The present study explored elite athletes experiences of a sport-related concussion (SRC), i.e. cognitive, emotional and behavioral responses in rehabilitation. The participants were four elite athletes, 2 men and 2 women (23-25 years old), from cycling and martial arts, all suffering protracted concussion symptoms. A semi-structured interview guide was used, and data was analyzed through thematic analysis, with inductive reasoning. The findings suggest that emotional, cognitive and behavioral responses, such as uncertainty, stress, motivation and depression were present in the recovery from SRC, represented by six themes (1) Identity Loss, (2) Invisibility of the Injury, (3) Being In Charge of Recovery and Return to Sport, (4) Social Support and Pressure, (5) Uncertainty of Recovery Prognosis and (6) Depression and Substance Use. The findings also highlight the risk for mental illness following SRC and the importance of learning more about the psychological perspectives of SRC. Suggestions for practical implications and future research proposals are given. / Studien syftade till att undersöka elitidrottares kognitiva, emotionella och beteendemässiga responser i rehabilitering från en idrottsrelaterad hjärnskakning. Deltagarna bestod av 4 elitidrottare, 2 män och 2 kvinnor (23–25 år gamla), från cykling och kampsport, där alla deltagare hade lidit av långdragna hjärnskakningsrelaterade symptom. En semi-strukturerad intervjuguide användes och data analyserades genom tematisk analys, med induktivt resonemang. Resultatet föreslog att emotionella, kognitiva och beteendemässiga responser kopplade till osäkerhet, stress, motivation och depression förekom under tillfrisknandet från idrottsrelaterad hjärnskakning, representerade av sex teman; (1) Förlorad Identitet, (2) Skadans Osynlighet, (3) Ansvar för Tillfrisknande och Återgång till Idrott, (4) Socialt Stöd och Press, (5) Osäker Prognos för Tillfrisknande och (6) Depression och Medicinering. Ett viktigt fynd var att det förefaller finnas en ökad risk för psykisk ohälsa i samband med idrottsrelaterade hjärnskakningar, vilket antyder vikten av att ökad kunskap inom forskningsområdet har potential att tydligare kunna bistå idrottare med bättre behandlingsstöd. Förslag på praktiska implikationer och fortsatt forskning medföljer.

Mental återhämtning är en viktig del i livet för att må bra och orka med vardagensutmaningar. Lika stor betydelse har mental återhämtning för en elitidrottare, trotts detta är det vanligare att prata om fysisk återhämtning till skillnad från mental återhämtning inom idrottsvärlden. I den här undersökningen är syftet att studera den mentala återhämtningens betydelse för elitidrottare och därför har följande frågeställningar använts för att uppfylla syftet i undersökningen: Upplever elitidrottare att mental återhämtning har en betydelse för en längre elitidrottskarriär och ökade idrottsprestationer? Hur hanterar elitidrottare balansen mellan idrotten och privatlivet och hur upplever dem att mental återhämtning kan hjälpa till att hantera den balansen? Hur upplever elitidrottare att idrottsföreningar arbetar med mental återhämtning och hur upplever elitidrottarna att idrottsföreningarna kan utveckla sitt arbete inom mental återhämtning?  Metoden för undersökningen bestod av en kvalitativ metod i form av intervjuer. För att analysera resultaten av intervjuerna användes en innehållsanalys. Resultatet visade att det är viktigt att ha något meningsfullt vid sidan av idrotten samt en balans mellan idrotten och privatlivet för att få en lång och hållbar karriär. Till sist konstateras att det finns en bristande kunskap om ämnet mental återhämtning hos vissa idrottsföreningar. Utifrån den forskningen som finns inom ämnet mental återhämtning hos elitidrottare stämde resultatet med tidigare forskning. / Mental recovery is an important part of health and a key to endure the daily challenges in everyday life. The mental health is just as important regarding elite athletes to enable strong performances and sustainable careers. Despite this, it is more common to talk about their physical recovery in the world of sports. In this study the purpose is to investigate the importance of mental recovery for elite athletes, it is therefore covering the following issues: Do elite athletes experience that mental recovery is important to enhance their performances and to enable a longer career? How are elite athletes managing the balance between their sport and their private life and what is their view on mental recovery helping them finding the balance? What are the athletes’ views on how the sport teams are working with mental recovery and how do they think that the teams can improve their work within this field?  The method used to search for answers on these issues was a qualitative method enforced by interviews. To study the results of the interview, the content was analysed. The results showed that it is important for the athletes to do something meaningful in their private lives and that their personal life and their professional life are balanced, to get a long and sustainable carrier. Finally, it is found that the knowledge of mental health is inadequate in a lot of sport teams. When analysing earlier studies in this field, it can be concluded that the result from this study is in line with the already known research.

This thesis analyses how elite athletes travel to/from sport events and which barriers prevent them from engaging in a more sustainable travel behaviour. For this purpose, unstructured interviews with elite athletes were conducted to gain an in-depth understanding about travel experiences and decision-making from elite athletes’ perspective. The sport of biathlon, which combines cross-country skiing with rifle shooting, was used as a case study. The analysis revealed that biathletes engage in frequent and extensive travelling, and that their most-used modes of transportation are road and air transportation. Travel arrangements were found to be usually taken care of by national federations and not by biathletes themselves. Moreover, the analysis demonstrated that while biathletes generally seem to be concerned about the environment, their environmental concern does not seem to translate into pro-environmental travel behaviour, which can be explained by the fact that sustainable transportation represents a high-cost situation. Furthermore, some barriers were found to prevent elite athletes from travelling more sustainably. The barriers are related to individuality (other priorities – performance), responsibility (not athletes’ responsibility) and practicality (national regulations regarding rifle transport in public transportation (PT)). However, many barriers were found to lie on a continuum between individuality and practicality. The most important of these barriers include travel time, equipment, exposure to other people or inconvenient PT system. Based on the findings, it was recommended to optimize schedules, which was found to be to be overall highly appreciated by biathletes. Some other recommendations include, for example, reservation of train compartments and/or special buses for biathletes and teams, communal equipment transportation between competition venues, vehicle provision at venues, or clear and updated information about regulations regarding rifle transport. These and other recommendations are believed to help biathletes to overcome some of their barriers and, thereby, encourage a more sustainable travel behaviour. Thereby, it is hoped that the knowledge gained in this thesis can help sport organizations and athletes to reduce the emissions from travelling to/from sport events. / <p>2024-01-19</p>

This thesis examines the influence of active exercise according to the concept of the Dynamic Neuromuscular Stabilization on local sensory perception in the mid-thoracic spine in elite athletes - cross-country skiers. It also describes the most common health problems in these athletes and assesses the impact of the integration of active exercise according to the DNS concept into everyday practice of cross-country skiers on the intensity and frequency of pain in cervical, thoracic and lumbar spine. It also presents theoretical knowledge about the concept of the Dynamic Neuromuscular Stabilization and interdependence of quality of sensory and motor functions. Methods: The study included a total of 20 elite athletes - cross-country skiers aged 17- 27, randomly divided into two groups. The training group integrated into their practice selected three exercises according to the Dynamic Neuromuscular Stabilization targeting segmental motion in the thoracic spine. A total of five measurements were performed on the quality of sensory perception during two months for all athletes. Furthermore, we evaluated the immediate effect of the therapy in the test group through the examination of sensory perception before and immediately after the treatment. At the beginning and at the end of the study each athlete...

Les conduites à risques des jeunes sont au centre des politiques de santé publique actuelles. Afin de tenter de prévenir leur occurrence, il semble important d’en comprendre les origines. Dans cette logique, ce travail doctoral s’intéresse aux facteurs psychologiques de vulnérabilité à la consommation d’alcool et aux troubles alimentaires subcliniques chez les jeunes. Plus spécifiquement, il appréhende les influences de l’attachement parental, la personnalité et l’alexithymie sur ces conduites au travers de modèles complexes. Trois études ont été mises en place. La première a permis d’explorer le rôle de l’attachement parental et du concept de soi dans la consommation d’alcool des adolescents (N = 245). La seconde a souligné les effets directs et indirects de l’attachement parental, la personnalité et l’alexithymie sur la consommation d’alcool et les troubles alimentaires subcliniques au sein d’une population d’étudiants sportifs (N = 434). La troisième a mis en évidence l’existence de relations directes et indirectes entre l’attachement parental, les facettes de la personnalité, l’alexithymie et les troubles alimentaires subcliniques des athlètes de haut niveau (N = 275). Les résultats révèlent que les comportements risqués des jeunes sont liés à un attachement parental insécurisé et à des difficultés dans l’identification et la description de leurs émotions. La consommation d’alcool est associée à un faible caractère consciencieux alors que les troubles alimentaires subcliniques sont liés à un névrosisme élevé. Plus précisément, l’attachement parental insécurisé favorise la consommation d’alcool au travers de son influence sur le caractère consciencieux et la régulation des affects. Ce type d’attachement contribue également à l’occurrence des troubles alimentaires des sportifs en induisant un névrosisme élevé, et plus particulièrement une forte impulsivité chez les athlètes de haut niveau. / Risk-taking behaviours of young people are issues that need to be addressed. Understanding their origins could prevent them from wide spreading. Consequently, this thesis focused on the psychological factors of vulnerability to alcohol use and subclinical eating disorders amongst young people. More specifically, we examined the influences of parental attachment, personality characteristics and alexithymia on these risk-taking behaviours through different models. Three studies have been carried out. The first one aimed to assess the role of the parental attachment and self-concept in alcohol use of adolescents (N = 245). The second one identified direct and indirect effects of parental attachment, personality characteristics and alexithymia on alcohol use and subclinical eating disorders amongst a sample of student athletes (N = 434). The third study emphasized the direct and indirect relationships between parental attachment, personality facets, alexithymia and subclinical eating disorders amongst a sample of elite athletes (N = 275). The findings provided evidence that risk-taking behaviours of young people were linked with an insecure parental attachment and difficulties in identifying and describing their feelings. Alcohol use was related to low conscientiousness whereas subclinical eating disorders were related to high neuroticism. Insecure parental attachment influenced alcohol use through its influence on conscientiousness and difficulties in identifying one’s feelings. Finally insecure attachment influenced subclinical eating disorders through high neuroticism, and specifically high impulsivity amongst elite athletes.Key words: alcohol use, subclinical eating disorders, parental attachment, alexithymia, personality factors, adolescents, student athletes, elite athletes.

Cette thèse a démontré que les athlètes élites vivent en moyenne 7 ans de plus que la population générale, notamment en raison d’une réduction de 35 à 45% de la mortalité par maladies cardiovasculaires et par cancers. Ces résultats s’appuient sur l’analyse de l’ensemble des sportifs français (n= 3.600) ayant participé aux Jeux Olympiques depuis 1912 et au Tour de France depuis 1947. Des nouvelles méthodes en analyse de survie ont été mises au point pour investiguer ces cohortes qui ont la particularité de survivre mieux que leurs référents. A ces démonstrations s’ajoute le ralentissement de la progression de la longévité maximale humaine. Ce constat résulte de la comparaison des tendances de durée de vie de tous les olympiens depuis 1896 (n= 19.012) et des doyens de l’humanité (n= 1.205). Ces travaux répondent au besoin de mieux comprendre la relation dose-réponse de l’activité physique, médicament du 21ème siècle, en raison de son impact majeur sur la longévité des populations, ainsi qu’à l’intérêt d’explorer les marges d’augmentation possibles de cette longévité. / Background and objectives: along their careers, elite athletes are subjected to specific constraints that distinguish them from the general population. Such constraints, related to the high intensity of their physical activity, their overexposure to injuries or particular lifestyle, may have long-term consequences on the athletes' health, and ultimately on their longevity. Thus, the main goals of the present study are the following: 1) to describe and analyze elite athletes’ longevity and specific causes of mortality in comparison with the general population and according to the type of effort they performed; and 2) to investigate their lifespan trends in comparison with the longest-lived humans in order to apprehend the current scenario of human longevity trends. Methods: we collected data on the biography and the athletic performances of all the French athletes who participated in the Olympic Games (OG) from 1912 to 2012 (n = 4708), and all the French cyclists who participated in the Tour de France (TDF) from 1947 to 2012 (n=786). Then, we verified their vital statuses through the National Registry of Identification of Physical Persons (RNIPP). For the deceased athletes, we obtained the causes of their deaths through the Centre for epidemiology on medical causes of death (CépiDc). We compared the athletes’ overall and specific mortality (according to the main chapters of the International Classification of Disease) with the French civilian life tables using Standardized Mortality Ratio (SMR) and the Kaplan-Meier methods. We adapted and applied the life years-lost method under the competing risk model to quantify differences on longevity due to major causes of death according to the athletes’ type of effort. Furthermore, we collected data on worldwide deceased Olympians participating in the OG from 1896 to 2012 (n=19 012) and on worldwide supercentenarians (>110 years) deceased between 1900 and 2013 (n= 1 205) in order to analyze their lifespan trends using a density analysis tool (total number of life durations per birth date). Findings and conclusion: French elite athletes show consistently lower mortality (≈40-50% lower) in comparison with their compatriots, whether female or male Olympians, or professional cyclists, mostly related with a lower cardiovascular (≈ 40-60% lower) and cancer mortality (≈ 45% lower). No excess mortality was observed in elite athletes for any of the specific causes of death we studied. French Olympians’ lower mortality results in an average of seven years of life saved in relation to the general population. This gain partitioned according to specific causes of deaths shows that cardiovascular longevity benefit is associated with the type of sports practiced during the Olympic career, favoring combined type of effort over very short- or very long-duration effort. In relation to cancer mortality, all types of effort studied were associated with better longevity. Despite their survival advantage, no Olympian in the world, up to date, has ever reached the status of a supercentenarian, as the longest-lived was 106 years old. The common lifespan trends between Olympians and supercentenarians indicate similar mortality pressures over both populations that increase with age, a scenario that is better explained by a biological “barrier” limiting further progression. The supercentenarians’ density trends show a current stagnation of the human longevity.

The essay starts with an introduction to the chosen topic. Then the background goes through the different definitions of mental illness and elite sports, the correlation between these two, the stigmatisation of mental illness and lastly promotional and preventional work. Later, today’s problem with mental illness is raised along with floorball and furthermore the essay’s objectives. The essay’s purpose is to investigate which factors cause mental illness to a greater extent in national series than in federal series in Swedish floorball. Also how associations work to prevent mental ill health within their organization. Additionally the essay’s method is a quantitative and digital survey. The survey is distributed via email and the authors personal contacts. The essay´s results showed that the swedish floorball players have a high level of stress, anxiety and overtraining. It also shows that the players don't feel support from their organisation when a player is experiencing mental disorders. Furthermore, the result shows that floorball club is not working with prevention and supporting of mental illness.

Elitidrottare har identifierats som en riskgrupp för psykisk ohälsa utifrån exponering av såväl generella som sportspecifika påverkansfaktorer. Bland elitidrottare är förekomsten av psykisk ohälsa dessutom större bland kvinnor än män. Första syftet med studien är att kartlägga förekomsten av symtom på psykisk ohälsa (ångest, depression och sömnsvårigheter) och psykisk hälsa bland spelare i Svenska Damhockeyligan (SDHL). Andra syftet är att undersöka samband mellan symtom på psykisk ohälsa/hälsa och demografiska variabler (skador, anställningsstatus), socialt stöd och psykologisk flexibilitet. 182 av 199 SDHL-spelare (medelålder 22,3±SD 4,8, 16–35 år) från alla nio lag deltog i denna tvärsnittsstudie. Självskattningsformulär användes som datainsamlingsmetod och data analyserades vidare genom statistiska analyser. Resultatet visade att över 4 av 10 spelare rapporterade måttliga eller högre nivåer av symtom på ångest, depression och/eller sömnsvårigheter, där ungefär hälften rapporterade komorbiditeter. Detta indikerar ett glapp för prevention. Sammantaget rapporterade 6 av 10 ett sub-idealt tillstånd (d.v.s. ingen psykisk ohälsa och psykiskt välbefinnande), vilket indikerar ett glapp för promotion. Statistiskt signifikanta positiva samband fanns för psykologisk flexibilitet och socialt stöd. Förslagsvis kan dessa faktorer bli fördelaktiga att adressera vid preventivt och promotivt hälsoarbete med målgruppen. Framtida forskning kan adressera dessa faktorer vid interventionsstudier liksom följa populationens psykiska hälsotillstånd och dess påverkansfaktorer över tid. / Objectives: First, to map the prevalence of symptoms of mental illness (i.e., anxiety, depression, and sleep difficulties) and mental health among players in the Swedish Women’s Hockey League (SDHL). Second, to investigate relationships between mental illness/health and demographic variables (i.e., injuries, employment status), social support and psychological flexibility. Methods: SDHL players (n=182; mean age 22.3±SD 4.8, range 16-35) from nine teams participated in this cross-sectional study. 79% (n=145) combined sports with education or work (i.e., “dual careers”). 20% (n=54) reported injuries. Self-assessment questionnaires were used to measure perceived levels of symptoms of anxiety, depression, sleep difficulties, psychological flexibility, and social support. Mental health/illness variables were presented as descriptive statistics and associations were investigated through multivariate binary logistical regression analyses. Results: Moderate or severe levels of symptoms were reported among 29% for sleep difficulties and 26% for anxiety and/or depression. 19% reported comorbidities. 58% reported flourishing mental health. Lower psychological flexibility was associated with lower odds of flourishing mental health and higher odds of symptoms of mental illness. Social support was associated with higher odds of flourishing mental health and lower odds of sleep difficulties. Conclusion: 6 of 10 players reported not reaching the ideal state of mental health (i.e., no mental illness and flourishing mental health). Statistically significant associations were found with psychological flexibility and social support, suggesting these factors will be beneficial to consider when working to promote mental health and prevent mental illness in this population.

Les perturbations de l'identité suite à une commotion cérébrale liée au sport (CCS) ont été explorées du point de vue de l'identité athlétique. Cependant, ces études négligent d'autres constructions identitaires importantes, comme l'identité personnelle (p.ex. la personnalité, les émotions) et sociale (p. ex. la famille) ainsi que le concept de soi, c'est-à-dire l'identité collective, personnelle et sociale. En utilisant l'approche de l'identité sociale pour conceptualiser le concept d'identité, cette étude qualitative multiméthodes a exploré l'impact d'une CCS sur les constructions identitaires de sept athlètes élites (n = 6 femmes, M = 25,1 ans). Deux entretiens semi-structurés (durée moyenne de 83,7 minutes et 76,9 minutes respectivement) et l'outil nommé Social Identity Mapping Tool ont été utilisés pour collecter les données. Suite à une analyse thématique réflexive, trois thèmes ont été développés. Thème A : L’impact de la CCS durant le rétablissement sur les constructions identitaires des participants menace le concept de soi. Le thème B : L’identité post-commotion décrit comment les constructions identitaires des participants ont changé après le rétablissement de la CCS. Le thème C : La gestion de l’identité via l’identité sociale explique comment les dynamiques du réseau social des participants impactent leurs constructions identitaires. Les résultats démontrent que les athlètes élites ayant subi une CCS peuvent éprouver une perturbation allant au-delà de l’identité athlétique. Les futures recherches devraient explorer les interventions nécessaires afin de gérer adéquatement cette perturbation de l’identité. / Researchers have explored the impact of a sport-related concussion (SRC) on athletes’ identity almost exclusively through the lens of athletic identity. However, this approach neglects other important identity constructs, such as personal (e.g., personality, emotions), and social identity (e.g., family, student), and the self-concept (i.e., collectively, personal, and social identity). Using the Social Identity Approach, this qualitative, multi-method study explored the impact of SRC on the identity constructs of seven (n = 6 female, M = 25.1 years) elite soccer, swimming, ice hockey, and curling athletes. We collected data using two semi-structured interviews (Mtime = 83.7 and 76.9 minutes, respectively). The second interview included the Social Identity Mapping Tool, a comprehensive visual display of individuals’ social identity and social network. We used a reflexive thematic analysis and organized the data into three themes. SRC Experience Threatening the Self-Concept (Theme A) explored disruption to participants’ identity constructs during SRC recovery. Post-Concussion Identity (Theme B) described how participants’ identity constructs changed when recovered. Identity Management Through Social Identity (Theme C) explained how the dynamics of participants’ social identity impacted disruptions to identity constructs throughout the SRC experience. Results highlight that elite athletes with SRCs may encounter identity disruption that extends beyond merely their athletic identity. Although this study expands the knowledge around identity disruption from SRCs, we suggest future research explore potential intervention strategies for managing identity disruption from SRCs.

Background: It has been proved that bystander cardiopulmonary resuscitation (CPR) saves lives; however, which training method in CPR is most instructive and whether survival is affected by the training level of the bystander have not yet been fully described. Aim: To identify the factors that may affect 7th grade students’ acquisition of CPR skills during CPR training and their willingness to act, and to describe 30-day survival from outof- hospital cardiac arrest (OHCA) after bystander CPR and the actions performed by laymen versus off-duty medically educated personnel. Methods: Studies I–III investigate a CPR training intervention given to students in 7th grade during 2013–2014. The classes were randomized to the main intervention: the mobile phone application (app) or DVD-based training. Some of the classes were randomized to one or several additional interventions: a practical test with feedback, reflection, a web course, a visit from elite athletes and automated external defibrillator (AED) training. The students’ practical skills, willingness to act and knowledge of stroke symptoms, symptoms of acute myocardial infarction (AMI) and lifestyle factors were assessed directly after training and at 6 months using the Laerdal PC SkillReporting system (and entered into a modified version of the Cardiff test scoring sheet) and a questionnaire. The Cardiff test resulted in a total score of 12–48 points, and the questionnaire resulted in a total score of 0–7 points for stroke symptoms, 0–9 points for symptoms of AMI and 0– 6 points on lifestyle factors. Study IV is based on retrospective data from the national quality register, the Swedish registry of cardiopulmonary resuscitation, 2010-2014. Results: A total of 1339 students were included in the CPR training intervention. The DVD-based group was superior to the app-based group in CPR skills, with a total score of 35 (SD 4.o) vs 33 (SD 4.2) points directly after training (p&lt;0.001) and 33 (SD 4.0) vs 31 (SD 4.2) points at six months (p&lt;0.001). Of the additional interventions, the practical test with feedback had the greatest influence regarding practical skills: at six months the intervention group scored 32 (SD 3.9) points and the control group (CPR only) scored 30 (SD 4.0) points (p&lt;0.001). Reflection, the web course, visits from elite athletes and AED training did not further increase the students’ acquisition of practical CPR skills. The students who completed the web course Help-Brain-Heart received a higher total score for theoretical knowledge in comparison with the control group, directly after training: stroke 3.8 (SD 1.8) vs 2.7 (SD 2.0) points (p&lt;0.001); AMI 4.0 (SD 2.0) vs 2.5 (SD 2.0) points (p&lt;0.001); lifestyle factors 5.4 (SD 1.2) vs 4.5 (SD 2.0) points p&lt;0.001. Most of the students (77% at 6 months), regardless of the intervention applied, expressed that they would perform both chest compressions and ventilations in a cardiac arrest (CA) situation involving a relative. If a stranger had CA, a significantly lower proportion of students (32%; p&lt;0.001) would perform both compressions and ventilations. In this case, however, many would perform compressions only. In most cases of bystander-witnessed OHCA, CPR was performed by laymen. Off-duty health care personnel bystanders initiated CPR within 1 minute vs 2 minutes for laymen (p&lt;0.0001). Thirty-day survival was 14.7% among patients who received CPR from laymen and 17.2% (p=0.02) among patients who received bystander CPR from off-duty health care personnel. Conclusions: The DVD-based method was superior to the app-based method in terms of teaching practical CPR skills to 7th grade students. Of the additional interventions, a practical test with feedback was the most efficient intervention to increase learning outcome. The additional interventions, reflection, web course, visit from elite athletes and AED did not increase CPR skills further. However, the web course Help-Brain-Heart improved the students’ acquisition of theoretical knowledge regarding stroke, AMI and lifestyle factors. For OHCA, off-duty health care personnel bystanders initiated CPR earlier and 30-day survival was higher compared with laymen bystanders.