Psychological health and wellbeing

This section contains work covering several related areas:

• The relationship between physical activity and general aspects of psychological well-being; self esteem; the management of anxiety and depression;
• Work on general life satisfaction material dealing with specific groups (older women, children and young people);
• The role of sport in assisting personal and social integration among people with disabilities.

Expand Acute psychological benefits of aerobic exercise: A field study into the effects of exercise characteristics

 

Title

Acute psychological benefits of aerobic exercise: A field study into the effects of exercise characteristics

Authors

Rendi, M; Szabo, A; Szabo, T; Velenczei, A and Kovacs, A

Date

2008

Keywords

Psychological wellbeing, exercise, adults

Country of research

Hungary

Summary of findings

This article reports on a Hungarian study of 76 male and 4 female regular participants (mean age: 35) in fitness activities and the psychological benefits of aerobic exercise.  Half the sample exercised on a stationary bicycle and half on a treadmill in their normal environment and at self-selected workloads. 

All participants completed the Exercise-Induced Feeling Inventory based on a series of Likert scales before and after 20 minutes of exercise and all wore a heart rate monitor. 

Distance travelled and weight-corrected calories burned were read directly from the equipment displays.  The exercise intensity and heart rate, perceived intensity and estimates of burned calories were higher in runners than cyclists.  However, there were no differences in self-reports of enjoyment of the exercise sessions and in the psychological improvements from pre- to post-exercise between the two groups.  The authors conclude that significant psychological improvements occur after a 20-minute bout of exercise and, in line with previous research, that these changes are independent of the workload or exercise intensity.

Methodology

Randomised comparison, heart rate monitor

Source of reference

Psychology, Health and Medicine, 13(2), 180-184

Web reference

http://www.tandf.co.uk/journals/carfax/13548506.html

Expand Come out and play: Shyness in childhood and the benefits of organised sports participation

Authors

Findlay, LC and Coplan, RJ

Date

2008

Keywords

Psychological health and well-being, anxiety, self-esteem, emotional well-being, sports participation, children

Country of research

Canada

 

Summary of findings

This article reports on a Canadian short-term longitudinal study to examine the potential role of participation in organised sport to act as a moderator between shyness and psychosocial maladjustment in childhood. It was hypothesised that sports participation would have unique benefits for shy (and anxious) children in terms of their peer relationships, socioemotional functioning and general well-being. The research was undertaken with 201 schoolchildren (average age: 10; 52% female) using two survey points 12 months apart.

Parents completed a Social Skills Rating Scale; the children completed a Children’s Shyness Questionnaire, a Conflict Tactics Scale measuring physically aggressive behaviour over the previous six months, a self-report sports participation information sheet, a general well-being questionnaire, a self-description questionnaire, a Social Anxiety Scale, a Loneliness and Social Dissatisfaction measure and positive and negative affect schedule.

The authors’ analysis suggests that participation in organised sport was related to various positive psychosocial outcomes, with sports participants reporting more assertiveness, self-control, positive affect and well-being, physical ability self-esteem, physical appearance self-esteem and peer self-esteem than non-participants. Shy children who took part in organised sport had higher general self-esteem than did shy non-participants.

The authors suggest that this effect might reflect the importance of sport in determining social status.

Over the 12 month period shy children who took part in sport demonstrated a significant decrease in social anxiety. The authors list a number of limitations with their research: it relied largely on children’s self-report and recall (especially for sports participation), if failed to explore issues of aptitude and there was substantial attrition in the sample over the 12 months, with those who opted out being recorded as a being the least cooperative, least assertive and more social anxious at stage 1, which will have reduced the variability of outcomes at stage 2.

The authors conclude that sports participation can play a protective role against some of the negative outcomes associated with shyness.

Methodology

Longitudinal study, statistical analysis

Source of reference

Canadian Journal of Behavioural Science, 40(3) 153-161

Web reference

http://www.cpa.ca/ac-main.html

 

Expand Team sports achievement and self-esteem development among urban adolescent girls

Authors

Pedersen, S and Seidman, E

Date

2004

Keywords

Mental health / psychological well-being, personal development, self-esteem, adolescent, girls.

Country of research

Canada

Summary of findings

This longitudinal Canadian study explores the association of girls’ self-esteem with their achievement and self-evaluations on interest and competence in team sports. Following a review of relevant literature the authors conclude that previous research tended to ignore low-income female populations; fail to differentiate between individual and team sports and tend to be cross-sectional. It seeks to test two hypotheses:

1. Girls’ early adolescent team sports achievements will predict higher global self-esteem later in adolescence;
2. This association will be mediated by the girls’ team sports self-evaluations. Adolescent girls (n: 247) from racially and ethnically diverse backgrounds were surveyed as apart of a larger study investigating the development of poor urban youth.

The average age of the survey population at stage one was 13 years and 16 at the second stage. At each stage data were collected on self-esteem, team sports achievement (type of team, whether captain, if won an award), team sports self-evaluation of interest and competence (e.g. ‘compared to others, how good are you?’, ‘how much do you like playing team sports?’), individual sports self-evaluations of interest and competence.

The authors conclude that their data are consistent with the hypotheses that team sport achievement in early adolescence is related to girls’ global self-esteem in middle adolescence and that team sports self-evaluations mediate the relation between achievement and self-esteem. In contrast, the self-evaluations of individual sports failed to explain a significant proportion of the variance in global self-esteem.

The findings suggest that the associations of team sports achievement and team sports self-evaluations with global self-esteem may be due in part to the esteem–enhancing qualities of the team environment and are not entirely a function of sports’ participants higher rates of physical activity or a sense of general athletic competence. The authors also state that their findings support the view that domain-specific evaluations (in this case team sport) is the building blocks of global self-esteem.

However, the proportion of variance accounted for by team sports achievement and self-evaluations in global self-esteem were small.

The authors suggest that this small effect size may reflect the fact that a variety of experiences influences global self-esteem, or that the effects of team sport achievement may be vary, being moderated by team structure, team composition or team leadership qualities.

The authors suggest that sport for girls should address issues of the development of self-efficacy directly via such things as positive feedback, most valuable or improved player awards and creating roles of honour.

Methodology

Survey data

Source of reference

Psychology of Women Quarterly, 28, 412-422

Web reference

http://www.wiley.com/bw/journal.asp?ref=0361-6843

Expand The moral worth of sport reconsidered

Contributions of recreational sport and competitive sport to life aspirations and psychological well-being

Authors

Chatzisarantis, NLD and Hagger, MS

Date

2007

Keywords

Psychological well-being, sport, adults.

Country of research

United Kingdom

Summary of findings

This article reports on a study to test the hypothesis that the effects of participation in recreational and competitive sport on psychological well-being are mediated by the importance ratings of life aspirations. 

The article begins with an exposition of self-determination theory and a theoretical discussion of the importance of the basic psychological needs for experience of competence, autonomy and relatedness and their centrality to human development and growth and relationship with psychological well-being. 

They explore the distinction between hedonic enjoyment and eudemonia (personally expressive activities that facilitate self-realisation through the fulfilment of personal potentials).  The authors also explore the related concepts of intrinsic and extrinsic life aspirations and suggest that the relative importance of these is critical for psychological well-being. 

Further, not all forms of sports participation are associated with psychological well-being because they do not promote valuing and/or attainment of intrinsic life aspirations.  This is most obviously the case with competitive sport and its emphasis on extrinsic rewards. 

Within this context the authors seek to explore three hypotheses:

• While intrinsic aspirations would positively predict both hedonic and eudemonic happiness, attainment ratings of extrinsic aspirations would predict neither hedonic or eudemonic well-being;
• ndividuals who participate in competitive sport would assign greater importance to extrinsic aspirations relative to intrinsic aspirations compared to recreational participants;
• The effects of activity type on psychological well-being would be indirect via importance ratings of life aspirations.

The study was conducted on 83 male and 35 female university students (average age: 20.8 years).  Life aspirations were measured and their importance evaluated via 14 categories, including intrinsic life aspirations, meaningful relationships and health-related goals.  Extrinsic goals included financial success, fame and image.  A personal expressiveness scale was used to asses psychological well-being on hedonic (pleasure vs pain) and eudemonic (activities congruent with deeply held values) facets.  The type and level of current and previous physical activity were recorded. 

The authors claim that their findings indicate that, compared to recreational sport, competitive sport is associated with diminished psychological well-being when it is viewed as a means to achieve extrinsic life goals. 

Consequently the relative importance of intrinsic and extrinsic life aspirations is a key dimension in predicting psychological well-being.  Whereas attainment of intrinsic life aspiration through sport is associated with both hedonic enjoyment and eudemonia attainment of extrinsic aspirations was associated with neither. 

They conclude that the key factor determining the level and quality of psychological well-being is life aspirations rather than sports participation per se.  They suggest that the moral worth of sport does not lie so much in sport participation itself, or in the frequency of participation, but in the goals and values that people express though sports participation.

Methodology

Survey

Source of reference

Journal of Sports Sciences, 25(9), 1047-1056

Web reference

http://www.tandf.co.uk/journals/titles/02640414.asp

Expand Physical activity and physical self-concept among sedentary adolescent females: An intervention study

Authors

Schneider, M; Dunton, GF and Cooper, DM

Date

2008

Keywords

Psychological well-being, self-concept, physical activity, females, adolescents

Country of research

United States of America

Summary of findings

This article reports on a 9-month controlled trail in the USA to explore the extent to which physical activity can promote increased physical self-concept and increased global self-concept among sedentary adolescent females (intervention groups: 61; comparison group: 59). 

The research sought to test  two hypotheses:

1. Participants would report increased physical self-concept in multiple domains and this would be accompanied by an increase in global self-concept
2. The enhancements in self-concept would be more pronounced among those intervention participants who increased their physical activity and/or their cardiovascular fitness (a measure ignored in most previous research). 

Before the trial commenced physical activity levels were self-reported on a 3-day (30 minute intervals) recall basis and these data were converted into metabolic equivalents.  During the trial period one weekday and two weekend days were assessed.  Cardiovascular fitness was obtained via a ramp-type progressive exercise test on a cycle ergometer, heart-rate monitors were used once per week and body mass index and body fat were recorded.  Data on physical self-concept were recorded on a 70 item Physical Self-Description Questionnaire. 

The intervention group met 5 days per week for 60 minutes each day (40 minutes activity time) for aerobic dance, yoga, basketball, swimming and Tae Bo.  In addition there was a once per week discussion on the benefits of physical activity.  The comparison groups did not have the discussion session and attended regular PE lessons. 

The study found that the intervention was not effective for enhancing physical self-concept (or global self-esteem), despite an increase in self-reported vigorous activity and a significant improvement in cardiovascular fitness. 

However, there was an interaction between improved cardiovascular fitness and enhanced global physical self-concept.  The authors hypothesise that, given the central role that body fat plays in adolescent females’ self-concept, the fact that the intervention was not intensive enough to  reduce this may explain the lack of impact on self-concept.  They also speculate that something more than simple participation in group-based physical activities might be needed to raise self-concept. 

The authors conclude that their study does not offer strong support for the hypothesis that increased physical activity leads to enhanced self-concept among sedentary adolescent females.  Rather, it appears that there may be a trend for enhanced physical self-concept over time, with increased fitness  accelerating this trend only in the context of an intervention that includes a didactic component informing participants why physical activity is important.  The authors suggest that their study raises new questions about the relative roles of cognitive and behavioural interventions.

Methodology

Survey, fitness testing

Source of reference

Psychology of Sport and Exercise, 9, 1-14

Web reference

http://www.elsevier.com/wps/find/journaldescription.cws_home/620792/description#description

Expand The effects of exercise on self-perceptions and self-esteem

Authors

Fox, KR

Date

2000

Keywords

Psychological well-being; physical activity; self-esteem; self-perception; exercise

Country of research

United Kingdom

Summary of findings

This provides an overview of the literature on the impact of exercise on self-esteem.

It examines the complex nature of self-esteem and the self-system and the role of the physical self within this. It explores the potential for exercise in the promotion of self-esteem and the various mechanisms through which this might be achieved. It reviews current research evidence on the effect of exercise on self-esteem and summarises the general conclusions to be drawn from cross-sectional research, intervention research (concentrating on 36 randomised controlled studies). It examines findings for various age groups and explores the characteristics of effective exercise, frequency, intensity and duration and outlines possible mechanisms underpinning the positive relationships between exercise and self-esteem (although these are not well understood).

Mechanisms may include: an undetermined psycho-physiological mechanism; improvements in fitness or weight loss; autonomy and personal control; sense of belonging and significance.

The general implications for practice are:

1. Greatest improvements in self-perception/self-esteem are likely to occur in those groups who have the most to gain physically from exercise participation, such as the middle-aged, the elderly and the overweight and obese.
2. Greatest improvements are likely to occur in those who are initially low in self-esteem, physical self-worth and body image, including women in general, those with mild depression, physically disabled children and adults, overweight and obese adults and, perhaps, offenders.
3. There is greatest support for the effectiveness of cardiovascular exercise and weight training programmes.
4. A focus on moderately demanding exercise, with sessions of about 60 minutes.
5. Programmes should last at least 12 weeks with some form of contact continuing for 6 months or more.
6. Adherence factors cannot be separated from those that promote self-esteem. Conditions that affect the attractiveness of the exercise programme, such as the qualities of the leader or the exercise setting, may be crucial to changes in self-esteem.

Methodology

Literature review

Source of reference

In: Biddle, SJH; Fox, KR and Boutcher, SH (eds), Physical activity and psychological well-being. London: Routledge; 2000, 88-117.

Expand The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression

Authors

Lawlor, DA and Hopker, SW

Date

2001

Keywords

Psychological well-being; exercise; physical activity; depression

Country of research

United Kingdom

Summary of findings

This is a systematic review of 14 randomised control trials of exercise programmes aimed at managing depression. These studies were selected from 72 similar studies based on rigorous methodological selection criteria and details of each study are provided. Despite this, all 14 studies had important methodological weaknesses; randomisation was inadequately concealed, intention to treat analysis was rarely undertaken and assessment of outcome was blinded in only two and follow-up periods were short. Participants in most studies were non-clinical, community volunteers and diagnosis was determined by their score on the Beck depression inventory. Studies indicate that aerobic and non-aerobic exercise have a similar effect. However, this may be because the effect is due to psychosocial factors, such as learning new skills or socialising, rather than the exercise itself. In the UK rates of compliance with exercise on prescription schemes vary from 20 percent to 50 percent. Consequently, the authors argue that it is reasonable to assume that compliance among patients with depression would be similar or worse and the widespread use of non-clinical samples suggests that any positive results may have limited generalisability. The authors conclude that it is not possible to determine from the available evidence the effectiveness of exercise on the management of depression. However, exercise may be effective in reducing the symptoms of depression in some volunteers in the short term. Doctors could recommend more physical activity to their motivated patients, but this should not replace standard treatment, particularly for those with severe disease. Exercise may be efficacious in reducing depressive symptoms, but the poor quality of much research is of concern.

Methodology

Systematic review and meta-regression analysis

Source of reference

British Medical Journal, 2001, 322, 1-8.

Web reference

http://bmj.bmjjournals.com/

Expand Changes in psychosocial factors and physical activity frequency among-third- to eight-grade girls

Authors

DeBate, RD; Gabriel, KP; Zwald, M; Huberty, J and Zhang, Y

Date

2009

Keywords

Physical activity; physical fitness and health; self-esteem; girls

Country of research

United States of America

Summary of findings

This article reports on a before-and-after study of 1,034 female participants (aged 8-13) in a 12 week twice-weekly developmentally focussed sports programme.  The research explored the impact of participation on self-esteem, body-size satisfaction, commitment to physical activity and risk behaviour.  The 12 week programme was structured around a series of topics relating to self-awareness, team-building and cooperation, community issues and media stereotypes.  Each session was structured around warm-up activities, stretching, multiple running activities involving a game to teach the session topic and a closing session to encourage individual and group behaviour. At the end of the 12 weeks all take part in a 5k running event.  A pre- and post-test self-completion questionnaire was used to collect the data.

Because of the non-experimental nature of the research the authors emphasise the preliminary and non-conclusive nature of the findings.  Nevertheless they conclude that participation in the programme resulted in beneficial changes in self-esteem, body-size satisfaction and physical activity commitment and frequency.  The two key findings are: (i) participation increased commitment to be physical activity, especially among the 11-15 age group; (ii) although improvements were greatest after the first exposure to the programme, those returning to the programme also experienced further improvements. The authors outline a number of threats to validity.  Although they conclude that some threats are minor, the issue of self-selection and a relatively low response rate (46%) are a possible concern and emphasise the preliminary nature of the findings.  The authors conclude that prior to initiating programmes to promote physical activity for girls it is important to consider structuring educational programmes which promote the development of self-esteem and positive attitudes toward physical activity in a fun atmosphere that does not stress exercise.

Methodology

Pre- and post-intervention study; survey

Source of reference

Journal of School Health, 2009, 79(10), 474-484

Web reference

http://www.blackwellpublishing.com/journal.asp?ref=0022-4391

Expand Club sport: Contributing to health-related quality of life?

Authors

Eime, R; Harvey, J; Payne, W and Brown, W

Date

2010

Keywords

Psychological well-being; quality of life; sports clubs; women.

Country of research

Australia

Summary of findings

This article reports on Australian research exploring the relationship between physical activity and health-related quality of life (HRQoL) and life satisfaction in women who participate in three forms of physical activity - club sport, gymnasium activities and walking.  Because of the social nature of participation in club sport, the researchers hypothesised that participants in sports clubs would have greater HRQoL than participants in the two other activities.

This was an observational study (n: 793 women) of the relationship between type, frequency and duration of physical activity plus measures of HRQoL and life satisfaction.  These data were compared with 2,345 women from a normative population sample.  Data were collected on the potential confounders of age, marital status, having children aged less than 16 years, and perceived financial stress.

After adjusting for the potential confounders, significant differences were found between the groups for six of the 36 measures on the HRQoL scale:  physical role functioning; general health; vitality; social functioning; emotional role functioning; mental health and the life satisfaction score.  In each case the club sport group had the highest mean score.  The differences between club and gymnasium groups were significant for all 8 variables, and between club and walk groups for 4 variables.

The authors admit that such a cross-sectional approach research cannot definitively establish a causal link, the results suggest that sport clubs are likely to enhance the health benefits of physical activity and support the notion that sports clubs might be beneficial settings for health promotion.  However, they conclude by suggesting that sports must develop strategies to overcome health and social barriers to participation.

Methodology

Cross-sectional; observational study

Source of reference

Journal of Science and Medicine in Sport, 12, Supplement 2, e90

Web reference

http://www.sciencedirect.com/science/journal/14402440

Expand The relationship between sports participation and self-esteem during early adolescence

Authors

Bowker, A

Date

2006

Keywords

Psychological well-being; sports participation; self-esteem; adolescence.

Country of research

Canada

Summary of findings

This Canadian study explores the nature of the links between sports participation and self-esteem via a sample of 382 students (167 boys; 215 girls) in Grades 5-8 (ages 11-14) in four schools. The author provides a broad overview of the research on the nature of such relationships and adopts a hierarchical and multi-dimensional approach to the issues. In this, physical self-esteem is viewed as a potential mediator of the relationship between sports participation and general self-esteem. Further, physical self-esteem is divided into two components – physical appearance and physical competence – which may be differentially associated with boys and girls and have different impacts on global self-esteem. The issue of possible age-related changes to self-esteem are addressed by dividing the sample into younger adolescents (Grades 5 and 6) and older adolescents (Grades 7 and 8). 

A 70-item Physical Self-description Questionnaire was used to explore the multidimensional aspects of physical self-concept. A 23 item Body Esteem Scale was used to determine how positively individuals perceive themselves in terms of appearance and body image. A Sports Participation Information Sheet collected data on number of sports, years and level of participation.

No significant age-related differences in self-esteem were found. Girls felt less positively than boys in terms of physical competence and global physical self-esteem. However, girls and boys felt similarly satisfied about their physical appearance, with both reporting positive feelings about physical appearance and general self-esteem.  The benefits of sports participation were consistent for both sexes, making them feel better about themselves physically (appearance and competence) and generally. There was little difference between competitive and non-competitive sport. Consistent with previous research, the relationship between sports participation and general self-esteem was not direct, with participation having its strongest impact on physical self-esteem, which in turn was predictive of general self-esteem. Physical competence played a more significant role for boys in determining general self-esteem, with the more difficult to attain physical appearance more important for girls.

The authors list some limitations with the study: (i) it is cross-sectional and offers limited generalisability; (ii) it did not include other indices of domain-specific self-esteem which contribute to general self-esteem.

The authors conclude that sports participation can lead indirectly to improved self-esteem by impacting on domain-specific self-esteem which are closely related to physical self-attributes. The apparently direct link between physical appearance and general self-esteem for both boys and girls illustrates the strong social emphasis on physical appearance. They conclude that further research is needed into the impacts of types of sports participation, the level of sports participation and the frequency of regular physical activity.

Methodology

Cross-sectional; survey.

Source of reference

Canadian Journal of Behavioural Science, 38(3), 214-229

Web reference

http://www.apa.org/pubs/journals/cbs/

Expand National well-being and international sports events

Authors

Kavetsos, G and Szymanski, S

Date

2009

Keywords

Major events, psychological well-being

Country of research

United Kingdom

Summary of findings

This paper uses data on self-reported life satisfaction for 12 European countries to explore two hypotheses:

• The success of a nation’s athletes produces a measurable increase in reported happiness among citizens of that nation;

• Simply acting as host produces an increase in happiness among the citizens of a host nation.

The events chosen were Olympic Games, FIFA World Cup and the UEFA European Championships.

The authors provide a review of the literature and evidence on the economic impact of sporting events and on happiness.  They review the literature of the impact of events on employment and wages pointing out that jobs created are off-set by jobs lost due to substitution effects and that the multiplier for sports related expenditure may be lower than for other types of expenditure and long term employment might be part-time, casual, low skilled and low waged.  The review material related to sports stadia and legacy, estimating tourist numbers – time switchers, causal, crowding out – and infrastructure investments and urban regeneration.  As many of the economic arguments are weak the authors suggest that stronger justification for public expenditure in events might lie in the economics of happiness.  They provide a brief overview of the strengths and weaknesses of research on the extent of happiness in populations and the various factors which have been explored.  They propose that their work contributed to this emerging branch of economics by focussing on the relationships between sporting events and population happiness.

The authors use life satisfaction data for 12 countries from the Eurobarometer Survey series between 1974 and 2004.  For the Olympics they focus on measures that relate expected performance to actual performance and for the hosting hypothesis they include a dummy variable for the host.  For football tournaments they used FIFA rankings before and after tournaments.

The results indicate that reported life satisfaction is positively affected when national athletic performance is better than expected, but the effect is not significant except where performance is measured relative to lagged medals (an adaptive expectations approach to Olympic performance).  Overall they conclude that it is plausible that national sporting success can lead to an increased sense of life satisfaction, but the effect is not a very powerful one.  With regard to the impact of hosting events there is a stronger effect, at least relating to soccer tournaments – it seems that it is not the performance at an event, but hosting the event that matters for happiness.

However, they conclude that overall the results do not generally support the view that there are systematically significant and positive anticipatory or post event legacy effects with respect to measured happiness. The authors argue that the data indicate that hosting events does not create more than a short-term feelgood factor.

Methodology

Literature review, secondary source analysis.

Source of reference

Journal of Economic Psychology, 31, 158-171

Web reference

http://www.elsevier.com/wps/find/journaldescription.cws_home/505589/description#description

Expand Amputees and sports: a systematic review

Authors

Bragaru, M; Dekker, R; Geertzen, JHB and Dijkstra, PU

Date

2011

Keywords

Sport; sport participation; amputees.

Country of research

Netherlands

Summary of findings

This is a systematic review of literature and research relating to a variety of aspects of amputees’ participation in sports: biomechanics, cardiopulmonary function, psychological aspects, sports participation and physical functioning and sports injuries.  Following an extensive search of databases the authors identified 3,689 papers, of which only 47 (1.3%) met their specific criteria.  All papers are listed providing the details of methods, amputee characteristics, study design and results.  Most were older than 10 years and had cross-sectional designs.  Study participants were generally younger and often had more traumatic amputations than the general population of individuals with limb amputations.  The heterogeneity of population characteristics, intervention types and main outcomes made pooling of data impossible.  The findings are accompanied by advice about the implementation of exercise and sports programmes.

Participation in a variety of relevant sports (related to individual capabilities) and physical activity was found to positively influence physical fitness, psychosocial well-being and physical functioning.  Interestingly data indicates that in Europe only between 11% and 39% of amputees take part in sport, compared to an estimated 61% in the USA.  Studies have identified different factors influencing participation in sports for this group, but there is no overall agreement.  The review provides brief information on limitations on certain activities such as running and long-jumping and the role of prosthetic limbs (although the evidence suggests that most do not use prostheses [note: most of these studies are at least 10 years old]).  Cardiopulmonary function was better when a simple physical exercise programme was included (the intensity of which needs to be tailored to individual abilities).

The psychological impact of the disability on athletes with limb amputations was found to be smaller as compared to those with other disabilities.  Participation in sports and physical activities had a positive influence on self-esteem, perceived body image and locus of control.  In general the benefits of sports participation outweigh the inconvenience of the disability. There is some indication that participants improve their mobility skills, personal relationships and the acceptance of their own disability.  The evidence in relation to physical functioning, mobility and activity level including age, aetiology, amputation level and previous sports participation is mixed and difficult to draw conclusions.  Sport-related muscle pain was more frequent among limb amputees than others with different physical disabilities.  The limited nature of the research made it difficult to identify disability-specific injury rates or patterns.  Also the sports which individuals with limb amputations prefer – fishing, swimming, golf – were not investigated.

The authors caution that the review findings should be treated with caution because only few studies had a high methodological value.  However, their overall conclusion is that participating in sports or physical activity is beneficial for those with lower limb amputations, with the psychosocial benefits being at least equal to those experienced by able-bodied people.  Further research should focus on the inclusion of a larger variety of sports and individuals with upper limb amputations and the influence of sports on quality of life needs to be more thoroughly investigated, along with determinants of participation.  Finally a physical training programme to improve cardiopulmonary function as part of a rehabilitation programme should be developed and tested for its efficacy.

Methodology

Systematic review

Source of reference

Sports Medicine, 41(9), 721-740

Web reference

http://adisonline.com/sportsmedicine/toc/2011/41090