A Survey of Lifestyle and Performance Factors of Elite and Pre-Elite Athletes

Background An online survey was used to investigate athlete perceptions of lifestyle practices and support services amongst 135 Australian Olympic, Paralympic, National, and state-level athletes across 25 Olympic sports. lead-up a competition, and (iii) during competition. of IP-athletes for IP-athletes 14.1 p 0.005). in the to competition during male weeks up to competition (18.5 15.4 hrs) and during competition (11.7 8.6 hrs) (p<0.05). Further analysis using ANOVA this to be associated with any other factor, and it cannot be based type of sport or level of sporting achievement.

Australian athletes in Olympic and Paralympic sports, who had competed at state level or above in the past 10 years, were invited to participate. Participants were recruited via an email sent from one of the following: National Sporting Organisations (NSO's); State Institute and Academies of Sport; State Sporting Organisations; and the Australian Olympic and Paralympic Committee. This email contained an invitation to participate in the study, a participant information form, and a link to the online survey. Athletes aged over 18 years were emailed this information from their relevant sporting body (listed above), whilst for athletes aged less than 18 years, the email was sent to their parents/guardians with a request to forward the information and survey link to the athlete. Within this email it was stated that parental consent would be inferred, if they forwarded the survey to their child, and that child assent to completing the survey would be inferred from their submission of the completed survey. The survey was completed 'anonymously', however, whilst minimal personal and identifying information was asked for in the survey, the researchers acknowledged that in a few cases there was a risk that the sporting achievements reported by the athlete, such as individual medals in international competitions in a speci c sport, could enable the researchers to identify the respondent. Participants were informed of the study's purpose and informed that no identifying information about them would be used when reporting the results of the study. Participation was voluntary, and only the researchers had access to the data.

Analysis
Data were exported from Qualtrics (Qualtrics Labs Inc.) into SPSS (v 25) and cleaned. Cleaning involved: removing all participants who did not meet the inclusion criteria (see below) and the removal of data from partially completed surveys.
In the analysis, the FTEM (Foundation, Talent, Elite, Mastery) developmental framework was used to classify the achievement levels of the athletes 5,6 . These classi cations are as follows: M = Attained Multiple Podiums (medals) in Senior International Events; E2 = Attained a Single Podium (medal) in a Senior International Event; E1 = Competed at Senior International level (but no medals at Senior International level); T4 = Competed at Junior International or Senior State or Senior National level; T3 = Practicing/Achieving at state level. 'Foundation' level athletes, as de ned in the model, as not having competed at state level or above, were not intentionally recruited or their data included in the survey, since the focus of the research was on the issues facing athletes at a higher level in the development pathway. Athletes meeting the criteria were then categorised into two groups for comparison: (i) M and E2 athletes who had achieved at least one International Podium (IP) and (ii) E1, T4 and T3 athletes who had not achieved an International Podium (n-IP). Additional classi cations were: Able-Bodied (AB), and Athletes with a Disability (AwD).
A total of 331 participants commenced the survey. One-hundred and ninety-six were excluded due to not meeting the inclusion criteria, such as their event not an Olympic sport, or having competed more than 10 years ago. Incomplete responses and duplicates were also removed. The responses of 135 athletes were therefore included in the analysis. Quantitative data were checked for statistical violations and SPSS (v25) statistical software were used to analyse the data.
Descriptive (mean and SD) and comparative (ANOVA and t-tests) statistics were used for parametric data, whilst frequencies, percentages and chi-square analyses were used for categorical data.
The responses to the qualitative questions (written response questions) were categorised, using Strauss and Corbin's method of grounded theory into headings consistent with the higher order themes identi ed from previous research 7,8

Results
The responses of 135 athletes (58 male and 77 female) were included in the analysis (see Table 1 for athlete demographics). Twenty-ve different Olympic and Paralympic sports were represented. All quantitative data are presented as mean ± SD, unless otherwise stated. Forty-ve percent of athletes described their Daily Training Environment (DTE) as centralised (services provided e.g. massage, physiotherapy), 48% were de-centralised, and 7% selected 'other'. Forty-four percent of athletes had a scholarship with a state sporting institute, 3% with a regional academy, 15% with a professional club, and 37% indicated 'other'.
Three independent-sample t-tests were conducted to compare the training hours per week of IP and n-IP athletes at time periods: (i) throughout the year, (ii) lead-up to a competition, and (iii) during competition. The mean training hours of IP-athletes throughout the year was higher than for IP-athletes (19.7 v 14.1 hrs; p < 0.005). Training hours in the lead up to competition and during competition were not different between these groups. However, female athletes reported training more hours than male athletes in the weeks leading up to competition (18.5 v 15.4 hrs) and during competition (11.7 v 8.6 hrs) (p<0.05). Further analysis using ANOVA did not reveal this difference to be associated with any other factor, and it cannot therefore be explained based on the type of sport or level of sporting achievement.
Time spent away at international events in the previous year was signi cantly higher for IP-athletes (10.9 v 5.2 weeks; p < 0.001) while time spent away from home at domestic events were similar (IP 6.2 v n-IP 8.1 weeks). Factors such as male vs female and AB vs AwD were not associated with any differences in training or travel time.
The results and ndings are presented under the established themes of: Psychological Skills and Attributes; Interpersonal Relationships; Performance Factors / Strategies; and Lifestyle Practices. With illustrative responses from the athletes presented in Table 6.

Psychological Skills and Attributes
Athletes were unanimous in perceiving psychological attributes as vital to their success, and all the psychological attributes previously reported by elite athletes were rated as highly important by more than 80% of both AB and AwD respondents across the achievement spectrum ( Table 2). 3 Notably, all IPathletes stated that their Ability to Change and Resilience was vital to their success. Similarly, 'Self Discipline' and 'Mental Toughness' were deemed as important by virtually all athletes. There were no statistically signi cant differences between males and females, or cgs and non-cgs athletes, for any of the responses concerning 'Psychological Skills and Attributes', but AB-athletes were more likely than AwD to perceive 'Ability to Manage Performance Nerves' and 'Rituals' as being vital to their success.
These quantitative data were supported by the athletes' written responses (qualitative data), whereby for example, when asked, "If they achieved a medal at a benchmark event, why, in their opinion, did they succeed compared to their less successful counterparts?" the athletes identi ed the themes of: superior selfregulation; strong mindset; and effective coping strategies as being fundamental.
Additionally, when in relation to psychological skills and attributes, they were asked for their thoughts and suggestions concerning "What KEY advice/strategies would you advocate for younger athletes?" the responses were in the themes of: Superior self-regulation; Intrinsic Motivation; and Effective Coping Strategies and Positive Mindset. Furthermore, when asked: Is there anything in your sporting journey so far, that you would have done differently? A key recommendation was: "invested in mental training earlier", so as to develop 'Superior Self-Regulation' (IP).
Interpersonal Relationships (Table 3) Virtually all athletes (>98%) attributed having people to support them during their career as being important for their success. These included: Family members/partners; Friends; Coaches and Professional Medical/Allied Heath staff, with all being highly prevalent in the athlete's responses (72 -94%). Furthermore, most (>88% of athletes) said their coach's ability to relate on a personal level was as important as their technical ability. Additionally, the majority of athletes (>93%) agreed that having someone in their life who made them laugh was important to their success. The importance of family members was valued by more AwD (100%) than AB-athletes (87%) (p < 0.05), but there were no statistically signi cant differences between males and females, or cgs and non-cgs athletes in the responses to these questions.

Performance Factors / Strategies
Mental preparation, recovery strategies, and using medical/allied health services were all rated as important, as was sleep (Tables 4 and 5).

Recovery Strategies
The most prevalent recovery strategies were: 'Remedial Massage', 'Stretching' and 'Mindfulness'. 'Visualisation' was also highly prevalent, thereby further reiterating the perceived importance of psychological skills and attributes. Athletes' perceived sleep, a lifestyle factor as well as being important for recovery, to be important and reported getting 7 ± 1 hours a night. There were no differences between any of the athlete categories for the reported amount of sleep.
Eight recovery practices were identi ed with statistically signi cant differences (p < 0.05) in the prevalence of utilisation, with IP-athletes use being higher than n-IP-athletes for: Remedial Massage, Mindfulness, Hot/Cold Immersion, Ice-bath, Meditation, Plunge-pool, Infrared sauna, and Neuro Linguistic Programming (NLP). Finnish saunas and Spas were used more by AB-athletes than AwD (p < 0.05), and NLP used signi cantly more by AwD-athletes than AB-athletes (p < 0.005). There were no statistically signi cant differences between males and females, nor cgs and non-cgs athletes.
Service Providers (Table 5) All athlete referrals to frequently used practitioners were via their State Institute, except the family GP. Overall, IP-athletes had higher utilisation than n-IPathletes for all services except for osteopathy. Of these, there were statistically signi cant differences in the use of four service providers, with utilisation by IPathletes being statistically greater (p < 0.05) for Massage Therapist; Dietician/Nutritionist; Sports Medicine Doctor; and Sports Psychologist. Chiropractors and Naturopaths were used signi cantly more by AB-athletes than AwD-athletes (p < 0.05) and Sports Psychologists were used signi cantly more by females than males (p < 0.05). There were no differences between cgs and non-cgs athlete.

Weight Division Practices
Around one quarter of participants (n=35) were required to make a competition weight division (89% from combat sports). Nine athletes dropped 1-2kg below what they considered their baseline training weight, 12 athletes dropped 5kg below baseline, 6 athletes dropped 6-8kg below baseline, and one athlete dropped 10kg below baseline weight. Fifteen athletes reported using a sauna to lose weight before competing. Other weight-loss strategies included running, skipping, walking, and sports speci c exercise. No differences in the prevalence of these practises were evident between; IP and non-IP; males and females, nor cgs and non-cgs athletes.

Qualitative responses
In response to the question: If they achieved a medal at a benchmark event, why, in their opinion, did they succeed compared to their less successful counterparts? Having the right support team was perceived to be crucial, particularly amongst IP athletes (IP 79%, n-IP 21%).
Responding to the question: What could be done better to educate and empower athletes regarding their knowledge and effective usage of athlete and lifestyle strategies etc.? Two new sub-themes emerged within Performance Strategies, these being: education (for athletes and coaches), which was mentioned by more than 98% of athletes, and get advice from experienced/retired athletes. Additionally, making effective use of sports science sports medicine (SSSM), maximising training, and performance opportunities, were also emphasised.

Lifestyle Practices
The vast majority of athletes (>91%) agreed that activities that helped them relax when not training or competing was important to their success. Similarly, Lifestyle practices such as: nutrition/hydration, the importance of having time-out, and lifestyle 'balance', were also perceived as important. As a recovery practice (mentioned previously), the importance of sleep was a common theme in recommendations athletes would make to younger athletes.
Athletes predominantly sought dietary advice from either a quali ed naturopath or herbalist (95% IP 94% n-IP) or quali ed dietician or nutritionist (44% IP 36% n-IP). The prevalence of source of dietary advice was not statistically signi cantly different between athlete categories. Most athletes (>94%) predominantly ate home-cooked meals. A range of dietary practises were reported, with a 'high protein' diet being most prevalent, and the proportion of n-IP-athletes on a 'high protein' diet was statistically signi cantly higher than for IP-athletes (n-IP 54%, IP 38%) (p= 0.047). There were no other statistically signi cant differences in diet between IP and n-IP athletes and no statistically signi cant differences between the other athlete categories.
Water was the most common beverage consumed (>95% of athletes). Teas and herbal teas were drunk by 20 -30% of athletes, whilst commercial sports drinks were only reported by 20% of athletes. The percentage of IP-athletes who regularly consumed coffee was signi cantly higher than for n-IP-athletes (IP 68% and n-IP 47%). There were no other statistically signi cant differences between athlete categories.

Discussion
Psychological skills and attributes were seen as vital to success across the range of attainment levels, with an ability to change and resilience rating the highest. While the importance of resilience and adaptation is well documented 2 , most athletes wished they had access to these skills earlier in their career 2 .
An holistic psychological support program, inclusive of training in mental fortitude 2 , emotional intelligence 9 , mental toughness 10 , and mindfulnessacceptance-commitment (MAC) practices could be used to support athlete wellbeing [11][12][13] . The potential value of such an inclusion would be in assisting them to enhance performance and embrace the pressure and expectation to perform and succeed at important benchmark events, as well as contributing to the attainment of important psychological and mental aspects of wellness.
In support of this, athlete responses indicated that pre-elite athletes desire deeper knowledge, understanding, and autonomy. Given the focus on psychological skills being critical to performance, this receptiveness presents an opportunity to hone and develop psychological skills earlier, so that they are well-practiced by the time the athlete reaches career maturity. However, contrary to these written responses, the second most common response concerning sports psychologists was: 'I don't discuss my sport with them'. Hence whilst the athletes' perceived their sport psychologist to be important to them, their role may not always be what the referring Sports Governing Bodies and Institutes assume. Consequently, further clari cation is required to better understand the multifaceted role of sport psychologists in providing support, education and skills training in both the athlete wellbeing/mental arena as well as for performance optimisation. Additionally, education about this service earlier in the developmental pathway may provide more targeted as well as holistic and effective use of this professional service.
All athletes perceived interpersonal relationships as vital, and valued people who made them laugh and supported them during their careers. Most also valued their coach's ability to relate to them on a personal level as being equally important as their technical ability. Perceived support is understood to affect emotional and informational esteem positively and have stress-buffering effects on self-con dence and resilience 2,14,15 , including performance factors 16 . The coach-athlete relationship can directly in uence athletes' motivation as the coaches' ability to facilitate autonomy-supportive behaviours, bene cially impact an athletes' intrinsic and extrinsic motivation, and drive performance and perseverance 17 . In an environment where there is pressure to perform and high stress levels, controlling behaviours are more likely and accidental violence 17 , non-accidental violence, maltreatment, harassment, coercion, and abuse are not uncommon in elite sport 18,19 . Hence an emphasis on a culture of personal support and respectful interpersonal relationships may not only prevent potentially harmful interactions, but may also serve to drive higher levels of performance and enhance athletes lives both within and external to the sporting arena. 4 The results revealed that IP-athletes were more likely to utilise support services for recovery practices (hot/cold immersion, infrared sauna etc.), massage therapists, dietician/nutritionists, sports medicine doctors and sports psychologists. The difference in the use of recovery practices may re ect access to facilities such as hot/cold immersion, or massage, as professional services are often recommended by NIN/NSO's who also offer nancial support. Indeed, many athletes expressed that they would have liked access to these services earlier, suggesting these services are highly regarded and perceived as bene cial, as indicated in the following quote: I wish I had asked for help sooner from professionals regarding my coping strategies and stress levels. The pressure and stress of hitting my peak in sport at a young age has permanently affected my mental and physical health….I wish I had diversi ed my support network to outside of the sport itself. (n-IP-athlete) In our previous research, the use of ice-baths was reported as a common practice amongst world-class athletes and the nding that hot/cold immersion, 3 plunge-pools and ice-baths was more common amongst IP-athletes suggest perceived merit in introducing contrast bathing to athletes earlier in their career.
Additionally, the responses to the qualitative questions resulted in two new sub-themes within Performance Strategies theme, these being: education (for athletes and coaches), which was mentioned by more than 98% of athletes, and get advice from experienced/retired athletes.
Advice to young athletes included, being proactive in the context of being a knowledge-seeker, and 'standing up for yourself'. Contextually this included, the advice to 'change clubs earlier'. Athletes commented that their choice to remain at their club was often due to loyalty or 'aiming to please' rather than making the right career choice. But with hindsight they re ected that it was important to know when to move to a more specialised club or DTE. Furthermore, the recommendations to young athletes included seeking professional assistance, such as sports psychologist, dietician and other specialists earlier. Within these responses, the perceived importance of an understanding of nutritional strategies and the implementation of recovery strategies was strongly re ected, particularly concerning preventing burn-out, fatigue, and injuries.
Finally, a new lifestyle sub-theme of 'balance' emerged from the survey responses and was interlinked with social activity and connection/support, where athletes made recommendations to connect with other aspects of life such as study, family, and friends.
In virtually all aspects of the data there were almost no statistically signi cant differences between AB-athletes and AwD, and the few statistical differences that were identi ed may be due to their disability e.g., 'walking' was utilised more as a recovery practice amongst AB athletes (79%) compared to AwD (25%). Family support was greater for AwD, perhaps indicating support for managing various disabilities. The reasons why AB athletes reported practicing more rituals than AwD, requires further investigation as the reasons for this are not overtly evident. Again, there were very few statistically signi cant differences between males and females, but notably there were differences in the use of some recovery strategies and training hours leading up to and during competition.
These results indicate that athletes of state level and above perceive lifestyle factors, performance strategies, and social support as important factors in sporting success. Their responses also indicate that they would welcome the implementation of educational strategies, recovery practices, and access to service providers earlier in their athletic career. To facilitate this, athlete development programs may bene t from facilitating athletes' social support networks and implementing speci c programs to foster a culture of respectful interpersonal relationships amongst athletes and their friends, coaches, family and support staff.
Success both within sport and transition out of sport requires an holistic approach to athlete development that includes a complimentary mix of wellbeing, lifestyle practices, performance strategies, psychological attributes, education, and supportive interpersonal relationships. 20 Pre-elite athletes have been identi ed as the most vulnerable population coming through athlete development pathways and are subject to drop-out and burn-out. 21 Therefore, it is essential to quantify and understand gaps in the system and provide support, screening, and education platforms that can assess a developing athlete's competence, facilitate sport-speci c education, and implement interventions to maximise an athlete's longevity, performance-success, and transition to retirement. The importance of Psychological Skills and Attributes, Interpersonal Relationships, Performance Factors / Strategies, and Lifestyle Practices were all identi ed as important by the athlete, and where possible should be considered within holistic models of athlete development and support.

Declarations Ethics approval and consent to participate
The study was approved by RMIT University Human Research Ethics Committee  and all aspects of the study were undertaken in accordance with the approved procedures. All participants aged over 18 years completing the survey provided informed consent, whilst for participants aged under 18 years, consent was provided by parents/guardians and assent provided by the participants themselves.

Consent for publication
Not applicable Availability of data All data are securely stored on RMIT University servers in accordance with the approved 'data management plan'. Collated data les may be accessed upon request.

Competing Interests
The authors have no competing interests

Funding
No funding was linked to the undertaking of this research.

Author Contributions
All authors contributed equally to the design of the study. LB and JW facilitated the data collection. LB undertook the data analysis and drafted the manuscript. SB completed the writing of the manuscript. JW and MC reviewed and provided comments on the manuscript.  Tables   Table 1  Athlete Table 6. Representative quotes in response to questions: If you have achieved a medal at a benchmark event -why, in your opinion did you succeed compared to your less successful counterpart Superior Self-Regulation Train hard, believe in yourself, maintain perspective and be in the moment. (IP)

Strong Work Ethic
We set out the goal to win, and everything we did, every training session, every meeting, every recovery session, was all very much focused on that and it was consistently at the forefront of our mind. That melted away any complaints, of too much hard work, or too boring meetings, or being tired, it drove us to DO the right things, even if and when we didn't FEEL like it, because the goal was bigger than any obstacle. (n-IP) Effective Coping Strategies and Positive Mindset Con dence in the process and the training (IP) Responses in the themes of: Superior self-regulation; Intrinsic Motivation; and Effective Coping Strategies and Positive Mindset Superior Self-Regulation Self-re ection. To know the good in the bad, and the bad in the good and to subulate each into your performance. For me, being an athlete is about the movement of your own performances throughout your career. Incorporate your previous performances into how you will perform in the present. (n-IP)

Intrinsic Motivation
You have to be tough. And I also feel that if you are able to cultivate an internal motivational complex, you are far more likely to be successful. For example, if your motivation come from within, you are more likely to train harder every session, miss less training sessions and put yourself in the necessary uncomfortable situations without prompting. (n-IP)

Effective Coping Strategies and Positive Mindset
Mental training is the key to success, invest time in this. (IP)

Examples of responses from athletes concerning the importance of interpersonal relationships
Establish a support team around the athlete as early as possible. These support members will then be able to guide the athlete and help develop the mental framework so that the athlete exhibits better thoughtful action and awareness, as suitable for the individual athlete and their individual sport.
Find a great coach who understands you and who you are as a person as well as who you are as an athlete, and the ways to support you best. Find the best people to support you and guide you and to train with as early as possible so you don't miss out on valuable time, or waste time learning poor techniques/skills/ideas/strategies. Work hard so you have no regrets. (IP) To insure sport/life/school balance. The earlier you can see a counsellor or sport psych is important, particularly if you are competing at a high-level during puberty. Insuring support is always in place at training, not always sporting related but social support for LGBTQI and gendered related issues as the dynamic at training with a group of young people can bring up a lot of issues/concerns in this area. (n-IP) Support from friends and family is crucial, let them know you appreciate it. (n-IP) Ensuring that those who are around young/newer athletes in a sport have the athletes' best interests at the heart of their core priorities. I witnessed rst-hand in two sports parents/coaches living their goals & expectations through young athletes. It often destroyed the athlete and most certainly their passion for the sport.