Research methods and employability in the sport and exercise sciences. Are we throwing out the baby with the bathwater?

Twelve years ago I wrote a piece for The Sport and Exercise Scientist entitled ‘Preparing Students for the Real World’. It addressed the, at the time, all too evident skills gap between what sport and exercise sciences programmes were producing and what many employers in industry and public health needed. A lot has happened since, and it could be argued that universities have addressed the problem. In this article however I’d like to draw attention to a second and different problem that has emerged, potentially as the result of the methods many universities have used in addressing the first. I have been working in the physical activity and health sector since 1992. In two senior roles in industry I have employed over 3,000 health and fitness professionals, the majority of whom were graduates. I have personally delivered and assessed continuing professional development (CPD) courses, usually 3-5 days intensive contact focusing on applied and interdisciplinary sport and exercise, for a further 1,000+ candidates, again the majority of whom were graduates. All of the above were working in capacities such as fitness instructor, personal trainer, sports development officer, sports therapist, and nutritionist. Given the public health issues the UK is currently facing, these professionals play an increasingly important role. The early stages of my CPD work in industry focused on my belief that knowledge was an important factor in determining the quality of exercise prescription, nutritional analysis, etc. It became increasingly evident however that the best practitioners were not necessarily the most knowledgeable; in fact, an almost text-book knowledge of physiology or nutrition were often relatively unrelated to success. Gaining more coal face experience of the applied settings in which our graduates are often employed, I began to orientate my teaching to the idea that it was the practitioner’s ability to communicate with clients that was in fact the critical factor; that there was a ‘sweet-spot’ where adequate levels of knowledge met with good communication skills characterised the best practitioners. But this idea was also found wanting. I became increasingly aware that many effective and successful practitioners were in fact not especially good communicators. After perhaps 15 years of working in industry (and at the same time holding posts in HE), I realised that the core indicator of effectiveness was the practitioner’s ability to find things out, to identify what information s/he needed, to know where to find it, and once found, to discriminate good information from bad information. This idea also extended to information about the client; what are the key variables that underlie to the client’s current health status and their goals? How can these be manipulated to a successful outcome? How can these be reliably assessed over time? In short, the best practitioners are good at research methods. That doesn’t mean that they’re good statisticians, that they can necessarily define epistemology, or can necessarily argue the relative merits of quantitative versus qualitative methods. But they do understand the ideas that underpin all of these, and often they’ve been doing it so consistently and for so long, that this understanding has become automatic and intuitive as opposed to deliberate and formal. Now, all well and good. All - or certainly most - undergraduate programmes in the UK have a significant Research Methods component. Over and above this, research methods are learned explicitly and implicitly in other modules such as biomechanics, nutrition, physiology, psychology and sociology. We are therefore surely preparing students for the real world by the criteria I’ve presented above? Ten years ago I would have agreed. Now, I’m less convinced. There has certainly been a shift in the way we teach the undergraduate curriculum, with an evident focus on greater real world relevance. But at the same time, the ‘real world relevance’ is morphing into ‘employability’. The evolution of the graduate skills agenda is entirely consistent with my 2005 paper described above. That the graduate skills component so often appears to be embedded in Research Methods components of programmes is not. In fact, I argue that it is entirely counter-productive and entirely at odds with what employers need and expect of graduates. It is increasingly my experience that Research Methods modules are front-loaded with content aimed at orienting the student to the higher education environment and back loaded with content aimed at enhancing employabilty (I will return to this poorly used term below). In some programmes I have seen, this process has reduced the Research Methods content by over 50%. This comes with two clear problems. Firstly, the students are not receiving the breadth and quality of teaching that the subject deserves. Second, the students are not seeing research methods per se as that important relative to other areas of content. Whereas historically Research Methods constituted up to 30% of some programmes - especially if a dissertation is factored in to the equation - in some cases it is now less than 10%, and as low as 5% in real terms. “But employability has to go somewhere, and Research Methods presents the best place” is an argument I often hear. Well, I beg to differ. Firstly, one of the reasons that employability and skills gets dumped into Research Methods modules is that, unlike the case with biomechanics, nutrition, physiology, psychology and sociology, all of which tend to have discipline-specific teaching staff who will often defend their ‘air time’ vigorously, many departments have no such dedicated staff for Research Methods. In short, there is no-one to defend Research Methods in the ‘where shall we put employability’ debate. Secondly, and most importantly, Research Methods, if taught and assessed appropriately, is employability. And unlike much of what passes for it these days, it is real employability. If we reduce the total content of Research Methods to increase employability content, we are de facto throwing the baby out with the bathwater. How many graduates will actually use the knowledge base of biomechanics, nutrition, physiology, psychology and sociology in their future careers? Some for sure, but all things considered, it’s a relatively low number. How many graduates will use research skills? Probably all of them… And here’s why (and I know I’m preaching to the converted here). We live in an age in which there has been an explosion of often conflicting information media. There is at the same time an emerging post-truth landscape in which it is considered OK for politicians to tell outright lies to win elections or referendums. Further still, individuals and groups are increasingly being handed responsibility for their own health under the guise of prudent healthcare (a proxy for lower cost healthcare). In these contexts, the graduate with research skills is not only going to be more employable, more effective and more successful, but is also going to be able to make better informed decisions about her or his life (and those of their families) in relation to health, law, finance, and many other core aspects of life. Now all of the above is well and good, I doubt many would disagree. Here is the sting in the tail. Employers are increasingly saying that graduates are better able to get the job but less able to do it (a comment to me a while back summed it up; “in the old days good candidates often had poor CVs but you knew what to look for, now everyone, even the worst candidates has a good CV.”) The employability agenda is working, but it might be counterproductive in the long term. If sport and exercise sciences graduates are seen as being less effective in the workplace than graduates of other disciplines, we are doing them, and ourselves a disservice. So what’s the solution? First, defend Research Methods modules. It is the science in sport and exercise science, arguably more so than any other discrete components of the programme. Do not let it be encroached upon but generic and often significantly less valuable content. Second, assess Research Methods broadly; students work hard to learn and understand content on which they are assessed (or at least, the majority work harder on content that is assessed), but as importantly, students also see the content on which they are assessed as the important stuff! Lastly, interrogate what your employability content is really achieving; is it providing students with skills that the employers need, or is it ticking boxes defined by units in universities which, in many cases, do not have one staff member who has worked outside the university sector. Speak to employers, speak to alumni, speak to the individuals who our graduates are increasingly working with, for example, the inactive or at risk. And this last point is crucial; in a recent conversation it became clear to me that the concept of employability that defines the approach of many academics is itself defined by the university context. Whilst interrogating assignments based on 2,000 word essays and 10,000 word dissertations, I pointed out that the need to ever write anything of such length in the ‘real world’ was minimal. The response was that all academics need to be able to write! Agreed, but must all undergraduates aspire to academic skills? No, of course not (and how many journals would accept a 10,000 word paper these days anyway). Let’s not assume that employability means giving students the skillsets we ourselves need. I’ve interviewed hundreds of graduates and non-graduates. What’s my favourite response, irrespective of the question? “I don’t know the answer, but I do know how I would find it.” Give a student a piece of reliable information and they’ll eat for a day. Teach them how to find that information for themselves, to discriminate it from poor information, and how and when to apply it, and, well you know the rest

Studying placebo effects in model organisms will help us understand them in humans

The placebo effect is widely recognized, but important questions remain, for example whether the capacity to respond to a placebo is an evolved, and potentially ubiquitous trait, or an unpredictable side-effect of another evolved process. Understanding this will determine the degree to which the physiology underlying placebo effects might be manipulated or harnessed to optimize medical treatments. We argue that placebo effects are cases of phenotypic plasticity where once predictable cues are now unpredictable. Importantly, this explains why placebo-like effects are observed in less complex organisms such as worms and flies. Further, this indicates that such species present significant opportunities to test hypotheses that would be ethically or pragmatically impossible in humans. This paradigm also suggests that data informative of human placebo effects pre-exists in studies of model organisms

Is Olympic inspiration associated with fitness and physical activity in English schoolchildren? A repeated cross- sectional comparison before and 18 months after London 2012

Objectives: To compare cardiovascular fitness and physical activity of schoolchildren 18 months after London 2012 according to Olympic ‘inspiration’. Design: A cross-sectional comparison between groups of schoolchildren categorised according to self- reported Olympic inspiration and a repeated cross- sectional comparison using data collected pre-2012. Setting: Schools within a 50 km radius of the Olympic Park, Stratford, London. Participants: 931 students (10.0–15.9-year-olds) attending 6 schools assessed in 2013 and 2014 (18 (range: 14–20) months after London 2012) and 733 students from the same schools assessed in 2008–2009 (42 (range: 38–46) months before London 2012). Primary outcome measures: Self-reported Olympic inspiration; cardiorespiratory fitness (V_ O mL/kg/ 2peak min) assessed using the 20 m shuttle-run and self- reported physical activity. Secondary outcomes measures: Differences in V_ O2peak before and after London 2012. Results: 53% of children reported being inspired to try new sports or activities. Compared with those not inspired by the Games, V_ O2peak was higher in boys (d=0.43) and girls (d=0.27), who continued to participate in activities at 18(14–20) months. This 45% of sample was also more physically active (boys, d=0.23; girls, d=0.38) than those not or only briefly inspired to participate in activities (boys, d=0.24; girls, d=0.21). Compared with pre-2012 values, V_ O2peak was lower post-2012 in boys (d=0.37) and in girls (d=0.38). Conclusions: High levels of inspiration to participate in new activities reported following London 2012 and positive associations with fitness are encouraging. We cannot discount the possibility that inspired participants may have already been fitter and more active pre-2012. These associations must be interpreted in the context of the significant declines in fitness shown by our repeated cross-sectional comparison. Olympic host countries should employ longitudinal monitoring using objectively measured fitness and physical activity to provide evidence of health-related legacy

Community Fitness Center-Based Physical Activity Interventions: A Brief Review

Sedentary lifestyle is associated with cardiovascular and metabolic diseases. A compelling body of evidence demonstrates the amelioration and prevention of such conditions with increased levels of physical activity (PA). Despite this evidence, many public health initiatives aimed at increasing PA have failed to demonstrate clinically relevant effects on public health. It has been hypothesized that the highly controlled environments in which PA and health research is conducted limits its replicability in real-world community settings. This review aimed to evaluate the effectiveness of community fitness center-based interventions on inactivity-related diseases in adults. Data from 11 investigations highlighted 3 factors: 1) a lack of community-based PA studies, 2) a lack of clinically relevant data, and 3) further reliance on self-report and rudimentary measurements. It is concluded that the current laboratory-based evidence for PA and health is to be replicated yet in real-world settings and that rigorous and clinically relevant naturalistic research is required

Capitalizing on the placebo component of treatments

A placebo treatment is traditionally administered in a double-blind, randomized controlled trial to control for the ‘real’ effects of the treatment under investigation. In the present paper a broader view of the placebo is proposed, one in which the idea of a potentially ‘useable’ placebo component of a sports or exercise medicine treatment is presented. It is argued that many interventions in sport and exercise psychology might contain a placebo component that could be capitalized upon by practitioners, through processes often as simple as communicating positive expectations of a treatment to clients. Research findings relating to factors that might influence an individual’s response to a placebo, such as personality, situation and genetics, are briefly addressed. Ethical considerations for practice and future research are discussed

An educational placebo effect intervention reduces the likelihood of athletes using performance enhancing drugs

Background Recent research has reported that placebo effects can significantly improve sport performance. However, while research has generated knowledge about placebo effects on sport performance, there is limited research devoted to how this can support applied practice. In light of this, it has been suggested that placebo effect research could be harnessed and used as a tool to prevent drug use in sport. The aim of this study was to investigate the effect of an educational placebo effect intervention on an athlete’s decision to use performance enhancing drugs. Method Elite athletes (N=169; 56% male, age=18.2±0.4yrs) attended a one-hour educational placebo effect intervention. The session was delivered by a facilitator using Power-point in a university classroom. The session introduced participants to placebo effects, the role expectations and prior experiences can have on the effectiveness of performance enhancing drugs and placebo effect research on sport performance. Throughout the session, participants were encouraged to critically examine the need to use performance enhancing drugs and to consider the role of placebo effects. Participants completed measures of performance enhancing drug use pre and one-week post intervention. Results Data indicated that participants were less likely to use performance enhancing drugs following the intervention (p<.001, d=0.42). Conclusion The results of this study provide novel evidence to suggest that an educational placebo effect intervention may be an effective in preventing drug use in sport. Future research should aim to harness knowledge of placebo effects to prevent other drug use behaviours

Is there a role for implicit and explicit information about placebo and nocebo effects in reducing the use of drugs in sport?

Background: The gateway hypothesis posits that the use of sport supplements by athletes can lead to the use of banned and possibly harmful performance-enhancing drugs. Previous data suggest that athletes implicitly exposed to a placebo intervention and/or explicitly informed about the role of placebo effects in sport may be less likely to use sports supplements, and therefore - in line with the gateway hypothesis - less likely to progress to drugs. Methods: Participants (n=629) completed the Sports Supplements Beliefs Scale (SSBS), Performance Enhancement Attitude Scale (PEAS) and a Likert-type scale measuring intention to use sports supplements. They were then randomised to Placebo (n=263), Nocebo (n=209) and Control (n=157). All participants completed a performance trial (see Hurst et al., this conference). Placebo and Nocebo participants subsequently received the results of the trial as well as a brief educational session describing the role of placebo/nocebo effects in sports performance. Controls received no information. All participants re-completed the questionnaires. Results: Analyses indicated that following the intervention, beliefs (P=0.009, Cohens d [d]=0.43), attitudes (P=0.047, d=0.29) and intentions (P=0.020, d=0.33) relating to the use of drugs and sport supplements were significantly lower in the Placebo and Nocebo group compared to Controls. Conclusions: Implicit exposure to a placebo/nocebo intervention and explicit exposure to a brief educational intervention about placebo effects influenced athlete’s beliefs, attitudes and intentions about drugs and sport supplements. Given the gateway hypothesis, experience of, or education about the placebo and nocebo effect may prevent athletes transitioning towards doping