13 2022 2 AnnaleSKinesiologiae UDK / UDC 796.01:612 | Annales Kinesiologiae 13, 2022, 2, pp. 89–200 | ISSN 2232-2620 8, 2017, 1 A nnaleSK inesiologiae AnnaleSKinesiologiae UDK / UDC 796.01:612 | Annales Kinesiologiae 8, 2017, 1, pp. 1–64 | ISSN 2232-2620 AnnaleSKinesiologiae UDK / UDC 796.01:612 | Annales Kinesiologiae 13, 2022, 2, pp. 89–200 | ISSN 2232-2620 Koper 2022 ISSN 2232-2620 UDK/UDC 796.01:612 Volume 13, Year 2022, Number 2 ISSN (online ed.) 2335-4240 Editor in Chief / Glavni in odgovorni urednik: Rado Pišot Editors / Uredniki in urednice: Peter Čerče, Petra Dolenc, Mitja Gerževič, Mihaela Jurdana, Uroš Marušič, Cecil J. W. Meulenberg, Nina Mohorko, Armin Paravlić, Saša Pišot, Matej Plevnik, Boštjan Šimunič Editorial Board / Uredniški odbor: Guglielmo Antonutto (Ita), Bojan Borštner (Slo), Andrej Čretnik (Slo), Natale Gaspare de Santo (Ita), Nandu Goswami (Aut), Jay R. Hoffman (USA), Anita Hökelmann (Ger), Aleš Holobar (Slo), Peter Kokol (Slo), Stefano Lazzer (Ita), Zlatko Matjačić (Slo), Zoran Milanović (Srb), Ivana Milovanović (Srb), Jurij Planinšec (Slo), Pietro Enrico di Prampero (Ita), Carlo Reggiani (Ita), Vesna Štemberger (Slo), Matjaž Vogrin (Slo), Jernej Završnik (Slo), Milan Žvan (Slo) Technical Editors / Tehnični urednik in urednica: Peter Čerče, Language Editors / Lektorji in lektorice: Rick Harsch, Karry Close, Jezikovna Zadruga Soglasnik (an.), Nina Novak (sl.) Translation / Prevod: Petra Berlot Kužner (an./sl.) Graphic Design of the Cover / Oblikovanje naslovnice: Mateja Oblak Typesetting / Stavek: Alenka Obid Publisher / Izdajatelj: Science and Research Centre Koper, Annales ZRS / Znanstveno-raziskovalno središče Koper, Annales ZRS Journal secretary contact / Sedež: Annales Kinesiologiae, Science and Research Centre Koper, Garibaldijeva 1, SI-6000 Koper/Capodistria tel.: +386 5 663-77-00; fax: +386 5 663-77-10 E-mail: annaleskin@zrs-kp.si Home page: http://ojs.zrs-kp.si/index.php/AK Printing / Tisk: Grafika 3000 d.o.o. Quantity / Naklada: 250 copies per issue Financial support / Finančna podpora: The publishing of this journal is supported by the Foundation for Financing Sport Organisations in the Republic of Slovenia and the Slovenian Research Agency. Izdajo revije sofinancirata Fundacija za financiranje športnih organizacij v Republiki Sloveniji in Javna agencija za raziskovalno dejavnost Republike Slovenije. Journal abbreviation: Ann. Kinesiol. Annales Kinesiologiae is an international journal published twice a year. Annual subscriptions (2 issues in English language) are available for 25 eur, and a single issue is available for 15 eur. For students 20% discount applies upon presenting an international valid student ID. Subscription requests can be send to: annaleskin@zrs-kp.si TABLE OF CONTENTS Mihaela Jurdana: .................................................................................................... Editorial Uvodnik Pia Lina Vilar, Tine Kovačič, Mitja Gerževič: ...................................................... Injury Prevention and Physiotherapy Procedures for Ankle Injuries in Ballet Dancers: A Literature Review Preventivna vadba in fizioterapevtski postopki pri poškodbah gležnja baletnih plesalcev: pregled literature Uroš Perko, Maša Černelič-Bizjak: ....................................................................... Disordered Eating Attitudes, Depressive Symptomatology and Alcohol Consumption in Young Athletes Odnos do neurejenega prehranjevanja, simptomi depresije in uživanje alkohola pri mladih športnikih Erol Kovačević, Denis Čaušević, Seth Spicer, Siniša Kovač, Ivor Doder, Slavenko Likić, Boris Metikoš: .......................................................... Body Composition of Young Soccer Players Telesna sestava mladih nogometašev Pete Allison: ............................................................................................................. Outward Bound and Outdoor Adventure Education: A Scoping Review, 1995-2019 Organizacija Outward Bound in izobraževanje skozi pustolovščine na prostem: pregledna študija, 1995–2019 REVIEWS AND REPORTS OCENE IN POROČILA Uroš Marušič: .......................................................................................................... Neuroscience of Movement Nevroznanost gibanja 89 93 115 131 143 186 Kaja Teraž: .............................................................................................................. Conference Report – 4th International Conference on Technology Innovations for Healthcare (ICDHT) Poročilo s 4. Mednarodne konference o tehnoloških novostih v zdravstvu (ICDHT) Boštjan Šimunić, Nika Štravs, Matej Kleva, Peter Čerče: .................................. “Knowledge for Health”: Integrated Health Care »Znanje za zdravje«: Celostna skrb za zdravje Guidelines for authors .............................................................................................. Navodila avtorjem 189 191 197 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 89 EDITORIAL Being physically active can improve your brain health, help manage weight, reduce the risk of disease, strengthen your bones and muscles, and improve your abilities in many everyday activities. Professional athletes are well-known for the stress and strain they put on their bodi- es, and it is generally accepted that they will eventually suffer physical damage. Howe- ver, as more male athletes report their personal experiences, more attention is being paid to mental health as well. Stress can be amplified in elite sports, and the pressures they experience in terms of competition and performance can be compounded by ad- verse life events. The fields of sport psychology and sport psychiatry are rapidly evol- ving and aim to understand, diagnose, treat and rehabilitate athletes. In this issue, we present a study that examined the prevalence of eating disorders and other behaviours in male and female Slovenian athletes relating to depressive symptoms and alcohol use. Significant differences were found between male and female athletes, and an associati- on was found between eating disorders and depression. The unique repetitive nature of ballet dance, which often exceeds the stress limits of anatomical structures, leaves dancers vulnerable to injury. This volume evaluates the effectiveness of physiotherapeutic and athletic interventions in treating injuries in ballet dancers. In recent years, numerous studies have attempted to gather as much information as possible about the abilities and characteristics of young soccer players. Based on the results, most of the conclusions of previous studies that investigated the morphological characteristics of young soccer players can be confirmed. These results indicate that younger soccer players have lower absolute values of morphological characteristics compared to older players. Outdoor adventure education programming is often referenced as an effective inter- vention that encourages a wide range of outcomes in participants such as increased con- fidence, independence and communication skills. But as outdoor adventure education continues to grow globally, what does the academic literature say about outcomes rela- ted to these programs? In this issue, you will find a summary of the academic literature on one of the major international providers of outdoor adventure education, Outward Bound. Fifty-four studies published between 1995 and 2019 have been summarized in this review. Recommendations are made for developing more rigorous methods for understanding the role of the physical environment in the learning experience and for using theoretical approaches to integrate outdoor adventure education into broader aca- demic fields. James Parkinson recognized that progressive Parkinson’s disease (PD) is associated with debilitating postural instability and gait difficulty (PIGD) such as falls and freez- ing of gait. PD initially causes physical symptoms but later, problems with cognitive function, including forgetfulness and difficulty concentrating, may occur. As the disease worsens over time, many people develop dementia. For this reason, we are pleased to report on the activities of the TwinBrain Summer School “Neuroscience of Movement: 90 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Exploring Brain Dynamics in Parkinson’s Disease and Related Disorders”, which was held in Piran, Slovenia in July 2022. Two other activities that we are presenting in this issue are the 4th International Conference on Technology Innovations for Healthcare (ICDHT), Magdeburg, Germany, and the annual “Knowledge for Health” event, tradi- tionally organised for the general public by ZRS Koper and the Izola General Hospital. Mihela Jurdana, Editor ANNALES KINESIOLOGIAE • 13 • 2022 • 2 91 UVODNIK Gibalna/športna aktivnost lahko izboljša delovanje možganov, pomaga uravnavati telesno maso, zmanjša tveganje za bolezni, okrepi kosti in mišice in izboljša številne sposobnosti vsakega posameznika pri vsakodnevnih dejavnostih. Poklicni športniki so dobro znani po tem, da zelo obremenjujejo svoje telo, in v splošnem velja, da bodo sčasoma utrpeli telesne poškodbe. Ker vse več moških špor- tnikov deli svoje osebne izkušnje, se vse več pozornosti namenja duševnemu zdravju v vrhunskem športu. Stres se lahko v vrhunskem športu dodatno poveča, pritisk, ki ga doživljajo v zvezi s tekmovanjem in uspešnostjo, pa lahko povečajo še neugodni življenjski dogodki. Področji športne psihologije in športne psihiatrije se hitro razvijata ter sta usmerjeni v razumevanje, diagnosticiranje, zdravljenje in rehabilitacijo športni- kov. V tej številki med drugim predstavljamo raziskavo, ki je proučevala razširjenost prehranskih motenj in vedenja pri slovenskih športnikih in športnicah v povezavi z depresijo in zlorabo alkohola. Ugotovljene so bile pomembne razlike med športniki in športnicami ter povezava med motnjami hranjenja in depresijo. Zaradi edinstvene ponavljajoče se narave gibov pri baletnem plesu, ki pogosto prese- ga meje obremenitve anatomskih struktur, so baletnice in baletniki pogosto izpostavlje- ni poškodbam. V tej številki avtorji predstavljajo oceno učinkovitost fizioterapevtskih in kinezioloških obravnav pri zdravljenju poškodb baletnih plesalcev. V zadnjih letih so številne raziskave poskušale zbrati čim več informacij o spo- sobnostih in značilnostih mladih nogometašev. Na podlagi rezultatov je mogoče potr- diti večino ugotovitev prejšnjih raziskav, ki so proučevale morfološke značilnosti. Ti rezultati kažejo, da imajo mladi nogometaši v primerjavi s starejšimi nižje vrednosti morfoloških značilnosti. Programi izobraževanja na prostem se pogosto omenjajo kot učinkovita intervenci- ja, ki pri udeležencih spodbuja širok nabor rezultatov, kot so večja samozavest, neod- visnost in komunikacijske spretnosti. Ker pa trend izobraževanja na prostem globalno narašča, se avtor članka v tej številki sprašuje, kaj o rezultatih, povezanih s tovrstnimi programi, pravi strokovna literatura. V temeljitem preglednem članku boste našli pov- zetek strokovne literature o enem od glavnih mednarodnih ponudnikov izobraževanja na prostem Outward Bound. V pregledu je povzetih 54 raziskav, objavljenih med le- toma 1995 in 2019. Navedena so priporočila za razvoj strožjih metod za razumevanje vloge fizičnega okolja pri učni izkušnji in za uporabo teoretičnih pristopov za vključe- vanje izobraževanja na prostem v širša akademska področja. James Parkinson je ugotovil, da je progresivna Parkinsonova bolezen (PB) poveza- na z izčrpavajočimi značilnostmi posturalne nestabilnosti in težavami s hojo (PNTH), kot so padci in zamrznitev hoje. PB sprva povzroča telesne simptome. Pozneje se lahko pojavijo težave s kognitivnimi funkcijami, vključno s pozabljivostjo in nezmožnostjo koncentracije. Ko se bolezen sčasoma poslabša, se pri številnih ljudeh razvije demenca. Zato z veseljem poročamo o dejavnostih poletne šole TwinBrain Nevroznanost gibanja: Raziskovanje možganske dinamike pri Parkinsonovi bolezni in sorodnih motnjah, ki je 92 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 julija 2022 potekala v Piranu. Drugi poročili se nanašata na 4. mednarodno konferenco o tehnoloških inovacijah v zdravstvu (ICDHT), ki je potekala v Magdeburgu v Nemčiji, ter na vsakoletni dogodek Znanje za zdravje, ki ga za širšo javnost tradicionalno orga- nizirata ZRS Koper in Splošna bolnica Izola. Mihaela Jurdana, urednica ANNALES KINESIOLOGIAE • 13 • 2022 • 2 93 INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES FOR ANKLE INJURIES IN BALLET DANCERS: A LITERATURE REVIEW Pia Lina VILAR1, Tine KOVAČIČ1, Mitja GERŽEVIČ1,2 1Alma Mater Europaea – ECM, Department of Physiotherapy 2MILLEO, Sports, Tourism and Education, Mitja Gerževič s.p. Corresponding author: Mitja GERŽEVIČ Department of Physiotherapy, Alma Mater Europaea – ECM, Slovenska ulica 15, 2000 Maribor, Slovenia e-mail: mitja.gerzevic@almamater.si ABSTRACT The aim of this study was to investigate the most frequent, effective and up-to-date injury prevention and physiotherapy procedures used in relation to ballet dancers’ ankle injuries. A literature review with a qualitative analysis was performed using the following databases: PubMed, SAGE, ScienceDirect, PlosOne and Cochrane Li- brary. The inclusion criteria were: both genders, age > 18, journal impact factor > 0, age of study ≤ 10 years and the following search keywords were used: “ankle”, “in- jury”, “ballet”, “dancers”, “physiotherapy”, “physical therapy” and “prevention”. A total of 520 articles were found, out of which six were determined to be appropriate according to the inclusion and exclusion criteria. They dealt with the prevention/ rehabilitation of ankle sprains (N=2), tendinopathy of the Achilles tendon (N=2), tendinitis of the m. hallucis longus (N=4), rupture of the Achilles tendon (N=2), and anterior (N=3) and posterior (N=4) impingement syndrome. It was found that for injury prevention in ballet, strengthening and stretching exercises are the most often used methods, while rest, ice therapy, muscle strengthening exercises, foot braces and dance technique optimisation are the most frequently used methods in injury manage- ment. These seem to also be the most up-to-date injury prevention and physiotherapy procedures, while the most effective procedures could not be retrieved due to a lack of relevant studies, which prevented the quantitative comparison of their effectiveness. The published clinical evidence endorses physiotherapy/kinesiotherapy as an effec- Review article DOI: https://doi.org/10.35469/ak.2022.349 received: 2022-10-14 UDC: 792.82:615.8 94 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 tive ankle injury prevention and management modality in ballet dancers, although additional studies with a better quality of methodology are required. Keywords: rehabilitation, ballet, ankle, injury, physiotherapy, prevention PREVENTIVNA VADBA IN FIZIOTERAPEVTSKI POSTOPKI PRI POŠKODBAH GLEŽNJA BALETNIH PLESALCEV: PREGLED LITERATURE IZVLEČEK Cilj študije je bil raziskati najpogostejše, najučinkovitejše in najsodobnejše preven- tivne in fizioterapevtske postopke pri poškodbah gležnja baletnih plesalcev. Pregled literature s kvalitativno analizo je bil opravljen s pomočjo naslednjih podatkovnih baz: PubMed, SAGE, ScienceDirect, PlosOne in Cochrane Library. Pri tem smo uporabili naslednje vključitvene kriterije: oba spola, starost > 18 let, faktor vpliva publikaci- je > 0, starost študije ≤ 10 let ter naslednje iskalne ključne besede: »ankle«, »injury«, »ballet«, »dancers«, »physiotherapy«, »physical therapy« in »prevention«. Skupno smo našli 520 člankov, izmed katerih je bilo glede na vključitvene in izključitvene kri- terije primernih 6 člankov. Ti so obravnavali preventivo/rehabilitacijo zvina gležnja (N=2), tendinopatijo Ahilove tetive (N=2), tendinitis m. hallucis longus (N=4), rupturo Ahilove tetive (N=2) ter anteriorni (N=3) in posteriorni (N=4) utesnitveni sindrom. Ugotovili smo, da se v preventivne namene najpogosteje uporabljajo krepilne in raz- tezne vaje, za fizioterapevtsko obravnavo poškodb pa počitek, terapija z ledom, vaje za krepitev mišic, nožne opornice in optimiziranje plesne tehnike. Slednji so kot kaže tudi najsodobnejši preventivni in fizioterapevtski postopki, medtem ko najučinkovitejših preventivnih in fizioterapevtskih postopkov ni bilo mogoče izluščiti, saj je bilo premalo študij za kvantitativno primerjavo učinkovitosti med postopki, kar nakazuje potrebo in možnosti za nadaljnje raziskovanje. Objavljeni klinični dokazi potrjujejo, da je fi- zioterapija/kinezioterapija učinkovito preventivo in kurativno sredstvo pri poškodbah gležnja baletnih plesalce, čeprav so potrebne dodatne študije z bolj kakovostno meto- dologijo. Ključne besede: rehabilitacija, balet, gleženj, poškodba, fizioterapija, preventiva poškodb 95 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 INTRODUCTION Classical ballet is considered a high-performance dance art form that requires an ad- vanced level of technical skills (Campbell, Lehr, Livingston, McCurdy, & Ware, 2019). It demands from the dancer a similar level of development of motor and functional abil- ities and physiological characteristics as some top athletes have. Due to strict schedules and repetitive movements during exercise, training sessions and performances, where specific ballet movements are often performed with large amplitudes and in extreme positions at the limits of the range of motion, where muscles, tendons and other pas- sive structures are weaker and thus more prone to injuries, ballet dancers experience relatively large loads on joints, muscles, tendons and ligaments. Therefore, they have an increased chance of acute and chronic injuries (Bickle, Deighan, & Theis, 2018; Leanderson et al., 2011; Nunes et al., 2019). Ballet dancers can jump up to 200 times in an hour and a half. The force acting on the lower limbs during jumps can represent up to 12 times their body weight, which increases the risk of injury to the lower limbs, especially the ankle (Steinberg et al., 2018). Previous research has shown that the lower extremities account for the largest share (77%) of ballet dancer injuries (Bickle et al., 2018; Leanderson et al., 2011; Rietveld, 2013; Nunes et al., 2019). More specifically, ankle injuries account for up to 33% of all injuries (Ekegren, Quested, & Brodrick, 2014) in ballet, which, according to most authors, is also the most frequently injured body part in rhythmic gymnastics (Meeu- sen & Borms, 1992). In ballet, the most common of these injuries is the lateral sprain, which most often occurs during the landing phase or when rising to the tips of the toes, when the foot is less stable (Morton, 2013). In addition to ankle sprains, the following are common ankle injuries: fractures, Achilles tendinopathy, Achilles tendon ruptures, posterior and anterior impingement syndromes, and m. flexor halluces longus tendinitis (Kadel, 2014; Morton, 2013). A meta-analysis by Doherty et al. (2014) found that the female gender is a risk factor for lateral ankle sprain (LAS), with a cumulative inci- dence rate for females of 13.6 per 1000 exposures (95% CI: 13.25, 13.94). Conflicting evidence exists that previous LAS elevates risk for a subsequent LAS (Vuurberg et al. 2018). There is also conflicting evidence on the role of injury severity in the clinical course after a LAS, as well as weak evidence for primary injury prevention regarding the use of prophylactic balance training exercises in individuals who have not expe- rienced a first-time LAS (Martin et al. 2021). Regarding the secondary prevention of recurrent LAS following an initial sprain, there is strong evidence that physiothera- pists should use proprioceptive and balance-focused therapeutic exercise training pro- grammes to address impairments identified during physical examination to reduce the risk of a subsequent injury in patients with a first-time LAS (Martin et al. 2021), yet there is a lack of evidence for the use of these interventions for ballet dancers. Vuur- berg and colleagues (2018) reported that while there is evidence to support the use of exercises to prevent recurrent sprains, there is a lack of evidence to support the use of prophylactic exercises to prevent first-time ankle sprains and a lack of evidence to support the use of these interventions in professional ballet dancers. According to Vera 96 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 and colleagues (2020), their randomised controlled investigation of an injury preven- tion programme was the first of its kind for professional ballet dancers. Due to the high incidence of ankle injuries (Bickle et al., 2018; Ekegren et al., 2014; Leanderson et al., 2011; Rietveld, 2013; Nunes et al., 2019) and based on current Clinical Practice Guidelines (CPG) (Martin et al., 2021) there is conflicting evidence as to the best way to augment the components of rehabilitation programmes (e.g. by written instructions, exercise-based videos or app-based instruction) in patients with acute and post-acute ankle sprains and other injuries. The physiotherapist should determine what actions to take according to the individual’s specific motor and functional abilities, learning needs and access to relevant treatment options such as proprioceptive and neuromuscular therapeutic exercises in order to improve dynamic ankle stability and patient-perceived stability during function (ballet training sessions and performances) in individuals with chronic ankle instability (CAI) in order to prevent further injuries. Although the CPG describe evidence-based physiotherapy practice, including diagnosis, prognosis, in- tervention, and assessment of the outcome of patients with ankle injuries commonly managed by orthopaedic or sports physiotherapists, there is a lack of evidence for the use of these approaches for professional ballet dancers due to extremely high demands on dynamic ankle stability. As Biernacki, Stracciolini, Fraser, Micheli, & Sugimoto (2018) established, there is no consensus in the literature regarding risk factors for bal- let-related injury in females, despite the high prevalence of dance injuries among this group. This may stem from methodological inconsistencies including a lack of standard definition of injury, time loss and medical attention, and limited high-quality original studies. In the previous systematic reviews of studies which assessed the effects of the therapeutic alliance on the effectiveness of primary and secondary prevention strate- gies for ankle injuries there is a lack of evidence pertaining to the therapeutic alliance in rehabilitation of musculoskeletal conditions (Doherty et al., 2014; Vuurberg et al., 2018). Due to the heterogeneity of impairments and activity limitation experienced by individuals with LAS and CAI, methods should be tailored to the specific needs of the patient. Furthermore, intrinsic and environmental factors that mediate outcomes should also be addressed when prescribing treatments for individuals with LAS and CAI (Mar- tin et al., 2021). Therefore, it was the aim of this study to determine, through a literature review, the most up-to-date, most common and most effective prevention and physiotherapy procedures for ballet dancers’ ankle injuries. Based on this, the following two research questions were posed: i) “What are the state-of-the-art physiotherapy treatments for ankle injuries in ballet dancers?” and ii) “What are the most common and the most effective prevention procedures for ankle injuries in ballet dancers?” 97 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 METHODS Procedures In this literature review, a qualitative research method was used. A compilation me- thod was used to collect the most relevant original scientific and review articles and to describe and summarise their findings. The method of analysis and synthesis was used to analyse and integrate the facts already known in order to deepen the knowledge of the problem we identified in this literature review. The method of comparison was used to compare the different findings and conclusions of the collected articles in an attempt to arrive at the most common, effective and up-to-date preventive and physiothera- peutic procedures in the management of various ankle injuries in ballet dancers. The conclusion and findings were thus formulated using the method of deduction. In the introduction, the known facts were described and the key concepts, problem, aim and research questions were defined based on a review of domestic and internati- onal literature as well as based on our professional experience in the field of classical ballet. The literature review was performed using the following specialised scientific databases: PubMed, SAGE, ScienceDirect, PlosOne and Cochrane Library, and the fol- lowing keywords: “ankle”, “injury”, “ballet”, “dancers”, “physiotherapy”, “physical therapy” and “prevention”. The search syntax was performed in four stages, using four combinations of key- words (search strings). The first search string was related to rehabilitation with the fol- lowing combination of keywords used in all databases: “rehabilitation” AND “ballet” AND “dancers” AND “ankle” AND “injury”, while the second one was related to pre- vention and was also used in all databases with the following keywords combination: “prevention” AND “ballet” AND “dancers” AND “ankle” AND “injury”. Since there were no hits in the Cochrane Library using the previous two search strings, the next two were used in the Cochrane Library only, first “ballet” AND “injury” AND “prevention” and then “ballet” AND “dancer” AND “ankle” (Table 1). The literature review included articles that dealt with professional ballet dancers over the age of 18, to avoid the influence of growth and development on the results. The focus was on the most up-to-date, most common and most effective prevention and physiotherapy procedures for ballet dancers’ ankle injuries. All articles were first evaluated for adequacy based on title, then based on the abstract, then based on a quick full-text overview and finally based on the following specific inclusion and exclusion criteria. The inclusion criteria were: i) both genders, ii) age of dancers > 18 years, iii) professional ballet dancers with ankle injuries in rehabilitation, iv) prevention exercise for ankle injuries, v) age of the study ≤ 10 years, vi) publication impact factor > 0, and vii) articles accessible in full-text, while the exclusion criteria were other injuries of ballet dancers and/or no physiotherapy treatment and/or without ankle injury preven- tion exercises. 98 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Data analysis To facilitate editing and data collection, Microsoft Office Excel 2016 (Microsoft Corporation, New York, USA) was used and the results were presented with the help of tables and diagrams. The search process and the final selection of articles was perfor- med and presented using the PRISMA diagram (Page et al. 2021). Also presented are all the physiotherapy procedures discussed in the studies. The content and characteristics of the studies found in the field of prevention exercises and physiotherapy for ankle injuries were qualitatively analysed and described in detail. On this basis, guidelines and practical examples of exercises and training methods for prevention of ankle inju- ries in ballet dancers were prepared. RESULTS Results of the search and selection procedure of articles Based on search keywords and their combinations (search strings) in connection with ballet and ankle injuries of ballet dancers, we found a total of 520 articles in the research databases. Out of these, 30 were repeated in different databases, which gave a final total number of 490 articles. Of these, 130 matched by title, 60 by abstracts and 33 by quick full-text overview. Finally, there were 6 full-text articles on the defined topic matching also the inclusion and exclusion criteria. An overview of the search and selec- tion procedure is presented in the PRISMA diagram in Figure 1, while the extended and detailed search results for individual databases using different search strings (syntaxes) are presented in Table 1. An overview of the finally selected articles’ titles, journals’ impact factors, field of study and injuries considered are shown in Table 2. 99 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 Figure 1: Search and selection procedure for the literature review Search and selection procedure in the study In cl ud ed O ve rv ie w Se ar ch Hits in the databases: PubMed (n = 77) ScienceDirect (n = 324) SAGE (n = 97) PlosOne (n = 9) Cochrance Library (n = 13) Consulted article title (n = 520) Articles included in the study (n = 6) Excluded articles before consulting abstract: Duplicated articles (n = 30) Unsuitable title (n = 360) Unsuitable articles according to abstract (n = 70) Excluded articles: Without impact factor (n = 15) Minor participants involved (n = 7) Unsuitable content (n = 2) Amateur dancers involved (n = 2) Inability to get full-text (n = 1) Unsuitable articles according to content (n = 27) Consulted article abstracts (n = 130) Quick full-text overview (n = 60) Compliance with selected criteria (n = 33) 100 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Ta bl e 1: D et ai le d se ar ch re su lts a cr os s d at ab as es u si ng d iff er en t s ea rc h st ri ng s ( sy nt ax es ) N o. Se ar ch st ri ng s D at ab as e To ta l hi ts Su ita bl e ar tic le s b y tit le D up lic at ed ar tic le s Su ita bl e ar tic le s b y tit le Su ita bl e ar tic le s by q ui ck fu ll- te xt ov er vi ew Su ita bl e ar tic le s by im pa ct fa ct or Su ita bl e ar tic le s b y th e cr ite ri a an d fu ll- te xt 1 “r eh ab ili ta tio n” an d “b al le t” an d “d an ce rs ” an d “a nk le ” an d “i nj ur y” SA G E 42 7 1 5 5 0 0 Sc ie nc eD ire ct 20 5 54 11 6 2 0 0 Pu bm ed 31 17 0 14 8 6 3 Pl os O ne 0 0 0 0 0 0 0 C oc hr an e Li br ar y 0 0 0 0 0 0 0 27 8 78 12 25 15 6 3 2 “p re ve nt io n” an d “b al le t” an d “d an ce rs ” an d “a nk le ” an d “i nj ur y” SA G E 55 17 8 4 4 0 0 Sc ie nc eD ire ct 11 9 34 3 13 5 2 1 Pu bm ed 46 22 6 13 6 7 1 Pl os O ne 9 2 0 1 1 0 0 C oc hr an e Li br ar y 0 0 0 0 0 0 0 22 9 75 17 31 16 9 2 3 “b al le t” a nd “i nj ur y” a nd “p re ve nt io n” C oc hr an e Li br ar y 6 2 0 2 1 1 1 6 2 0 2 1 1 1 4 “b al le t” a nd “d an ce r” a nd “a nk le ” C oc hr an e Li br ar y 7 5 1 2 1 2 0 7 5 1 2 1 2 0 TO TA L 52 0 16 0 30 60 33 18 6 101 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 Ta bl e 2 : F in al ly se le ct ed a rt ic le s’ tit le s, jo ur na ls ’ i m pa ct fa ct or s, fie ld o f s tu dy , i nj ur ie s c on si de re d an d su m m ar y o f s tu di es ’ r es ul ts No. Author (year of publication) Title Impact factor Article type Field of study (prevention, injury, rehabilitation) Results Ankle sprain Ankle fracture Achilles tendinopathy Rupture of Achilles tendon Posterior impingement syndrome Anterior impingement syndrome Tendinitis of flexor hallucis longus 1 Ve ra e t a l. (2 02 0) A n In ju ry Pr ev en tio n Pr og ra m fo r P ro fe ss io na l B al le t 2. 49 2 C lin ic al st ud y Pr ev en tio n (d an ce -s pe ci fic in ju ry p re ve nt io n pr og ra m m e) 82 % d ec re as e in in ju ry ra te fo r t he in te rv en tio n gr ou p an d an e xt en de d pe rio d fr om p re vi ou s i nj ur y to su bs eq ue nt in ju ry . 2 M or to n (2 01 3) Th e vi rtu os o fo ot 1. 77 4 R ev ie w in ju ry 1. A ny in ju ry to th e fo ot a nd a nk le w ill h av e a rip pl e eff ec t f ur th er u p th e ki ne tic c ha in . 2. A ny c lin ic al e xa m in at io n sh ou ld in vo lv e a gl ob al p er sp ec tiv e. 3. C or re ct e ar ly d ia gn os is a nd tre at m en t i s v ita l t o th ei r p hy si ca l, ps yc ho lo gi ca l a nd fi na nc ia l w el l- be in g. 4. W he n tre at in g a da nc er , t he cl in ic ia n sh ou ld a ls o be a w ar e of th e hi gh to le ra nc e fo r p ai n in th is el ite g ro up o f a th le te s. x x x x x re ha bi lit at io n x x x x 3 R ie tv el d (2 01 3) D an ce rs a nd m us ic ia ns ’ i nj ur ie s 1. 77 4 R ev ie w in ju ry 1. U ni la te ra lly p ai nf ul a ra be sq ue is a sp on dy lo ly si s / st re ss fr ac tu re of th e ve rte br al a rc h un til p ro ve n ot he rw is e. 2. P os te rio r a nk le im pi ng em en t, w ith o r w ith ou t t en ov ag in iti s o f t he m .fl ex or h al lu ci s l on gu s i s t he m os t co m m on d an ce rs ’ i nj ur y. 3. T he ru le o f t hu m b is to n ot op er at e on a h al lu x va lg us in a n ac tiv e da nc er o r d an ce -te ac he r. x x x re ha bi lit at io n x x 102 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 No. Author (year of publication) Title Impact factor Article type Field of study (prevention, injury, rehabilitation) Results Ankle sprain Ankle fracture Achilles tendinopathy Rupture of Achilles tendon Posterior impingement syndrome Anterior impingement syndrome Tendinitis of flexor hallucis longus 4 Vo ss el le r et a l. (2 01 9) A nk le In ju rie s i n D an ce rs 2. 28 6 R ev ie w in ju ry 1. A te am a pp ro ac h to tr ea tm en t w ith k no w le dg ea bl e ph ys ic al th er ap is ts c an o bv ia te th e ne ed fo r su rg ic al tr ea tm en t. 2. If su rg ic al tr ea tm en t p ro ve s ne ce ss ar y, g oo d re su lts c an b e ac hi ev ed w ith so un d su rg ic al te ch ni qu e an d a w el l-t ho ug ht -o ut re ha bi lit at io n pr og ra m m e. x x x re ha bi lit at io n x x 5 K ad el (2 01 4) Fo ot a nd A nk le Pr ob le m s i n D an ce rs 0. 93 0 R ev ie w in ju ry 1. T o ke ep d an ce rs h ea lth y, th e he al th c ar e te am a nd th e da nc er m us t w or k to ge th er . 2. T he p hy si ci an m us t b e an ad vo ca te fo r t he d an ce r a nd w or k to p ro vi de a n ac cu ra te d ia gn os is an d an e ffe ct iv e tre at m en t s tra te gy . 3. M on ito rin g pe rf or m an ce a nd re he ar sa l l oa d, fi tn es s, an d ge ne ra l he al th o f t he d an ce r w ill h el p to m ax im is e th e da nc er ’s h ea lin g po te nt ia l. 4. C or re ct io n of m us cl e im ba la nc es , a tte nt io n to p ro pe r te ch ni qu e, se qu en tia l s ki ll pr og re ss io n, a nd p ro pe r s ho e fit m ay h el p lim it ac ut e in ju rie s t o th e da nc er . 5. C re at iv ity is n ee de d to m od ify tre at m en t p la ns to a cc om m od at e th e da nc er ’s n ee d to m ai nt ai n st re ng th , fl ex ib ili ty , a nd fi tn es s du rin g re co ve ry . x x x x x x re ha bi lit at io n x x x x x 103 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 No. Author (year of publication) Title Impact factor Article type Field of study (prevention, injury, rehabilitation) Results Ankle sprain Ankle fracture Achilles tendinopathy Rupture of Achilles tendon Posterior impingement syndrome Anterior impingement syndrome Tendinitis of flexor hallucis longus 6 C am pb el l et a l. (2 01 9) In tri ns ic m od ifi ab le ris k fa ct or s i n ba lle t da nc er s: A pp ly in g ev id en ce -b as ed pr ac tic e pr in ci pl es to e nh an ce c lin ic al ap pl ic at io ns 1. 92 6 R ev ie w Pr ev en tio n (r is k fa ct or s a nd sc re en in g to ol s id en tifi ca tio n) 1. Id en tifi ca tio n of se ve n in tri ns ic m od ifi ab le fa ct or s s pe ci fic al ly fo r b al le t d an ce rs a nd se ve n ap pr op ria te sc re en in g to ol s. 2. In tri ns ic m od ifi ab le ri sk fa ct or s: hy pe rm ob ili ty , f at ig ue , o ve ru se , ne ur om us cu la r d ys fu nc tio n, d eg re e of tu rn ou t, w ea kn es s o f c or e an d lo w er e xt re m ity m us cu la tu re , a nd lo w er e xt re m ity ra ng e of m ot io n (R O M ) d is cr ep an ci es . 3. A pp ro pr ia te sc re en in g to ol s: M ov em en t C om pe te nc y Sc re en in g (M C S) , B ei gh to n H yp er m ob ili ty Sc al e (B H S) , R ol lin g (to d et ec t co m pe ns at io n an d ne ur om us cu la r dy sf un ct io n) , S ta r E xc ur si on B al an ce T es t ( SE B T) , F un ct io na l A gi lit y Sh or t-T er m F at ig ue pr ot oc ol (F A ST -F P) , S lo w L in ea r O xi da tiv e Fa tig ue p ro to co l ( SL O - FP ) a nd T ot al P as si ve T ur no ut (T PT ). 104 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Results of the most common prevention and treatment procedures of ankle injuries in ballet dancers The physiotherapy procedures discussed in the reviewed articles have been collec- ted and arranged by individual types of injuries in Table 3. The review showed that the most common procedures in the treatment of ankle injuries in ballet dancers are the fol- lowing: rest (Kadel, 2014; Morton, 2013), ice therapy (Kadel, 2014; Vosseller, Dennis, & Bronner, 2019), muscle strengthening (Kadel, 2014; Morton, 2013), night brace (Ka- del, 2014; Vosseller et al., 2019) and optimising ballet technique (Morton, 2013; Kadel, 2014; Vosseller et al., 2019; Rietveld, 2013). For injury prevention purposes, mainly strengthening and stretching exercises are used, to which functional joint stabilisation and plyometric exercises can be added (Vera et al., 2020). Results related to ankle sprain Kadel (2014) states that the ankle sprain is the most common ballet injury. Most often, an inversion ankle sprain occurs (the foot turns inward). Conservative rehabili- tation should thus include: a compression bandage, ice therapy, ankle brace, wearing good athletic shoes outside of ballet training and rest from training as long as the ankle is painful. Some sprains also require the wearing of a special therapeutic shoe, which the ballet dancer wears when walking and sleeping. It is recommended that dancers who have had multiple ankle sprains perform floor barre ballet classes, combined with pilates and gyrotonics training before returning to the ballet halls (Kadel, 2014). Results related to Achilles tendinopathy Morton (2013) states that Achilles tendinopathy occurs in both men and women and can be seen in many other dance styles as well. For conservative rehabilitation, both authors recommend rest, use of physiotherapy and careful active stretching of the Achilles tendon and triceps surae muscles. Kadel (2014) states that it is useful to add deep tissue massage, while Morton (2013) adds that it is also necessary to correct any incorrect ballet technique (e.g. foot tilt in the direction of pronation, incomplete lan- ding) so that dancers avoid new injuries and, in their free time, to wear shoes that are large, wide, hard and supportive for the feet. Results related to Achilles tendon rupture Kadel (2014) and Morton (2013) state that Achilles tendon rupture occurs after the age of 30 and that the injury is more common in men than in women. Kadel (2014) adds that the rupture of the Achilles tendon is felt as a sharp pain and that the ballet dancer 105 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 Table 3: Physiotherapy and other procedures discussed in the articles included in the literature review Author(s) (Year of publication) Injury Physiotherapy and other procedures Morton (2013) Kadel (2014) Sprain Compression bandage, ice therapy, ankle brace, wearing good athletic shoes outside of ballet training and taking a rest from training, wearing a special therapeutic shoe, ankle and core strength exercises, sensorimotor training, range of motion (ROM) training, manual therapy (ankle mobilisation) and edema control Morton (2013) Kadel (2014) Achilles tendinopathy Rest, physiotherapy, careful active stretching of the Achilles tendon and triceps surrae muscles, deep tissue massage and elimination of incorrect ballet technique Morton (2013) Kadel (2014) Rupture of Achilles tendon There is no conservative treatment, as surgery is recommended Morton (2013) Kadel (2014) Rietveld (2013) Vosseller et al. (2019) Posterior impingement syndrome Limiting painful activities, including stopping tiptoe dancing, physiotherapy (muscle strengthening and ankle mobilisation), eliminating improper ballet technique, ice therapy and anti- inflammatory medications Rietveld (2013) Vosseller et al. (2019) Kadel (2014) Anterior impingement syndrome Avoiding ballet jumps, squats/demi-pliés; raising the heel with an insole in both ballet shoes and day shoes; physiotherapy (correction of incorrect foot posture) and the use of day and night braces. Morton (2013) Kadel (2014) Rietveld (2013) Vosseller et al. (2019) Tendinitis of m. flexor hallucis longus Rest; discontinuing the use of ballet pointe, grand plié and jumps; physiotherapy, stretching the flexor hallucis longus; optimising dance technique; anti- inflammatory medications, ice therapy, ultrasound therapy; functional exercise; good everyday footwear and use of a night brace. / Ankle fracture / 106 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 is unable to rise to half-toes or demi-pointe. An Achilles tendon rupture usually occurs during a rebound or eccentric load landing. It also means that the Thompson’s test is positive. The authors do not mention conservative treatment, as surgery is recommen- ded for this injury. Despite undergoing surgery, the dancer will be able to continue their dance career, but rehabilitation may take up to a year (Morton, 2013; Kadel, 2014). Results related to posterior impingement syndrome The authors describe posterior impingement syndrome or “dancer’s heel” as a pain- ful condition occurring due to the compression of soft tissues on the back of the tibiae and calcaneus during plantar flexion (Rietveld, 2013; Vosseller et al., 2019; Kadel, 2014; Morton, 2013). For conservative treatment, it is first recommended to limit ballet activity that is painful, including ceasing to dance on the toes (Kadel, 2014; Morton, 2013; Vosseller et al., 2019), as well as using physiotherapy, where muscle strengthe- ning and ankle mobilisation (Kadel, 2014; Morton, 2013), eliminating incorrect ballet technique (Kadel, 2014; Vosseller et al., 2019) and using ice therapy and anti-inflam- matory drugs (Vosseller et al., 2019). Rietveld (2013) recommends that if the condition does not subsequently improve, an injection of cortisol is used, which also acts as an anti-inflammatory drug (corticosteroid). If conservative treatment does not help, surge- ry is recommended (Rietveld, 2013; Vosseller et al., 2019; Kadel, 2014; Morton, 2013). Results related to anterior impingement syndrome Anterior impingement syndrome can be the result of hypertrophied (thickened) soft tissues or osteophytes at the anterior edge of the tibiotalar joint (Kadel, 2014). Kadel (2014) hypothesises that osteophytes are the result of repeated ankle sprains or micro- traumas from extreme dorsiflexion and plantarflexion positions. In conservative treat- ment, Kadel (2014) recommends avoiding ballet jumps and squats/demi-pliés and heel elevation with insoles in both ballet shoes and day shoes. Physiotherapy should also include correcting incorrect foot posture. Using day and night splints can relieve pain and inflammation. If the pain persists, surgery is recommended (Kadel, 2014). Results related to tendinitis of flexor hallucis longus Flexor hallucis longus tendinitis injury is very common in dancers. This injury is also called “dancer’s tendinitis” (Morton, 2013; Kadel, 2014; Rietveld, 2013). It is more common in the female population due to the repetitive movement from dorsi- flexion (demi-plié) to plantarflexion (standing on the tips of the toes). For conservative treatment, it is recommended to rest and stop using ballet pointe shoes, stop performing grand plié and jumps (Kadel, 2014; Morton, 2013; Vosseller et al., 2019), use physi- 107 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 otherapy (Kadel, 2014), stretch the flexor hallucis longus, optimise dance techniques (Rietveld, 2013; Vosseller et al., 2019), use anti-inflammatory drugs (Kadel, 2014; Vos- seller et al., 2019), ice therapy, ultrasound, functional exercise, good daily footwear and, if necessary, night braces (Kadel, 2014; Vosseller et al., 2019). Results related to ankle fracture Unfortunately, the ankle fracture was not mentioned in the analysed articles, nor was rehabilitation. Results related to the prevention of ballet dancers’ injuries Out of all the retrieved articles, injury prevention exercises in ballet dancers were discussed by Campbell et al. (2019) and Vera et al. (2020) only. Campbell et al. (2019) identify seven different intrinsic modifiable risk factors for injury: i) hypermobility, ii) fatigue, iii) overuse, iv) degree of turnout, v) neuromuscular dysfunction, vi) weakness of core and lower extremity musculature, and vii) lower extremity range of motion discrepancies, which are all commonly present in the ballet population. The authors emphasise that much care must be taken when creating an injury prevention program- me for ballet dancers and take into account the mentioned seven internal factors in order to avoid the most common ballet injuries. Vera et al. (2020), however, addressed a general whole-body injury prevention pro- gramme for ballet dancers. The study was conducted on 39 professional dancers with 19 dancers in the control group (9 men and 10 women, average age 26.6 ± 4.0 years) and 20 dancers in the experimental group (11 men and 9 women, average age 25.1 ± 5.1 years). The dancers carried out the injury prevention programme 3 times a week. It included a total of 24 exercises, which were arranged in such a way that each training day included different exercises. The injury prevention exercise programme lasted 30 minutes per session over a period of 52 weeks. Dancers performed 10–30 repetitions or 15–45 seconds of each exercise in 2 to 3 sets with 30 to 60 seconds of rest between sets. When the exercises were no longer challenging enough for the participants the intensity was increased by carrying out more difficult variants of the exercises, using stronger elastics and free weights. The dancers carried out the injury prevention programme wi- thout supervision, however, they had supervision for as long as they needed. The results of this study showed an 82% reduction in injuries and a longer period of time passing before the reappearance of old or appearance of new injuries. 108 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 DISCUSSION The aim of this literature review was to identify the most common, most effective and up-to-date injury prevention and physiotherapy procedures for ankle injuries in ballet dancers. The results of the review and qualitative analysis performed showed that, despite the small number of studies in this field, the research questions on the sta- te-of-the-art physiotherapy treatments and the most common and effective prevention procedures for ballet dancers’ ankle injuries could be at least partly answered. Most of the articles were review articles (5 out of 6), which means that relatively few original scientific studies on prevention and physiotherapeutic procedures for an- kle injuries have been performed in the last 10 years. This prevented the authors from directly answering the question of which prevention and physical therapy procedures are most effective. However, it was possible to identify the state of the art and the most common physiotherapy treatments and prevention procedures for ankle injuries in bal- let dancers. It was found that among all injuries, ankle injuries are the most common in ballet dancers and seven different ankle injuries were most commonly evidenced in the re- viewed literature. These are ankle sprain, Achilles tendinopathy, rupture of the Achilles tendon, anterior and posterior impingement syndromes, tendinitis of m. flexor hallucis longus and ankle fracture. This is in accordance with earlier studies, where the inci- dence of Achilles, peroneal, flexor hallucis longus and tibialis posterior tendinopathies, ankle impingement, stress fractures and metatarsalgia was the highest in ballet dancers (Nilsson et al., 2001 in Sobhani, Dekker, Postema, & Dijkstra, 2012) or in theatrical dancers (Rovere et al., 1983 in Sobhani et al., 2012), as well as in running and soccer (Sobhani et al., 2012). Comparing the results of this literature review to studies in other sports, where most frequently studied are soccer, running and gymnastics, it has been similarly shown that the most frequently studied overuse injuries are Achilles tendi- nopathy (in 44% of studies) and tendinopathy of other foot and ankle muscles, such as toe extensors and flexors, the tibialis anterior and posterior, and peroneal tendinopa- thies, as well as plantar fasciitis and stress fractures (Sobhani et al., 2012). However, weak methodology and poor reporting were highlighted, especially lack of a clear case definition, description of assessment procedures and reporting sample characteristics (Sobhani et al., 2012), showing the need for more and better original scientific studies. Regarding rehabilitation, the most frequently used modalities and/or interventions for the management of ankle injuries in ballet dancers are rest, ice therapy, muscle strengthening exercises, foot braces and dance technique optimisation. Of course, tre- atment of each individual injury has also some individual and specific modalities and procedures, as presented in Table 3. Interestingly, among all evidenced injuries, specific physiotherapy treatments for ankle fractures could not be found in this literature review, even though earlier studies identified stress fractures as one of the prevalent injuries in ballet and theatrical dancers as well as in athletes of other sports (Sobhani et al., 2012). For ankle sprains, as the most common injury in sports, at the time of injury, Chen, McInnis and Borg-Stein (2019) first recommend the application of the Ottawa Ankle 109 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 Rules to assess risk of fracture and reduce unnecessary radiographs, since these rules represent highly sensitive tools for detecting fracture in the setting of acute ankle spra- in. Further, they report that modalities, such as RICE therapy (rest, ice, compression and elevation), electrical stimulation, oral and topical nonsteroidal anti-inflammatory drugs (NSAID) and Tylenol do not accelerate recovery, but are reasonable interventions for short term pain reduction. They also suggest early mobilisation (manual therapy) after acute lateral sprain as it has been shown to improve ankle dorsiflexion, pain reduc- tion and stride length and thus accelerate return to play. Besides this, the introduction of early neuromuscular training programmes, typically balance and proprioception tasks with recurrent voluntary or involuntary destabilisation during exercise showed to be beneficial in all athletes with ankle sprains to reduce the risk of recurrent sprains, since ankle joint position sense, muscle reaction time and functional outcome scores improve with such exercises (Chen et al., 2019). In addition, the same authors found that altho- ugh neuromuscular training programmes are effective for the prevention of recurrent sprains, the evidence for reducing the rate of first-time ankle sprains is not so robust. In addition, non-rigid ankle bracing is recommended for 1 year after ankle sprain to prevent recurrent sprain. Finally, Chen et al. (2019) endorse surgical referral and con- sideration of stabilisation for cases of chronic ankle instability that do not respond to non-operative measures after concomitant pathologies have been ruled out. The retrieved studies in this literature review and the presented physiotherapy mo- dalities, procedures and/or treatments are also the most up-to-date ones for ballet dan- cers’ ankle injuries, which are in line also with professional guidelines for physical the- rapy, medical and sports rehabilitation such as the Clinical Practice Guidelines (Martin et al., 2021). Regarding the most up-to-date and effective prevention procedures for ankle inju- ries in ballet dancers, based on the only available study of Vera et al. (2020) it is clear that too little original scientific studies, especially randomised controlled investigati- ons, have been performed in the last 10 years. Nevertheless, Vera et al. (2020) found out as much as an 82% reduction in injuries after a 52-week period of a whole-body prevention exercise, as well as longer period of time for the recurrence of old or occur- rence of new injuries in ballet dancers. However, for all sports/athletes in general, Chen et al. (2019) recommend the introduction of early mobilisation after acute ankle sprain injuries and early (as soon as tolerated after injury) as well as preventive neuromuscular training programmes for reducing the risk of recurrence of ankle sprains, resulting in higher overall activity levels without increasing pain, swelling, or the rate of reinjury when compared with traditional RICE therapy (Bleakley et al., 2010). On the other hand, due to lack of original scientific studies it was not possible to determine whether and which of these procedures are the most effective. To answer this question, we would need to quantitatively analyse, using meta-analysis, the results of the control and experimental groups before and after the intervention in a larger or more relevant number of original scientific articles/studies and compare the effect sizes of each intervention in these studies. 110 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 In addition to an injury prevention programme, which should be implemented by all ballet dancers regardless of age and gender, the authors believe that it is also necessary to reduce or limit the risk factors of elite/professional ballet injuries, as found out by Bi- ernacki et al. (2018) and Campbell et al. (2019). These parameters are: alignment, poor lumbopelvic movement control, inappropriate transversus abdominis contraction, dec- reased lower-extremity strength, and poor aerobic fitness (Biernacki et al., 2018), and hypermobility, fatigue, overload, degree of leg opening, neuromuscular dysfunction, trunk and lower extremity weakness, and lower extremity range of motion commonly present in the ballet dancer population (Campbell et al., 2019). This means that firstly, the duration of the ballet class could be reduced by focusing on the quality of the training and optimising the training techniques, means and me- thods used. This could reduce one of the essential training parameters that affects inju- ries, i.e. the extent or the volume of exercise (duration, number of repetitions, sets, etc.), which would affect both the onset of fatigue and the possibility of acute and chronic overuse injuries. Secondly, nutritional consultants or nutritionists should be involved in ballet institutions, as this would avoid injuries resulting from malnutrition or nutritio- nal deficiencies, as well as too frequent nutritional disorders, especially among female ballet dancers (Obrul, 2020). Thirdly, as far as environmental conditions are concerned, the ballet dancers themselves have no influence on them, but the management of the ballet institution has and as such should ensure that the dancers have optimal and safe working or training conditions (e.g. suitable temperatures, the right choice of floor and work space). Ballet dancers are ultimately responsible for choosing suitable training/ dance shoes – ballet pointe shoes, but also for choosing suitable everyday shoes, beca- use the wrong ones can also cause certain micro-injuries, which over time can lead to other, more serious injuries. Unfortunately, the individual has no influence on certain causes or risk-factors, such as general accidents and anatomical factors. However, they have an influence on previous injuries or on their occurrence in the future, namely by following prevention guidelines and recommendations as much as possible in the given situation. This literature review showed that in the future more original scientific studies ba- sed on different injury prevention programmes for the whole body or specific body parts, for instance for the foot and ankle, are needed or studies older than 10 years should be analysed. However, by analysing older studies, it would be inappropriate to consider the prevention procedures to be the most up-to-date. In addition, future research should involve more professional ballet dancers so that the findings have less variance and greater statistical power. It would also be advisable for researchers to work with dance or ballet institutions so that ballet dancers would have injury prevention exercise programmes included in their daily or at least weekly schedules. In this way, a greater and more accurate insight into the effectiveness of injury prevention procedures could be achieved. The findings of this literature review should also be tested with further studies to de- termine which physiotherapy and injury prevention procedures are the most appropria- te and efficient in the treatment or prevention of ankle or other injuries in ballet dancers. 111 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 It would thus make sense to conduct randomised controlled clinical research to verify the success and effectiveness of specific injury prevention programmes in practice. Limitations of the study One of the major limiting factors of this study was the quite restrictive inclusion and exclusion criteria, which most probably significantly limited the amount of literature retrieved. Especially the age of the study and the impact factor, as could be seen from the PRISMA diagram in the Methods section (Figure 1). CONCLUSION In this literature review the most common, effective and up-to-date injury preven- tion and physiotherapy procedures for ballet dancers’ ankle injuries were qualitatively analysed. It was found that ballet dancers experience a high incidence of ankle injuries, which is also the case in other sports, especially in soccer, running and gymnastics, yet there have been very few in-depth and original scientific studies on this topic in the last 10 years, with only one randomised controlled investigation in the field of prevention of ballet injuries in general. Due to the small number of retrieved articles, it was not possible to directly answer the question on what the most successful physiotherapy procedures for the treatment of ankle injuries in ballet dancers are. However, it was possible to determine the most up-to-date procedures that were used in the reviewed literature, which actually represent the general guidelines for treatment, regardless of where the injury occurs. The most common procedures for treating ankle injuries in ballet dancers were shown to be rest, ice therapy, muscle strengthening, use of a night brace and optimising ballet technique (Morton, 2013; Kadel, 2014; Vosseller et al., 2019; Rietveld, 2013). For prevention purposes, mainly strengthening and stretching exercises are used, to which functional joint stabilisation and plyometric exercises can be added (Vera et al., 2020). Clearly, further high-quality research designs with a low risk of bias are neces- sary to further evaluate the effectiveness of specific prevention exercises programme and the optimal timing of the intervention for the prevention of ankle injuries in ballet dancers. Also, future studies are needed to validate this conclusion regarding injury pre- vention exercise programmes to properly and efficiently address future ankle injuries and to reduce the risk of a subsequent injuries in professional ballet dancers. Acknowledgements The first and the last author contributed equally to the preparation of this article. 112 Pia Lina VILAR, Tine KOVAČIČ, Mitja GERŽEVIČ: INJURY PREVENTION AND PHYSIOTHERAPY PROCEDURES ..., 93–113 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 REFERENCES Bickle, C., Deighan, M., & Theis, N. (2018). The effect of pointe shoe deterioration on foot and ankle kinematics and kinetics in professional ballet dancers. 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ANNALES KINESIOLOGIAE • 13 • 2022 • 2 115 Original scientific article DOI: https://doi.org/10.35469/ak.2022.358 received: 2022-11-05 UDC: 796.071.2:159.97 DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL CONSUMPTION IN YOUNG ATHLETES Uroš PERKO1, Maša ČERNELIČ-BIZJAK2 1 Institute Mitikas, Slovenia 2 University of Primorska, Faculty of Health Sciences, Slovenia Corresponding author: Uroš PERKO Institute Mitikas, Cankarjeva street 39, Mekinje, SI-1241 Kamnik, Slovenia Phone: +386 31 828 782 E-mail: uros.perko@siol.net ABSTRACT Purpose: The aim of the study was to investigate the prevalence of disordered ea- ting behaviours and attitudes in Slovenian male and female categorized athletes in relation to depressive symptoms and their alcohol consumption. Methods: The sample included 198 categorized athletes between 18 and 20 years of age. The Eating Attitude Test, the Center for Epidemiologic Studies Depression Scale, and the Alcohol Use Disorders Identification Test were used to measure disordered eating behaviours, level of depression, and alcohol use, respectively. Results: Significant differences were found between female and male at- hletes, with female athletes reporting higher levels of disordered eating atti- tudes and depressive symptoms. 13.90% of athletes reported clinically signi- ficant eating disorder symptoms, 40% reported clinically significant depres- sive symptoms, and 10.50% reported risky alcohol use. Results also showed that athletes with higher eating disorder attitudes had higher depressive levels. Conclusion: These findings have important practical value and point to the importance of building a professional team trained to recognize mental health problems in athletes in order to provide appropriate help. Keywords: disordered eating behaviours, athletes, depression, alcohol consumption 116 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 MOTENO PREHRANJEVANJE IN ODNOS, DEPRESIVNA SIMPTOMATIKA IN VNOS ALKOHOLA PRI MLADIH ŠPORTNIKIH IZVLEČEK Namen: Namen raziskave je bil ugotoviti razširjenost motenega prehranjevalnega vedenja med slovenskimi kategoriziranimi športniki in športnicami v povezavi s simpto- mi depresivnosti in uživanjem alkohola. Metode: V vzorec je bilo vključenih 198 kategoriziranih športnikov, starih od 18 do 20 let. Za merjenje motenega prehranjevanja, stopnje depresivnosti in uživanja alkoho- la so bili uporabljeni test odnosa do prehranjevanja, lestvica depresivnosti Centra za epidemiološke študije in test identifikacije motenj uživanja alkohola. Rezultati: Ugotovljene so bile pomembne razlike med športnicami in športniki, pri čemer so športnice poročale o višjih stopnjah motenega prehranjevanja in depresivnih simptomov. 13,90 % športnikov je poročalo o klinično pomembnih simptomih motenj hranjenja, 40 % o klinično pomembnih depresivnih simptomih in 10,50 % o tveganem uživanju alkohola. Rezultati so tudi pokazali, da so imeli športniki z več simptomi mo- tenega prehranjevalnega vedenja višje ravni depresivnosti. Zaključek: Te ugotovitve imajo pomembno praktično vrednost in potrjujejo po- membnost oblikovanja strokovnega tima, usposobljenega za prepoznavanje duševnih težav in nudenja ustrezne pomoči športnikom. Ključne besede: moteno prehranjevalno vedenje, športniki, depresivnost, uživanje alkohola ANNALES KINESIOLOGIAE • 13 • 2022 • 2 117 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 INTRODUCTION In sports that emphasize leanness or a low body weight, especially in endurance, aesthetic and weight class sports, athletes adhere to rigid diets and strenuous exercise regimens to optimize performance. This may increase the risk of disordered eating behaviours and vulnerability to develop ED (Knapp, Aerni, & Anderson, 2014). EDs are serious mental disorders, characterized by an excessive preoccupation with food, body weight and figure, and are classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), or in the International Classification of Diseases (ICD-10; World Health Organization, 2018). To meet clinical criteria, the conditions must impair physical health or psychosocial functioning. The DSM-5 categorizes EDs into several specific types, including: Ano- rexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), Unspeci- fied Feeding or Eating Disorder (UFED) etc. The aetiology of EDs is multifactorial, being influenced by genetic, environmental and psychological factors but also factors specific to the practicing of sport (Sanchis, Balmaseda, & Hidalgo, 2022). These fac- tors are particularly present in some disciplines involving endurance, those that have weight categories, or where low weight is a competitive advantage and aesthetics are important (Sanchis et al., 2022; Joy, Kussman, & Nattiv, 2016; McDonald, Pritchard, & McGuire, 2019). Athletes face a unique set of ED risk factors related to sport participation, such as performance pressure, and injury (Bratland-Sanda & Sundgot- -Borgen, 2013; Sundgot-Borgen & Torstveit, 2010). In addition, teammates are also an important source of influence on athletes’ ea- ting attitudes and behaviours, and critical comments and body comparisons among teammates may promote disordered eating (Scott, Haycraft, & Plateau, 2019). This context might put athletes at risk for the development of pathological attitudes or behaviours, as seen in clinical ED. While research indicates an increase in ED point prevalence in the general population in recent years from 3.5% in 2000–2006 to 7.8% in 2013–2018 (Galmiche, Déchelotte, Lambert, & Tavolacci, 2019), the estimated prevalence of DE and/or EDs in athletes ranged from 0% to 19% in men and 6% to 45% in women (Reardon et al., 2019; Kristjánsdóttir, Sigurðardóttir, Jónsdóttir, Þorsteinsdóttir, & Saavedra, 2019; Ackerman et al., 2019), with higher prevalence compared to the general population (Martinsen & Sundgot-Borgen, 2013). Identi- fying eating disorders in this population is complicated (Chapa et al., 2018) and the nature of the relationship between athletic involvement and eating problems is still unclear. However, athletes suffer from a number of negative effects on their health and performance related to their disordered eating behaviours (Joy et al., 2016), which can negatively affect the well-being of the athlete. More specifically, several findings showed a significant association between depression and eating disorders (Deepthi, Praveen, Chandrashekhar-Rao, Vincent, & Kishore, 2014), as depression is one of the comorbid illnesses of EDs (Godart et al., 2015; McIntyre & Calabrese, 2019), and the relationship is interrelated and bi-directional (Villamisar, Dattilo, & Pozo, 118 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 2012). Depression is manifested by a constant feeling of sadness and lack of interest in pleasurable activities, lack of energy, changes in appetite or weight, disruptive sleep disorders, anxiety, lack of attention, feelings of guilt and self-harm or suicidal thoughts. Some studies showed that depression leads to progression of eating patho- logy (Villamisar et al., 2012; Jones, Buckner, & Miller, 2014); in addition, improper nutrition and severe fasting can create chemical imbalances that play a significant role in causing certain types of depression (Sathyanarayana, Asha, Ramesh, & Ja- gannatha, 2008). In a study assessing depression in collegiate athletes over a 3-year period (Wolanin, Hong, Marks, Panchoo, & Gross, 2016) results showed that 23.7% of athletes reported clinically relevant depressive symptoms, with 6.3% reporting moderate to severe depression, similar to non-athletes. The relationship between EDs and alcohol consumption has also attracted consi- derable attention as it is well known that EDs often co-occur with substance use di- sorders (SUD) (Fouladi et al., 2015). It has also been suggested that depressive symp- toms are an underlying factor for the relationship between the clinical variables and the comorbidity between alcohol use and EDs, such as bulimia nervosa (Vaz-Leal et al., 2015). When considering alcohol consumption in the population of athletes, most studies have found that participation in sports is positively associated with alcohol use, and recent meta-analyses showed that the prevalence for alcohol misuse ranged around 19% (Gouttebarge et al., 2019), while some studies report less susceptibility to problematic alcohol consumption (Purcell, Rice, Butterworth, & Clements, 2020). The serious health consequences of disordered eating behaviours and the short- and long-term consequences that can impair athletic performance, as well as the conflicting findings in the literature on ED in sport, argue for the need to further investigate the prevalence of disordered behaviours, related symptoms in athletes and its associated risk factors. For these reasons, the aims of the current study were: to examine the prevalence of disordered eating behaviours and disordered attitudes in male and female categorized athletes and to examine the relationships between eating behaviours and psychological dimensions such as depression and behavioural dimensions such as alcohol use, and to assess the difference between groups based on these variables. METHODS Study design This study is a descriptive, correlational study with a cross-sectional design based on self-reporting. We used a non-random, purposive sample. To participate in the study, we invited athletes who were categorized in the year of the implementation of the re- search plan according to the standards for categorization of athletes established by the Olympic Committee of Slovenia. The inclusion criteria for participation in the study were: the age of the athlete between 18 and 20 years and the categorization of the at- ANNALES KINESIOLOGIAE • 13 • 2022 • 2 119 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 hlete at the beginning of the study. The exclusion criteria were either lack of consent to participate in the study or failing to complete the questionnaires. The athletes were con- tacted through the coaches of their clubs and national teams, who invited them to parti- cipate. All subjects voluntarily chose to participate in the study without compensation. Participants The participants were 198 categorized Slovenian athletes (according to the Olym- pic Committee of Slovenia, 2018). There were 120 male and 95 female athletes who participated in both individual and group sports and were between 18 and 20 years old. The average age of the athletes was 18.34 years with a standard deviation of 0.48 years. Instruments and measurements The evaluation protocol consisted of three self-reported measures to assess symp- toms of disordered eating, depression, and alcohol consumption. Informed consent was obtained from the authors for the use of the questionnaires. We followed the ethical principles of using and adapting the questionnaires into the Slovenian language and carried out the intended methodological procedures of translation and adaptation. The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk and symptoms and concerns characteristic of EDs (Garner & Garfinkel, 1979). It is one of the most widely used screening instruments in the field of eating disorders, in both clinical and epidemiological studies, to assess a range of behaviours and attitudes toward eating, weight, and abnormal eating habits and concerns about weight (Garner, Olmsted, Bohr, & Garfinkel, 1982). It consists of a self-administered questionnaire with 26 items. Each item is a 6-point Likert scale ranging from “never” to “always” and is a valid instrument for examining and assessing the risk of an eating disorder. Twenty-six of the items make up the following three subscales: Dieting (13 items) assesses inadequate food intake and obsession with weight loss; Bulimia and preoccupation (6 items) assesses excessive eating with loss of control (binge eating) with vomiting and various thoughts and preoccupations with food and eating; the oral control scale (7 items) assesses self-control in food intake and environmental pressure for weight loss. The cut-off point proposed in the original 1979 version is 20. Scores above 20 indicate the need for further assessment by a qualified professional. Low sco- res (below 20) may nevertheless indicate serious eating problems, as denial of symp- toms can be a problem in eating disorders. In the present study, the Cronbach’s alpha coefficient was 0.82. The Center for Epidemiologic Studies Depression Scale –– CES-D (Radloff, 1977) was used to assess depression symptoms. This is a self-report assessment of symptoms associated with depression, such as restless sleep, loss of appetite, and loneliness. It contains 20 items rated on a 4-point scale with subscale scores ranging from 0 to 60, 120 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 with higher scores indicating a more severe symptom of depression. A total score of 16 or higher indicates clinically significant depression (Okun, Stein, Bauman, & Silver, 1996; Junge & Feddermann-Demont, 2016; Prinz, Dvorak & Junge, 2016). In this stu- dy, the Cronbach’s alpha was 0.9. The Alcohol Use Disorders Identification Test (AUDIT; Babor, Higgins-Biddle, Sa- unders, & Monteiro, 2001) was used to assess alcohol use. The AUDIT is a well-vali- dated and reliable 10-item questionnaire developed by the World Health Organization (WHO) to identify individuals whose alcohol use has become hazardous or harmful. AUDIT -a total score of 8 and above has been shown to be a reliable indicator of ha- zardous alcohol-related behaviour. The AUDIT consists of three subscales that assess alcohol use (AUDIT-C; three items assessing frequency and quantity of alcohol use), symptoms of alcohol dependence (AUDIT-D; three items), and harmful consequences of alcohol use (AUDIT-H; four items assessing frequency of negative events). The sub- scale AUDIT-C is considered a sensitive indicator of alcohol use. In the present study, we use only the AUDIT total score (α = 0.81) in the analyses. Procedure Data and contacts were obtained through the individual coaches and selectors of each national team and federation. Athletes who met the inclusion criteria received an email invitation to participate in the study with a detailed description of the research, goals, and objectives. The purpose of the study and procedures were explained in detail to all participants. The survey was completed electronically; the link was sent to partici- pants’ email addresses. This study was conducted in accordance with the guidelines of the Declaration of Helsinki. Ethical considerations such as anonymity, confidentiality, and voluntary participation were ensured in accordance with the Ethical Principles for Psychologists of the American Psychological Association. This study was approved by the National Medical Ethics Committee of Slovenia (KME, No. 0120-95/2018/6). Statistical analysis The data were edited in Microsoft Excel 2019 (Microsoft Corporation, Redmond, Washington, USA) and statistical analysis was conducted in IBM SPSS 20.0 (Statistical Package for Social Sciences Inc., Chicago, USA). Cronbach’s alpha was calculated to assess internal consistency of the measurement instruments. Frequency distribution was calculated for descriptive variables, and averages and standard deviations were calculated for numerical variables. To determine the differences in studied symptoms between participants we used the Mann-Whitney U-test. ANNALES KINESIOLOGIAE • 13 • 2022 • 2 121 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 RESULTS Descriptive statistics for the enrolled subjects (mean, standard deviation, skewness and kurtosis values) are presented in Table 1. The average score on the CES-D questi- onnaire was high, indicating possible more serious depressive symptoms. The average score on AUDIT and EAT-26 was relatively low. The results revealed that most of the data did not follow normal distribution, therefore non-parametric statistics were per- formed in further analysis. Moreover, correlational analysis with Spearman test was applied in order to explore the relations between the main variables. The eating attitude test (EAT-26) had a statistically significant positive correlation with depression, that is, as the scores in the subscales of depression increased, the attitude to eating worsened (Table 1). Table 1: Descriptive statistics and correlations for study variables (n=198) Variable n M SD Skewness Kurtosis 1 2 1. EAT-26 180 9.05 8.88 1.95 5.24 - 2. CES-D 198 15.59 9.83 0.99 0.87 0.44** - 3. AUDIT 172 3.32 3.80 2.40 8.56 0.15* -0.01 Note: *p<.05. **p<.01. ***p<.001. Next, we found that 25.3% of the female athletes demonstrated problematic eating attitudes (EAT-26 > 20), and report clinically significant eating disorder symptoms (Ta- ble 2). The authors of EAT-26 give a cut-off point of 20, which helps identify individu- als with clinically (in)significant eating disorder symptoms, with good sensitivity and specificity and high internal consistency (Garner et al., 1982). A score of 20 or above on the EAT-26 test indicates that further clinical investigation is needed. As shown in Table 2, 13.9% of athletes report clinically significant symptoms of eating disorders. Moreover, a score above 16 on the CES-D may indicate a high level of depressive symptomatology, e.g. clinical depression, with good sensitivity and specificity and high internal consistency (Lewinsohn, Seeley, Roberts, & Allen, 1997). In studies (Arm- strong & Oomen-Early, 2009; Junge & Feddermann-Demont, 2016; Prinz et al., 2016), the cut-off value of 16 points is most frequently used, while some studies (Nixdorf, Frank, Hautzinger, & Beckmann, 2013; Nixdorf, Frank, & Beckmann 2016) used a more conservative score value of 22 points. In this study, both values were considered. Moreover, the proportions of young athletes exceeding the cut-off value of 16 points on the CES-D test was very high, i.e. 40.9%. The highest score, i.e. CES-D ≥ 22, was observed in 25.2% of participants, which means that they very likely experience clini- cally significant depressive symptoms. In the results separated by gender, we can see 122 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 that 59.1% of women report experiencing clinically significant depressive symptoms, (CES-D ≥ 16). The highest score, i.e. CES-D ≥ 22, was reported by 38.6% of women. For men, 26.3% of respondents exceed 16 points, and 14.5% exceed 22 points or more. The authors of the AUDIT test (Babor et al., 2001) give a cut-off point of 8, which helps to identify individuals with risky and harmful drinking patterns with good sen- sitivity and specificity and high internal consistency (Conigrave, Saunders, & Reznik, 1995). In this study 10.50% of athletes reported risky and harmful alcohol consumption and drinking patterns. The results, separated by gender, showed that 12.2% of men exceed AUDIT > 8, slightly less women, 8.1%. Table 2: Results split across cut-off point relevant clinical categories Variable/ total score Male Female Total EAT-26 N % N % N % Low score 96 95.00 59 74.70 155 86.10 High score 5 5.00 20 25.30 25 13.90 CES-D Low score 81 73.70 36 40.90 117 59.10 High score 13 11.80 18 20.50 31 15.70 Severe score 16 14.50 34 38.60 50 25.20 AUDIT Low score 86 87.80 68 91.90 154 89.50 High score 12 12.20 6 8.10 18 10.50 In addition, the analysis revealed some statistically significant differences between the groups of male and female elite athletes, which are shown in Table 3. On EAT-26, female athletes scored statistically significantly higher than male athletes (U = 5.012, p = 0.003), indicating that female athletes are at higher risk for eating disorders. Females also achieve statistically significantly higher mean scores than males on the CES-D (U = 6.707, p = 0.000), thus reporting higher levels of depressive symptoms. On the AU- DIT, there were no statistically significant differences in mean scores between genders (U = 3.150, p = 0.135). ANNALES KINESIOLOGIAE • 13 • 2022 • 2 123 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 Tabela 3: Comparison of male and female athletes on EAT-26, CES-D, and AUDIT questionnaires EAT-26 Diference Male N M SD U p 101 6.92 5.97 5.012 0.003* Female 79 11.78 11.03 CES-D Diference Male N M SD U p 110 12.58 7.80 6.707 0.000** Female 88 19.36 10.80 AUDIT Diference Male N M SD U p 98 3.47 4.37 3.150 0.135 Female 74 2.40 2.80 DISCUSSION The purpose of the current study was to examine the prevalence of disordered eating behaviours and attitudes in male and female categorized athletes and to examine the relationships between eating behaviours and psychological dimensions such as depres- sion and behavioural dimensions such as alcohol use. The serious health consequences of eating disorders, depression, and alcohol abuse, as well as the short- and long-term consequences that can impair athletic performance, point to the need for further inve- stigation of these risk factors in athletes. We found a significantly increased prevalence of pathological attitudes or behavi- ours as seen in clinical eating disorders. As many as one quarter (25.30%) of young female athletes reported behaviours and attitudes related to food, weight, abnormal eating habits, and concerns about weight that indicate risk for an eating disorder, as well as symptoms and concerns characteristic of EDs. Among male athletes, this percentage is much lower at 5%. Lower scores may still be associated with severe eating disorder symptomatology, as symptom denial can be a major problem in eating disorders (Gar- ner et al., 1982). Therefore, some authors use a cut-off point of 10 (Rosendahl, Bor- mann, Aschenbrenner, Aschenbrenner, & Strauss, 2009). These findings are consistent with the known fact that women are affected by ED to a greater extent than men (Keel & Forney, 2013; Kristjánsdóttir et al., 2019). Furthermore, reports of ED prevalence in sport worldwide vary by gender, sport, and level of competition from 0% to 19% in male athletes and 6% to 45% in female athletes (Bratland-Sanda & Sundgot-Borgen, 124 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 2013). However, the question of whether athletes really represent a subgroup at risk of developing an eating disorder remains controversial. Moreover, the results of this study showed a significant association between incre- ased attitudes toward EDs and depression symptoms. These results are consistent with those of other studies showing that depression is significantly associated with eating disorder (Deepthi et al., 2014; Manaf, Saravanan, & Zuhrah, 2016; McIntyre, & Cala- brese, 2019; Wolanin et al., 2016). 40% of all participating athletes exceed the cut-off point of 16 on the CES-D. Of particular note is the percentage of 59.10% of young categorized athletes who have clinically significant depressive symptoms. Even when using a more conservative cut-off point of 22, the number is still extremely high, with 38% of young athletes exceeding the above cut-off point. Of concern is the fact that more than half of the young female athletes and slightly more than a quarter of the yo- ung male athletes showed clinically significant symptoms of depression. Compared to other studies, our athletes showed clinically significant symptoms of depression (CES- -D ≥ 16) more frequently than athletes in other studies (Armstrong & Oomen-Early, 2009; Junge & Feddermann-Demont, 2016; Nixdorf et al., 2013; Prinz et al., 2016). In the aforementioned studies, the percentage of athletes exceeding 16 points on the CES-D ranges from 12% to 20%, and the mean scores range from 8 to 12 points. The results also showed some differences in reported depression symptoms related to gen- der. Similar to other studies, our female athletes were more likely to report significant depressive symptoms and achieved higher mean scores than men. In a well-designed study (Wolanin et al., 2016) using the CES-D scale to assess depression in 465 athletes over a 3-year period, it was found that females had the highest rates of depression on the CES-D scale. They also found that 23.7% of athletes reported clinically relevant depressive symptoms, with 6.3% reporting moderate to severe depression, similar to non-athletes (Wolanin et al., 2016). The scores obtained in our study on the AUDIT questionnaire were not high. The average score for the participants was 3.01. However, it should be noted that still 10.50% of the participants obtained a score higher than 8 points on AUDIT, among them 12.20% of male athletes and 8.10% of female athletes. The percentages may not seem high, but great caution must be taken when interpreting them, as the issue of excessive alcohol consumption, harmful patterns, and alcohol dependence is very com- plex and sensitive. If we consider the three facts, first that participants do not usually report actual amounts and that we can usually add one point to each score (Babor et al., 2001); second, that alcohol has different effects depending on age and gender, so that the cut-off point for women and adolescents is often recommended at 7 rather than 8, leaving the determination of the cut-off point to judgment even by national and cultural standards; and third, that any time when young people drink alcohol is a risky drinking pattern (Sorko & Boben, 2014). Based on what has been written we can assume that the observed average scores are not particularly low. However, considering the low age of the athletes in our sample, the results are concerning. Importantly, four participants re- ported a value higher than 17 points. However, this is a value that may already indicate alcohol dependence syndrome. ANNALES KINESIOLOGIAE • 13 • 2022 • 2 125 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 Different authors (Brenner & Swanik, 2007; Diehl, Thiel, Zipfel, Mayer, & Schne- ider, 2014; Dunn, Thomas, Swift, & Burns, 2011; Dunn & Thomas, 2012; Du Preez et al, 2017; Lakasing & Mirza; 2009; Lisha & Sussman, 2010; Lorente, Souville, Griffet, & Grélot, 2004; O’Brien, Ali, Cotter, O’Shea, & Stannard, 2007; Peretti-Watel et al., 2003) indicate a positive association between sport participation and alcohol consump- tion, and that alcohol consumption among athletes is often risky and can lead to de- pendence. Based on our results we cannot conclude that there is a positive association between sport participation and alcohol consumption. Regarding the difference between our population and the general population of 18–20-year-old young adults, it should be noted that comparison is difficult because diagnostic and screening methods are different. Globally, it is estimated that 12–50% of college students have at least one diagnostic criterion for one or more mental disorders (Bruffaerts et al., 2018). Studies conducted on different samples of college students have found a moderate to high prevalence of depression in this population (Al Bahhawi et al., 2018, Ramón-Arbués et al., 2020). In the study conducted with 1210 participants in 194 cities in China using online questionnaires, 69.7% of participants were found to have normal depression, 13.8% had mild depression, 12.2% had moderate depression, and 4.3% had severe or extreme depression (Wang et al., 2020). Another recent study found that of the participants, 47% had minimal depression symptoms and 5% had severe depression symptoms (Ustun, 2021). In our study, the response rate (exceeding the cut-off value) for depressive symptoms was very high, 40.90%. In a study of Hong Kong college students using AUDIT (n = 345), 35.4% scored 8–15 points and 7.8% scored 16–19 points, and 0.9% scored 20 or more points (Chow, Ling Poon, Lui, Chan, & Lam, 2021). An Australian study reported an average AUDIT score of first-year col- lege students of 10.79 (Corney & du Plessis, 2022), compared with our result, i.e. 3.01. Worldwide, many epidemiological studies have been conducted on ED with different prevalence rates. In India, among 1600 students aged 15–25 years, 10.6% of the total population had high EAT -26 scores (Nivedita, Sreenivasa, Rao, & Malini, 2018). The prevalence scores from our study (13.90% with high score in EAT-26) are higher than this report. Another study (Syed et al., 2018) conducted on 250 adolescent college stu- dents in Pakistan found that 29.2% of young girls had EAT-26 scores of 20 or higher. It should be emphasized that it is not necessarily the case that elite sport and its demands are factors that directly cause the occurrence and frequency of symptoms of certain mental health problems (Perko, 2021). Sport, for example, can act as a positive factor that alleviates the unpleasant symptoms of mental disorders, and as such is only a training ground where latent or pre-existing problems can manifest themselves. Of course, to confirm this assumption, a long-term study would have to be conducted. 126 Uroš PERKO, Maša ČERNELIČ-BIZJAK: DISORDERED EATING ATTITUDES, DEPRESSIVE SYMPTOMATOLOGY AND ALCOHOL ..., 115–130 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 CONCLUSION The findings of the present study suggest that the percentage of young athletes presenting clinically significant symptoms of eating disorders, depression, and risky alcohol consumption is high. 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ANNALES KINESIOLOGIAE • 13 • 2022 • 2 131 Original scientific article DOI: https://doi.org/10.35469/ak.2022.367 received: 2022-11-28 UDC: 572.087:796.332.071.2 BODY COMPOSITION OF YOUNG SOCCER PLAYERS Erol KOVAČEVIĆ1, Denis ČAUŠEVIĆ1, Seth SPICER3, Siniša KOVAČ1, Ivor DO- DER1, Slavenko LIKIĆ1, Boris METIKOŠ2 1University of Sarajevo, Faculty of Sport and Physical Education 2 University of Applied Sciences, Zagreb 3 Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA Corresponding author: Denis ČAUŠEVIĆ, PhD Faculty of Sport and Physical Education, University of Sarajevo, Bosnia and Herzegovina, Patriotske lige 41, 71000 Sarajevo, Bosnia and Herzegovina E-mail: denis.causevic@fasto.unsa.ba ABSTRACT Purpose: The main aim of this study was to examine and analyse the body composi- tion of young soccer players across different age groups. Methods: A cross-sectional study was carried out among 126 young soccer players divided into age categories: U15 – 53 players (age=14.68±0.47); U17 – 51 players (age=16.47±0.50); U19 – 22 players (age=18.05±0.38). The subjects’ height was mea- sured using an anthropometer, while their body composition was measured using the TANITA BC-420MA digital scale. Results: On average, soccer players in the U15 group had significantly lower body height, weight, body mass index and fat free mass than U17 and U19 players, but had a higher percentage of body fat (p < 0.05). In addition to the percent of body fat mass, which tends to significantly decrease with age, the results also demonstrate significant non-linear increases in body height, weight, and lean body composition concurrent with the players’ ages. Conclusion: These results indicate that younger soccer players have lower abso- lute values of morphological characteristics compared to senior players. Keywords: BMI, anthropometry, fitness, body fat, soccer 132 Erol KOVAČEVIĆ, Denis ČAUŠEVIĆ, Seth SPICER, Siniša KOVAČ, Ivor DODER, Slavenko LIKIĆ, Boris METIKOŠ: BODY ..., 131–141 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 TELESNA SESTAVA MLADIH NOGOMETAŠEV IZVLEČEK Cilj: Glavni cilj te raziskave sta bili proučitev in analiza telesne sestave mladih nogometašev v različnih starostnih skupinah. Metode: Med 126 mladimi nogometaši, razdeljenimi po starostnih kategorijah U15 – 53 igralcev (starost = 14,68 ± 0,47) –, U17 – 51 igralcev (starost = 16,47 ± 0,50) – in U19 – 22 igralcev (starost = 18,05 ± 0,38) –, je bila izvedena presečna študija. Telesna višina vseh udeležencev je bila izmerjena z antropometrom, telesna sestava pa z digitalno tehtnico TANITA BC-420MA. Rezultati: Nogometaši iz skupine U-15 so imeli v povprečju bistveno nižjo telesno višino, težo, indeks telesne mase in maso brez maščobe kot igralci U-17 in U-19, vendar so imeli višji odstotek telesne maščobe (p < 0,05). Poleg odstotka telesne maščobne mase, ki se s starostjo značilno zmanjšuje, rezultati kažejo tudi značilno nelinearno povečanje telesne višine, telesne mase in puste telesne sestave, sočasno s starostjo igralcev. Zaključek: Ti rezultati kažejo, da imajo mlajši nogometaši nižje absolutne vrednosti morfoloških značilnosti v primerjavi s starejšimi. Ključne besede: ITM, antropometrija, telesna pripravljenost, telesna maščoba, bi- oelektrična impedanca 133 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Erol KOVAČEVIĆ, Denis ČAUŠEVIĆ, Seth SPICER, Siniša KOVAČ, Ivor DODER, Slavenko LIKIĆ, Boris METIKOŠ: BODY ..., 131–141 INTRODUCTION Soccer is one of the most popular sports today, played by men, women and children all over the world. In the last few years, numerous studies have tried to gather as much information as possible about the abilities and characteristics of young soccer players (Čović et al., 2017; Nikolaidis et al., 2016; Castillo, Yanci, Cámara, & Weston, 2016; Figueiredo, Gonçalves, Coelho e Silva, & Malina, 2009), with the aim of achieving better planning and programming of sports training, but also of higher-quality selecti- on. Studies have confirmed the importance and role of body composition as one of the key indicators of physical fitness and general health of athletes in soccer (Mala, Maly, Zahalka, & Hrasky, 2015). Body composition provides us with an athlete‘s detailed physiological profile (Mala et al., 2015), which is considered one of the key elements of the soccer game because it greatly affects the possibility to complete 90 minutes of competitive play. Researching the influence of body composition on player performan- ce in soccer is particularly complex, because success in the game depends on how the individual characteristics of 11 players come together to form a dynamic team. Previo- us research has pointed to the negative effects of excess adipose tissue, considering that it acts as dead weight in activities during which the body’s mass must be repeatedly ra- ised against gravity during locomotion and jumping (Reilly, 1997; Talović et al., 2018), which ultimately leads to reduced performance and increased energy requirements in the soccer game. In contrast, a high percentage of fat-free mass is a desirable indicator given that it contributes to the production of power during high-intensity activities such as soccer. Body composition data can be an indicator of an athlete’s nutritional state; moreover, it can provide information on current body fluid homeostasis (Andreoli et al., 2003). Andreoli et al. (2003) state that the assessment of intracellular and extracellular mass is one of the best predictors of muscle efficiency that can ultimately predict physi- cal performance. Changes in body composition, such as an increase in lean mass or a decrease in fat-free mass, can therefore be expected to improve a player’s performance in regards to the specific speed and agility demands experienced during a soccer game. It has been proven that age influences physical performance, especially in young people, because of its strong relationship to the growth of individuals and their level of experience (França et al., 2022; Mroczek, Golachowska, & Kaczorowska, 2022). However, to date there has been little research on the body composition trends of ado- lescent soccer players (U15, U17 and U19). This information is of great interest for coaches, especially when it comes to optimizing and selecting training programmes that can improve players‘ long-term development. Therefore, the aim of this study was to examine and analyse the body composition of young soccer players across different age groups. 134 Erol KOVAČEVIĆ, Denis ČAUŠEVIĆ, Seth SPICER, Siniša KOVAČ, Ivor DODER, Slavenko LIKIĆ, Boris METIKOŠ: BODY ..., 131–141 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 METHODS Sample of subjects This cross-sectional study included 126 young soccer players. Players were cate- gorized by age categories: U15 – 53 players (14.68±0.47 years); U17 – 51 players (16.47±0.50 years); U19 – 22 players (18.05±0.38 years). All participants had compe- ted at the regional level in Bosnia and Herzegovina. The testing was conducted at the Institute of Sport at the University of Sarajevo by the Faculty of Sports and Physical Education. The protocols were carried out by qualified personnel of the research team. Participation in this study was voluntary, all players and their parents were fully in- formed verbally and in writing about the demands and nature of the study, and written parental consent was obtained for all participants. Body composition Body height in all subjects was measured with a possible error of 0.1 cm using an anthropometer (Holtain 610, Crymych, United Kingdom), and body composition was measured using the Tanita scale (Tanita BC-418, Tokyo, Japan). The measurements took place early in the morning (09:00) for three consecutive days. A group of 40 to 45 players was evaluated each day and the average time between the first and last review was approximately 35 minutes. At the time of evaluation, participants were in a fasted state and wore only their underwear. During the testing procedure all participants were barefoot with their arms held nearly 45° from their trunk. Body composition variables included: body mass (BM), body mass index (BMI), body fat percentage (BF%), fat mass (FM) and fat-free mass (FFM) (Kapo et. al., 2018). Statistical analysis Descriptive statistics were presented as means ± standard deviation (Mean±SD). Normality and equality of variance of the variables were assessed using a Shapiro-wilk test. A one-way analysis of the variance (ANOVA) and post hoc comparisons using the Bonferroni adjustment were conducted to investigate differences in age and body com- position between groups. All data were processed using IBM SPSS Statistics software 22.0 (SPSS Inc., Chicago, IL, USA). The significance level was set at p ≤ 0.05. 135 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Erol KOVAČEVIĆ, Denis ČAUŠEVIĆ, Seth SPICER, Siniša KOVAČ, Ivor DODER, Slavenko LIKIĆ, Boris METIKOŠ: BODY ..., 131–141 RESULTS The variables for body composition (U15, U17 and U19) of subjects are shown in Table 1. The results of the one-way ANOVA between groups suggest significant differences in body composition. The U15 group had significantly lower body mass (F = 29.308, p ≤ 0.01); body height (F = 42.636, p ≤ 0.01), greater BF% (F = 15.003, p ≤ 0.01), and lower FFM (F = 39.543, p ≤ 0.01) than their older peers. In terms of FFM, the U17 group also had a significantly lower mean value than the U19 group (Table 2). Table 1. Results of descriptive parameters of U15, U17 and U19 U15 (n=53) U17 (n=51) U19 (n=22) ANOVA Mean±SD Mean±SD Mean±SD F p Age [years] 14.68±0.47 16.47±0.50 18.05±0.38 687.822 .000* BM [kg] 53.61±7.85 61.52±9.80 69.43±6.28 29.308 .000* Height [cm] 165.14±6.48 174.55±7.38 179.22±6.01 42.636 .000* BMI [kg · m–2] 19.72±2.35 19.91±2.85 21.65±1.43 5.121 .007* BF [%] 13.48±5.29 9.77±2.84 8.86±2.98 15.003 .000* FM [kg] 7.45±3.82 6.22±2.69 6.20±2.21 2.348 .100 FFM [kg] 46.21±5.76 54.32±10.03 63.22±5.70 39.543 .000* 136 Erol KOVAČEVIĆ, Denis ČAUŠEVIĆ, Seth SPICER, Siniša KOVAČ, Ivor DODER, Slavenko LIKIĆ, Boris METIKOŠ: BODY ..., 131–141 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Table 2. Differences among the categories Group (I) Group (J) Mean Difference (I-J) Sig. BM [kg] U15 U17 -7.90 .000* U15 U19 -15.81 .000* U17 U19 -7.91 .001* Height [cm] U15 U17 -9.41 .000* U15 U19 -14.08 .000* U17 U19 -4.67 .024* BMI [kg · m–2] U15 U17 -0.19 .693 U15 U19 -1.92 .002* U17 U19 -1.73 .007* BF [%] U15 U17 3.71 .000* U15 U19 4.61 .000* U17 U19 0.90 .385 FM [kg] U15 U17 1.23 .049* U15 U19 1.24 .123 U17 U19 0.01 .990 FFM [kg] U15 U17 -8.10 .000* U15 U19 -17.00 .000* U17 U19 -8.89 .000* 137 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Erol KOVAČEVIĆ, Denis ČAUŠEVIĆ, Seth SPICER, Siniša KOVAČ, Ivor DODER, Slavenko LIKIĆ, Boris METIKOŠ: BODY ..., 131–141 Figure 1. Body composition trend lines according to age groups 138 Erol KOVAČEVIĆ, Denis ČAUŠEVIĆ, Seth SPICER, Siniša KOVAČ, Ivor DODER, Slavenko LIKIĆ, Boris METIKOŠ: BODY ..., 131–141 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 DISCUSSION The aim of this study was to examine and analyse the body composition of young soccer players across different age groups (U15, U17, U19). To generalize the findings of this study, the age of a soccer player effects their body composition (Graph 1). The mean body height, weight, body mass index and fat-free mass of U15 soccer players was significantly lower than those of the U17 and U19 age groups, while the percen- tage of body fat mass and total fat mass was significantly higher. Our results showed that the U19 group was substantially taller and heavier than the younger groups while exhibiting a lower BF% and greater FFM. In comparison to the previous studies (Speh- njak et al., 2021; Nikolaidis et al., 2016), the current sample of soccer players has similar body size when comparing height and weight. It is evident that there is a trend of increasing height and body mass from U15 to U19. These results indicate that the morphological growth of young soccer players continues during that period, which is in agreement with previous studies (Spehnjak et al., 2021, Matta, Figueiredo, Garcia, & Seabra, 2014, Da Silva, Bloomfield, & Marins, 2008). Body mass index results show that young soccer players in all selections have BMI values in a normal range. These results are also in agreement with the results of previ- ously published studies (Spehnjak et al., 2021; Nikolaidis et al., 2016; Mroczek et al., 2022). However, as a predictor of high performance and especially motor and functional abilities, indicators of FFM play a significantly greater role (Milsom, Barreira, Burgess, Iqbal, & Morton, 2014). Regarding the FFM expressed in kg, the results show that there is an evident increase from an average of 46.2 kg in the U15 selection, over 54.3 kg in the U17 all the way to 63.2 kg in the U19. These increases of 16.1% between U15 and U17 and 15.1% between U17 and U19 are attributable primarily to increased muscle mass considering the results in Figure 1. Similar results were obtained in some earlier studies by Milsom et al. (2015), who reported that FFM increased by 29.1% between U15 to U17. Evidently, this is the period in which there is a significant increase in fat free mass in young soccer players, and Mala et al. (2020) state that the highest percent- age of relative lean mass was observed in the U18 category. The same authors state that age had a significant influence on the proportions of muscle mass, and thus a significant increase in the percentage of muscle mass. In previous studies, it has been reported that the BF% tends to decrease with age (Leão et al., 2019; Milsom et al., 2015; Nikolaidis et al., 2011) which was also confir- med in this study. BF% in young soccer players in our research ranged from approxi- mately 8.86±2.98% in the U19 selection to 13.48±5.29% in the U15 category. These re- sults are consistent with most previously published studies. Thus, Marković and Bradić (2009) state that elite soccer players have a relatively low percentage of body fat of around 10%. These results are consistent with the results of Mala et al. (2020), who state that the percent of adipose tissue in younger players (U12 to U15) was greater than 10%, while older players (U16 to adult) had lower BF% values. In this study, it is interesting that young soccer players from the U15 selection have body fat percentage 139 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Erol KOVAČEVIĆ, Denis ČAUŠEVIĆ, Seth SPICER, Siniša KOVAČ, Ivor DODER, Slavenko LIKIĆ, Boris METIKOŠ: BODY ..., 131–141 values close to the older categories, which deviates from some earlier research. Spe- cifically, in the study by Spehnjak et al. (2021), the percentage of body fat in the U15 category was 12.9 ± 6%, and in the study by Nikolaidis et al. (2016) was 17.4 ± 3%. The reason for this may be the higher training load of the players in this study, but since there are no objective indicators, this remains based on assumptions. This study has some limitations. One of the limitations was that the athlete’s dietary intake was not monitored during the stay-at-home orders. Another is that longitudinal data would be more informative to account for the fact that this study did not assess the players maturity status. CONCLUSION Based on the results of the realized study, it is possible to confirm most of the con- clusions of previously conducted studies that studied the morphological characteristics of young soccer players. The determination of the morphological profile is important from the aspect of selection and prediction of future success in the game. 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Ford Building, University Park, State College, PA 16802, USA Phone: +1 814 470 5954 e-mail: pra7@psu.edu ABSTRACT Outdoor adventure education (OAE) programming is often referenced as an ef- fective intervention that encourages a wide array of outcomes in participants such as increased confidence, independence, and communication skills. However, as outdoor adventure education continues to increase globally, what does the academic literature say about the outcomes related to these programs? Hattie, Marsh, Neill, and Richards (1997) conducted the last major review of program efficacy in this realm. This updated scoping review, largely following PRISMA guidelines (Tricco et al., 2018), aims to summarize the academic literature on one of the primary outdoor adventure education providers internationally, Outward Bound (OB). Fifty-four studies, published betwe- en 1995 and 2019, have been summarized in this review. Utilizing Outward Bound International’s (OBI) framework of “people”, “place”, and “process”, themes and gaps in the literature are explored. Specifically, the OB literature has progressed since 1995 in demonstrating social and emotional outcomes in a variety of settings, a better understanding of the nature of effective programming, and further documenting the role the instructor plays in the learning experience. Recommendations are provided on developing more rigorous methodologies for future research, understanding the role of the physical environment in the learning experience, and utilizing theoretical approa- ches to integrate outdoor adventure education into broader academic realms. Keywords: outdoor education, adventure education, Outward Bound, emotional le- arning, experiential learning, scoping review 144 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 ORGANIZACIJA OUTWARD BOUND IN IZOBRAŽEVANJE SKOZI PUSTOLOVŠČINE NA PROSTEM: PREGLEDNA ŠTUDIJA, 1995–2019 IZVLEČEK Programi izobraževanja na prostem se pogosto omenjajo kot učinkovita intervenci- ja, ki pri udeležencih spodbuja širok nabor rezultatov, kot so večja samozavest, neodvi- snost in komunikacijske spretnosti. Ker pa trend izobraževanja na prostem globalno še naprej narašča nas zanima, kaj o rezultatih, povezanih s temi programi, pravi strokov- na literatura? Hattie, Marsh, Neill in Richards (1997) so opravili zadnji večji pregled učinkovitosti programov na tem področju. Namen tega posodobljenega pregleda obse- ga, ki sledi smernicam PRISMA (Tricco et al., 2018), je povzeti znanstveno literaturo o enem od glavnih ponudnikov izobraževanja skozi pustolovščine na prostem na med- narodni ravni, Outward Bound. V tem pregledu je bilo povzetih štiriinpetdeset študij, objavljenih med letoma 1995 in 2019. Z uporabo okvira Outward Bound International „ljudje“, „kraj“ in „proces“ so raziskane teme in vrzeli v literaturi. Natančneje, li- teratura o Outward Boundu je od leta 1995 napredovala pri dokazovanju socialnih in čustvenih rezultatov v različnih okoljih, boljšem razumevanju narave učinkovitega programiranja in nadaljnjem dokumentiranju vloge, ki jo ima inštruktor pri učni iz- kušnji. Podana so priporočila za razvoj strožjih metodologij za prihodnje raziskave, razumevanje vloge fizičnega okolja pri učni izkušnji in uporabo teoretičnih pristopov za vključevanje izobraževanja na prostem v širša akademska področja. Ključne besede: izobraževanje na prostem, izobraževanje skozi pustolovščine, Outward Bound, čustveno učenje, izkustveno učenje, pregledne študije ANNALES KINESIOLOGIAE • 13 • 2022 • 2 145 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 INTRODUCTION Time spent outdoors has been associated with both mental and physical benefits (Kuo, 2015), and research has found that outdoor experiential learning programs, such as those offered by Outward Bound (OB), can promote positive development for adole- scent participants (Orson, McGovern, & Larson, 2020). OB is one of, if not the, largest provider of Outdoor Adventure Education globally. How effective these educational experiences are is unclear. It has been over 20 years since Hattie, Marsh, Neill, and Richards (1997) stated in their prominent meta- -analysis on outdoor adventure education that “adventure programs can obtain notable outcomes and have particularly strong, lasting effects. It is clear, however, that adven- ture programs are not inherently good. There is a great deal of variability in outcomes between different studies, different programs, and different individuals” (p. 77). Since this meta-analysis, research on outdoor adventure education has paralleled the field’s growth, becoming a focal area for several academic journals such as Journal of Outdo- or Recreation, Education, and Leadership; Journal of Experiential Education; Journal of Outdoor and Environmental Education; and Journal of Adventure Education and Outdoor Learning. While the body of research around these educational programs has continued to grow, the reviews that have been undertaken are weak and easily critici- zed. For example, Fiennes et al. (2015) noted that “We found 15 systematic reviews of the effects of outdoor learning. They provide extensive evidence of the effects of out- door learning. However, the set is somewhat confusing because many of them overlap in terms of the primary studies they include.” (p. 5) and go on to note that “Almost all outdoor learning interventions have a positive effect” (p. 7). However, the methodolo- gical challenges of the previous systematic and scoping reviews of outdoor learning literature have not been addressed primarily because they have repeatedly used too wide a definition, thus creating too much diversity in the evidence. Thus, in this work, we focused exclusively on one organization to minimize this problem. A lack of recent synthesis on outdoor adventure education has potentially hindered progress in research moving forward given the inability to clearly state what is known and unknown about the subject. By reviewing the current state of knowledge about the- se educational programs, more effective studies and practices can be informed. While summarizing the entire field of research on outdoor adventure may be too broad and unrealistic in a single review, compiling information from specific programs and the associated educational interventions will prove useful and provide opportunities to ge- neralize to the broader literature and practices. OB exists as one of these arguably representative programs, serving as a primary provider of outdoor adventure programming in countries across the world. Originally founded in Britain in 1941 by Kurt Hahn and Lawrence Holt, OB originally focused on character development for young men (Millikan, 2006). Since these early stages, OB’s focus has transitioned from character development to personal growth while also expanding its program internationally to include a wide variety of audiences (Freeman, 2011; Millikan, 2006). Like many other outdoor adventure programs, OB attempts to 146 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 provide transformative learning for individuals of all ages through challenging experi- ences in natural environments (OB Trust, 2017). Since its founding years, OB has now expanded to serve over 150,000 students each year in over 30 countries (OBI, 2020). As such, OB has been associated with a number of positive outcomes identified as essential for the labor market and associated with positive youth development, such as improved goal-setting (Ang, Farihah, & Lau, 2014), resilience, leadership skills, the transfer of learning (Jostad, Paisley, & Gookin, 2012), general psychological well-be- ing, improved sense of belonging, and empowerment (D’Amato & Krasny, 2011). Ad- ditionally, research suggests that participation in OB has been associated with increases in youth autonomy and self-confidence (Orson et al., 2020). The studies reviewed in this article generally reflect the diversity of the courses: some explore day-programs utilizing high ropes courses to facilitate teambuilding acti- vities, others examine extended backcountry expeditions and their associated outcomes, and others still look at classrooms utilizing the OB framework to facilitate experiential learning, amongst many others. While diverse in nature, understanding the commona- lities and differences amongst these educational experiences can help work towards developing a general model of learning for the OB experience. A limited understanding of these common traits between programs was a weakness in the academic literature identified by Hattie et al. (1997). Therefore, the research question guiding this review is What is known of the outdoor adventure education process through OB from academic literature published following Hattie and colleagues’ (1997) meta-analysis? We utilize OB’s conceptualization of “people”, “place”, and “process” as educational components to present our findings in an attempt to bridge this gap between research and practice. What constitutes each of these components within the OB experience is detailed further in the methods section and those that follow. The upcoming sections of this paper outli- ne details on how the scoping review was conducted. This is followed by three sections outlining trends and progress on how the academic literature has developed since Hattie et al. (1997) within the categories of people, place, and process. Each of these sections conclude with recommendations for future research on how forthcoming studies can better understand these concepts and integrate them into a more holistic understanding of the OB process. Finally, a general discussion follows each of these three sections in which we present an argument for greater theoretical rigor in OB research. This scoping review, largely following PRISMA methodologies and previous methodological guidelines established through Arksey and O’Malley (2005), Levac, Colquhoun and O’Brien (2010), and specifically the extension for scoping reviews (Tri- cco et al., 2018), is intended to be of use for two primary audiences: OB practitioners who wish to understand the best practices supported by previous research, and educa- tional researchers looking to build upon the previous work examining OB courses and methodology. ANNALES KINESIOLOGIAE • 13 • 2022 • 2 147 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 METHODS Scoping Review Process This study utilized a scoping review methodology (Arksey & O’Malley, 2005; Levac et al., 2010; Moher, Liberati, Tetzlaff, & Altman, 2009; Tricco et al., 2018) to summarize the academic literature on OB. This approach looks to review the literature with the goal of summarizing and reporting what is currently known on the subject and identifying gaps in current understanding (Arksey & O’Malley, 2005). It is considered especially useful when the field being reviewed is heterogeneous (Pham et al., 2014), as is the case with research done on OB programming given the variety of programs offe- red and methodologies utilized to study the program. As will be obvious when discus- sing the findings, a broad array of methods have been used to study OB programming. These methods have ranged from intensive ethnographic studies to widely distributed surveys. Due to the wide variety of data being interpreted, a scoping review methodo- logy was chosen over the meta-analysis technique utilized by Hattie et al. (1997). Locating Studies Relevant to the Research Question We identified relevant studies for inclusion through database searching. The fol- lowing databases were utilized: WorldCAT, Academic Search Complete (Ebsco), ERIC (Proquest), and Google Scholar. For each of these databases, the following terms were entered: “Outward Bound” and “education”, “Outward Bound” and “adventure”, “Out- ward Bound” and “experiential”, and “Outward Bound” and “learning”. In addition, an email message was distributed via OBI requesting various practitioners across the OB network (in 37 different countries) to forward relevant studies to the authors for review. The following additional filters were applied to these searches to increase the relevance of the gathered studies: – Articles must have been published in a peer-reviewed academic journal. – The articles must have been published after 1995. Using Hattie et al. (1997) as a benchmark, this scoping review aims to summarize the research on OB pro- gramming from that point forward. – Articles must have been published in English, the first language of all the authors of this review. These inclusion criteria aim to parallel the recommendations made by Levac et al. (2010) where the established inclusion criteria allow for a breadth of studies to be collected that characterizes a given field while also acknowledging relevant limitations. 148 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Selecting Studies that Meet the Inclusion Criteria This initial search provided over 1000 potentially relevant research articles. The titles and abstracts of these initial results were reviewed by the first author. Many arti- cles at this stage presented research on other outdoor adventure programs or were not presented in peer-reviewed academic journals and were thus excluded from further consideration in this review. This resulted in 148 research articles being downloaded for closer reading. In following the recommendations for screening and eligibility criteria established by PRISMA, and those of previous studies (i.e., Arksey & O’Malley, 2005; Levac et al., 2010), the research team met regularly to discuss inclusion criteria. In total, 54 studies were determined to fully meet the inclusion criteria after overlaying these additional inclusion criteria and were included in this scoping review (indicated using an asterisk in the reference list). Extracting Data from the Studies The research team met regularly to determine the most useful data to extract from the included studies to best answer the outlined research questions. The information extracted from each study included study goals and research questions, study characte- ristics and data collection methods, and the primary findings from the study. As sugge- sted by Levac et al. (2010), two authors extracted data from five of the same articles and the results were compared to establish consistency in the data extraction methods, and rather than quantifying the findings, we followed PRISMA methods for qualitative synthesis during this Inclusion phase of the research process. A similar process is used in establishing coding consistency in qualitative research projects (Saldaña, 2009). Dif- ferences in extraction methods were discussed and a mutual understanding of what to record from each included study was established. This allowed for greater consistency across the research team during data collection. Summarizing and Synthesizing the Findings Following the recommendations outlined in Levac et al. (2010), the process of sum- marizing the findings from this scoping review were developed referencing qualitative research techniques. As detailed by Saldaña (2009), broad thematic categories were de- veloped from information extracted during the initial analysis. The initial information gathered from each research article studying OB was summarized into larger categories in order to present the findings within a cohesive, logical framework. This was done through an iterative process with the research team meeting regularly to discuss the emergent themes. These findings were considered within the context of their broader ANNALES KINESIOLOGIAE • 13 • 2022 • 2 149 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 implications of identifying productive directions for future research, as well as how research can inform more effective OB programming. Given the broader themes found within the academic literature and the goals of this scoping review, it was decided that the “three Ps” of OB programming - people, place, and process - provided an effective framework for conceptualizing the findings. This framework has been recently adopted by OBI as a guide for implementing the curricu- lum across OB schools globally. By utilizing these categories to summarize the selected studies, the academic research on outdoor adventure education can be organized in a manner that is meaningful to the unique educational context it is intended for. In implementing this framework to conceptualize the initial information extracted from each article, “people”, “place”, and “process” were adapted as follows to summa- rize the studies and findings for this scoping review: 1. People: The findings are relevant to a specific population of interest and how the OB experience is perceived by or impacts them. 2. Place: The findings are relevant to how the physical environment or setting in- fluences the learning or developmental experience. 3. Process: The findings are relevant to program activities, elements, or instructio- nal techniques and how they influence the OB experience, including the corre- sponding outcomes. The following sections utilize this framework in categorizing papers based on their research goals and objectives. The broad themes and findings are reviewed within each of the “three Ps” categories. REVIEW OF RESEARCH METHODS Research Approach Responding positively to Hattie et al’s (1997) recommendation to consider alterna- tive research designs beyond the dominant use of a pretest-posttest design, literature on OB programming between 1995 and 2019 is distributed nearly evenly between quan- titative, qualitative, and mixed methodology approaches. Of the 54 studies, 18 studies (33.3%) were constructed as quantitative research, 19 (35.2%) as qualitative, and 17 (29.6%) as a mixed methodology approach based on their design characteristics com- pared to Creswell’s (2014) definitions of the three approaches. Quantitative Research Regardless of the design, all 18 quantitative articles applied self-administered su- rveys, scales, or questionnaires. Examples of established surveys and scales used or modified among the studies are the OB Outcomes Instrument (OBOI; Ewert, 2014; Faircloth & Bobilya, 2013), the Mississippi Scale for Combat-Related PTSD and the 150 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Impact of Events Scale (Hyer, Boyd, Scurfield, Smith, & Burke, 1996). These instru- ments were used to measure dimensions such as resilience (Ewert, 2014; Neill & Dias, 2001), positive and negative affect (Kirwin et al., 2019), long-term outcomes (Gassner, 2008; Gassner & Russell, 2008) and personal effectiveness and locus of control (Gref- frath et al., 2011). Qualitative Research Throughout the qualitative studies, an array of data collection methods were uti- lized. Of the 19 qualitative articles, 14 employed one of the five qualitative designs highlighted by Creswell (2013) - six case studies, five ethnographies of various con- structs, two phenomenological studies, and one each of grounded theory approach and narrative. The data collection methods used in the 14 studies demonstrating the five designs brought into focus by Creswell (2013) corresponded with the data collection methods characteristic of each design (see table 1). The remaining five studies were two historical analyses, two interpretive studies, and a heuristic design. Table 1. Qualitative Data Collection Narrative Phenomenology Grounded Theory Ethnography Case Study L ite ra tu re in r ev ie w Video, interviews Interviews, semi-participant observations, document analysis Interviews Interviews, document analysis, observation, self-reflection Interviews, photography, moodboards, document analysis, observations, open response survey Self-reported data in the qualitative research articles were collected through intervi- ews and with open response surveys. Interviews were the most prominent self-reported qualitative data collection method, occurring in 13 studies. Data from open-ended que- stionnaires were utilized in only two case studies (Leberman & Martin, 2002; Martin, Leberman, & Neill, 2002). Observations were conducted in eight studies, one of which used video to record and observe afterwards (Benham & Shephard, 1995). Data from the observations were also used to construct narratives (Benham & Shephard, 1995), to explore through phenomenology (Broaddus et al., 2013), and to gain an ethnographic perspective (Lowan, 2009; Vernon, 2015). Two studies (Freeman, 2011; Millikan, 2006) were reliant solely on document analysis to develop their historical analyses of ANNALES KINESIOLOGIAE • 13 • 2022 • 2 151 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 OB programming. Other applications of document analysis have been exemplified in case studies (Hickman Dunne, 2018; Klein & Riordan, 2009; Klein & Riordan, 2011) and in ethnographies (Lowan, 2009; Newbery, 2004) as the documents acted as tools for triangulation. Mixed Method Research The majority of mixed-method research has predominantly been conducted using a dominant-less dominant design with quantitative data collection methods supplemen- ted by qualitative data collection. Seven of the 17 mixed-method studies used surveys, ranging from mixed-response surveys with as few as three open-ended questions (Mar- tin & Legg, 2002) to exclusively open-response surveys (Bobilya, Kalisch, & Daniel, 2014; McKenzie, 2003). The remaining 10 studies integrated more formal qualitative data collection methods such as observations (e.g., Hanna, 1995; McKenzie, 2003), document analysis (e.g., Jirásek & Dvorackova, 2016), and interviews (e.g., Gassner, Kahlid, & Russell, 2006; Mott & Martin, 2017). Although grounded theory, case study, and phenomenology are most typically categorized as a qualitative research strategy (Creswell, 2013), five studies incorporated quantitative data collection within these traditionally qualitative designs (Bobilya et al., 2014; Jirásek & Dvorackova, 2016; Martin & Leberman, 2008; McKenzie, 2003; Mott & Martin, 2017). Data Collection An analysis of the timing of data collection in OB programming literature was con- ducted to depict the length of time the data represent in relation to OB programming. Data collection across the literature occurred in a range from pre-program to up to eight years after OB programs conducted between 1995 and 2020. A frequency table of when data collection among the three research designs occurred is described in Table 2. Among the literature, 24 articles reported on data collected at one timepoint where- as the remaining 30 articles collected data at two or more timepoints. Studies using a single timepoint data collection period were non-experimental or qualitative in nature. Studies that gathered data at multiple time points took on a quantitative quasi-expe- rimental or single-sample repeated measures design, or a longitudinal approach in a qualitative or mixed methods approach. 152 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Table 2. Frequency of Data Collection Periods Pr e- Pr og ra m D ur in g Pr og ra m Im m ed ia te ly Po st -P ro gr am U p to 6 m on th s af te r 6 m on th s – 1 y ea r af te r 1 ye ar + a ft er U ns pe ci fie d Quantitative (n = 18) 11 0 14 7 0 2 0 Qualitative (n = 19) 0 12 8 5 3 1 4 Mixed Methods (n = 17) 8 2 15 4 3 4 1 Total 19 14 37 19 3 7 5 Several notable findings on data collection arose. First, no qualitative research col- lected data prior to the OB programming. The data collection methods conducted du- ring programming were primarily of a qualitative nature, except for Jirásek & Dvorack- ova (2016), who administered a quantitative frequency chart at three points during pro- gramming. While no qualitative data were collected pre-program in a qualitative study, eight mixed-method studies incorporated pre-program and post-program quantitative surveys in addition to qualitative data collection methods such as interviews, focus gro- ups, observations, and document analysis that occurred during or after programming (e.g., Greffrath et al., 2011; Hanna, 1995; Harper, Norris, & D’astous, 2014). Finally, among all 54 studies, only one study under review (Mott & Martin, 2017) collected and examined data beginning with the pre-program and extending to over 1 year proceeding program participation. PEOPLE, PLACE, AND PROCESS The 54 reviewed studies provide insight into how research has further developed in understanding the people, place, and process of the OB learning experience since 1995. While these categories are not mutually-exclusive, we have used people, place, and process as a means to organize the results of this study. A brief overview of each study reviewed is provided in Table 3 (on pages 158 to 168). The information in Table 3 is intended to provide context on the diverse areas that these studies were conducted in and the various methodologies utilized to produce the current state of knowledge on ANNALES KINESIOLOGIAE • 13 • 2022 • 2 153 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 OB programming since Hattie et al. (1997). We hope this table will serve as a quick reference for individuals seeking more information on a study referenced in a later sec- tion as all relevant background information cannot be immediately included in the text of the manuscript. Findings within each of the people, place, and process categories are outlined briefly in the following paragraphs prior to being explored in greater depths in the subsequent categories. Regarding the people aspect of the OB experience, a considerable amount of re- search in the past 25 years has focused on unique groups of interest and documented how the outdoor adventure education experience impacts these diverse populations. Specifically, a large portion of recent research has examined veterans and other at-risk populations and the expansion of OB outside of traditional Eurocentric and North Ame- rican settings. Given that Hattie et al. (1997) noted the lack of participant background information incorporated into early OB research, this has been one area in which the literature has seen a notable expansion since 1995. While this progress has been promi- sing, we recommend that researchers look to more modern research techniques in hu- man development and educational literature to further build upon this initial progress. Studies examining the influence of place on the OB educational experience have been surprisingly scant since 1995. Two primary lines of research have emerged from this relatively small body of literature, exploring the influence of the physical envi- ronment on the learning process or the influence of an OB course on the participants’ pro-environmental learning outcomes. Given that learning in challenging outdoor en- vironments is touted as a primary component of the OB experience (OB Trust, 2017), this presents a promising direction for future research. This could be an especially im- portant gap in knowledge to explore if competing models of learning through outdoor adventure education are to be developed, something that has still not come to fruition in the academic literature since Hattie et al. (1997) called for it almost twenty years ago. Lastly, and somewhat unsurprisingly, process represents a well-studied aspect of the OB educational experience since 1995. Research has examined specific parts of the OB experience such as the final expedition (the autonomous final journey independent of course instructors on OB expeditions), the solo camping experience incorporated into many expeditions, course facilitation by instructors, social relations, perceptions of challenge, and post-course learning outcomes. This represents considerable progress since 1995 as Hattie et al. (1997) noted that many outcomes from the outdoor adventure education experience were not linked back to specific course components or that the nature of many programs had not been well documented. Additionally, some of this re- search on the OB learning process has begun to “ascertain the effects of the instructor” (p. 72), another suggestion for future research made by Hattie et al. (1997). To further develop our understanding of the OB learning process, we point to other educational and psychological concepts that could add greater methodological rigor and theoretical grounding to the field of outdoor adventure education research. The following three sections expand upon the information provided in the prece- ding paragraphs in greater detail. Each of the three outlined components of the OB lear- ning experience – people, place, and process – are inherently interrelated with the other 154 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 components. We do not aim to explore each of these parts in isolation in the following sections. Rather, we attempt to explore the nuances that emerge in our understanding of outdoor adventure education when each element is the focal area of study. General themes and findings within people, place, and process are discussed and benchmarked against the state of the academic literature reviewed by Hattie et al. (1997). We then conclude each section with recommendations for future research and how studies on OB can continue to develop in rigor and applicability to practice. A brief general di- scussion is then presented in the conclusion making the case for greater theoretical rigor within the field of outdoor adventure education. People The academic literature on “people” has primarily explored the OB experience thro- ugh two primary lenses: how programming helps veterans and other at-risk populations and how OB coursework manifests itself across multiple cultures in educating different audiences. For various populations acting as participants in the OB experience, social- -emotional growth, defined in a variety of ways, was supported by findings. There was less evidence that the OB experience aided in helping specific psychological issues in at-risk populations. Furthermore, interactions between the culture of the participants and the cultural roots of the programming may play a role in determining program outcomes. Despite the mixed results on these fronts, the social-emotional growth pro- vided evidence that most populations gained outcomes such as confidence, goal-setting skills, and interpersonal skills from their OB experience. While many of these findings parallel those reported by Hattie et al. (1997), significant progress has been made in the area of their call to better incorporate the background of the participants into the study design. We conclude this section by indicating some methodological approaches for quasi-experimental designs that may help researchers better understand the effects of the OB educational experience on unique populations. Four studies specifically focused on OB’s effect on veteran populations in Canada and the United States, examining how it helped ease their transition back into eve- ryday life (Ewert, 2014; Harper et al., 2014; Hyer et al., 1996; Scheinfeld, Rochlen, & Russell, 2017). While each of these studies defined social-emotional constructs in slightly different terms, the OB experience was linked to various outcomes for veteran populations in North America such as increased interpersonal skills, goal-setting, and self-confidence (Ewert, 2014; Harper et al., 2014). Scheinfeld et al. (2017) similarly found that an OB course helped improve various aspects of mental health (e.g. distress and the perception of interpersonal relationships) for individuals. Despite these positive findings in other studies, Hyer et al. (1996) found that the OB experience had no effect on the post-traumatic stress disorder symptoms of veteran participants. Similar studies examining the influence of OB educational experiences on other at-risk adult populations have paralleled the results found in veteran populations. Out- comes included improved goal-setting abilities, interpersonal skills, and confidence ANNALES KINESIOLOGIAE • 13 • 2022 • 2 155 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 (Leberman, 2007; Maxwell, Perry, & Martin, 2008; Walker, Onus, Doyle, Clare, & McCarthy, 2005). Maxwell et al. (2008) notably departed from approaches taken by other studies on populations of interest by purposively sampling individuals that dro- pped out of an OB educational intervention focused on helping those facing long-term unemployment. The findings indicate that a lack of social integration contributed to the individuals discontinuing their participation in the program (Maxwell et al., 2008). While this finding is largely in line with those of other studies, this study design pre- sents a promising alternative to understanding OB programming. Additionally, as a notable parallel to Hyer et al.’s (1996) findings on veterans, Walker et al. (2005) also found that their at-risk adult population, those recovering from traumatic brain injuries, saw increased emotional growth but no improvement in their specific psychological condition after an OB course. While this body of evidence suggests that OB course participation can result in social and emotional growth for at-risk adult populations, it is not as effective in improving psychological conditions that are unique to specific at-risk groups (Hyer et al., 1996; Walker et al., 2005). Four additional studies examined the impacts of the OB experience on at-risk youth in various contexts (Ang et al., 2014; Broaddus et al., 2013; Fischer & Attah, 2001; Pommier & Witt, 1995). These studies provided similar evidence for social-emotional growth to what was found within veteran OB participants and other at-risk adult popu- lations. The varied contexts within which these studies were conducted provides inte- resting insight into how different cultures intersect with programming for at-risk youth. For example, Purdie and Neill (1998) examined under-achieving Japanese students enrolled in a 22-day OB Australia program. The participants showed a significant dec- rease in confidence and peer relations when surveyed post-program. When compared to a population of Australians enrolled in a similar course, the Japanese students rated the group cohesion and course value significantly lower than their Australian counterparts (Purdie & Neill, 1998). Alternatively, two other OB interventions for at-risk youth that were provided within the individuals’ own culture, the United States (Broaddus et al., 2013) and Singapore (Ang et al., 2014) respectively, were more successful in achieving their desired goals. While this contrast was only examined explicitly by Purdie and Neill (1998), these findings suggest that cultural factors may play a role in determining the success of an OB educational program for at-risk individuals. This may be especial- ly true as OB programming has had difficulty in moving past its roots in traditional cha- racter-building practices originating in the European context (Freeman, 2011; Millikan, 2006). In addition to these studies, Sibthorp, Funnell, Riley, Chan, and Meerts-Bran- dsma (2018) specifically examined how course language administration (as a potential proxy for the participants’ cultural views) influenced program outcomes for youth in an OB Hong Kong program. This was found to have no effect on the course outcomes (Sibthorp et al., 2018). While this contrasts with the findings of other studies, this may be due to language preference not being an adequate representation of the participants’ cultural views. As a whole, these studies suggest that the intersection of participant and program culture may matter for at-risk youth learning outcomes. 156 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 In complement to these trends within at-risk youth studies, a variety of research projects have explored how OB courses have become tailored to various geographical and cultural contexts of participants. The use of “dramaturgy” in the Czech Republic (Jirásek, Jirásková, Majewská, & Bolcková, 2017; Jirásek, Veselský, & Poslt, 2017; Martin, 2011; Martin et al., 2002) or incorporating indigenous perspectives into OB Canada courses (Lowan, 2009) are examples of this. The dialectic nature of individuals’ cultural backgrounds interacting with OB course content exemplifies how the people of OB courses are continually co-creating the learning process and how the experiences are simultaneously influencing them. Jirásek, Veselský, et al. (2017) discuss how the “dramaturgical” approach to OB education in the Czech Republic is grounded in the unique people, place, and culture of the area. Martin (2011) used an autoethnographic approach to summarize his past work studying dramaturgical techniques, stating that the dramaturgy approach supported the holistic development of participants through a variety of games stimulating different learning and development styles, including physically, socially, psychologically, and spiritually (Martin, 2011). These assertions have been supported empirically by other studies (Jirásek & Dvorackova, 2016; Martin et al., 2002). Lowan (2009), utilizing a collaborative ethnographic approach in a Cana- dian context, asserts that “grounding Indigenous education programs in the teachings and traditions of respective Indigenous cultures in order to support decolonization and cultural revitalization” can help improve program efficacy. Taken as a whole, these studies examining OB across cultural contexts suggest that tailoring educational pro- gramming to the unique background of the participants may help improve the course outcomes. While the findings across many of these unique groups parallel the social and emo- tional outcomes already reported by Hattie et al. (1997), studies within this variety of unique contexts represent significant progress in terms of their call to further incor- porate participant background into the study design. As Lerner (2018) asserts in his writing on human development research, growth and change throughout the lifespan is a non-ergodic process. Therefore, researchers should take an idiographic approach and study a phenomenon of interest across many contexts. Commonalities should then be identified across these contexts to find generalizable concepts (Lerner, 2018). While social and emotional growth within these various unique populations and contexts may simply reinforce Hattie et al.’s (1997) general findings, the consistency across these various groups is encouraging. We wish to conclude this section by briefly looking at other research approaches within the educational and human development literature to identify ways in which the people aspect of the OB experience may be studied more effectively. Many studies within this section took a broad array of descriptive and reductionist approaches to understanding OB programs. While much of the rich qualitative data presented through these studies have helped further the theoretical understanding of learning in outdoor adventure education, the pre- and post-test approaches utilized do not fully explore the complexity of the learning experience for participants. Approaches such as propensity score matching (Caliendo & Kopeinig, 2008; Dehejia & Wahba, 2002) and regression ANNALES KINESIOLOGIAE • 13 • 2022 • 2 157 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 discontinuity design (Cappelleri & Trochim, 2001; Cook, 2008) provide opportunities to more fully account for participant background when studying educational processes and outcomes. Propensity score matching allows researchers to “find in a large group of nonparticipants those individuals who are similar to the participants in all relevant pre- treatment characteristics” (p. 32, Caliendo & Kopeinig, 2008). This way, quasi-experi- mental studies can more effectively isolate the effects of OB educational intervention while also acknowledging the relevant background characteristics of those involved in the learning process. Similarly, regression discontinuity design examines similar in- dividuals who fall above or below a certain threshold in qualifying for a program or intervention. The regression analysis then explores whether “a treatment effect appears as a ‘jump’ or discontinuity at the cutoff point in the regression function linking the assignment variable to the outcome” (p. 152, Cappelleri & Trochim, 2001). This may prove to be a useful approach in designing future quasi-experimental studies, especially for OB programs that target qualifying at-risk populations such as that done by Ang et al. (2014). As OB research continues to explore the program’s influence for new and different populations, methodological advances will also help to better understand the program effects in these different contexts. Place OB asserts that challenging experiences in outdoor environments are a central ele- ment of their programming (OB Trust, 2017). To cater for a wide array of participants around the world, there are OB schools in 37 locations across 34 countries on six con- tinents around the world (OBI, 2023). The articles under review discuss research con- ducted in OB programs from 10 different countries, representing 28.6% of the countries covered by OBI. Given that the physical environment is touted as a critical component within OB, this section reviews research that has explored its role within the learning experience. Relative to other areas of the OB experience, studies that have explicitly examined “place” as a central concept have been relatively scarce. Hattie et al. (1997) called for an expansion of competing models within the outdoor adventure education literature. Understanding the physical environment as an interrelated component of the learning experience is necessary if these models are to be developed. This section concludes with recommendations for future research on how to better incorporate place into future OB research. Recommendations include incorporating research on the sense of place and perspectives from environmental psychology. The link between culture and place represents an interrelationship within which OB courses can ground their practice of promoting learning outcomes. This lens inherently acknowledges people grounded in place as a driver of the learning process. Lowan (2009) linked these elements via collaborative ethnography in a Canadian indigenous context. They assert that indigenous OB programming should be designed specifically around the symbiotic relationship indigenous peoples have with their unique geographi- 158 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 cal location (Lowan, 2009). Furthermore, a pair of studies examining the dramaturgical approach to OB programming in the Czech Republic found that the course helped to inspire a strong spiritual connection to nature and appreciation for human-nature relati- onships (Jirásek, Jirásková, et al., 2017; Jirásek, Veselský, et al., 2017). As outlined in the previous section, cultural context may play an integral role in OB programming out- comes. It is of note that a large portion of studies with findings relevant to the physical environment were also grounded in a specific culture. Two additional studies that did not find pro-environmental outcomes for OB participants were not as closely grounded in a specific culture or location (Hanna, 1995; Martin, Bright, Cafaro, Mittelstaedt, & Bruyere, 2009). Other studies have more closely examined how the physical environment influen- ces the OB learning process. Many of these studies focused on challenge and risk and how such elements promote learning amongst participants. Hickman Dunne (2018) explored how participants interpret their interactions with the physical environment in the context of outdoor adventure education in a British setting. Using an ethnographic approach, they found that participants derived both joy and unpleasant memories from their interactions with the physical environment. Outdoor adventure equipment and clothing also emerged as a dominant theme with participants often expressing frustrati- on with its appearance or function, while its necessity was acknowledged by both par- ticipants and staff (Hickman Dunne, 2018). Given this challenge and the corresponding risk specifically associated with the physical environment on OB courses, a small body of studies also explored how safety and risk influenced the course outcomes (Holden, 2004; Leberman & Martin, 2002; Mott & Martin, 2017). The staff working for OB New Zealand saw risk mitigation as one of their primary jobs (Mott & Martin, 2017). This represents a balancing act for OB program managers as challenge via the physical environment is acknowledged as a central part of program learning (Hickman Dunne, 2018), yet risk mitigation is a vital component of program management (Mott & Mar- tin, 2017). These findings indicate that the physical environment and the associated challenge are inextricably related to the OB learning process, much of which has al- ready been acknowledged by OB practitioners. Despite this, the specific relationships between challenges involving the physical environment and learning outcomes have largely been unexplored. As place remains a relatively understudied idea within the academic literature on OB, there are ample opportunities to look to other areas of research for inspiration on how to explore this concept. Research on sense of place (e.g. Kudryavtsev, Stedman, & Krasny, 2012; Stedman, 2003; White, Virden, & Van Riper, 2008) may provide one direction on how to study the physical environment embedded within the OB learning experience. The literature on sense of place often defines the concept as having three components: the physical environment, human behavior, and psychosocial processes (Stedman, 2003). Studies that have previously explored OB programs embedded within specific areas and cultural contexts somewhat unsurprisingly were found to have the strongest outcomes related to the physical environment (Jirásek, Jirásková, et al., 2017; Jirásek, Veselský, et al., 2017; Lowan, 2009). Despite this, none of the aforementioned ANNALES KINESIOLOGIAE • 13 • 2022 • 2 159 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 studies explored these relationships in a way that grounded the research in a broader sense of place theory. As OB presents the opportunity for individuals to experience a relationship with the physical environment in new and challenging ways (Hickman Dunne, 2018; Holden, 2004; Leberman & Martin, 2002; Mott & Martin, 2017), indivi- duals may experience a shift within the tripartite framework that makes up a sense of place. This shifting sense of place may then have implications for the learning proces- ses and outcomes. Furthermore, while outdoor adventure education does not explicitly hold connec- tedness to nature as one of its primary goals, the wide variety of writings within the field of environmental psychology could help provide insight into how the physical environment influences the learning process. For example, concepts such as the affec- tive forecasting of experiences in nature (Nisbet & Zelenski, 2011), linked pathways between nature and general health (Kuo, 2015), and the mental health benefits of outdo- or recreation (Lackey et al., 2021) all indicate that individuals feel mentally and physi- cally better when immersed in natural environments. These shifts linked to elements of the physical environment potentially hold implications for the learning experience in outdoor adventure education. Despite this possible connection, there are currently few studies exploring these relationships. The physical environment represents an element of the OB learning experience that is inextricably linked to other parts of the process. The physical environment of OB courses helps to facilitate challenge (Hickman Dunne, 2018) while also connecting individuals to each other (Lowan, 2009). If the field is to develop effective models of learning in the setting of outdoor adventure education, as Hattie et al. (1997) called for over 20 years ago, these relationships need to be explored further. Research opportu- nities can take advantage by examining the role of ‘place’ in any one of the remaining 71.4% countries with OB programming yet to be studied. The research recommendati- ons indicate ways forward in which the field of outdoor adventure education research can begin to explore these gaps in understanding. Process The following section focuses on the OB process, specifically exploring course ac- tivities that facilitate learning and the outcomes that correspond to these activities. In examining OB learning processes broadly, the relationships with other participants, course challenges, and instructor facilitation were all identified as elements of the OB experience that impact participant learning. Regarding expedition-based programs, the solo camping experience and the final expedition have both been retrospectively cited as specific course elements that also contribute heavily to the learning outcomes. A broader understanding of the learning outcomes linked to these course elements does not seem to have progressed significantly since the broad social and emotional compo- nents identified by Hattie et al. (1997). Despite a lack of progress on this front, linking outcomes back to course elements and the learning process does show a significant 160 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 step forward in the academic literature since 1995. We specifically explore the role the instructor plays in the learning process for individuals as Hattie et al. (1997) identified this as a major gap in the literature over 20 years ago. Finally, as in previous sections, this section concludes with recommendations for future research on how to better un- derstand the learning processes of OB. Specifically, we recommend utilizing a life co- urse approach to studying the relationship between the learning process and outcomes. Future researchers can also look at the ways specific OB organizations have built upon the general OB model in attempts to improve program efficacy. The growth of social relationships (closely related to the people category previously outlined) and challenge (closely linked to the place category previously outlined) are two course components that have been consistently identified across studies as being impactful for OB participants. Regarding social relationships amongst participants, this has been found to be an impactful course element in a variety of contexts. Locations in which studies have identified the importance of social relationships for OB learning include: New Zealand (Martin & Leberman, 2005), Australia (Neill & Dias, 2001), Hong Kong (Sibthorp et al., 2018), the Czech Republic (Jirásek & Dvorackova, 2016), and the United States (Goldenberg, Klenosky, McAvoy, & Holman, 2002; Goldenberg, McAvoy, & Klenosky, 2005). As outlined previously in the section on people, Maxwell et al. (2008) exemplify the role social relationships play in the OB experience. In pur- posively sampling individuals who dropped out of an OB program focused on at-risk individuals, a lack of social integration into the program was cited as one of the pre- dictive components leading to dropout (Maxwell et al., 2008). Given the need for tea- mwork on OB courses due to the challenging nature of the experience (Goldenberg et al., 2002; Goldenberg et al., 2005; Greffrath et al., 2011), social relationships seem to be a key component for success. In examining the other end of the dialectic relationship between course components that lead to positive learning outcomes, course challenges, which are often an impe- tus to form close social bonds on OB courses, have also been cited frequently as an impactful element of the OB experience (Goldenberg et al., 2002; Goldenberg et al., 2005; Tolich, 2012). The challenge explored in this section is often facilitated by the physical environment in which OB courses are situated (Hickman Dunne, 2018). While these challenges leading to growth exist across OB course types (Greffrath et al., 2011), two specific challenging elements that have been frequently cited in previous studies are traditionally associated with expedition-based programs. These two course com- ponents are the solo camping experience and the final expedition in which participants autonomously complete a task without the guidance of the instructor (Bobilya et al., 2014; Gassner et al., 2006; Gassner & Russel, 2008; Kalisch, Bobilya, & Daniel, 2011). Bobilya et al. (2014) specifically explored perceptions of the final expedition for pro- gram participants at the North Carolina OB School. They found that the autonomy and teamwork associated with the experience were both impactful for participants (Bobilya et al., 2014). In a similarly structured study, Kalisch et al. (2011) explored participant perceptions of the solo camping experience. The participants reported feeling both pe- aceful and anxious while also taking the time to reflect (Kalisch et al., 2011). While it ANNALES KINESIOLOGIAE • 13 • 2022 • 2 161 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 is beyond the scope of this review to cover all the forms of challenge that have been documented by the OB literature, these examples indicate that both internal reflection and external collaboration facilitated by challenging experiences are part of the lear- ning process in OB courses. We now turn our attention to the influence of course instructors within the OB expe- rience. As mentioned previously, this is a specific element of the learning process that Hattie et al. (1997) noted as under-researched. Since 1995, a wide variety of studies have been conducted examining the role of instructors and the broader administrati- on within the OB experience (Hovelynck, 2001; Galloway, 2007; McKenzie, 2003; Sibthorp et al., 2018). Many of the reviewed studies list instructors as an impactful element of OB courses without exploring the relationship in further detail (Gassner & Russel, 2008; Martin & Leg, 2002; McKenzie, 2003; Sibthorp et al., 2018). This evidence indicates that course instructors play the primary role in facilitating the OB learning process but does not provide much context for the nature of the process. As a beneficial complement to some of the previously cited studies, researchers have collected qualitative data to provide further context on the role of OB instructors. Interviews conducted by Hovelynck (2001) in Belgium with OB instructors found that group development is key to their educational model. The conversations they facilitate transition from technical aspects of an activity to the communication methods them- selves, then to the group “owning up” to communication development, and finally to the development of a group theme. This process inherently weaves personal and group learning together (Hovelynck, 2001). Furthermore, Martin, Dench, and Paku (2016) conducted a broad study using semi-structured interviews to examine how school and executive directors perceive the culture of OB New Zealand. The findings show that these managerial positions believe that, while language has changed over the years, the primary learning outcome of this program is still self-discovery and that course instructors play a key role in facilitating experiences (Martin et al., 2016). This concep- tualization of instructor roles aligns well with impactful elements of the learning pro- cess that have been previously cited. In both the solo camping experience and the final expedition, the instructor facilitates a learning process with the goal of eventually fully turning the leadership over to the group and individual (Bobilya et al., 2014; Gassner et al., 2006; Gassner & Russel, 2008; Kalisch et al., 2011). Within this thread of thought, OB instructors can be seen as catalysts coordinating learning experiences across vario- us interrelated parts within an outdoor adventure education course. Following the review of the course components that help to contribute to the OB learning process, we turn our attention briefly to the outcomes associated with these course components. While understanding how these course elements contribute to the learning process represents significant progress since Hattie et al. (1997), the under- standing of course outcomes has seemingly not advanced as much. The inconsistent language across studies describing social and emotional growth has likely hindered the ability for studies to build upon each other. The following summarizes the social and emotional growth outcomes identified by studies in this section: savoring, mindful- ness, and positive affect (Kirwin et al., 2019); initiative, self-confidence, and kindness 162 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 (Sibthorp et al., 2018); self-confidence, self-awareness, and time management (Martin & Leberman, 2005); accomplishment, autonomy, community, and teamwork (Bobilya et al., 2014); self-confidence and reliance, interpersonal effectiveness, and mental to- ughness (Bobilya, Kalisch, Daniel, & Coulson, 2015); and resilience (Neill & Dias, 2001), to name a few. These all fall under the umbrella of “personal growth” (Freeman, 2011) or “self-discovery” (Millikan, 2006), which are at the heart of the OB philosophy and programming. We conclude this section with recommendations on how researchers examining OB programming can further their understanding of the learning process. It is notable that many studies simply examined the outcomes linked to course components without pro- bing the learning process further. Taking a life course approach to understanding post- -course outcomes (e.g. Colley, Currie, & Irvine, 2019; Tsang & Havitz, 2014) represents one direction that researchers could take to better understand how learning processes are effective beyond pre- and post-program measures. In this approach, researchers purposi- vely sample individuals with a common experience (in this case, an OB course), and have participants reflect on the meaning and nature of the experience later in life (Colley et al., 2019; Elder, 1994; Tsang & Havitz, 2014). This can potentially help researchers under- stand how course components such as social relationships or the solo camping experience potentially trigger a cascading effect that leads to positive outcomes later in life (Masten & Cicchetti, 2010). This approach could help to add depth and understanding to the rela- tionship between learning outcomes and the educational process. Additionally, as has been done extensively with the dramaturgical approach to the OB experience (Jirásek, Jirásková, et al., 2017; Jirásek, Veselský, et al., 2017; Martin, 2011; Martin et al., 2002), purposively sampling and studying unique variations on the OB experience may help provide a better understanding of impactful learning proces- ses. As Martin et al. (2002) did, these approaches to the learning process can then be piloted in other settings. These program variations can help provide new directions on how to further develop OB programming more broadly. DISCUSSION AND CONCLUSION We now conclude this scoping review by making a brief case for the incorporation of broader theory within the academic literature studying OB. In examining the studies reviewed within this manuscript, the following statement by Hattie et al. (1997) rema- ins relevant: “Adventure programs have been conducted as if they operated in isolation from the educational world. There is little incorporation of research on group dynamics, attitude change, educational theory, and cognitive processes” (p. 77). The reviewed studies have provided rich descriptions of what makes the learning process effective on OB courses, but there have been only limited attempts to reintegrate findings into bro- ader educational or developmental conversations following these descriptive results. In studying psychological processes such as learning in an OB program, it is important for theory to remain at the forefront of discussions (Bringmann & Eronen, 2016). This can ANNALES KINESIOLOGIAE • 13 • 2022 • 2 163 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 help to maintain a strong conceptual understanding of the relationships between course elements and provide direction on how to improve programming. Considering perspectives such as the relational developmental systems metatheory (Lerner, 2018) in OB research may provide a useful shift in perspective for the future of the academic literature. This theory about theories acknowledges that “change across life occurs through mutually influential relations between individuals and their con- texts” (p. 18, Lerner, 2018). This perspective presents the opportunity to acknowled- ge many of the tensions that we have probed throughout this review and incorporate them into the study design. These include but are certainly not limited to the relation- ship between the cultural roots of a program and the cultural roots of the participants, the connection between the challenge presented via the physical environment and the growing social relations between participants, and the relationship between participant backgrounds and the corresponding learning outcomes. Each of these elements creates a “layer” to the learning experience that is in dynamic tension with the other layers. The broader fields of human development and education have approached this tension thro- ugh more specific theories, such as self-determination theory (Ryan & Deci, 2000) or transformative learning theory (Mezirow, 1997), which bring forward new perspectives for OB and outdoor adventure education researchers more broadly. What other broader perspectives should researchers consider? It is our hope that the conceptual (e.g. utilizing sense of place as a research lens) or methodological (e.g. regression discontinuity for quasi-experimental designs) recommendations at the end of each section (people, place, and process) can provide some direction for these future directions. Obviously, there are innumerable theories and lenses for outdoor adventure education researchers to examine beyond those recommended in this paper, and we look forward to seeing the innovative perspectives that evolve in the future. With this final recommendation, we return to the original goals of this paper. This scoping review was intended to provide perspective on how the academic literature has developed since the prominent meta-analysis conducted by Hattie et al. (1997) and provide recommendations for future directions for the field of study. Research has mo- ved forward on several fronts, such as better incorporating participant background into studies, documenting effective program elements, and better understanding the role the instructor plays in the OB experience. Other areas, such as understanding the role the physical environment plays (place) within the OB experience and understanding the na- ture of outcomes beyond social-emotional growth have not progressed as quickly. We hope that by examining the other areas of academic literature recommended throughout this article, these gaps in knowledge can be explored more effectively in the future. There is evidence that OB and outdoor adventure education more broadly provide impactful experiences for participants, and growing evidence supports this claim on an international scale. But as Hattie et al. (1997) stated, these programs are not inherently good. Academic research has the responsibility of helping OB and the broader field of outdoor adventure education build toward more effective programming. Progress has been made on this front since Hattie et al. (1997), and it is our hope that this scoping review can help this progress continue in the future. 164 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 Ta bl e 3. A b ri ef o ve rv ie w o f t he st ud ie s i nc lu de d fo r r ev ie w in th is m an us cr ip t A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze A ng e t a l., 2 01 4 O ut w ar d B ou nd Si ng ap or e A t-r is k yo ut h pa rti ci pa tin g in a fi ve - da y ce nt er -b as ed o ut do or ad ve nt ur e pr og ra m Yo ut h A t-R is k Pr og ra m E va lu at io n su rv ey ad m in is te re d at th re e po in ts : p re -p ro gr am , o ne m on th p os t-p ro gr am , a nd th re e m on th s p os t- pr og ra m ; b eh av io ra l d at a (n um be r o f c la ss es a nd ex tra cu rr ic ul ar a ct iv iti es sk ip pe d in th e pa st w ee k) co lle ct ed fr om sc ho ol p re -p ro gr am a nd 3 -m on th s af te r t he p ro gr am 13 6 (C on tro l= 60 , Tr ea tm en t= 76 ) B en ha m & Sh ep ar d, 1 99 5 U ns pe ci fie d, pr og ra m to ok p la ce on th e sh or e of La ke M ic hi ga n in th e U ni te d St at es A fr ic an A m er ic an sc ho ol le ad er s p ar tic ip at in g in a ce nt er -b as ed p ro fe ss io na l de ve lo pm en t p ro gr am V id eo re co rd ed p ar tic ip an ts ' a ct iv iti es a t t he pr of es si on al d ev el op m en t r et re at fo r A fr ic an A m er ic an e du ca to rs th ro ug ho ut th e w ee k; e ac h pa rti ci pa nt p ar tic ip at ed in a n in te rv ie w a t t he co nc lu si on o f t he w ee k an d th re e fo llo w -u p in te rv ie w s o ve r t he fo llo w in g si x m on th s 5 B ob ily a et a l., 20 14 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol In di vi du al s e nr ol le d in e xp ed iti on -b as ed pr og ra m s o f 7 -5 0 da ys Fi na l E xp ed iti on S ur ve y so lic iti ng o pe n- en de d re sp on se s c om pl et ed o n th e la st d ay o f t he fi na l ex pe di tio n 33 1 B ob ily a et a l., 20 15 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol In di vi du al s e nr ol le d in e xp ed iti on -b as ed pr og ra m s o f 8 -2 8 da ys Po st -c ou rs e su rv ey : o pe n- en de d qu es tio ns o n co nt en t l ea rn ed a nd th e in te nt io n to tr an sf er le ar ni ng ; t w o- ye ar fo llo w -u p: o pe n- en de d qu es tio ns on c on te nt le ar ne d an d th e w ay s s ki lls w er e ut ili ze d po st -c ou rs e; th e re su lts w er e in de pe nd en tly c od ed by th re e re se ar ch er s. Po st - C ou rs e= 36 9, Tw o- ye ar =3 0 B ob ily a et a l., 20 17 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol In di vi du al s e nr ol le d in e xp ed iti on -b as ed pr og ra m s o f 4 -2 8 da ys O pe n- en de d su rv ey q ue st io ns c om pl et ed o n th e fin al d ay o f p ro gr am m in g on p os t-p ro gr am le ar ni ng an d gr ow th , t he re sp on se s w er e co de d an d th em es de ve lo pe d in du ct iv el y 18 9 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 165 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze B ro ad du s e t a l., 20 13 B al tim or e C he sa pe ak e B ay O ut w ar d B ou nd B al tim or e po lic e offi ce rs an d m id dl e sc ho ol st ud en ts p ar tic ip at in g in a on e- da y te am bu ild in g pr og ra m Su rv ey s u se d to m ea su re b ot h re si lie nc e an d se lf- co ns tru ct s; O ut w ar d B ou nd O ut co m es In st ru m en ts w as u se d to m ea su re se lf- co ns tru ct s; th e M ul tid im en si on al R el at io ns hi p Q ue st io nn ai re w as us ed to m ea su re re si lie nc e 27 Ew er t, 20 14 O ut w ar d B ou nd fo r Ve te ra ns U ni te d St at es V et er an s in a fi ve -d ay o ut do or ad ve nt ur e pr og ra m Su rv ey s u se d to m ea su re b ot h re si lie nc e an d se lf- co ns tru ct s; O ut w ar d B ou nd O ut co m es In st ru m en ts w as u se d to m ea su re se lf- co ns tru ct s; th e M ul tid im en si on al R el at io ns hi p Q ue st io nn ai re w as us ed to m ea su re re si lie nc e 31 0 Fa irc lo th & B ob ily a, 2 01 3 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol In di vi du al s e nr ol le d in e xp ed iti on -b as ed pr og ra m s o f 4 -2 8 da ys Ps yc ho m et ric in ve st ig at io n of th e N or th C ar ol in a O ut w ar d B ou nd S ch oo l C ou rs e Im pr es si on S ur ve y, an a da pt ed v er si on o f t he O ut w ar d B ou nd O ut co m es In ve nt or y; a na ly si s i nc lu de d de sc rip tiv e st at is tic s, in te r-i te m c or re la tio ns , t es t-r et es t r el ia bi lit y, ex pl or at or y fa ct or a na ly si s, an d in te rn al c on si st en cy 26 8 Fi sc he r & A tta h, 2 00 1 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol Te en s i n fo st er c ar e pa rti ci pa tin g in a se ve n- da y ou td oo r a dv en tu re co ur se Pr e- a nd p os t-p ro gr am su rv ey s c on si st in g of b ot h sc al ed a nd o pe n- en de d qu es tio ns fo cu si ng o n pr og ra m p ar tic ip an t b eh av io r a nd e xp er ie nc es w er e gi ve n to th e pr og ra m p ar tic ip an ts , f os te r ca re w or ke rs , a nd fo st er p ar en ts a t t hr ee p oi nt s: pr e- pr og ra m , p os t-p ro gr am , a nd th re e m on th s p os t- pr og ra m . 23 Fo uh ey & Sa ltm ar sh , 1 99 6 Th om ps on Is la nd O ut w ar d B ou nd Ed uc at io n C en te r U ni ve rs ity st ud en ts en ro lle d in a se rv ic e le ar ni ng p ro gr am Ex am in ed c ou rs e co m po ne nt s t hr ou gh th e le ns of v ar io us e xp er ie nt ia l e du ca tio n an d ou td oo r ad ve nt ur e th eo rie s. 6- 10 Fr ee m an , 2 01 1 H is to ric al A na ly si s N /A H is to ric al a na ly si s o f p rio r r es ea rc h, w rit in gs fr om pr om in en t e du ca to rs , a nd o th er re le va nt d oc um en ts . N /A 166 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze G al lo w ay , 2 00 7 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol ; V oy ag eu r O ut w ar d B ou nd Sc ho ol O ut w ar d B ou nd c ou rs e le ad er s O ut do or L ea de r E xp er ie nc e U se H is to ry su rv ey s an d Fa ct or ia l D ec is io n V ig ne tte s ( pr ov id in g le ad er sh ip c ho ic es fo r v ar io us o ut do or a dv en tu re - re la te d m ed ic al d ec is io ns ) p ro vi de d to tr ip le ad er s, re sp on se s a na ly ze d vi a a hi er ar ch ic al li ne ar m od el . 10 3 G as sn er , 2 00 8 O ut w ar d B ou nd Si ng ap or e A du lts w ho p ar tic ip at ed in th e C la ss ic C ha lle ng e co ur se (2 1 da y ex pe di tio n) Su rv ey w ith p ar tic ip an ts ra tin g ho w im pa ct fu l di ffe re nt c ou rs e co m po ne nt s w er e on th ei r c ur re nt liv es 31 8 G as sn er & R us se ll, 2 00 8 O ut w ar d B ou nd Si ng ap or e A du lts w ho p ar tic ip at ed in th e C la ss ic C ha lle ng e co ur se (2 1 da y ex pe di tio n) Su rv ey w ith p ar tic ip an ts re tro sp ec tiv el y ex am in in g th e ov er al l i m pa ct o f t he ir O ut w ar d B ou nd c ou rs e on th ei r c ur re nt li ve s a nd h ow im pa ct fu l v ar io us as pe ct s o f t he e xp er ie nc e w er e 31 8 G as sn er e t a l., 20 06 O ut w ar d B ou nd Si ng ap or e A du lts w ho p ar tic ip at ed in th e C la ss ic C ha lle ng e co ur se (2 1 da y ex pe di tio n) Q ue st io nn ai re a sk in g pa rti ci pa nt s t o ra te th e pe rc ei ve d im pa ct o f t he ir O ut w ar d B ou nd c ou rs e an d th e co ur se c om po ne nt s c on tri bu tin g to th es e im pa ct s 31 8 G ol de nb er g et al ., 20 02 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol In di vi du al s e nr ol le d in ex pe di tio n pr og ra m s o f 4- 21 d ay s i n le ng th Q ue st io nn ai re a sk in g pa rti ci pa nt s t o id en tif y im pa ct fu l c ou rs e co m po ne nt s, th e ou tc om es re la te d to th os e co ur se c om po ne nt s, an d ul tim at el y th e br oa de r v al ue s i m pa ct ed b y th os e ou tc om es ; re sp on se s a rr an ge d in to h ie ra rc hi ca l v al ue m ap s 21 6 G ol de nb er g et al ., 20 05 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol In di vi du al s e nr ol le d in ex pe di tio n pr og ra m s o f 4- 21 d ay s i n le ng th Q ue st io nn ai re a sk in g pa rti ci pa nt s t o id en tif y im pa ct fu l c ou rs e co m po ne nt s, th e ou tc om es re la te d to th os e co ur se c om po ne nt s, an d ul tim at el y th e br oa de r v al ue s i m pa ct ed b y th os e ou tc om es ; re sp on se s a rr an ge d in to h ie ra rc hi ca l v al ue m ap s 21 6 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 167 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze G re ffr at h et a l., 20 11 O ut w ar d B ou nd So ut h A fr ic a 3r d- ye ar u ni ve rs ity st ud en ts p ar tic ip at in g in tw o di ffe re nt o ut do or ad ve nt ur e ed uc at io n pr og ra m s A c ro ss ov er re se ar ch d es ig n w ith tw o se pa ra te ex pe rim en ta l g ro up s p ar tic ip at in g in e ith er a c en tre - ba se d ad ve nt ur e pr og ra m o r a n ex pe di tio n- ba se d w ild er ne ss p ro gr am , t he g ro up s s w itc he d tre at m en ts af te r fi ve m on th s; g ro up s c om pl et ed p re - a nd po st -p ro gr am "R ev ie w o f P er so na l E ffe ct iv en es s an d Lo cu s o f C on tro l" su rv ey s f or e ac h tre at m en t; po st -tr ea tm en t s em i-s tru ct ur ed in te rv ie w s a nd fo cu s gr ou ps w er e al so c on du ct ed 28 H an na , 1 99 5 C ol or ad o O ut w ar d B ou nd S ch oo l Yo ut h en ro lle d in pr og ra m s o f 1 0- 11 d ay s Su rv ey m ea su rin g m in im al im pa ct k no w le dg e, b as ic ec ol og ic al k no w le dg e, w ild er ne ss is su e at tit ud es , a s w el l a s p re di sp os in g fa ct or s, be ha vi or al in te nt io n, an d se lf- re po rte d be ha vi or fo r O ut w ar d B ou nd a nd A ud ub on F ie ld E co lo gy C am ps a t t hr ee ti m e po in ts : pr e- pr og ra m , p os t-p ro gr am , a nd si x m on th s a fte r pr og ra m c on cl us io n 32 H ar pe r e t a l., 20 14 O ut w ar d B ou nd C an ad a C an ad ia n ve te ra ns pa rti ci pa tin g in a se ve n- da y ou td oo r a dv en tu re ed uc at io n pr og ra m U til iz ed th e O ut w ar d B ou nd O ut co m es In ve nt or y to m ea su re p sy ch os oc ia l c on st ru ct s p re -p ro gr am , im m ed ia te ly p os t-p ro gr am , a nd si x w ee ks p os t- pr og ra m ; 1 2 se m i-s tru ct ur ed in te rv ie w s e xa m in in g co ur se o ut co m es , h ea lth a nd w el lb ei ng , a nd th e co ur se in re la tio n to p ar tic ip an t’s c ar ee r a nd m ili ta ry se rv ic e w er e al so c on du ct ed Su rv ey =5 0, In te rv ie w =1 2 H ic km an D un ne , 2 01 8 O ut w ar d B ou nd Tr us t ( U ni te d K in gd om ) Sc ho ol g ro up s b as ed in th e U ni te d K in gd om o n ou td oo r e xp ed iti on s Se m i-s tru ct ur ed in te rv ie w s w ith O ut w ar d B ou nd Tr us t s ta ff; a n et hn og ra ph y of fo ur sc ho ol g ro up tri ps th ro ug h th e O ut w ar d B ou nd T ru st ; p ai re d fo llo w -u p in te rv ie w s w ith p ar tic ip an ts in cl ud in g m oo d bo ar d ac tiv ity St aff =2 6, Pa rti ci pa nt s= 44 168 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze H ol de n, 2 00 4 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol A du lts p ar tic ip at in g in an e xp ed iti on -b as ed pr og ra m o f a t l ea st 1 4 da ys A q ua si -e xp er im en ta l d es ig n w ith so m e co ur se s be in g in fo rm ed a bo ut th e pr es en ce o f a sa te lli te ph on e an d ot he rs n ot ; a ll th e pa rti ci pa nt s fi lle d in a p os t-c ou rs e su rv ey m ea su rin g w ild er ne ss ex pe rie nc e, ri sk -ta ki ng , t he p er ce pt io n of sa fe ty , a nd le ve l o f s tre ss . 26 1 H ov el yn ck , 20 01 O ut w ar d B ou nd B el gi um O ut w ar d B ou nd c ou rs e le ad er s M ul tip le se m i-s tru ct ur ed in te rv ie w s w ith c ou rs e le ad er s d is cu ss in g 2- 3 m om en ts p er d ay p er pr og ra m a nd h ow th ey w er e fa ci lit at ed 8 H ye r e t a l., 19 96 Pa ci fic C re st O ut w ar d B ou nd Sc ho ol ; N or th C ar ol in a O ut w ar d B ou nd S ch oo l V ie tn am W ar v et er an s w ith c hr on ic P TS D pa rti ci pa tin g in a fi ve - da y ou td oo r a dv en tu re ed uc at io n pr og ra m Ve te ra ns in a m ul ti- w ee k PT SD tr ea tm en t p ro gr am ad m in is te re d a 5- da y O ut w ar d B ou nd p ro gr am in lie u of sc he du le d tre at m en t ( th e co nt ro l g ro up d id no t a tte nd th e O ut w ar d B ou nd p ro gr am ); ve te ra ns su bj ec t t o a ba tte ry o f s ur ve ys m ea su rin g sy m pt om ch an ge in P TS D su bj ec ts p re -p ro gr am , i m m ed ia te ly po st -p ro gr am , a nd o n ex it fr om th e m ul ti- w ee k tre at m en t; th e O ut w ar d B ou nd p ar tic ip an ts a ls o fil le d in a su rv ey a nd p ro vi de d op en -e nd ed co m m en ts o n th ei r p er ce pt io n of th e ex pe rie nc e 21 9 (C on tro l= 11 1, Tr ea tm en t= 10 8) Ji rá se k et a l., 20 16 Va ca tio n Sc ho ol o f Li pn ic e- O ut w ar d B ou nd C ze ch R ep ub lic A du lts p ar tic ip at in g in a 12 -d ay e xp ed iti on M ix ed m et ho d de si gn in cl ud in g fr eq ue nc y ch ar ts w ith p ar tic ip an ts id en tif yi ng c lo se re la tio ns hi ps in th e gr ou p re co rd ed a t t hr ee p oi nt s t hr ou gh ou t th e ex pe di tio n, p os t-c ou rs e re fle ct iv e es sa ys , a po st -c ou rs e su rv ey o n gr ou p co he si on , a nd m id - co ur se a nd p os t-c ou rs e m in d m ap s e xp lo rin g ho w pa rti ci pa nt s f ee l a bo ut th e O ut w ar d B ou nd c ou rs e 26 Ji rá se k, Ji rá sk ov á et a l., 20 17 Va ca tio n Sc ho ol o f Li pn ic e- O ut w ar d B ou nd C ze ch R ep ub lic A du lts p ar tic ip at in g in a 12 -d ay e xp ed iti on Po st -c ou rs e un st ru ct ur ed in te rv ie w s a nd th e de ve lo pm en t o f s ys te m ic c on st el la tio ns ; c on te nt an al yz ed fo r s pi rit ua l e le m en ts o f t he e xp er ie nc e 12 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 169 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze Ji rá se k, Ve se ls ký e t a l., 20 17 Va ca tio n Sc ho ol o f Li pn ic e- O ut w ar d B ou nd C ze ch R ep ub lic A du lts p ar tic ip at in g in a 12 -d ay e xp ed iti on -b as ed pr og ra m U ns tru ct ur ed in te rv ie w s o n th e sp iri tu al a sp ec ts o f th e ex pe di tio n pa ire d w ith th e Pr ag ue S pi rit ua lit y Q ue st io nn ai re . 12 K al is ch e t a l., 20 11 N or th C ar ol in a O ut w ar d B ou nd Sc ho ol In di vi du al s e nr ol le d in e xp ed iti on -b as ed pr og ra m s o f 7 -4 5 da ys Pa rti ci pa nt s g iv en a n op en -e nd ed su rv ey o n th ei r pe rc ep tio ns o f t he so lo e xp er ie nc e du rin g th e la st ho ur o f t he so lo , r es po ns es c od ed fo r s al ie nt th em es an d fr eq ue nc y ta bl es c on st ru ct ed 33 5 K irw in e t a l., 20 19 O ut w ar d B ou nd C an ad a In di vi du al s e nr ol le d in an e ig ht -d ay e xp ed iti on - ba se d pr og ra m Th re e pr ev io us ly d ev el op ed su rv ey s w er e us ed to m ea su re sa vo rin g, m in df ul ne ss , a nd p os iti ve a ffe ct in b ot h th e co nt ro l ( no O ut w ar d B ou nd p ro gr am pa rti ci pa tio n) a nd e xp er im en ta l ( pa rti ci pa tio n in th e ei gh t-d ay O ut w ar d B ou nd m in df ul ne ss pr og ra m ) g ro up s a t t hr ee ti m e pe rio ds : p re -p ro gr am , im m ed ia te ly p os t-p ro gr am , a nd th re e m on th s p os t- pr og ra m 30 (C on tro l= 16 , Tr ea tm en t= 14 ) K le in & R io rd an , 2 00 9 Ex pe di tio na ry Le ar ni ng S ch oo ls O ut w ar d B ou nd Ed uc at or s i n N ew Y or k C ity A q ua lit at iv e ca se st ud y an al yz in g ha rd co py m at er ia ls li ke st ud en t w or k, c la ss ro om o bs er va tio ns , an d te ac he r i nt er vi ew s; a na ly ze d fo r s al ie nt th em es by b ot h au th or s 8 K le in & R io rd an , 2 01 1 Ex pe di tio na ry Le ar ni ng S ch oo ls O ut w ar d B ou nd Ed uc at or s i n N ew Y or k C ity A q ua lit at iv e ca se st ud y co m pr is in g in te rv ie w s, si te v is its , a nd d oc um en t a nd a rti fa ct a na ly si s; da ta w er e co de d an d an al yz ed v ia a na ly tic m em os , tri an gu la tio n, a nd m em be r c he ck s 8 170 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze Le be rm an , 20 07 O ut w ar d B ou nd N ew Z ea la nd Fe m al e off en de rs to b e re le as ed fr om pr is on w ith in o ne y ea r pa rti ci pa tin g in a 2 0- da y ou td oo r a dv en tu re ed uc at io n co ur se 27 se m i-s tru ct ur ed in te rv ie w s a t t he e nd o f t he co ur se ; f ol lo w -u p in te rv ie w s w ith 1 4 w om en th re e m on th s a fte r t he e nd o f t he c ou rs e; fi el d ob se rv at io ns , i ns tru ct or re po rts , a nd c as e offi ce r r ep or ts w er e al so u til iz ed ; a na ly ze d in a ph en om en ol og ic al m an ne r 27 Le be rm an & M ar tin , 2 00 2 O ut w ar d B ou nd C ze ch R ep ub lic , O ut w ar d B ou nd N ew Z ea la nd In te rn at io na l p ar tic ip an ts in th e C ze ch R ep ub lic ; fe m al e off en de rs in N ew Z ea la nd ; b ot h pa rti ci pa tin g in m ul ti- da y ou td oo r a dv en tu re ed uc at io n pr og ra m s Tw o se pa ra te st ud ie s a na ly zi ng c om fo rt, ri sk , a nd th e re la tio ns hi p th es e co nc ep ts h av e to le ar ni ng ; fo r O ut w ar d B ou nd C ze ch R ep ub lic , p ar tic ip an ts co m pl et ed a n op en -e nd ed q ue st io nn ai re 6 -m on th s af te r c ou rs e co nc lu si on ; f or O ut w ar d B ou nd N ew Ze al an d, in te rv ie w s c on du ct ed p os t-c ou rs e an d th re e m on th s a fte r c ou rs e co nc lu si on . O ut w ar d B ou nd C ze ch R ep ub lic =2 5, O ut w ar d B ou nd N ew Ze al an d= 27 Lo w an , 2 00 9 O ut w ar d B ou nd C an ad a Fo rm er G iw ay ki w in st ud en ts , O ut w ar d B ou nd st aff m em be rs , A bo rig in al E ld er s, an d co m m un ity m em be rs in vo lv ed w ith th e pr og ra m A c ol la bo ra tiv e et hn og ra ph y st ud y co ns is tin g of in te rv ie w s, fie ld jo ur na l f ro m re se ar ch er , co lla bo ra tiv e ex am in at io n of p ar tic ip an ts ' c ou rs e jo ur na ls , a nd c ou rs e ar tif ac ts 9 M ar tin & L eg g, 20 02 O ut w ar d B ou nd N ew Z ea la nd In di vi du al s e nr ol le d in ni ne -d ay a nd 2 2- da y ex pe di tio n- ba se d co ur se s A m ix ed m et ho d lo ng itu di na l s tu dy , a dm in is te rin g a m ul tid im en si on al se lf- co nc ep t q ue st io nn ai re pr e- an d po st -p ro gr am ; t hr ee o pe n- en de d qu es tio ns w er e ad m in is te re d pr e- pr og ra m , p os t-p ro gr am , a nd si x m on th s a fte r t he p ro gr am e xa m in in g co ur se at m os ph er e; q ue st io ns e xa m in ed c ou rs e ou tc om es an d w ha t e le m en ts o f t he c ou rs e co nt rib ut ed to th em 93 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 171 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze M ar tin , 2 01 1 Va ca tio n Sc ho ol o f Li pn ic e- O ut w ar d B ou nd C ze ch R ep ub lic Se lf- ex am in at io n an d re fle ct io n A ut oe th no gr ap hy u si ng p ar tic ip an t o bs er va tio n w ith th e au th or e xa m in in g th e pe rs on al m ea ni ng o f t he O ut w ar d B ou nd e xp er ie nc e 1 M ar tin & Le be rm an , 20 05 O ut w ar d B ou nd N ew Z ea la nd Pa rti ci pa nt s w ho w er e 16 y ea rs a nd o ld er pa rti ci pa tin g in a v ar ie ty of o ut do or a dv en tu re co ur se s A m ix ed m et ho d lo ng itu di na l a pp ro ac h, c on du ct in g qu es tio nn ai re s o n th e fir st d ay , l as t d ay , a nd 1 2 w ee ks a fte r p ro gr am c om pl et io n; su rv ey s a nd o pe n- en de d qu es tio ns e xa m in ed le ar ni ng a ro un d a va rie ty of c on ce pt s s uc h as le ad er sh ip , s el f- co nfi de nc e, a nd so ci al c om pe te nc e 15 7 M ar tin e t a l., 20 16 O ut w ar d B ou nd N ew Z ea la nd Sc ho ol a nd e xe cu tiv e di re ct or s A c as e st ud y fr am ew or k on o rg an iz at io na l c ul tu re w ith p rim ar y da ta b ei ng c ol le ct ed th ro ug h se m i- st ru ct ur ed in te rv ie w s; fi nd in gs fu rth er tr ia ng ul at ed vi a an al ys is o f O ut w ar d B ou nd N ew Z ea la nd a nn ua l re po rts a nd re se ar ch er s' fir st ha nd k no w le dg e of O ut w ar d B ou nd 14 M ar tin e t a l., 20 02 O ut w ar d B ou nd C ze ch R ep ub lic , O ut w ar d B ou nd A us tra lia In di vi du al s e nr ol le d in 14 -d ay e xp ed iti on -b as ed pr og ra m s O pe n- en de d su rv ey q ue st io ns w er e ad m in is te re d to pa rti ci pa nt s 6 -m on th s a fte r a ll co ur se s; se co nd ar y fo llo w -u p w as d is tri bu te d to tw o co ur se s o ne y ea r af te r c om pl et io n an d tw o ye ar s a fte r c om pl et io n fo r th e th ird c ou rs e; e xa m in ed th e im pa ct fu l e le m en ts of O ut w ar d B ou nd c ou rs es u til iz in g a dr am at ur gi ca l ap pr oa ch to e du ca tio n 70 M ar tin e t a l., 20 09 C ol or ad o O ut w ar d B ou nd S ch oo l 7t h an d 8t h gr ad e st ud en ts e nr ol le d in a n Ex pe di tio na ry L ea rn in g O ut w ar d B ou nd S ch oo l Ex am in in g th e in flu en ce o f a w at er sh ed e du ca tio n un it; c hi ld re n’ s E nv iro nm en ta l V irt ue S ca le su rv ey ad m in is te re d pr e- a nd p os t-p ro gr am to p ar tic ip an ts ; re su lts c om pa re d to a c on ve ni en ce sa m pl e of e ig ht h- gr ad e st ud en ts in C ol or ad o se rv in g as a c on tro l gr ou p 11 2 (T re at m en t= 45 , C on tro l= 67 ) 172 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze M ax w el l e t a l., 20 08 O ut w ar d B ou nd N ew Z ea la nd Yo un g ad ul ts fa ci ng lo ng -te rm u ne m pl oy m en t w ho a re p ar tic ip at in g in a 2 1- da y re si de nt ia l pr og ra m A na ly si s o f O ut w ar d B ou nd p ar tic ip an t d at a in cl ud in g de m og ra ph ic s, ex te rn al e nv iro nm en ta l fa ct or s, in te rn al e nv iro nm en ta l f ac to rs , a nd so ci al in te gr at io n; in te rv ie w s c on du ct ed w ith a sa m pl e of 10 p ro gr am d ro po ut s Su rv ey =5 85 , In te rv ie w =1 0 M cK en zi e, 20 03 O ut w ar d B ou nd W es te rn C an ad a A du lts , y ou th , f em al e su rv iv or s o f a bu se , an d at -r is k yo ut h pa rti ci pa tin g in o ut do or ad ve nt ur e co ur se s ra ng in g fr om 7 to 3 6 da ys in le ng th A n in te rp re tiv e ca se st ud y ex am in in g O ut w ar d B ou nd st ud en t l ea rn in g pr oc es se s; d at a co lle ct io n co ns is te d of a p os t-p ro gr am q ue st io nn ai re , in te rv ie w s, re se ar ch er o bs er va tio n of g ro up di sc us si on s Su rv ey =9 2, In te rv ie w =2 0 M ill ik an , 2 00 6 H is to ric al A na ly si s N /A H is to ric al a na ly si s o f O ut w ar d B ou nd p ro gr am m in g N /A M ot t & M ar tin , 20 17 O ut w ar d B ou nd N ew Z ea la nd In di vi du al s e nr ol le d in v ar io us o ut do or ad ve nt ur e co ur se s A m ix ed m et ho ds d es ig n co ns is tin g in te rv ie w s, in ci de nt re po rt an d qu al ity c on tro l f or m a na ly si s, an d pr e- a nd p os t-p ro gr am e va lu at io n qu es tio nn ai re s an al yz in g pe rc ep tio ns o f r is k an d sa fe ty o n O ut w ar d B ou nd N ew Z ea la nd c ou rs es Su rv ey = 6 79 2, In te rv ie w = 5 N ei ll & D ia s, 20 01 O ut w ar d B ou nd A us tra lia Yo un g ad ul ts o n a 22 - da y ex pe di tio n or ie nt ed pr og ra m A q ua si -e xp er im en ta l d es ig n; th e ex pe rim en ta l gr ou p co m pl et ed a R es ili en ce S ca le fo r p re - a nd po st -p ro gr am m ea su re s a nd th e So ci al S up po rt Sc al e up on c ou rs e co m pl et io n; c on tro l g ro up o nl y co m pl et ed R es ili en ce S ca le fo r p re - a nd p os t- pr og ra m m ea su re s 72 (T re at m en t= 41 ; C on tro l= 31 ) N ew be ry , 2 00 4 G en er al O ut w ar d B ou nd pr og ra m m in g Fe m al e O ut w ar d B ou nd in st ru ct or s A q ua lit at iv e de si gn c om pr is in g se m i-s tru ct ur ed in te rv ie w s c on du ct ed o ve r 6 m on th s b et w ee n 19 99 - 20 00 , i nd iv id ua l r efl ec tiv e jo ur na l t ra ns cr ip ts a nd a gr ou p in te rv ie w. 4 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 173 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze Po m m ie r & W itt , 1 99 5 O ut w ar d B ou nd Fa m ily in N ee d of Se rv ic es p ro gr am A do le sc en t s ta tu s off en de rs a nd p ar en ts pa rti ci pa tin g in a m ul ti- m on th su pp or t p ro gr am A lo ng itu di na l q ua nt ita tiv e st ud y; su rv ey s w er e ad m in is te re d be fo re th e pr og ra m st ar t, 28 d ay s af te r t he p ro gr am st ar t, an d fo ur m on th s a fte r t he pr og ra m st ar t; co nt ro l g ro up w as n ot e xp os ed to th e Fa m ily in N ee d of S er vi ce s p ro gr am 10 7 (T re at m en t= 61 ; C on tro l= 46 ) Pu rd ie & N ei ll, 19 98 O ut w ar d B ou nd A us tra lia U nd er -a ch ie vi ng Ja pa ne se st ud en ts pa rti ci pa tin g in a 2 2- da y ou td oo r a dv en tu re pr og ra m in A us tra lia , pr og ra m a cc om pa ni ed b y a la ng ua ge d ev el op m en t co m po ne nt C on tro l a nd e xp er im en ta l g ro up s c om pl et ed th e "A bo ut M ys el f" se lf- co nc ep t i ns tru m en ts a t t hr ee tim e pe rio ds : p re -c ou rs e, im m ed ia te ly p os t-c ou rs e, an d si x w ee ks p os t-c ou rs e; e xp er im en ta l g ro up al so c om pl et ed "E va lu at io n of C ou rs e" in st ru m en t im m ed ia te ly p os t-c ou rs e; m ul tiv ar ia te re pe at ed m ea su re s a na ly si s w as u til iz ed a nd c ha ng e sc or es w er e co m pa re d to p re vi ou s fi nd in gs w ith in pr im ar ily W es te rn p op ul at io ns 72 (T re at m en t= 32 ; C on tro l-4 2) Sc he in fe ld e t al ., 20 17 O ut w ar d B ou nd fo r Ve te ra ns U ni te d St at es V et er an s pa rti ci pa tin g in a si x- da y ou td oo r a dv en tu re ed uc at io n pr og ra m A q ua si -e xp er im en ta l s tu dy w ith e xp er im en ta l a nd co nt ro l g ro up s c om pl et in g pr e- a nd p os t-p ro gr am su rv ey s m ea su rin g de m og ra ph ic in fo rm at io n, m as cu lin e ro le c on fo rm ity , a nd m en ta l h ea lth sy m pt om s 19 9 (T re at m en t= 18 1; C on tro l= 18 ) Si bt ho rp e t a l., 20 18 O ut w ar d B ou nd H on g K on g Se co nd ar y an d un iv er si ty st ud en ts p ar tic ip at in g in a v ar ie ty o f o ut do or ad ve nt ur e ed uc at io n pr og ra m s A p re - a nd p os t-c ou rs e ad m in is tra tio n of th e O ut w ar d B ou nd H on g K on g Pe rf or m an ce Ev al ua tio n Q ue st io nn ai re ; s ur ve y re su lts u se d to ex pl or e ho w c ou rs e ou tc om es w er e re la te d to c ou rs e la ng ua ge , s en se o f b el on gi ng , a nd te ac he r-s tu de nt re la tio ns hi p 22 92 To lic h, 2 01 2 O ut w ar d B ou nd N ew Z ea la nd Se lf- ex am in at io n an d re fle ct io n A n au to et hn og ra ph ic st ud y fr om a re se ar ch er - pa rti ci pa nt le ns o n th e m ea ni ng o f t he O ut w ar d B ou nd e xp er ie nc e 1 174 Timothy J. MATEER, Joshua PIGHETTI, B. Derrick TAFF, Pete ALLISON: OUTWARD BOUND AND OUTDOOR ADVENTURE EDUCATION ... , 143–181 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 A ut ho rs Pr og ra m P ro vi de r St ud y Po pu la tio n St ud y M et ho ds Sa m pl e Si ze Ve rn on , 2 01 5 U ni te d St at es , un sp ec ifi ed pr og ra m p ro vi de r St ud en ts fr om a d iv er si ty pr og ra m p ar tic ip at in g in an u ns pe ci fie d O ut w ar d B ou nd p ro gr am A q ua lit at iv e st ud y co ns is tin g ob se rv at io ns co up le d w ith jo tti ng s, fie ld n ot es , p ho to gr ap hs , an d au di o re co rd in gs ; i nt er vi ew s w ith st ud en ts a nd ad m in is tra to rs N /A W al ke r e t a l., 20 05 O ut w ar d B ou nd A us tra lia In di vi du al s w ith re ce nt br ai n in ju ry p ar tic ip at in g in a n O ut w ar d B ou nd co ur se e m be dd ed in a br oa de r t re at m en t pr og ra m U po n co m pl et io n of th e pr og ra m , p ar tic ip an t g oa ls w er e an al yz ed fo r c om pl et io n; p re - a nd p os t- m ea su re s u si ng th e D ep re ss io n, A nx ie ty , a nd S tre ss Sc al es , t he G en er al W el l-B ei ng Q ue st io nn ai re , a nd th e Eu ro pe an B ra in In ju ry Q ue st io nn ai re w er e al l ga th er ed ; p os t-p ro gr am e ffi ca cy sc or es fo r d iff er en t pr og ra m e le m en ts a nd th e pr og ra m a s a w ho le w er e ga th er ed 11 W an g et a l., 20 06 O ut w ar d B ou nd Si ng ap or e Fe m al e se co nd ar y sc ho ol st ud en ts p ar tic ip at in g in a fi ve -d ay o ut do or ad ve nt ur e ed uc at io n pr og ra m Pr e- a nd p os t-p ro gr am su rv ey s w er e ad m in is te re d to p ar tic ip an ts m ea su rin g le ad er sh ip , s oc ia l s ki lls , in te rp er so na l s ki lls , s el f- es te em , m ot iv at io n fo r pa rti ci pa tin g in th e pr og ra m (p re -p ro gr am o nl y) , an d sa tis fa ct io n w ith th e ex pe rie nc e (p os t-p ro gr am on ly ) 14 9 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 175 Timothy J. 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We only realize how difficult a task is when we (re)learn a certain cognitive-motor task, such as keeping our balance on skis or while surfing, or even when grasping a spoon after a stroke. On the other hand, we know of several progressive neurodegenerative diseases that prevent the smooth performance of eve- ryday tasks. James Parkinson recognized that progressive Parkinson’s disease (PD) is associated with debilitating features including postural instability and gait difficulties (PIGD), such as falls and freezing of gait. PD initially causes physical symptoms but later, problems with cognitive function, including forgetfulness and difficulty concen- trating, may occur. As the disease worsens over time, many people develop dementia. Studying the dynamics of the brain during the most routine movements, such as walking, balancing or learning new motor-cognitive tasks, remains a major challenge for neuroscience. For the TwinBrain Summer School 2.0, we have invited an interna- tional team of experts to report on the latest discoveries in the field of neuroscience on movement topics and to provide insight into how brain imaging technology can contri- 186 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 bute to the understanding of brain function and disease development. Recent advances in wireless and portable technologies allow us to take experimentation a step further into real life or situations that reflect everyday experiences. Therefore, the latest de- velopments in Mobile Brain/Body Imaging (MoBI) were presented by internationally recognized experts from Slovenia, Germany, Switzerland, Italy, Belgium, the Czech Republic, Croatia, Bosnia and Herzegovina and the USA. The TwinBrain Summer School 2.0 was held on July 4-9, 2022, in Piran, Slovenia. The next Summer School 3.0 is scheduled for June 19-24, 2023, again in Piran, Slovenia. Uroš Marušič ANNALES KINESIOLOGIAE • 13 • 2022 • 2 187 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 NEVROZNANOST GIBANJA Poletna šola TwinBrain 2.0, Piran, Slovenija, 4. –9. julij 2022 V vsakdanjem življenju veliko stvari počnemo samodejno. In čeprav se pogosto zdi, da se odzovemo brez najmanjšega miselnega napora, v naših možganih potekajo številni kompleksni procesi. Kako težka je ta naloga, se zavemo šele, ko se (ponovno) naučimo določene kognitivno-motorične naloge, kot je ohranjanje ravnotežja na smu- čeh ali med deskanjem ali celo prijemanje žlice po možganski kapi. Hkrati poznamo več nevrodegenerativnih bolezni, ki napredujejo in onemogočajo nemoteno opravljanje vsakodnevnih opravil. Že James Parkinson je poročal, da je progresivna Parkinsonova bolezen (PD) povezana z izčrpavajočimi značilnostmi, kot so posturalna nestabilnost in težave pri hoji (PIGD) ter tudi padci in zamrznitev hoje. PD na začetku povzroči telesne simptome. Pozneje se lahko pojavijo tudi težave s kognitivnimi funkcijami, vključno s pozabljivostjo in nezmožnostjo koncentracije. Ko se bolezen sčasoma poslabša, veliko ljudi razvije demenco. Proučevanje dinamike možganov med večino rutinskih gibov, kot so hoja, ravno- težje ali učenje novih motorično-kognitivnih nalog, ostaja velik izziv za nevroznanost. Na poletno šolo TwinBrain 2.0 smo povabili mednarodno ekipo strokovnjakov, da bi 188 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 poročali o najnovejših odkritjih na področju nevroznanosti gibanja in zagotovili vpo- gled v to, kako lahko tehnologija slikanja možganov prispeva k razumevanju delovanja teh in razvoja bolezni. Novejši napredek na področju brezžičnih in prenosljivih tehno- logij nam omogoča, da gremo korak naprej pri eksperimentiranju in sicer v resnično življenje oz. okoliščine, ki odsevajo vsakodnevne izkušnje. Zato so najnovejše dosež- ke na področju Mobile Brain/Body Imaging (MoBI) predstavili mednarodno priznani strokovnjaki iz Slovenije, Nemčije, Švice, Italije, Belgije, Češke, Hrvaške, Bosne in Hercegovine in ZDA. Poletna šola TwinBrain 2.0 je potekala od 4. do 9. julija 2022 v Piranu. Naslednja Poletna šola 3.0 bo predvidoma organizirana od 19. do 24. junija 2023, ponovno v Piranu. Uroš Marušič ANNALES KINESIOLOGIAE • 13 • 2022 • 2 189 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 CONFERENCE REPORT – 4TH INTERNATIONAL CONFERENCE ON TECHNOLOGY INNOVATIONS FOR HEALTHCARE (ICDHT) Magdeburg, Germany, 14th‒16th September 2022 The Otto von Guericke University hosted the 4th ICDHT conference in Magdeburg, Germany. Lectures were held in the Lukas Klause building and in the main building of the college. The two-day conference featured a comprehensive scientific program addressing the latest developments in research and technology for digital health with clinical and technical perspectives. The conference focused on future P4 medicine (predictive, pre- ventive, personalized and participatory) and on supporting performance in all sports through information technology tools. The program featured 8 keynote speakers and 27 oral presentations. Among the participants, colleagues from the Institute for Kinesiolo- gy Research ZRS Koper presented their work; Prof Dr Rado Pišot (Digital Technology – from an Obstacle to an Incentive for a Healthy and Active Lifestyle), Prof Dr Boštjan Šimunič (The Decomposition of Tensiomyography Using Advanced Mathematics) and Prof Dr Uroš Marušič (Wearables and Wireless Technology for Training and Tele-Re- habilitation Services) were the keynote speakers and Dr Saša Pišot and Kaja Teraž gave their oral presentation. The issued “Book of Abstracts” contains 27 abstracts of scientific papers with cur- rent research results in the field of digital health technology. The rich historical background of the city of Magdeburg, the hospitality of the orga- nizers and the interesting social program allowed us to exchange professional thoughts and ideas related to this field, which will experience many innovations in the future. Kaja Teraž 190 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 POROČILO S 4. MEDNARODNE KONFERENCE O TEHNOLOŠKIH NOVOSTIH V ZDRAVSTVU (ICDHT) Magdeburg, Nemčija, 14.‒16. september 2022 Univerza Otto von Guericke je gostila 4. konferenco ICDHT, ki je potekala v Mag- deburgu v Nemčiji. Predavanja so potekala v stavbi Lukas Klause in glavni stavbi uni- verze. Dvodnevna konferenca je vključevala obsežen znanstveni program, v okviru kate- rega so bili obravnavani najnovejši dosežki na področju raziskav in tehnologije za di- gitalno zdravje z njegovimi kliničnimi in tehničnimi vidiki. Konferenca se je osredinila na obetavno P4 medicino (prediktivna, preventivna, personalizirana in participativna medicina) in podporo športnim dosežkom v vseh športih s pomočjo orodij informacij- ske tehnologije. V okviru programa je sodelovalo osem vabljenih govornikov, pred- stavljenih pa je bilo 27 povzetkov prispevkov. Med vsemi udeleženci so svoje delo predstavili tudi kolegi z Inštituta za kineziološke raziskave ZRS Koper, in sicer prof. dr. Rado Pišot (Digitalna tehnologija – od ovire do spodbude za zdrav in aktiven ži- vljenjski slog), prof. dr. Boštjan Šimunič (Dekompozicija tenziomiografije z uporabo napredne matematike) in prof. dr. Uroš Marušič (Nosljiva in brezžična tehnologija za usposabljanje in storitve rehabilitacije na daljavo) kot osrednji govorci, dr. Saša Pišot in Kaja Teraž pa sta predstavili svoj povzetek prispeveka. Izdan zbornik vsebuje 27 povzetkov znanstvenih prispevkov z aktualnimi rezultati raziskav na področju digitalne zdravstvene tehnologije Bogato zgodovinsko ozadje mesta Magdeburg, gostoljubnost organizatorjev in za- nimiv družabni program so nam omogočili izmenjavo številnih strokovnih misli in idej o omenjenem področju, ki bo v prihodnosti doživelo številne novosti. Kaja Teraž ANNALES KINESIOLOGIAE • 13 • 2022 • 2 191 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 “KNOWLEDGE FOR HEALTH”: INTEGRATED HEALTH CARE Koper, Slovenia, 1 October 2022 The annual “Knowledge for Health” event was held on 1 October, International Day of Older Persons. The United Nations General Assembly proclaimed this day to highli- ght the often overlooked role and position of this population group in society, despite the fact that the proportion of older people in the population is increasing. Experts from various fields participated in the event, which was aimed at a broad audience and was intended to highlight the issue of holistic health at the intersection of muscular, cogni- tive and cardiovascular health. Talking about the consequences of an inappropriate lifestyle and how to take care of one’s health in a holistic way that is also accessible to the general public remains the main goal of the initiators of the “Knowledge for Health” event, held for the eleventh consecutive year in collaboration with the Institute for Kinesiological Research of the Scientific Research Centre (ZRS) Koper and the Izola General Hospital. During this pe- riod, numerous meetings and discussions were held and thousands of measurements of physical and functional fitness and risk factors were performed. Numerous public lectu- res were held with top experts who have time and again offered new insights for health. This year’s event took place in the morning at Taverna in Koper, Slovenia, and included measurements of physical characteristics, functional abilities and health risk 192 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 factors. Participants had the opportunity to assess their cardiovascular, muscular and cognitive health through simple but relevant tests. On the occasion of the International Day of Older Persons, the organizers of the event emphasized the importance of monitoring sarcopenia for general health. They identified severe sarcopenia in 9% of those measured and urged them to change their lifestyle for better health. Sarcopenia can have very serious consequences, such as in- sufficient muscle strength, decreased metabolic capacity, decreased aerobic capacity, leading to physical limitations, immobility, poorer quality of life, more fragile bones, cognitive decline, cardiovascular disease and ultimately premature death. This is main- ly due to the excessive loss of muscle fibers and the reduction of the remaining fibers. What causes this is not yet entirely clear, and the answer is certainly very broad, which is why it is a syndrome rather than a disease. However, we can confirm with certainty that one of the causes is a lack of proper exercise with sufficient intensity to stimulate the repair and growth of muscle fibers. In addition to proper exercise, adequate protein intake is also important to support muscle repair after exercise. The testing of participants at the “Knowledge for Health” event is an example of knowledge transfer to the general public, as it comes directly from the research work of colleagues from the Institute for Kinesiology Research, ZRS Koper. The irrevers- ibility of the processes of muscle deterioration in the elderly motivated Prof. Dr Boštjan Šimunić to obtain two new national research projects. The “Validation of a muscle- quality marker for the diagnosis of sarcopenia (ARRS J7-2605)” project will develop a method that will enable the early detection of changes in muscle properties and per- formance during ageing, before they become visible with standard clinical instruments. The goal is to allow early intervention before sarcopenia actually sets in. The “Neuro- muscular decline after physical inactivity: a comparison of younger and older adults (ARRS J5-4593)” project aims to investigate the mechanisms and temporal patterns of muscle mass and performance decline in younger and older adults, which is critical for understanding the processes of decline and for developing preventive and cura- tive interventions/guidelines. The central nervous system controls muscle function and has been shown to be a key determinant of muscle performance. Under the leadership of Assoc. Prof. Dr Uroš Marušič, the researchers have been awarded the “TWINning the BRAIN with machine learning for neuromuscular efficiency – TwinBrain” interna- tional project, which investigates brain function during movement, during execution of various movements, and during motor learning with and without skeletal movement. With the completion of the testing in Taverna in Koper, each participant received a ticket to the afternoon part of the event, which took place at Koper Theatre, where a panel of experts spoke about the importance and role of monitored characteristics in health. Too often we want to “measure health”, compare ourselves to the norms without knowing more about the parameters and indicators of (un)healthiness that are being measured. High-profile speakers and top experts tried to find answers to the question of what holistic health is and how muscular, cognitive and cardiovascular health form a whole. Prim. Dorjan Marušič, MD, PhD, spoke about cardiovascular health, Bojan ANNALES KINESIOLOGIAE • 13 • 2022 • 2 193 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 Rojc, MD, PhD, spoke about neuromuscular health and Uroš Marušič, PhD, Associate Professor, spoke about cognitive health. The discussion was moderated by the founding fathers of the meeting, Prof. Dr Rado Pišot and Assoc. Prof. Dr Mladen Gasparini. The event was another in the series of events that brought together Koper Theatre, ZRS Koper and Izola General Hospital in an effort to contribute to the health and quality of life of our citizens, and was there- fore once again supported by the Koper City Council. Boštjan Šimunić, Nika Štravs, Matej Kleva, Peter Čerče 194 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 ANNALES KINESIOLOGIAE • 13 • 2022 • 2 »ZNANJE ZA ZDRAVJE«: CELOSTNA SKRB ZA ZDRAVJE Koper, Slovenija, 1. oktober 2022 Vsakoletni dogodek »Znanje za zdravje« je tokrat potekal 1. oktobra, ob medna- rodnem dnevu starejših. Generalna skupščina Združenih narodov je ta dan razglasila zaradi pogosto spregledane vloge in položaja, ki ga ima ta skupina prebivalstva v druž- bi, čeprav se delež starejše populacije povečuje. Strokovnjaki z različnih področji so na dogodku, ki je namenjen najširši zainteresirani javnosti, poskušali osvetliti problem celostnega zdravja v preseku med mišičnim, kognitivnim in srčno-žilnim zdravjem. Spregovoriti o posledicah neustreznega življenjskega sloga in kako celostno poskr- beti za svoje zdravje na način, ki je dostopen najširši javnosti, tudi sicer ostaja glavno vodilo pobudnikov dogodka »Znanje za zdravje«, ki je že enajsto leto zapored potekal v sodelovanju Inštituta za kineziološke raziskave Znanstveno-raziskovalnega središča (ZRS) Koper in Splošne bolnišnice (SB) Izola. V tem času so izvedli številna srečanja in pogovore, več tisoč meritev telesne in funkcionalne pripravljenosti ter dejavnikov tveganja. Organizirali so številna javna predavanja z vrhunskimi strokovnjaki, ki so vedno znova ponudili nova znanja za zdravje. Na letošnji prireditvi so v koprski Taverni v dopoldanskem času potekale meritve telesnih značilnosti, funkcionalnih sposobnosti in dejavnikov tveganja za zdravje. Ude- leženci so imeli možnost na osnovi preprostih, vendar relevantnih meritev preveriti svoje srčno-žilno, mišično in kognitivno zdravje. Ob svetovnem dnevu starejših so organizatorji dogodka posebej poudarili pomen spremljanja sarkopenije za celostno zdravje. Pri kar 9 % izmerjenih so odkrili hudo obliko sarkopenije in jih opozorili, naj spremenijo svoj življenjski slog za kakovostnej- še zdravje. Sarkopenija lahko privede do zelo hudih posledic, kot so premajhna mišična ANNALES KINESIOLOGIAE • 13 • 2022 • 2 195 REPORTS AND REVIEWS/POROČILA IN OCENE, 185–195 moč, manjše presnovne sposobnosti in manjše aerobne sposobnosti, vse to pa vodi v gibalne omejitve, nemobilnost, slabšo kakovost življenja, krhkejše kosti, kognitivni upad, srčno-žilne bolezni in v skrajni posledici v prezgodnjo smrt. Razlog je predvsem v preveliki izgubi mišičnih vlaken in zmanjšanju tistih, ki še ostanejo. Kateri so vzroki, ki privedejo do tega, še ni popolnoma jasno, in odgovor je gotovo zelo širok, zato je to tudi sindrom, bolj kot bolezen. Prav gotovo pa lahko kot enega od vzrokov potrdimo pomanjkanje primerne, dovolj intenzivne gibalne vadbe, ki spodbuja obnovo in rast mišičnih vlaken. Ob pravilni vadbi je pomemben tudi zadosten vnos beljakovin, ki podpirajo obnovo mišic po vadbi. Na dogodku »Znanje za zdravje« izvedene meritve udeležencev so primer preno- sa znanja v širšo javnost, saj izhajajo neposredno iz raziskovalnega dela sodelavk in sodelavcev Inštituta za kineziološke raziskave ZRS Koper. Ireverzibilnost procesov upada mišične mase pri starejših je namreč motivirala prof. dr. Boštjana Šimuniča k pridobitvi dveh novih nacionalnih raziskovalnih projektov. V sklopu projekta Valida- cija markerja mišične kakovosti za diagnosticiranje sarkopenije (ARRS J7-2605) raz- vijajo metodo, ki bo omogočala zgodnjo zaznavo sprememb v mišičnih značilnostih in zmogljivostih med staranjem, še preden bo ta vidna s standardnimi kliničnimi orodji. Cilj je zagotoviti še pravočasno ukrepanje pred dejanskim nastopom sarkopenije. V sklopu projekta »Upad živčno-mišičnega sistema po gibalni neaktivnosti: primerjava mlajših in starejših odraslih (ARRS J5-4593)« pa nameravajo proučiti mehanizme in časovne zakonitosti upada mišične mase in zmogljivosti pri mlajših in starejših, kar je ključno za razumevanje procesov upada ter oblikovanje preventivnih in kurativnih ukrepov/smernic. Centralni živčni sistem nadzoruje delovanje mišic in je bil prepoznan za ključni dejavnik mišične zmogljivosti. Pod vodstvom izr. prof. dr. Uroša Marušiča so raziskovalci pridobili mednarodni projekt TWINning the BRAIN with machine lear- ning for neuromuscular efficiency – TwinBrain, v sklopu katerega proučujejo delovanje možganov med gibanjem, v procesu izvedbe različnih gibov, med motoričnim učenjem s premikanjem skeleta in brez premikanja. Z opravljeno meritvijo v koprski Taverni je vsak udeleženec pridobil vstopnico za popoldanski del dogodka, ki je potekal v Gledališču Koper. Na njem so strokovnjaki spregovorili o pomenu in vlogi spremljanih značilnosti za zdravje. Prevečkrat si namreč želimo »izmeriti zdravje«, se primerjati z veljavnimi normami, ne da bi hkrati o merje- nih parametrih in kazalnikih (ne)zdravja vedeli kaj več. Eminentni predavatelji, vrhunski strokovnjaki, so poskušali poiskati odgovore na vprašanja, kaj sploh je celostno zdravje ter kako mišično, kognitivno in srčno-žilno zdravje tvorijo celoto. Prim. mag. Dorjan Marušič, dr. med., je tako spregovoril o srčno-žilnem zdravju, doc. dr. Bojan Rojc o ne- vromišičnem zdravju, izr. prof. dr. Uroš Marušič pa o kognitivnem zdravju. Pogovor sta povezovala idejna očeta srečanja prof. dr. Rado Pišot in doc. dr. Mla- den Gasparini. Dogodek je ponovno združil Gledališče Koper, ZRS Koper in SB Izola v želji, da bi prispevali h kakovosti zdravja in življenja naših občanov, zato ga je tudi tokrat podprla Mestna občina Koper. Boštjan Šimunić, Nika Štravs, Matej Kleva, Peter Čerče ANNALES KINESIOLOGIAE • 12 • 2022 • 2 197 GUIDELINES FOR AUTHORS, 197–200 GUIDELINES FOR AUTHORS 1. Aim and scope of the journal: Annales Kinesiologiae is an international interdisciplinary journal covering kinesiology and its related areas. It combines fields and topics directed towards the study and research of human movement, physical activity, exercise and sport in the context of human life style and influences of specific environments. The journal publishes original scientific articles, review articles, technical notes and reports. 2. General policy of Annales Kinesiologiae Annales Kinesiologiae pursues the multi-disciplinary aims and nature of Kinesiology with the main goal to promote high standards of scientific research. a) Reviewing: Each manuscript, meeting the technical standards and falling within the aims and scope of the journal, will be subjected to a double-blind peer-review by two reviewers. Authors can propose up to two reviewers for revision of their work and also up to two reviewers they would like to avoid. The referees are chosen by the Editors. Assessments by the referees will be presented anonymously to the author and will be returned to the author for correction. The corrected copy of the manuscript, with the list of corrections on a separate page, should be returned to the responsible Editor. b) Permissions: Authors wishing to include figures, tables, or text passages that have been published elsewhere, are required to obtain permission from the copyright owner(s) and to include evidence that such permission has been granted when submitting their manuscript. Any material received without such evidence it will be assumed that the authors hold the copyright. c) Copyright agreement: Submitting the article through the OJS (Open Journal System), the corresponding author will be asked to accept the terms of the copyright agreement. The aforementioned agreement is effective if and when the article submitted to be published in Annales Kinesiologiae is accepted. 3. Manuscript preparation a) Language and style: The language of Annales Kinesiologiae is USA English. The authors are responsible for the language, grammar, and style of the manuscript, which need to meet the criteria defined in the guidelines for authors. Manuscripts are required to follow a scientific style style. The journal will be printed in grayscale. b) The length of the manuscript should not exceed 36,000 characters (excluding spaces). Text formatting: It is required to use the automatic page numbering function to number the pages. Times New Roman font size 12 is recommended, with double spacing between lines. Use the table function, not spreadsheets, to make tables. Use an equation editor for equations. Finally, all lines need to be number, were the first line of a pages is assigned line number 1. c) Miscellaneous: Whenever possible, use the SI units (Système international d’unités). 198 GUIDELINES FOR AUTHORS, 167–200 ANNALES KINESIOLOGIAE • 12 • 2022 • 2 d) The title page should include the title of the article (no more than 85 characters, including spaces), full names of the author(s) and affiliations (institution name and address) of each author; linked to each author using superscript numbers, as well as the corresponding author’s full name, telephone, and e-mail address. e) The authors are obliged to prepare two abstracts – one short abstract in English and one (translated) in Slovene language. For foreign authors translation of the abstract into Slovene will be provided. The content of the abstract should be structured into the following sections: purpose, methods, results, and conclusions. It should only contain the information that appears in the main text, and should not contain reference to figures, tables and citations published in the main text. The abstract is limited to 250 words. f) Under the abstract a maximum of 6 appropriate Keywords shall be given in English and in Slovene. For foreign authors the translation of the key words into Slovene will be provided. g) The main text should include the following sections: Introduction, Methods, Results, Discussion, Conclusions, Acknowledgement (optional), and References. Individual parts of the text can form sub-sections. h) Each table should be submitted on a separate page in a Word document after the Reference section. Tables should be double-spaced. Each table shall have a brief caption; explanatory matter should be in the footnotes below the table. Abbreviations used in the tables must be consistent with those used in the main text and figures. Definitions of symbols should be listed in the order of appearance, determined by reading horizontally across the table and should be identified by standard symbols. All tables should be numbered consecutively Table 1, etc. The preferred location of the table in the main text should be indicated preferably in a style as follows: *** Table 1 somewhere here ***. i). Captions are required for all figures and shall appear on a separate manuscript page, under the table captions. Each figure should be saved as a separate file without captions and named as Figure 1, etc. Files should be submitted in *.tif or *.jpg format. The minimum figure dimensions should be 17x20 cm and a resolution of at least 300 dpi. Combinations of photo and line art should be saved at 600–900 dpi. Text (symbols, letters, and numbers) should be between 8 and 12 points, with consistent spacing and alignment. Font type may be Serif (Times Roman) or Sans Serif (Arial). Any extra white or black space surrounding the image should be cropped. Ensure that participant-identifying information (i.e., faces, names, or any other identifying features) should be omitted. Each figure should be saved as a separate file without captions and named as Figure 1, etc. The preferred location of the figure in the main text should be indicated preferably in a style as follows: *** Figure 1 somewhere here ***. ANNALES KINESIOLOGIAE • 12 • 2022 • 2 199 GUIDELINES FOR AUTHORS, 197–200 j) References The journal uses the Harvard reference system (Publication Manual of the American Psycho- logical Association, 6th ed., 2010), see also: https://www.apastyle.org). The list of references should only include work cited in the main text and being published or accepted for publication. Personal communications and unpublished works should only be mentioned in the text. Referen- ces should be complete and contain up to seven authors. If the author is unknown, start with the title of the work. If you are citing work that is in print but has not yet been published, state all the data and instead of the publication year write „in print“. Reference list entries should be alphabetized by the last name of the first author of each work. Titles of references written in languages other than English should be additionally translated into English and enclosed within square brackets. Full titles of journals are required (no abbreviati- ons). Where available, DOI numbers should be provided in the form of a resolvable URL https:// doi.org/10.1037/rmh0000008. Examples of reference citation in the text One author: This research spans many disciplines (Enoka, 1994) or Enoka (1994) had con- cluded... Two authors: This result was later contradicted (Greene & Roberts, 2005) or Greene and Roberts (2005) pointed out... Three to six authors: a) first citation: Šimunič, Pišot and Rittweger (2009) had found... or (Šimunič, Pišot & Rit- tweger, 2009) b) Second citation: Šimunič et al. (2009) or (Šimunič et al., 2009) Seven or more authors: Only the first author is cited: Di Prampero et al. (2008) or (Di Prampero et al., 2008). Several authors for the same statement with separation by using a semicolon: (Biolo et al., 2008; Plazar & Pišot, 2009) Examples of reference list: The style of referencing should follow the examples below: Books Latash, M. L. (2008). Neurophysiologic basis of movement. Campaign (USA): Human Ki- netic. Journal articles Marušič, U., Meeusen, R., Pišot, R., & Kavcic, V. (2014). The brain in micro- and hyper- gravity : the effects of changing gravity on the brain electrocortical activity. European journal of sport science, 14(8), 813–822. https://doi.org/10.1080/17461391.2014.908959 200 GUIDELINES FOR AUTHORS, 167–200 ANNALES KINESIOLOGIAE • 12 • 2022 • 2 Šimunič, B., Koren, K., Rittweger, J., Lazzer, S., Reggiani, C., Rejc, E., … Degens, H. (2019). Tensiomyography detects early hallmarks of bed-rest-induced atrophy before changes in muscle architecture. Journal of applied physiology, 126(4), 815–822. https://doi.org/10.1152/ japplphysiol.00880.2018 Book chapters Šimunič, B., Pišot, R., Mekjavić, I. B., Kounalakis, S. N. & Eiken, O. (2008). Orthostatic intolerance after microgravity exposures. In R. Pišot, I. B. Mekjavić, & B. Šimunič (Eds.), The effects of simulated weightlessness on the human organism (pp. 71–78). Koper: University of Primorska, Scientific and research centre of Koper, Publishing house Annales. Rossi, T., & Cassidy, T. (in press). Teachers’ knowledge and knowledgeable teachers in physical education. In C. Hardy, & M. Mawer (Eds.), Learning and teaching in physical educati- on. London (UK): Falmer Press. Conference proceeding contributions Volmut, T., Dolenc, P., Šetina, T., Pišot, R. & Šimunič, B. (2008). Objectively measures physical activity in girls and boys before and after long summer vacations. In V. Štemberger, R. Pišot, & K. Rupret (Eds.) Proceedings of 5th International Symposium A Child in Motion “The physical education related to the qualitative education” (pp. 496–501). Koper: University of Primorska, Faculty of Education Koper, Science and research centre of Koper; Ljubljana: University of Ljubljana, Faculty of Education. Škof, B., Cecić Erpić, S., Zabukovec, V., & Boben, D. (2002). Pupils‘ attitudes toward endurance sports activities. In D. Prot, & F. Prot (Eds.), Kinesiology – new perspectives, 3rd International scientific conference (pp. 137–140), Opatija: University of Zagreb, Faculty of Ki- nesiology. 4. Manuscript submission The article should be submitted via online Open Journal Systems application, which is open source journal management and publishing software at http://ojs.zrs-kp.si/index.php/AK/ about/submissions. All the communication process with authors proceeds via Open Journal System and e-mail. 5. For additional information regarding article publication, please do not hesitate to contact the secretary of Annales Kinesiologiae. ISSN 1318-0185ISSN 2232-2620 A nnaleSK inesiologiae