Monday, September 27, 2010

Excercise Program for Breast Cancer Survivors

WHAT:  In the case study proposed you are a director of an exercise program for survivors of breast cancer at a cancer center.  Your designed exercise program includes yoga, tai chi, aerobic, and anaerobic exercises.   The participants are not only concerned about improving their physical health but their quality of life as well.  Two of the main issues facing breast cancer survivors are the effects on ones quality of life and sense of self worth.  Breast cancer survivors often times suffer from depression and anxiety as well as fear of death, dependency, disfigurement, and disability.  Woman also experience problems including: pain, weight gain, loss of range of motion and strength, and decrease in endurance and overall function.  Anyone who’s had lymph nodes removed or radiation administered also must be concerned with Lymphedema.  Lymphedema is painful swelling in the arm and chest caused by a build-up of protein rich fluid due to disruption in the lymphatic system.  After considering these issues it’s your responsibility as the program director to organize a program for optimal physical and mental health benefits.

SO WHAT: As an exercise professional it’s your responsibility to design a safe and effective exercise program that meets both physical and mental health goals.  The physical goals of a breast cancer survivor should include increasing endurance through aerobic exercises, increasing lean body mass, range of motion, and strength through strength training, and preventing frozen shoulder or lymphedema, all of which will decrease pain.  The mental health goals of a breast cancer survivor should include relief from depression, anxiety, fear, stress, and improving self-efficacy, all of which improve quality of life (Aaronson,2010).  Quality of life is defined as an “individuals’ perceptions of their position in life in the context of the culture and value systems in which the live and in relation to their goals, expectations, standards, and concerns”.  It’s a broad concept incorporating   the effectiveness of a designed exercise plan for breast cancer survivors can be determined by using the conceptual model of quality of life.  The conceptual model of quality of life reflects the definition of quality of life as a broad, integrative construct composed of a person’s perceived physical, social, and psychological well-being (Gill, 2008).  By implementing an effective exercise plan these women’s quality of life can be greatly increased.

NOW WHAT:  The first thing I would do is sit down with each woman and find out how they feel about beginning an exercise program as well as their fitness goals.  Most importantly I would find out each of their mental health goals and how they feel they can improve their quality of life.  I would next begin by running the woman through a simple strength training and cardiovascular workout to establish how physically fit each individual is so I’m sure not to push the individuals to far right away.  I’d then begin each individual on the exercise program I’ve developed a couple days a week at first to develop their confidence and so they become comfortable in an exercise environment.  Right away if my developed exercise program works how I hope, these woman’s stress levels, pain, fear, anxiety, and depression will all decrease.  All of which will improve their self-efficacy, and level of self-efficacy, but most importantly their quality of life.  Once this is established I’d then eventually work up to 5 days a week and possibly every day.  I’d base my exercise program on the studies that show exercise training is proven to reduce arousal during stress, to improve cardiovascular and psychological functioning of cardiac patients, and to reduce depression following prolonged life stress.  Fitness is also associated with lower cardiovascular arousal during and following stress, as well as with less physical illness following prolonged life stress (Stein, 2010). All of these things will increase quality of life.
CONCLUSION: In conclusion, the most important aspect of this exercise program is to increase these women’s quality of life.  By helping reach their fitness health goals it’s possible to help them reach their mental health goals at the same time.  By improving these two aspects of life it’s highly likely that quality of life will increase significantly.

Aaronson, Naomi. "Survival of the Fittest - Exercise for Breast Cancer Surivors." American Fitness (2000). Web. 23 Sept. 2010. <>.
Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.)                                 Champaign, IL: Human Kinetics.
Stein, Jeannine. "Breast Cancer Survivors Can and Should Exercise." Los Angeles Times (2010). Web. 23 Sept. 2010. <,1,4379607.story>.

Monday, September 20, 2010

Cognitive Strategies useful during Rehabilitation

WHAT: In the case study described you are an athletic trainer working with a volleyball player who is now in rehabilitation after anterior cruciate ligament (ACL) surgery.  She’s estimated to return to practice 6-8 weeks post operation.  The issue at hand is whether or not to incorporate cognitive skills during this athlete’s rehabilitation process and which ones will be most effective. 

SO WHAT: Rehabilitation for any injury definitely has its ups and down which you can help control by encouraging her to use cognitive strategies.  Some cognitive strategies such a goal setting, self-talk, and attention control for example are all skills which can be incorporated during the rehabilitation process.  Using these skills can help her make rehabilitation more effective so she will be able to return to play well prepared.  Its possible cognitive skills may not be effective and because no two cases are the same it’s important to be able to change your plan and have multiple options which can be adapted depending on the individual, setting, and time. 

NOW WHAT: During the rehabilitation process the first thing I would do is sit down with the athlete and find out how she feels about the injury, surgery, the rehabilitation process, and returning to play.  The next thing I would do is sit down with this athlete and helps her set goals, short term goals for the rehab process and long term goals for returning to play.  I would encourage her to set S.M.A.R.T. goals.  S.M.A.R.T. is an acronym for a number of ideal criteria that should be considered when setting rehabilitation goals.  Ideal goals should be Specific, Measurable, Achievable, Realistic, and Timely.  When setting rehabilitation goals it’s important to avoid common goal setting problems including: failure to monitor goal progress and readjust goals, failure to recognize individual differences, failure to set specific and measurable goals, and setting to many goals.
          Another effective cognitive skill this athlete can try is attention control and concentration.  She can use Attention Control Training (ACT) to improve her ability to shift attention styles.  ACT involves assessing individual attention strengths and weaknesses, the attention demands of sport, and personal characteristics that affect behavior under pressure.  ACT can be effective but it takes training.  Other simpler attention control ideas can also be effective for example: avoiding distractions, mental rehearsals, and biofeedback.
The next cognitive strategy I would recommend she use is self-talk, which is when a person thinks and makes perceptions and beliefs conscious.  During rehabilitation athletes can use self-talk to correct bad habits, for example bending his/her leg during straight leg raises, focusing attention, for example when doing quadriceps contraction exercises, and building self-confidence, for example getting back to doing the activities he/she was able to do prior to injury.  One effective use of self talk is the idea of thought stopping.  Thought stopping is when a person uses a cue to interrupt unwanted thoughts as they occur and then substitutes a positive thought.  Another use of self-talk is changing negative thoughts to positive ones, similar to thought stopping, which can also be very constructive in stressful situations.  Another effective self-talk technique is countering, which is similar to the above two techniques.  Countering is an internal debate using reason to counter negative thoughts with positive thoughts.  The last effective use of self-talk is the technique of reframing, or when an athlete views the situation in a more positive way, for example learning new skills and developing as a higher level player rather than having negative thoughts about the injury and rehabilitation process.  I think self-talk is by far the most effective cognitive skill an athlete can use during the rehab process.

CONCLUSION: In conclusion, I would definitely use cognitive strategies during this athlete’s rehabilitation process so she is able to return to play well prepared.  After evaluating several cognitive strategies I feel setting S.M.A.R.T. goals and using effective self-talk could possibly be the most effective during the rehabilitation process.  Again all athletes and situations are different so no cognitive skills will be effective 100 percent of the time but being able to change your rehabilitation  plan is extremely important.

Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champain, IL: Human Kinetics
Siegert, Richard, and William Taylor. "Theoretical aspects of goal-setting and motivation in rehabilitation." Disability and Rehabilitation 26.1 (2004): 1-8. Print.

Monday, September 13, 2010

Multidimensional measures of sport-specific psychological skills

In the proposed case study a high school girl’s basketball coach has picked up information on a new personality measure, the BPS (Basketball Personality Scale), which is reported to assess characteristics matching those of elite professional basketball players. As her colleague I would advise her against using the BPS with her team this upcoming season. My reasoning for telling her not to use the BPS is that the BPS assesses elite professional athletes, not high school athletes. High school athletes are not on the same skill level or maturity level as professional athletes so it’s hard to believe it’s an accurate assessment of high school athletes.

I agree with Diane L. Gill, author of Psychological Dynamics of Sport and Exercise Third Edition, and would tell her not to use the BPS but consider using the ACSI-28 or TOPS measure to evaluate psychological skills. The ACSI-28 (Athletic Coping Skills Inventory-28) is a multidimensional measure of sport-specific psychological skills. The ACSI-28 contains seven subscales including: Coping with adversity, Peaking under pressure, Goal setting and mental preparation, Concentration, Freedom from worry, Confidence and achievement motivation, and Coachability.

The TOPS (Test of Performance Strategies) is a self-report measure of psychological skills and strategies used by athletes, similar to the ACSI-28. The TOPS contains eight subscales for practice and competition including: Goal setting, Relaxation, Activation, Imagery, Self-talk, Emotional control, Automaticity, Attention control (practice) and negative thinking (competition).

Of these two psychological measures I’d use the ACSI-28 measure to assess high school athletes. Although it may be meant to assess elite professional athletes I think the subscales can be a good assessment for high school athletes as well. The first subscale, peaking under pressure, assesses whether an athlete is challenged rather than threatened by pressure. These athletes perform well under pressure, for example having the ability to make a game winning shot or free throw. The second subscale, freedom of worry, assesses whether an athlete worries about making mistakes or performing poorly and what others will think if he/she does. I think this one of the most important subscales in the ACSI-28 measure when it comes to high school athletes. The third subscale, coping with adversity, assesses an athlete’s ability to stay positive, calm, and collected when things are going badly. For example when losing a game these athletes are able to stay motivated and “keep their head in the game” or in a practice environment these athletes are able to continue to better themselves no matter the situation. The forth subscale, concentration, assesses the athletes ability to stay focused in either a game or practice situation. For example, an athlete’s ability to not become distracted by factors outside the game, like the opponents crowd when shooting free throws. The fifth subscale, goal setting and mental preparation, assesses athletes ability to set goals and work toward accomplishing those goals. Subscale five also assesses an athlete’s ability to prepare oneself for competition. The sixth subscale, confidence and achievement motivation assesses an athlete’s ability to stay confident and positively motivated no matter the situation. For example, these athletes continue to give 100 percent during practice and games while continually working hard towards improving skills. The last subscale is coachability. Coachability assesses an athlete’s ability to accept criticism without taking it personally or become upset. These athletes for example are able to learn from instruction to better their skill level. When assessing high school athletes I think coachability is extremely important considering the majority of the athletes guidance comes from coaches.

After reviewing the ACSI-28 measure I think it is a much better way to assess the psychological skill level of high school athletes compared to the BPS measure. By identifying strength areas using the ACSI-28 measure the coach can improve team effectiveness and team cohesiveness.

Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics

Smith, R.E., Schultz, R.W, Smoll, F.L., & Ptacek, J.T. (1995). Development and validation of Multidimensional measure of sport-specific psychological skills: The Athletic Coping Skills Inventory-28. Journal of Sport & Exercise Psycology, 17, 379-398.

Thomas, Murphy, & Hardy. (1999). Test of performance strategies: Development and preliminary validation of a comprehensive measure of athletes' psychological skills. Journal of Sports Sciences, 17, 697-711.