Beyond the Finish Line: Examining the long-term benefits of competitive sport as recovery through the lens of the Invictus Games

Military sport recovery programming has proliferated internationally over the past 20 years in response to increased numbers of military personnel with physical and/or psychological illnesses and injuries from the conflicts in Afghanistan and Iraq. The “Beyond the Finish Line” research project, funded by the Forces in Mind Trust, aimed to examine the long-term benefits of competitive sport participation as recovery through the lens of the Invictus Games, an international sport competition for Service members and Veterans with physical and/or psychological illnesses and injuries. The research team further aimed to work with the international community of 23 Invictus nations to identify best practices for military sport recovery programming. This research spotlight provides a summary of how these aims were addressed, what was found, and the resulting recommendations for consideration for future games.

Aim/Question 1: What are the long-term benefits of large scale international competitive sport programming implemented to promote rehabilitation?

Methods

This research focused on the Invictus Games Sydney 2018 and the Invictus Games The Hague 2020 (which took place in 2022 due to the COVID-19 pandemic). To best capture the impact on competitors, both competitors (individuals selected for the Games) and non-competitors (individuals who weren’t participating in the Games, whether because they hadn’t been selected or because they had chosen not to participate or try out) were recruited to participate. The researchers sought to capture the entirety of the Invictus Games experience from selection and training through to post-Games. As such, data collection took place at 1-year pre-Games, 6-months pre-Games, 3-months pre-Games, immediately pre-Games, immediately post-Games, 3-months post-Games, 6-months post-Games, and 1-year post-Games. Since every country had its own timeline for selection, these timepoints were chosen based on Team UK. Surveys were used to assess psychosocial outcomes (positive and negative feelings, self-perceived success, satisfaction with life, post-traumatic growth) and physical health (general health, health compared to the previous year, bodily pain, and pain interference with activities of daily living). We also captured demographic information, which indicated that:

• Participants included 116 competitors and 182 non-competitors;
• 70 participants were female and 225 participants were male;
• Participants ages ranged from 21 to 73 years old;
• In terms of the type of illness or injury, a mix of both physical and psychological illness or injury was most prevalent;
• The majority of participants were no longer Serving in the military;
• 14 nations were represented in the study, with the greatest percentage of study participants representing the UK.

Key Outcomes

Given the impact of the pandemic on the Invictus Games The Hague 2020 and sport programming, as well as, subsequently, our data collection, this research spotlight focuses on the findings from Invictus Games Sydney 2018. However, the full findings are available in the research report.  

Invictus Games Sydney 2018 competitors demonstrated better outcomes (better general health, better health compared to the previous year, less pain interference with daily living, more positive moods, greater self-perceived success, greater satisfaction with life, and greater post-traumatic growth) than non-competitors, even when accounting for any initial differences in demographics, health, or well-being that may have impacted selection. However, the competitor effect did decrease over time. Based on additional information collected in the surveys, the research team believes that this decrease may be a result of the selection processes for the next Games (the Invictus Games The Hague).  For many nations, team selection began right after the closing ceremonies for Invictus Games Sydney 2018. Many of our study non-competitors were training for selection and engaging in Invictus training camps, developing a sense of connection with the Invictus community. Our previous research has demonstrated that selection is highly impactful in beginning to improve health and well-being. As a result, the narrowing between competitor and non-competitor outcomes may not necessarily reflect competitor well-being but improved non-competitor well-being as they began training and engaging with the Games. This highlights the value of activities between the Games for competitors and non-competitors.

The finding on the decrease in the “competitor effect” over time may also reflect the limitations of research and our ability to capture the fundamental and lasting experience that competitors may have experienced. While we seek to reflect these outcomes through our life satisfaction or post-traumatic growth outcomes, individuals described their experience as “lifesaving” and “lifechanging” – these are difficult concepts to capture in a survey.

A further significant finding was that type of illness and injury was an important factor for physical health outcomes, with individuals with both physical and psychological illnesses and injuries demonstrating poorer physical health. This finding is important when considering how to develop and deliver programming and how the programming may need to be tailored based on each individual’s type of illness or injury.

Aim/Question 2: What are best practices for achieving long-term health and well-being through sport recovery programming?

The research team did not want to focus solely on the impact of participation but wanted to also understand how positive benefits can be achieved. This latter research question would provide the foundation for training materials and toolkits for Invictus Games nations or any non-Invictus community programs seeking to support the health and well-being of military personnel with illnesses and injuries through sport.

Methods

This research focused on Invictus Games nation staff and competitors. The nation staff research consisted of observations during training camps and the Invictus Games, as well as iterative interviews and surveys to discuss nation approaches and best practices. Meanwhile, the competitor research consisted of an additional survey distributed with the Question 1 surveys. This survey sought to examine aspects of quality participation and coaching behaviours experienced during training (distributed in the survey sent out at the end of training, right before the Games) and during the Games (distributed in the survey immediately after the Games).

Key Outcomes

Findings from both the nation staff and competitor research indicated the importance of not just focusing on sport and competition but rather using sport as the opportunity to bring competitors together for resilience and mental skills training (e.g., goal setting, confidence building, mental preparation). This allows participation to be framed as looking at how competitive sport can provide the skills for life and goals after the Games (e.g., family relationships, education, employment) rather than the competition and sport performance as the be-all and end-all of Invictus Games participation. This approach further suggests the benefit of implementing transformational leadership approaches from training through to post-Games.

The Impact of the COVID-19 Pandemic

The research was significantly impacted by the COVID-19 pandemic, with social distancing regulations influencing sport programming to various degrees within and across participating nations, as well as resulting in the rescheduling of the Invictus Games The Hague. While these unforeseen barriers influenced data collection and analysis, the pandemic also provided an opportunity to examine the impact of the pandemic in a cohort of military personnel with physical and/or psychological illnesses and injuries participating in our study. This additional research presented two main findings for future research and consideration:

• First, interviews with competitors and their family members highlighted the potential of virtual advancements in adapted sport, such as the Invictus Games Foundation active esports programming to complement or extend the benefits of existing in-person programming. This finding is especially relevant given future Games, like Invictus Games Birmingham 2027, will include esport components.
• Second, survey data from The Hague Invictus Games suggested that individuals experiencing psychological illnesses and injuries demonstrated poorer psychological well-being than individuals experiencing physical illnesses and injuries. This finding indicates differing responses to pandemic challenges based on type of illness or injury that should be considered in future evaluations or programming.

Key Take-Away Points

This research represents, to our knowledge, the first international longitudinal investigation of the benefits of international adapted sport competition for military personnel experiencing physical and/or psychological illnesses and injuries, as well as the first global guide to evidence-based best practices for military adapted sport recovery programming (the full list of the 71 best practices strategies is available in the report). Findings reinforced the value of competitive adapted sport. However, the findings also highlighted the need for training to focus not only on sport but also on psychological resilience (mental skills, goal setting for life after the Games, etc.) so competitive sport participation is framed as a platform for personal growth. Additionally, the findings suggest the importance of continuing to engage community members and support sport participation for those who are not selected for competition, as well as for competitors to maintain connection and engagement between competitions. One of the potentially promising methods for achieving these aims may be active esports.

Recommendations

Recommendations were identified for practice and research.

Practice Recommendations for Sports Programs:

1. Broadening programming to support those who aren’t selected for competition so that they continue to work towards their goals and feel connected to the community.
2. Implement resilience training alongside sport programming prior to and after competition to improve long-term health and well-being.
3. Tailor programming based on whether the individual has a physical illness or injury, psychological illness or injury, or both.
4. Screen for the impact of COVID-19 experiences on well-being to determine whether the pandemic experience compounded negative psychosocial outcomes or manifestations of an illness or injury.

Research Recommendations:

1. Explore the experiences of family and the role that military sport recovery programming can play to support family rehabilitation and improve family relationships after illness or injury.
2. Further examine and evaluate the implementation of resilience training.
3. Explore transformational leadership as an approach to coaching in military sport-based rehabilitation.
4. With research often either focusing on physical or psychological illness or injury, build an evidence base on the experiences and recovery of military personnel experiencing both physical and psychological illnesses and injuries.
5. Assess active esports programming as an approach for sport-based rehabilitation.

 Acknowledgements

The research team would like to express their gratitude to the Forces in Mind Trust for funding this research. The research team would also like to thank the Invictus Games Foundation for their support, as well as Invictus Games nations and study participants for their participation.

Authorship

This research was led by Dr. Celina Shirazipour (Cedars-Sinai Medical Center; Invictus Games Foundation) in collaboration with Dr. Emily Mayhew (Imperial College London), Dr. Blair Evans (Western University), Dr. Amy Latimer-Cheung (Queen’s University), and Dr. Alice Aiken (Dalhousie University). Additional contributors included Jessica Capaldi, Bianca Luna-Lupercio, Nadia Huynh, Yujie Cui, Dr. Vinicius Calsavara, and Dr. Marcio Diniz (Cedars-Sinai Medical Center).

Thank you to Dr Celina Shirazipour for writing this research summary for the FiMT Research Centre.