High-performance Athletes Research Articles (Page 1)

Background: Sudden cardiac death (SCD) remains an intriguing and devastating event among competitive athletes, disproportionately affecting male basketball players (MBP), prominently African Americans. Physiological cardiac remodeling is expected in this group due to high-intensity interval training. However, distinguishing adaptive from maladaptive changes remains challenging. Cardiac troponin I (cTnI), typically is used for myocardial infarction, may also reflect subclinical injury when repeatedly elevated post-exercise. Methods: We performed a systematic review and meta-analysis (PROSPERO: CRD420251047421) following PRISMA guidelines. Observational studies from 2000–2025 in English and Portuguese were included if they reported cTnI levels, structural cardiac parameters (LV mass index [LVMI], relative wall thickness [RWT], or left ventricular diameter [LVD]), ECG findings, or SCD in male athletes aged 14–40. Data from 35 studies were included. Random-effects meta-analyses were performed using the DerSimonian–Laird method, and heterogeneity assessed via I^2. Results: We analyzed data from 580 athletes for RWT, 108 for LVD, 566 for LVMI, and 176 for cTnI. LVMI was higher in basketball players than in military or endurance athletes. NBA players with abnormal ECGs had higher LVMI (-114 vs. -111 g/m^2). RWT was elevated in athletes with early repolarization (0.49 vs. 0.38), suggesting concentric remodeling. LVD was greatest in endurance athletes (56 mm) and intermediate in basketball players (50–54 mm). Post-exercise cTnI increased by a pooled mean of +0.115 ng/mL (95% CI: 0.089–0.142), with higher values in athletes with fibrosis or concentric patterns. T-wave inversion was more common in athletes with abnormal geometry (OR: 4.12, 95% CI: 2.3–7.4), often coexisting with elevated RWT and cTnI. Conclusion: MBP exhibit a hybrid remodeling pattern due to their training load profile, combining volume overload (typical of endurance sports) and pressure overload (typical of strength sports). Often considered benign, these findings may mimic pathological features, as gray zones complicates clinical decision-making in athletes. Persistent post-exercise elevations in cTnI may reflect subclinical myocardial stress and carry long-term prognostic significance. Integrating ECG, imaging, and cTnI monitoring could enhance early risk stratification and SCD prevention in high-performance athletes. Longitudinal studies are needed to confirm prognostic value and guide screening strategies.

Introduction: Burnout and pre-competition anxiety are interrelated phenomena that affect the well-being and performance of elite athletes. Valid instruments to assess these constructs are essential. Objective: To validate the Athlete Burnout Inventory-Revised (IBD-r) in the Uruguayan high-performance athlete population. Methodology: To this end, 121 high-performance athletes from Uruguay who participated in the recent Pan American Games, ranging in age from 14 to 52 years (M = 24.01; SD = 6.2), were evaluated. The Athlete Burnout Inventory-Revised (IBD-R; Garcés de Los Fayos et al., 2012) was administered, as well as the Competitive State Anxiety Inventory (CSAI-2), developed in an initial version by Martens (1977). Results: The results indicated an acceptable overall internal consistency (.71), similar to that found by Garces de los Fayos, De Francisco, and Arce (2012) with the IBD-R, and by Maslach and Jackson (1981) with the Maslach Burnout Inventory (MBI). Furthermore, confirmatory factor analysis indicated a good fit of the three-dimensional model, demonstrating a solid psychometric structure. Discussion: The IBD-R is a valid and reliable tool for assessing burnout in high-performance individuals. Furthermore, pre-competitive anxiety was confirmed as a significant predictor of burnout, highlighting the need for preventive psychological interventions.

Patellar tendinopathy is one of the most frequent injuries among high-performance athletes, especially soccer players, due to the repetitive overload imposed on the lower limbs. This study aimed to analyze, through an integrative literature review, the main physiotherapeutic strategies aimed at the prevention and treatment of this condition. The search was conducted in the SciELO, PubMed, and Brazilian Journal of Physical Therapy databases, considering publications from the last ten years. Twenty articles addressing preventive and therapeutic methods were selected, highlighting the role of progressive load exercises, with emphasis on eccentric, isometric, and proprioceptive contractions, combined with individualized training control. It was observed that complementary resources, such as shockwave therapy and percutaneous electrolysis, enhance the effects of supervised exercise and reduce recurrences. It is concluded that continuous physiotherapeutic intervention, combined with muscle strengthening and appropriate load management, is essential for maintaining performance and preventing patellar tendinopathy in professional soccer players.

This study aimed to explore high-performing dancers’ and athletes’ perceptions of motherhood compatibility and provide recommendations, based on pregnancy experiences, to support the journey from preconception to pregnancy disclosure. A multi-methods design included an online survey with 51 high-performance dancers and athletes from 10 countries, followed by semi-structured interviews with 2 high-performance dancers and 6 athletes from the UK who had experienced pregnancy. Thematic analysis was applied to data before exploring findings though a bioecological lens. Microsystem role models were found to positively influence perceptions of motherhood compatibility. While UK exosystem policies for pregnant athletes supported this view, broader support remains lacking. Factors such as limited evidence, personal goals, age, and inadequate support contributed to perceptions of incompatibility. Support recommendations include better microsystem education and psychological support, clearer and flexible exosystem and microsystem policies and funding, and macrosystem cultural acceptance to help athletes navigate pregnancy and motherhood in high-performance environments.

ABSTRACT Talent identification and development are fundamental processes for cultivating high-performance athletes in sport. However, these processes remain insufficiently understood in regions such as the Middle East, Africa, Latin America, the Caribbean, Pacific Oceania, and Asia. These areas often face challenges including limited infrastructure, resource constraints, and sociocultural barriers, which complicate the identification and nurturing of emerging talent. This study employs a qualitative approach, drawing on insights from semi-structured interviews with a sample composed of the ten development officers from the International Tennis Federation (ITF) who are based in these regions. Reflective thematic analysis was used to identify four key factors: structures and systems, economic challenges, access, and support influencing the effectiveness of developmental systems. By examining the nuanced interactions between these factors, the study identifies key obstacles and facilitators within these regions. The findings offer practical recommendations to improve talent pathways and ensure a more equitable distribution of opportunities. This work contributes to ongoing discussions in sports science, emphasising the need for inclusive and context-sensitive approaches to athlete development in underrepresented areas of the global tennis landscape.

ABSTRACT The aim of this study was to explore criteria for return to sport (RTS) across physical, psychological, social, and contextual domains from the perspectives of key decision-makers. In-depth semi-structured interviews were conducted with 15 clinicians [9 physiotherapists, 6 Sport and Exercise Medicine (SEM) doctors] working in elite-level clubs across Europe and Asia, averaging 70 minutes per interview. Data were transcribed, thematically analysed using the framework method, and triangulated with participants. Three core themes were identified: 1) definitions of RTS, 2) actors and processes, and 3) criteria for RTS. SEM doctors and physiotherapists were viewed as pivotal decision-makers, with athletes’ preferences central. Findings support defining RTS as a continuum of phases and adopting a biopsychosocial, criteria-based, and shared decision-making approach. Consensus on relevant factors and athlete preferences is needed to guide future research, including trials and longitudinal studies assessing the efficacy of RTS protocols for musculoskeletal injuries.

In this commentary we introduce athletic retirement literacy (ARL) as a concept and a novel approach for summarizing and structuring athletic retirement competencies to inform sport psychology practice. Meta-reflections from three recent papers about athletes’ mental health, transition literacy, and transition interventions (Schinke et al., 2024; Stambulova et al., 2025; Stambulova & Schinke, 2025) helped to formulate rationale for a specific focus on ARL. Following the promotion of mental health literacy as well as transition literacy among athletes and their supporters in this commentary we (a) define ARL among high-performance athletes as a set of basic competencies helping them and their supporters to understand the transition to a post-sport career from the individual and ecological perspectives, communicate about it, and make informed decisions and planning; (b) propose a schematic illustration of ARL structure with four major clusters of competencies, and (c) promote ARL-informed interventions. We believe that ARL-informed sport psychology practice will lead to reduced mental health concerns, improved general resilience, and a healthy path forward among retired athletes.

Studies conducted in various countries have demonstrated that childhood interpersonal violence (IV), encompassing psychological, physical, sexual violence, and neglect, is a widespread issue in high-performance sports. However, research in this area has largely focused on countries in the Global North, and no prevalence studies have been conducted within Brazilian sport. This study examined the prevalence of childhood IV among high-performance athletes in Brazil, explored gender differences, and identified associated risk factors. A total of 857 high-performance Brazilian athletes completed the survey about their experiences in sport before the age of 18. The sample included 563 women, 290 men, and 4 individuals who either did not disclose their gender or identified as non-binary, fluid, or queer. The findings indicate that childhood IV is a widespread issue, with 93% of athletes reporting having experienced at least one form of IV. Psychological violence and neglect were most common (91%), followed by sexual violence at 63% and physical violence at 55%. The study also showed that having a professional sports contract after the age of 18 and practicing a team sport were associated risk factors for physical violence. Moreover, athletes with a professional contract were more likely to experience psychological violence in the context of their sport. Finally, practicing a para-sport was associated with a lower risk of reporting psychological violence. These findings underscore the urgent need for targeted safeguarding measures and evidence-informed policies to prevent childhood IV in Brazilian sport.

BackgroundDoping remains an ongoing threat to clean competition. To date, global preventive initiatives have not addressed critical psychosocial antecedents of doping thoroughly due to the scarcity of knowledge regarding its psychosocial mechanisms from a harmonised cross-country perspective. We, therefore, conducted a multi-country investigation testing the interplay of two important yet overlooked attributes, namely narcissism and self-compassion, and examined their psychosocial mechanisms underpinning doping.MethodsUsing a sample of 499 high-performing athletes (80% competing at national level or above) from the UK, US, and China, we performed a series of multi-variate multi-group moderation models to test the narcissism × compassion interaction on doping and examined potential psychosocial mechanisms underlying such effects. In all analyses, we applied cluster control to adjust for coach-/team-level confounds and compared fixed vs. random effects models for cross-country comparisons.ResultsWe found an identical interaction across study countries showing self-compassion alleviates narcissism-related doping willingness (especially that vulnerable narcissism drives). Grandiose narcissism’s protective effect on vulnerable narcissism-related doping moral disengagement was invariant across countries. Resilient coping appears to be a consistent mechanism across study countries that explains narcissism-related risk and compassion-related protection. Fear of failure manifested varied mechanistic effects in different study countries, inferring potential cross-cultural differences.ConclusionVulnerable narcissism is a critical person-level correlate of doping. Grandiose narcissism, in the presence of self-compassion, can alleviate such risk thanks to enhanced resilient coping. Future education and interventions should tackle these important person-level attributes for anti-doping.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12954-025-01304-x.

ABSTRACTBackgroundNutrient timing strategies are commonly employed by athletes to support recovery, sleep quality, muscle protein synthesis, and overnight metabolic regulation. However, limited research has explored the glycemic impact of different macronutrients consumed prior to sleep, particularly in elite female athletes. α-lactalbumin (ALA), a whey-derived protein rich in tryptophan, has been proposed to support stable overnight glucose levels and sleep quality. In contrast, carbohydrate (CHO) ingestion before bed is known to acutely elevate blood glucose, yet its influence on nocturnal glycemia during sleep remains less understood in high-performing athletes. This This study compared the effects of pre-sleep ingestion of ALA, casein (CAS), CHO, and a non-caloric placebo (PLA) on nocturnal continuous glucose monitoring (nCGM) metrics over a 4-week, randomized, double-blind, crossover study in elite female athletes.MethodsEach participant consumed one of four pre-sleep treatments—40 g of ALA, CAS, CHO, or a non-caloric PLA – for three consecutive nights per condition. Supplement was taken 2 hours after the final meal and 30 minutes before bedtime. Blood glucose was tracked every 15 minutes using continuous glucose monitoring (CGM) devices that were worn on the back of the arm for the duration of the study. Glycemic responses were collected for 24 hours each day of the study; starting from the two hours before the participants reported their bedtime, while they were sleeping, and continued up to the hour after the participant reported waking up was analyzed. Participants reported their bed and wake times in daily surveys, and CGM data was matched accordingly. Repeated measures ANOVA was used to evaluate the effects of time, condition, and time × condition interaction on glucose concentrations.ResultsSix NCAA Division I female athletes (n = 6; Age: 22.5 ± 0.96 yrs, Height: 1.68 ± 0.06 m, Weight: 60.77 ± 7.02 kg) completed the study. A significant main effect of time on nocturnal glucose was observed (p = 0.008), reflecting expected glycemic variation during sleep. However, no significant differences were found between macronutrient conditions (p = 0.187), and there was no time × condition interaction (p = 0.550), suggesting the type of macronutrient ingested before bed did not significantly influence overnight glucose dynamics. Wake-time blood glucose values also did not differ significantly across conditions (p = 0.58).ConclusionPre-sleep ingestion of protein (ALA or CAS), carbohydrate, or placebo does not significantly impact nocturnal or next-morning glycemic control in elite female athletes. These findings suggest that pre-sleep macronutrient intake can be flexibly applied without negatively affecting overnight glucose regulation in elite female athletes.

Functional movement screen (FMS) is widely utilized in judo to assess movement patterns and identify potential deficiencies. The main objective of this study was to compare FMS results between high-performance (HP) and recreational-level (RL) judo athletes. Additionally, we examined asymmetries within each group. A cross-sectional study was conducted on 49 male judo athletes, with 23 in the HP group and 26 in the RL group. Functional movement was assessed using the FMS battery, and differences between and within groups were analyzed. The HP group achieved a higher total FMS Score (17.09±1.38) compared to the RL group (16.50±2.42), but the difference was not statistically significant (P=0.51; r=-0.29). Significant differences were observed favoring HP athletes in the hurdle step test for the left leg (P=0.013; r=0.35) and in the rotator stability test, with HP athletes scoring higher on both the left (P=0.001; r=0.47) and right sides (P=0.030; r=0.31). In contrast, RL athletes demonstrated significantly better results in the right shoulder mobility test (P=0.028; r=0.31). Within-group analysis revealed asymmetries in HP athletes in the hurdle step test (right vs. left, P=0.042; r=0.41), whereas RL athletes showed asymmetries in the in-line lunge test (right vs. left, P=0.011; r=0.48). The HP group demonstrated superior trunk rotational stability, suggesting that the rotator stability test may serve as a distinguishing factor among judo athletes of varying competitive levels. Additionally, shoulder mobility limitations in HP judo athletes were highlighted. The presence of movement asymmetries within both groups suggests potential imbalances that could impact injury risk and performance. These findings emphasize the importance of targeted training interventions to enhance movement quality and address asymmetries in judo athletes. Furthermore, judo appears to be an effective activity for improving functional movement even at the recreational level, as indicated by the relatively high FMS Scores among RL athletes.

High-performance athletes navigate a delicate balance between stress and recovery to optimize performance and mitigate risks of injury and burnout. This qualitative study investigated the athletes’ perceptions, motivations, and behaviors toward recovery, and factors influencing recovery engagement. Guided by a critical realist ontology, semi-structured interviews were conducted with nine coaches and eight athletes from national to world-class levels across various sports. Data were subsequently analyzed using reflexive thematic analysis. Three main themes were developed: Factors Shaping Recovery, Maintaining Motivation and Adherence, and Barriers to Recovery Engagement. The findings reveal that athletes and coaches differed in their understanding of the purpose of recovery; athletes primarily viewed recovery as a means to prevent injury and reduce fatigue, while coaches emphasized its role in enhancing performance. Recovery strategies were more consistently followed when they were convenient and satisfying, but a lack of education concerning recovery, disrupted routines, and sleep restrictions frequently hindered effective recovery. These results affirm the need for future research to target educational programs to enhance recovery knowledge, integrate recovery routines into training schedules, and foster supportive coach-athlete relationships to ensure consistent and effective recovery strategies.

Mental health research on elite athletes in Asian populations trails behind that of the West, especially in multiethnic societies such as Singapore. This study explored the prevalence and risk factors associated with mental health symptoms among national athletes in Singapore across various sports. Singapore national athletes answered an internet-based questionnaire comprising validated screening tools for symptoms of four mental health conditions - athlete-specific psychological strain, depression, anxiety and disordered eating. A total of 356 athletes participated in the study. Of these, 70% of respondents reported 'high' to 'very high' levels of athlete-specific psychological strain, 41% reported clinically significant ('mild' to 'severe') depressive symptoms, 18% reported 'moderate' to 'severe' anxiety symptoms, and 16% were suspected for disordered eating. Females were more likely to have clinically significant depressive (adjusted odds ratio [aOR] 3.44, P < 0.001) and anxiety (aOR 2.59, P = 0.006) symptoms compared to males. Athletes of Indian ethnicity were more likely to have depressive (aOR 4.18, P = 0.018), anxiety (aOR 4.24, P = 0.032) and psychological strain (aOR 11.83, P = 0.021) symptoms than their Chinese counterparts. Athletes who recently underwent a change in school (aOR 8.89, P = 0.002) or major examinations (aOR 3.23, P = 0.014) were more likely to have depressive symptoms than those who did not. Respondents with a current injury were more likely to experience greater athlete-specific psychological strain (odds ratio 1.79, P = 0.031) compared to those who were not injured. High-performance athletes from various sports in multiethnic Singapore carried a significant burden of poor mental health, comparable to both the local general population and Western sporting populations. Prioritisation of resources to target high-risk groups may serve to bridge the sizeable treatment gap.

Abstract Background Guidelines of cardio-oncology recommend implementation of maintained exercise intervention in outpatient treatment. Although awareness of cancer therapy-related cardiac dysfunction (CTRCD), coronary artery disease (CAD), and heart failure (HF) is growing with the advent of new oncological treatment regimens, the value of exercise to prevent adverse cardiac events and improve outcomes remains underrated. Purpose To propose an outpatient setting for sports intervention in cardio-oncological patients to reduce the burden of cardiovascular disease. Methods We report the setting at our institution to facilitate the early diagnosis and treatment of adverse cardiac events in cancer patients. Patients are referred to our department from the cooperating cancer treating centers before, during and after cancer therapy. Following assessment of cardiac biomarkers and echocardiography, patients undergo cardiopulmonary exercise testing with blood gas analysis to determine cardiorespiratory fitness and identify cardiac, pulmonary, circulatory, and peripheral limitations. Basic resistance tests are added to assess muscle strength. The results are used to provide individualized exercise prescriptions. Similar to high-performance athletes, sports cardiologists and sports scientists re-assess performance at the end of each training (chemo-) cycle. Results are discussed with the treating oncologists. Prior to inclusion, patients can attend sports medical consultation hours, where a concise overview of training offers is provided. Reference to this consultation is provided by the treating oncologists. Stable patients without relevant comorbidities are integrated into cooperating outpatient physiotherapeutic care or cancer sports groups. Exercise training consists of resistance, endurance as well as balance training. In cooperation with the departments of gynaecology and obstetrics as well as gastroenterology small training groups are being established to exercise with patients with more severe impairments. After initial on site- training with a sports scientist, patients receive access to our online video exercise program, where the aim of each specific activity is demonstrated and explained by a sports scientist. Thus, patients can maintain their efforts by home-based training. Within clinical trials we also provide video-supported home-based exercise training in cancer patients, which is also performed during chemotherapy to facilitate response to treatment and counteract treatment associated side-effects. Conclusions Our approach implements sports cardio-oncology and sports science into oncological treatment as a means for pre- and rehabilitation, maintenance therapy and as an adjunct to chemotherapy. This concept should serve to mitigate the burden of CTRCD, CAD and HF.

The COVID-19 pandemic significantly impacted high-performance athletes (HPAs) by affecting their training and participation in competitions due to cancellations. The aim of this study is to analyze HPAs' physical activity, sedentary behavior, and mental health during and after the COVID-19 lockdown while considering sex and type of sport. A repeated-measures observational study with a census sampling approach (N = 556) HPAs from a public university in Mexico. Informed consent was obtained, and a survey was administered in person and online. Physical activity and sedentary behavior were measured using the International Physical Activity Questionnaire (IPAQ), and mental health was assessed using the Profile of Mood States (POMS). Percentages, means, standard deviations, Student's t-test, and Kruskal-Wallis tests were analyzed. Participants were an average age of 19.5years; 50.2% were male, 55.9% practiced ball sports, 28.5% engaged in athletic sports, and 15.6% participated in combat sports. During confinement, 63.1% reported a high level of physical activity, which increased to 89.4% after confinement (X2 = 20.37, p < 0.0001). Moreover, 86% exhibited sedentary behavior during confinement, which decreased to 57.9% afterward (p < 0.00001). No significant differences were found considering sex or type of sport. Regarding mental health, significant improvements were observed in all dimensions by sex and type of sport (p < 0.05), except for the vigor dimension. The lockdown impacted HPAs' physical activity levels and mental health. After confinement, athletes increased their levels of vigorous physical activity and reduced sedentary behavior, reflecting adaptation to the new circumstances. Mental health indicators improved post-lockdown, although differences by sex and type of sport persisted in certain aspects.

Ankle injuries are a common concern among track and field athletes, particularly sprinters, due to the high mechanical demands placed on the ankle during rapid acceleration, deceleration, and repeated forceful foot strikes. These injuries, if not addressed promptly and appropriately, may significantly affect athletic performance and career longevity. This case report presents a national-level female 100m sprinter who developed progressive left anterior ankle joint line pain extending to both medial and lateral joint lines extending over one month, affecting her ability to train and compete. Despite symptomatic treatment and continuation of intense training, her symptoms persisted, prompting her to seek specialized care. This case highlights the clinical approach to diagnosing and managing ankle pain in a high-performance athlete, with particular focus on footwear assessment, imaging correlation, and a comprehensive rehabilitation plan that ultimately enabled the athlete to return to peak performance and surpass her personal best.

The squat is one of three lifts within the sport of powerlifting. This study examined how increasing intensity in the squat affects joint contact forces in elite powerlifters. Twenty-nine Austrian top-ranked powerlifters (16 male, 13 female) performed squats at 70% to 90% of their one-repetition maximum (1-RM). 3D motion capture and force plate data were used to estimate joint contact forces using musculoskeletal modelling. In contrast to the hip and ankle joints, which exhibited peak resultant joint contact forces in the deepest squat positions, the tibiofemoral and patellofemoral joints maintained consistently high loads over a broad portion of the squat cycle. During large parts of the concentric phase, the resultant joint contact forces did not significantly differ between intensity conditions, with the exception of the hip joint contact force. At 90% 1-RM, average peak joint contact forces reached 15.5 ± 3.0 times body weight (BW), 23.2 ± 3.9 BW, 26.7 ± 4.3 BW, and 11.5 ± 2.2 BW for the hip, tibiofemoral, patellofemoral, and ankle joint, respectively. The high and sustained joint contact forces observed in our study emphasise the need for load management strategies to optimise performance and reduce injury risk. These insights offer a valuable foundation for tailoring strength training programs and supporting long-term joint health in high-performance athletes.

The squat is one of three lifts within the sport of powerlifting. This study examined how increasing intensity in the squat affects joint contact forces in elite powerlifters. Twenty-nine Austrian top-ranked powerlifters (16 male, 13 female) performed squats at 70% to 90% of their one-repetition maximum (1-RM). 3D motion capture and force plate data were used to estimate joint contact forces using musculoskeletal modelling. In contrast to the hip and ankle joints, which exhibited peak resultant joint contact forces in the deepest squat positions, the tibiofemoral and patellofemoral joints maintained consistently high loads over a broad portion of the squat cycle. During large parts of the concentric phase, the resultant joint contact forces did not significantly differ between intensity conditions, with the exception of the hip joint contact force. At 90% 1-RM, average peak joint contact forces reached 15.5 ± 3.0 times body weight (BW), 23.2 ± 3.9 BW, 26.7 ± 4.3 BW, and 11.5 ± 2.2 BW for the hip, tibiofemoral, patellofemoral, and ankle joint, respectively. The high and sustained joint contact forces observed in our study emphasise the need for load management strategies to optimise performance and reduce injury risk. These insights offer a valuable foundation for tailoring strength training programs and supporting long-term joint health in high-performance athletes.

Accurate assessment of body composition is essential for monitoring health and performance in high-performance athletes. While anthropometric equations are widely used in conventional sports, their validity in athletes with unilateral lower-limb amputation remains unclear due to assumptions of symmetrical fat and muscle distribution. This study aimed to assess the concurrent validity and reliability of anthropometric equations for estimating body composition in this population, using Dual-energy X-ray Absorptiometry (DEXA) as the reference method. A cross-sectional study was conducted with 27 athletes (22 men, 5 women; mean age 32 ± 7.4) from para-sports including athletics, swimming, triathlon, and others. Anthropometric measurements and DEXA were used to estimate body density (BD), fat percentage (FP), lean percentage (LP), lean mass (LM), and fat mass (FM). Forty-seven anthropometric equations were evaluated. Validity was assessed using Pearson or Spearman correlation coefficients, reliability with Intraclass Correlation Coefficients (ICC), and agreement through Bland-Altman analysis and Reduced Major Axis (RMA) regression. For FP, the Hastuti equation and the ISAK 5 components model showed the closest agreement with DEXA (mean differences 0.7 ± 4.55%, and 0.32 ± 4.8%, respectively; ICCs > 0.83). Durnin and Womersley with Siri also showed high reliability but a greater bias (2.6 ± 3.69%). For FM, the ISAK 5 components model and Lee DH equation demonstrated acceptable agreement (mean differences -0.71 ± 3.64% and 1.04 ± 4.35%, respectively; ICCs > 0.85). For LM, the Olshvang, Chien, and Lee DH equations showed the strongest agreement with DEXA (ICCs > 0.87). The Hastuti and the ISAK 5 components model are recommended to estimate FP. For FM, we recommend the ISAK 5 components model, followed by Lee DH equations, and for LM, the Olshvang, Chien and Lee DH. Finally, we do not recommend the use of any of the Lee, Poortsman, or ISAK 5 components model equations to estimate LP in this population.

This paper explores the New Zealand (NZ) high-performance sport industry from the perspective of occupational health and safety (OHS). High-performance athletes face significant psychosocial stresses and hazards in the course of their work, which have not been sufficiently addressed through top-down leadership, or safe systems of work. This paper outlines best practice for managing psychosocial hazards in the NZ high-performance sport industry, culminating in a proposed safeguarding policy. The “Proposed HPSNZ Policy: Wellbeing and Mental Health Support for High-Performance Athletes” is grounded in international best practice incorporating literature from OHS, hauora Māori (Māori health), and sport psychology. If implemented by High Performance Sport NZ (HPSNZ), this policy could safeguard NZ high-performance athletes from psychosocial workplace hazards. Such a policy was recommended following the death of NZ Olympian Olivia Podmore, and this paper presents a viable option allowing HPSNZ to fulfil that recommendation.