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.

Athletes who have already experienced an injury are more prone to adhere to an injury risk reduction approach than those who do not: an online survey of 7870 French athletics (track and field) athletes.

Objective: To compare the perception towards injury risk reduction approach between athletes who have already experienced an injury and those who have not. Methods: We conducted a cross-sectional study using a one-time online survey asking athletics athletes licensed at the French Federation of Athletics (http://www.athle.fr) about their perceptions regarding injuries and injury risk reduction behaviours. We statistically compared athletes who already experienced an injury and those who did not. Results: A total of 7870 athletes were included. 90% of athletes declared having experienced at least one injury. They (1) were proportionally more men than women, (2) had significantly more years of experience in athletics, (3) had a significant difference in disciplines (more hurdles, jumps and combined events and fewer sprint athletes), (4) had a significant difference in competition levels (more national and less departmental levels) and (5) reported significantly higher values or agreements in favour of injury risk reduction approach, compared with uninjured athletes. There were significantly more athletes declaring following injury risk reduction programmes among athletes who experienced at least one injury than those who did not. Conclusions: Athletes who experienced at least one injury during their lifetime were more prone to adhere to injury risk reduction strategies than athletes who have never experienced an injury. Their entourage (coaches and health professionals) should use this fertile ground to implement injury risk reduction strategies. In addition, their experience should be disseminated to uninjured athletes to help them adhere to injury risk reduction without injury experience.

FEPSAC Position Statement: Athletes' dual careers in the European context.

The aim of this FEPSAC Position Statement is to summarize current knowledge about athletes' dual careers (DCs) in the European context and propose recommendations for future DC research, practice, and policy. Inspired by the European Union's Guidelines on Dual Careers of Athletes (European Commission, 2012), researchers, practitioners, and policy makers collaborated over the last decade to create the European DC discourse as a context-informed and negotiated body of DC knowledge. In this paper, we proceed from analyzing this body of knowledge using recent review papers and European DC psychological research projects to formulating seven postulates summarizing DC research findings on factors influencing athletes in their striving for DC excellence. These factors include (1) context, (2) pathways and transitions, (3) challenges, (4) resources and coping, (5) support and empowerment, (6) student-athletes' mental health, and (7) DC development environments. In the final section, we acknowledge the contributions of European DC discourse in serving athletes in their pursuit of DC excellence and European DC culture. We also provide a critical discussion on DC knowledge gaps and, on behalf of FEPSAC, offer recommendations for DC research, practice, and policy in Europe.

Effects of Acute Physical Fatigue on Gaze Behavior in Expert Badminton Players.

Perceptual cognitive skills in real game settings, under conditions of fatigue, such as the ability to gather relevant visual information, are key factors in achieving motor goals in sports. The objectives were to evaluate the effects of acute physical fatigue on gaze behavior during a badminton game (Study 1) and in an unfavorable force ratio situation (Study 2). Six international-level badminton players played two sets and unfavorable force ratio situations while wearing eye-tracking glasses before and after a fatiguing task. During the set, fatiguing physical exercise led to fewer fixations per exchange and more fixations on one area of interest. During unfavorable force ratio situations, fatiguing physical exercise led to shorter fixation durations per exchange, shorter fixation durations on two areas of interest, and longer fixation durations on one area of interest. The results showed that gaze behaviors were adapted in acute physical fatigue conditions to maintain performance.

Relationship between a daily injury risk estimation feedback (I-REF) based on machine learning techniques and actual injury risk in athletics (track and field): protocol for a prospective cohort study over an athletics season.

INTRODUCTION: Two-thirds of athletes (65%) have at least one injury complaint leading to participation restriction (ICPR) in athletics (track and field) during one season. The emerging practice of medicine and public health supported by electronic processes and communication in sports medicine represents an opportunity for developing new injury risk reduction strategies. Modelling and predicting the risk of injury in real-time through artificial intelligence using machine learning techniques might represent an innovative injury risk reduction strategy. Thus, the primary aim of this study will be to analyse the relationship between the level of Injury Risk Estimation Feedback (I-REF) use (average score of athletes' self-declared level of I-REF consideration for their athletics activity) and the ICPR burden during an athletics season. METHOD AND ANALYSIS: We will conduct a prospective cohort study, called Injury Prediction with Artificial Intelligence (IPredict-AI), over one 38-week athletics season (from September 2022 to July 2023) involving competitive athletics athletes licensed with the French Federation of Athletics. All athletes will be asked to complete daily questionnaires on their athletics activity, their psychological state, their sleep, the level of I-REF use and any ICPR. I-REF will present a daily estimation of the ICPR risk ranging from 0% (no risk for injury) to 100% (maximal risk for injury) for the following day. All athletes will be free to see I-REF and to adapt their athletics activity according to I-REF. The primary outcome will be the ICPR burden over the follow-up (over an athletics season), defined as the number of days lost from training and/or competition due to ICPR per 1000 hours of athletics activity. The relationship between ICPR burden and the level of I-REF use will be explored by using linear regression models. ETHICS AND DISSEMINATION: This prospective cohort study was reviewed and approved by the Saint-Etienne University Hospital Ethical Committee (Institutional Review Board: IORG0007394, IRBN1062022/CHUSTE). Results of the study will be disseminated in peer-reviewed journals and in international scientific congresses, as well as to the included participants.

Vegetarianism and weight status: What are the differences in eating styles, impulsivity, and emotional competences? A preliminary study.

Recent studies suggest that vegetarian diets may be recommended to promote weight loss in individuals living with obesity. However, limited studies have examined psychological factors (e.g., eating styles, impulsivity) among individuals who have adopted this type of diet, even though these factors are known to play a role in being overweight. The primary objective of the present study was to compare these characteristics in participants living with obesity or those with normal-weight across diet types. Participants were recruited from two hospital nutrition departments and the general population. They completed a diagnostic interview assessing the presence of an eating disorder, followed by self-administered questionnaires measuring dysfunctional eating styles (DEBQ), impulsivity (UPPS), and emotional competence (PEC). Vegetarian participants living with obesity engaged in more dysfunctional eating styles than did normal-weight omnivores and experienced more emotional difficulties than did both normal-weight omnivores and vegetarians. In contrast, there were no significant differences between omnivore participants living with obesity and those in the other groups. Moreover, participants living with obesity had comparable emotion regulation abilities to normal-weight participants. These results suggest that emotion regulation deficits can more likely be explained by the presence of psychopathological traits than by being overweight or one's choice of diet.

French Athletics Stakeholders' Perceptions of Relevance and Expectations on Injury Prevention.

This study aimed to explore how stakeholders in athletics perceive the relevance of injury prevention, determine their communication preferences, and describe their expectations regarding injury prevention. We conducted a cross-sectional study using an exploratory online survey with high-level athletes (i. e. listed by the French ministry of sports), non-high-level athletes (i. e. all competitive level except high-level athletes), coaches, and health professionals licensed with the French Federation of Athletics. The survey was composed of three parts regarding stakeholder's characteristics (4 questions), perceived relevance (2 questions), communication preferences and expectations (3 questions) towards injury prevention. There were 2,864 responders to the survey. Almost all responders found that injury prevention is relevant (97.7% [95% CI 97.0% to 98.2%]), without any significant differences in the distribution between stakeholders' age, experience and sex (p>0.05). About three-quarters of the stakeholders preferred to find injury prevention information on a website (77.4%) without significant differences between stakeholders' categories (p>0.05); other media to find injury prevention information was chosen by less than 50% of responders. Expectations about injury prevention were mainly explanations, advice and tips about injury knowledge, management and prevention, based on expert opinion and/or scientific research. In conclusion, these results confirm that injury prevention is a challenge shared by numerous stakeholders in athletics, within France, and provide some orientation on how and what information to disseminate to these stakeholders.

Determinants of the adoption of injury risk reduction programmes in athletics (track and field): an online survey of 7715 French athletes.

OBJECTIVES: To identify individual characteristics associated with the adoption of injury risk reduction programmes (IRRP) and to investigate the variations in sociocognitive determinants (ie, attitudes, subjective norms, perceived behavioural control and intentions) of IRRP adoption in athletics (track and field) athletes. METHODS: We conducted a cross-sectional study using an online survey sent to athletes licensed with the French Federation of Athletics to investigate their habits and sociocognitive determinants of IRRP adoption. Sociodemographic characteristics, sports practice and history of previous injuries were also recorded. Logistic regression analyses and group comparisons were performed. RESULTS: The final sample was composed of 7715 athletes. From the multivariable analysis, competing at the highest level was positively associated with IRRP adoption (adjusted OR (AOR)=1.66; 99.9% CI 1.39 to 1.99 and AOR=1.48; 99.9% CI 1.22 to 1.80) and presenting a low number of past injuries was negatively associated with IRRP adoption (AOR=0.48; 99.9% CI 0.35 to 0.65 and AOR=0.61; 99.9% CI 0.44 to 0.84), both during their lifetime and the current season, respectively. These results were supported by higher scores of sociocognitive determinants among athletes who reported IRRP adoption compared with other athletes. CONCLUSION: Some characteristics of athletes seem to be associated with IRRP adoption either positively (competing at the highest level) or negatively (presenting a lower number of past injuries), whereas all the sociocognitive determinants tested appear to be linked to IRRP adoption. Since many athlete characteristics are difficult or impossible to change, IRRP promotion may be enhanced by targeting athletes' beliefs and intentions to adopt an IRRP.

Effects of Acute Physical Fatigue on Gaze Behavior and Performance During a Badminton Game.

In badminton, the ability to quickly gather relevant visual information is one of the most important determinants of performance. However, gaze behavior has never been investigated in a real-game setting (with fatigue), nor related to performance. The aim of this study was to evaluate the effect of fatigue on gaze behavior during a badminton game setting, and to determine the relationship between fatigue, performance and gaze behavior. Nineteen novice badminton players equipped with eye-tracking glasses played two badminton sets: one before and one after a fatiguing task. The duration and number of fixations for each exchange were evaluated for nine areas of interest. Performance in terms of points won or lost and successful strokes was not impacted by fatigue, however fatigue induced more fixations per exchange on two areas of interest (shuttlecock and empty area after the opponent's stroke). Furthermore, two distinct gaze behaviors were found for successful and unsuccessful performance: points won were associated with fixations on the boundary lines and few fixation durations on empty area before the participant's stroke; successful strokes were related to long fixation durations, few fixation durations on empty area and a large number of fixations on the shuttlecock, racket, opponent's upper body and anticipation area. This is the first study to use a mobile eye-tracking system to capture gaze behavior during a real badminton game setting: fatigue induced changes in gaze behavior, and successful and unsuccessful performance were associated with two distinct gaze behaviors.

Exercise-Based Injury Prevention in High-Level and Professional Athletes: Narrative Review and Proposed Standard Operating Procedure for Future Lockdown-Like Contexts After COVID-19.

In regular times, implementing exercise-based injury prevention programs into the training routine of high-level and professional athletes represents a key and challenging aspect to decrease injury risk. Barriers to implementing such prevention programs have previously been identified such as lack of resources, logistic issues or motivation. The COVID-19 pandemic associated with restrictions on daily life dramatically impacted sports participation from training to competition. It is therefore reasonable to assume that such lockdown-like context has exacerbated the challenge to implement exercise-based injury prevention programs, potentially leading to a greater musculoskeletal injury risk. In this narrative review, recommendations are proposed for building an expertise- and evidence-based Standard Operating Procedure for injury prevention in lockdown-like contexts for high-level and professional athletes. The following recommendations can be provided: (1) assess the global and sport-specific risks in the light of the ongoing cause of isolation; (2) adapt remote training materials and programs; (3) ensure regular quality communication within the staff, between athletes and the staff as well as between athletes; (4) follow the athlete's mental well-being; and (5) plan for a safe return-to-sports as well as for an ongoing monitoring of the load-recovery balance. These key domains should further be addressed to comply with local policies, which are subject to change over time in each individual country. The use of these recommendations may improve the readiness of athletes, coaches, physicians and all sports stakeholders for future lockdown-like contexts.

Anxiety and Motivation to Return to Sport During the French COVID-19 Lockdown.

Feeling anxious and presenting self-determined motivations about returning to sport after a break may impair sport performance and increase the risk of sustaining an injury. Hence, the aim of this study is to explore differences in anxiety and motivation to return to sport according to gender, expertise, training status before and during the lockdown, and athletes' availability (i.e., injury status) at the time of the lockdown. A total of 759 competitive athletes (49% female; mean age: 27 ± 10 years old) completed the cross-sectional study. Participants were invited to state their expertise, training status before and during the lockdown (did they have a training program), and whether they were injured at the start of the lockdown. Additionally, participants filled out psychometric self-report measures of anxiety (TFAI-return) and motivation (SMS-return) to return to sport. Due to non-normal distributions in the TFAI and SMS scores, non-parametric group comparisons were performed to compare participants for each categorical variable: non-parametric correlation tests were also performed to test the associations between continuous variables. Group comparisons showed higher scores of anxiety for females, younger athletes, athletes practicing and competing at the highest level, and athletes without a training program during the lockdown. Moreover, results suggested lower motivation scores (i.e., autonomous and controlled) for older athletes, experts (practicing for more than 10 years), athletes practicing and competing at a lower level, and athletes without a training program during the lockdown. Additionally, participants who were injured at the start of the lockdown reported higher scores of cognitive anxiety to return to sport than non-injured participants. The results of this study suggest that elite athletes may have suffered from external pressures to return to sport during the lockdown. Additionally, participants with a training program during the lockdown seemed to be less anxious and more self-determined to return to sport after the lockdown. Future studies may focus on the impact of cognitive behavioral interventions on anxiety and motivation to return to sport.

Associations of lifetime traumatic experience with dysfunctional eating patterns and postsurgery weight loss in adults with obesity: A retrospective study.

This study aimed to examine the associations of lifetime traumatic experience with presurgery and postsurgery eating pathology and postoperative weight loss in a sample of adult bariatric surgery patients using electronic medical record (EMR) data. Presurgery lifetime exposure to traumatic event, presurgery and postsurgery dysfunctional eating patterns, and post-operative total and excess weight losses were extracted from electronic medical records of 200 adult bariatric surgery patients in 2013 and 2014. Logistic regression analyses were conducted. During their lifetime, 60.5% of the patients (81.5% women, age = 44.4 ± 11.5 years; BMIpre = 44.9 ± 5.5 kg/m2 ) reported that they were exposed to a traumatic event. Before surgery, trauma exposure was associated with impulsive, compulsive, or restrictive eating patterns (OR = 2.40), overeating or disturbed eating (OR = 1.55), and grazing or night eating behaviours (OR = 1.72). After surgery, trauma exposure was associated with lower total weight loss at 6 (OR = 2.06) and 24 months (OR = 2.06), and to overeating or disturbed eating (OR = 1.53) 12 months after surgery. Bariatric surgery candidates with a history of trauma exposure could benefit from closer medical, dietetic, and/or psychological follow-up care to avoid insufficient postoperative weight loss as well as reappearance of dysfunctional eating patterns after surgery.

Differential Associations Between Excess Body Weight and Psychiatric Disorders in Men and Women.

BACKGROUND: The current investigation is the first large-scale population-based study from France that documents the association between excess body weight and common psychiatric disorders, and examines the influence of gender on the association between excess body weight and these disorders. A recent plan has been implemented in France to treat the rising rate of those who are overweight or obese, and we seek to demonstrate whether integrated treatment of excess weight and psychiatric conditions appears as indicated. MATERIALS AND METHODS: Data were drawn from a cross-sectional general population survey of 17,237 adults. Past-year psychiatric disorders were assessed using the Composite International Diagnostic Interview-Short Form. Body mass index was used to determine excess weight status. RESULTS: Overall, 3.7% of the sample were underweight, 57% were normal weight, 28% were overweight (35% of men, 22% of women), and 11% were obese (11% of men, 11% of women). Being overweight was more common in men than women, although obesity did not differ by gender. Sociodemographic variables significantly associated with weight status included, age, marital status, education, employment status, income level, and population density. Adjusting for these variables, being overweight was associated with major depression and other disorders among women and inversely associated with drug abuse and dependence among men. Obesity was associated with major depression, panic disorder, agoraphobia, social phobia, specific phobia, and obsessive-compulsive disorder among women. Only generalized anxiety was associated with obesity among men. CONCLUSION: Past year, mental disorders were more likely associated with being overweight or obese among women as compared with men. The prevalence of these co-occurring psychiatric disorders in the context of the rising rate of obesity in France indicates a clear need for psychiatric assessment and treatment in caring for those with excess weight, especially women. Preliminary reports suggest this need is unmet within the otherwise progressive move in France to assist those struggling with excess weight.

The effects of mindfulness training on weight-loss and health-related behaviours in adults with overweight and obesity: A systematic review and meta-analysis.

The aim of this study was to conduct a comprehensive quantitative synthesis of the effects of mindfulness training interventions on weight-loss and health behaviours in adults with overweight and obesity using meta-analytic techniques. Studies included in the analysis (k=12) were randomised controlled trials investigating the effects of any form of mindfulness training on weight loss, impulsive eating, binge eating, or physical activity participation in adults with overweight and obesity. Random effects meta-analysis revealed that mindfulness training had no significant effect on weight loss, but an overall negative effect on impulsive eating (d=-1.13) and binge eating (d=-.90), and a positive effect on physical activity levels (d=.42). Meta-regression analysis showed that methodological features of included studies accounted for 100% of statistical heterogeneity of the effects of mindfulness training on weight loss (R2=1,00). Among methodological features, the only significant predictor of weight loss was follow-up distance from post-intervention (ß=1.18; p<.05), suggesting that the longer follow-up distances were associated with greater weight loss. Results suggest that mindfulness training has short-term benefits on health-related behaviours. Future studies should explore the effectiveness of mindfulness training on long-term post-intervention weight loss in adults with overweight and obesity.

Randomized controlled trial of a 12-month computerized mindfulness-based intervention for obese patients with binge eating disorder: The MindOb study protocol.

BACKGROUND: Mindfulness-based interventions for healthy behaviors such as exercise and dietary modifications have aroused growing interest. This study aims to test the effectiveness of a mindfulness-based intervention for the reduction of impulsive eating and the improvement of motivation to exercise among obese individuals. METHODS: One-hundred and twenty obese outpatients, aged 18 to 65years, diagnosed with a binge eating disorder, will be randomly assigned to one of the three following groups: mindfulness practice, sham meditation, or treatment as usual control. The tested intervention consists of a 1-year computerized mindfulness-based program. Mindfulness sessions are audio recordings that the patients are asked to listen to, 10min every day. Self-reported questionnaires measuring impulsive eating, motivation to exercise, physical activity level, mood, and mindfulness skills are filled in at baseline, 1, 6, and 12months. Physical activity, calories consumption, and biomarkers are measured with more objective measurement tools at baseline, 6months and 12months. CONCLUSION: Mindfulness, as both a de-automation element and as a moderator of motivation to exercise, can lead to the reduction of impulsive eating and also to an increase in levels of physical activity. These effects could cause weight loss in obese patients suffering from binge eating disorder. TRIAL REGISTRATION: clinicaltrials.gov: NCT02571387.

Do karate fighters use situational probability information to improve decision-making performance during on-mat tasks?

This study examined the contribution of situational probability information to the perceptual and cognitive processes underlying decision-making behaviour during in situ Karate performance. Experts and novices were required to make decisions about various attacks in different fight scenarios. The order in which the fight situations were presented was modified in order to provide advanced probability information and identify whether fighters were able to use the latter information to make better decisions. Specifically, one of the attacks was repeated every four actions. Results revealed that experts were more accurate and faster than their less skilled counterparts to block and counterattack the opponent. The experts picked up the occurrence of the attack pattern after the fifth repetition whereas novices did not. This enabled experts to improve decision time and decision accuracy. Findings suggest that such superiority could stem from the perceptual and cognitive skills possessed by the experts, thus giving them the opportunity to recognise a situation more easily. This was reinforced by gaze behaviour which demonstrated that experts used a more efficient search strategy involving fewer fixations of longer duration on a lesser number of areas relative to the novices. Moreover, experts generated more refined karate-specific knowledge structures compared with the novices.

A Cognitive and Virtual Reality Treatment Program for the Fear of Flying.

BACKGROUND: Passenger air transport has considerably increased in the past 50 yr. It is estimated that between 7 and 40% of the population of industrialized countries is currently afraid of flying. Programs treating the fear of flying have been developed to meet this problem. This study measures the effectiveness of one of these programs by focusing on flight-related anxiety before the program and after the first flight following the intervention. METHODS: There were 157 individuals recruited to participate in a 1-d intervention aiming at treating the fear of flying, and using both cognitive behavioral techniques and virtual reality. Anxiety was measured with the Flight Anxiety Situations (FAS) and the Flight Anxiety Modality (FAM) questionnaires. RESULTS: Statistical analyses were conducted on 145 subjects (69.7% female; ages from 14 to 64) after the exclusion of individuals with missing data. The results showed a decrease in flight-related anxiety for each subscale of the two questionnaires: the somatic (d=2.44) and cognitive anxiety (d=1.47) subscales of the FAM, and the general flight anxiety (d=3.20), the anticipatory flight anxiety (d=1.74), and the in-flight anxiety (d=1.04) subscales of the FAS. CONCLUSIONS: The effectiveness of the treatment program using both cognitive behavioral techniques and virtual reality strategies for fear of flying reduced flight-related anxiety in the subjects in our study. Our results show that subjects demonstrated lower anxiety levels after the first flight following the program than before the intervention.