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Rachael E. Flatt and Craig Barr Taylor

Eating disorders (EDs) are common amongst athletes, yet few receive treatment. Given that athletes have a unique set of risk factors for eating disorders and are faced with additional barriers to treatment, new models outside of face-to-face treatment are necessary to reach the population and provide more affordable, tailored, evidence-based care. One solution is to use digital mental health programs to provide primary or supplemental therapy. Digital programs can provide accessibility and privacy, and recent advancements allow for more personalized online experiences. However, there have been no studies to date that integrate technology-based tools to address the especially high prevalence rates of EDs in athletes. This paper describes how an integrated model that includes online screening linked to guided self-help programs, all adapted specifically for athletes, can be used to provide prevention and intervention of EDs in athletes.

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Jenny H. Conviser, Amanda Schlitzer Tierney and Riley Nickols

It is estimated that 1.6 million people in the United States are currently diagnosed with an eating disorder. Eating disorders (EDs) have high rates of morbidity and mortality and remain the most severe mental illness. Unfortunately, rates of EDs and disordered eating behaviors (DEBs) among athletes appear to be increasing. In this study, authors summarize ED-related risks that pose compromises in psychological and social functioning, medical health, and overall quality of life. The importance of early detection and formal evaluation in preserving the athlete’s health, well-being and sustaining successful sport participation, and performance are highlighted. Athlete-specific factors, which challenge the ease and accuracy of ED detection and assessment, are noted. The recommended components of effective ED assessment are identified, including use of self-report measures and clinical interviews conducted by ED certified and licensed professionals. The importance of being well informed in tenets of ED awareness, prevention and supporting early detection, and referral for formal ED assessment are noted. Conclusions reflect the vital roles that both the multidisciplinary sport personnel and the sport environment/culture play in reducing the serious health risks of DEBs and EDs. Each is needed to protect an athlete’s well-being while fostering safe and successful sport participation.

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Sasha Gorrell and Drew A. Anderson

Purpose: The current study evaluated associations between exercise identity (Exercise Identity Scale; EIS), compulsive exercise (Compulsive Exercise Test; CET), and their association with Eating Disorder Examination – Questionnaire (EDE-Q) scores among adult runners registered for mid- and long-distance races (N = 282, 48.2% male). Methods: Runners of half and full marathon races completed the EIS, CET, and EDE-Q. Results: Regression analyses indicated that increased EIS, b = −.21, and CET, b = −3.25, scores contribute to decreased eating pathology amongst half-marathon runners; a significant interaction effect emerged for EIS × CET scores, b = .08, such that relations between EIS and EDEQ scores were significant among runners reporting either lower or higher CET scores. These associations were not demonstrated in marathon runners. Conclusions: Results suggest that it is beneficial to consider running status when addressing the effect that exercise identity and compulsive exercise may have on eating pathology in competitive runners.

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A.P. (Karin) de Bruin and Raôul R.D. Oudejans

The aim of the study was to investigate if and how body image, taken from a contextual perspective, contributes to the eating disorder history. This qualitative study investigated the process of eating disorder development in eight elite women athletes in at-risk sports. The results showed that the relationship between eating disorder symptomatology and the sports environment was clearly recognized by the elite women athletes. Contextual body image, more specifically negative body-evaluations and upward body comparisons, appeared as an important factor in the development of eating disorders, particularly in the athletic context. It became clear that the two aesthetic and two endurance athletes as well as the two weight-class athletes in rowing described quite negative body evaluations in the context of sport, while some of them also recognized an impact of body image experiences in daily life. However, for both judokas, their eating disorder had nothing to do with their body image but was attributed to the weight-classes in their sport and accompanying weight making. Several unique trajectories and individual eating disorder histories were distinguished which confirms the value of taking a qualitative approach in investigating eating disorders in sport. We also discovered links between what the athletes had reported as contributors to their eating disorder history and how they told their stories by combining content analysis and narrative inquiry. Furthermore, the present study also highlights several critical aspects for prevention and treatment that should support sport federations and clinical sport psychologists in taking appropriate actions to deal more effectively with eating disorders in athletes.

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Anamaria Laudet Silva Mangubat, Janet Hanwen Zhang, Zoe Yau-Shan Chan, Aislinn Joan MacPhail, Ivan Pui-Hung Au and Roy Tsz-Hei Cheung

A stable gaze is necessary to optimize visual conditions during running. Head accelerations generally remain stable when looking in front; however, it is unclear if this response is similar when the head is turned sideways, and whether other adaptive strategies are present to maintain this stability. The purpose of this study, therefore, was to examine whether runners maintained stable head accelerations while gazing at fixed targets in front and to their sides. The authors collected biomechanical data from 13 runners as they directed their gaze to visual targets located in front, 45°, and 90° to the sides at a random sequence. Vertical head and tibial accelerations were the primary outcome measures, while vertical loading rate, footstrike angle, contact time, stride length, and stride rate were the secondary measures. A reduction in vertical head accelerations was found in the rightmost direction (P = .04), while an increase in vertical tibial accelerations was found on the same direction (P = .02). No other significant differences were observed for the other variables. The results of this study suggest that the tibia accommodated the increased shock to maintain head stability.

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Hayley Perelman, Joanna Buscemi, Elizabeth Dougherty and Alissa Haedt-Matt

Body dissatisfaction is associated with marked distress and often precipitates disordered eating symptomology. Literature on body dissatisfaction in athletes appears to be mixed, perhaps because athletes vary along several key characteristics related to how they experience their bodies. This study sought to investigate group differences in body dissatisfaction between sex (men vs. women), sport type (lean-promoting vs. non-lean-promoting), and division level (Division I vs. Division III). Collegiate athletes (N = 191) completed a self-report measure of body dissatisfaction, demographics, and sport characteristics. A factorial ANOVA revealed that women reported greater body dissatisfaction compared to men regardless of division level and sport type. There was an interaction between sex and sport type such that men in lean-promoting sports reported greater body dissatisfaction than men in non-lean-promoting sports. Findings suggest that some athletes participating in lean-promoting sports may be at risk of developing significant body dissatisfaction. Research on body dissatisfaction in collegiate athletes can be used to develop clinical interventions that aim to reduce body dissatisfaction and the potential of developing disordered eating and related psychopathology.

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Stephen M. Glass, Christopher K. Rhea, Matthew W. Wittstein, Scott E. Ross, John P. Florian and F.J. Haran

Transitioning between different sensory environments is known to affect sensorimotor function and postural control. Water immersion presents a novel environmental stimulus common to many professional and recreational pursuits, but is not well-studied with regard to its sensorimotor effects upon transitioning back to land. The authors investigated the effects of long-duration water immersion on terrestrial postural control outcomes in veteran divers. Eleven healthy men completed a 6-hour thermoneutral pool dive (4.57 m) breathing diver air. Center of pressure was observed before and 15 minutes after the dive under 4 conditions: (1) eyes open/stable surface (Open-Stable); (2) eyes open/foam surface (Open-Foam); (3) eyes closed/stable surface (Closed-Stable); and (4) eyes closed/foam surface (Closed-Foam). Postdive decreases in postural sway were observed in all testing conditions except for Open-Stable. The specific pattern of center of pressure changes in the postdive window is consistent with (1) a stiffening/overregulation of the ankle strategy during Open-Foam, Closed-Stable, and Closed-Foam or (2) acute upweighting of vestibular input along with downweighting of somatosensory, proprioceptive, and visual inputs. Thus, our findings suggest that postimmersion decreases in postural sway may have been driven by changes in weighting of sensory inputs and associated changes in balance strategy following adaptation to the aquatic environment.

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Fabian Mager, Jim Richards, Malika Hennies, Eugen Dötzel, Ambreen Chohan, Alex Mbuli and Felix Capanni

Forefoot stiffness has been shown to influence joint biomechanics. However, little or no data exist on metatarsophalangeal stiffness. Twenty-four healthy rearfoot strike runners were recruited from a staff and student population at the University of Central Lancashire. Five repetitions of shod, self-selected speed level walking, and jogging were performed. Kinetic and kinematic data were collected using retroreflective markers placed on the lower limb and foot to create a 3-segment foot model using the calibrated anatomical system technique. Ankle and metatarsophalangeal moments and angles were calculated. Stiffness values were calculated using a linear best fit line of moment versus of angle plots. Paired t tests were used to compare values between walking and jogging conditions. Significant differences were seen in ankle range of motion, but not in metatarsophalangeal range of motion. Maximum moments were significantly greater in the ankle during jogging, but these were not significantly different at the metatarsophalangeal joint. Average ankle joint stiffness exhibited significantly lower stiffness when walking compared with jogging. However, the metatarsophalangeal joint exhibited significantly greater stiffness when walking compared with jogging. A greater understanding of forefoot stiffness may inform the development of footwear, prosthetic feet, and orthotic devices, such as ankle foot orthoses for walking and sporting activities.

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Mary Emily Littrell, Young-Hui Chang and Brian P. Selgrade

Clinically, measuring gait kinematics and ground reaction force (GRF) is useful to determine the effectiveness of treatment. However, it is inconvenient and expensive to maintain a laboratory-grade gait analysis system in most clinics. The purpose of this study was to validate a Wii Balance Board, Kinovea motion-tracking software, and a video camera as a portable, low-cost system, and overground gait analysis system. We validated this low-cost system against a multicamera Vicon system and research-grade force platform (Advanced Mechanical Technology, Inc). After validation trials with known weights and angles, 5 subjects walked across an instrumented walkway for multiple times (n = 8/subject). We collected vertical GRF and segment angles. Average GRF data from the 2 systems were similar, with peak GRF errors below 3.5%BW. However, variability in the balance board’s sampling rate led to large GRF errors early and late in stance, when the GRF changed rapidly. The thigh, shank, and foot angle measurements were similar between the single and multicamera, but the pelvis angle was far less accurate. The proposed system has the potential to provide accurate segment angles and peak GRF at low cost but does not match the accuracy of the multicamera system and force platform, in part because of the Wii Balance Board’s variable sampling rate.

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Chadwick Debison-Larabie, Bernadette A. Murphy and Michael W.R. Holmes

This study examined sex differences in head kinematics and neck muscle activity during sudden head perturbations. Sixteen competitive ice hockey players participated. Three muscles were monitored bilaterally using surface electromyography: sternocleidomastoid, scalene, and splenius capitis. Head and thorax kinematics were measured. Head perturbations were induced by the release of a 1.5-kg weight attached to a wire wrapped around an adjustable pulley secured to the participant’s head. Perturbations were delivered in 4 directions (flexion, extension, right lateral bend, and left lateral bend). Muscle onset times, muscle activity, and head kinematics were examined during 3 time periods (2 preperturbation and 1 postperturbation). Females had significantly greater head acceleration during left lateral bend (31.4%, P < .05) and flexion (37.9%, P = .01). Females had faster muscle onset times during flexion (females = 51 ± 11 ms; males = 61 ± 10 ms; P = .001) and slower onset times during left lateral bend and extension. Females had greater left/right sternocleidomastoid and scalene activity during extension (P = .01), with no difference in head acceleration. No consistent neuromuscular strategy could explain all directional sex differences. Females had greater muscle activity postperturbation during extension, suggesting a neuromuscular response to counter sudden acceleration, possibly explaining the lack of head acceleration differences.