Presentation to NSCA conference in Las Vegas July 2009 on a practical, evidence-based approach to strength and conditioning.

1. A Practical, Evidence-Based
Approach to Strength and
Conditioning
NSCA 32nd National Conference
July, 2009
Ann M. York, PhD

2. NSCA Mission Statement
• “As the worldwide authority on strength and
conditioning, we support and disseminate research-
based knowledge and its practical application to
improve athletic performance and fitness.”
• “Bridging the gap between science and
application.”

3. Objectives
• Define the process of evidence-based practice (EBP).
• Discuss the challenges to EBP or EBSC
• Identify some reasonable approaches to EBSC.
• Leave with specific strategies and tactics to
implementing EBSC.

4. JASPA* Quiz

5. JASPA =
Journal Associated Score of Personal Angst
• 0 = outlier
• 1-3 = normal range
• >3 = at risk for polythenia gravis and related
conditions
• Polythenia gravis: increasing sense of guilt and
inadequacy associated with an inability to keep up
with the journals.
• Related condition: increased fall risk associated with
tripping over piles of unread journals.

6. Evidence-Based Approach
“Evidence does not make decisions, you do!”

7. Leaks in the Evidence-Based Knowledge Pipeline
Aware Accept Target Doable Recall Agree Done
Valid
Research
Strauss, Richardson, Glasziou &Haynes (2005)

8. From EBP to EBSC….
• Consistent evidence of failure to translate research
findings into clinical practice
▫ 30-40% patients do not get treatments of proven effectiveness
▫ 20–25% patients get care that is not needed or potentially
harmful
• What’s happening in the strength and conditioning
realm?
Schuster, McGlynn, Brook (1998). Milbank Memorial Quarterly
Grol R (2001). Med Care

9. Pressures Slowing Growth of EBP

10. What is evidence worth?
Usefulness = Validity X Relevance
Work
Strauss, Richardson, Glasziou & Haynes (2005)

11. Why Bother with EBSC?
Motivation: Who are you?
• Client expectation • Doer (researcher/teacher
• Competitive advantage • User (coach/trainer)
• Lifelong learning • Replicator (gurus are
• Satisfaction, pride good enough for you).
• Ethical thing to do
• Contribution to the
profession
• Professional
development

12. Cycle of EBSC

13. Step 1: Asking a question
• Background questions
▫ general: who, what, where, why, how
• Foreground or PICO questions
▫ specific: questions on managing clients
Foreground
Questions
Background
Questions
Less Experience More

14. PICO Questions
• P: person/problem
• I: intervention
• C: comparison
• O: outcome

15. What questions to ask?
• Most common scenarios
• Unique situations
• Desire to become an expert
• Curiosity
• The more specific the question, the better.

16. Step 2: Acquiring the Evidence
• How much time do you want to spend?
• What databases to you have access to?
▫ Online versus paper
▫ PubMed
▫ Ebsco
▫ Professional membership
• What is your skill level at searching?
• Think QUALITY of evidence!

17. Evidence Pyramid
Synopses
Meta-Analysis
Systematic Review
Randomized Controlled Trial
Cohort studies
Case studies
Basic/Bench Research
Editorials/Gurus/Colleagues

18. Narrative v. Systematic Reviews
Narrative Systematic
• No systematic • Rigorous methodology
methodology • Focused research question
• Tend to be broad • Search strategy developed
• Potential for author’s bias • Inclusion/exclusion criteria
• References gathered ad for references
hoc • Quality assessment
• Qualitative approach • Quantitative approach
Qualitative Quantitative

19. Evidence Information Management
Push Technology
• RSS Feeds*
• PubMed saved searches*
• Email alerts*
Pull Technology
• Specific searches for questions
• Databases/publications/other resources
Storage Technology
• RefWorks, Endnote
• Zotero,* Delicious,* Evernote*
*Free!

21. RSS Feeds + iGoogle = Efficiency
How to use RSS feeds tutorial:
http://www.youtube.com/watch?v=0klgLsSxGsU

23. Step 3: Appraise
• Most traditional EBP training occurs at this step
• Yet it is time consuming/intimidating
• Many do not have skill or time to appraise well…
• Solution?

24. Let others do the first appraisal
HIGH QUALITY Pre-appraised evidence
▫ Systematic Reviews (Cochrane, PubMed)
▫ Evidence summaries
▫ Professional organization guidelines
BUT first you must ASK a good question
and ACQUIRE the summaries!

25. Then do your OWN appraisal:
• Is the evidence source high quality?
• Does it apply to my client?
• Is it useful?
• Does this fit with client goals/preferences?

26. Step 4: Apply the Evidence
“Evidence does not make decisions, you do!”

27. Step 5: Assess
• What worked?
• How did this benefit your client?
• What more do you want to know?
• Do you have information to share?

28. Summary
• What role can EBSC play in your career?
• What is your strategic plan of EBSC?
• What tactics can you use to achieve this plan? List 3

29. If you only have….
• 1 minute: Write a PICO question
• 5 minutes: Set up an RSS feed, run a quick search.
• 1 Hour: Read a study in depth, discuss a study with a
colleague, watch a free online tutorial, explore a new
database.

30. Objectives Reveiw
• Define the process of evidence-based practice or
EBSC.
• Discuss the challenges to EBSC.
• Identify some reasonable approaches to EBSC.
• Leave with specific strategies and tactics to
implementing EBSC.

31. Resources
No doubt I will add to these slides. Updates, additional
references, and EBP resources can be found at:
NSCA EBSC Pageflake:
http://www.pageflakes.com/ayork/2501555

33. Selected References
• Davis, J. (2007). Evaluating education in evidence-based practice. JAMA:
The Journal of the American Medical Association, 297(1), 39.
• Guyatt, G., & Rennie, D. (Eds.). (2002). Users' guides to the medical
literature. Chicago, Ill.: AMA Press.
• Ho, P.M., Peterson, P.N., & Masoudi, F.A. (2008). Evaluating the evidence:
Is there a rigid hierarchy? Circulation, 118, 1675-1684.
• Shaneyfelt, T., Baum, K. D., Bell, D., Feldstein, D., Houston, T. K., Kaatz, S.,
et al. (2006). Instruments for evaluating education in evidence-based
practice: A systematic review. JAMA: The Journal of the American Medical
Association, 296(9), 1116-1127.
• Slawson, D. & Shaughnessy, A.F. (2005). Teaching EBM: Should we be
teaching information management instead? Academic Medicine, 80 (7),
685-689.
• Strauss, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005).
Evidence-based medicine, how to practice and teach EBM. (3rd ed.).
Edinburgh: Elsevier.

34. Contact Information
Ann M. York, PhD
Associate Professor
Master of Health Care Administration Program
College of Health Sciences
Des Moines University
3200 Grand Ave
Des Moines IA 50325
515-271-1641
ann.york@dmu.edu

35. Questions?