International Journal of Sport Nutrition and Exercise Metabolism, 2015, 25, 326 -334 http://dx.doi.org/10.1123/ijsnem.2014-0195 © 2015 Human Kinetics, Inc.
ORIGINAL RESEARCH
Evaluation of Sports Nutrition Knowledge and Recommendations Among High School Coaches Steven Couture, Benoit Lamarche, Eliane Morissette, Veronique Provencher, Pierre Valois, Claude Goulet, and Vicky Drapeau The objectives of this study were to evaluate high school coaches’ knowledge in sports nutrition and the nutritional practices they recommend to their athletes. Forty-seven high school coaches in “leanness” and “non-leanness” sports from the greater region of Quebec (women = 44.7%) completed a questionnaire on nutritional knowledge and practices. “Leanness sports” were defined as sports where leanness or/and low bodyweight were considered important (e.g., cheerleading, swimming and gymnastics), and “non-leanness sports” were defined as sports where these factors are less important (e.g., football). Participants obtained a total mean score of 68.4% for the nutrition knowledge part of the questionnaire. More specifically, less than 30% of the coaches could answer correctly some general nutrition questions regarding carbohydrates and lipids. No significant difference in nutrition knowledge was observed between coaches from “leanness” and “non-leanness” sports or between men and women. Respondents with a university education scored higher than the others (73.3% vs. 63.3%, p < .05). Coaches who participated in coaching certification also obtained better results than those without a coaching certification. The most popular source of information about nutrition used by coaches was the Internet at 55%. The two most popular nutrition practices that coaches recommended to improve athlete performance were hydration and consumption of protein-rich foods. Recommendation for nutritional supplements use was extremely rare and was suggested only by football coaches, a nonleanness sport. Findings from this study indicate that coaches need sports nutrition education and specific training. Keywords: coach knowledge, sports nutrition, nutritional practices Studies have shown that physical activity and exercise training may lead to nutrition-related problems in adolescence, a life period when energy requirements increase because of growth and hormonal changes (Benson et al., 1990). Although some athletes have adequate dietary habits (Aerenhouts et al., 2008; Croll et al., 2006; D’Alessandro et al., 2007), a high proportion of athletes do not meet their energy requirements, leading to important energy and nutritional deficits (D’Alessandro, et al., 2007; Ziegler et al., 2002). On the other hand, the use of supplements to manage body weight and to improve performance appears to be highly prevalent in young athletes. A study conducted among high school students indicated that the proportion of those believing in the beneficial effects of supplements on sports performance was higher among students who reported parCouture, Lamarche, Morissette, and Provencher are with the Institute of Nutrition and Functional Foods, Laval University, Québec, Canada. Valois is with the Dept. of Educational Fundamentals and Practices, Faculty of Education, Laval University, Québec, Canada. Goulet and Drapeau are with the Dept. of Physical Education, Faculty of Education, Laval University, Québec, Canada. Address author correspondence to Vicky Drapeau at [email protected].
326
ticipating in high levels of physical activity than among more sedentary students (Bell et al., 2004). One review indicated that 22–71% of child and adolescent athletes used supplements, of which vitamin and minerals were the most common (McDowall, 2007). The use of protein supplements is also highly frequent among young athletes involved in strength sports, such as football, and these athletes frequently have unrealistic expectations with regards to the actual benefits that protein supplementation may produce (Duellman et al., 2008). In terms of sports nutrition, several studies have shown that coaches represent one of the main sources of information and influence for young athletes (Douglas & Douglas, 1984; Krowchuk et al., 1989; McDowall, 2007). Most coaches, however, do not have formal training in nutrition (Graves et al., 1991). In this regard, it has been shown that 82% of high school wrestling coaches felt they had the competence to coach but that they were not well-informed regarding sports nutrition, weight loss and supplement use (Sossin et al., 1997). Moreover, average sports nutrition knowledge scores related to weight-loss practices, dieting, hydration and body composition assessment were considered low for these coaches (Sossin, et al., 1997). In other studies, the knowledge test identified a tendency to overvalue proteins, excessive low fat diets and food myths (Juzwiak &
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Sports Nutrition Knowledge Among Coaches 327
Ancona-Lopez, 2004) and almost half of coaches reported believing that proteins were a major source of energy for muscle (Baer, Dean, & Lambrinides, 1994; Bedgood & Tuck, 1983; Juzwiak & Ancona-Lopez, 2004). While most coaches acknowledge that rapid body weight loss may have negative effects on endurance, performance, strength and health (Sossin, et al., 1997), it appears that there are knowledge deficits related to body weight control and specific nutritional strategies related to pre, during and post training periods (Juzwiak & AnconaLopez, 2004). This situation is not entirely surprising considering that, at present, training and certification in nutrition is not entirely fully regulated nor is it formally required for coaches (Lemyre & Trudel, 2004). In summary, inadequate dietary intakes combined with misguided dietary practices, including use of supplements, appear to be highly prevalent among high school athletes. Coaches’ knowledge regarding sports nutrition also seems to be inadequate for educating and guiding their young athletes on this topic. This is of particular importance considering that coaches remain one of the main sources of information regarding sports nutrition for the young athlete. To our knowledge, no study evaluates nutrition knowledge and nutritional practices among high-school French Canadian coaches. Moreover, It is important to point out that, the most research regarding this sport nutrition has focus on coaches or athletes at the university or college level, thus involving athletes over the age of 18 or adults (McDowall, 2007; Petrie et al., 2004). In that context, the purpose of this study was 1) to evaluate high school coaches’ level of knowledge in sports nutrition, and 2) to describe the nature and quality of nutritional practices recommended to the young athletes they supervise.
Questionnaire Development and Content A questionnaire divided in four sections was developed for this study based on previously validated work by Parmenter & Wardle (1999) and other published literature (Marinaro, 2008; Zinn et al., 2005), as well as based on the researchers’ experiences in sports nutrition. Part I of the questionnaire was a “true/false/I don’t know” section, comprising of 54 questions on general and sports nutrition knowledge. The second part of the questionnaire included 4 specific questions (multiple-choice format) assessing knowledge about lipids, vitamins and precompetition meal. Part III of the questionnaire concerned nutritional recommendations that coaches made to their athletes to enhance performance (25 items with a yes/no format). In this part, areas of interest were the use of supplements for muscle gain and weight loss, the use of foods rich in carbohydrate and protein, and hydration practices. The last part of the questionnaire (part IV) gathered data on demographic and personal information about coaches’ education level, e.g., number of years of coaching, nutrition information sources, coaches’ training and certification. The questionnaire was reviewed by two dieticians specialized in sport nutrition for content validation. A pilot test was also performed with four coaches to verify comprehension of the questions. Adjustments to improve the comprehension of the questions were made after both evaluations. Moreover, after collecting all the data, the internal consistency was tested with Cronbach’s alpha which represent a valid measure of reliability (Kline, 1993). This was measured separately for the different questionnaire sections and indicates a good internal reliability of our questionnaire (all Cronbach’s alpha over 0.7, data not shown).
Data Analysis
Methods Sample Coaches working for either academic or extracurricular programs were recruited to participate in this study. Coaches were either recruited from sports categorized as “leanness” (e.g., gymnastic, swimming, cheerleading, etc), and sports categorized as “non-leanness” (e.g., basketball, football, tennis, badminton, etc.) (Martinsen et al., 2010). The “non-leaness” sports were selected based on popularity in this age group (12- to 17-years-old) to ensure adequate recruitment of participants. Football was the most represented “non-leanness” sport in the study. Coaches working with female athletes, male athletes, and both were eligible. With permission from the school administrators, participants were recruited through emails and posters distributed in one public and four private high schools of the greater Quebec City region offering these sport disciplines. Interested candidates were in communication with the project contact-person to verify eligibility. This study was approved by the Laval University Ethic Committee. All participants signed an informed consent form.
Data were analyzed using the Statistical Analysis System (SAS; v. 9.2 for Windows; Cary, NC). Three groups of coaches were defined for the purpose of the analysis: 1- non leanness group, i.e., mainly coaches involved in football, a sport that focuses on muscle mass and strength, 2- leanness group, i.e., coaches involved in sports with focus on aestheticism including cheerleading, gymnastics and swimming and, 3- others nonleanness group, i.e., coaches involved in sports not focusing primarily on gaining mass and strength such as basketball, soccer, crosscountry skiing. This third group was formed to include less represented “non-leanness” sports in the study i.e., those with a sample of coaches ranging between 1–3 and put together in the group “others” for facilitating the statistical analysis interpretation. One-way analysis of variance or Chi-Square test was used to examine differences in sports nutrition knowledge scores between between groups. T-test and general linear model (ANOVA) with a posteriori test (Tukey) were also used. Nonparametric test (Wilcoxon) was applied to validate some of our results obtained with the general linear model (ANOVA). A p-value of < 0.05 was considered statistically significant.
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328 Couture et al.
Table 1 Coach Characteristics Participants Characteristics (n = 47)
Percent of Coaches
NCCP certified
72%
Education
University: 51% College/ high-school: 49%
Experience in coaching
10 years or less: 57% More than 10 years: 43%
Coaching level
Regional/provincial: 43% National/international: 57%
Downloaded by New York University on 09/18/16, Volume 25, Article Number 4
Note. NCCP = National Coaching Certification Program
Figure 1 — Percentage of coaches reporting using sources of information for nutrition-related issues.
Results
Nutrition Knowledge
Sample Characteristics Participants included 47 coaches from five high schools in the greater region of Quebec (Table 1). Slightly over half were male (55.3%) with a mean age of 29.5 years ranging from 17 to 55 years. Coaching experience of the participants ranged from 1 to 30 years with an average of 9.5 years of experience. Almost 60% of the coaches considered that they were knowledgeable in the area of sport nutrition. The main source of information for nutrition-related issues used by coaches was the Internet (55%) (Figure 1). Friends, TV, colleagues and dieticians represented other important nutrition information sources for coaches.
The percentage of correct answers provided by coaches to all nutrition-related questions (part I) was similar when we compared the 3 groups of sport categories, with an average score of 68.4% (Table 2). The score of the leanness group on questions related to hydration, minerals and precompetition meal was significantly lower (p < .05) than in the nonleanness group (63.5 vs. 81.3%, respectively) and than the other coaches group (83.3%). There was also a tendency among the leanness group to have a lower score on questions related to carbohydrates. Table 3 indicates the questions to which more than 80% or fewer than 30% of all participants answered correctly. The overall nutrition knowledge scores were virtually identical among women and men (68.3 vs. 68.4%,
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Sports Nutrition Knowledge Among Coaches 329
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respectively). However, women obtained a higher score than men on questions related to weight management (75.4 vs. 62.2%, respectively, p < .05), but no other sex differences were observed. Number of years of coaching experience (< 10 years vs. ≥ 10) showed no association with nutrition knowledge. On the other hand, coaches with a university education had overall significantly better results than coaches with a lower education degree (73.3 vs. 63.3%, respectively, p < .05). The level of coaching (regional/provincial; n = 20 vs. national or international; n = 27) had no influence on the coaches’ overall knowledge. However, coaches involved at the national and international level obtained more correct answers on the weight management topic than other coaches (72.8 vs. 61.7%, respectively, p < .05).
Coaches certified by NCCP had significantly better scores than those who were not certified (70.9 vs. 61.7%, respectively, p < .05). Finally, coaches who rated themselves as knowledgeable in the area of sports nutrition scored significantly higher than those who rated themselves as less knowledgeable (71.1 vs. 62.9%, respectively, p < .05).
Nutritional Practices Coaches were asked to identify which nutritional practices they had recommended to their athletes to enhance performance (part III) from a predetermined list divided into five categories: 1) use of supplements for massbuilding, 2) use of supplements for weight loss, 3) consumption of foods rich in carbohydrates, 4) consumption
Table 2 Correct Responses to Nutrition Questions Separated by Sport Grouping Topic
Overall (%; n = 47)
Nonleanness (%; n = 16)
Leanness (%; n = 13)
Others (%; n = 18)
Protein
67.2
65.2
63.7
71.4
Carbohydrate
61.5
67.4
48.7
65.4
Lipids
71.5
72.7
67.3
73.6
Weight management
68.1
62.5
73.1
69.4
Supplements
68.9
68.8
63.8
72.7
Other
77.1
63.5
83.3 b
All topics/questions
68.4
81.3
ab
68.9
a
62.9
71.9
Note. No significant differences. ANOVA significant at p
ORIGINAL RESEARCH
Evaluation of Sports Nutrition Knowledge and Recommendations Among High School Coaches Steven Couture, Benoit Lamarche, Eliane Morissette, Veronique Provencher, Pierre Valois, Claude Goulet, and Vicky Drapeau The objectives of this study were to evaluate high school coaches’ knowledge in sports nutrition and the nutritional practices they recommend to their athletes. Forty-seven high school coaches in “leanness” and “non-leanness” sports from the greater region of Quebec (women = 44.7%) completed a questionnaire on nutritional knowledge and practices. “Leanness sports” were defined as sports where leanness or/and low bodyweight were considered important (e.g., cheerleading, swimming and gymnastics), and “non-leanness sports” were defined as sports where these factors are less important (e.g., football). Participants obtained a total mean score of 68.4% for the nutrition knowledge part of the questionnaire. More specifically, less than 30% of the coaches could answer correctly some general nutrition questions regarding carbohydrates and lipids. No significant difference in nutrition knowledge was observed between coaches from “leanness” and “non-leanness” sports or between men and women. Respondents with a university education scored higher than the others (73.3% vs. 63.3%, p < .05). Coaches who participated in coaching certification also obtained better results than those without a coaching certification. The most popular source of information about nutrition used by coaches was the Internet at 55%. The two most popular nutrition practices that coaches recommended to improve athlete performance were hydration and consumption of protein-rich foods. Recommendation for nutritional supplements use was extremely rare and was suggested only by football coaches, a nonleanness sport. Findings from this study indicate that coaches need sports nutrition education and specific training. Keywords: coach knowledge, sports nutrition, nutritional practices Studies have shown that physical activity and exercise training may lead to nutrition-related problems in adolescence, a life period when energy requirements increase because of growth and hormonal changes (Benson et al., 1990). Although some athletes have adequate dietary habits (Aerenhouts et al., 2008; Croll et al., 2006; D’Alessandro et al., 2007), a high proportion of athletes do not meet their energy requirements, leading to important energy and nutritional deficits (D’Alessandro, et al., 2007; Ziegler et al., 2002). On the other hand, the use of supplements to manage body weight and to improve performance appears to be highly prevalent in young athletes. A study conducted among high school students indicated that the proportion of those believing in the beneficial effects of supplements on sports performance was higher among students who reported parCouture, Lamarche, Morissette, and Provencher are with the Institute of Nutrition and Functional Foods, Laval University, Québec, Canada. Valois is with the Dept. of Educational Fundamentals and Practices, Faculty of Education, Laval University, Québec, Canada. Goulet and Drapeau are with the Dept. of Physical Education, Faculty of Education, Laval University, Québec, Canada. Address author correspondence to Vicky Drapeau at [email protected].
326
ticipating in high levels of physical activity than among more sedentary students (Bell et al., 2004). One review indicated that 22–71% of child and adolescent athletes used supplements, of which vitamin and minerals were the most common (McDowall, 2007). The use of protein supplements is also highly frequent among young athletes involved in strength sports, such as football, and these athletes frequently have unrealistic expectations with regards to the actual benefits that protein supplementation may produce (Duellman et al., 2008). In terms of sports nutrition, several studies have shown that coaches represent one of the main sources of information and influence for young athletes (Douglas & Douglas, 1984; Krowchuk et al., 1989; McDowall, 2007). Most coaches, however, do not have formal training in nutrition (Graves et al., 1991). In this regard, it has been shown that 82% of high school wrestling coaches felt they had the competence to coach but that they were not well-informed regarding sports nutrition, weight loss and supplement use (Sossin et al., 1997). Moreover, average sports nutrition knowledge scores related to weight-loss practices, dieting, hydration and body composition assessment were considered low for these coaches (Sossin, et al., 1997). In other studies, the knowledge test identified a tendency to overvalue proteins, excessive low fat diets and food myths (Juzwiak &
Downloaded by New York University on 09/18/16, Volume 25, Article Number 4
Sports Nutrition Knowledge Among Coaches 327
Ancona-Lopez, 2004) and almost half of coaches reported believing that proteins were a major source of energy for muscle (Baer, Dean, & Lambrinides, 1994; Bedgood & Tuck, 1983; Juzwiak & Ancona-Lopez, 2004). While most coaches acknowledge that rapid body weight loss may have negative effects on endurance, performance, strength and health (Sossin, et al., 1997), it appears that there are knowledge deficits related to body weight control and specific nutritional strategies related to pre, during and post training periods (Juzwiak & AnconaLopez, 2004). This situation is not entirely surprising considering that, at present, training and certification in nutrition is not entirely fully regulated nor is it formally required for coaches (Lemyre & Trudel, 2004). In summary, inadequate dietary intakes combined with misguided dietary practices, including use of supplements, appear to be highly prevalent among high school athletes. Coaches’ knowledge regarding sports nutrition also seems to be inadequate for educating and guiding their young athletes on this topic. This is of particular importance considering that coaches remain one of the main sources of information regarding sports nutrition for the young athlete. To our knowledge, no study evaluates nutrition knowledge and nutritional practices among high-school French Canadian coaches. Moreover, It is important to point out that, the most research regarding this sport nutrition has focus on coaches or athletes at the university or college level, thus involving athletes over the age of 18 or adults (McDowall, 2007; Petrie et al., 2004). In that context, the purpose of this study was 1) to evaluate high school coaches’ level of knowledge in sports nutrition, and 2) to describe the nature and quality of nutritional practices recommended to the young athletes they supervise.
Questionnaire Development and Content A questionnaire divided in four sections was developed for this study based on previously validated work by Parmenter & Wardle (1999) and other published literature (Marinaro, 2008; Zinn et al., 2005), as well as based on the researchers’ experiences in sports nutrition. Part I of the questionnaire was a “true/false/I don’t know” section, comprising of 54 questions on general and sports nutrition knowledge. The second part of the questionnaire included 4 specific questions (multiple-choice format) assessing knowledge about lipids, vitamins and precompetition meal. Part III of the questionnaire concerned nutritional recommendations that coaches made to their athletes to enhance performance (25 items with a yes/no format). In this part, areas of interest were the use of supplements for muscle gain and weight loss, the use of foods rich in carbohydrate and protein, and hydration practices. The last part of the questionnaire (part IV) gathered data on demographic and personal information about coaches’ education level, e.g., number of years of coaching, nutrition information sources, coaches’ training and certification. The questionnaire was reviewed by two dieticians specialized in sport nutrition for content validation. A pilot test was also performed with four coaches to verify comprehension of the questions. Adjustments to improve the comprehension of the questions were made after both evaluations. Moreover, after collecting all the data, the internal consistency was tested with Cronbach’s alpha which represent a valid measure of reliability (Kline, 1993). This was measured separately for the different questionnaire sections and indicates a good internal reliability of our questionnaire (all Cronbach’s alpha over 0.7, data not shown).
Data Analysis
Methods Sample Coaches working for either academic or extracurricular programs were recruited to participate in this study. Coaches were either recruited from sports categorized as “leanness” (e.g., gymnastic, swimming, cheerleading, etc), and sports categorized as “non-leanness” (e.g., basketball, football, tennis, badminton, etc.) (Martinsen et al., 2010). The “non-leaness” sports were selected based on popularity in this age group (12- to 17-years-old) to ensure adequate recruitment of participants. Football was the most represented “non-leanness” sport in the study. Coaches working with female athletes, male athletes, and both were eligible. With permission from the school administrators, participants were recruited through emails and posters distributed in one public and four private high schools of the greater Quebec City region offering these sport disciplines. Interested candidates were in communication with the project contact-person to verify eligibility. This study was approved by the Laval University Ethic Committee. All participants signed an informed consent form.
Data were analyzed using the Statistical Analysis System (SAS; v. 9.2 for Windows; Cary, NC). Three groups of coaches were defined for the purpose of the analysis: 1- non leanness group, i.e., mainly coaches involved in football, a sport that focuses on muscle mass and strength, 2- leanness group, i.e., coaches involved in sports with focus on aestheticism including cheerleading, gymnastics and swimming and, 3- others nonleanness group, i.e., coaches involved in sports not focusing primarily on gaining mass and strength such as basketball, soccer, crosscountry skiing. This third group was formed to include less represented “non-leanness” sports in the study i.e., those with a sample of coaches ranging between 1–3 and put together in the group “others” for facilitating the statistical analysis interpretation. One-way analysis of variance or Chi-Square test was used to examine differences in sports nutrition knowledge scores between between groups. T-test and general linear model (ANOVA) with a posteriori test (Tukey) were also used. Nonparametric test (Wilcoxon) was applied to validate some of our results obtained with the general linear model (ANOVA). A p-value of < 0.05 was considered statistically significant.
IJSNEM Vol. 25, No. 4, 2015
328 Couture et al.
Table 1 Coach Characteristics Participants Characteristics (n = 47)
Percent of Coaches
NCCP certified
72%
Education
University: 51% College/ high-school: 49%
Experience in coaching
10 years or less: 57% More than 10 years: 43%
Coaching level
Regional/provincial: 43% National/international: 57%
Downloaded by New York University on 09/18/16, Volume 25, Article Number 4
Note. NCCP = National Coaching Certification Program
Figure 1 — Percentage of coaches reporting using sources of information for nutrition-related issues.
Results
Nutrition Knowledge
Sample Characteristics Participants included 47 coaches from five high schools in the greater region of Quebec (Table 1). Slightly over half were male (55.3%) with a mean age of 29.5 years ranging from 17 to 55 years. Coaching experience of the participants ranged from 1 to 30 years with an average of 9.5 years of experience. Almost 60% of the coaches considered that they were knowledgeable in the area of sport nutrition. The main source of information for nutrition-related issues used by coaches was the Internet (55%) (Figure 1). Friends, TV, colleagues and dieticians represented other important nutrition information sources for coaches.
The percentage of correct answers provided by coaches to all nutrition-related questions (part I) was similar when we compared the 3 groups of sport categories, with an average score of 68.4% (Table 2). The score of the leanness group on questions related to hydration, minerals and precompetition meal was significantly lower (p < .05) than in the nonleanness group (63.5 vs. 81.3%, respectively) and than the other coaches group (83.3%). There was also a tendency among the leanness group to have a lower score on questions related to carbohydrates. Table 3 indicates the questions to which more than 80% or fewer than 30% of all participants answered correctly. The overall nutrition knowledge scores were virtually identical among women and men (68.3 vs. 68.4%,
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Sports Nutrition Knowledge Among Coaches 329
Downloaded by New York University on 09/18/16, Volume 25, Article Number 4
respectively). However, women obtained a higher score than men on questions related to weight management (75.4 vs. 62.2%, respectively, p < .05), but no other sex differences were observed. Number of years of coaching experience (< 10 years vs. ≥ 10) showed no association with nutrition knowledge. On the other hand, coaches with a university education had overall significantly better results than coaches with a lower education degree (73.3 vs. 63.3%, respectively, p < .05). The level of coaching (regional/provincial; n = 20 vs. national or international; n = 27) had no influence on the coaches’ overall knowledge. However, coaches involved at the national and international level obtained more correct answers on the weight management topic than other coaches (72.8 vs. 61.7%, respectively, p < .05).
Coaches certified by NCCP had significantly better scores than those who were not certified (70.9 vs. 61.7%, respectively, p < .05). Finally, coaches who rated themselves as knowledgeable in the area of sports nutrition scored significantly higher than those who rated themselves as less knowledgeable (71.1 vs. 62.9%, respectively, p < .05).
Nutritional Practices Coaches were asked to identify which nutritional practices they had recommended to their athletes to enhance performance (part III) from a predetermined list divided into five categories: 1) use of supplements for massbuilding, 2) use of supplements for weight loss, 3) consumption of foods rich in carbohydrates, 4) consumption
Table 2 Correct Responses to Nutrition Questions Separated by Sport Grouping Topic
Overall (%; n = 47)
Nonleanness (%; n = 16)
Leanness (%; n = 13)
Others (%; n = 18)
Protein
67.2
65.2
63.7
71.4
Carbohydrate
61.5
67.4
48.7
65.4
Lipids
71.5
72.7
67.3
73.6
Weight management
68.1
62.5
73.1
69.4
Supplements
68.9
68.8
63.8
72.7
Other
77.1
63.5
83.3 b
All topics/questions
68.4
81.3
ab
68.9
a
62.9
71.9
Note. No significant differences. ANOVA significant at p
