IDENTIFICATION OF THE NUTRITION KNOWLEDGE, SOURCES OF SPORT

NUTRITION INFORMATION, AND ATTITUDES TOWARD THE ROLE OF NUTRITION

AND PERFORMANCE OF THE BALL STATE UNIVERSITY SWIM TEAM

A PROPOSAL

SUBMITTED TO DR. CAROL FRIESEN

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR

NUTR 697 RESEARCH METHODS IN NUTRITION AND DIETETICS

BY

JD MIDDLETON

DR. CAROL FRIESEN - ADVISOR

BALL STATE UNIVERSITY

MUNCIE, IN

DECEMBER 2017

i
 ABSTRACT

THESIS: Identification of the Nutrition Knowledge, Sources of Sport Nutrition

Information, and Attitudes Toward the Role of Nutrition and Performance of the
Ball State University Swim Team
STUDENT: JD Middleton

DEGREE: Master of Arts in Nutrition and Dietetics

COLLEGE: College of Health

DATE: December 2017

PAGES: 43

The nutritional needs of athletes are typically much different than the average non-

athlete. However, despite the importance of nutrition to sports, most collegiate athletes lack

reliable sources to acquire this knowledge and make the connection for their success. The most

reliable source of nutrition information for athletes is a registered dietitian who is Board

Certified as a Specialist in Sports Dietetics (CSSD). The Ball State swim team does not have

access to a sports dietitian who works with the team to optimize their nutrient intake, forcing

swimmers to obtain nutrition information from other sources that may or may not be evidence-

based, resulting in unreliable or false information. To provide evidence to Ball State University

administration regarding the need for a sports dietitian, it is important to identify the sport

nutrition knowledge, the sources athletes use to obtain sport nutrition knowledge, and the

attitudes toward the role of nutrition on performance of the swim team at Ball State University.

To conduct this study, all 45 student-athletes from the men’s and women’s swim teams (49%

men; 51% female) will be asked to complete an online survey to assess their nutrition

knowledge, attitude, and sources. The results of this study can be used as evidence for the

university to hire a full-time sports dietitian

ii
for the athletic department to improve student-athlete nutrition knowledge and enhance their

athletic performance.

TABLE OF CONTENTS

PAGE

ABSTRACT ................................................................................................................................. ii

CHAPTER 1: INTRODUCTION...................................................................................................1

Problem Statement...............................................................................................................3

Purpose Statement ................................................................................................................3

Research Questions ..............................................................................................................3

Rationale ..............................................................................................................................4

Assumptions.........................................................................................................................5

Definitions............................................................................................................................5

Summary ..............................................................................................................................5

CHAPTER 2: REVIEW OF LITERATURE..................................................................................7

Introduction ..........................................................................................................................7

Nutrition and the Athlete.....................................................................................................7

Energy Needs of the Athlete....................................................................................7

Sports Dietitian ........................................................................................................9

Nutrition Knowledge .........................................................................................................10

Athletes ..................................................................................................................10

Coaches ..................................................................................................................12

Nutrition Education............................................................................................................14

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 Sources for the Athlete...........................................................................................14

Effect on the Athlete..............................................................................................15

Summary ............................................................................................................................18

iv
 PAGE

CHAPTER 3: METHODOLOGY ................................................................................................19

Institutional Review Board ................................................................................................19

Subjects ..............................................................................................................................19

Instruments .........................................................................................................................19

Letter of Permission and Information................................................................................20

Methods..............................................................................................................................20

Statistical Analysis .............................................................................................................21

Summary ............................................................................................................................22

REFERENCES ..............................................................................................................................23

v
 LIST OF APPENDICES

Appendix A: Institutional Review Board Documents ......................................................25

CITI Completion Certificate ..................................................................................26

Appendix B: Survey Instruments .......................................................................................27

Athlete Sports Nutrition Survey.............................................................................28

Appendix C: Letters of Consent and Permission ..............................................................32

C-1: Letter of Permission from Athletic Director ..................................................33

C-2: Letter of Permission from Men’s Swim Coach .............................................34

C-3: Letter of Permission from Women’s Swim Coach........................................35

C-4: Letter of Information.....................................................................................36

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 CHAPTER 1

INTRODUCTION

The nutritional needs of athletes are typically much different than the average non-athlete

in order to be at top performance (Pandey & Singh, 2013). Depending on the type of exercise

(endurance vs. resistance), training by itself can increase the caloric needs of the athlete by 5-

40% (Pandey & Singh, 2013). If athletes do not consume the needed amount of calories and

nutrients, they risk being in a state of negative energy, resulting in poor athletic performance

among many other issues (Thomas et al., 2016). The requirements of carbohydrates, fat, and

protein are increased in athletes to meet the demands of their training (Pandey & Singh, 2013).

The timing of nutrient intake is also vital in order to ensure the athlete has efficient energy

during training and competition (Thomas et al., 2016). Each of these nutritional aspects are vital

for an athlete’s success in their sport (Pandey & Singh, 2013; Thomas et al., 2017).

Despite the importance of nutrition to sports, most collegiate athletes lack reliable

sources to acquire this knowledge and make that connection to success (McGehee et al., 2012).

The most reliable source of nutrition for athletes is a registered dietitian who is Board Certified

as a Specialist in Sports Dietetics (CCSD). These individuals, certified by the Academy of

Nutrition and Dietetics, are registered dietitians who apply evidence-based nutrition knowledge

in exercise and sport. Being board certified allows the dietitian to work with athletes and give

1
them nutrition counseling, meal plans, or nutrition advice to athletes on an individual or team-

wide setting (SCAN, 2015).

The lack of sports nutrition knowledge among college student-athletes and coaches is

strongly associated with the general lack of certified sports dietitians at most universities

(McGehee et al., 2012). If a university does not hire a specialist to counsel and teach the athletes

about nutrition and performance, it is highly likely this population will not get the accurate sport

nutrition information they need (Valliant et al., 2012)

Research indicates athletes often turn to the internet, their coaches, or their training staff

for nutrition information (Abbey et al., 2017; McGehee et al., 2012), while coaches tend to turn

to the internet or other colleagues as sports nutrition sources (Abbey et al., 2017). As a result,

misinformation is commonly being disseminated, resulting in a dangerous cycle for athletes as

they continue to get false information about their nutritional needs (McGehee et al., 2012).

Nutrition education from a sports dietitian has significantly positive impacts on student athletes

and coaches. With increased nutritional knowledge also comes improved nutritional behavior

and outlook on nutrition, which has a positive effect on performance (Cholewa et al., 2015).

Ball State University, a Division I NCAA school in the Mid-American Conference, does

not employ a CSSD for the athletic teams, placing their athletes at risk for poor nutrient intake

and reduced performance. Identifying the nutrition knowledge and sources of nutrition

information used by the Ball State athletes could be used as evidence in an attempt to convince

the athletic director to budget money for a CSSD. This study will examine the nutrition

knowledge and sources of nutrition information of the Ball State swim team.

2
Problem Statement

The nutritional needs of athletes are typically much different than the average non-athlete

(Pandey & Singh, 2013). Despite the importance of nutrition to sports, most collegiate athletes

lack reliable sources to acquire this knowledge and make the connection for their success

(Mcgehee et al., 2012). The most reliable source of nutrition information for athletes is a

registered dietitian who is Board Certified as a Specialist in Sports Dietetics (CSSD) (SCAN,

2015). The Ball State swim team does not have access to a sports dietitian who would work with

the team to optimize their nutrient intake, forcing swimmers to obtain nutrition information from

other sources that may or may not be evidence-based, resulting in unreliable or false information

(Abbey et al., 2017). In order to provide evidence to the Ball State University administration

regarding the need for a sports dietitian, it is important to identify the sport nutrition knowledge,

the sources athletes use to obtain sport nutrition knowledge, and the attitudes toward the role of

nutrition on performance of the swim team at Ball State University.

Purpose

The purpose of this study is to identify the sport nutrition knowledge, sources of sport

nutrition information, and attitudes toward the role of nutrition on performance of the Ball State

University swim team.

Research Questions

The following questions will be addressed in the study:

RQ#1: What is the overall sport-nutrition knowledge of the BSU swim team?

RQ#2: What sources of sport-nutrition information are used by the BSU swim team?

3
RQ#3: What are the attitudes of the BSU swim team toward the role of nutrition and their

individual performance?

RQ#4: Is there a difference in attitudes between the role of nutrition and performance based on:

a) Gender

b) Academic standing

c) Number of years competing in swimming

d) Event specialty

Rationale

Many studies have been done in order to test the knowledge of student-athletes and

coaches at various universities; time and time again these prove that there is a lack of nutrition

knowledge among this population (Abbey et al., 2017, Andrews et al., 2016, Botis & Holden,

2015, Danaher & Curley, 2014, Dunn et al., 2007, Hornstrom et al., 2011, McGehee et al., 2012,

& Shapiro et al., 2015). Additionally, many studies have shown that a sports dietitian has a

significantly positive impact on the nutritional knowledge of student-athletes and coaches

(Cholewa et al., 2015, Hull et al., 2016, Hull et al., 2017, Silva et al., 2016, & Valliant et al.,

2012). The purpose of this study is to test the sports nutrition knowledge of the Ball State

University swim team in order to see if their knowledge is concurrent with other similar studies.

The result of this will be used to prove that the university needs a sports dietitian for the student-

athletes and coaches. It’s important to break it down into gender, academic standing, number of

years in the sport, and event specialty to see if these variables have an effect on the sports

nutrition knowledge or attitude.

4
Assumptions

The researcher makes the following assumptions in the implementation of the study and

in the interpretation of the data:

1. The nutrition survey given to the athletes accurately tested their knowledge.

2. The questions asked accurately assessed the athletes to give us the necessary

information on this topic.

3. The athletes truthfully answered the questions.

Definitions

For the purpose of this study, the following definitions will be used:

1. Nutrition- the intake of food, considered in relation to the body’s dietary needs

(World Health Organization, 2014)

2. Sports Dietitian- experienced registered dietitian who applies evidence-based

nutrition knowledge in exercise and sport (SCAN 2015)

3. Certified Specialist in Sports Dietetics (CSSD)- being Board Certified as a

Specialist in Sports Dietetics designates specific knowledge, skills, and expertise

for competency in sports dietetics practice (SCAN, 2015)

Summary

Nutrition is very important for an athlete’s recovery and athletic performance, but they

need to be educated on this topic in order to ensure this is done properly. This is why a sports

dietitian is extremely useful for universities to have in order to ensure their athletes are properly

educated, and that they are getting their facts from a reliable source. The purpose of this study is

5
to test and assess the sports nutrition knowledge of the Ball State University swim team in order

to prove that the university needs a sports dietitian for the athletes and coaches. As seen with

other studies, nutrition education from a sports dietitian has significant improvements in nutrition

knowledge and nutrition practices of athletes. This will be useful for Ball State University

athletes to enhance their performance and ensure they are performing at their best.

6
 CHAPTER 2

REVIEW OF LITERATURE

The purpose of this study is to identify the sports nutrition knowledge, sources of sports

nutrition information, and attitudes toward the role of nutrition on performance of the Ball State

University swim team. This chapter will present a review of the literature to: 1) identify the

energy needs of college athletes; 2) understand the importance of a sports dietitian 3) assess

collegiate student-athlete nutrition knowledge; 4) assess nutrition knowledge of college coaching

staff; 5) discover the sources of nutrition education for college student-athletes and coaches; and

6) evaluate the effects of nutrition education on college student-athletes.

Nutrition and the Athlete

Energy Needs of Athletes

Athletes can have an altered and increased nutritional need compared to the general

population in order to avoid negative energy balance from training and to enhance performance

(Pandey & Singh, 2013). The US Dietary Guidelines and Dietary Reference Intakes typically

underestimate the amount of macronutrients needed to meet the athlete’s energy requirements

(Thomas et al., 2016). The timing of nutrient intake is also very important with the athlete

population for practice and competition (Thomas et al., 2016). Athletes typically have busy

7
schedules, often resulting in issues related to time management and food access restraints when

practicing and competing, making it difficult to get the proper nutrition needed (Heany, 2008).

Carbohydrates are the main source of energy (Pandey & Singh, 2013). Energy needs

differ based on sex, sport, and body composition (Pandey & Singh, 2013). Training alone can

increase the caloric needs by 5-40% depending on the type of exercise (i.e. endurance vs.

resistance/strength) and length of time of physical activity (Pandey & Singh, 2013). A limited

amount of carbohydrate is stored as glycogen that the body can use as energy for the athlete to

perform. The recommended daily intake of carbohydrates for a moderate to high trained athlete

is 60-65% of their total energy intake (Pandey & Singh, 2013). The Academy of Nutrition and

Dietetics recommends that macronutrients be recommended as “grams per kilogram of body

weight per day” rather than a percentage to make more personalized and specific dietary

recommendations. Using this format, the recommended carbohydrate intake for a moderate-

intensity-exercising athlete would be 5-7 g/kg/d and 6-10g/kg/d for a high-intensity-training

athlete (Thomas et al., 2016).

It’s important to consume enough carbohydrates to spare the amino acids of proteins in

the body. Protein is important for recovery of the muscles after exercise, and the timing of intake

is vital (Thomas et al., 2016). The recommended daily intake for protein is 0.8g/kg/d (Institute of

Medicine, 2005), athletes, however, need 1.2-2 g/kg/d in order to have enough for repair from

intense exercise (Thomas et al., 2016). The early phases of recovery, a time period that

encompasses approximately 0-2 hours after exercise, requires the intake of at least 15-25 g

protein to ensure the body has enough amino acids to start the recovery process (Thomas et al.,

2016).

8
 Dietary fat tends to have a bad reputation, especially for a population where body

physique can be very important, but it is vital to include fat as part of a balanced diet to optimize

athletic performance. Fat, like carbohydrates, serves as a source of energy (Thomas et al., 2016).

No more than 30% of one’s daily calories should come from fat (Pandey & Singh, 2013).

Athletes should not consume less than 20% of their daily calories from fat; if they do, this can

lead to a reduction in the foods that are high in their fat-soluble vitamins and essential fatty acids

(Thomas et al., 2016).

Sports Dietitian

As defined by the Academy of Nutrition and Dietetics, a sports dietitian is an experienced

registered dietitian who applies evidence-based nutrition knowledge in exercise and sport

(SCAN, 2015). Some duties of a sports dietitian include counseling athletes on proper nutrition

for their sport, provide personalized meal plans, and address any nutritional challenges athletes

are having with their performance. To be certified in this area of dietetics, the registered dietitian

must pass the Board to become a Certified Specialist in Sports Dietetics (CSSD). This

certification (CSSD) indicates the dietitian holds advanced knowledge in the field of sports

nutrition, allowing them to work with athletes and give them the proper, evidence-based nutrition

advice and education (SCAN, 2015)

Sports dietetics is a relatively new field that continues to grow in popularity as evidence-

based research continues to show the importance of nutrition to athletic performance (SCAN,

2014). Sports dietetics was not a field until 2004, with the CSSD credentialing introduced in

2006 (SCAN, 2014). In 2013, the National Collegiate Athletic Association (NCAA) paired with

the CSSD to create optimal feeding recommendations (SCAN, 2014). Although the relationship

9
between proper nutrition and athletic performance is well established, the number of CSSDs

employed in the field continues to lag (Spriet, 2017).

Nutrition Knowledge

Athletes

Nutrition is especially important for athletes to have optimized performance and recovery

in their sport. However, a lack of reliable nutrition sources causes athletes to lack the correct

nutrition knowledge needed to optimize their performance (McGehee et al., 2012). Many studies

have been done with universities that lack a CSSD to examine the nutrition knowledge of

student-athletes. Andrews, Wojcik, Boyd, and Bowers (2016) examined the nutrition knowledge

of mid-major division I university student-athletes. These researchers surveyed 123 athletes from

baseball, softball, men’s soccer, track and field, and tennis. To be considered as having

“adequate sports nutrition knowledge,” the athletes had to have a passing score of at least 75%.

Results indicated the mean score of these student athletes was 56.9%; only 12 athletes achieved a

score over 75%. No significant difference was found between the mean score of males (n=47;

57.1% mean score) and the female (n=76; 56.5% mean score) (p=.445). No significant

differences were found between class standing (p=.993). When the athletes were divided into

upper classmen (juniors and seniors, n=73) and underclassmen (freshmen and sophomores,

n=50), the mean scores were 56.9% and 56.8% respectively.

Dunn, Turner, and Denny (2007) tested the nutrition knowledge and attitudes of college

athletes (n=190) at a Southern university. The knowledge of athletes recruited from the football,

volleyball, basketball, softball, gymnastics, golf, tennis, swimming, cross country/track and field,

and soccer teams were assessed by using the Nutrition and Knowledge Questionnaire developed

10
by Parameter and Wardle (2000). Overall, the mean score of this group was 51.49% (13.57%).

Although exact scores were not given for each group, there was a significant difference found

between the male (n=92) and female (n=97) athletes in nutritional knowledge (p <0.001).

Shapiro, Friesen, Pike, and Lee (2015) tested the nutrition knowledge of athletes at a

specific mid-major university (n=134) using a 34-question survey based on the Sport Nutrition

Knowledge Survey created by McGehee (2012). The nutrition survey included four constructs:

1) nutrition problems, 2) sport-nutrition knowledge 3) recovery nutrition and timing, and 4)

hydration. With the exception of the men’s and women’s basketball teams, there were

participants from all 18 of the varsity sports sponsored by the university. Subjects included 134

student-athletes, of whom 59.7% were female (n=80) and 40.3% were male (n=54). Overall,

these athletes had a mean nutrition knowledge score of 16.75.6 out of 34 questions (49%), with

mean subunits as follows: nutrition problem (64% correct), sports nutrition knowledge (53%),

recovery nutrition and timing (60%), and hydration (48%). There were no significant differences

by gender (p=0.074), but there were differences by the number of semesters completed

(p=0.021), with juniors having the highest mean score of 21.65.0 (63%) and freshmen having

the lowest mean score of 18.35.3 (54%).

Abbey, Wright, and Kirkpatrick (2017), conducted a more sport-specific-cross-sectional

study to test the nutritional knowledge of NCAA Division III football players (n=88). These

researchers used a 17-question, multiple-choice quiz designed by McGehee et al. (2012) that

covered macro- and micronutrients, supplements, weight management, and hydration. Results

indicated the overal mean score was 55.2% 16.3%, with a significant difference (p <0.001)

between those who had taken a nutrition course in college (71.2%) and those who had not

(53.6%). The most missed questions were related to macro- and micronutrients (<50% answered

11
correctly), while over 75% of the athletes correctly answered the questions about pre-exercise

fueling, potential performance benefits of creatine supplementation, post-exercise rehydration

guidelines, and possible side effects of electrolyte loss.

Hornstrom, Friesen, Ellery, and Pike (2011) conducted a sport-specific study to test the

nutrition knowledge of Mid-American Conference (MAC) college softball players (n=185).

These researchers used a questionnaire that contained 80 questions related to basic nutrition and

sports nutrition, seven questions that addressed typical nutrition choices, 5 questions that

addressed typical nutrition practices, and 20 questions that addressed the softball players’

attitudes, behaviors, and intentions of a sport-enhancing diet. Results indicated mean score of the

nutritional knowledge questions was 45.7 4.7 (57.1%), nutrition choice was 19.4 (3.8),

nutrition practice was 2.8 (1.3), and attitude towards a sport-enhancing diet was 1.9 (0.4). No

significant difference was found by class standing (p=0.074). There was a significant relationship

between the player’s nutrition knowledge and the quality of her food choices (p=0.002, r=-0.23),

as well as between nutrition knowledge and nutrition practices (p=0.002, r=0.23), and between

the player’s nutrition knowledge and her attitude toward a sport-enhancing diet (p=0.02, r=-

0.17), indicating that healthier diet choices overall are made more often with increased nutrition

knowledge.

Coaches

The coaching staff is often a trusted source of nutrition knowledge and advice for student

athletes (Danaher & Curley, 2014). It’s important that the people in these trusted positions are

giving correct information about nutrition so that the athlete is not falsely led (McGehee et al.,

2012). In order to test their knowledge, similar studies were conducted with the coaching staff of

universities as well.

12
 McGehee, Pritchett, Zippel, Minton, and Cellamare (2012) assessed, in part, the nutrition

knowledge of collegiate coaches, athletic trainers (ATs), and strength and condition specialists

(SCSs). These researchers used a 20-multiple-choice-question survey to test the knowledge of

the coaches (n=131), ATs (n=192), and SCSs (n=71) from NCAA Division I, II, and III

universities. Although the overall score was over 70%, the coaches (n=47) scored 35.9% correct

(65.914.3), the ATs (n=137) scored 71.4% correct (77.810.3), and the SCS (n=59) scored

83.1% correct (81.610.3).

Botis and Holden (2015) obtained similar results, supporting the findings of McGehee et

al. (2012). These researchers tested the nutritional knowledge of head and assistant college

coaches (n=21) of an NCAA Division I school in the southern United States. These were coaches

of the women’s volleyball, softball, men’s and women’s track/cross country, football, and men’s

and women’s basketball teams. They used the Sports Nutrition Questionnaire developed by Zinn

(2004) that included 23 multiple-choice questions over 6 sections that covered nutrition, fluid,

recovery, weight gain, weight loss, and supplements. The study found that only one of the 21

coaches who participated had adequate knowledge of nutrition with a score of 74%. The mean

score of all the coaches was a 48 (55%; standard deviation not available). There was a significant

difference found between coaches who coached one gender and those who coached both genders,

with the mean score for those who coached male or female athletes being 46 (52%; standard

deviation not available) and 47 (53%; standard deviation not available) respectively, while those

who coached both genders had a mean score of 53 (60%; standard deviation not available). There

was not a correlation found between years coached and nutrition knowledge. The highest scoring

coach received a score of 65 (74%; standard deviation not available), and only had two years of

13
coaching experience, while the two most experienced coaches, who had 18 years of experience,

received a score of 54 (61%; standard deviation not available).

A similar study was done at a university in Canada to assess the coaches’ (n=5)

nutritional knowledge. Danaher and Curley (2014) used a 95-question survey. The questions

addressed the following seven constructs: fluid needs, training diet, pre-competition diet,

recovery diet, dietary supplementation, weight loss, and weight gain. The mean scores for these

categories were as follows: 49.5 for fluid needs (range=40.9-61.4), 58.1 (range=45.6-67.5) for

training diet, 68.3 (range=41.7-100) for pre-competition diet, 56.4 (range=35.3-64.7) for

recovery diet, 50.6 (range=35.3-64.7) for dietary supplementation, 53.8 (range=28.1-68.75) for

weight loss, and 57.5 (range=37.5-87.5) for weight gain. The coaches rated the confidence in

their answers and their overall knowledge of nutrition as being a 6 out of 10 (range not available.

Nutrition Education

Sources for the Athlete

The nutrition knowledge of athletes often depends on the sources where they get their

facts. This is why having a CSSD at universities is vital for student-athletes. The most common

sources tend to be the internet or the coaching staff for advice on nutrition for most athletes.

Results of the study done by Abbey and Wright (2017) with NCAA Division III football players

(n=88), found that the athletes went to their coach most often (25%), followed by the internet

(21%), and athletic trainers (19%), despite indicating the athletes felt most comfortable talking to

athletic trainers (29%) about nutrition, followed by the coach (27%) and a dietitian or nutritionist

(18%) (Abbey et al., 2017).

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 Similar results were found by McGehee (2012) who assessed 185 athletes from various

NCAA Division I, II, and III universities. The athletes were asked to rank their top three

nutrition information sources and their top three recommended nutrition information sources.

These answers were assessed by combining the first and second choices to determine the top

sources. Of these athletes, 16.2% (n=90) went to strength and conditioning specialists for

nutrition advice, with 11.4% (n=63) going to athletic trainers, and 7.7% (n=43) going to their

coach. An estimated 17.1% (n=95) believed they should be going to a strength and conditioning

specialist, followed by 13.9% (n=77) going to an athletic trainer, and only 13.5% (n=75) going to

a registered dietitian for nutrition advice.

Effects on the Athlete

Research has been done to test the effectiveness of nutrition education from a CSSD or

sports dietitian (SD). Hull, Jagim, Oliver, Greenwood, Busteed, and Jones (2016) assessed the

influence a SD has on the dietary habits of student-athletes from 10 collegiate sports (n=383).

The student-athletes took a survey that asked them about their dietary habits that included eating

habits, breakfast habits, hydration habits, nutritional supplementation use, pre-workout nutrition,

post-workout nutrition, nutrition during team trips, and nutrient timing. This data was

categorized by whether the source of the athlete’s nutrition information was from a SD or

another source. Results indicated that those athletes who used a SD as their primary source had a

great understanding of nutrition (47.12% vs. 32.85%), were more likely to be provided with

boxed meals while on team trips (21.29% vs. 6.77%), and were less likely to consume fast food

while on team trips (9.90% vs. 19.55%).

Hull, Neddo, Jagim, Oliver, Greenwood, and Jones (2017) examined the effect of having

a SD available for NCAA Division I baseball players from three universities (n=78). These

15
researchers surveyed athletes with 5 questions about their dietary habits and 10 questions about

their nutrient timing practices. The results were compared by whether the athlete’s primary

nutrition source was a SD (n=36) or a strength and conditioning coach (SCC, n=42). For the

dietary habits questions, the SD group was less likely to eat fast food (31% vs. 14%; p=0.02),

more likely to prepare their own meals (57% vs. 46%; p=0.02), and took daily vitamins (56% vs.

32%; p=0.02). For the nutrition timing questions, it was found that the SD group ate breakfast

before training/lifting sessions (67% vs. 37%; p=0.02), had post-workout nutrition options

available (61% vs. 27%; p=0.01), and had coaches who were more aware of healthy food options

(39% vs. 65%; p=0.05). This study shows that having a SD can have a significant impact on the

athletes.

To further support the positive impact a SD can have, Valliant, Emplaincourt, Wenzel,

and Garner (2012) conducted a study to assess the difference nutrition education from an RD had

on the dietary intake and nutrition knowledge of a NCAA female volleyball team (n=11). These

athletes were evaluated during two off-seasons for their nutrition knowledge with a pre-test and

their total energy and macronutrient with food records compared to their estimated needs. From

these results, each athlete was given a personalized nutrition intervention by an RD (four

separate visits). After the intervention, everything was evaluated again. Before the intervention,

the average energy intake for the team was 56% of their individual estimated needs, with a range

of 25-88% (1756 kcal 557.5), and after the intervention this number rose to 70% with a range

of 44-95% (2178 kcal 491.8; p=0.002). Before the intervention, the team’s carbohydrate intake

was 48% of their individual estimated needs, with a range of 29-76% (224.3g 64.4), and after

the intervention the intake increased to 66% with a range of 33-101% (304g 79.9; p=0.01). The

average intake of protein before the intervention was 59% of their individual estimated needs,

16
with a range of 16-88% (69.3g 26.8), but after the intervention it increased to 72% with a range

of 37-102% (84g  20.5; p=0.01). The fat intake before intervention was 77% of what their

individual estimated needs, with a range of 23-124% (67.4g  27.8), but after the intervention it

increased to 79% with a range of 52-118% (69g 24.8; p=0.63). There was also a significant

improvement in the team’s nutrition knowledge (p=0.001) after the intervention.

In a study of Brazilian volleyball players, Silva, Pilon, Costa, and Ridel (2016) evaluated

the impact that interdisciplinary food, nutrition, and health education had on the athletes’

nutrition knowledge and eating behaviors. The athletes took a survey about their eating habits

and routines, as well as answered multiple-choice questions about their nutrition knowledge.

They also answered 18 statements with a five-point Likert scale. Following an 8-month (one

session per month) nutrition education class, these questions were all re-evaluated and compared.

It was found that the athletes had an overall nutrition knowledge score of 579.9 (p=0.03) before

the classes and 63.011.8 (p=0.03) afterward.

Cholewa, Landreth, Beam, Jones, and MacDonald (2015) conducted a study on the

effects of a sports nutrition education intervention on NCAA Division I baseball players (n=30).

This was a 12-week study that required the athletes to participate in monitored strength,

conditioning, and skills training programs weekly, as well as a 90-minute nutrition intervention

course every three weeks. The baseball players each had to complete a sports nutrition

questionnaire and a three-day dietary journal at the beginning and at the 12-week mark to assess.

The researchers also tested the players one RM back squat, vertical jump, and broad jump at the

beginning and the 12-week mark. Results indicated that the nutrition knowledge of the baseball

players increased significantly (p < 0.05), and their squat (25.515.9 kg), vertical jump

(.1440.09m), and broad jump (.1350.1m) significantly increased (p <0.05) as well.

17
Summary

Nutrition is extremely important to an athlete’s training regime. Unfortunately, most

universities do not treat the role of nutrition and athletic performance with the respect it deserves.

Athletes need to have the resources available to them to ensure that they are educated on proper

nutrition for performance. Without the use of a SD or CSSD, sports teams lack access to the

nutrition knowledge they need. In most cases, not even the coaches and coaching staff are

properly educated about sports nutrition. Every athlete should have access to a reliable nutrition

source in order to optimize their athletic performance.

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 CHAPTER 3

METHODOLOGY

The purpose of this study is to identify the sports nutrition knowledge, sources of sports

nutrition information, and attitudes toward the role of nutrition on performance of the Ball State

University swim team. This chapter will describe the methods used to conduct the study.

Institutional Review Board

Permission will be requested from Ball State University Institutional Review Board prior

to implementing this study. The researcher conducting this analysis completed the Collaborative

Institutional Training Initiative (CITI) training (Appendix A-1).

Subjects

The population for this study will be members of the Ball State swim team who were

enrolled at the university and active on the team during the 2017-2018 school year. Currently,

there are 22 men and 23 women (n=45) on the swim team. All members will be surveyed in this

study. Ages of the participants will range from 18-23 years old.

Instruments

A nutrition survey, adapted from those used by Shaprio et al (2015) and Dvorak (2007),

will be used to assess the sports nutrition knowledge of the Ball State University swim team

19
(Appendix B-1). This survey will include sections about nutrition knowledge, attitudes towards

nutrition, and sources of nutrition information used by the swimmers. The survey contains 20

nutrition knowledge questions; of those, 10 are true/false and 10 are multiple-choice. The

nutrition attitude questions will be answered using a 4-point Likert scale (1= agree, 4=disagree).

The nutrition source questions will be answered using a 3-point Likert scale (1=never, 3=

always). Face and content validity of the content in the survey will be determined by three

registered dietitians, including a Board Certified Specialist in Sports Dietetics (CSSD), all

faculty members in the Department of Nutrition and Health Science at Ball State University. The

reliability of the survey has been previously determined, with the Spearman rho correlation 0.87,

meeting the requirements of 0.80 or higher (unpublished data, personal communication, Friesen,

November 22, 2017).

Letter of Permission and Information

Letters of permission to conduct the anonymous study were received from Pat Quinn,

Athletic Director at Ball State University (Appendix C-1), Bob Thomas, and Kristy Patterson,

swim coaches at Ball State University (Appendix C-2; Appendix C-3). The participants in this

study will be asked to read a letter or information that discusses the purpose of the study prior to

beginning the anonymous survey (Appendix C-4). Participation in the study is voluntary; there

will be no repercussions if a student-athlete chooses not to participate in the survey.

Methods

The survey will take place on the first Monday of December 2017. Both teams will take

the survey at separate times after their afternoon practice on that day. The survey will be on Ball

20
State University Qualtrics survey system, and the student-athletes will be asked to bring their

personal computers. On the day of the survey, the researcher will send a link of the survey to all

of the swimmers. After their practice, the coaches will ask the athletes to go to the pool

classroom. Once the athletes are seated, the researcher will describe the purpose of the survey.

The researcher will indicate that the results of the survey may be used as evidence to help

convince administration to hire a CSSD to work with the Ball State athletes. The research will

instruct the student-athletes to answer the questions truthfully and to the best of their knowledge.

Once they are finished, the participants will be free to leave after that time. This procedure will

be done once with the men’s swim team and then again with the women’s swim team. If an

athlete is unable to take the survey at the appointed time due to a scheduling conflict, the second

Saturday of December 2017 will be used as a make-up date.

Data Analysis

Data will be analyzed using SPSS v.23 for Windows (SPSS, 2016). Descriptive statistics

and frequency counts will be run on all variables. Frequency counts (number and percent) will

be used to determine the overall prevalence of specific survey questions. The nutrition attitudes

and sources will be analyzed by summing each of the Likert scale responses to each statement to

assess the overall trends seen. Each of the nutrition questions will be “scored” as right or wrong;

the number of “right” answers will be summed to create a total sport nutrition knowledge score.

The individual will be considering as having adequate nutrition knowledge if they answer 75%

of the nutrition questions right. One-way analysis of variance (ANOVA) will be used to compare

the scores of overall nutrition knowledge by gender, class standing, years competing in

21
swimming, and stroke specialty. Tukey post hoc will be used to calculate the mean differences

among these groups. Statistical significance will be set at p ≤ 0.05

Summary

This study will be a survey to assess the nutrition knowledge of the Ball State University

swim team. The survey will assess their nutrition knowledge, attitude, and sources. Information

from this survey will be used to provide evidence to the Ball State University administration

regarding the need for a sports dietitian.

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 REFERENCES

Abbey, E., Wright, C., & Kirkpatrick, C. (2017). Nutrition practices and knowledge among
NCAA division III football players. Journal of the International Society of Sports
Nutrition, 14, 13-13.

Andrews, A., Wojcik, J., Boyd, J., & Bowers, C. (2016). Sports nutrition knowledge among mid-
major division I university student-athletes. Journal of Nutrition and Metabolism, 2016,
5(1), 5 pages.

Botsis, A. & Holden, S. (2015). Nutritional knowledge of college coaches. Sports Science
Review, 24(3-4), 193-198.

Cholewa, J., Landreth, A., Beam, S., Jones, T., & MacDonald, C. (2015). The effects of a sport
nutrition education intervention on nutritional status, sport nutrition knowledge, body
composition, and performance in NCAA division I baseball players. Journal of the
International Society of Sports Nutrition, 12(1), 44-44.

Danaher, K. & Curley, T. (2014). Nutrition knowledge and practices of varsity coaches at a
Canadian university. Canadian Journal of Dietetic Practice and Research, 75(4), 210-
213.

Dunn, D., Turner, L., & Denny, G. (2007). Nutrition knowledge and attitudes of college athletes.
The Sport Journal, 10(4), 947-947.

Dvorak, T. (2007). The adolescent sport nutrition knowledge questionnaire: Validity and
reliability. (Unpublished master’s thesis). University of Utah, Salt Lake City, Utah.

Heany, S. (2008). Towards an understanding of the barriers to good nutrition for elite athletes.
International Journal of Sports Science & Coaching, 3(3), 391-401.

Hull, M., Jagim, A., Oliva, J., Greenwood, M., Busteed, D., & Jones, M. (2016). Gender
differences and access to a sports dietitian influence dietary habits of collegiate athletes.
Journal of the International Society of Sports Nutrition, 13, 38-38.

Hull, M., Neddo, J., Jagim, A., Oliver, J., Greenwood, M., & Jones, M. (2017). Availability of a
sports dietitian may lead to improved performance and recovery of NCAA Division I
baseball athletes. Journal of the International Society of Sports Nutrition, 14, 29-29.

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Hornstrom, G., Friesen, C., Ellery, J., & Pike, K. (2011). Nutrition knowledge, practices,
attitudes, and information sources of Mid-American Conference college softball players.
Food and Nutrition Sciences, 2, 109-117.

Institute of Medicine. (2005). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty
acids, cholesterol, protein, and amino acids. The National Academies Press, 1-1332.

McGehee, T., Pritchett, K., Zippel, D., Minton, D., & Cellamare, A., et al. (2012). Sports
nutrition knowledge among collegiate athletes, coaches, athletic trainers, and strength and
conditioning specialists. Journal of Athletic Training, 47(2), 205-211.

Pandey, S. & Singh, V. (2013). Nutritional needs of athletes. Pedagogìka, Psihologìâ ta

Mediko-bìologìčnì Problemi Fìzičnogo Vihovannâ ì Sportu, 4, 88-92.

SCAN (2014). Sports dietetics USA milestone. Retrieved October 26, 2017 from https://scan-
dpg.s3.amazonaws.com/media/files/2151421c-8fff-4c3d-8bd2-bbee5870a108/SD-
USA%20Milestones%202003-2013_Web%20Update_012014.pdf

SCAN (2015). Board certified specialist in sports dietetics (CSSD). Retrieved October 26, 2017
from https://scan-dpg.s3.amazonaws.com/media/files/f67b399e-c6b6-4258-bd7f-
fb71da92c0b3/CSSD_WEBINAR_03.13.14.pdf

Shapiro, K. & Friesen, C. (2015). Application of the theory of anticipatory guidance to identify
the anticipated use of a certified specialist in sports dietetics by collegiate student-athletes
at a Division I university. (Unpublished master’s thesis). Ball State University, Muncie,
Indiana.

Silva, N., Pilon, L., Costa, R., & Ridel, C. (2016). Impact of an interdisciplinary food, nutrition,
and health education program for adolescent Brazilian volleyball players. Revista de
Nutrição, 29(4), 567-577.

Spriet, L. (2017). Maximizing athletic performance through innovation, education, and practical
applications. Sports Medicine, 47, 3-4.

Thomas, D., Erdman, K., & Burke, L. (2016). Position of the Academy of Nutrition and
Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition
and the athletic performance. Journal of the Academy of Nutrition and Dietetics, 116(3),
501-528.

Valliant, M., Emplaincourt, H., Wenzel, R., & Garner, B. (2012). Nutrition education by a
registered dietitian improves dietary intake and nutrition knowledge of a NCAA female
volleyball team. Advances in Sports Nutrition, 4(6), 506-516.

World Health Organization (2014). Nutrition. Retrieved November 5, 2017, from

http://www.who.int/topics/nutrition/en/

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 APPENDIX A

INSTITUTIONAL REVIEW BOARD MATERIALS

CITI Certificate of Completion

25
Appendix A: CITI Certificate of Completion

26
 APPENDIX B

SURVEY INSTRUMENTS

Athlete Sports Nutrition Survey

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 Appendix B: Athlete Sports Nutrition Survey

True/False

1. Feeling tired in the middle of a workout may be a sign of not eating enough food- T/F

2. Carbohydrates are the most important energy source for high-intensity exercise- T/F

3. For one pound of weight lost after exercise an athlete should drink at least 3 cups (24 oz)
of water- T/F

4. Dietary supplements are tested for purity and safety before being sold- T/F

5. Oils from plants, fish, nuts, and seeds are considered healthful fats- T/F

6. Most athletes require about four times as much protein as non-athletes- T/F

7. Iron is found in meat, dark green vegetables, eggs, and fortified cereals- T/F

8. Refueling immediately after exercise with a sports drink and snack optimizes recovery-
T/F

9. Consuming a snack or beverage with calories before weight lifting will promote muscle
build- T/F

10. During exercise in the heat, drinking water is better than drinking sports drinks to
maintain hydration- T/F

Multiple Choice

1. Which of the following is the most critical goal of sports nutrition?

a. Adequacy of total calories (energy availability)
b. Availability of glycogen stores
c. Adequate protein intake
d. Maintenance of ideal body composition

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2. Significant losses of electrolytes (i.e. sodium, chloride, potassium, or magnesium) during
heavy exercise may lead to symptoms such as ____ or ____.
a. Drop in blood pressure, increased urination
b. Stress fracture, swelling
c. Dyspnea (difficult or labored breathing), indigestion
d. Muscle cramps, heat illness

3. Which of the following would be the most effective in aiding post-exercise recovery of
muscle and glycogen stores?
a. Granola bar
b. Chocolate milk
c. Banana
d. Energy drink (Red Bull, Monster, etc.)

4. Adequate daily intake of the following is the best way to ward off over-training
symptoms:
a. Total calories
b. Carbohydrates
c. Essential fats
d. Protein

5. If an athlete is properly fed, which of the following nutrients should not be used as a
primary source of fuel for exercise?
a. Carbohydrates
b. Protein
c. Fat

6. A concern for athletes who are under-eating is:

a. Underlying eating disorder
b. Female athlete triad
c. Overtraining Syndrome
d. All of the above

7. What is the fastest nutrient-related deficiency to develop in sports nutrition?

a. Carbohydrate (glycogen) depletion
b. Protein deficiency
c. Fat depletion
d. Fluid and electrolyte imbalance

8. Sports with several intervals of high intensity sprints (basketball, soccer, high intensity
interval training) require more of which nutrient for both the activity and the recovery?
a. Carbohydrate
b. Protein
c. Fat
d. None of these

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 9. The optimal timing for consuming a post event meal to restore glycogen would be:
a. Wait until you feel hungry
b. Within 2 hours post-exercise
c. 3-4 hours post-exercise
d. Timing of the meal is not relevant to glycogen restoration

10. Which pre-competition goal is not associated with carbohydrate intake directly before
exercise?
a. Avoiding hunger during competition
b. Delaying fatigue
c. Adding to glycogen stores
d. Minimizing gastrointestinal distress

Nutrition Information Sources

Rank on a scale of 1-3 (1=never, 2=occasionally, 3=always) of who you go to, and feel most
comfortable going to, for nutrition advice:
 Coach-
 Athletic Trainer-
 Weight Coach-
 Friends-
 Parents-
 Internet-
 Registered Dietitian-

Rank of a scale of 1-3 (1=never, 2=occasionally, 3=always) of who you think you SHOULD be
going to for nutrition advice:
 Coach-
 Athletic Trainer-
 Weight Coach-
 Friends-
 Parents-
 Internet-
 Registered Dietitian-

Nutrition Attitude

Respond to the following statements with a number 1-4 (1=agree, 2=somewhat agree,
3=somewhat disagree, 4=disagree) in regards to accurate you feel these are to your life and your
opinions on nutrition.

 I eat three meals a day.

 I care about eating healthy.

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  I eat most of my meals from restaurants or fast food places.
 I prepare most of my own meals.
 I know how many servings of each food group I should be eating daily.
 I usually feel tired midway through my workouts.
 I eat in the appropriate timeframe after a workout for muscle recovery.
 I drink water during exercise.
 I drink a sports drink during exercise.
 I take dietary supplements to aid in my athletic ability.
 I maintain a consistent weight during my sports season.
 I feel that I have access to reliable sources of nutrition advice.
 I think a registered sports dietitian would be a benefit to this team.

Demographics

1. Identify your gender

a. Male
b. Female

2. Choose your class ranking

a. Freshman
b. Sophomore
c. Junior
d. Senior
e. Second-year senior
f. Graduate student

3. How many years have you been swimming competitively?

a. 1-3 years
b. 4-6 years
c. 7-10 years
d. 11+ years

4. What is your stroke specialty?

a. Butterfly
b. Backstroke
c. Breaststroke
d. Freestyle
e. IM

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 APPENDIX C

LETTER OF PERMISSION AND INFORMATION

C-1: Letter of Permission from Athletic Director

C-2: Letter of Permission from Men’s Swim Coach

C-3: Letter of Permission from Women’s Coach

C-4: Letter of Information

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 Appendix C-1: Letter of Permission from Athletic Director

Email received October 17, 2017:

JD,

I certainly give you permission to conduct this survey. I think it’s a great area to be doing
research on and could greatly benefit the athletic department. Let me know if you need anything
else from me, and I wish you the best of luck!

Sincerely,
Pat Quinn
Deputy Athletics Director for Internal Affairs
Ball State University
Email: pquinn@bsu.edu
Phone: 765-285-8907

Original email sent October 12, 2017:

Pat Quinn

My name is JD Middleton, and I am a graduate student studying Nutrition and Dietetics here at
Ball State. I am writing my thesis on the nutrition knowledge of the men’s and women’s swim
teams. I was wondering if you could give me permission to conduct this survey with these teams
to help in my thesis. The survey will be completely anonymous to the student-athletes and
university. I can provide you with any further information that you might need in order to grant
my request.

Thank you so much, and I look forward to hearing from you soon.

Sincerely,
JD Middleton

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 Appendix C-2: Letter of Permission from Men’s Swim Coach

Email received October 21, 2017:

JD,

Yes, I give you permission to do this for the team. If PQ has no problem with it, then I’m
certainly okay with it. Just let me know when you want to do the survey or if you need anything
from me or the guys.

Sincerely,
Bob Thomas
Head Coach- Men’s Swim Team
Ball State University
Email: bthomas3@bsu.edu
Phone: 765-285-8909

Original email sent October 18, 2017:

Coach Thomas,

My name is JD Middleton, and I am a graduate student studying Nutrition and Dietetics here at
Ball State. I want to write my thesis on the assessment of nutrition knowledge of the Ball State
men’s and women’s swim teams, and I was wondering if I could have your permission on behalf
of the men’s team to conduct this. This survey would be completely anonymous to the student
athletes and university. I have already been granted permission from Pat Quinn on behalf of the
university to conduct this survey, but I wanted to check with you as well.

Thank you so much, and I look forward to hearing from you soon.

Sincerely,
JD Middleton

34
 Appendix C-3: Letter of Permission from Women’s Swim Coach

Email received October 20, 2017:

JD,

Absolutely! I think that’s a great thesis to do, and I would certainly allow you to survey the girls.
Just keep me updated, and let me know if you need anything from me!

Sincerely,
Kristy Patterson
Head Coach- Women’s Swim Team
Ball State University
Email: krcastillo@bsu.edu
Phone: 765-285-5173

Original email sent October 18, 2017:

Coach Kristy,

My name is JD Middleton, and I am a graduate student studying Nutrition and Dietetics here at
Ball State. I want to write my thesis on the assessment of nutrition knowledge of the Ball State
men’s and women’s swim teams, and I was wondering if I could have your permission on behalf
of the women’s team to conduct this. This survey would be completely anonymous to the student
athletes and university. I have already been granted permission from Pat Quinn on behalf of the
university to conduct this survey, but I wanted to check with you as well.

Thank you so much, and I look forward to hearing from you soon.

Sincerely,
JD Middleton

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 Appendix C-4: Letter of Information

Study Purpose and Rationale

The purpose of this study is to identify the sport nutrition knowledge, sources of sport nutrition
information, and attitudes toward the role of nutrition on performance of the Ball State
University swim team. The survey will be used to provide evidence to the Ball State University
administration regarding the need for a sports dietitian. It is important to identify the sport
nutrition knowledge, the sources athletes use to obtain sport nutrition knowledge, and the
attitudes toward the role of nutrition on performance.

Inclusion/Exclusion Criteria

To be eligible to participate in this study, you must be 18 years of age or older and a current
student-athlete on the Ball State University swim team for the 2017-2018 competitive season.

Participation Procedures and Duration

For participation in this study, you will be asked to complete a survey containing questions about
your nutrition knowledge, your sources of nutrition information, and your attitude regarding
nutrition. The survey consists of multiple-choice and fill-in-the-blank questions, and should take
approximately 10-15 minutes to complete.

Data Confidentiality

All data will be collected anonymously. You will not be asked to provide any identifiable
information.

Risks or Discomforts

There are no anticipated risks or discomforts associated with taking this survey. This survey is
completely voluntary. You are not required to answer all of the questions and may choose not to
answer any question that makes you feel uncomfortable. You may also quit the study at any time
without any prejudice from the investigator. Your anticipation or non-participation in this study
will not affect your athletic or academic standing within the university in any way.

IRB Contact Information

For questions about your rights as a research subject, please contact the Director, Office of
Research Compliance, Ball State University, Muncie, IN 47306, (765) 285-5070, irb@bsu.edu

36
Researcher Contact Information
Investigator: Faculty Supervisor:
JD Middleton, Graduate Student Dr. Carol Friesen
Nutrition and Dietetics Nutrition and Dietetics
Ball State University Ball State University
Muncie, IN 47306 Muncie, IN 47306
Email: jdmiddleton@bsu.edu Email: cfriesen@bsu.edu

By selecting the “I agree” button you acknowledge that you have read the information above and
agree to participate in the survey by giving your informed consent. If you do not wish to
participate in the survey and do not give your informed consent, please select the “I do not
agree” button.

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