How to Maximize Wellness Questionnaires in an Operational Monitoring System

A team of 30 athletes walks into the weight room. Since you last saw them 48 hours ago, each of those 30 athletes has lived a completely different life. Each one is in a different state of wellbeing, driven by the choices they made over those hours. Athletes have to decide whether they ate enough or brace themselves through another plate of dining hall food; whether they should finish their assignment or go to bed now to be ready for practice tomorrow morning.

These choices affect the readiness of the body to train the next day. Wellness questionnaires are a great tool for initially screening athletes to understand their readiness. In my previous article, I expanded on how I use focused questions to extract the most meaningful information with wellness questionnaires. In this article, I will expand on how to integrate questionnaires into an operational monitoring system that has set checkpoints for protecting athlete wellbeing.

Individual readiness is part of what makes team sports challenging to work with—a multitude of factors are at play and various stakeholders hope to control them. Each stakeholder has their methods and input into the final product:

• Sport coaches have practices, competitions, film sessions, and more.
• Athletic trainers have rehab sessions, preparticipation screening, coverage of practice, and more.
• Strength and conditioning coaches have weight room sessions, speed sessions, conditioning sessions, and more.

Individual readiness is part of what makes team sports challenging to work with—a multitude of factors are at play and various stakeholders hope to control them, says @Torinshanahan42. Share on X

Athletes are pulled in different directions. Each make their own choices and respond differently.

Varying responses lead to different degrees of wellbeing for each athlete. Asking each athlete how they feel before each training session takes time, something strength and conditioning professionals do not have a lot to spare. Wellness questionnaires are a tool that coaches can use to screen athletes and focus their attention on those in the most need of their time.

Combining subjective and objective information signals athletes who may feel something is wrong or objectively a measure is telling you something is wrong. Combined with a coach’s experience and expertise, coaches can provide the proper modifications to training and/or recovery, if necessary, to protect the health and safety of the athlete.

Questionnaires need to ask streamlined questions with unambiguous answer choices. The questionnaires I use ask about the athlete’s current level of fatigue, mood, the quality of the previous night’s sleep, and how many hours of sleep they got the night before. The first three questions—fatigue, mood, and sleep quality—are the subjective questions. These are up to the athlete based on their interpretation of their own body.

The response system for these questions removes ambiguity. They have three possible responses: below average, average, and above average. In that previous article, I argue that this system increases the signal by increasing the concreteness and relatability of the answer options. A fifth question can be added about resting heart rate for centralized data collection. With resting heart rate added, there are two objective questions.

The subjective questions signal when athletes feel something is wrong, while the objective questions signal when their body is telling them something is wrong. Once signaled, coaches can use their experience and expertise to provide the proper modifications to training and/or recovery, if necessary, to protect the health of the athlete.

Operational readiness systems create change by impacting decision-making, while non-operational systems are just for show. The following will provide steps to enact an operational readiness monitoring system.

Operational readiness systems create change by impacting decision-making, while non-operational systems are just for show, says @Torinshanahan42. Share on X

Making the System Operational

Every strength coach has the same goals: more resilient and effective athletes. Creating change means applying a stimulus as an external load that creates a responsive internal load. Training is the application of stress to athletes. Their readiness comes from the ability to recover from the previous stressors. Wellness is the athlete’s health, and readiness is defined as an athlete’s ability to perform. Both are impacted by previous training, sports competitions and practice, sleep, nutrition, and many more factors.

An operational monitoring system determines the athlete’s wellbeing through multiple measures. Coaches then utilize expertise, experience, and evidence to respond to the state of an athlete. As always in this field, context is king. When making a system operational, factors that must be accounted for are:

• The sport
• The number of athletes
• Recovery and nutrition resources
• Time of year
• Current goals

The objective of any readiness system is not to make decisions, but to provide support to conversations about those decisions around the development of more resilient and superior athletes.

Operational wellness monitoring systems:

1. Provide information

• Combine subjective and objective information
• Measure multiple systems

2. Guide discussions about training modifications
3. Enhance training outcomes by responding to an athlete’s capability to train

Measuring the Multiple Systems Involved in Readiness

The complexity of the human body offers decision-makers a high degree of uncertainty. Facts that reduce uncertainty are information. Data can become information by quantifying systems involved in the complexity that is trying to be understood. Extracting information from data revolves around the ability to simplify it to a point that can be interpreted. Enough data points must be mapped to paint a clear picture of the most impactful complements to the complex system.

Painting clear pictures requires building a battery of sources from specific systems with large effects on the wellbeing of the athlete. Wellbeing has psychological and physical roots. The psychological systems involved are the athlete’s mind and thoughts. Physical systems involved in the recovery process between training are the central nervous system, the musculoskeletal, and many more.

On the psychological side in the readiness equation are subjective questions. The human mind is incredibly powerful, and a person’s perception can drastically alter the physical outputs of the body. Understanding an athlete’s own reflection on their status with subjective questions informs the practitioner on where they feel they are at. There is commonly a link between their physical status and perception of this status, but inaccuracies here must be understood as they require a specific approach from the coach.

The human mind is incredibly powerful, and a person’s perception can drastically alter the physical outputs of the body, says @Torinshanahan42. Share on X

Objective measures cut through the ambiguity of perceptions to the true status of the body. The central nervous system (CNS) ties into every other part of the body. The CNS is highly involved in readiness due to its widespread effect. Heart rate measures like resting heart rate or heart rate variability provide information on autonomic nervous system function. Information can be gathered on the stress response and recovery drive of the nervous system. The somatic nervous system (SNS) is the branch controlling the muscles. Testing the SNS sheds light on the maximal output that the athlete is capable of, which can include (but is not limited to) counter-movement jumps, depth jumps, and isometric mid-thigh pulls.

Recovery between training is important, as insufficient recovery with constant training pushes athletes down the hole and eventually off the cliff. Sleep is the most important input to recovery. Subjective sleep quality informs coaches on the effectiveness of sleep, and the total hours of sleep informs how much recovery time has been available. Hours of sleep are not effective without sufficient quality of sleep, so understanding both components can help coaches catch problems before they start rolling downhill.

Combined, coaches have quantitative data on psychological wellbeing, autonomic status, residual fatigue of the somatic nervous system, and how well and long they slept. Putting all this information together is no easy task.

The Workflow

Being efficient with your time is important. A specific workflow helps with the effective implementation of the monitoring system. Questionnaire data informs on the possible status of the athlete while the testing allows the athletes to prove they are ok.

The first step in data collection is when athletes fill out their questionnaire in the morning and it is collected in one central location. This data then populates a dashboard and is the first checkpoint on the path to making decisions. Experience and context help with interpreting information from the data that the athletes present.

Experience and context help with interpreting information from the data that the athletes present, says @Torinshanahan42. Share on X

Athletes are pooled by their status into compromised and normal readiness groups. Both groups have different thresholds for scoring readiness tests. This provides more or less wiggle room based on their responsiveness to previous training. The criteria for grouping is the number of red flags they have, which can come from any of the four broad categories of data:

• Subjective perceptions
• Sleep
• Resting heart rate
• Extra comments

Generally, a “red flag” in any two or more of these categories changes their readiness group. One red flag with a declining history of readiness might also change their group. These are not hard rules but general guidelines. The groupings are then translated onto the readiness testing Google Sheet through dropdown boxes on the sheet.

The second phase of the workflow is testing. After the warm-up, the athletes conduct multiple trials of the readiness testing. For example, I have previously used a counter-movement jump on a Just Jump Mat. Athletes then used an iPad to input their jump height. Using an automatic analysis formula, the sheet would automatically report the next steps for the athletes. This analysis is modified by thresholds set by the group the athlete is in. The next step would be one of three options:

1. Normal results testing prompted athletes to continue with the training session as planned.
2. A significantly different readiness test result prompted athletes to check in with me.
3. An extremely different result promoted athletes to check in and automatically reduced their training volume.

This check-in is the second checkpoint where conversations can be had based on guidance from the data. From there, multiple options are available based on the information and context like modification of training, counseling on recovery practices, or prescription of additional recovery modalities.

Analysis

Analyzing the data is a way of answering questions. To get to the important questions, basic questions like who is viewing the report and when they view it must be answered first. Second, specific questions like what information is needed in their decision-making process must be answered next. The analysis needs to be as streamlined as possible. Creating reports and workflows that allow for near-immediate communication of the impactful information is important to give you more time coaching and not analyzing.

Context

Reports should be built specifically for the person making decisions and the decisions they have to make. Sport coaches and strength and conditioning coaches have different jobs and need different information. Different time-periods have different objectives requiring different decisions to be made; the two big time-periods are in-season and off-season.

Reports should be built specifically for the person making decisions and the decisions they have to make, says @Torinshanahan42. Share on X

In the off-season: Off-season readiness boils down to the question, “Is the athlete recovering enough to keep building?” The goal of the off-season is building up better athletes. Building requires time to build, which the body does during sleep.

Questionnaires provide the checkpoint to counsel athletes on their sleep. Athletes who more frequently have better quality sleep and/or sleep more hours in total have higher responses to training. During training, stress is applied to athletes and heart rate measures inform of the stress response. Resting heart rate changes acutely and over the last week can help you catch someone who is struggling to keep up, getting sick, or is highly stressed. Whatever the reason, these are great points to check in with that athlete. Remember, it’s the off-season—they will be sore and tired, but training must go on.

During in-season periods: Readiness becomes a daily checkpoint in-season. Are the athletes going to be prepared to perform at their best given the training program between now and the competition? After the competition, central fatigue can manifest for 72 hours afterward. Readiness motioning and testing allows for verification that the athletes have recovered or are in the process of recovering in time for the next competition.

Athletes can only help us win if they are healthy. You can help keep them healthy by fine-tuning training to meet them where they are at. In-season all metrics have value. A comment from the athlete or a flagged score in any of the categories of sleep, resting heart rate, or subjective wellbeing will place them on a list. Everyone on the list gets an initial check-in prior to training with two or more flags adapting their readiness testing thresholds.

This modification increases the chances they have to check in again and that modifications will be put in place. This is all done because sport practice is the most important component for preparing athletes for competitions. While weight room training might not be the root of the problem, modifications reduce the total stress on compromised athletes while allowing them to practice fully.

Sport practice is the most important component for preparing athletes for competitions, says @Torinshanahan42. Share on X

Reports for sport coaches: When reporting to sport coaches, they need to know one thing: can their athletes practice. Understanding that coaches do not have a background in exercise science is critical. Adapting metrics to be intuitive is important for your success. Sport coaches understand one thing—the game. Presenting metrics as percentages of their max or normal value is more intuitive for coaches to understand.

Additionally, coaches do not need all the metrics. They need the one, maybe two, metrics that best summarize the status of the athlete. Reports should be in formats coaches understand best. Some like graphs and charts, while some like numbers. Get to know your coach and report your data in the way they can best receive the key information they need for their job.

Reports for S&C: An S&C coach’s combined expertise in physiology, knowledge of the context, and understanding of training allows them to interpret meaning from the data. More data points can be digested, and data should be reported in raw value form and with context using z-scores. For each athlete, you should be able to see what their resting heart rate is (72 bpm) and the z-score of that heart rate for that athlete (1.21).

For each athlete, you should be able to see what their resting heart rate is and the z-score of that heart rate for that athlete, says @Torinshanahan42. Share on X

This gives the context of what is their norm and how different is this data point. This provides the information for discussions. Questioning athletes on why their heart rate was 1.21 standard deviations above normal will not resonate, but explaining, “Hey, I saw your heart rate was 72 this morning, how is everything going?” will go over much better. On the other hand, only reporting the raw data does not provide the context to know this is not normal for this athlete. Reports can use tables and graphs for the quick analysis of trends over time, while conditional formatting gives visual cues of what needs to be examined further. In short, reports for S&C coaches need to provide them with the information to do their jobs.

Simplicity

Unless you are a sport scientist, chances are you did not get into this field to stare at spreadsheets all day. Simple and automatic workflows will reduce the amount of time spent staring at spreadsheets. With a budget, Athlete Management Systems and other software options make things very simple for coaches. Without a budget, learning how to get the most out of Excel is needed to make things simple. Straightforward workflows are possible with Excel. Connections between spreadsheets, power queries, and different formulas will allow for the building of dashboards that report with the click of the refresh button.

Connections between spreadsheets, power queries, and different formulas will allow for the building of dashboards that report with the click of the refresh button, says @Torinshanahan42. Share on X

Creating an operational monitoring system starts with the goal of enhancing athlete health to further increase the effectiveness of training. Using objective and subjective information, along with readiness testing results, provides the information that improves the understanding of an athlete’s status. Using data points over various physiological systems improves the signal from the very complex interactions in the body. Understanding the context of the situation allows the development of very specific questions that need to be answered with the data.

Automatic workflows with helpful visualization techniques improve the simplicity of analyzing data. Together, the hope is that coaches can better modify training to the individual athlete’s ability to handle the load at that given moment. Healthier athletes will have a better chance of helping to win games, the ultimate goal of team sports.

Lead Photo by Bradley Rex/Icon Sportswire

Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF