Biofeedback Use in Sport

The general purpose of this dissertation was to examine the effects of biofeedback training on sport performance. This dissertation was divided into three studies. Study 1 qualitatively explored athletes’ perspectives of biofeedback post-intervention. Five varsity athletes were provided with a five-session biofeedback intervention training respiration rate, heart rate variability, and skin conductance. Following the intervention, an interview was conducted. Athletes perceived biofeedback to enhance self-regulation skills both in sport and academics, contributing to perceptions of superior performance. To further examine perspectives of biofeedback training, Study 2 qualitatively explored mental performance consultants’ use of biofeedback and their perceptions of the tool. Ten experienced mental performance consultants were interviewed. Consultants indicated that biofeedback can provide athletes with the self-awareness and self-regulation skills intended for optimal performance, but that there are limiting factors to the biofeedback device (e.g., high cost, time constraint, limited education and training). Once perceptions were attained, a biofeedback intervention was designed to investigate the practice effect of biofeedback and to determine if sessions could be optimized with the integration of imagery (i.e., Study 3). 27 varsity athletes were assigned to one of three groups (biofeedback, imagery, comparison). The biofeedback group participated in five, 15-minute biofeedback training sessions. The imagery group participated in five, 10-minute biofeedback training sessions and each session was interspersed with an imagery script. The comparison group participated in five, 10-minute biofeedback training sessions and each session was interspersed with a rest period. There was a significant Group x Time interaction (p\u3c .05), indicating differences in respiration rate, heart rate variability, and skin conductance across groups over time. Specifically, it was found that athletes who take rest periods between biofeedback training can regain resonance frequency and physiological control once biofeedback resumes. Therefore, it may be worth interspersing biofeedback with imagery to enhance the quality of the session. Overall, this dissertation supported the use of biofeedback to enhance sport performance in high performance varsity athletes. From a practical standpoint, mental performance consultants and/or sport psychologists who offer biofeedback may optimize delivery and performance outcomes by including imagery to generate the management of both psychological and physiological processes

The mental well-being and coping strategies of Canadian adolescents during the COVID-19 pandemic: a qualitative, cross-sectional study

BACKGROUND: Qualitative research is lacking on the mental well-being of adolescents during the COVID-19 pandemic. The aim of this study was to explore the feelings and emotions adolescents experienced during the first wave of the COVID-19 pandemic and the coping strategies they identified and employed to manage those emotions. METHODS: Participants living in Canada aged 13-19 years were recruited through social media platforms and youth-serving organizations. Qualitative data were gathered from 2 open-ended questions included in a youth-informed cross-sectional online survey: What feelings and emotions have you experienced around the pandemic? and What coping strategies have you used during the pandemic? We collected data from June 2020 to September 2020. A summative content analysis was undertaken to analyze survey responses inductively. RESULTS: A total of 1164 open-ended responses from Canadian adolescents (n = 851; mean age 15.6, standard deviation 1.7, yr) were analyzed. We identified 3 major themes within the category of feelings and emotions associated with the pandemic: sociospatial and temporal disconnections, emotional toll of the pandemic and positives amid the pandemic. Within the category of coping strategies used during the pandemic, 2 major themes were identified: connecting online and outdoors, and leisure and health-promoting activities. INTERPRETATION: Although the emotional toll of the first wave of the COVID-19 pandemic is evident, participants in our study adopted various positive coping strategies to mitigate their distress, including physical activity, safe peer interactions and hobbies. The results have important implications for public health policy and practice during pandemic times, emphasizing the importance of accessible mental health resources for those experiencing psychological distress

The mental well-being and coping strategies of Canadian adolescents during the COVID-19 pandemic: a qualitative, cross-sectional study

Background: Qualitative research is lacking on the mental well-being of adolescents during the COVID-19 pandemic. The aim of this study was to explore the feelings and emotions adolescents experienced during the first wave of the COVID-19 pandemic and the coping strategies they identified and employed to manage those emotions.Methods: Participants living in Canada aged 13–19 years were recruited through social media platforms and youth-serving organizations. Qualitative data were gathered from 2 open-ended questions included in a youth-informed cross-sectional online survey: “What feelings and emotions have you experienced around the pandemic?” and “What coping strategies have you used during the pandemic?” We collected data from June 2020 to September 2020. A summative content analysis was undertaken to analyze survey responses inductively.Results: A total of 1164 open-ended responses from Canadian adolescents (n = 851; mean age 15.6, standard deviation 1.7, yr) were analyzed. We identified 3 major themes within the category of feelings and emotions associated with the pandemic: sociospatial and temporal disconnections, emotional toll of the pandemic and positives amid the pandemic. Within the category of coping strategies used during the pandemic, 2 major themes were identified: connecting online and outdoors, and leisure and health-promoting activities.Interpretation: Although the emotional toll of the first wave of the COVID-19 pandemic is evident, participants in our study adopted various positive coping strategies to mitigate their distress, including physical activity, safe peer interactions and hobbies. The results have important implications for public health policy and practice during pandemic times, emphasizing the importance of accessible mental health resources for those experiencing psychological distress

Teens talk vaping: A co-produced participatory study exploring teens’ reflections on vaping experiences and exposures in their everyday environments

Increasing prevalence of vaping (e-cigarette use) among youth in Canada and elsewhere has become a serious public health concern. The Teens Talk Vaping project sought to co-produce research about teen vaping with teens to generate in-depth qualitative evidence about the everyday socio-environmental dimensions of teen vaping experiences and exposures across perspectives of both teens who vape and those who do not. Our participatory approach included a capacity-building programme to train teen team members to contribute to the project as ‘co-researchers’, equipping them with the research skills necessary to contribute to all phases of the project, from data collection through to knowledge translation. Paired with adult researchers, teen co-researchers facilitated 7 online focus groups with teens (n=17) from across Canada, including teens who vaped (n=3) and those who did not (n=14). Our participatory thematic analysis generated five themes: (1) Secrecy and surveillance at school; (2) Online omnipresence; (3) Social pressures and positionings; (4) (Un)restricted mobilities and access; and (5) Re-thinking school-based vaping education. Our findings reveal the extent to which exposure to vaping is deeply embedded and normalized in the everyday micro-geographies of teens in Canada as seemingly ‘everywhere.’ Teen vaping prevention efforts must be equity-centred, youth-driven, and take account of the nuanced ways in which vaping is layered into the day-to-day online and offline contexts of young people’s lives

‘Ahhh it was like paradise, but inside’: children’s experiences and perceptions of a free physical activity program

As most Canadian children are not attaining the recommended 60 minutes of daily physical activity, it is imperative that affordable and accessible programs are implemented to help children become more physically active. Specifically, community-based programs that are free and easy to access have shown to be advantageous for promoting beneficial health behaviours at a population level. The Grade 5 ACT-i-Pass (G5AP) is a community-based physical activity program in the mid-sized Canadian city of London, Ontario that offers free programming to all grade 5 children (ages 9–11 years) at various recreational facilities across the city. The data from 28 focus groups with past G5AP participants (n = 101) were analysed to understand the influence of the program on children’s perceived physical activity levels, and to investigate the enablers and/or barriers that children believe influenced their participation in, or access to, G5AP programming. Five distinct themes were identified during the analysis, including two themes describing participants’ perceived changes to their physical activity levels (i.e. additional physical activity opportunities, and well-being and self-efficacy), and three themes explaining enablers and/or barriers to G5AP programming (i.e. program structure and implementation, spatial accessibility of programming, and social supports and constraints). The findings from the focus groups were used to generate recommendations for current and future community-based physical activity programs as a means to improve the health and well-being of children

Neighbourhood influences on youth mental health and stress levels during the first six months of the COVID-19 pandemic

The impacts of the COVID-19 pandemic on youth mental health and stress levels warrants urgent attention. In Canada, as elsewhere in the world, public health measures in the early stages of the pandemic dramatically transformed the everyday geographies of young people. In the hyper-localisation of everyday life, surrounding neighbourhood features like parks and food-related stores may have provided the only outlets for physical activity, social interaction, and relaxation outside of the home. We examine how health-related behaviours, neighbourhood features, and demographic factors may relate to changes in youth mental health and stress levels during the first six months of the pandemic. A cross-sectional youth-informed online survey was conducted with youth, aged 13-19, in London, Ontario, Canada. Respondents were surveyed about their mental health and stress levels before and during the first six months of the COVID-19 pandemic. From 279 respondents, we identified how age, gender, ethnicity, dietary habits, physical activity levels, and availability of parks, fast food, convenience stores and grocery stores could correlate with mental health and stress levels. Given the role played by public spaces, our work underscores the importance of including youth perspectives in the planning of the public realm which contributes to healthy and thriving communities

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine