Contemporary Sports Issues – Page 31

Body Image Disturbances in NCAA Division I and III Female Athletes

Kato, K., Jevas, S., and Culpepper, D.

### Abstract

The purpose of this study was to examine and compare eating characteristics and body image disturbances in female NCAA Division I and III athletes in the mainstream sports of basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. Female collegiate athletes (N = 118) from Division I and III universities completed the EAT-26 and MBSRQ. Personal demographics and anthropometric data including height, weight, BMI and Body Fat estimates were also assessed. The study found that 49.2% (Division I) and 40.4% (Division III) of female athletes were in the subclinical eating disorder range. Results assessing body satisfaction, reported that 24.2% of Division I female athletes and 30.7 % of Division III female athletes were either very dissatisfied or mostly dissatisfied with their overall appearance. Results also showed that Division I female athletes were less satisfied with their appearance evaluation (body areas satisfaction, and lower torso). Division III female athletes reported higher levels of bulimic behaviors and weight preoccupation. The results indicate that athletes in refereed female sports are at risk for eating disorders, and that body image risk factors vary between NCAA competition divisions. This research provides sport professionals with a better understanding of risk factors influencing the prevalence of eating disorders between female athletes’ divisional competition levels.

**Key words:** body dissatisfaction, eating disorders, NCAA division, collegiate female athletes, eating disorder risk factors

### Introduction

Eating disorders are among the four leading causes of disease that may lead to disability or death (2). Eating disorders have the highest mortality rate of any mental health illness (41). Approximately nine million Americans suffer from an eating disorder with a lifetime prevalence rate of 0.9% – 4.5% and approximately 10% of college women suffer from a clinical or near clinical eating disorder (19,22).

Body image refers to the self-perception and attitudes an individual holds with respect to his or her body and physical appearance. Body image is a complex synthesis of psychophysical elements that are perpetual, emotional, cognitive, and kinesthetic. Cash and Fleming (10) defined body image as “one’s perceptions and attitudes in relation to one’s own physical characteristics” (p. 455). Body dissatisfaction focuses on body build and is often operationalized as the difference between ideal and current self selected figures (7).

Body dissatisfaction is a significant source of distress for many females. Gender is reported to be a convincing risk factor for disordered eating since females are 10 times more likely to develop an eating disorder compared to males (14). Research shows that the size of the “ideal” woman is far smaller than the size of the average woman (25). “The overwhelming evidence of female gender as a risk factor for the development of an eating disorder highlights the importance of determining the factors that put women at risk, particularly the sociocultural context in which these disorders develop” (31, p. 766).

Risk factors that accompany eating disorders are multi-factorial in nature. Research has revealed that sociocultural, developmental, personality, athletic, trauma, familial, and biological factors are critical identifiable areas that house potential eating disorder risk factors (31). Within these specific areas, body image dissatisfaction and low self-esteem are two situational aspects typically associated with individuals who are at risk for developing an eating disorder. In an early study on body dissatisfaction (5), 23% of the women expressed dissatisfaction with various parts of their body. The particular areas problematic for women were the abdomen, hips, thighs, and overall weight. When the study was replicated in the mid-1980s (11), the percentage of females dissatisfied with their body increased to 38%, with the same general body areas being defined by the participants. These same general body areas were also identified in a more recent study (16) in 56% of women.

Considerable scientific attention has been directed toward the potential role that sport involvement play in an athletes’ development of attitudes and behaviors about disordered eating. Female athletes experience a higher rate of eating disorders than non-athletes (4,24,43). Female athletes have an eating disorder prevalence of 15% to 62% compared to 0.5% to 3% in late adolescent and young adult female non-athletes (21). Researchers (33) assessed disordered eating in female collegiate athletes (N = 204) from three NCAA universities. The responses to the Questionnaire for Eating Disorder Diagnoses (Q-EDD) found 72.5% (n = 148) of the female athletes were asymptomatic, 25.5% (n = 52) symptomatic, and 2.0% (n = 4) eating disorder (29). Compared to recent research (8,39), this research study found a higher percentage of female athletes who were symptomatic. Athlete’s prevalence rate is an important factor, but understanding variables associated with increasing or decreasing risk factors for disordered eating is significant etiological information that should be evaluated (32).

Athletic factors promoting eating disorder development were first identified through research that began in the 1980s, which found particular sports induced higher rates of disordered eating behaviors (1,17). Even though physical activity may develop self-esteem and encourage physical and emotional well-being, there is verification that female athletes are at greater risk for developing disordered eating than their peers who are non-athletes (6). Female athletes encounter the same sociocultural pressures that of non – athletes, however the increased demand of sport – related pressures may independently or dependently increase their risk of eating disordered attitudes and behaviors (40). Coaches, sponsors, and families may all play a role in influencing an athlete’s weight and shape. Negative comments from those that surround and evaluate the athlete may trigger the onset of abnormal eating behaviors leading to an eating disorder (12,28).

The type of sport may also play a role in predisposing an individual to eating disorders based on struggles with body performance satisfaction. Specific sports where performance is judged on body leanness, shape and movement such as ballet, gymnastics, figure skating, diving, and cheerleading have a higher incidence of eating disorders (1,42,47). Shape judged sports such as gymnastics, diving, cheerleading, and dance place more importance on the individual’s body appearance, which may lead to body shape discontent among competitors (47). Researchers also report that 15% to 65% of women in “thin build” sports such as gymnastics or ballet have pathogenic eating patterns known to influence or manipulate the history and development of the eating disorder (27,44). Participation in competitive “thin build” sports in conjunction with personality traits associated with disordered eating could put these individuals at an even greater risk for developing an eating disorder (15, 44). The personality trait of many perfectionist increase disordered eating behaviors for female athletes (20). Researchers (26) compared athletes and non-athletes and reported perfectionism was the only factor that significantly distinguished the groups. In addition, Wilmore (46) reported that athletes high in perfectionism had an increased drive for thinness than athletes low in perfectionism. Refereed sports such as basketball place a stronger emphasis on training and do not rely as much on body appearance; therefore athletes participating in these sports may be less likely to be associated with disordered eating patterns (47).

Most research to date focuses on Division I female athlete’s prevalence rates, while female athletes regardless of NCAA division, experience similar sport specific pressures associated with body image disturbances. Limited research has compared prevalence between NCAA divisions, eating attitudes, and body image disturbances in female athletes. Research has reported that the prevalence of disordered eating, unhealthy dieting, and distorted body image in the athletic population ranges from 12% to 57% (30). Elite female athletes who suffer from eating disorders put themselves at greater risk for serious illnesses and/or death (38). Research has shown that more than one-third of female Division I NCAA athletes report attitudes and symptoms placing them at risk for an eating disorder (2). The National Collegiate Athletic Association study that surveyed student athletes from 11 Division I schools (N = 1,445) reported 1.1% of the female athletes met DSM-IV criteria for bulimia nervosa while 9.2% of female athletes had clinically significant symptoms of bulimia nervosa. This study also reported 0% female athletes met the DSM-IV criteria for anorexia nervosa while 2.85% of the female athletes had clinically significant symptoms of anorexia nervosa (24). Researchers believed the results suggest that Division I female athletes are at significant risk for the progression of eating disorder thoughts and behaviors. The study also stressed the need for future research to examine non-elite Division I, II and III schools since eating disorder risk factors may be higher among lower tier schools. Comparing divisional levels of competition in NCAA athletics could be an important aspect to understanding risk factors involved in the developmental process of an eating disorder.

The purpose of this study was to examine and compare eating characteristics and body image disturbances in female NCAA Division I and III athletes in mainstream sports of basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. This study also examined female body part dissatisfaction and eating attitudes utilizing the Multidimensional Body Self-Relations Questionnaire (MBSRQ) and Eating Attitudes Test (EAT-26). These findings may assist coaches, strength and conditioning coaches, and athletic trainers in understanding disordered eating and body image disturbances across various female sports in different competition divisions.

### Methods

#### Participants

Participants (N = 118) included Division I (n = 41) and Division III (n = 87) female athletes from National Collegiate Athletic Association (NCAA) member institutes of the following sports: basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. The convenient sample participants were voluntary, anonymous, and in accordance with university and federal guidelines for human subjects.

#### Instruments

Each athlete completed questionnaires assessing participant demographics and athletic involvement (sport, division). Eating behavior patterns were assessed utilizing the Eating Attitudes Test (EAT-26) and attitudes concerning body image were assessed with the Multidimensional Body-Self Relations Questionnaire (MBSRQ). Anthropometric measurements (height and weight) and body fat measurements were taken on each athlete. (Omron Fat Loss Monitor, Model HBF-306C). The Fat Loss Monitor (Omron Fat Loss Monitor, Model HBF-306C) displays the estimated value of body fat percentage by bioelectrical impedance method and indicates the Body Mass Index (BMI). The bioelectrical impedance, skinfold, and hydrostatic weighing methods have all been shown to be reliable measures of body composition (r = .957 – .987) (23).

##### Eating Attitudes Test (EAT-26)

Eating Attitudes Test (EAT-26) was used to differentiate participants with anorexia nervosa, bulimia nervosa, binge-eating, and those without disordered eating characteristics. It is a 26-item measurement consisting of three subscales: 1) dieting, 2) bulimia and food perception, and 3) oral control. Scoring for this instrument was a Likert scale of six possible answers (always, usually, often, sometimes, rarely, never). Scores ranged from zero to three for each question and a total score greater than 20 indicates excessive body image concern that may identify an eating disorder (Garner et al., 1982; Williamson et al., 1987). EAT-26 has been proven to be a reliable measurement (r = .88) (17). The total score of the EAT-26 and the Drive for Thinness scale of the Eating Disorder Inventory (EDI) have reports of a 90% agreement (37).

##### Multidimensional Body-Self Relations Questionnaire

The Multidimensional Body-Self Relations Questionnaire: The Multidimensional Body-Self Relations Questionnaire (MBSRQ) is a 69 item self-report inventory for the assessment of self-attitudinal aspects of the body image construct. The MBSRQ measures satisfaction and orientation with body appearance, fitness, and health. In addition to seven subscales (Appearance Evaluation and Orientation, Fitness Evaluation and Orientation, Health Evaluation and Orientation, and Illness Orientation), the MBSRQ has three special multi-item subscales: (1) The Body Areas Satisfaction Scale (BASS) approaches body image evaluation as dissatisfaction-satisfaction with body areas and attributes; 2) The Overweight Preoccupation Scale assesses fat anxiety, weight vigilance, dieting, and eating restraint; and 3) The Self-Classified Weight Scale assesses self-appraisals of weight from “very underweight” to “very overweight.” Internal consistency for MBSRQ subscales range from .74 – .91. This questionnaire has been studied and used extensively in the college population. Internal consistency for the subscales of the MBSRQ ranged from .67 to .85 for males and .71 to .86 for females (9).

### Results

#### Descriptive statistics

Participants in the study included 118 female athletes from NCAA Division I (34.7%) and Division III (73.7%) universities. Participants reported their ethnicity as 80.5% White (n =95), 16.1% Black (n =19), .02% Hispanic (n =2), .01% Asian (n =1), and .01% as other (n = 1). The female athletes had a mean age of 19.81 years + 1.29 and a mean body fat percentage of 21.17% + 5.07 (Table 1). There was no significant difference between the divisions in regards to body fat percentage F (1,117) = .727, p = .395.

#### Test for Significance

A multiple analysis of variance (MANOVA) was conducted to determine the effect of NCAA Divisional Status (I or III) on eating characteristics and body image (Table 2). Significant differences were found between Division I and III, Wilks’s Lambda = .664, F(17, 114), p<.0001.

##### Disordered Eating Behaviors

Base frequency scores indicated that 49.2% of Division I female athletes and 40.4% of Division III female athletes scored a 20 or higher on the EAT-26. A follow – up ANOVA reported no significant differences between 20 or higher EAT-26 scores and NCAA Division, F (1, 117) = 1.732, p = .190. A significant difference was found between divisions on the bulimia subscale of the EAT-26, F (1, 117) = 9.107, p = 003. No significant differences were found between division for the EAT-26 dieting subscale, F (1, 117) = .125, p = .724 and oral control subscale F (1, 117) = 2.123, p = .148.

##### Body Disturbance

The results of the MANOVA indicated a significant difference between divisions on the MBSRQ, F(17,114 ) = 3.391, p = .000. The results of the MBSRQ, which assessed body satisfaction, found that 24.2 % of Division I female athletes and 30.7 % of Division III female athletes were either very dissatisfied or mostly dissatisfied with their overall appearance. In addition, a difference was found between Division I and III athletes for appearance evaluation, F (1, 3) = 10.525, p = .001, body areas satisfaction F (1, 3) = 8.36, p = .004, lower torso F (1, 3) = 5.975, p = .016, and overweight preoccupation F (1, 3) = 17.895, p = .000. Division I female athletes were less satisfied with their appearance evaluation, body areas satisfaction, and lower torso than Division III female athletes. Division III female athletes were more weight preoccupied than Division I female athletes.

### Discussion

The main purpose of this study was to examine and compare the eating attitudes and body image satisfaction in female NCAA Division I and III athletes in mainstream sports of basketball, softball, track/cross country, volleyball, soccer, tennis, swimming/diving, and ice hockey. Limited research is available comparing eating disturbances between NCAA divisions so the information acquired may help explain the prevalence of body image disturbances and eating disorder among college female athletes at different levels of competition.

The results of this study indicated that 49.2% (Division I) and 40.4% (Division III) of the female athletes scored 20 or higher on the EAT-26, putting them in a subclinical eating disorder range (18). Comparative research studies using the EAT-26 reported percent subclinical populations of females athletes to be 15.2%, N = 425 (3); 5.8%, N = 190 (13); and 10.2%, N = 59 (36). The current research study did not find a significant difference between subclinical population scores and division, however both Division I and Division III female athletes had a considerably higher subclinical eating disorder female athletic population compared to these previous studies. This finding may be an important implication because the desire to be thin does not always result in clinically diagnosed signs and symptoms of anorexia or bulimia. If left undetected, subclinical eating disorders may result in dysfunctional social interaction, decreased physical performance reduced physical health, and an increase in the propensity for athletic injury.

Between divisions, a significant difference was found on the bulimia subscale of the EAT-26. Division III female athletes struggled more with bulimic behaviors compared to the Division I female athletes. This finding agrees with previous research suggesting that disturbed eating behavior may be higher among lower tiered athletes (35). Bulimic behaviors may be viewed as more destructive to athletic performance so the elite competitive athletes (Division I) may be deterred from participating in such behaviors. Bulimic behaviors may also require a greater level of secrecy, so elite competitive female athletes competing may avoid such behaviors due to increased time commitment, travel requirements, and contact they experience with their coaches and athletic trainers.

It has been reported that female athletes participating in judged sports such as gymnastics, cheerleading, and dance are more prone to eating disorders compared to those who participate in referred sports such as basketball, swimming, and softball (26,34,47). The assessment of body satisfaction through the MBSRQ found that 24.2 % of Division I female athletes and 30.7 % of Division III female athletes were either very dissatisfied or mostly dissatisfied with their overall appearance. We believe that our findings warrant further investigation into the relationship of female athlete’s body dissatisfaction and those participating in referred sports.

A significant difference was also reported on the MBSRQ subscales between Division I and III athletes for appearance evaluation, F (1, 3) = 10.525, p = .001, body areas satisfaction F (1, 3) = 8.36, p = .004, lower torso F (1, 3) = 5.975, p = .016, and overweight preoccupation F (1, 3) = 17.895, p = .000. Division I female athletes were less satisfied with their appearance evaluation, body areas satisfaction, and lower torso than Division III female athletes. Division III female athletes were more weight preoccupied than Division I female athletes. A performance-related drive for thinness through appearance evaluation, body areas satisfaction and lower torso may have a greater impact on female athletes that compete in higher level divisions such as Division I. Being weight preoccupied may not be as closely associated with physical performance measures as compared to general body dissatisfaction.

Even though this was a well-designed study and used a diverse sample of female athletes, it is not without limitations. The participant sample was limited in racial/ethnic minorities, therefore future research should examine female athletic samples with greater racial/ethnic diversity. This research also compared Division I female athletes to Division III female athletes. Increasing the number of institutes and divisions would greatly benefit the findings of this study. Lastly, although a diverse group of female athletic teams was represented in this study, equal number of female athletes from each team was not available due to the sports each institution offered, scholarships, and general participation. For example, ice hockey could only be evaluated at the Division III level. It is possible that the results would have varied if there were equal participant representation. Future research should examine a greater number of institutions at varied divisions to increase participant representations among each sport.

### Conclusion

Our results indicate that refereed female sports are at risk for eating disorders and body image risk factors vary between NCAA competition divisions of female sports. Body dissatisfaction factors that may lead to serious eating disorders will continue to impact the female athletic audience due to added pressures innate to sport performance. Female athletes, regardless of sport, show evidence of risk for developing an eating disorder. Understanding what motivates the developmental process to accelerate in sport may vary depending on level of competition. The educational and scholarly implications of this research project include contributing to the body of literature in the area of body image and eating attitudes of female athletes and providing professionals with a better understanding of the risk factors that influence the prevalence of eating disorders at varied levels of competition.

### Applications in Sport

These findings may assist coaches, strength and conditioning coaches, and athletic trainers in understanding disordered eating and body image disturbances across various female sports in different competition divisions. Professionals that work with female athletes understand the sensitive nature of optimizing performance without compromising overall health. Recognizing and identifying prevention indicators for body image disturbances that lead to disordered eating will assist professionals when dealing with at risk female athletes in varied levels of competition of referred sports. This information will also greatly benefit programs aimed at ceasing the progression of disordered eating

### References

1. Abraham, S. (1996). Characteristics of eating disorders among young ballet dancers. Psychopathology, 29, 223-229.
2. Academy of Eating Disorders. (2008) Statistics and study findings: Burden and prevalence of eating disorders. Retrieved from <http://www.aedweb.org> on January 31, 2008.
3. Beals, K.A., & Manore, M.M. (2002). Disorders of female athlete triad among collegiate athletes. International Journal of Sports Nutrition and Exercise. 12(3), 281 – 293.
4. Berry, T.R., & Howe, B.L. (2000). Risk factors for disordered eating in female university athletes. J. Sport Behavior, 23(3), 207–218.
5. Berscheid, E., Walster, E., & Bohrnstedt, G. (1973) The happy American body: a survey report. Psychology Today, 7(6), 119.
6. Brownell, K.D., Rodin, J., & Wilmore, J.H. (1992). Eating, Body Weight and Performance in Athletes: Disorders of Modern Society. Lea and Febiger, Philadelphia, PA.
7. Candy, C.M., & Fee, V.E. (1998). Underlying dimensions and psychometric properties of the eating behaviors and body image test for preadolescent girls. Journal of Clinical Child Psychology, 27(1), 117-127.
8. Carter, J.E., and Rudd, N.A. (2005). Disordered eating assessment for college student athletes. Women in Sport and Physical Activity Journal, 14, 62–75.
9. Cash, T.F. (2000). The multidimensional body-self relations questionnaire users’ manual. Available from the author at www.body-images.com or through email (TCash@odu.edu).
10. Cash, T.F., & Fleming, E.C. (2002). The impact of body-image experiences: Development of the Body Image Quality of Life Inventory. International Journal of Eating Disorders, 31, 455-460.
11. Cash, T.F., Winstead, B.A., & Janda, L.H. (1985). Your body, yourself: A reader survey. Psychology Today, 20(4), 30-44.
12. Cobb, K.L., Bachrach, L.K., Greendale, G., Marcus, R., Neer, R., Nieves, J. et al. (2003). Disordered eating, menstrual irregularity, and bone mineral density in female runners. Medical Science, Sport, and Exercise, 35, 711-719.
13. Dunn, D., Turner, L.W., & Denny, G. (2007). Nutrition knowledge and attitudes of college athletes. The Sport Journal. 10(4), Retrieved July 5th, 2010, from <http://www.thesportjournal.org/article/nutrition-knowledge-and-attitudes-college-athletes>
14. Fairburn, C.G., & Beglin, S. J. (1990). Studies of the epidemiology of bulimia nervosa. American Journal of Psychiatry, 55, 425-432.
15. Fulkerson, J.A., Keel, P.K., Leon, G.R., & Dorr, T. (1999). Eating disordered behaviors and personality characteristics of high school athletes and nonathletes. International Journal of Eating Disorders, 26, 73-79.
16. Garner, D.M. (1997). The 1997 body image survey results. Psychology Today, 30(1), 30-57.
17. Garner, D.M. & Garfinkel, P.E. (1979). The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9, 273-279.
18. Garner, D.M., Olmsted, M.P., Bohr, Y., & Garfinkel, P.E. (1982). The eating attitudes test: Psychometric features and clinical correlations. Psychological Medicine, 12, 871-878.
19. Gurze Books. (2010). Eating disorder statistics. Retrieved July 14th, 2010, from http://www.bulimia.com/client/client_pages/eatingdisorderstats.cfm
20. Hausenblas, H. & Carron, A. (1999). Eating disorder indices and athletes: An integration. Journal of Sport and & Exercise Psychology, 21, 230-258.
21. Hinton, P.S. & Kubas, K.L. (2005). Psychosocial correlates of disordered eating in female collegiate athletes: validation of the ATHLETE questionnaire. Journal of American College Health, 54, 149 – 156.
22. Hudson, J.I., Hiripi, E., Pope, H.G., & Kessler, R.C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 348-358.
23. Jackson, A.S., Pollock, M.L., Graves, J.E., & Mahr, M.T. (1988). Reliability and validity of bioelectrical impedance in determining body composition. Journal of Applied Physiology, 64, 529-534.
24. Johnson, C., Powers, P.S., & Dick, R. (1999). Athletes and eating disorders: The national collegiate athletic association survey. International Journal of Eating Disorders, 26, 79 – 88.
25. Katzmarzyk, P.T., & Davis, C. (2001). Thinness and body shape of Playboy centerfolds from 1978 to 1998. International Journal of Obesity and Related Metabolic Disorders, 25, 590-592.
26. Krane, V., Stiles-Shipley, J.A. Waldron, J., & Michalenok, J. (2001). Relationship among body satisfaction, social physique anxiety, and eating behaviors in female athletes and exercisers. Journal of Sport Behavior. 24(3), 247-265.
27. Macleod, A.D. (1998). Sport psychiatry. Australia New Zealand Journal Psychiatry. 32, 860-866.
28. McLean, J.A., Barr, S.I., & Prior, J. C. (2001). Dietary restraint, exercise and bone health in young women: Are they related? Medical & Science in Sport & Exercise, 33, 1292-1296.
29. Mintz, L.B., O’Halloran, M.S., Mulholland, A.M., & Schneider, P.A. (1997). Questionnaire for eating disorder diagnoses: Reliability and validity of operationalizing DSM-IV criteria into a self-report format. Journal of Counseling Psychology, 44, 1997.
30. Montenegro, S.O. (2006). Disordered eating in athletes. Athletic Therapy Today, 11, 60- 62.
31. Mussell, M.P., Binford, R.B., & Fulkerson, J.A. (2000). Eating disorders: Summary of risk factors, prevention programming, an prevention research. The Counseling Psychologist, 28, 764-796.
32. Petrie, T.A., & Greenleaf, C. (2007). Eating disorders in sport: From theory to research to intervention (pp. 352–378). In G. Tenenbaum & R. Eklund (Eds.), Handbook of Sport Psychology 3rd ed. Wiley & Sons, Inc, Hoboken, NJ.
33. Petrie, T.A., Greenleaf, C., Reel, J., & Carter, J. (2009). Personality and sychological factors as predictors of disordered eating among female collegiate athletes. Eating Disorders: The Journal of Treatment and Prevention, 17, 302 – 321.
34. Powers, P.S. (2000). Athletes and eating disorders. Healthy Weight Journal, 14(4), 59-62.
35. Powers, P.S., & Johnson, C. (1996). Small victories: Prevention of eating disorders among athletes. Eating Disorders: The Journal of Treatment and Prevention. 4, 364-367.
36. Raymond-Barker, P., Petroczi, A., & Quested, E. (2007). Assessment of nutritional knowledge in female athletes susceptible to female athlete triad syndrome. Journal of Occupational Medicine and Toxicology. 2, Retrieved January 27th, 2010, from <http://www.occup-med.com/content/2/1/10>
37. Raciti, M.C. & Norcross, J.C. (1987). The EAT and EDI: Screening, interrelationships and psychometrics. International Journal of Eating Disorders, 6, 579-586.
38. Ryan, J. (1995). Little girls in pretty boxes: The making and breaking of elite gymnasts and figure skaters. New York: Doubleday.
39. Sanford-Martens, T.C., Davidson, M.M., Yakushko, O.F., Martens, M.P., Hinton, P., & Beck, N.C. (2005). Clinical and subclinical eating disorders: An examination of collegiate athletes. Journal of Applied Sport Psychology, 17, 79–86.
40. Smith, A. & Petrie, T. (2008). Reducing the risk of disordered eating among female athletes: A test of alternative interventions. Journal of Applied Sport Psychology, 20, 392 – 407.
41. Sullivan, P.F. (1995)/ Mortality in Anorexia Nervosa. American Journal of Psychiatry, 152(7), 1073 – 1074.
42. Sundgot-Borgen, J. (1994). Risk and trigger factors for the development of eating disorders in female elite athletes. Medical & Science in Sports & Exercise, 14, 59-63.
43. Sundgot-Borgen, J., & Torstveit, M.K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine, 14(1), 25–32.
44. Warren, M.P. & Shantha, S. (2000). The female athlete. Baillière’s Clinical Endocrinology and Metabolism, 14, 37-53.
45. Williamson, D., Goreczny, A., & Duchman, E. (1987). Behavioral and psychophysiological assessment of bulimia. Annals of Behavioral Medicine, 9, 8-11.
46. Wilmore, J.H. (1996). Eating disorders in the young athlete. In O. Bar-Or (Ed.), The child and adolescent athlete (pp. 287-303). Oxford, England: Blackwell.
47. Zucker, N.L., Womble, L.G., Williamson, D.A., & Perrin, L.A. (1999). Protective factors for eating disorders in female college athletes. Eating Disorders, 7(3), 207-219.

### Corresponding Author

Kim Kato, Ed.D.
PO Box 13015, SFA Station
Nacogdoches, TX 75962-3015
<kkato@sfasu.edu>
936-468-1610

Dr. Kim Kato is an Assistant Professor in Health Science in the Department of Kinesiology and Health Science at Stephen F. Austin State University in Nacogdoches, Texas.

### Authors

**Kim Kato**, EdD, NSCA-CPT
Stephen F. Austin State University

**Stephanie Jevas**, PhD, ATC, LAT
Stephen F. Austin State University

**Dean Culpepper**, PhD, CC-AASP
Lubbock Christian University

U.S. Sports Academy2016-04-01T09:52:41-05:00September 30th, 2011|Contemporary Sports Issues, Sports Coaching, Sports Management, Sports Studies and Sports Psychology, Women and Sports|Comments Off

Contemporary Issues of Heat Illnesses

Ms. Jennifer Parker

### Abstract
Heat illnesses are of major concern. More and more high school, college, and professional athletes are suffering from and/or dying from heat related illnesses. With all of the knowledge that medical professionals have in this day-in-age, there should be fewer instances of heat illnesses. Parents, coaches, and athletes also need to be aware of prevention and treatment procedures in case an emergency occurs. Heat stroke, the most serious heat illness, is a life threatening emergency and needs to be treated immediately. Ice water immersion is the best method for lowering the body temperature quickly and effectively.

**Key Words:** heat illness, heat stroke, heat index, prevention, treatment

### Introduction

After working on a sports medicine team for the last two years, exertional heat illnesses (EHI) were brought to my attention. I never knew how often they occurred or how life-threatening they could be. The purpose of this paper is to spread awareness to athletes, parents, and coaches, of the dangers of heat illnesses as well as how to prevent, treat, and return-to-play after an episode of heat illness. Heat illness-related deaths are on the rise, and I am curious to know why athletes are dying from heat injuries, such as heat stroke. In 2004, Coris et al. (4) stated, “the recent high-profile deaths of a collegiate athlete and a professional athlete in Florida and a professional athlete in Minnesota have the sports medicine and family medicine communities in a state of ‘high alert’ and searching for the most efficacious methods of preventing such tragedies.” In 2007, heat stroke was “the third leading cause of death in U.S. high school athletes.” (Coris, Walz, Konin, & Pescasio, 2007). Now, in 2010, “exertional heat stroke is the second leading cause of death among athletes, followed only by sudden cardiac death.” (Mazerolle, Scruggs, Casa, Burton, & McDermott, 2010). There are several different heat illnesses, ranging from mild to life threatening. Heat edema, heat rash, heat syncope, and heat cramps are the milder heat illnesses while heat exhaustion and heat stroke are more serious. Sunburns can also be considered a heat illness, ranging from mild to severe (1st degree to 3rd degree burns). Heat edema is swelling of the extremities, often found in people who are not used to activity, heat, or a combination of the two. Heat rash is a specific area of skin that has been irritated. It is often, red, inflamed, itchy, and tingly. Heat cramps are painful, involuntary muscle spasms, most often occurring in the abdomen or calf. Heat syncope is defined as an orthostatic dizziness which is a result of a sudden pooling of the blood in the extremities, commonly seen in marathon runners after they cross the finish line and abruptly stop running. Heat exhaustion occurs when an athlete has become dehydrated and has a core body temperature of approximately 102°F. This athlete will often feel dizzy, and present as pale, warm, and diaphoretic. They may also present with a rapid pulse and could be hyperventilating. Heat stroke is a life threatening emergency and care needs to be provided immediately. An athlete suffering from heat stroke will usually suddenly collapse. The athlete will have hot and dry skin, a rapid pulse, and a core body temperature above 104°F. Athletes, coaches, and medical staff will benefit the most from this paper as I provide information on how to prevent and treat heat illnesses, learn how to identify and modify risk factors, as well as considering communication and special circumstances. However, parents, family and friends of athletes can also benefit from this article in learning about ways to help if need be.

### Levels of Care
_Prevention_

One of the best methods for preventing heat illnesses, if done correctly, is the preparticipation physical exam (PPE). The PPE is used to find any intrinsic risk factors that an athlete may have. It could be anything from low blood pressure, to heart problems, from asthma to obesity, and everything in between. “Several intrinsic risk factors that increase susceptibility to EHI have been identified, but information about their relative contributions is limited. These risk factors include (a) previous history of EHI, (b) poor cardiovascular (CV) fitness, (c) obesity, (d) inadequate heat acclimatization, (e) dehydration or electrolyte imbalance, (f) recent febrile illness, (g) sleep deprivation, (h) a ‘never give up’ or ‘warrior’ mentality (high level of motivation or zealousness), and (i) use of questionable drugs, herbs, or supplements.” (Eberman, & Cleary, 2009). Each of these risk factors needs to be considered so that appropriate actions can be taken to provide the safest situation possible for the athlete at risk. An athlete with any of the previously mentioned risk factors is at a higher risk for experiencing a heat illness.

Not only do members of the sports medicine team need to be educated, but athletes, coaches, and parents should also be informed about the risks, signs and symptoms, and treatments of heat illnesses. If an athlete is suffering from heat stroke, it is essential to provide immediate treatment, and with more people being educated properly, faster treatment may be more readily accessible. Hydration is one of the most important factors in preventing heat illness. It is important to educate athletes and coaches on proper hydration techniques. In some instances, mostly seen in football, coaches have withheld water breaks as a form of punishment or as a motivation technique. The coaches may or may not have known that withholding water could be dangerous and life threatening in long durations. It seems that football players are more susceptible to heat illnesses because they have “double days” usually during the hottest part of the year. The double days often take place in the beginning of summer after a long summer break where athletes have not been practicing and have lost any acclimatization to exercise and heat that they had before. Therefore, the athletes are more likely to suffer from some form of heat illness during the first few weeks of practice. “During prolonged work periods in the heat, the maintenance of high sweat rates leads to progressive dehydration, which may be accompanied by impairment of mental and physical performance and of heat dissipation.” (Bates, & Miller, 2008). The combination of water and sports drinks seem to offer the best hydration. The sports drinks replenish sodium and other electrolytes that water does not have. However, only drinking sports drinks can provide too much salt and therefore, drinking water becomes necessary as well. “Ingestion of non-caffeinated sports drinks containing vital nutrients such as water, electrolytes and carbohydrates during exercise may help maintain physiological homeostasis, resulting in enhanced performance and/or reduced physiological stress on an athlete’s cardiovascular, central nervous and muscular systems. Both the volume of the rehydration fluid and its composition are critical in maintaining whole body fluid homeostasis.” (Snell, Ward, Kandaswami, & Stohs, 2010).

Proper clothing, equipment, and preparation are also key factors in preventing heat illness. “Heat production during exercise is 15 to 20 times greater than at rest, and is sufficient to raise a person’s core body temperature 1°C every five minutes, if there were no inherent regulatory mechanisms.” (Miners, 2010). It is important to drink fluids, monitor oneself and others and wear proper clothing. Players should be aware of how much fluid they drink and take note if they start to cramp or feel lightheaded. Players and coaches need to be sure to wear sunscreen and to reapply it accordingly. Lightweight, breathable clothing should be worn in order to allow air to flow and dissipate heat. Light-colored clothing should be worn when possible as the light colors reflect the sun’s rays where as darker colors such as black absorb the rays and thus intensifies the heat that the body is absorbing. Shorts and short-sleeved shirts should also be worn when possible to allow for as much breeze to flow to skin contact. This is the idea behind the recommendation of the National Athletic Trainer’s Association (NATA) and American College of Sports Medicine (ACSM) to acclimatize to the heat. It is especially important for football players in the early summer months to follow this safety guideline. It can take up to 14 days to acclimatize the body to the heat. So, it is important to start off with shorter practices during the early morning or later evenings. The players should start practices in shorts and short-sleeved shirts and build up to pads, then full pads, and then finally full pads with full uniform. It is also important to slowly increase the length of time the players practice and to modify which part of the day they are practicing in. Not only do the athletes need their proper equipment to help prevent heat illness, but the coaches and sports medicine team need their proper equipment as well. Ice water immersion has been identified as the best way to cool a person’s body rapidly and so a small pool-like container is needed on the sidelines of every sporting event. Coolers of ice and others with water should be kept next to the pool with the intent to use it only for the need of an emergency. Other coolers should be provided for drinking water. In some cases where a small pool-like container is not available, ice water buckets and towels should be available to cool an athlete. The sports medicine team should also supply a few tents to allow a place for athletes to escape from the sun. Although it may be an uncomfortable situation for the athlete and/or the athletic trainer, rectal temperature is the best way to determine core body temperature. Oral, tympanic, or other methods of reading a temperature are just not sufficient enough. They do not read a true core body temperature. Ingestible pills that read the body’s temperature are a great way to find out the athlete’s temperature for a few days, however, they are costly. The pills can be used to track an athlete’s body temperature, which is especially important for those who are susceptible to heat illnesses.

_Modifiable Risks_

Some of the things listed above in prevention techniques are also found in the modifiable risks category. Acclimatization to heat, dehydration, humidity, and high heat are all risks that can be modified, and thus, prevented. With proper education and planning, a heat acclimatization process can be initiated, proper hydration methods can be provided, and practices and games can be modified accordingly whether high heat, humidity, or other environmental factors occur. As mentioned above, the ACSM has set recommendations for acclimatization to heat but they also include information on hydration, humidity, and heat. “These recommendations consist of guidelines that measure heat stress and define the severity of heat stress by a Wet Bulb Globe Temperature (WBGT) Index. Based on the WBGT at the time of the event, the ACSM also has recommendations regarding the type, durations, and frequency of exercise regimes for a particular day, the frequency of hydration and rest breaks, and whether or not the activity should be moved to a different time of day or cancelled altogether.” (Cooper, Jr, Ferrara, & Broglio, 2006). Each sports medicine team should make their own policy based on these recommendations. Each employee should receive a copy and should sign a form acknowledging receipt and cooperation. The WBGT Index has become widely recognized and used as one of the best methods to determine whether it is safe to engage in physical activity outside or not. “WBGT is not air temperature, but is measuring the relative heat and humidity. It indicates web bulb globe temperature, an index of climatic heat stress that can be on the field by the use of a psychrometer…High WBGT indicates extreme risk of heat-related problems and appears to be one of the best predictors of heat illness.” (Cleary, 2007).

_Measuring Heat_

Another way to help determine whether it is safe to participate in physical exercise outside is by using one of the many heat index charts available to the public. A new one in particular, the Kleiner Exertional Heat Illness Scale (KEHIS), eliminates the many traditional categories of heat edema, heat cramps, heat, syncope, heat exhaustion and heat stroke and combines them to set three categories: mild, moderate, and severe. This scale is similar to the Glasgow Coma Scale in that it uses a points system to help determine which category the person falls into. Since not every person will have each sign or symptom found in the traditional categories, Kleiner felt this method of a point system would help identify the seriousness of the illness the athlete is suffering from. The points range from zero to 25. “A need exists for a universal scale that can objectively quantify the severity of heat-related illness. The KEHIS has been designed to fill that void. A KEHIS score of 12 is different than a KEHIS score of 15, and a score of 15 on one patient has the same level of urgency as a score of 15 in another. There is no disagreement about the level of severity.” (Kleiner, 2002). So, the WBGT and other heat index charts are used to determine whether it is safe to begin play and the KEHIS is used to determine which level of heat illness a person is experiencing. It is important to identify which level the athlete is experiencing because a severe, or heat stroke illness, is life threatening and needs to be treated immediately. It is also important to determine if an athlete is experiencing a mild or moderate heat illness. Heat illnesses are a continuum and one level can progress to the next very quickly.

### Considerations
_Communication_

Communication between medical team members is crucial when dealing with an emergency. The Certified Athletic Trainer (ATC) is usually the only medical personnel on the sideline for athletic events. In some cases a physician, physical therapist, and/or Emergency Medical Services (EMS) may also be present. One of the best ways for a medical team to effectively communicate during a medical emergency is by having an Emergency Action Plan (EAP) in place. Practice of the EAP is essential so that every person knows exactly what their job is in order to help eliminate confusion and chaos during the actual emergency. The EAP should specifically list every member of the medical team, their title, and contact information. Each venue; baseball field, soccer field, gymnasium, tennis courts, pool, etc., will need their own specific EAP established. Things included should be where to locate the ATC and emergency equipment such as Automated External Defibrillator (AED), splints, crutches, spine board, and bandages, to name a few. Communication lines such as cell phone, land lines, or 2-way radio with frequency and channel information, should also be noted. Also included in the venue section are directions for EMS to reach the specific facility. Details on who will call 911 and who will meet the ambulance when it arrives should also be included. This section should also have a list of all the area hospitals and directions so that they may be given to family members of those being transported. Other things to consider are environmental concerns such as thunderstorms, lightening, hail, hurricane, tornados, etc. For each of these situations, there needs to be a specific “safe location” for people to evacuate. Instructions for athletes to drop any metal equipment (bats, rackets, clubs, etc.) and for anyone to avoid metal stadium seating or tall trees are of utmost importance. The ATC will be in direct communication with the head coaches and officials and can suspend the game for safety reasons at any point.

With specific regards to heat illness injury, communication is crucial between members of the medical team. From the time the athlete suffers an attack, the ATC must put the EAP into action. After the athlete is released from the hospital, communication needs to be present between the athlete, athletic trainer, physician, coach, and in the case of a minor, the parents or guardians. Communication is crucial in order to provide the best care possible for the athlete.

_Returning-to-play_

Currently, there is no one set of standards for returning-to-play (RTP) after suffering a heat illness attack. Some commonly found suggestions include: 1) athlete suffered from heat cramps can RTP after hydrating until the cramps are gone, 2) athlete who suffered heat exhaustion should not RTP for 24 hours or more, and 3) athlete who suffered from heat stroke should stay out of activity for at least one week and must be cleared by a physician. “Recovery from EHI is typically determined by normalization of serum electrolytes, CK, creatinine, liver function tests, and normal mental status. When EHI victims meet these conditions, they can resume light to moderate exercise for 15 minutes daily. Maximal efforts, such as competitive running, and competitive sports, such as football, should not be permitted until recovery is complete. . . If the victim does not exhibit heat tolerance after three months post EHI episode, recommendations can be modified to an unrestricted exercise/workload, but maximal exertion, particularly during significant heat load conditions, should avoided.” (Muldoon, Deuster, Voelkel, Capacchione, & Bunger, 2008). Even though there are no set standards of returning an athlete to play, it seems wise to assure proper hydration and clear mental status as well as being cleared by a physician before allowing the athlete to compete. The timeline of RTP widely varies depending on the type of heat illness suffered and varies from athlete-to-athlete. As far as I, a medical professional, am concerned, we need to establish a professional standard for returning athletes back to practice and competition.

_Special circumstances_

There are many special circumstances to consider when dealing with heat illnesses. Amateur athletes, older athletes, and “weekend warriors” are of major concern themselves. These athletes tend to be out of shape or far less active than the collegiate or professional athlete, and yet many expect to go out and perform just as well. They push themselves too far and often experience a myriad of injuries and illnesses as a result. “Amateur participants may not have a complete understanding of recommended strategies for handling outdoor extreme conditions like heat and humidity. Thus, heat-related illnesses like heat stress and eventually heat stroke become increasingly possible, with susceptibility increasing with age, vulnerability factors like co-morbidity (e.g., chronic diseases), and various health-related behaviors (e.g., nutrition, hydrations, and sleep or rest).” (Shendell, Alexander, Lorentzon, & McCarty, 2010).

When thinking of athletes, many think of sports that take place on land. However, athletes who compete in or on the water are also of concern. Just because the athlete is in or on the water does not mean that they should be treated any differently than the land athlete. With regards to those athletes on the water, “paddlers should be encouraged to drink to thirst and replace electrolytes during long distance races and frequently be assessed for signs and symptoms of heat illness to prevent life threatening increases in body temperature and heat stroke. Paddlers should aggressively seek sun protection and have lacerations and skin injuries properly cleaned and evaluated by medical personnel if there are signs of infection.” (Haley, & Nichols, 2009).

On the other end of the spectrum are those who may have other health issues, thus, making them even more susceptible to exertional heat illnesses. Some researchers believe that there may be a link between exertional heat illness with those who have exertional rhabdomyolysis (ER), malignant hyperthermia (MH), and/or menstrual cycles. While exertional heat illness can be described as someone who has extreme high core body temperature, impaired mental status, and possible musculoskeletal or organ damage, a person with malignant hyperthermia does as well. Both EHI and MH are also both found in otherwise healthy people. Some of the people, who suffered from what appeared to be EHI, were later found to actually have been malignant hyperthermia. In contradiction, ER can also occur in warm or cool environments. However, like EHI and MH, “ER also is a hypermetabolic state wherein the skeletal cell membrane is severely compromised and serum CK values are markedly increased.” (Muldoon, et al, 2008). The recovery process of each of these seems to be very similar in that it calls for normalization of CK, serum electrolytes, creatinine, and liver functions. As of 2008, there are no biochemical tests, genetic tests, or functional bioassay tests available to determine the differences between the three. Further research is needed in order to be able to identify the similarities, differences, and treatments for each. In addition, Muldoon mentioned that females are more susceptible to heat illnesses than males. While searching through other articles I ran across an article researching the physiological responses to the menstrual cycle. In this article it was shown that females had a longer time to exhaustion than expected but was thought that by extending their time to exhaustion they become more susceptible to injury or illness. “Given the difficulty in conducting clinical research into the development of heat illness, obtaining evidence of the theoretical increased susceptibility to heat illness during the luteal phase in females remains elusive; however, it is an area that warrants further investigation.” (Marsh, & Jenkins, 2002).

The last special circumstance to consider is that of actually warming up before an activity while wearing an ice vest. The ice vest warm up was used on runners in a long distance race. The results showed that although heart rates varied, a lower body temperature was a consistent result. “The ice vest slowed the increase in core temperature throughout cross-country warm-up and racing among the participants of this study. With the reduced thermal strain, greater blood flow may be available for transport of oxygen to muscle. Sweat rate will likely be decreased during performance when the ice vest is used during the warm-up, and with a decreased sweat rate, blood volume should be better maintained, improving oxygen delivery to muscles. The greater blood flow and blood volume should lead to a better performance.” (Hunter, Hopkins, & Casa, 2006). While it is a fairly new idea, the ice vest warm up seems to provide impressive results. If we can decrease the core body temperature before an athletic event, it will theoretically, take longer for an athlete’s core body temperature to rise to a dangerous level. I found this article of interest because I am an athletic trainer in southern California where heat illnesses seem to be on the rise.

### Conclusions

In conclusion, the hope of this paper was to provide insight to how serious heat illnesses can be and how easy it is to prevent them. Currently, it seems that not enough people are knowledgeable of heat illnesses and the danger they possess. I urge everyone to take the time to learn about the prevention, treatments, and possible outcomes of heat illnesses. Learning this information could save a life. Even after years of education and research on heat illness, more and more athletes are suffering and dying from heat stroke. It is currently the second most leading cause of death in high school athletes and I find that totally unacceptable. The research and information on heat illness is out there for the public, however, they seem unaware of it. Medical professionals need to find a way to educate the public about heat illnesses, whether it is for the athlete or just a regular person.

### Applications in Sport

The mild versions of heat illness include: heat edema, heat rash, heat syncope, and heat cramps while heat exhaustion and heat stroke are much more serious and can lead to death. Parents and athletes need to be educated about the risks of playing sports, including environmental factors such as heat and humidity. Athletes also need to be aware of proper hydration methods to keep themselves healthy. The parents, athletes, coaches, and sports medicine team need to be on the same page with regards to the athletes’ safety and well being. Things like acclimatizing to the heat over a period of at least two weeks, proper hydration techniques, wearing proper, light-colored, breathable clothing, and identifying any underlying health issues before the start of the season are all important factors in helping to prevent heat illnesses. The sports medicine team is ultimately responsible for the safety of the athletes and must provide proper equipment, like a small pool with coolers of ice and water, for use of an ice water-immersion in the event of a heat related emergency. Communication between athletes, coaches, parents, and the sports medicine team are a necessity. An emergency action plan needs to be in place and implemented should an emergency arise. The timeline of when an athlete can return to play is unclear, however, the participant should be properly hydrated, have a clear mental status and should be cleared by a physician before returning to competition. There are always athletes with special circumstances or underlying health issues and it is important to try to identify these before the sport season begins so appropriate planning can be done regarding those issues. Further research is needed in the distinction between exertional heat illness, exertional rhabdomyolysis, and malignant hyperthermia. Additional information is also sought for those with menstrual cycles and the effect of possible heat illnesses. Warming up with an ice-vest also seems like it could be beneficial to the athlete, however, I believe additional research is still needed.

### Acknowledgments

None

### References

1. Bates, G.P., & Miller, V.S. (2008). Sweat rate and sodium loss during work in the heat. _Journal of Occupational Medicine and Toxicology_, 3(4), Retrieved from http://www.occup-med.com/content/3/1/4 doi: 10.1186/1745-6673-3-4
2. Cleary, M.A. (2007). Predisposing risk factors on susceptibility to exertional heat illness: clinical decision-making considerations. _Journal of Sport Rehabilitation_, 16, 204-214.
3. Cooper, Jr, E.R., Ferrara, M.S., & Broglio, S.P. (2006). Exertional heat illness and environmental conditions during a single football season in the southeast. _Journal of Athletic Training_, 41(3), 332-336.
4. Coris, E.E., Ramirez, A.M., & Van Durme, D.J. (2004). Heat illness in athletes. _Sports Medicine_, 34(1), 9-16.
5. Coris, E.E., Walz, S., Konin, J., & Pescasio, M. (2007). Return to activity considerations in a football player predisposed to exertional heat illness: a case study. _Journal of Sport Rehabilitation_, 16, 260-270.
6. Eberman, L.E., & Cleary, M.A. (2009). Preparticipation physical exam to identify at-risk athletes for exertional heat illness. _Athletic Therapy Today_, 14(4), 4-7.
7. Haley, A., & Nichols, A. (2009). A survey of injuries and medical conditions affecting competitive adult outrigger canoe paddlers on Oahu. _Hawaii Medical Journal_, 68(7), 162-165.
8. Hunter, I., Hopkins, J.T., & Casa, D.J. (2006). Warming up with an ice vest: core body temperature before and after cross-country racing. _Journal of Athletic Training_, 41(4), 371-374.
9. Kleiner, D.M. (2002). A new exertional heat illness scale. _Athletic Therapy Today_, 7(6), 65-70.
10. Marsh, S.A., & Jenkins, D.G. (2002). Physiological responses to the menstrual cycle. _Sports Medicine_, 32(10), 601-614.
11. Mazerolle, S.M., Scruggs, I.C., Casa, D.J., Burton, L.J., & McDermott, B.P. (2010). Current knowledge, attitudes, and practices of certified athletic trainers regarding recognition and treatment of exertional heat stroke. _Journal of Athletic Training_, 45(2), 170-180.
12. McDermott, B.P., Casa, D.J., Ganio, M.S., Lopez, R.M., & Yeargin, S.W. (2009). Acute whole-body cooling for exercise-induced hyperthermia: a systematic review. _Journal of Athletic Training_, 44(1), 84-93.
13. Miners, A.L. (2010). The diagnosis and emergency care of heat related illness and sunburn in athletes: a retrospective case series. _J Can Chiro Assoc_, 54(2), 107-117.
14. Muldoon, S., Deuster, P., Voelkel, M., Capacchione, J., & Bunger, R. (2008). Exertional heat illness, exertional rhabdomyolysis, and malignant hyperthermia: is there a link? _Current Sports Medicine Report_s, 7(2), 74-80.
15. Shendell, D.G., Alexander, M.S., Lorentzon, L., & McCarty, F.A. (2010). Knowledge and awareness of heat-related morbidity among adult recreational endurance athletes. +Int J Biometeorol_, 54, 441-448.
16. Snell, P.G., Ward, R., Kandaswami, C., & Stohs, S.J. (2010). Comparative effects of selected non-caffeinated rehydration sports drinks on short-term performance following moderate hydration. _Journal of the International Society of Sports Nutrition_, 7(28), Retrieved from http://www.jissn.com/content/7/1/28 doi: 10.1186/1550-2783-7-28
17. Spain, J.K., Liotta, C., Terrell, T., & Branoff, R. (2010). Heat-related illness in athletes: recognition and treatment. _Athletic Training & Sports Health Care_, 2(4), 152-154.
18. Spann, T. (2007). Avoiding heat illness. _Hughston Health Alert_, 19(3), 5-6.

U.S. Sports Academy2014-11-24T05:56:18-06:00August 24th, 2011|Contemporary Sports Issues, Sports Coaching, Sports Management, Sports Studies and Sports Psychology|Comments Off

Usefulness of Bioelectrical Impedance in the Prediction of VO2max in Healthy Men and Women

Jordan R. Moon, Vincent J. Dalbo, Michael D. Roberts, Chad M. Kerksick, and Jeffrey R. Stout

### Abstract

VO₂max is an invaluable measure for the assessment of aerobic fitness; however, to yield accurate results direct assessment requires costly equipment, trained investigators, and that the participant produce a maximal effort to volitional fatigue. The majority of VO₂max prediction equations have attempted to predict aerobic capacity without considering physiological variables other than age and body composition. As a result, a majority of VO₂max prediction equations have been found to be invalid. A recent study proposed an equation accounting for additional physiological variables known to influence aerobic capacity, including blood volume, fat-free mass, urinary creatine excretion, and total body potassium. Therefore, this investigation sought to evaluate the validity of novel non-exercise prediction equations, which utilize bioelectrical impedance analysis (BIA) to obtain an estimate of blood volume and skeletal muscle mass as predictor variables in an attempt to increase the accuracy of non-exercise VO₂max prediction equations. VO₂max was assessed using indirect calorimetry. Healthy male (30.9 ± 6.0 y, 179.0 ± 4.3 cm, 94.1 ± 19.5 kg; n = 23) and female (32.0 ± 6.1 y, 167.8 ± 7.9 cm, 72.0 ± 9.6 kg; n = 25) participants completed a VO₂max test and a physical activity survey (PA-R) and were analyzed using bioelectrical impedance. Results indicated that each equation resulted in a significant (p ≤ 0.025) underestimation of VO₂max. These outcomes suggest that the use of BIA to estimate blood volume and skeletal muscle mass does not improve the accuracy of VO₂max prediction equations. Coaches and trainers will not benefit from the inclusion of BIA in an equation to predict aerobic fitness. Currently, the best methods to estimate aerobic fitness require submaximal and maximal exercise testing. Predicting aerobic fitness using non-exercise equations does not appear to be practical or valid.

**Keywords:** maximal, aerobic capacity, prediction, gender-specific

### Introduction

The rate of maximal oxygen consumption (VO₂max) has practicality in research and field settings as a measure of aerobic fitness, in order to prescribe exercise intensities and to assess exercise training responses following an intervention (19). An acceptable standard for VO₂max determination is the direct measure of expired gas samples obtained while an individual is performing maximal exertion exercise (2). From a research perspective reliable non-exercise VO₂max prediction equations could prove to be beneficial, as experimenters could obtain an immediate, valid measure of the aerobic fitness of an individual without maximal exercise testing. Additional advantages of non-exercise VO₂max prediction equations include the ease and cost associated with test administration and use in participants who are unable to perform a treadmill test, as VO₂max tends to be underestimated with other modes of exercise (19). However, the greatest advantage of an accurate VO₂max prediction equation is the practicality of use in research laboratories that do not possess the necessary equipment to access VO₂max and for coaches and trainers looking to evaluate several athletes and/or an entire team. Due to the disadvantages associated with VO₂max testing numerous submaximal (1,8,18,23) and non-exercise prediction equations (4,5,10,17,21,24,25) have been developed to reduce the necessity of direct VO₂max assessment.

Previous non-exercise prediction equations have been developed but the need to improve the accuracy of these equations has been suggested in previous literature (4,16,17,21). However, due to known deviations in VO₂max values determined from varying modes of exercise (bike, treadmill walking, treadmill running, and arm ergometry), the use of VO₂max prediction equations are dependent on the task. For example, a prediction equation for VO₂max during a treadmill run may not be accurate for predicting VO₂max during cycle ergometry. In addition, another primary shortcoming of non-exercise VO₂max prediction equations is the limited ability to account for genetic variability in VO₂max (21). According to Stahn et al. (21), the primary physiological determinants measured at rest to predict VO₂max are blood volume, which has been found to account for up to 80% of the variance in VO₂max, and a group of variables including fat-free mass, urinary creatine excretion, and total body potassium, which have been proposed to be related to skeletal muscle mass. Additional evidence supporting this claim was provided by Sananda et al. (20) who found total skeletal muscle mass to be highly correlated (r = 0.92, p < 0.001) with VO₂max (20).

Stahn et al. (21) sought to obtain an estimate of blood volume and skeletal muscle mass using bioelectrical impedance analysis (BIA). Previous work has suggested BIA to have a strong correlation with blood volume (r = 0.89, SEE = 9.0%) using the impedance index of height squared divided by impedance (22) and skeletal muscle mass, as compared to magnetic resonance imaging (r = 0.927, SEE = 9.0%) (11). As a result Stahn et al. (21) developed a non-exercise VO₂max prediction equation, which utilizes BIA to estimate resting levels of blood volume and skeletal muscle mass as predictor variables. However, the equation by Stahn et al. (21) has yet to be validated by an independent laboratory, and the benefits of utilizing BIA for predicting VO₂max have not been established. Therefore, the purpose of this study was to validate treadmill VO₂max predictions using the recently published BIA equation of Stahn et al. (21). It was hypothesized that the BIA equations would produce accurate VO₂max predictions due to the relationship between VO₂max, BIA, skeletal muscle mass, and blood volume.

### Methods
#### Subjects

Sixty participants chose to participate in this study, but 12 were eliminated for not reaching VO₂max (n = 48; Table 1). All testing was conducted after the participant signed the IRB-approved informed consent and completed comprehensive medical history questionnaires. Participants were excluded if they: 1) had a history of metabolic, hepatorenal, musculoskeletal, autoimmune, or neurological disease; 2) were currently taking androgenic medications; or 3) had consumed nutritional supplements that may affect metabolism [i.e., over 100 mg•d-1 of caffeine, ephedrine alkaloids, etc.] and/or muscle mass [i.e. creatine, protein/amino acids, androstenedione, dihydroepiandrosterone (DHEA), etc.] within three months of starting the study; 4) were unable to reach at least two of the three stated criteria for reaching VO₂max.

Table 1. Participant characteristics of validated equations

	Stahn et al. (21)			Current Validation Participants
	N	Males	Females	N	Males	Females
N	66	33	33	48	23	25
Age (yr)	24.0 (4.0)	25.0 (4.0)	23.0 (4.0)	31.5 (6.0)	30.9 (6.1)	32.1 (6.1)
Height (cm)	174 (6)	180 (5)	168 (6)	173 (9)	179.0 (4)	169 (8)
Weight (kg)	68.4 (7.6)	74.9 (8.3)	61.8 (6.8)	82.6 (18.7)	94.1 (19.5)	72.0 (9.6)
PA-R	6.6 (1.1)	6.6 (0.9)	6.3 (1.3)	2.9 (1.9)	3.4 (2.3)	2.4 (1.5)
VO₂max (mlkgmin^-1)	53.6 (5.0)	59.6 (5.5)	47.6 (4.4)	43.9 (13.4)	42.4 (14.4)	45.2 (12.6)

#### Non-Exercise VO₂max Prediction Equations

The equations selected for validation were developed by Stahn et al. (21) and are presented in Table 2.

Table 2. Submaximal VO₂max prediction equations

2MF	Stahn et al. (21)	VO₂max (DF50) = 14.29 · H²/Z + 104.14 · PA-R – 440.79 • Gender (M = 1, F = 0) + 489.47
2M	Stahn et al. (21)	VO₂max (DF50) = 14.29 • Height/Z + 104.14 • PA-R– 440.79 • Gender (M = 1) + 489.47
2F	Stahn et al. (21)	VO₂max (DF50) = 14.29 • Height2/Z + 104.14 • PA-R – 440.79 • Gender (F = 0) + 489.47

∗ All values from prediction equations were converted to ml•kg•min-1
H = Height (cm)
Z = Impedance (Ohm)
PA-R = Physical activity rating scale
M = Male
F = Female

#### Experimental Design

Testing was performed between 9:00 a.m. and 3:00 p.m. in a temperature-controlled laboratory maintained at 21.6 ± 0.7oC and 28.2 ± 5.5% relative humidity. Prior to testing, each subject was instructed to avoid the consumption of alcohol, refrain from heavy exertion for 48 hours, and avoid smoking and caffeine consumption the day of testing. Subjects were also instructed to consume 2 liters of water the day before testing in an effort to promote normohydration.

#### Anthropometry and Physical Activity Assessment

After voiding their bladders, subjects changed into minimal clothing and removed footwear for measurement of body mass and height, conducted on a calibrated scale and stadiometer (Detecto, Webb City, MO). Body mass was measured to the nearest 0.2 kg and height was assessed to the nearest 0.5 cm. The PA-R was used to assess the average weekly physical activity patterns of each participant in the 6 months prior to testing (7).

### Bioelectric Impedance Measurement

Whole-body impedance measurements were performed using a single frequency (50 kHz) bioelectrical impedance analyzer (IMPTM DF50, ImpediMed Inc, Queensland, Australia). Each morning prior to testing, the bioelectrical impedance device was calibrated following the manufacturer’s guidelines. Measurements were taken from the right side of the body using a tetrapolar electrode arrangement following the standard procedures used by Stahn et al. (21). Prior to testing each subject was asked remove jewelry and excess clothing before being instructed to lie in a supine position for 10 minutes with arms and legs abducted from the body at 10˚ and 20˚ respectively, allowing body fluids to stabilize. Following identification of electrode placement, body hair was removed with a razor before the skin was cleaned with alcohol and allowed to dry. Current-inducing electrodes (575 mm2: 25 mm x 23 mm) (ImpediMed Electrodes, Queensland, Australia) were placed 1 cm below the phalangeal-metacarpal joint in the middle posterior surface of the hand and 1 cm below the transverse (metatarsal) arch on the dorsum of the foot. Detector electrodes of the same type were placed on the lateral epicondyle of the humerus and the lateral condyle of the femur according to the guidelines of Stahn et al. (21). Interclass and intraclass correlation coefficients for within and between days using this technology vary between 0.960 and 0.997 (6,21), while interindividual within-day reliability measures are commonly 1.3-2.0% (13,15,21).

#### VO₂max Assessment

VO₂max testing was performed on a calibrated Quinton treadmill (Q65 Series 90, Bothell, WA) according to Stahn et al. (21). Participants began the test with a 4-minute warm-up at 1.5 m·s-1 at a 1% gradient. Following warm-up, 3-minute testing periods began at speeds of 2.0 m·s-1 for women and 2.5 m·s-1 for men. Completion of each stage resulted in a speed increase of 0.5 m·s -1 until volitional fatigue despite verbal encouragement.

Maximal heart rate, respiratory exchange ratio (RER), and VO₂max were measured with a calibrated metabolic cart (ParvoMedics TrueOne® 2400 metabolic measuring system, Sandy, UT). The system was calibrated 15 minutes prior to testing according to manufacturer specifications. Mean oxygen uptake (VO2), carbon dioxide output (VCO2), and pulmonary ventilation (VE) were computed for each breath and averaged over 15-second intervals. Heart rate was monitored during testing using a heart rate monitor (Polar F6, Lake Success, NY). The test was considered maximal if two of the following criteria were obtained: 1) a plateau of VO2 occurred, defined as an increase of less than 150 ml·min-1 despite increasing speed, 2) Respiratory exchange ratio (RER) was ≥ 1.15, and 3) maximal heart rate was within 10 beats of age-predicted maximal heart rate (21).

#### Data analysis

Validity of VO₂max estimates were based on an evaluation of predicted values versus the criterion value from direct treadmill VO₂max assessment by calculating the constant error (CE = actual VO₂max – predicted VO₂max), r value (Pearson product moment correlation coefficient), standard error of estimate and total error (9,14). The mean difference (CE) between the VO₂max prediction equations and the direct measure of VO₂max was analyzed using dependent t-tests with the Bonferroni alpha adjustment (12). The method of Bland and Altman (3) was used to identify the 95% limits of agreement between actual VO₂max values and predicted VO₂max values.

### Results

Demographic information of participants in the Stahn et al. (21) study and the current investigation are presented in Table 1. To optimize the accuracy of the prediction equations, results of the validation analysis are presented in two groups: male- and female-specific equations (Table 3). Each sex-specific equation produced a significantly different VO₂max value from the direct measure (p<0.05). TE values were greater than 13.2 ml•kg•min-1, SEE values were greater than 9.1 ml•kg•min-1 and r values were less than 0.75.

Table 3. Validity of non-exercise prediction equations for estimating VO₂max ml•kg•min-1

Method	VO₂max ± (x SD)	CE	r	Slope	Y-intercept	SEE	TE
Direct VO₂M	42.4 (14.4)
Male	33.3 (8.3)	9.1*	0.74	1.2	-0.5	9.9	13.3
Direct VO₂F	45.2 (12.6)
Female	34.0 (6.5)	11.2*	0.70	1.3	-0.78	9.2	14.5

### Discussion

The sex-specific equations analyzed in this investigation produced predicted VO₂max values that were significantly below the actual VO₂max (p<0.05). Using the predicted VO₂max values to produce exercise prescriptions would yield exercise intensities underestimated by an equivalent amount.

The aim of the Stahn et al. (21) study was to demonstrate the viability of using BIA for the non-exercise prediction of VO₂max. The authors attempted to account for the influence of physiological variables on aerobic performance by indirectly accounting for blood volume, fat-free mass, urinary creatine excretion and total body potassium with a time efficient assessment of blood volume and skeletal muscle mass using a BIA device. Results from the Stahn et al. (21) study appeared promising as their equation was reported to account for 88.7% of the variance in VO₂max in an athletic population, and the authors postulated the equation would be more effective in a more diverse population. However, in the current investigation the equations developed by Stahn et al. (21) were found to be invalid in a population of healthy men and women. Errors in the equations were most likely introduced by using predicted values of blood volume and skeletal muscle mass (via BIA). In essence, predicted variables were used to predict another predictor, VO₂max. The validity of the equations developed by Stahn et al. (21) may be improved by using a more accepted and still cost-effective measure of skeletal muscle mass, such as a multiple-site skinfold, as was used in VO₂max prediction equations developed by Jackson et al. (10).

### Conclusions

The equation developed by Stahn et al. (21) may have been effective at predicting VO₂max in the athletic population used in the original investigation but appears to significantly underestimate VO₂max in a representative sample of healthy young men and women. Future prediction equations should include percent body fat and physical activity rating scales, as these variables appear to have the greatest predictive power in the estimation of non-exercise VO₂max prediction equations. Although the prediction equations developed by Stahn et al. (21) were not found to be valid in this investigation, non-exercise VO₂max prediction equations should attempt to increase their predictive power by accounting for physiological factors that are known to influence VO₂max, namely skeletal muscle mass. Furthermore, future research should examine the accuracy of the equations developed by Stahn et al. (21) in an athletic population and determine the viability of using a BIA device in the prediction of VO₂max.

### Applications in Sport

An athlete’s aerobic fitness is a crucial component of performance regardless of the sporting event. Aerobic athletes and coaches/trainers can benefit from accurate measurements of aerobic fitness through VO₂max testing. However, direct VO₂max testing requires expensive equipment and is not practical in the field. Many prediction equations have been developed in an attempt to find an easy way to predict VO₂max in the field. However, results from this investigation suggest that using BIA in a non-exercise VO₂max equation may not be appropriate or valid in healthy men and women. Specifically, the Stahn et al. (21) BIA VO₂max equations underpredicted VO₂max, resulting in significantly lower VO₂max values, giving the impression of an individual who is less aerobically fit. Therefore, it is suggested that coaches and trainers utilize either submaximal or maximal VO₂max prediction equations for their athletes and clients, as non-exercise prediction equations may not provide valid information.

### Acknowledgements

The authors would like to thank all the participants for their willingness to participate in this investigation.

### References

1. Astrand, & Ryhming, I. (1954). A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol, 7(2), 218-221.
2. Balady, G. J., Berra, K. A., Golding, L. A., Gordon, N. F., Mahler, D. A., Myers, J. N., et al. (2000). ACSM’s guidelines for exercise testing and prescription (6 ed.). Philadelphia: Lippincott, Williams & Wilkins.
3. Bland, J. M., & Altman, D. G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1(8476), 307-310.
4. Davis, J. A., Storer, T. W., Caiozzo, V. J., & Pham, P. H. (2002). Lower reference limit for maximal oxygen uptake in men and women. Clin Physiol Funct Imaging, 22(5), 332-338.
5. Fairbarn, M. S., Blackie, S. P., McElvaney, N. G., Wiggs, B. R., Pare, P. D., & Pardy, R. L. (1994). Prediction of heart rate and oxygen uptake during incremental and maximal exercise in healthy adults. Chest, 105(5), 1365-1369.
6. Fornetti, W. C., Pivarnik, J. M., Foley, J. M., & Fiechtner, J. J. (1999). Reliability and validity of body composition measures in female athletes. Journal of Applied Physiology, 87(3), 1114-1122.
7. George, J. D., Stone, W. J., & Burkett, L. N. (1997). Non-exercise VO₂max estimation for physically active college students. Med Sci Sports Exerc, 29(3), 415-423.
8. Golding, L. A. (2000). YMCA Physical Fitness Testing and Assessment Manual (4 ed.). Champaign: Human Kinetics
9. Heyward, V. H., & Wagner, D. R. (2004). Applied Body Composition Assessments. Champaign, IL: Human Kinetics.
10. Jackson, A. S., Blair, S. N., Mahar, M. T., Wier, L. T., Ross, R. M., & Stuteville, J. E. (1990). Prediction of functional aerobic capacity without exercise testing. Med Sci Sports Exerc, 22(6), 863-870.
11. Janssen, I., Heymsfield, S. B., Baumgartner, R. N., & Ross, R. (2000). Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol, 89(2), 465-471.
12. Keppel, G. a. T. D. W. (2004). Design and Analysis: A Researchers Handbook (4th ed.). Upper Saddle River, NJ: Prentice Hall.
13. Kushner, R. F., & Schoeller, D. A. (1986). Estimation of total body water by bioelectrical impedance analysis. Am J Clin Nutr, 44(3), 417-424.
14. Lohman, T. G. (1996). Human Body Composition. Champaign, IL: Human Kinetics.
15. Lukaski, H. C., Johnson, P. E., Bolonchuk, W. W., & Lykken, G. I. (1985). Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr, 41(4), 810-817.
16. Malek, M. H., Berger, D. E., Housh, T. J., Coburn, J. W., & Beck, T. W. (2004). Validity of VO₂max equations for aerobically trained males and females. Med Sci Sports Exerc, 36(8), 1427-1432.
17. Matthews, C. E., Heil, D. P., Freedson, P. S., & Pastides, H. (1999). Classification of cardiorespiratory fitness without exercise testing. Med Sci Sports Exerc, 31(3), 486-493.
18. Pare, G., Noreau, L., & Simard, C. (1993). Prediction of maximal aerobic power from a submaximal exercise test performed by paraplegics on a wheelchair ergometer. Paraplegia, 31(9), 584-592.
19. Ross, R. M. (2003). ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med, 167(10), 1451; author reply 1451.
20. Sanada, K., Kearns, C. F., Kojima, K., & Abe, T. (2005). Peak oxygen uptake during running and arm cranking normalized to total and regional skeletal muscle mass measured by magnetic resonance imaging. Eur J Appl Physiol, 93(5-6), 687-693.
21. Stahn, A., Terblanche, E., Grunert, S., & Strobel, G. (2006). Estimation of maximal oxygen uptake by bioelectrical impedance analysis. Eur J Appl Physiol, 96(3), 265-273.
22. Stahn, A., Terblanche, E., & Strobel, G. (2004). Relationships between bioelectrical impedance and blood volume. Proceedings of the 11th Pre-Olympic Congress, 219-220.
23. Storer, T. W., Davis, J. A., & Caiozzo, V. J. (1990). Accurate prediction of VO₂max in cycle ergometry. Med Sci Sports Exerc, 22(5), 704-712.
24. Wier, L. T., Jackson, A. S., Ayers, G. W., & Arenare, B. (2006). Nonexercise models for estimating VO₂max with waist girth, percent fat, or BMI. Med Sci Sports Exerc, 38(3), 555-561.
25. Williford, H. N., Scharff-Olson, M., Wang, N., Blessing, D. L., Smith, F. H., & Duey, W. J. (1996). Cross-validation of non-exercise predictions of VO2peak in women. Med Sci Sports Exerc, 28(7), 926-930.

### Corresponding Author

Jordan R. Moon, PhD
Department Head
Department of Sports Fitness and Health
United States Sports Academy
One Academy Drive
Daphne, AL 36526

### Author Affiliations

Jordan R. Moon, PhD
Department of Sports Fitness and Health
United States Sports Academy
One Academy Drive
Daphne, AL 36526

Chad M. Kerksick, PhD and Jeffrey R. Stout, PhD
Department of Health and Exercise Science
University of Oklahoma
1401 Asp Ave.
Norman, OK 73019

Vincent J. Dalbo, PhD
School of Medical and Applied Sciences
Institute of Health and Social Science Research
Central Queensland University
Rockhampton, Australia

Michael D. Roberts, PhD
University of Missouri-Columbia
Department of Biomedical Science
Veterinary Medicine Building
Columbia, MO 65211

U.S. Sports Academy2016-04-01T09:13:13-05:00July 27th, 2011|Contemporary Sports Issues, Sports Exercise Science, Sports Management, Sports Studies and Sports Psychology|Comments Off

IOA President’s Closing Remarks on the 11th Joint International Session for Directors of National Olympic Academies

Isidoros Kouvelos, International Olympic Academy president

Dear participants, the 11th International Session for Directors of NOAs, which has just been completed, has left us a remarkably positive sense regarding the future of the Olympic Education dissemination in a global scale.

Nowadays, the meaning of globalization is totally understandable to have been identified more with a political movement and less with an effort to achieve educational uniformity in the field of promotion of the Olympic Education in different regions of the world.

Even though I didn’t have the opportunity to attend all the lectures, I have realized from their presentations that they face the special subject of the Session with great sensitivity. Through the presentations of prominent lecturers, like Dr. T.J. Rosandich, from the USA and Professor Axel Horn from Germany, we have all found out that the new forms of technology which are currently developing really fast, apart from the risks that are being involved, such as abuse of one-sided and insufficient information, they also offer unlimited potentialities of the dissemination of the Olympic Idea.

Proessor A.M. Najeeb has introduced us a new level of knowledge concerning teaching systems and methods, which have been developed recently, via globally recognized interdisciplinary strategies, while our oncologist friend, Dr. Spyros Retsas, has guided us, in an elegant way, through the medical paths of Ancient Greece and the influence of medicine in the formation of a social culture connected to nature and competitive sports.

Dr Yohan Blondel, through his presentation regarding the recent French approach to the teaching of Olympic Values, has convinced us that we will always have the hope of improving the classical methodology for the dissemination of the Olympic Values, through school programs which associate directly the sport action with the Olympic knowledge.

The IOC Vice President and Chairman of the Organizing Committee for the 1st Youth Olympic Games Singapore 2010, Mr. Ser Miang Ng, has brought us close to the astonishing IOC efforts for the creation of an athletic culture, on a different basis, which combines physical exercise with the cultural education of youth and the new model athlete we have all anticipated. At this point, I would like to underline my friend’s Miang Ng’s presence in this Session, which is of great importance, since it shows the IOC’s interest for the works of the Session and the issues raised by the National Olympic Academies.

I would also like to point out Professor Margaret Talbot’s interesting approach with regard to the controversy between the educators and the sports administrators. It is a controversy which creates various side effects, ambiguous interpretations and most times, human dead ends. In an era where the phenomena don’t respond to the reality, the need to enhance the role of the Olympic educators becomes more and more significant.

The subject we have chosen this year for discussion in the Session for the National Olympic Academies has left a margin of reasoning pursuit, while at the same time, has provided an opportunity of evaluation of the course, followed until recently, towards the propagation of the Olympic Ideals.

The conclusions as well as the thoughts you have just expressed (even though they were not known to me the moment I prepared this speech) is certain that they will be further discussed by all of us. More specifically, the National Olympic Academies members are requested to examine in depth the issues that have come into question and define their stance, which we would like to record as soon as you return to your home countries.

As I have already stated in the 10th Joint International Session for Presidents or Directors of NOAs and Officials of NOCs “The contemporary societies desperately need ideas and people with vision.”

I am absolutely sure that these people are within the National Olympic Academies, and if you have not discovered them yet, search around you and especially among the young people.

Give them food for thought and action and take advantage of their anxiety before the oncoming New Era which comes along with globalization. Simultaneously, make use of the things that this New Era offers you, along with the technological evolution and innovations, so that you can form the conditions which will facilitate the work of educating and training the youth, through a global procedure.

The Olympic Values are not going to corrupt because of the globalization. On the contrary, the prefabricated ideas as well as the nihilistic dogmatic perceptions, which usually follow such movements, could be influenced by the purity included in the terms, fair play, respect, meritocracy and peace.

Dear friends, I would like to thank you, once more, for your presence here, in this sacred place of Olympia and for your efforts to attend this Session in an active way. I wish you a safe return back home, health to all of you and I promise to be always close to you and assist you in your work. Thank you.

U.S. Sports Academy2013-11-25T15:27:55-06:00July 1st, 2011|Contemporary Sports Issues, Sports Coaching, Sports Management|Comments Off

Closing Remarks on Behalf of the Lecturers

Dr. T.J. Rosandich

I know that I’m speaking on behalf of all of my colleagues who have presented over the past few days when I say that I consider it both an honor and a privilege to have been asked to come here to the birthplace of the Olympics to participate in this conference. There are very few places in the world where the conference topic spans some 3,000 years of human existence as was both the venue and lecture topics we have all enjoyed over the past few days.

Following the opening remarks of President Kouvelos which set the agenda for the conference, Dr. Retsas discussed medicine in the ancient Olympic Games. As one considers events in the ancient Games such as the Pankration, it is little wonder that medical invention was often needed. The next day as we toured the Sanctuary, I thought of Dr. Retsas’ presentation wondering about how almost 50,000 people on that site in the height of summer got by with the medical services available at the time.

From the ancient to the modern, there were presentations on the Information Age and digital revolution. The presentations given by Professor Horn and myself complimented each other well. I provided an overview of the information evolution wrought by the advent of the internet and described some of the pros and cons of Web 2.0 technology. With this overview as a backdrop, Professor Horn did an admirable job in describing some of the societal effects of the digital age, especially in the younger generation. Whatever your personal attitude toward technology, it is important to recognize that the society-wide changes being brought about by the digital revolution are here to stay and we all need master the skills of using these tools.

Speaking of Games, the presentation by IOC Vice President Ng who served as the Chairman of the Singapore Organizing Committee of the inaugural Youth Olympic Games was superb. An outstanding multi-media presentation on the Games set the stage for earnest questioning from the delegates on the event and raised our expectation for the Games yet to come.

A common theme throughout the program was the primacy of education as a means for the dissemination of the Olympic ideals and values. Dr. Najeeb described how he was able to get the National Institute of Technology-Calicut to include a course on Olympic Values as a requirement in that institution’s curriculum. Given that the world-class bureaucracy that is India, to do so is a testament to perseverance and determination. Dr. Blondel also presented a similar success story on getting the OVEP into France’s national educational curriculum and their strategies to insure it is actually carried out. Last, and certainly not least, Ms. Talbot, President of the International Council of Sport Science and Physical Education did an outstanding presentation on the role of Olympic education in today’s world of sports which closed out the presentations of the 11th NOA Session.

Speaking on behalf of the lecturers, I’m sure that we too have all been enriched by our participation in the program. I, for one, feel I’m taking away from the program far more than I contributed. Watching the presentations of the NOAs over the past few days was for me both inspiring and educational. I was continually impressed with the untiring efforts being put forth by the NOAs to spread the message and ideals of the Olympic movement and the philosophy of Olympism across the globe. I also found the creativity of the NOAs in the undertaking of these tasks to be a marvelous learning experience given the wide divergence of resources available and the difference in cultures where this work is being done.

But more than that was the exchange between colleagues that took place outside of the auditorium. This gathering afforded us the opportunity to make new acquaintances from different corners of the globe and much of our discussion over a meal or a beverage went far beyond “shop talk” into topics that provided insights into who and what we are. This person-to-person exchange is every bit as important as the formal exchange in the lecture hall in making the Olympic values a reality.

I would like to take a moment to thank the administration and staff of the IOA for all their efforts to make this program a success. From the very beginning with the invitation to speak, the secretariat responded in a timely, helpful and professional way to requests for information or other administrative details. The technology staff has done a marvelous job on making sure that all of the presentations received the support they needed. Having observed Mr. Voggelis race up and down the stairs as a regular occurrence, I think he is faster than some Olympic sprinters and has about worn out the carpet. And last, but certainly not least, is the work of the translators, those unseen voices over the earphones without whose intervention the conference would have been greatly diminished. I believe that they all deserve a round of applause.

I hope that all of the participants are leaving here energized with new ideas to make your programs more vital and how to reach more of your constituents. Good Luck in your endeavors and thank you.

U.S. Sports Academy2013-11-25T15:25:57-06:00July 1st, 2011|Contemporary Sports Issues, Sports Coaching, Sports Management|Comments Off