondents (n = 27) appeared to be infrequent park users (number of respondents for 'my first visit': 7, and 'one to two times per month: 9), with the new signs making them feel less anxious about exploring unfamiliar areas, while motivating them to walk further than originally planned and helping them to 'take notice' of the landscape. Directional wayfinding for recreational walking appears to help infrequent users engage with urban greenspace.

Room for Improvement in Sports Nutrition Knowledge amongst Parents and Caregivers of Male Academy Soccer Players in the UK: A Cross-Sectional Study.

In professional soccer clubs in the UK, nutrition support is often polarised towards senior players or those in the senior academy age groups seeking first team selection/involvement. Accordingly, there is an increased reliance on parents and caregivers to provide support regarding nutritional intake. Therefore, the aim of this study was to evaluate the quality of nutrition knowledge of parents and caregivers of male youth soccer players within developmental academies in the UK. Across a single competitive season, 360 registered parents and caregivers of male soccer players from English Premier League under 9-11 (Foundation Phase) and under 12-16 (Youth Development Phase) age group academies completed an online version of the 88-item validated Nutrition for Sport Knowledge Questionnaire. Nutrition knowledge scores were classified as "poor" (43 ± 23%). Nutrition knowledge scores were significantly greater in respondents with dependents representing Category 1 (45 ± 13%) vs. Category 2 (39 ± 15%) academies and in Foundation Phase (44 ± 13%) vs. Youth Development Phase (41 ± 15%). These results demonstrate that there is room for improvement in the nutrition knowledge levels of parents and caregivers of male soccer academy players. We recommend that club academies provide appropriate resources towards nutritional education for parents and caregivers.

Eating Disorders and Disordered Eating in Competitive Cycling: A Scoping Review.

This article reports on the findings from a scoping review on eating disorders and disordered eating in competitive cycling. The review was informed by a scoping review methodological framework as well as the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) reporting guidelines. PubMed, SPORTDiscus and Web of Science were used to identify relevant literature for review. Fourteen studies met the eligibility criteria and were included in the full review. A narrative synthesis was used to summarise the main findings and themes across the included literature. Findings from the review are presented under the following themes: cycling as an 'at-risk' discipline; power to weight ratio; energy requirements and risk of low energy availability; the social environment of cycling; nutrition support provision; relationship between eating disorders/disordered eating and exercise addiction; and recommendations made in identified literature. Overall, the literature suggests competitive cycling is a sport with a high prevalence of disordered eating and/or eating disorders and a sport with unique risk factors that contribute to this. Crucially, more research is needed in this area. The article concludes with the gaps in the literature highlighted, implications for future research, and applications to policy and practice suggested.

A Qualitative Exploration of Parents' Perceptions of Risk in Youth Contact Rugby.

The purpose of this study was to explore the understandings and perceptions of risk related to brain trauma amongst parents of children that play contact rugby. A qualitative approach was taken, using semi-structured interviews with 7 mothers and 27 fathers of children that participate in contact rugby. A thematic analysis of data suggests that parents used two primary cognitive strategies to process the risk they consented to with their children's participation in rugby; (1) minimalizing rugby risk to be equivalent to less injurious sports; and (2) elevating physical and social advantages above what they think other sports are capable of providing. From the findings it is suggested that parents who permit their children to play contact rugby are both aware of the high risks of injury in the sport, but simultaneously utilize two cognitive distortion techniques to rectify the dissonance caused between their choice to have their children play, and the salient number of concussions they observe. These results suggest that it will take properly informed consent, inclusive of concussion rates compared to other sports, in order to reduce cognitive distortion and effectively communicate risks associated with participation in contact rugby.

An Investigation into Helmet Use, Perceptions of Sports-Related Concussion, and Seeking Medical Care for Head Injury amongst Competitive Cyclists.

The purpose of this study was to investigate competitive cyclists' helmet use, perceptions of sports-related concussion (SRC), and medical-care-seeking behaviors. A mixed-method approach was used with qualitative and quantitative data presented. The study comprised of a cross-sectional analysis of 405 competitive cyclists who completed an online survey. Results indicated that most participants believed a bicycle helmet protects against SRC (79.5%) and considerable numbers of participants would not seek medical care for potential head injury in scenarios where this would be recommended. It was also discovered that marketing of concussion reduction technology influences cyclists' helmet-purchasing behaviors. With the data presented, it is recommended that governing bodies in cycling need to develop educational resources to address gaps in knowledge regarding SRC amongst cyclists. We also suggest that more independent research on concussion reduction technologies in bicycle helmets is needed, with advertising supported by clear scientific evidence to avoid negatively influencing head injury management and reporting behaviors amongst cyclists.

Imposing Compulsory Rugby Union on Schoolchildren: An Analysis of English State-Funded Secondary Schools.

Objective: To establish the extent to which Rugby Union was a compulsory physical education activity in state-funded secondary schools in England and to understand the views of Subject Leaders for Physical Education with respect to injury risk. Method: A cross-sectional research study using data obtained under the Freedom of Information Act (2000) from 288 state-funded secondary schools. Results: Rugby Union was delivered in 81% (n = 234 of 288) of state-funded secondary school physical education curricula, including 83% (n = 229 of 275) of state-funded secondary school boys' and 54% (n = 151 of 282) of girls' physical education curricular. Rugby Union was compulsory in 91% (n = 208 of 229) of state-funded secondary schools that delivered it as part of the boys' physical education curriculum and 54% (n = 82 of 151) of state-funded secondary schools that delivered contact Rugby Union as part of the girls' physical education curriculum. Subject Leaders for Physical Education also perceived Rugby Union to have the highest risk of harm of the activities they delivered in their school physical education curriculum. Conclusion: Notwithstanding discussions of appropriate measures (i.e., mandatory concussion training, Rugby Union specific qualifications and CPD) to reduce injury risk, it is recommended that Rugby Union should not be a compulsory activity given that it has a perceived high risk of injury and is an unnecessary risk for children in physical education.