Health prevention in youth sports: innovative and interdisciplinary experiences at the Lausanne 2020 Youth Olympic Games

Tercier Stéphane^1,2, Depallens Sarah¹, Michel Juliette³, Roberts Katherine⁴, Saubade Mathieu^1,5,6, Wenger Nathalie¹, Gojanovic Boris^1,7
1 Interdisciplinary Division for Adolescent Health (DISA), Department of Women-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland
² Unit of Paediatric Orthopaedic Surgery (UPCOT), Department of Women-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland
³ Youth Protection Service, Canton de Vaud, Switzerland
⁴ Psychiatric Department, University Hospital of Lausanne, Lausanne, Switzerland
⁵ Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland
⁶ Sport Medicine center, Division of Physical and Rehabilitation medicine, University Hospital of Lausanne, Lausanne, Switzerland
⁷ La Tour Sport Medicine, Swiss Olympic Medical Centre, Hôpital de la Tour, Meyrin, Switzerland

Abstract

The Youth Olympic Games were introduced in 2010 with the aim to bring young athletes not only an experience of competition on the world stage, but also to help them learn about the Olympic values, explore other cultures and develop the skills to become true ambassadors. The Lausanne 2020 Games provided an excellent opportunity to develop innovative concepts for health promotion and sports-related prevention. The enthusiasm across various sectors of society (political, academic and economy) empowered us to bring together multiple skills to materialize the IOC’s pledge.
We developed communication concept around key sports-related issues targeting the competitors and population of our region. We set up pavilions hosting the various modules in Lausanne, at the Olympic Villages (Lausanne Vortex and St. Moritz), where the modules could be tested and videos were presented.
Deep Impact is a virtual reality immersion into concussion, And You …? explores the perceptions of sports-related abuse through five excerpts of blockbuster movies. The Safety Clips for youth athletes introduce ten typical adolescent sports medicine topics in a youth-friendly format. Youth and elite (role model) athletes delivered the messages rather than professionals, whilst the content was true to current scientific knowledge.
Three key elements emerged. 1. The power of interdisciplinarity and innovation to promote healthy sports. 2. Adolescence is the best time to sensitize athletes and their entourage. 3. The need for strong institutional and political support to develop health prevention in sport. We look forward to building on these positive experiences and bring prevention and health in sports forward.

Résumé

Les Jeux Olympiques de la Jeunesse ont été introduits en 2010 avec l’objectif de permettre aux athlètes non seulement de faire l’expérience de la compétition mondiale, mais aussi de les aider à connaître les valeurs Olympiques, explorer d’autres cultures et développer leurs compétences pour devenir de vrais ambassadeurs. Les JOJ de Lausanne ont constitué une excellente occasion de développement de concepts innovants de promotion de la santé et de prévention dans le sport. L’enthousiasme multisectoriel (politique, académique, économique) nous a permis de réunir de nombreuses compétences pour matérialiser la volonté du CIO.
Nous avons développé un concept de communication autour de problèmes clés du sport, ciblant les jeunes compétiteurs et la population de notre région. Nous avons monté des pavillons dans les deux villages olympiques (Lausanne Vortex et St. Moritz) et en ville de Lausanne, dans lesquels les modules éducationnels ont pu être testés.
Deep Impact est une immersion en réalité virtuelle dans la commotion. And You …? explore les perceptions de l’abus dans le sport au travers de cinq extraits de films à succès. Les Safety Clips for youth athletes présentent dix problèmes typiquement rencontrés en médecine du sport des adolescents, dans un format adapté aux jeunes. Les athlètes jeunes et élite amènent les messages en lieu et place des professionnels, tandis que le contenu est scientifiquement validé.
Trois éléments majeurs émergent. 1. Le pouvoir de l’interdisciplinarité et l’innovation pour promouvoir le sport sain. 2. L’adolescence comme période fondamentale pour sensibiliser les athlètes et leur entourage. 3. Le besoin de soutien institutionnel et politique fort, si l’on veut développer la prévention dans le sport.
Nous nous réjouissons de construire sur ces expériences positives pour améliorer la prévention et la santé dans le sport.

Introduction

In 2010, the International Olympic Committee (IOC) launched the Youth Olympic Games (YOG), with the first event hosted in Singapore. This new competition brings together talented young athletes aged 15 to 18 from over 200 countries around the world. The IOC states on their website: “The sports programme is mainly based on that of the Olympic Games. […] In addition, it includes exciting new sports, disciplines and formats. […] Away from the field of play, the education programme uses a variety of fun and interactive activities, workshops and team-building exercises to give the participating athletes the opportunity to learn about the Olympic values, explore other cultures, develop the skills to become true ambassadors of their sport, and improve their training methods and performance” [1]. The YOG are designed as a “Compete, Learn & Share” experience, which means a blend of sporting, cultural and educational activities. The target groups are not only the young athletes, but also their entourage (coaches and delegation personnel) and the local youth. The Lausanne 2020 YOG Organizing Committee (YOGOC) has worked closely with the IOC, the University of Lausanne (UNIL), the Ecole Polytechnique Fédérale de Lausanne (EPFL), the University Hospital of Lausanne (CHUV) and Youth Protection Service of Canton de Vaud, in order to bring an educational programme. This programme was carried the vision of “Health for Performance” at its centre and focuses on the following aspects: training guidance based on performance/skills tests, prevention of abuse and concussion in sports, prevention of illness and injury across a series of key topics. Many other activities, including encounters with champions or media management have allowed the 1880 athletes from over 70 countries to learn and experience from the YOG beyond the competitions.
In this article, we present the development, the content and the experience of the three main health-related components: Deep Impact, a virtual reality immersive experience about sports-related concussion, And You …?, a cinematographic depiction of harassment and abuse situations in sports, and finally the Safety Clips for youth athletes, a series of 10 short youth-friendly clips on the most prevalent injury and illness topics. All these activities were available at the two Youth Olympic Villages (YOV), called the Vortex in Lausanne, and in St-Moritz, where only athletes and delegation staff had access, but also at a public venue in Malley-Lausanne (the ice hockey competitions venue), where a temporary “Health for Performance” pavilion supported by the local public institutions (CHUV, UNIL, EPFL and School of Health  Sciences HESAV) presented the same activities for the general public, kids and parents alike. 

Deep Impact, a virtual reality immersive experience about sports-related concussion

Concussions are an integral part of sports activities and are often unavoidable. In our opinion, the value of prevention in this area lies mainly in training young athletes to recognize a concussion and manage it adequately, in order to minimize its consequences or after-effects. Although sports-related concussion is common and its prognosis generally favorable, it remains too often under-diagnosed or trivialized in children and adolescents. Knowledge of the various symptoms and signs to recognize is essential for appropriate and safe management. Initial treatment relies mainly on cognitive and physical rest, followed by a gradual return to school and, subsequently, sports activities.
The Deep impact module was developed as an innovative prevention activity, materialized through a 7-minute virtual reality film (Figure 1). The participant puts on virtual reality goggles, before following Pat Burgener, a member of the Swiss snowboarding team, on the half-pipe. He falls and gets concussed. During the interactive movie, the participant has to answer 5 questions asked by Pat about the correct attitude to adopt in order to hope for an uncomplicated recovery. We take advantage of these questions to slow down the flow of the immersive movie and insist on key messages: for example, no return to sport on the same day, deadlines and progressive steps before return to school and sport. One essential aspect, as with the Safety Clips (see the next paragraph), is that the advice proposed by the team of medical experts is delivered to the young athlete by an elite athlete role model, not a sports physician. We believe that this improves the knowledge transfer and increases impact and acceptance of the information by the adolescent. The scenario and the recommendations were developed by a group of sports doctors and pediatric neurorehabilitation specialists from the CHUV, guaranteeing the scientific content in accordance to current best practice [1].

This activity received mainly positive feedback from the young athletes and their supervisors as well as representatives of the local public authorities who tested it. During the Lausanne 2020 YOG, at least 430 athletes experienced the interactive movie in Lausanne or St-Moritz and more than 2000 local children and teenagers at the public pavilion “Realize your potential! – Health for Performance” in Malley-Lausanne.
For the future, important public health work must be done to deliver this message and these values to individuals and sports federations alike. We hope to replicate this awareness-raising activity in school and sports associations in conjunction with the general and physical education Department, along with sports clubs or federations.

And You …? An interpersonal violence awareness experience to prevent abuse among teenage athletes

The adolescent population is often confronted with situations of interpersonal violence during sport practice. Up to 75% of psychological violence and between 2 to 22% of sexual acts happen in this population [2]. Despite its frequency, abuse remains too often undetected in the world of sport. Various hypotheses can explain this, such as over-emphasis on competition, rivalry between peers, separation from the family environment or the sense of shame pushing the victim into silence. When not identified, abuse produces a repetition cycle, endangering the victim’s physical and psychological health (Figure 2).

We showed mainstream movie clips in an individual booth, illustrating situations of interpersonal violence. The film sequences used in the project took different forms, from sexual abuse to public humiliation, or to a coach pushing training to injury. The audio-visual support was therefore the chosen medium to initiate a discussion with the young athlete about his or her perception of the situations shown in the movie clips (feelings, available resources and possible steps to take). The athlete evaluated the situations through three questions on a touch pad. The results were then printed out and discussed with a member of the team of experts (paediatrician, psychiatrist or social worker) (Figure 3). The entire experience lasted about 10 minutes.

During the discussion, three main messages were transmitted:

1. Violence against athletes is frequent, exists in different forms and has a negative impact on health and performance, sometimes in the very long term.
2. By trusting one’s feelings and emotions, acts of abuse can be identified.
3. When one is a victim of violence, it is important not to stay alone. Available resources exist to stop this violence.

Among the Lausanne 2020 young athletes, 220 took part in the And You …?  activity. The participants’ responses were recorded on a database and are currently being processed for further analysis by our clinical research team. In addition, about one hundred professionals supervising the young athletes (coaches, physiotherapists or national delegation members) also took part in the And You …? experience. They welcomed this prevention concept with interest and most of them stressed the importance of addressing this topic during such international sporting event.
The first qualitative results show that young athletes, whether they be witness or direct victims, and their adult supervising team, encounter difficulties in identifying and talking about inappropriate or abusive situations, their feelings and the short or long-term consequences on their physical and mental health, as well as their performances. By discussing with the athletes and their entourage, our group of experts were able to emphasize these outcomes and try to help them with their struggles.
Implementing abuse prevention programs during sports events, whether local or international, is fundamental in order to raise the awareness of target audiences, provide resources to potential victims and thus try, over the years, to reduce the incidence of this destructive phenomenon.

Safety Clips for youth athletes

Sport has proven benefits for young people’s physical and mental health, but it is also a major source of injuries, and some of which are specific to adolescence.[3] Too many young athletes consult late, due to a lack of awareness, a lack of medical support or not knowing where to consult. The potential consequences are injuries that recur, worsen, and/or take longer to heal.[4,5] Moreover, measures to prevent injuries via a healthy lifestyle and appropriate physical preparation do not always seem to be followed, even among elite athletes.
Teenagers being regular consumers of videos on Internet, mainly on Youtube or social networks,[6] a series of 10 video clips, called Safety Clips for youth athletes, has been designed to raise awareness among adolescent athletes on the prevention of specific injuries and pathologies (Figure 4). These clips were broadcast on the social networks of the Lausanne 2020 YOGOC and the University Hospital of Lausanne during the YOG. They were also part of the educational program areas designed for the young athletes in the Olympic Villages of Lausanne and St. Moritz, and finally in the Pavilion for the public in Malley-Lausanne.

The conception and realization of this project gave the opportunity for a very enriching interdisciplinary collaboration – namely, sports medicine doctors from the SportAdo team, various experts (nutritionist, sports psychologist and physiotherapist, maxillofacial surgeon), the CHUV multimedia support service, the YOGOC, the CHUV foundation, the specialists of Messieurs.ch (digital content creation agency specialized in video), adolescent elite athletes from the canton de Vaud, and Swiss professional athletes chosen among the YOG ambassadors.
The objective was to convey good practices in the field of sport to minimize injuries among adolescents of any sport level with the ambition to reach as many as possible. The chosen concept was a series of 2-minutes video clips in English, with French or English subtitles. Each clip covers a topic and systematically features an adolescent and a professional athlete (Figure 5). The clips contain simple and scientifically valid health prevention messages with a dynamic and humorous rhythm, tone and animations, matching the style of web videos targeting teenagers. With this format, it is obviously impossible to be exhaustive. Yet, the primary objective was to make young people aware and question themselves on these topics.

During the YOG, the majority of feedback was very positive, as much from athletes, parents, or sports professionals, as from the relevant political representatives of the canton of Vaud. This already represents a success for us! The clips will continue to be broadcast on our websites (www.chuv.ch/safety-clips-jeunes-athletes), social networks, and at sporting events, with the ambitious objective of sharing them with the majority of adolescents in Romandie and beyond.
In order to measure the clips impact, the number of views, likes, shares, etc. in the different broadcasting channels, as well as any comments, will be evaluated (more than 16 000 views during the YOG). In addition, we plan a qualitative evaluation with questionnaires and focus group interviews.
This original project was an exciting experience for all the participants. Hopefully, it will promote the practice of sports among adolescents in optimal health and performance conditions!

Discussion and Perspectives

Power of interdisciplinarity and innovation to promote healthy elite sports participation

One remarkable aspect of these educational activities lies in the very effective collaborative work between the health experts and the other professionals: technical, digital, communication, faculty of cinema, and the elite youth and adult athletes who participated in the clips. It probably shows that when we put the focus on the most important aspect of sports-related performance – health – everyone can contribute positively. The alignment of philosophy and of the ensuing health-promoting messages become obvious.

Need of strong institutional and political supports to develop health prevention in sport

The YOGOC Lausanne 2020 and the IOC Medical and Scientific Department has always shown an interest in including activities related to optimizing the health of young athletes in the content of the educational programme. They offered us their support and the opportunity to develop independently these prevention activities, present for the first time in the context of such an international event.
This innovation has been noticed by many media and prominently highlighted in several articles and interviews related to the “Health for Performance” programme. More specifically, activities such as And You …? have been of particular interest due to the originality of their approach to young people.
Holding such a world event in the Olympic capital means many official visits by the Federal and Cantonal government officials, as well as the majority of local authorities. In addition to the President of the Swiss Confederation and the Federal Councilor in charge of sports, many political figures visited the Vortex. All were positively interested in the clear desire to convey public health messages to adolescents and sometimes surprised by the mode of delivery.

Adolescence is the best time to sensitize athletes (and entourage)

Taking part in the YOG from the inside not only allowed our team to create a life-size space dedicated to health promotion in the field of elite sports, but also to provide the young local population with a public health platform to share these preventive messages. These structures, which were made possible thanks to support from the public institutions (mainly the local Department of Health), were visited by Cantonal public health and education officials. We hope that the interest they showed during the YOG for prevention activities will last beyond the Games. We wish to perpetuate their use in the context of schools and sports, to popularize them among the greatest number of adolescents and to develop new prevention activities or tools.
A fundamental message delivered to people visiting these spaces is that adolescence is an ideal time for raising awareness, although it requires imagination, creativity and adaptation to capture the attention of young people. We know that if the message gets across, it will not be too late for it to have an impact on their health. That means involving adolescents as much as possible in all phases of the development of these activities, because communication modes and codes change very quickly.
Promoting the concept of “Health for Performance” means giving young elite or amateur athletes a more informed view of their health and the idea that taking care of one’s health is not a waste of time, but a profitable investment, bringing overall well-being, which will allow them to minimise their problems and increase their performance over time, whatever their level.

Acknowledgments, conflict of interest and funding

None declared.

Corresponding author

Tercier Stéphane 
SportAdo Consultation, Interdisciplinary Division
for Adolescent Health (DISA), Department of
Women-Mother-Child, University Hospital of
Lausanne (CHUV), Nestlé Hospital 04-312,
Avenue de la Sallaz 2, 1011 Lausanne, Switzerland
Tel: +41 21 314 37 60
Email: stephane.tercier@chuv.ch

References

1. Consensus Statement on Concussion in Sport. McCrory P, Meeuwisse W, Dvorak, et al. Br J Sports Med. 2017;51(11):838-847.
2. Safeguarding the child athlete in sport: a review, a framework and recommendations for the IOC youth athlete development model. Mountjoy M, Rhind DJ, Tiivas A, Leglise M. Br J Sports Med. 2015;49(13):883-336.
3. Sport Suisse 2014 : Rapport sur les enfants et les adolescents. Lamprecht M, Fischer A, Wiegand D, Stamm HP. 2015. Macolin : Office fédéral du sport OFSPO.
4. International Olympic Committee consensus statement on youth athletic development. Bergeron MF, Mountjoy M, Armstrong N, et al. Br J Sports Med. 2015;49(13):843-851.
5. Epidemiology of severe injuries among United States high school athletes: 2005–2007. Darrow CJ, Collins CL, Yard EE, Comstock RD. Am J Sports Med. 2009;37(9):1798-805.
6. Children and Adolescents and Digital Media. Reid Chassiakos YL, Radesky J, Christakis D, et al. COUNCIL ON COMMUNICATIONS AND MEDIA. Pediatrics. 2016; 138(5). pii: e20162593