The Evolution of Evidence-Based Research Towards Holistic, Evidence-Informed Decision Making in Health and Performance Fields
The Evolution of Evidence-Based Research Towards Holistic, Evidence-Informed Decision Making in Health and Performance Fields
Evidence-based research (EBR) has revolutionised the health, medical, and fitness industries, offering a systematic and scientific foundation for decision-making. Traditionally, EBR relied heavily on direct experimental findings such as randomised controlled trials (RCTs). However, as practitioners and researchers grapple with the complexities of human health and performance, a more inclusive and adaptable approach - evidence-informed decision-making (EIDM) has emerged. This paradigm integrates scientific research with professional expertise, individualised client needs, and real-world contexts, creating a nuanced framework for action.
This article explores how EBR has evolved into EIDM across health and performance sectors, guided by the contributions of thought leaders in fitness science, medical research, and public health.
Expanding on the Traditional Model of Evidence-Based Research
Evidence-based research (EBR), as first formalised in the medical field by pioneers like Dr. David Sackett, represents a significant milestone in how decisions are made in clinical settings. Its foundational principles revolve around combining rigorous scientific evidence with the professional expertise of clinicians and the preferences of patients. Below is an expanded examination of these three elements and the associated challenges that emerged when applying them to diverse and complex fields.
1. Best Available Evidence
The cornerstone of the traditional EBR model is the reliance on high-quality, peer-reviewed research. This typically includes:
Randomised Controlled Trials (RCTs): Considered the "gold standard" in medical research, RCTs minimise bias and establish causal relationships between interventions and outcomes. For instance, studies testing the efficacy of medications or procedures use RCTs to produce reliable data.
Systematic Reviews and Meta-Analyses: These synthesise findings from multiple RCTs, offering a broader overview of the evidence. This approach is essential for summarising data on well-researched topics, such as the efficacy of vaccines or the impact of lifestyle changes on cardiovascular health.
Limitations in Broader Fields
While the reliance on such high-quality evidence ensures robust conclusions, it poses challenges in other domains, such as fitness and sports science:
Complex Variables: RCTs often control for variables to establish causality, but this can oversimplify dynamic real-world scenarios. For example, fitness outcomes depend on numerous interacting factors like genetics, environment, and motivation, which are difficult to control in research settings.
Lack of Direct Evidence: Many fitness-related practices lack sufficient RCTs due to resource constraints or ethical considerations. This leads to gaps where indirect evidence or observational studies must be used instead.
2. Clinical Expertise
Another critical pillar of EBR is the integration of practitioner expertise. Clinicians draw on years of training and hands-on experience to:
Interpret research findings in the context of individual cases.
Adjust treatments when scientific evidence alone does not provide clear guidance.
Manage unpredictable situations where strict adherence to protocols may be impractical.
The Importance of Expertise
While evidence from trials may guide broad recommendations, experienced clinicians are often required to adapt these to specific patients. For instance:
In medicine, a doctor treating a patient with multiple chronic conditions might need to prioritise interventions based on the patient’s unique risks and preferences, even if those decisions deviate from clinical guidelines.
In fitness, a trainer working with an older client recovering from injury might modify standard resistance training programmes based on their expertise, even if such modifications have limited direct research support.
Challenges of Over-Reliance
Despite its importance, expertise alone cannot replace evidence. Over-reliance on anecdotal knowledge can lead to inconsistent practices or adherence to outdated methods, particularly when newer research challenges long-held beliefs.
3. Patient Values and Preferences
EBR’s human-centric focus acknowledges that treatments should align with the individual goals, needs, and values of patients or clients. This ensures that:
Patients are active participants in their care, improving adherence and satisfaction.
Treatments are ethically aligned with individual rights and circumstances, such as cultural or religious considerations.
Context-Specific Application
For example:
In medicine, a patient with terminal cancer might prioritise quality of life over aggressive treatments, influencing the chosen intervention.
In fitness, a recreational gym-goer may value mental health benefits over maximal performance, shaping the trainer’s recommendations.
The Challenges of Individualisation
Incorporating patient or client preferences adds complexity to decision-making:
Balancing evidence with individual demands can lead to ethical dilemmas, such as whether to proceed with treatments not supported by strong evidence.
Understanding diverse populations requires cultural competence and empathy, skills that are not always well-integrated into EBR protocols.
Challenges in Applying EBR to Fitness and Sports Science
The standardised protocols and controlled environments favoured in traditional EBR have proven less adaptable to dynamic fields like fitness and performance. Some specific challenges include:
1. Individual Variability:
Medical treatments often aim for average effects across populations. In fitness, individual responses to interventions like resistance training can vary widely due to factors such as muscle fibre composition, hormonal profiles, or psychological resilience.
2. Dynamic Environments:
Unlike medical trials conducted in controlled conditions, fitness programmes often operate in diverse and less predictable settings, such as gyms, outdoor environments, or at-home workouts.
3. Ethical and Practical Constraints:
Conducting RCTs in sports or fitness contexts may not always be ethical or feasible. For example, denying athletes a potentially beneficial training method for the sake of a control group could undermine fairness.
The Need for a Broader Scope
These challenges have prompted experts to advocate for a more inclusive model that supplements direct scientific evidence with:
Indirect and observational evidence to fill research gaps.
Insights from theoretical frameworks, such as biomechanics or exercise physiology.
Practical experience and real-world testing to validate evidence in diverse populations.
By adopting this broader scope, fields like fitness and sports science can better address the complexities and individualised nature of human performance while maintaining the integrity of evidence-based principles.
The traditional model of EBR, with its focus on rigorous scientific evidence, clinical expertise, and patient values, laid a strong foundation for advancing healthcare and related fields. However, its reliance on standardised protocols and tightly controlled methodologies often struggles to accommodate the complexities of fields like fitness and sports science. Recognising these limitations has paved the way for a broader, evidence-informed approach, which incorporates diverse evidence types and prioritises adaptability in real-world contexts.
The Shift Towards Evidence-Informed Decision Making
Integrating Broader Evidence Types
Modern proponents of EBR, including fitness researchers like Brad Schoenfeld and James Krieger, advocate for incorporating diverse evidence sources:
Direct empirical evidence: Findings from robust scientific studies remain foundational.
Indirect evidence: Related research, such as biomechanical or physiological studies, provides contextual insights when direct studies are unavailable.
Theoretical frameworks: Concepts like progressive overload or hypertrophy principles fill gaps in data, offering logical predictions.
Practical experience: Coaches, trainers, and medical practitioners contribute real-world observations to complement scientific theory.
Collaboration with clients and peers: Conversations with athletes, patients, and other professionals ensure approaches are adaptive and relevant.
This integrative framework addresses limitations of traditional EBR, creating a more dynamic and flexible model suited to complex, individualised environments.
Applications in Fitness and Performance Science
Brad Schoenfeld and James Krieger’s Contributions
Schoenfeld and Krieger, leading voices in exercise science, have championed EIDM in their works. Schoenfeld’s Science and Development of Muscle Hypertrophy exemplifies this by combining RCTs, theoretical supposition, and anecdotal evidence from athletes. Similarly, Krieger’s work emphasises tailoring interventions to individual needs through a combination of data analysis and practical insight.
Their approach underscores the importance of:
1. Critical evaluation of evidence: Distinguishing high-quality studies from less reliable ones.
2. Contextual application: Adapting general findings to specific populations, such as beginners versus elite athletes.
3. Interdisciplinary collaboration: Engaging with physiotherapists, sports psychologists, and nutritionists for holistic solutions.
Expanding on Schoenfeld and Krieger’s Contributions to Evidence-Informed Decision Making
Brad Schoenfeld and James Krieger are pivotal figures in exercise science, blending rigorous research with practical insights to develop evidence-informed approaches in fitness and performance. Their work exemplifies how evidence-informed decision-making (EIDM) incorporates scientific rigour while acknowledging the nuanced, individualised nature of human health and performance.
1. Critical Evaluation of Evidence
Schoenfeld and Krieger prioritise critical appraisal of research quality to guide practice effectively. This involves:
Evaluating Study Design and Methodology
Randomised Controlled Trials (RCTs): Schoenfeld frequently references high-quality RCTs in his book Science and Development of Muscle Hypertrophy . For example, studies exploring the dose-response relationship between training volume and muscle growth provide actionable recommendations.
Systematic Reviews and Meta-Analyses: Both researchers utilise these methods to synthesise large bodies of research. Krieger’s meta-analyses on topics like protein intake and resistance training frequency highlight their commitment to aggregating reliable data for practitioners.
Weighing Research Validity
Schoenfeld and Krieger recognise that not all studies are equal in quality or applicability:
They consider factors such as sample size, control for confounding variables, and statistical significance. For example, in the absence of large-scale RCTs, Schoenfeld incorporates findings from observational and smaller-scale studies, supplemented with theoretical understanding.
Navigating Conflicting Evidence
Fitness science often features conflicting results due to variable methodologies. Both researchers emphasise:
Looking for consistent patterns across multiple studies rather than relying on isolated findings.
Applying Bayesian reasoning to adjust confidence levels in specific interventions based on the totality of evidence.
2. Contextual Application of Research
Both researchers stress that applying evidence requires adapting findings to the specific context of individual clients, recognising differences in fitness level, goals, and other variables.
Beginner Versus Advanced Athletes
Schoenfeld and Krieger differentiate training recommendations based on experience levels:
Beginners: Generalised programmes with lower volumes and frequencies often yield significant results. For example, a beginner may thrive on 2–3 sets per muscle group per week.
Elite Athletes: Advanced individuals often require higher training volumes and periodisation strategies to elicit further adaptations. Schoenfeld’s research into the optimal set volumes for hypertrophy addresses this complexity.
Population-Specific Modifications
Both researchers also highlight the importance of tailoring interventions for unique populations:
Older Adults: Lower recovery capacity necessitates adjustments in intensity and volume. Evidence from Schoenfeld’s work supports the use of lighter loads combined with higher repetitions to achieve similar hypertrophic benefits.
Female Athletes: Krieger has analysed data specific to female physiology, such as menstrual cycle effects on strength training outcomes.
Real-World Feasibility
They advocate for strategies that consider adherence and practicality. For instance:
While research might suggest a high-frequency training model for hypertrophy, Krieger emphasises balancing this with clients’ time constraints and preferences to ensure consistency.
3. Interdisciplinary Collaboration
Schoenfeld and Krieger recognise that optimal results in fitness often require collaboration across disciplines. They advocate for integrating insights from various experts, creating a holistic approach to health and performance.
Physiotherapists
Collaborating with physiotherapists ensures that training interventions are safe and rehabilitative for clients recovering from injury or managing chronic conditions. For example, they may incorporate rehabilitation exercises alongside strength training protocols.
Sports Psychologists
Motivation, adherence, and mindset significantly influence training outcomes. Working with sports psychologists helps develop mental strategies to maintain discipline, particularly in long-term training programmes.
Nutritionists
Nutritional intake is fundamental to recovery, hypertrophy, and performance. Krieger’s expertise in analysing protein timing and intake exemplifies the importance of dietary considerations in programme design.
Case Example: Holistic Programme Design
Imagine a client recovering from an ACL injury. A collaborative team might include:
A physiotherapist designing mobility and stability exercises.
A coach implementing progressive resistance training.
A sports psychologist addressing confidence in returning to sport.
A nutritionist ensuring optimal macronutrient intake for healing and performance.
Schoenfeld and Krieger advocate for integrating these elements to create programmes that address both short and long-term goals.
The Practical Impact of Their Work
The methodologies championed by Schoenfeld and Krieger highlight how EIDM can be operationalised:
1. Enhanced Training Adaptations: By leveraging both theoretical and empirical evidence, clients achieve faster and more sustainable results.
2. Improved Client Compliance: Contextualising recommendations to individual needs fosters better adherence.
3. Safety and Longevity: Collaboration across disciplines minimises injury risk while promoting long-term health.
By blending rigorous scientific analysis with practical considerations, Schoenfeld and Krieger’s approaches exemplify the future of fitness and sports science—evidence-informed, adaptable, and client-centred. Their work continues to shape a field increasingly driven by nuanced, multidimensional decision-making.
Other Advocates in Fitness Science
Researchers like Dr. Eric Helms, Dr. Bret Contreras, and Dr. Andy Galpin echo these sentiments, blending science with practical expertise. For example:
Helms’ Muscle and Strength Pyramids integrates client goals and preferences into evidence-based programme design.
Contreras highlights the role of anecdotal insights, especially when coaching elite performers.
The Medical Perspective: Evidence-Informed Healthcare
Lessons from Medicine
Medical research has long struggled with balancing scientific rigour and real-world applicability. Pioneers like Dr. Sackett and Dr. Gordon Guyatt advocate for the integration of multiple evidence sources:
Direct clinical trials provide a solid evidence base.
Observational studies offer insights where RCTs are unfeasible.
Qualitative research captures patient perspectives, essential for personalised care.
Expanding the Evidence Base
Dr. Trisha Greenhalgh, a leading voice in evidence-based medicine, critiques an over-reliance on quantitative studies. Her work highlights the value of:
Contextualised decision-making: Adapting protocols to resource-limited settings or diverse patient populations.
Interdisciplinary dialogue: Including nurses, allied health professionals, and patients in the decision-making process.
Similarly, Dr. John Ioannidis, renowned for his meta-research, emphasises the need for methodological flexibility. He advocates for integrating observational and theoretical evidence to address real-world complexities.
Bridging the Gap Between Health and Performance
Shared Principles Across Fields
Both fitness and medical sciences are converging on shared principles:
1. Holistic decision-making: Incorporating biological, psychological, and social factors into evidence evaluation.
2. Individualised approaches: Recognising that "one-size-fits-all" solutions are rarely effective.
3. Practical validation: Testing interventions in real-world settings to ensure their feasibility.
A Collaborative Model
EIDM fosters collaboration across disciplines. For instance:
Medical research on recovery protocols informs athlete rehabilitation programmes.
Fitness science insights into resistance training guide physical therapy for elderly populations.
Challenges and Opportunities in Evidence-Informed Practice
Challenges
1. Balancing rigour with flexibility: Integrating diverse evidence types without compromising scientific validity.
2. Overcoming biases: Ensuring that anecdotal or observational data do not overshadow robust research.
3. Navigating information overload: Sifting through an ever-growing body of literature to extract actionable insights.
Opportunities
1. Technological advancements: Data analytics and wearable devices provide real-time evidence to support decisions.
2. Interdisciplinary research: Collaborations between clinicians, coaches, and scientists enhance knowledge translation.
3. Patient and client empowerment: Engaging individuals in decision-making fosters adherence and trust.
Conclusion: The Future of Evidence-Informed Decision Making
The shift from traditional EBR to holistic EIDM reflects a broader recognition of the complexities in health and performance fields. By combining rigorous science with practical experience and client-centred approaches, professionals can deliver tailored, effective solutions.
This evolution underscores the importance of adaptability, critical thinking, and collaboration. As both fields continue to embrace EIDM, practitioners are better equipped to navigate the challenges of modern healthcare and fitness, ensuring outcomes that are not only evidence-based but also deeply informed by the realities of individual lives.
References and Further Reading
1. Schoenfeld, B., Science and Development of Muscle Hypertrophy. Human Kinetics.
2. Sackett, D. et al. (1996). Evidence-Based Medicine: What It Is and What It Isn’t. BMJ.
3. Greenhalgh, T. (2014). How to Read a Paper: The Basics of Evidence-Based Medicine. Wiley-Blackwell.
4. Contreras, B., Glute Lab: The Art and Science of Strength and Physique Training. Victory Belt.
5. Helms, E. et al. The Muscle and Strength Pyramids. Muscle and Strength Nutrition.
6. Ioannidis, J. (2005). Why Most Published Research Findings Are False. PLOS Medicine.
For additional insights, visit:
[Cochrane Collaboration](https://www.cochrane.org/)
[Weightology by James Krieger](https://weightology.net/)
[PubMed](https://pubmed.ncbi.nlm.nih.gov/)
