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Self/Auto violence

Définition : “An intentional practice specific to the sport context and perpetrated by the athlete himself that directly endangers his physical, psychological, or emotional health and well-being.” (Atkinson & Young, 2008). This can take different forms such as continuing to participate in sport despite injury or fatigue, using performance enhancing methods or products, and engaging in compensatory behaviors to achieve an ideal weight (Parent & Fortier, 2018).

December 2023 – March 2024

Background: The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence. Methods: Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors. Results: The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran’s Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE. Conclusion: The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete’s life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.

Objectives: There is limited research into the use of performance and image enhancing drugs among women who participate in sport, despite evidence that women do use these substances and experience related harms. The aim of this project is to capture stakeholder perspectives on the current research, policy, and practice landscape in Australia regarding women’s performance and image enhancing drug use in regulated and unregulated sport settings. Desing: Qualitative interviews. Methods: Thirty-two semi-structured interviews were conducted online with stakeholders from Australia between September and December 2021. Interviews ranged between 15 and 90 min in duration. Data were imported into the NVivo (Version 12) platform and analysed using thematic analysis. Results: Thirty-two participants (20 females and 12 males) who held a variety of roles (e.g., coach/strength coaches, gym owners, anti-doping agents, athletes) were interviewed. Fourteen participants reported performance and image enhancing drug use. There were four overarching themes generated from the data: ‘participation in untested sports’; ‘environmental factors driving use’; ‘individual rationalisation’; and, ‘the dark side of performance and image enhancing drug use’. Conclusions: Performance and image enhancing drug use was identified as an issue of concern for women competing in non-elite strength and power-based sports. Of particular concern is the influence of unqualified advice from third parties (i.e., coaches and partners) regarding performance and image enhancing drug use. The environments in which performance and image enhancing drug use occurs can impact individual decisions of women and eventuate in significant and long-lasting physical and psychological harms.

Objectives: The purpose of this scoping review was to explore what is known about eating disorders and disordered eating in elite youth athletes aged 12–18. This review intended to explore what is known about the prevalence, risk factors, and outcomes of these conditions. Design: Scoping Review. Method: A scoping review was conducted following the Johanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology. Six key databases were searched to identify articles for inclusion: PsycInfo, MEDLINE, CINAHL, SPORTDiscus, Scopus, and Google Scholar. Data was subsequently extracted and summarised in line with the research questions. Results: In total, 21 studies were found that met inclusion criteria. The included studies overwhelmingly focused on girls, European populations, and used a cross-sectional quantitative study design. Where clinical interview was used, there were higher rates of eating disorders among elite youth athletes compared to the general youth population. The most cited risk factors included female gender, leanness sports, and those with higher body mass index. Eating disorders and disordered eating were found to be associated with higher rates of depression and anxiety but there was limited investigation of other associated outcomes. Conclusions: Findings from this review suggest that elite youth athletes are at risk of eating disorders and disordered eating. However, significant limitations in the field exist and further research is needed using clinical interview and population specific screening tools to better understand the prevalence, risk factors and outcomes of disordered eating and eating disorders to support this population.

Background: Limited studies on AN in Africa, including Ethiopia. Internet and media have changed body image portrayal in developing countries. A need for a multidisciplinary approach to treatment, training on positive coaching styles, and future research. The Global Burden of Disease had estimated anorexia nervosa (AN) or bulimia nervosa to be 13.6 million people. The lifetime prevalence of AN ranges from 2.4 to 4.3 percent. During their lifetime, up to 4% of females and up to 0.3% of males suffer from anorexia nervosa. Studies assessing AN in Africa, including Ethiopia, are limited. Methods: This case report describes a 23-year-old female patient who presented with anorectic symptoms and signs in Ethiopia. This case report describes a 23-year-old female patient who participated in sports activities. Results: She had a low body weight based on a BMI of 13.15 kg/m2 and lost around 10 kg within the past 6 months. She feared gaining weight or becoming fat, thus restricting food intake. The findings on psychiatric evaluation encompassing detailed history and mental state examination suggested the diagnosis of Extreme anorexia nervosa, restricting type; adult malnutrition; major depressive disorder (MDD) (in remission); low risk of aggression; low risk of suicide; severe functional impairment. The general management principles implemented in this patient included assessment of medical complications, weight restoration, psychological intervention, medication for comorbid depression, and long-term psychological and biological treatment follow-up to avoid relapse. Conclusion: The presented case of a 23-year-old Ethiopian female patient who is athletic shows weight-controlled sports activities and the manifestation of anorexia nervosa. Easy access to the Internet and media has changed body image portrayal in developing countries including Ethiopia. There is a need for a multidisciplinary approach involving psychiatrists, psychologists, internists, and nutritionists for the management of AN. The early screening and management of medical complications are crucial. There is a need for close monitoring of vital signs, restriction of caffeine, excess fluid, and salt, and limiting excessive exercise. Furthermore, to assess micronutrient deficiencies, vitamin supplements should be prescribed in the form of multivitamin and thiamine preparations. The need for future training about positive coaching styles for coaches is mandatory to reduce the future impacts on young athletes. There is a need for future research on eating disorders in developing countries such as Ethiopia.

Background: To protect the integrity of sport, and the health of athletes, global anti-doping programmes seek to prevent doping, and elicit anti-doping and clean sport behaviours, through education, deterrence, detection, enforcement, and rules. Objectives: To guide programme development, this meta-synthesis of qualitative research applied a behavioural science framework to identify barriers and enablers to doping, anti-doping, and clean sport. Methods: A systematic search of electronic databases up to May 2022, followed by critical appraisal, resulted in 73 included articles. Results: Fifty-two articles reported the athlete perspective, thirteen included athletes, athlete support personnel (ASP), and other experts, and eight focused on ASP only. Rigorous methods of thematic synthesis were drawn upon to construct analytical themes in line with the theoretical domains framework (TDF) and the capability, opportunity, and motivation model of behaviour (COM-B). A wide range of barriers and enablers were identified which influenced capability, opportunity, and motivation to participate in a clean sport environment. The weight of evidence pointed to limitations in the current anti-doping education system in providing athletes and ASP with the knowledge and skills to protect against doping, as well as the significant influence of social and cultural norms in shaping doping and clean sport behaviours through a shared social identity, and risky contexts leading to moments of vulnerability to doping. We identified a need for anti-doping programmes to move beyond the current focus on athlete capability, and address the opportunity and motivation components of clean sport behaviours through a targeted and tailored focus on education, training, persuasion, modelling and environmental restructuring interventions.

September 2023 – November 2023

The phenomenon of doping is a public health issue that poses threats to sport and society. In recent decades, the emphasis on efforts to address the issue and reduce the incidence of doping by young people in sport has shifted from deterrence through testing and punishment to the promotion of clean sport behaviours through values-based education. The “I Run Clean project” sought to develop new and effective tools targeting grassroots athletes and those around them (coaches, medical support personnel, sport leaders, parents). These included sport-specific e-learning and in-person peer-to-peer workshops led by trained volunteer ambassadors. The aim of all “I Run Clean” measures is to go beyond the warnings and provision of factual information about early anti-doping campaigns to a more holistic educational approach that focuses participants on their personal and sport-related values in order to encourage good decision-making and resistance to doping-related behaviours. This study evaluates the efficacy of the peer-to-peer workshops and their impact on selected psycho-social variables. The collaboration of the volunteer ambassadors is shown to effectively transmit the desired reasoning, reduce doping risk factors and enhance protective factors.

Objectives: There is limited research into the use of performance and image enhancing drugs among women who participate in sport, despite evidence that women do use these substances and experience related harms. The aim of this project is to capture stakeholder perspectives on the current research, policy, and practice landscape in Australia regarding women’s performance and image enhancing drug use in regulated and unregulated sport settings. Desing: Qualitative interviews. Methods: Thirty-two semi-structured interviews were conducted online with stakeholders from Australia between September and December 2021. Interviews ranged between 15 and 90 min in duration. Data were imported into the NVivo (Version 12) platform and analysed using thematic analysis. Results: Thirty-two participants (20 females and 12 males) who held a variety of roles (e.g., coach/strength coaches, gym owners, anti-doping agents, athletes) were interviewed. Fourteen participants reported performance and image enhancing drug use. There were four overarching themes generated from the data: ‘participation in untested sports’; ‘environmental factors driving use’; ‘individual rationalisation’; and, ‘the dark side of performance and image enhancing drug use’. Conclusions: Performance and image enhancing drug use was identified as an issue of concern for women competing in non-elite strength and power-based sports. Of particular concern is the influence of unqualified advice from third parties (i.e., coaches and partners) regarding performance and image enhancing drug use. The environments in which performance and image enhancing drug use occurs can impact individual decisions of women and eventuate in significant and long-lasting physical and psychological harms.

The use of substances to improve sports performance is a widespread phenomenon among adolescents. Several anti-doping programs have been developed, mainly based on knowledge-based evidence. Objective: The main aim of the present study was to implement an anti-doping intervention in sports high school students, based on a psychological framework, such as Socio-Cognitive Theory, through the development of a Serious Game (SG), i.e., digital learning based on the game. Methods: The experimental design included an intervention group (n = 167; F = 37.7%; Meanage = 17.5 years; SD = 0.58) and a control group (n = 112; F = 42%; Meanage = 17.6; SD = 1). Both of the groups completed the same questionnaire on two different occasions (i.e., time 1 and time 2) for measuring doping intention, self-regulatory efficacy to resist social pressure for the use of substances, moral disengagement, and doping knowledge. Data were analyzed through repeated measures of Group X Time ANOVA, demonstrating some degree of efficacy of the intervention, in particular in terms of the decrease in doping intention and the strengthening of doping knowledge. Results: Moreover, the study demonstrated that the score obtained during the implementation of the SG could partially represent a coherent measure of the participants’ beliefs regarding doping. These results could be considered a starting point for future research to better develop technological anti-doping interventions.

Objective: The purpose of this study was to examine whether subgroups of disability-sport athletes exist on morality- and norm-based doping cognitions and whether these groups differ in anticipated guilt or doping intentions. Methods: A survey was completed by 186 athletes (Mage = 37.5 years, 78.0% male, 45.1% wheelchair basketball) assessing norms, doping moral disengagement, anticipated guilt, and intentions to dope. Results: Cluster analysis revealed four distinct subgroups of athletes, including one potentially high-risk subgroup characterized by relatively high scores on doping moral disengagement, subjective norms, and descriptive norms. One-way analysis of variance revealed significantly lower anticipated guilt in two athlete subgroups characterized by relatively higher doping moral disengagement than the other two subgroups. Moreover, the potentially high-risk group had a greater proportion of athletes showing some presence of intention to dope. Conclusions: This study suggests there is a small subgroup of disability-sport athletes at elevated risk of doping who might benefit from targeted antidoping interventions. 1123/apaq.2023-0041

Background: The World Anti-Doping Agency’s International Standard for Education instructs that national and international sport organisations evaluate their education programmes. Objective: We addressed this directive by examining the effectiveness of a national anti-doping programme. Methods: Athletes (N = 302, 41% female) completed measures of doping susceptibility, intention to use dietary supplements, Spirit of Sport and moral values, anti-doping knowledge and practice, and whistleblowing, prior-to and three-months after attending an anti-doping education programme. Results: At three-month follow-up, athletes reported decreased doping susceptibility and intention to use dietary supplements coupled with increased importance of values, anti-doping knowledge, anti-doping practice and whistleblowing. Within-participant, moderated-mediation analyses revealed that programme-related changes in doping susceptibility were indirectly related to changes in intention to use dietary supplements, and, that this indirect relationship was moderated by moral values. Conclusions: These findings confirm the effectiveness of a national anti-doping education programme and highlight the contribution of dietary supplement use and personal values to changes in doping susceptibility.

Objective: To assess the association between analgesic use and willingness to compete hurt (WCH) in Danish youth elite athletes, and to explore factors associated with such willingness. Design: 4-week prospective cohort study. Methods: 592 Danish youth elite athletes (15–20 years) completed a baseline questionnaire assessing demographic information, sport history, and WCH, and provided weekly reports on analgesic use for 4 weeks via text messages. Analgesic use was categorized as no use (0 weeks) or use across 1, 2, 3, or 4 weeks, and as the total number of days with analgesic use. Multinomial logistic regression and zero-inflated negative binomial regression analyses estimated the association between analgesic use and WCH. Linear backward stepwise regression analysis was used to identify factors associated with WCH. Results: Overall, risk of analgesic use increased significantly with increasing WCH scores (relative risk ratios ranging from 1.06 (95% CI 1.0 to 1.12%) to 1.34% (95% CI 1.15 to 1.57)). The incidence rate of analgesic use increased significantly with increasing WCH scores (incidence rate ratio 1.09 (95% CI 1.04 to 1.14)). Associations between the investigated possible antecedent factors and WCH were weak and not considered practically important (R2 = 0.05 or lower). Conclusions: Higher WCH scores were associated with increasing risk of analgesic use, irrespective of the underlying reason for the use, in Danish youth elite athletes, suggesting that analgesics may be an ingrained part of a sport-specific culture of risk acceptance. Future studies should include measures of culture, norms, and social interaction to better explain the variance in WCH.

Backgroung: Existing data reveals prevalent performance and image-enhancing drug (PIED) use in specific global regions and higher rates among athletes, however, research on performance-enhancement experiences among elite untested athletes is lacking. Objectives: Drawing on conceptual frameworks that emphasize the intersection of context and practice, this research aims to gain insights into the subjective perspectives, motivations, and challenges faced by athletes in managing and optimizing their performance while using PIEDs. Methods: In-depth interviews were conducted with seventeen strength sports athletes, including powerlifters and bodybuilders, who had competed at national and/or international levels within untested federations. Thematic analysis was employed to examine the interview data within a social constructivist ontology. Results: Findings revealed that PIEDs have dual roles as tools for enhanced recovery and heightened training stress, a delicate balance that aligns with Foucault’s notion of self-transformation through technological advancements. These substances exerted power beyond consumption events with long-term psychological effects such as anxiety and irrational behavior emerging as key concerns. Peers with lived experience were key actors in the relationship between responsible drug management, however, the need for informed guidance was acknowledged. Non-human actors, notably biometric data tracking, played a pivotal role in guiding substance consumption. Conclusions: The study underscores the need for further research and tailored frameworks to support the health and well-being of athletes in this domain while addressing the broader implications of PIED use in public health discourse. Specifically, this study highlights the significance of integrating lived experiences and social contexts, emphasizing the need for nuanced harm-reduction strategies in this space.

Objective: This research forum describes the use of the intervention mapping for adaptation (IMA) framework to develop and evaluate a novel intervention for athletes with mild eating disorder (ED) symptoms. Methods: The six IMA steps were followed. In step 1 (needs assessment), we conducted a systematic review of athlete ED interventions and held interviews/focus groups with athletes and sports professionals to inform intervention format and delivery. In step 2 (intervention search), needs assessment information guided the search for an evidence-based intervention suitable for adaptation to athletes. In steps 3 and 4 (intervention development), the identified intervention was adapted and feedback sought from athletes and sport professionals. In steps 5 and 6 (implementation and evaluation), a feasibility study was conducted with athletes (n = 35; females: n = 27; Mage = 27.1). Results: The review highlighted poor evidence for the acceptability and relative efficacy of existing interventions, which were all delivered face-to-face in groups. Interview/focus group data suggested a need for more accessible intervention formats (e.g., self-help). One non-athlete self-help intervention was determined suitable for adaptation to athletes, and adaptations were made. Initial feedback suggested the adapted intervention was relevant within sport settings. The feasibility study revealed that the intervention (MOPED-A: Motivational and Psycho-Educational Self-Help Programme for Athletes with Mild Eating Disorder Symptoms) can be feasibly implemented, is acceptable to athletes and shows potential for reducing ED symptoms. Conclusions: IMA is a useful framework for developing participant-centered and evidence-based interventions. The findings and approach taken provide a framework for other researchers and clinicians in developing similar interventions in the ED domain. Public significance: The novel self-help intervention described in this article was developed using intervention mapping and provides promise as a tool for reducing eating disorder symptoms in athletes. We describe how adopting and systematically following a health intervention development approach, such as intervention mapping, can ensure that eating disorder interventions are participant-centered, contextually relevant, and evidence-based, which in turn could help to maximize their reach and effectiveness.

May 2023 – August 2023

Introduction: Limited effort has been invested in understanding doping in Paralympic sport. The limited evidence that exists suggests that factors influencing doping in parasport are similar to Olympic sport. However, based on the design and nature of the previous studies, where methods have been mostly limited to qualitative data and prevalence numbers, further research is warranted to extend previous findings. Method: Informed by current evidence from Paralympic and Olympic sport, we aimed to investigate (1) para-athletes’ perceptions of Anti-Doping Rule Violations (ADRVs) and responsibility for them, (2) descriptive norms for doping in parasport (3) perceptions of anti-doping education and legitimacy of anti-doping authorities, and (4) coach engagement in doping prevention and levels of doping confrontation efficacy using a quantitative survey approach. Results: In total, valid survey responses from 126 Paralympic athletes and 35 coaches from four countries (Germany, Austria, Switzerland, UK) were analysed for experience with anti-doping, descriptive norms, anti-doping education, perceived legitimacy, knowledge, and doping confrontation efficacy (coaches only). Across both athletes and coaches, the level of education was generally good and doping willingness was low. Classification cheating was considered a form of doping and seems to be an important issue for athletes and coaches, especially within the UK sample. For 33.3% of the athletes, doping control was their first experience with anti-doping. Coaches’ engagement with doping prevention activities and their perceived efficacy to confront doping-related matters appears to be higher compared to Olympic coaches’ samples. Discussion: Sport organisations/NADOs in Paralympic sport could use synergies with those organisations in Olympic sport, adopting similar approaches to anti-doping education, also focusing on a balanced communication of doping prevalence numbers and testing figures. Efforts to ensure athletes are educated about anti-doping before they are tested should be upheld. It seems that in para sport, different compared to able-bodied coaches, anti-doping organizations do not have to convince the coaches about their roles (i.e., being responsible for anti-doping education) anymore but can directly build on these resources. Overall, it seems that there are few differences between parasport and able-bodied sports and thus responsible organisations could use the existing programmes in Olympic sport and only adapt special content (e.g., boosting) which is unique to Paralympic athletes.

Background: Eating disorders negatively influence athletes’ health and performance. To achieve a high level of performance and conform to cultural expectations regarding an athletic body type, female athletes often restrict their diets, which can lead to eating disorders. In addition to factors related to the sports environment, adolescent athletes are subject to changes caused by the maturation process. Therefore, the same factors may have different effects on eating disorder risk among adolescent and adult athletes. This study examined the relationship between eating disorder risk, specific aspects of the sports environment (sport type, level of competition [national and international], and training background), and individual aspects (body satisfaction and body mass index) in two groups of athletes: adolescents and adults. Methods: The sample included 241 highly trained female athletes aged 12–30 years (M = 20.68, SD = 4.45) recruited from different sports clubs in Poland. The subgroup of adolescents consisted of 82 athletes, while the number of adult athletes was 159. The Eating Attitudes Test questionnaire was used to assess the eating disorder risk among the athletes. Body satisfaction was measured using the Feelings and Attitudes Toward Body Scale incorporated into the Body Investment Scale. Results: Eating disorder risk was prevalent among 14.6% of the adolescent and 6.9% of the adult athletes. Significant associations between eating disorder risk and the studied variables were noted only among adolescent athletes. Univariate logistic regression analysis revealed that the occurrence of eating disorder risk was associated with participation in lean non-aesthetic sports (OR = 11.50, 95% CI: 3.58–37.09). Moreover, eating disorder risk was associated with athletes’ lower body satisfaction (OR = 0.80, 95% CI: 0.70–0.92). Body mass index was not included in the final regression model. Conclusions: The study indicated that eating disorder risk in adolescent female athletes was related to sport type and body satisfaction. The findings showed that, in adolescent athletes, eating disorder risk was the most associated with.

Objectives: Better understanding of compulsive exercise is needed in sports medicine. Whilst compulsive exercise may impact mental health, the limited research exploring the relationship between compulsive exercise and psychosocial outcomes is equivocal. The majority of studies have examined eating disorder populations where the eating disorder pathology might account for distress. This study explores relationships between compulsive exercise and mental health. Design: Cross-sectional observational study. Methods: Australian recreational exercisers and athletes (N = 1157; Mage 36.4, standard deviation = 12.9, 77 % female) recruited through sporting organisations, clubs, and gyms, completed measures of compulsive exercise, depression, anxiety, stress, life satisfaction, social physique anxiety, and self-esteem. Regression analyses examined relationships between dimensions of compulsive exercise and wellbeing. Results: After adjustment for eating disorder symptoms and sporting level, compulsive exercise was associated with increased risk of clinically-significant anxiety, depression, and stress symptoms. Compulsive exercise was also associated with lower life satisfaction and self-esteem, and higher social physique anxiety. Notably, different dimensions of compulsive exercise had varying relationships with outcomes, and avoidance and rule-driven behaviour and lack of exercise enjoyment were associated with poorer mental health and wellbeing. Conclusions: Results suggest that compulsive exercise is uniquely associated with a range of psychosocial and mental health outcomes. Results support the need to improve identification and treatment of compulsive exercise in sport and exercise settings. Results highlight that mental health intervention is an important component of treatment, and treatments targeting symptoms related to avoidance and rule-driven behaviour, and anhedonia may be valuable treatment components for those with compulsive exercise.

In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help international and national sport organisations understand the degree to which dietary supplement use is related to doping, the objectives of this systematic review and meta-analysis were to 1) compare the prevalence of doping between dietary supplement users and non-users and 2) identify whether supplement use is related to doping social cognitive factors. We searched for studies sampling athletes and that measured both dietary supplement use and doping in EMBASE, MEDLINE, PsychINFO, CINAHL and SPORTDiscus from database creation to May 2022. Risk of bias was assessed using JBI Critical Appraisal Checklist for cross-sectional studies and the STROBE checklist. Twenty-six cross-sectional studies, involving 13,296 athletes were included. Random-effect models revealed that doping was 2.74 (95% CI=2.10 to 3.57) times more prevalent in dietary supplement users (pooled prevalence = 14.7%) than non-users (6.7%), and that users reported stronger doping intentions (r=0.26, 0.18 to 0.34) and attitudes (r=0.21, 0.13 to 0.28) compared to non-users. Preliminary evidence also suggests that dietary supplement users were less likely to dope if they were more task oriented and had a stronger sense of morality. Results of the review are limited by the cross-sectional design used in all studies and lack of consistency in measurement of dietary supplement use and doping. Data indicate that athletes using dietary supplements are more likely to self-report doping Anti-doping policy should, therefore, target dietary supplement use in anti-doping education programmes by providing alternative strategies for performance enhancement or highlighting the safest ways they can be consumed. Similarly, as a large proportion of athletes use dietary supplements without doping, further research is needed to understand the factors that protect a dietary supplement user from doping. No funding was received for the review.

BACKGROUND: “Image- and performance-enhancing drugs” are widely used in sports worldwide to improve body image and performance goals. In view of the growing research interest and use of these substances, and the paucity of data on the situation in Switzerland, we conducted a scoping literature review on evidence of the use and users of these substances in Switzerland. METHODS: A scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) statement. We searched PubMed/Medline, Embase and Google Scholar for articles published before August 2022. Primary outcomes were evidence of the use and users of image- and performance enhancing drugs in Switzerland. We used a narrative synthesis approach for data analysis. RESULTS: Overall, 18 studies were reviewed, which in total comprised 11,401 survey participants, 140 interviews and 1368 toxicologically analysed substances. Articles were mostly peer-reviewed (83%) and mostly included evidence from professional athletes (43%). The mean publication year was 2011. In most articles both outcomes (78%) were evaluated simultaneously. We demonstrate that image- and performance-enhancing drugs appear to be prevalent among athletes and non-athletes in Switzerland. A wide variety of substances exist, and the type of substances used varied by age, motivation, sex and sports discipline. The main motivations for using these substances were, among others, image- and performance enhancement. The main route of acquisition of these substances was the Internet. Furthermore, we demonstrated that substantial proportions of these substances, as well as supplements, may be counterfeit. Information on image- and performance-enhancing drug use was acquired from different sources. CONCLUSIONS: Although evidence of image- and performance-enhancing drug use and its users in Switzerland is scarce and there are major gaps, we demonstrate that these substances are also prevalent among athletes and non-athletes in Switzerland. Furthermore, high proportions of substances acquired from unregulated drug markets are counterfeit, which puts users in a situation of unpredictable risk when consuming them. Overall, the use of these substances may pose a substantial risk to individual and public health in this possibly growing and often insufficiently informed and medically neglected user community in Switzerland. There is a great need for future research, as well as prevention, harm-reduction and treatment programmes for this hard-to-reach user community. Doping policies in Switzerland should be critically reviewed as simple medical care and evidence-based treatment for non-athlete image- and performance-enhancing drug users is excessively criminalized under the current legislature, leaving possibly over 200,000 image- and performance-enhancing drug users in Switzerland with inadequate medical care.

December 2022 – April 2023

Background: Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders. Methods: The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021–2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper. Results: A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms. Conclusion: Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.

Background and Aim: Measuring the prevalence of doping in recreational sport is difficult. However, to fit their initiatives, National Anti-Doping Organizations are interested in knowing the numbers, so their scarce resources are not wasted. The present study aimed to estimate the prevalence of doping and over-the-counter medicine use for performance enhancement among recreational athletes in eight European countries. Design: A survey covering + 200 sports aimed at recreational athletes 15 years and older was distributed via social media to sports clubs and individuals in eight European countries. To overcome social desirability bias, we applied indirect questioning by using the Randomized Response Technique and asked for the use of over-the-counter medicine and doping for the year 2019. Results: The prevalence of the use of over-the-counter medications for performance enhancement was estimated at 10.4%. We differentiated between the concept of “doping” as the behavior to enhance performance in a certain sport and the concept of “a doper” as a property of a person. The prevalence of dopers in recreational sport was found to be 0.4%, with 3.1% male and 0% female dopers. Responses were separated into four categories: “Artistic sports,” “Combat sports,” “Games,” and “CGS sports” (i.e., sports measured in centimeters, grams, and seconds). The overall prevalence of doping in recreational sports was found to be 1.6%, and the results from Artistic and CGS sports did not differ significantly from this. However, in Games we found an estimated doping prevalence of 6.9%. Discussion: The estimates for the prevalence of dopers and doping in this study do not equal Anti-Doping Rule Violations as stipulated by the World Anti-Doping Agency. Still, while doping is not absent in recreational sport in Europe, it appears to be a low frequent phenomenon. Also, the differences in doping prevalence between the sports categories might reflect structural and competition-related differences, rather than differences in the logic of the sporting competition or discipline-related subcultures. Conclusion: While few recreational athletes appear to use illegal drugs to enhance performance, those who do use them are more often men than women. Yet, 1 in 10 recreational athletes uses over-the-counter medication for performance enhancement and more than 4 out of 10 use medication for other reasons than performance enhancement when doing sports. The highest doping prevalence was found in the sub-category of Games, which can likely be attributed to competition-related differences between the categories. Therefore, research on doping in recreational sports needs tailored approaches to come to a better understanding of the phenomenon.

Objectives:  Doping is a maladaptive behaviour which poses numerous risks and potentially enhances athletic performance while supplement use poses threats of positive, yet inadvertent, doping control results. Investigation is required to understand factors that influence adolescent supplement use and doping in New Zealand (NZ). Design:  A survey was completed by 660 athletes aged 13 to 18 years, of any gender, who competed at any level of any sport in NZ. Forty-three independent variables measured autonomy, confidence sources, motivational climate, social norms and age. Methods: Multivariate, ordinal, and binary logistic regression models measured associations between independent variables and five dependant variables: supplement use, doping, doping considerations and intent (soon and in the next year). Results: Confidence through mastery, internally perceived locus of control (IPLOC) and volition decreased the odds of doping while confidence through self-presentation, subjective and descriptive norms increased the odds of supplement use and doping. Conclusion: To decrease the odds of doping, adolescent autonomy should be increased in sport through opportunities for volitional decision making and exposure to mastery as a confidence source.

Doping continues to be one of the biggest risks to the credibility of elite sports, and its practice remains widespread among athletes despite improved controls. Athletes’ support personnel could be key to preventing doping behavior. In this sense, anti-doping education for this population appears as a possible strategy to reduce doping behaviors in elite sport, but these programs must be evaluated and designed based on scientific evidence. The aim of this research is to explore the impact of an anti-doping education program about substances perceived efficacy, ill-health short- and long-term effects, and the morality of doping substance use in Spanish sports sciences students. Method: A total of 145 students of Physical Activity and Sport Sciences (PASS) from different Spanish universities who took an online anti-doping educational course of the Spanish Anti-Doping Commission (CELAD) answered a questionnaire on their perceptions about doping before, after, and four months later. Results: The results show that the course reduced students’ ignorance about the effects of substances on performance and health and increased their moral judgment and feelings against doping. Discussion: The results are in line with previous research that showed that the moral stance against doping can be improved through educational programs. Conclusion: Online educational interventions can be effective in reducing doping behavior, so their future implementation among ASP can be an effective strategy to reduce doping behavior.

Background: High levels of admitted doping use (43.6% and 57.1%) were reported for two international sport events in 2011. Because these are frequently referenced in evaluating aspects of anti-doping, having high level of confidence in these estimates is paramount. Objectives: In this study, we present new prevalence estimates from a concurrently administered method, the Single Sample Count (SSC), and critically review the two sets of estimates in the context of other doping prevalence estimates. Methods: The survey featuring the SSC model was completed by 1,203 athletes at the 2011 World Championships in Athletics (WCA) (65.3% of all participating athletes) and 954 athletes at the 2011 Pan-Arab Games (PAG) (28.2% of all participating athletes). At WCA, athletes completed both UQM and SSC surveys in randomised order. At PAG, athletes were randomly allocated to one of the two surveys. Doping was defined as “having knowingly violated anti-doping regulations by using a prohibited substance or method.” Results: Estimates with the SSC model for 12-month doping prevalence were 21.2% (95% CI: 9.69–32.7) at WCA and 10.6% (95% CI: 1.76–19.4) at PAG. Estimated herbal, mineral, and/or vitamin supplements use was 8.57% (95% CI: 1.3–16.11) at PAG. Reliability of the estimates were confirmed with re-sampling method (n = 1,000, 80% of the sample). Survey non-compliance (31.90%, 95%CI: 26.28–37.52; p < 0.0001) was detected in the WCA data but occurred to a lesser degree at PAG (9.85%, 95% CI: 4.01–15.69, p = 0.0144 and 11.43%, 95% CI: 5.31–11.55, p = 0.0196, for doping and nutritional supplement use, respectively). A large discrepancy between those previously reported from the UQM and the prevalence rate estimated by the SSC model for the same population is evident. Conclusion: Caution in interpreting these estimates as bona fide prevalence rates is warranted. Critical appraisal of the obtained prevalence rates and triangulation with other sources are recommended over “the higher rate must be closer to the truth” heuristics. Non-compliance appears to be the Achilles heel of the indirect estimation models thus it should be routinely tested for and minimised. Further research into cognitive and behaviour aspects, including motivation for honesty, is needed to improve the ecological validity of the estimated prevalence rates.

Background: the aim of this study was to determine the factors that affect the occurrence of behaviors related to possible eating disorders in Spanish high-performance Olympic wrestling athletes. Methods: The sample consisted of 22 elite female wrestlers selected through purposive sampling with inclusion criteria of (i) having been a national champion, (ii) having been part of the Spanish team, and (iii) suffering or having suffered from an eating disorder. The semistructured interviews were conducted online and lasted between 20 and 40 min. A statistical analysis was performed with NVivo10 software. Results: the athletes showed a series of issues grouped into three main themes, which were divided into the following categories—firstly, the reasons why wrestlers lose weight; secondly, the inadequate procedures they use; and, finally, the reference persons involved in the process. Conclusions: The training conditions in high-performance sports have psychological and behavioral effects on wrestlers. Wrestlers have to move down to lower categories; however, they do not take into account how this practice influences their health when using inadequate procedures. Rapid and significant weight loss produces negative effects, especially in the female population, generating an incidence of eating disorders. The information obtained provided elements of interest for reflection on possible solutions to prevent existing eating disorders.

Background: Use of banned performance enhancing substances in sport is one of the most widely recognized anti-doping rules violation. Research evidence suggests that self-regulatory efficiency is one of the key psychosocial processes related with doping. Therefore, aiming to generate more insights on the self-regulatory efficacy, sport-specific doping self-regulatory efficacy scale was proposed. The aim of the present study was to adapt and validate the Lithuanian version of the sport-specific doping self-regulatory efficacy scale. Material and Methods: The scale construct validity and reliability was tested using a sample of 453 athletes (mean age 20.37, SD = 2.29; 46% male). Structural validity was assessed by exploratory and confirmatory factor analyses, convergent and discriminant validity of the scale were evaluated by assessing average variance extracted and also via correlational analyses. Cronbach’s alpha and composite reliability values were used for reliability analysis. Results: Exploratory and confirmatory factor analyses confirmed the one factor structure of the sport-specific doping self-regulatory efficacy scale. The results also indicated that the scale had sufficient convergent and discriminant validity. The results showed an excellent level of internal consistency. Conclusions: This study makes a contribution by confirming the validity and reliability of the Lithuanian version of the sport-specific doping self-regulatory efficacy scale.

January – November 2022

Objectives: The purpose of this qualitative study was to utilize the Capability, Opportunity, Motivation – Behavior model (COM-B) to: (1) evaluate athlete knowledge and understanding of current asthma-related anti-doping regulations, (2) explore the impact of environmental and societal influences on athletes with asthma, and (3) examine athlete perception of asthma medication use in competitive sport. Methods: Semi-structured interviews were conducted with ten competitive endurance athletes (five athletes with asthma and five without asthma). Interviews were guided by the COM-B model and transcripts were analyzed inductively and deductively using reflexive thematic analysis. Results: Mapping the experiences and perceptions of athletes against an established behavioral framework identified that: (1) athletes’ possess limited knowledge and understanding of the World Anti-Doping Agency (WADA) Prohibited List and Therapeutic use exemption (TUE) policy with respect to asthma medication; (2) the use of sub-optimal diagnostic methods is commonplace and increases the risk of misdiagnosis and unnecessary inhaler therapy; (3) negative media portrayal of high-profile asthma-related doping allegations impacts public opinion and contributes to the perception of wrongdoing within the sporting community. Conclusion: The novel application of behavioral science highlights several factors that may contribute to asthma medication avoidance and promote misuse in competitive sport. The findings from this study provide a foundation for the development and implementation of targeted education programmes, and it is hoped that employing this approach will ultimately improve overall perceptions of asthma treatment in athletes, which is necessary to maintain respiratory health, optimize performance and protect the integrity of sport.

Problem: Children and adolescents are exposed to high peak loads at an early age in junior competitive sports. Little is known in this age group about the injury-free occurrence of pain and the sport-related consumption of painkillers. Methodology: Narrative review with multivariate and paired keyword search for studies that evaluated localization-dependent, injury-free prevalence of pain, analgesic use, and determinants of use in junior competitive sports. Results: Derived from the few existing studies, a pronounced willingness to participate in competitions and training despite pain (“playing hurt”) is found in junior competitive sports among injury-free junior athletes. Analogous to adult competitive sports, analgesics, especially from the group of non-steroidal anti-inflammatory drugs, are used at an early stage. Especially in adolescents with increasing performance progress, in particular female athletes, the use of analgesics for joint pain has been documented. The consumption takes place for the compensation of post-exposure pain conditions but also prophylactically. The use of analgesics and the decision to take them are influenced by the immediate care environment in 2/3 of cases. A physician is involved in only 1 of 3 analgesic use decisions. Discussion: For exertional pain, a displacement mentality exists among many stakeholders in the junior setting. There is early, with age increasingly uncritical and excessive analgesic use. This consumption behavior harbors a high potential for abuse due to self-defined indications, procurement, dosage and duration of use. There is an individual need for a stronger appreciation of pain conditions by the caregivers in junior competitive sports with early consultation with a doctor, combined with the question of how much pain is allowed.

The use of extreme weight-control behaviors is prevalent among adolescent athletes and may result from individual and sport-specific factors. Weight-related maltreatment from coaches and parents, and conformity to sport ethic norms have recently been linked to the use of extreme weight-control behaviors. This study aims to investigate the role of sport ethic norms and weight-related maltreatment from coaches and parents in the use of extreme weight-control behaviors among adolescent athletes. A sample of 999 French-Canadian athletes aged 14–17 years competing in a variety of sports completed an online survey assessing extreme weight-control behaviors, weight-related maltreatment from coaches and parents, and conformity to sport ethic norms. A total of 16.9% of the adolescent athletes reported having adopted extreme weight-control behaviors during their athletic careers. Extreme weight-control behaviors were significantly more prevalent among girls (19.75% vs 9.7% in boys) and weight-class-sport athletes (44%). In addition, 7.4% of the sample experienced at least one type of weight-related maltreatment by coaches or parents. Sex, weight-related neglect by coaches and parents, and weight-related psychological violence by coaches explained 24.4% of extreme weight-control behaviors variance. Indeed, participants who engaged in extreme weight-control behaviors experienced significantly more violence than the other participants did. In contrast, no differences were observed between people who engaged in extreme weight-control behaviors and those who did not due to conformity to sport ethic norms.

The available evidence suggests that affective disorders, such as depression and anxiety, increase risk for accelerated cognitive decline and late-life dementia in aging individuals. Behavioral neuropsychology studies also showed that cognitive decline is a central feature of aging impacting the quality of life. Motor deficits are common after traumatic brain injuries and stroke, affect subjective well-being, and are linked with reduced quality of life. Currently, restorative therapies that target the brain directly to restore cognitive and motor tasks in aging and disease are available. However, the very same drugs used for therapeutic purposes are employed by athletes as stimulants either to increase performance for fame and financial rewards or as recreational drugs. Unfortunately, most of these drugs have severe side effects and pose a serious threat to the health of athletes. The use of performance-enhancing drugs by children and teenagers has increased tremendously due to the decrease in the age of players in competitive sports and the availability of various stimulants in many forms and shapes. Thus, doping may cause serious health-threatening conditions including, infertility, subdural hematomas, liver and kidney dysfunction, peripheral edema, cardiac hypertrophy, myocardial ischemia, thrombosis, and cardiovascular disease. In this review, we focus on the impact of doping on psychopathological disorders, cognition, and depression. Occasionally, we also refer to chronic use of therapeutic drugs to increase physical performance and highlight the underlying mechanisms. We conclude that raising awareness on the health risks of doping in sport for all shall promote an increased awareness for healthy lifestyles across all generations.

Purpose: To determine the association between sport nutrition knowledge, nutritional intake, energy availability, and training characteristics with the risk of an eating disorder amongst highly trained competitive cyclists. Methods: Using an observational cohort study design, 36 male cyclists (age = 23.1 ± 3.9 years) provided information on personal characteristics, training history and functional threshold power. The cyclists completed the sports nutrition knowledge questionnaire (SNKQ) and brief eating disorder in athletes questionnaire (BEDA-Q) before submitting a three-day food diary to quantify energy and macronutrient intake, and calculate energy availability. Results: The estimated lean body mass, years training, weekly on-bike training and functional threshold power were 57.6 ± 3.9 kg, 5.9 ± 3.0 years, 16.4 ± 3.2 h and 355 ± 33 W, respectively. The mean score for the SNKQ was 60.0 ± 8.4% whilst the BEDA-Q score was 4.3 ± 4.1 AU. Training and rest day energy availability was 16 ± 18 kcal·kg eLBM−1 and 44 ± 14 kcal·kg eLBM−1, respectively. Associations between SNKQ with energy intake (r = 0.13, P = 0.553) and availability (r = 0.21, P = 0.345) were trivial to small. There was a large, negative association between SNKQ and BEDA-Q (r = –0.55, P = 0.006) suggesting that for every correct answer on the SNKQ, the BEDA-Q score reduced by 0.3 AU. All other association with the BEDA-Q were trivial to small (r = –0.29–0.27, all P > 0.05). Conclusion: The results indicate that sport nutrition knowledge and energy intake was insufficient to match their training demand on training days. The large, negative association between SNKQ and BEDA-Q suggests that those highly trained cyclists with less sport nutrition knowledge may be at a greater risk of an eating disorder.

The sports environment can be considered as a context characterized by interactions typical of social groups, where children have the chance to learn good values. Positive and negative behaviours in sports, also called prosocial and antisocial behaviours, have been studied according to a moral perspective, as has doping behaviour, taking into consideration the concept of moral disengagement. Moral disengagement in children has been associated with maladaptive behaviours later in life, even though it should disappear with growth. Concerning the sports environment, previous reviews on the topic have extensively illustrated the role of moral variables in sport and their relation to antisocial behaviour and doping, positing some research questions that should be investigated in the future. Starting from these questions, the current narrative review aims to update literature about the effects of moral disengagement on youth athletes. Therefore, new studies about the predictors of moral disengagement are introduced, followed by contributions concerning the relationship between moral disengagement and doping and between moral disengagement and antisocial behaviour. Finally, the review summarizes which research questions have been solved in the last decade and which should be researched further on.

The Incremental Model of Doping Behaviour suggests doping grows out of the habitual use of performance-enhancing methods (e.g., sport supplements) and belief that they are necessary for performance. Importantly, in this model, doping is viewed as functional rather than moral choice. In two studies, we examined whether sport supplement use was indirectly related to doping use via sport supplement beliefs, and whether personal morality moderated this relationship. Competitive athletes (Study 1, N = 366; Study 2, N = 200) completed measures of supplement use, beliefs, and doping use. They also completed measures of moral values (Study 1) and moral identity (Study 2). In both studies, supplement use was indirectly related to doping use via beliefs. Moreover, this indirect relationship was moderated by moral values (Study 1) and moral identity (Study 2). That is, the relationship between supplement use and doping use via beliefs was negated when moral values and moral identity were high but not when they were low or moderate. Taken together, our findings suggest that sport supplement users, who believe they are necessary, are more likely to dope if they have low moral values and believe that being a moral person is unimportant to their self-image.

A growing body of evidence suggests sport supplement use is positively related to doping likelihood, both directly and indirectly via beliefs that sport supplements are effective for improving performance. However, it is unclear what leads an athlete to use sport supplements and whether such factors play a role in the supplement-beliefs-doping relationship. To address this issue, we examined whether motivational goal orientations were related to doping likelihood directly and indirectly via sport supplement use and sport supplement beliefs. Competitive athletes (N = 362, 39% female, mean ± SD; age = 23.6 ± 10.3 years, hours per week training = 5.8 ± 2.1, years competing = 5.8 ± 5.4) from a range of sports (e.g. athletics, soccer, weightlifting) completed an online survey measuring task and ego goal orientation, sport supplement use, sport supplement beliefs, and doping likelihood. Results indicated that ego orientation, but not task orientation, was indirectly related to doping likelihood via sport supplement use and sport supplement beliefs. This suggests that athletes who are ego oriented are more likely to use supplements, believe supplements are effective, and dope. These data suggest that researchers should consider ego goal orientations when interpreting relationships between sport supplement use and doping likelihood. Highlights Ego orientation is related to doping likelihood via sport supplement use and beliefs. Task orientation is not related to doping likelihood via sport supplement use and beliefs. Ego-orientated athletes using sport supplements may be more likely to dope. Researchers should consider ego goal orientation when interpreting relationships between sport supplement use and doping likelihood.

Elite competitive sport climbers exhibit a high strength-to-weight ratio and are reported in the literature to be lighter and leaner than their athletic counterparts. Current research regarding nutrition among climbers is sparse but suggests that they may be at high risk for low energy availability and Relative Energy Deficiency in Sport (RED-S). The prevalence of amenorrhea, one of the primary indicators of RED-S, is unknown in this athletic population. The purpose of this study was to determine the prevalence of current (previous 12 months) amenorrhea among elite level competitive sport climbers. Methods: An anonymous online survey was distributed via email to 1,500 female climbers registered as competitors within the International Federation of Sport Climbing to assess the prevalence of amenorrhea over the past 12 months. Results: A total of 114 female sport climbers answered all survey questions regarding menstrual function and 18 athletes (15.8%) presented with current amenorrhea. The majority of the athletes (72%; n = 82) were categorized with eumenorrhea. An additional 14 athletes (12.3%) provided information that indicated irregular cycles, but answers to all menstrual cycle questions were not congruent to elicit a classification of amenorrhea and these athletes were categorized with a menstrual status of unsure. The average BMI for climbers with eumenorrhea was 20.8 ± 1.8 kg/m 2 and 19.9 ± 2.4 kg/m 2 for those with amenorrhea. A higher percentage of climbers with amenorrhea revealed they currently struggle with an eating disorder compared to those without amenorrhea (13.5 vs. 22.2%, respectively). Conclusion: This study indicates that some female climbers competing at the World Cup level do have menstrual disturbances with relatively normal BMIs and some currently struggle with one or more eating disorders. Even though World Cup competitions use BMI critical margins to screen competitors, this research highlights the need for more medical supervision of competitive elite female sport climbers in order to protect their overall health, including menstrual function. Further research is required to clarify how many climbers suffer from endocrine abnormalities related to RED-S. With more scientific evidence in this area practitioners will be better equipped to educate the athlete and coach with evidence-based nutrition recommendations.; Competing Interests: Author MM is self-employed by Real Nutrition, LLC and serves on the USA Climbing Medical Committee. She assisted with the survey question development and is not currently associated with a university, but has specific expertise in climbing nutrition, eating disorders, and female health.

Purpose: Energy availability (EA) is considered an important measure for athletes, particularly due to the possible health and performance outcomes defined under the RED-S. Low EA is reported to have far-reaching health consequences among female athletes, especially in weight-sensitive sport. However, it is less explored among male athletes, particularly in the traditional Indian tag sport called Kho-Kho. This cross-sectional observational study aimed to determine the prevalence of LEA and associated RED-S health and performance outcomes among Kho-Kho players. Methods: Fifty-two male national-level Kho-Kho players aged 16-31 years were assessed for energy availability, bone mineral density (BMD), sleep quality, disordered eating, selected metabolic (hemoglobin, blood glucose, etc.) and performance outcomes (agility, speed, and power) as per RED-S risk assessment tool. Differences across the low EA (≤ 25 kcal/ kg fat-free mass) and Optimal EA (> 25 kcal/ kg fat-free mass) groups were evaluated using the Independent Samples t test and the chi-square test. Results: Low EA among athletes was associated with lower z -scores for BMD, sleep quality and agility, compared to athletes with optimal EA. At least one moderate-to-high RED-S risk outcome was prevalent among 98% of the Kho-Kho players, irrespective of EA. Most athletes exhibited a lower EAT score and disordered eating outcomes, with no significant differences across groups. Conclusion: The male Kho-Kho players showed a prevalence of low EA that can be due to higher training loads and unintentional under-eating, not related to an eating disorder. The players also exhibited higher RED-S risk outcomes; however, it was irrespective of low EA.

This study examined the weight pressures within the gymnastics environment and explored associations between these pressures and eating disorder (ED) symptoms in adolescent female gymnasts. One hundred and forty-seven competitive gymnasts and 122 recreational-level gymnasts (11-17 years old) completed the Eating Attitudes Test (EAT-26), the Weight-Pressures in Sport-Females (WPS-F), the Social Desirability Scale (SDS) and provided information on their training. It was found that 16.3% of competitive gymnasts and 7.4% of non-competitive gymnasts scored ≥20 in EAT-26, indicating disordered eating behavior. Competitive gymnasts scored higher than non-competitive in the total score of EAT-26 ( p = 0.027), as well as in the total score of WPS-F, the sport and coaches weight pressures sub-scale and the appearance and performance weight pressures sub-scale ( p < 0.001). Multiple regression analyses indicated that sport and coaches weight pressures, appearance and performance weight pressures and body mass index accounted for 30.3% of the variance of EAT-26 in competitive gymnasts, while the appearance and performance weight pressures sub-scale accounted for 16.3% of the variance of EAT-26 in non-competitive gymnasts. Sport and coaches weight pressures are associated with ED in competitive gymnasts, while body appearance and performance demands correlate with ED in female gymnasts irrespective of competitive level.

Powerlifters compete in the squat, bench press, and deadlift, with winners determined by the highest 3-lift total in each weight class. As a weight class-based sport, athletes often compete in classes lower than their habitual weight, using various strategies to make weight. This study’s purpose was to examine weight cutting prevalence, magnitude, and methods among 42 male and 22 female powerlifters (25 ± 8 years old; 4 ± 2.2 years of competitive experience) competing at the 2018 International Powerlifting Federation classic world championship. The lifters, 83% of whom cut weight losing an average 2.9 ± 4.3% of body mass, completed a previously validated weight cutting questionnaire. The most frequently used weight cutting methods were gradual dieting (42.18%, 31.25%), fluid restriction after fluid loading (32.8%, 34.4%), restricting fluid ingestion without fluid loading (23.4%, 9.4%), fasting (15.6%, 18.7%), increased activity (9.4%, 24.4%), laxatives (9.4%, 18.7%), sauna (7.8%, 6.3%), diuretics (7.8%, 6.3%), skipping meals (4.7%, 21.9%), and wearing rubber suits (1.6%, 2.6%). Most lifters experienced negative changes in psychological state, with only 9% reporting never experiencing any negative effect on psychological state across the 5 states measured. Lifters reported experiencing fatigue (15.6%, 45.3%), anger (3.2%, 26.6%), feelings of isolation (4.7%, 12.5%), and anxiety (14.1%, 35.95%), and 11 of the 12 lifters who reported a perceived decrement in training performance performed weight cutting. Both weight cutting methods and negative psychological changes experienced were reported as always, sometimes. Therefore, it is vital to provide specific recommendations based on scientific research to improve the efficacy and safety of making weight while minimizing performance decrements.

Female athletes are at a great risk of developing an eating disorder due several risk factors. The purpose of this systematic literature review was to explore what sport psychology preventative interventions are effective for eating disorders within elite female individual-sport athletes, and to create best-practice recommendations for preventing eating disorders within this population. This project synthesized and analyzed literature related to preventing eating disorders among the elite female individual sport population, and determined which interventions were most effective and why. The results indicated sport psychology interventions such as athlete modified healthy weight focus interventions (AM-HWI) and athlete modified cognitive-behavioral-dissonance-based interventions (AM-CBT) were most effective at preventing eating disorders. Findings also suggested that interventions such as providing prevention education to coaching staff and athletes were also effective with prevention. The findings were integrated into a pamphlet that can be distributed to coaches and practitioners with the purpose of educating elite coaching staff and peers on the warning signs, risk factors, and ways to assist athletes with eating disorders.

This study aimed to investigate athletes’ hypothetical use of non-steroidal anti-inflammatory drugs (NSAIDs), a behavior similar to doping, and its association with doping attitudes, competitive anxiety and situational opportunity. One hundred twenty-two sport science students completed an online survey assessing biographical information, doping attitudes, and competitive anxiety. Students’ intention to use analgesics was measured via two different hypothetical situations using the vignette technique. The favorable situation included an absence of potential witnesses and presence of an attractive good whereas witnesses were present in the unfavorable situation and an attractive goal was absent. The results of two hierarchical multiple regression models showed that doping attitudes and competitive anxiety, especially worry, predicted the use of analgesics. In the situation featuring a favorable opportunity, worry was the strongest predictor, whereas in the situation of an unfavorable opportunity, doping attitudes was the strongest predictor for using NSAIDs. Results indicate that NSAID use is associated with positive attitudes toward doping and competitive anxiety, and that it is situationally dependent. Future research perspectives and practical implications are discussed.; Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Doping refers to engaging in one or more of eleven anti-doping rule violations (ADRVs) outlined in the World Anti-Doping Code; these include possession, administration and trafficking of prohibited substances or methods, as well as complicity in any of these activities, prohibited association with anyone who has been found to have committed an ADRV, and acts to discourage or retaliate against anyone who reports doping-related information to authorities. Testing statistics likely show only a fraction of the true number of athletes doping. Evidence shows that specific situations individuals find themselves in are pivotal. The suggestion for psychological support aligns well with recent developments in the United Kingdom, where there are plans to introduce new Professional Standards for Personal Development Practitioners,1 whose role will include supporting athletes throughout transitions, including beyond their sporting career.

A paucity of research persists surrounding disordered eating among sub-populations of athletes with diverse identities. In this commentary, we argue that in the absence of extensive research to understand the nuances embedded in sub-populations of athletes, using a culturally humble approach is preferable and recommended in identifying and preventing disordered eating in athletes. Cultural humility is a powerful guiding framework for sport psychology professionals to navigate the underrepresented, “unheard voices” of disordered eating in sport. Specifically, engaging in the 5 Rs of cultural humility (Reflection, Respect, Regard, Relevance, and Resiliency) may help sport psychology professionals: a) become aware of and help reduce stereotypes that label certain athletes as disordered, and b) listen deeply to the individual experiences of the athlete while remaining aware of the inherent sport professional-athlete power imbalance. We offer recommendations based on current eating disorder research, gaps in this body of literature, and highlight recent publications on cultural humility for professionals to consider when addressing and preventing disordered eating concerns.

Anorexic Readiness Syndrome (ARS) is a concept used in research for the early detection of disordered eating (DE). It is a set of indicators located primarily within the cognitive and behavioral sphere of an individual’s functioning. The aim of this study was to examine whether among the elite acrobats there are girls showing a high level of anorexic tendency, and if so, what behaviors and attitudes are the most common. In addition, an attempt to determine what sport-related factors or other non-sport variables may increase the risk of ARS was conducted. The study group was made up of 133 acrobatic gymnasts aged 10-19, representing six countries that participated in the Acro World Cup competition held in Poland. The study procedures included surveys (personal questionnaire and the Eating Attitudes Questionnaire), anthropometric measurements such as weight, height, waist circumference (WC) and determination of the Body Mass Index (BMI), fat percentage (Fat%), and waist to height ratio (WHtR). A high level of ARS was found in 9.8% of acrobats. This group most often declared attitudes and behaviors indicative of anorexic tendencies. A strong relationship with the level of ARS was noted in the following: the use of fasting and diets ( p ≤ 0.001; V = 0.54), limiting of fats and carbohydrates ( p ≤ 0.001; V = 0.60), feeling angry after eating too much ( p ≤ 0.001; V = 0.55), knowing the caloric value of many food products ( p ≤ 0.001; V = 0.59), and the desire to improve the appearance of one’s body ( p ≤ 0.001; V = 0.52). The role played in the acrobatic partnership and the region of residence were considered as the sport-related risk factors. Among non-sport factors, the strongest predictor of ARS was the age of gymnasts (β = 0.516; p ≤ 0.001).

Windsurfing is dynamic water Olympic sport in which surfer is using wind force to generate forward motion on the water while maintaining balance on the board. Although is fast-raising and popular sport, previous studies have not addressed the issue of doping in this sport. The main aim of this study was to identify predictors of potential doping behaviour in windsurfing. The sample of participants included 48 senior windsurfers (40 males, 8 females, average age 31.1) in slalom class. The testing occurred during European Championship 2014. The participants filled previously validated questionnaires that included socio-demographics and doping- related factors variables. Descriptive statistic parameters were calculated and binary logistic regression was used to determine association between predictors and criterion (potential doping behaviour). Only 60% participants showed negative attitude towards potential usage of doping, while the rest of them were positive or neutral. Logistic regression identified only opinion about penalties for doping offenders as a predictor of potential doping behaviour in windsurfers (OR: 2.99, 95% CI: 1.44-6.2). The results of this study showed that windsurfers who advocate higher penalties for doping offenders are less likely to use doping. The lack of association of other variables with the criterion can probably be attributed to the heterogeneous sample of windsurfers since most of them are recreational sailors. In future studies windsurfers for other disciplines and additional predictor variables should be included.

Introduction: Recent studies indicate high prevalences of disordered eating or eating disorders in adult athletes and a worrying increase in adolescent athletes. Although several risk factors for developing eating disorders have been identified for adult athletes (e.g., personality factors, sport-related pressure), research on risk factors in adolescent athletes is scarce. Methods: This study investigates the prevalence of disordered eating and eating disorder symptoms and its association with personality- and sport-related risk factors in a sample of 439 elite athletes aged 13-18 years. Self-regulatory personality factors, sports and social pressure, as well as sports biographical data, were investigated in relation to different weight control methods and the Eating Disorder Examination Questionnaire measuring disordered eating and eating disorder symptoms. Results: Results indicate a prevalence rate of clinically significant eating pathology of 5.5% for the total sample, in which female athletes aged 15-18 years show the highest rate (9.6%). The structural equation model indicates a predominant association of sports and social pressure and personality factors with eating disorder symptoms. Conclusion: Being in the age range 15-18 years, being female, and being an athlete in a high-risk sport (e.g., aesthetics, weight class, or endurance sports) were identified as risk factors as well as athletes’ mental association with weight loss and success, and athletes’ perceived social pressure on eating and on body shape. Disordered eating and eating disorders are not only of concern for adults but also for young elite athletes and recommendations for adolescent elite athletes, coaches, and parents are given.

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