Occupational Vocal Health of Elite Sports Coaches:

An Exploratory Pilot Study of Football Coaches

*Katie L. Buckley, *Paul D. OHalloran, and Jennifer M. Oates, *yMelbourne, Victoria, Australia
Summary: Objective. To explore the occupational voice use and vocal health of elite football coaches.
Study Design. This pilot study explored coaches voice use patterns and vocal demands across workplace environments. Each coachs experiences of voice symptoms and voice problems were also investigated.
Methods. Twelve Australian professional football coaches participated in a mixed-methods data collection approach.
Data were collected through acoustic voice measurement (Ambulatory Phonation Monitor), semistructured interviews,
and a voice symptom questionnaire (Voice Capabilities Questionnaire).
Results. Acoustic measures suggested heavy vocal loads for coaches during player training. All participants reported
experiencing voice symptoms. They also suggested that the structure of their working week, workplace tasks, and vocal
demands impacted on their voices. Despite this, participants reported little previous reflection or awareness of what
impacted on their voices. Coaches typically did not consider how to support their voices during daily work and discussed
experiencing voice symptoms as an inevitable part of their jobs.
Conclusions. This study demonstrates that occupational vocal demands may negatively impact on sports coaches
vocal health. This is particularly important, considering coaches heavy vocal loads across coaching tasks and reported
negative occupational vocal health experience. Furthermore, coaches limited insight into voice use and vocal health
management may impact on their vocal performance and health. Given the exploratory nature of this study, further
research into coaches occupational vocal health is warranted.
Key Words: Occupational voice userSports coachVocal healthVocal loadAmbulatory phonation monitoring
Vocal health experiencesVoice use patterns.
INTRODUCTION
Vocal health is an important workplace consideration,13
especially for occupational voice users1,2,4,5 and their
employers. These workers critically rely on dynamic voice
performance as a pivotal part of their employment.6,7 This
includes consistent voice performance to effectively
undertake job tasks.3,8,9
Occupational voice users are more likely to experience voice
symptoms and voice problems than the general working population.3,4 Furthermore, voice symptoms and voice problems
may negatively impact on the work performance and general
health of occupational voice users.4,10
To date, occupational voice research has primarily focused
on schoolteachers. An estimated 5090% of teachers will experience voice symptoms at work,10 such as hoarseness11 and
vocal fatigue.12 Occupations such as performing artists,1 call
center workers/telemarketers,13 the clergy,14 and aerobics instructors15 are also considered within occupational voice literature. This research base suggests that several commonly
occurring risk factors appear to affect the vocal health of occupational voice users. These risk factors include long durations
of voice use; loud talking and yelling over distances; suboptimal room acoustics; background noise; vocal tract irritants;
lack of health awareness; stress; and workload demands.12,16,17
Accepted for publication September 15, 2014.
From the *Department of Public Health, School of Public Health and Human Biosciences, La Trobe University, Melbourne, Victoria, Australia; and the yDepartment of
Human Communication Sciences, La Trobe University, Melbourne, Victoria, Australia.
Address correspondence and reprint requests to Katie L. Buckley, School of Public
Health and Human Biosciences, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria 3086, Australia. E-mail: katie.buckley@live.com.au
Journal of Voice, Vol. 29, No. 4, pp. 476-483
0892-1997/$36.00
2015 The Voice Foundation
http://dx.doi.org/10.1016/j.jvoice.2014.09.017

Sports coaches vocal demands and workplace environments

appear similar to other occupational voice users. As such, the
risks of vocal health problems experienced by other occupations may be similar for coaches. Like other occupational voice
users, sports coaches engage in various vocally demanding
communication tasks. Vocal communication with athletes often
occurs in groups, where coaches talk for long periods of time,
without breaks. This vocal health risk may also be magnified
by lengthy exposure to vocally demanding physical environments. Coaching in outdoor environments exposes coaches to
loud background noise, long distances between coaches and
their players, and weather elements (ie, rain and wind).18 These
conditions are likely to require increased vocal effort while
coaching. Furthermore, other coaching environments (such as
basketball stadiums and gymnasiums) have consistently high
reverberation times.
Although similarities may exist between sports coaches and
other occupational voice users, specific aspects of sports coaching may result in additional vocal demands and risks to vocal
health. Research suggests that coaches ongoing focus on athlete
excellence19 may intensify the stressful nature of coaches
workplaces.20 This may be compounded by athletes heavy reliance on effective vocal communication by coaches to achieve
performance success.21,22 Furthermore, the unregulated nature
of the industry appears to result in coaches working long
hours (frequently without regular scheduled days off), under
intense periods of stress. As highlighted by ONeill and
McMenamin,18 the current evidence base strongly suggests
that both psychoemotional factors and stress may increase risk
of developing vocal overload and voice disorders.16,23
Currently, limited published research exists concerning the
occupational vocal health of sports coaches. Two published
studies have focused on coaches voice use and vocal health.

Katie L. Buckley, et al

477

Vocal Health of Elite Sports Coaches

Gorham-Rowan et al24 explored the benefits of providing

coaches with a voice education program. The voice handicap
index (VHI) was administered to seven volunteer soccer
coaches before and after this education program. The VHI includes items concerning the participants experiences of voice
symptoms. Gorham-Rowan et al24 noted that the majority of
their participants reported some voice symptoms (although specific statistical data were not reported) such as hoarseness, temporary voice loss, voice strain, and vocal fatigue. One month
after the education program, four of the seven coaches reported
improvement in their vocal quality.24
The voluntary status of the coaches in the study reported by
Gorham-Rowan et al24 makes these findings difficult to apply to
elite sports coaches. Furthermore, the investigators intervention appears to be based on current general knowledge about
occupational voice users rather than empirical evidence of the
specific needs of sports coaches. A population-specific evidence base may build on the findings of Gorham-Rowan
et al24 to strengthen future research into sports coaches as occupational voice users. This could include investigation of the nature of sports coaches vocal tasks.
ONeill and McMenamin18 also sought to extend the vocal
health knowledge base by exploring the voice use and vocal
health of soccer managers in Ireland. Although this role extends beyond coaching, much of the vocally demanding aspects
of soccer managers roles mirror those of sports coaches. This
includes overcoming background noise and long distances
when communicating with players. The authors also noted
the potential for phonotrauma due to lengthy voice use and psychoemotional factors at work.
The purpose of the present pilot study was to explore elite
sports coaches occupational voice use and vocal health. To
this end, the study considered the following research questions:
(1) What are the voice use patterns and vocal demands of elite
sports coaches? (2) Do coaches experience specific voice symptoms or voice problems while at work? (3) Do coaches perceive
that vocal demands and workplace environments influence their
vocal health? (4) How do coaches manage their voices at work?
METHODS
Methodology
A mixed-methods approach, involving quantitative and qualitative methods, was considered most appropriate for addressing
the research questions of this study.
Participants
Twelve Australian football coaches participated in this study.
These coaches worked within two national-level football competitions: the Australian Football League (AFL, n 9) and the
Australian Rugby Union (ARU, n 3). While considered two
different types of football, coaches engage in equivalent roles
and tasks within both leagues. They were therefore considered
a single group of participants. Participants ages ranged
from 3248 years (mean 39 years, standard deviation
[SD] 6.7) and their coaching careers spanned 113 years
(mean 5.8 years, SD 3.1).

Participants were recruited through the researchers industry

connections within each sport. The AFL Coaches Association
provided all members with an information flyer about the
research. ARU coaches within Australian Super-Series clubs
were sent the flyer by an ARU staff member. Coaches then contacted the primary researcher (K.L.B.) directly if they were
interested in participating in the study.
Inclusion criteria required participants to be coaching at an
elite football club as their primary means of employment. Reflecting the current employment demographic within the two
football leagues, all participating coaches were male.
Procedures
Overview. Data were collected initially through coaches
wearing the Ambulatory Phonation Monitor (APM) (KayPENTAX Model 3200 - Lincoln Park, Montvale, NJ) during a
training session. Coaches then participated in an interview
and completed the Voice Capabilities Questionnaire (VCQ).23
Approximately 2 hours were required for each coach to complete their participation in this process. All activities occurred
within club training facilities.
Acoustic measurement APM. The APM is a portable unobtrusive voice dosimeter. It consists of a small accelerometer,
a microprocessor, and the APM computer software. The device
measures vibrations of neck tissues that are created by the vocal
folds during phonation. From this information, the APM software calculates the wearers phonation time, fundamental frequency (F0), and estimates of vocal intensity. Specifically, the
software calculates the following characteristics of the wearers
voice use:
- Phonation time: the accumulated duration (minutes) of
vocal folds vibration.
- Percent phonation time: the percentage of time phonation
occurred while the APM was worn.
- Mean fundamental frequency (F0 mean): the estimated
mean frequency of vocal fold vibration (hertz).
- Fundamental frequency mode (F0 mode): the fundamental
frequency value where most phonation occurred while the
APM was worn.
- Vocal intensity (dB SPL): The estimated mean amplitude
value (amount of energy created with voice sound wave)
during wear25 (Table 1).
TABLE 1.
Descriptive Statistics for APM Measurements
Measure

Mean

SD

Range

Phonation time (min)

% Phonation time
Vocal intensity (dB SPL)
F0 average (Hz)
F0 mode (Hz)

13.40
19.25
83.67
150.00
124.72

6.50
4.90
10.25
30.50
20.15

4.2423.34
11.3526.88
65.92103.62
114.97200.43
104.00176.00

Notes: F0 average, the mean fundamental frequency scores in hertz (as

used by the APM software); F0 mode, the most commonly occurring
fundamental frequency score within an individuals data set in hertz (as
used by the APM software).

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Journal of Voice, Vol. 29, No. 4, 2015

The APM was selected for use in this research based on

maintenance of conversation confidentiality (conversations
are not audio recorded),26 its portability,27 relative unobtrusiveness for long-term use in various activities, and lack of susceptibility to background noise.26
During the study, coaches wore the APM for a typical
training session (nominated by each participant). Coaches
defined training as any time they engaged with players to
assist in the athletes football development. Data were collected
in a variety of coaching environments, including meeting
rooms, a sprung floor (similar to a basketball court), an outdoor
oval, and a gymnasium. Four of the 12 coaches moved between
training locations while wearing the APM (Table 2). The varied
training sessions nominated by coaches also resulted in
differing durations of APM wear (from approximately 30 minutes to 2 hours; Tables 1 and 2).
Before APM data collection for each participant, the device
was calibrated for sound pressure level (decibel) according to
the manufacturers protocol. Successful calibration was
achieved on the first attempt for nine coaches. Repetition of
the process yielded successful calibration for two additional
coaches. However, despite three attempts, calibration could
not be achieved for one participant. Therefore, APM data
were not obtained for this coach.
Self-rating - VCQ. The VCQ is a self-rated inventory concerning vocal health at work. The version used in this study
(Appendix A) was based on a similar questionnaire for teachers
developed by Russell.28 Respondents rate how frequently they
experience 16 voice symptoms, such as vocal fatigue, difficulties with projection, voice quality, pitch characteristics,
loudness characteristics, and throat pain/discomfort. Each of
the 16 items is presented on a five-point Likert-type scale
(1 never to 5 every time I use my voice). Total
VCQ scores can range from 16 (all symptoms rated as never)
to 80 (all symptoms rated as every time I use my voice). An
additional item asks respondents to indicate if they believe they

have experienced a voice problem. If so, they then rate the

severity of the problem on a five-point Likert-type scale
(1 slight to 5 severe).
The VCQ was used given it measures vocal symptoms
without implying that the respondent has a voice disorder per
se. It was also used because it measures vocal symptoms rather
than the broader aspects of voice-related quality of life. This is
in contrast to other currently used voice self-rating tools such as
the VHI,29 the Voice-Related Quality of Life30 questionnaire,
and the Voice Activity and Participation Profile.31,32
In the present study, participants completed the paper-based
VCQ twice in the same session. Initially, coaches considered
each item for the current football season (current season).
They then rated the same items over their entire coaching careers (overall coaching career).
Internal consistencies were good for both versions of the
VCQ used in this study33 (Cronbach alpha was .81 for items
pertaining to overall coaching career and 0.90 for items pertaining to the current season).
Semistructured interviews. Each coach participated in a
one-on-one semistructured interview with the primary
researcher. This covered coaches perceptions and awareness
of their occupational voice use, their vocal health experiences,
and any methods they used to manage their voices. Example
questions included Have you found that certain practices
help your voice function better at work?, What did you do
to overcome any difficulties caused by your voice underperforming?, and Can you describe a time when you have
noticed your voice was not performing as you needed it to for
your work?
Interviews were conducted in an office or meeting room at
each football club and ranged between 3575 minutes (most
lasting around 50 minutes). All interviews were audio recorded,
using a Sony Clear Voice VOR Dictaphone (Analog voice
recorder model TCM-200DV; Sony Corporation, Tokyo, Japan)
and cassette tape.

TABLE 2.
Descriptive Statistics for APM Measurements of Each Participants Fundamental Frequency Data
Total
Amplitude
Examination Phonation % Phonation F0 Mode F0 Average Average
Participant
Duration
Time
Time
(Hz)
(Hz)
(dB SPL)
A
B
C
D
E
F
G
H
I
J
K

1:14:40
0:53:38
1:38:38
1:17:07
1:07:01
2:02:40
0:26:37
1:04:15
1:23:25
0:30:24
1:08:25

0:20:04
0:14:03
0:23:34
0:15:43
0:13:35
0:21:59
0:04:44
0:11:19
0:12:26
0:04:24
0:07:45

26.88
26.21
23.90
20.38
20.29
17.92
17.79
17.62
14.92
14.52
11.35

116
116
104
128
176
104
116
128
116
128
140

121.74
135.19
114.97
135.66
200.43
155.30
186.36
151.85
120.23
194.70
142.49

82.32
98.23
82.88
82.24
82.87
82.11
87.20
77.36
65.92
103.62
75.52

Coaching Environment/s
Meeting room
Outdoor training, meeting room
Meeting room, playing oval
Sprung floor, meeting room
Gymnasium
Playing oval
Playing oval
Playing oval
Meeting room
Sprung floor
Meeting room

Notes: F0 average, the mean fundamental frequency scores in hertz (as used by the APM software); F0 mode, the most commonly occurring fundamental frequency score within an individuals data set in hertz (as used by the APM software).

Katie L. Buckley, et al

Vocal Health of Elite Sports Coaches

Analyses
All quantitative data were analyzed with descriptive statistics
using the Statistical Package for Social Sciences (SPSS)
version 17 (SPSS Inc., Chicago, IL, USA). For APM data,
descriptive statistics were calculated for participants phonation
times (accumulated duration and percent phonation time),
fundamental frequency F0 (hertz), and vocal intensity (dB
SPL) (Table 1). For the VCQ data, descriptive statistics
(mean, SD, and range) were calculated for both sets of data.
Qualitative data that emerged from semistructured interviews were transcribed and then thematically analyzed using
manual coding. Initially, the primary researcher transcribed
all 12 interviews. These transcripts were then read line-byline and each idea was given a label (this process is referred
to as open coding). Once all ideas were labeled, common ideas
were grouped into categories (known as axial coding). These
categories were then compared and contrasted to create
themes.34 Open coding was validated through two processes.
All participants were given the opportunity to read their respective coded transcript to ensure they agreed with the interpretation of each idea (known as member checking). Two coaches
engaged in this process and no amendments to open codes
were noted by the coaches. As a form of inter-researcher peer
review, an additional member of the research team undertook
open coding of a full interview transcript. The open codes
were then compared with those of the primary researcher and
the level of overlap was high. The researchers discussed any
variations in coding interpretation and a consensus was
reached. No themes required amendment from this process.
In keeping with the traditions of qualitative research, anonymity was maintained by allocating each participant with a
pseudonym for the purposes of data analysis.34
RESULTS
Ambulatory Phonation Monitor
Results revealed that the mean percent phonation time for all
coaches was 19.25% (SD 4.9%) and mean vocal intensity
was 83.67 dB SPL (SD 10.25 dB SPL). Across the participant
group, the mean fundamental frequency was 150 Hz
(SD 30.5 Hz). Table 1 summarizes descriptive data for
phonation time (percent and accumulated duration), vocal intensity, and fundamental frequency across the participant
group. Table 2 provides descriptive data for each participant,
including each coachs total examination time, overall and
percent phonation time, vocal intensity, and fundamental frequency. Table 2 also notes the coaching environment/s where
data were collected for each coach.
Voice Capabilities Questionnaire (VCQ)
When considering voice symptoms for coaches during the current season, the mean total score was 32.08 (SD 7.56). For
the overall coaching career VCQ, the mean total score for
voice symptoms was 35.83 (SD 10.26). Although no normative data are available for total VCQ scores, all coaches provided responses that indicated the presence of some
symptoms. Specifically, no coach selected 1 (never) for all

479

symptoms with respect to either the current season or their

coaching careers. Any item with a mean of 2.5 or more was
noted (to determine whether some voice symptoms were potentially more salient for coaches than others). This arbitrary cut
off was used as it approximates the mid-way point of the frequency scale (1 never to 5 every time I use my voice).
For the current season VCQ, hoarseness (mean 2.58,
SD 1.31) and vocal effort (mean 2.58, SD 0.79)
were rated at or above this cut off. For the overall coaching
career VCQ, vocal fatigue (mean 2.67, SD 0.98), dry
throat (mean 2.50, SD 1.00), need to clear throat
(mean 2.58, SD 1.08), and hoarseness (mean 2.83,
SD 1.19) were rated at or above this cut off.
Coaches responses to the VCQ also provided data on their
perceived experiences of voice problems. Three of the 12
coaches (25%) indicated that they believed they had a voice
problem during the current season. Four of the 12 coaches
(33%) indicated experiencing a voice problem during their careers. The mean severity rating for the current season was 3
(SD 0.82) and for overall coaching careers was 2.33
(SD 1.15).
Semistructured interviews
The themes that emerged from analysis of interview transcripts
are described in the following section.
Awareness of voice use behaviors. Many coaches
admitted that voice was not something they regularly contemplated. For example, one participant suggested that he did not
typically consider how he used his voice at work:
It is quite interesting that Ive never really thought about it
(voice) before. I never really thought about the different
ways in which I use it (voice).

In discussing his own lack of consideration of his voice,

another coach also noted that this was common in behavior of
his colleagues:
I dont notice anyone doing anything with any purpose or
with any logic to it at all. I just think its an untapped area.
I think this is the first time that Ive ever thought about it
(voice). And its never been raised; its never been spoken
about.

Experiencing voice symptoms and voice problems.

Although they did not often discuss vocal health as a
concept, all coaches spoke about situations when their voices
did not feel quite right. Coaches often conceptualized sensations after heavy voice use as fatigue and also used terms
such as strained and run down in the throat.
Although coaches comments suggested they were aware of
these voice experiences while coaching, symptoms were often
dismissed as just part of the gig. Furthermore, some coaches
admitted that, as players, they had considered experiencing
voice symptoms as a positive reflection on their performance:
I was always hoarse after the match and I was conscious of it.
And actually I had players that I played with (that would) use
that tool. The fact that it usually indicated wed worked.
Yeah, a bit of a badge of honour. I probably treated it like

480
that too. I was actually happy that I was working that hard on
that part of the game (talking).

For some participants, considering voice symptoms in these

ways had not appeared to alter when they became coaches.
During the interviews, coaches were asked about any neck
trauma they had experienced (as a player or as a coach). Three
coaches reported neck trauma as players, with only one
acknowledging that it had affected his voice. No coaches reported consulting health care professionals, such as general
practitioners, otolaryngologists, or speech pathologists for specific issues related to their voices.
Identifying and addressing risk factors for vocal ill
health. Coaches identified that both indoor and outdoor environments impacted on their voices. When speaking during
training, coaches noted that they required increased effort to
overcome distance from players. They also experienced
increased vocal effort when communicating over high levels
of background noise, high sound reverberation, and adverse elements of the weather (eg, wind and rain). Coaches also suggested that the structure of the working week, workplace
tasks, and vocal demands impacted on their voices. Coaches reported experiencing overall fatigue and voice symptoms on
more vocally demanding days. These were typically during
game days (requiring intense, frequent, short bursts of
speaking) and game review days (requiring lengthy vocal
communication with players).
Despite coaches often suggesting that they were unaware of
how to support their vocal health, coaches discussed how drinking fluids, vocal rest, and use of a whistle assisted their voices at
work. Coaches noted that resting their voices and drinking
fluids seemed to alleviate throat discomfort and improve voice
quality after heavy or lengthy voice use. Most coaches suggested that use of a whistle was helpful for outdoor training.
However, many felt that using a whistle did not completely
replace the need to yell. Coaches felt that these behaviors (hydration, vocal rest, and use of instrumental support) benefited
their voices. However, they noted that habit or job tasks often
dictated when these behaviors occurred. For example, a whistle
would be used because it gained players attention quickly not
because it reduced the need for coaches to yell.
DISCUSSION
The current research findings provide preliminary insights into
coaches occupational vocal health, their voice use patterns at
work, and the nature of their working environments. Each of
these is considered in the following section within the broader
context of occupational vocal health literature.
Voice use patterns and demands
Data from this study indicate that coaches may experience
heavy vocal loads during coaching activities. Coaches phonation times, estimated vocal intensity, and fundamental frequency data suggest that training players may be a vocally
demanding task. Sustained vocal effort, accompanied by prolonged vocal loading, is assumed to increase the risk of voice
problems in occupational voice users.35

Journal of Voice, Vol. 29, No. 4, 2015

Percent phonation time. The percent phonation times

demonstrated in the present study (19%) are comparable with
those reported for occupations considered moderate voice
users. Previously reported percent phonation times considered
moderate have included those of preschool teachers
(17%)36 and call center workers (15%).25
However, caution is required when comparing the current
findings with those of previous studies of other occupational
voice users. This study only recorded APM measures for a single training session (albeit a vocally demanding aspect of
coaching). It was beyond the scope of this pilot study to collect
data on coaches voice use over one or multiple days of work.
Other studies using dosimeters have measured occupational
voice use over durations spanning a full work day13,25 to
more than a week.35,3739 Therefore, it would be informative
for future research into sports coaches to collect vocal use
data over extended periods of time.
The range of individual percent phonation times for the current
participant group varied from 11.3526.88%. This variation may
be explained by personal factors, variation in coaching environments (Table 2), and the varied nature of voice demands undertaken by coaches while wearing the device. Substantial
variability in percent phonation times has also been found in
research on call center workers conducted by Cantarella
et al.25 However, it seems that the vocal demands of coaches in
the present study were not as high as some other occupational
voice users such as teachers who have been reported to have daily
percent phonation times at almost 30%.40 Given the reported
variability in this study, future studies should examine diversities
in coaching tasks, personal factors, and coaching environments.
Fundamental frequency and vocal intensity. The fundamental frequency data (mode and average) for coaches in the present study appear unremarkable. However, the literature does
suggest that prolonged use of elevated fundamental frequency
may increase the likelihood of vocal overload41 and phonotrauma.38 This may be a consideration for sports coaches, as the
APM data indicated the use of average fundamental frequencies
at the upper range of normal (mean 150 Hz, SD 30.5 Hz).
Similarly, coaches average vocal intensities across training
environments (mean 83.67 dB SPL) appeared to exceed
safe levels. Participants data were similar to those reported
from other studies using the APM to estimate vocal intensity
in teachers38 and opera singers39 (occupations characterized
by high vocal loads). Vilkman suggests that output levels
greater than 65 dB at 2 m are a potential risk factor for vocal
health.41 Again, this conclusion must remain speculative given
that only estimated vocal intensity can be derived from the
APM. Furthermore, specific vocal dose measures, such as distance dose, were not made in this study.
Coaches experiences of voice symptoms and voice
problems
VCQ and interview data revealed that all coaches experienced
voice symptoms at least some of the time while coaching. No
participants rated all items as 1 (never) within their responses
to the VCQ. Furthermore, all participants discussed situations

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Vocal Health of Elite Sports Coaches

481

where their voices did not feel right and most went on to
contextualize these experiences within work tasks. Hoarseness
and vocal fatigue were the most frequently reported symptoms
in both quantitative and qualitative data. Both of these symptoms are commonly reported among teachers.11,12 Within the
present study, the rates of reported voice problems for both
the current season and overall coaching career (25
33%) also fall within12,23 or just slightly below reported rates
for teachers.43 This suggests that, like teachers, coaches often
experience voice symptoms while at work.
However, although coaches recognized their occupational
reliance on voice, they infrequently spoke about vocal health.
No coaches had sought help from health care professionals
regarding experiences of voice symptoms or voice problems.
This appears common to the experiences of schooteachers,23,28
potentially reflecting a lack of awareness regarding vocal
health. Thomas et al3 found that teachers who did not perceive
voice in terms of vocal health were unlikely to seek health treatment for voice symptoms or voice problems. Gilman et al44 also
highlighted this phenomenon in their research into health attitudes in performing artists. Coaches lack of vocal health
awareness may mean that participants in the present research
underestimated rates of voice problems as their ability to recognize and manage voice problems may be limited. Furthermore,
coaches often considered experiencing voice symptoms as just
part of the gig or their voices having a good workout.
These views are alarming given the negative impact voice
symptoms may have on overall vocal health.

environmental adaptations (eg, alterations to acoustic

environments and use of personal amplification devices) may
also support coaches vocal health.38,42
Some coaches did suggest that drinking fluids and vocal rest
helped their voices. However, they did not appear to recognize
the importance of these behaviors for normal biomechanical
functioning of their voices. Nor did they appreciate the importance of these strategies for the normal repair of vocal fold tissues after demanding voice use.46 This lack of awareness may
limit the success of workplace vocal health intervention programs with coaches.
Active awareness of vocal health may empower individuals
to avoid harmful vocal habits.1 When considering how health
awareness impacts on health behaviors, Rosenstock47 proposed
the Health Belief Model. In line with this model, if coaches
are not aware of why vocal health-related actions are successful, these actions are unlikely to be implemented.47 Furthermore, lack of vocal health awareness may mean that coaches
are unlikely to hold strong beliefs about the benefits of interventions. However, Rosenstock47 purports that a person will take
health-related action if they become actively aware of required
actions and believe benefits will stem from healthy behaviors.
Furthermore, these healthy behaviors will be undertaken if
the consequences of health issues are serious enough to avoid.47
Increasing coaches awareness of vocal health (both related to
voice use practices and environmental factors) may increase
positive occupational health actions.

Vocal demands, environmental risk factors, and

management
Research suggests several commonly occurring risk factors that
impact on the vocal health of occupational voice users. These
factors include lengthy duration of voice use; yelling over distances; room acoustics; background noise; irritants; lack of
health awareness; stress; and workload demands.12,16,17
During the present study, coaches discussed several physical
risk factors that are commonly experienced by other occupational voice users. Participants noted that distance from other
coaches and their players, background noise, adverse elements
of weather, and reverberation seemed to require increased vocal
effort. Previous research also suggests that distance, background noise, and acoustic reverberation may impact on the
vocal health of occupational voice users such as call center
workers,6 performers,1 and school teachers.38 Specifically,
physical education (PE) teachers are considered to be at risk
of vocal health problems. PE teaching includes job tasks similar
to coaching, such as needing to overcome distance and background noise while yelling instructions to others.1,11,45
Characteristics of physical environments and workplace organizations may negatively influence the vocal demands of
coaches. Heavy vocal demands, increased vocal effort, and
lack of vocal rest may increase coaches likelihood of
experiencing voice problems. Occupational voice literature asserts the importance of considering workplace context when
investigating vocal health.5,10 Suggestions made for other
occupations, such as the inclusion of voice care strategies and

CONCLUSIONS
This research is one of a limited number of studies to address
the vocal health of elite sports coaches. It is also among a
very small number of studies that have used a holistic mixedmethods approach to explore voice use at work.
During this study, participants acknowledged that voice use
is critical for coaching success. Despite this critical reliance,
coaches infrequently considered their voice use or vocal health.
All participants reported experiencing voice symptoms at least
some of the time. Furthermore, 25% indicated experiencing a
voice problem during the current season and 33% during
their overall coaching careers. However, coaches rarely implemented strategies intended to support their vocal functioning
or vocal health at work.
Like many pilot studies, this research is associated with several
limitations. Measuring voice use across different job tasks for each
participant could strengthen the study. This would provide a more
comprehensive data set on coaches voice use across a greater
range of work tasks. Furthermore, analysis of habitual speech
samples to better identify potential changes in acoustic characteristics between everyday voice use and that required when coaching would be valuable. Finally, when generalizing findings, it is
important to consider that the present results were based on a small
sample of male coaches from two types of football.
Wearing of the APM by coaches over an entire working week
would be desirable in future research to provide a more complete representation of voice use in coaches. Future research
could also focus on both male and female coaches from a

482
variety of sports. Investigation of larger and more representative samples of coaches will also be necessary to provide
more robust prevalence data on coaches voice disorders and
symptoms. Inclusion of control groups (of nonoccupational
voice users) and comparison groups of other occupational voice
users would allow researchers to delineate any unique features
of the vocal demands and vocal health of sports coaches.
Given the paucity of voice research with this occupational
group, further research is needed to build the evidence base pertaining to the voice use and vocal health demands of sports coaches.
Such an evidence base may better inform the design of programs
to facilitate effective and safe voice use in sports coaches.
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Vocal Health of Elite Sports Coaches

APPENDIX A
Voice capabilities questionnaire
1. Indicate the extent to which the following statements apply currently to you as a coach/during your coaching career:

Never
My voice has tired or fatigued
My voice has been hoarse, croaky, husky etc
My voice has been crackly or had breaks
My voice has been lower in pitch than usual
My voice has been higher in pitch than usual
I have had difficulty making my voice as loud as I have needed
I felt that using my voice was effortful
My voice has not projected as well as needed
I have had difficulty with breath control (eg, running out of breath, gasping)
My throat has felt dry
I have felt scratchiness or tickling in my throat
I have felt as if I have had a lump in my throat
My throat has ached or felt sore
I have felt pain in my throat
I have had a burning sensation in my throat
I have needed to clear my throat or cough

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

2a. Do you believe that you are currently experiencing a voice problem?

Always
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4

Yes

5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5

No

2b. If you believe that you had a voice problem, how severe is the problem?
Slight
1

Severe
5