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Matthew J. Smith and Oliver R. Runswick

In elite sport, research has highlighted the significant incidence of athletes experiencing mental ill health. The aim of the present study was to make sense of stories that elite athletes tell about experiencing mental ill health through sampling the autobiographies of four male, elite cricketers. In each book, the player spoke in detail about mental ill health and how this impacted on their international career. Horizontal and vertical analyses of the data resulted in six progressive themes being identified, from Early Warning Signs, Fluctuations of Mental Health, Build-up to the Severe Incident, the Severe Incident, the Recovery Process, to Relapsing. The findings are considered in line with how they might be used to meet the call to develop mental health literacy, in aiming to help coaches and other psychology support staff understand more about the process of athletes who experience mental ill health across their career.

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Inhyang Choi, Damian Haslett, Javier Monforte and Brett Smith

Academics and sport organizations have recently recognized Para-sport as a powerful platform for disability activism. However, little attention has been given to Para-sport activism in non-Western cultures. This study explored the influence of Confucianism on South Korean Para-sport activism. Data were collected through interviews conducted with four stakeholders from the Korea Paralympic Committee and 18 Para-athletes. Through a reflexive thematic analysis, the authors crafted five themes corresponding to Confucian values: position hierarchy, age hierarchy, parent–child relationship, factionalism, and collectivism. All values had the capacity to encourage and discourage participants toward engaging in activism. These findings contribute to the field of  Cultural Sport Psychology by highlighting a multitude of cultural factors affecting Para-sport activism. Practical suggestions to promote Para-sport activism are offered, including sociocultural and organizational legacy.

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Irfan A. Khan and Kelley Henderson

Clinical Question: What is the efficacy of myofascial release, combined with trigger point therapy, in treating pain in patients with tension-type headaches? Clinical Bottom Line: There is significant evidence to support the use of myofascial release and trigger point therapy in patients with pain from tension-type headaches.

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Dominic Malcolm

This article deploys a qualitative media content analysis to examine discourses linking sport, head injury, and longer term neurocognitive decline. It draws on a seminal British television documentary and associated print media coverage to demonstrate that the representation of sport-related brain injury is intricately connected to both conceptions of risk in sport and a wider social response to aging and dementia. The article augments existing North American analyses to provide the first cross-cultural comparison of this phenomenon and, in doing so, illustrates how the social prominence of cultural representations of sport-related brain injury relates in part to the distinct characteristics of the sport-related phenomenon, which extend and amplify both the broader cultural crisis of concussion in sport and existing representations of dementia. The study is therefore important because it provides a unique perspective on both a key contemporary sporting issue and this global health concern.

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Kendra Nelson Ferguson and Craig Hall

Biofeedback is among the various self-regulation techniques that mental performance consultants can utilize in their practice with athletes. Biofeedback produces psychophysiological assessments in real time to enhance awareness of thoughts and emotions. Quantitatively, research shows that biofeedback can facilitate self-regulation, allowing an athlete to gain control over psychophysiological responses that could be detrimental to performance. With technology becoming a widespread tool in monitoring psychophysiological states, an exploration of consultants’ use of biofeedback, their perceptions of effectiveness, and limitations of their use was warranted to qualitatively evaluate efficiency of the tool. A qualitative descriptive approach was taken through semistructured interviews with 10 mental performance consultants. Inductive reasoning uncovered three themes: positive implications, practical limitations, and equipment options. With biofeedback, athletes have the ability to develop a deeper level of self-awareness and thereby facilitate the use of self-regulation strategies intended for optimal performance states and outcomes.

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Dawn Scott, Dean Norris and Ric Lovell

Purpose: To examine the dose–response relationship between match-play high-speed running (HSR), very high-speed running (VHSR), and sprint (SPR) distances versus subsequent ratings of fatigue and soreness. Methods: Thirty-six outfield players competing in the professional National Women’s Soccer League (NWSL, United States) with a minimum of five 90-minute match observations were monitored during the 2016 and 2017 seasons (408 match observations, 11 [6]/player). HSR (≥3.47 m·s−1), VHSR (≥5.28 m·s−1), and SPR (≥6.25 m·s−1) were determined generically (GEN) in players using a 10-Hz global positioning system. HSR, VHSR, and SPR speed thresholds were also reconfigured according to player peak speed per se and in combination with the final velocity achieved in the 30:15 Intermittent Fitness Test (locomotor approach to establishing individual speed zones). On the morning following matches (match day [MD + 1]), players recorded subjective wellness ratings of fatigue and soreness using 7-point Likert scales. Results: Fatigue (−2.32; 95% CI, −2.60 to −2.03 au; P < .0001) and soreness (−2.05; 95% CI, −2.29 to −1.81; P < .0001) ratings worsened on MD + 1. Standardized unit changes in HSRGEN (fatigue: −0.05; 95% CI, −0.11 to 0.02 and soreness: −0.02, 95% CI, −0.07 to 0.04) and VHSRGEN (fatigue: −0.06; 95% CI, −0.12 to 0.00 and soreness: −0.04; 95% CI, −0.10 to 0.02) had no influence on wellness ratings at MD + 1. Individualized speed thresholds did not improve the model fit. Conclusions: Subjective ratings of fatigue and wellness are not sensitive to substantial within-player changes in match physical performance. HSR, VHSR, and SPR thresholds customized for individual players’ athletic qualities did not improve the dose–response relationship between external load and wellness ratings.

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Gianluca Vernillo, Adrien Mater, Gregory Doucende, Johan Cassirame and Laurent Mourot

Purpose: To study the consequences of a fatiguing ultratrail run of 6 hours on self-optimizing capability during uphill and downhill (DR) running. Methods: The authors collected temporal stride kinematics and metabolic data in 8 (experimental group) male runners before and after the ultratrail run and in 6 (control group) male ultramarathon runners who did not run but stayed awake and performed normal, daily physical activities avoiding strenuous exercises over the 6-hour period. For each subject, preferred and optimal stride frequencies were measured, where stride frequency was systematically varied above and below the preferred one (±4% and ±8%) while running 3 conditions on level, 5% uphill, or 5% DR in a randomized order. Results: Preferred and optimal stride frequencies across grade, group, and time showed no significant differences (P ≥ .184). Metabolic cost and the energetically optimum metabolic cost showed a grade × group × time interaction (P ≥ .011), with an ∼11% increase in the 2 variables only during the DR bouts (P ≥ .037). Conclusions: Despite maintaining similar dynamics of stride frequency adjustments during the DR bout, the experimental group was not able to optimize its gait. This suggests that the DR section of ultratrail runs can introduce a perturbing factor in the runners’ optimization process, highlighting the need for incorporating DR bouts in the training programs of ultratrail runners to minimize the deleterious effects of DR on the energetically optimal gait.

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Alex S. Ribeiro, João Pedro Nunes, Karina E. Coronado, Aluísio Andrade-Lima, Leandro dos Santos, Andreo F. Aguiar, Brad J. Schoenfeld and Edilson S. Cyrino

This study aimed to compare the effects of resistance training performed with low versus moderate loads on systemic resting blood pressure (BP) in older women. A total of 29 women (72.6 ± 5.1 years) were randomized into two groups: low load (LOW, n = 15) and moderate load (MOD, n = 14). An 8-week whole-body resistance training program was carried out 3 days/week (eight exercises, three sets, 10 or 15 repetition maximum). The LOW and MOD groups trained with a relative load of 15 and 10 repetition maximum, respectively. Outcome measures included resting systolic and diastolic BP. After 8 weeks, both groups presented significant changes (p < .05) in systolic BP (LOW = −3.0%; MOD = −4.6%) and mean BP (LOW = −1.9%; MOD = −3.1%). There was no change for diastolic BP in the posttest in both groups. The results suggest that low and moderate loads are equally effective for promoting decreases in resting BP in older women.

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Laurent Schmitt, Stéphane Bouthiaux and Grégoire P. Millet

Purpose: To report the changes in the training characteristics, performance, and heart-rate variability (HRV) of the world’s most successful male biathlete of the last decade. Method: During the analyzed 11-year (2009–2019) period, the participant won 7 big crystal globes, corresponding to the winner of the International Biathlon Union World Cup. The training characteristics are reported as yearly volume (in hours) of low-intensity training (LIT), moderate- and high-intensity training, and speed and strength training. Performance was quantified by the number of World Cup top-3 positions per season. HRV was expressed as low- and high-frequency spectral power (in milliseconds squared), root-mean-square difference of successive R–R interval (in milliseconds), and heart rate (in beats per minute). Results: The training volume increased from 530 to ∼700 hours per year in 2009–2019, with a large polarization in training intensity distribution (ie, LIT 86.3% [2.9%]; moderate-intensity training 3.4% [1.5%]; high-intensity training 4.0% [0.7%]; strength 6.3% [1.6%]). The number of top-3 positions increased from 2 to 24–26 in 2009–2018 but decreased to 6 in 2019. The mean supine values in the root-mean-square difference of successive R–R interval and high-frequency spectral power divided by heart rate increased until 2015, which were stable over 2016–2018 but decreased in 2019. The number of top-3 positions was related to the total (r = .66, P = .02) and LIT (r = .92, P < .001) volume and to several markers of supine parasympathetic activity. Conclusion: The improvement in performance of the participant was mainly determined by the progressive increase in training volume, especially performed at low intensity, and was correlated to parasympathetic activity markers. This case study confirms the effectiveness of the training method, with a large amount of LIT in an elite endurance athlete, and of regular HRV monitoring.

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Rachel A. Millstein, Jeff C. Huffman, Anne N. Thorndike, Melanie Freedman, Carlyn Scheu, Sonia Kim, Hermioni L. Amonoo, Margot Barclay and Elyse R. Park

Background: Positive psychological constructs (eg, optimism, positive affect) may help people engage in physical activity, though the details of these relationships and their directionality have not been studied in depth in people with cardiovascular risk factors. The objectives of this study were to use qualitative research to explore the relationships of positive psychological constructs with physical activity among people with metabolic syndrome. Methods: Participants with metabolic syndrome and low physical activity from an academic medical center completed semistructured phone interviews about associations between physical activity and positive psychological constructs, and perceptions about benefits, motivation, and barriers to physical activity. Results: The participants (n = 21) were predominantly older (mean age = 63 y) white (95.2%) women (61.9%). Engaging in physical activity was commonly associated with enjoyment, energy, relaxation, accomplishment, and determination. Experiencing positive psychological constructs like enjoyment, energy, connectedness, optimism, and determination also helped them engage in physical activity. Perceived benefits, facilitators, and barriers of physical activity engagement were noted. Conclusions: The participants at high risk for chronic diseases described many specific positive psychological constructs that both promote and result from physical activity. Testing ways to increase positive psychological constructs may be a novel way to help people at high risk of chronic diseases become more active.