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Tell us more about yourself and the author team
I, the first author Nils Moseid, was fortunate to get a position as a PhD-candidate at the Oslo Sports Trauma Center in 2017. Before starting work at OSTRC, I had worked as a general practitioner for 18 years, doing sports medicine as a sideline, mainly freeski, and as a football coach for children and adolescents. After joining the OSTRC, I have been a team doctor for various Norwegian national teams in football, mainly boys 15 – 17.
The word “strong” does not fully describe the team behind this study. Professor Roald Bahr, my main supervisor, has been a leading researcher, lecturer, clinician and administrator within the sports medicine realm for three decades. Professor Pierre-Nicolas Lemyre, my first co-supervisor, is a leading sports psychology researcher specializing in motivational processes and burnout, he has headed the Norwegian Research Centre for Children and Youth Sports and has worked with Norwegian elite skiers. Professor emeritus Glyn C. Roberts, my second co-supervisor, has been a leading researcher and administrator in the field of sports psychology for five decades, focusing on motivational determinants of achievement, particularly in children engaged in competitive sports. My beloved wife, Christine Holm Moseid, was among the first researchers to study the prevalence of injury and illness in adolescent elite athletes and the associations between health problems, early specialization and physical fitness; she now manages “Skadefri”, in English known as “Get Set” and “FitToPlay”, an international initiative to prevent injury and illness in athletes. Finally, Morten W. Fagerland, head of the Section for Statistics in Clinical Trials at Oslo University Hospital, with over 150 scientific articles within statistics, medicine, and sports science behind him, has provided invaluable support regarding statistics.
What is the story behind your study?
My PhD project is a follow-up of a cohort of elite youth athletes that started their first year at Sports Academy High School in 2014. The cohort was recruited by Christine, and she defended her thesis, “The Health of The Young Elite Athlete”, in 2020. She found a high prevalence of injury and illness during the athletes’ first year at Sports Academy High School. However, no associations were found between health problems and physical fitness level, health problems and athletic performance level at the start of Sports Academy High School, and health problems and early specialization.
In 2016, when Christine was still working on her PhD, I asked Roald for a meeting to discuss possibilities for doing a research project sometime in the future. At the meeting, he presented me with the possibility of doing the follow-up of Christine’s cohort, using her data and adding some of my own. After a short consideration, Christine and I agreed that this might be a good idea and having her support gave me a flying start, and she has also kept me flying.
I have encountered some health problems since the start of the project, and I must praise Roald and Sigmund Andersen, Head of the Department of Sports Medicine, for their support during this period. Without their support, I would probably have given up. Without Christine’s support, I would surely have given up.
My project aims to study the possible associations between the burden of illness and injuries in these athletes and athletic development and performance. Does it really matter if you are injured or ill? To the best of our knowledge, we are the first to do this.
We had the prospective data on injuries and illnesses from Christine’s study, covering 26 weeks in the student’s first year at Sports Academy High School. After interviewing the athletes at the end of their third year at Sports Academy High School, we had 124 weeks of data on health problems. At this last measurement point, we also asked the students about symptoms of athlete burnout using the Athlete Burnout Questionnaire. We also asked about social relations in sports and school, coach relations, living situations and major life events.
In your own words, what did you find?
We found that a greater burden of health problems was associated with higher symptoms of burnout in young elite athletes, and the effect was clinically meaningful.
We used the Oslo Sports Trauma Research Center’s Questionnaire on health problems to gather information on the burden of health problems. We also asked about symptoms of athlete burnout using the Athlete Burnout Questionnaire. We found that 23 of 210 athletes had a burden of health problems that were three times beyond the median. Having a burden of health problems three times the median corresponds to answering “Sometimes”, “Frequently”, or “Always” on 11 of 15 items. A median burden of health problems corresponds to answering “Rarely” on 12 items and “Sometimes” on three. This difference matters in the daily life of an athlete.
We put the burden of illnesses, acute injuries and overuse injuries into a multivariable model. For the total cohort, we found that a greater burden of all three categories of health problems was associated with higher symptoms of burnout. For boys, a greater burden of acute injuries was associated with higher symptoms of athlete burnout, for girls, this was true for illnesses. For endurance sports athletes, a greater burden of illnesses was associated with higher symptoms of athlete burnout, for technical sports athletes, this was true for illnesses and acute injuries, for team sports athletes, this was true for illnesses and overuse injuries. We are not sure if these differences are real or caused by a lack of power
We asked the athletes to what degree their coaches and parents influenced the training week. In the multivariate analysis, the athlete experiencing high support for basic psychological needs from the coach and the coach having a high influence on the training week was associated with lower symptoms of athlete burnout. But in the multivariable model, only the coach’s high influence on the training week was associated with lower symptoms of athlete burnout. This finding merits further investigation, but it fits well with stories we heard during the interviews about athletes feeling abandoned by their coaches during times of illness and injury.
The three dimensions of athlete burnout, physical and emotional exhaustion, reduced sense of accomplishment and sport devaluation, do not imply clinical illness. I like to view the symptoms of burnout as a measure of how things are going. Are you tired? Do you accomplish something meaningful? Is what you are doing still important to you? When we evaluate the results of this study, this is important to have in mind. The image of a totally exhausted cynic accomplishing nothing is easy to get. But burnout is a scale, and for the most part, the athletes are doing ok. But being ill or injured is associated with doing worse.
What was the main challenge you faced in your study?
Making a reliable and valid questionnaire for registering health problems two years back was a major challenge. But, with the help of the athletes’ training diaries and data from the coaches on major events like competitions and training camps, we hoped to register the major part of injuries and illnesses. When we summed up our data, it was fascinating and a relief to see how close the prevalence for the last 98 weeks was to the first 26 weeks.
If there is one take-home message from your study, what would that be?
Take care of those who struggle. We don’t know if health problems cause burnout or burnout causes health problems, maybe both are true. Athletes should perform validated injury prevention programs, and all stakeholders should be aware of the symptoms of burnout. Also, even if the study design doesn’t allow for conclusions on causality, we can assume that coaches are important people in the life of athletes, also in times of injury or illness.