‘The Power of One’ or the value of Case Studies Part 2

Now then, back to it. We left off having begun to discuss, in my opinion, the values of case studies. In part 2 we conclude the post highlighting some theoretical principles and a summary of lessons learned so far and future aspirations, in what is I admit a very green career!


Control, or lack thereof

In any study, of any kind, whether it be an RCT, crossover, or a case study we are always trying to control for factors which influence athletic performance. Simple. But in the real world or an applied setting, even in controlled environments and tests (diet and or training supposedly matched), we have the joys of confounding or extraneous variables ranging from the simple to the bizarre.

Here’s an example from my own work looking at an athlete’s response (performance and RPE) to sodium bicarbonate supplementation, data as yet unpublished:


Effort Placebo Perf. SB Perf. Placebo RPE SB RPE
1 62.4 64.1 8 5
2 63.1 63.5 8 5.5
3 63.1 62.6 8 5.5
4 63.8 62.0 8 5.5
Mean 63.1 63.05 8 5.4
SD 0.49 0.81 0 0.2
Effect Size 0.08 18.39
MBI Trivial Extremely Large


The data seem to suggest that the athlete is one of two things, or both: a physiological non-responder to sodium bicarbonate (SB), or a psychological responder to supplementation (i.e. an extension of the placebo effect).

But then we get to the coach’s notes that accompanied the values reported. Testing was performed on a Thursday, and the coach noted that Monday and Tuesday were heavy days in terms of volume and intensity, in effect giving our athlete only 1 day to recover before being asked to perform maximally – so this begs the question, does a massive reduction in RPE (as noted by the effect size), warrant use of a supplementation protocol with no marked physiological/ performance benefits? We thought so…and we got a national gold medal out of it, winning by ~1 second. That’s a real change – irrespective of what’s driven it.

Now this isn’t just down to the supplementation, but more a reflection on the measure of performance at that time, more measures give more information and if used appropriately may elucidate something about that athlete and the mechanism underpinning that particular supplement, on that athlete’s level. I’m of the opinion this may change day-to-day (have they eaten/ slept well), across a training cycle (injury/ illness/ race schedule/ training response) and certainly based upon performance level (elite athletes have lesser variability in performance, but the margins are tighter with respect to improvement/ winning). So back to our athlete, they have fallen victim of day-to-day and training cycle effects, but still produced a consistent performance, for less effort, suggesting they’re an elite performer.

Conversely, there are times when we want noisiness in our measures, and this is something I’m hoping to come back to as my PhD work progresses and we begin to apply that in ‘real life athletes’ outside of the lab.


Bishop Model

For those who’ve not read or seen this paper before, full text can be found here.

Bishop Diagram

But in brief, the paper outlines the above model (click link to access an image), an applied research model for the sports sciences as referenced. I feel case studies act as a fantastic way to tick every box on this model, arguably with the exception of meta-analyses.

Case studies allow us to generate, harbour and test our own hypotheses over time and under conditions, which cannot be replicated in the labs or cost-effectively with a sample >1. Provided we strive for control where possible, we can really journey through a multitude of these stages simultaneously over the course of working with an athlete.

Whilst case studies certainly rely on the application of previous findings and theory, they also accelerate the development of practice, theory and above all else opinion. This may be considered a negative to the purists, but experience driven opinion is really what we admire and seek in those that have been there and done it. I recall a lecture I attended where Dave Costill reflected on his career, and used his own swimming performances, pitted against a rival competitor to simply outline, contextualise and validate his academic work…N = 2.


Athletes are people, and so is everyone else

This one really speaks for itself. Athletes aren’t always athletes, and once they leave the track, lab or pitch they by and large become people again. The same applies for coaches, practitioners and even yourself. I’ll explore this point further in a subsequent post but for now I think the statement is a reflection of our duty of care to athletes and ourselves. Sport isn’t everything forever, but for the time an athlete has a competitive career it presents an interesting choice – do we take the long term approach, or opt for short term success? Or to put it another way…can we always win and be healthy?


Lessons Learned & Future Aspiration

Beliefs need to be fluid

What we believe is best for an athlete should charge slowly over time working with that athlete and others, and under guidance from the academic literature and other practitioners. This sounds really obvious but quite often it’s not. You may come up against resistance from a coach, or even the athlete themselves so it’s all about knowing how to change your stance in response to certain situations.

I think a great example of this is my own belief on supplementation, particularly in young athletes. Currently, I believe that supplements should be:

  • Used appropriately and sparingly, with the focus on food first
  • Be Informed Sport tested, and
  • Where possible serve a further purpose beyond performance.

Beetroot juice is perhaps the best example of this – we tried some supplementation with some athletes in a similar setting to the one described earlier in this post – the beetroot juice not only served as a potential ergogenic aid, it presented an opportunity to highlight the need for and benefits of dietary nitrate, as such athletes ate more green leafy vegetables in the 2-weeks prior to competition, hereby ticking all three of the above bullet points.

All athletes were under the age of 16 – would you have recommended supplementation to this cohort?

Previously I wouldn’t have done so, I’d have said something arbitrary like no supplements until athletes are 18/21, but having listened to the needs/ wants of their coach, reading the literature, assuring an informed sport product and gaining consent from parents, we actually got a lot of people thinking about a lot of things all at once!

Outside of my own work, I’d suggest we look at guys like Tim Noakes, whilst they seem like zealots on the surface and certainly on social media, a number are good scientists who’ve changed their beliefs based on what they believe to be sufficient evidence. So whilst I wouldn’t necessarily advocate the ardency of their beliefs, being able to evolve and deepen our beliefs, is essential if we want to stay relevant and effective as practitioners.

Value people as people

As I mentioned above athletes are just people. Putting yourself in their shoes best as possible is a sure fire way to help them gain an advantage. For instance, the coach of the ultra-runner mentioned in previous instalment of this post went out and ran/walked in excess of marathon (~30miles) to get a feel for what he was asking the athlete to do in training, and almost fortuitously actually messed it up a little bit too! The knowledge he/we gained from that experience was really helpful moving forwards toward completion, and I’ve even incorporated some similar training sessions to those the swimmers perform in my own schedule, to better assimilate their training demands.

But it goes beyond this, knowing athletes on a personal level (have they got a dog, hobby, partner etc.) allows for a more fruitful application of an intervention as it increases buy-in and efficacy, as the intervention now accounts for their life outside of sport too.

Involve as many pertinent people as possible and practical

Establishing a small team around key projects is great – it helps us feel less isolated, and sparks creativity and productivity by and large through sharing workload. Personally, I find a team of 3-5 works really well, as each person has a role, all can respond to the lead of others and it’s easy to fire emails around and actually understand what’s going on.

Also, if you don’t know something, you can go and ask someone about it without feeling foolish. There are no stupid questions in a small team, as everyone is working toward a common goal – getting that athlete(s) better.

Continued work, opportunity to develop and experience excellence

Hopefully this (long) post has shown I have an enthusiasm for what I do and a hunger to develop – helping athletes be better is pretty cool, but it’s the process behind it that really makes me tick. I’m looking forward to working with some great athletes this year, and potentially exploring a new sport or two in the process.

I’m hoping teaching doesn’t detract too much from my PhD and other applied opportunities and I’ve a little idea up my sleeve as to a sport I’d like to work in, but aside from that I’m really looking forward to working closely with one or two elite athletes this year; they’re already competing internationally and for one the Olympics is the next goal. For me, I’d love to attend an Olympics or Major Games in a professional capacity – that’d be the ultimate, as one of my mentors has done so multiple times

…I’ll be sure to keep you posted with how it all goes, thanks again for reading if you’ve made it this far.

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