For patients with type 1 diabetes, a fear of hypoglycaemia and a concern over a loss of control with wider diabetes management are the most salient barriers to exercise participation and adherence. A large proportion of patients report a lack of advice for preventing post-exercise hypoglycaemia, and many feel largely uninformed about insulin administration and carbohydrate intake around aerobic-based exercise. Presently, recommendations within the literature are based predominantly on anecdotal and observational, but not empirical or interventional data. Therefore, this thesis aimed to develop a strategy that enables patients to effectively self-manage glycaemia following exercise, supported by evidence pertaining to the deeper physiological implications and consequences. Study one (chapter 3) revealed that under conditions of reduced pre-exercise rapid-acting insulin dose, it is also necessary to reduce post-exercise rapid-acting insulin administration by 50% to prevent early-onset hypoglycaemia (≤ 8 hours post-exercise). Consequently, some patients experienced post-prandial hyperglycaemia with this intervention, although this was not associated with any other metabolic, counter-regulatory hormonal, or inflammatory disturbances. The results of study two (chapter 4) demonstrate that post-exercise meal composition, under conditions of reduced pre- and post-exercise rapid-acting insulin dose, carry important implications for post-prandial glycaemia. Specifically, consumption of low GI post-exercise carbohydrates normalise post-prandial hyperglycaemia, whilst protection from early onset hypoglycaemia is maintained. In addition, post-exercise meal composition heavily influences inflammatory markers; a high GI meal results in a pronounced inflammatory response, but a low GI meal completely prevented any rise in measured inflammatory markers. Lastly, study three (chapter 5) assessed the efficacy of a combined basal-bolus insulin reduction and low GI carbohydrate post-exercise feeding strategy. A 20% reduction in basal insulin provided full protection from hypoglycaemia for a total of 24 hours after exercise. Furthermore, ketonaemia did not increase to clinically meaningful levels, nor did inflammatory markers rise above concentrations seen at rest or when exercising under usual basal dose. No other metabolic or counter-regulatory hormonal disturbances were observed following a combined dose reduction to basal-bolus insulin and low GI carbohydrate post-exercise feeding. Collectively, this thesis has shown that acute prandial adjustments in rapid-acting insulin and carbohydrate feeding, in combination with alterations in basal dose, are effective for managing post-exercise glycaemia and protecting patients from hypoglycaemia for a total of 24 hours after exercise. Moreover, this strategy aims to maintain euglycaemia by reducing post-prandial hyperglycaemia. This is not associated with clinically significant rises in ketonaemia, nor does it induce inflammatory, counter-regulatory hormonal, or other metabolic disturbances. Clinicians are advised to tailor these recommendations to a patient’s individual exercise preferences, fitness and exercise ability, level of diabetes management, and treatment regimen.

Combining strength and endurance training within the same regimen is aptly referred to as “concurrent training”. Research conducted over the previous 3 decades has indicated concurrent training can result in attenuated development of strength, power and hypertrophy when compared to strength training in isolation. Despite extensive research the mechanisms contributing to this so called “interference effect” are yet to be fully elucidated, as is the influence of manipulating acute training programme variables within a concurrent regimen. As such, the purposes of this thesis were to investigate and draw conclusions regarding underlying physiological mechanisms relating to the interference effect. Additionally, this thesis sought to examine the effects of manipulating programme variables, including frequency and sequencing of exercise within concurrent training regimens on strength related adaptation. The findings of this thesis indicate overall training volume and frequency of endurance training within a concurrent intervention influences the presence and magnitude of the inhibition of strength development. Concurrent training volumes of 3 d·wk-1 elicited muted strength development, whereas lower frequencies did not. Whilst interference was not attributable to neuromuscular factors, it was reported that cortisol was only elevated following higher training frequencies, indicating training stress and catabolism may contribute to interference. Additionally, the sequencing of strength and endurance training can influence endocrine and signalling responses associated with strength adaptation, and it appears strength prior to endurance elicits greater increases in growth associated signalling. The findings of this thesis indicate that overall training stress influences the presence and magnitude of interference experienced, and is reflected in catabolic endocrine responses. Additionally, strength prior to endurance training promotes more favourable anabolic signalling than vice versa, which over time may contribute to greater strength type adaptations.

Whilst the benefits of physical activity have been well documented, many in the UK population remain insufficiently active to substantively benefit their health, placing individuals at greater risk of developing a range of non-communicable diseases and conditions. As a large percentage of the population accesses primary care, at least on an annual basis, the use of this health care sector to advocate increased physical activity has become widespread. Exercise referral schemes (ERSs) have enabled primary care professionals to refer their patients, typically to a local leisure facility, for supervised exercise. ERSs have seen prolific growth across the UK since their conception in the 1990s and yet their effectiveness has remained in question. Despite a variety of research designs being employed, evidence regarding schemes’ effectiveness continues to be inconclusive. Within the existing research literature, the complexity of context within which ERSs operate has remained largely overlooked; specifically, how individual interpretations of ERSs might be co-produced according to the interactions between those central to the service, and how this might influence both service delivery and impact. This study, therefore, aimed to address these lacunae by exploring participants’ understanding of ERSs, and how these perceptions contoured ERS service provision. The research focused on one case-study ERS in the East of England. Semi-structured interviews were employed through a combination of group and one-to-one interviews, with 27 participants (15 patients, 7 exercise practitioners, 5 health professionals) who were central to the ERS at a delivery level, and a further 5 (1 ii district manager, 2 representatives from the County Sports Partnership and 2 representatives from Public Health) one-to-one interviews were conducted with individuals who represented the strategic management of ERSs. A process sociological lens was adopted to provide novel insights into participants’ perceptions of ERSs, their role and their ability to influence ERS service provision. Data were also supported by self-elicited reflections born from the researcher’s ‘insider’ position to the County’s ERS. Thematic analysis generated salient themes that showed conflicting interpretations of ERS service provision, and perceptions of scheme receipt and impact. Data highlighted that the networks of relationships in which individuals were situated not only contoured participant experiences but shaped the delivery processes of ERSs. Individual ‘I’ identities were situated within interdependent networks of ‘we’ and ‘they’ relationships, where identifiable groups were formed according to individuals’ perceived role within the scheme. Relationships between individuals and groups were in a tensile state, marked by power balances that had impacted on service provision but also the associated meaning of ERSs, producing interesting, yet unexpected and unintended outcomes. Such findings could prove useful to policy-makers, those responsible for commissioning ERSs, and practitioners, as well as those in similar roles for other multi-agency interventions. By facilitating enhanced understanding of the complexities of this physical activity intervention, findings suggest how the actions and interpretations of those central to a service can fundamentally alter delivery mechanisms and receipt, potentially influencing the very existence of the intervention, or in this case ERSs.

It is commonplace for many high-performance coaches to be former elite athletes in the same sports they coach (Christensen, 2013; Mielke, 2007; Werthner & Trudel, 2009). In many cases, such individuals are ‘fast-tracked’ through formal coach accreditation structures into these high-performance coaching roles (Rynne, 2014). The reasons why former elite athletes dominate coaching roles in professional sports clubs and why a ‘fast-track’ pathway from elite athlete to high-performance coach is supported remain unclear. The project builds upon existing research on coach development to understand the social processes for how high-performance athletes negotiate the career transition into post-athletic high-performance coaching roles in men’s association football and rugby union. The project employed a Straussian grounded theory methodology which consisted of three iterations of empirical data collection and analysis. The first and second iterations respectively sampled eight senior club directors and 11 academy directors of men’s professional association football and rugby union clubs on why they appointed ‘fast-tracked’ coaches and how they valued particular sources of coaching knowledge. Data were abductively analysed (Blaikie, 2009) and signified Bourdieu’s concepts of habitus, capital and hexis in addition to Foucault’s concepts of docile bodies, surveillance and technologies of power. The data suggested that elite athletes were drawn through within their clubs into high-performance coaching roles based on three main themes: a) to ensure the perpetuation of specific playing and coaching philosophies; b) clubs’ former athletes were regarded to act as docile bodies when embodying the clubs’ values in their coaching, and; c) ‘fast-tracked’ appointments were often based upon enhanced levels of symbolic capital and the perceived ability to gain player ‘respect’. Such appointment processes imposed symbolic violence onto other populations for whom competing in male elite sport is inaccessible, most distinctly women. The final iteration investigated how current or former elite athletes negotiated a ‘fast-tracked’ career trajectory when developing their coaching identities. Current or former elite athletes (n=15) were interviewed on two occasions over a 10-12 month period whilst registered onto their respective national governing body’s level three coach qualification. Both courses were designed only for senior professional athletes to attend. The resulting grounded theory provides an original contribution to the field of coach development by signifying a number of distinct social process for how the athletes negotiated the ‘fast-track’ coaching pathway for developing their coaching identities. The difficulties the coaches encountered in balancing the values imposed on them by their clubs during the process of consolidating their own coaching identities are critically discussed in alignment with Bourdieu and Foucault’s conceptual frameworks. Recommendations for the provision of formal coach education programmes are made concerning how coaches mediate developing their own coaching philosophies against imposed structural regimes of truth, along with conceptualising the value the coaches attributed to informal mentors over formal mentors. Recommendations are also provided to inform the policies surrounding coach recruitment at the high-performance level in the hope that directors’ recorded subconscious discriminatory practices are addressed.

Athletes can approach competition positively, as a challenge, or negatively, as a threat. The theory of challenge and threat states in athletes (TCTSA) outlines that a challenge state, contrary to a threat state, is characterised by high levels of self-efficacy and perceived control, approach goals, positive emotions, a helpful interpretation of emotional state and a cardiovascular reactivity pattern of increased cardiac output and decreased total peripheral resistance. The aim of this thesis was to examine relations between these cognitive, affective, and physiological components of challenge and threat states in a sport setting; research in sport have mostly examined these components separately. Five studies were conducted to examine this aim. These comprised a qualitative analysis of athletes‟ interviews about an upcoming competition, a cross-sectional questionnaire study, two studies where self-report data were associated with cardiovascular responses to an upcoming competition or previous competition, and a case study. Overall, the cognitive and affective components are somewhat supportive of the TCTSA, with a positive relation between self-efficacy, perceived control and approach goals. Threat appraisal and anxiety were positively predicted by avoidance goals. Most of the physiological findings, however, were not in line with the predictions of the TCTSA. Specifically, participants who had high levels of self-efficacy appeared to be physiologically threatened by an upcoming competition. There was no consistent relation between the cognitive, affective, and physiological components regarding previous competitions. Temporal patterning may be one of the main confounding factors for the inconsistent findings as the relations between physiological, cognitive, and affective components all change in the lead up to competition. This thesis makes an original contribution to stress research by exploring the combination of cognitive, affective, and physiological components outlined by the TCTSA using a holistic understanding of how athletes approach competition.

Obesity amongst children and young people is increasing, and it is predicted that over half of the UK population will be obese by 2050. Daily physical activity is effective in preventing and treating overweight and obesity, yet many children do not participate in enough physical activity to be beneficial to health. Behaviour change interventions to increase children‘s physical activity have demonstrated limited impact which is not maintained over the longer-term. The social ecology model recognises that interventions are unlikely to work in the absence of environmental supports. This has led researchers to recommend multi-component interventions in schools, with support through school policies and strategies. This research addresses four key research questions: 1. What are the relationships between the social, economic, physical and political elements of the school environment and physical activity? 2. What are the views, perceptions and experiences of physical activity and the school environment amongst a sample of primary school children? 3. Will an ecological physical activity intervention increase physical activity levels in primary school children in the immediate and longer term (6 months)? 4. Will an ecological intervention change the relationships between pupil perceptions, the school environment, and physical activity?

The concept of trust features prominently in research into interpersonal relations and effective leadership. Yet while references to trust are extensive, gaps regarding the conceptualisation and measurement of trust exist in a number of contexts in the psychological literature. This is particularly true in the context of sport, where the relevance and worth of trust in leaders is routinely acknowledged but rarely seen from the truster’s perspective; thus, little is known about how followers define, appraise and award trust. The present series of studies sought to examine perceptions of trust in the context of football, devising five distinctive investigations to explore trust in football leaders from the perspectives of both close followers (players) and distant followers (fans). Studies 1 & 2 explored academy football players’ views on trust, first through interviews, and then by employing a computer-based repertory grid technique. Findings demonstrated the relevance of trust to players in professional academy settings where both cognitive and affective sources of trust are employed in appraisals. Furthermore, results showed that within high-level football teams, both male and female players construct trust in a similar manner, differentiating trusted figures from others by appraising reliability, personal characteristics and interactions. Utilising online survey techniques, Studies 3 and 4 examined the perspective of football fans. Study 3 tracked the decline in trust of national leaders over the course of a World Cup competition, and explored fans’ reasons for awarding trust. Results demonstrate that appraisals of trust were based primarily on outcomes and observable role-related competencies such as selections and tactics. Study 4 examined fans’ trust in both club and national managers, testing the relevance of items from existing trust measures. Findings indicated that trust in more proximal distant leaders (club managers) was significantly higher than trust in national leaders. Furthermore the results showed that perceptions of likeability and reliability were the most consistent predictors of trust in both types of manager. Study 5 proposed a conceptual model of trust in football leaders which illustrates the trust appraisals made by both close and distant followers in Studies 1-4. Using the critical incident technique, the final study tested the adequacy of the proposed model for explaining ‘real-world’ incidents where trust had been gained or lost. Results demonstrated the efficacy of the model, as well as demonstrating similarities and differences among both player and fan appraisals, and incidents where trust was gained or lost. Importantly, this research presents a contribution to the understanding of trust in football contexts. Moreover, the work demonstrates the types of appraisals made by two distinct kinds of followers in this setting, and the value of employing mixed methods in research of this type.

Interleukin-6 (IL-6) is a pluripotent cytokine which has inflammatory properties. It is suggested to mediate a variety of processes including increased perception of fatigue during inflammatory states. In addition, prolonged exercise can cause a marked increase in circulating IL-6, and although there is a widely reported association between plasma IL-6 and fatigue in disease and inflammatory conditions, this relationship has remained relatively unexplored in healthy individuals during exercise. Therefore, the aims of this thesis were firstly, to develop a repeatable preload time trial in order to examine the variability of circulating IL-6 and other signalling molecules in response to an exercise challenge; secondly, to investigate the effect of plasma IL-6 and signalling molecules on fatigue and performance during a pre-loaded time trial; and thirdly, to evaluate the impact of nutritional interventions (glutamine intake during exercise, manipulation of pre-exercise diet and carbohydrate intake during exercise) on the response of circulating IL-6, IL-6 signalling molecules and biomarkers associated with IL-6 during exercise and their effect on preload time trial performance. Results from the studies determined that there was large variability in the plasma IL-6 and signalling receptors response to the pre-loaded time trial (8-20%) but that the exercise protocol was repeatable. Nutritional interventions did not alter the signalling receptor response, nor biomarkers associated with IL-6, including hepcidin. However, carbohydrate intake during exercise attenuated the circulating IL-6 response to exercise by 49% which correlated well with an improved time trial performance. Regardless of the intervention, a consistent finding in all studies indicated that a greater plasma IL-6 response to the preload exercise bout correlated well with a reduced relative exercise performance as a percentage of velocity at VO 2max during the subsequent time trial. To summarise, the findings from this thesis indicate that elevated levels of plasma IL-6 are associated with a decrement in exercise performance. Associated IL-6 signalling molecules are elevated in response to exercise but are not associated with performance and are unaltered by nutritional interventions.

The overall aim of this thesis was to investigate modalities used as components of pre event/training preparation, to try to develop an optimal preparation strategy for sports performers. It concentrates on the stretch modalities commonly used by athletes as part of a warm-up designed to prepare them for subsequent performance. Past literature suggests that static stretching as part of a warm-up leads to a decrease in performance when compared to an active warm-up or a warm-up including dynamic stretches. Not surprisingly this has led to a movement away from static to dynamic stretches by many athletes. The presented publications were conducted to clarify a number of issues raised by past research studies. A lack of ecologically valid studies is apparent; the static stretch protocols used in most of the early research in this area has failed to explore what sports performers actually use as part of their training, while there was a lack of research examining the effect of dynamic stretches on performance. Of particular relevance is the lack of research looking at the mechanisms behind the changes in performance linked to warm-ups incorporating dynamic stretches. Therefore, this group of publications attempts to systematically examine the effects on performance of manipulating the stretch component of an active warm-up, while exploring the potential mechanisms linked to any changes in performance. The general findings of this series of papers provides evidence that static stretches, as part of an active warm-up, are linked to a decrease in the acute performance of a range of physical capabilities; including sprint, agility, jump and maximal force output. The mechanisms behind these performance changes are multifaceted, with decreases in core temperature and heart rate, decreases in musculotendinous unit stiffness and a decrease in muscular activity, when compared to a general active warm-up established. In contrast when a dynamic stretch replaces the static stretch component and is incorporated within a warm-up, performance is enhanced when compared to an active warm-up. The mechanisms behind this seem to be less temperature related and more closely linked to the neuro-muscular system. Greater muscular activity is linked to dynamic stretches, causing an increase in peak force and rate of force development, compared to an active warm-up protocol. This effect seems to be enhanced the faster and more specific the dynamic stretches are to the chosen performance measure, while combining static stretches with dynamic stretches as part of a preparation strategy still leads to decreases in performance compared to an active warm-up combined with dynamic stretches. In conclusion, to maximise acute maximal performance in sports specific motor skills, an active warm-up combined with specific dynamic stretches is recommended to sports performers and coaches.

The principle aim of this work was to provide an insight into the prevalence of the metabolic syndrome (MetS) in children and adolescents and to examine the associations of body composition measures, cardiorespiratory fitness (CRF), and physical activity with cardiometabolic risk. The combined association of adiposity and CRF on cardiometabolic risk in youths is also explored, as is the association of CRF with potentially modifiable variables, such as physical activity. This work has shown that, dependent on the definition employed, MetS may be present in 2.3% to 9.8% of children and adolescents in Bedfordshire, UK. When applying modified Adult Treatment Panel III definitions (Cook et al. 2003; de Ferranti et al. 2004), the condition was significantly more prevalent in overweight compared to non-overweight youths. Backward regression analyses identified that only body mass index (BMI) explained significant amounts of variance in clustered cardiometabolic risk, although being overweight according to internationally proposed cut points for BMI, waist circumference (WC), and waist-to-height ratio conferred participants to increased risk compared to their non-overweight counterparts. Clustered risk was also elevated in children and adolescents with low levels of CRF compared to those with high levels, whereas time spent in moderate-to-vigorous physical activity and vigorous physical activity (VPA) held no association. When stratified into groups according to level of fatness (BMI z-score) and CRF, those with high fatness/low CRF generally exhibited the most unfavourable cardiometabolic risk profiles. Cardiometabolic risk was higher in the high fatness/low CRF group compared to those with low fatness/low CRF and low fatness/high CRF when excluding WC from the score, and those with low fatness/low CRF when including WC in the score. Multiple regression and ANCOVA revealed that increased visceral fatness (indirectly measured using WC) was associated with reduced CRF, while increased time spent in VPA was associated with elevated CRF. These data suggest that BMI may be the best simple measure of obesity to employ when exploring adiposity-related cardiometabolic in children and adolescents. In addition, results from this iv investigation indicate that low CRF and overweight/obesity may have deleterious effects on the cardiometabolic health of children and adolescents and that interventions to reduce risk may target decreases in fatness and improvements in CRF and VPA as standard.