Physical activity in former elite cricketers and strategies for promoting physical activity after retirement from cricket: a qualitative study

Objectives The health benefits of professional sport dissipate after retirement unless an active lifestyle is adopted, yet reasons for adopting an active or inactive lifestyle after retirement from sport are poorly understood. Elite cricket is all-encompassing, requiring a high volume of activity and unique physical demands. We aimed to identify influences on physical activity behaviours in active and insufficiently active former elite cricketers and provide practical strategies for promoting physical activity after cricket retirement. Design 18 audio-recorded semistructured telephone interviews were performed. An inductive thematic approach was used and coding was iterative and data-driven facilitated by NVivo software. Themes were compared between sufficiently active and insufficiently active participants. Setting All participants formerly played professional cricket in the UK. Participants Participants were male, mean age 57±11 (range 34–77) years, participated in professional cricket for 12±7 seasons and retired on average 23±9 years previously. Ten participants (56%) were classified as sufficiently active according to the UK Physical Activity Guidelines (moderate-intensity activity ≥150 min per week or vigorous-intensity activity ≥75 min per week). Eight participants did not meet these guidelines and were classified as insufficiently active. Results Key physical activity influences were time constraints, habit formation, intrinsic and extrinsic motivation, physical activity preferences, pain/physical impairment and cricket coaching. Recommendations for optimising physical activity across the lifespan after cricket retirement included; prioritise physical activity, establish a physical activity plan prior to cricket retirement and don’t take a break from physical activity, evaluate sources of physical activity motivation and incorporate into a physical activity plan, find multiple forms of satisfying physical activity that can be adapted to accommodate fluctuations in physical capabilities across the lifespan and coach cricket. Conclusions Physically active and less active retired cricketers shared contrasting attributes that informed recommendations for promoting a sustainable, physically active lifestyle after retirement from professional cricket.

Key physical activity influences were: time constraints; habit formation; intrinsic and extrinsic motivation; physical activity preferences; pain and physical impairment; and cricket coaching. Recommendations for optimising physical activity across the lifespan after cricket retirement included: prioritise physical activity; establish a physical activity plan prior to retirement and don't take a break from physical activity; evaluate sources of physical activity motivation and incorporate these into a physical activity plan; find multiple, satisfying forms of physical activity that can be adapted to accommodate fluctuations in physical capabilities across the lifespan; coach cricket.

Conclusions
Physically active and inactive retired cricketers share contrasting attributes that have informed recommendations for promoting a sustainable, physically active lifestyle after retirement from professional cricket.

Strengths and limitations of this study
• A purposive sampling strategy was utilised to capture contrasting physical activity behaviours and experiences, enabling comparisons between active and less active individuals.
• The study may have been subjected to selection bias, individuals who desire participation in a qualitative interview may differ from those who decline participation.
• The interviewer was a physiotherapist with knowledge of cricket and sports medicine and experience in interviewing and building rapport with individuals. Strong rapport enabled participants to share personal perspectives in a reflective and open manner that enriched the findings of this study.  When an individual adopts an inactive lifestyle, maladaptive responses lead to metabolic 2 dysfunction increasing the risk of developing chronic disease. 1 Physical inactivity increases 3 the relative risk of stroke by 60%, coronary artery disease by 45%, hypertension by 30% and 4 diabetes by 50%, resulting in profound personal, societal and economic costs. 2 In contrast, 5 regular sport participation is associated with a wide array of psychological, social and 6 physical health benefits. 3 4 However, the physical benefit of sports participation dissipates 7 following sport cessation; elite athletes who become inactive after retirement face the same, 8 or worse, risk of developing chronic disease as the inactive general population. 5 If the 9 physiological and psychological benefits an athlete obtained through professional sport could 10 be maintained by adopting a physically active lifestyle after retirement, a career in 11 professional sport could pave the way for a fulfilling and active life with multiple health 12 benefits. In order to develop strategies for promoting physical activity after retirement from 13 sport, a greater understanding of reasons for physical inactivity in this population is needed. 14 15 Cricket is a popular team sport played by people of all ages across various continents. A 16 professional cricketer must dedicate a large proportion of daily life to being physically active, 17 as games are often played over entire days and can last up to five consecutive days in 18 duration. Individuals who become professional cricketers, have typically been training and 19 playing large volumes of cricket since childhood, making cricket an ideal sport to explore 20 physical activity behaviours after retirement. The vast majority of cricket-related research has 21 focused on skill acquisition, performance optimisation and cricket injury. A professional 22 cricket career predisposes players to injury [6][7][8][9][10][11] which also places a professional cricketer at 23 risk of developing osteoarthritis in later life. [12][13][14][15][16] Developing osteoarthritis or chronic pain 24 F o r p e e r r e v i e w o n l y 7 after retirement from cricket has potential to negatively impact physical activity levels in later 25 life, although this has not yet been explored. A better understanding of the factors that 26 influence physical activity levels in retired professional cricketers will enable the design of 27 interventions and strategies to support cricketers to adopt a sustainable physically active 28 lifestyle after cricket retirement. Such insights may also be applicable to other professional 29 athletes. 30 The aim of this study was to draw upon retired-cricketers' personal perspectives and 31 experiences to: 32 i) identify key influences on physical activity behaviours after retirement from 33 professional cricket 34 ii) provide practical strategies for promoting a physically active lifestyle after 35 retirement from professional cricket. 36 37 Methods 38 This study is reported in accordance with the consolidated criteria for reporting qualitative 39 research (COREQ) guidelines. 13 40 41 Recruitment 42 Participants were purposively sampled from a cohort of 187 retired professional English 43 cricketers who completed a questionnaire collecting information on cricket-related factors, 44 current health, medical history and demographics. Responses from two items in this 45 questionnaire were used to allocate participants to one of two groups for purposive sampling: or agree that participation in cricket has resulted in a decrease in current physical activity 49 levels (n= 27, 25%). This sampling strategy was utilised to capture contrasting physical 50 activity behaviours and experiences to enable comparisons between active and less active 51 individuals. The age of retired cricketers was considered during recruitment to ensure the 52 sample represented men of varying ages. Only individuals from the larger cohort study who 53 indicated a willingness to participate in future sport-related research were invited into the 54 current study. Invitations and study information (including study rationale, procedure, 55 dissemination plans and the interviewer's credentials) were sent via email. 42 invitations 56 were sent to eligible participants, 19 received no response, 2 people declined to participate, 2 57 people were unavailable due to overseas travel and 1 person did not respond to further 58 correspondence despite an initial desire to participate. If no reply was received within two 59 weeks, a new individual was invited into the study. structured interview guide was pilot tested with three people with cricket experience prior to 73 ethics approval. The interview guide addressed key areas of interest while allowing the 74 researcher to adapt the interview guide to elicit relevant and rich information from 75 respondents through probing and prompting. 17 Open-ended questions provided participants 76 with the opportunity to consider personal perspectives and experiences ( Table 1). The 77 interview guide was iteratively adapted throughout the interviews to incorporate any 78 additional issues of importance to respondents (for example, by adding a question to explore 79 their relationship with cricket post-retirement). Participants had the opportunity to contribute 80 any additional information at the end of the interview.  Table 1.   10 An inductive thematic approach was used 18 19 facilitated by NVivo version 11 software. 20 A 96 study journal was used to summarise each interview and reflect upon initial ideas. Transcripts 97 were read multiple times with accompanying audio to identify all information potentially 98 relevant to the research aims. 21 This information was coded into multiple categories to be 99 later refined and analysed for themes. 18 Data coding was iterative and data-driven, performed 100 without engagement with literature to avoid sensitization to themes and without reference to a 101 pre-existing coding structure. 18 21 102 During subsequent stages of analysis, the data was further analysed for repeated patterns, 103 codes were sorted into a hierarchical structure representing themes and subthemes, 104 overlapping themes were merged, and those outside the scope of the current study were filed 105 separately. These themes and sub-themes were repeatedly reviewed and refined to confirm 106 external heterogeneity and internal homogeneity within themes and to ensure an accurate 107 representation of the entire dataset. The study journal was also revisited to check that themes 108 accurately reflected the key issues discussed by participants. 18 22 Themes were compared 109 amongst active and less active participants to better understand factors influencing physical 110 activity behaviors. 111 A selection of six transcripts representing participants with diverse physical activity patterns 112 were analysed by a second investigator (F.L.B) blinded to the coding structure developed by 113 the first author (S.R.F). A meeting was then held where key themes were discussed and a 114 high level of agreement was achieved between investigators. Key themes will be described 115 with reference to participant quotes. 18 11 To enable comparison of physical activity behaviors and perspectives in active and less active 119 counterparts, participant descriptions of current activity level (including type of activity and 120 frequency) were used to categorise participants into active and less active groups with 121 reference to the UK Physical Activity Guidelines. 23 The UK Physical Activity Guidelines 122 recommend adults undertake moderate intensity activity at least 150 minutes per week, or 123 vigorous intensity activity at least 75 minutes per week for health enhancing benefits 124 including reduced susceptibility and burden from chronic disease. 23

130
Participant characteristics 131 Participants were all male, aged a mean 57±11 (range 34 to 77) years and had been retired 132 from professional cricket for an average 23±9 (range 7 to 38) years. Ten participants were 133 physically active, meeting or exceeding the UK Physical Activity Guidelines and eight 134 participants were not active frequently enough to meet these guidelines. One in two (n=9, 135 50%) would prefer to be participating in a greater volume of physical activity. Full 136 participant characteristics are presented in Table 2.   137   138   Insert Table 2. Time constraints 144 The most common physical activity barrier identified by retired cricketers who expressed that 145 they would like to be more active, was time constraints. Many participants were working long 146 hours in sedentary professions which was a stark contrast from life as a professional cricketer 147 and resulted in difficulty finding the time to be physically active. In contrast, participants who were active and satisfied with their physical activity levels 156 prioritised physical activity, and irrespective of work and family commitments, allocated time 157 to be physically active on a daily basis.  13 Retired cricketers not meeting the physical activity guidelines who were dissatisfied with 170 their current physical activity level, had difficulty establishing an exercise routine and 171 integrating regular physical activity into their daily life. These individuals described adopting 172 "poor habits" early after retirement that were difficult to break when physical activity desires 173 changed.  32 and osteoarthritis is often perceived by those with the disease as a barrier to 331 physical activity. 33 A proportion of people living with osteoarthritis, express a misconception 332 that exercise will exacerbate osteoarthritis symptoms, and hold pain-avoidance behaviors 333 which become a barrier to being physically active. 34 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59 1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59

Abstract Objectives
The health benefits of professional sport dissipate after retirement unless an active lifestyle is adopted, yet reasons for adopting an active or inactive lifestyle after retirement from sport are poorly understood. Elite cricket is all-encompassing, requiring a high volume of activity and unique physical demands. We aimed to identify influences on physical activity behaviours in active and insufficiently active former-elite cricketers and provide practical strategies for promoting physical activity after cricket retirement.

Design
18 audio-recorded semi-structured telephone interviews were performed. An inductive thematic approach was used and coding was iterative and data-driven facilitated by NVivo software. Themes were compared between sufficiently active and insufficiently active participants.

Setting
All participants formerly played professional cricket in the United Kingdom.

Participants
Participants were male, mean age 57±11 (range 34-77) years, participated in professional cricket for 12±7 seasons and retired on average 23±9 years previously. Ten participants (56%) were classified as sufficiently active according to the UK Physical Activity Guidelines (moderate intensity activity ≥150 minutes per week, or vigorous intensity activity ≥75 minutes per week). Eight participants did not meet these guidelines and were classified as insufficiently active. Key physical activity influences were: time constraints; habit formation; intrinsic and extrinsic motivation; physical activity preferences; pain/physical impairment; and cricket coaching. Recommendations for optimising physical activity across the lifespan after cricket retirement included: prioritise physical activity; establish a physical activity plan prior to cricket retirement and don't take a break from physical activity; evaluate sources of physical activity motivation and incorporate into a physical activity plan; find multiple forms of satisfying physical activity that can be adapted to accommodate fluctuations in physical capabilities across the lifespan; coach cricket.

Conclusions
Physically active and less active retired cricketers shared contrasting attributes that informed recommendations for promoting a sustainable, physically active lifestyle after retirement from professional cricket.

Strengths and limitations of this study
• A purposive sampling strategy was utilised to capture contrasting physical activity behaviours and experiences, enabling comparisons between sufficiently active and insufficiently active individuals.
• The study may have been subjected to selection bias, individuals who desire participation in a qualitative interview may differ from those who decline participation.
• The interviewer was a physiotherapist with knowledge of cricket and sports medicine and experience in interviewing and building rapport with individuals. Strong rapport enabled participants to share personal perspectives in a reflective and open manner that enriched the findings of this study. When an individual adopts an inactive lifestyle, maladaptive responses lead to metabolic 2 dysfunction increasing the risk of developing chronic disease. 1 Physical inactivity increases 3 the relative risk of stroke by 60%, coronary artery disease by 45%, hypertension by 30% and 4 diabetes by 50%, resulting in profound personal, societal and economic costs. 2 In contrast, 5 regular sport participation is associated with a wide array of psychological, social and 6 physical health benefits. 3 4 However, the physical benefit of sports participation dissipates 7 following sport cessation; elite athletes who become inactive after retirement from sport face 8 the same, or worse, risk of developing chronic disease as the inactive general population. 5 If 9 the physical and psychological benefits an athlete obtained through professional sport could 10 be maintained by adopting a physically active lifestyle after retirement, a career in 11 professional sport could pave the way for a fulfilling and active life with multiple health 12 benefits. In order to develop strategies for promoting physical activity after retirement from 13 sport, a greater understanding of reasons for physical inactivity in this population is needed. 14 15 Cricket is a popular team sport played by people of all ages across various continents. A 16 professional cricketer must dedicate a large proportion of daily life to being physically active, 17 as games are often played over entire days and can last up to five consecutive days in 18 duration. During the course of the seven month summer season the playing schedule is 19 relentless and many elite cricketers also play overseas during the winter period. Elite 20 cricketers train during the preseason months and in between games with a mixture of skills 21 practice, aerobic and strength based conditioning. Individuals who become professional 22 cricketers, have typically been training and playing large volumes of cricket since childhood, 23 making cricket an ideal sport to explore physical activity behaviours after retirement. The vast majority of cricket-related research has focused on incidence, prevention, prediction 26 and treatment of cricket injuries. [6][7][8][9][10][11][12][13] A professional cricket career predisposes players to 27 injury 6 8 14-17 which also places a professional cricketer at risk of developing osteoarthritis in 28 later life. [18][19][20][21][22] Developing symptomatic osteoarthritis after retirement from cricket has 29 potential to negatively impact physical activity levels in former cricketers, although this has 30 not yet been explored. The Professional Cricketers' Association (PCA) published an online 31 report from a past player survey of 506 former cricketers of mean age 49 (range 22 to 86) 32 years. 23 The PCA reported that 88% of former cricketers needed to find work after retiring 33 from cricket and 20% suffered health consequences from playing sport. 23 Transitioning from 34 professional sport to a sedentary profession and health consequences from playing sport have 35 potential to impact physical activity behaviours in former cricketers, although this was not 36 investigated by the PCA. A better understanding of the factors that influence physical activity 37 levels in retired professional cricketers will enable the design of interventions and strategies 38 to support cricketers to adopt a sustainable physically active lifestyle after cricket retirement. 39 Such insights may also be applicable to other professional athletes. 40 The aim of this study was to draw upon retired-cricketers' personal perspectives and 41 experiences to:  Analysis procedure 110 The analysis procedure is summarised in Figure 1. An inductive thematic approach was 111 used 27 28 facilitated by NVivo version 11 software. 29 A study journal was used to summarise 112 each interview and reflect upon initial ideas. Transcripts were read multiple times with 113 accompanying audio to identify all information potentially relevant to the research aims. 30

114
This information was coded into multiple categories to be later refined and analysed for 115 themes. 27 Data coding was iterative and data-driven, performed without engagement with 116 literature to avoid sensitization to themes and without reference to a pre-existing coding 117 structure. 27 30 118 During subsequent stages of analysis, the data was further analysed for repeated patterns, 119 codes were sorted into a hierarchical structure representing themes and subthemes, 120 overlapping themes were merged, and those outside the scope of the current study were filed 121 separately. These themes and sub-themes were repeatedly reviewed and refined to confirm 122 promoting physical activity will be described with reference to participant quotes 27  groups. Participants were asked to describe any 'physical activity, exercise or sport' that they 145 currently take part in and were prompted to provide details regarding activity type, duration,    37 and African-Americans. 38       impairments as opposed to osteoarthritis in relation to physical activity. For these reasons, we 559 refer to 'pain and physical impairment' rather than osteoarthritis in the results section but 560 draw upon osteoarthritis literature to aid with interpretation of findings. We also 561 acknowledge that using self-report to assess physical activity levels and categorise 562 participants into sufficiently active and insufficiently active groups has limitations. 563 Categorising into two groups based on the UK Physical Activity Guidelines resulted in a loss 564

COREQ (COnsolidated criteria for REporting Qualitative research) Checklist
A checklist of items that should be included in reports of qualitative research. You must report the page number in your manuscript where you consider each of the items listed in this checklist. If you have not included this information, either revise your manuscript accordingly before submitting or note N/A.

Abstract Objectives
The health benefits of professional sport dissipate after retirement unless an active lifestyle is adopted, yet reasons for adopting an active or inactive lifestyle after retirement from sport are poorly understood. Elite cricket is all-encompassing, requiring a high volume of activity and unique physical demands. We aimed to identify influences on physical activity behaviours in active and insufficiently active former-elite cricketers and provide practical strategies for promoting physical activity after cricket retirement.

Design
18 audio-recorded semi-structured telephone interviews were performed. An inductive thematic approach was used and coding was iterative and data-driven facilitated by NVivo software. Themes were compared between sufficiently active and insufficiently active participants.

Setting
All participants formerly played professional cricket in the United Kingdom.

Participants
Participants were male, mean age 57±11 (range 34-77) years, participated in professional cricket for 12±7 seasons and retired on average 23±9 years previously. Ten participants (56%) were classified as sufficiently active according to the UK Physical Activity Guidelines (moderate intensity activity ≥150 minutes per week, or vigorous intensity activity ≥75 minutes per week). Eight participants did not meet these guidelines and were classified as insufficiently active.

Conclusions
Physically active and less active retired cricketers shared contrasting attributes that informed recommendations for promoting a sustainable, physically active lifestyle after retirement from professional cricket.

Strengths and limitations of this study
• A purposive sampling strategy was utilised to capture contrasting physical activity behaviours and experiences, enabling comparisons between sufficiently active and insufficiently active individuals.