HEALTH PRIORITIES IN AUSTRALIA

Critical Question 1 - How are priority issues for Australias health identified?
Measuring Health Status
Role of Epidemiology The collection and analysis of the data used to make this assessment is known as Epidemiology. Measures of Epidemiology Morbidity: The rates, distribution and trends of illness, disease and injury in a given population. Mortality: The number of deaths for a given cause in a given population, over a set timeperiod. Infant Mortality: The number of deaths in the first year of life per 1000 live births. Life Expectancy: An estimate of the number of years a person can expect to live at any particular age.

Identifying Priority Health Issues

Social Justice Principles Equity Diversity Supportive environments Priority Population Groups Prevalence of condition Potential for prevention and early intervention Costs to the individual and community Direct individual costs include the financial burden that is associated with illness and disability such as ongoing medical costs (hospital charges, medical professional fees, medications, travel etc.) and loss of employment In-direct individual costs include persistent pain and loss of quality of life, possible exclusion from social activities, increased pressure on families to offer support and the emotional toll of chronic illness Direct community costs include the vast funding of the Australian health care system (which is projected to markedly increase with an ageing and growing population). Most of this supports primary health care and pharmaceuticals, and the nature of chronic illness tends to require high degrees of medical intervention to manage them In-direct community costs include the premature loss of contributing and valuable members of society and the cost for employers in absenteeism, decreased productivity and re-training

Critical Question 2 - What are the priority issues for improving Australias health?
These determinants can be categorised as either: Sociocultural determinants (E.g. family, peers, media, religion and culture) Socioeconomic determinants (E.g. education, employment and income) Environmental determinants (E.g. geographical location and access to health services and technology)

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Groups experiencing health inequities

Aboriginal and Torres Strait Islander peoples Socioeconomically disadvantaged (Low SES) People living in rural and remote communities Overseas-born people Elderly People with disabilities

High levels of preventable chronic disease, injury and mental health problems
Cardiovascular Disease Nature Cardiovascular Disease (CVD) refers to all diseases of the heart and blood vessels, caused by a build up of fatty tissue inside the blood vessels (i.e. atherosclerosis) and the hardening of the blood vessels (i.e. arteriosclerosis) 3 types of CVD include Coronary heart Disease, Cerebrovascular Disease, Peripheral Vascular Disease Extent The leading cause of death and sickness Both mortality and morbidity is decreasing for males and females Risk Factors and Protective Factors Non-Modifiable Risk Modifiable Risk Factors Factors - Age: rates increase sharply - Smoking and alcohol abuse over 65 years of age - Diet high in fat, salt and - Being male sugar - Family history - Low physical activity levels - High blood pressure and cholesterol levels - Being overweight Determinants Sociocultural Determinants - Family history - Indigenous: higher rates of all risk factors - Males: less likely to engage in preventative health measures Socioeconomic Determinants - Low levels of disposable income - Unemployed - Low level of education Protective Factors - Nutritious and balanced diet - Daily physical activity - Responsible use of alcohol - No smoking - Maintain healthy weight - Control stress levels

Environmental Determinants - People who live in rural and remote communities

Groups at Risk Indigenous Australians Socioeconomically disadvantaged communities People who live in rural and remote regions of Australia Elderly Cancer

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Nature A group of diseases leading to the uncontrolled growth of abnormal body cells. Skin, Breast and Lung cancers are of most concern to health authorities Extent Mortality and morbidity rates are both increasing. The most commonly occurring cancer is non-melanoma skin cancer (which is mostly nonlife threatening). The most common life threatening cancers include: Men: prostate, colorectal, lung and melanoma and Women: breast, colorectal, lung and melanoma Risk Factors and Protective Factors Non-Modifiable Risk Modifiable Risk Factors Factors - Gender: specific cancers - Exposure to carcinogens - Age: leads to increased (cancer causing agents), risk such as smoke, asbestos, - Family history UV radiation from the sun - Genetic makeup e.g. being - Lifestyle behaviours, such fair skinned as smoking, alcohol misuse and poor dietary habits Protective Factors - Avoid carcinogen e.g. Slip, Slop, Slap, Wrap - Personal screening habits e.g. breast and testicular - Public screening e.g. breast mammograms and prostate blood test - Seeking early medical intervention Environmental Determinants - People who work outdoors - People who live in rural and remote communities - Exposure to chemicals in the workplace

Determinants Sociocultural Determinants - Smoking amongst young females - Tanning habits, such as excessive sun exposure

Socioeconomic Determinants - Unemployed: higher rates of smoking - Low levels of education e.g. awareness of warning signs and personal testing

Groups at Risk Indigenous Australians Socioeconomically disadvantaged communities People who live in rural and remote regions of Australia Males and Females Other minor groups include smokers, outdoor workers, young adults and people with fair skin Diabetes Nature A disease that affects the bodys ability to take glucose from the bloodstream to use it for energy Caused by a malfunctioning of the pancreas leading to insufficient insulin levels, the hormone responsible for regulation of blood glucose levels (BGL) 3 types: 1. Insulin Dependent Diabetes (IDDM) Known as Type 1 usually presents early in life and patients require insulin injections and must monitor diet and physical activity to maintain a safe BGL 2. Non-Insulin Dependent Diabetes (NIDDM) Known as Type 2 usually presents later in

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life, as a result of long-term poor health behaviours related to diet and exercise. Requires medication and lifestyle modifications 3. Gestational Diabetes (GD) occurs during pregnancy The long-term effect s of each type include vision problems, kidney disease, circulatory issues in arms and legs and a strong link to CVD (similar risk factors) Extent Worlds fastest growing disease similar issues are evident in Australia Prevalence increases with age, especially NIDDM Type 2 The age of onset is decreasing which is a growing concern, especially for young people. Due to unhealthy lifestyles 3.5% of all Australians have Diabetes Risk Factors and Protective Factors Modifiable Risk Factors Non-Modifiable Risk Factors - High blood pressure - Over 55 years of age - Having CVD or its risk - Family History factors - Over 45 years with CVD - Having diabetes in risk factors pregnancy - Over 35 and being of - Being overweight Aboriginal, Chinese, India or Pacific Islander descent Determinants Sociocultural Determinants - Indigenous 10-30% may have diabetes much is undiagnosed - Being Chinese, Indian or Pacific Islander - Social acceptance of binge drinking - Ageing population - Being time poor leads to increased reliance on convenient food Protective Factors - Maintaining a healthy weight - A balanced and nutritious diet, full of Low GI foods. Eating 5-6 smaller meals per day - Healthy use of alcohol - Daily physical activity Environmental Determinants - Technology has lead to a more passive society e.g. popularity of video games - People from rural and remote and Indigenous have difficulty in accessing medical services - Junk food advertising to children

Socioeconomic Determinants - Low SES more likely to have poor diet, drink excessive alcohol, be physically inactive and be overweight - Low education less awareness of prevention strategies and health lifestyle behaviours

Groups at Risk Elderly Indigenous Australians Socioeconomically disadvantaged People from rural and remote regions Mental Health Problems Nature Any illness that negatively affects a persons emotional stability, perceptions, behaviour and social well-being, such as depression, anxiety, addictions, obsessive compulsive disorder, bipolar disorder, eating disorders and dementia

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Extent 20% of people suffer form a mental health problem at some stage of life Prevalence is increasing and much is unreported 18-24 years olds have the highest rates, especially substance abuse and depression Risk Factors and Protective Factors Modifiable Risk Factors Non-Modifiable Risk Factors - Drug use - Age increased risk of - Chronic disease e.g. dementia arthritis - Males suffer mostly - Perceived self-worth and depression and addictions sense of identity (substance abuse) - Coping skills - Females suffer mostly Stressful situations e.g. depression and anxiety family breakdown and - Uncontrolled life changes occupational stress e.g. death or abuse - Grief - Family history Determinants Sociocultural Determinants - Family breakdown lack of support - Difficult life circumstances e.g. abuse - ABTSI Increased alcohol and drug abuse, and difficult life circumstances - Elderly people increased social isolation and grief Protective Factors - Social acceptance as legitimate health concerns - Awareness of social support structures e.g. GP, online help, telephone counseling - Strong sense of connectedness with family, friends, work mates and neighbours - Personal resiliency skills

Socioeconomic Determinants - Unemployed higher rates of depression - Low education risk factors - People in financial distress e.g. farmers during a drought

Environmental Determinants - Living in remote regions lack of support and medical services - Stigma amongst males as well as common stoical attitudes - Lack of emotional support e.g. family breakdown

Groups at Risk Elderly Indigenous Australians Socioeconomically disadvantaged People from rural and remote regions People born overseas, especially refugees People with a disability Respiratory Diseases Nature Common diseases that affect the respiratory system include: Asthma, Chronic Obstructive Pulmonary Diseases, Hay fever Extent 6 million Australians have a long-term respiratory disease Morbidity rates are now decreasing, a result of reduced smoking Mortality is also decreasing, due to effective education programs Asthma is the leading burden of disease amongst children

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Risk Factors and Protective Factors Modifiable Risk Factors Non-Modifiable Risk Factors - Use of preventative - Environmental changes e.g. medication for asthma pollen in spring and cold and - Exposure to environmental dry weather patterns hazards, e.g. chemicals - Stress - Passive smoking in homes and cars Determinants Sociocultural Determinants - Indigenous Australians higher rates of smoking - Family history Socioeconomic Determinants - Increased smoking amongst low SES - Low income less money for preventative medication - Low SES more likely to be exposed to occupational hazards

Protective Factors - Awareness of personal asthma triggers e.g. exercise - Education about personal prevention strategies and plans for asthma attacks - No smoking

Environmental Determinants - Higher rates of pollution in cities - People who live in remote region are further from emergency services - Childrens exposure to passive smoke

Groups at Risk Indigenous Australians Socioeconomically disadvantaged People from rural and remote regions Smokers Injury Nature There are many types of injuries, which affect all stages of life. They often result in lingterm harm of ones physical, emotional and social well being. Examples include: 1. Road injuries and Motor Vehicle Accidents (MVAs) 2. Suicide and self-harm 3. Injuries around the home e.g. poisonings, falls, drowning, cuts, fires 4. Workplace accidents 5. Acts of violence 6. Sports and recreational injuries Extent Leading cause of death in 1-44 years age group (particularly MVAs and suicide amongst males) Greatest cause of potential life lost under 65 years Major cause of hospitalisation Deaths from injuries are decreasing in frequency, especially MVAs The elderly are prone to injuries such as falls, which has a significant impact on their quality of life

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Risk Factors and Protective Factors Modifiable Risk Factors Non-Modifiable Risk Factors - Driving behaviour and - Age elderly are more at attitudes risk of falls - Inadequate supervision of - Gender higher rates of children risk taking behaviour and Occupational hazards suicide Unsafe home environment e.g. chemicals, pool fencing and trip hazards - Safe roads and effective road laws - Safe use of alcohol Determinants Sociocultural Determinants - Indigenous people suffer more injuries - Attitudes towards driving and risk taking amongst males - Family breakdown, leading to social isolation of young people - Societal pressure for tougher road laws e.g. P plate regulations - Societal awareness of hazardous environments

Protective Factors - Minimising driving distractions e.g. Mobile phones and GPS - Effective driver education - Positive attitude towards road and OHS rules and regulations - Home modifications for the elderly - Strong social support to prevent suicide

Socioeconomic Determinants - Low SES higher rates of hospitalisation from injuries - Low education less awareness of dangers around the home - Low income makes it harder to purchase safety equipment - MVAs are highest amongst low SES populations

Environmental Determinants - Workplace injuries are most common in agricultural settings - Suicide is highest amongst males from rural and remote regions - Unsafe home environment of elderly people and children can lead to increased risk of injury

Groups at Risk Elderly (Falls) Indigenous Australians (MVAs and self-harm) People from rural and remote regions (occupational injuries) Children (poisoning and drowning) Young Adults (MVAs, sport and recreational injuries and self-harm) Males (Suicide and MVAs)

A growing and ageing population

A number of significant trends have been observed in Australias population in the last 50 years: A decrease in the birth rate over this time A decline in mortality rates, along with an increase in life expectancy Sustained rates of immigration from overseas The percentage of people aged over 70 years is set to double to 20% over the next forty years. Also, the total population is expected to double to 40 million people in the same time. Healthy Ageing

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Enabling and empowering people to live a healthy, productive and contributing life for as long as possible, is a key strategy of the government. Increased Population Living with Chronic Disease and Disability A larger elderly population inevitably leads to more people living with chronic disease and disability. Demand for Health Services and Workforce Shortages To meet the demands placed upon our government and society by a growing and ageing population, the full range of health services will need to expand dramatically. This increase needs to include; more specialist health professionals and GPs, more primary and emergency health services such as ambulances and public hospitals and more housing and accommodation for people who require assistance with basic living needs. Availability of Carers and Volunteers Carers provide informal care of people living with chronic diseases and disability. The contribution of volunteers is also recognised as essential in meeting the demands of our ageing population. They assist with activities such as transport, shopping, meals on wheels and social activities.

Critical Question 3 - What role do health care facilities and services play in achieving better health for all Australians?
Health care in Australia
Range and types of health facilities and services Category Examples Public health services Cancer screening Immunisation programs Primary and community health care GPs Ambulance services Royal Flying Doctor Service Dental Hospitals Public Private Mental Specialised health services Specialised medical practitioners Reproductive health Mental health Palliative care Responsibility for health facilities and services Health care provider Facilities and/or services provided Commonwealth Government Formation of national health policies Collection of taxes to finance the health system Provision of funds to state/territory governments Special concern for ATSI Pharmaceutical funding State/Territory Government Hospital services Mental health Home and community care

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Local Government

Private organisations

Community groups

Family health services Dental health Womens health Health promotion Regulating health industry providers Vary from state to state Environmental control Antenatal clinics Meals on Wheels Private hospitals Dentists Alternative health services (physiotherapy, chiropractor, etc) Local needs basis Cancer Council, Dads in Distress, Diabetes Australia, etc

Equity of access to health facilities and services All Australians should have equal access to health care facilities and services. This is achieved in Australia through Medicare. Health care expenditure versus expenditure on early intervention and prevention Health-care expenditure incorporates private health insurance, households, individuals and all levels of government. In 2007-08 Health-care expenditure was $103.6 billion (Australias Health 2010, AIHW). Less than 2% of this figure was spent on preventable services or health promotion. Reasons for increasing funding for preventative health strategies include: Cost effectiveness Improvement to quality of life Containment of increasing costs Use of existing resources Reinforcement of individual responsibility Maintenance of social equity Reduced mortality and morbidity Impact of emerging new treatments and technologies on health care, e.g. cost and access, benefits of early detection New treatments and technologies have the potential to significantly improve the health status of Australians. Examples of developments in emerging treatments and technologies include: development of new machinery, image technology in keyhole surgery, improvement in materials, drug advancements, prosthetic limb development, artificial organs and transplant technology. Health insurance: Medicare and private Health care in Australia is provided by the public sector (Medicare) or through private health insurance. Medicare is the health-care system for all Australians. Its aim is to provide equity in terms of cost and access for health care services. Funding for Medicare comes from income tax (1.5% of taxable income) and the Medicare levy surcharge (1% for high income earners). Every Australian is covered for 85% of the scheduled fee. Bulk Billing allows patients to pay nothing and the doctor receives the scheduled fee from

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Medicare. People have the option of increasing the health insurance they have by taking out private health insurance. The extra insurance covers private hospital and ancillary or extras (dental, physiotherapy, naturopathy, etc). Reasons for choosing private health insurance include: - Shorter waiting times - Hospital choice - Own doctor of choice - Ancillary benefits such as physiotherapy - Peace of mind - Private rooms in hospital - Health cover while overseas - Avoiding increase tax To combat falling private health insurance numbers the Commonwealth Government has implemented several schemes. - 30% tax rebate for people with private health insurance - 1% Medicare levy surcharge - Lifetime health-care incentive with lower premiums to those who join before age 30 Medicare Private health insurance Payment Commonwealth Government Commonwealth Government Taxpayers Individuals and families Payment type Income tax Annual, monthly, fortnightly Levy surcharge premiums Benefits Basic public hospital services Hospital cover Basic medical services - Hospital services Some specialist services - Choice of doctor 85% of scheduled fee - Choice of hospital Availability of bulk billing - Private or public hospital Ambulance cover Ancillary cover - Physiotherapy - Chiropractor - Naturopathy, etc Some special benefits such as gym membership Overseas cover

Complementary and alternative health care approaches

Reasons for growth of complementary and alternative health products and services World Health Organization recognition Recognition of Eastern cultures Marketing strategies Proven results for many when traditional medicine had failed Desire for natural medicines Holistic nature Addition to ancillary benefits by private health insurers Societal changes with multiculturalism Societal changes with globalisation Societal changes with demographics Formal qualifications enhancing credibility

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Range of products and services available Alternative health-care approach Acupuncture Aromatherapy Bowen therapeutic technique Chiropractic Herbalism Homeopathy Iridology Massage Meditation Naturopathy

Description Involves inserting needles into skin Use of pure essential oils to influence the mind, body or spirit System of muscle and connective tissue movements that realigns the body and balances energy flow Adjustments are made to the spine to realign correct body function Uses plants and herbs System that recognises the symptoms are unique to an individual Analysis of the human eye to detect signs of wellbeing or otherwise Includes remedial, Swedish, sports State of inner stillness Holistic treatment aiming to treat the underlying cause as well as the symptoms of the illness

How to make informed consumer choices It is important to investigate and critique health-care providers and services. This can include: what is it they offer, what are the benefits, experience, qualifications, governing body and cost.

Critical Question 4 - What actions are needed to address Australias health priorities?
Health promotion based on the five action areas of the Ottawa Charter
The five action areas of the Ottawa Charter are: - Developing personal skills - Creating supportive environment - Strengthening community action - Reorienting health services - Building healthy public policy Levels of responsibility for health promotion The Australian government, state and local governments, non-government organisations, communities and individuals are all responsible for promoting health. The benefits of partnerships in health promotion The chance of successful health promotion is greatly increased when all levels of government, non-government organisations, communities and individuals work together towards one common goal. How health promotion based on the Ottawa Charter promotes social justice Health promotion to be effective needs to address the social justice principles (equity, diversity and supportive environments). Equity Diversity Supportive

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Developing personal skills Creating supportive environments Strengthening community action Reorienting health services Building healthy public policy

Mandatory PDHPE K - 10 Provision of health enhancing items Lobby groups Health services for ATSI Bulk billing PBS

Access to Medicare Community based support Destigmatising health conditions Lobby groups Language assistance Abstudy Health care card

environment Media campaigns Legislative bans Provision of health enhancing items Lobby groups Partnerships with the community Health campaigns

The Ottawa Charter in action Application of the Ottawa Charter requires critical analysis of the 5 areas of the Ottawa Charter: developing personal skills, strengthening community action, creating supportive environments, reorienting health services, building healthy public policy. Examples of health promotions that are based on the Ottawa Charter to an extent include: Closing the Gap, Fresh Tastes @ School, National Tobacco Strategy, National Action Plan on Mental Health, Measure Up and Swap It Dont Stop It.

HSC Core 2: FACTORS AFFECTING PERFORMANCE

Critical Question 1 - How does training affect performance?
Energy Systems
Alactacid system (ATP/PC) Creatine phosphate Less than 1 ATP molecule 5 - 10 seconds Depletion of PC None PC replenishment in 2 5 minutes Lactic Acid system Carbohydrate Glycogen Approximately 2 ATP molecules 30 - 45 seconds Increased accumulation of hydrogen ions Lactic acid Removal of lactic acid with active recovery in 15 30 mins Aerobic system Carbohydrate Fat Protein Glucose 36 ATP molecules Fatty acid 130 ATP molecule Unlimited depending upon intensity Depletion of fuel sources Carbon dioxide water Restoration of glycogen up to 48 hours

Source of fuel Efficiency of ATP production Duration Cause of fatigue By-products Process and rate of recovery

Types of training and training methods

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Aerobic Aerobic training generally follows the FITT principle. F = frequency at least 3 sessions per week are required for aerobic training to be effective. Serious athletes may complete 12 sessions. I = intensity usually measured using heart rate. Aerobic training usually occurs between 70% and 85% of max HR. T = time will depend upon the intensity but needs to be at least 20 minutes duration. T = type there are a range of training types one can utilise to develop aerobic capacity Continuous training requires training without rest for at least 20 minutes. Fartlek training or speed play involves continuous exercise with sprints or a higher intensity effort (e.g. Hill climb) interspersed throughout the session. Aerobic interval training involves alternating repetitions of an exercise and a period of rest or recovery. Circuit training involves a series of exercises that are performed one after the other with little or no rest in between each exercise. Anaerobic Anaerobic training involves exercise of high intensity and therefore short duration. Interval training is a very common form of anaerobic training usually requiring maximal effort. Generally the recovery rate ratio will determine the type of training and aims of the sessions. Speed, acceleration and agility are components that can be developed through anaerobic training. Plyometrics is a very common training style to develop anaerobic power. Plyometrics involves exercises that produce an explosive muscular contraction. Flexibility Flexibility is the ability to move a muscle through its full range of motion. Good flexibility will assist: - Prevention of injury - Improved coordination - Muscular relaxation - Decreasing muscle soreness Static stretching the muscle is slowly and smoothly taken to the end of its range of motion and held for approximately 30 seconds. This method is useful for rehabilitation, warm up and cool down. Dynamic stretching involves a series of movements that replicate game movements and take the muscle through its full range of motion. It is popular for warm-ups. Ballistic stretching involves a bouncing action at the end of the range of motion. This form of stretching activates the stretch reflex. The force of the movement takes the muscle beyond its preferred length. Therefore, this type of stretching has risks and is only recommended for elite athletes. PNF stretching proprioceptive neuromuscular facilitation involves lengthening a muscle against a resistance. Generally it involves a static stretch, followed by an isometric contraction then a period of rest before being repeated. Used often during rehabilitation. Strength training Strength is the maximal force generated by a single muscular contraction. Hypertrophy an increase in the size of the muscle fibres and connective tissues Isotonic involves exercises where the muscle shortens and lengthens Isometric involves exercises where the muscle does not change length Isokinetic involves exercises where the load remains constant throughout Machine weights very popular method allowing for isotonic contractions and are very simple to use. It is very easy to isolate muscle groups using this method of training.

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Free weights include dumbbells, barbells, medicine balls and kettlebells. Allow a wide range of exercises, muscle groups and types of contractions to be catered for. Good techniques are needed to avoid injury. Resistance bands are often used in rehabilitation but have become a popular form of training lately due to their convenience. They allow for a range of contractions and a wide range of muscle groups. Stability balls have become popular of late. Their focus is to develop the core muscles and majority of free weight exercises can be adapted to be performed incorporating the stability ball. Hydraulic resistance effort is made against an opposing force. Resistance is constant through the entire movement.

Principles of training
Progressive overload To continue to have training improvements, progressive overload needs to occur. The body adapts to the training it undergoes. When this adaptation occurs the training needs to be increased to stress the body beyond its current capabilities to achieve further training gains. It also needs to be progressive so that the stress placed on the athlete does not cause injury or fatigue. Overload can be achieved by increasing intensity, resistance, repetitions, duration, frequency, etc. Specificity Exercise needs to be specific for the energy systems, muscles, movement patterns, etc required for the athletes sport. Reversibility Training adaptations are lost once training ceases or lowers below the current capacity of the athlete. A detraining effect results in the physiological adaptations gained through training being reversed. Variety Completing the same or similar activities can lead to boredom which in turn may result in a reduced training effort. Therefore it is important for training sessions to incorporate a range of training types, settings, activities and drills. Training thresholds Training thresholds are the upper limits of a training zone and when passed take the athlete to a new level. The aerobic threshold (Lactate transition 1) is approx 70% of MHR. This level is sufficient to cause a training effect. The aerobic training zone is when athlete is working above the aerobic threshold and below the anaerobic threshold. The anaerobic threshold (Lactate transition 2 or Onset Blood Lactate Accumulation OBLA) is approx 85% of MHR. Exercise beyond this point will see a marked increase of lactic acid build up and therefore fatigue and the cessation of exercise. Warm up and cool down For most sports a warm up will last approximately 20 minutes. This will incorporate a general warm up followed by a more specific warm up. The aim of the warm up is to prepare the body both physically and mentally for optimal performance. The general warm up will contain some running or aerobic activities and dynamic stretching. The specific component of the warm up will contain activities relating to the sport. The cool down is recommended to form part of the active recovery for the athlete. Generally

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this will involve low intensity exercise. The aim of the cool down is to decrease blood lactate levels and to minimise muscle soreness.

Physiological adaptations in response to training

Resting heart rate Stroke volume Cardiac output Oxygen uptake Lung capacity Haemoglobin level Muscle hypertrophy Effect on slow-twitch muscle fibres Adaptation Decreased resting heart rate due to more efficient stroke volume Increased at rest and throughout exercise Increased maximal cardiac output Increased due to an increase in capillaries, myoglobin, mitochondria and enzyme activity Increased maximal ventilation but remains relatively unchanged Increased due to an increase in blood plasma and RBC numbers Increased size with resistance training No change to percentage Increased hypertrophy, capillary supply, mitochondrial function, myoglobin content enzymes and glycogen stores No change to percentage Increased ATP and PC supply, enzymes, hypertrophy and lactic acid tolerance

Effect on fast-twitch muscle fibres

Critical Question 2 - How can psychology affect performance?

Motivation
Positive and negative Positive motivation is the desire to be successful in a pursuit that will result in happiness, satisfaction and pleasure. An example of this is for a high jumper to hope to compete at the Olympics. Negative motivation is the desire to be successful with the aim of avoiding unpleasant consequences. The motivation is to avoid something bad happening as opposed to a positive outcome. An example is training hard and playing trying to avoid being dropped from the team. Intrinsic and extrinsic Intrinsic motivation is internal motivation. It is emphasised by feelings of satisfaction and enjoyment. It is self-sustaining and is usually associated with an orientation towards the task. This type of motivation promotes longevity as external factors are not driving the athlete, for example continuing to play football despite regularly being in a lower grade and losing. Extrinsic motivation is motivation that comes from external sources. This includes things like trophies, money and praise. It tends to have an outcome orientation. This generally does not promote longevity as the money and praise are not often sustainable. Extrinsic rewards can deter from intrinsic motivation.

Anxiety and arousal

Trait and state anxiety Anxiety is a negative emotional state. It is the result of perceiving situations as threatening. State anxiety is feelings of tension related to a specific event or moment in time. For example an athlete prior to the start of a 100m race feels nervous and anxious. The tension and anxiousness is related to the event, the bigger event the bigger the anxiety.

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Trait anxiety is a behavioural or personality disposition to display anxiety and to perceive various situations as threatening. A person with high trait anxiety often displays high state anxiety in competitive situations. Sources of stress Stress is the imbalance between what is expected of a person and their perceived ability to meet those expectations. When there is a large imbalance then the person becomes stressed. There are many sources of stress and these include: financial concerns, selection concerns, injury concerns, contract concerns, crowds, preparation and expectations. Optimal arousal Optimal arousal is the physical and emotional response related to a specific moment or event. Arousal is important for successful sporting performance, however, not all athletes or sports require the same level of arousal. An archer requires a different level of arousal (calm and quiet) compared to a weightlifter (pumped up). Optimal arousal is generally described utilising the inverted u hypothesis. As arousal increases so does performance until optimal arousal and this performance is reached. If arousal continues past this point (over arousal) then performance declines. High Performance Low Low High Level of arousal

Psychological strategies to enhance motivation and manage anxiety

Concentration/attention skills (focusing) The ability to focus on appropriate cues is essential for an athlete. Shutting out distractions and irrelevant cues will assist the athlete to perform at a higher level. Strategies for focusing or regaining focusing can include music, cues, set routines, training for distractions and focus training. Athletes often train to replicate as much as possible the same environment as game day to ensure their focus is on the important cues at the crucial time. Mental rehearsal/visualisation/imagery This involves creating mental images or pictures of the upcoming event, action or skill. This allows the athlete to experience (success) prior to the actual event. This allows the athlete to feel confident due to the fact that it is as if the athlete has been in this position previously and therefore knows how to feel and react and more importantly can picture a successful outcome. Athletes may use various methods of mental rehearsal. One method is as spectators watching themself perform the skill and the other is from their internal view as they are actually performing the skill. Mental rehearsal needs to be as realistic as possible for it to be effective. Therefore the detail, timing and settings all need to replicate the real event.

Relaxation techniques Over-aroused and anxious athletes benefit greatly from having a range of relaxation strategies available to them. Relaxation will lower breathing rates, heart rate, blood pressure

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and muscle tension leading to greater control and focus. Examples of relaxation include listening to music, massage, watching TV or a movie, controlled breathing exercises, yoga, Pilates, meditation and hypnosis. Goal-setting Setting long term and short term goals can assist an athlete greatly to remain focused. The goals of an athlete can be about the outcome of their performance (e.g. winning gold at the Olympics) or the process (e.g. swimming a personal best at the Olympics).Short term goals should contribute to achieving the long term goal.

Critical Question 3 How can nutrition and recovery strategies affect performance?
Nutritional Considerations
All athletes must ensure that the food and drink they consume will support maximum performance. These considerations are as important for both training and actual competition. They also apply to both before and after intense physical activity. The primary aims of good nutrition are: Adequate fuel reserves, such as maximum glycogen stores for triathletes Repair of damaged body tissue from training, such as increasing protein intake for strength training Prevention of dehydration, through adequate fluid intake Optimal functioning of all body systems (e.g. Immune System), by meeting the recommended dietary intakes for all nutrients, such as vitamins and minerals Pre-performance Nutrition Changes to an athletes regular diet may be necessary in the days and hours leading up to an intense training session and competition. This is to ensure the required fuel reserves are full and the athlete is well hydrated. Knowing what and how much to eat, as well as when to eat, will enable the body to perform intense physical activity. The last significant meal should be eaten 3-4 hours prior to the event. It should contain at least 100 grams of carbohydrates, be low in fat and fibre and have a small amount of protein. At least 500 mL of water should also be consumed. A light meal can also be eaten 1-2 hours prior, which should consist of some high GI Carbohydrates, as well as more fluid. Carbohydrate Loading Endurance athletes require more carbohydrates than other athletes, and may need to increase their intake for 3-4 days leading up to an event. By maximising muscle and liver glycogen reserves, they ensure that glycogen is used as a primary fuel for as long as possible. Hydration To avoid the negative effects of dehydration on sporting performance, athletes should overcompensate for their projected fluid needs. For a normal person, 2 litres of fluids should be consumed daily; therefore a person who is expecting to perform intense physical activity should drink at least 3 litres in the 24 hours leading up to an event. During Performance Continued hydration is the main priority during physical activity. Small amounts of fluid should be consumed at all possible times, such as time-outs, half time and stoppages (150mL per 15 minutes). For endurance events, lasting longer than 60 minutes, refuelling may also be necessary. This is best achieved by eating concentrated forms of glucose such as energy gels, bananas, sports bars or sports drinks.

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Post Performance The primary aim of post-exercise recovery is to return all body systems as quickly as possible to their pre-event condition. The specific details of what to eat and when will depend on the duration and intensity of the activity itself. The primary aims of the first 12 24 hours after intense exercise are: Restore depleted glycogen Repair damaged muscle tissue Rehydrate the athlete

Supplementation
Supplementation is the process of eating additional nutrients to account for a deficiency in an athletes diet. In most cases, sports nutritionists generally prefer to make regular dietary modifications. Vitamins and Minerals Vitamins are chemical compounds, which can only be sourced through dietary intake. They enable the normal functioning of the body and promote growth and development. Vitamins are available in a wide range of foods, which is why a diverse range of food is needed to meet the RDIs of each one. Minerals are also chemical compounds, which play a similar role in the body. They are also normally sourced through the food eaten in a regular diet, but can be supplemented if needed. Deficiencies of some minerals can have a direct and adverse effect on the health and performance of certain athletes. Minerals of significance include: Iron Calcium Protein Protein is required for the growth, repair and maintenance of muscle tissue. Athletes must ensure they eat sufficient amounts of protein to aid recovery and promote growth of muscle tissue. This is especially important for athletes who are undertaking strength training or highintensity interval training. Good food sources of protein include lean meat, dairy products, nuts and eggs. Caffeine Caffeine is a stimulant, which speeds up the Central Nervous System. It is normally consumed through chocolate, coffee, cola drinks and advertised energy drinks. It is also available in the form a caffeine tablets. The supposed benefits of caffeine for athletes include increased alertness, decreased perception of fatigue and the mobilisation of fat cells leading to glycogen-sparing. Possible negative side effects include an elevated heart rate, overarousal and uncontrolled muscle twitches leading to decreased fine-motor control. In highdoses, it also acts as a diuretic, leading to dehydration. Creatine Creatine is a fuel source, which is stored in skeletal muscles. It is produced partly in the body cells, but regular intake of protein, especially from meat sources, ensures the RDI for Creatine is achieved. Its role is to assist in the production of Creatine Phosphate, which is the fuel source for the replenishment of ADP back into ATP. This is commonly known as the ATP-CP Energy System, which provides for ATP regeneration during short bouts of powerful, high-intensity exercise, such as 100m sprints or shot-put. Athletes who either train for these types of sports or undertake a heavy resistance-training program, may achieve training benefits such as increased lean muscle mass and improved performance levels.

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Recovery Strategies
Physiological Strategies Both active recovery exercises and appropriate nutrition are important factors in restoring the body to a pre-event condition, allowing the athlete to prepare for the next training session or game as quickly as possible. Examples include: Hydration Nutrition Cool Down Stretching Neural Strategies Intense physical activity is very taxing on the muscular system, but also the Central and Peripheral Nervous System. These neural strategies are aimed at relaxing the body and muscles, reducing the perception of localised muscle fatigue as well as decreasing general mental fatigue. Hydrotherapy Massage Tissue Damage Strategies Following intense physical activity and competition, it is common for athletes to suffer from a variety of levels of tissue damage. This can range from microscopic muscle tears as a result of heavy resistance training, to bruises and minor sprains and strains, right through to more significant soft-tissue injuries. Cryotherapy Psychological Strategies The pressure involved in participating in elite sport can be immense, and this can come from both internal and external sources. For an athlete to maintain good mental and emotional health, as well as manage their levels of motivation and anxiety, a range of personal strategies can be employed to achieve this Relaxation Sleep

Critical Question 4 - How does the acquisition of skill affect performance?

Stages of Skill Acquisition
Cognitive Stage This stage is characterised be the learner developing an understanding of the task requirements. Associative Stage This stage is characterised by the need for the athlete to practise the skill, until a correct motor pattern is established in the mind and body. Autonomous Stage In this stage, the athlete is able to perform the skills automatically, without intentional thought about the task requirements. Characteristics of the Learner Personality

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Innate personality traits can have a significant effect on an athlete in all stages of skill acquisition. Examples of relevant traits include confidence, motivation, a positive outlook, self-discipline, focus, enthusiasm, competiveness and whether you are an introvert or an extrovert. Heredity Certain genetic features can provide a varying degree of advantage with regard to the potential for success. Specific inherited factors, which may be influential, include: Muscle Fibre Type

Body Shape Gender

Confidence Whilst this is a personality trait, it stands alone as making a significant contribution to sporting success at the elite level Prior Experience Certain sports have common characteristics, which can enable a person to transfer their ability from one sport, and quickly adapt and learn the specific skills and tactics in another sport. Some factors that can be transferred from one sport to another include: Motor patterns

Tactics and strategies Skills Components of Fitness

Ability Some people seem to have a natural ability at sport, which is most evident in the rate that they move through the stages of skill acquisition. They almost seem to be dominant in any game they play. Some of the factors that may underpin this phenomenon include spatial awareness (awareness of who and what is around them), kinaesthetic sense (awareness of the bodys position in space), tactical awareness (awareness of what equipment should feel like as it makes contact with the body), coordination (ability to move multiple limbs with timing and precision e.g. hand-eye or foot-eye coordination), fast reaction time and perceptive senses (enhanced sensitivity of the senses, especially during fast-paced sports)

The Learning Environment

The Nature of Skill Skills can be categorised based on the following. Closed Skills are performed in a leaning environment which is unchanging, stable and predictable Open Skills are performed in a leaning environment which is changing, less stable and somewhat unpredictable Gross Motor Skills require the use of large muscle groups to produce a less refined movement Fine Motor Skills require the use of small muscle groups to produce a precise and accurate movement Self-paced skills are performed when the athlete chooses to, such as when to bowl the cricket ball or when to commence a high jump attempt Externally paced skills are not at the discretion of the athlete, and they must perform the

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skill based on forces out of their control, such as hitting a baseball or being a goalkeeper in hockey Discrete skills have a clearly defined beginning and end, such as a golf shot, a 100m sprint or a pass in football Serial Skills are a combination of a range of discrete skills into one whole movement. Team sports are require serial skills as an athlete is constantly using a variety of skills in competition Continuous Skills have no clear beginning or end, and the point at which they start or end is at the discretion of the athlete, such as going for a run or swim

The Performance Elements Decision making

Strategic and tactical development

The Practice Method Massed Practice is characterised by periods of continuous practice with short rest intervals. This is suitable for activities that are fun, of moderate intensity or for highly motivated athletes. Suitable examples include golf putting or goalkeeping Distributed Practice is characterised by shorter periods of work with more regular periods of rest. This is suitable for monotonous or difficult activities, for high-intensity activities that cause excessive or where motivation is low. This would suit activities such as waterskiing or tackling in rugby league Whole Practice involves practicing the complete skill in its entirety. This suits advanced learners or for skills that cannot be broken down into sub-components that can be practiced in isolation, such as archery or sailing Part Practice involves isolating the various sub-components, practicing each and then combining it all together in a complete movement. This is suitable for very complex skills such as pole vault, or for beginners who are in the cognitive stage Feedback Intrinsic Feedback information that is received internally through the senses by the performer. As a learner continues to improve, they should be developing the ability to detect and correct their own errors. A Refined kinaesthetic sense is critical in enabling them to analyse the feel of the movement Extrinsic Feedback information that is received from an external source, such as a coach, the crowd or video analysis Concurrent Feedback is feedback that is received during the performance, and is closely aligned with intrinsic feedback. The athlete may be able to adjust the current movement as it is being executed, such as a batter adjusting their shot selection as the ball swings unexpectedly. Or they can adjust the skill the next time it is executed Delayed Feedback is feedback that is received after the completion of the skill. It can be either intrinsic, via video analysis, or through an extrinsic source such as a coach. Sometimes this feedback can arrive days later during a video analysis session Knowledge of Results information concerning the outcome or success of the skill, such as whether ball was in or not. This information can then be used to analyse why the skills was successful or not. This is most useful for beginners as the develop their basic motor patterns Knowledge of Performance information concerning the actual technique or the patterns of play. This is used more so by learners in the autonomous stage and can arrive from both extrinsic and extrinsic sources. Coaches of elite athletes must be very competent in

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carefully analysing performances to detect and help correct even minor errors. Also in team sports, the coach must be very good at analysing the play and identifying areas of strengths and weakness in both teams, and communicating relevant feedback and strategies for the team

Assessment of Skill and Performance

Characteristics of a Skilled Performance There are a number of observable differences between a skilled and unskilled performance. Kinaesthetic Sense Anticipation Consistency Technique Mental Approach Objective and Subjective Performance Measures There are a range of tests that can be used in order to make a measurement or an appraisal as to the quality of performance. Objective Measurement Where an assessment is not based on human interpretation or analysis, the test is described as objective. Sporting examples include high jump, the 100m sprint and the score in a team sport. These measurements are the most fair and reliable in terms of who the winner was. However, they may not provide enough information for a complete analysis of the technique or performance Subjective Measurement Assessment that relies on personal opinions and judgment is described as subjective. Some sports rely solely on a subjective measurement, such as in diving or gymnastics. The analysis of technique or tactical performance also relies on subjective measures, as the coach makes a personal interpretation Validity and Reliability of tests The assessment of sporting performances must measure what it actually intends to measure (validity) and also ensure the same results are achieved regardless of who, where or when the test is administered (reliable). Personal versus Prescribed Judging Criteria When a subjective measurement is to be made of any sporting performance, some degree of criteria is used which enables a more complete and fair appraisal. To increase the objectivity required for official competition, prescribed criteria are developed by the judges or governing body. These involve rating scales, checklists and scoring systems that minimise the chance of error or bias affecting the results. Commitment and degree of difficulty

HSC Option 1: THE HEALTH OF YOUNG PEOPLE

Critical Question 1 What is good health for young people?
The Nature of Young Peoples Lives
How the Developmental Stage can vary in Motivations, Values, and Sociocultural Background The Influence of Family and Peers The Influence of Prevailing Youth Cultures

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The Influence of Global Events and Trends The Influence of Technology Epidemiology of the Health of Young People Patterns of Morbidity and Mortality Comparisons of Health Status with that of Other Age Groups The Effects of the Determinants of Health on Young People Individual Factors Sociocultural Factors Socioeconomic Factors Environmental Factors Developmental Aspects that Affect the Health of Young People Revising roles within relationships Clarifying self-identity and self-worth Developing self-sufficiency and autonomy Establishing education, training and employment pathways Determining behavioural boundaries

Critical Question 2 To what extent do Australias young people enjoy good health?
The Major Health Issues that Impact on Young People
Mental health problems and illnesses Alcohol consumption Violence Road safety Sexual health Body Image Other relevant/emerging health issues that impact on the health young people include gambling, cyber-bullying, party crashes and drink spiking.

Critical Question 3 What skills and actions enable young people to attain better health?
Skills in Attaining Better Health
Building Self Concept Developing Connectedness and Support Networks Developing Resilience and Coping Skills Developing Health Literacy Skills Developing Communication Skills Accessing Health Services Becoming Involved in Community Service Creating a Sense of Future Actions Targeting Health Issues Relevant to Young People Social Action Legislation and Public Policy Health Promotion Initiatives

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HSC Option 2: SPORT AND PHYSICAL ACTIVITY IN AUSTRALIAN SOCIETY

Critical Question 1 How have meanings about sport and physical activity changed over time?
The beginnings of modern sport in 19th century England and colonial Australia
Links with manliness, patriotism and character The meaning of amateur and professional sport Womens historical participation in sport

Sport as a commodity
The development of professional sport Sport as big business Sponsorship, advertising and sport The economics of hosting major sporting events Consequences for spectators and participants

Critical Question 2 What is the relationship between sport and national and cultural identity?
Australian sporting identity
National and regional identity through sporting achievements Government funding Politics and sports

The meaning of physical activity and sport to Indigenous Australians

Traditional activities and sports Links between community and identity

Physical activity, sport and cultural identity

The role of competition Links to cultural identity Relationships to health Ways of thinking about the body

Critical Question 3 How does the mass media contribute to peoples understanding, values and beliefs about sport?
The relationship between sport and the mass media
The representation of sport in the media Economic considerations of media coverage and sport

Deconstructing media messages, images and amount of coverage

Differences in coverage for different sports across various print and electronic media The emergence of extreme sports as entertainment

Critical Question 4 What are the relationships between sport and physical activity and gender?
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Sport as a traditionally male domain

Sport and the construction of masculinity and femininity Implications for participation Sponsorship, policy and resourcing The role of the media in constructing meanings around femininity and masculinity in sport

HSC Option 3: SPORTS MEDICINE

Critical Question 1 How are sports injuries classified and managed?
Ways to Classify Sports Injuries
Direct and Indirect Soft and Hard Tissue Overuse Soft Tissue Injuries Tears, Sprains and Contusions Skin Abrasions, Lacerations and Blisters Inflammatory Response Hard Tissue Injuries Fractures Dislocations Assessment of Injuries TOTAPS

Critical Question 2 How does sports medicine address the demands of specific athletes?
Children and Young Athletes
Medical Conditions Overuse Injuries Thermoregulation Appropriateness of Resistance Training

Adult and Aged Athletes

Heart Conditions Fractures and Bone Density Flexibility and Joint Mobility

Female Athletes
Eating Disorders Iron Deficiency Bone Density Pregnancy

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Critical Question 3 What role do preventative actions play in enhancing the wellbeing of the athlete?
Physical Preparation
Pre-Screening Skill and Technique Physical Fitness Warm-up, Stretching and Cool Down Sports Policy and the Sports Environment Rules of Sports and Activities Modified Rules for Children Matching of Opponents Use of Protective Equipment Safe Grounds, Equipment and Facilities Environmental Considerations Temperature Regulation Climatic Conditions Guidelines for Fluid Intake Acclimitisation Taping and Bandaging Preventative Taping Taping for Isolation of Injury Bandaging for the Immediate Treatment of Injury

Critical Question 4 How is injury rehabilitation managed?

Rehabilitation Procedures
Progressive Mobilisation Graduated Exercise Training Use of Heat and Cold Return to Play Indicators of Readiness for Return to Play Monitoring Progress Psychological Readiness Specific Warm up Procedures Return to Play Policies and Procedures Ethical Considerations

HSC Option 4: IMPROVING PERFORMANCE

Critical Question 1 How do athletes train for improved performance?

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Strength training
Resistance training Weight training Isometric training Aerobic training Continuous/uniform Fartlek Long interval Anaerobic training (power and speed) Developing power through resistance/weight training Plyometrics Short interval Flexibility training Static Dynamic Ballistic Skill training Drills practice Modified and small-sided games Games for specific outcomes

Critical Question 2 What are the planning considerations for improving performance?
Initial planning considerations
Performance and fitness needs Schedule of events/competitions Climate and season Planning a training year (periodisation) Phases of competition Subphases Peaking Tapering Sport-specific subphases Elements to be considered when designing a training session Health and safety considerations Providing an overview of the session to the athletes Warm up and cool down Skill instruction and practice Conditioning Evaluation Planning to avoid overtraining Amount and intensity of training Physiological considerations Psychological considerations

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Critical Question 3 - What ethical issues are related to improving performance?

Use of drugs
The dangers of performance enhancing drugs For strength For aerobic performance To mask other drugs Benefits and limitations of drug testing Use of technology Training innovation Some training innovations include: Equipment advances

HSC Option 5: EQUITY AND HEALTH

Why do inequities exist in the health of Australians?
Factors that create health inequities
Daily living conditions Quality of early years of life Access to services and transport Socioeconomic factors Social attributes Government policies and priorities

Critical Question 2 What inequities are experienced by population groups in Australia?

Populations Experiencing Health Inequities
Aboriginal and Torres Strait Islander Peoples Homeless People Living with HIV/AIDS Incarcerated Aged Culturally and Linguistically Diverse Backgrounds Unemployed Geographically Remote Populations People with Disabilities

Critical Question 3 How may the gap in health status be bridged?

Funding to Improve health
Funding for Health Funding for Specific Populations Limited Resources

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Actions that Improve Health

Enable (Using Knowledge and Skills for Change) Mediate (Working for Consensus) Advocating (Speaking up for Specific Groups, their Needs and Concerns)

A Social Justice Framework for Addressing Health Inequities

Empowering Individuals in Disadvantaged Circumstances Empowering Disadvantaged Communities Improving Access to Facilities and Services Encouraging Economic and Cultural Change

Characteristics of Effective Health Promotion Strategies

Working with the Target Group in Program Design and Implementation Ensuring Cultural Relevance and Appropriateness Focusing on Skills, Education and Prevention Supporting the Whole Population while Directing Extra Resources to those in High Risk Groups Intersectoral Collaboration

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