Author: Andre Coleman

Q1.

a) The reasons that prompted Nike to change its approach to demand forecasting:

Nike’s growth from being the 12th largest shoe manufacturer in 1984 to the world leader in the footwear industry by mid 1990’s increased the intricacy of its manufacturing schedules.
The demand forecasting adopted by Nike prior to considering the new approach saw the retailers placing an order six months ahead of the delivery. Due to the six months lag in delivery Nike could not forecast whether the ordered shoes would be in demand after six months once they reach the store shelves[1].
The existing forecasting technique failed in identifying the quantity of order to be placed with such a long lead time. And had to depend solely on their brand name and hoped that the product would sell.
The expanding market demanded a faster delivery, thus pressurizing Nike to shorten the lead time from the standard shipping time of six months.
The 27 order management systems that formed Nike’s supply chain crumbled under pressure to develop accurate demand forecasts, these factors lead Nike to implement a new demand forecasting.

b) Outcomes of the new demand forecasting system.

The vigorous demands indirectly affected the new demand forecasting system, resulting in excess manufacturing of some products while developing inventory shortages for others as they struggled to cope up with the customer demands.
Nike ended up ordering US $90 million worth of shoes which were in low demand like Air Garnett II, also a shortfall of US$80 million to US$100 million on popular models, like Air Force One.
Nike filled the back orders that were to be supplied and disposed of excessive inventory through discount sales and ‘bargain basement prices’ through its outlet stores. This continued for about 6-9 months to neutralize the incorrect proportions in inventory and two years to overcome the financial losses.
Nike’s share prices dropped considerably due to the losses and faulty forecasts. Costing Nike more than US$100 million in lost sales, there by lowering its stock prices by 20% and also leading it to a series of legal battles.
Q2.

a) The reasons that resulted in such a huge gap between demand and supply at Nike:

The implementation of i2 had adverse effects for Nike, since I2 were inexperienced in providing supply-chain systems for the footwear and apparel industry.
Nike’s higher demand data meant heavy customisation was done on i2 this clogged up the software thus by slowing it considerably to such an extent that a single screen would take 3 minutes to load[2].
Further analysts stated that Nike was installing SAP software to help take orders from customers and get those orders through manufacturing. This led to queuing which led to the complexity in matching up of information from SAP and i22.
Thus Nike had erroneous orders being sent to the manufacturers and was unable to recover from the errors until it was too late.

b) According to my opinion this situation could have been avoided:

If Nike would have considered the facts of acquiring actual data from retailers like direct point-of-sale integration rather than software algorithms.
By developing a better collaboration with the far east manufacturers to reduce the overall lead time there by converting the supply chain from make-to-sell to make-to-order.
Nestle and Nike: ‘How they almost failed’ by Gene Leshinsky…February 18th, 2008
Long Strange Trip: Nike Finally Regains Footing: By Larry Barrett

In the modern day sprint training is the most common method in the new age of sports training, to enhance the ability of an athlete to run at optimum speed, sprint training must be an essential part of an athlete’s training regime (McKenna, M et al, 1997). As equipment advanced so did training methods, therefore to improve performance a certain amount of resistance was added to further enhance an athlete’s performance therefore improving an athlete’s overall speed this was named “Resisted Sprint Training” (RST) is defined by Alexander 1989 as running at top velocity while resistance forces work in the opposite direction. There is countless ways of applying an opposing force; weighted clothing, sleds containing weights, parachutes with different surface areas and common hills are all used to counter act the sprints being undertaken by the athlete. Due to the research that has gone into this area of RST it has provided coaches with more options to experiment and implement with their athlete. The author of this review will be analysing literature and research into sled training commonly shortened to ST and whether the common usage of this in a training programme is an effective method to improve certain variables such as acceleration, maximum velocity, force application and finally stride length/frequency. As RST is a popular method for most modern day sports people from low to elite levels, it has an uncertain concluding factor as to the links to improve sprint kinematics.

(Faccioni, 1994a) “The benefits of the use of resisted sprint running is that it recruits more muscle fibers, requires more neural activation” therefore due to this quote the effects of ST have been probed and primed for many years, especially the way the way it influenced the acceleration on track athletes. After completing a study using males taking part in resistance using 10% plus of the participants body mass, a decrease in stride frequency and stride length was evident, while performing the tests other visual physiological differences were evident such as increased muscle flexibility especially in regards to the hip flexors. When concluding their findings in 1994 they found that when carrying a heavier load. Stress was evident on the participants body therefore hampering the test, this is why a lower weight was used to improve acceleration when using ST for RST.

Murphy et al 2003 study was establishing the load for sprint training with sled towing in the maximum velocity phase. 12 athletes participated in the study. They ran 30 m flying sprints, an unloaded sprint and sprints pulling loads of 6%, 10%, and 15% of their body mass, on a synthetic track surface wearing spikes, they found that this equitation lets coaches and strength trainers to calculate the load for resisted sprint training with sled towing due to the increase in Mean maximum velocity, 30-m sprint time. These findings support another study that was done in 2004 by LeBlanc, J. S.et al who studied the comparisons and differences between free sprint training and resisted in relation to the key attributes of sprinting in the top phase of the athletes speed. Both results show significant differences and shows signs towards ST being beneficial for sprinters top speed phase.

When looking at the literature published the main area of study which has been evident is whether ST increased maximum speed and overall acceleration Hansen, K. T.et al (2006).found that RST with 8% body mass sled towing for 4 week improves transition performance (16-31 m), while traditional sprint training improves performance in the maximum velocity phase (31-51 m) in elite athletes.

In contrast to improving overall acceleration and maximum speed studies have been done to improve sprint specific strength Ettema, G. J. C. (2006) et al stated that RST does improve this evidently in the lower body being the legs and lower back, having this strength is always going to beneficial due to the strength of the lower limbs. The way this evaluation was concluded was down to using and comparing a weighted belt for the athlete to wear, a parachute to provided resistance to the athlete and finally the sled to be able to place weights on to provide a resisted force when completed 30 metre flying sprints. It became evident that the sled training was best for developing maximum sprint strength, however the literature contradicts itself when talking about biomechanical properties which could affect the athletes speed therefore further biomechanical analysis needs to be undertaken to provide a coach with exact biomechanical movements to fully utilise the ST.

After researching the literature which is available to get a good insight into ST, when talking about biomechanical influences in the ST, the practioners should be using 3D analysis software to enable them to have a clear view of the correct posture and movements in each phase especially when the athlete is being specific to stride length, stride frequency and velocity also as other areas in the forever changing world, further research will give myself a better and broader insight into the ability of ST in relation to RST. Putting a focus into the specifics of each ST session such as sets and repetitions of the training being undertaken this therefore would need to client specific as previously stated the weight of each ST is set to a fix rate, however increasing this could either have a positive or negative effect on success and sustainability. When focusing on the suggested correct amounts of training when concerning sets and reps, no previous research has actually indicated a set number to work from. This is why variation and expert analysis needs to be scrutinised to enable a benchmark to be set for initial improvement.

References

Alexander, M.J.L. The relationship between muscle strength and sprint kinematics in elite sprinters. Can. J. Sport Sci. 14:148–157. 1989.

Cronin, J. B., and Hansen, K. T. (2006). Resisted sprint training for the acceleration phase of sprinting. Strength Cond. J., 28, 42-51

Faccioni, A. (1994a). Assisted and resisted methods for speed development: Part 1 Modern Athlete & Coach, 32, 3-6.

Kristensen, G. O., van den Tillaar, R., and Ettema, G. J. C. (2006). Velocity specificity in early-phase sprint training. J. Strength Cond. Res., 20, 833-837

LeBlanc, J. S., & Gervais, P. L. (2004). Kinematics of assisted and resisted sprinting as compared tonormal free sprinting in trained athletes. Proceedings of the 22th International Symposium onBiomechanics in Sport, Ottawa, Canada 536.

Lockie, R. G., Murphy, A. J., and Spinks, C. D. (2003). Effects of resisted sled towing on sprint Kinematics in field-sport atlethes. J. Strength Cond. Res., 17, 760-767.

McKenna, M. J., G. J. F. Heigenhauser, R. S. McKelvie, J. D.MacDougall, and N. L. Jones. Sprint training enhances ionic regulation during intense exercise in men. J. Physiol. (Lond.) 501: 687–702, 1997

Murphy, A. J., Lockie, R. G., and Coutts, A. (2003). Kinematic determination of early acceleration in field sport athletes. J. Sports Sci. Med., 2, 144-150.

Critically discuss interdisciplinary and multidisciplinary approaches to sport and exercise science within the professional experience undertaken in term 1. Support your answers with relevant literature and theory

Research within sport and exercises science is done in many different disciplines. The majority of published research, however, is mono-disciplinary (from a singular discipline) in nature (Burwitz et al. 1994). A professional experience was undertaken to assess the approaches to inter and multi-disciplinary within sport and exercise science research. The experience was of a sport science nature which involved assisting in an undergraduate research project of 3D biomechanical analysis of a gymnastic vault using CODA, focussing specifically on the approach and springboard take-off. Sports biomechanics uses the scientific methods of mechanics to study the effects of various forces on the sports performer (Bartlett, 2007). It is important to monitor technique in gymnastics to help prevent injury and improve performance. It is then possible to feed this information back to coaches to highlight strengths and weaknesses of individual athletes.

Multi or inter-disciplinary research requires a combination of methods and knowledge from more than one sub-discipline (Burwitz et al. 1994).

This essay will outline what multi and inter-disciplinary approaches to sport and exercise science are, compare how similar they are and then show how they differ. It will then outline how the two approaches can be applied to the professional experience undertaken.

An interdisciplinary approach within sport and exercise science involves a partnership of coaches with sport and exercise scientists such as physiologist or psychologists. Smith (2005) split sport science from exercise science due to differences of individual needs from elite athletes to members of the public. Smith (2005) described sport science as being characterised by collaborations with coaches and performance directors and exercise science as being characterised by collaborations with general practitioners and professionals allied to medicine. Interdisciplinary research needs to involve a strong integration of information from more than one sub-discipline of sport and exercise science from the outset of a particular research programme (Burwitz et al. 1994). Williams and James (2001) stated that a sport or exercise team should have a scientific basis. Williams and James (2001) also developed a model to demonstrate inter-disciplinary approaches, where the goal of the sport or exercise is affected by each area involved.

Multi-disciplinary research involves less integration of the sub-disciplines of sport and exercise science. Each discipline tends to work in parallel on a common topic (Burwitz et al. 1994). Miles et al (1997) adapted Burwitz et al. (1994) definition to state that multi-disciplinary research involves sport and exercise scientists working together to solve a problem in an isolated unitary fashion and co-coordinated manor. In a multi-disciplinary approach each sub-discipline will look for problems to a solution from within only that discipline, for example a biomechanist will look at technique. Then each discipline will collate their results, whereas in an interdisciplinary approach the biomechanist may work with a physiologist to look at technique changes due to fatigue (Burwitz et al. 1994). Multi-disciplinary research may be the result of a lack integration of sub-disciplines from the outset of sport and exercise science, and so it is harder to integrate then together when trying to bring about an inter-disciplinary approach to problem solving.

Multi and inter-disciplinary research are both ways of improving research and developing is away from mono-disciplinary work in sport and exercise sciences. The majority of sport and exercise research is mono-disciplinary (Burwitz et al 1994) which is when research looks solely at one sub-discipline and provides answers and conclusions from only that discipline. Both multi and inter-disciplinary approaches endeavour to link sub-disciplines, such as psychology and biomechanics, together to improve the ability to solve problems such as injury, fatigue and poor technique. Both approaches work in teams or groups (that include the sport and exercises scientists, coacher or practitioners and the athlete or patient) to combine knowledge and methods from their different areas.

Despite these similarities there are still major differences between the two stated approaches. The inter-disciplinary approach appears to be the best way to bring about improvements as it integrates the sub-disciplines which takes the form of ‘bridge-building’ (Squires et al 1975) which requires a combination of specialist knowledge from various disciplines focusing on a specific problem. Contrastingly, multi-disciplinary approaches collate rather than combine knowledge; therefore the sub-disciplines work separately during research processes before coming together to attempt to reach a conclusion about a stated problem (Burwitz et al 1994). It is also believed that an interdisciplinary approach will reveal potential conflicts between the sub-disciplines (Burwitz et al 1994). As there is immediate interaction between sub-disciplines, an opinion given by one area is disputed by another. This is less likely to occur in multi-disciplinary approaches as sub-disciplines do not work in direct contact with one another.

Despite the above examples no clear definition is given of the distinctions between the two approaches because many sport and exercise scientists have regarded multi and inter-disciplinary as synonymous terms (Burwitz et al 1994).

The professional experience was involved with sport science which smith (2001) described as being characterised by collaborations with coaches and performance directors. It was first and foremost a biomechanical approach.

Biomechanics is a highly scientific and mathematical based sub-discipline, usually looking at technique, and problems with technique, as causes of problems such as injury and failure of achievement. Gymnastics is a sport that utilises these methods frequently as it is a very technical sport where injuries can be common. This is due to the fact that gymnastics encompasses a seemingly endless quantity of movement skills (George 1980). During the professional experience questions were putt to the researcher regarding the involvement of other sub-disciplines to determine the dimension of the research. These questions were: ‘are there any sport scientists or performance director present for sub-disciplines other than biomechanics to help assess the primary information gathered from the research?’ ‘Will the results of the research be collated with other sub-disciplines and fed back to the performer?’

From the answers given to these questions it was concluded that the research being carried out was mono-disciplinary as there was no interaction, in any way, with other sub-disciplines. As discussed above there is an increasing need from multi or inter-disciplinary research in sport and exercise science, this study may have been improved by the introduction of other sub-disciplines and the feedback given to an athlete would have increased in value.

The research itself was looking at the approach and take off of the gymnast during the vault, as well as having technique assessed biomechanically, the researcher may have advised the athlete to be assessed by a physiologist or physiotherapist, this may produce results that show differences in muscle pair which could lead to injury, for example one calf being larger than the other, which could mean production of force at take of is unbalanced. This could then be fed to the biomechanist who has also found that during takeoff the gymnast has been unbalanced and therefore the athlete would need to undergo strengthening in the shorter calf to get it up to a similar size to the other calf.

This would create a multi-disciplinary approach as sub-disciplines of sport science will have collated data after the research to improve feed back to the performer.

It may also have been helpful to have had a psychologist present at the time of testing who had watched the subject in competition and seen if their routine or performance differed between in and out of competition performance. It may be possible that the pressure of performing in competition had led the athlete miss time a move which led to a decrease in performance; the psychologist could then work with the performer to help improve confidence during competition and therefore improve the athlete’s performance.

This would create an inter-disciplinary approach as sub-disciplines of sport science will have integrated during research to improve feed back to the performer.

If the approach’s dimension was changed to either a multi or an inter-disciplinary approach it will give the gymnast a much better chance of improving performance in competition.

The professional experience undertaken was shown to be mono-disciplinary as it was a piece of research focusing solely on the biomechanics of the approach and take off of the gymnastics vault. As discussed above introducing further dimensions to the research may have been more beneficial to the athlete as they may receive more feedback. However the piece of research was an undergraduate study which had a primary focus on biomechanics and introducing other sub-disciplines may have confused the findings and taken away from the aims of the research. This essay has described multi and inter-disciplinary approaches within sport science and described their application within a sporting context.

Critically discuss interdisciplinary and multidisciplinary approaches to sport and exercise science within the professional experience undertaken in term 1. Support your answers with relevant literature and theory’

The advance in sports professionalism and the increasing intensity of competition has made a scientific approach to sport vital to monitoring and improving performance (Campbel. 2007). British expertise in sport and exercise science is reflected in the growing number of postgraduate qualifications that offer the chance to study new and exciting developments.

The applications of scientific principles are studied by examining three branches of science – biomechanics, physiology and psychology – although this knowledge is applied differently to each of the sport and exercise disciplines. Sport science largely offers expert scientific backup for top sport training and performance, while exercise science has a central role in physical programmes aimed at improving general health (Campbel.2007). The qualified sport and exercise scientist can expect to have a broad technical, physiological and psychological knowledge, and stands to benefit from current developments within the field offering a professional status.

Although research within sport and exercise science is done in many different disciplines, the majority of published research is mono-disciplinary. Burwitz et al (1994) defined mono-disciplinary as a singular discipline in nature. A professional experience was undertaken to assess the approaches to inter and multi-disciplinary within sport and exercise science research. The experience was of a sport science nature which involved the participation of a newly created test, designed to monitor endurance performance. The test focused on heart rate response, ground contact times and oxygen uptake whilst running on a treadmill at sub maximal speeds. The data collected from this test will, as a result, be used to better the understanding of factors that contribute to endurance performance and importantly to easily be able to measure these factors. A similar study created by Blackadar et al (2001) found that the measurements of ground contact times and heart rate response during level running at chosen speed can provide accurate estimates of maximal aerobic power. Carpenter and Ledger (2004) suggests that an understanding of physiological factors is essential for anyone involved in sport (coach or performer), appreciation of this is vital in developing effective training programmes and optimising performance.

This essay will outline what multi and interdisciplinary approaches to sport and exercise science are. It will then delineate how the two approaches can be applied to the professional experience undertaken.

An Interdisciplinary approach within sport and exercise science involves a partnership of coaches with sport and exercise scientists such as physiologists or psychologists. Miles et al (1997) defines an interdisciplinary approach as more than one area of sport and exercise science working together in an integrated and co-ordinated manner to solve a problem. Interdisciplinary research needs to involve a strong integration of information from more than one sub-discipline of sport and exercise science from the outset of a particular research programme (Burwitz et al. 1994). Williams and James (2001) developed a model to demonstrate interdisciplinary approaches, where the goal of the sport or exercise is affected by each area involved.

Multidisciplinary research involves less integration of the sub-disciplines of sport and exercise science. Each discipline tends to work in parallel on a common topic (Burwitz et al. 1994). Just like interdisciplinary, it involves more than one sport working together but the difference being they work together in an isolated, unitary and co-ordinated manner (Miles et al 1997). In a multidisciplinary approach each discipline will look for problems to a solution from within only that discipline, for example, a physiologist will look at how the body responds to exercise; each discipline will then assemble their findings. Alternatively in an interdisciplinary approach, the physiologist may work together with a biomechanist to look at if rate of fatigue changes with different technique (Burwitz et al. 1994). The deficient in the integration of sub-disciplines from the outset of sport and exercise science may be resultant to the multidisciplinary research, thus, making it harder to integrate them together whilst trying to bring about an interdisciplinary approach to problem solving.

The majority of sport and exercise science research is mono-disciplinary (Burwitz et al 1994) but introducing the involvement of multi and interdisciplinary research will help to improve the overall standard of research. It will bond together more than one discipline of sport and exercise science such as physiology and biomechanics, consequently, improving the ability to solve problems such as injury, fatigue and poor technique. More than one approach working together as a team will combine their knowledge and methods from their different areas to be able to solve a problem.

Regardless of these resemblances, fundamental disparities between the two stated approaches are still apparent. Interdisciplinary approaches look to be the best in terms of bringing about improvements as it incorporates the disciplines which take the form of ‘bridge-building’ (Squires et al 1975). This requires an amalgamation of expert knowledge from diverse disciplines concentrating on a precise problem. Contrastingly, multidisciplinary approaches gather rather than combine knowledge; consequently the sub-disciplines work independently during the research processes before coming together to reach a conclusion about a stated problem (Burwitz et al 1994). Burwitz et al (1994) believes that an interdisciplinary approach will disclose possible conflicts between the disciplines. As there are direct dealings among sub-disciplines, a view given by one area could be disputed by another. This is less likely to occur in multi-disciplinary approaches as the disciplines do not work in direct contact with one another.

Despite the above examples, no clear definition is given of the distinctions between the two approaches because many sport and exercise scientists have regarded multi and inter-disciplinary as synonymous terms (Burwitz et al 1994).

The professional experience undertaken was involved with sport science; Smith (2001) describes sport science as being characterised by collaborations with coaches and performance directors. The experience undertaken was first and foremost a physiological approach.

Researchers have amassed so much knowledge about physical activity that it is now a separate academic field of study within the biological sciences (Katch et al 2000). Physiology of exercise can be defined as the study of how the body responds and adapts to exercise and importantly identifies physiological characteristics that explain rather than simply describe performance and also focus on ways to improve performance (Bromley et al 2007). Middle distance running is a sport that utilises this definition very well. In this event, oxidative phosphorylation represents the principal energy-producing metabolic pathway and, therefore, it is not surprising that the parameters of fitness which correlate most closely with performance are those related to oxygen uptake (VO2max), the various oxygen uptake required to run at different speeds (running economy), and the oxygen uptake that can be sustained without appreciable accumulation of lactate in the blood (Jones. 1998). Understanding the principles of these factors will contribute to improving endurance performance, and as a result enable an athlete to overcome these issues and improve them. During the professional experience questions were put to the researcher regarding the involvement of other disciplines to determine the dimension of the research. These questions were: ‘are there any other areas of sport and exercise science e.g. biomechanist, psychologist, etc, other than yourself (a physiologist) present to help assess the data gathered from the research?’ ‘Will the results of the research be collated with other disciplines and fed back to the performer?’ The response from the questions asked clearly demonstrated that the research being carried out was of a mono-disciplinary nature as there was no interaction with other disciplines of sport science. As discussed, an increase in the need from multi or interdisciplinary in sport and exercise science, would have much improved this study as more than one are of sport and exercise science being involved would have given feedback to an athlete, therefore increasing the value. The research itself was looking at the reliability and validity of a heart rate by looking at its response to ground contact times whilst running on a treadmill to see if it can be used to predict endurance performance. As well as being assessed physiologically, the researcher may have advised the athlete to be assessed by a biomechanist, this may show results that running technique could affect fatigue, for example, the biomechanist could get the athlete to run over a force plate, and the force generated on the plate could show that too much force is being exerted and as a result making you fatigue more quickly. This could then be fed back to the physiologist whereby a solution could be put together to rectify this and therefore the enabling the athlete to have a better running efficiency. This would create an interdisciplinary approach as more than one discipline is working together in an integrated fashion thus improving feedback to the athlete and as a result give the athlete a much better chance of improving performance.

The professional experience undertaken was shown to be mono-disciplinary as it was a test focusing solely on the physiological changes of an athlete whilst performing a treadmill run. As discussed above, introducing further dimensions may have been more beneficial to the athlete as they receive more feedback of ways to improve. However the test was a funded study by a recognised middle distance running corporation (The British Milers Club) to specifically look at the monitoring of endurance performance and the introduction of other disciplines may have confused the findings and taken away the aims of the study.

PDG.

Understanding Injury in Sport and Exercise Settings – Self-Selected Case Studies

Introduction

In this case study we shall consider three athletes who are superficially similar and have presented with injuries as a result of their sport. The athletes will be referred to as Mr.A, Mr. B and Mr. C. Each is in their twenties and are club standard runners. Mr.A fell during a training run and sustained an inversion injury to his left ankle. Mr. B presented with a pre-patella bursitis of his right knee and Mr. C could not compete because of severe metatarsalgia.

Mechanism and pathophysiology of injury

If we consider the aetiology and mechanisms of each injury we can see that although they are largely sports related and, to a degree sports specific, each is fundamentally different in terms of presentation, cause, treatment and outcome.

Let us consider Mr. A. who fell during training. He was a modest club runner who ran sporadically for personal enjoyment. He sustained an acute inversion injury which resulted in a partial tear of the lateral malleolar ligament. This ligament effectively joins the Tibia to the talus and calcareous and is largely responsible for the lateral stability of the joint. (Clemente C D 1975). There was immediate pain and subcutaneous swelling and, although he could weight bear immediately after the injury, Mr.A could only walk with great pain. Lateral distortion of the joint was extremely painful. The fundamental aetiology of the injury was a sudden inversion stress to the ankle which was greater than the ligament could withstand and this resulted in rupture of some of the collagen fibres of the lateral ligament together with the underlying joint capsule. This allowed substantial bleeding to track into the surrounding tissues which, together with both extravasation of synovial fluid and accumulation of tissue oedema, led to the clinically apparent swelling over the lateral malleolus.

Mr. B, by contrast, was a fiercely competitive sub-elite runner who noticed his injury developing more slowly over a period of about ten days. He was preparing for a race and had increased his running schedule both in intensity and distance covered. Initially he was aware of a discomfort in the anterior aspect of his knee which felt superficial. This was apparent at the end of his training sessions and persisted for a few hours while travelling home. As the training sessions intensified, the pain grew more persistent until it occurred throughout his running session. Although it was a nuisance, it was not severe. By the end of ten days it had become very severe to the point that there was demonstrable swelling over the lower pole of the patella which was tender to the touch and constantly painful. The mechanism of this injury is typical of the overuse injury seen with overtraining. It is believed to arise initially from micro tears within the body of the patella ligament which become inflamed and the constant stresses involved with training do not let the injury heal sufficiently and the inflammation becomes accumulative to the point that histology would show inflammatory changes occurring throughout the ligament and this, in turn, causes friction on the surrounding structures. (Hewett T E et al. 1999)

This is manifest as a constant progressively painful swelling localised in the region of the patella ligament and is aggravated by movement of the knee joint. It is tender to the touch and limits exercise.

Mr. C was a club runner of modest ability, but with an over optimistic appreciation of his own ability, who trained with the elite runners at the club. He frequently complained of minor injuries that were blamed for his particular lack of performance in races. On this occasion he presented with pains in his forefoot over the metatarsal heads which was very specific and occurred when the toes were flexed but not when they were extended (an unphysiological finding). He could run, but complained bitterly of forefoot pain after the race and could be seen hobbling off the track and around the changing rooms after the race. Examination of his foot was completely unremarkable and no consistent physical abnormality could be found. It was noticeable that Mr. C vociferously blamed this problem for his inability to perform well. No physical diagnosis was made but the aetiology of his complaint was thought to be a psychosomatic manifestation of his anxiety relating to his inability to beat the better runners at the club. This equated to a mechanism of cognitive distortion and denial together with a compensatory conversion symptom complex to rationalise his poor performance. (Patel D R et al. 2000)

In short we see three competitive runners with common presentations of injury, but three very different mechanisms of pathophysiology and aetiology. Each will require a different approach to treatment and will follow a very different illness trajectory.

Psychology of sports injury

There are a number of different theoretical concepts (with differing degrees of security of evidence base) that can be usefully employed in describing sporting motivation and are therefore relevant to the incidence of sporting injury. (Wigfield A et al. 2000)

The literature on these subjects is very extensive and beyond the scope of this essay to consider in any degree of detail. Reversal theory (Apter M J 2001) is commonly utilised in this regard and can describe relationships between the personality characteristics and motivational stimuli. Paratelic dominant athletes commonly enter the paratelic motivational state and are typically arousal seekers and engage in high risk and highly competitive sports (viz Mr. B )(Cogan N A et al. 1998)

Mr.A, by contrast is the typical telic dominant athlete who tend to be arousal avoiders, who plan and consider their training carefully and prefer low intensity experiences. (Kerr J H et al. 1999)

Let us start this consideration of the psychology of sports injury with an assessment of Mr. C who presents with a primarily psychological complaint

Mr. C has an overtly psychosomatic presentation. This can be conveniently described in terms of reversal theory (Apter M J 2001).

and the paratelic concept (Murgatroyd S et al. 1978). There are aspects of the metamotivational states described in the theory which are relevant to Mr. C’s perception of his motives for continued participation in running even when he was clearly failing to achieve his set targets.

If appears that Mr. C has developed a variation of a paratelic protective framework with somatic constructs. He needs the high arousal gratification of the paratelic dominant athlete by lining up on the starting line with the elite athletes, but has developed his idiosyncratic phenomenological frame as a coping mechanism which allows him a sensation of safety from his perception of failure with a series of somatic excuses for his failure to perform. (Kerr J H 2001)

One psychological technique that has been demonstrated to work in this type of case is a form of cognitive behaviour therapy which allows a realisation of the implications of an action to be re-evaluated by the client. (Fowler D et al. 1995) This was combined with a strategy of the setting of “step-by-step” short term goals. This effectively allowed the client to consider his need to unrealistically compare himself with the elite athletes and to allow him to achieve progressive attainable targets, thereby recognising and capitalising on achievement rather than ruminating on poor past performance comparisons with other (better) athletes. (Pain M et al. 2004). The idea is that by setting and achieving some short term goals, the client can focus on the present, make small progressive steps, and recognise new achievements, instead of ruminating on past performance level. (Hall H K et al. 2001). Complicity by the clinician in agreeing that his symptoms may actually be physical can be completely counterproductive in this type of case (see on)

Injury management

The object of management of any injury is clearly to maximise the degree of recovery possible and to limit and residual disability that may occur as a result of the injury. In broad terms we can consider the immediate (first aid) treatment and the subsequent longer term management as separate issues. (Hergenroeder A C 2003)

In the case of Mr.A’s acute injury the essential elements of treatment (once the diagnosis has been confidently made) should be to prevent further tissue damage and bleeding by immobilisation of the joint (splinting), prompt cooling to reduce the tissue reaction to the injury, analgesia to relieve the pain (but with the caveat that pain relief should not be an indication to stress the joint) and pressure to minimise blood and tissue fluid accumulation. The longer term considerations should be that weight bearing should be kept to a minimum for about 7-10 days. Mobilisation should then begin in a graded fashion over about four to six weeks. Running on flat surfaces could realistically begin (possibly with an ankle support) after that time. Mobilisation (both active and passive) is necessary to ensure that the fibroblastic activity of the ligament repair mechanism does not restrict movement of the joint to the degree that the long term restriction of movement becomes a problem. (Orchard J 2003)

Mr.A would be well advised to avoid running on uneven surfaces for a period of many months and to undertake a course of physiotherapy involving modalities such as wobble board training to improve his proprioceptive capabilities. (Lephart S M et al. 1997) Because of the injury, Mr.A should always regard himself as more prone to get a recurrence if he were to have another fall.

Mr. B should be treated in a distinctly different way. There is no “acute” first aid treatment as such, as the critical factor here is to recognise that the injury is the result of overuse of a joint. Rest, or in some cases simply a reduction in the training schedule, is often all that is needed to allow the condition to resolve.

(Krivickas L S 1997)

There is some evidence to suggest that the use of NSAIAs may help to reduce the inflammatory reaction and thereby increase the speed of recovery but their use must be undertaken with caution because of the propensity of runners to consider that the analgesic properties of the NSAIA group can be equated with evidence of suppression of the pathophysiology of the lesion, and therefore they can start to increase their training schedule thinking that the inflammation has settled because the knee is pain free. (Nickander R et al. 2005)

Some clinicians would recommend the use of steroid injections in the paratendon tissues. It has to be noted that this is contentious because of the risk of tendon damage if the steroid is injected into the wrong area.

Mr. C requires no immediate physical treatment. Indeed on an intuitive basis, physical treatment could be considered counterproductive as it could be viewed as reinforcing his aberrant adaptive and compensatory mechanisms by colluding in the physical nature of his pathology. By entrenching his position, the clinician could be actually aggravating the problem. Once confidently diagnosed, Mr. C should be promptly referred to a competent sports psychologist for treatment along the lines that we have outlined above.

Lecture to club

The first serious examination of sports injuries as a specific entity was carried out by William Haddon in 1962 (Haddon W et al. 1962). The growth in interest since then has been exponential. In terms of general observation about sports related injuries we can observe that it is generally accepted that one of the common predictive factors for an injury is a history of previous injury. (Watson A W 2001) ( Lee A J et al. 2001) Various studies have reported increased odds ranging from 1.6 to 9.4. (Chalmers D J 2002). In order to accommodate this information it is clearly important to know the other risk factors involved

The practical problem is that in order to assemble a coherent evidence base on this issue it is vital to have well designed and robust trials to consider. In short, there are very few of these. (Parkkari J et al. 2001). A critical analysis of the literature on the subject reveals that there is a surprising paucity of evidence for any significant preventative measure for sports injury. Part of the reason for this is that if there is anecdotal evidence that a procedure reduces the risk of injury then it is likely that a substantial proportion of participants will already be using it. This makes double blind trials almost impossible. Van Mechelen ran a trial of the prophylactic value of warming up and down only to find that over 90% of participants were using the technique already. (van Mechelen et al. 1993)

It is clearly of dubious ethical possibility, quite apart from a practical possibility to get a control group of athletes not to warm up just to see if they are more likely to get injured.

The management of sports injuries is therefore largely a combination of intuition based on anatomical and physiological principles, guided by experience and validated by what scientific evidence base there is on the subject.

The three case studies presented above have all occurred in similar status club runners for completely different reasons. This therefore exemplifies the need to undertake a holistic assessment of each case in order to be in a position to make a confident and accurate diagnosis. One should note that there are occasions when the injury or the pathology is blindingly obvious, but it is more common to have to undertake further investigations in order to firmly establish the diagnosis. Mr.A might require X-Rays to exclude a chip fracture of his lateral malleolus. Mr. B might require some blood tests to exclude a connective tissue disorder and Mr. C may need further assessment in order to be confident that there is no genuine physical pathology.

References

Apter M J. (2001). Motivational styles in everyday life: a guide to reversal theory. Washington: American Psychological Association, 2001.

Chalmers D J (2002). Injury prevention in sport: not yet part of the game? Inj. Prev., Dec 2002 ; 8 : 22 – 25.

Clemente C D. (19750. Anatomy: A Regional Atlas of the Human Body. Philadelphia, PA: Lea & Febiger; 1975 (Figure 180).

Cogan N A, Brown R I F. (1998). Metamotivational dominance, states and injuries in risk and safe sports. Pers Individ Dif 1998 ;10 :789–800.

Fowler D, P A Garety, L Kuipers (1995). Cognitive Behaviour Therapy for Psychosis: Theory and Practice. London : Wiley 1995

Haddon W, Ellison A E, Carroll R E. (1962). Skiing injuries: epidemiologic study. Public Health Rep 1962 ; 77 : 973–85.

Hall H K, Kerr A W. 92001). Goal-setting in sport and physical education: tracing empirical development and establishing conceptual direction. In: Roberts GC, ed. Advances in motivation in sport and exercise. Campaign, IL: Human Kinetics, 2001 : 183–233.

Hergenroeder A C (2003) Prevention and treatment of sports injuries. Clin Sports Med 2003

Hewett T E , T N Lindenfeld, J V Riccobene, F R Noyes (1999). The effect of neuromuscular training on the incidence of Knee injuries in Female athletes. The American Journal of Sports Medicine, 1999

Kerr J H, Svebak S. (1999). Motivational aspects of preference for and participation in risk and safe sports. Pers Individ Dif 1999 ; 27 : 503–18

Kerr J H. (2001). Counselling athletes: applying reversal theory. London: Routledge, 2001.

Krivickas L S (1997) Anatomical factors associated with overuse sports injuries Sports Med, 1997 Vol 5, no 3

Lee A J, Garraway W M, Arneil D W. (2001). Influence of preseason training, fitness, and existing injury on subsequent rugby injury. Br J Sports Med 2001 ; 35 : 412–17

Lephart S M, D M Pincivero, J L Giraldo, F H Fu (1997) The role of proprioception in the management and rehabilitation of athletic injuries, American Journal of Sports Medicine, 1997 Vol 3 Pg 55-59

Murgatroyd S, Rushton C, Apter M J. (1978). The development of the telic dominance scale. J Pers Assess 1978 ;42 : 519–28.

Nickander R, FG McMahon, AS Ridolfo (2005). Anti-inflammatory agents, Annual Review of Pharmacology and Toxicology Vol. 19 : 469-490

Orchard J, T M Best (2002) The management of muscle strain injuries: an early return versus the risks of recurrance. Clin J Sport Med, 2002 vol 3 pg 26-30

Pain M and J H Kerr (2004). Extreme risk taker who wants to continue taking part in high risk sports after serious injury. Br. J. Sports Med., Jun 2004 ; 38 : 337 – 339.

Parkkari J, Kujala U M, Kannus P. (2001). Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work. Sports Med 2001 ; 31 : 985–95.

Patel D R , E F Luckstead (2000). Sport participation, risk taking and health risk behaviours. Adolesc Med, 2000 Vol 312 pg 22-30

Stevenson M R , Peter Hamer, Caroline F Finch, Bruce Elliot, and Marcie-jo Kresnow (2000). Sport, age, and sex specific incidence of sports injuries in Western Australia. Br. J. Sports Med., Jun 2000 ; 34 : 188 – 194.

van Mechelen W, Hlobil H, Kemper H C G, et al. (1993). Prevention of running injuries by warm-up, cool-down, and stretching exercises. Am J Sports Med 1993 ; 21 : 711–19

Watson A W. (2001). Sports injuries related to flexibility, posture, acceleration, clinical defects, and previous injury, in high-level players of contact sports. Int J Sports Med 2001 ; 22 : 222–5

Wigfield A, JS Eccles (2000). Expectancy -value theory of achievement motivation. Contemporary Educational Psychology, 2000

##############################################################

PDG

A sports injury can be serious and cause profound physical and emotional distress. The physical aspects of the injury can even contribute to loss of a sports career. The emotional stress of a sports injury can result in affects such as anxiety and depression which result in obstacles to healing and future performance (Myers, Peyton & Jensen, 2004). After injury most athletes will suffer from a change in their mood for a short length of time. This change in mood will manifest as anger, depression, tension, and low energy levels. Normally the athlete returns to their pre-injury mental status once they are on their way to recovery (McDonald & Hardy, 1990)

Sports injuries can have a devastating impact on athletes and the search for effective psychological rehabilitation methods have been ongoing. One study using the open-ended Sports Injury Survey found that athletes that healed the fastest engaged in more positive self-talk, goal setting and healing imagery than slower healing athletes. It was found that the mental strategy of goal setting was the most productive technique and scientists believe the reason for this is that it is easy to learn and is within the athlete’s control. The results of the study would suggest that there are numerous psychological factors that play an important role in injury recovery. A number of other studies have demonstrated that speed of recovery was effected by goal setting, attitude, imagery, social support, and coping skills (Ievleva & Orlick,1991). One study demonstrated that imagery can be helpful in injury rehabilitation. Imagery is used often in training and competition, but athletes don’t use it as often for recovery from healing and need to be reminded of its efficacy (Sordoni, Hall & Forwell, 2000)

It has been found that an athlete’s inability to return to pre-injury performance levels was due to psychological factors and stressors rather than physical ones (Evans, Harding & Fleming, 2000). One of the factors with an impact on performance levels post-injury is the athlete’s perceived inability to demonstrate the same skills they enjoyed pre-injury. One example of this isa rugby player who returned to the game after suffering a shoulder injury. He favoured the injured shoulder and used the other shoulder more frequently. The result of this behaviour was that he put extra pressure on the one shoulder setting himself up for future injuries (Evans et al., 2000). When an athlete returns to the game before they are truly ready the risk for more injures or re-injury is increased. Even if an athlete has been told by his sports physician that they can return to competition they may not be ready psychologically (Evans et al., 2000). Cupal (1998) claims evidence exists that indicates when an athlete returns to the sport before they are psychologically ready they increase the risk of more injuries

There are different approaches to explaining how an athlete responds to injury. One of these approaches is designated the cognitive appraisal approach. This approach focuses on the athlete’s perception of the injury and it offers an explanation for individual differences in responses to injury and their perception of the injury (Brewer, 1994). Brewer (1994) believes that one of the positive aspects regarding the cognitive appraisal approach is that it offers explanations for the diverse responses to injuries unlike other methods that don’t provide such insight. There are a number of influencing factors with cognitive appraisal. The individual personality characteristics of the athlete that remain constant over time are a factor. Another factor is the athlete’s changeable situation which they have no control of. One example of this is time of season of the injury (Gayman & Crossman, 2003).

A study of the psychology of season ending injuries amongst skiers from the USA Ski Team was conducted (Gould, Udry, Bridges & Beck, 1997a; Gould, Udry, Bridges &Beck, 1997b). This study included lengthy interviews and revealed different factors of the injury experience. Researchers discovered that some athletes received what they perceived were benefits from the injury. If they had a problem with the stress of the competition they may see this injury as a blessing in disguise and a way out. Performance anxiety can be another reason why an athlete sees the injury as beneficial. Also, rehabilitation can be physically painful and emotionally trying (Gould et al., 1997a). Other factors researchers uncovered were the sources of stress, social support systems, and coping strategies. In some instances a severe injury can interfere with social activities especially if they are sports-oriented (Bianco, Malo, & Orlick,1999). Bianco et al. (1999) interviewed skiers from the Canadian Alpine Ski Team. What they learned was that there was an early phase when the athlete is injured or ill and then they move into a phase of rehabilitation where they begin to recover, and the last phase is when they are fully recovered and back to pre-injury activity. Every one of these phases included a set of events that influenced the emotional and cognitive responses (Granito, 2001, pg. 63). Researchers looked to cognitive appraisal to explain why some athletes suffer from greater psychological distress following an injury than others (Brewer, 1994). What they found was that the manner in which an athlete perceives the injury experience plays an important role in how well they recover and are able to return to pre-injury performance levels (Brewer, 2001, as cited in Gayman & Crossman, 2003).

The time of the year when an athlete is injured may determine how well and fast they recover and return to competition. For example, one athlete may be distraught and stressed over being injured post-season because after all his hard work and team effort he will not be able to participate in the play-offs. Another athlete may regard the injury as beneficial because they can get out of a horrendous season where the team didn’t do very well. The athlete who perceives the injury in a more positive light will have an easier time of recovery than the athlete who experiences more negative emotions surrounding the injury (Gayman & Crossman, 2003)

Pre-season is important because after a break from sports the athletes are ready to get back in the game again and are looking forward to try-outs. An injury sustained pre-season can be regarded in different ways. The more severe the injury is the greater the athlete’s frustration and disappointment (Gayman & Crossman, 2003). An injury that isn’t serious enough to keep the athlete out for the entire season may not be as devastating for some because they become motivated to heal and spend the rest of the season in the game. Different factors enter the picture for mid-season injuries. An athlete who is out due to injuries during mid-season can be more stressed because by this time the team members are bonding. The athlete will also have lost some of their physical abilities that are important to the game. The team has been traveling and playing many games together by mid-season and the injured athlete will feel that they are missing out on the camaraderie and fun (Gayman & Crossman, 2003). When an athlete is injured end of season the success of the entire team may be hindered and this is a source of great stress and disappointment for the athlete. If it’s the athlete’s last year of college, for example, the injury could end his career in sports. If the injury is severe enough regardless the season; it is devastating for the athlete and requires different and more intense coping techniques (Gayman & Crossman, 2003). Finally, the playoffs are important because the team has bonded and worked hard together for an entire season to get that far. Injuries sustained during this time could hamper efforts for the championship title not to mention the personal satisfaction of success (Gayman & Crossman 2003)

How an athlete reacts to their injury may be based on how they personally view the situation. For instance, injury in pre-season may be regarded more negatively by one athlete than another. It all depends on how they perceive the situation (Gayman & Crossman, 2003). There are different factors in the injury recovery process. One of those factors is gender differences. One study found there were differences in the perceptions of male and female injured athletes. It was found that male athletes had reported a more positive relationship with their coaches than the females. Males also were more apt to have a special person in their lives that they received emotional support from. It was discovered that female athletes were more apt to worry about how their injuries would affect their future health than the males (Granito, 2002). Regardless of male or female, it would appear that a good social support network and positive relationships with coaches are important when an athlete sustains an injury. There are, however, more factors involved in the success of an athlete’s rehabilitation and recovery than that of emotional support from others. Other interventions and coping mechanisms involve goal setting, imagery, and self-talk (Ievleva & Orlick, 1991)

There are numerous psychological intervention strategies for rehabilitation from sports related injuries. Oftentimes the athletes’ erroneous thoughts about intervention strategies keep them away from getting the help they need to recover more quickly and fully. The interventions could help them return to competition not only physically ready but psychologically ready as well. Due to a lack of knowledge and understanding leading to faulty beliefs about intervention strategies the athlete doesn’t always get the help they need. The efficacy of any post-injury therapy or treatment depends on the ability of the athlete to accept and receive different techniques and strategies (Myers et al., 2004).

One of the strategies in treatment for sports injuries that isn’t fully understood is that of positive self-talk. Self-talk in injury recovery is even less understood than other techniques and strategies even though athletes do use it for performance improvements. Athletes have used both self-talk that is instructional in nature and self-talk that consists of positive affirmations (Van Raalte, Cornelius, Brewer, & Hatton, 2000). Self-talk has been recognized as an effective tool for improvements in performance but unfortunately, has not been given as much thought as a strategy for recovery from injury. One reason that has been given to explain why there is a lack of knowledge regarding self-talk and its importance to recovery from injury has to do with understanding the fundamentals behind performance improvement in sports (Hardy, 2005)

There is a relationship between performance improvements and self-talk. It has been suggested that it’s the aspect of self-talk that involves functionality that sheds light on its relationship with performance. This includes the cognitive and motivational aspects of self-talk (Hardy, Gammage, & Hall, 2001a). Theodorakis, Weinberg, Natsis, Douma & Kazakas (2000) investigated the efficacy of self-talk with athletes using positive self-talk in proportion to the specific demands of their physical activity. Instructional self-talk was used for the technical demands and motivational self-talk was used for less technical demands such as the athlete’s strength and stamina. The researchers expected that instructional self-talk would be more effective when the demands of the activity involved skills and accuracy and the motivational self-talk would be more effective when the demands involved strength and stamina. The results demonstrated that instructional self-talk for technical demands met the researcher’s expectations, however when the demands were for motivational self-talk the results weren’t as expected (Hardy,2005). The researchers discovered that both types of self-talk generated an increase in performance in the activity of leg extensions but not in the activity of sit-ups which requires stamina. Theodorakis et al. (2000) believe one reason for this outcome is that there wasn’t an equal distribution of males and females for the study thus affecting the results. Theodorakis et al. rightly calls for more research in order to determine why positive self-talk (or negative) impacts athletic performance (Hardy, 2005).

One factor that may impact the effectiveness of self-talk on an athlete’s performance is how they interpret their self-talk as far as it relates to motivation. The athlete may regard their self-talk in either a negative or positive light (Hardy, Hall, & Alexander, 2001b). If an athlete regards their self-talk asde-motivating it certainly not help them recover faster and can even keep them from getting back to pre-injury performance levels. Theodorakis et al.(2000) explains that the lack of differences across groups in his study is that there are motivational aspects to the instructional self-talk and some of the self-talk used by the athletes may have been either motivating or de-motivating. Self-talk is supposed to be positive for the athlete. The attitude of the injured athlete is important to their recovery. If the athlete is optimistic their chances of recovery are greater and they have better coping mechanisms. Suggestions to encourage the athlete are for them to use only positive words, language and tone, during the rehabilitation-in and out of the clinic (Mind, Body, pg.1). Examples of positive self-talk are: “I will get through this” “I will recover fully” “I will get back to playing my sport, better than I was before” “I will get 115 degrees of flexion today” (Mind, Body, 2005, pg. 1). These self-talk strategies will create a more positive and healthy mind set in the injured athlete (Mind, Body,2005). In a study with tennis players it was found that instructional self-talk had a positive outcome on performance but not on self-efficacy (Landin & Hebert, 1999). It is suggested then that practitioners determine if the athlete finds self-talk is to be de-motivating or motivating. An athlete can learn to perceive themselves in a healthier and more self-affirming manner by engaging in positive self-talk (Hardy, 2005).

The speed with which an athlete recovers from injury can be increased by using certain mental strategies. It is up to the athlete and their physician to determine, in light of the patient’s situation and personal preferences, what would be the best strategy to ensure a rapid and full recovery from injury. The athlete and their sports doctor can be creative in coming up with what techniques seem to fit. Special attention should be given to the psychological state of the athlete and the seriousness of the injury. A comprehensive approach to injury management has been proven to be successful through research suggesting that by using more goal setting, positive self-talk, and imagery, athletes recover more quickly from injuries (Mind, Body, 2005, pg. 1)

Self-talk is useful for injury recovery and quite often for the management of physical pain and distressing emotional states. Self-talk is described as, .the endless stream of thoughts that run through your head every day (Chronic Pain, 2005, pg. 1). This self-talk or automatic thinking can be positive or negative and based on logic and reason (Chronic Pain, 2005, pg. 1). There are times when self-talk can be negative and based on faulty perceptions due to inadequate information. In order for self-talk to be effective for recovery from injury the faulty thinking must be recognized and changed. In order to recognize the faulty thinking it’s important to recognize the different categories of non-productive thinking. One method of thinking that is not positive self-talk is generalizing. An example of this is when the individual regards one event as a trigger for a never ending series of negative events. As the pain continues the individual thinks they will not be able to carry on as before and they begin to devalue themselves. Another example of negative thinking is when the individual thinks in terms of catastrophes. With this type of thinking the individual imagines the worst case scenario. For example, they imagine that the pain from the injury will become a problem and they will become embarrassed if out in public or with friends (Chronic Pain, 2005). Another example of catastrophic thinking is when the athlete thinks things will never change and they will never get any better (Lake, 2005). Polarizing is another thinking style that leads to negative self-talk. This is when the individual sees everything as black and white, good or bad, positive or negative. They cannot concede that there is oftentimes a place in the middle. One of the more serious consequences of this thinking is that the individual feels they have to be perfect or else they are a failure; there is no acceptance of the fact that they are human like everyone else and can make mistakes while not seeing themselves as losers. Filtering is when the individual looks at the negative thoughts in a situation through a magnifying glass and minimizes the positive thoughts. One example given of this is when the individual did a great job at work that day but when they get home they realize they forgot to do one thing. The entire evening is ruined because the individual sits there and ruminates on that one task they failed to do. All the accolades they received that day from boss and co-workers is forgotten and only the negative is focused upon. Another negative thinking pattern that leads to unhealthy self-talk is that of personalizing. When something unpleasant, unfortunate, or bad happens the individual thinks that they are blame, even if it’s something out of their control and has nothing to do with them. Emotionalizing is thinking where the heart rules the head. Objectivity is pushed aside for irrational thinking. One example of this is if an individual feels they are dull or stupid and therefore they believe that is what they are (Chronic Pain, 2005).

This type of thinking is dangerous for the athlete especially one who is recovering from an injury. The athlete must recognize the negative thinking and begin the exercise of positive self-talk. An interesting rule of thumb regarding the process of positive self-talk is as follows:

Don’t say anything to yourself that you wouldn’t say to someone else

Be gentle and encouraging. If a negative thought enters your mind, evaluate it rationally and respond with affirmations of what is good about yourself. Eventually your self-talk will automatically contain less self-criticism and more self-acceptance. Your spontaneous thoughts will become more positive and rational. (Chronic Pain, 2005, pg. 1)

What people say to themselves all too often sets the stage for how they look at life and what they do about it. One example of this is when the individual comes home after a day of working and says, I don’t want to exercise today. It’s cloudy outside, there’s no one to walk with, and besides, I’ve already exercised twice this week (Managing Your Pain, 2005, pg.1). A more positive way to respond to this situation is to say, “I don’t feel like exercising today, but I know I’ll feel better afterward and have an easier time falling asleep” (Managing Your Pain, 2005, pg.1). These examples are very important in retraining the mind to engage in positive self-talk. The self-talk one engages in can literally change the way an individual experiences physical pain. Negative messages can lead to increased pain, while positive messages can help distract you from pain (Managing Your Pain, 2005, pg. 1)

There are several steps to take in order to change negative self-talk that leads to increased pain into positive self-talk which speeds up the healing process and leads to decreased pain. The first of these steps is for the individual to make a list of all negative self-talk engaged in. The second step is to change each negative statement on the list into a positive statement. One example would be the following, I’m tired and don’t feel like attending my support group tonight, but if I don’t go I might miss out on some good tips like the ones I learned last month. I can always leave the meeting a little early” (Managing Your Pain, 2005, pg. 1). The third step is to practice the positive self-talk. Even though it doesn’t come naturally and may take some time to become comfortable with keep at it until it becomes second nature (Managing Your Pain, 2005, pg. 1).

Sports studies with business

Chapter 1 – Introduction

The importance of physical activity and physical fitness in terms of “… health and longevity …” have been linked since the “… earliest records of organized exercise used in health promotion … (which were) … found in China around 2500 B.C….” (Hardman et al, 2003, p. 3). Hippocrates, who is “… often called the Father of Modern Medicine, wrote …”:

“… all parts of the body which have a function, if used in moderation and exercised in labours in which each is accustomed, become thereby healthy, well-developed and age more slowly, but if unused and left idle they become liable to disease, defective in growth and age quickly” (Hardman et al, 2003, p. 3).

The link between exercise and health has been a long established fact in medicine that also traces back to “Cicero in 44 BC (who was himself echoing Aristotle) …” who believed that health as one ages is improved by having a good diet along with exercise and mental stimulation (Harlow, 2006). In fact, Cicero “… saw old age as something yet to happen to him …” when he was in his sixties and writing his treatise in an period when less than “… seven percent of the population reached sixty” (Harlow, 2006). The preceding three factors of diet, exercise and mental stimulation as mentioned by Cicero are ingredients that are present in when one participates in sports.

The subject of elderly participation in sporting activities in the United Kingdom represents one of considerable importance as the percentage of older adults increases in proportion to the UK’s total population. This examination shall seek to equate the participation rates for sports in the United Kingdom, delving into how, and if social class represents a contributing factor concerning the potential of this group participating in sporting activities in later life. The prospect of sport participation in later life shall also be undertaken along with whether social class enters into this facet as well concerning participation rates.

The importance of age is impacting the population in the United Kingdom whereby the number of people over the age of 65 has increased to 16 percent, with the age group 85 and older comprising 12 percent of the total population (National Statistics, 2007). The significance of the foregoing is that people are living longer as a result of better nutrition, health care, and living conditions as well as life styles (Quanten, 2004). Interestingly, Quanten (2004) makes the observation that medical science has determined that our basis for calculating the longevity of ancient civilizations is faulty in that the technique utilized in estimating age was based upon bone density. The bone samples generally belonged to middle aged men and women, thus the formula utilized to determine age was based upon the weakening of said density which was slower then than it is now (Quanten, 2004). Thus it was found that the estimation of age has been seriously under represented, putting the average life span of early man in the range of somewhere between 80 and 100 years, meaning that in modern terms civilization has lost ground in aging as opposed to gaining, as was the consensus of thought (Quanten, 2004). Evidence supporting the preceding in today’s world can be found in the fact that there are many examples of individuals living to 120 to 130 years, with the vast majority of them living in extreme conditions where a high degree of physical labour is required for survival, as represented by jungles untouched by modern society, and harsh climates as found in Northern Russia (Quanten, 2004). The common fact linking the ancient study and present day examples of individuals living 120 to 130 years is that their environments were and are more physical in their demands, with the lifestyles requiring more exercise.

Kligman and Pepin (1992, pp. 33-34, 37-44. 47), the American College of Sports Medicine (1998, pp. 992-1008), Dishman (1994, pp. 1087-1094) and Nelson et al (1991, pp. 1304-1311) along with numerous other sources all attest to the benefits of exercise in early life as well as throughout life as beneficial in staving off disease as well as prolonging life. Studies as undertaking by Shepard (1993, pp. 61-64) and, Paffenbarger et al (1989, pp. 605-613) for example, cite incidences in Finland as well as Harvard University in the United States where those who consistently exercised lived on average 2 to 3 years longer that their more sedentary counterparts.

The foregoing brief examples and analysis of age and exercise has been conducted to provide an initial foundation for understanding the framework of this examination which shall delve into elderly sports participation rates in the United Kingdom. The topic of this study is to attempt to determine, if possible, how social class affects the likelihood of doing sporting activities in later life, with its aim to see if social class does have an influence on people taking/carrying on sporting activity in this context. In conducting this examination, the foregoing also seek to compare individuals in the age group representing 55 years of age and above who participate in sporting activities against those who do not through a comparison of their social class backgrounds as represented by working middle class and upper middle class classifications to determine if any correlation exists.

Chapter 2 – Literature Review

Resnick et al (2006, p. 174), in “Screening for and Prescribing Exercise for Older Adults” advise that there is substantial scientific evidence that supports the benefits of exercise in maintaining “… function, health, and overall quality of life for older adults. The article advises that physical activity represents “… one of the greatest opportunities to extend …” an individual’s active as well as independent life and reduce the incidence of disability, and that regular physical activity by older adults are more likely to have better health (Resnick et al, 2006, pp. 174-182). In spite of the clear evidence of the preceding, most adults do not participate or engage in either sport or physical activity, and unfortunately the prescription of a regular physical regime is not yet a routine clinical practice (Resnick et al, 2006, pp. 174-182). The article went on to state that the best methodology via which to engage in a sport or physical exercise is to first seek the aid of a physician to reach a determination of one’s present medical and physical state in order for a person to understand the types of activities they should / can engage in, as well as seeking help with a program to ease them into a proper regime.

The Council of Europe (1993) defines sport as encompassing “… all forms of physical activity …” which includes casual participation for which the aim of the activity is to improve “… physical fitness and mental well-being …” along with the formation of social relationships and or obtaining competitive results. As such, the foregoing expands what one traditionally understands as the defintion of sport into a broader context that includes individual sport as well as fitness activities that include certain dance activities, and aerobics along with walking and cycling (Rowe et al, 2004). The Council of Europe’s (1993) definition includes informal and casual participation, along with the more serious club and professional pursuits (Rowe et al, 2004). The study conducted by Rowe et al (2004) defined participation as at least once a week in the activity, and found that the evidence collected indicated that the United Kingdom had moved towards stagnation with regard to participation levels. The following chart reflects these findings:

Table 1 – Sport, Game and Phyisical Activity Participation in the United Kingdom

(Rowe et al, 2004)

Age

Participation %

1987

Participation %

1993

Participation %

1996

16-19

80

81

79

20-24

69

70

69

25-29

65

67

65

30-44

57

59

58

45-59

35

43

40

60-69

24

28

30

70+

9

15

12

The preceding indicates the fluctuating levels of particpation occuring at the rate of at least one time a week over a four week period for the indicated periods. The following Table shows the foregoing, but excludes walking.

Table 2 – Participation in Sports, Games and Physical Activity

(Excludes walking)

(Rowe et al, 2004)

Age

Percent

Males

Percent

Females

30-44

76

52

45-59

50

39

60-69

45

29

70+

20

10

Social class differences explored in the study by Rowe et al (2004) showed a marked difference in sport participation between the highest and lowest social classifications, as one would expect owing to differences in the ability to spend time on pursuits as a result of disposable income and time, in addition to living closer to facilities and or having the transportation and or a circle of friends who also participate, thus making sport an increased part of their lifestyle.

Table 3 – Differences in Social Class, Sport Participation 1987 – 1996

(Rowe et al, 2004)

Social Class

1987

(Percent)

1990

(Percent)

1993

(Percent)

1996

(Percent)

Professional

65

65

64

63

Senior Manager

52

53

53

52

Junior Manager

47

49

49

48

Skilled

49

50

46

45

Semi-skilled

34

37

35

36

Unskilled

27

28

30

24

Table 4 – Projected Chanages in Number of Sport Participants between 1996 – 2026, Based on Trends Established 1990 – 1996

(Rowe et al, 2004)

Age

1996

(in thousands)

2026

(in thousands)

30-44

6,300

5,500

45-59

3,500

3,600

60-69

1,300

2,400

70+

700

950

The total number of estimated particpants in varied sports activity is shown projected into the year 2026 in the above Table. The increased number is due to the rise of the number of people in these age groups as opposed to actual increased participation (Rowe et al, 2004). Older aged individuals, as shown by Tables 1 and 2 have significantly lower sport activity participation rates which to a large degree, as expressed in the study conducted by Rowe et al (2004), is due to reduced participation in their social group, aliments, lack of income, non-inclusion in their lifestyle as well as being uninformed that sport and exercise represent a healthful benefit that should be continued throughout an individual’s life.

Thurston and Green (2004, pp. 379-387) support the previous contention of the development of more active lifestyles for older individuals, as does the Department of Health (1995) in their document “More People, More Active, More Often. Physical Activity in England”, and Department of Health douments in the years 1999, 2000, 2001 and 2002 that all make references to the overwhelming evidence that indicates that frequent and regular physical activity is beneficial to health. The foregoing includes an increased life expectancy, diabetes, control over obesity, reduction in coronary heart disease, positive health outcomes, increased mobility and coordination as well as other benefits (Thurston and Green, 2004, pp. 379-387). Studies have shown that even if an adult begins sport and exercise programs as late as 60 years of age they can improve their life expectancy by 1 to 2 years, however 40% of adults in the above 60 year age group do not partake in such a regime even if they were aware of the benefits (Thurston and Green, 2004, pp. 379-387).

The understanding of the importance of the older generation as a part of the overall national profile as well as economic, health, medical and social system, the House of Lords published is document titled “Aging: Scientific Aspects”, in 2005 (House of Lords, 2005). The Report stated that the “… economic implications of changing life expectancy are … of great importance …”, with the “… urgency of these matters … “made plain from statistics that point out “… for the first time the number of people in England and Wales aged 60 and over was greater than the number aged under 16” (House of Lords, 2005). When the figures for what is termed the ‘oldest old’, meaning individuals above the age of 85 are included, the implications are even more striking:

Table 5 – Oldest Old Comparisons, UK and the World

(House of Lords, 2005)

Age

Year

UK

Globe

85

1900

5%

1%

85

2000

16%

7%

85

2020

20%

12%

85

2050

—

20%

The growth rate of the aging population in the United Kingdom is outstripping the global rate to the point whereby the UK is projected to reach a figure of 20% of its total population in 2020, fully thirty years before the global population will reach that figure, thus making the prospect of old age health an important one for the country.

Table 6 – Life Expectancy, United Kingdom

(House of Lords, 2005)

Sex

Year

Age

Year

Age

Increase

In Years

United Kingdom

Males

1981

70.8

2002

75.9

5.1

Females

1981

76.8

2002

80.5

3.7

England

Males

2002

76.2

Females

2002

80.7

Scotland

Males

2002

73.5

Females

2002

78.9

The above Table indicates that the life expectancy in England is higher when counted alone. In examining the elderly sports participation rate for the older population in the United Kingdom utilizing social class distinctions, it is important equate the defining aspects of these groups. The following defines the preceding as found in the House of Lords document “Aging: Scientific Aspects”:

Table 7 – Social Class Segments

(House of Lords, 2005)

Class Description

Examples of Occupations

Non-manual

Professional

Doctors, chartered accountants,

professionally qualified engineers

Managerial and

Technical/intermediate

Managers, school teachers,

journalists

Skilled non-manual

Clerks, cashiers, retail staff

Manual

Skilled manual

Supervisors of manual workers,

Plumbers, electricians, goods

Vehicle drivers

Partly skilled

Warehousemen, security guards,

machine tool operators, care

assistants. Waiters and waitresses

Unskilled

Labourers, cleaners and

messengers

Table 8 – Life Expectancy by Social Class

(House of Lords, 2005)

Class Description

Life Expectancy Gap

Life Expectancy Gap

Non-manual

Males

Females

Professional

7.4

3.1

Manual

Unskilled

5.9

2.6

The preceding Table represented an aid in the later determination of social class and if this factor has any bearing, and or influence upon participation in carrying on sporting activities in later life. The House of Lord’s report on “Aging: Scientific Aspects” did indicate through the study of varied reports as well as consultations that it came to the conclusion, which is a consensus view, “… that aging is caused by lifelong accumulation of molecular and cellular damage …” as opposed to the theory of a “… rigid inner clock …” (House of Lords, 2005). Importantly, the ‘Report’ indicated that the process of aging “… is more malleable than has been generally appreciated …” and that the “… mechanisms governing health in old age …” are processes that are ongoing throughout the lives of individuals (House of Lords, 2005). In reference to the implications of this examination, the ‘Report’ “… summarized what appears to be a consensus view …” regarding the key factors promoting good health as well as slowing down the ageing process as (House of Lords, 2005):

physical activity;
having a social role and function;
good nutrition;
absence of risk factors such as smoking and drinking to excess; and
good mental health and well-being

The ‘Report’ stressed that physical activity represents a ‘key’ facet of good health and “… is the major modifiable influence on health in old age” (House of Lords, 2005). In making such a statement the ‘Report’ referred to ‘The Royal Society of Edinburgh’ which stated that exercise has been shown as being a critical factor in maintaining as well as modestly increasing bone density of adults, and more importantly can aid in the minimization of bone loss in older individuals (House of Lords, 2005). The overall ‘Report’ on “Aging: Scientific Aspects” provided key background information that proved helpful, with regard to general information, and indispensable with regard to demographic groups, exercise, and the government’s recognition of the importance of the issue as well as the specific and key identification of key points.

With regard to sport, the Department for Culture, Media and Sport (2007a) aims to encourage wider sports participation, and in regard to the focus of this examination, to promote sport at the grassroots level, which has implications concerning facilities that the older generation either has available, and or needs (Department for Culture, Media and Sport, 2007b). In its Report “Where are we Now: The State of Sport Today”, it clarifies that the government does not run sport, but recognizes it as an important factor in the health, and well being of children, adults, and the older generation (Department for Culture, Media and Sport, 2007b). Overall, across all age and demographic groups, the United Kingdom ranks in the middle of the European Union in sports participation by the general public, as shown by the following:

Table 9 – European Union General Population Sport Participation

(In Percent)

(Department for Culture, Media and Sport, 2007b)

Country

Participate

more than

12 times a year

Occasional,

less than

12 times a year

Non-Participant,

takes part in some

other physical

activities

Non- Participant,

no other physical

activities

Finland

79

2

16

3

Sweden

70

0

8

22

Netherlands

57

6

37

0

UK

47

20

15

19

Ireland

43

21

10

26

Spain

25

6

43

26

Italy

18

5

37

40

In terms of intensity, individuals in the United Kingdom participate in sports on a less regular basis, and with less intensity (Department for Culture, Media and Sport, 2007b). The last aspect does not have applicability with regard to older adults, however the former is a telling statistics concerning its bearing on older sports participation.

Table 10 – UK Sport Participation

(In percent)

(Department for Culture, Media and Sport, 2007b)

Rate of Intensity

Country

Intensive

Regular

Occasional/rare

UK

18

10

72

Sweden

37

22

41

Finland

39

34

27

The following table indicates the rates of participation of residents in the UK.

Table 11 – Competitive and Organized Sport Participation in the UK

(Department for Culture, Media and Sport, 2007b)

Age Groups

Percent

16-19

54

20-24

47

25-29

36

30-34

35

35-39

30

40-44

25

45-49

20

50-54

19

55-59

17

60-64

14

65+

10

The ‘Report’ indicates participation rates among social economic groups varies, however it does not break out these statistics into age groups.

Table 12 – UK General Population Sports Participation by Social Economic Group

(Department for Culture, Media and Sport, 2007b)

Socio-Economic Group

Males

Females

Unskilled manual

34

19

Semi-skilled manual

49

29

Skilled manual

48

34

Intermediate/junior

Non-manual

61

43

Employer/manager

56

49

Professional

61

67

Table 13 – UK Sport Participation by Ethnic Minority

(Department for Culture, Media and Sport, 2007b)

Ethnic Group

Male

Female

Black Caribbean

45

34

Black African

60

34

Black other

80

45

Indian

47

32

Pakistani

42

21

Bangladeshi

47

29

Chinese

53

39

Other

51

41

National Average

54

39

Sport England (2005) undertook a study that systematically reviewed published and unpublished research studies regarding children, and adult reasons concerning participation as well as non-participation in sport, which this examination utilized to add to the other research and literature sources. An important facet that was identified in the study was one representing an individual’s personal appearance and proficiency levels. The preceding two aspects are generally overlooked factors that are a part of a person’s sport participation consideration. The very real concern of having an unfit body, being out of shape, not able to conduct certain aspects of sport participation performance on a level that could potentially lead to personal embarrassment, are very real concerns that could and do enter into dissuading individuals from participating in a sporting activity (Sport England, 2005).

Facilities and availability are also factors that enter into the participation equation, along with costs. For example, the incidence of parks, walkways, golf, tennis, cricket, bicycle paths, gym facilities and the like are more likely to be located near to upper income neighbourhoods than lower income

Critically analyse how the physiological benefits of exercise contribute to an improvement in coping with the physical demands of everyday life in this client group and how it compares with traditional Physiotherapy Techniques (Postural Drainage and Percussion)

Cystic fibrosis is an inherited disease very common among Caucasians, but rare in Asians and Negroes. It is an autosomal recessive condition, with an estimated one in twenty of a Caucasian population heterozygous for the condition. The number of live births of children having cystic fibrosis is high; between 1 in 500 and 1in 3000 (P. Howard, 1991 p.137), or 1 in 2000 (P. McGowan, 20003 p.142, G.K. Crompton, 1987 p.289). In the UK a figure of 1 in 4000 is given (W.J.M/ Kinnear et al, 1999 p.52). Kinnear et al (p. 52) also suggest a reason for the extremely high number (1 in 20) of heterozygotes in the population, that perhaps this high number is the result of some selection advantage, in this case possibly providing some protection from severe secretory diarrhoea caused by for example cholera.

A mutation in a single gene (called pf) causes a defect in a plasma membrane protein called cystic fibrosis transmembrane conductance regulator (CFTC). This gene is found on chromosome 7 (W.J.M. Kinnear et al, 1991 p. 52), and it is this gene that normally controls the movement of calcium ions. With it non-functional, calcium ions cannot pass through the membrane (P.H. Raven & G.B. Johnson, 2002 p.261). As with many other inherited disorders, the pf gene has pleiotropic effects, i.e. one gene has multiple effects, in this case overly sticky mucus, clogged blood vessels, salty sweat, pancreas and liver failure and many other symptoms (Raven & Johnson, 2002, p.253).

Sometimes the gene appears to have the correct amino acid sequence but the condition is still produced. This appears to be due to a defect in one of the chaperone proteins, proteins that enable the gene product to fold to its final form. With the chaperone protein defective this does not occur and so cystic fibrosis is still the result (P.H. Raven & GB Johnson, 2002 p.44). The table below shows (a) features of cystic fibrosis, (a) and (b) some complications arising from it.

FEATURES OF CYSTIC FIBROSIS

Respiratory manifestations

Gastrointestinal manifestations

Recurrent bronchopulmonary infection

Meconium ilius

Bronchiectasis

Rectal prolapse

Diarrhoea

Failure to thrive

Malabsorption

COMPLICATIONS OF CYSTIC FIBROSIS

Respiratory complications

Other complications

Bronchiectasis

Abdominal pain

Cor pulmonale

Biliary cirrhosis

Haemoptysis

Delayed puberty

Lobar collapse

Diabetes mellitus

Allergic aspergillosus

Gall stones

Sinusitis

Growth failure

Nasal polyps

Male infertility

Wheezing

Portal hypertension

Pneumothorax

Rectal prolapse

(Definitions:cor pulmonale: disease of the heart characterised by hypertropy and dilation of the right ventricle and secondary disease of the lungs or their blood vessels.

Bronhiectasis: a chronic inflammatory or degenerative condition of one or more bronchi or bronchioles marked by dilation and loss of elasticity of the walls. Anon, 2006 in Medline Plus, Medical Dictionary)

Other complications can also occur, some these being given by P. McGowan (2003 p.142) as Meningitis, Metastatic abscess (e.g. in the brain, and Amyloid formation (e.g. in the kidney).

At present cystic fibrosis is always a fatal condition, death occurring either from the condition itself, or from one of its many complications. However the outlook for the patient, both in terms of life span and quality of life has continued to improve over the last few decades. Where once it was largely a disease of childhood with only about 5% reaching the age of 17, a 1987 publication estimates perhaps 25% surviving to age 20 (G.K. Crompton, 1987 p. 292). By 2003 though, the mean survival had risen to 29 years (P. McGowan, 2003. p.143).

There are several methods of treatment for cystic fibrosis, improvements in some of these being responsible for much of the improvement in outcome for patients seen today. These methods will be discussed, in particular the traditional physiotherapy methods of Postural Drainage and Percussion, and compared to the effect of exercise on the patient’s prognosis. But first a brief consideration of the effects of cystic fibrosis so that it is clear what the treatment is aiming to change.

Cystic Fibrosis: Signs and Symptoms

Cystic fibrosis is primarily a disease of the respiratory system, although various other parts of the body are also affected. It is caused by the gene mutation referred to in the introduction. There are up to 500 different mutations, but 3 main ones, which cause 90% of the cases (W.J.M. Kinnear et al, 1999, p.52). These adversely affect the exocrine glands and the mucus-secreting glands, resulting in excess mucus and difficulty in clearing it. All such glands are affected, thus its wide ranging effects on other organs apart from the lungs, e.g. the pancreas. The excess mucus production is difficult to remove, due to impaired ciliary action in the airways leading to repeat infections and bronchiectasis.

The disease is normally present at birth, although initially it may be asymptomatic or confused with other respiratory conditions such as asthma. Early signs of the disease are not always of a respiratory nature however, as some new-borns present with meconium ilius, while in some young children malabsorption and failure to thrive occur (W.J.M. Kinnear et al, 1999, p.52). Respiratory complications are however, the main feature, and generally present by age ten. Thick, viscid mucus is produced which is difficult to shift, and the bronchial obstruction it causes leads to infection. This leads to further obstruction as DNA from dead bacteria increases the viscosity and so produces a cycle of infection and increasing viscosity.

Coughs, occasional at first, become more frequent, eventually leading to bronchiectasis with persistant purulent sputum expectoration. There may be blood in the sputum (haemoptysis), wheezing and intestinal obstruction, and the patient may become breathless (P. Howard, 1991, p. 28). These conditions worsen, nutrition may be poor leading to stunted growth, and finger clubbing becomes common as bronchial infection takes hold, and finally, in the terminal stages there may be cyanosis and cor pulmonale

As can be seen from the aforementioned, cystic fibrosis is not a straightforward disease, and often, especially in babies and young children positive diagnosis can be difficult. Symptoms may be similar to other respiratory conditions, particularly in the early stages, plus secondary conditions may occur. These include infections such as with Staphylococcal pneumonia, this initial infection allowing further infections with other bacteria, particularly where broad spectrum antibiotics have been used so removing non-pathogens and allowing colonisation by drug resistant Staphylococci. If the patient survives to 16 or 17 years of age gastrointestinal problems may continue, but then respiratory disease tends to dominate, ending with cor pulmonale and/or respiratory failure (P. Howard, 1991, p138).

Because of the variety of symptoms and the difficulty sometimes of diagnosing cystic fibrosis, there is no one specific treatment, treatment being aimed at the removal of mucus secretions so aiding prevention and control of pulmonary symptoms (GK Crompton, 1987, p. 291). And this is the more effective the earlier in the disease process it is started. Thus a definite diagnosis as early as possible will lead to more effective treatment.

Various tests are carried out when cystic fibrosis is suspected. This may be because of a family history of the disease, failure of the child to grow at the expected rate, gastrointestinal problems or other respiratory problems such as asthma with which it may be confused. Pre-natal diagnosis may be carried out by amniocentesis or chorion-villous sampling if parents are known to be carriers of the condition. Otherwise various tests, e.g. the Guthrie test, the Immunoreactive trypsin test or most commonly the Sweat test (in which raised levels of sodium and chloride in the sweat are taken as a clear indication of the disease and is the most accurate test for this) are carried out. However the sweat test is not always so effective in adults.

Traditional Treatments: Postural Drainage and Percussion

Once the condition has been diagnosed treatment should be started immediately, even if the child has only minor symptoms or is asymptomatic. Treatment(s) may be based on any or all of the following: Physiotherapy, Antibiotics, DNase (to degrade the bacterial DNA that builds up in the airways, Anti-inflammatory drugs and nutritional support. It is the physiotherapy treatment that will now be considered.

The two traditional physiotherapy techniques that are used for Cystic Fibrosis patients are Postural Drainage and Percussion. As the name implies, the former technique centres around placing the patient in a particular posture to facilitate draining of excess mucus from the airways. It is used in the treatment of bronchiectasis and lung abscesses, and the patient is placed head downwards so that the trachea is down and below the affected area so allowing drainage to occur (Anon, 2006). The use of postural drainage has quite a long history, with the first reference to its use in 1901 by W. Ewart in the Lancet (L. Lannefors et al, 2004). Ewart suggested continuous drainage for hours, with the patient sleeping in the position if possible.

For postural drainage their are 12 positions, one for each lung unit, and once the patient is in the appropriate one percussion is applied (L.Lannefors et al, 2004). Percussion is a technique used to assess changes in the thorax or abdomen, and is carried out by tapping the surface to deduce the underlying structure. It is “done with the middle finger of the right hand tapping on the middle finger of the left hand, which is positioned with the whole palm on the body” (Anon, 2006). This can produce four different sounds, sonorous, hypersonorous, relatively dull sound, or completely dull sound, these indicating the structure below. For example a solid mass will produce a dull sound, while a hollow, air-containing structure will produce a sonorous sound.

No studies have been carried out on the effects of manual percussion, but it is thought that air trapped between the chest wall and the cupped hand produces a vibratory wave that loosens secretions attached to the airway walls. These two techniques are often used in conjunction, a problem with the postural draining being the time that the patient must lie in the appropriate position, an hour being suggested as the effective time. For babies and toddlers an hour in this position is only likely to be possible when they are asleep. For older patients compliance with the treatment may be difficult – how many children or teenagers can happily stay still in a particular position for up to an hour without boredom setting in?

But what of the actual effectiveness of these techniques? They have been used for a long time now often with modifications to the original method. There is much in the literature concerning these methods but including much that is conflicting, leaving the benefit of these treatments not always clear.

There are now many techniques for airway clearance including variations on the two in question, thus it is difficult to make a straight comparison between them all. SG Butler and RJ Sutherland (1998) looked at several airway clearance techniques and concluded that no one technique was shown superior to the others. But a long-term study comparing conventional postural drainage and percussion with the positive expiratory pressure (PEP) technique found PEP to be significantly better. One other study looking at several techniques concluded that there was no particular difference between them, but that all were better than no treatment (J Thomas & D Brooks, 1995).

More recent papers indicate a lesser use of postural drainage in its original form, for example BM Button et al, (2004), compared traditional postural drainage with a modified form and found that the latter resulted in less episodes of gastro-oesophageal reflux. Similarly a review of the physiotherapy management of hospitalised children (K Farbotko et al, 2005) revealed a significant decrease in the use of postural drainage, but an increase in the use of a modified postural drainage system, and positive expiratory pressure devices. Other methods showed no significant change in their use.

Another recent study (F Dennis & MJ Rosen, 2006) considered non pharmacological airway clearance therapies by reviewing many papers on the subject, and concluded that such therapies did increase airway clearance, but that their effect compared with the unassisted cough was unknown. Thus there are many studies but they are often not comparable, they assess different methods, do not always have large enough sample sizes to make statistical comparisons, and of course are using different groups of patients who may vary in many ways. For instance in age, sex, seriousness of their symptoms, or in compliance with the treatments. CM Oermann et al, (2000) found that it was the sicker patients who were more likely to be compliant, something that could skew results if not taken into account in further studies.

Benefits of Exercise

In recent years more emphasis has been placed on the use of exercise as a means of treating cystic fibrosis patients, and for these an improvement in aerobic capacity is particularly useful. Exercise has benefits for all, and changes in both anaerobic and aerobic systems can occur depending on the type of training undertaken. Improvements in anaerobic systems are of more use in preparing for short-lived events requiring power or speed, e.g. weight lifting or sprinting, while improvements in aerobic systems are needed for distance events. In patients whose respiratory systems are compromised as in cystic fibrosis there will often be a reduction in lung volume or distensibility, with a corresponding reduction in vital capacity, total lung capacity and also inspiratory muscle strength (M Estenne et al, 1993). For these patients aerobic exercise is likely to be useful.

Aerobic respiration causes various changes in the individuals’ metabolism and in the cardiovascular and respiratory systems. Some of these are listed below, the list being compiled from Exercise Physiology, by McArdale et al, (1996)

Metabolic Adaptations
Mitochondria from trained skeletal muscle become larger and more numerous
Increased capacity to generate ATP
An increase in the trained muscles capacity to mobilise, deliver and oxidise lipids
Increased carbohydrate metabolism
Selective hypertrophy of fast and slow twitch muscle types depending on use
Cardiovascular and Respiratory Adaptations
Heart size generally increases
Increase in plasma volume
Heart rate decreases as a result of aerobic training
The heart’s stroke volume and cardiac output increases
A significant increase in quantity of oxygen extracted from the blood
Aerobic training causes a large increase in total muscle blood flow during maximal exercise
Blood pressure is reduced both at rest and at sub-maximal exercise
Psychological benefits.

A consideration of the above list indicates several changes of interest for the cystic fibrosis patient, for example the increase in oxygen extracted from the blood and an increase in the ability to oxidise lipids. And psychological changes produced by sport or any physical activity are important for both the healthy individual and the CF patient. It can reduce mild depression, aid in sleeping, and give confidence in ones physical abilities, all which will make the patient more confident in themselves and in their handling of their condition. Although exercise alone is not going to replace all other treatments, it has a definite place as one of them, especially in the earlier and milder stages of the disease.

An overview of treatment for cystic fibrosis (L Lannefors et al, 2004), describes the methods used at the Lund CF Centre in Sweden, starting in the 1980’s. There the treatment is tailored to each individual, with an emphasis on physical activity and absolutely no use of postural drainage or percussion (not used there since 1983). The treatment is started as soon as the condition is diagnosed and incorporates much physical activity. This is particularly important for babies or very young children, as they need to get used to someone applying physiotherapy. Left to the age of 3 or 4 years the child may not be very amenable to what to them is a boring and pointless activity, but started sooner is more likely to accept the treatment.

The activity part of the treatment is tailored for each individual with their input taken into account, and aims to keep air-ways as clear as possible using physical activity, and physical activity as therapy for adults with bronchiectasis has been described ( J Pryor, 2004). Although there appears to be little to back the approach considering the lack of rigorous clinical studies available, it does appear from accumulated clinical experience that patients benefit from it.

The paper by DM Orenstein et al, (2004) considers at length strength and aerobic training in children with cystic fibrosis, with many similar points made as in L Lannefors et al, (2004) overview of CF treatments. The introduction to this paper contains a brief review of many others, often showing similarities in results but not backed up by rigorous clinical studies. This study is the first fully randomised trial, measuring fitness, pulmonary function and quality of life, and was tested on a home based exercise programme. The CF patients were chosen according to pre-set criteria and randomly allocated to treatments. Thus the results could be analysed to check for any significant changes in outcomes.

Results for this study were not always as expected, particularly for the aerobic training group which showed no increase in measures of aerobic fitness over time. It did not produce any greater fitness or pulmonary function than strength training. However both groups showed significant increases in weight gain, of particular importance, as CF children are often underweight leading to increased morbidity and mortality. The trial did not always give the expected results, but as great care had been taken with the experimental design, at least the results could be properly quantified and analysed.

Conclusion

In conclusion, it would appear that work still needs to be done regarding appropriate experimental design, to fully understand the rationales for treatment, and to fully appreciate the effect of physical activity on aerobic capacity and disease progression. For as Orenstain et al comment:

“Exercise has the ability to improve the ability of a patient with Cystic Fibrosis to cope with the physical demands of everyday life” (Chest 2004, 126:1204-1214)

REFERENCES
Anon (2006) Medline Plus on-line Medical Dictionary http://www2.merriam-webster.com/cgi-bin/mwmednlm accessed 29/04/06
Butler, SG, & Sutherland, RJ (1998) Current airway clearance techniques. New Zealand Medical Journal vol 111:183-186
Button, BM, Heine, RG, Catto-Smith, AG, Phelan, PD & Olinsky, A (2004) Archives of Disease in Childhood vol 89:435-439
Crompton,GK (1987) ‘Diagnosis and Management of Respiratory Diseases’ 2^nd ed pub: Blackwll Scientific Publications
Dennis, F, & Rosen, MJ (2006) Monpharmacological Airway Clearance Therapies Chest. vol 129;250S-259S
Estenne, M., Gevenois, PA, Kinnear, W, Soudon, P, Heilporn, A & De Troyer, A. (1993) Lung volume restriction in patients with chronic respiratory muscle weakness: the role of microatelectasis. Thorax vol. 48(7):698-701
Farbotko, K, Wilson, C, Watter, P and MacDonald, J (2005) Change in physiotherapy management of children with cystic fibrosis in a large urban hospital. Physiotherapy Theory and Practice vol. 21(1)pp13-21
Howard, P (1991) ‘Respiratory Medicine in Clinical Practice’ pub: Edward Arnold
Kinnear, WJM, Johnston, IDA. & Hall, IP. (1999) ‘Key Topics in Respiratory Medicine’ pub: Biosis Scientific Publishers
Lannefors, L, Button, BM & Mcilwaine, M. (2004) Physiology in infants and young children with cystic fibrosis: current practice and future developments. Journal. of the Royal Society of Medicine vol 97 (suppl 44):8-25
McArdle, WC. Katch FI, & Katch, VL. (1996) ‘Exercise Physiology: Energy, Nutrition, and Human Performance’ 4^th ed. Williams & Watkins, pub: McGowan, P (2003) ‘Respiratory System’ 2^nd ed. Mosby, pub.
McIlwaine, PM, Wong, LT, Peacock, D & Davidson, AGF (1997) Journal of Pediatrics vol 131(4):570-574
Raven, PH & Johnson, GB (2002) ‘Biology’ 6^th ed. pub: McGraw Hill,
Oermannr, CM, Swank, PR & Sockrider, MM. (2000) Chest vol 118(1):92-97
Orenstein, DM, Hovell, Mulvihill, MF, Keating, KK, Hofstetter, CR, Kelsey, S, Morris, K, and Nixon, PA. (2004) Strength vs Aerobic Training in Children with Cystic Fibrosis. Chest. vol 126:pp 1204-1214
Pryor, J. (2004) Physical Therapy for Adults with Bronchiectasis. Clinical Pulmonary Medicine vol. 11(4):201-209 J R Soc Med 2004;97(suppl. 44):pp8-25
Thomas, J, Cook, DJ & Brooks, D. (1995) Chest physical therapy management of patients with cystic fibrosis: a meta-analysis. American Journal of Respiratory and Critical Care Medicine. vol 151 (3 part 1):846-850

What is outward Bound

Outward Bound believe in reaching out to people who constantly seek to challenge themselves people with the will to chase their dreams and the zest to drive others forward. Through a wide range of fun and unique activities, Outward Bound brings out the dynamics of teamwork and drives people to go beyond themselves. Outward Bound believes that no obstacles are insurmountable as long as we work together.

Outward Bound Singapore is part of global network of Outward Bound centres and is recognised locally and internationally as a leader in outdoor education and adventure learning.

Outward bound is a learning adventure – one that impels you to discover more about your inner self as it challenges your body, mind and soul to respond to an unfamiliar journey.

It inculcates both mental and physical ruggedness and enables you to be more adaptable to changes and unafraid of the unknown. It also fosters teamwork and prepares you for the service of the larger community.

OBS believe that while life slices and values may be taught in the classroom, they only gain true meaning through real life experiences. Through direct and purposeful outdoor experiences, OBS facilitate their trainees to face adventures and move beyond their personal boundaries to discover themselves.

How Outward Bound (OB) was developed

OB was established in 1941 in UK. Outward Bound’s outdoor education courses are based on the principles learnt from training young British seamen to survive in the North Atlantic Ocean during the second world war. It was inspired by Dr. Kurt Hahn who was a German educator. Dr. Kurt Hahn recognized the needs of Lawrence Holt who is the head of the Blue Funnel Shipping Line which was a merchant shipping company.

During World War II, when Blue Funnle Shipping Line was hit by German torpedoes the new seamen from Blue Funnle Shipping Line could not endure the surroundings in the lifeboat as compared to the sophisticated seamen

Hahn felt that not having enough life experience might be the reason for the Blue Funnle Shipping line to be unable to endure the conditions in the boat during World War II. The German experienced seamen learnt a lot of piratical skills and they also knew how to handle a difficult situation which enabled them to have more confidence and ability to cope with the demanding challenges.

Enhancing the young people confidence and the capacity to cope with life was the main intention of the intensity and mini-life experiences of outward bound

To discover his students true capabilities through life experience that would help them find their greater capabilities, was one of Hahn’s philosophies.

The name Outward Bound was given by Lawrence Holt. “Outward Bound” is used to refer to the flag Papa, flown on a ship when it was soon to leave port. It would be a signal to the sailors to return to the ship if the “Outward Bound” flag was flying. “Outward Bound” literally refers to the moment a ship leave’s the harbour. This symbology remains important in Outward Bound, and participants on courses in many Outward Bound schools today receive a pin lapel of the flag papa.

History of Outward Bound Singapore (OBS)

In 1967, the idea of an Outward Bound School of Singapore (OBSS) was suggested by the Minister of the Interior and Defence and Deputy Chairman of the People’s Association, Dr. Goh Keng Swee. Then, the nation was going through a period of uncertainty and to face challenges ahead, Singapore’s leaders had called for the building of a “rugged society”.

The original school was started by two New Zealanders – Hamish Thomas and Al Cameron in December 1967. It began with the objectives that still form the basis of the OBS today: “To provide education, leadership and character training; developing the physical, mental and spiritual faculties of boys, girls, young men and women of all races of Singapore”.

The management of OBS was moved from the People’s Association to the Ministry of Defence (Mindef) in 1971. Besides providing adventure training and leadership training to young men and women, it was an avenue to give ordinary Singaporeans a taste of military life.

OBS was returned to the People’s Association in 1991 and the school was been renamed Outward Bound Singapore. The aim of the school was to offer Singapore’s young people exciting activities to develop their physical and mental ruggedness, personal confidence and leadership qualities.

What is OBS mission & vision, motto and core values?

MISSION

To develop character, leadership skills and team spirit through direct and purposeful experience in the outdoors

VISION

To be a world-class Outward Bound centre for outdoor education and leadership development

OBS MOTTO

To serve, to strive and not to yield

Their core values are:

Safety Minded

Safety is the foundation of the OBS. We are committed to the highest safety standard in whatever we do.

Teamwork

We contribute individually and as a team to achieve our vision and mission.

Professionalism

We strive for integrity and excellence in our work and conduct. To be the best in our field of contributions.

Learning Driven

We constantly challenge ourselves towards new areas of improvements and growth.

People Centred

We value our staff. We recognise good performance of our staff and are committed to developing them to their fullest potential.

Customer Focused

We value our customers and commit ourselves to constantly deliver excellent quality service. We strive to meet and exceed expectations.

OBS’s target group

OBS does not only target youths, it is for everyone. With the wide range of courses, there will be something for everyone at OBS. OBS courses is customized to meet the society needs. Outward Bound Singapore target groups can be categorized into: Professionals, Youths, Kids and Family and for outdoor enthusiasts.

Professionals

In the corporate arena, leadership is the key to success and teamwork is essential to getting things done better, faster and more efficiently

Many corporate leaders need to hone their ability to lead and motivate their teams. Through OBS’s specially designed programmes, they will have the perfect opportunity to unleash their true potential and take themselves and their team to new heights.

For executives looking to grow in the areas of leadership, team-building and change management, OBS’s Professional Development Programmes (PDP) has a range of course that will help equip them with skills to overcome future challenges.

Youths

At OBS, they believe in helping young people make the most of their potential. Through learning-driven outdoor activities including rafting, kayaking and climbing guided by OBS’s professional instructors, they give youths the opportunity to challenge themselves and develop valuable life skills.

Step out of the classroom and venture beyond the textbook

For kids and family

OBS offers customised programmes for students aimed at fostering independence and interdependence life skills. Making use of outdoor experience such as camping, trekking, raft building, rock climbing and more, these programmes give children the opportunity to learn from each other and develop leadership qualities early in life.

In addition, OBS’s family programmes are designed to maximise quality time together for parents and children in which emotional bonds and family ties can be strengthened.

When it comes to nurturing future leaders, an early start goes a long way.

For Outdoor Enthusiasts

Whether you’re a newcomer to the great outdoors or an experienced outdoor leader, OBS has training programme which will hone your skills and enhance your development

Nothing makes for a better outdoor experience than total confidence in your skills.

OBS’s Programmes

OBS programmes are designed to be physically and mentally rugged, the programmes utilise the outdoor settings to develop character, values, mental ruggedness and a community spirit.

By allowing them to learn through focused discussions and practical applications within fun environment, OBS’s programmes complement what the participants have learnt in schools to provide them with a complete learning experience.

Some programmes offered by OBS are:

Character and leadership programmes

Global programmes

Special programmes/Youth-At-Risk

Character & Leadership Programmes

OBS Youth Programmes are drawn out to attract the youth with an action-packed blend of adventures and surprises. Youths develop competencies such as self-awareness, social awareness, self-management, relationship management and responsible decision making as they move progressively through challenging problem-solving activities and expeditions.

Orientation & Induction Programmes – Esprit de Corps

My Outward Bound Journey

A Leader’s Journey

Orientation & Induction Programmes – Esprit de Corps

The Orientation & Induction Programmes aims to build greater understanding and cohesion, school or class spirit in newly formed school cohorts.

This programme focuses on self and team discovery. In Primary four and Secondary One, the students are relatively new to each other. In order to build greater understanding, cohesion, class spirit and strong bonds between the class mates, there is a special designed programme which is specially made for them, which is called “Camp Discovery.”

Character Development Programmes – My Outward Bound Journey

Outward bound programmes is not only an outdoor adventure, it sis essentially an inward odyssey. It helps an individual to find out about his or her capabilities or potential and also learn to improve personal and leadership qualities.

Character building, teamwork , dealing with the unfamiliar, familiarity with Challenge, Initiative, Tenacity and Personal Mastery are what one can gain from My Outward Bound Journey.

Leadership Development Programmes – A Leader’s Journey

By developing the key characteristics and competencies of an effective leader, one can be equip with the knowledge and skills of leadership through A Leader’s Journey by OBS.

The leadership Development not only allows personal growth but as well as acquirement of team management skills. Numerous leadership theories are included in each module and can be included in the Primary Four syllabus. Characteristics and styles of a leader and models of leadership are also used in the programme.

Global programmes

OBS also has overseas programmes. They have partnered with overseas Outward Bound and adventure centres to bring richness of an overseas experience to the participants.

These overseas programmes are designed to give our youth a global outlook in life. OBS aim to inculcate:

An Adventurous Spirit

An adventurous spirit is basically helping youths to:

Accept and overcome challenges and obstacles.

Discover new horizons.

Go beyond their limits.

An Enterprising Spirit

Help youths to:

Knowledge the value of teamwork, trust, mutual support, leadership in decision making and problem solving skills.

Become resourceful and creative.

An International Perspective

To help youths to:

Knowledge the richness of culture, social and economic diversity available in other countries.

The reason why OBS started the Global Programmes was because they wanted to give young people exposure to foreign cultures and environments. Each programme helps youths in building confidence, leadership, tenacity and other personal attributes aimed at helping youths develop a more adventurous and enterprising attitude.

Through a global disclosure the Global Programmes are intended to give youth a global outlook in life, aimed to inculcate an adventurous & enterprising spirit, and cultivate an international perspective. Participants can anticipate an experience that ranges from 8 to 26 days in an abroad centre.

The programmes are categorized into series of the Adventure Challenge Courses.

Adventure Challenge – A Global Perspectives

Classic 21-Day Challenge – The ultimate of OB Experience

Other Customised Programmes

Adventure Challenge – A Global Perspective

OBS takes secondary and tertiary students on an exhilarating Outward Bound journey to Sabah, Perak, Brunei Darussalam, India, Mongolia, Philippines, Croatia, Taiwan and Australia for Adventure Challenge programme.

Having severe expeditions in deep snow conditions in South Korea, Japan and China is a challenge that will be faced by the student leaders given by OBS. Awareness of personal and group goal-setting, planning and coordinating as a group, team development and personal leadership styles are skills that will be developed in the participants through the disclosure to unknown tropical and winter environments.

Classic 21-Day Challenge – The ultimate of OB Experience

To help young adults realize their potential, a mentally and physically demanding course that features a range of activities and challenges are designed. The surrounding islands of Singapore and the rural environment of Pulau Ubin is the classroom of the classic 21-day Outward Bound programme.

The programme uses the journey concept and allows participants to experience an array of elements and multi-expeditions which keep them on the move most of the time.

It will help participants develop their personal attributes and contribution in the context of a group while also exploring their leadership potential.

Other Customised Programmes

OBS is specialized character development and/or leadership development and team development.

OBS alter programmes just to meet the precise needs of their customers. Before arriving at the final conclusion of the programme design, OBS works with their clients to establish objectives, expectations and desired outcome.

These programmes can be targeted at explicit profile groups such as Gifted Education groups, Integrated Programme schools, International schools, Specialized Independent schools, School Staff Training (Teachers/ HODs /Principal) and many more.

Sharing by two students who have attended Outward Bound Singapore’s Global programmes:

“I’ll definitely remember this Outward Bound Course for life because it has given me immense satisfaction. The safety precautions are all kept in check, and I have never once felt that my safety has been compromised. It has indeed been a fruitful experience, and it has helped in shaping my character and building up my ability to adapt to different situations and face greater challenges in my personal, academic and work life.”

– Tong Pei Shan, undergraduate (after completing her South Africa programme)

“I have learnt that as we step out of our comfort zone, we adapt to our new environment and grow stronger in the process, if we were to stay in our comfort zone, we can never be successful in life. This programme to Australia has left great impact on me and I learnt a lot in the 10 days and this is something that cannot be achieved in the classrooms.”

– Chen Libo. Hwa Chong Institution (after completing his Australia programme)

Special programmes/Youth-At-Risk

OBS does not only cater to normal youth but also there are programmes that help youths who needs special needs and youths who had once gone through a bad phase in life (youths that had done things which are against the law). The special programmes are:

Youth at risk programmes
Special needs programme

These programmes are developed by using programming principles based on psychology and social work research.

Youth at Risk Programmes

These altered programmes are made to help the youth to learn and know more about themselves. Development of life skills and promotion of healthy lifestyles, attitudes and perspectives are also achieved by these programmes.

Basically what this programme aims to do is to instil this phrase in them, “a difficult past does not mean a difficult future.” These programmes might give the youths a fast and good solution on the spot but rather it is helping them to create opportunities to help them discover that the solution they are seeking for is found within themselves and no one else.

Special Needs Programmes

In these programme, the participants may have an intellectual disability, learning disability and or a physical disability. Through this programme these participants with special needs can experience what outdoor is. They will also be able to build self confidence and develop life skills like teamwork, communication and leadership.

Below are some comments shared by the special need programmes participants:

“ Don’t give up easily, persevere, be patient, cooperate…and only we can overcome our fear. There is no way we can overcome our fear if we don’t want to, no matter how much our friends or parents or others encourage us, if we don’t want to overcome it, we can’t.”

“ I learnt that I should be more cooperative towards others and when we make mistakes, the issue is that we should learn how to admit it, learn from it and don’t repeat it again”.

“I learned life lessons – it’s our CHOICE, our LIFE. Learn to walk out of DARKNESS.”

Conclusion

OBS helps people discover and develop their potential to care for themselves, others and the world around them through challenging experiences in unfamiliar settings.

“OBS nurtures the youths to be physically and mentally strong. They develop self-confidence, resilience, leadership and teamwork. They are instilled with the resolve to strive and succeed, and the sense of responsibility to give back to the society. Through the ruggedness of the OBS course, inner strength is built up and values vital to the success of our nation are imbued.”

Prime Minister Lee Hsien Loong

The question is how does OBS benefit the society? The answer is by instilling values in them, by teaching them beyond the classroom. The sense of community service, teamwork, self-confidence, discipline and values inculcated during OBS course are very important for an individual to have.

OBS does not only help youths, it helps the whole society; everyone, from young to middle age to old and even special children (having any kind of disability). One of OBS’s target groups is the corporate world. In the corporate world there will be new challenges everyday and we will need good leaders to lead. Not only do we need a good leader but a good team who can work well with each other and have the “never give up” attitude to overcome any obstacles. Outward Bound Singapore does help companies with this; Outward Bound Singapore’s programmes will have the perfect opportunity to unleash the leaders’ true potential and take themselves and their team to new heights.

Instilling values in oneself is never too early. OBS programmes for kids and family instil leadership qualities in the kids who will one day go into the working world and apply their values that they have learned in OBS. Not only that, OBS strengthens the bond between the family members too.

There is more to learn outside the classroom. Outward Bound Singapore gives the society these opportunities to learn and instil the values which will be life-long and priceless values. They help individuals to overcome their fears, challenge themselves, instil values like perseverance, confidence, discipline, teamwork and also unleash their potential.

All these do benefit the society, it benefits every individual who goes for the Outward Bound Singapore course and I think it will be a life changing experience if one were to go for OBS’s course. OBS is indeed an organization that makes a difference in the society and gets a youth ready for anything in life.

Below are some appreciation shown to OBS by some principals. The reason for putting this in this report is to show how much of a difference can OBS make in the society.

It’s very good programmes organised by OBS for my staff. We enjoyed and picked up some learning points that will be very useful for all of us.

– Mr Yap Juye Long, Principal, Yuhua Secondary School

I enjoyed the morning at OBS very much. I appreciate the meaningful work and experience at OBS. Good place for my staff too.

– Miss Yap Wah Choo, Principal, Nanyang Girls’ High School

Thank You OBS for your hospitality and for being our long-term partner in nurturing our sec 3 students each year, imparting the mental resilience they will need to succeed at their ‘O’ levels and in life.

– Mrs Tan Ming Fern, Vice-Principal, Tanjong Katong Girl’s School

By the sharing of the principal’s and the special children (mentioned earlier in the report) experience from what they have learnt in OBS I hope we all can see how important is or rather how huge impact does Outward Bound Singapore does on an individual which makes up the society.

I would like to end of the report by two sharing which is by Mr Lui Tuck Yew and Outward Bound International (OBI)

“This is an important programme because it contributes to how we prepare our young well for the future. Prepare them well and we prepare Singapore well for the challenges ahead.”

– RAdm (NS) Lui Tuck Yew, Minister of State, Ministry of Education

“As one of the longest established Outward Bound centres worldwide, your training programmes have contributed to the development of leadership, character and team spirit of Singapore’s youth and future leaders. OB Singapore has been a model global citizen, always willing and able to offer assistance across borders in many ways.”

– G. Kelly O’Dea, Chairman of the Board, Outward Bound International

References:

http://www.outwardbound.org.au/index2.php?option=com_content&do_pdf=1&id=1

http://wilderdom.com/outwardbound/ob.html

http://www.obs.pa.gov.sg/1145960592565/1150181215714.html

http://www.obs.pa.gov.sg/1216716473248.html

http://www.obs.pa.gov.sg/1216716476527.html

Magazines

“London 2012’s ambition is to create a Games for everyone, where everyone is invited to take part, join in and enjoy the most exciting event in the world” ( www.london2012.com ). This is a laudable aim for those who are charged with the responsibility for producing the Games in London. The aim of this study is to look at the potential impact of hosting the Games for Britain and how this reflects the ideology of those who are running it.

In order to assess the potential impact of the Games on Britain, one needs to investigate the success or otherwise of other major sporting events that have been staged in the past. The most notable or should I say notorious failure in terms of the Olympics was the Montreal Games; Henry Aubin, a Canadian newspaper columnist commented that the Games had been “a financial disaster. There has not been a single successful legacy of the Olympics” (from Evening Standard, Nov. 2006). The event itself was poorly organised from the start, with the result that it took the organisers thirty years to pay for the Games in their entirety; this is something that Lord Coe and his team need to bear in mind.

In more recent times, Olympic Games have been run much more efficiently and have left not only a financially positive mark, but also left a legacy in terms of facilities and economic benefits which reflected not only the efforts but the ideology of those who were in charge. In Barcelona the people of the city and indeed the Spanish nation as a whole were involved in the project. The organisers realised that they needed the wholehearted support of the people, particularly the citizens of Barcelona. Their attention to detail was very impressive, even down to inviting comments to be made about road improvements before going ahead with them to give the people a sense of ownership of the developments that were taking place. The ideology that is being reflected here is that the Games are for everyone and that all can have an active part in its ultimate success (or failure). The city already had a good deal that was positive about it before plans to hold the Games began, not least a hugely successful football team in Barcelona FC along with their impressive stadium. The organisers highlighted the need for urban redevelopment to provide better facilities for the people in terms of sport, leisure, art, media, housing and transportation. Their other concern was to develop the tourist trade by improving the overall image of the city and the surrounding areas. It was evident that “…there was a clear strategy for the post-event use of this area, which has subsequently become part of the city’s tourist attractions and as such, seems to have had a positive effect on the city” (Roche 2000, P 145). The philosophy was clear from the outset – the desire to provide an excellent Games to reflect well on the city at the same time as providing benefits for the people of Barcelona in the long term through redevelopment and through tourism. The organising committee commented that “the … direct beneficiaries are the citizens of Barcelona whose surroundings have been immeasurably improved” (Roche 2000, P 144). This statement is borne out by the physical improvements that were left in the city; a new waterfront and residential area, a new international airport, two new skyline communication towers, six new sports stadia (with another being extensively refurbished), a new museum of contemporary art, a remodelled Catalonian arts museum and new media facilities. Roche (2000, P 144) concludes that “the social policy aim was successfully achieved through, among other things, the new sports facilities, transport and housing built in a deprived city area.”

The aims of the organisers of the Manchester Commonwealth games were along similar lines, “to leave a lasting legacy of sporting facilities and social, physical and economic regeneration” (www.gameslegacy.co.uk). The ideology of the government and the local organisers was one of progressive development across a number of areas through sound investment, marketing, planning and implementation. The New East Manchester Partnership aimed to double the local population, to build new homes, to create a new town centre with a large area for retail provision, to create a business park and to construct a ?100 million sports complex with a 48,000 capacity stadium. The Sportcity complex includes the City of Manchester Stadium, the Regional Athletics Arena, the National Squash Centre, the National Cycling Centre, the Regional Tennis Centre, the English Institute of Sport and numerous hotels, bars, cafes, restaurants and a superstore. The benefits of this complex alone include ?151 million investment in sports and leisure- a large amount of which was secured from Sport England (?165 million split between facilities construction and the provision for the athletes themselves), local people being involved in building the venues, community access guaranteed through targeted sessions at the venues, facilities being made available to local schools and clubs as well as people being trained as local sports coaches. “The transformational impact of Sportcity, in particular in re-positioning East Manchester as an attractive area to invest, would not have been possible without the Games” (Manchester City Council from www.gameslegacy.co.uk). Over the next fifteen years the area expects to attract in the region of ?2 billion of investment from both the private and public sectors as a direct result of staging the Games and enabling people to rediscover Manchester as both a business and tourist destination.

Both of these events and the subsequent positive effects that have been seen and felt by the community and the nation have led there to be a drive to stage further large events either in the country or even in the cities themselves. These successful ventures have led to an increased desire for the ‘feel good factor’ that is generated to be sought again. The communities in both Barcelona and Manchester fully supported the events that were being staged, which was evidenced by the huge demand for tickets for both Games. Hence both Spain and the United Kingdom have bid to host subsequent major events, with London securing the 2012 Olympic Games.

The reasons behind the London bid for the Olympics are many. The bid began with the vision of the British Olympic Committee who felt that following the success of the Manchester Commonwealth games in terms of planning and eventual delivery, a credible case could be made for London to host the 2012 Games. The Mayor of London and the government were encouraged to see the vision for the future of sport in the United Kingdom and “strategies were developed and deployed around regeneration, legacy, employment, tourism, new housing and health of the nation” (www.olympics.org.uk). The ideology that is displayed here is one of community, encouraging the nation to take part in a global sporting event just for the event in itself but also for the improvement of the nation in a number of ways; the kudos of running a global event would put the United Kingdom in the spotlight and potentially lead to foreign investment for the economic betterment of the country as a whole; the opportunities for employment both pre and post Games; the chance to enhance the lives of those in the East End of London through the provision of new housing and sports facilities as well as the regeneration of a very run down area of the capital; the opportunity to improve the health of the nation as a whole (particularly its children) through increased awareness of sporting opportunities provided across the country and through a better understanding of the need to eat a healthy diet. There is also the direct sporting legacy which will exist as a result of the provision of world class facilities which can be accessed by both elite athletes and the general public. The ideas could not solely be based on the sporting angle and had to be a multi-dimensional benefit package in order for the government to be willing to underwrite the whole venture. A successful Games would bring untold benefits not only to the capital but the country as a whole; Baroness Valentine eluded to this when she said “the 2012 Games offer a once-in-a-lifetime opportunity to transform an exhilarating but rundown part of London and, most importantly, transform the lives of people who find themselves excluded from London’s booming economy” (Evening Standard March, 2007).

Those who were opposed to hosting the Games focused on the negative experiences of the cities who had made huge losses in the past and the fact that the direct benefits would only be felt by those in London and the surrounding area (with the notable exception of the sailing venue). Many highlighted the ideological vision of inclusion and opportunity for all as being undermined by the way that little consideration had apparently been given to hosting more of the events away from the capital and the financial effect that this event might have on the United Kingdom as a whole. Glyptis (1989) comments that when looking back on major events such as the Olympics, “virtually all provision had been made on the basis of assumed need and assumed benefit” which was rarely backed by evidence. Pete Wishat, Scottish Nationalist Member of Parliament for North Tayside voiced concerns when he said “I am strongly opposed to the UK taxpayer underwriting the entire cost, regardless of what that cost my finally be – and particularly when there is a very real danger of the London bid soaking up lottery funding from Scotland and elsewhere in the UK” (Daily Telegraph December, 2003). The experiences of the problems with the Millennium Dome also loomed large in people’s minds with regard to the eventual use of the facilities that were proposed for the Olympic Park. They did not want to have a financial millstone around their neck. They also voiced their concerns over the legacy that would be left – how could guarantees be given with regard to not only the facilities but also the sporting legacy for elite athletes and benefits to the nation as a whole through increased participation?

Supporters of the event held a different and ultimately successful view; “increasingly sports events are part of a broader strategy aimed at raising the profile of a city and therefore success cannot be judged on simply a profit and loss basis” (Gratton, Henry, 2001 P 36). The National Heritage Committee (1995) stated that “it is clear that bids to stage major sporting events… can operate as a catalyst to stimulate economic regeneration even if they do not ultimately prove successful.” They drew upon the experiences of the organisers of the Manchester Commonwealth Games who were left with a superb legacy in terms of urban regeneration, better sporting facilities for all and increased employment opportunities. “The Games are a shot in the arm for the UK economy at this difficult time, offering jobs on the Olympic Park for the previously unemployed and millions of pounds worth of contracts for UK businesses” (John Armitt, www.london2012.com). The lasting effects of a venture such as this can be seen above through the experiences of Manchester following the hosting of the Commonwealth Games.

The Western Mail (2005) stated that “while other nations boasted of their ability to run a smooth Games, Lord Coe’s team told the world how much it would mean to the future of this country and the Olympic movement if London was given the opportunity to stage the 2012 Games.” Lord Coe continued the theme of legacy when he said “we’re serious about inspiring young people because they will be touched most directly by our Games” (The Mirror July, 2005). There is also the ‘feel good factor’ of improved mood and morale in the country which can never be underestimated, as was evidenced by the huge crowds for the parade held in London for the medallists from the Beijing Olympics – “even though they are not present at a sports event, millions may gain benefits of this nature from it” (Gratton, Henry 2001 P 31). Many more can be reached as a result of the influence of the media and the blanket coverage that an event such as this receives and this has been a factor which has made sport far more important to all nations in recent years (Houlihan 1997). This has the effect of “enhancing the market benefits to the cities” (Gratton, Henry 2001 P 37) in terms of business investment and tourism and it also enables millions to be inspired by the efforts of others to participate in sport themselves.

Overall the evidence that is available covering recent major sporting events would indicate that there will be a positive legacy for both London and the UK as a whole in hosting this event, as “…the real value of the games comes from being associated with the Olympic image” (Burbank; Andranovich; Heyling; Rienner 2001 P1). The plans that have been drawn up for the urban redevelopment, the creation of employment opportunities, increased tourism as well as the benefits of increased participation in sport, alongside better facilities for the training of elite athletes should bring the legacy for which the organisers are hoping. They reflect the idea that there must be an investment in the future if there are to be long term benefits across a variety of areas for the benefit of the largest amount of people possible.

The implications of hosting an event like the Olympics for elite athletes and the general public are enormous. The elite athletes need world class facilities in which to train and prepare for major events and “more recently the government has sought to narrow the focus of sport policy, giving priority to a more limited range of sports and concentrating on youth/school sport and elite development” (Houlihan 1997 P 46). This will have the dual effect of producing the elite athletes of the future, while providing for the people who are at the top of their chosen field now. This follows the idea that sport is for all and that all should be provided with the opportunity to fulfil their full potential. A glowing example of this effect is the success of the British Cycling team in the Beijing Olympics. Having been able to utilise the velodrome in Manchester (specifically constructed for the Commonwealth Games in 2002) as a training base and centre of excellence, their results in both the Olympics and the recent World Championships have been staggering. They not only reflect well on the government in terms of their investment but also in terms of the kudos that such results bring to the country as a whole. This in turn has brought a ‘feel good’ factor to the cycling community, to the city of Manchester where the team is based and has had an effect on the amount of people who are enquiring about participating in cycling. The investment in elite athletes who achieve success can have a direct effect on the numbers of those who are wishing to become involved with any given sport. Another spin off from this is the training and subsequent employment of coaches within sport to nurture the talent that is emerging as a result of increased participation.

Increased funding to train coaches also has the effect of helping sport at the ‘grassroots’ level. The more coaches that are available, the more people can be involved in the enjoyment of their chosen activity as a part of the community – “community sporting capacity will be improved in a number of ways, such as training and development of volunteers, leaders and coaches…” (London 2012 Community Sports Legacy, www.sportengland,org.uk ). There is a chance to “provide excluded groups with opportunities for participation and inclusion” (Bradford MDC 1997). There is also the opportunity to increase the emphasis that is being laid on sport in schools and for the youth of Britain, in order to foster the idea of a healthy lifestyle in terms of both physical activity and the way that people regard their health.

Media coverage of the event will also have the effect of keeping sport in the public eye in a positive way, highlighting the benefits of a healthy lifestyle and encouraging people to become involved in sport. They have a responsibility to continually highlight the facilities that are available, how to be able to contact the national organising bodies for each sport in Britain and the benefits of becoming involved in sporting activity.“The success of the Games will, in part, be measured by the increase in ordinary people taking exercise at new sports facilities…” (Evening Standard 2007). Only long term study will reveal the full extent of the effect of the Games on sport as there needs to be a sustained long term effect rather than ‘a flash in the pan.’

Clearly the UK government and the organisers of the London Games hope that “the legacy of the Games will be twofold. Physically they will bequeath a redeveloped area in and around the Olympics site… the Games are meant to deliver a more sporting nation…” (Evening Standard 2008). The former will be much easier to assess in the short term – the latter will need to be looked at over the months and years following the Games.

Bibliography

Burbank, M; Andranovich, G. D; Heyling, C.H; Rienner, L. 2001 Olympic Dreams:The Impact of Mega Events on Local Politics Boulder, CO: Lynne Rienner

Glyptis 1989 Leisure and Unemployment Milton Keynes: OUP

Gratton, C; Henry, I. 2001 Sport in The City; The Role of Sport in Economic and Social Regeneration London: Routledge

Houlihan, B 1997 Sport, Policy and Politics: A Comparative Analysis London: Routledge

Roche, M 2000 Mega-events and Modernity: Olympics and Expos in The Growth of Global Culture New York: Routledge

Bradford Metropolitan District Council Recreation Division 1997 A Strategy For Sport and Recreation; A Framework and Guiding Principles

National Heritage Committee 1995 Bids to Stage International Sporting Events Fifth Report House of Commons London: HMSO

Daily Telegraph December 29, 2003 from www.telegraph.co.uk

Evening Standard November 22, 2006 Monster Truck Races, Dilapidated stands and a Billion Dollar Debt that after 30 Years Will Finally Be Paid This Month – The Warning We in London Must All Heed From The Montreal Olympics

Evening Standard March 1, 2007 MPs and Peers Poised For Revolt over 2012 Raid on Lottery Funds

Evening Standard May 15, 2007 The Councils Who Are Failing to Make London Fit for 2012 Games; Boroughs Not Investing in Facilities

Evening Standard May 15, 2008 The Real Legacy of The Olympics

The Mirror July 7, 2005 London Olympics 2012: Our Golden Generation; Lord Coe Winning The Games For London Can Bring Kids Back To Sport

Western Mail July 7, 2005 Editorial Comment on Olympic Games Which Can Be A Winner For Us All

www.gameslegacy.co.uk

www.london2012.com

www.olympics.org.uk

www.sportengland.org