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The effects on Formula One of the European directive banning tobacco advertising and associated sponsorship.Abstract

In this piece we set out to try to determine the effects on the Formula One organisation that would be brought about by the European Union’s ban on tobacco advertising. We investigate the issues by firstly attempting to establish whether Formula One tobacco advertising actually does pose a threat to health.

We then look at the actual evolution of the European Union’s ban on tobacco advertising with the various responses that the FIA and Formula One management have made and contrast that to the actual actions which we can see that they have taken.

An examination of the actual amounts of money involved helps to put into perspective the difficulties faced by the Formula One management in trying to deal with the potential losses of revenue from an advertising ban.

We try to analyse the political issues that are relevant to the decisions that the FIA have to make and also examine the mechanisms that they have used to try to influence them.

Finally, having examined and quantified these issues, we outline the impact of the European Union’s ban on tobacco advertising an the effects that it has had, and probably will have, on Formula One racing.

Formula One racing is a major player on the world’s sporting stage. It is considered both glamorous and exciting. As such it is watched and followed by millions of people across the globe. Because of this popularity it enjoys huge influence in our collective consciousness. Over the last 37 years it has courted controversy by balancing the enormous advertising revenue it receives for tobacco products against the various ethical and health considerations that are obviously consequent on that decision.

The history of tobacco advertising and Formula One stems from the original decision in 1968 for Gold Leaf to sponsor the Lotus 49, in return for prominent displays of its logo. The so-called “fag packet on wheels” achieved a certain notoriety in the press and in doing so generated far more positive publicity and awareness than the tobacco company could ever have dreamed of.

We do not know what the value of this original sponsorship was in financial terms but in terms of the publicity generated, the value was colossal. This comparatively modest beginning started 45 years of controversy which is still both raging, and indeed possibly gathering momentum even today. The implications of that first black and gold logo appearing on the side of a racing car would be the precursor of the selling of colosally valuable real-estate (in terms of car panels, driver’s overalls and helmets) that would shape decisions as basic as just where and when Formula One Grand Prix races were held – if they were to be held at all – as Canada, Germany, Belgium France and Austria have all found to their cost. It has involved the governments of most of the Formula One participating countries. It has involved the European Union in making legislation specifically tailored to tackle the Formula One problem, and it has involved Formula One making public pronouncements while clearly pursuing an alternative agenda behind the scenes. It has nearly brought down Tony Blair’s government and certainly has left a very unpleasant stain on his reputation and credibility. (see on)

In this piece we are going to try to evaluate the effects of the impending ban on tobacco advertising in all sports imposed by the European Union, particularly in its relevance to Formula One.

The first question that we have to consider is “Why all the fuss?” Just why is the European Union getting involved in an ostensibly minor issue which, on the face of it is only relevant to a small proportion of the sports-following public?

Literature review

There is a quite extensive literature on this subject, ranging from the weighty legal documents issued by the European Union, including the academic comment on the subject, through to the mountains of opinions expressed in newsprint. In this review we shall present a critical analysis of a representative proportion of it and attempt to analyse all of the major perspectives that have been taken on the issue.

A good place to start is the excellent and comprehensive paper by Dewhirst and Hunter (2002) which is generally accepted to be an unbiased overview of the area. It is cited by a great many other papers as an authority. It provides a fairly current review of the position of tobacco advertising and sponsorship across the whole spectrum of motor sport. It is notable as it does not take a particular stance but is analytical in nature.

It analyses the role of sponsorship in its widest ramifications together with the benefit of both the advertising and association with the sport that the tobacco companies derive from their money and also the benefit that the racing teams derive from the money that they receive. It also provides a useful insight into the evolution of the culture of Formula One being associated with tobacco advertising from the beginnings of the clamp-down, through the advertising bans on broadcast media and then the bans on newsprint advertising and right through to the culture of reducing to public acceptance of smoking in general. Interestingly, this paper analyses, in financial terms, the costs and benefits that the tobacco companies secure from their Formula One exposure and we have quoted this in our article. It is well written and very readable. In essence, it underpins most of the thrust of this current article.

Blum (1991) looks at one specific aspect of the issue. He takes the example of Marlboro and how one brand managed to circumvent the effects of the television ban on tobacco advertising in the USA and in Europe. He points out the staggering statistic that, by sponsoring the 1989 racing season, Marlboro managed to obtain 5933 images of its logo or direct verbal referrals in a positive context. This is on Nationwide (probably also a large – although undefined world wide) audience.

Seigel (2001) went on to study the fall out from this observation. It soon became clear that the realisation the tobacco companies were effectively circumventing the advertising restrictions imposed in various countries triggered off the Master Settlement Agreement with the television companies and other media. The agreement was voluntary and restricted the tobacco companies to their level of exposure in 1999. Seigel’s paper details just how completely the tobacco companies paid public lip service to the agreement and then privately flouted it. It gives chapter and verse of blatant instances where the tobacco companies have taken marketing decisions that are economically based and then deliberately disguised to make them publicly acceptable.

A more up to date review is given by Carlyle (et al 2004). They specifically look at the role of one tobacco company – British American Tobacco – and just how this company has turned its marketing strategy to make Formula One sponsorship its prime mechanism of reaching boys and young men. Because it is comparatively recent, this paper also is able to examine the impact of the Asian markets – which have virtually no regulation on advertising – on the marketing strategy of the tobacco companies.

Specifically it charts a new emerging trend, that of the tobacco companies finding that it is profitable to actually own Formula One brands. With the effective acquisition of BAR, British American Tobacco became a major player in the battle with the Public Health authorities on a global scale. The ownership effectively allowed them to dictate just what their profile would be and exactly how they could market themselves in the area.

Kawane (2004) takes this argument and examines it further. He looks specifically on the impact that tobacco advertising has on the Asian (specifically Japanese) market and contrasts this with the various Public health initiatives that have been set up in Japan. He refers to a new development in the field of advertising. Japan tobacco has sponsored several mobile trailers which it sends to car race associated venues (where public smoking is banned in Japan) These colloquially named “SmoCars” allow smokers a haven where they can smoke legally in public places. He comments on the form of wording used by the companies to justify this new departure.

“Japan Tobacco claims that SmoCar has been developed as part of the company’s initiative for increased coexistence between smokers and non-smokers in public spaces.”

Two papers on very similar subjects – the illegal shipment of tobacco products to Asia and China – reflect both the direct impact that tobacco advertising has and also the size of the potential market that there currently is in these countries. It shows the less than glamorous side of the arguments that we have been presenting in this article. Lee, ( et al.2004) analysis the impact from 1979 to 2000 when the marketplace was effectively opened to the tobacco companies after their expulsion in 1950. To back up their arguments the cite extensively from documents that have been on file for many years but only opened to public scrutiny after a number of successful law suits in the USA. Collin, ( et al. 2004) looks at a different aspect of the same problem. They take an analytical view of the apparent complicity of Chinese Government with the tobacco companies. One of the concluding sentences of the study is:

“BAT documents demonstrate that smuggling has been driven by corporate objectives, indicate national measures by which the problem can be addressed, and highlight the importance of a co-ordinated global response via WHO’s Framework Convention on Tobacco Control.”

Both papers illustrate many of the points that we have cited in our arguments in the main article and are both well written and informative.

Hasting & MacFadyen (2000) return the argument closer to home with a look in a rather novel, but nonetheless relevant slant on the subject. The article is provocatively entitled “A day in the life of an advertising man”. Its light hearted title belies a serious review as it examines a number of documents from the tobacco industry’s advertising agencies. At the end of its examination, the paper comes to the conclusion the, as far as the tobacco industry is concerned, history reflects the fact that voluntary agreements are of no value at all (other than as a temporary smoke screen) and statutory enforcement is the only way to regulate the tobacco industry.

Watson (1997) reviews the evolution of the European Union’s ban on tobacco advertising from its initial high hopes and aspirations to a watered down and late implemented ban in 2006.

He charts the various factors that have militated against the implementation of the ban together with the major players who wished to have it enforced and their concessions that had to be made in order to secure their eventual goal. He highlights the, often overlooked, problem of drafting legislation that will be effective in all of the member states without weakening the position of those states who already have a total ban on tobacco advertising. He cites unanswerable figures (that we have quoted elsewhere) that in the countries that have successfully implemented a total ban on advertising, the per capita consumption of tobacco products has fallen by between 14-37%

The legal aspects of the European Union’s ban on tobacco advertising is examined in a detailed paper in the European Journal of Law and Economics. It is relevant to our deliberations here because it examines the effects of a ruling by the European Union’s Courts that the European Union did not have the right to impose a total ban immunohistochemical the presence of national legislation to the contrary. It upheld the right of each individual nation to set its own limits on economic activity.

We should, perhaps, accord the last place in our Literary Review to a very well written and eminently readable article by Chapman (2002). The author writes an article based on the obvious (but seldom stated) hypocrisy. He starts by observing that in the 2001 Melbourne Grand Prix Jacques Villeneuve’s car disintegrated – a wheel killing a trackside Marshal. The author comments:
“A full coroner’s inquest was held, followed by a review by motor racing’s governing body Federation Internationale De L’automobile (FIA). One death was deemed worthy of a full investigation involving an international review team, front page reportage, and endless speculation about whether the 2002 race would be safe for spectators and officials.”

This is in such stark contrast to the tens of thousands who will be injured and killed by the inhalation of tobacco smoke that is blatantly advertised on the sides of the Formula One’s cars.

It compounds this analogy with another:

“While the racing fraternity routinely participate in road safety campaigns in recognition of their massive influence with the young who are over represented in road death statistics, promoting smoking to the same adoring fans seems to trouble few of them. “

We have discussed the hypocritical stance of the tobacco companies throughout this article and Chapman seems to encapsulate the whole situation very succinctly.

Aims and objectives

The aims and objectives of this article can be outlined very succinctly. We aim to examine the effects on Formula One of the European directive banning tobacco advertising and associated sponsorship. We have already reviewed some of the relevant literature in the area. We shall be using that (and other sources) to examine the evidence to our investigation. We shall attempt to define the various issues involved including whether or not Formula One tobacco advertising does actually represent a real or imagined danger to the public health. We shall consider the finances involved and the political implication of decisions that have been made. We shall also trace the history and evolution of the European Union’s ban on tobacco advertising before drawing appropriate conclusions of the actual effect on Formula One of the European directive banning tobacco advertising and associated sponsorship.

Is advertising on Formula One cars a real threat to the Public Health?

The issue of whether smoking is a personal health risk has been so well rehearsed over the recent few decades that it scarcely needs repeating here. Some factors are undoubtedly relevant to our considerations however.

Smoking trends have varied greatly over the past few decades. The actual prevalence of smoking has declined, as far as the general population is concerned, by about 40% since 1960 (CDC 1993) As far as the UK is concerned, this diminishing trend has actually levelled out over the last 15 yrs. (Dobson et al. 1998). It is particularly relevant to our considerations here that, with specific reference to the adolescent and young adult fraction of the population, the actual trends in cigarette consumption has actually increased (Nelson et al. 1995) (NCHS 1995).

The age range which has the current highest prevalence of smokers is the 20-24yr. age group where 42% of men and 39% of women report regular smoking (NCHS 1995). Many other studies have produced consistent and corroborating results, so we can have a considerable confidence in their validity.

The peak incidence of smoking is generally found to be at about 21 yrs. (Paavola et al 2004) which contrasts to the peak age for alcohol intake which occurs at about 28yrs. The relevance of these points will become clear later on in our considerations. One interesting, and possibly very relevant observation, that also came from this same study, was the fact that the incidence of smoking correlated highly with individuals who watched large amounts of television. There is possibly a link here as Formula One is clearly a prime time occupant of some television channels.

Also of relevance to our considerations here, is the study by Van Den Bree (2004) who found that the single biggest predictor of smoking and drinking in the adolescent years was the endorsement of that particular activity by the teenager’s peer group.

There is little doubt that one of the major attractions of Formula One is the aspirational qualities that it appears to possess. Fifty years ago the aspiring teenager typically wanted to be a train driver. One could argue that a similar reverential status is now held by the racing driver who is perceived as glamorous, skilled and dashing and risking his life in his chosen career – all qualities that are commonly perceived as worthy of adoption in a peer-group scenario.

The thrust of this section is to try to establish the evidence to support the view that by sponsoring Formula One, the tobacco companies do pose a threat to the public health. There seems little doubt that the young adult (being the largest smoking group) and the adolescent (being the most impressionable group) are the two most important and potentially profitable targets for the tobacco companies in their advertising campaigns. (Teague 1973) This has been clearly demonstrated in the wake of some very prominent lawsuits in the USA.

As a result of these lawsuits a number of tobacco company documents were ordered to be released into the public domain. (Phelps 1998) (Schwartz 1998) these confirmed beyond a shadow of doubt that the tobacco companies were deliberately targeting the young adult and adolescent market in order to try to create a brand loyalty and they were using Formula One as a suitable medium (For reasons already outlined) to do it.

Three examples are given here from the documents released at the trial

1957: A Philip Morris Executive writes that
“Hitting the youth can be more efficient even though the cost to reach them is higher, because they are willing to experiment, they have more influence over others in their age group than they will later in life, and they are far more loyal to their starting brand “.

1971: An internal RJ Reynolds document outlines that
“the lower age limit for the profile of young smokers is to remain at 14”. (Pioneer press 1998)

1973: Claude Teague, Assistant Chief in R&D at RJ Reynolds, writes a paper: “Some Thoughts About New Brands of Cigarettes for the Youth Market”;
“At the outset it should be said that we are presently, and I believe unfairly, constrained from directly promoting cigarettes to the youth market … if our company is to survive and prosper, over the long term we must get our share of the youth market.

1974 Claude Teague also said in a memo to other executives:

Importance of Younger Adult Smokers

Why, then, are younger adult smokers important to RJR? Younger adult smokers are the only source of replacement smokers. Repeated government studies (Appendix B) have shown that:
? Less than one-third of smokers (31 percent) start after 18.
? Only 5 percent of smokers start after age 24.
Thus, today’s younger adult smoking behavior will largely determine the trend of industry volume over the next several decades. If younger adults turn away from smoking, the industry must decline, just as a population which does not give birth will eventually dwindle. In such an environment, a positive RJR sales trend would require disproportionate share gains and/or steep price increases (which could depress volume)
(Schwartz 1998)

The whole area is clearly targeted at the young adult population – which is the best represented at a typical Formula One meeting. Formula One sponsorship is clearly therefore a very important asset to the tobacco advertising industry. (Phelps 1998)

The whole area of tobacco advertising being attached to Formula One is primarily to raise brand awareness, reinforcing the brand image and (hopefully) increasing the market share of the product. By association of the particular tobacco product with the image of Formula One that we have described it is hoped that the product will be perceived as “Cool, glamorous and exciting” ( Cornwell et al 1998) (Irwin et al. 1994)

In a document which we shall comment on further later in this piece, the FIA (World motor Sport Council) commissioned a report (December 1998) to look at the evidence to support this view. The key findings in this report can be summarised as follows:

that the tobacco companies were driven by an obsessive need to recruit young smokers to satisfy their market demands which required vast numbers of new smoking recruits – in the UK alone they need 300 new smokers a day – and that for decades tobacco companies marketed their products to young people, including to children too young to purchase the products legally
that this obsession with new, young smokers is evident in companies’ market research on teenagers, some as young as 12-, 13- and 14- years old and in one instance as young as five years old
that studies showed that the majority of smokers start using tobacco while in their teenage years, and that hardly anyone starts smoking in their twenties but that those who started at around the ages of 12 or 13 years old often want to quit by the age of 16, concerned that smoking was damaging their ability to participate in sports. Knowing this, the tobacco companies sought to lure and addict children to cigarettes before the desire to stop grew strong, and sought sponsorship deals with sport to counteract any concerns they may have about the health dangers of smoking
that tobacco companies knew that lifelong brand preferences are formed in the early teenage years and that increased visibility for their products could shape these preferences
that sponsorship of Formula One is the jewel in tobacco’s crown – it is the pinnacle of successful, glamour-laden global events with a massive potential to reach the young through both the televised events and the spin-off merchandise.

This evidence seems self explanatory. There is clear benefit for the tobacco companies to promote their goods to the young on the basis that they are the most susceptible to their advertising and that once smoking they are likely to continue. Their strategy is to present smoking as an acceptable pastime endorsed by a glamorous high profile sport that effectively negates the plentiful and contrary messages that smoking is bad for sporting performance.

There is further evidence to support this view. A survey of adolescent boys (Smee 1992) found that the boys who had stated that their favourite broadcast sport was Formula One, were more likely to name Marlborough and Camel cigarettes (brands associated with Formula One) than any other brand and were also more likely to have begun smoking within the following year (Andrews& Franke 1991). This same survey also found that in the age range of 12-13yr old UK boys, only 7% smoked, this proportion rose to 13% in those boys who said that their favourite sport was Formula One.

Further, and extremely important retrospective studies, looked at the effects of removal of tobacco advertising in the four countries France, New Zealand, Finland and Germany between the years of 1975 and 1993 and they found that the cigarette consumption (per capita of the population) had fallen from between 14 – 37%.

It follows from the evidence presented so far, that we can reasonably conclude that tobacco advertising associated with Formula One racing does form a threat to the Public Health. It poses a threat to the impressionable youth who may well wish to emulate their peer group by appearing “Cool, sophisticated and glamorous” which is exactly the inference that tobacco advertising seeks to imply by associating itself with the “cool, sophisticated and glamorous” sport of Formula One motor racing. There is no reasonable doubt that tobacco smoking is a major deterrent to health. It clearly follows from this argument that the policy currently pursued by Formula One is having a deleterious impact on the Public Health on a global scale (See on)

How much money is involved?

The whole issue of Formula One advertising only really became an issue of public concern and debate when the whole area of tobacco advertising on terrestrial television became a censorship issue. This occurred in the UK in 1965, the USA in 1971 and Canada in 1972. It has since occurred in the vast majority of western countries although it has to be noted that a significant proportion of the far east (where Formula One racing is now starting to spread) there still is no effective curtailment of any type of tobacco advertisements in any of the differing forms of media.

The tobacco advertisers therefore had to turn to other mechanisms for getting their products into the public consciousness and sponsoring major sporting event that were to be broadcast seemed the way forward for them. (Ledwith 1984) (Stoner 1992). Formula One has a virtual monopoly of the broadcasting rights to their races world-wide and they have the ability to dictate a great deal of exactly what (and how) we, as the viewing public, see their races

One study on the subject discovered that Marlboro managed to obtain nearly 3.5 hours of “In-focus” exposure during the 15 races of the 1989 Formula One season. (Blum 1991) The same report stated that during the same season the name Marlboro was either seen or mentioned 5933 times. To equate that to a financial basis, between 1997 and 1999 the tobacco companies collectively managed to achieve 169 hours of advertising exposure in the USA alone which equates to about $411 million in advertising value. (Siegel 2001)
To put this figure into perspective it should be noted that tobacco companies themselves are seldom the only sponsor of a team or an event. In Formula One the running costs are enormous. We can quote the figures for the 2001 season for the top three teams as Ferrari at $284.4 million; McLaren at $274.6 million and BAR Honda at $194.5 million. (Formula 1 Magazine 2001)

The actual spending of the money is harder to quantify in terms of figures but a fairly accurate estimate is thought to be that Philip Morris (Marlboro) in its sponsorship of Ferrari spends $23 million on Michael Schumacher’s salary and a further $65 million for the privilege of having their logo placed strategically on the car and the overalls and helmets of the drivers (Saward 2001) (Donaldson 2001)

Similar orders of money are spent on the other teams Reemtsma (West) sponsors the McLaren team spending $37 million to have their brand name prominently displayed( Saward 2001). British American tobacco who are the prime sponsors of BAR invested about $47 million during the 2000 season (Donaldson 2001)

The collective total of tobacco sponsorship money invested in Formula One in the 2000 season was thought to be $250 million (Grange 2001)

Despite all that we have outlined above, it is not only the exposure at race-day that is important to the tobacco advertisers, but there is also the visibility obtained by all of the “third party” pictures and co-sponsors. The tobacco product attains an added prestige boost when seen in the company of other high prestige products. A classic example of this came when Philip Morris (Tobacco) was a co-sponsor of a Formula One team along with TAG Heuer watches which provide the time keeping at Formula One races. TAG Heuer place a lot of newsprint and poster adverts and these show the Philip Morris logo on the Formula One car which, if it were advertising tobacco, would be prohibited but as it is purporting to advertise watches it bypasses this particular restriction.

In just the same way Benson & Hedges share sponsorship of the Honda BAR and Jordan teams so Benson & Hedges gain significant visibility through Honda advertising. This kind of relationship is quite risky from a Public Relations point of view (Both from the co-sponsor perspective as well as from the Formula One racing team’s viewpoint).

Again if we consider the impact that the withdrawal of tobacco advertising revenue would have from Formula One then we should consider the recent case of TAG Heuer and Reemtsma (Makers of West cigarettes) the fall out from which did nobody any favours. In June 2001 the premier French newspaper Le Monde raised an objection to a TAG Heuer advertisement which prominently displayed a Formula One carbohydrate with an equally prominent West logo displayed upon it. (Anon En France 2001) TAG Heuer was accused of violating French laws regarding tobacco advertising. It did manage to successfully defend itself by asserting that as an official sponsor of McLaren it was contractually required to use official team images. It was a situation that did not bring any particularly favourable publicity to any of the protagonists. Certainly none to TAG Heuer or West and it did not show Formula One in a particularly favourable light either. (Anon Tag Heuer 2001)

Although the financial impact of tobacco advertising on Formula One racing is quite clear from these figures There is also the converse argument which we have not considered yet. The sponsorship agreement locks in a sponsor for a certain finite period of time for a certain fee. But these agreements also impel the sponsors to utilise the racing team’s photographs and other images on any piece of promotional material that links them with the sport. This represents another, less well publicised impact that withdrawing tobacco advertising sponsorship would have on Formula One. It is curious that high prestige brands such as Hewlett-Packard and TAG Heuer find themselves locked into a sponsorship agreement with products that, on the face of it, you would not expect to share a particular brand image.

The value of tobacco advertising to Formula One, or indeed the value of Formula One to tobacco advertising, can hardly be understated. It is only when one considers the absolute magnitude of the sums of money involved that one can fully appreciate the difficulties that Formula One would face if the tobacco advertisers were stopped from continuing their sponsorship of the industry. Despite their posturing and public statements, one can begin to understand the enormous cash vacuum that would be left if Formula One voluntarily detached itself from the tobacco industry

The evolution of the current tobacco ban by the European Union

The European Union’s Directive on the banning of tobacco advertising in print, radio advertising and event sponsorship by tobacco companies is due to come into force on July 31st 2005. This is the culmination of a prolonged multifaceted campaign from many sources and has many potential ramifications for both the sport and its followers. We will highlight some of the important events in the evolution of this Directive. The Directive was originally published in 1997 with the intention that it would come into force in 2005

In November 1997 The then Health Secretary Frank Dobson announced on Radio while being interviewed by John Humphries, that the government would ban all sports sponsorship by tobacco companies

In March 1998 the FIA announced at the Australian grand Prix of that year that it was going to ban tobacco advertising from 2002. That would have been four years ahead of the time that it would have been required to do so by the European Union’s ban on tobacco advertising. This was the so-called Melbourne Declaration.

The Melbourne Declaration was a timely statement put out by the FIA as a result of pressure form the world’s media after the European Union’s ban on tobacco advertising was first mooted. In essence it said that:

“if presented with evidence of a direct link between tobacco advertising / sponsorship and smoking, it would act to eliminate tobacco advertising / s

Sources of stress in elite football players.Abstract

In this piece we shall look at stress, its definition, and its potential occurrence in the world of the professional football player. We will examine the possible sources and use current literature sources to support our assertions.

Having done that we shall examine in detail the case of Mr Vasey, a youngster who embarked on a professional football career but did not make it onto the elite circuit. We shall examine his personal account for evidence to support or refute our assessment.

If you read some of the tabloid newspapers, you could be forgiven for thinking that an elite footballer’s life is little more than huge amounts of money, fast cars, a succession of pretty women and endless adulation from mindlessly adoring fans when performing on the football pitch. Some of the more disreputable papers may also dwell on a slightly different (but generally equally false) aspect of their life, the drink, drugs, sordid sex romps in hotel rooms and gambling.

The truth of the matter, in the vast majority of cases, is that the elite footballer is a finely honed athlete at the peak of his training. He is required to perform daily in training routines and in the gym, less frequently on the pitch, and put himself at risk of career threatening injuries on a regular basis. All this is done in the full knowledge that he has worked his way up a professional ladder to a comparatively short window of elite performance and that there are always many more hopefuls who are climbing up behind him either waiting to push him off or to watch him as he falls.

You may regard the introduction as rather melodramatic, but it is intended to illustrate the very different perceptions that are commonly held about the lifestyles of the elite footballer. In this piece we are going to review the stresses and pressures that are commonly experienced by this elite group and also how they (generally) manage to cope with them.

We also intend to illustrate the theoretical problems faced by the elite footballer with a real case study of a young man, Mr Peter Vasey who has gone a long way to becoming one of the elite group and then, for various reasons, which we shall discuss, decided not to pursue it further.

Stress and Stress management

We all think that we know what stress is and that we can easily recognise it. It actually proves to be a very hard item to define as firstly, it is important to distinguish between physical (biological) stress and psychological stress. The two are clearly related but fundamentally different. Secondly, stress is a multitude of different responses to a multitude of different potential causes.

In this piece we are going to consider the various causes of psychological stress on elite footballers. In this context we can look for a definition of stress in a particularly informative article by Crampton et al. (1995) . She reviews the various definitions of stress.

“Hans Selye (1956), a pioneer in stress research, has defined stress as “the non-specific response of the body to any demands made upon it” (Kreitner & Kinicki, 1992, p. 597). It is considered to be an internal state or reaction to anything we consciously or unconsciously perceive as a threat, either real or imagined (Clarke, 1988). Stress can evoke feelings of frustration, fear, conflict, pressure, hurt, anger, sadness, inadequacy, guilt, loneliness, or confusion (Cavanagh, 1988). Individuals feel stressed when they are fired or lose a loved one (negative stress) as well as when they are promoted or go on a vacation (positive stress). While many individuals believe they must avoid stress to live longer, Freese (1976) argues that it is the salt and spice of life and that to have no stress we would have to be dead.”

Selve defines the basic “biological” interpretation of stress while the Kreitner definition starts to incorporate the possible psychological elements that generate the biological responses. Clarke adds to our understanding by considering the psychological responses that can be produced by various stresses and Cavanagh modifies the definition further by introducing the concept of positive and negative stress. Freese makes the very perceptive comment that stress is an integral and inevitable feature of life itself. This particular insight can be taken rather further insofar as there are some individuals who find stress hard to cope with (non-copers) and others who appear to positively thrive in stressful situations (copers)

In terms of our footballers under consideration, we must accept that stress can, and does affect performance as we shall discuss (see on). Basic psychological theory shows us that individuals who are less than optimally stressed may not make enough effort to achieve their designated goal whereas those who are overstressed may not be able to concentrate on the task in hand and perform to their maximum capacity. In either eventuality it is clear that optimal performance is impaired. Equally it follows that there is an optimal amount of stress to achieve optimum performance. In practical terms, that “optimal amount” is only really possible to quantify in retrospect, and that is why many would describe the work of the team manager, coach and trainer as an art rather than a science.

Haspels (2004) looked specifically at the levels of stress in pre- and post-match footballers. Unsurprisingly, he found that the highest levels of stress were found pre-match in an International game. One of the standard measures of stress in the resting subject is the cortisol level. Unfortunately physical activity also puts up cortisol levels so one of the major predictors of stress was rendered useless in this study. Haspels also found that the players performed best when their stress levels were controlled before the game

Work by Anshel (2001) looked at the causes of acute stress on the playing field and came to the rather surprising conclusion that the major causes of stress in that particular situation was consistently found to be receiving what was perceived to be a bad call from the referee and making a major physical error (missed kick etc.) When these eventualities occurred, the athletes concerned tended to make negative cognitive appraisals followed by an avoidance coping strategy. The same study also found that approach coping was most commonly seen after positive appraisals. These observations clearly support the transactional coping model. The use of appraisals and coping strategy was directly dependent on the perceived nature of the stressful event.

Stress is an inherent part of football. It may, in part, be added to by the unrealistic expectations of the coaches, managers and the fans. Every team in the league is told that “this year the cup will be ours” at the beginning of the season and all the training, playing and motivation will be directed towards winning it. The reality, of course, is that only one team will win it.

Continued stress has been cited as the main reason for many of the younger players (including our study subject) for their lack of enjoyment and subsequently leaving the game. It is interesting to note that many sources cite youth as one of the causes of acute stress on the grounds that the youngster may not yet have developed the physical sports skills and coping strategies that the older, more experienced players have. We will not consider this element further as our concern in this piece is primarily the elite footballer who, by definition, has already mastered his game.

In broad terms, according to Lazarus (1999), coping with stress consists of a person’s conscious attempt at managing the demands and intensity of events perceived as stressful or improving one’s personal resources (e.g., positive affect, confidence, self-control) in attempting to reduce or manage one’s perceived stress intensity. He also observes that one of the critical factors in an athlete’s adoption of a particular coping strategy is their cognitive appraisal of the stressful event or situation. Lazarus sums up his appreciation of the coping response as an athlete’s ability to accurately appraise the situation and the subsequent use of an appropriate coping strategy as the critical factor in explaining an athlete’s physiological and psychological adaptation to stress in sport.

Method

Our method of investigation falls into two parts. In terms of the stresses faced by elite footballers and their coping mechanisms, we have consulted, appraised and quoted authoritative literature on the subject. In terms of the real problems faced by Mr. Vasey, we have interviewed him and the results of the interview are appended to this piece as appendix I

Sources of potential stress

Clearly there are a great many sources of potential stress that our hypothetical elite footballer may face. Broadly speaking they can be categorised into:-

Sport related stress.
– Performance anxiety
– Alpha male problems in a team game
– Age
– Competition stress
– Constant motivation
– Exercise dependence
– Constant levels of fitness
– Injury concerns
– Dietary concerns
– Drug monitoring concerns
– Premature retirement

Financial
– Living up to a perceived lifestyle
– Transient nature of income
– Income dependent on continued performance

Publicity related
– Media attention
– Family intrusion
– Privacy intrusion

Direct stress-related problems
– Drink
– Drugs
– Relationship problems
– Cognitive functioning

Let us consider each one of these potential stresses in turn

Sports related stresses

Performance anxiety

In a well written and comprehensive article, Poczwardowski and Conroy (2002) discuss the stresses and coping mechanisms of elite performers. They categorise the various coping mechanisms into 36 sub-categories on the basis of direct interviews. The standard categorisations of problem-focused, emotion-focused, appraisal-focused, and avoidance-focused etc. were amplified and extended to cover a greater rang of detected strategies. For example “greater motivational changes after failure” was reported by one athlete as a stimulus to train harder so as not to fail a second time.

Stress can affect different sportsmen in different ways. Some appear to thrive and perform well, others find that it is a bar to optimum performance. Those elite footballers in the first category do not need any intervention as far as their performance in the game is concerned but an interesting study by Solberg et al. (2000) looked at the use of different relaxation techniques pre- and post performance in elite athletes. They found that athletes who practised meditation-related relaxation techniques had their blood lactate levels returning to normal quicker than their non-relaxed counterparts. Contrary to expectation however, they found no significant difference in their levels of pre-exercise anxiety.

Alpha-male problems in a team game

This is an anecdotally reported phenomenon which does not appear to have been investigated from a scientific perspective. The typical alpha-male personality type is over represented in the elite footballer community. Aggression, speed, firmness of decision making, independence and rapid responses are all prized attributes of the elite footballer. These are seldom attributes that are seen in the personality types that are happy playing as an integral part of a team. Football, by its very nature, is played by a team of eleven on the pitch and off the pitch, a very much larger team is involved. Prima Donna behaviour, typical of the alpha-male, cannot be easily accommodated in such circumstances. It may be tolerated as long as the player concerned is delivering the results, but it can be an enormous cause of stress when the results stop being delivered.

Age

Footballers get older. In terms of their professional use, they age perhaps faster than professionals in other fields. There is a very narrow “window of opportunity” for them to be at the top of their chosen field. To play at elite level for more than a decade is considered to be quite unusual. Part of the reason for this is the natural ageing process which is present in every other individual, but also there is the ever-present problem of both career threatening injury and also the huge wear and tear on the joints (see on) which can give rise to significant health impairment in later life.

Turner et al. (2000) examined this problem in some detail and their results make impressive reading. Their cohort were all professional footballers. 32% of whom reported having surgery on at least one occasion. Of those, over half had knee surgery and a quarter of those had complete joint replacements. 15% reported
having hip surgery with another 9% awaiting surgery.

Others in the group were having non-invasive treatments. Nearly half had physiotherapy in one form or another for injuries sustained during their career and over a quarter were having some form of analgesia or anti-inflammatory drugs for pain associated with football injuries.

Osteoarthritis (OA) was diagnosed in at least one site in nearly half of the respondents and the vast majority of those were hips and knees. Significantly nearly 10% were registered as disabled due to OA and, very significantly, 72% of all respondents agreed with the statement “I am concerned with how OA may affect my body in the future”, clearly a major source of potential stress.(Barlow et al. 2000)

Although joint problems were, predictably, seen as the most common pathology, other morbidity was found. Neuropsychological problems were not uncommon, presumably related to episodes of concussion or repeated trauma such as heading the football. 10 of the group reported problems such as memory complaints, dizziness and headaches.

Sport related problems included early retirement, enforced reduction in working hours or even a change to a sedentary occupation. Not only can all of this be viewed as a major source of stress to those who are suffering because of it, but also it must be stressful for the still-active player who may know what may be in store for him.

Competition stress

This is an area that has been extensively studied. Competition stress can be an enhancer for some players but equally it can be an inhibitor for others. There is a distinction to be made between the trait of anxiety and the state of anxiety which is quite significant and, to a large extent, is a reflection of the ability of the individual to cope with and handle the stress levels.

Sanderson and Reilly (1983) did the classic study in this field. Their target group were elite athletes. They found that the group of athletes who had the anxiety trait correlated highly with those who had high pre-race anxiety states and this correlated highly with the actual race performance. Very significantly, the greatest reduction in post-race anxiety levels was seen in those runners who performed well in their races.

Constant motivation

In order to maintain elite footballer status a player must find a source of constant motivation. Initially, in his adolescent training days, the motivation may be personal glory and the goal orientated drive that comes with wishing to achieve professional status.

Having achieved that goal however, the player must then find other motivational drives to maintain his progress. For some, it drive comes from considerations of status and wealth, for others it could be the need for adulation and fame, others may have personal goals of achieving the pinnacle of their chosen profession, these are the achievement-junkies that are seen in any professional walk of life. Whatever the motivation, success invariable comes at a cost. Decisions, and therefore usually sacrifices, have to be made along the route of attainment and achievement.

In this piece we are considering specifically the elite footballer who, by definition, has managed to achieve the peak of his career. We should perhaps also consider the other athletes who by virtue of circumstance, situation, lack of motivation or perhaps even random differences in pre-natal myelination patterns, do not actually achieve the top of their profession. We shall discuss one such case in the case-study at the end of this piece. For every elite footballer, there are many who do not make the top echelon of players. There are arguably even more stress factors in this group who what to achieve but for one reason or another, cannot.

As far as motivation is concerned, this is a major concern of every coach and manager in the country for reasons that we have set out above. Most premier teams will have psychologists who are motivational specialists. Motivational theory is evolving at a rapid rate and reversal theory is the current “idea of the moment”. A particularly good book on the subject is edited by Apter (2001) . It deals with not only the current thinking on the subject but also the actual evolution of the reversal theory from its conception in the 70’s through to the applications of the present day. Significantly it also deals with the specific subject of stress engendered by the motivational process. It is a highly technical book and therefore we do not propose to enter into detail about its contents, but it highlights the psychological issues of burn-out, apathy and depression that are commonly seen in constantly ( and inappropriately) motivated players.

In the context of elite footballers, there is a fascinating and short article by McNair (1996) which looked at the effect of verbal encouragement on maximal effort output. The game of football is anecdotally renowned for the aggressive verbal abuse beloved by many trainers, coaches and managers. One may argue that it is only a manifestation of their own frustrations and stresses that causes them to behave in this way and it is certainly a cause of stress to the players (clearly it is intended to be). McNair’s paper produces a cast-iron rationale for this “encouragement” as he found, by means of a very simply designed study, that verbal encouragement does increase the maximal output of skeletal muscle. Interestingly, while measuring the actual power output, he also measured the EMG tracings of the afferent nerves supplying the relevant muscles and found that verbal encouragement did not change the EMG readings, so the actual cause of the improvement was not ascertained but it was nonetheless real.

Constant levels of fitness

Constant levels of fitness are clearly a pre-requisite for an elite footballer. There may well be periods of injury where the fitness levels fall, but they must be quickly re-established in order to achieve optimum performance levels. Fitness, in general terms equates with earning power and job security for a elite footballer, so the overriding goal must be to achieve peak fitness at all times. This, in certain circumstances, can become an obsession (See on – exercise dependence)

Exercise dependence

Many studies have shown the exercise can give rise to demonstrable health benefits – both chronic and acute. There are some people for whom exercise actually becomes an obsession (Hurst et al. 2000). This is a real disease entity resulting in behaviour patterns that compel an individual to exercise despite the presence of obstacles. It also can produce both psychological and physical symptoms of withdrawal, if exercise cannot be taken (Pierce, 1994) ( Veale, 1995) (Thaxton 1982). These patterns are commoner in women and often associated with eating disorders but they are also seen in male athletes. Bamber et al. (2000) has authored a paper which produced a qualitative analysis of the whole issue. She found that elements of an eating disorder were always present to a greater or lesser degree, but that this was hard to quantify as many athletes will pursue closely monitored dietary regimes in any event.

This syndrome is commonest in women, but does occur in men, particularly it seems in those who have low self-esteem or a poor self-image. It may be thought that such traits are unusual in the context of elite footballers but perceived body image does not always reflect the true physique. Any experienced healthcare professional will tell you about the anorexic or muscle dysmorphic who perceives something quite different when they look in the mirror. It is commonly believed that such conditions are a result of compensation syndromes. People may have a need to try to excel in one area if they feel that they are in some way failing in another.(Bamber 2003)

Injury concerns

Injury is the footballer’s constant fear. Football is a fast and occasionally violent game with frequent body contact being an intrinsic part of the game plan. Injury can vary from trivial to catastrophic or even life-threatening. Most injuries will have an impact on the elite footballer either at the time of the injury or, as we have seen above, at a later stage in his life. We have referred earlier to the comparatively short earning window of the elite footballer and clearly there will be considerable stresses involved if that window is cut short for any reason.

Because of the huge investment that the average elite footballer represents to any club, a huge amount of energy and resources are employed to get an injured player back onto the field of play. It has to be said that the vast majority of professional clubs act responsibly in allowing injuries to heal properly before returning the player to training, but there will be the inevitable pressure on the less-than-scrupulous coach to get the player back on the field before full recovery has taken place. This has costs to the player in terms of impaired performance and also in terms of long term problems arising from an incompletely healed injury.

Ekstrand et al. (2004) looked at the problem as a result of the 2002 World Cup. They cite one of the major reasons for injury as being the frequency of the matches in a packed calendar for the top players. Injuries which would normally be regarded as comparatively minor did not get the usual chance to heal completely before the next game was due to be played. This resulted in a rising accumulative total of injuries above what might otherwise be expected over a comparatively short period.

The study found that, over the ten months of the World Cup games the average player played 36 matches. The top players form each team played, on average, 46 matches over the same period. The survey showed that the players who played in the World Cup matches sustained 29% more injuries than players from the same teams who did not play. 32% underperformed when compared to their normal standard. These players had played statistically more matches than those who were felt to have played better than expected. One major finding was that 60% of the players who had played more than one match in the week before a World Cup match were either injured or underperformed during the World Cup game. The clear inference from this study is that tiredness and physical burnout affects performance in elite footballers. At the highest levels, players, clubs and coaches should be aware that this is a real phenomenon. And, at the very least, is a considerable cause of stress to the players.

Orchard and Seward (2002) Took this concept a stage further and looked at the injuries sustained by the entire Australian Football League over seasons from 1997-2000. Their findings are a major source of concern to the elite footballer world.

In a season each team of 40 players would expect to receive 39 separate injuries. Clearly some players would be injured more than once (The major predisposing factor for injury is a pre-existing injury). The injury prevalence of players missing through injury in a week was 16% with a recurrence rate of 17%. They found that the commonest injury was to the hamstrings, followed by ACL strains and then groin injuries. For an elite footballer who depends upon his ability to play for his income, these figures represent a great cause of potential stress.

Before leaving this area, we should consider one other area of injury which we touched upon earlier, and that is the sequelae of concussion. Bloom et al (2004)

looked at this particular problem in great detail with particular reference to the psychological changes that were observed to occur after the injury. After suffering a concussive injury, the elite footballer was found to suffer from a greater incidence of symptoms of isolation, pain,anxiety, and disruption of daily life as a result of the injury. The investigators found that a source of added stress was, unexpectedly, from other team members who appeared to be giving support but were subliminally putting pressure on the injured athlete to return to play. The investigators found a worrying number of unexpected psychological symptoms including anger, denial, depression, distress, bargaining, and shock. Clearly this needs to be both recognised and addressed if the impact of the injury is not to be a further source of stress to the injured footballer

Dietary concerns

The elite footballer must always be at peak fitness and as a result his diet must always be under scrutiny. Fitness generally needs a BMI in the region of 20-23. Significant weight gains beyond this range not only reduce performance levels but also increase the wear and tear on the joints. We have already discussed the extent to which the knee joint is stressed during football training and playing. Adding weight to this joint is clearly only going to add to the degenerative changes that occur.

An elite footballer needs to be able to accelerate his body mass rapidly in a given direction. It follows that the greater the body weight, the greater effort is needed. He will know this both at a cerebral level and also at an instinctive level. He will know that if his weight goes up significantly then it becomes harder for him to run as fast and to turn as efficiently. The average elite footballer is therefore very careful with regard to his diet. The average man in the population can afford to go out for an occasional extravagant meal or the odd evening or two at the pub without worrying too much about the consequences. The consequences for the elite footballer are that, in doing such things he would have to reduce his calorie intake over the next few days in order to maintain the status quo. This again can become a major source of stress for many.

As the years go by, the average male tends to become slower and to put on weight as a natural process. This insidious reduction in the body’s efficiency is obviously a concern to a footballer who will often try to combat this trend with ever more aggressive training programmes and dietary regimes – again another source of stress.

Drug monitoring concerns

A number of elite footballers have hit the headlines lately as a result of random drug tests, either through failing or missing them. Doping and drug-enhanced training is a fact of professional football life in the current climate. It follows that the regulatory powers have to be ruthless in their quest for a drug-free sport. The fact that some players do gamble against the odds and take performance enhancing medications and drugs is a reflection of the stress and pressure that they feel under to constantly perform. It equally follows that they must feel that their performance is not good enough if they need to resort to such measures.

The problems do not stop at performance enhancing drugs. Stress and other factors may tempt a player to use drugs of a different sort. Recreational drugs are common in elite footballer circles. In support of this statement we would consider the paper by Turner (2003) In which he states that a recently retired elite footballer claimed that 80% of elite footballers in Australia had either been offered or used recreational drugs. This statement was extensively reported in the Press and other sources quoted the figure as being nearer 30%. The truth of the matter will clearly never be known but it can be contrasted with the figure from the UK which shows that over 18% of all the positive drugs screening tests done on athletes are currently for recreational drugs. This can be put in perspective against the 35% positive findings for stimulants and 25% for anabolic agents

Premature retirement

Retirement is a fact of life for all workers. As we have discussed earlier, retirement from active playing – and therefore from a high earning capacity – tends to come at a much earlier age for a footballer. It is therefore a major incentive to keep playing at a high level for as long as possible.

Retirement through the natural ageing process is something that the elite footballer obviously has to come to terms with. It is comparatively unusual for a top rank footballer to be playing into his forties. He may have the experience to play well, but he is always judged on his results, and the fact of the matter is that there will always be younger players who will generally be faster and filled with raw enthusiasm ready to jump into any vacant slot at the top. The elite footballer therefore knows that his playing days are always numbered.

We have discussed earlier the problems faced by the elite footballer in respect of the ever-present danger of injury. Clearly a career-ending injury can come at any time. It can be career-ending because of a dramatic incident such as a major fracture of a major bone or it can be a more subtle process, a bad tackle gives rise to an ankle injury which, in turn gives rise to an unstable ankle that does not allow the pivoting action necessary for efficient play. It becomes obvious that the player is not performing as well as another player in the squad and therefore he is replaced with greater frequency and then he becomes dispirited and eventually dropped from the team. The end process is just the same in either eventuality – cessation of an active playing career and the concurrent loss of high earning capacity.

The result can be devastating for a man who, in order to achieve elite footballer status, may well have devoted a substantial proportion of his adolescent and adult life to improving and perfecting his football skills. He finds himself effectively out of a job at an age where most men are still looking forward to at least twenty more years of productive work. The immediate openings for him are limited to training, coaching or managing, all of which are highly competitive as they have been filled by his footballing predecessors and generally, they are not as well paid as his previous career. The stresses and psychological traumas are all too easy to see if the elite footballer has not been particularly level-headed in his approach to the profession.

The unlikely body of Windsor Insurance Brokers Ltd. published a study of an investigation into the career-ending incidents of professional footballers in the UK (1997) which makes interesting reading. They did not analyse the actual levels of stress that we are concerned about in this piece, but their findings make sobering reading to the current generation of elite footballers. It would appear that few elite footballers actually reach retirement age without a significant injury. That injury is responsible (either directly or indirectly) for the eventual d

INTRODUCTION

The aim of the report is to analyse the position of Fitness Express, a business consisting fourteen fitness clubs and recommend Steve Taylor and Dave Courteen on how they can improve the business over the next five years. To achieve this, an analysis of both the external and internal environment of the business will be considered. A study of the external environment will be done with the help of the Porter’s five forces analysis followed by a life cycle study leading to a PESTEL analysis. This will be followed by a SWOT analysis to study the internal environment of the business. Thus by analyzing the external influences and the strengths and weaknesses of the business, a conclusion will be drawn on the development options of the business.

NATURE OF THE BUSINESS

Position to date:

Fitness Express was founded by Dave Courteen and Steve Taylor in 1987. The business constituted 14 fitness clubs as of January 2000. By then over 190 staff were employed. The partnership of Dave and Steve had matured into a highly professional business in the last 13 years providing first class systems for the customers.

Mission:

The mission of Fitness Express was to bring excellence, a passion for health & fitness, and professionalism to the fitness industry. A fitness club is where the customers come to feel good, have fun and keep fit at the same time. Fitness Express ran on this philosophy.

Short Term Objective:

The business was projected to turnover in excess of ?2million that year.

Long Term Objective:

They intended to develop a winning service formula and to create first class systems and routines to bear their offering.

Key personnel:

The business was run by Dave Courteen and his partner Steve Taylor. They had employed over 190 staff.

STRATEGY

Fitness Express was born in June 1987. From the beginning it was evident that the skills of the partners complemented each other. Dave was the negotiator and Steve was the man-manager. Dave enjoyed building the business; Steve was good at the operational side.

Staff were hired on the basis of their personality rather than on their fitness. Dave and Steve paid great attention to the personal development and training their staff.

The policy of Fitness Express was “EXCELLENT CUSTOMER SERVICE”, which required friendly and approachable staff. Gym users were frequently spoken to. In order to maintain a friendly environment they greeted their customers by their first names.

The partners also realized that there was enthusiasm amongst the under-represented part of the population who were over 40’s and 50’s “de-conditioned” segment. This saw them place an emphasis on developing the club as a place to come and socialise.

Four years into the business, Dave and Steve realized that they should expand their business. As they had no funds to build new health centres in different venues, they began to offer consulting services to independent hoteliers like Best Western Hotels. They also had an opportunity to work with Thomas Cook on their ?4milloin staff leisure facility which secured them the contract to run Legal and General’s facility in Tadworth, Surrey.

DEVELOPMENT OPTIONS

1. Deal with Swallow:

The Swallow Hotel Group approached Fitness Express to merge in a joint venture. In that case 50% of the shares would be acquired by Swallow. All the leisure centres would be run by Fitness Express. The hotel will continue to employ their own staff. They will be supported by a Fitness Express Team.

2. To expand through acquisition:

Following 12 successful years, Fitness Express was cash rich with over ?300,000 sitting in the bank to use in acquisitions. So another option was to expand through acquisition. There was existing a similar contract management company as Fitness Express but far less profitable per club. Integrating them into Fitness Express and expand their business seemed to an alternative.

3. Organic growth:

Organic growth can also be considered as an option. Fitness Express was running a tight ship and there was limited room to increase the earnings potential within the existing clubs. They already ran added-value revenue generating services, such as a holiday club, but perhaps more could be done with the existing hotels such as running weekend fitness breaks.

IDENTIFYING SOURCES OF COMPETITION
1. THREAT OF NEW ENTRANTS

Threat of new entrant might not be a matter of huge concern as there are high barriers to entry in this industry. Highly developed equipments and expert staff requirement make it difficult for fitness centres to enter in the market.

2. BARGAINING POWER OF BUYERS

With the membership levels rising steadily and the market getting oversaturated the buyer powers were high.

3. BARGAINING POWERS OF SUPPLIERS

It was important to invest with hotels of the right hotels. But the number of quality hotels being less the bargaining powers of suppliers was high.

4. THREAT OF SUBSTITUTES

The threat from the substitutes was not very high as there were few companies in the UK of the same stature as of Fitness Express. One of these was a similar contract management company with thirty contracts, but their profit margins were comparatively low compared to Fitness Express.

5. COMPETITIVE ENVIRONMENT

With the merger activities going on the competition were on the high. LivingWell, the health clubs operated by Stakis, the hotel and casino group, had overtaken David Llyod Leisure. Cannons and First Leisure also came close to merging their health and fitness business.

LIFE CYCLE OF THE BUSINESS

Development Stage

Users/buyers:

Dave and Steve started their business as they took over the total control of the gym of the Barnham Broom hotel in Norwich. The business depended on the membership fees and the customers were those who were the members of the hotel leisure club.

Competitors:

Competitors were very few.

Growth Stage

Users/buyers:

A monthly guest appearance on local Radio Broadlands ‘fitness phone-in’ programme for 30 minutes seemed to be effective. Answering listeners, questions on fitness, e.g. how to work off excess fat gained over Christmas, gave FE wide coverage in the local area.

Competitors:

At this stage they were entry of the competitors. There was a high competition to niche the market position.

Shakeout Stage

Users/buyers:

A swimming pool was added to the hotel site. The facilities attracted more people. Thus there was increase in the number of customers. Fitness Express effected a change in the payment structure.

Competitors:

Very high competition led to develop the business in other venues.

Maturity Stage

Users/buyers:

They began to offer consulting services to independent hoteliers like Best Western Hotels. They also had an opportunity to work with Thomas Cook on their ?4milloin staff -leisure facility. Thus their business continued to develop at other venues.

Competitors:

Three new contracts were established in 1993. One of them was located only five miles away from their base at Barnham Broom. So the competition was high and there was a threat of losing customers.

Decline Stage

Users/buyers:

With the days going through the contract expiry dates were around the corner. Thus it was evident that there could be a decline soon.

Competitors:

The issue of the contract was solved by ensuring that one would serve the family and children while the other would serve only the older group people. Thus the competition was reduced

ENVIRONMENTAL FACTORS AFFECTING THE COMPANY’S MARKET POSITION

1. POLITICAL:

Political issues include government policies or legislation. For a fitness organization, there is very little to be concerned about trade restrictions and tax.

2. ECONOMIC:

Economic issues are a key factor for a fitness company. Fitness companies are leisure service providers. There might be a decrease in number of customers when there is an economic decline. People will not spend money on leisure activities when they have less disposable income.

3. SOCIOCULTURAL:

Population demographics are an important factor which influences a fitness company. This includes age, sex and income of people. There is high demand from both young and old people for fitness and physical development. Fitness is also independent of sex. As discussed in the economic issues, fitness companies provide leisure facilities the economic condition of people is a matter of concern. Fitness Express was based on urban centre in East Anglia. This was strength of the business.

4. TECHNOLOGICAL:

While technological issues might favour the company in terms of providing high barriers to entry for new entrants, it might be a matter of concern for the high demand and expectation from customers. Highly developed equipments and expert staff requirement make it difficult for fitness centres to enter in the market. At the same time in order to compete with the existing competitors, a fitness company should be aware of the technological developments and provide the latest equipments to its customers.

5. ENVIRONMENTAL:

Environmental factors could come in way of a fitness company. Energy consumption is high as the equipments run on electricity. Hence the environmental protection laws can come in the way.

6. LEGAL:

Being a fitness company, legal issues come into play in health and safety matters. Rules and regulations should be strict regarding quality of equipments used. All the staff should be well qualified and trained. This in turn will have an impact on the staff costs.

SWOT ANALYSIS

Strength

Weakness

Experience of Dave and Steve
Both Dave and Steve were highly respected within their industry
Excellent Customer Service provided by Fitness Express
Staff recruitment policy
Wide coverage in the local area through media
Small business of 14 clubs
Despite the number of staff they employed, Dave and Steve were still very hands-on
Increase in staff cost
High buyer power
High supplier power

Opportunities

Threat

Growing the business in other venues
Deal with Swallow
Including acquisition
Organic growth
Expiry of contracts with customers
Customer loyalty and insufficient facilities
Competition
Loss of niche market power

STRENGTH
Steve worked with a large sports retailing outlet in York as a student, where he gained valuable experience in managing the operations of a large facility. Dave did his summer job in Lowesoft. He was involved in designing a mobile gym and providing fitness assessment for holidaymakers during his summer job. These experiences paid off when they started their own business. Steve involved himself in the operational side of the business. Dave looked upon developing the business.
Their strength was the respect they enjoyed within the industry. Dave was also appointed as Chairman of the Fitness Industry Association (FIA). The goodwill in the market certainly attracts customers towards a business.
The policy of Fitness Express was “EXCELLENT CUSTOMER SERVICE”, which requires friendly and approachable staff. Gym users were frequently spoken to. In order to maintain a friendly environment they greeted their customers by their first names.
The quality of the staff, and their ability to communicate with the guests would be the most important factor whether or not a guest would return the following year. Staffs were more likely hired on the basis of their personality than on their fitness, and any future business run by Steve would pay great attention to the personal development and training their staff.
Word of mouth and the local PR that they encouraged generated membership for their club. A monthly guest appearance on local Radio Broadlands ‘fitness phone-in’ programme for 30 minutes seemed to be effective. Answering listeners, questions on fitness, e.g. how to work off excess fat gained over Christmas, gave FE wide coverage in the local area.
WEAKNESS
Building the small empire of 14 clubs had taken Dave and Steve over 12 years. Their competitors had a more widespread business.
Despite having employed over 190 staffs, Dave and Steve were both still very hands-on. Managing at both the tactical and the strategic level was physically exhausting and they knew that it was unsustainable in the long run.
Since the industry demands well qualified and trained staff. This will have an impact on the staff costs.
With the membership levels rising steadily and the market getting oversaturated the buyer powers were high.
As the number of quality hotels to deal with was few, the bargaining powers of suppliers were high.
OPPURTINITIES
Four years into the business, Dave and Steve realized that they should expand their business. As they had no funds to build new health centres in different venues, they began to offer consulting services to independent hoteliers like Best Western Hotels. They also had an opportunity to work with Thomas Cook on their ?4milloin staff leisure facility which secured them the contract to run Legal and General’s facility in Tadworth, Surrey.
A deal with Swallow, a major UK hotel chain meant that 50% of the shares of FE would be purchased by them. All the chain’s leisure facilities would be managed by Fitness Express on a ‘joint venture’ basis, with the hotels continuing to employ their own staff, but supported by a dedicated Fitness Express team. This came as a big opportunity and everyone was exited.
Following 12 successful years, Fitness Express was cash rich with over ?300,000 sitting in the bank to use in acquisitions. There was existing a similar contract management company as Fitness Express but far less profitable per club. Integrating them into Fitness Express, with all the personnel and cultural issues that would emerge, would be even more difficult, especially given the geographic spread of the contracts they would be buying.
Organic growth can also be considered as an option. Fitness Express was running a tight ship and there was limited room to increase the earnings potential within the existing clubs. They already ran added-value revenue generating services, such as a holiday club, but perhaps more could be done with the existing hotels such as running weekend fitness breaks.
THREAT
One of their customers was the Hotel Norwich who served notice to leave, with their contract of two years expiring over the following three months. Applying this to their other contracts, Dave and Steve realized that within two years the basis of their entire business could collapse. So they went back to all their sites and renegotiated their contracts. Most customers eventually agreed to a three-year contract with a six-month notice either way. This was a mere temporary solution. But it was to be kept on mind that expiry of contracts is a continuous threat for Fitness Express.
A ‘disaster’ hotel was taken on. The management of the hotel was not committed to the customer service and facilities were not up to the mark to generate sufficient turnover (e.g. there was no car park), so quickly the two partners realized that this could never be made to work satisfactorily. Luckily the contract being an incorrectly-worded one, they found a way to get out of the agreement after one year. Though they incurred a loss of ?30k but overall disaster was avoided. So it was important to grow with the right hotels. But were there sufficient hotels of the right quality out there?
With the merger activities going on the competition were on the high. LivingWell, the health clubs operated by Stakis, the hotel and casino group, had overtaken David Llyod Leisure. Cannons and First Leisure also came close to merging their health and fitness business.
Three new contracts were established in 1993. One of them was located only five miles away from their base at Barnham Broom. This came as a potential threat. The high competition in the market can also affect loss of the market power that the company secured over the past years.
RECOMMENDATIONS AND CONCLUSION

As the options of further growth of the Fitness Express seemed to be three-fold, with the analysis of the macro and the microenvironments it can be concluded that expanding Fitness Express through acquisition would be a good option. Though the deal with Swallow is attractive financially, but to sell the company and let the business become another highly professional fitness chain does not seem to be the best measure. Again they were running in a tight ship and there was limited room to increase the earnings potential within the existing clubs. The only way to grow significantly was to increase the number of clubs. Dave and Steve were highly respected in the industry. They were very experienced. Fitness express provided excellent customer service. With these strengths, the company should focus on acquiring another management company and work on the improvements of the existing infrastructure to make it pay.

Exploring sport opportunities for young athletes with different abilities

Abstract

The aim of the study is to develop a new terminology from the negative term of “disability” and to try and hava an inclusive system during physical activities in schools. In addition is tries to highlight the importance of having more inclusive sport opportunities for everyone and to improve the self-esteem of people with different abilities.

In Malta few athletes with different abilities have the opportunity to be included into sport activities. In schools there is not much time allocated for persons with disability both during physical education lessons and also during break time. As the athlete with different abilities starts thinking seriously of sport activities he encounters a lot of mishaps primarily the over-protection from parents and organisers. In addition he also faces the disadvantage of the lack of sport opportunities for him. This reason led the researcher to investigate what is really going on, both during childhood when it comes to school activities i.e. physical education lessons, and at later later stage during adolescence and adulthood when it comes to sport opportunities offered by society.

This study is made up of five chapters which start from the history and defenition of disability and ends up with the guidelines to a way forward.

Introduction

The aims of the study are:

To try and transit from a terminology that might sound negative “disability” to a better word “Different abilities”
To try and have an inclusive system during physical education in both primary and secondary schools
To have more sport opportunities which include everyone both for leisure and also on a professional level
To strengthen the self-esteem of persons with different abilities

The study is made up of five chapters. Chapter 2 tackles the history of disability and sports. An overview of the study background and key terms used within the study investigation are also provided.

Chapter 2 gives an overview of some basic terms and general knowledge related to disability and sports which give a better understanding of the aims of the study. An evaulation and illustrations from experts regarding sport and disability sectors also follow.

Chapter 3 investigates the approach taken and the processes involved in achieving the dissertation objectives. Details of the sources used as well as a description of the method used to collect the primary and secondary research data are also provided.

The study concludes with an evaluation of the achieved results in the previous section. The conclusions derived state the opportunities available and what can be really done to enhance further inclusion into sport for persons with different abilities, compared to the literature review findings. A study critique concludes the dissertation.

CHAPTER TWO:

History of disability

1.0 Introduction

1.1 History

People with different abilities better known in society as people with a disability have always been in existence. For many different reasons they have become more present in the twenty first century than before.

About ten percent of the population is considered to have different abilities and the parliament directives of the late twentieth century improved the accessibility and availability of services and facilities for this group which is considered to be the largest minority group in society. This resulted in more individuals with different abilities going along more easily with their daily living. These people are being more recognized in society even in sport. Athletes with different abilities have been participating since at least the last hundred years. However it has only been from recent times that these athletes started receiving the appreciation that they merit and have also been recognized as athletes.

The roots of the link between sport and disability to disability sport started primarily during the 20th century and developed into a new movement. This movement has developed up to the point so as to include the complexity of its members and also restructuring of its aims and visibility. Athletic opportunities have expanded so as to have individual accomplishments of athletes with different abilities. These overlooked and unseen sportspersons are gaining increased recognition firstly as athletes and above all as humans with different abilities.

Exceptional performances by top athletes with different abilities are purely seconds or tenths of seconds behind those of top able-bodied athletes, in sport disciplines like downhill skiing and swimming. Athletes with bi-lateral leg amputations finished a hundred metre race in 10.85 seconds and others with less severe impairments finished in even less time. A top male wheelchair athlete finishedd a marathon at an average of 3.5 minutes per mile and managed to complete marathons in almost ninety minutes or less, while a female wheelchair athlete did the same marathon in an hour and forty nine minutes.

1.2 Definition of Disability

The terms functioning and disability must be defined clearly in order to understand the interrelationship between functioning and disability. The term “functioning” describes the functions and structures of the body. It helps to grasp an individual’s interaction with a health condition and the environmental and personal contexts. Disability is viewed as the result of the interaction between individual functioning and the environment when linked with a health condition. The level of difficulty is highly dependent on the degree of functional autonomy and independence of persons living with disabilities, be they sensory, physical or mental. Accordingly, functionality is defined as the ability to perform those activities necessary to achieve well-being through interaction between the biological, the psychological (cognitive and affective) and the social spheres (Sanhueza Parra, 2005), and whose loss entails the risk of disability and dependence. Care thus avoids what Morris (2001) terms the social construct of dependence, which negates the individual. For people with disabilities, respecting their right to care gives them access to assistance from others and to essential technical aids, and a physical and social environment that is adapted to their particular impairment.

Following the environmental approach taken by WHO, functional autonomy may therefore be defined as the ability to perform functions related to daily life, such as those activities necessary to achieve well-being through appropriate interaction between the biological, the psychological (cognitive and affective) and the social. This enables the individual to live in the community with little or no help from others, albeit with assistive technology. (United Nations, 2012 pg 183)

… Very often, lay and, sometimes, professional people do not seem to make a distinction between such terms as Impairments, Dis-abilities, Handicaps. These are often taken to mean one and the same thing. But this is wrong. The World Health Organisation, in 1980, published a manual titled International Clasification of Impairments, Disabilities and Handicaps, whereby, three distinct and independent were proposed, each relating to a different plane experience.

… Disability is “any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being”. It represents objectification of an impairment and, as such, reflects disturbance at the level of the person.

… Disability is concerned with abilities in the form of activities and behaviour a person`s body is expected to carry out as essential components of every day life, such as represented by tasks, skills, and behaviour. Disability signifies a departure from the normal in so far as the performance of the individual is concerned as opposed to that of the organ or mechanism. ( Troisi, 1992 pg 3 & 4)

CHAPTER THREE: LITERATURE REVIEW

Young people are often seen as challenges to most people in society. This is exactly what the article “Positive Youth Development through Sport” edited by Nicholas L. Holt declares.

According to Holt speaking from the perspective of Positive Youth Development (PYD), argues that young people are frequently pointed out as problems in society waiting to be solved. However young people are understood to embody potential, awaiting development.

Holt points out that sport itself provides a developmental context that has been associated with PYD, but sport on its own does not lead to PYD. In fact he points out that in some environments there are instances when negative outcomes arise from sport participation. Thus it is the manner in which sport is structured and delivered to children that influences their development.

Nicholas Holt quotes Larson and expresses that, organized activities can provide youth with opportunities to experience positive development. He states that sport is the most popular organized activity into which youth engage (Larson and Verma 1999).

Both theory and research point out the importance of structural out-of-school-time (OST) activities as important assets in the positive development of youth (Mahoney et al. 2005).

Holt in his article says that youth participation in organized sports has been linked to indicators of adolescent’s physical, social, psychological, and achievement related behaviour and development. Researchers (Barber et al. 2001: Eccles et al. 2003) found that, in comparison to non-participants, youth who participate in sport enjoyed attending school more, received more frequent educational and occupational support, had higher academic performance, longer periods of tertiary education by age 25, and attained a job at age 24 that offered autonomy and a promising future. Although there where diverse research findings regarding the relationsip of sport participation and alcohol use, some found a relationship between sport participation and a lower level of alcohol use (Peretti-Watel et al 2003). Other findings indicated a positive relationship between sport participation and alcohol use. Sport participation has also been consistently linked to a lower use of cigarettes, marijuana, cocaine, and ‘other drugs’ (Page et al 1998). Furthermore it was also related to lower rates of depression and lower incidence of suicidal behaviour.

Researchers and youth advocates have proposed important benefits of sports involvement. However, to date, little research has accounted for the dynamic ways in which youth spend their free time.

A book entitled No one`s perfect, tells the story of a Japanese Boy who despite being born without arms and limbs he managed to do it his way into sport.

This Japanese little boy, named Ototake, came home from school one day and told his parents he had signed up to play basketball. In contrary to other parents who would be delighted to such a request, they where shocked. Oto was born with no arms and no legs. Despite his disability, this extraordinary young man has always proven a hard-worker, rich in versatility and with an upbeat approach to life. This positivity served him as valuable as limbs. No One’s Perfect is his true account of how he slam-dunked one challenge after another, including basketball.

Ototake says that thanks to having short arms and legs plus a wheelchair, he was a winner in the popularity department. He found himself always the centre of a circle of friends. With time the typical willfulness of an only child began to kick in. Ototake maintains that at first break time, when everyone would be playing tag in the playground, or physical education lessons, were dead boring for him since with his power wheelchair he could not keep up with his friends. Thus he usually yelled for them to come and play with him: “If you want to play in the sandbox, follow me!” Strangely enough, the kids who had been happily chasing one another a short while before would all troop after the wheelchair to the sandbox.

Ototake highlights that looking back to school days, most people with disabilities admit that recess was the worst part of their day. This is that particular time when ordinary children, unless they are real bookworms, would enjoy. The main reason is that for disabled kids the forty five to fifty minutes of a class period pass quickly enough while they sit quietly in their seat, but during breaks, when they can`t join in the fun their classmates, they feel greater sense of isolation so they can`t wait for recess to be over.

Evaluation of Exercise Tests Used to Examine Aerobic Capacity

Aerobic exercise was developed by Dr. Kenneth Cooper in 1969, to study why some individuals with superior muscular strength, scored poorly in long distance running, cycling or swimming regimes (Cooper, 1969). Dr. Cooper’s research involved using a bicycle ergometer to measure sustained human performance, in terms of an individual’s ability to utilize oxygen (Cooper, 1969). The data Dr. Cooper collected for his research is the foundation for the development of all modern aerobic tests and programs (Cooper, 1969). Aerobic exercise describes a physical activity performed at moderate levels of intensity for extended periods of time; ultimately increasing heart rate (Donatelle, 1969). This includes exercises like long distance jogging but not sprinting (Donatelle, 1969). In aerobic exercise, glycogen is decomposed to produce glucose; however, when glucose levels are minimal, fat is broken down (Donatelle, 1969). The ability an individual’s respiratory and cardiovascular systems can meet the oxygen demands of exercising muscles is called aerobic capacity (NYCFD, 2006). It is the maximum volume of oxygen muscles will intake during exercise (Donatelle, 1969). High aerobic capacity translates to better performance (Donatelle, 1969), not only because oxygen is efficiently delivered to and used by muscles, but also because recovery from extreme efforts by the muscles is faster (NYCFD, 2006). To boost aerobic capacity, heart rate needs to be worked up to 70% to 85% of its maximum; this is known as the heart’s “Target Heart Rate” or “Training Sensitive Zone” (NYCFD, 2006). This can be done by participating in aerobic training that recruits large muscle groups, such as those in the legs (NYCFD, 2006).

As exercise intensity increases, oxygen consumption (VO2) linearly relates to workload, but only to a certain point, where VO2 plateaus, even as exercise intensity rises (McArdle et al, 2001). This plateau value, known as the maximal oxygen consumption (VO2 max), is synonymous with aerobic power (Peterson, 2004), which is defined as the extent at which aerobic capacity, the peak aerobic energy strength, is exploited (Sports Resource Group, 2003). However, VO2 max is not the only predictor of aerobic capacity (Peterson, 2004); expressed as a fraction of VO2 max (% VO2 max ) (Peterson, 2004), the physiological value (LT), typically known as lactate threshold or anaerobic threshold (Peterson, 2004), also provides valuable information. LT defines situations when glycogen decomposition does not meet the required energy demands of the exercising muscles (Donatelle, 2005), and measures the degree of muscular and metabolic stress during exercise (Peterson, 2004). It is the point above resting level, when light elevating levels of exercise causes glycogenolysis increases (Peterson, 2004), and lactate begins to accumulate in active muscles and blood (Farrell et al, 1993). Although lactic acid build up is removed gradually by slow oxidative muscle fibers, lactic acid often builds up in muscles before LT is reached (Peak Performance, 2006). Since there is no definitive start point in lactic acid build up, a set lactate accumulation value of 4 mmol/L of lactic acid in the blood is usually used as the point of onset of blood lactic acid (OBLA) (Peterson, 2004).

LT is considered to be a more accurate predictor of aerobic capacity than VO2 max, however, it pertains only to the local muscles’ training state (Peterson, 2004). The LT phenomenon helps to explain why individuals with similar VO2 max can differ in endurance performance times (Peterson, 2004); those with a higher LT exhibit better ability to exercise because they use a larger fraction of their aerobic capacity (85-90% VO2 max) (Peterson, 2004). Factors leading to these results include examining whether subjects have undergone previous strength and endurance training in the muscles being analyzed and the percentage of Type 1 muscle fibers in the targeted muscles (Peterson, 2004).

Exercise tests that informatively examine aerobic capacity, should help describe the overall changes in the cardiovascular system, as well as the local changes in the muscles, active in exercise (Peterson, 2004). Theses changes, collectively known as adaptations (Peterson, 2004), include increase in plasma volume, blood flow redirection to active muscles, heart size enlargement, heart rate reduction (HR), stroke volume elevation (SV), increase in cardiac output (Q), total muscle blood flow increase during maximal exercise and blood pressure reduction (Peterson, 2004). When capillary density is increased because of aerobic exercise, muscles take in more oxygen (Peterson, 2004). The local adaptations of the muscles that should be regarded as a part of examining aerobic capacity include: increase in the number and size of mitochondria, more carbohydrate oxidation because of increased oxidative enzyme activity, improved fat metabolism, the amount of muscle and type of muscle fiber evident during the exercise (Peterson, 2004).

Today, common forms of aerobic capacity testing are the treadmill (TM), walk tests and cycle ergometer (CE) tests (Peterson, 2004). These methods are effective because they require the use of large muscle groups and are also cheap and straightforward enough for subjects to handle (Peterson, 2004). In all incidences, the clinical exercise testing protocols would involve initial warm-up; gradual increasing loads of uninterrupted exercise, with adequate duration per level; and finally a recovery period (Fletcher et al, 1995).

Endurance running can be defined as maintainable velocity over a given distance (Peterson, 2004). Measuring aerobic capacity using treadmill facilitated tests require subjects to walk at a light pace, then gradually pickup the workload at set time intervals (Donatelle, 1969). The equipment used is an accurately calibrated, standard treadmill with variable speed and grade capability (Fletcher et al, 1995). Subjects should refrain from tightly grasping handrails on the treadmill during the test, as this results in decrease in VO2 and increase in muscle exertion and exercise time (Fletcher et al, 1995). The duration of an average protocol is 6 to 12 minutes (Fletcher et al, 1995), but a number of different protocols exist, varying in the increments of time or amount of increase in workload (Fletcher et al, 1995). The ideal protocol however, should be tailored to the type of subject being tested (Fletcher et al, 1995).

The values usually measured in TM tests, VO2 and peak cardiac power output (CPOmax) , (Fletcher et al, 1995), give an idea about an individual’s aerobic capacity, and are used as data for many different studies. For example, studies have used TM tests to determine aerobic capacity of subjects (Williams et al, 2001 and Cooke et al, 1998). Their data gave evidence that CPOmax during exercise, was significantly related to aerobic capacity and also correlated to exercise duration (Williams et al, 2001 and Cooke et al, 1998). CPOmax was found to be an independent mortality predictor (Williams et al, 2001), and using TM cardiopulmonary exercise testing is beneficial because it is non-invasive, therefore less stressful for patients to participate (Williams et al, 2001 and Cooke et al, 1998). This finding was consistent in a population of normal subjects and individuals with heart disease (Cooke et al, 1998), and ultimately gave a more definitive idea about the extent of cardiac impairment of patients with heart failure (Williams et al, 2001 and Cooke et al, 1998).

A lower impact alteration of the TM test is the six minute walk test (6MWT), which is cheaper and simpler to conduct (American Thoracic Society, 2002). This test is usually used on patients with health problems, and measures the distance of hard, flat surface subjects can briskly over in 6 minutes (American Thoracic Society, 2002). The test is useful for evaluating the body’s overall and local adaptation responses involved in exercise (American Thoracic Society, 2002). This includes pulmonary and cardiovascular systems, systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism (American Thoracic Society, 2002). However, since the 6MWT evaluates the submaximal level of functional capacity (American Thoracic Society, 2002), information generated is not specific about the causes of limitation (Johnson, 2004).

Measuring performance at submaximal levels of exertion, the 6MWD gives a good indication of the level of functional exercise in daily physical activities (American Thoracic Society, 2002). However, for patients with severe chronic obstructive pulmonary disease (COPD), the test generates a similar stress as a maximal test (Johnson, 2004). In studies conducted using a population of patients with cardiac and or respiratory problems (Solway et al, 2001), the 6MWT was established to be the easiest to administer, most tolerated by patients and most reflective of daily activities, out of 2-min walk tests (2MWT), 12-min walk tests (12MWT), self-paced walk tests (SPWT), and shuttle walk tests (SWT) (Solway et al, 2001). In order to study the effects aerobic and strength training have on improving aerobic endurance and muscle strength in female cardiac transplant recipients (Haykowsky et al, 2005), the 6MWT was administered to measure cardiac transplant patients’ aerobic endurance before and after placing them in aerobic training programs (Haykowsky et al, 2005). However, firm conclusions on the usefulness of the test in clinical practice, are still lacking (Opasich et al, 2001). In a study to investigate the correlation between walk test performance, cardiac function and exercise capacity (Opasich et al, 2001), it was found that for moderate to severe chronic heart failure patients, the 6-min walk test is not related to cardiac function and only moderately related to exercise capacity (Opasich et al, 2001). Therefore, the paper deemed the test to have only limited usefulness as a decisional indicator in clinical practice (Opasich et al, 2001).

Some disadvantages of the 6MWT is that being a time controlled test, the only way a subject can show improved aerobic capacity in subsequent testing, is by walking faster (Johnson, 2004). However, for some COPD patients, walking faster is difficult due to factors such as stride length (Johnson, 2004); a TM test on the other hand can accommodate for a steeper grade, hence allowing patients to show improvements in their overall condition (Johnson et al, 2002). TM testing can be deemed better than 6MWT as it is more versatile; it can be used with or without advanced monitoring such as continuous electrocardiography or expired gas analysis (Johnson, 2004). However, TM tests are more expensive and require more expertise (Johnson, 2004). Although 6MWT is a good test to repeat for the purposes of documenting decline in exercise tolerance (Johnson, 2004), TM tests are better at documenting improvements in function because they test at constant workload, and is therefore more sensitive (Johnson, 2004).

For individuals untrained in cycling, VO2 max is higher when tested on TM compared to CE (Peterson, 2004), while trained cyclists generated only slightly higher VO2 max values when tested via CE compared to TM (Peterson, 2004). VO2 values from TM tests are generally higher than those attained from CE protocols (McArdle et al, 2001). The cause is because most individuals are more comfortable walking or running, as oppose to cycling (McArdle et al, 2001). It could also be because CE testing causes discomfort and fatigue of the quadriceps muscles (Fletcher et al, 1995). Leg fatigue of an inexperienced cyclist causes subjects to stop before reaching a true VO2max (Fletcher et al, 1995), making the value 10% to 15% lower in CE than TM tests (Fletcher et al, 1995).

In cycling terms, endurance performance is the power output maintained for a given time (Peterson, 2004). CE tests require an initial power output of about 10 or 25W, followed by a 25W increase in 2 to 3 minute increments (Fletcher et al, 1995). Arm ergometry would require a similar approach, but with a smaller initial power output and lower incremental increases; usually every 2 minutes (Franklin, 1985 and Balady et al, 1985). Studies have also shown that it is possible to measure actual aerobic capacity in a single session by continuously increasing the load (Birkhorst & Leeuwen, 1963).

The equipment used for CE tests can either be mechanical or electrically braked cycles with adjustable variable force on the pedals (Fletcher et al, 1995). The highest values of VO2 and heart rate can usually be obtained with pedaling speeds of 50 to 80 rpm (Fletcher et al, 1995). The cycles are calibrated in kilopounds (kp) or watts, where 1 W corresponds to about 6 kilopound-meters per minute (kpm/min) (Fletcher et al, 1995). This can be converted to oxygen uptake in milliliters per minute for aerobic capacity measurement purposes (Fletcher et al, 1995). A cycle ergometer is usually less expensive, more space efficient and less noisy than a treadmill (Fletcher et al, 1995). Other advantages of CE tests are that upper body movement of subjects’ are reduced, which facilitates measurements in blood pressure and making ECG recordings (Fletcher et al, 1995). CE tests also give precise quantization of external work, ultimately facilitating the calculation of certain parameters for aerobic capacity examination (Johnson, 2004). Like the TM test, it is important that subjects refrain from exercising their arms in a resistive fashion, because this results in attaining inaccurate data for aerobic capacity (Fletcher et al, 1995).

In studies of patients with COPD, in addition to being inconsistent with patients’ normal activities, CE tests are less commonly used because they produced significant respiratory differences when compared with walking tests (Johnson, 2004). However, CE tests have been useful for identifying that the pathology of Gulf War veterans (GV) with chronic fatigue syndrome (CFS), do not show a decreased aerobic capacity like most normal CFS patients (Nagelkirk et al, 2003).

Overall, although TM, 6MWT and CE tests are all used to examine aerobic capacity, there are fundamental differences between the three tests (Peterson, 2004); these include differences in the muscle group exerted, pattern of muscle use, contraction speed and time of muscles and the metabolic processes (Peterson, 2004). In summary, TM and walking tests are more likely to identify oxygen desaturation (Turner et al, 2004). 6MWT is the easiest test to perform (Turner et al, 2004), and is adequate for most purposes (Johnson, 2004). However, depending on how and what the data from the aerobic capacity testing is used for, an important factor for choosing the most suitable test is the population of subjects being observed.

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Proposal for Exercise Referral Scheme

According to the NHS (www.nhs.gov.uk), approximately three million people within the UK are diagnosed with osteoporosis, and 230,000 fractures occur every year as a result of osteoporosis. Osteoporosis is a condition that affects the bones in the skeletal system, due to a loss of calcium and other mineral content, causing a loss of bone mass therefore bones becoming weak and brittle (Lawrence and Barnett, 2006). Due to this a person with osteoporosis is more susceptible to break or fracture a bone with a minor fall during daily activities, compared to a person with healthy bone mass; especially seen in the wrists, hips and spine (www.nhs.gov.uk).

A number of common risk factors for osteoporosis have been identified; gender, age, diet, family history, low body mass, smoking, hormones, lack of physical activity and medication (Durstine and Moore, 2003; Lane, 1999; Lawrence and Barnett, 2006; www.nos.org.uk). However the most common cause of osteoporosis is seen to be due to hormones. Woman have been seen to be more susceptible to osteoporosis than men, especially over the age of 45, due to a decrease in the hormone oestrogen after the menopause, however men with low testosterone levels are also at high risk (Durstine and Moore, 2003).

Awareness of osteoporosis arises from the number of fractures and mortalities from fractures that occur every year. Goodman (1985) found that calcium alone can prevent bone reduction, however this ‘combined with exercise, ideally before menopause, can prevent bone loss’. Exercise has been seen as a key factor in reducing the risk of fractures and consequentially falls in individuals with osteoporosis, through improving balance, mobility, flexibility, coordination and muscle strength as peak bone density is maintained as well as the rate of bone loss is reduced (Bass et al. 2001; Deal, 1997; Sherrington et al. 2004). With risk factors for osteoporosis identified; intervention for prevention and management schemes, focusing specifically on exercise, nutrition and life-style (Notelovitz, M 1993) should be created to concentrate on the individual’s weaknesses.

The aim of the scheme is to focus on prevention and management of fractures from falls, for individual’s suffering from osteoporosis, to improve the individual’s quality of life by becoming more active in a safe and supervised exercise environment, through the formation of best practice through existing research evidence. The scheme will focus on osteoporosis sufferers, however specifically targeting sedentary populations and pre and postmenopausal women.

The scheme will take a multidisciplinary team approach. The use of general medical practitioners will be required. The role of the general practitioner (G.P) is to prescribe and inform the client about a suitable exercise referral system, once a physical examination and a medical history of the client is obtained. The G.P is responsible for the overall management of the client, therefore explains the risks and benefits of the proposed scheme to the client. The roles of physiotherapists and occupational therapists are also required within the scheme. Physiotherapists play a key role in the scheme, they are there not only to exercise the clients, however educate and reassure them about the benefits of physical activity for the client’s specific condition (Guideline 4, Section C; NQAF). They will also play a large role in supervising clients who are in the high risk category of osteoporosis. A nutritionist will also be part of the multidisciplinary team, as diet is a major factor that influences the onset of osteoporosis. Lastly, an advanced exercise instructor will be used and will play a key role in the multidisciplinary team. The practitioner will hold Level 3 of the National Occupation Standards (Guideline 7, Section A, Guideline 1, Section C; NQAF) therefore allowing the instructor to adapt physical activities to meet the needs of the client, and create long term exercise program plans. The role of the instructor is to do a pre-exercise assessment to assess the client’s current physical status, and to create an exercise programme to benefit the client’s medical condition. The exercise instructor will focus on cardiovascular training, muscle strength, flexibility and functional ability.

G.P’s will discuss the benefits of the scheme to the client, and the client will need to reach Stage 3 of the ‘Change of Behaviour’ Model (Prochaska and DiClemete, 1992); therefore showing signs that they are ready to change their current ways of living to adapt to a more physical lifestyle to facilitate their medical condition, once this has been established a needs assessment, programme plan and evaluation may occur (Parker and Parikh, 2001), this follows Guideline 2 in Section C of the NQAF document, which state ‘Instructors should understand and apply a proven model of behaviour change in interactions with referred patients participating in the referral scheme’.

The initial stages start with medical examinations of the client, which will be conducted through the G.P to determine the clients current medical status (heart rate and blood pressure included) and medical history, the clients family history and any medications the client may be on, allowing the G.P to refer the client to an appropriate health care professional (Duty of care; NQFA). Confidentially consent forms are signed by the client stating the G.P is able to pass relevant information to the exercise practitioner about the client therefore allowing the exercise practitioner to draw up a suitable exercise programme relating to the clients current condition. During the first session the client will present a G.P referral letter to the exercise practitioner, stating reasons for the referral and the clients’ medical history allowing the exercise practitioner to conduct appropriate testing examining the level of fitness and current physiological and psychological status to assess the amount and level of physical activity to be prescribed (Guideline 1, Section B; NQAF). The client will be informed of the rate of perceived exertion (RPE) scale during testing therefore will be able to stop at any time if exhaustion or pain is to permit, and the use of a cycle ergo-meter is recommended (ACSM 2009).

As the scheme focuses on individuals with osteoporosis, especially targeting that of a sedentary population, as well as pre and postmenopausal women, the scheme will be a home and community based scheme lasting 20 weeks in total.

Initially, homes will be assessed by Occupational Therapists to focus on possible modification to reduce the risk of falls and inevitably fractures in osteoporotic patients. Cumming et al. (1999) found that home visits through occupational therapists could reduce the risk of falls, consequentially reducing the risk of fractures. Occupational Therapists have been chosen as they are trained and have experience in home modification. Chang et al. (2004) supports the findings of Cumming et al. (1999), through stating home assessment is an effective way of reducing risks of falls consequentially reducing anxiety of falling allowing an individual to feel confident around the home. In assessing a home one may look at improving floor surfaces, for example securing rugs properly, as well as applying non skid mats and grab bars to bathrooms (O’Hara et al. 2007)

Clients will visit a nutritionist during the beginning of the programme to obtain adequate information on diet. ‘Calcium is one of the main bone forming minerals’ (Palacois 2006). Santora (1987), Williams (1999), and ACSM guidelines (2009) recommend that postmenopausal women should obtain 1000-1500 milligrams of calcium per day and 400-800 IU per day, while pre menopausal women should obtain 1000-1300 milligrams. Studies support these recommendations stating a higher bone mass density and lower bone loss is achieved through adequate calcium intake (Cumming et al. 1997).

Physiotherapists will be involved in home based programmes once a week, lasting up to 30 minutes. Focus will be to assist those at high risk of fractures due to osteoporosis, as well as the sedentary population. It will focus on improving an individual’s quality of life therefore attention will be on muscle strength, balance, mobility, posture and functional ability ultimately reduction pain (Bennell et al. 2000). Exercises will be gradually introduced, especially to that of the sedentary population, to minimize fatigue and reduce soreness (Forwood & Larsen 2000, cited in Bennell et al. 2000). Chair-based sessions will be used, as these have been noted to improve one’s mobility, flexibility and muscle strength (Durstine and Moore, 2003; Lawrence and Barnett, 2006; Sinaki et al. 1984 and 1986 cited in Avioli, 1993), as well as specific exercises depending on the individuals’ weaknesses. Postural taping is recommended to maintain correct posture during exercises (Bennell et al. 2000). Safe activities should be repeated to continue to improve and maintain muscle strength.

Community based exercise programmes, run by a qualified advanced exercise instructor, will involve the use of a local leisure centre and swimming pools. Exercise sessions will be open to individuals suffering from osteoporosis. Gym based exercise sessions will be once a week, lasting around 60 minutes at a time, low intensity exercises with focus on aerobic and resistance exercises will improve individuals’ general fitness, muscle strength, posture, balance, flexibility and functional ability. Aerobic exercises will include activities such as walking on treadmills and cycling on a cycle ergometer as these benefit bone mass maintenance (Durstine and Moore, 2003). Resistance exercises with the use of free weights and elastic bands will be used in supervision of instructors (ACSM 2009). These are beneficial to improve individual’s strength and balance. Bennell et al. (2000) found weight training in pre-menopausal woman increases strength in the lumbar region of the spine. Hartard et al (1996, cited in: Bennell et al. 2000) stated that 70% of 1RM was effective in maintaining hip and spine bone mass in postmenopausal women. Here, the clients will be closely monitored by the exercise practitioners, especially during balance training. Attention will be made to ensure the exercise environment is safe and hazard free, for example no lose mats or exercise equipment across the floor.

Swimming sessions will also be held once a week, lasting 30 minutes per session. Swimming is recommended especially for individuals where resistance exercises are intolerable (ACSM 2009). Swimming is beneficial to strengthen back extensor muscles, improve balance and increase individuals’ general fitness levels; a study by Koichi et al. (2008) on water exercises recommended deep water running for elderly individuals with poor balance.

The scheme itself will be monitored for evaluation annually through the local Primary Care Trust; who provide funding for the scheme to occur, to review and impose any modifications needed (Guideline 3, Section D, NQAF). At the end of the programme a follow up assessment will occur identifying the clients’ physical and psychological behavioural changes and long term goals will be considered.

Individuals who are susceptible to fractures therefore being at higher risk of falling may be more reluctant to participate in exercise, therefore motivational strategies are needed to further incline the client to participate with no hesitation. Motivational strategies such as goal setting and feedback on the clients’ progress will be used, which relates to Guideline 5, Section E in the NQAF, as well as informing the client about supervision of exercise from the exercise practitioners. The advantage of group exercise sessions allows social interaction among individuals with similar medical conditions; through positive encouragement from peers, adherence can be created. Clients will be closely monitored by the health care professionals. Communication between G.P’s and exercise practitioners are vital to assure no negative health changes of clients occur. Record activity books, which will be filled out every session, will be given to clients within the programme to assess progress; these also play a key role in prevention of drop out. Exercise practitioners will have good understanding of behaviour changes therefore will be able to identify and intervene if negative change is observed.

Adherence and long term goals will need to be promoted during the programme to prevent drop out. This can be achieved through encouragement, positive feedback; as this creates confidence, realistic goal setting and pre, mid and post assessment follow up on the clients’ progress through the use of a patient activity log book. These are seen to be affective as the client will be able to observe their progress. Post-programme follow up is particularly important as it benefits long term adherence (BHFNC).

In conclusion, the aim of the scheme is improve an individual suffering from osteoporosis’ quality of life through multidimensional strategies through the use of best practice and existing research evidence, allowing the individual to become more active in a safe and supervised exercise environment.