Well Being

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The current UK guidelines suggest that adults should accumulate 150 minutes of moderate intensity physical activity across the week (National Institute for Health and Care Excellence [NICE}, 2012). Despite evidence of the positive health benefits, a paradox exists where exercise may produce negative effects such as depression and anxiety (Szabo, 1998). A dependence on exercise […]

The current UK guidelines suggest that adults should accumulate 150 minutes of moderate intensity physical activity across the week (National Institute for Health and Care Excellence [NICE}, 2012). Despite evidence of the positive health benefits, a paradox exists where exercise may produce negative effects such as depression and anxiety (Szabo, 1998). A dependence on exercise is often cited as a symptom of an underlying eating disorder, such as anorexia nervosa (Yates, Leehey & Shisslak, 1983) conditions all of which are recognised by the DSM-V. This has raised a debate about whether the dependence on exercise can occur without another underlying psychological disorder being present.

Positive and Negative Dependence

Research examining the negative consequences of physical activity has mainly focused on exercise dependence (Hausenblas & Symons Downs, 2002a). The term was first used to describe over-commitment to exercise in middle-aged men who continued to exercise despite suffering injuries from involvement (Little, 1969). Baekeland (1970) suggested that exercise dependence can have either a positive or negative nature. It was first described as a ‘positive’ addiction because it was thought to produce both psychological and physiological benefits such as feelings of euphoria, increased mental strength and could lead to self-transcendence (Glasser, 1976). By contrast, a negative addiction reflects the withdrawal symptoms of agitation, anxiety and depression (Szabo, 1998) experienced by exercisers when they are denied access to exercise opportunities (Allegre, Souville, Therme & Griffiths, 2006).

Negative dependence on exercise was researched by Morgan (1979). Dependence was present if the individual required daily exercise in order to exist or cope and if deprived of exercise, the individual would manifest withdrawal symptoms (such as depression, anxiety or irritability) Morgan argued that these withdrawal symptoms were no different to the chemical-dependence process seen for other drug and substance abuses. Symptoms of negative dependence include: an increased in dose dependence with exercise, an increase in withdrawal symptoms (including depression, anxiety, irritability, muscle tension and decreased appetite) and putting exercise as a high priority (Morgan, 1979). In 1985, Dishman coined the term obligatory exercise which described people who have an unhealthy need to exercise. This included the three symptoms of negative dependence described by Morgan.

Classification in the ICD and DSM

Goodman (1998) argues that addictions are distinguished from impulsive and compulsive behaviour by their dual capacity to reduce negative affect and create a positive mood. The ICD-10 doesn’t classify exercise dependence as an individual disorder, but rather as: symptoms of compulsion (a desire/compulsion to take the substance); impaired control (difficulty in controlling behaviour regarding the substance); withdrawal (occurring once the substance has been withdrawn); relief use (substance is used to avoid or relieve symptoms of withdrawal); tolerance (increased amount of substance required to achieve the desired effect) and salience (increase in the amount of time taking, obtaining and recovering from the effects of the substance).

By contrast, within the DSM-V, exercise dependence is not classified as a standalone disorder but rather as a symptom of another such as anorexia nervosa (APA, 2013). Despite this, Hausenblas and Symons Down (2002b) used the DSM-IV criteria for substance abuse to demonstrate the plausibility of individuals fulfilling the criteria of this disorder. These include: tolerance (need for an increase in exercise); withdrawal (anxiety or fatigue); intention effect (more exercise is undertaken then was intended); lack of control (a desire or unsuccessful effort to cut down or control exercise); time (spent on activities needed to obtain exercise); reduction of other activities (such as social or occupational) and continuance (exercise is continued despite the knowledge of an injury or psychological problem).

Currently, within the sport and exercise psychology literature, the Hausenblas and Symons Down (2002a) definition is utilised. However, the debate still continues as to whether it can ever be viewed as a primary or secondary phenomena. Indeed, revisions of the DSM made to version 5 saw the introduction of gambling disorder which reflects the evidence that some behaviour activated the brain reward system with effects similar to those of drug abuse (APA, 2013). This lack of recognition of exercise as a form of substance abuse further illustrates the divergent opinions on the origins of dependence on exercise.

Primary and Secondary Dependence

As described above, exercise dependence can be split into two elements namely: primary dependence and secondary dependence. Primacy dependence is defined as meeting the criteria for exercise dependence and continually exercising solely for the psychological gratification resulting from the exercise behaviour its self (Bamber, Cockerill & Carroll, 2003). Secondary exercise dependence is defined as meeting the criteria for exercise dependence but using excessive exercise to accomplish some other end (e.g. weight loss) that is related to another disorder, such as an eating disorder (Bamber et al., 2003). Secondary exercise dependence is secondary to a more severe psychopathy and presents more severe consequences such as earlier eating disorder onset, lower BMI, more eating disorder symptoms and higher anxiety (Dalle, Grave, Calugi, & Marchesini, 2008).

Who is susceptible?

There has been research carried out to try and identify who (if anyone) is susceptible to developing exercise dependence. Research suggests that the number of people suffering from exercise dependence ranges from 2-3% (Symos Down, Hausenblas & Nigg, 2004; Griffiths, Szabo & Terry, 2005) to 20-30% (Zmijewski & Howard, 2003; Anderson, Basson & Geils, 1997). Research also suggests that between 15-20% of people with exercise dependence are also addicted to nicotine, alcohol or drugs (Aidman & Wollard, 2003) and it is also common within individuals who are addicted to sex and have buying addiction (Lejoyeux, Avril, Richoux, Embouazza & Nivoli, 2008; Carnes, Murray & Charpentier, 2005). Endurance sports such as running, swimming and triathlons are believed to attract or develop people with an addiction to exercise (Chapman & DeCastro, 1990; Kerr, 1997; Pierce, McGowan & Lynn, 1993; Veale, 1985).

Exercise Dependence and Eating Disorders

It has been suggested that 39-48% of people who suffer from an eating disorder also suffer from exercise dependence (Hausenblas & Downs, 2002a; Klein, Bennett, Schebendach, Foltin, Devlin & Walsh, 2004; Bamber, Cockerill, Rogers & Carroll, 2000). As discussed earlier, this idea of exercise dependence in line with an underlying psychological disorder is referred to as secondary dependence. There is strong empirical evidence that links eating disorders to secondary exercise dependence (Blaydon & Lindner, 2002). With this in mind, Bamber, Cockerill and Carroll (2000) argue that in the absence of an eating disorder, those who identify as exercise dependent do not exhibit the level of psychological distress that warrant primary exercise dependence as a widespread pathology. Eating disorders serve as an ineffective coping strategy to cope with emotional regulation, with exercise also serving as a similar regulatory function (Lawson, Baron-Cohen, & Wheelwright, 2004).

The characteristics of exercise dependence are common among eating disorder patients (Touyz, Beumont, Hook, 1987). 28% of eating disorder patients described themselves as compulsive exercisers (Brewerton, Stellefson, Hibbs, & Hodges, & Cochrane 1995) while another study found that 93% of eating disorder patients felt their need to be active was out of control (Davis, Kennedy, Ralevski, & Dionne 1994). Bamber et al, (2000) state that if exercise dependence is pathological, sufferers should display clear evidence of psychological issues, at a similar level for other behavioural pathologies. In a study for pathological gamblers, 60% had a lifetime mood disorder, 40% a lifetime anxiety disorder and 87% a personality disorder (Black & Moyer, 1998). Similarly, 60% of heroin addicts have been found to have an anxiety disorder and 41% have a depressive illness (Darke & Ross, 1997). There is little information on psychological disturbances and distress as general characteristics of exercise dependence (Bamber et al., 2000) suggesting that exercise dependence is a secondary disorder to another disorder, such as an eating disorder.

Within the exercise dependence and eating disorder literature, the primary focus is with exercise dependence and anorexia nervosa (Veale, 1987). There is a strong similarity between obligatory runners and anorexic patients (Yates et al., 1983). Yates et al, (1983) argued that male obligatory runners resembled anorexia nervosa patients on personality traits such as introversion, inhibition of anger, high expectations, depression and excessive use of denial and as such they could be viewed as ‘sister activities.’ Exercise behaviour is also reinforcing to individuals who suffer with anorexia nervosa (Klein et al., 2004).

There is also evidence to suggest that exercise dependence is linked to muscle dysmorphic disorder in experienced bodybuilders and strength athletes (Hurst, Hale, Smith & Collins, 2000). Muscle dysmorphia is a condition that can be characterised by individuals having a distorted body image including gaining muscle size and definition and a fear of being perceived as weak or thin (Hurst et al., 2000). An exploratory study predicted that some individuals start bodybuilding because they suffer from poor self-esteem and become dependent on the training to feel good about their body (Smith, Hale & Collins, 1998). Although, as this was only an exploration, more research would need to be conducted before this relationship can really be determined.

It is clear that exercise dependence does in some form exist. However, in order for those suffering to get access to the treatment they need, than it should be included as a primary disorder and not just treated alongside a secondary eating disorder. Although more research is being done into the area, better methods of testing should also be developed before this area is fully understood.

Article

It doesn’t seem that long since the London 2012 Olympic Games were gracing our TV screens in the Summer that saw Great Britain achieve 29 Olympic Gold medals across 26 sports. Fast forward to the present and we are edging ever so closer to another sport filled Summer, with the 2016 Olympic Games being held […]

It doesn’t seem that long since the London 2012 Olympic Games were gracing our TV screens in the Summer that saw Great Britain achieve 29 Olympic Gold medals across 26 sports. Fast forward to the present and we are edging ever so closer to another sport filled Summer, with the 2016 Olympic Games being held in Rio De Janeiro, Brazil. With average temperatures at that time of the year approximately 24 degrees celsius and a 50% chance of a cloudy day, the weather conditions have potential to be close to perfect, or at least better than the UK.

There are a whole host of things that can play upon the performance of an athlete; the weather, travelling, diet, sleep, training and physical ability. One of the most important aspects of sporting performance, regardless of the type of sport, is the mental mind set of the athlete. The physical performance of an athlete can only take them so far; everyone at the Olympics trains hard, eats right, gets the right amount of sleep, and what sets an athlete apart from the rest is their mental game.

An athlete’s mental game comes in the form of mental toughness. A mentally tough performer can be thought of as an individual who makes fewer mistakes, who doesn’t deny the problem but is efficient with their response, and who does not dwell on defeat but accepts its inevitability graciously at some point in their career (Sheard, 2012).

“Every practise and competition begins with the way you think. The quality of your thoughts is critical; think in ways that promote the outcomes that you desire”

  • Stephany Coakley

Across many sports athletes often attribute their success to mental toughness, but what exactly is mental toughness and how is it defined?

Unfortunately there are many different definitions of mental toughness in literature including: an ability to cope with pressure, stress and adversity (Goldberg, 1998), an ability to overcome or rebound from failures (Dennis, 1981), and the possession of superior mental skills (Bull, Albinson & Shambrook, 1996). There are also many characteristics of mentally tough athletes as proposed in literature, such as high levels of optimism, confidence, self belief, determination and concentration (Loehr, 1982). Despite the general lack of clarity surrounding mental toughness it has long since been one of the most important aspects of sporting performance (Gould et al., 1987). Research shows that sport performers achieving the best results are those with more mental toughness, as measured by commonly associated attributes (Crust & Clough, 2005; Golby & Sheard, 2004).

Research conducted on international athletes has attempted to define and identify key attributes of mental toughness in order to set fourth a universally accepted set of attributes (Jones, 2002). From the study, a definition of mental toughness emerged as having a psychological edge that enables:

  • The athlete to cope better than opponents with the demands sport places on them
  • The athlete to be more consistent than components in remaining determined, focused and confident
  • The athlete to remain in control when under pressure (Jones, 2002).

The attribute of self belief emerged to be the most critical aspect of mental toughness closely followed by motivation in the form of desire and determination (Jones, 2002).

Other important attributes of mental toughness were:

  • Being able to cope with an internally-derived anxiety response to the pressures of competition
  • Being able to remain focused
  • Being able to maintain technique and effort whilst experiencing physical and emotional pain resulting from failure (Jones, 2002).

This study made clear conclusions regarding a generally accepted view of mental toughness from the qualitative interviews of international athletes themselves, giving a valid representation of such an important sporting quality.

As mental toughness is so important for sporting performance, how does one become more mentally tough? Development of mental toughness is a long term process that requires many underlying mechanisms that operate in combination to achieve such a mind set (Connaughton, Wadey, Hanton & Jones, 2008). These underlying mechanisms are associated with the motivational climate of an athlete (whether they are involved in sport for enjoyment or for rewards). In addition, coaches, parents and peers are amongst many individuals who affect the mental toughness of an athlete with the work of a sport psychologist playing a pivotal role too (Connaughton et al., 2008). Experiences in and outside of sport and internalised motives to succeed are also important aspects of developing mental toughness (Connaughton et al., 2008). Once mental toughness has been developed the maintenance relies on an internalised desire and motivation to succeed, a support network within and outside of the sporting environment and effective use of basic and advanced psychological skills (Connaughton et al., 2008).

Whilst it is not certain what exactly may equate to mental toughness, it is a commonly accepted view that mental toughness is as important to sporting performance as physical ability. Perhaps mental toughness is different for every individual and what defines it is not something that can be put into words but something you know is there inside of your mind that gives you the strength to push on when it gets tough, ignoring the pain and the opposition’s determination. When it seems the world is against you and everything is set out to destroy your performance, the mental toughness inside of you persists and does not give in.

There are many aspects of sport that can impact upon performance and the important thing to remember is that every single athlete there at that moment may also be competing against those setbacks too, whether it be bad weather conditions, tiredness and fatigue from travelling, not having enough sleep or not eating the right food prior to performance. What makes an athlete a champion is that regardless of all those implications that are standing in the way of the athlete and success, they stand tall in the face of adversity and remain in belief of their ability to win. Success does not come with time, it comes with toil and to those who persevere, compete with guts, dignity and integrity, holding themselves together when things are trying to tear their performance apart. Believe in yourself and the rest will follow.

“Mental toughness is the stuff of champions”

Sheard (2012)

Article

In this day and age, technology is everywhere we go. We carry it with us on a day to day basis and are glued to it when we leave work to go home. This is particularly prominent in the younger generation, which is affecting the health and wellbeing of our future prospects. This article will […]

In this day and age, technology is everywhere we go. We carry it with us on a day to day basis and are glued to it when we leave work to go home. This is particularly prominent in the younger generation, which is affecting the health and wellbeing of our future prospects. This article will touch on the stats which suggest technological advances have led children to become more sedentary than ever, how this affecting their health and wellbeing and how it might be possible to use gaming to encourage exercise, reviewing how exergaming has not been successful previously.

70% of young people do not undertake the recommended levels of PA per week according to recent statistics, which we know to have severe physical and psychological issues as a result. The reason they are becoming more sedentary… Technology. 62% of 11 year olds, 71% of 13 year olds and 68% of 15 year olds watch more than 2 hours of television a day on weekdays. In comparison, in Switzerland, television viewing across the same three age groups mentioned above was at 35% or below for all groups. In England, between 2006 and 2010, gaming time of 2+ hours per night during the week increased significantly from 42% to 55% in boys and from 14% to 20% in girls.

Government research has supported its previous work. Finding that increased TV viewing and game time increases anxiety levels in children. Moreover, it is likely to have a negative affect on children’s general wellbeing, including lower self worth, lower self esteem and lower levels of self happiness. The study also found that those children who do watch more TV and spend more time on computer games experience higher levels of emotional distress, anxiety and depression.

In spite of these problems, technology isn’t going away any time soon and is continuously producing more and more innovative products in what can only be described as a worldwide phenomenon. Instead of preventing the use of it as a sedentary behaviour (which is essentially impossible), why not use it to increase physical activity levels? The PlayStation released the ‘eye toy’ in 2003, which involved a camera that monitored movement to carry out fun activities through the PlayStation 2 console, including heading a football, cleaning windows as quickly as possible and boxing among a few. However this never really kicked on and a number of issues arose, such as lighting issues, meant fluidity of movement restricted gameplay, whilst the 2D nature of the games didn’t allow for complicated 3D movements.

Then there was the ‘Nintendo Wii’, which involved a sensored remote to track movement. This became extremely popular and advances led to the ‘Wii fit’ which was specifically designed so people could exercise at home, with guidancefrom an animated personal trainer who participants were able to set goals with., activities ranged from hula hooping to yoga. At the time it was innovative and easily accessible, however due to the nature of the motion sensor being within the remote itself, people were able to ‘cheat’ and discovered they did not have to run and jump as the console suggested. Also the animated images produced did not create the same visual effect that a PlayStation 3 or Xbox would, therefore not as stimulating to the imagination of the players minds.

More recently we had the ‘X box Kinect’, which incorporated a similar system to the eye toy, just with greater advances in the camera systems and 3D imaging. This created a more realistic gaming experience, and did involve physical activity. For one reason or another, the nostalgia wore off, and just like the eye toy and the Wii, the Kinect was left to collect dust. It seems that despite technological advances, exergaming goes through nostalgic spells that evidently are not able to sustain physical activity.

I think that despite the failures of previous gaming giants attempting to produce the next big thing in terms of exergaming, it does have the potential to increase physical activity levels, particularly during an age where so many of us use technology and do play video games. Although gaming has been popular for many years, I feel that now is the time for the next big step in exergaming, and hopefully can be used in the future as a tool for interventions in physical activity.

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One of the most discussed topics in sport at present is the doping scandal and corruption that has taken place widespread across athletics, resulting in many athletes losing confidence in the sport and the people that govern it. As more and more information comes out of the woodwork about the possibility of athletes taking performance […]

One of the most discussed topics in sport at present is the doping scandal and corruption that has taken place widespread across athletics, resulting in many athletes losing confidence in the sport and the people that govern it. As more and more information comes out of the woodwork about the possibility of athletes taking performance enhancing drugs or covering up the intake of them, we witness many well known athletes that were once seen as incredibly talented individuals become better known for their lies and deceit towards the sport as the truth is uncovered regarding their doping involvement.

Recently, it became apparent that Ethiopian born 2014 World Indoor 1500m Champion, Abeba Aregawi, failed an out-of-competition dugs test and has voluntarily pulled out of competition whilst further tests are carried out.  It has been rumoured that Aregawi has tested positive for Meldonium (also known as Mildronate). This is a performance enhancer originally meant for the treatment of Ischemia, which occurs due to a lack of blood flow to a limb causing the limb tissues to become starved of oxygen. Interestingly, Ethiopia’s 2015 Tokyo marathon winner Endeshaw Negesse has recently tested positive on a doping test for Meldonium. Other athletes to have reportedly tested positive for the drug are Ukrainian biathletes Artem Tyshchenko and Olga Abramova. Meldonium was only added to the World Anti-Doping Agency banned list on January 1st 2016, so there could yet be more and more athletes who test positive for this performance enhancer in the near future.

So, what exactly is Mildronate?

Also known as Meldonium, Mildronate was originally developed as a growth-promoting agent for animals and has since been identified as an effective anti-ischemic drug (Simkhovich et al., 1988). The clinical benefits of Mildronate stem from carnitine metabolism, which plays an important role regulating cellular energy metabolism via a fatty acid beta-oxidation pathway and glycolysis; in the mitochondria carnitine is the main molecule in fatty acid metabolism (Gorgens et al., 2015). Mildronate works to inhibit the last step of carnitine biosynthesis. During oxygen deficient conditions (anaerobic exercise), there is insufficient oxygen supply and a lower amount of free carnitine which means fatty acid metabolism is lowered and glycolysis is enhanced. This increases the effectiveness of ATP production. Rather than fatty acid oxidation producing energy, there is carbohydrate oxidation which requires less oxygen per ATP molecule compared to fatty acid oxidation (Liepinsh, Kalvinsh & Dambrova, 2011), making the body more efficient at producing energy in those tough, anaerobic states.

When it comes to showing the performance benefits of Mildronate, studies have demonstrated an increase in endurance performance in athletes, an improvement in recovery after exercise and an increase in learning and memory performance (Gorgens et al., 2015), which can be a benefit for many athletes across a wide variety of sports (Dzintare & Kalvins, 2012; Klusa et al., 2013). The use of such a drug has been shown to be worryingly vast across many elite sports and the easy access of Mildronate has allowed many athletes to use it freely and without guilt before the inevitable ban earlier this year (Gorgens et al., 2015).

Whilst it is wrong to take performance enhancing drugs and cheat your way to the top, we often forget the larger context and what it is that drives people to do this rather than just train hard like everyone else and be the best you can be naturally. The psychology of drug taking in sport is extremely interesting and opens your mind into an area that is very rarely discussed.

One of the most common reasons to use performance enhancing drugs in sport is to achieve athletic success, closely followed by financial gain (Morente-Sánchez & Zabala, 2013). This is important. Many athletes dedicate their lives to their chosen sport and sacrifice so much in order to gain huge performance accomplishments that could financially support their family and change their lives. The decision to take a drug to increase performance is a massive risk, however for some it could be an opportunity to enhance their performance to a level that would enable them to provide for their family and to make the years of gruelling training, knockbacks, giving up time with family, injury and psychological strain worth it. The mere thought of gaining recognition for sporting achievements as opposed to going unnoticed for so long is a tempting outlook, one which could push an athlete into believing that taking a performance enhancing drug is the only way forward.

On the other hand, some athletes are pressured by their coach or family members (Pitsch, Emrich & Klein, 2007). The power of manipulation stemming from a coach that craves world class results could pressure an athlete into taking a drug that they don’t even know is a banned substance. Who really knows what goes on in the world of athletics these days?

Some athletes genuinely believe that taking performance enhancing supplements is the only way to continue in their career or to prevent nutritional deficiencies, maintaining their ‘natural’ health (Erdman, Fung, Doyle-Baker, Verhoef & Reimer, 2007; Lentillon-Kaestner & Carstairs, 2010).

The concept of the “false consensus effect” has been studied in literature (Petroczi, Mazanov, Nepusz, Backhouse & Naughton, 2008) and it suggests that athletes who take performance enhancing drugs usually overestimate the prevalence of drug taking in sport. It seems that athletes who believe that other athletes are taking drugs to enhance their performance are more likely to take drugs themselves which could lead us into a vicious cycle that propagates a pro-doping culture (Tangen & Breivik, 2001; Uvacsek et al., 2011). This is something that can be applied to the doping culture in athletics of recent.

In relation is “the doping dilemma” which stems from the classical prisoner’s dilemma (Haugen, 2004). If there is suspicion that other athletes are doing, which there certainly is right now, other athletes feel they need to take performance enhancing drugs in order to play on a level playing field. The power of the unknown comes into play here, with athletes being sceptical as to whether the competitor on the start line next to them is clean or not. The decision to take performance enhancing drugs suddenly seems that little bit more acceptable.

When Lance Armstrong was asked whether he would dope again after being caught he replied with “If I was racing in 2015, no, I wouldn’t do it again because I don’t think you have to. If you take me back to 1995, when doping was completely pervasive, I would probably do it again.” When an athlete believes that everyone else is taking performance enhancing drugs they are more likely to take part in this same behaviour; social acceptability within a small, performance focused environment can pressure an athlete into doping whilst they strive to be the best.

Unfortunately there remains a lack of education surrounding the use of doping in sport and it is important that at an early age sport coaches should emphasis to their athletes that drug taking in sport is simply not an option; if a sport coach’s task is to educate their athletes in this way then the coach will be the primary source of sport education for that athlete (Vangrunderbeek & Tolleneer, 2010). Without such an education regarding this matter an athlete may be more likely to regard drug taking in sport as an option.

We are more likely to cheat if we see others doing so. We tend to conform to accepted norms of reasonable behaviour, rather than adhere to strict rules.” – Evan Davis.

Whilst it is easy to point the finger at athletes who have taken drugs in order to enhance their sporting capabilities, we are far too reluctant to take into consideration the wider context and the problems that still face us regarding the lack of education for doping in sport. The above points are not excuses for doping, they are reasons, and behind the reason is a person who knows that the behaviour is wrong but still feels the need to go ahead with the decision to dope, even with all the devastating consequences that could follow.

A focus is needed on the antecedents of doping behaviour and associated attitudes and behaviours that lead up to the action. With a focus here and the correct education, doping in sport could be lowered and hopefully diminished in the long term, allowing a wide open space for natural ability to blossom through and a regaining of trust and confidence in sport.

Article

In recent years there has been increasing acknowledgement of the problem of mental health in elite sport. Research shows that while sports people are susceptible to mental health problems to broadly the same extent as the wider community, there are a number of key risk periods – such as times of injury, retirement and competitive […]

In recent years there has been increasing acknowledgement of the problem of mental health in elite sport. Research shows that while sports people are susceptible to mental health problems to broadly the same extent as the wider community, there are a number of key risk periods – such as times of injury, retirement and competitive failure – when sports people may be particularly vulnerable to illnesses such as depression (Rice et al. 2016; Hughes and Leavey 2012).

In spite of the high incidence of mental health issues, concerns have arisen about the limited support-seeking amongst elite athletes, with stigma and fears of being viewed as weak cited as the most common reason for suffering in silence (Gulliver et al. 2012).

Stigma surrounding mental illness is not limited to a sporting context but is pervasive in society generally. However, it is also notable that stigma is tolerated variably, with research showing ethnic minorities, youth and men are disproportionately deterred from seeking support as a result of stigma (Clement et al. 2015).

Whilst there are variations between sports concerning the extent to which they have sought to address mental health issues, there remains a dominant narrative within sporting culture as a whole which promotes mental toughness.

Mental toughness has been defined by Jones (2002) as a psychological edge that enables you to ‘cope better than your opponents with the many demands (competition, training, lifestyle) that sport places on a performer. Specifically, be more consistent and better than your opponents in remaining determined, focused, confident, and in control under pressure.’ Given the emphasis on coping and control, the concept of mental toughness could be seen to be at odds with concepts of mental illness, with disclosure of mental illness and support- seeking potentially undermined by fears of being perceived as mentally weak (Bauman, 2016).

Indeed, research (not specifically sports-related) has indicated that those who rated high on ‘toughness’ were more likely to take a ‘wait and see’ approach rather than proactively seek treatment for depression (O’Loughlin et al.2011).

This leads to questions about whether the mental toughness narrative undermines efforts at addressing mental illness in sport. Indeed, it is notable that whilst a growing number of high-profile sports people have spoken about their mental health issues (e.g Dame Kelly Holmes, Marcus Trescothick, Damon Hill, Mike Tyson, Freddie Flintoff, Ian Thorpe, etc), the majority have done so once their careers have concluded, when there is less at stake professionally and perhaps also at a time when they are less immersed in a sporting culture that is uncomfortable with vulnerability.

That said, mental toughness interventions delivered by sports psychologists can also facilitate good mental health, with athletes who demonstrate high on mental toughness scales also tending to rate higher on the indices of mental health (Gucciardi et al. 2016). Promoting mental health and promoting mental toughness from this perspective can be complementary rather than oppositional stances, as long as there is space within these narratives for expressions of distress. However, recent research by Doherty et al. (2016) on the experience of depression in elite male athletes noted that there was little scope for athletes to admit vulnerability, stating ‘in addition to their worth being conditional on results, performances, and actions on the sporting stage, they were expected to express positivity, deny weakness, display emotionless qualities and fit the script of the mentally tough athlete’.

This fits with my experiences of working as a psychotherapist with sports people. Even when clients have the courage to acknowledge that they are struggling, accepting support is another challenge and seen as evidence of not coping. While mental toughness and coping go hand in hand, in the eyes of many, for coping to really count it must be done alone. Seeking out and committing to therapeutic input often seems to be a frightening prospect and one that challenges a sports person’s idea of themselves as mentally tough. Instead, people who are experiencing difficulty are prone to avoiding: avoiding feelings, denying vulnerability and ignoring what’s actually going on, as ways of maintaining the mentally tough persona, but at a cost. Often ways of avoiding difficult feelings become problems in themselves, such as excessive alcohol use, gambling, emotional disconnection and numbness, relationship problems, etc.

The barriers to expression of mental health issues and support-seeking are not only mediated by the cultures – sporting and otherwise – that someone identifies with. How people cope with distress is also a feature that arises at the individual level from childhood experiences of close attachment relationships (see attachment theory). Someone with a responsive caregiver, who was available to assist a child in the regulation of their emotional states, develops more adaptive coping strategies for times of crisis, being able to flexibly shift between self-regulatory strategies and turning towards others, with an expectation of others as reliable and available to offer comfort. Someone with an early experience in which caregivers were absent, either physically or emotionally, would not develop the expectation of others as emotionally responsive and would tend to withdraw and isolate at times of crisis with an over-reliance on coping alone.

To seek support and be comfortable doing so is not easy. First, a client has to tolerate stigma, both from others and their own internalised self-stigmatising beliefs. They must also be able to acknowledge a need for support without it presenting an intolerable challenge to their self-image.

Sporting organisations have a key role to play in encouraging this by moving towards a culture which supports rather than undermines recovery and values personal development as well as performance goals (Doherty 2016). This can be achieved by supporting athletes’ efforts at self-care, recognising key trigger points for mental health issues and actively encouraging the use of therapeutic input. Sports counselling or sports psychotherapy can help athletes expand their tolerance of difficult emotions, and broaden their self-identity and self-worth beyond sport whilst also honouring the many positives of a sporting career. Sport also needs to embrace a more nuanced understanding of mental toughness. To my mind, mental toughness is not just about coping and motivation, but also about facing – rather than avoiding – what is uncomfortable, and having the courage to acknowledge vulnerability and seek support at times of crisis.

Article

“Until one is committed, there is hesitancy, the chance to draw back, always ineffectiveness. Concerning all acts of initiative and creation, there is one elementary truth the ignorance of which kills countless ideas and splendid plans: that the moment one definitely commits oneself, then providence moves too.” – W.H. Murray (Scottish mountaineer and writer) The […]

“Until one is committed, there is hesitancy, the chance to draw back, always ineffectiveness. Concerning all acts of initiative and creation, there is one elementary truth the ignorance of which kills countless ideas and splendid plans: that the moment one definitely commits oneself, then providence moves too.” – W.H. Murray (Scottish mountaineer and writer)

The Facts – Marathon Des Sables

The race consists of 6 days of running, covering approximately 156 miles in total, with the longest stage covering approximately 55 miles.

Based in Morocco, identifiably the Sahara Desert – heats sour to 100 degrees Fahrenheit

Rules require you to be self-sufficient, to carry with you on your back everything except water that you need to survive

So what exactly convinces these athletes to put their bodies and mind through this gruelling adventure in one of the world’s most hospitable climates? This is an event that will have inevitable setbacks and challenges that will need to be addressed throughout. This requires extreme levels of personal resilience in order to not only train, but to ultimately succeed. What are the secrets behind sustained performance in the most extreme environments?

Make intentions a reality: 1) Know what success is – First, define it. Success is not so much about the situation, event or outcome, it more represents what that ‘thing’ means to you. 2) Get comfortable being uncomfortable – expect injury, pain is a great teacher. 3) Identify the best course of action to take to survive – simplify.

Growth mindset: See your abilities as capable of being cultivated. Recognise that challenging yourself is an exciting part of learning, and that failure is a necessary component of success. When confronted with a tricky task, embrace the challenge, and pick yourself up if you fall. Keep your end goal in mind.

Resilient Character: Sir Ranulph Fiennes crossed the Antarctica completely on foot. After losing 5 stone during his expedition (despite eating 8000 calories a day) due to the amount of effort of trawling the equipment, losing the tips of his fingers on his left hand due to gangrene, and ensuring his colleague continued with the expedition despite gangrene in both his feet and having a severe head injury, they completed what he had set out to do. Ranulph bases his success on not wanting to let his father and grandfather down, but perhaps more importantly, it is the application of his underlying resilience and determination. How many of us would give up if put in that position? Look beyond the immediate challenge to the long term goal.

Well-Being: Place a great deal of importance on your general health – this can have an effect on your resilience. Mauro Prosperi, who competed in the Marathon Des Sables in 1994, was hit by a ferocious sandstorm that lasted 8 hours. After waking he was completely lost, and for 10 whole days he was without bearing of his surroundings and completely alone in the heat of the Sahara. Mauro realised he needed to conserve the strength he had remaining. As soon as he realised he was lost, the first thing he did was urinate in a spare water bottle. After 2 failed attempts to raise the alarm to crossing planes, he began to feel very depressed – he attempted to commit suicide. After surviving death he decided to see this circumstance as a new competition against himself. He regained his strength and mental lucidity. From this point he was so aware of his body and health, and the maintenance of his well-being, he was able to survive. Through his attempt to find humanity he learnt that food was all around him. He rested during peak heat and made sure he was hydrated at all times before continuing on his journey. Mauro finally found a local community and was rescued. 4 years later Mauro returned and completed a further 8 desert marathons.

If you’re thinking about taking part in a challenge facing extreme environments, do your research. Luckily, I had the opportunity to speak with someone that has completed the MDeS in 2003 with vast experience in the health and fitness industry, so I have left you with some top tips and tricks:

  1. Preparation and planning are arguably the most important things
  2. Be realistic in your approach
  3. Improve your ability to be more mentally resilient – focus on the positive
  4. Train properly in a periodised way. Do NOT go out too hard
  5. Have it as your intention to complete NOT compete
  6. Know your strategy and pace before face day
  7. Use this experience as a goal in which to teach yourself how to achieve an increased level of physical well-being
  8. Follow this basic philosophy: it’s just a start, not an end
Article

The beauty with happiness is that it means different things for different people. For some people happiness is about living life to its full and living in the moment. To others, happiness is about helping people.  Within society most people relate happiness to wealth and money. We live in a modern age where money is […]

The beauty with happiness is that it means different things for different people. For some people happiness is about living life to its full and living in the moment. To others, happiness is about helping people.  Within society most people relate happiness to wealth and money. We live in a modern age where money is perceived to bring us the most happiness and without it people often worry and stress that they won’t be able to function. Money can bring us short term happiness but does not bring long term happiness for the pure fact that once you achieve a certain amount you will constantly want to achieve more. Your level of happiness will keep growing and growing and you will never feel as though you have reached your highest level.

Some people spend their whole lives trying to find happiness and I believe that perception plays a large role within this process. How you perceive the world will influence your level of happiness. Do you perceive happiness to be a social construct? Does society influence your view of happiness?  What makes you truly happy? When trying to find happiness we think about what makes our friends or family happy. We spend very little time thinking about ourselves and being honest. As human beings we are naturally biased to remembering negative events. Therefore if you told someone to write down all the good and bad things that have happened over a week, they are more likely to remember the bad. Reflection plays an important role within happiness. How often do you reflect on the good things that have happened over your day, week, month or year? When you achieve a goal do you praise yourself for the goal? Most people who achieve their goals don’t give themselves enough credit.

So what is happiness? Happiness is unique to you. It is not a specific definition that has been constructed by society. It is not about trying to please others. Happiness is about understanding what makes you feel good. Happiness can lead to more success, better health and longevity.  Did you know that out of 145 countries Panama leads the world in overall wellbeing? Costa Rica and Puerto Rico came 2nd and 3rd. This is related to the Global well being index that looks at 5 main elements:

  • Purpose: This is associated to achieving your goals and liking what you do every day
  • Social: This is focused around the amount of love a person has in their life and having supportive relationships.
  • Financial: managing your economic life to reduce stress and increase security
  • Community: feeling safe and liking where you live
  • Physical: having good health and enough energy to do things daily

The terms wellbeing and happiness are often used interchangeably. People associate high levels of wellbeing with high levels of happiness. Next time you think about happiness why don’t you think about these 5 constructs.

  • Do you enjoy what you do each day?
  • Are you achieving yours goals?
  • Do you have supportive relationships and love in your life?
  • Can you manage your finances?
  • Do you like where you live?
  • Do you have good physical health?
Article

Summer is winding down over here in the States. Temperatures are cooling down, and leaves will soon begin changing colors. Fall is approaching, which means one thing in the U.S.: football season is upon us. Months of two-a-day practices in the summer heat and hours of meetings have prepared thousands of teams for the upcoming […]

Summer is winding down over here in the States. Temperatures are cooling down, and leaves will soon begin changing colors. Fall is approaching, which means one thing in the U.S.: football season is upon us.

Months of two-a-day practices in the summer heat and hours of meetings have prepared thousands of teams for the upcoming season. Historically, preparation has involved drills aimed at increasing physical strength, endurance, and agility, as well as positional meetings between players and coaches where strategy and set plays are carefully reviewed. However, as in many other sports, the emergence of sport and performance psychology has become an increasingly popular addition to the training regimen.

Commonly used techniques in sport performance psychology include goal-setting, positive self-talk, and visualization. However, the emergence of Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) in the realm of clinical psychology has spawned a novel application to sport psychology, as manifested by approaches such as the Mindfulness-Acceptance-Commitment-Approach (Gardner & Moore, 2007)

ACT is a form of behavior therapy that incorporates traditional behavioral techniques with the concepts of mindfulness, acceptance of thoughts and emotions, and values. The primary focus of ACT is the promotion of the ability to contact the present moment fully, and act in accordance with one’s chosen values based on the situation (Hayes, Strosahl, & Wilson, 2012). Based on this focus, researchers have hypothesized that ACT may help athletes focus their attention on their actual performance in athletic situations, rather than being overly involved with worry, anxiety, frustration, or other thoughts and emotions that can interfere with an athlete’s ability. ACT attempts to enhance performance through six ideals: acceptance, cognitive defusion, making and maintaining contact with the present moment, self as context, recognition of values, and committed action towards value-driven behavior (Twohig, 2012).

Acceptance involves a mindset where one is willing to experience emotions or thoughts without having to label these experiences as positive or negative and without allowing them to influence behavior (Hayes et al., 1999). Acceptance may be practiced when facing a rival team in a road game, with the opposing crowd taunting one’s team and trying to upset the players. Learning to accept the noise from the opposing team as a natural part of the game without judging the sounds as distracting, demeaning, or frustrating would be an example of practicing acceptance. Rather than trying to drown out the noise, which most would argue is an impossible task, the goal is instead to make room for it; to acknowledge that the noise can exist with optimal performance.

Cognitive defusion is the process of viewing thoughts simply as automatic events unfolding in the mind that do not have to influence behavior (Hayes et al., 1999). Defusion may be particularly relevant for a quarterback reading the defense before executing a play. A linebacker may be slowly inching towards the line, preparing to blitz. The quarterback knows that the play call is for a quick slant, and he knows that with the timing of the play he will be able to complete the pass before the linebacker gets to him. However, the thought of the inevitable hit he will receive may cause the quarterback to make an errant throw. The quarterback would be practicing defusion by telling himself “I’m having the thought that I will get blitzed,” and rather than clinging to this thought so rigidly that he panics and makes a bad call, he envisions it as though the thought is physically standing on the sidelines while he continues with the play. The thought isn’t gone and the quarterback can still see it very clearly; however, it is not occupying the entirety of his mental vision.

Contact with the present moment refers to staying present with one’s current situation versus being overly focused on past or future events (Harris, 2009). Present-moment awareness can be thought of as focusing on the current play versus previous plays in the game that may have gone poorly or that a player may have made a critical mistake on. For example, a wide receiver who drops several catchable balls in the first half of the game may think of himself as having a case of the “drops,” and may worry about catching the football late in the fourth quarter because of his previous mistakes. By remaining focused on the present-moment instead of ruminating about past performance, the receiver can allow all of his attention to be used on catching that late, crucial pass instead of allowing his past performance to dictate his present performance.

The conceptualized self refers to self-evaluations that are formed through communication with other people and the world around us (Harris, 2009). In other words, the conceptualized self is who we view ourselves to be. In some cases, the conceptualized self can be helpful, such as a cornerback believing he can cover anyone and that he is a shutdown corner. However, the self can also be overly influenced by negative events. If the same cornerback gets badly beaten by a receiver numerous times because he became too sure of himself and thus underestimated the receiver, the corner may believe that he has lost his ability or that he isn’t able to cover this receiver. The self-story he had once relied on is now hurting him. It is important in this situation for the cornerback to realize that this circumstance is due to a variety of factors – the other player’s ability, the defensive and offensive schemes, and the position of other players on the field, to name a few – and that he has to rely on more than his own self-impressions to make important decisions.

Values-driven behavior is the ability to behave in a way that is congruent with one’s goals and values (Hayes et al., 1999). A linebacker who wants to be the head of the defense and the most feared player by the other team has to not only consciously accept and work towards this image, but most importantly acknowledge his love for the sport, the dedication to his team, and his desire to continually improve himself as a player and leader.

After recognition of values comes committed action to values, which involves engaging in productive behavior even in the face of undesirable thoughts, emotions, or events (Harris, 2009). This is of particular importance in football when the daily grind of practice, player meetings, and team meetings can be both physically and mentally exhausting even for the most experienced players. It is inevitable for a player to feel as if he cannot give 100 percent in a weight training session or give his full attention during film study. Reminding himself of the player he wants to become and realizing that, in order to become that player he needs to push through the fatigue, and then following through on this realization by consistently working hard, would be practicing committed action.

As the season unfolds, I will be posting additional articles concerning the application of ACT to the game of football, using specific examples to illustrate the six core concepts of ACT in greater detail. For additional information about ACT or MAC approach, refer to my previous articles, read the resources listed below in the references section, or contact me at mitchplemmons15@gmail.com. Who’s ready for some football?

 

Article

I dislike how we use the word ‘talent’. A quick google of the word ‘talent’ provides the following definition: natural aptitude or skill. Despite this rather narrow definition, I feel ‘talent’ is too often given as the independent reason and cause to explain how people reach elite performance in sport. I would instead argue that […]

I dislike how we use the word ‘talent’. A quick google of the word ‘talent’ provides the following definition: natural aptitude or skill. Despite this rather narrow definition, I feel ‘talent’ is too often given as the independent reason and cause to explain how people reach elite performance in sport. I would instead argue that talent is not enough.

My argument isn’t a new one, yet it still fails to pervade lay understanding of elite performance. Of course, talent undoubtedly plays a role in helping sportspeople to reach elite performance, though there are other factors which are too often neglected. Let’s look at two of them: opportunity and prolonged deliberate practice.

1) Opportunity

One of my favourite illustrations of the importance of opportunity in reaching elite performance has been popularised by Malcolm Gladwell, who was citing a Canadian psychologist named Roger Barnsley (Gladwell, 2009). Whilst studying elite Canadian hockey players, Barnsley uncovered that 40% of professional players were born between January and March, 30% between April and June, 20% between July and September and only 10% between October and December.

Does this suggest players born between January and March have more talent, or ‘natural aptitude or skill’? I don’t think so. Rather, the cut-off for age-class hockey is the 1st of January in Canada. So, when coaches are scouting players for junior sides, they understandably choose those born earlier in the year since these children tend to be better due to their extra months of physical and motor development. The result is that only these children are able to regularly practice in the ice rink and benefit from professional coaching. This only serves to enlarge the performance gap between these children and their unfortunate peers who have equal talent but not opportunity. And despite this, we still attribute elite performance solely to natural talent.

2) Prolonged Deliberate Practice

Deliberate practice is a well-known concept in sport psychology, where individuals specifically look to practise specific skills to improve their performance. Equally well-known is the 10,000 hour rule where in general, elite sportspeople have had 10,000 hours of deliberate practice before they reach an elite level. Indeed, the importance of deliberate practice to reach an expert or professional level has become so well-known because it is based on a great level of empirical research (Colvin, 2010). For instance, in summarising their research, Ericcson, Krampe and Clemens (1993) stated:

“We deny that these differences are immutable, that is, due to innate talent. Only a few exceptions, most notably height, are genetically prescribed. Instead, we argue that the differences between expert performers and normal adults reflect a life-long period of deliberate effort to improve performance in a specific domain. 

So it’s clear that thousands of hours of deliberate practice are vital for elite performance. So why do we continue to label people as ‘talented’?

Maybe it’s because we like to put others on pedestals, praising their ‘supernatural’ talent because it’s the easiest reason for us to give. Maybe because it’s easier than saying ‘I might be able to be that good if I put in a few thousand hours of good practice’. Or maybe because it’s easy to see the current gap in ability between us and elite performers, but not the thousands of hours of practice that they had to put in to get there. Whatever the reason, research has dispelled the myth that talent is enough to ensure elite performance. Not only should we adopt this view because research supports it, but also because our current outlook on high performance merely serves to encourage a fixed mindset: ‘he/she is that good, you’re this good and there’s little you can do about it. However, if we were to listen to the research, we’d have a far more positive and healthy understanding of high performance.

Although it’s undeniable that some individuals are born more talented than others (not all ice hockey players born in January are scouted by coaches!), a huge amount of research has shown us that natural talent is rarely enough for elite performance. By recognising the importance of opportunity and deliberate practice, I’ve only scratched the surface in accounting for what underlies elite performance. For instance, attitude and resilience, amongst other factors, are also undoubtedly key to reaching world-class performance.

Why do you think we continue to use the word ‘talent’ as the sole reason underlying high performance?

What else do you think needs to accompany talent to reach elite performance?

Article

We are now looking at a situation in the Western world where obesity is becoming an epidemic. Reports suggest that over 35% of people in the USA (National Health and Examination Survey (NHANES)) in 2010. Reports also suggested that about 25% of people in Britain (NHS 2008) and Ireland (OECD 2010) are reported to be […]

We are now looking at a situation in the Western world where obesity is becoming an epidemic. Reports suggest that over 35% of people in the USA (National Health and Examination Survey (NHANES)) in 2010. Reports also suggested that about 25% of people in Britain (NHS 2008) and Ireland (OECD 2010) are reported to be obese with growth estimated at about 1% per annum. This suggests a drastic rise in obesity from 1993 when just 13 per cent of men and 16 per cent of women reported to be obese. The importance of sport and physical activity is emphasised by Twisk et al (1997) who found that long-term exposure to daily physical activity was inversely related to body fatness.
If the growth rate continues at the present pace, over 50% of people in these countries will be obese by 2050 with significant cost to the exchecquer in respective countries through their health bill. Scarily, huge volumes of 4-5 year old children (24.5%) in Britain (NHS) reported to be obese in 2008. This does not account for the massive population of children that are overweight, not yet obese but will be by the time they reach adulthood.
Bearing this in mind, physical activity, sport and exercise is going to be ever more important going forward, not just for the enjoyment value but the state of the nations health. Therefore, the importance of the sports coach and the role that they play will be infinitely more important.
The child’s experience in sport is critical for the ongoing development of any athlete. However due to various reasons including increased perssure to succeed, children’s sport is often now a negative experience due to pressure placed by coaches to win. According to recent studies, 45% of ten year old boys participate in sports. By the age of eighteen only 26% of them stay active. An overview of youth sports carried out in America showed that dropout is well under way at age ten and peaks at 14-15. This was found across a range of ten different sports. Presently, there is a huge drop out from sport among adolescents. In all sports, almost half as many 16 – 24 year old women take part in sport as men of the same age while only 15% of girls aged 15 in the UK meet recommended daily physical activity levels, and are contributing hugely to the high levels of obesity among our youth.This contrasts strongly with Australia, who who have a huge emphasis in youth sport for the health of their nation. In Fact, just recently (Summer 2014), a government minister came out strongly in an address to the nation that the problem of physical inactivity in youth sport among 16 year old girls is getting to dangerous levels as recent metrics showed that participation rates had dipped below 60% – the first time below 60% since metrics were taken.
So they are the facts but are there other contributary reasons for the obesity epidemic?

These may be generalisations in certain cases, many of these societal and socio-economic reasons will ring true for many people. Through the noughties in Ireland, there existed a building boom that overpriced land, resulting in houses being being squashed together at the expense of play space for children. Had planners been more informed with forward thinking from a societal perspective, would it have been conceivable to put minimal requirement for play space and areas for children in built up suburban areas. If such thought processes were in place, would there be so much concern among parents about letting their children out to play; a genuine concern among many parents due to the speed of traffic on roads in such areas with minimal green space.
In such an environment and with the growth of technology and children’s entertainment through social media and computers, occupational sitting time for young children has increased starkly in the past 15 years due to ease of access and reduction in cost.
The huge increase in land and property prices in the mid noughties may also have had an indirect effect on the diets of our children. As house prices increased, it became more of a requirement to have both parents out at work to pay for mortgages and living costs. As a result, fast food became the norm with Chinese, Indian and fast food take away food shops springing up overnight often replacing what was previously a nutritious meal prepared by one of the parents. The major supermarkets even got in on the take away food concept and is now a huge part of their revenue generation with a full aisle often dedicated to high calorie ready made take away meals. Convenience was everything as nobody had time to look after the health of our youth.
The net effect is that now, a cohort of teenagers cannot organise their own games as they never learned how to play in a group setting. How often now do you drive through a housing estate and see children playing football, hurling, soccer or any sport for that matter on the green. It doesn’t happen, often because there is no green to play on.
So now as we count the cost of our Celtic tiger greed, it is rarely that we look at the deeper underlying issues we have caused, that without urgent attention, have contributed hugely to the obesity epidemic that will strangle our nation to early death.
Article

What is sporting injury? Injury is a common issue facing all sport performers (Ristolainen et al. 2012). Sporting injury can be defined as “loss or abnormality of bodily structure, or functioning, resulting from an isolated exposure to physical energy during sports training or competition, that following examination is diagnosed by a clinical professional as a […]

What is sporting injury?

Injury is a common issue facing all sport performers (Ristolainen et al. 2012). Sporting injury can be defined as “loss or abnormality of bodily structure, or functioning, resulting from an isolated exposure to physical energy during sports training or competition, that following examination is diagnosed by a clinical professional as a medically recognized injury” (Timpka et al. 2014: p.425). There are two types of sports injury; acute and overuse (Fagher & Lexell 2014). Acute/traumatic injuries refer to the immediate, or first time, occurrence of an injury (Flint et al. 2014), caused by a specific event (Fuller et al. 2006), such as, the breaking of an ankle after a sliding tackle in football. While overuse/chronic injury is a reoccurring injury (Flint et al. 2014) caused by repeated micro trauma, with the source of the issue being unidentifiable (Fuller et al. 2006), such as tennis elbow. Acute and overuse injuries can be caused by physical factors, such as contact (Ivancic 2012), as well as psychological factors including stressors such as perfectionism (Masten et al. 2014). The sports injury response most commonly discussed is physical pain and discomfort however, psychological responses also play a role in the road to recovery (Walker et al. 2007). As injuries have the potential to be career ending (Fuller et al. 2006), the concept of injury is usually associated with negative emotions (Evans et al. 2008).

Numerous models and psychological emotions/responses to injury exist. However, it is beyond the scope of this paper to cover every response. Therefore, only several models and responses will be identified. Two models that have attempted to identify the psychological response process athletes enter post injury are the 5-stage grief response model (Kubler-Ross 1989), and the Integrated Model of Response to Injury (Weise-Bjornstal 1998). The 5-stage grief response model (Kubler-Ross 1989) is based on an athlete experiencing grief post injury. Despite limitations, such as a lack of individual differences, this model has been used to explain psychological responses to sports injury for years (Walker et al. 2007). The 5 stages include:

1 – Denial

2 – Anger

3 – Bargaining

4 – Depression

5 – Acceptance

However, Weise-Bjornstal et al. (1998) proposed another model; The Integrated Model of Response to Sports Injury, incorporating both grief and cognitive appraisal responses (Walker et al. 2007). The model views injury as a dynamic process, taking personal and situational factors into consideration, with regards to rehabilitation adherence, while also outlining cognitive, emotional, and behavioural responses to sports injury (Weise-Bjornstal et al. 1998). Both Kubler-Ross (1989) and Weise-Bjornstal et al. (1998) emphasize the importance of adhering to the rehabilitation program, without which recovery process time is increased. As both models are concerned with adherence to rehabilitation programs it is suggested both models are more applicable to long term/severe injuries (Levy et al. 2008).

Walker et al. (2007) identified self-motivation as the most important factor concerned with rehabilitation adherence. Therefore, it can be suggested with increased motivation, adherence is improved, resulting in positive health outcomes (Grindley & Zizzi 2005), in this instance recovery. A psychological intervention used to increased motivation is imagery; ‘an experience that mimics real experience’ (Wesch et al. 2012: p.695). Within sport, imagery serves two functions: cognitive, the rehearsal of skills (Milne et al. 2005), and motivational, imagining goals and the steps required to achieve them (Wesch et al. 2012). With regards to a rehabilitation program cognitive imagery can be used to rehearse strengthening exercises, such as pistol squats, while motivational imagery can be used to set a goal date for recovery.

Psychological emotions/responses to injury include body image; one’s thoughts and feelings about their own body (Grogan 1999). Performers with chronic/severe injuries may suffer from a loss of athleticism (Cassidy 2006b), whereby the performer loses muscle definition and/or skill ability during inactivity (Cassidy 2006a). A result of this can be an increase in anxiety prior to sporting return (Monsma et al. 2009). Increased anxiety is associated with re-injury concerns, not being able to achieve one’s goals, and a lack of competency (Podlog & Eklund 2006), all of which can have a negative impact upon performance. Consider a rugby performer’s goal was to achieve the same standard of performance prior to injury, but do not enter a tackle with 100% commitment due to re-injury concerns. Consequently, frustration may occur (Walker et al. 2007), as the player is not tackling to their full potential. This can lead to reduced competence, whereby the athlete is not sensing effectiveness in the activity they are undertaking, resulting in disinterest. To restore competence goal setting (GS) can be used (Podlog & Eklund 2006). However, it is crucial GS follows the SMART principles (specific, measureable, attainable, relevant, & timely) (Johnson et al. 2014), and allow the athlete to have a say in the goal being set (Podlog et al. 2011), thus ensuring the performer’s autonomy is preserved (Podlog & Eklund 2006).

Athletic identity (Madrigal & Gill 2014); “the extent to which a person identifies with the athlete role” (Horton & Mack 2000: p.102), is another response to injury weakened during situations where the sport-related outcome is unfavorable (Grove et al. 2004), such as injury. Consequently, the individual cannot train and/or compete. Therefore, the behaviours of the individual are not in line with those of an athlete (Perrier et al. 2014). Consider a rugby player who cannot train or compete due to injury, he/she may no longer identify as an athlete, as they are not carrying out the similar behaviours.

A reduction in athletic identity can lead to a state of depression (Madrigal & Gill 2014) through the loss of social support groups, such as team members, causing the injured individual to feel isolated (Cassidy 2006a). From which motivation towards the individual’s sport can change (Proios 2012). All of these factors can negatively impact performance. For example, a change in motivation from autonomous to controlled (Chan et al. 2011) can result in an attitude change, whereby the performer may no longer care about their performance (Martin & Horn 2013) and therefore, do not put 100% effort into training resulting in not being selected for the team. This can further reduce an individual’s athletic identity (Grove et al. 2004) and feeling of isolation, as the performer is pushed further away from team situations. To overcome motivational changes and a loss of social support Chan et al. (2011) suggests the trans-contextual model can be used to transfer motivation from coaches to the performer. For example, if coaches remained autonomously supportive of the injured performer throughout the recovery process, the performer will not lose their social support network (Cassidy 2006b) and may retain their own autonomous motivation from feeding off of the coach’s, which as previously identified is key to rehabilitation adherence (Walker et al. 2007).

Within the constraints of this paper the issues outlined above have highlighted several psychological responses to injury. A more extensive review would identify additional responses, including the perception of weakness.

Article

Four decades after the beginning of the global obesity epidemic, awareness of the threat of obesity to the population’s health and well-being can be seen in a plethora of national reports and strategic plans from various countries, however, conversion to action remains mainly unrealised (Swinburn et al., 2011). Posing the question: Why? Divergent beliefs exist […]

Four decades after the beginning of the global obesity epidemic, awareness of the threat of obesity to the population’s health and well-being can be seen in a plethora of national reports and strategic plans from various countries, however, conversion to action remains mainly unrealised (Swinburn et al., 2011). Posing the question: Why?

Divergent beliefs exist about what drives and sustains obesity, consequently, substantial debate surrounds who is responsible for delivering effective actions and what, specifically, these actions should entail.

The determinants of obesity and its solutions are complex, however, many of these debates have become entrenched in overly simple dichotomies that present seemingly competing perspectives. Examples of such dichotomies include: individual versus environmental causes, government regulation versus industry voluntary codes, top-down versus bottom-up drivers for change, evidence-based versus lobby-responsive policy and making and prioritisation of treatment versus prevention. Genuine progress lies beyond the impasse of these entrenched dichotomies. Therefore, an urgent rethinking of causes, enablers, and barriers to change is required to begin to make a difference in the global obesity epidemic (Kleinert & Horton, 2015).

This narrative previews papers in The Lancet’s 2015 Series on Obesity, which provides an opportunity for such a rethinking. Papers in the series identify high priority actions on key obesity issues and challenge some of the entrenched dichotomies that dominate thinking about obesity and its solutions.

In the first paper of the series, Roberto and colleagues (2015) challenge the false dichotomy that obesity is driven by either personal choice or environment influence, and suggest that the two competing perspectives be merged to show the reciprocal relationship between individual person and environment. Roberto and colleagues (2015) discuss that obesity must be reframed to acknowledge that individuals will bear some responsibility for their health, yet, on the other hand, environmental factors exploit biological, psychological, social and economic vulnerabilities, making it easier for individuals to consume unhealthy products. A vicious cycle is then created in which preferences and demands for unhealthy food are not only shaped by the environment, but lead to environmental changes. Thus, this cycle makes it difficult for people to act in their long-term self-interest, yet Roberto and colleagues (2015) comment it can be broken by regulatory action from governments and joint efforts from industry and civil society to create healthier food environments.

The second paper by Hawkes and colleagues (2015) also challenges the dichotomy between a traditional public health-based perspective (which identifies food systems, food environments, and food industry as leading causes of obesity) and an individual-based perspective (which argues that consumer demand drives unhealthy food consumption because the market simply delivers what consumers want). Hawkes and colleagues (2015) discuss that the learning, expression, and reassessment of food preferences in the context of individual’s environments are important elements in understanding how food polices work. Indicating that effective food policy actions are tailored to preference, behavioural, socio-economic, and demographic characteristics of the individuals they seek to support, are designed to work through the mechanisms through which they have greatest effect, and are implemented as part of a combination of mutually reinforcing actions.

The paper by Huang and colleagues (2015) challenges the false dichotomy that either top-down (e.g. government) or bottom-up (e.g. grassroots) solutions are needed.  Public health officials and political leaders tend to focus on top-down solutions (i.e. polices that can be passed down to alter the environment and improve health). Although, the passage of policies is pivotal, there is a need to mobilise policy from the bottom-up. The paper emphasises that public mobilisation is needed to enact obesity prevention and to mitigate reaction against their implementation. Huang and colleagues (2015) focus on bottom-up strategies that view people as active agents who can change their environments, not as passive recipients of information and change as top-down strategies do.

Closing the series is a paper by Swinburn and colleagues (2015), who focus on a shift from a responsibility to an accountability framework (diminishing arguments about who is to blame for obesity), which involves multiple actors of varying degrees of power over one another to ensure each other’s performance. Swinburn and colleagues (2015) propose a four step accountability framework (take the account, share the account, hold to account, and respond to the account). The framework identifies multiple levels for change, including innovative application of quasi-regulatory approaches which hold some promise to overcoming the impasse of the debate of whether to use regulatory or voluntary policies.

In conclusion, overall this Lancet series offers the reader an understanding of why conversion to action has remained mainly unrealised. However, by rethinking obesity, major areas (e.g. fundamental framing of the issues, food policies and societal movement for change) for potential progress have emerged. The papers in this series, challenge dichotomies, seek improved ways to move forward by understanding interactions, synergies, alternative frames, and different pathways within the complexity of obesity (Swinburn et al., 2015). Ultimately, we now need to turn this progress into serious strides to reverse the tide in the global obesity epidemic.

 

Article

Given the high demands of life in our fast moving society, we are all vulnerable to experiencing feelings of both stress and anxiety. Feelings of nervousness, worry and fear are therefore common symptoms, which are normal emotions to feel from time to time. Panic attacks, however, are more than just feelings of stress and anxiety. […]

Given the high demands of life in our fast moving society, we are all vulnerable to experiencing feelings of both stress and anxiety. Feelings of nervousness, worry and fear are therefore common symptoms, which are normal emotions to feel from time to time. Panic attacks, however, are more than just feelings of stress and anxiety.

A panic attack is a rush of intense psychological and physical symptoms, that onset suddenly and are extremely intense. Panic attacks impact upon thoughts, perceptions and emotions, and are experienced through many unpleasant physical sensations. These symptoms can occur either unexpectedly or can be triggered by fears, phobias or trauma. Panic attacks generally peak at around 10 minutes before symptoms reduce but they generally last between 5 and 20 minutes.

Panic attacks are not recognised as a mental health condition on their own. According to the DSM – IV – TR a panic attack is characterised by four or more of the following symptoms:

  1. Palpitations, pounding heart or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feeling of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady lightheaded or faint
  9. Feelings of unreality or being detached from oneself
  10. Fear of losing control or going crazy
  11. Fear of dying
  12. Numbness or tingling sensations (paresthesias)
  13. Chills or hot flushes

Physical symptoms of panic attacks are caused by the body going into “fight or flight” mode, in response to a perceived threat. Breathing quickens as the body tries to increase oxygen levels in the blood. Hormones, such as adrenaline, are also released causing the heart to beat faster and muscles to tense up.

When experiencing a panic attack, remaining calm and concentrating on breathing are important to help symptoms subside quickly. Breathing in deeply through your nose and slowly out of your mouth can help to reduce the symptoms of a panic attack. As levels of carbon dioxide in the blood return to normal, you will begin to start feeling better, although you may feel tired.

Although scary, generally panic attacks are not damaging to your health. However, if symptoms continue for more than 20 minutes, you still feel unwell after your breathing returns to normal, you still have a rapid or irregular heartbeat or chest pains after the panic attack has subsided or you have regular panic attacks you may need to seek medical advice.

Article

Social influence looks at how behaviour can be changed through pressures from others within a social context, once this pressure is understood it can be in turn used to influence participation in physical activity and exercise (Darlow & Xu, 2011). In exercise it has been shown how when the social pressures within an exercise group be […]

Social influence looks at how behaviour can be changed through pressures from others within a social context, once this pressure is understood it can be in turn used to influence participation in physical activity and exercise (Darlow & Xu, 2011). In exercise it has been shown how when the social pressures within an exercise group be it in a gym setting or a more social setting, social influence plays a role in participation and effort (Yuna & Silkb, 2011). Exercise is known generally as being a healthy behaviour with many benefits both physically and mentally (Bishop-Bailey, 2013). It has been found that some individuals become addicted to exercise and physical activity, making it a compulsion to engage in excessive exercise frequently leading to both psychologically and physiological impairing (Gapin et al. 2009). There are many names for this phenomena such as exercise dependence, exercise addiction, obligatory exercise, compulsive athleticism, compulsive exercising, and exercise abuse (Lichtenstein et al. 2014). As stated exercise can be addictive and in a social settings with pressures to participate with maximal effort in conjunction with others, can exercise addiction be fuelled in this setting if so what are the issues it raises. But is this pressure always a negative there can be positive as well, in order for treat exercise addiction social influence and assistance is vital.

There are multiply similarities between exercise addiction and drug addiction, the similarities include effects on tolerance, mood and withdrawals (Brown et al. 2010). The neurotransmitters which is the brains reward system is key in exercise and other addictions. An example of such a neurotransmitter is dopamine which has been found to be key in the brains rewarding system, a studies have been shown that regular excessive exercise can influence these sections of the brain which involve dopamine (Tanaka et al. 2009). As with many addictions exercise has symptoms, these symptoms in exercise addiction can be both mental and physical (Krivoschekov & Lushnikov, 2011). Once these symptoms arise within an exercise group, the group may see them as just the norms of exercise and pressure can be applied in order for the symptoms to be pushed aside and continue to exercise, as within the social context of the exercise group these maybe seen as the norms (Johnston et al. 2011). The symptoms of exercise addiction range across many fields and in terms of behaviour each person will react differently to situations. These behaviour can include a person’s desire to control their body both its weight, shape and size (Kiadó, 2012). It has been found that the main motivation in this strive and desire is to achieve the exercise induced “high”. This “high” is translated across many sports with many different phrases, in weight lifting it is described as “the pump” in long distance running its referred to as “the runners high” although it has different names and terminology it is the same euphoric feeling (Dishman & O’Connor, 2009). This euphoric state can become addictive and is a part of exercise addiction draws into compulsion. The social group setting of exercise applies pressure to members of the group when discussing this “high” other who may not have of experienced it will feel a need to experience this euphoria by further pushing themselves within exercise to reach this state. Pressure to adhere to exercise no matter how excessive within a social group setting mean that individuals meet the norms of the group and these norms within a this social setting maybe quite different from them of general society (McGrath, O’Malley, & Hendrix, 2011). The social pressures in the group depend on the norms of the groups, the positive effects of continuous exercise mentally and physically are well known and documented, but within the group if these positive effects are distorted to meet internal goals which are difficult to achieve the process of achieving them can become addictive (Wilson et al. 2012). There are factors which can affect the group’s persuasive powers on an individual’s thoughts feelings and behaviours in terms of exercise (Carron et al. 1996).  There have been a few methods put forward when it comes to measuring exercise addiction through questionnaires, but Hausenblas and Downs (2002a) identified some problems with these questionnaires. They found they can indirectly measure addiction through withdrawal symptoms, they were too specific in their focus meaning they were fixed on one activity (e.g. cycling, running, weightlifting), they discover how most questionnaires failed to provide a definition of exercise addiction and did not distinguish between primary or secondary dependence of the addiction and they were not theory driven so had no conceptual basis.

Chapman and De Castro (1990) developed the first method of identifying exercise addiction with their Running Addiction Scale (RAS) which has been used in other studies directed at running (Aidman and Woollard, 2003). From their review Hausenblas and Downs (2002b) developed the 21-item Exercise Dependence Scale (EDS). This scale can be used to determine and categorised exercise addiction into three categories, these are ‘at risk for exercise dependence’, ‘nondependent symptomatic’, or ‘non-dependent-asymptomatic’ groups. One limitation of this scale is that it does not distinguish between primary and secondary exercise dependence Hausenblas and Downs (2002b).There is no precise way to measure social influence there have been many theories put forward to explain social influence, these theories along with theories of exercise addiction will further look to draw conclusions to the effect they can have on exercise groups.

The social cognitive theory (Bandura, 1986) was developed with an emphasis on the acquisition of social behaviours, social cognitive theory continues to emphasise that learning occurs in a social context and that much of what is learned is gained through observation. This is turn can help to show how exercise behaviour can be influenced by human cognition and external stimuli, this can play a role in exercise behaviour within groups (Annesia et al. 2011). This feeds into Orfords (2001) model of addictive behaviours called The Social Behavioural Cognitive Moral Model of Excessive Appetites, Orford preferred the term appetite in place of addictive. This model looked at how a person’s involvement in an addictive behaviour can come about due to some factors which include personality, opportunities to take part in the activity and the normative influence of friends (Orford, 2001). This looks at the influence of friends or leaders in exercise groups, Parastatidou et al. (2012) looked at how this theory can be used to explain how adherence levels increase when involved in an exercise group, this looks at how social influence plays a role in exercise groups. Mónoka et al. (2012) discovered in his studies on exercise addition once it becomes a behaviour within a close groups can spread to others as the beliefs, goals and attitudes can change. In this group setting the Theory of Planned Behaviour can play a role with how the control over the situations within the exercise setting can become more controlling (Hagger et al. 2010). This theory can show how a favourable attitude towards exercise can happen due to pressure within a group, this attitude change can be to one of an addictive nature with exercise due to the group’s beliefs, norms and pressures (Prochaska, 2013).

The “high” discussed earlier obtained through exercise can influence the addiction process, this is can be seen in the Stimulus Response Theory through positive reinforcement of the “high” and also from within the exercise groups setting (Manzi et al. 2009). The positive intrinsic reinforcements in studies have been said to be the “high”, increased self-efficacy, more energy and increased confidence (Raichlen et al. 2012). The extrinsic reinforcements can be praise from others or compliments, within an exercise groups these extrinsic reinforcement can lead to greater adherence to the exercise behaviours within the group (Kelley et al. 2013). Can the persuasion within a group effect an individual’s judgement towards exercise, the theory of reasoned action looks at how behaviour can be influenced by both the attitudes towards the behaviour and also the influence of social environment and general subjective norms on the behaviour. These social norms in an exercise group can be set by the leaders in the group and/or others held in high regard with the attitude they convey to the group (Fishbein & Ajzen, 2011). If these attitudes are of an addictive nature towards exercise this in turn can lead to the overall social norm on the group being one of the same (Cook et al. 2013). In the group the social facilitation theory of effort within the group in studies have shown how when being observed in the group by both peers and external observers perceived effort levels increases (Snyder, Anderson-Hanley, & Arciero, 2012).  These theories all look at the social influences which may push the group towards exercise addiction norms and behaviours, the conceptual model of group cohesion looks at how the group becomes a cohesive group showing how these previous theories can then become prevalent in the influence of exercise addiction in the exercise group (Jenkins & Alderman, 2011). This development of group cohesion has been shown to increase adherence, feelings of distinctiveness, group norms and making sacrifices for the group (Spink et al. 2013). Research into group cohesion has been based around Carron et al. (1985) conceptual model of group cohesion. This model states that there are two predominant categories of group cohesion. The first category is group integration this look at the member’s view on how the group functions as a unit (Carron, 1985), within the exercise group setting this can mean the group are achieving their goals both collectively and individually (Burkea & Shapcott, 2010). In terms of exercise addiction this category the individual leaders who are intensely and frequently exercising may feel that others need to be matching the example they set (Weinberg & Gould, 2010). The second category is individual attraction and this reflects how attractive the groups is to an individual (Carron, 1985), within an exercise group this can explain the adherence to the group as the exercise addiction is the groups norm, therefore external norms against the addiction are not a prevalent (Weinberg & Gould, 2010). These two categories are further divided into two more categories, task and social cohesion. Task cohesion involves the degree to which members will work together to achieve group goals, this can involve many facets within an exercise group such as motivation, education and drive (Caperchione et al. 2011). Social cohesion looks at the relationships within the group and if member’s like each other and the social interactions, in an exercise group with exercise addiction as a driving force the social relationships are formed through exercise (Pitkala et al. 2011). These theories and models looked at the group’s ability to become cohesive and how exercise can become an addiction in some situations. This information looked at the group and its influences on its members as well as how the addiction may spread across the group to become an acceptable norm, within this new norm there are positive and negative pay offs to the addiction (Weinberg & Gould, 2010).

Exercise has psychological benefits such as stress reduction, prevent cognitive decline, increased relaxation, increased self-confidence and alleviate anxiety to name a few (Hogan, Mata, & Carstensen, 2013). In a study by Ruby et al. (2011) another benefit to exercise is the ability for it to control addiction, it was stated that the release of dopamine during exercise helps to reduce addiction in other fields such as drugs and alcohol which release the chemical dopamine. Weinstein and Weinstein (2014) investigated how this release of dopamine can not only control addiction but become itself an addiction. Thayer (1989) produced a two dimensional model of mood and its link with general bodily arousal which includes conscious components of energy and tension. This model is applicable as it shows how the psychological benefits involved with arousal states later researched by Sakairi et al. (2013), looks at how self-regulation of mood state can be obtain through exercise, reaching their optimal mood state. It has been shown that exercise can benefit moods (Johansson et al. 2011) and change emotions (Zi-xin & De-long, 2011) both in terms of pleasant and unpleasant emotions. These positive and negative changes in emotions and mood states can contribute to the “high” experience within exercise (Anderson & Brice, 2011), part of this feeling can carry into post exercise recovery and even beyond with the levels of unpleasant emotions and negative mood factors such as anxiety reduce due to exercise (Hamer, Endrighi, & Poole, 2012). The individuals experiences in exercise plays a role in how they perceive exercise, many group based studies have confirmed that there are psychological benefits which occur as a result of exercise (e.g. Rasmussen & Laumann 2013, Cruise et al. 2011 and Morgan & Goldston, 2013). These theories however have not paid attention to the individuals own unique experiences, the reversal theory can be used to predict exercise motivation and also experience (Brown, 1988). The reversal theory considers human behaviour is inherently inconsistent looking at the basis of human emotion, personality and motivation (Brown, 1988). Glasser (1976) looked at exercise and its general positive correlation with good health termed exercise as a “positive addiction” comparing exercise to more destructive addictions which had more severe consequences, later research however looked at the negative consequences of exercise addiction (Cook, Hausenblas, & Freimuth, 2014). The psychological benefits of exercise can aid participants in exercise but the benefits can also fuel exercise addiction (Lynch et al. 2013), the negative psychological consequences linked with exercise addiction have been proven to damage an individual both physically and mentally (Kiadó, 2014).  Studies into social aspects of exercise addiction have shown that close relationships are pushed aside and deteriorate as the exercise regime does not allow for deviation (McNamara & McCabe, 2012), this behaviour has been shown in a group setting with similar goals and norms to encourage participation in the group activates isolating relationships and distractions outside of the groups norms (Meyer, 2011). Another consequences of exercise is injury, but in cases of exercise addiction it has been shown that athletes will exercise regardless of the injury or the pain (Lichtenstein et al. 2014). This can lead to the body not healing properly and in time this can limited the abilities of the individual, for a person who is involved in a groups who’s norm incorporate exercise addiction this can lead to depression form lack of ability to exercise (Heyman et al. 2012). Direct correlation between exercise addiction and depression have be shown to affect individuals who cannot meet the expectations of others in a group (Grandi et al. 2011), social facilitation plays a role in the individual exerting maximal effort and not meeting this level of perceived effort can lead to depression (Kiadó, 2013). Eating disorders are a major issue with people involved in in exercise but this issue increases dramatically with exercise addiction (Yates, 2013). In a group setting eating disorders are quite prevalent with leaders perceived in a group to have an ideal weight or body composition influences poor eating behaviours which have been shown to influence to group (Cook et al. 2011). There are many types of eating disorders to increase rapid body changes such as anorexia nervosa and bulimia nervosa, in women who lose too much body fat rapidly can suffer from Amenorrhea which affects the menstrual cycle (Fietza, Touyz, & Hay, 2014). These eating disorders can lead to many other issues in both genders with anorexia physical damages are highly dangerous these include an irregular heartbeat, liver damage, muscle wasting, dehydration, malnutrition and sleep disturbances to name a few (Arcelus et al. 2011). All of these damages can lead to a lowered immune system, meaning the individual is more susceptible to illness and infection. Due to the severity of these damage to eating disorders it is important to try and identify them early on before damages become increasingly dangerous.

The Eating Attitudes Test (EAT) developed by Gamer and Garfinkel (1979) and the Eating Disorder Inventory (EDI) developed by Gamer and Olmsted (1984) measure and identify eating disorders with individuals, the reason for choosing these identifiers is there link with exercise in there testing (Rivasa et al. 2010). These disorder play a huge role in exercise addiction and how a group may influence such behaviours on some of its members through unjustified and delusional diet plans (Rohde et al. 2014). Exercise addiction as seen from information above as dangerous consequences once it is attached to a groups norms and individuals take part within the group are influenced to adhere to the norms, once an individual is addicted to exercise and intervention has been seen to be the best solution to alter this behaviour (Landolfi, 2013). The assignment has looked conclusively at exercise addiction and how groups can affect this addiction in other, also how exercise can be a secondary dependence where exercise can be secondary to an eating disorder or vice versa (Cook et al. 2013). Brown’s (1997) model and primary exercise dependence look at exercise addiction broken into sections to give a better understanding of the addiction and this in turn help to discover how to treat the addiction through understanding, this model looks into how the addiction is established and the cycles which affect individuals. Changing an individual with exercise addiction behaviours can be difficult because it has become a crucial part of their hedonic tone which is the experience of pleasurable mood and emotional states (Bruce et al. 2014), this means the behaviour is difficult to extinguish. Cutting down on exercise will be extremely difficult (Darlow & Xu, 2011), however if the individual changes activity from their primary one and cuts down slightly such as increased rest days this has been shown to help with the addiction as well as changing the time of day for exercise which breaks up the routine (Glasner-Edwards & Rawson, 2010). Education from outside of their exercise group form trained professionals on how rest days and proper nutrition (Veasey et al. 2013) can help them to healthy reach their target goals through safe and proven methods without long term consequences to mental and physical health (Epling & Pierce, 2013). Study into treatment for addiction stressed how clinical psychology in most extreme cases is required to help in dealing with the addiction. Through Browns (1997) model West & Brown (2013) look at how in the treatment of exercise addiction it is key for the individual to become more aware of the renforcement process of their behaviour leading to changes in personal decision making, they stated that the individuak must become more tolerant of short stages of unpleasent hedonic tone. This can lead to an ability to manipulate the hedonic tne but as found in the works of Kurimayet al. (2013) this can take up to seven years. The changes can be monitor through the continuous quality improvement (CQI) in Addiction Treatment Settings (Hunter et al. 2011).

In conclusion the assignment looks into social influence and its effects on exercise addiction in group exercise, looking at social influence (Lichtenstein et al. 2014) and exercise addiction (Dishman & O’Connor, 2009) separately then linking them together through various theories and studies. It is explained why individuals may become addicted to exercise either by the chemical releases (Tanaka et al. 2009) and personal experiences (Spink et al. 2013) or by the influence of others/leaders in an exercise group who’s norms accept the consequences of exercise addiction (Parastatidou et al. 2012). These consequences as detailed above affect the individual both mentally and physically in detrimental ways (Rivasa et al. 2010), with a look into proven methods of addiction treatment through different methods and techniques. The assignment looks into the affects a group can have on exercise addiction and how the addiction itself affects individuals, giving a revised and explored method of treatment.

Article

So January comes around again and everybody sets out with fantastic aims of losing weight and improving their health after the Christmas excess. Gyms and weight loss clinics are full to the brim with new enthusiastic and eager customers looking to change their lives and improve their health for the better. However, scientific research has […]

So January comes around again and everybody sets out with fantastic aims of losing weight and improving their health after the Christmas excess. Gyms and weight loss clinics are full to the brim with new enthusiastic and eager customers looking to change their lives and improve their health for the better.

However, scientific research has shown that adherence to such programs is difficult to maintain for many with a large decrease in new participants after 3 months and about a 50% drop off after 6 months (Tudor-Locke & Chan, 2006). Additionally, research has indicated that only 8% of people who take up such a programme will still be adhering to that programme 12 months later (Journal of Clinical Psychology, 2012).

So what can we do?

Effective Goal Setting

Effective goals is key in helping you to facilitate your intentions. These goals must sit closely with the issues concerning what you want to achieve and how you want to achieve it. Setting of what are known as SMART goals (Doran 1981) can prove very effective.

SMART is an acronym that ensure goals set are

Specific:
What, How, Where, When I will take action?
What exactly i want to achieve?
How exactly i will achieve the goals?
Where and when will i go about reaching these goals.

Measureable:
How much exercise I am going to do?
How often, many?
How much weight i intend to lose?
Reach my target weight of 10 stone.

Achievable

If the goal is unrealistic or out of reach, then there is a greater chance of one giving up on the programme. Trying to lose three stone in a month is unrealistic and unhealthy. Trying to get a non runner to run a marathon within a few weeks is also unattainable. Is this goal realistic to what you can actually achieve in the set time frame? Small but achievable steps lead to attainable outcomes.

Relevant

Are your goals relevant to you reaching your long term goal. Are they facilitating you to reach your longer term targets?

Time Managed

What kind of time frame are you allowing to reach each aspect of the goal. As stated previously, trying to lose three stone in a month is unrealistic and unhealthy. Trying to get a non runner to run a marathon within a few weeks is also unattainable.

The following is an example of such SMART goals with a strategic and realistic aim of weight loss and healthier living under various characteristics.

Time Management, Children & Responsibilities

When cooking, I will prepare dinner for two days to reduce the time spent cooking each week.
I will delegate that husband cooks on one evening per week –Reduce my cooking from 7 – 3 days.
I will delegate children to make their own lunch each evening and make rota to share cleaning, hoovering etc

Diet & Nutrition

  • I will eat in accordance with the diet programme for the next six weeks. I will eat 5 pieces of fruit as snacks and wholegrain carbohydrate only.
  • I will drink 2 litres of water each day. Keep one litre bottle at work to monitor hydration intake
  • I will have my dinner eaten before 6.30 each evening.
  • I will eat a bowl of porridge with fruit each morning – prepared the night before.
  • I will restrict my chocolate intake to one bar every week.

Exercise Motivation

  • I will cycle to and from work every day. Total 20 mins / day.•Go for 3 mile walk with friends on Tuesday and Thursday evenings.
  • Go to fitness class every Monday evening with friend. (Aqua-aerobics, Zumba, Spinning)
  • Organise bag for exercise the night before and get to bed for 10am on weekdays.
  • Socialisation / Enjoyment Factor
  • Go for 3 mile walk with friends on Tuesday and Thursday evenings.
  • Go to fitness class every Monday evening with friend. (Aqua-aerobics, Zumba, Spinning)
  • I will take part in activities that I enjoy and find fun.
  • As a family, we will do fun exercise activities on Sundays – Hill Walking etc in nearby mountains.

Self Reflection

  • I will keep a diary of my progress and log how and where i am doing well and how i can improve.
  • One must remember that you cannot lose 3 stone or 5 stone very quickly in a sustainable and healthy way so the goals must be process oriented. You must walk before you can run and the same goes for goal theory.
  • The first step must be taken before making the 2nd and third step of the ladder. Set yourself a target of losing 2-3 pounds per week and make the goal realistic and achievable. If you can maintain this consistency over a period of time, then you will eventually reach your long term goal. Remember that Rome wasn’t built in a day.
  • As adherence levels tend to decrease over time, there are factors that may help you influence and maintain your adherence (Flegal et al, 2007)

Enjoyment – People tend only to maintain participation if the experience is enjoyable. Take up a sport you enjoy or make your exercise fun and something you enjoy doing. There are numerous fun classes out there- zumba, aqua-aerobics, spinning, yoga, pilates etc while activities like hill walking, social running clubs etc have become quite popular of late.

Motivation – Keep a record of what you are doing and note how you can improve your levels of fitness. Use this self reflection to monitor your emotions about participation and your beliefs about progress.
Belief and Knowledge -read up and inform yourself of the benefits of what you are doing and eating and how to maintain a healthy lifestyle. Knowledge is power.

Exercise Plan – Try and set targets to increase your activity levels as you gain in fitness levels – example being SMART goal setting as above. What you find challenging today might not produce the same benefits as you get fitter so loo to challenge yourself a little more as you go through the process.
Social support – One is more likely to maintain a programme if they have the social support of a friend, so get your friends involved in your regime or bring a friend to a class you are taking. It will be a key factor in you achieving your goals.

Other Tips

  • Allow yourself a treat every now and then.
  • Be prepared for a relapse every now and again and don’t let it discourage you. It will happen from time to time but use it as motivation to spur you on. If you could do it before you can do it again.
  • Use reminders – Set reminders on your phone to help organise your time and day.
Article

Now 2016 is fully upon us, many of us will have noticed an increase in the amount of people in your local gym. A diverse range of individuals, some of whom may never have taken part in any exercise before, will be busting a gut on the cross trainer, hoping to burn off the calories […]

Now 2016 is fully upon us, many of us will have noticed an increase in the amount of people in your local gym. A diverse range of individuals, some of whom may never have taken part in any exercise before, will be busting a gut on the cross trainer, hoping to burn off the calories from over Christmas. The 1st of January brings with it a burst of motivation, in stark contrast to the end of January when the gyms are back to how they were just before Christmas. Motivation to take yourself to the gym or to go out on a run starts to decrease when teamed with having to balance it with a work life, social life or family life.  Understanding motivation and how to maintain motivation is the key to establishing a lifestyle that incorporates regular exercise for the long term.

Motivation represents one of the most important variables within sport and exercise, known to be one of the most important elements that facilitate exercise participation and a positive experience (Vallerand, 2004). The two main types of motivation are intrinsic and extrinsic motivation. Intrinsic motivation is evident when individuals engage in exercise purely for the pleasure and satisfaction of participation. An example of intrinsic motivation would be when an individual takes part in a spinning class because they enjoy it and find it satisfying when they complete the session. The psychological needs that underpin intrinsic motivation are the needs to determine one’s behaviour, the need to feel competent and the need for relatedness (Adie, Duda & Ntoumanis, 2008). When these basic needs are satisfied, an individual will have high intrinsic motivation, striving to learn new skills, get fitter and adhere to exercise regimes.

Extrinsic motivation involves individuals taking part in exercise for some kind of reward that is external to the activity itself (Vallerand, 2004). An example of extrinsic motivation would be when an individual partakes in exercise in order to beat someone in a competition or perform better than their personal best. Further to this, a number of types of extrinsic motivation exist on a self determination continuum (Deci & Ryan, 2011). External regulation, the lowest level of self determination, refers to behaviour that is regulated through external means such as avoiding constraints or achieving rewards. Introjected regulation refers to when the individual begins to internalise the reasons for exercise, exercising to avoid feeling guilty. When the behaviour becomes valued and important to the individual, for example when an individual exercises to get fitter and run for longer next time, it is referred to as identified regulation. Finally, the highest level of self determination is integrated regulation which refers to when an individual exercises because it is good for their health.

“If a reward—money, awards, praise, or winning a contest—comes to be seen as the reason one is engaging in an activity, that activity will be viewed as less enjoyable in its own right.” Alfred Kohn.

For maintaining motivation, intrinsic motivation is extremely important. Extrinsic motivation is not sustainable alone because as soon as the reward is taken away the motivation disappears. If the rewards stay at the same level, motivation will slowly drop off and to get the same motivation each time, the reward needs to get bigger. Individuals who have the best motivational outcomes such as persistence, a positive attitude and excellent concentration are those who are both extrinsically and intrinsically motivated (Karageorghis & Terry, 2011). If you are a person who regularly takes part in exercise by going to the gym or attending classes, you may be motivated by both an internal satisfaction and enjoyment of exercising but also because you want to be better, fitter and more able to exercise harder each time.

Once a basic understanding of motivation is developed, it is always handy to know ways to keep the motivation high and not dip as the weeks go on. One important area within exercise adherence involves a situation that we all may find ourselves in; high risk situations combined with a lack of coping resources. In other words: finding the time to continue exercising when you are faced with the daily challenges of family life, work life, going on holiday, poor weather, stress and travelling. This is known as the Relapse Prevention Model (Marlatt & Gorden, 1985). Identifying these situations and developing strategies in order to deal with them early on will prevent lapses or relapses in an exercise regime (Jones & Rose, 2005).

Often, many of us do not feel like exercising; the mere thought of going to the gym after work or early in the morning fills us with dread. Part of the Relapse Prevention Model is to help individuals question their “all-or-nothing” thinking, for instance, when an exercise session is missed, many individuals decide to wait until the following week or even month to resume their regime with the all too familiar, “I’ll start again on Monday”. The negatives thoughts that lead to this can be replaced with more realistic and positive ones by being aware of how the negative thought lead to the behaviour of missing that gym session or not going for that run. It is important to challenge those thoughts! Think about what you would say to a friend that has the same negative thought and is contemplating not continuing with the exercise, and focus on the positivity you would give to them.

It is also useful to remind yourself why you started exercising in the first place. Write down all the reasons you want to start exercising and when the going gets tough read through them and think about why you started in the first place. Continue to set goals, short term and long term, which will help you get through the days, weeks and months and keep your mind focused on that final aim, making it easier to overcome any hurdles along the way. Write down at the start of each week a goal that you want to achieve by the end of the week, and do the same for each month as well as having one big goal that you want to achieve by the end of the year. All the short term goals will help you to reach that long term goal.

Some people find that a good motivating tool is to take a picture of themselves at the start of an exercising regime and have it on their mirror at home so on days when you don’t feel like exercising you can look at the picture and get a boost of motivation.

Finally, remember the balance of extrinsic and intrinsic motivation. It is great to have a motivation that stems from wanting to be a bit competitive and be beat people or be able to set personal bests or received rewards, but the most important aspect of exercising is the intrinsic enjoyment. There is nothing that will keep you exercising more than the internal drive that is rooted in enjoyment. Enjoy what you do, and it won’t feel like a regime or a ‘chore’, it will make you wonder why you haven’t been doing it all along.

Article

Orthorexia is becoming increasingly well known across many individuals, within the media and by researchers. This relatively new identified eating disorder just may be the stepping stone between an individual who eats a ‘healthy’ diet and someone clinically diagnosed with an eating disorder such as Anorexia Nervosa. In 1997, a physician named Dr. Steve Bratman, […]

Orthorexia is becoming increasingly well known across many individuals, within the media and by researchers. This relatively new identified eating disorder just may be the stepping stone between an individual who eats a ‘healthy’ diet and someone clinically diagnosed with an eating disorder such as Anorexia Nervosa.

In 1997, a physician named Dr. Steve Bratman, coined the term ‘Orthorexia’ to describe a pathological obsession for biologically pure food; a strict diet carried out by many individuals who want to eat more healthily (Sánchez, Garcia & Ríos Rial, 2005). Although Orthorexia nervosa is not currently recognised as a clinical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, it is an all-consuming problem that shares similar characteristics with other eating disorders such as anorexia and bulimia nervosa, including a desire for a thin physique and stemming from wanting to gain complete control and to improve self esteem (Aksoydan & Camci, 2009). Put simply, Orthorexia involves extreme healthy eating behaviour to improve health (Aksoydan & Camci, 2009). This could involve having a controlled amount of calories each day or controlling the type of food by just eating vegetables, fruit and other natural, healthy foods.

For athletes, many exert control of their diet to enhance performance and reach a certain weight or body shape (Bonci et al., 2008) which can lead to a high risk of developing eating disorders (Kirk, Singh & Getz, 2001; Segura-Garcia et al., 2010). Eating disorder behaviours may result from individuals being exposed to high levels of sporting competition, partaking in sports that emphasise a thin body shape ideal and past or present body dissatisfaction (Holm-Denoma et al., 2009; Martinsen et al., 2010; Schwarz et al., 2005). Orthorexia comes into play here when the athlete tries to target the solution to the mentioned risk factors by eating more healthily. This then spirals out of control to the point of developing a clinical eating disorder (e.g. anorexia nervosa).

The first study to examine the prevalence of orthorexia nervosa was completed recently and showed a high frequency of orthorexia nervosa across both male (30%) and female (28%) athletes who were largely professional athletes involved in a range of sports (running, swimming, basketball) (Segura-Garcia et al., 2012). This study is the first to highlight the all too frequent participation in potentially damaging eating behaviours that stem from innocent, healthy eating habits which can be hard to detect as a coach, parent or fellow athlete. Previous to this, research conducted in fitness centres identified that internalisation and awareness of one’s body image explained the orthorexia test results from a sample of men and women (Eriksson et al., 2008).

Research related to orthorexia is still ongoing as it is still considered a new and emerging topic (Håman et al., 2015). Little research on orthorexia within sport gives rise to many unanswered questions that will hopefully be explored in the near future. Research should delve more thoroughly into orthorexia nervosa and the prevalence of such a disorder across both male and female athletes within the UK and further afield and how this compares to individuals who are not involved in competitive sports but still enjoy an active lifestyle. As another possibly devastating eating disorder rears its unpleasant head, it is vital to remember that it is not just females that suffer from disordered eating.

Identifying orthorexia within sports could bridge a gap between healthy eating patterns and unhealthy eating behaviours, adding a step between the two that aids the progression from one to another and a way to target the behaviours before it is too late. Future interventions would benefit from such identification by having a more in depth understanding of not just ‘healthy’ eating and disordered eating, but also everything in-between.

Anyone who would like further information or help with regards to disordered eating can visit the following websites:

http://www.orthorexia.com/

https://www.nationaleatingdisorders.org/resource-links#K-O

Article

Injury is one of the most common threats that athletes encounter during the season. Athletes frequently take part in major competitions despite ‘having a niggle’ or carrying a larger injury, ignoring the pain and pushing through the pain barrier in order to achieve their goals. In the end, this can result in further injury and […]

Injury is one of the most common threats that athletes encounter during the season. Athletes frequently take part in major competitions despite ‘having a niggle’ or carrying a larger injury, ignoring the pain and pushing through the pain barrier in order to achieve their goals. In the end, this can result in further injury and in turn less time in competing in your sport. You have trained so hard, you have put in the time and the hard core effort and then you feel your body lets you down, thus resulting in feelings of anger, frustration and disappointment. The physical extent of an injury may be very clear for an athlete to see, however when it comes to an athlete’s ability to cope psychologically it is not as transparent.

For athletes, their sport can be a major boost for their self esteem, they gain enjoyment and self satisfaction in achieving their set target goals and mastering new skills. They can use their sport as a constructive way to cope with stress in their everyday life,for example a cyclist might jump on their bike, the road opens up without a care in the world, a sense of release, a physical outlet for stress. If you are a serious athlete then you have spent a substantial amount of your time, training, competing, surrounding yourself with like minded individuals, “I am an athlete” it is how you see yourself and how others see you. However, when injury raises its ugly head it can take a significant psychological toll on the athlete. Feelings of losing one’s identity is a common feeling that athlete’s face, now that you are injured those training sessions with your friends are replaced with feelings of not knowing what to do with yourself, even feelings of jealousy that you can’t join them. Research has highlighted many psychological factors that are common for athletes to experience once injured: feelings of isolation, anxiety, fear of re-injury, however frustration, depression, anger and tension are highlighted as the highest ranked emotions that athletes encounter when injured. As an athlete how you cope with injury  may define your path to full recovery or re-injury.

As an athlete how can I cope with injury in an effective way so that the psychological pain is minimized?

As an athlete you can follow this step by step process using the acronym: R-E-C-O-V-E-R

R-E-C-O-V-E-R

R – REST: Rest and restrict activity, follow protocols and refuel.

It is very easy to become over anxious and trying to rush the healing process, but this may set yourself up for another more serious injury. Sometimes the fastest way of coming back is the slowest. GO SLOWER, ARRIVE SOONER!

E –EVALUATE: Evaluate with experts, share concerns and follow rehab.

Ensure that you make regular contact with the experts, follow the rehab program that is outlined.

C-CONNECT: Connect with others, both inside and outside your sporting bubble

Research highlights the enormous benefit of social support during the rehabilitation phase. This social support can refer to staying connected with individuals within your sporting world, but also it is very important to note that this in-built support network may be too involved in their own training to be objectively helpful during the hard times so it is important that you have a support network outside of  your sporting world also. Social support and community connections can benefit our physical and mental health and wellbeing.

O – OPPURTUNITY: Oppurtunity to learn new skills and address any weaknesses

This is the perfect opportunity to either brush up on or to really practice the mental aspect of the game. Visualization, goal setting, remaining focused or only a small number of the exercises that you can practice, so when you do return after recovery, not only are you physically strong but also mentally strong. 

V – VISUALISE: Visualise your progress step by step, keeping it real.

Visualization is beneficial to athletes who are injured as it does not require any physical activity, yet it still improves an athlete’s self confidence. Research has highlighted how using visualization and by imagining the injury repairing it can promote healing and manage pain.

E- ELIMINATE FEAR: Eliminate fear, trust your body and be flexible in your recovery goals

Fear of re-injury is a very common fear for athletes, they often have a heightened experience of vulnerability. Athletes need to draw on their mental skills to improve their focus and concentration. Focus on what you WANT to happen, NOT what you’re afraid will. You can also use skills such as goal setting to help you with your recovery goals. Goal setting is an extremely beneficial technique for improving performance.

R- RETURN TO PLAY: Return to play, focus on psychological readiness and  improvement

You have been patient, you have followed the steps of recovery and you are psychologically ready, now it is time to  get back to the sport that you love.

Article

There are around 2.7 million people diagnosed with diabetes in England, 90% of who have Type 2 diabetes (UK Health and Social Care Information Centre 2013); a chronic disease characterised by the body’s inability to regulate blood glucose concentrations. Incidence rate has been strongly associated with physical inactivity. (National Institute for Clinical Excellence 2012), which poses […]

There are around 2.7 million people diagnosed with diabetes in England, 90% of who have Type 2 diabetes (UK Health and Social Care Information Centre 2013); a chronic disease characterised by the body’s inability to regulate blood glucose concentrations. Incidence rate has been strongly associated with physical inactivity. (National Institute for Clinical Excellence 2012), which poses challenges for the design of physical activity interventions that both promote physical activity participation and encourage long term subscription to a physically active lifestyle.

Transtheoretical Model (TTM)

The Transtheoretical Model of change (TTM; Prochaska & DiClemente 1982) has dominated empirical evidence about the making of behavioural change. TTM stipulates behaviour change, ie, physical activity, is cyclical and involves progression through five stages. Those reporting no current or future intention to change current activity levels are categorised as being in a precontemplative stage. Those thinking about making changes but not acting on thought are categorised as contemplative. Those making small changes on an irregular basis are categorised as being in a stage of preparation. The action stage represents people who have recently increased activity levels on a regular basis and the final maintenance stage represents those performing regular physical activity for more than 6 months. The aim is to encourage people to progress through stages via goal setting, decisional balance (weighing up pros and cons of activity) and self-monitoring (Avery, Flynn, Van Wersh, Sniehotta & Trenell 2012).

Strengths and limitations of TTM

Empirical evidence has associated TTM based intervention with short term improvement in glycaemic control in diabetic populations (Zanuso et al 2010). However, there are limitations to this model’s utility for such populations. Firstly, although broadly categorising people into distinct stages and timescales can aid understanding about facilitators/barriers to change, broad categorisation into a stage does not take into account fluctuating health difficulties associated with Type 2 diabetes that may result in a person moving back and forth between stages for reasons outwith perceived control, ie cardiovascular complications. Thus people may be categorised in a particular stage but unlikely to “progress” due to ill health. Secondly, the TTM model proposes people can move back and forth between stages, which may strengthen likelihood of behaviour change as people learn from mistakes (Prochaska & DiClemente 1982). However, within Type 2 diabetes populations it may be difficult to assess whether people move across stages in response to a trigger or consequence. More specifically, engaging with regular physical activity might be “triggered” by a fear of developing diabetes related health complications, and/ or social triggers such as concerns from significant others and/or medical teams about one’s health. Alternatively, engaging with regular physical activity may be a “consequence” of reward gained from activity, improved glycaemic control and psychological well-being.  Thus the TTM doesn’t help to fully understand the variables that explain stage transition.

Evidence for long term efficacy

Evidence from applied studies suggest that a stage based activity programme based on TTM philosophy is effective in supporting people with diabetes to make short term changes in activity, however activity frequency returns to baseline levels over the long term (Krug, Haire-Joshu & Heady 1991). The heterogeneous nature of interventions (ie group versus individual format), cross sectional designs, and a lack of details about intervention content also limit generalisation and replicability of findings.

Conclusions

In light of the above, it is suggested alternative psychological models are worthy of further exploration to help develop empirically coherent and robust formulations about physical activity and adults with long term conditions such as diabetes. Further work to understand the complexity of factors contributing to long term enthusiasm for physical activity particularly amongst adults with Type 2 diabetes is also suggested.