case study of sports person

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Climbing Nutrition

Case study #1: simon (20-year-old athletic male).

by Brian Rigby, MS, CISSN

March 31, 2016 10 Replies

Case Studies

Since I started this blog almost a year ago, I’ve written many articles on good practices in sports nutrition, eating for climbing performance, and also on popular myths that ought to be debunked. I hope that through these articles you have been able to make healthy changes to your diet, and as a result have seen your climbing improve.

This is all good, but there’s still something missing—sometimes it’s hard to bridge the gap between theory and practice. For this reason, I’m debuting a new type of feature I’ll be running every now and again on Climbing Nutrition: Case Studies . Basically, I’m going to show you some of the process I would go through were I to see a particular individual as a client.

Though each case study is by nature individual (and therefore not necessarily cut to fit your own physiology), the basic work remains similar—so you should be able to go through the process yourself to come up with your own results.

Alright, let’s begin:

Client Information

Name: Simon Age: 20 Sex: Male Height: 5′ 10″ (178 cm) Weight: 145 lbs (66 kg)

Client’s Reason for Inquiry

I climb 3-4 days each week and ski (teaching and touring) another 2. For a long time, I’ve tried to keep my weight low in order to have the best strength-to-weight ratio, but whenever I make gains on the strength side from my training it doesn’t seem to transfer to my climbing. I’ve been stuck at v5-v6 for about a year now.

Simon’s weight and height gives him a BMI (body mass index) of 20.8, well within the healthy range of 18.5 to 24.9. A flaw in the design of the BMI, however, is that it cannot accurately measure fat mass vs. lean mass. Athletes tend to have greater amounts of lean mass (and less fat) than the average individual whom the BMI was designed for, and so in reality Simon is likely even leaner than the BMI indicates (in extreme cases, large athletes can appear to be “overweight” according to their BMI due to muscle mass). Without a body fat reading we cannot know for certain, but it’s probable that Simon has no more than 10-12 lbs of (perfectly healthy) fat he could lose before dropping into an unhealthy range. Thus, as far as strength-to-weight ratio is concerned, losing weight is not likely to yield a major benefit, especially for the amount of work it would require to lose fat below this already low level.

In our correspondence, Simon says he eats around 2,400 calories each day. Since Simon exercises 5-6 days each week, it’s unlikely this is enough calories to support his strength goals. Instead, this amount of energy is likely to be on the lower end of weight maintenance—a sort of metabolic limbo where the body attempts to preserve muscle tissue but doesn’t have enough energy to support muscle growth. Chances are good that Simon could eat significantly more calories each day and still maintain weight, or gain only minimal weight through muscle gain. He will also have more energy to train harder (or longer at a higher intensity), which will have even more significant effects on his strength.

Client Caloric Goal

Using the Harris-Benedict Energy Equation , we can calculate that Simon has a basal metabolic rate (BMR) of roughly 1,675 kcal/day.

Harris-Benedict Energy Equation

• Imperial: (4.55 * weight in lbs) + (15.88 * height in inches) – (5 * age in years) = BMR
• Men: Add 5 calories to the calculated BMR
• Women: Subtract 161 calories from the calculated BMR

A BMR only covers the essential functions necessary for sustaining life at its most basic level, though; unless Simon is literally lying in bed all day—eating nothing, drinking nothing, doing nothing—we need to multiply it by the appropriate modifier. There are two ways of doing this: the simple, averaged approach; or the more complex, individualized approach. Since Simon has given me a breakdown of his weekly activities, I will ultimately use the individualized approach. First, however, I’ll show you the generalized approach in case you choose to use this method instead.

Harris-Benedict Activity Modifiers

• Sedentary:  BMR * 1.2
• Light (1-3 days/week):  BMR * 1.375
• Moderate (3-5 days/week):  BMR * 1.55
• Vigorous (6-7 days/week):  BMR * 1.725
• Extreme (6-7 days/week, multiple workouts per day):  BMR * 1.9

Since Simon exercises an average of 5-6 days per week (3-4 days climbing, 2 days skiing), he falls into the “Moderate” to “Vigorous” category of physical activity level. “Moderate” has a modifier of 1.55, while “Vigorous” has a modifier of 1.725. Thus, for a more moderate week, Simon will need roughly 2,600 kcal per day (1,675 kcal/day * 1.55), while a more vigorous week calls for roughly 2,900 kcal per day (1,675 kcal/day * 1.725).

Based on this information, Simon’s daily intake appears to be 200-500 calories shy of the recommended amount for maintainance—and low enough to have a noticeable negative impact on his climbing and training. By increasing calories to the recommended amount, he would have more energy, gain strength easier (and transfer that strength to climbing), and still maintain weight.

Really, though, it’s better to individualize your plan whenever you can. The problem with modifiers is that they’re very broad, subject to interpretation, and error-prone. For example, it would appear based on the above list that exercising for one hour three days a week and exercising for two hours five days a week are equivalent, when it’s instantly apparent that they’re not—but two people might still calculate their metabolic rates as equivalent based on the above modifiers, despite having wildly different lifestyles! Furthermore, there’s no concern with intensity. An hour of walking is equivalent to an hour of race-pace running, even though there is a huge difference in the calories burned by each activity. An individual approach overcomes these limitations.

To individualize your plan, you just need to know approximately how many calories your chosen exercises burn, and approximately how long you engage in them each day. There is still room for error (overestimation of intensity or time, for example), but these errors will likely be much smaller in magnitude—only a 25-100 calorie difference across a day, rather than a 200+ calories difference.

The first step in an individualized plan is to calculate your  sedentary metabolic rate —your BMR multiplied by the sedentary modifier of 1.2. This sedentary rate accounts for all the little things we do everyday that are  not included in your BMR, such as eating, sitting upright, walking around, standing, etc. Simon’s sedentary rate is roughly 2,000 calories per day (1,675 * 1.2 = 2,010).

Next, we determine the average caloric cost of the activities Simon engages in. The easiest way to go about this is to just use an online calculator such as this on e and plug in your weight and the activity you’re interested in.

For Simon (weight 145 lbs), ski touring will burn between 400 (for an easy pace on gentle terrain) to 525 (for vigorous effort) per hour, with higher rates possible for certain conditions. Teaching skiing is a little harder to quantify because it’s variable, but light downhill skiing burns roughly 264 calories per hour (this would only include the time actually  skiing , not chairlifts, etc.) and it’ll likely be at least that.

According to the exercise calculator, climbing burns about 660 calories per hour, but we can be more specific here based on intensity. Based on this research , climbing burns roughly 17 kcal/minute for easy routes, 19 kcal/minute for moderate routes, and 22 kcal/minute for difficult routes (for an experienced climber). For a new climber, a difficult route—“difficult” is relative to skill, by the way, not absolute based on grades—burns 23 kcal/minute. Bouldering is of higher intensity, so it’s possible that it burns even more calories, but given the lack of data we’ll just assume it burns 22 kcal/minute. This is “on the wall” time only, which varies from person to person, but is likely to average 10-20 minutes per hour for bouldering. That means that each hour of bouldering will burn an average of 220-440 kcal.

Now, all we have to do is multiply each activity’s caloric cost by the time spent doing it and add that to Simon’s daily total. If we assume he climbs two hours per day with an average amount of “on the wall” time, he would burn 660 calories doing so. That means he should consume about 2,660 calories on a day he climbs (2,000 from his sedentary metabolic rate and 660 from his activities) to maintain weight. Or, on a day of ski touring that lasts six hours, he should consume 4,400 calories to maintain weight.

Macronutrient Breakdown

The final step is to determine the macronutrient breakdown of any given day. This is perhaps a little more complicated just because protein needs remain static  (roughly 100-160 grams per day) while carbohydrate and fat needs will vary based on total daily activity. Normally when I work with clients, I provide a “base goal” for each macronutrient (in addition to calories) and then a “per hour of exercise” goal as well (with variations according to intensity), but here I’m going to show a slightly easier variation.

First, based on Simon’s BMR of 2,000 calories per day, protein should account for roughly 24% of the calories in his diet (120 grams of protein at 4 calories per gram equals 480 calories, divided into 2,000 calories equals 24%—the 120 grams is the important part). Since this is a sedentary day, we’ll leave carbohydrates towards the lower end at 50%, which leaves fat at 26%. Even though 50% isn’t ideal for aerobic activities such as ski touring , the actual percentage will wind up being significantly  higher on ski touring days because protein doesn’t increase. If this isn’t clear right now, don’t worry, you’ll see the math in just a bit.

Simon’s Macronutrients on a Sedentary Day

• Protein:  120 g (480 kcal; 24%)
• Carbs:  250 g (1,000 kcal; 50%)
• Fat:  58 g (520 kcal; 26%)

To determine what his needs will be on non-sedentary days, we’ll figure out the ratio of carbohydrate-to-fat calories. In Simon’s case, it’s roughly 2-to-1 (50% carbs to 26% fat, or 50:26 –> 1.92:1), and he should try to keep this ratio approximately the same on active days as well. That means getting two calories of carbohydrate-based energy for every single calorie of fat-based energy.

For those interested in the gram-to-gram breakdown, carbohydrates weigh in at 4 calories per gram and fat weighs in at 9 calories per gram, which makes the gram of carbohydrate to gram of fat ratio about 4.5:1 (1/2 gram of carbohydrates for every 1/9 gram of fat). This isn’t necessary to figure out the rest of Simon’s macronutrient schedule, though, so don’t worry too much about it.

On days when Simon climbs, he should consume an estimated 2,660 calories (or more or less depending on the total amount of climbing). When the 480 calories from protein are subtracted, we are left with 2,180 calories—66.6% of which should come from carbohydrates, and 33.3% of which should come from fat (that 2-to-1 ratio). That comes out to roughly 1,440 carbohydrate calories (55% of his total caloric intake) and 720 fat calories (27% of his total caloric intake), which is about 360 grams of carbs and 80 grams of fat. So Simon’s climbing day macronutrients look more like this:

Simon’s Macronutrients on a Climbing Day

• Protein:  120g (480 kcal; 18%)
• Carbs:  360 g (1,440 kcal; 55%)
• Fat:  80 g (720 kcal; 27%)

Already you can see that carbohydrates are playing a much more significant role!

Now let’s do the same operation for the ski touring day. Removing the 480 calories of protein from the assumed 4,400 he will burn throughout the day, we are left with 3,920 total calories. At a 2:1 carb/fat ratio, about 2,600 of those calories should come from carbs while 1,300 should come from fat—this is equivalent to 650 grams of carbs and 144 grams of fat. Now, carbohydrates make up about 59% of his diet, fat is about 30%, and protein is only 11%!

Simon’s Macronutrients on a Ski Touring Day

• Protein: 120 g (480 kcal; 18%)
• Carbs: 650 g (2,600 kcal; 59%)
• Fat: 144 g (1,300 kcal; 30%)

The greater Simon’s caloric need, the greater role carbohydrates will play in his day, according to our specified ratio. Moving from a sedentary day to a moderately active climbing day to a significantly active ski touring day, Simon’s carbohydrate goal moves from 50% to 55% to almost 60% while fat only moves from 26% to 30% (and protein dwindles in relative “importance”).

For most people, starting with a similar caloric ratio (roughly 1:2:1 protein/carbs/fat) as the one demonstrated here is probably adequate, especially if you do a combination of anaerobic (bouldering, single-pitch sport climbing, campus training, fingerboarding, etc.) and aerobic (low-intensity multi-pitch climbing, hiking, cycling, etc.) activities. If you’re much more on the anaerobic side of spectrum, you can safely alter the carb-to-fat ratio to be 1.5:1 (45% carbohydrates, 30% fat on a sedentary day) without affecting performance. If you engage in a lot of aerobic activity, you may wish to increase it to 2.75:1 (55% carbohydrates, 20% fat on a sedentary day) or even 4:1 (60% carbohydrates, 15% fat on a sedentary day).

Test in the Real World

Determining theoritical ratios is only the first step for any nutrition plan. After we have a target to aim for, we need to gauge it against real world results, which means implementing the plan and monitoring Simon’s weight. If Simon continues to maintain weight with the increased caloric load, then we know we’ve hit about the right area, and we might even increase calories slightly until we find the point at which he starts to gain weight (so we can be certain he is doing the most for muscle recovery and strength gain). If Simon gains weight, then we’ll back calories off slowly until he starts to maintain again. He shouldn’t lose weight since we’re increasing calories.

Aside from monitoring progress in a concrete way such as through weight maintenance (or body fat readings, if he had a way to do it), Simon should also subjectively feel stronger and more able to translate his training strength gains to his climbing. He should have more energy, recover faster, and stay strong longer. If all of this is true, and his weight is stable, then we would consider Simon’s plan to be successful and he would follow it until his goals changed. If there are problems that persist longer than a week or two (the amount of time it can sometimes take to “break in” a diet), then we’ll make some changes depending on the specifics of the problems.

Wrapping Up

Simon is a great example of an average, active male climber. His focus on staying lean no matter the cost was inhibiting his strength gains on the wall and providing no discernible benefit since he was already quite lean. By increasing his daily calories to a more appropriate level, he should be able to continue to maintain weight while improving his ability to gain strength. If followed accurately for an extended period of time, he may even gain small amounts of muscle and lose equal amounts of fat (AKA “body recomposition”), thereby dramatically improving his strength-to-weight ratio.

If Simon does not resemble you or your goals, don’t fret! This is just our first case study, and I’ll more than likely cover someone with a similar goal or physique to your own in the future. In the meantime, you should hopefully be able to apply the lessons learned from this first case study to yourself (provided your goal is weight maintenance) and get positive results.

If you have questions about this case study, please ask them in the comments below so I can answer publicly on this page and clarify the confusion for everyone! If you think you’d be a great example for a case study, fill out the form on this page and  please be patient. I will do my best to answer your needs via email (at the least), or possibly use you as another example in the months to come.

Until next time!

10 comments

Very interesting from a theoretical point of view. But it seems almost impossible to implement in the real world. How does numbers and ratios translate to real food. It must take a lot of planning just to figure out what to actually eat. Also, how can you time your food intake on a normal workday that leaves little or no room for frequent food breaks and prepping.

Also, I have been a hardgainer my whole life and I can testify to eating enough calories is no way as easy as stated in post. Seems like you need to eat tons of food in very frequent intervals. Again the macro breakdown leads to a more practical issue: How does numbers translate to real food?

There are logistical issues, to be sure—issues that are probably better tackled in a separate post—but let me try to provide a little hope here. Let’s assume Simon will have the chance to eat 5 meals/snacks on a given climbing day. With his base carb requirement of 250 grams, that means he should eat approximately 50 grams of carbohydrate per meal, or just over a single cup of most cooked starchy carbs. A cup is not a lot, so this shouldn’t be infeasible. The remaining 110 grams of carbs that he needs from climbing can come from preloading before exercise (slow-digesting carbs to buoy blood glucose during his climb), intraexercise replenishment (such as a sports drink, or fruit), or afterwards in the form of extra food (over the next few hours, about an extra 2.5 cups of starchy carbs). In this case, I’m only focusing on carbohydrates because they are the most challenging to get enough of for most people, at least without resorting to highly concentrated forms like refined sugars.

A ski touring day would be more challenging, but since he will presumably be exercising with little break we can rely more on the above-mentioned concentrated sources, which will also be easier to digest during exercise. Dried fruit, sports drink mixed into his water, and granola bars all make it easier to get the necessary number of calories.

In all cases, it does take planning, but the end result is worth it, I think. Energy will be higher, recovery faster, and training gains will be increased. This isn’t to say everyone must plan like this, but rather than there’s value in doing it if you care to, just as there’s value in putting together a training schedule and sticking with it despite the logistical and motivational problems associated with putting together a weeks-long exercise schedule in advance. But, as I said, I think another post will ultimately do your question/comment more justice, so I’ll try to get one out soon!

you have a great blog here! would you like to make some invite posts on my blog?

Thanks! Send me an email here if you’re interested in guest posts .

Thank you for this post. It is very helpful. Because I don’t want to pay the $39.95 to read the article at https://link.springer.com/article/10.1007%2Fs00421-007-0501-0 , could you help me in determining the number of calories burned per minute for a 115# female for easy, moderate, and difficult bouldering ? I assume the numbers in the case study, 17 kcal/minute for easy routes, 19 kcal/minute for moderate routes, and 22 kcal/minute for difficult routes, are specific to Simon’s weight.

The numbers provided were based on the averages in the article itself, which were themselves based on an average weight of 64 kg (141 lb). It’s an imperfect approximation, but we just really don’t have any good data on the caloric cost of climbing so it’s the best I could offer! Based on weight, we could estimate up or down by the same factor as the weight change and get in the same ballpark, so a heavier 160 lb climber might burn 19 kcal/min while a lighter 120 lb climber might burn 15 kcal/min. But, these are only estimates because it’s tough to know precisely how the caloric costs associated with climbing relate to weight compared to how they do for running or other more well-studied sports. Sorry I couldn’t give a more precise answer!

I have a question with regard to carbohydrates. Do they include fibre or not? I used the formula kcal from all carbohydrates equals 4*gramms of carbohydrates + 2*gramms of fibre. And then I took the ratio 2:1 for all carbohydrates to fat. Is that correct in your opinion? The fibre should somehow be included since it contributes to the calorie intake.

Thank you very much and best regards, Chris

Fiber doesn’t have a significant effect on our caloric intake since it’s indigestible. Some fibers are fermentable by our gut bacteria and those bacteria will release short-chain fatty acids as a by product that will be absorbed and used by the cells lining our intestine and thereby technically add to our caloric intake, but overall the net calories from fiber will be negligible.

Since Simon is active on most days of the week, there are days when he is not. Compute for his TER on his sedentary days.??

Since Simon is active on most days of the week, there are days when he is not. Compute for his TER on his sedentary days.

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This case study will closely examine and outline a sports person.

Sarah: a case study

This case study will closely examine and outline a sports person. It will provide an insight into the psychological concept of the individual, describe the consequences of this psychological concept and give a theoretical underpinning and possible suggestions of how to explain the individual’s behaviour.

The individual:

The individual in this case study is called Sarah, a 27 year old female, playing table tennis. Having started at the age of 19, she is now in her eighth year of playing, she only started playing regularly and competitive, i.e. twice or three times a week, at the age of 22 when she finally joined a club to enter competitions. She is not only competing for a local club but in addition she is part of the university squad and also plays occasionally for the county team competing in the 2 nd  division. Even though she is already aged 27, she is still pursuing higher ambitions, playing as a regular team member for the county league and hoping for selection into the regional team to represent North England.

The last season has been fairly successful for Sarah, having only lost very few matches. Her local team got promoted into a higher local division and is still ambitioning a further promotion with her being the most successful player in the team and one of the most successful in the league.

The start of the actual season was very promising for Sarah and her team having won all matches so far and being number one in the league table. But her appearance in the county league was not as successful. Having won the first match, she got injured in the second match, entirely rupturing one of her dominant foot’s ankle tendons. A surgery had been undertaken to fix the tendon. The accident caused a three months break from any physical activity but included physiotherapy. After this break she appeared back on court, first losing her matches but then winning occasionally. She is now slowly getting back to her old strength. Her team meanwhile lost the top position and is now third in the league, still in a good position to come back to the lead.

The psychological concept:

Sarah is reporting a severe loss of self-confidence. Feeling unsure about her ability to play well, she is not only worrying about her self and her original ambitions but also about what her fellow team members and her coach is thinking about her. Even though no negative comments about her performance were mentioned, she feels that her losses have affected the team’s overall ability. Guilt is arising in her. Not only the team’s hope for promotion seems to have gone, Sarah is very doubtful about becoming a full member of the county squad. She is now feeling very disappointed that her ambition for a national team seems to have completely gone. She is thinking that her age plus the injury and the time she’ll need to come back to full strength will not make her ambitions become fulfilled.

When playing she feels weak and tends to think back to the times when she wasn’t injured, often saying to herself: “If I haven’t had this injury, we would still be top of the league and I wouldn’t have lost so many matches. Normally I could have beaten these opponents easily but I feel so weak on my foot since the accident”.

Consequences of the psychological concept:

Due to her ankle injury not only Sarah’s behaviour but also her cognitions and perceptions as well as emotions have been affected and changed.

This is a preview of the whole essay

Her performance is weaker than before her injury, even though occasional wins occur. No longer is she the dominating player in the team nor the league. Within her behaviour, a change of performance style can be noticed. She now is defensive and temporising rather than aggressive and impulsive. She is trying not to put too much impact on her injured foot as she fears another injury could happen even though her GP has told her the tendon is now stronger and more stable than before. But Sarah is still wearing a special support on her ankle, thinking that without she couldn’t uphold the fast game’s demandings.

Sarah has also started negative self talk affecting her cognitions and perceptions of her play. She is putting herself into pressure as she is blaming her poor performance to have caused a knock-on effect on to the team’s performance.

She is disappointed being no longer a good performer and losing against opponents she once had beaten easily. Worries and guilt have arisen as well as fear of a future injury in her injured foot that she perceives as weak.

Effects on the performance:

Sarah is now doubting about her own ability to play and competing well enough for the team and her ambitions. As she has lost several matches since coming back from her injury break, she changed her tactical behaviour from playing aggressively to a more defensive and temporising play. Since then, she has become more successful even though not every one of her matches has been won. Occasionally she is playing aggressively but most of the time she is hoping for errors made by her opponents. Her overall fitness has been affected by the injury causing her to feel weak and tired after a short time of play. Nervousness before and during a match is now felt more often by her, causing a lot of unforced errors in her performance resulting in a loss of the match.

Theoretical underpinning:

Trying to describe and explain Sarah’s behaviour, cognitions and affects, different theories can be used. The most helpful however would be those examining the self-confidence of the individual. Therefore, the most useful will be Bandura’s self-efficacy theory.

According to Cox (1998), self-efficacy is a situation specific self confidence. Additionally, Gill (2000) states that it is also the belief or the perception that one is competent and can do whatever is necessary in a specific situation to perform a task successfully.

The following diagram according to Gill (2000) and Weinberg & Gould (1995) will illustrate Bandura’s theory:  

                                            ↘                          

                                            ↘    

                                                                                          ➔

                                            ↗

Performance accomplishments, according to Gill (2000) as well as Weinberg & Gould (1995), are based on mastery experiences and provide therefore the most dependable information on self-efficacy.

Vicarious experiences, stated be Weinberg & Gould (1995) include modelling and imagery. Seeing demonstrations and watching somebody else successfully accomplishing the skill will increase self-efficacy (Gill, 2000). The effect will be enhanced when similarity between model and individual is greatest (Weinberg & Gould, 1995).

Verbal persuasion will also influence the individual’s behaviour and represents verbal encouragement from the coach or fellow athletes like “You can do it”, “You have done it well”, as well as positive self talk like “I can do it”. Most influential on the performance will be a trustworthy and credible source (Weinberg & Gould, 1995).

Along with Gill (2000), the role of the forth source of efficacy is less clear, but Bandura suggests that the perceptions of arousal, respectively the physiological states, positively affect the performance through efficacy expectations. Noticing a fast beating heart prior to a starting match will negatively affect confidence when interpreted for example as nervousness or anxiety.

In favour for the individual in this case study, all four sources of self-efficacy can be used to successfully change and improve her self confidence.

As vicarious experiences play an important role in building up efficacy experiences, it is vital for Sarah to observe other athletes from a similar age group, that have undergone a very similar or the same situation like hers, successfully coming back to a very good performance on court. Seeing athletes that have undergone surgery for a ruptured tendon who are still performing well ,without even wearing a special support, so well that they have been selected for high level teams or athletes that dominate a league, will beneficially affect her self-confidence and positively influence her performance. She will then notice that it is possible to come back from an injury without loss of performance. Her coach should arrange training and exercise with those fellow athletes to provide bases for modelling and imagery.

Meanwhile verbal persuasion should take place in addition to positively reinforce her. Praise from her coach for good effort and successful play like “Good shot”, “Well played”, will also build up her self-confidence. Praise in the right situation from her team members like “We are proud of you”, “You are a great player” and fellow athletes will be useful too, especially when coming from those who had the same injury and will persuade her in keeping up the effort and the good play as they will represent a similar model. These verbal persuasion will relief her from her guilt and self-inflicted pressure she experienced since coming back.

Perceiving her nervousness before and meanwhile playing as negative has affected her play in a negative way as she produced more unforced errors causing a loss of the match. By using relaxation techniques as well as changing her negative perception of the nervousness to a normal and/or even positive/beneficial aspect before a match, Sarah will be able to concentrate more on the actual match itself rather than on the physiological state. If Sarah is perceiving her injured foot as still weak even though her surgeon has reassured the stability of it, her coach might introduce special weight training to build up supporting muscles to change Sarah’s perception. Her perceived loss of fitness and stamina should be explained to her by her coach as a natural result due to her three months break from physical activity. The coach should then develop a special fitness programme to regain the same level again. No longer will she feel tired after a short time within her matches.

As performance accomplishments play a major role in the build up of self-efficacy, it is important for Sarah to remember her previous accomplishments and use these as positive reinforcement. But her coach should not only remind her of her previous dominance in the team and of the league but also create a special training for her where she can regain self-efficacy in her play, that is practicing shots and an aggressive play in a realistic game play situation. The more often applied and undertaken, the more Sarah will be successful. The more successful Sarah will be, will then in turn beneficially affect her play in matches.

No longer should Sarah feel less confident and guilty as she is now back on the winning side, her negative self talk will be transformed into positive reinforcement like “I can do it”. Her nervousness will be perceived as beneficial to raise her attention before a match and meanwhile performing well in the match she will hear praise from her coach and team members which then will again increase her self-efficacy and enhance her performance. The enhanced performance then might have an influence on the other team member’s play, i.e. a motivation to perform as well as she did. In turn, this might then bring the team back to its top position in the table as their best player is playing well again and a further promotion is not out of reach.

Further notes:    

As Thomas and Nelson (2001) state, a case study is a ‘ form of descriptive research in which a single case is studied in depth to reach a greater understanding about other similar cases ’, producing qualitative data. But it has to be stated that the interpretation of the evidence from a case study has to be linked to certain factors that might question the above mentioned quote about understanding similar cases.

Eysenck (2000) mentions the problem of generalisability of the findings. A causal relationship can not always be established as further factors might have affect the findings. And a case study is producing a lot of data as well as being very time consuming.

But according to Eysenck (2000), the case study is an inductive way suggesting a hypothesis/theory where no model or theory existed. This new theory can then be tested under more controlled conditions with more participants (Eysenck, 2000).

Hence, using Bandura’s self-efficacy theory to build up an injured athlete’s confidence might have been helpful in this particular case, but in general it can not be said that this theory is will build up injured athletes’ self-confidence when applied. Depending on further factors, the application of , e.g., Weiner’s attribution theory or the Achievement goal theory could lead to a similar, respectively same result, i.e. building up the self-efficacy of an injured athlete.

Reference List:

COX, R.H.  (1998)   Sport Psychology - Concepts and applications.    4 th  ed.  

Boston.  McGraw-Hill.

EYSENCK, M.W.  (2000)   Psychology  A student’s handbook.   East Sussex.  Psychology Press.

GILL, D.L.  (2000)   Psychological dynamics of sport and exercise.   2 nd  ed.  Leeds.  Human Kinetics.

THOMAS, J.R. and NELSON, J.K.  (2001)   Research Methods in Physical Activity  

4 th  ed.  Leeds.  Human Kinetics.

WEINBERG, R.S. and GOULD, D.  (1995)   Foundations of Sport and Exercise Psychology.   Leeds.  Human Kinetics.      

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• Word Count 2193
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• Level AS and A Level
• Subject Physical Education (Sport & Coaching)

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Flow State in Sports: Case Studies of Elite Athletes

Flow Sports and Activities , Flow State

Understanding Flow State in Sports

Flow State, as defined by psychologist Mihaly Csikszentmihalyi, is a state of complete immersion in an activity. Athletes often describe it as being "in the zone," where they feel at one with their sport, experiencing heightened focus, confidence, and performance. As Csikszentmihalyi puts it, "In a Flow State, people are so involved in an activity that nothing else seems to matter."

Case Study 1: Michael Jordan

Arguably the greatest basketball player of all time, Michael Jordan's career was punctuated with moments that seemed superhuman. Observers often noted how Jordan seemed to play as if time had slowed down for him.

Quotes and Observations:

• "When I'm in the zone, I don’t think about the game... the game just comes to me... and everything else is just blocked out." - Michael Jordan.

Studies and Analysis:

• A study by Jackson and Csikszentmihalyi found that elite athletes, like Jordan, often experience Flow when the challenge of the game matches their skill level , leading to peak performances.

Case Study 2: Serena Williams

One of the most dominant figures in tennis, Serena Williams has displayed moments of unparalleled prowess on the court. Her ability to maintain composure and deliver under pressure is a testament to her frequent encounters with Flow.

• "When I'm out there, and I'm in the zone, I don’t think about anything else... just my game, and my next move." - Serena Williams.
• A study by Swann et al. found that athletes in Flow, like Williams, were more likely to win medals in international competitions. The study also highlighted the importance of a supportive team environment in facilitating Flow.

Case Study 3: Usain Bolt

The fastest man on Earth, Usain Bolt's record-breaking sprints are a blend of physical prowess and mental alignment. His races, though mere seconds long, are a vivid display of Flow.

• "You don’t think about the start of the race, or the finish, or the crowd. You just run." - Usain Bolt.
• Research by Young and Pain suggests that athletes in short-duration, high-intensity sports like sprinting often enter a state of Flow due to the sheer demand for focus and the immediate feedback the activity provides.

Harnessing Flow in Sports: Key Takeaways from the Case Studies

• Training and Preparation : All elite athletes emphasize the importance of rigorous training. This preparation ensures that when the challenge arises, their skill level is ready to meet it, facilitating Flow.
• Mental Conditioning : Athletes like Jordan and Williams often engage in visualization and mindfulness practices, training their minds to enter the zone .
• Immediate Feedback : Sports provide immediate feedback – a shot made, a race won. This immediacy is a crucial component of Flow.
• Supportive Environment : The role of coaches, teammates, and even the crowd can significantly influence an athlete's ability to enter Flow.

The Flow State, while not exclusive to sports, finds a vivid and compelling expression in the arena of elite athletic performance . The case studies of athletes like Michael Jordan, Serena Williams, and Usain Bolt offer invaluable insights into this optimal experience. Their journeys underscore the blend of physical training, mental conditioning, and the right environment in achieving moments of Flow. For aspiring athletes and individuals in other fields, these case studies serve as a testament to the heights one can reach when body, mind, and passion align seamlessly.

Unlock the secrets of the Flow State with our comprehensive program, " 4 Cycles of Flow ." Dive deeper into the world of optimal performance, drawing insights from elite athletes and understanding how you too can harness this state in your endeavors. Whether you're an athlete, coach, or simply someone looking to elevate your performance in any field, the "4 Cycles of Flow" program is your roadmap to achieving unparalleled excellence. Join the program today and embark on a transformative journey toward your peak potential.

• Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. Harper & Row.
• Jackson, S. A., & Csikszentmihalyi, M. (1999). Flow in sports: The keys to optimal experiences and performances. Human Kinetics.
• Swann, C., Keegan, R. J., Piggott, D., & Crust, L. (2012). A systematic review of the experience, occurrence, and controllability of flow states in elite sport. Psychology of Sport and Exercise, 13(6), 807-819.
• Young, B. W., & Pain, M. D. (1999). The zone: Evidence of a universal phenomenon for athletes across sports. Athletic Insight, 1(3), 21-30.

GET 4 FREE COURSES  TO HACK THE FLOW STATE

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Once you have gathered the necessary information, a draft of your analysis should include these sections:

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Case Studies in Sport Communication

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Case Studies in Sport Communication: You Make the Call goes beyond the box scores by offering readers the opportunity to evaluate popular and diverse issues in sport—including management, crisis, health, ethics, gender, race, and social media. Each chapter incorporates theory and communication principles as well as topical background information, and concludes with discussion questions and engaging assignments. This volume presents real-life, provocative sports cases that bring contemporary headlines into perspective and inspire critical thinking. Each chapter features scholarly evidence that will keep the conversation lively, thoughtful, and informative. Students are encouraged to challenge the ethical implications of what they have read and to “make the call.” This is an invaluable resource for upper-level undergraduate and graduate students of sport communication and sport management.

TABLE OF CONTENTS

Part i | 93  pages, front office, section section i | 52  pages, strategic communication, chapter 1 | 7  pages, “there’s no media plan for the first gay player in the nfl”, chapter 2 | 9  pages, civic recovery in the aftermath of a hockey crisis, chapter 3 | 11  pages, patching a crisis with csr, chapter 4 | 9  pages, explaining sports fans’ recognition of sponsors using the elaboration likelihood model, chapter 5 | 14  pages, coming home, section section ii | 39  pages, corporate and organizational identity, chapter 6 | 8  pages, should the team hire the controversial but successful head coach, chapter 7 | 12  pages, to create our own legacy, chapter 8 | 8  pages, life after signing, chapter 9 | 9  pages, broadcast yourself and multiply your revenue, part ii | 84  pages, section section iii | 40  pages, image repair and redemption, chapter 10 | 10  pages, roping off the ring, chapter 11 | 9  pages, does the nfl still own sundays, chapter 12 | 9  pages, drafting like a king, chapter 13 | 10  pages, what did ryan lochte do, section section iv | 42  pages, gender, race, and identity, chapter 14 | 10  pages, challenging a boy’s club, chapter 15 | 10  pages, a failure to defend against cyberbullying, chapter 16 | 10  pages, topsy-turvy times, chapter 17 | 10  pages, gender stereotypes in college mascot dyads, part iii | 95  pages, section section v | 39  pages, social media, chapter 18 | 10  pages, a grand slam, chapter 19 | 9  pages, chapter 20 | 9  pages, “i was very intoxicated”, chapter 21 | 9  pages, swimming against the tide, section section vi | 53  pages, social justice and ethics, chapter 22 | 11  pages, taking a knee or not taking a stand, chapter 23 | 11  pages, the offensive line, chapter 24 | 8  pages, paradigm repair and the hero myth in sports journalism, chapter 25 | 10  pages, “don’t say”, chapter 26 | 11  pages, the bathroom bill and the basketball game.

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“As Many as Possible for as Long as Possible”—A Case Study of a Soccer Team That Fosters Multiple Outcomes

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The personal assets framework suggests that dynamic elements of (a) personal engagement in activities, (b) quality social dynamics, and (c) appropriate settings will influence an athlete’s long-term outcomes of performance, personal development, and continued participation in sport. The aim of the present study was to conduct a case study of a Norwegian age-restricted team that was successful in promoting participation, performance, and positive development for individual participants and to investigate how the dynamic elements of activities, social dynamics, and settings have led to these long-term outcomes. The results indicated that the case is a best-practice example of successful attainment of personal development and long-term participation and performance through appropriate structure and application of the dynamic elements within the personal assets framework, including enjoyable peer-led play activities and quality practice, quality relationships with teammates and coaches, and access to facilities.

Participation in sport is highly popular worldwide ( Eime et al., 2015 ; Hulteen et al., 2017 ). For example, more than 1.9 million people in Norway—over 35% of the population—are registered in a sport club, with children and youth sport experiencing the highest participation rates ( Norwegian Olympic and Paralympic Committee and Confederation of Sports, 2017 ). Sport participation is generally considered a beneficial arena for obtaining various adaptive outcomes, such as good physical and mental health (see Eime et al., 2013 for a review), positive youth development ( Holt, 2016 ), and high levels of performance ( Haugaasen & Jordet, 2012 ; Rees et al., 2016 ).

It has been proposed that the adaptive outcomes of sport participation can be grouped into the three P’s of performance (the development of sport expertise), participation (engagement in sport or physical activity throughout life), and personal development (healthy psychological, social, and emotional development; Côté et al., 2014 ; Côté et al., 2016 ). However, sport participation alone does not seem to be sufficient to explain the attainment of these long-term adaptive outcomes, as sport participation also can lead to maladaptive results, such as burnout, stress, and dropout ( Crane & Temple, 2015 ; Fraser-Thomas et al., 2008 ). Indeed, participation rates in sport have been found to decline through adolescence ( Zimmermann-Sloutskis et al., 2010 ), for instance, as competition focus becomes increasingly important for sport organizations ( Skille, 2011 ). Thus, long-term goals of achieving higher levels of skills in sport often come at the cost of immediate gratification and enjoyment ( Côté & Abernethy, 2012 ).

Côté and colleagues ( Côté et al., 2014 ; Côté et al., in press ) proposed the personal assets framework (PAF) to describe the interacting elements that, over time, influence performance, personal development, and continued participation in sport. Particularly, the PAF asserts that youths’ sport experiences are shaped by three dynamic elements: (a) personal engagement in activities, (b) quality social dynamics, and (c) appropriate physical and competitive setting. In a limited time frame (e.g., one season), the characteristics and interactions of these dynamic elements will influence a person’s competence, confidence, connections, and character (i.e., four C’s; Côté et al., 2010 ; Little, 1993 ). The PAF suggests that an enhancement of the four C’s is associated with positive sport experiences that can lead to long-term (e.g., over multiple seasons) performance, participation, and personal development (i.e., three P’s) outcomes ( Côté et al., 2014 ). The PAF thereby presents a multisystem perspective of youth sport, supported by research highlighting the importance of activities, relationships, and settings on three P’s outcomes (e.g., Henriksen et al., 2010a ; Turnnidge et al., 2014 ; Vella et al., 2011 ).

Sport research has typically focused on the importance of one isolated dynamic element (e.g., activities) on one outcome (e.g., performance). For instance, the activities element of sport engagement has often been examined in terms of the types and amounts of play and practice activities needed to develop an expert level of performance (see Coutinho et al., 2016 for a review). Côté et al. ( 2007 ) developed the Developmental Model of Sport Participation (DMSP) to describe two main developmental pathways that lead to various developmental outcomes: (a) the early specialization pathway, characterized by large amounts of deliberate forms of practice from an early age, and (b) the early sampling pathway, characterized by large amounts of play activities and participation in different sports from an early age. Although researchers still debate the importance of childhood engagement in play and practice activities throughout childhood for the development of expertise ( Ford et al., 2015 ; Ford & Williams, 2017 ), the current state of knowledge generally supports the notion that peer-led play activities throughout childhood are beneficial before specializing in adolescence ( Baker & Young, 2014 ; Coutinho et al., 2016 ; Memmert et al., 2010 ). Playing different sports in childhood may also provide a breadth of experiences (e.g., social, physical, and emotional) that can be beneficial for continued involvement in sport ( Fredricks & Eccles, 2006 ). Early specialization, on the other hand, may lead to negative sport experiences (e.g., burnout or reduced enjoyment) and increased risk of dropout ( Fraser-Thomas et al., 2008 ; Myer et al., 2015 ). However, DiSanti and Erickson ( 2020 ) have recently criticized the sport specialization literature for its lack of holistic consideration for athlete development, advocating researchers to use ecological-grounded theories to also emphasize contextual factors and the interplay between various social actors involved. Thus, to be developmentally sound, diversification and deliberate play in childhood need to be integrated within an appropriate physical/competitive setting with quality social dynamics.

Indeed, a vast amount of research shows that long-term outcomes in sport are influenced by various social agents, such as individuals within the family ( Côté, 1999 ), the coach ( Arthur et al., 2017 ), and teammates ( Martin et al., 2014 ). More specifically, the coach has an important role as the leader of the team ( Price & Weiss, 2013 ), which may influence athletes’ performance, participation, and personal development ( Côté & Gilbert, 2009 ; Vella et al., 2011 ). Specifically, an increasing body of evidence is highlighting transformational leadership behaviors by coaches as particularly beneficial for promoting athletes’ positive outcomes ( Arthur et al., 2017 ; Stenling & Tafvelin, 2014 ; Tucker et al., 2010 ; Turnnidge & Côté, 2016 ). Transformational leaders inspire, challenge, and motivate followers to reach their potential through idealized influence, inspirational motivation, intellectual stimulation, and individual consideration ( Bass & Riggio, 2006 ). Furthermore, youth team sport athletes spend a considerable amount of time with teammates throughout development ( Ward et al., 2007 ), where the interactions and characteristics of the group may affect individuals ( Martin et al., 2014 ). Accordingly, both social and task cohesion have been positively associated with relationships and social dynamics that optimize young athletes’ engagement in sport ( Bruner et al., 2014 ).

The third dynamic element of the PAF is an appropriate setting that addresses how the broader physical and competitive environment may shape athletes’ personal assets. Research has been consistent in finding that where an athlete is born may influence the development of personal assets and long-term engagement in sport (i.e., birthplace effects; Côté et al., 2006 ). In a classic study, Curtis and Birch ( 1987 ) demonstrated that city size influences the likelihood of becoming a Canadian Olympic or National Hockey League ice hockey player, where large (greater than 500,000 inhabitants) and small (fewer than 1,000 inhabitants) regions produced fewer elite athletes than the expected proportion. More recently, studies have found that athletes from smaller cities have prolonged engagement in sport and are less likely to drop out of sports when compared with athletes of larger urban center ( Imtiaz et al., 2014 ; Turnnidge et al., 2014 ) and also score higher on personal development indicators (e.g., commitment to learning and positive identity; Fraser-Thomas et al., 2010 ). It is suggested that explanations for such findings may be that smaller communities can offer better opportunities for peer-led sport activities and supportive social relationships, as well as promote higher perceptions of competence ( Côté et al., 2014 ; Zell & Alicke, 2010 ).

By investigating the larger systems that interact to contribute to athlete development, studies have indicated that factors at both the micro- (i.e., settings of athletes’ daily interactions) and macro-level (i.e., more distant forces such as the sport federation) may influence an athlete’s sport experiences, career development, and transitions ( Henriksen et al., 2014 ; Henriksen et al., 2010b ; Henriksen et al., 2011 ; Stambulova & Alfermann, 2009 ). For instance, Henriksen and colleagues conducted three case studies on sport clubs that regularly produced international-level athletes and found proximity to elite athletes, a “whole-person-approach,” cohesiveness, and focus on long-term development to be among the characteristics of the environments ( Henriksen et al., 2010a ; Henriksen et al., 2010b ; Henriksen et al., 2011 ). Furthermore, Balish and Côté ( 2014 ) highlighted that some communities are more successful in developing elite athletes than others. By investigating a Canadian community that was successful in developing elite athletes, Balish and Côté identified three distinct themes that characterized the community: (a) developmental experiences (e.g., participation in organized and unorganized sport activities with stable teammates throughout development), (b) community influences (e.g., accessible facilities and stable relationships), and (c) socio-cultural influences (e.g., collective identity). Furthermore, in a qualitative study of a community youth sport program that successfully promoted positive youth development, coaches reported opportunities to play the sport, develop quality relationships with coaches and peers, and participate in competitive games with equal distribution of playing time across team members ( Vierimaa et al., 2017 ). Bearing in mind that findings from such case studies lack generalizability to wider populations, the aforementioned research has provided valuable insight into the processes and characteristics of various successful cases. However, the success of these cases is mainly delimited to either performance, participation, or personal development, highlighting the need for studies that address how more than one of these outcomes may be obtained simultaneously.

In summary, sport has the potential to influence the long-term outcomes of performance, participation, and personal development ( Côté et al., 2014 ). However, it could be argued that these outcomes may be difficult to obtain simultaneously without sacrificing one outcome over another. For instance, the development of expert performance in the long term may come at the cost of athletes’ positive sport experiences or personal development ( Fraser-Thomas et al., 2008 ). Studies have investigated isolated cases that have been successful in the development of long-term participation or performance ( Balish & Côté, 2014 ; Henriksen et al., 2014 ); however, a dearth of research remains regarding cases that have been successful in developing multiple outcomes simultaneously (e.g., participation, performance, and positive development). Accordingly, the aim of the present study was to conduct a case study of a team that had individual athletes who had achieved a high level of performance or long-term recreational participation and successfully navigated life challenges (e.g., personal development), to understand the characteristics of the physical settings, social dynamics, and sport activities that may have led to these outcomes.

• Research Design and Paradigm

The present study was positioned within a phenomenological tradition (see Allen‐Collinson, 2009 ), and an interpretivist understanding was applied to discover reality through informants’ views, background, and experiences ( Schwartz-Shea & Yanow, 2013 ; Thanh & Thanh, 2015 ). This approach was underpinned by an epistemological constructivist (i.e., knowledge is subjective and socially constructed) and a relativistic perspective (i.e., the reality is subjective and mind-dependent). Thus, a case study design was applied in the present study. Such a method allows an in-depth examination of a phenomenon through multiple sources of evidence and was considered appropriate to describe the underlying mechanisms that may have contributed to the realization of adaptive sport outcomes in a specific singular successful case. In addition to conducting interviews, training diaries were examined. This allowed the investigators to supplement the informants’ subjective perceptions with more objective evidence, as recommended by Stambulova ( 1994 ).

• Case Selection and Description

An age-restricted team from the Norwegian soccer club Bryne FC was selected for the present study. Bryne FC has approximately 750 registered members and is from the city of Bryne on the west coast of Norway, which has a population of approximately 12,000 people. The male senior team of Bryne has traditionally played competitively at Level 1 or 2 in Norway (the two highest levels of the Norwegian soccer league system) but was relegated to Level 3 in 2016. The team in the present study was established as a grassroots soccer team (with no entrance requirements) for a cohort of boys born in Bryne in 1999. Norwegian soccer is generally characterized by high participation rates among children and youths and has specific regulations to avoid exposing children under 13 years to intense competition, such as disallowing national competitions and arrangements involving results-based prizes (see Tuastad, 2019 ). The team played together as an age-restricted team from the time players were 5–6 years old until approximately reaching age 16. At this point, the team was restructured due to the Norwegian League system. However, the majority of the group continued playing together at the junior level in Bryne (approximately aged 17–19 years), while others were recruited to senior soccer. The team was selected for the present study due to three main characteristics that aligned with the purpose of the study: (a) several players became professional players (performance), (b) the team experienced low dropout rate (participation), and (c) there were indicators that the players experienced personal development through their contribution to the team and their community.

In terms of performance indicators, 10 of 40 players were selected at the regional level, 1 indicating they were considered among the most promising players within their region (i.e., Rogaland). Furthermore, five players were selected for the Norwegian U-national team. As of August 2020, six of the players progressed to play senior soccer at a professional level (i.e., obtained a professional contract), including one player in the Norwegian Premier League and two players earning professional contracts in international clubs at Champions League level. In addition to having produced high-performing athletes, the team has also been known for its remarkably low drop-out rate. In fact, personal communications with the club revealed that teams in Bryne FC often were dissolved or restructured between the ages of 13 and 16 due to dropout; however, on the present team, 35 of 40 players continued playing soccer until entering adulthood. Finally, some social indicators showed that the athletes on the team experienced personal development, as the players promoted fair play and demonstrated good behavior outside the sport domain. More particularly, publicly available documents in Norway, including articles in Norwegian national newspapers and coach presentations at various seminars, suggest that this specific group of athletes had positive social interactions, promoted fair play, and contributed to their communities outside the sport domain.

We first approached the head coach of the Bryne team with an invitation to participate in the study. The coach was the father of two players on the team and had coached the group voluntarily throughout its existence. He started taking formal coaching courses after he retired from competitive soccer due to injuries in his youth and holds a Union of European Football Associations (UEFA) A license (the second-highest coaching license mandated by UEFA, the official governing body of European soccer). Prior to coaching the team, he had coached various other soccer groups, including age-restricted and senior teams. Besides coaching, he worked as a teacher at an upper secondary school and thus holds formal pedagogic competence. After the coach was informed and agreed to partake in the study, four players, four parents, and one club representative (i.e., the person that was responsible for player development in Bryne during this period) were invited to participate in the study. Selection of the athletes, parents, and representatives was done through purposeful sampling ( Patton, 2002 ; Tongco, 2007 ), where the coach was asked to identify players and parents that could provide insightful information about the Bryne team. Such deliberate choice of informants is considered appropriate when aiming to use the most information-rich sources about a phenomenon ( Etikan et al., 2016 ). To ensure data were collected from both recreational and professional players, the coach was asked to identify two players who had progressed to a professional level and two players who had been part of the team for recreational purposes (e.g., social and/or enjoyment motives). Similarly, the coach was asked to identify four parents (two elite and two recreational) who could provide adequate information about their child’s involvement in the team. The final sample thereby included 10 informants: four players (all males), four parents (three males, one female), the head coach of Bryne 99 (male), and one player development staff (male). All informants had been involved in the team for approximately 10 years or longer and thus had to retroactively recall relevant information.

• Data Collection

The present study was approved by the ethics committee of the relevant university and the Norwegian Social Science Data Services. Informed consent from all informants was obtained prior to data collection. A semi-structured interview guide 2 ( Kvale, 1994 ) grounded in existing literature ( Côté et al., 2016 ) was developed to help direct the interview toward topics of interest. The interview guide had three main parts, inspired by the dynamic elements of the PAF (activities, physical settings, and social dynamics). Sample questions included “Please describe how a typical organized practice session with the team was like for you” and “Please describe the social relationships within the team.” In addition, the interviews addressed informants’ background, as well as their general perception of the team over time. The general interview guide was adjusted for the distinct roles held by the individual interviewed (i.e., one for players, one for parents, one for the coach, and one for the club representative).

In addition, a timeline methodology was applied for the four players in the first part of the interview (see Adriansen, 2012 ; Allan et al., 2019 ). In this phase, the interviewer and athletes used a timeline to mark the informant’s soccer involvement, including milestones, transitions, and other important information throughout their career (e.g., important persons). This timeline was brought forward to the semi-structured interview to facilitate the informant’s recall of their sport involvement throughout development, as recommended by Adriansen ( 2012 ). The last source of data for the present study was training diaries and records produced by the coach throughout the team’s development. These documents contained the amount and content of the team’s organized practice (e.g., sessions per week, duration, and focus area) throughout the distinct phases of development. These documents also recorded the start of participation in various forms of competitions (e.g., local league, regional tournaments, and national tournaments).

A pilot study of a Norwegian Premier League player was conducted to test the specific interview guide in a relevant setting. Based on the pilot, minor revisions were made to the interview guide. Prior to data collection, an appointment was made with the date and time for the 10 interviews. Eight interviews were conducted in person in a meeting room in Bryne, while the two remaining interviews were conducted online (i.e., via Skype and Messenger). The audio was recorded using a digital voice recorder, and each interview lasted between 19 and 61 min (mean = 44 min).

• Data Analysis

The interviews were transcribed, and a thematic analysis was applied to identify patterns of meaningful units ( Braun & Clarke, 2006 ). The thematic analysis provides a theoretically flexible approach to analyzing qualitative data and has previously been applied in sport research on successful cases ( Vierimaa et al., 2017 ). The first part of this analysis was inductive and included the review of the transcribed manuscripts and the coding of the texts into meaningful units. These units were organized into themes and sub-themes in the second part of the analysis. For example, “soccer-specific skills and knowledge” and “interest in the individual athlete” were examples of sub-themes that emerged under the broader theme of “the coach.” Finally, the authors used a combined inductive and deductive approach, where the PAF ( Côté et al., 2014 ) was used to organize the categories that corresponded with the dynamic elements of activities, physical settings, and social dynamics. No data were forced into the PAF categories; on the contrary, the content that did not fit into the dynamic elements of PAF were all related to some consequences of players’ engagement with this team and were regrouped under a theme labeled “outcomes” (e.g., immediate and short-term outcomes).

The thematic analysis resulted in the themes “outcomes,” “activities,” “social dynamics,” and “physical settings.” The findings from each theme are elaborated in the section below, and quotations (translated from Norwegian) from the informants are presented to illustrate and clarify the themes.

Immediate and Short-Term Outcomes

Both recreational and now professional players reported that playing soccer is an activity that provides immediate gratification and enjoyment: “I play soccer because it is fun” (Elite player 2) and “I love the sport … . All of my friends love soccer” (Recreational player 1). Players described how their participation in the team fostered the development of soccer-specific skills. They added that values and norms within the team were transferred to other aspects of life; “We also pushed each other to perform at school” (Recreational player 2). The respondents further highlighted that the players on the team became close friends across skill levels and that it was important to show pro-social behaviors both on and off the soccer field.

Long-Term Outcomes

The coach described that the team was distinct from other teams on several parameters. Most prominently, the coach stated that “six out of 40 players have played for the Norwegian youth national team, and 10 of them have played for the regional team.” Also, as previously described, six players obtained a professional senior contract (as of August 2020), including one player in the Norwegian Premier League and two international-level players with UEFA Champions League experience. Furthermore, data revealed that the team was highly successful in getting players to stay involved in the sport. Specifically, 35 of the 40 players who started on the team (at approximately age 6) participated in organized soccer throughout the team’s existence. After that, most of the group continued playing soccer (i.e., continued in Bryne or were recruited to other clubs) throughout high school and until approximately age 19. Through the interviews, the players described that other teams in the region regularly experienced dropout, particularly from approximately age 13, while Bryne 99 remained a stable group. Indeed, all players recognized the uniqueness of the Bryne team, where team members were enjoying training and competitions during both childhood and adulthood and, thus, found no reasons to quit.

Younger and elder players started earlier with alcohol and that kind of behaviour, while we were more serious with school and everything… . We cleaned the wardrobe after we used it, and when we played matches, we always thanked the opponents after the match.

The players, parents, coach, and club representative highlighted that respect and inclusion were values that were important in the soccer context and in the players’ personal lives. Elite player 2 described that “I have become a much better person from being a part of this team.” Furthermore, the interviews revealed that the players developed positive social interactions with teammates, coaches, and others and that the players still are friends that have contact on a regular basis.

Organized Practice

While the informants described that they were involved in additional sports throughout their development (e.g., gymnastics, handball, and athletics), the present section will focus on soccer-related activities. Examination of training diaries revealed that until players reached the age of 10, the team had one to two organized practice sessions of 60 min each week (except holidays). During these sessions, the focus was on individual skill development and enjoyment. The coach also highlighted that an important area of focus during the early years was to present drills and activities that the players could also perform in a nonorganized setting. The amount of practice increased from two to three sessions weekly from the age of 11, until the team was divided into two groups at age 13. From ages 13 to 19 years, one group engaged in two practice sessions of 90 min weekly, and the other group engaged in four to five practice sessions of 90 min weekly. Through interviews and analysis of training diaries, it was indicated that relational and tactical skills became increasingly more prominent from approximately 11 years of age. From approximately 15 years of age, positional skills (e.g., finishing skills for strikers) were more emphasized.

Elite player 1 described that “We did not think about it at the time, but the coach had different focus areas throughout the years. That was different compared to other teams.” Particularly, it was described that organized practice in early years was characterized by playful activities, competitions, and individual skill development. “We had a lot of competitions during practice. A lot of skill development, and a lot of competition” (Elite player 1). From early youth years, there was an increased focus on practice with the deliberate intention of improving performance. Nevertheless, the interviews made it clear that the players perceived organized soccer as fun throughout all age categories: “I have always had fun at the practice sessions” (Recreational player 1).

Matches and Tournaments

Throughout ages 6–12, the team played soccer matches against other local clubs but did not participate in tournaments. From age 13, the team started playing tournaments in addition to their regional league participation. Matches were typically played once a week from mid-April to mid-October (except July). Training histories and interviews showed that the team participated in approximately three tournaments per year, distributed between both elite and recreational tournaments.

Peer-Led Activities

The players reported that most of their soccer involvement throughout childhood was peer-led soccer play activities. The players described that this activity often was performed in local soccer fields—most often in the local soccer dome—and that it became a routine to play soccer on the weekends. The players described that they developed a game they called “World Cup,” where they divided the participants into equal teams and played matches like the real World Cup. The players described this as a joyful yet competitive activity. The players also described that they played soccer whenever they could, such as between classes during school. “At elementary school, we played soccer each break, even if it was only a 10-min break” (Recreational player 2). The interviews revealed that peer-led soccer activities were conducted by players across all skill levels. Further, it was described that the amount of soccer play was most prominent throughout childhood and declined as players got older, and the amount of organized practice increased.

Activities in Relation to Outcomes

In summary, interviews and training diaries revealed that the activity involvement of the group in early years (approximately 6–10 years) were characterized by relatively small amounts of organized practice sessions, characterized by enjoyment, play activities, and individual skill development. Furthermore, many players engaged in substantial amounts of peer-led soccer play, characterized by play, enjoyment, and competition. From approximately age 11, the activity involvement of the group was characterized by increased amounts of organized practice, characterized by individual skill development, competitions, relational skills and enjoyment, and reduced involvement in peer-led soccer activities.

All players described that participation in both peer-led and organized soccer gave them immediate gratification and enjoyment and that soccer was an important social arena. To achieve prominent performance levels, the respondents highlighted the importance of peer-led soccer activities and a combination of enjoyment and quality at organized practice. To explain individual differences in performance, the players who progressed to professional soccer highlighted that they had worked harder and engaged in more hours of practice compared with less skilled players. Furthermore, the players highlighted that quality practice, enjoyment, and optimal challenges for all players were important to keep players involved in sport over time.

• Social Relationships

Culture and Role Models

The informants described the city of Bryne as “a soccer place” and noted that the senior teams have traditionally performed relatively well in the Norwegian setting. Furthermore, the team had several proximal role models, as both coaches and parents had played soccer professionally. “We had coaches that played at a high level and knew what it takes” (Recreational player 2). Players described that the culture and proximity to role models made it natural to participate in soccer, and further aim to progress to the highest level.

Team Aspects

All respondents described a group with strong and positive social connections, as indicated in sources described in the “Methods” section (i.e., coach presentations and articles in Norwegian newspapers). For instance, elite player 2 stated that “We were a large group of friends that played soccer together,” and recreational player 2 stated that “You were friends with approximately 40 people. I had a lot of friends there.” The respondents described that the players from a young age were friends across skill levels and would socialize at school, practice, and in their spare time. Respondents further described that the group developed a climate where they pushed each other to train and learn. This involved a climate for attending organized and peer-led soccer activities, and for making the most out of the practice sessions. “When we were at training it was to train – it was not just fooling around” (Elite player 1). “We have always pushed each other, without anything negative. Always positive and motivational. Then we have seen that people make it to a higher level, and that pushes others to get to an even higher level” (Recreational player 2).

Coach Aspects

The head coach was the parent of two players and served as head coach from when the players started playing organized soccer (at approximately age 6). In addition, other parents were involved in the team throughout the years. Both parents and players described that the head coach had detailed knowledge of the game, and the parents highlighted that he and the other coaches sought input to further develop their coaching. This is underpinned by the fact that the head coach had a UEFA A license, and two other parents that were involved as coaches had a UEFA B license (the third highest coaching license). The rest of this section will focus on the head coach.

To be recognized as a person is a fundamental thing. It builds confidence. In contrast; the most common form of bullying in a workplace or elsewhere is ignoring people, or not see them. That gives people an incredibly bad feeling.

He asked questions and did not always give us the answer. I remember we played a match in the regional series, and there was a striker we couldn’t handle. The coach told us that he knew how we could handle the striker, but he wanted us to figure it out ourselves. He challenged us all the time.

Furthermore, the respondents highlighted that the head coach was a good role model, that he treated all players, referees, and opponents with respect. For instance, it was described that he did not yell at players if they made a mistake or behaved in discrepancy with desired values, but rather invited players to talk and discuss the situation. The coach also encouraged the players to make positive choices in life, such as prioritizing school: “The coach has always expressed that school comes first, no matter what” (Recreational player 1). See Table  1 for subcategories and examples of the various coach aspects.

Overview With Description and Examples of Subcategories on Coach Dimensions

Social Relationships in Relation to Outcomes

The interviews indicated that specific characteristics of the social relationships of the group contributed to multiple adaptive outcomes. For instance, close relationships with teammates and the coach were highlighted as beneficial for enjoyment during practice sessions and highlighted as important for both continued participation and the development of soccer skills. Yet, factors that emerged as important in relation to the development of prominent levels of performance were (a) proximity to role models; (b) competitiveness within a socially safe environment; and (c) having a highly competent coach who provided support, challenges, and inspiration. The camaraderie among all members and a coach who established close relationships with all players was described as important to prevent drop-out. In addition, the coach’s focus on positive values influenced the individuals in their everyday lives, for instance, to prioritize school and to be respectful toward others.

• Physical Settings and Competitive Structure

A soccer dome was placed centrally in Bryne when the players were 5–6 years old. The dome had artificial turf and was unlocked and available for the players. Elite player 1 highlighted that the facilities became more accessible for peer-led activities after changing from natural to artificial turf, “It was natural grass there earlier, and then we weren’t allowed to be there. But when they changed to artificial turf it became an area where many went to practice.” In addition, there were other available soccer fields around the city, including a soccer field at school. Elite player 2 stated, “We have been very fortunate to have the soccer dome so we could train year-around.” “The soccer dome was always open. If the soccer dome was occupied, there was an available soccer field just outside” (Elite player 1). The players and parents further described that accessibility to facilities allowed the players to participate in regular peer-led activities; “The cohort we talk about here was raised in that dome” (Elite parent 1).

Organization of the Team

From the beginning, a vision for the team was developed by the coaches; “As many as possible, for as long as possible, and as good as possible.” However, the interviews indicated that the coaches placed less emphasis on the performance aspect of the vision. Specifically, the players reported that “To have as many as possible for as long as possible. I think that has been their (the coaches) main goal” (Elite player 2). Furthermore, the club representative stated that “The overriding aim has always been that all players should be proper citizens … . Whether they become [professional] soccer players or not is less important.”

Even if it was the recreational team, the sessions were properly organized. Even if they only trained 1–2 times a week, it was always good structure on the practice sessions and planned preparation for matches. When we met other reserve [recreational] teams, the other teams made a big fuss out of being only the reserves. Just nonsense. But we did things seriously. It was allowed to smile, but we took them seriously.

Competitions

If their [the coaches] goal was to win the division when we were 13, 14 or 15 [years old], we could have done it. But they rather preferred to make it more equal and develop the players. Rather than putting together a team that could win 6–0, they put the best players with the players that was not that skillful.

Physical Settings in Relation to Outcomes

All respondents highlighted that the group had almost unlimited access to facilities, which enabled players to engage in substantial amounts of peer-led soccer activities that help them develop their soccer skills. In addition, the soccer dome was highlighted as central in the players’ childhoods, as it became an important social arena where the children developed strong social bonds. In relation to the organization of the team, the respondents highlighted that dividing the group into teams of equal strength (rather than putting the best players together), and equal distribution of playing time was instrumental in establishing positive social relations across skill levels. Further, equality during competitions was argued to prevent less skilled players from being demotivated and dropping out and also positive for the development of skilled players (e.g., in terms of taking more responsibility). When dividing into two teams and training groups, the players highlighted that sharing training hours was important for social well-being and continued participation. “Although we were on two different teams, we were still with our friends” (Recreational player 2). “Other teams were divided into a first and second team from age 13 which operated separately. Then people dropped out” (Elite player 1).

The purpose of the present study was to conduct a case study of an age-restricted soccer team that was successful in developing multiple long-term outcomes for individual participants (i.e., participation, performance, and positive development), and to investigate perceptions and experiences through the underlying mechanism of the physical settings, social dynamics, and sport activities that may have led to these adaptive outcomes. A soccer team from Bryne in Norway was selected due to the alignment with the attainment of the 3 P’s (performance, participation, and personal development) within the PAF ( Côté et al., 2014 ). While researchers have pinpointed the potential challenges in obtaining multiple adaptive outcomes simultaneously ( Côté & Abernethy, 2012 ), and previous studies have tended to focus on groups that have been successful in achieving one outcome (e.g., Balish & Côté, 2014 ; Henriksen et al., 2014 ), the present study contributes to the existing literature by yielding insight into how the various dynamic elements of sport may be structured and implemented to promote individuals’ attainment of performance, participation, and personal development from childhood to adulthood.

Regarding engagement in activities, the respondents in the present study described a developmental pathway characterized by substantial amounts of enjoyable peer-led soccer activities, which aligns with the early sampling pathway in the DMSP model ( Côté et al., 2007 ). The respondents further argued that enjoyable sport experiences were beneficial for their continued motivation to practice and participate and contributed to the development of positive relationships with peers. Accordingly, the DMSP contends that early engagement in peer-led play activities promotes the long-term outcomes of performance, participation, and personal development, while early investment in large amounts of deliberate forms of practice may lead to high levels of performance but reduces the likelihood of long-term participation and enjoyment ( Côté et al., 2007 ). Empirical evidence has generally supported the current findings and the theoretical predictions of the DMSP-model by associating early engagement in playful activities to more positive developmental outcomes than early engagement in more deliberate forms of practice (see e.g., Côté & Vierimaa, 2014 ; Waldron et al., 2020 ). However, in line with other studies in the soccer context (e.g., Ford et al., 2009 ), the activities described by the Bryne players were mainly restricted to the soccer context, indicating that positive developmental outcomes may occur from diversification within a sport (e.g., small-sided games, drills, and adapted games, i.e., soccer tennis). Further, although the amount of organized practice was relatively low (one to two sessions each week from ages 6 to 10), the respondents highlighted the importance of having properly organized practice sessions with quality coaching also during the early years. The quality and microstructure of early practice engagement is rarely emphasized in research involving practice histories of successful athletes ( Erikstad et al., 2018 ; Haugaasen et al., 2014 ). The coaches of Bryne generally structured practice sessions with much playing form activities and less traditional instruction, which previously has been argued to be beneficial for developing an understanding of the game and sport-specific decision-making skills (see Cushion et al., 2012 ). The sport experiences described by the informants may also lay a foundation for a lifelong healthy lifestyle, as research generally indicates that sport participation in childhood is associated with higher levels of physical activity in adulthood ( Tammelin et al., 2003 ): specifically, perceptions of fun and enjoyment in sport can promote an active and healthy lifestyle ( Visek et al., 2014 ).

Further, the respondents in the study described Bryne as a “soccer place” with residents sharing pride in the local soccer club. Similarly, Balish and Côté ( 2014 ) found that “community pride” was a key characteristic in their case study of a small community that successfully developed elite athletes. The respondents in the present study also highlighted the beneficial role of proximal role models, which also is similar to characteristics highlighted in previous case studies that have mainly focused on successful attainment of the isolated outcome of performance ( Balish & Côté, 2014 ; Henriksen et al., 2010a ; Henriksen et al., 2011 ). In the present case, these role models were parents and coaches with international experience in professional soccer. In addition to the beneficial aspect of these role models in promoting and supporting the athletes’ performance, the present findings also highlight the potential role for these role models in promoting personal development among players, for instance, by encouraging the players to prioritize school and pro-social values.

The respondents described that all members of the team were friends and that the team developed a competitive yet supportive climate that promoted both the amount and quality of practice. The importance of peers and teammates is generally acknowledged within the sport literature ( Martin et al., 2014 ) as well as in previous case studies (e.g., Henriksen et al., 2010b ; Vierimaa et al., 2017 ). From a group dynamics perspective, such a description of the team can relate to high levels of both social and task cohesion (e.g., see Carron & Eys, 2012 ). In line with the respondent’s descriptions of the beneficial role of the group climate in terms of both skill development, continued participation, and establishing positive interactions with peers, previous studies have found the task and/or social cohesion to be positively associated with both performances, participation, and personal development indicators ( Bruner et al., 2014 ; Eys et al., 2009 ).

Further, Côté and Gilbert ( 2009 ) have proposed that coaches influence athletes’ four C’s, and thus three P’s, over time, through their professional, interpersonal, and intrapersonal knowledge and behaviors. The head coach of Bryne was described to have detailed knowledge of the game (i.e., professional knowledge), and he organized quality practice sessions and helped players to learn. Although the interview did not focus on how the coach developed his coaching philosophy, it may be that the coach’s teaching background has shaped his holistic approach to coaching. Further, the respondents described that the head coach displayed multiple positive leadership qualities (e.g., role model, development-oriented, and positive coach-athlete relationships) that closely align with the four I’s of transformational leadership (see Bass & Riggio, 2006 ; Turnnidge & Côté, 2018 ). Indeed, a growing body of literature highlights the potential beneficial role of transformational leadership for athletes adaptive outcomes, such as motivation, commitment, perceived competence, and the development of personal and social skills (see Arthur et al., 2017 ; Turnnidge & Côté, 2016 ). The coach’s focus on pro-social behaviors and an inclusive learning environment emerged as important factors for the development of the previously described team climate. Such findings may not be surprising, as past research has indicated a positive relationship between transformational leadership and cohesion in sport ( Smith et al., 2013 ) and between caring climates and task-involving climates ( Hall et al., 2017 ). It was described that the parents generally had good faith in the coach, which is of relevance as Gledhill and Harwood ( 2015 ) highlighted in their case study the importance of the various social agents (e.g., parents, coaches, and teachers) coherently interacting for avoiding negative sport experiences.

Finally, regarding physical settings and competitive structure, the team was established in a smaller community and had unlimited access to high-quality facilities through the local soccer dome. The existing literature indicates that such settings are beneficial for the development of the three P’s over time, as athletes from smaller cities are more likely to become elite athletes ( Côté et al., 2006 ), experience personal development ( Fraser-Thomas et al., 2010 ), and stay engaged in sport over time ( Imtiaz et al., 2014 ) compared with athletes from bigger cities. While recreational sport participation generally focuses on positive social interactions and enjoyment, in contrast to development/performance contexts that primarily focuses on skill development ( Trudel & Gilbert, 2006 ), the present case was organized to promote both recreational and competitive participation. In line with previous case studies of successful environments ( Balish & Côté, 2014 ; Vierimaa et al., 2017 ), the variability of abilities was argued to allow the more skilled player to take more responsibility and develop leadership skills through peer-facilitated learning. Further, equality during competitions (i.e., mixed skill teams and equal distribution of playing time) was argued to prevent less skilled players from being demotivated and dropping out. The results of the present study further indicated that team stability contributed to the athletes’ positive developmental experiences, and that this was promoted through shared training hours and no de-selection. Although challenges and setbacks (e.g., de-selection) may be beneficial for an athlete’s development ( Collins et al., 2016 ), stable social relationships through an athlete’s development are generally considered beneficial ( Balish & Côté, 2014 ).

Limitations of the study must be considered when interpreting the findings. First, the study did not investigate other cases, and it is thus hard to firmly establish the uniqueness of the team. While the team undoubtedly was successful in developing good athletes and preventing drop-out, the athletes’ attainment of personal development through their involvement is more difficult to objectively establish. Further, the respondents had to recall over 10 years back when describing the dynamic elements. Although a timeline methodology was applied to facilitate respondents’ recall (see Adriansen, 2012 ), the study may be subject to recall biases ( Côté et al., 2005 ). Although minor issues were mentioned when asking about negative aspects (e.g., single events regarding playing time), the informants generally drew an almost ideal picture of the team. However, based on the positive outcomes attained, it may be that informants have overstated the positive characteristics described in the results and made causal interpretations that do not exist.

In addition, an ethical consideration was completed on the decision to name the relevant soccer team. For instance, naming the team may increase publicity for the players and coaches on the team. However, it was considered impossible to describe the uniqueness of the case without presenting information that could identify the team. In addition, the case has already been identified and profiled in the media for its positive outcomes. Thus, it was decided that naming the team was both necessary and ethically justifiable.

• Practical Recommendations

From a practical standpoint, the present study yields insight into how the various dynamic elements of sport participation may be structured and implemented to promote individuals’ attainment of the P’s. From a system perspective, the case has highlighted that the three P’s are not mutually exclusive. Sport organizations and clubs should, therefore, be careful to not build systems that reduce individuals’ opportunities for long-term engagement and/or personal development (e.g., promoting early specialization, early focus on results, and selection of athletes). Further, a central finding of the present case was the instrumental role of the coach and his transformational leadership behaviors in facilitating the positive outcomes attained. Notably, coaches’ leadership behaviors have recently been contextualized within the sport setting through systematic observations ( Turnnidge & Côté, 2019 ). Other coaches should thus aim to implement transformational leadership behaviors in their daily practice (e.g., discussing and modeling pro-social values or behaviors, expressing confidence in athletes’ capabilities, emphasizing the learning process, and showing interest in athletes’ needs), as the present study aligns with previous studies in highlighting the positive role of transformational leadership for various performance-, participation-, and personal development–related outcomes in sports ( Arthur et al., 2017 ; Stenling & Tafvelin, 2014 ).

The regional team consists of approximately 25 of the most promising players from each age cohort between ages 13 and16 years in the Rogaland region, which has approximately 450,000 inhabitants.

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* Erikstad, Johansen, Johnsen, and Haugen are with the University of Agder, Kristiansand, Norway. Erikstad is also with Nord University, Bodø, Norway. Côté is with Queen’s University, Kingston, ON, Canada.

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Embedding Perceptual–Cognitive Training in the Athlete Environment: An Interdisciplinary Case Study Among Elite Female Goalkeepers Preparing for Tokyo 2020

Goalkeepers play a very specific and crucial role in water polo. They rely on advanced perceptual–cognitive (P–C) skills to make fast and accurate decisions. However, their daily training environment often lacks stimulation and representativeness of game demands. This was exacerbated by the COVID-19 pandemic, where noncontact practices became the “new normal.” In the Canadian Women’s National Team preparation for the 2020 Olympics, goalkeepers’ P–C training was made a priority. Led by the team’s mental performance consultant and experts from transdisciplinary fields, the initiative began with an evaluation of a broad range of P–C skills in goalkeepers. Leading up to the Olympics, a series of P–C activities (i.e., anticipatory training using video occlusion, eye–hand coordination, and visuomotor drills) were adopted based on ecological dynamics principles. Virtual reality technology and constraints-focused tools were used to enrich and diversify the goalkeepers’ daily trainings environment. This case study reports the evaluation of P–C skills, the context, and the way in which the P–C activities were implemented, as well as their holistic impact on goalkeepers. Reflections and limitations are also shared to encourage interdisciplinary efforts in sport psychology and increase awareness among mental performance consultants about the importance of psycho-perceptual-motor skill training for mental performance.

Brazilian Gymnastics in a Crucible: A Media Data Case Study of Serial Sexual Victimization of the Brazilian Men’s Gymnastics Team

Elite gymnastics sport culture is presently under global scrutiny. Largely ignited by the highly publicized case of serial sexual abuses in USA Gymnastics, multiple national gymnastics teams have disclosed stories of athlete abuse. Our author team utilized media data to investigate the serial sexual abuses that occurred on the Brazilian Men’s Gymnastics Team. Using media data to conceptualize athlete maltreatment is novel and facilitated our holistic interpretation of athlete maltreatment across multiple levels of athletes’ developmental systems. The authors traced the media coverage temporally and identified four overarching themes: (a) uncovering the case (subthemes—the Brazilian sport context; the Brazilian men’s gymnastics context; the club context), (b) before abuse was identified (subthemes—the coach–athlete dyad: before disclosure; the athlete: a lost childhood; social connectivity: isolation; the gymnastics system: mechanisms of abuse), (c) when abuse was recognized (subthemes—the coach–athlete dyad: athlete resistance; the athlete: identifying the impact; social connectivity: building connections; the gymnastics system: consequences of abuse), and (d) the legacy of abuse (subthemes—the coach–athlete dyad: ongoing abuses; the athlete: cyclical victimization; social connectivity: expanding connections; the gymnastics system: after abuse). Utilizing media data facilitated our culturally contextualized interpretation of athlete abuse to present tailored recommendations for practitioners.

Experiencing the Social Environment of a Canoe Kayak Club: A Case Study of a Special Olympics Program

For individuals with an intellectual disability, emerging adulthood (18–25 years) may be a disruptive time with an abrupt ending to programming and services after adolescence. This study critically explores the social environment and experiences of individuals involved in a Special Olympics paddling program for emerging adult athletes with an intellectual disability. Using an instrumental case study design, multiple qualitative methods were implemented including photography, videography, observations, and interviews. The participants included four athletes (one female and three male; three with autism spectrum disorder, one with mild intellectual disability), three fathers, a coach, a program coordinator, and an administrator. Analyses were guided by interpretivism and the quality parasport participation framework. The findings highlight how the limited staff training and preparation, the complexity of providing such a program, and parental hidden labor in their adult children’s sport involvement influence the social environment. Implications for coaching practices include the importance of communication strategies and coach education.

“A Blank Slate”: Preparing for Tokyo 2021 During COVID-19

This article presents a case study of an applied consultancy experience with WL, an Olympic athlete preparing for Tokyo 2021. WL sought psychological support after decreases in performance and well-being forced them to consider their future as an athlete. COVID-19 and the lockdown of the United Kingdom were highly influential to the consultancy process, providing WL with the opportunity to explore their identity in the absence of sport. WL framed their emergence from the lockdown as a “Blank Slate,” which was a critical moment allowing them to “find themselves on and off the mat.” The sport psychologist’s existential philosophy is presented and discussed in detail. Furthermore, reflections are provided by WL’s strength and conditioning coach about the referral process and by WL themself about the efficacy of the interventions. The importance of supporting both the person and the performer when working with aspiring Olympic athletes is also discussed.

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Transitioning Concussion Care to Mental Health Care: A Case Study of an Elite Athlete

Athletes with recent concussion experience a constellation of physical (e.g., headache, nausea), cognitive (e.g., memory problems, difficulty concentrating), sleep, and emotional (e.g., anxiety, depressed mood) symptoms after injury. Mental health changes may also be a product of typical maturation in adolescents/young adults, making mood disruption difficult to disentangle from concussion sequelae. In this case study, we present the case of a high-achieving 18-year-old female rower whose concussion clinical trajectory exhibits this type of difficulty. Specifically, we provide a detailed chronological summary of the athlete’s visits with a multidisciplinary concussion team. We highlight in this case study (a) an individualized, biopsychosocial model of concussion care and (b) subtle aspects of her clinical presentation that led the clinical team to transition her treatment focus from concussion specific to formal mental health care.

Pavel Datsyuk: Learning, Development, and Becoming the “Magic Man”

Who is the “Magic Man” (https://youtu.be/5EgNF6X2MJs?t=78)? In 2017, Pavel Datsyuk was named as one of the 100 greatest National Hockey League players in ice hockey history. His Detroit Red Wings teammate Niklas Kronwall quipped, “Pav is the Magic Man for a reason. He does things out there with the puck that no one else can do.” This statement begs the questions: When, where, and how did Pavel learn those creative skills? To gain insight into how the “Magic Man,” Pavel Datsyuk, acquired such sophisticated yet unorthodox skills, we endeavored to investigate the preprofessional years of Pavel’s development. Utilizing a case study methodology and leaning on the theoretical framework of ecological dynamics, we sought to examine the ecological niche that helped shape Pavel’s learning in development. Our case study highlights the ecological nature of the development of expertise and the nonlinear impact ecological constraints had on the development of Pavel’s expertise.

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Existing tools measuring athletes’ psychological strategies have various practical limitations including (a) not capturing the perceived effectiveness of psychological strategies in pursuing desirable outcomes; (b) overlooking stages of competitive involvement, such as before training or the night before competition; (c) and being predominantly paper-based. In the present case study, the author explains the process of developing an alternative assessment tool called the Profile of Psychological Strategies (ProPS). This new profile aims to measure athletes’ perceptions of which strategies they use, to pursue which desirable outcomes, and how effectively. The ProPS has its theoretical roots in Fletcher and Sarkar’s approach to developing psychological resilience and was developed based on an adapted version of Radhakrishna’s Sequence for Instrument Development. This case study can be useful both for sport experts looking for a practical and flexible way to measure athletes’ psychological strategies and for those aiming to develop their own applied assessment tool.

“Caught in the Headlights”: A Reflective Account of the Challenges Faced by a Neophyte Practitioner Working With a National Squad

This article provides a neophyte practitioner’s account of providing psychological support to a national team for the first time. The practitioner felt “caught in the headlights” due to his lack of preparation for the range of organizational issues he encountered. In this confessional tale, experiential knowledge gained by the practitioner is shared through the presentation of self-reflections from the 6-month period when he supported the squad. While the practitioner’s time with this national squad was limited, it gave him a sense of the micropolitical landscape of the sporting organization and illuminated some of the complexities and dilemmas that characterize applied sport psychology practice. These reflections are offered to guide other aspiring professionals during their initial training experiences.

An Existential Counseling Case Study: Navigating Several Critical Moments With a Professional Football Player

The current article presents a reflective case study following an applied service delivery experience with a 21-year-old professional footballer. The primary aim of the intervention was to support the client while facing several critical moments (breakdown in relationships, identity, and contract negotiations). This support involved creating a confidential space for her to discuss her values, beliefs, and identity while considering some of the tensions and dilemmas experienced while considering her future. Throughout this process, the first author adopted an existential counseling approach to practice and utilized the Four Dimensions of Existence and Emotional Compass as hermeneutic devices to analyze the client’s presenting challenges. The working relationship lasted for 3 months and spanned eight online sessions. Reflections on practitioner individuation and the value of adopting an existential approach to service delivery are provided.

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Volume 8 (2024): Issue 1 (Jan 2024)

Journal Name: Case Studies in Sport and Exercise Psychology

A Case Study of a Senior High-Performance Leader Managing Psychological Effects During the COVID-19 Pandemic

Journal Name: Case Studies in Sport and Exercise Psychology Volume: 8 Issue: 1 Pages: 1-7

Using an Acceptance and Commitment Therapy Approach to Overcome Distractive Overthinking With a High School Baseball Player

Journal Name: Case Studies in Sport and Exercise Psychology Volume: 8 Issue: 1 Pages: 8-15

The Dad and the Lad: Who Is My Client?

Journal Name: Case Studies in Sport and Exercise Psychology Volume: 8 Issue: 1 Pages: 16-23

Life as a Sport Psych Nomad: Thierry Middleton in Conversation With Shameema Yousuf on Advocating for Change as a Sport Psychologist

Journal Name: Case Studies in Sport and Exercise Psychology Volume: 8 Issue: 1 Pages: 24-27

“Don’t Just Speak About It, Be About It”: Rebecca Busanich in Conversation With Shannon Baird on Choosing the Principled Path as a Practitioner

Journal Name: Case Studies in Sport and Exercise Psychology Volume: 8 Issue: 1 Pages: 28-30

Nichola Kentzer in Conversation With Göran Kenttä: Recipient of the 2022 Association for Applied Sport Psychology Distinguished Professional Practice Award

Journal Name: Case Studies in Sport and Exercise Psychology Volume: 8 Issue: 1 Pages: 31-36

Using Acceptance and Commitment Therapy to Develop Self-Confidence in a Neurodivergent Athlete

Journal Name: Case Studies in Sport and Exercise Psychology Volume: 8 Issue: 1 Pages: 37-46

“But I Am a Runner”: Trying to Be a Rogerian Person-Centered Practitioner With an Injured Athlete

Journal Name: Case Studies in Sport and Exercise Psychology Volume: 8 Issue: 1 Pages: 47-54

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Case Study: Stressed Out Athletes

Geoff Miller’s book,  Intangibles: Big-League Stories and Strategies for Winning the Mental Game — in Baseball and in Life , is now available!

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From time to time, I will be posting case studies that include sample data from our TAIS inventory.  TAIS stands for The Attentional and Interpersonal Style inventory and we use it with all of our coaching clients in corporate, sport, and military settings.  In my work with elite athletes, aspiring amateurs, Major League Baseball players, and teams, I use TAIS to help players identify their mental game strengths and weaknesses, then use TAIS data to help them shape performance improvement plans.  On the scouting side, I use TAIS to evaluate potential draft picks, which are not used in a “thumbs up, thumbs down” fashion, but more to help provide another level of detail on who the player is on and off the field, how he will handle failure and pressure, and the best ways to help each player develop skills and learn the game.  This case study is on an extremely stressed out football player who was having trouble getting his performance back on track.  I’m including only a sampling of TAIS scales (there are twenty factors that are measured when someone takes TAIS and a brief description on each so you can understand the context of the case.  Learning a bit about this athlete may help you if you have athletes like the one I’m profiling here.

Case Study:  D Sport: Football Biggest Derailer:  Stress Comparison Group: World Champions

My normal approach when reviewing a profile is to look for key concentration strengths, find out strong personality factors, and pinpoint potential derailers so I can understand who the athlete is and predict where he or she will struggle in pressure situations.  However, when I see a profile like this one, my approach changes.

D was a college football player at a major Division I school and he contacted me because he only had one more year of eligibility and while he had performed well at times, his career had more ups and downs than he had hoped and he had never been able to play at a consistently high level.  He was worried about playing in the NFL, he was worried that he was going to let down his parents, coaches, and teammates, and he was worried that he was going to look back on his career and wonder why he didn’t live up to the expectations he had for himself.  My first order of business was to help him get back in control of his emotions and to reduce his stress level.

Take a look at D’s Awareness and External Distractibility scores.  Notice how different they are from the average Awareness and Distractibility scores of world champion athletes (as shown in the gray shaded areas.)  Then take notice that the same patterns are true for Analysis and Internal Distractibility and Action and Reduced Flexibility.  This pattern of scores tells me that the athlete is overwhelmed by his environment, by his thoughts, and by his emotions.  He can’t think, he can’t focus, and he doesn’t feel in control of anything going on in his life.  This is also reflected in D’s low Control score.  It was easy for me to see that D was feeling stressed out.

Social Style

On Extroversion, D scored 36% and on Introversion, he scored 99%.  In general, there are times when D enjoyed being around others, but for the most part, he was a private, guarded person who needed personal space.  Team sports are much less stressful on people who need to be around others and seek out social situations.  However, I’ve worked with many introverted athletes who mostly enjoy the atmosphere of sharing so much of their time and their lives with their teammates.  What I usually hear from those athletes is that they are comfortable socially with their teammates, but they don’t let many people in too close.  They save most of their stronger friendships for people outside their sport.  D was a trusting person, but he didn’t confide much in teammates or coaches.

Communication Style

When discussing pleasant topics or good performances, D was open and talkative.  But he was quiet and unwilling to discuss tough situations or the discomfort he was experiencing with others.  When it came to volunteering information, D was a closed book, which made it tougher on teammates, coaches, family and friends to know how much stress and anxiety he was experiencing.

My strategy with D was to get him more comfortable developing a support system among people who were close to him.  We outlined a list of topics that he would be comfortable discussing with his girlfriend, another list that he felt like he could discuss with his position coach, and another that he could share with a few teammates who he felt closest to.  In getting some of his worries off his chest, D was able to sort through them in his head.  By hearing from teammates and coaches he hadn’t opened up to before, he saw that he didn’t have as much to worry about as he had built up in his mind.  We discussed how this communication process would help to expand his comfort zones and make it easier for him to share information with others in the future.  Then we worked on taking control of his game again.  Instead of measuring his success by the results he got in games, he would only focus on his effort.  He would rate his effort in practices and in games and each week, he would give himself a score on a scale of 1 to 10.  Effort was something he had 100% control over and he knew he could achieve this goal every time he put on his pads.  And as a talented athlete, if he gave his best and didn’t get the results he wanted, he would know that there was nothing else he could have done about it, which helped him stop second-guessing his play.

D’s improved communication with people close to him relieved stress and helped him stay focused on working hard each day instead of worrying about the future.  His focus on effort instead of results gave him back the control he was looking for, which made him more confident and more comfortable on the field.

If you are interested in taking TAIS or for more information on Winning Mind performance coaching programs for individuals and teams, please contact Geoff Miller at [email protected]

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Case Study: Youth who play multiple sports tend to be healthier, become better athletes, and have a lot more fun

Here are more reasons why award-winning Certified Strength and Conditioning Coach Scott Sahli is happy when kids are involved in multiple sports programs and supervised by certified strength coaches.

Some parents fear that if their child is not specializing in a single sport while in middle school and high school, then that child may not excel at that sport later on. “All the research says that’s exactly the wrong thing to do,” cautions award-winning strength and conditioning coach Scott Sahli. “It’s truly eye-opening for parents when they discover the pitfalls of pigeonholing children at an early age, and the numerous benefits of diversifying their sports experiences.”

Sahli speaks from decades of experience and successes. A current strength coach at Lakeville South High School in Minnesota, Sahli was named the 2010 National Strength and Conditioning Association (NSCA) High School Strength and Conditioning Coach of the Year. He has led his high school teams to multiple State Championships.

Diversifying sports help reduce injuries and increase opportunities

Parents of student athletes are trying to do the right thing for their kids, but are frequently surprised when Sahli names his reasons for encouraging kids to play multiple sports. “The research is very clear,” he says, “but parents generally don’t have access to the information.” 

●     Youth who play multiple sports are less likely to get hurt. “Injuries among sports-specialized kids are most often from overuse. They have been doing the same repetitive motions, sometimes for years. They may end up developing arthritis later in life. It can be devastating.”

●     Diversifying may increase the opportunities for a sports career.  “University scouts are more likely to recruit multi-sport athletes because they tend to be more well-rounded athletes with lower injury risks. Plus, 87 percent of NCAA DI athletes and professional athletes are playing sports they probably didn’t even play when they were young. They are multiple sport athletes, who discovered their current sport as they matured.”

●     Youth who play multiple sports tend to stay interested in physical activity. “The dropout rate of youth sports is 70 percent. Youth who don’t move on to join other sports are at higher risk for Exercise Deficit Disorder (EDD). Inactive children and teens exhibiting signs of EDD are more likely to be overweight or obese, more prone to injuries, and are more likely to burn out or drop out from sports and physical activities for the rest of their lives.”

●     Youth who play multiple sports tend to be healthier emotionally. “While the research is just touching the surface on this, kids can struggle socially if most of their interactions are with the same group of people all the time.”

●     Youth who play multiple sports generally have more fun. “When I’ve worked with high school-level kids who have previously only played one sport, they almost universally tell me they didn’t know other sports could be that much fun! After the experience, they often feel rejuvenated for their original sport. Changing groups and sports also expands kids’ social circles. And crossing over to new sports helps their central nervous systems make new connections, and saves their bodies from overuse. Collectively the research says this variety and diversity makes them better athletes.”   

Other ways to raise healthy, well-rounded student athletes

Sahli explains that having an NSCA Certified Strength and Conditioning Specialist (CSCS) on a high school’s staff can elevate the program to a whole new level. “Certified strength and conditioning coaches understand that kids are not little adults. They need to train at their appropriate age level, and a long-term athletic development model needs to be in place.”

He explains that, “Injuries can also be caused by how kids train. If they aren’t using certified coaches, the likelihood of injuries goes way up. Certified strength and conditioning coaches know how to train and what to look for to prevent injuries. They also know how to work with sport coaches in the school’s athletic program to ensure kids are receiving a well-rounded training program. They understand the same language and objectives. They’re in sync with one another, knowing that certain things need to take place in a certain order. As a result, the kids tend to be stronger, perform at a higher level, and have fewer injuries.”

Sahli gets tremendous satisfaction from watching the youth in his programs succeed in life, not just in the field or on the court. “Physical activity encourages development of their self-worth, self-confidence and motivation. It also lays the groundwork for a lifetime of physical fitness.”

Parents can educate themselves even more about how to support their child’s long-term athleticism by viewing the NSCA’s infographic, the 10 Pillars for Successful Long-Term Athletic Development .

Biography: Scott Sahli, CSCS,*D, NSCA-CPT,*D, RSCC*E, USA Weightlifting National Coach 

Scott Sahli is the Strength & Conditioning Coordinator at Lakeville South High School, Lakeville, MN. Sahli was formerly Strength and Conditioning Coordinator at Northfield High School. His Olympic Weightlifting teams at Northfield won 7 consecutive State Championships. The football teams won 11 section championships and competed in the State Championship game five times.

In 2011, Sahli took the Strength and Conditioning Coordinator position at Burnsville High School with the purpose of creating a top notch strength and conditioning program and getting teams to championships.  In six years his Olympic Weightlifting teams at Burnsville won four State Championships and the football team played in thre4e section championship games and went to state one time after at 20-year drought. 

Coach Sahli is a two-time Minnesota High School Strength Coach of the Year and was the NSCA 2010 National High School Strength Coach of the Year. 

The nationally-known weightlifting clinician was a State Director for the Minnesota NSCA for six years and was named the State Director of the Year for the NSCA in 2008. Sahli is currently the North Central Regional Coordinator for the NSCA.  Sahli is the co-author of two DVD’s on weightlifting and coached Hannah Means in the 2004 USA Olympic Team Trials for Weightlifting.

The NSCA is a recognized 501(c)(3) educational nonprofit dedicated to advancing strength and conditioning research and education for all people.

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CASE STUDY: STIGMA OF MENTAL HEALTH IN SPORTS

Mental health issues, whether in the form of personality disorders, depression, or other illnesses, are stigmatized in much of the sports world. This can be explained through a variety of reasons, such as the masculinity value of sport, violent contact in many sports, or due to the overall stigma of mental health in society at large. Adding to the stigma is the fact that mental health issues are often more difficult to diagnose than physical health problems – there is not apparent broken body part, no bruise to see, etc. When these problems are harder to diagnose, they may seem to be less prevalent than they truly are. The stigmatization of mental health in sports should be seen as an problem, just as the prevalence of concussions without recognition of their true harm was seen as a problem. Here are two articles highlighting the issue: Brenden McLean writes on how the stigma is still an opponent here , and Chris Curry writes about a few of the many affects of the stigma here .

The mental health issues have led to many athletes suffering from depression during their career as well as into their retirement. Junior Seau’s unfortunate suicide was most likely the result of depression, and it could be argued that if there was less of a stigma on mental illness and injuries that this as well as other mental illness related deaths could have been prevented, or at least lessened. Sports leagues and organizations would do well to explicitly address this issue, so that the consequences of mental illness can be helped, rather than ignored. Ken Reed writes here how mental health programs are the next step in the care for athletes and sports participants. Following his and others’ advice, it is important to ask ourselves questions regarding the issue of mental health in sports.

A few questions which may be important to ask are:

How might the stigma be best addressed? What would a mental health program look like in a professional sports league? In collegiate athletics? What is the biggest resistor to mental health being confronted? Who is at risk if mental health continues to be stigmatized and ignored? What can athletes, coaches, managers, and others is sports do to fight this stigmatization?

How do you think conflicts in sports should be resolved?

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A case study of a trainee sport psychologist adopting a person-centred approach with a professional basketball player

Research output : Contribution to journal › Article › peer-review

• person-centred
• holistic approach
• relationship

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This is a pre-publication version of the following article: Black, Z & McCarthy, P 2020, 'A case study of a trainee sport psychologist adopting a person-centred approach with a professional basketball player', Sport and Exercise Psychology Review, vol. 16, no. 2.

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T1 - A case study of a trainee sport psychologist adopting a person-centred approach with a professional basketball player

AU - Black, Zoe

AU - McCarthy, Paul

N1 - Acceptance in SAN AAM: no embargo Only MM/YYYY available for publication dates, used last date in month. ST 03/02/21

PY - 2020/12/31

Y1 - 2020/12/31

N2 - This case study reports the experiences and reflections of a trainee sport and exercise psychologist adopting a person-centred approach to service delivery with a professional basketball player. We supplement personal reflections and notes from client work with learning logs and supervision as part of coursework components on a taught doctorate in sport and exercise psychology. This case study examines the client change process and how working in in a non-directive and relational manner enabled the client to take responsibility for shaping sessions to meet his unique reality, needs and preferences. Throughout this paper the trainee reflects on the experiences and specific challenges of working non-directly, offering unconditional positive regard and empathy. This case study contributes to the literature by presenting person-centred therapy within a professional sport environment and supports the recommendation of counselling and communication skills training in the development pathway for applied sport and exercise psychology practitioners.

AB - This case study reports the experiences and reflections of a trainee sport and exercise psychologist adopting a person-centred approach to service delivery with a professional basketball player. We supplement personal reflections and notes from client work with learning logs and supervision as part of coursework components on a taught doctorate in sport and exercise psychology. This case study examines the client change process and how working in in a non-directive and relational manner enabled the client to take responsibility for shaping sessions to meet his unique reality, needs and preferences. Throughout this paper the trainee reflects on the experiences and specific challenges of working non-directly, offering unconditional positive regard and empathy. This case study contributes to the literature by presenting person-centred therapy within a professional sport environment and supports the recommendation of counselling and communication skills training in the development pathway for applied sport and exercise psychology practitioners.

KW - person-centred

KW - basketball

KW - holistic approach

KW - relationship

UR - https://shop.bps.org.uk/sport-exercise-psychology-review-vol-16-no-2-december-2020

M3 - Article

SN - 1745-4980

JO - Sport and Exercise Psychology Review

JF - Sport and Exercise Psychology Review

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Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies

Bethany alice jones.

1 Nottingham Centre for Gender Dysphoria, 3 Oxford Street, Nottingham, NG1 5BH UK

2 School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK

Jon Arcelus

3 Division of Psychiatry and Applied Psychology, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK

Walter Pierre Bouman

Emma haycraft.

Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation.

To the authors’ knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature.

Eight research articles and 31 sport policies were reviewed.

In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport’s policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based.

Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.

Introduction

Transgender people are those who experience incongruence between the gender that they were assigned at birth (based on the appearance of their genitals) and their gender identity/experienced gender. Gender identity, or experienced gender, can be defined as a person’s internal sense of gender, whether this be male, female, neither or somewhere along the gender continuum. Some transgender people, but not all, will choose to affirm their gender identity by socially transitioning (i.e. living as their experienced gender socially, at work or at an educational institution, with friends and family, outside the home) and some, in addition, will choose to medically transition with cross-sex hormones and gender-confirming surgeries [ 1 , 2 ]. Although over time various different terms have been used, the term ‘transgender female individual’ will be used to describe individuals assigned male at birth, based on their genital appearance, but who later identify as female. ‘Transgender male individual’ will be used to describe people who are assigned female at birth, based on their genital appearance, but later identify as male. ‘Cisgender’ will be used to describe people who do not experience incongruence between their gender assigned at birth and their gender identity.

Recent reports indicate that the number of transgender individuals who attend transgender health services has increased substantially over the years in many European countries [ 3 – 5 ]. There has also been a significant increase in the number of people who self-identify as transgender and do not necessarily attend transgender health services [ 6 ]. For example, Kuyper and Wijsen [ 6 ] found that 4.6 % of people who were assigned male at birth and 3.2 % of people who were assigned female at birth in their Dutch population sample reported an ambivalent gender identity (equal identification with the other gender as with the gender they were assigned at birth). The authors also reported that 1.1 % of the people who were assigned male at birth and 0.8 % of the people who were assigned female at birth identified as transgender. It remains unknown how many of these people will seek treatment through a transgender health service. The increase in people who identify as transgender may be at least partly explained by the increase in visibility of transgender people within Western society [ 4 , 5 ]. For example, Caitlin Jenner, a former athlete and current television personality, recently came out as transgender during a television interview that was viewed all over the world [ 7 ]. Increases in visibility may have prompted some people to reflect and question their gender identity [ 8 ].

Some transgender people experience stigma, transphobia, prejudice, discrimination and violence as a consequence of their gender identity [ 9 – 11 ]. Ellis et al. [ 12 ] found that transgender people were more likely to avoid situations when they were afraid of being harassed, identified as transgender or ‘outed’, such as in clothes shops, public toilets and gyms. Gyms are a popular outlet to engage in sport-related physical activities (i.e. gym fitness exercises) and therefore it is important to create an inclusive environment given the established mental and physical health benefits of physical activity and sport [ 13 , 14 ]. This is particularly important for transgender people as they have been found to report a high prevalence of depression and anxiety [ 15 , 16 ], which could be managed with physical activity. Furthermore, physical activity and sport can also contribute towards maintaining the appropriate weight necessary to undergo gender-confirming surgery, acknowledging that not every transgender person will wish to do so [ 1 , 2 , 17 ].

The premise of competitive sport is fairness (i.e. inclusion in the absence of advantage) and, owing to fears surrounding the perceived athletic advantage of transgender people, the question of whether transgender people should be permitted to compete in accordance with their gender identity has been raised and greatly contested within the literature, among sport organisations, fellow competitors and spectators. It is a commonly held belief that androgenic hormones (especially testosterone) confer an athletic advantage in competitive sport. Therefore transgender female individuals, because of high endogenous testosterone levels, are perceived to hold an advantage in sport (when testosterone has not been blocked to a cisgender female level). Transgender men are not thought to possess an athletic advantage, despite being injected with testosterone if they chose to medically transition with cross-sex hormones. However, there has been a paucity of research that has directly explored how androgenic hormone levels are associated with athletic competence in both cisgender and transgender populations (e.g. running time).

To facilitate the inclusion of transgender competitors, in 2004, the International Olympic Committee (IOC) [ 18 ] announced that transgender people could participate in all future Olympic games providing they had fully medically transitioned (i.e. had been prescribed cross-sex hormone treatment for 2 years and undergone gender-confirming surgery). Although the requirements of this policy appear to concur with the commonly held belief that transgender people hold an athletic advantage, they have been criticised for not being underpinned by an evidence-based rationale [ 19 ]. The IOC [ 20 ] has recently updated its policy to be more inclusive of transgender athletes (i.e. fewer restrictions); however, the 2004 policy has been extremely influential on other sport organisations’ policy development. The new (2016) IOC policy will be considered in Sect. 3 .

In an attempt to draw a consensus as to whether transgender people should be able to compete in accordance with their gender identity, in 2005 Reeser [ 21 ] conducted a review of the literature pertaining to gender identity issues in competitive (elite) sport. Reeser paid particular attention to the evolution of gender verification in competitive sport and whether current competitive sport policies for transgender people are fair. He concluded that, while gender verification has made significant advances, there is a lack of physiological performance-related data in transgender people. This is preventing an overall consensus from being made as to whether transgender sport policies are fair or not (i.e. fairness in the absence of advantage). Reeser’s review, although important, has some limitations. He did not adopt a systematic methodology and therefore did not include the majority of transgender sport policies. Additionally, Reeser only considered the implications of such policies in relation to elite competitive sport and did not consider the experiences of transgender people who engage in sport or sport-related physical activity for leisure or fitness (e.g. gym fitness activities, jogging).

With the intention of addressing the limitations of the previous literature review, this systematic review has two aims. First, to systematically analyse and critically review the available literature regarding transgender people’s experiences in relation to competitive sport (elite and recreational) and sport-related physical activity participation (e.g. jogging, gym fitness activities). Second, to systematically review the available transgender competitive sport policies with regard to their fairness (i.e. competition in the absence of advantage). It is hoped that this systematic review will further enhance the understanding of sport participation and competition amongst transgender people. It may be expected that as more people define themselves as transgender, the issues that transgender people experience in competitive sport and sport-related physical activity will become more pronounced. It is therefore important that those who work to facilitate and promote sport and develop policies for their own sport organisations (e.g. sport medicine specialists, sport policymakers) are informed about the issues that this vulnerable population face. This will allow for a non-discriminatory atmosphere in sport, whilst ensuring a fair system for all participants and competitors (regardless of their gender identity).

Search Strategy

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to undertake this systematic review [ 22 ]. To obtain relevant peer-reviewed articles, an electronic search of literature published between January 1966 and August 2015 was conducted using the following search engines: ScienceDirect, Web of Science, Scopus and PubMed. Within each search engine, the following search terms were entered: gender dysphoria, gender identity disorder, trans people, trans individual, transgender and transsexual. These terms were combined with three terms relating to sport (physical activity, exercise and sport) using the “AND” operator. The reference lists of eligible papers were searched for potentially relevant publications. Sport policies were obtained through a Google search using the above search terms with the addition of “policy” at the end of all sport-related terms.

Inclusion and Exclusion Criteria

To address the first aim, articles that were selected were concerned with the experiences and issues surrounding physical activity and sport participation for transgender people. This systematic review only considered articles eligible if they were research articles, as opposed to discussion papers. Case studies were also considered eligible, as research articles were limited. Peer-reviewed articles that were written in English only were included. For the second aim, all available national and international policies on competitive sport in transgender people were selected and reviewed.

Study Selection

Thirty-one research articles were considered potentially relevant to the remit of this review. The search also identified 31 competitive sport policies for transgender people. After screening the abstracts, ten research articles were excluded as six were concerned with lesbian, gay, bisexual and transgender sport, one was a Scottish non-academic survey, one was a book chapter, one was concerned with an irrelevant topic and another focused on cisgender participants. The remaining 21 articles were downloaded for full-text review and 13 papers were excluded as they were discussion papers, as opposed to research articles. Therefore, eight research articles fulfilled the inclusion criteria and were consequently included within this systematic review (Fig.  1 ). All 31 competitive sport policies for transgender people were reviewed and included within this systematic review.

Process of identifying eligible research articles. LGBT : lesbian, gay, bisexual, transgender

This section presents the findings from the research articles and sport policies included within this systematic review. First, the findings from the research articles that explored participation in sports (both elite and recreational standards) and sport-related physical activities (i.e. gym fitness activities, jogging) are provided. Second, findings from the reviewed competitive sport policies relating to transgender inclusion are given.

Transgender People and Sport Participation

Characteristics of the eligible research studies.

The oldest research article included was published in 2004 [ 23 ] and the most recent publication was from 2015 [ 24 ]. The majority of the studies were qualitative in nature, all of which employed interviews [ 24 – 29 ]. The remaining two research articles included an experimental study [ 23 ] and a cross-sectional survey [ 30 ]. Most of the studies were concerned with transgender people who participated in sport competitively, at an elite or recreational level [ 21 , 23 , 25 – 29 ]. Some authors focused on a specific sport; ice hockey, netball and softball [ 26 , 28 , 29 ] while others were concerned with transgender people engaging in any sport [ 25 , 27 , 29 ]. Broadly, across all sports, Gooren and Bunck [ 23 ] explored whether transgender athletes have a physiological advantage in competitive sport. One study explored participation in competitive sports and sport-related physical activity [ 24 ] and another study discussed participation in sport-related physical activity only [ 30 ]. Details of all of the research articles included within this systematic review can be found in Table  1 .

Table 1

Study characteristics of research articles included within the review

Review of Transgender People and Competitive Sport Participation (Elite and Recreational): Research Articles

The same data were extracted from all research articles reviewed (Table  1 ). Below, we provide the most prominent findings in relation to competitive sport participation from each of these articles. Six research articles were concerned with competitive sport participation within this systematic review [ 23 , 25 – 29 ]. The only experimental study was by Gooren and Bunck [ 23 ] who aimed to explore whether transgender people taking cross-sex hormone treatment can fairly compete in sport. The authors measured transgender people’s muscle mass (via magnetic resonance imaging) and hormone levels (via urine and blood analyses) before and 1 year after cross-sex hormone treatment. They found that 1 year after transgender male individuals had been administered cross-sex hormone treatment, testosterone levels significantly increased and these levels were within a cisgender male range. They also found that 1 year after cross-sex hormone treatment, transgender male individuals’ muscle mass had increased and was within the same range as transgender female individuals (assigned male at birth) who had not been prescribed cross-sex hormone treatment. In relation to transgender female individuals, Gooren and Bunck found testosterone levels had significantly reduced to castration levels after 1 year of cross-sex hormone treatment. Muscle mass had also reduced after 1 year of cross-sex hormone treatment. However, muscle mass remained significantly greater than in transgender male individuals (assigned female at birth) who had not been prescribed cross-sex hormone treatment.

Therefore, Gooren and Bunck concluded that transgender male individuals are likely to be able to compete without an athletic advantage 1-year post-cross-sex hormone treatment. To a certain extent this also applies to transgender female individuals; however, there still remains a level of uncertainty owing to a large muscle mass 1-year post-cross-sex hormones. While this study was the first to explore, experimentally, whether transgender people can compete fairly, the sample size was relatively small ( n  = 36). Additionally, they did not explore the role of testosterone blockers and did not directly measure the effect cross-sex hormones had on athletic performance (e.g. running time). Many, but not all, transgender female individuals are prescribed testosterone blockers to help them to reach cisgender female testosterone levels, when administration of oestrogen alone is not enough to reduce testosterone levels. This is particularly important if the person aims to undergo gender-confirming surgery, as 6 months of testosterone suppression is a requirement for such procedures. However, if a transgender woman does not wish to undergo surgery or does not wish to have their testosterone blocked to cisgender female levels (e.g. as they wish to use their penis), their testosterone levels will be above cisgender female levels. Differentiating not only between those taking cross-sex hormones and not taking cross-sex hormones, but also transgender female individuals taking testosterone blockers, may be necessary when discussing an athletic advantage.

The remaining studies considered within this section are qualitative, and although they have provided insight into the experiences of transgender people participating in competitive sport, the findings cannot be generalised. Semerjian and Cohen’s [ 27 ] narrative account provides a good overview of how diverse and individual the issues and experiences of transgender people participating in competitive sport can be. Some participants felt anxious when engaging in sport because they felt their genitals may be revealed (e.g. when changing). In contrast, one participant used sport as a safe space to escape from the harassment he received at school. It must be considered though, that participants within the study engaged in different sports and their experiences could therefore be associated with the specific sport (i.e. some sports could be more inclusive then others).

Three qualitative studies described the implications that sport policies had on the experiences of transgender people who engaged in sport [ 26 , 28 , 29 ]. Cohen and Semerjian [ 26 ] published a case study about a transgender woman (pre-gender-confirming surgery) who was playing in the women’s national ice hockey tournament, but who was eventually banned from playing in the tournament because it was felt she had an athletic advantage. She described how she felt under constant surveillance when she was playing and at times felt ambivalent about what gendered team she should play on. It was apparent that although teammates were supportive, the issues she experienced in relation to inclusion in the tournament were primarily related to constraints put in place by competitive sport policies. Similarly, the discussions held by two former New Zealand transgender female netball players in Tagg’s [ 28 ] study gave the impression that although transgender sport policies were supposedly implemented to increase the inclusivity of transgender people, this was not always the case. They discussed how policy would allow a pre-gender-confirming surgery transgender woman to compete in a male or mixed-gender netball team only and they must obey male dress codes. However, the participants in this study were former netball players and therefore their discussions may not have been based on the current state of netball in relation to transgender participation. In contrast to the previously mentioned studies, the majority of participants ( n  = 12) in Travers and Deri’s [ 29 ] study discussed the positive experiences they had in relation to transgender participation in competitive sport. However, some of the transgender men did discuss how they had hostile experiences (e.g. incorrect pronoun use). Several of the participants in this study also felt that testosterone gave transgender women (endogenous) and men (when injected) an athletic advantage.

For the two young transgender male individuals in Caudwell’s [ 25 ] study, the stage of transition appeared to be instrumental in disengagement from participation in competitive sport. The discussion held by the participants highlighted how accessing sport during their transitional period was difficult as they would not be accepted or feel comfortable on either a male or female team during this period. However, this study again discussed sport very broadly and therefore it is unknown whether the participants’ experiences were associated with specific sports or whether they are generalisable across other sports.

In summary, there is limited research from which to draw any conclusion about whether transgender people have an athletic advantage in competitive sport or not. The limited physiological research conducted to date has informed the development of transgender sport policies that are implemented by sporting organisations all over the world. It is these sport policies that appear to be instrumental in transgender people’s experiences with competitive sport, most of which are negative.

Review of Transgender People and Sport-Related Physical Activities: Research Articles

Within this systematic review, only two studies explored sport-related physical activities [ 24 , 30 ]. Muchicko et al. [ 30 ] set out to quantitatively explore the relationship between gender identity and physical activity. They compared levels of physical activity between cisgender and transgender people. The study found that self-identified transgender participants ( n  = 33) reported engaging in less physical activity than cisgender participants ( n  = 47). Social support and self-perception were found to mediate the relationship between gender identity and physical activity. The authors suggested that their study highlights how leisure centres need to be more inclusive, and transgender people need to be given more social support to encourage physical activity. However, this study was limited by the sampling methods employed. The cisgender participants were recruited from a university campus where they potentially had more opportunity to walk around campus, and opportunity for discounted gym memberships, whereas the transgender participants were recruited from a support group for transgender people and were not associated with the university.

As with transgender people who engage in sport at a competitive level, transgender people who engage in sport-related physical activity also appear to experience a range of different barriers. Hargie et al. [ 24 ] found in their qualitative study that transgender people prefer to engage in individual, as opposed to group, sport-related physical activities. This was reportedly owing to their fear of being ‘outed’. Regardless of whether sport-related physical activities are engaged in individually or in a group, changing rooms appeared to be a significant barrier. Being excluded from sport-related physical activities was distressing for participants, as they could not maintain physical fitness, which they felt was important in preparation for gender-confirming surgery. Despite these interesting findings, the study is limited by the lack of sociodemographic information provided about participants. Within qualitative research, because of the small sample size, it is often desirable to provide a large amount of sociodemographic detail about participants so that the findings can be interpreted in relation to this information. For instance, in the context of sport-related physical activities, the stage of transition may be an important factor when interpreting the individuals’ current experiences of sport-related physical activities.

The limited research studies concerned with sport-related physical activities suggest that inclusive environments are not created for transgender people engaging in such activities, which may deter engagement.

Transgender-Inclusive Sport Policies

Characteristics of the eligible sport policies.

Of the 31 transgender inclusive policies reviewed, 13 were from the USA [ 31 – 43 ]. Ten of the policies reviewed were from the UK [ 44 – 53 ]. One policy was from Australia [ 54 ]. The rest of the policies ( n  = 7) were international [ 18 , 20 , 55 – 59 ]. Details of all of the sport policies included within this review can be found in Table  2 .

Table 2

Transgender-inclusive sport policies included within this systematic review

GCS gender-confirming surgery, CHT cross-sex hormone therapy, IOC International Olympic Committee, TUE therapeutic use exemption, n.d. no date

a Gender dysphoria is the diagnostic name included within the Diagnostic and Statistical Manual for Mental Disorders , Fifth Edition, for people who experience an incongruence between their gender assigned at birth and gender identity [ 60 ]

Review of the Sport Policies

Policies within this section were systematically reviewed in relation to their inclusiveness of transgender competitors (i.e. maintaining fairness in the absence of advantage for all competitors). The fairness of the policy requirements was judged against the available physiological research that has explored athletic advantage. The time restrictions associated with each requirement were also reviewed (e.g. cross-sex hormones must have been administered for at least 2 years prior to competition). The requirements from each policy are summarised within Table  2 and the most salient points of these policies are then presented in the section that follows.

In 2004, the IOC [ 18 ] announced that transgender people who transition after puberty are permitted to compete in sport in line with their experienced gender identity providing they have had gender-confirming surgery, can provide legal recognition of their gender, have been prescribed cross-sex hormone treatment for at least 2 years and have lived in their experienced gender for the same amount of time [ 18 ]. Additionally, transgender people who had undergone gender-confirming surgery pre-puberty are eligible to compete in sport in line with their experienced gender identity [ 18 ]. This is an international policy and has been adopted by sport organisations all over the world.

While the 2004 IOC [ 18 ] policy has been praised for its efforts to address the inclusion of transgender athletes [ 61 ], several flaws have been identified [ 61 ]. First, the policy excludes transgender people who choose not to have gender-confirming surgery owing to a lack of genital dysphoria (distress), medical reasons, fears about risk during operations, and/or because of other personal reasons [ 28 , 62 , 63 ]. The 2004 IOC [ 18 ] policy also excludes transgender people who are in the process of transitioning. For instance, a transgender athlete may be prescribed cross-sex hormone treatment, but be yet to undergo gender-confirming surgery. The 2004 IOC policy [ 18 ] therefore adopts a very narrow definition and excludes a large proportion of transgender people [ 19 ]. In addition to this, the policy appears to have been developed with only transgender female individuals in mind, possibly as transgender male individuals are not thought to possess athletic advantages in the majority of sports, and therefore the policy discriminates against transgender male individuals [ 21 ]. Moreover, the 2004 IOC [ 18 ] policy fails to take into consideration the regional, national and international differences in accessing cross-sex hormone treatment and gender-confirming surgery [ 18 , 63 – 65 ]. Within this policy, there also appears a lack of an evidence-based rationale as to why a period of 2 years was chosen as the length of time cross-sex hormone treatment must be administered prior to sport competition and why individual differences in blood hormone levels are not considered [ 66 ]. As mentioned previously, the role of testosterone blockers in transgender women is also not considered. Although the rationale for the 2-year time period is not made explicit, it may be related to the fact that this time period was imposed by the IOC in 2004, when banning athletes from competitive sport to discipline them for doping violations. The evidence-based rationale for gender-confirming surgery is also not clear [ 61 ]; whether an athlete has a penis or vagina appears irrelevant, as this will not change the physiology of the body or the physiological advantage of the person [ 63 ].

Approximately 200 days before the 2016 Rio Olympic Games, the IOC announced changes to their competitive sport policy for transgender people. The new 2016 IOC [ 20 ] policy suggests that transgender male athletes are able to compete in a male category without any restrictions. Transgender female athletes may compete in a female category if they have declared their gender as female for at least 4 years and their blood testosterone levels are below 10 nmol/L for at least 12 months prior to competition. However, the latter requirement is a general guideline, and each case will be reviewed individually to determine whether 12 months is a sufficient amount of time to suppress testosterone levels to an appropriate level. If transgender female athletes do not meet these requirements, they will be able to compete in a male category. This is a great improvement in sport policy, which considers gender assigned at birth and individual difference in relation to bloody hormone levels and moves away from the requirement of surgery to compete in their experienced gender category. However, we could not find any evidence to support the requirement for testosterone levels to be below 10 nmol/L for at least 12 months.

Despite its flaws, the 2004 IOC policy [ 18 ] has been adopted by several other sport organisations. Within this systematic review, 11 sport organisations adopted the policy outlined by the IOC in 2004 [ 33 , 36 , 38 – 40 , 45 , 46 , 48 , 49 , 51 , 57 ]. All but one (the International Tennis Federation) of these sport organisation policies are employed at a national level. Not only is it problematic that other sport organisations adopted the 2004 IOC policy, but elements of the 2004 IOC policy concerning children pre-puberty are not applicable to sport organisations in the UK and many other countries. Within the UK (and many other countries), children presenting with gender incongruence cannot undergo gender-confirming surgery before the age of 18 years, by which time puberty has usually started.

Three policies stated that it is only necessary to provide legal recognition of gender and to be prescribed cross-sex hormone treatment for a ‘sufficient amount of time’ (international policy) [ 56 ] or so that hormone blood levels are within cisgender female or male ranges (national policy) [ 44 , 52 ]. Policies from the National Collegiate Athletic Association [ 32 ] and British Rowing [ 50 ] also state that only cross-sex hormone treatment is required; however, the specifics of this requirement differ for both transgender male and female individuals. With both of these policies, transgender female individuals have to provide more evidence of cross-sex hormone treatment and their blood hormone levels in comparison to transgender male individuals. Similarly, the Association of Boxing Commissions [ 31 ] in its national policy has different cross-sex hormone treatment requirements depending on gender assigned at birth and how the athlete identifies themselves (transgender or transsexual). The language used within the Association of Boxing Commissions’ policy [ 31 ] may be seen as offensive by some transgender people and the difference between “transsexuals” and “transgender” people remains unclear. Policies held by the Ladies Professional Golf Association (international policy) [ 43 ] and the International Association of Athletics Federations [ 55 ] differ dramatically in relation to gender and gender-confirming surgery as a requirement. In both cases, it is necessary for transgender female individuals to have undergone this procedure, but not for transgender male individuals. Although some of the requirements of these policies are unreasonable and not evidence based (e.g. gender-confirming surgery), the gender difference in relation to the amount of evidence that is required about their gender change seems acceptable considering that only transgender female individuals (and not transgender male individuals) are currently seen to potentially have an athletic advantage [ 23 ].

The more inclusive sport policies reviewed here only required legal or medical recognition or do not ask for any evidence of gender; thus they encourage competition in line with the experienced gender (five were national policies and two were international) [ 34 , 35 , 41 , 42 , 53 , 54 , 59 ]. The Fédération Internationale de Volleyball [ 58 ] had the most invasive policy considered within this systematic review; they ask players to provide a birth certificate to verify gender. Additionally, female players may be asked to provide a gender certificate or submit themselves to a medical examination if the medical evidence is not sufficient. Both British Universities & Colleges Sport [ 47 ] and USA Triathlon [ 37 ] do not have their own policies, but suggest the adoption of other policies (i.e. those relevant to the sport in question or guidelines of the US Anti-Doping Agency, respectively).

Currently, the majority of sport policies unfairly exclude transgender people from competitive sport, as the requirements they place on them are not underpinned by evidence-based medicine. Until (and if) there is consistent and direct evidence to demonstrate transgender people have an athletic advantage, it seems unreasonable to exclude them on any basis.

The first aim of this systematic review was to explore the experiences of transgender people in relation to competitive sport participation (elite and recreational) and sport-related physical activity. The majority of the studies within this body of literature are qualitative in nature, which may be at least partly a reflection of the low numbers of transgender people in the general population. It is therefore difficult to draw any definite conclusions because of the lack of quantitative research. By its very nature, the findings from qualitative research cannot be generalised but the findings can be used to form a platform from which generalisations can be made. The research articles reviewed here described a generally negative experience of sport participation and sport-related physical activity for transgender individuals. It was evident from these studies that transgender people are facing barriers when engaging in competitive sport and sport-related physical activity. In relation to sport-related physical activity, lack of accessibility to an inclusive and comfortable environment appeared to be the primary barrier to participation. Charities and support organisations working with transgender people should consider developing campaigns to raise awareness about different gender identities. Leisure centres should also be made more aware of potential gender differences (i.e. via training and greater information provision) and be given advice on how to make such environments more inclusive of transgender people (e.g. gender neutral changing facilities with cubicles). In relation to competitive sport participation, the findings from this systematic review suggest that the requirements that transgender competitive sport policies place on competitors were instrumental in transgender athletes’ negative experiences.

While a distinction needs to be made between the issues and experiences transgender people have with regard to participation in sport and competitive sport, it also needs to be acknowledged that there is an overlap. Transgender male and female individuals have anecdotally discussed that access to sport participation (such as becoming part of the local football team) is restricted as even community and local sport organisations who play at a recreational level implement transgender competitive sport policies.

The second aim was to review the available sport policies regarding the fairness for transgender people in competitive sport (i.e. fairness in the absence of advantage). Owing to overinterpretation and fear of the athletic advantage in transgender athletes, the majority of the policies reviewed were discriminatory against transgender people, especially transgender male individuals (i.e. exclusion in the absence of advantage). Although the updated IOC policy may be perceived as more inclusive then the 2004 version, there are still flaws. The requirement for a transgender female individual to have declared their gender as female for at least 4 years is excessive. In the UK and many other countries, once a transgender person has accessed a transgender health service, it is likely to be less than 4 years before a person legally changes their name, undergoes irreversible treatments and, hence, fully commits to their experienced gender. There appears to be a lack of rationale regarding the 4-year time period for transgender athletes, although this time restriction is consistent with the current disciplinary action for cisgender athletes when a doping incident occurs [ 67 ]. The 2016 IOC policy [ 20 ] also states that to avoid discrimination against transgender female individuals, they are allowed to complete in a male category if they do not meet the requirements for transgender female athletes. For most transgender female individuals, competing in a male category, when their experienced gender is female, would be distressing and may deter engagement in competitive sport altogether. This particular requirement may be promoting exclusion of transgender female individuals in competitive sport, rather than avoiding discrimination.

Several sport policies, including the recently updated IOC 2016 [ 20 ] policy, have based their requirements for transgender competitors on indirect, inconsistent and unambiguous evidence. Physiological research involving cisgender people has shown that testosterone deficiency in young men is associated with a decrease in muscle strength [ 68 ] and testosterone injections in cisgender men are associated with an increase in some aspects of muscle strength [ 69 ]. However, this research did not determine whether these decreases and increases in muscle mass are within ranges for cisgender female and male individuals and the time required to reach cisgender male or female levels. Elbers et al. [ 70 ] expanded on this research by exploring the effects of oestrogen supplements and androgen deprivation on fat distribution and thigh muscle mass (by using magnetic resonance imaging) in 20 transgender female individuals. They found that 12 months after cross-sex hormone treatment, transgender female individuals had a more feminine pattern of adiposity and their thigh muscles had decreased. Other research has found that transgender female athletes who have hormonally and surgically transitioned have reported feeling weaker and their testosterone levels tend to be lower than average compared with cisgender women [ 19 , 71 ]. However, this research does not tell us anything about the relationship between androgenic hormones and athletic ability.

To date, Harper’s study [ 72 ] is the only one to directly explore androgenic hormones and athletic ability. The aim of the study was to explore the long-distance (5–42 km) running times of eight transgender female individuals pre- and post-testosterone suppression. It was found that post-testosterone suppression running times were significantly slower in comparison to pre-testosterone suppression. Harper stated that owing to reductions in testosterone and haemoglobin, transgender female individuals post-transition would have the same endurance capabilities as a cisgender female individual. However, the sample size was very small ( n  = 8) and participants were asked to self-report their race times, which might have been subject to recall or social desirability bias.

On average, men perform better than women in sport; however, no empirical research has identified the specific reason(s) why. Based mainly on indirect research with cisgender people, it is commonly believed that androgenic hormones (specifically high testosterone levels) confer an advantage in competitive sports (i.e. enhance endurance, increase muscle mass) and, while this belief has informed several sporting policies, testosterone may not be the primary, or even a helpful, marker in determining athletic advantage [ 73 ]. Karkazis et al. [ 73 ] have argued that there is no evidence to suggest that endogenous testosterone levels are predictive of athletic performance (apart from doping), as there is variation in how bodies make and respond to the hormone. Testosterone is only one part of a person’s physiology and there are other important factors (both biological and environmental) that should be considered if fairness (the absence of advantage) is the aim in competitive sport. For instance, having large hands is key for manipulation in some sports (e.g. basketball), but this is not seen as an unfair advantage. Establishing what an athletic advantage is in competitive sport would facilitate inclusion of all athletes (regardless of their gender identity) on the premise of fairness.

The Canadian Centre for Ethics in Sport [ 74 ] recently released a document offering guidance to sport organisations on how to develop inclusive competitive sport policies for transgender people. An expert panel maintained the viewpoint that everyone has the right to compete in accordance with their gender identity at a recreational and elite level. Cross-sex hormones and gender-confirming surgeries should not be a requirement at any level of sport. If any sport organisation requires transgender competitors to take cross-sex hormones for a specified time, they will have to provide evidence to support that this is reasonable. The panel suggests that when sporting organisations are concerned about safety, based on the size or strength of competitors, such organisations should develop skill and size categories, such as in wrestling.

The issues and challenges that transgender people experience when engaging in competitive sport and sport-related physical activity will undoubtedly become more prominent as the visibility and prevalence of transgender people become more pronounced. Consequently, health professionals working in sport will need to become more familiar with the specific issues and challenges that a transgender person may experience when engaging in sport. By doing this, these professionals will be able to ensure transgender people can start or continue to engage in sport in a safe and inclusive manner. The most common question of people working within the sport domain will likely be: When it is safe and fair to permit a transgender person to compete in sport in line with their experienced gender? At the current time, this is a difficult issue to address considering that there is a lack of direct and consistent physiological performance-related data with transgender people, which is preventing a consensus from being made as to whether transgender people (especially transgender female individuals) do or do not have an athletic advantage. It may be sensible to suggest that until there are direct and consistent scientific data to suggest that transgender competitors have an advantage, transgender people should be allowed to compete in accordance with their gender identity with no restrictions (e.g. no requirement to have cross-sex hormones, gender-confirming surgery). The athletic advantage transgender female individuals are perceived to have (based on indirect and ambiguous evidence) may be no greater than widely accepted physiological (e.g. large hands) and financial (e.g. training opportunities) advantages that some cisgender people possess in competitive sport. Sport organisations wanting to exclude a transgender person from competing in their experienced gender category would need to demonstrate that the sport is gender affected and that exclusion is necessary for fair and safe competition [ 74 , 75 ]. At the current time, this would be difficult considering there is no evidence to suggest that androgenic hormone levels consistently confer a competitive advantage [ 74 , 75 ].

Limitations of the Area and Directions for Future Research

Within the area of sport, physical activity and transgender individuals, research is limited and mainly qualitative. More quantitative research needs to be conducted to increase the applicability and generalisability of the research findings and so that conclusions about transgender people and sport can be drawn. At a medical level, more physiological research is needed with the transgender population to accurately determine whether transgender people have an advantage in competitive sport or not. Future studies should investigate when a person can be considered physiologically as their experienced gender. This in turn should aid more inclusive (i.e. inclusion in the absence of advantage) sport policies for transgender individuals and a fair system for all. To date, the few studies exploring the experiences of transgender people have mainly been concerned with exploring experiences in relation to competitive sport. This research now needs to be extended to those who participate in sport-related physical activity for leisure and fitness. It is also important to understand transgender people’s experiences in the context of different sports. The barriers to, and facilitators of, football participation, for example, may greatly differ to those experienced when engaging in gymnastics, athletics, swimming or aquatic activities. For the latter four sports, clothing may be revealing and an indication of one’s gender. For example, feeling comfortable in swimwear may be an issue for transgender people, especially when they are in the process of transitioning, as the body is often more exposed than in other sportswear (e.g. a football kit) and swimwear is heavily gendered (i.e. swimming trunks are worn by male individuals and swimming costumes by female individuals). In light of this, it would be interesting to explore the experiences of transgender people who have previously participated, or are currently participating, in aquatic activates, gymnastics and/or athletics.

Overall, it appears that the majority of transgender people have a negative experience of competitive sport and sport-related physical activities. Accessibility to sport-related physical activity needs to be improved. Within competitive sport, the athletic advantage transgender athletes are perceived to have appears to have been overinterpreted by many sport organisations around the world, which has had a negative effect on the experiences of this population. When the indirect and ambiguous physiological evidence is dissected, it is only transgender female individuals who are perceived to potentially have an advantage as a result of androgenic hormones. Within the literature, it has been questioned as to whether androgenic hormones should be the only marker of athletic advantage or, indeed, if they are even a useful marker of athletic advantage. Given the established mental and physical health benefits of engaging in physical activity and sport [ 13 , 14 ], the barriers transgender people experience are a significant limitation to the promotion of healthy behaviours in transgender individuals. There are several areas of future research required to significantly improve our knowledge of transgender people’s experiences in sport, inform the development of more inclusive sport policies, and most importantly, enhance the lives of transgender people, both physically and psychosocially.

Acknowledgments

We sincerely thank Prof. Barrie Houlihan for his helpful advice and feedback on an early draft of this systematic review.

Compliance with Ethical Standards

Bethany Jones was supported by a PhD studentship co-funded by Leicestershire Partnership NHS Trust and Loughborough University. No other sources of funding were used to assist in the preparation of this article.

Bethany Jones, Jon Arcelus, Walter Bouman and Emma Haycraft declare that they have no conflicts of interest relevant to the content of this review.

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Case Study: Are the Right People in the Right Seats?

• Nitin Nohria

A new CEO considers changes to her top team.

The newly appointed CEO of Highstreet Properties has doubts about several members of the top team she has inherited. She’s trying to drive a turnaround, the company has a complicated matrix structure, and some team members seem opposed to her strategy. She’s debating replacing several of them, but she’s worried about making too many changes too quickly, upsetting her board, and bringing in too many former colleagues.

Shannon Levy, the new CEO of Highstreet Properties, stared out the window of the company’s London headquarters, wondering whether she should call Justin Mooney and fire him. A once-thriving developer of retail malls, Highstreet had been battered by consumers’ shift to e-commerce, Covid-19 mall closures, and internal discord over strategy. Shannon had been brought in to turn the business around. She was fast approaching her 100-day mark and already feeling behind on selecting, aligning, and motivating her senior leadership team.

• Nitin Nohria is the George F. Baker Jr. and Distinguished Service University Professor. He served as the 10th dean of Harvard Business School, from 2010 to 2020.

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A public-private-people partnership gives old shoes a second life

Oct 25, 2022

Used shoes are making new tracks in Singapore – jogging tracks, that is.

Earlier this summer, Dow joined the national sports agency Sport Singapore (SportSG) and other partners to establish a first-of-its-kind permanent shoe-waste collection ecosystem in Asia Pacific. The new public-private partnership will recycle the rubberized soles and midsoles of used shoes into materials used to make sports surfaces and infrastructure. The shoes can be dropped off at any of 100 collection sites across Singapore.

The collaboration rethinks what can be done with waste that previously went to landfills and builds upon a successful  2020  pilot program between Dow and SportsSG that saw more than 75,000 shoes collected – the equivalent of approximately 3.3 kilometers of jogging track built. It also is an example of how public-private partnerships can play an important role in implementing real-world recycling solutions that are accessible and scalable.

The project aligns with Dow’s commitment to advance a circular economy and increase global recycling rates, including its “Stop the Waste” target that seeks to enable 1 million metric tons of plastic to be collected, reused or recycled through direct actions and partnerships by 2030.

CHALLENGE: RUNNING OUT OF TIME

Singapore is an island nation with one offshore landfill, the Semakau Landfill. The landfill is projected to hit capacity in 2035. In order to reduce the amount of waste sent to the landfill, the government of Singapore has launched a  Zero Waste Masterplan  that aims to reduce the waste to landfill daily by 30 percent. This will help extend the useful life of the landfill.

To help meet its zero-waste goals, the government of Singapore is seeking to partner with businesses, non-governmental organizations, community groups and schools to come up with innovative and effective solutions to curbing waste and promoting a zero-waste lifestyle.

One opportunity to close the loop on waste is shoes. Each year, approximately  22 million pairs of shoes are sold in Singapore, and only a small percentage is recycled.

SOLUTION: ON TRACK TO REDUCE WASTE FOOTPRINT

Why shouldn’t the same shoes that once rounded the jogging track become part of the track itself? Establishing a permanent shoe-waste collection ecosystem helps Singapore residents give a second life to their used sports shoes and contribute to building new sports services and infrastructure. At the same time, their actions help reduce the load on the nation’s landfill. The program seeks to recycle 170,000 pairs of used sports shoes annually.

Drawing on its technological and R&D expertise, Dow is working with Sport Singapore to transform shoes contributed by members of the community into jogging tracks, fitness corners and playgrounds. Through the program, the rubberized soles and midsoles are to be ground into granules that then will be bound together by a water-based and solvent-free binder technology. The collaboration also involves partners such as B.T. Sports, Alba WH, Decathlon and Standard Chartered Bank.

An important component of the pilot program was to educate Singapore residents to adopt new recycling behaviors and drive positive change in the community. A robust, permanent program has the potential to shift mindsets across the value chain, so recycling used shoes becomes business as usual in Singapore.

STEPPING UP TO BUILD A CIRCULAR ECONOMY

A goal of the shoe-waste collection program is that, over time, it can help bring about fundamental behavioral shifts that change the sport ecosystem. This will in turn help champion a Singapore that produces less waste and less carbon emissions.

When it comes to tackling common challenges such as climate change and a mounting waste problem, we all need to reduce our ecological footprint. Public-private-people partnerships can be a step forward – helping to build a global circular economy where resources are used efficiently, proper recycling supports economic activity, and innovation and technology push the boundaries of resource recovery.

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Lost chances to treat overdose survivors are documented in new Medicare study

Packages of the overdose antidote naloxone await use on Thursday, June 6, 2024, at OnPoint NYC, an overdose prevention center in New York. According to a study published Monday, June 17, 2024, in JAMA Internal Medicine, people on Medicare who survived a drug overdose in 2020 were much more likely to later receive opioid painkillers than any medication to treat addiction — and some went on to die of an overdose. (AP Photo/Carla K. Johnson)

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A new study documents lost opportunities to treat drug overdose survivors covered by the Medicare program — and illustrates the difficulty of managing chronic pain.

Overdose survivors “should be at the front of the line for the full range of medications and counseling and support,” said Dr. Brian Hurley, president of the American Society of Addiction Medicine, who was not involved in the study, published Monday in JAMA Internal Medicine.

Instead, those on Medicare who survived a drug overdose in 2020 were much more likely to later receive opioid painkillers than any medication to treat addiction — and some went on to die of an overdose .

U.S. government researchers found 53% of overdose survivors received opioid painkillers while 4% received treatments such as buprenorphine. Only 6% filled prescriptions for the overdose antidote naloxone. Within a year of their overdose, 17% experienced a second nonfatal overdose and 1% died of an overdose.

The researchers looked at nearly 137,000 Medicare beneficiaries who survived an overdose in 2020, when the emergence of COVID-19 scrambled drug treatment efforts.

The group included about 30% who qualified for Medicare because of a disability rather than their age. About 80% of them had been treated for acute or chronic pain, and nearly half had prescriptions for opioids before the overdose.

In some situations, it might be appropriate to continue to prescribe opioids after an overdose, but “these patients should be closely monitored, provided naloxone” and have plans in place to reduce overdose risk, said lead author Capt. Christopher Jones of the Substance Abuse and Mental Health Services Administration.

Gaps in treatment for overdose survivors exist throughout the U.S. health care system and predate the pandemic, said Dr. Michael Barnett of the Harvard T.H. Chan School of Public Health, who was not involved in the new study, but found similar results among Medicare patients from 2016-2019.

“The health system is very poor at connecting people to life-saving medication after they overdose,” Barnett said. “It’s a health system problem. And it’s also a problem of stigma and public education that many people may not be interested or may not trust medications for opioid use disorder.”

In 2020, Medicare expanded coverage to include methadone to address a longstanding treatment gap . Methadone is the oldest, and experts say, the most effective of the three approved medications used to treat opioid addiction. It eases cravings without an intense high, allowing patients to rebuild their lives.

Medicare still does not cover residential addiction treatment, another gap that should be closed, Hurley said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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2 years after Roe v. Wade reversal: Impacts and what’s to come

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On June 24, 2022, the U.S. Supreme Court overturned Roe v. Wade, ending 50 years of federal protection of abortion rights in the U.S. and opening the door for states to craft their own bans.  

Since then, 14 states have banned abortion and 11 have established previously illegal limits on when a person can have one. About one in three women of childbearing age live in one of those states.

“We are seeing profoundly unprecedented restrictions, far more extreme than anything that we saw in the decade of escalating restrictions that preceded Dobbs,” said Amanda Stevenson, a sociologist and demographer who studies the impacts of abortion and family planning policy. “We’ve seen restrictions that try to prevent all abortions, including abortions to save people's lives, and restrictions on abortion after six weeks, which is two weeks after a missed period—before most people know they're pregnant.”

Amanda Stevenson

The Dobbs v. Jackson Women’s Health Organization ruling, or the Dobbs decision, has already fundamentally changed the way people access abortion in the U.S. and even impacted the way people feel about sex and pregnancy.

CU Boulder Today caught up with Stevenson on the eve of the two-year anniversary of Dobbs to get her take on the impacts thus far and what’s to come.

How are people in states with bans accessing care?

We saw an estimated 171,000 people travel across state lines for abortion in 2023 alone—about one in five of all abortions that year. These are often people whose lives are already really hard. They’re not ready to parent because they don’t have a safe place to live or are in an abusive relationship or are very young. People who get abortions are roughly twice as likely to be poor as the general population. They have to pay to travel, take off work and pay for childcare on top of paying for the procedure.

Some are turning to abortion pills delivered through the mail. About 63% of abortions in the U.S. are now medication abortions, up from 53% in 2020. Because of all this, the number of abortions in the U.S. has not actually changed very much since Dobbs. In fact, it appears the number has continued to increase .

How has the Dobbs decision impacted states where abortion is still legal?

An estimated 6,700 nonresidents came to Colorado for abortion care in 2023, representing 27% of all reported abortions in the state, up from about 10% before 2022. Even people who aren’t physically coming to Colorado from states with bans may be relying on physicians here to help manage their medication abortions. Either way, providers’ time is spent caring for these people, so there are bottlenecks in service. People who need an abortion in Colorado have to wait longer than they did before Dobbs.

Are people worried about getting in legal trouble?

Yes. One nonprofit has seen a 900% increase in calls to its helpline for people concerned about legal issues with respect to abortion and reproduction. It’s hard to get concrete numbers on how often people are being prosecuted, because crime data in the United States is so fragmented, and prosecutors charge people under different laws in different places. But we do know that it happens.

Even before the Dobbs decision, at least 61 people were prosecuted for allegedly trying to self-manage abortion between 2000 and 2020. In one recent case, a Texas woman was charged with murder after allegedly attempting to self-manage her abortion.

Emergency Medical Treatment & Labor Act: What is it and how could it impact care?

There used to be this problem where hospitals would refuse to care for people who were at death's door because they knew they couldn't pay. And the federal government passed a law called the Emergency Medical Treatment & Labor Act (EMTALA) that required hospitals to provide stabilizing care to people at risk of death or severe consequences. If a woman is experiencing complications when she's pregnant and goes to the hospital, stabilizing care is often going to be miscarriage management or potentially abortion.

States that have banned abortion are suing the federal government saying that their state abortion bans should supersede EMTALA. If the court agrees with the states, then doctors who stabilize pregnant patients as required by EMTALA would be at risk of state prosecution and people would probably be denied critical emergency care.  

What other changes could lie ahead?

Without a doubt, contraception is at risk. In his Dobbs concurrence, Justice Clarence Thomas explicitly placed the legal theories that had underpinned Roe v. Wade in question, and those same theories underpin the decisions that legalized contraception in the United States. If federal protection for the right to use contraception is eroded, states will be able to enforce bans on specific methods of contraception that opponents, contrary to medical evidence, believe are abortifacients. That includes IUDs, oral contraceptives and emergency contraception.

We have also been hearing explicit plans to enforce the Comstock Act, a Victorian era law that banned the sending of drugs and devices that are contraceptive or abortifacient in the mail. That would criminalize sending of abortion pills across state lines and could also potentially ban the transmission of medical equipment used to provide surgical abortion. If federal protections for contraception are eroded, the Comstock Act could also effectively ban contraception.

How has society changed since Dobbs?

Well, anecdotally we are hearing that at least some people are avoiding sex and relationships, and potentially avoiding pregnancy altogether—even if they want to have kids. Pregnancy can be dangerous, and if you can't rely on the medical system to protect you if something goes wrong, then the calculus about whether to get pregnant with a wanted pregnancy is different too. It’s just too scary for some people.

CU Boulder Today regularly publishes Q&As with our faculty members weighing in on news topics through the lens of their scholarly expertise and research/creative work. The responses here reflect the knowledge and interpretations of the expert and should not be considered the university position on the issue. All publication content is subject to edits for clarity, brevity and  university style guidelines .

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