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American Dietetic Association Standards of Practice
and Standards of Professional Performance forRegistered Dietitians (Generalist, Specialty, Advanced)

in Sports DieteticsThe American Dietetic Association Dietitians in Sports, Cardiovascular, and Wellness Nutrition Dietetic

Practice Group: Patricia L. Steinmuller, MS, RD, CSSD; Nanna L. Meyer, PhD, RD, CSSD;Laura J. Kruskall, PhD, RD, CSSD, FACSM; Melinda M. Manore, PhD, RD, CSSD, FACSM;

Nancy R. Rodriguez, PhD, RD, CSSD; Michele Macedonio, MS, RD, CSSD, FACSM;Randy L. Bird, MS, RD, CSSD, CSCS; Jacqueline R. Berning, PhD, RD, CSSD; and ADA Quality

Management Committee

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he Sports, Cardiovascular, andWellness Nutrition Dietetic Prac-tice Group (SCAN DPG) of the

merican Dietetic Association (ADA),nder the guidance of the ADA Qualityanagement Committee, has devel-

ped Standards of Practice (SOP) andtandards of Professional Performance

SOPP) for Registered Dietitians (RDs)n Sports Dietetics (See the Web sitexclusive Figures 1, 2, and 3, at www.dajournal.org). These documents areuilt upon the ADA Revised 2008 SOPor RDs in Nutrition Care and SOPPor RDs (1). As part of ADA’s Scope ofietetics Practice Framework (2), the008 SOP in Nutrition Care and SOPPor RDs, and ADA’s Code of Ethics (3),uide the practice and performance ofDs in all settings. The concept ofcope of practice is fluid (4), changing inesponse to the expansion of knowl-dge, the health care environment, andechnology. Recognizing advancementsn the practice of sports dietetics, theommission on Dietetic Registration

CDR) established the Board Certifiedpecialist in Sports Dietetics (CSSD)redential in 2006.

The 2008 SOP for RDs in Nutritionare and the SOPP for RDs are the

esult of a review and update of the005 ADA SOP in Nutrition Care andpdated SOPP (5). The SOP in Nutri-

0002-8223/09/10903-0020$36.00/0

edoi: 10.1016/j.jada.2009.01.015

44 Journal of the AMERICAN DIETETIC ASSOCIATIO

ion Care address the four steps of theutrition Care Process (NCP) and ac-

ivities related to patient/client careuring the NCP (6). They are designedo promote the provision of safe, effec-ive, and efficient food and nutritionervices, facilitate evidence-based prac-ice, and serve as a professional evalu-tion resource, enabling RDs to assessheir current level of practice in meet-ng the Standards and to determine theraining required for advancement to aigher level of practice. The SOPP areuthoritative statements that describecompetent level of behavior in the

rofessional role. Categorized behav-ors that correlate with professionalerformance are divided into six sepa-ate standards. Together, the SOP andOPP comprehensively depict the min-

mum expectation for competent pa-ient/client care and professional be-avior for RDs.SCAN DPG advocates that the afore-entioned standards also be used to

nhance recognition of the skills and

Approved November 2008 by the QAmerican Dietetic Association Housmittee of the Sports, Cardiovasculartice Group (SCAN DPG) of the Amreview date: March 2014. Questions rStandards of Professional Performanaddressed to Sharon McCauley, MSManagement at ADA at smccauley@Manager of Quality Management at

xpertise of sports dietitians, educate

N © 2009

Ds and others about the CSSD cer-ification, guide the development ofontinuing education materials andrograms, and conduct and publishutcomes research.The indicators for the SOP and

OPP for RDs in Sports Dieteticsere developed with input and con-

ensus of content experts represent-ng diverse practice and geographicerspectives and were reviewed andpproved by the Executive Commit-ee of the SCAN DPG, the Scope ofietetics Practice Framework Sub-ommittee, and ADA’s Quality Man-gement Committee. A 2005 job anal-sis survey for sports dietitiansonducted by CDR provided informa-ion to support the standards devel-ped for sports dietitians. These stan-ards are a guide for self-evaluationnd improving practice, a means ofdentifying areas for professional de-elopment, and a tool for demonstrat-ng competence in delivering sportsutrition services.

lity Management Committee of thef Delegates and the Executive Com-d Wellness Nutrition Dietetic Prac-an Dietetic Association. Scheduledrding the Standards of Practice andfor RDs in Sports Dietetics may beBA, RD, FADA, Director of Qualityright.org; or Cecily Byrne, MS, RD,A at [email protected].

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Three levels of practice in sports di-

by the American Dietetic Association

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tetics care, generalist, specialty anddvanced, are defined. An entry-levelractitioner has less than 3 years ofegistered practice experience andemonstrates a competent level of die-etics practice and professional perfor-ance. A general practitioner (or

eneralist) is an individual whose prac-ice includes responsibilities across sev-ral areas of practice including, but notimited to, more than one of the follow-ng: community, clinical, consultationnd business, research, education, andood and nutrition management. Apecialty practitioner is an individ-al who concentrates on one aspect ofhe profession of dietetics. This spe-ialty may or may not have a credentialnd additional certification, but it oftenas expanded roles beyond entry levelractice. An advanced practitioneras acquired the expert knowledgease, complex decision-making skills,nd competencies for expanded prac-ice, the characteristics of which arehaped by the context in which he orhe practices. Advanced practitionersay have expanded or specialty roles

r both. Advanced practice may or mayot include additional certification.enerally, the practice is more com-lex, and the practitioner has a higheregree of professional autonomy andesponsibility. In addition, it is recog-ized that sports dietetics care is mostffectively undertaken with a multidis-iplinary focus and at a level beyondhat practiced by an entry-level RD.

These standards, along with theDA’s Code of Ethics (3), answer theuestions: “Why is an RD uniquelyualified to provide sports nutritionervices?” and “What knowledge,kills and competencies does an RDeed to demonstrate for the provisionf safe, effective, and quality sportsietetics care at the generalist, spe-ialty, and advanced levels?” Thesetandards incorporate the principlesf ADA’s NCP. The outcomes (eg,ealth of physically active people, en-rgy and fluid balance, appropriateueling and hydration for trainingnd competition, achieving and main-aining appropriate body weight andody compositions goals, facilitatingthlete compliance with rules andegulations of sports organizationsegarding sport/dietary supplements)o be monitored and evaluated are theutcomes of dietetics professionalsracticing in sports dietetics related
o each step of the NCP along with C
rofessional practices outlined in theOPP.Other practice guidelines that build

n the NCP are evidence-based sportutrition guidelines, the establishededical nutrition therapy (MNT) pro-

ocols for general dietetics care, andest practice as determined by thoseith clinical expertise and extensivexperience in sports dietetics in aariety of settings. While these stan-ards are intended to serve as a pro-ession evaluation resource, the MNTrotocols are established practiceools that provide the specific contento use with a patient/client when pro-iding nutrition care using the NCP.hese standards cover the continuumf care that primarily takes place inn outpatient setting and can be ex-ended to interactions with the sportscience researchers and medicine pro-iders, support staff (eg, coaches, ad-inistration), and/or other health

rofessionals. MNT protocols are toe used when the athlete or activendividual (patient/client) requiresreatment for a nutrition-related dis-ase or condition that is negativelyffecting overall health or perfor-ance.

VERVIEWublic interest in nutrition and exer-ise has dramatically increased overhe last 20 years. This interest haseen fueled by factors such as the ris-ng incidence of obesity and chronicisease and recognition that nutritions integral to health and sport perfor-

ance. With 66% of the US adult pop-lation estimated to be overweight orbese, it is not surprising the interestn nutrition and exercise has in-reased (7,8). The role physical activ-ty plays in preventing weight gain,romoting weight loss, and prevent-ng weight gain subsequent to weightoss is well documented (9-11). Themportance of physical activity andutrition for attaining optimal weightnd overall health has also been high-ighted in a number of recent US De-artment of Health and Human Ser-ices (DHHS) and US Department ofgriculture documents. These in-lude the Dietary Guidelines formericans 2005 (12); Healthy People010 (13), with 11 goals specific toutrition and exercise; and the 2008hysical Activity Guidelines Advisory
ommittee Report (14). The Physical c
March 2009 ● Journa

ctivity Guidelines Report is the firsteport ever issued by the US govern-ent specifically for the American

ublic with regard to the health ben-fits of physical activity that is accom-anied by a summary of the scienceupporting these recommendations.n addition, the Food and Nutritionoard issued Dietary Reference In-

akes (DRIs) for energy intake, which,or the first time, specifically includesecommendations for the level ofhysical activity required for weightaintenance and weight loss (15).Obesity and many chronic diseases

eg, cardiovascular disease, hyperten-ion, diabetes, and some cancers) aressociated with physical inactivitynd poor dietary habits (16). RDs,specially those who are skilled inutrition, exercise, and weight man-gement, are needed to assist indi-iduals, communities, organizations,nd governments in realizing thealue of an integrative approach toutrition and physical activity in pro-oting overall health and wellness.

n addition, there is great interest intilizing the interactions of food, nu-rition, and physical activity to de-elop behavioral strategies that caneduce the risk of chronic diseases.or individuals interested in recre-tional sports and fitness, sports die-itians provide counseling in what,ow much, and when to eat to main-ain good health, appropriate bodyeight and composition, and to prop-

rly fuel the body for activities en-oyed by this population. Correspond-ngly, interest in the purportedenefits of widely promoted sportsoods, drinks, dietary supplements,opular diets, and quick-fix exerciselans continues to grow. Sports dieti-ians provide sound food and nutri-ion advice appropriate for an individ-al’s current level of fitness and sport/hysical activities, assist individualsn evaluating sports foods, drinks,nd dietary supplements, and helplients meet their goals for healthyody weight and physical activity orport.For competitive or elite athletes,

ports nutrition guidance can enhanceraining capacity, improve exercise per-ormance, reduce the risk of injury, pro-ote appropriate body weight and

omposition, and strengthen the im-une system. Applying sound nutri-

ion strategies can also facilitate re-
overy from strenuous exercise by
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efueling and rehydrating the body,roviding nutrients to build and re-air muscles, and preparing athletesor the next training session or com-etition. This is especially importantor competitive athletes who competeultiple times per day or participate

n tournaments and for individualsho engage in strenuous, repetitivexercise training one or more timeser day.Proper nutrition can help speed the

ealing process for injured athletes.ecovery from muscle or bone injuriesr from surgery requires extra energynd nutrients, including protein, vita-ins, and minerals. Sound nutrition

ontributes to appropriate manage-ent of body weight and body compo-

ition. Utilizing individualized ap-roaches to weight maintenance,eight/muscle gain, or weight loss

an significantly improve health andeduce stress. Sports dietitians edu-ate athletes regarding individual-zed menu planning, recipe modifica-ion, grocery shopping, and foodreparation and storage. In addition,ports dietitians educate on the use ofports foods, drinks, and dietary sup-lements in compliance with the rulesnd regulations of sports organiza-ions and governing bodies, such ashe National Federation of Highchool Associations (NFHS), the Na-ional Collegiate Athletic AssociationNCAA), the US Olympic CommitteeUSOC), the United States Anti-Dop-ng Agency (USADA), the World Anti-oping Agency (WADA), and profes-

ional sports organizations such ashe Major League Baseball (MLB),he National Basketball AssociationNBA), and the National Footballeague (NFL).A strong body of research evidence

emonstrating these benefits haseen compiled over the last 2 decades17-19). This research has provided aoundation for evidenced-based gov-rnment reports and position papersroviding specific nutrition guide-ines for individuals participating intrenuous exercise. Examples are theollowing: the joint position paper onutrition and Athletic Performancey the ADA, the American College ofports Medicine (ACSM), and the Di-titians of Canada (20-24). In addi-ion, there are numerous reports byhe Committee on Military Nutritionesearch (CMNR) of the Institute of
edicine (IOM) emphasizing the im- a
46 March 2009 Volume 109 Number 3

ortance of nutrition for soldiers per-orming high levels of physical exer-ion in harsh environments (25-28).

ithout question, the application ofports nutrition principles plays a vi-al role in exercise training and per-ormance, weight management, and

aintaining health of the athlete.he field is advanced by ongoing re-earch in sports nutrition.The sports dietitian working with

thletes and active individuals inractice settings needs to develop theppropriate knowledge, skills, andompetencies to provide safe and ef-ective care. In addition, every efforts taken to assure confidentiality andompliance with the regulations andtandards of the Health Insuranceortability and Accountability Act of996 (HIPPA). To provide sports nu-rition guidance that addresses theiverse needs of athletes and activendividuals, the sports dietitian mustossess a breadth of knowledge andkills that can be applied to variednd complex situations. The key toptimal nutrition for athletes is indi-idualization. The sports dietitianust recognize the demands of the

thletes’ annual training and compe-ition plans as well as the specificeeds of other patients/clients andork to meet those needs with a per-

onalized approach. Patients or cli-nts deserve individualized and spe-ific nutritional guidance related toptimizing body weight and composi-ion; recommendations for energy,utrient, and fluid intake before, dur-

ng, and after exercise; guidance inlanning, selection, and preparationf meals and snacks; and use of sportsoods, drinks, and dietary supple-

ents in a variety of settings, includ-ng traveling for competitions.

The sports dietitian delivers nutri-ion information specific to variousports or activities and has a thor-ugh understanding of how energynd nutrient needs change during thearious phases of training and compe-ition. Equally important is the abil-ty to effectively educate athletes,oaches, athletic trainers, and othersegarding compliance with the rulesnd regulations of sports organiza-ions (eg, NCAA, NFHS, USOC,SADA, WADA, MLB, NBA, NFL)

pecific to sports foods, drinks, andietary supplements. To integrate nu-rition effectively into the athlete’s
nnual training and competition plan, s
he sports dietitian works closely withoaches, physiologists, and other mem-ers of the multidisciplinary team.nce an individual’s nutrient needs arestablished, the sports dietitian devel-ps a plan for the patient or client toeet those nutritional goals with ap-

ropriate quantity; quality; and timingf food, fluid, and intake of dietaryupplements when appropriate. Dailychedule demands, environmental fac-ors, and cultural influences shouldlso be considered. Finally, in additiono performance outcomes, it is essentialor sports dietitians to provide serviceshat promote the overall health andellness of the athlete or active indi-idual.Sports dietitians have traditionallyorked with elite and recreationalthletes who are members of colle-iate, club, and professional sporteams and in settings such as healthlubs, corporate wellness centers, andlympic training centers. Sports die-

itians are also being recruited toork with the military, military affil-

ates and with occupational groupsuch as police and fire fighters whereuman performance as well as phys-

cal fitness is required. Moreover, de-and is growing for sports dietitians

o be employed in a number of areas,uch as private companies specializ-ng in sport performance by parentsor their children’s health or sporterformance, and to work with ath-etes who have disabilities and otherpecial needs. Sports dietitians arelso hired as consultants by research-rs to assist in selecting appropriatessessment methods such as dietaryntake, nutritional status, energy ex-enditure, and body composition. Thelinical skills of sports dietitians arencreasingly required to provide MNTor active and athletic patients or cli-nts diagnosed with medical condi-ions (eg, diabetes, gluten intoler-nce, food allergies, Crohn’s disease)nd in situations such as post–cancerreatment and post-bariatric surgery.learly, sports dietetics is a growingnd demanding new field of study andractice that requires the integrationf nutrition science and exercise prin-iples and corresponding researchnto a variety of settings where activend athletic populations participaten sports or workers engage in physi-ally demanding occupations.One’s level of physical fitness and

port performance is determined by a

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umber of factors including geneticharacteristics that influence physicalbilities, appropriate exercise trainingimed at optimizing physical potential,nd developing specific skills and dietehaviors. Appropriate food choices canead to improved performance and abil-ty to train, while inadequate nutritionractices can be detrimental to healthnd performance outcomes. Beyond un-erstanding how research findings inutrition and exercise sciences areranslated into nutrition guidelines forthletes and active individuals of allports, ages, sexes, and competitive lev-ls, sports dietitians must integratehese guidelines into the provision ofigh-quality sports dietetics care.

DA SOP AND SOPP FOR RDsGENERALIST, SPECIALTY, ANDDVANCED) IN SPORTS DIETETICShe sports dietitian uses the ADA SOPnd SOPP (Generalist, Specialty, anddvanced) for RDs in Sports Dietetics

see the Web site exclusive Figures 1, 2,nd 3 at www.adajournal.org) to:

identify the competencies needed toprovide sports dietetics care;self-assess whether they have theappropriate skill and knowledgebase to provide safe and effectivesports dietetics care for their levelof practice;identify the areas in which additionalknowledge and skills are needed topractice at the generalist, specialty,or advanced level of sports dieteticspractice;provide a foundation for public andprofessional accountability in sportsdietetics care;assist management in the planningof sports dietetics services and re-sources;enhance professional identity andcommunicate the nature of sportsdietetics;guide the development of sports di-etetics-related education programs,job descriptions, and career path-ways; andassist preceptors in teaching stu-dents and interns the competenciesand skills needed to work in sportsdietetics and the understanding ofthe full scope of this profession.

CDR launched the CSSD certifica-ion for RDs in 2006. Members of the
CAN DPG assisted CDR in writing a T
ob analysis survey for sports dieti-ians and contributed to developinghe certification. A sports dietitianho is a CSSD has met minimumractice experience requirements andas successfully completed the CSSDxamination. Eligibility criteria forhe credential, applications, andther information are available fromDR (www.cdrnet.org). A sports die-

itian’s job description, consistentith specialty level practice, devel-ped by SCAN members is publishedn Job Descriptions: Models for theietetics Profession, 2nd ed, 2008

29). The CSSD certification, ADAports dietitian job description, andhe SOP and SOPP for RDs in Sportsietetics are components of a system

hat assists sports dietitians in gaug-ng their level of practice and provid-ng a pathway for advancement byefining sports dietetics practice, doc-menting skill levels, and establish-

ng benchmarks. During the develop-ent of these standards, several

ssues unique to nutrition interven-ion in sports dietetics settings weredentified.

Principles of exercise science andexercise physiology are integratedinto the application of the sportsdietetics care.A nutrition approach matched tothe athlete’s annual training andcompetition plan is an essentialcomponent of sports dietetics care.Exercise/athletic performance para-meters are considered in the man-agement of body weight and bodycomposition of the target population.

pplication to Practicendicators described as specialty levelf practice designations in this docu-ent are not equivalent to the CSSD

ertification. Rather, the CSSD desig-ation refers to an RD who has devel-ped sports dietetics nutrition knowl-dge, skill, and application beyondhe entry-level or the generalist prac-itioner. An RD who has earned theSSD certification is an example ofn RD who has demonstrated, at ainimum, specialty level skills as

resented in this document.The Dreyfus model (30) identifies

evels of proficiency (novice, specialist,dvanced) during the acquisition andevelopment of knowledge and skills.
his model is helpful in understand- c

ng the levels of practice described inhe SOP and SOPP in Sports Dietet-cs. In ADA SOP and SOPP, thetages are represented as generalist,pecialty, and advanced practice lev-ls (Figure 4).All RDs, even those with significant

xperience in other practice areas, be-in at the Novice level (generalistevel) when practicing in a new set-ing. At the Novice level (generalistevel), the RD in sports dietetics isearning the principles that underpinhe practice and is developing skillsor effective sports dietetics practice.his RD, who may be an experiencedD or may be new to the profession,as a breadth of knowledge in nutri-ion overall and may have specialty ordvanced knowledge/practice in an-ther area. However, the RD new tohe specialty of sports dietetics mayxperience a steep learning curve dueo the wide range in demands posedy different sports and their special-zed annual training and competitionlans, the need for individualizedports dietetics approaches, and theomplexity of sports dietetics services.

At the Proficiency stage (specialtyevel), the RD has developed a deepernderstanding of sports dietetics carend is much better equipped to applyvidence-based guidelines and bestractices. This RD is also able to mod-fy practice according to unique situ-tions (eg, integrating environmentalactors such as heat, cold and altituden the evaluation of an athlete’s en-rgy, fluid, and nutrient needs).At the Expert stage (advanced prac-

ice level), the RD thinks criticallybout sports dietetics, demonstrates aore intuitive understanding of

ports dietetics care and practice, andisplays a range of highly developedlinical and technical skills (whichay include but is not limited to per-

orming sports-directed nutrition as-essment) and formulates judgmentscquired through a combination of ex-erience and education. Essentially,ractice at the advanced level re-uires the application of composite di-tetics knowledge, with practitionersrawing not only on their clinical ex-erience, but also on the experience ofhe sports dietitians in various disci-lines and practice settings. Experts,ith their extensive experience andbility to see the significance andeaning of sports dietetics within a

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le and, to some degree, autonomousn practice. They not only implementports dietetics practice, they alsorive and direct clinical practice, con-uct and collaborate in research, con-

Specialty RDa

A specialty level RD has acquired the proficknowledge base, complex decision-makincompetencies for specialty level practicethe context in which an RD practices.

Specialty RDs practice from both expandedknowledge, skills, competencies, and exp

Specialization is concentrating or delimitingthe whole field of dietetics (eg, ambulatordiabetes, renal, pediatric, private practicesupport, research, sports dietetics).

Expansion refers to the acquisition of new pskills, including the knowledge and skillsautonomy within areas of practice that mboundaries of dietetics practice.

Specialty level RDs are either certified or aptheir expanded, specialized areas.

Specialization does not always include an adbeyond RD certification.

Specialty certification may or may not requirpostgraduate level.

The Commission on Dietetic Registration (CDspecialty certifications:● Board Certified Specialist in Pediatric N● Board Certified Specialist in Renal Nutr● Board Certified Specialist in Sports Die● Board Certified Specialist in Gerontolog● Board Certified Specialist in Oncology N

Examples of other specialty certifications curre● Certified Diabetes Educator (CDE)● Certified Nutrition Support Clinician (CN

Educational Preparation (one or more of the fo● Educational preparation at the specialty● May include a formal educational prog

specialty practice● Dietetics practice roles accredited or a● May include a formal system of certific

Nature of Practice● Integrates research, education, practice● Moderate degree of professional auton

practice● Specialized assessment skills, decision

diagnostic reasoning skills● Nonclinical specialty practice (business

for example) may not include all characomplexity of the nature of practice wi

ExperienceExperience beyond entry level is recommend

Experience is required for specialty certifi

igure 4. American Dietetic Association (ADA)CDR�Commission on Dietetic Registration.

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nce and medicine teams, and leadhe advancement of sports dieteticsractice.Indicators for the SOP (Figure 2,

vailable online at www.adajournal.

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nline at www.adajournal.org) are ac-ion statements that illustrate howach standard may be applied in prac-ice. Within the SOP and SOPP inports Dietetics, an “X” in the gener-

el RD has acquired the expert knowledge,ng skills, and clinical competencies forcharacteristics of which are shaped by thepractices.

actice from both expanded and specializedpetencies, and experience.cquisition of new practice knowledge andowledge and skills that legitimize roleof practice that may overlap traditionalpractice.characterized by the integration of a broad

tical, research-based, and practicalas a part of training and experienceanced practice RDs are either certified ortheir expanded, specialized roles.

ot always include an additional certification. Certification may be one way ofd practice competency.ation typically implies a postgraduate

that the individual has the specializationpetencies, and experience, and thekills, competencies, and experience of

ot a prerequisite for Advanced Practice

ffer any Advanced level certifications.d level certifications for RD:vanced Diabetes Management (BC-ADM)e or more of the following characteristics):ion at the advanced levell educational program preparing for

les accredited or approvedl system of certification and credentialing

education, practice, and managementssional autonomy and independent practicewn case loadessment skills, decision-making skills, andskills

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ho is caring for patients or clients isxpected to complete this activitynd/or seek assistance to learn how toerform at the level of the standard.he generalist in sports dieteticsould be an entry level RD or an ex-erienced RD who has newly as-umed responsibility to provideports dietetics care of active or ath-etic patients or clients. The general-st could also be an experienced indi-idual who has changed the focus ofis or her sports dietetics practice tonother group (eg, children to adult)r to another specialty (eg, enduranceports to strength/power sports) (seeigure 4). An “X” in the specialty col-mn indicates that an RD who per-orms at this level has a deeper un-erstanding of sports dietetics andas the ability to modify therapy toeet the needs of patients/clients in

arious situations (eg, caring for aoung athlete who is participating inreseason conditioning and is suffer-ng from dehydration; helping an ath-ete with hypoglycemia to choose theight foods and fluids at the rightime before, during, and after exer-ise). An “X” in the advanced columnndicates that the RD who performst this level possesses a comprehen-ive understanding of sports dieteticsnd exercise physiology and a highlyeveloped range of skills and judg-ents acquired through a combina-

How to Use the Standards of Practice andand Advanced) in Sports Dietetics as part

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igure 5. Application of the Commission onegistration Professional Development Portfoliuring each 5-year recertification cycle and su

ion of experience and education. m

Bolded standards and indicatorsriginate from ADA’s 2008 SOP inutrition Care and SOPP for RDs (1)nd should apply to RDs in all threeategories. Several unbolded indica-ors are identified as applicable to allevels of practice. Where “X”s arelaced in all three categories of prac-ice, it is understood that all RDs inports dietetics are accountable forractice within each of these indica-ors. However, the depth with whichn RD performs each activity will in-rease as the individual moves be-ond the generalist level. Level ofractice considerations warrant thatholistic view of the SOP and SOPP

or RDs in Sports Dietetics be taken.t is the totality of individual practicehat defines the level of practice andot any one indicator or standard.RDs should review the SOP and

OPP in Sports Dietetics at regular in-ervals to evaluate their sports nutri-ion knowledge, skill, and competence.egular self-evaluation is importantecause it helps identify opportunitieso improve and/or enhance practicend professional performance. This ap-raisal also enables sports dietitians toetter utilize CDR’s Professional Devel-pment Portfolio for self-assessment,lanning, improvement, and commit-ent to lifelong learning (31). These

tandards may be used in each of theve steps in the Professional Develop-

andards of Professional Performance for Rthe Professional Development Portfolio Pro

ruoyrehtehwdnaecitcarpfoleveltnerrucruourrent level of practice. Review the Standards

ance document to determine what you wantths and areas for improvement. These documsional goals.

have identified your future practice goals, yords of Professional performance document toors, and define what continuing professionalf practice.your review of the Standards of Practice and

velop a plan to address your learning needsplement your learning plan, keep reviewing t

sional Performance document to re-assess knd level of practice.

achieve your goals and reach or maintain youe to review the Standards of Practice and Stssess knowledge, skills, and behaviors and y

tetic Registration Professional Developmentrocess is divided into five interdependent stepeding cycles.

ental Portfolio process (Figure 5). a


Ds are encouraged to pursue addi-ional training, regardless of practiceetting, to expand their personal scopef sports dietetics. Individuals are ex-ected to practice only at the level athich they are competent, and this willary depending on education, trainingnd experience (32). Sports dietitiansre encouraged to pursue additionalnowledge and skill training regard-

ess of practice setting and to pursueSSD certification to promote consis-

ency in practice and performance andontinuous quality improvement. Seeigure 6 for case examples of how RDs

n different roles, at different levels ofractice, may use the SOP and SOPPn Sports Dietetics.

In some instances, components ofhe SOP and SOPP in Sports Dietet-cs do not specifically differentiate be-ween specialty and advanced levelractice. In these areas, it was theonsensus of the content experts thathe distinctions are subtle—capturedn the knowledge, experience, and in-uition demonstrated in the context ofractice at the advanced level, whichombines dimensions of understand-ng, performance, and value as an in-egrated whole (33). A wealth of un-apped knowledge is embedded in thexperience, discernment, and practicef advanced-level sports dietetics prac-itioners. The knowledge and skills ac-uired through practice will continu-

tered Dietitians (Generalist, Specialty,sa

niatniamroecitcarpruoydnapxeoteraslaPractice and Standards of Professionalur future practice to be, and assess your

can help you set short- and long-term

an review the Standards of Practice andess your current knowledge, skills,

cation is required to achieve the desired

andards of Professional Performance, youhey relate to your desired level of practice.Standards of Practice and Standards ofedge, skills, and behaviors and your

desired level of practice, it is important toards of Professional Performance documentdesired level of practice.

tfolio process. aThe Commission on Dietetichat build sequentially upon the previous step

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Role Examples of use of SOP and SOPP documents by RDs in different practice roles

Clinical practitioner The sports dietitian employed by a sports medicine clinic and/or hospital would have a number of rolesincluding providing in- and outpatient services to active individuals and teams such as counseling,team presentations, and nutrition workshops. This RD would also be part of the multidisciplinarysports medicine team that serves individuals receiving rehabilitation, physical activity guidance, and/orexercise training. Related to the practice of sport dietetics, this RD would review available resourcesfor this patient/client population. The RD recognizes a need for specific knowledge and skills that arenot routine to general dietetics practice. The RD reviews the SOP and SOPP to evaluate individualskills and competencies before providing nutrition care to individual patients/clients with clinicalissues involved in exercise and sport and sets goals to improve competency in this area of practicebefore initiating patient/client care.

Manager An advanced-level sports dietitian oversees a number of RDs providing sports dietetics care toindividuals with various performance and health needs. The manager recognizes the SOP and SOPPas important tools for staff to use to assess their own competencies and to use as the basis foridentifying personal performance plans.

Individual not currentlyemployed

After several years out of clinical practice, an RD decides to establish an active practice with one of thefocus areas being sports dietetics. Prior to accepting referrals, the RD uses the SOP and SOPP as anevaluation tool to determine what is needed to competently provide quality sports dietetics care andpatient/client education prior to seeking continuing education and skill-building opportunities.

Public health practitioner/Corporate wellness

An RD working in a public health or wellness setting notices an increase in the number of overweightclients with type 2 diabetes who are advised by their doctor to begin an exercise program. The RDuses the SOP and SOPP to evaluate the level of competence needed to provide quality medicalnutrition therapy to diabetic clients initiating an exercise program. The RD also determines what levelof practitioner the patient/client needs and to whom to refer individuals who require a level of carehigher than the RD can competently provide.

Researcher An RD working in a research setting is awarded a grant to demonstrate the role of the RD and theimpact of sports dietetics care provided by RDs on performance and health outcomes. The RD usesthe SOP and SOPP in the design of the research protocol.

Dietetics educator/faculty The RD in sports dietetics develops tools (eg, written materials, presentations and workshop content forclubs and teams, health and wellness fairs) targeted to specific audiences/groups reflectingapplications of the SOP and SOPP.

An RD faculty member lecturing at an institution uses the SOP and SOPP to integrate sports dieteticspractical skills and competencies into the course syllabus.

Private practice An RD in private practice who has worked with recreational athletes is contacted by an elite team. TheRD uses the SOP and SOPP to learn about the multidisciplinary approach when providing sportsdietetics care to elite athletes.

An RD who provides a broad range of services to active and athletic individuals uses the SOP and SOPPto develop intervention strategies specific to sport, age, sex, and fitness level.

An RD who is also a certified personal trainer in his or her own private practice combines personaltraining services with sports dietetics care. He or she uses the SOP and SOPP to obtain guidance onintegrating dietetics care into the client’s exercise programs and goals to improve fitness componentssuch as strength, endurance, flexibility, and speed.

Other Settings An RD employed in a collegiate athletic department, with a professional sports team, or private companyspecializing in sport performance uses the SOP and SOPP to implement safe, effective, qualitydietetics care within the context of athletes’ annual training and competition plans.

An RD employed by or consulting with police academies, fire fighters, the military or national guard usesthe SOP and SOPP as a guide for delivering dietetics care in non-traditional settings (eg, combat ordisaster).

An RD who also holds a concurrent credential (eg, certified athletic trainer, certified personal trainer,certified strength and conditioning specialist) may use the SOP and SOPP as follows: to develop asport nutrition program for a female high school team and initiate screening for the Female AthleteTriad; complement his or her knowledge on rules and regulations regarding sport/dietary supplementsfor athletes; plan, implement, and communicate dietetics care for elite athletes as part of amultidisciplinary approach.

An RD who is also a clinical exercise physiologist uses the SOP and SOPP in a health care setting tocombine medical nutrition therapy with exercise prescription in the treatment of patients withhypertension, cardiovascular disease, diabetes, and obesity.

igure 6. Case examples of Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for the Registered Dietitian (RD)
Generalist, Specialty, and Advanced) in Sports Dietetics.

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aptured in refined indicators as ad-anced-level RDs systematically recordheir own experience using the conceptf clinical exemplars. The experiencedractitioner observes clinical events,nalyzes them to make new connec-ions between events and ideas, androduces a synthesized whole. Clinicalxemplars provide outstanding modelsf the actions of individual sports dieti-ians in clinical settings and the profes-ional activities that have enhancedatient or client care. They include arief description of the need for actionnd the process used to change the out-ome (34-36).

UTURE DIRECTIONShe SOP and SOPP for RDs in Sportsietetics are innovative and dynamicocuments. Future revisions will re-ect changes in practice, dietetics ed-cation programs, and outcomes ofractice audits. The authors acknowl-dge that the three practice levels re-uire more clarity and differentiationn content and role delineation andhat competency statements that bet-er characterize differences amonghe practice levels are needed. Cre-tion of this clarity, differentiation,nd definition are the challenges ofoday’s sports dietitians to bettererve tomorrow’s practitioners andheir patients, clients, and customers.

UMMARYhe SOP and SOPP for RDs in Sportsietetics are key resources for RDs atll knowledge and performance levels.hese standards can and should besed by RDs in daily practice to consis-ently improve and appropriately dem-nstrate competency and value asroviders of safe and effective sportsietetics care. These standards alsoerve as a professional resource for self-valuation and professional develop-ent for RDs specializing in sports di-

tetics practice. The development andvaluation process is dynamic. Just ashe professional’s self-evaluation andontinuing education process is an on-oing cycle, these standards are also aork-in-progress and will be reviewednd updated on a regular basis. Cur-ent and future initiatives of ADA willrovide information to use in these up-ates and in further clarifying andocumenting the specific roles and re-
ponsibilities of RDs at each level of
ractice. As a quality initiative of ADAnd the SCAN DPG, these standardsre an application of continuous qual-ty improvement and represent an im-ortant collaborative endeavor.

pecial acknowledgement to Robertanding, MS, RD, CSSD, CDE; Karenaigle, MS, RD, CSSD; Tara Coghlin-ickson, MS, RD, CSSD; and Ingridkoog, MS, RD, CSSD, who reviewedhese standards.

eferences1. American Dietetic Association Revised 2008

standards of practice for registered dieti-tians in nutrition care; standards of profes-sional performance for registered dietitians;standards of practice for dietetic techni-cians, registered, in nutrition care; and stan-dards of professional performance for die-tetic technicians, registered. J Am DietAssoc. 2008;108:1538-1542e9.

2. O’Sullivan-Maillet J, Skates J, Pritchett E.Scope of dietetics practice framework. J AmDiet Assoc. 2005;105:634-640.

3. Code of ethics for the profession of dietetics.J Am Diet Assoc. 1999:99:109-113.

4. Visocan B, Swift J. Understanding and us-ing the scope of dietetics practice frame-work: A step-wise approach. J Am Diet As-soc. 2006;106:459-463.

5. Kieselhorst K, Skates J, Pritchett E. Amer-ican Dietetic Association: Standards of prac-tice in nutrition care and updated standardsof professional performance. J Am Diet As-soc. 2005;105:641-645.

6. Lacey K, Pritchett E. Nutrition care processand model: ADA adapts road map to qualitycare and outcomes management. J Am DietAssoc. 2003;103:1061-1072.

These standards have been formu-lated to be used for individual self-evaluation and the development ofpractice guidelines, but not for in-stitutional credentialing or for ad-verse or exclusionary decisions re-garding privileging, employmentopportunities or benefits, disciplin-ary actions, or determinations ofnegligence or misconduct. Thesestandards do not constitute medi-cal or other professional advice,and should not be taken as such.The information presented in thesestandards is not a substitute forthe exercise of professional judg-ment by the health care profes-sional. The use of the standards forany other purpose than that forwhich they were formulated mustbe undertaken within the sole au-thority and discretion of the user.

7. Prevalence of overweight and obesity amongadults: United States, 2003-2004. Centers for


Disease Control and Prevention, NationalCenter for Health Statistics Web site. April2006. http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htm. Accessed September 2008.

8. Galusky DA, Gillespie C, Kuester SA, MokdadAH, Cogswell ME, Philip CM. State-specificprevalence of obesity among adults—UnitedStates, 2007. MMWR Weekly. 2008;57:765-768.

9. Jakicic JM, Clark K, Coleman E, DonnellyJE, Foreyt J, Melanson E, Volek J, Volpe SL.American College of Sports Medicine Posi-tion Stand. Appropriate intervention strate-gies for weight loss and prevention of weightregain for adults. Med Sci Sports Exerc.2001;33:2145-2156.

0. Amati F, Dube JJ, Shay C, Goodpaster BH.Separate and combined effects of exercisetraining and weight loss on exercise effi-ciency and substrate oxidation. J ApplPhysiol. 2008;105:825-831.

1. Donnelly JE, Blair SN, Jakicic JM, ManoreMM, Rankin JW, Smith BK. Update of the2001 American College of Sports Medicine(ACSM) Position Stand. Appropriate inter-vention strategies for weight loss and pre-vention of weight regain for adults. Med SciSports Exerc. 2009;41:459-478.

2. Dietary Guidelines for Americans, 2005. Ex-ecutive summary. Washington, DC: US De-partment of Health and Human Services,US Department of Agriculture Web site.2005. http://www.health.gov/dietaryguidelines/dga2005/document/html/executivesummary.htm. Accessed September 2008.

3. Healthy People 2010: The cornerstone forprevention. Office of Disease Preventionand Health Promotion, US Department ofHealth and Human Services Web site. 2005.http://www.healthypeople.gov/Publications.Accessed September 2008.

4. Physical Activity Guidelines Advisory Com-mittee, Physical Activity Guidelines Advi-sory Committee Report, 2008. Washington,DC: US Department of Health and HumanServices, 2008.

5. Institute of Medicine (IOM), Food and Nu-trition Board, National Academy of Science.Dietary Reference Intakes for Energy, Carbo-hydrate, Fiber, Fat, Fatty Acids, Cholesterol,Protein, and Amino Acids (Macronutrients).Washington, DC: National Academies Press;2005.

6. National Diabetes Fact Sheet, 2007. US De-partment of Health and Human Services,Centers for Disease Control and PreventionWeb site. 2007. http://www.cdc.gov/diabetes/pubs/factsheet07.htm. Accessed September2008.

7. Burke L. Practical Sports Nutrition. Cham-paign, IL: Human Kinetics, 2007.

8. Burke L, Deakin V. Clinical Sports Nutri-tion, 3rd ed. North Ryde, NSW, Australia:McGraw-Hill Australia; 2006.

9. Manore MM, Meyer N, Thompson J. SportNutrition for Health and Performance, 2nded. Champaign, IL: Human Kinetics; June2009.

0. Rodriguez NR, DiMarco NM, Langley S. Po-sition of the American Dietetic Association,Dietitians of Canada, and the American Col-lege of Sports Medicine: Nutrition and ath-letic performance. J Am Diet Assoc. 2009;109:509-527.

1. Nattiv A, Loucks AB, Manore MM, Sanborn
CF, Sundgot-Borgen J, Warren M. AmericanCollege of Sports Medicine position stand.

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http://www.healthypeople.gov/Publications

http://www.healthypeople.gov/Publications

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The female athlete triad. Med Sci SportsExerc. Oct 2007;39:1867-1882.

2. Sawka MN, Burke LM, Eichner ER,Maughan RJ, Montain, SJ. American Col-lege of Sports Medicine (ACSM) positionstand: Exercise and fluid replacement. MedSci Sports Exerc. 2007;39:377-390.

3. Bonci CM, Bonci LJ, Granger LR, JohnsonCL, Malina, RM, Milne LW, Ryan RR,Vanderbunt EM. National Athletic Trainers’Association position statement: Preventing,detecting, and managing disordered eatingin athletes. J Athletic Training. 2008;43:80-108.

4. Casa DJ, Armstrong LE, Hillman SK, Mon-tain SJ, Reiff RV, Rich BSE, Roberts WO,Stone JA. National Athletic Trainers’ Asso-ciation position statement: Fluid replace-ment for athletes. J Athletic Training. 2000;35:212-224.

5. Committee on Metabolic Monitoring for Mil-itary Field Applications (Vanderveen JE,Bistrian BR, Caldwell JA, Dwyer JT, Erd-man JW, Lane HW, Manore MM, MorganWP, O’Neil PM, Sternberg EM, Tepper BJ,Thayer J, authors). Monitoring MetabolicStatus: Predicting Decrements in Physiolog-ical and Cognitive Performance. StandingCommittee on Military Nutrition Research,Institute of Medicine. Washington, DC: Na-tional Academies Press; 2004.

6. Committee on Optimization of NutrientComposition of Military Rations for Short-Term, High-Stress Situations (Erdman JW,Bistrian BR, Clarkson PM, Dwyer JT, KleinBP, Lane HW, Manore MM, O’Neil PM, Rus-sell RM, Tepper BJ, Tipton KD, Yates AA,authors). Nutrient Composition of Rationsfor Short-Term, High-Intensity Combat Op-erations. Standing Committee on MilitaryNutrition Research, Food and NutritionBoard, Institute of Medicine. Washington,DC: National Academies Press; 2005.

7. Committee on Mineral Requirements forCognitive and Physical Performance by Mil-itary Personnel (Russel RM, Beard JL, BeckM, Bistrian BR, Cannon JG, Combs GF, Dw-yer JT, Erdman JW, Haymes EM, Hunt JR,Lane HW, Penland JG, Percival SS, WeaverCM, authors). Mineral Requirements of Mil-itary Personnel. Levels Needed for Cognitiveand Physical Performance During GarrisonTraining. Standing Committee on MilitaryNutrition Research, Food and NutritionBoard, Institute of Medicine. Washington,DC: National Academies Press; 2006.

8. Committee on Dietary Supplement Use byMilitary Personnel (Greenwood MRC, Ander-son C, Bistrian B, Erdman JW, Franke WC,Jeffery E, Kanarek RB, Keen CL, Mahady GB,Miller SA, Myer EF, Rankin JW, authors).Use of Dietary Supplements by Military Per-sonnel. Standing Committee on Military Nu-trition Research, Food and Nutrition Board,Institute of Medicine. Washington, DC: Na-tional Academies Press; 2008.

9. Job Descriptions: Models for the DieteticsProfession, 2nd ed. Chicago, IL: AmericanDietetic Association; 2008.

0. Dreyfus HL, Dreyfus SE. Mind over Ma-chine: The Power of Human Intuitive Exper-tise in the Era of the Computer. New York,NY: Free Press; 1986.

1. Weddle DO. The Professional DevelopmentPortfolio Process: Setting goals for creden-tialing. J Am Diet Assoc. 2002;102:1439-
1444.
2. Gates G. Ethics opinion: Dietetics profes-


sionals are ethically obligated to maintainpersonal competence in practice. J Am DietAssoc. 2003;103:633-635.

3. Chambers DW, Gilmore CJ, Maillet JO,Mitchell BE. Another look at competency-based education in dietetics. J Am Diet As-soc. 1996;96:614-617.

4. Clark N, Coleman C, Figure K, Mailhot T,Zeigler J. 2003. Food for trans-Atlantic row-ers: A menu planning model and case study.Int J Sport Nutr Exerc Metab. 2003;13:227-242.

5. Stout A. Fueling and weight managementstrategies in sport. Practice applications.J Am Diet Assoc. 2007;107:1475-1479.

6. Quatromoni PA. Clinical observations fromnutrition services in college athletics. Per-spectives in practice. J Am Diet Assoc. 2008;108:689-694.

FD lity Assurance (www.ncqa.org).

Standards of Practice and Standards of PSports Dietetics

Standards of Practice in Nutrition Care are anutrition assessment, nutrition diagnosis (promonitoring and evaluation (four separate staStandards of Practice in Sports Dietetics preevidence-based guidelines, current acceptedprocess as they relate to the standards. Staa competent level of behavior in the professcommunication and application of knowledgprofessional accountability (six separate stan

Standards of Practice and Standards of Profserve to describe the practice and professioRDs or to all practice settings and situationspolicies and guidelines. The standards are a

The term patient/client is used in these staany individual or group who receives sportsof Practice and Standards of Professional Pemost effectively into the training and compemultidisciplinary team within athletic perfophysical therapist, physiologist, biomechanishead/assistant coaches, and team administrmay include any or all of the following: prinstatisticians. In addition, it is recognized thaspecial health care needs, play critical rolesrange of evidence-based guidelines and besEvidence-based guidelines are determinedabsence of expert opinion, professional stan

Each standard is equal in relevance and impoutcomes. A standard is a collection of specThe rationale statement describes the intentmeasurable action statements that illustrateperformance of competent practitioners and

Standard definitions, rationale statements, cPractice in Nutrition Care and Standards ofspecialty, and advanced) of sports dieteticscompetence expectations of the RD in sport

igure 1. Standards of Practice and Standardsietetics. aNCQA�National Committee for Qua

rofessional Performance for Registered Dietitians (Generalist, Specialty and Advanced) in

uthoritative statements that describe a competent level of practice demonstrated throughblem identification), nutrition intervention (planning, implementation), and nutrition outcomes

ndards) and the responsibilities for which registered dietitians (RDs) are accountable. Thesuppose that the RD uses critical thinking skills, analytical abilities, theories, best availabledietetics and medical knowledge, and the systematic holistic approach of the nutrition care

ndards of Professional Performance in Sports Dietetics are authoritative statements that describeional role, including activities related to provision of services; application of research;e; utilization and management of resources; quality in practice; and continued competence anddards).

essional Performance for RDs in Sports Dietetics are complementary sets of standards— bothnal performance of sports dietetics. All indicators may not be applicable to the practice of all. RDs must be aware of federal and state laws affecting their practice as well as organizationalresource but do not supersede laws, policies, and guidelines.

ndards as a universal term. Patient/client could also mean customer, participant, consumer, ordietetics care. Sports dietetics services are provided to individuals of all ages. These Standardsrformance include clinical, outpatient, community, and other settings. To integrate nutritiontition plan for athletes, the sports dietitian works as part of a multidisciplinary team. Armance/sports settings may include any or all of the following: physician, registered dietitian,t, psychologist, athletic trainer, strength and conditioning coach, massage therapists,ators/managers. A multidisciplinary research team within athletic performance/sports settingscipal investigator, co-principal investigators, project consultants, lab technicians, andt the family and primary caregiver(s) of patients/clients of all ages, including individuals within overall health. The term “appropriate” is used in the standards to mean: Selecting from a

t practices, one or more of which would give an acceptable result in the circumstances.by scientific evidence or, in the absence of scientific evidence, expert opinion or, in the

dards (NCQAa).

ortance and includes a definition, a rationale statement, indicators, and examples of desiredific-outcome focused statements against which a practitioner’s performance can be assessed.of the standard and defines its purpose and importance in greater detail. Indicators arehow each specific standard can be applied in practice. Indicators serve to identify the level ofto encourage and recognize professional growth.

ore indicators, and examples of outcomes found in American Dietetic Association Standards ofProfessional Performance have been adapted to reflect three levels of practice (generalist,care. In addition, the core indicators have been expanded upon to reflect the uniques dietetics care.

of Professional Performance for Registered Dietitians (Generalist, Specialty and Advanced) in Sports

March 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 552.e1

http://www.ncqa.org

F Dietitians in Sports Dietetics.

5

Standards of Practice for Registered Diet

Standard 1: Nutrition AssessmentThe RDa in sports dietetics uses accurate anexercise, and sport performance.

Rationale: Nutrition assessment is the firstobtaining, verifying, and interpreting data inIt is initiated by referral and/or screening ofprocess that involves not only initial data coprovides the foundation for Nutrition Diagnos

Indicators for Standard 1: Nutrition Asses

Bold Font Indicators are ADAb Core RD S

1. Each RD:

1.1 Assesses dietary history and currperformance and recovery, health

Assesses

1.1A Adequacy and appropriatedelivery (eg, macro and m

1.1A1 Energy and nutrcompetition, and

1.1A2 Food allergies/in

1.1A3 Energy balance

1.1A4 Daily fluid balan

1.1A5 Energy balanceand competition

1.1A6 Special nutrientvitamins, minera

1.1A7 Sweat rate, advaspecific gravity)exercise and/or

1.1A8 Changes in appealteration in bodintensity, travel/jmedical conditioand psychologic

1.1A9 Changes in usuatraining/competitrestoration, rehy

1.1A10 Current and pasmeal replacemen

1.1A11 Develops and su

1.1B Adequacy and appropriat

igure 2. Standards of Practice for Registered

itians in Sports Dietetics

d relevant data and information to identify nutrition-related problems that affect health, fitness,

of four steps of the Nutrition Care Process. Nutrition Assessment is a systematic process oforder to make decisions about the nature and cause of nutrition-related conditions or problems.individuals or groups for nutritional risk factors. Nutrition Assessment is an ongoing, dynamicllection, but also reassessment and analysis of patient/client or community nutritional needs. Itis, the second step of the Nutrition Care Process.

smentThe “X” signifies the indicators forthe level of practice

tandards of Practice Indicators Generalist Specialty Advanced

ent intake for factors that affect exercise/athletic, and conditions including nutritional risk.

X X X

ness of food, beverage, and nutrient intake/nutrienticronutrients; meal patterns; food allergies)

X X X

ient intake, including before and during training and/orpost-exercise recovery

X X X

tolerances X X X

using routine measures of intake and expenditure X X X

ce X X X

and availability appropriate for various states of training X X

needs or requirements (eg, carbohydrate, protein, fat,ls, electrolytes, fluid)

X X

nced fluid balance assessment methods (eg, urineand patterns of fluid replacement (eg, during and aftercompetition)

X X

tite or usual intake (eg, as a result of weight control,y composition/physique, change in training volume/et lag, unfamiliar environments, competition phase,ns, illnesses and injuries, treatment and rehabilitation,al issues (eg, stress, trauma, depression)

X

l intake as a result of dietary manipulation to optimizeion (eg, tapers, carbohydrate loading, glycogendration, precompetition weigh-in)

X

t use of specialized diets, sport foods/drinks, liquidts, sport/dietary supplements and/or ergogenic aids

X

pervises nutrition assessment protocols X

eness of current diet prescription X X X

52.e2 March 2009 Volume 109 Number 3

F

Indicators for Standard 1: Nutrition Asses

Bold Font Indicators are ADAb Core RD S

1.2 Assesses health, exercise/athleticcondition(s) for nutrition-related c

Assesses:

1.2A Medical and family histor

1.2A1 Family history ofdiseases (eg, diaosteoporosis, dy

1.2A2 Exercise trainingabsorption, metabehaviors and p

1.2A3 Effect of patient/metabolism of n

1.2A4 History of metabsyndrome, polycinduced asthma)

1.2A5 Clinical factors (interfere with thutilization of nut

1.2A6 Past and recurremononucleosis)

1.2B Physical findings (eg, ph

1.2B1 Anthropometric mhistory, current acircumference, a

1.2B2 Nutrition-relatednot limited to: flnutrition (eg, dehperformance, mubeing, sleep and

1.2B3 Physical performanaerobic perfor

1.2B4 Menstrual histor

1.2C Assesses, as part of themanagement (eg, prescriergogenic aids, and herbinteraction; and adherenc

1.2C1 Sport/dietary supto sport)

1.2C2 Drug/nutrient int

1.2C3 Knowledge andprocedures of spNFHSf, IOCg, US

1.2C4 The need to add

igure 2. Continued

smentThe “X” signifies the indicators forthe level of practice

tandards of Practice Indicators Generalist Specialty Advanced

training and performance, and medicalonsequences

X X X

y and medical conditions X X X

and risk factors for medical conditions and chronicbetes, cardiovascular disease, hypertension,

slipidemia, obesity, disordered eating)

X X X

/competition issues that alter ingestion, digestion,bolism, utilization of nutrients, appetite, and eating

atterns

X X X

client condition on ingestion, digestion, absorption andutrients, including food allergies/intolerances

X X

olic and hormonal conditions (eg, diabetes, metabolicystic ovary syndrome, thyroid abnormalities, exercise-or chronic diseases

X X

mechanical, physiological, or psychological) that maye ingestion, digestion, absorption, metabolism andrients

X X

nt illnesses (eg, upper respiratory tract infections,and injury history

X X

ysical or clinical exam) X X X

easurements (eg, current weight and/or growthnd past body composition, and BMIc, and/or waists appropriate)

X X X

findings of physical examination that includes, but isuid balance, clinical signs of malnutrition and under-ydration, fatigue, inability to complete training, loss inscle cramps, muscle aches and pains, mental well-insomnia)

X X

ance measures (eg, VO2maxd, lactate threshold,mance, strength and power)

X X

y and status X X

multidisciplinary team: medication/supplementption, over-the-counter, sport/dietary supplements,al products; medication allergies; medication/foode)

X X X

plement evaluation (safety, efficacy, quality, application X X X

eractions X X X

experience with the antidoping rules, regulations, andorts organizations and governing bodies (eg, NCAAe,

ADAh, WADAi , professional sports)

X X

or discontinue sport/dietary supplements X X


F

5

Indicators for Standard 1: Nutrition AssessmentThe “X” signifies the indicators forthe level of practice

Bold Font Indicators are ADAb Core RD Standards of Practice Indicators Generalist Specialty Advanced

1.2C5 Knowledge of dose and timing of medication/supplements relative tomeals, training, competition, travel schedules, and time zone changes

X X

1.2C6 Drug/sport/dietary supplement/food interactions X X

1.2D Complications and risks X X X

1.2D1 Actual or risk of developing acute complications (eg, gastrointestinal,metabolic, infectious, musculoskeletal, hormonal)

X X X

1.2D2 Actual or risk of developing chronic complications (eg, poor bonehealth, menstrual dysfunction, disordered eating, anemia and irondepletion and deficiency, dyslipidemia)

X X

1.2D3 Appropriateness of current energy, nutrient, and sport/dietarysupplement intake for special conditions (eg, intense training,environmental extremes, competition/traveling challenges)

X X

1.2D4 Indicators of complications and risks related to ingested foods, fluids,sports/dietary supplements, ergogenic aids, or other substance inrelationship to athletic training and/or competition

X X

1.2E Diagnostic tests, procedures, evaluations X X X

1.2E1 Biochemical indices X X X

1.2E2 Implications of routine diagnostic tests and therapeutic procedures X X X

1.2E3 Implications of diagnostic tests and therapeutic procedures (eg, indirectcalorimetry measurements (RMRj), DXAk, EEEl, NEATm, gastrointestinaldiagnostic tests, iron status, metabolic panel, blood lipids, endocrineindices) in relation to sports/exercise

X X

1.2E4 Need for additional diagnostic tests (eg, gluten intolerance, malabsorptionstudies) or therapeutic procedures (eg, management of clinical problemssuch as anemia, diabetes, dyslipidemia in association with exercise/sport)

X X

1.2E5 Appropriateness and validity of tests to evaluate nutritional status, energybalance and energy availability, fluid balance, and body composition

X X

1.2E6 Appropriateness and validity of tests: a) for specific populations (eg,adolescent athletes, older athletes); b) for selection of best-fit equations inproducing measurement results; and c) to manage complications (eg, pre-exercise and post-exercise glycemic control in athletes with diabetes)

X X

1.2F Physical activity, exercise/athletic training, and restrictions X X X

1.2F1 History of exercise training, competition, sports participation X X X

1.2F2 Coordination of nutrition care with training and rehabilitation duringrecovery from illness/injury

X X

1.2F3 Effect of past dietary interventions on exercise/athletic training andcompetition

X X

1.2F4 Annual and monthly training plan, competitions, additional exerciseoutside of training plan

X X

1.2F5 Training state/fitness level, competitive status, and goals X X

1.2F6 Integration and coordination of nutrition into the annualtraining/competition plans for various teams and sports

X

1.2G Population-based surveys X X X

igure 2. Continued


F



1.3 Assesses psychosocial, socioeconomic, functional and behavioral factors related to foodaccess, selection, preparation, timing of intake, and understanding of health condition

X X X

Assesses

1.3A Uses validated tools to assess developmental, functional and mental status,and cultural, ethnic, and lifestyle factors

X X X

1.3B Barriers to adequate food access (eg, economic, transportation, training schedule,foodservice schedule, travel schedule, cooking proficiency, living situation such asdorm, apartment, hotel)

X X X

1.3C Compliance to nutrition prescription X X X

1.3D Access to medical care and multidisciplinary team X X X

1.3E Significant recent stressors (eg, injury, rehabilitation) X X

1.3F Risk/history of disordered eating and related factors (eg, food issues, weighthistory, physical activity, previous weight management methods, sport-specificculture of weight management)

X X

1.4 Assesses patient/client knowledge, readiness to learn, and potential for behaviorchanges

X X X

Assesses

1.4A History of previous nutrition care services/medical nutrition therapy X X X

1.4B Patient/client’s short- and long-term goals for nutrition intervention X X X

1.4C Behavioral mediators (or antecedents) related to sports nutrition (eg, attitudes,knowledge, intentions, readiness and willingness to change, perceived socialsupport, pressures)

X X

1.4D Potential barriers to success related to activity, training, and/or competition X X

1.4D1 Assesses cooking, meal preparation, financial resources available to client X X

1.4D2 Assesses various influences (eg, language, culture, ethnicity, religion)that relate to the potential for behavior change

X X

1.4E Personal and lifestyle skills and behaviors (eg, appropriateness of eating schedulerelated to training and competition, weight goals, coping strategies, and life,school, work and social influences and obligations)

X X

1.5 Assesses the nutrition implications of the patient/client’s intervention plan X X X

1.5A Goal of treatment or intervention, including need for referral related to specializedsports/exercise training, competition

X X X

1.5B Type, frequency, duration of planned intervention X X

1.5B1 Effect of planned intervention on the ingestion, digestion, absorption,appetite, metabolism, and utilization of nutrients

X X

1.5B2 Effect of planned intervention to meet nutrient and fluid requirementsto support sport/exercise training and competition

X X

1.5B3 Effect of planned intervention to support adaptation to training, recoverybetween training sessions, and performance enhancement

X X

1.5B4 Effect of planned intervention to support achieving and maintaining anoptimal physique for patient/client’s specific sport and health

X X

igure 2. Continued


F

5



1.5B5 Effect of planned intervention on reducing risk for illness and injury X X

1.5B6 Effect of planned intervention on maintenance of a regular menstrual cycle X X

1.5B7 Primary or senior investigator assessing, as part of a research protocol,the effectiveness of intervention

X

1.6 Identifies standards by which data will be compared X X X

1.6A Energy balance, macro- and micronutrient intake, hydration guidelines, andweight management as per the most current ADA, Dietitians of Canada, ACSMn

joint position on nutrition and athletic performance, and other evidence-basedguidelines and guidance on these topics

X X X

1.6B Hydration, fluid balance, and electrolyte balance as per the most current ADA, ACSM,and NATAo positions and other evidence-based guidelines and guidance on this topic

X X X

1.6C Treatment and prevention of the female athlete triad as per the most currentADA, ACSM, NATA, and IOC positions on this, and other evidence-basedguidelines and guidance on this topic

X X X

1.7 Identifies possible problem areas for determining nutrition diagnoses X X X

1.7A General dietetics complications such as food allergies, intolerances, preferences,and issues of clinical significance in exercising individuals

X X X

1.7B More complex issues related to food intake and clinical complications inindividuals exposed to variable exercise training and competition situations

X X

1.7C Most complex issues related to food intake and clinical complications in one ormore individuals or teams and their management within the multidisciplinarytreatment or performance enhancement team

X

1.8 Documents and communicates: X X X

1.8A Date and time of assessment X X X

1.8B Pertinent data and comparison with standards and norms X X X

1.8C Patient/client’s perceptions, values, and motivation related to presentingconditions or problems

X X X

1.8D Changes in patient/client’s perceptions, values and motivation, food andsports/dietary supplement-related behaviors, and other outcomes related topresenting conditions or problems

X X X

1.8E Ability of patient/client to achieve goals X X X

1.8F Reason for discharge/discontinuation or referral if appropriate X X X

Examples of OutcomesStandard 1: Nutrition Assessment for Registered Dietitians in Sports Dietetics

● Appropriate assessment tools and procedures (matching the assessment method to the situation) are implemented● Assessment tools applied in valid and reliable ways● Appropriate data are collected● Data are validated● Data collected, organized and categorized in a meaningful framework that relates to nutrition conditions or problems● Effective interviewing methods are utilized● Problems that require consultation with or referral to another provider are recognized● Documentation and communication of assessment are complete, relevant, accurate, and timely● Data are managed in accordance with HIPPAp regulations and standards

igure 2. Continued


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Standards of Practice for Registered Dietitians in Sports Dietetics

Standard 2: Nutrition DiagnosisThe RD in sports dietetics identifies, labels, and appropriately manages specific nutrition problem(s) affecting exercise/athletic performance,fitness, and health that the registered dietitian is responsible for treating. The sports dietitian shall work in collaboration with othermembers of the multidisciplinary team and other healthcare professionals as appropriate to treat the patient/client.

Rationale: Nutrition Diagnosis, the second of four steps of the Nutrition Care Process, follows initial Nutrition Assessment, and involvesassembling, analyzing, and evaluating data to formulate a specific nutrition diagnosis statement. A nutrition diagnosis evolves or developsas the client response changes, whereas a medical diagnosis does not change as long as the medical condition or disease exists. There isa firm distinction between a nutrition diagnosis and a medical diagnosis. Nutrition diagnosis is the identification and labeling that describesan actual occurrence of a nutritional problem that dietetics professionals are responsible for treating independently. The RD may alsoindicate that no nutrition problem currently exists, but the patient will be monitored for future occurrence of nutrition problem(s). In contrast,a medical diagnosis makes a final conclusion about the identity and cause of the underlying medical condition. The nutrition diagnosis(es)establishes a link to setting realistic and measurable expected outcomes, selecting appropriate interventions and tracking progress inattaining those expected outcomes.

Indicators for Standard 2: Nutrition DiagnosisThe “X” signifies the indicators forthe level of practice

Bold Font Indicators are ADA Core RD Standards of Practice Indicators Generalist Specialty Advanced

2. Each RD:

2.1 Derives the nutrition diagnosis(es) from the assessment data X X X

2.1A Identifies and labels the problem(s) X X X

2.1B Determines etiology (cause/contributing risk factors) X X X

2.1C Clusters signs and symptoms (defining characteristics) X X X

2.1D Organizes and groups data consisting of physical, nutrition, clinical, psychosocial,and behavioral-environmental assessment

X X X

2.1E Demonstrates understanding of appropriate diagnostic criteria (eg, hyperlipidemia,hypertension, DSM IVq for eating disorders)

X X X

2.1F Uses complex information and data (eg, biochemical, body composition, DXA,fitness assessment, diagnostic and therapeutic procedures) obtained fromassessment

X X

2.1G Systematically compares and contrasts findings in formulating a differentialnutrition diagnosis (eg, involuntary weight loss associated with increased trainingvolume versus purposeful weight loss via energy restriction)

X X

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5

Indicators for Standard 2: Nutrition DiagnosisThe “X” signifies the indicators forthe level of practice


2.2 Ranks (classifies) the nutrition diagnosis(es) X X X

2.2A Uses generalist level clinical judgment skills (eg, selects from a range of possibilitieswith additional consideration to exercise/athletic performance, fitness, and health)when ranking nutrition diagnoses in order of importance and urgency for the patient/client

X X X

2.2B Uses specialty level clinical judgment (eg, selects from a range of possibilitieswith additional consideration for exercise/athletic performance, fitness, and health)to rank nutrition diagnoses in order of importance and urgency for the patient/client

X X

2.2C Uses advanced reasoning and judgment which reflects the broad differencesbetween active individuals and various levels of athletes (eg, beginner,competitive, or elite) when ranking nutrition diagnoses in order of importance andurgency for the patient/client

X

2.3 Validates the nutrition diagnosis(es) by consultation with clients/community familymembers, members of the multidisciplinary team, or other health care professionalswhen possible and appropriate

X X X

2.4 Documents the nutrition diagnosis(es) using standardized language and writtenstatement(s) that include problem (p), etiology (e) and signs and symptoms (s) [PES]statement(s) when appropriate (eg, in clinic/office records and when medicalcharting is part of the patient/client care)

X X X

2.5 Re-evaluates and appropriately revises nutrition diagnosis(es) when additionalassessment data become available

X X X

Examples of Outcomes for Standard 2: Nutrition Diagnosis● Nutrition Diagnostic Statements are:

� Clear and concise� Specific—client or community centered� Accurate—relates to the etiology� Based on reliable and valid assessment data� Includes date and time

● Documentation of nutrition diagnosis(es) is relevant, accurate and timely● Documentation of nutrition diagnosis(es) is revised and updated as additional assessment data become available

igure 2. Continued


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Standard 3: Nutrition InterventionThe RD in sports dietetics identifies and implements appropriate, purposefully planned actions designed with the intent of changing anutrition-related behavior, risk factor, aspect of physique or health status for an individual, target group, or the community at large with thegoals to promote health and increase the capacity to exercise, train, improve recovery, promote training adaptation, and enhance exercise/athletic performance.

Rationale: Nutrition Intervention is the third of four steps of the Nutrition Care Process. It consists of two interrelated components: planningand implementation. Planning involves prioritizing the nutrition diagnoses, conferring with the patient/client and/or others, reviewing practiceguides and policies, and setting goals and defining the specific nutrition intervention strategy. Implementation of the nutrition intervention isthe action phase that includes communicating and carrying out the plan of care, continuing data collection, and revising the nutritionintervention strategy, as warranted, based on the patient/client response. The RD performs the interventions or assigns the nutrition carethat others provide in accordance with federal, state, and local laws and regulations and within the regulations of national and internationalsport governing bodies and associations. Interventions are based on scientific principles and rationale and are supported by evidence-basedguidelines.

The RD works collaboratively with the patient/client to create a realistic plan that has a good probability of positively influencing thediagnosis/problem. This client-driven process is a key element in the success of this step, distinguishing it from previous planning stepsthat may or may not have involved the client to this degree of participation.

Indicators for Standard 3: Nutrition InterventionThe “X” signifies the indicators forthe level of practice


3. Each RD:

Plans the Nutrition Intervention

3.1 Prioritizes the nutrition diagnosis based on problem severity, safety, patient/clientneeds, likelihood that nutrition intervention will affect problem and patient/clientperception of importance

X X X

Prioritization considerations may include:

3.1A Immediacy of the problem. X X X

3.1B Patient/client’s available resources and support X X X

3.1C Presence of medical conditions (eg, diabetes, dyslipidemia, depression, eatingdisorders, low bone mass, anemia, gastrointestinal conditions and disease,autoimmune disease, musculoskeletal injury)

X X X

3.1D Readiness of patient/client to receive selected nutrition interventions X X X

3.1E Timing of the problem relative to annual training and competition plan X X

3.1F Anticipation of emerging effects (eg, gastrointestinal problems, dehydration,glycogen depletion, diminished mental/physical performance, nutrient/dietarysupplement-drug interactions, late-effects of treatments such as weight loss/gain,compromised immune system, sub-optimal training adaptation)

X X

3.2 Bases intervention plan on evidence-based guidelines (eg, ADA EALr) and positionpapers (eg, ADA, ACSM, IOC)

X X X

3.3 Refers to policies and program standards X X X

3.3A Develops expected outcomes in observable and measurable terms that are clearand concise; client-centered, tailored to what is reasonable to the patient/client’scircumstances; and appropriate expectations for treatments and outcomes

X X X

3.3B Maintains confidentiality with regard to medical information X X X

3.4 Confers with patient/client, multidisciplinary team, support staff, management asappropriate, and family as appropriate

X X X

igure 2. Continued


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5



3.5 Determines patient/client-focused goals and expected outcomes X X X

Considerations of the intervention plan may expand but is not limited to include:

3.5A Plans intervention to address current issues (eg, fatigue; dehydration; musclecramping; inadequate recovery, exercise/athletic performance improvement andtraining adaptation; diarrhea and other gastrointestinal issues; illness; injury;eating disorder and female athlete triad; dietary and sports/dietary supplementuse, or other clinical issues)

X X

3.5B Anticipates barriers to successful implementation (eg, patient/client compliance,timing of intervention relative to annual training/competition and travel plans, foodavailability and preparation issues, financial issues, regulations of sport governingbodies and associations, issues related to team-athlete-coach-family dynamics)

X X

3.5D Anticipates issues related to off-season/transition weight change, detraining, andscheduled and unscheduled breaks in training such as holidays)

X X

3.5E Anticipates ways to minimize barriers and other issues, prevent treatment delays,reduce relapse, and reduce the need for more advanced/involved treatment options

X X

3.6 Details the nutrition prescription X X X

3.6A Considers the educational needs of the patient/client, including cultural competency X X X

3.6B Selects specific intervention strategies that are focused on the etiology of theproblem, that are effective, and based on evidence, best practices, professionalexperience, and time constraints (ie, sufficient time to make meaningful changesbefore a competition deadline)

X X

3.7 Defines time and frequency of nutrition intervention X X X

3.8 Utilizes standardized language for describing interventions X X X

3.9 Identifies resources and/or referrals needed X X X

Implements the Nutrition Intervention

3.10 Collaborates with colleagues X X X

3.10A Participates in communications within the multidisciplinary team and/orperformance enhancement team

X X X

3.10B Collaborates with the multidisciplinary team and/or performance enhancement team X X

3.10C Directs the multidisciplinary team and/or performance enhancement team X

3.11 Communicates the nutrition intervention plan to the referring physician,multidisciplinary team, and/or patient/client

X X X

3.12 Initiates the nutrition intervention plan X X X

3.12A Utilizes appropriate behavior change theories (eg, motivational interviewing,behavior modification, modeling) to facilitate self-management self-care strategies

X X X

3.12B Uses critical thinking and synthesis skills to guide decision-making incomplicated, unpredictable, and dynamic situations

X

3.13 Continues data collection X X X

3.14 Individualizes nutrition intervention X X X

3.14A Uses a variety of educational approaches, tools, and materials as appropriate X X X

3.14B Adapts general nutrition educational tools to individualized learning style andmethod of communication and culture of the sport

X X X

igure 2. Continued


F



3.14C Uses critical thinking and synthesis skills for combining multiple interventionapproaches as appropriate

X X

3.14D Draws on experiential knowledge and current body of scientific evidence aboutthe patient/client population to individualize the strategy for complex interventions

X

3.15 Monitors, follows-up, and verifies that nutrition intervention is occurring X X X

3.15A Communicates with multidisciplinary team and/or performance enhancement teamto verify progress

X X X

3.15B Collaborates with multidisciplinary team and/or performance enhancement teamto verify progress and adjust strategies

X X

3.15C Directs the integration of the athlete’s progress within the multidisciplinary teamand/or performance enhancement team

X

3.16 Adjusts nutrition intervention plan, if needed, as response occurs X X X

3.16A Adjusts nutrition intervention (eg, general energy balance, macro- and micronutrientneeds, hydrations guidelines) according to annual training/competition plan

X X X

3.16B Adjusts nutrition intervention (eg, energy balance, macro- and micronutrientneeds, hydrations guidelines for high intensity training and recovery, meetingweight class goals, adjusting to environmental extremes) according to annualtraining/competition plan

X X

3.17 Documents X X X

3.17A Date and time X X X

3.17B Specific treatment goals and expected outcomes X X X

3.17C Recommended interventions X X X

3.17D Adjustments to the plan and justifications X X X

3.17E Client/community receptivity X X X

3.17F Referrals made and resources used X X X

3.17G Other information relevant to providing care and monitoring progress over time X X X

3.17H Plans for follow-up and frequency of care X X X

3.17I Rationale for discharge/discontinuation or referral if appropriate X X X

Examples of Outcomes for Standard 3: Nutrition Intervention● Appropriate prioritizing and setting of goals/expected outcomes● Appropriate nutrition plan or prescription is developed● Interdisciplinary connections are established● Nutrition interventions are delivered and actions are carried out● Documentation of nutrition intervention is:

� Comprehensive� Specific� Accurate� Relevant� Timely� Dated and Timed

● Documentation of nutrition intervention is revised and updated

igure 2. Continued


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Standard 4: Nutrition Monitoring and EvaluationThe RD in sports dietetics monitors and evaluates outcome(s) directly related to the nutrition diagnosis and the goals established in theprescribed intervention plan. This will assist in determining if the goals or expected outcomes of nutrition care are being met. Throughmonitoring and evaluation, the RD uses pertinent outcome indicators (markers) that are relevant to the patient/client-defined needs, nutritiondiagnosis, and nutrition goals. Progress should be monitored, measured, and evaluated on a timely, planned schedule untildischarge/discontinuation.

Rationale: Nutrition monitoring and evaluation is the fourth step in the Nutrition Care Process. Progress should be monitored, measured andevaluated on a timely, planned schedule. Alterations in outcome indicators (eg, undesired body weight changes, illness or injury, comprisedexercise recovery) require reevaluation of the nutrition care process. Monitoring specifically refers to the review and measurement of thepatient/client’s status at a scheduled (pre-planned) follow-up consultation. The follow-up would relate to the nutrition diagnosis, interventionplans/goals and outcomes, whereas evaluation is the systematic comparison of the most current findings with the previous status,intervention goals, or a reference standard.

Indicators for Standard 4: Nutrition Monitoring and EvaluationThe “X” signifies the indicators forthe level of practice


4. Each RD:

4.1 Monitors progress X X X

4.1A Checks patient/client understanding and compliance with nutrition intervention X X X

4.1A1 Documents progress in meeting energy, fluid, nutrient intake, bodycomposition goals

X X X

4.1A2 Reviews gastrointestinal tolerance X X X

4.1A3 Assesses compliance of patient/client X X X

4.1A4 When necessary, modifies nutrition intervention/care plan based onpatient/client tolerance, response, and outcome measures with regardto documented goals and objectives

X X X

4.1A5 Documents adherence to recommended timing of nutrient intake X X X

4.1B Determines if the intervention plan is being implemented as prescribed X X X

4.1B1 Evaluates intervention plan implementation in recreational andcompetitive athletes relative to general sports performance issues

X X X

4.1B2 Evaluates intervention plan implementation in competitive athletesbalancing multiple situations (eg, environmental extremes, rapid weightchanges, travel and events, and/or clinical complications)

X X

4.1B3 Develops appropriate outcomes and assessment plan to determine ifthe goals of the intervention are being met

X

igure 2. Continued


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4.1C Provides evidence of effectiveness of the plan/intervention strategy ininfluencing change in patient/client behavior or status

X X X

4.1C1 Uses multiple data sources to assess progress. Examples may include: X X X

- nutrition focused physical exam (including but not limited to signs offluid, energy, and/or nutrition depletion or excess)

X X X

- assesses adequacy of nutrient intake from all sources X X X

- evaluates changes in body weight, body composition X X X

- considers pertinent medications and sport/dietary supplements indevelopment and implementation of care plan

X X

- evaluates fluid and electrolyte balance X X

- evaluates effects of intervention on exercise/athletic training andperformance

X X

- evaluates effects of intervention on recovery following exercise/athletictraining and competition

X X

- evaluates effects of intervention on progress in rehabilitation X X

4.1C2 Monitors and interprets laboratory and other data X X X

4.1C3 Monitors factors (physical, social, cognitive, environmental) that mayinfluence response to nutrition intervention

X X X

4.1D Identifies positive or negative outcomes X X X

4.1D1 Demonstrates understanding of intended effects and potential adverseeffects of intervention

X X X

4.1D2 Anticipates and assesses intended effects and potential adverse effects(eg, not meeting set weight class goal for competition) of intervention

X X

4.1E Gathers information to indicate progress or reasons for lack of progress X X X

4.1F Supports conclusions with evidence X X X

4.2 Measures outcomes X X X

4.2A Selects the nutrition care outcome indicator(s) to measure X X X

4.2A1 Impact on physical measures (eg, weight maintenance, body weightand body composition changes, laboratory values)

X X X

4.2A2 Impact on physical measures (eg, weight maintenance, body weightand body composition changes, laboratory values, fluid and electrolytebalance, bone density)

X X

4.2A3 Impact on treatment outcome (eg, minimize barriers, prevent treatmentdelays, reduce relapse and the need for more advanced/involvedtreatment options)

X X

4.2A4 Quality of life and athletic performance (eg, absence of fatigue,absence of muscle cramping, avoidance of gastrointestinal issues)

X X

4.2A5 Quality of life and athletic performance (eg, full sport participation,progress in rehabilitation, absence of fatigue, absence of musclecramping avoidance of gastrointestinal issues)

X

4.2B Uses standardized nutrition care outcome indicator(s) X X X

igure 2. Continued


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4.3 Evaluates outcomes X X X

4.3A Compares monitoring data with nutrition prescription/goals or reference standard X X X

4.3B Evaluates impact of the sum of all interventions on overall patient/client healthand exercise/athletic performance outcomes

X X

4.3C Establishes desired outcomes and develops evaluation plans to determine if goalsof program or facility are being met

X

4.4 Documents: X X X

4.4A Date and time X X X

4.4B Indicators measured, results, and the method for obtaining measurement X X X

4.4C Criteria to which the indicator is compared (eg, nutrition prescription/goal,evidence-based guidelines, reference standards, or national and internationalguidelines such as, ADA, Dietitians of Canada, ACSM, IOMs, IOC)

X X X

4.4D Factors facilitating or hampering progress X X X

4.4E Other positive or negative outcomes X X X

4.4F Future plans for nutrition care, nutrition monitoring, follow-up, discharge/discontinuation, or referral

X X X

Examples of OutcomesStandard 4: Nutrition Monitoring and Evaluation

● The patient/client/community outcome(s) directly relate to the nutrition diagnosis and the goals established in the intervention plan.● Examples include, but are not limited to:

� Nutrition outcomes (eg, change in knowledge, behavior, food, or nutrient intake)� Clinical and health status outcomes (eg, change in relevant laboratory values, body weight, body composition, hydration measures,

risk factors, signs and symptoms, clinical status, complications)� Client-centered outcomes (eg, quality of life issues) and improvement in issues related to athletic performance (eg, fatigue,

dehydration, muscle cramping, inadequate recovery, injury), weight management, sports/dietary supplement use, disordered eatingand the female athlete triad, diarrhea and other gastrointestinal issues, illness, diabetes, dyslipidemia, or other clinical issues

� Minimization of barriers (eg, patient/client compliance, timing of intervention relative to the annual athletic training/competition andtravel plan, food availability and preparation issues, schedule, living situation, mental health concerns, issues related to team-athlete-coach-parent dynamics, financial issues, and regulations imposed by sport governing bodies and associations regulations)

� Health care utilization and cost effectiveness outcomes (eg, decreased need for medications (iron), shortened recovery time frominjuries, decreased incidence of injuries, few illnesses)

● Documentation of the monitoring and evaluation is:� Comprehensive� Specific� Accurate� Relevant� Timely� Dated and Timed� Signed

igure 2. Continued


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Definitions:

Evidence-based guidelines are determined by scientific evidence or, in the absence of scientific evidence, expert opinion or, in the absenceof expert opinion, professional standardst.

A multidisciplinary team within athletic performance/sports settings may include any or all of the following: physician, RD, physicaltherapist, physiologist, psychologist, athletic trainer, strength and conditioning coach, massage therapist, other coaches.

An ergogenic aid is a substance or agent that may have performance-enhancing effects.

The Female Athlete Triad refers to the inter-relationships among energy availability, menstrual function, and bone mineral density, whichmay have clinical manifestations including eating disorders, functional hypothalamic amenorrhea, and osteoporosis.

aRD�registered dietitian.bADA�American Dietetic Association (www.eatright.org).cBMI�body mass index.dVO2max�maximal aerobic capacity, maximal rate of oxygen consumption, or maximal oxygen uptake.eNCAA�National Collegiate Athletic Association (www.ncaa.org).fNFHS�National Federation of High School Associations (www.nfhs.org).gIOC�International Olympic Committee (www.olympic.org).hUSADA�US Anti-Doping Agency (www.usantidoping.org).iWADA�World Anti-Doping Agency (www.wada-ama.org).jRMR�resting metabolic rate.kDXA�dual energy x-ray absorptiometry.lEEE�exercise energy expenditure.mNEAT�non-exercise activity thermogenesis.nACSM�American College of Sports Medicine.oNATA�National Athletic Trainers’ Association (www.nata.org).pHIPPA�Health Insurance Portability and Accountability Act of 1996 (http://www.hhs.gov/ocr/hipaa).qDSM IV�Diagnostic and Statistical Manual of Mental Disorders.rEAL�Evidence Analysis Library (www.eatright.org).sIOM�Institute of Medicine (www.iom.edu).tSource: National Committee for Quality Assurance. QI 9: Clinical Practice Guidelines, Element A: Evidence-based guidelines. 2009 Standards and Guidelines for Accreditation of HealthPlans. Washington, DC: National Committee for Quality Assurance; 2009.

igure 2. Continued


http://www.eatright.org

http://www.ncaa.org

http://www.nfhs.org

http://www.olympic.org

http://www.usantidoping.org

http://www.nata.org

http://www.hhs.gov/ocr/hipaa


http://www.iom.edu

http://www.wada-ama.org

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Standards of Professional Performance for Registered Dietitians in Sports Dietetics

Standard 1: Provision of ServicesThe RDa in sports dietetics provides quality service based on customer expectations and needs

Rationale: Quality service is provided, facilitated, and promoted based on the sports dietitian’s knowledge, professional experience, andunderstanding of patient/client needs and expectations.

Indicators for Standard 1: Provision of ServicesThe “X” signifies the indicator forthe level of practice.

Bold Font Indicators are ADAb Core RD Standards of Professional Performance Generalist Specialty Advanced

1. Each RD:

1.1 Participates in the development of nutrition screening parameters for sports-relatedsettings

X X X

1.1A Uses an evidence-based review process to determine screening parameters X X X

1.1B Evaluates the effectiveness of general nutrition and sports nutrition screening tools X X X

1.1C Participates in content and process revisions of policies and protocols X X X

1.1D Directs development, management, and monitoring of nutrition screening policiesand protocols

X

1.2 Audits nutrition screening processes for efficiency and effectiveness X X X

1.3 Contributes to and designs referral process and systems to facilitate public accessto sports dietitians

X X X

1.3A Receives referrals for services from and makes referrals to sports medicine andother sports staff (ie, physician, psychologist, physical therapist, physiologist,athletic trainer, strength coach, other coaches)

X X X

1.3B Evaluates the effectiveness of sports dietetics referral tools (eg, “Find a SCANc

Dietitian” feature on SCAN’s Web site and state, local affiliate, and other referralmechanisms)

X X

1.3C Provides leadership in documenting, evaluating, and updating referral processes X X

1.3D Directs and manages referral processes and systems X

1.4 Collaborates with patient/client to assess needs, background, and resources and toset priorities, establish goals, and create individualized action plans

X X X

1.4A Demonstrates understanding of behavior change and counseling theories andapplies theories (eg, motivational interviewing, stages of change) in practice

X X X

1.4B Recognizes how the athletic environment, culture, health literacy, and socioeconomicstatus may influence exercise/athletic training and performance, health/wellness, andpatient/client use of health care services

X X

1.4C Adapts practice to meet the needs of ethnically and culturally diverse populations(eg, uses interpreters, selects appropriate levels of interventions, adapts sportsnutrition education/counseling approaches and materials)

X X

1.4D Provides leadership in documenting and evaluating outcomes of using variousintervention models and techniques (eg, health belief model, social cognitivetheory/social learning theory, stages of change)

X X

1.4E Directs and manages systematic processes to identify, track, and update patient/client resources; documents patient/client use of sports nutrition, and health careand services

X

1.5 Informs and involves patients/clients and their families, when appropriate, in decision-making

X X X

igure 3. Standards of Professional Performance for Registered Dietitians in Sports Dietetics.


F



1.6 Recognizes patient/client concepts of illness, injury, and rehabilitation and their culturalbeliefs

X X X

1.7 Applies principles of sports nutrition in relation to exercise training, performanceenhancement, health promotion, and behavior change appropriate for diversepopulations

X X X

1.8 Collaborates and coordinates with colleagues X X X

1.8A Collaborates within multidisciplinary medical teams to provide quality care X X X

1.8B Works in partnership with exercise/athletic performance professionals, otherhealth care providers, and ancillary referral sources

X X X

1.8C Serves as a consultant for medical management of nutrition-related illnesses andconditions

X X X

1.8D Develops and delivers nutrition education and services that integrate nutritionwith exercise/athletic performance, health promotion, and wellness

X X X

1.8E Develops and manages sports nutrition programs and educational materials based onpatient/client needs, culture, evidence-based guidelines, and available resources

X X

1.8F Plans, develops, and implements systems of sports dietetics care and servicesusing evidence-based guidelines and best practices

X X

1.8G Directs systems of sports dietetics care and services X

1.9 Applies knowledge and skills to determine appropriate action plans X X X

1.9A Applies general sports dietetics knowledge and skills to develop intervention andaction plans

X X X

1.9B Applies knowledge and skills at the specialty level (eg, functional workingknowledge of sports dietetics, evidence-based guidelines, best practices, andclinical experience) to determine the most appropriate action plan

X X

1.9C Applies knowledge and skills at the advanced level (eg, advanced andcomprehensive knowledge of sports dietetics, evidence-based guidelines, bestpractices, and clinical experience) to determine the most appropriate action plan

X

1.10 Develops policies and procedures that reflect best evidence and applicable laws andregulations

X X X

1.10A Collects data and documents outcomes relative to evidence-based guidelines andbest practices

X X X

1.10B Participates in developing and updating policies and procedures and evidence-based sports dietetics practice tools in the work site.

X X X

1.10C Develops strategies for quality improvement tailored to the needs of theorganization and patient/client populations, (eg, identifies/adapts evidence-basedpractice guidelines/protocols/tools, skill training/reinforcement, and organizationalincentives and supports)

X X

1.10D Develops and manages sports dietetics education programs in compliance withevidence-based guidelines and national and international guidelines and standards(eg, ADA, Dietitians of Canada, ACSMd, NATAe, IOMf, IOCg)

X X

1.10E Leads the process of developing, monitoring, evaluating, and improvingprotocols, guidelines, and practice tools (eg, ADA, Dietitians of Canada);implements changes as appropriate

X

igure 3. Continued


F

5



1.11 Advocates for the provision of food and nutrition services as part of performanceenhancement, health promotion and public policy

X X X

1.11A Participates in patient/client advocacy activities X X X

1.11B Assesses patient/client populations for situations in which advocacy is needed X X

1.11C Advocates, at the policy level, for nutrition services related to exercise trainingand athletic performance and health promotion; participates in legislative andpolicy-making activities that influence sports dietetics services and practices

X X

1.11D Provides leadership in advocacy activities/issues; authors articles and deliverspresentations on topic; networks with other advocacy-oriented parties and organizations

X

1.12 Maintains records of services provided X X X

1.12A Maintains written documentation as mandated by applicable regulatory agencies,accrediting/credentialing bodies, local, state, and federal regulations and/or laws,and consistent with the Nutrition Care Process where appropriate

X X X

1.13 Develops nutrition programs, protocols, and policies for target populations X X X

1.13A Utilizes evidence-based guidelines, best practices, and national and internationalguidelines (eg, ADA, Dietitians of Canada, ACSM, NATA, IOM, IOC) in the delivery ofnutrition services

X X X

1.13B Develops nutrition programs, protocols, and policies based on evidence-basedguidelines, best practices, and national and international guidelines (eg, ADA,Dietitians of Canada, ACSM, NATA, IOM, IOC)

X X

1.13C Directs the development of nutrition programs, protocols, and policies based onevidence-based guidelines, best practices, and national and internationalguidelines (eg, ADA, Dietitians of Canada, ACSM, NATA, IOM, IOC)

X

1.14 Implements food/nutrient delivery systems in terms of nutrition status, exercise/athletic performance parameters, health, and well-being of target populations

X X X

1.14A Participates in foodservice planning and delivery for sporting events (eg, communitysporting events, training tables, eating out or eating on the road while traveling forcompetition)

X X X

1.14B Provides guidance to local and regional active and athletic communities regardingsport/dietary supplements and food products and pertinent regulatory issues

X X X

1.14C Provides guidance regarding sport/dietary supplements and food products that are incompliance and those that do not comply with anti-doping rules, regulations, andprocedures of sports organizations and governing bodies (eg, NCAAh, NFHSi, IOC,USADAj, WADAk, professional sports)

X X

1.14D Interacts with national and international sports governing bodies (eg, NCAA,NFHS, IOC, USADA, WADA , professional sports) regarding anti-doping rules,regulations, and procedures (eg, facilitates communication between USADA andelite athletes, contributes to anti-doping policy review and evaluation)

X

Examples of OutcomesStandard 1: Provision of Services

● Patients/clients participate in establishing goals● Patients/clients’ needs are met● Patients/clients are satisfied with service and products● Evaluations reflect expected outcomes● Effective screening and referral systems are established● Patients/clients have access to food assistance● Patients/clients have access to nutrition services

igure 3. Continued


F


Standard 2: Application of ResearchThe RD in sports dietetics applies, participates in, or generates research to enhance practice

Rationale: Application, participation, and generation of research promotes improved safety and quality of sports dietetic practice andservices.

Indicators for Standard 2: Application of ResearchThe “X” signifies the indicators forthe level of practice.

Bold Font Indicators are ADA Core RD Standards of Professional Performance Indicators Generalist Specialty Advanced

2. Each RD:

2.1 Accesses and reviews evidence-based guidelines for application to sports dieteticspractice

X X X

2.1A Demonstrates an understanding of research design and methodology, and use ofthe EALl

X X X

2.1B Demonstrates an understanding of data collection, interpretation of results, andapplication

X X X

2.1C Identifies key health and performance questions and uses systematic methods toapply evidence-based guidelines to answer questions

X X

2.1D Utilizes the EAL as a resource in writing or reviewing research papers X X

2.1E Functions as a primary or senior author of research and organizational positionpapers.

X

2.2 Bases practice on significant scientific principles and evidence-based guidelines X X X

2.2A Utilizes the EAL as a resource for evidence-based guidelines X X X

2.2B Follows evidence-based practice guidelines to provide quality care for physicallyactive individuals

X X X

2.2C Follows evidence-based practice guidelines at the specialty level to provide safe,effective, sports dietetics care specific to age, sex, sport, training level, andenvironment

X X

2.2D Follows evidence-based practice guidelines at the advanced practice level (ie,considering the complexity of care for competitive athletes balancing multiplesituations and complications)

X

2.3 Integrates evidence-based guidelines and patient/client values into clinical andmanagerial practice

X X X

2.3A Identifies and utilizes evidence-based policies and procedures for sports dieteticspractice

X X X

2.3B Develops and implements evidence-based policies and procedures for sportsdietetics practice

X X

2.3C Directs the integration of evidence-based policies and procedures into sportsdietetics practice

X

igure 3. Continued


F

5

Indicators for Standard 2: Application of ResearchThe “X” signifies the indicators forthe level of practice.


2.4 Promotes research through alliances and collaboration with food and nutrition andother professionals and organizations

X X X

2.4A Identifies research issues/questions X X X

2.4B Participates as a member/consultant to collaborative research teams thatexamine relationships among nutrition, exercise/athletic performance, and health

X X X

2.4C Serves as an investigator in collaborative research teams that examinerelationships among nutrition, exercise/athletic performance, and health

X X

2.4D Serves as a primary or senior investigator in collaborative research teams thatexamines relationships among nutrition, exercise/athletic performance, and health

X

2.5 Contributes to the development of new knowledge and research in sports dietetics X X X

2.5A Participates in practice-based research under the direction of a collaborativeresearch team

X X X

2.5B Participates in practice-based research networks (eg, ADA’s Dietetics PracticeResearch Network)

X X

2.5C Initiates research related to sports dietetics as the primary investigator or co-investigator with other members of the multidisciplinary research team

X

2.6 Collects measurable data and documents outcomes within practice setting X X X

2.6A Participates in research addressing outcomes of sports dietetics care X X X

2.6B Monitors and evaluates outcome data against expected results X X X

2.6C Uses data as part of a quality improvement process X X X

2.6D Develops systematic processes to collect data and to analyze, interpret, andevaluate outcomes

X X

2.7 Communicates research data and activities through publications and presentations X X X

2.7A Presents evidence-based sports nutrition research to community groups andcolleagues

X X X

2.7B Presents at professional meetings and conferences (local, regional, national,international)

X X

2.7C Authors articles in sports nutrition and related areas X X

2.7D Serves in a leadership role for sports nutrition related publications and programplanning at conferences (local, regional, national, international)

X X

2.7E Translates research findings for incorporation into the development of policies,procedures, and guidelines for sports dietetics practice at national andinternational levels

X

2.7F Directs collation of research data into publications and presentations X

Examples of OutcomesStandard 2: Application of Research

● Patient/client receives appropriate services based on the application of evidence-based guidelines and best practices● A foundation for performance measurement and improvement is established● Evidence-based guidelines are used for the development and revision of resources used in practice● Benchmarking and knowledge of best practices is used to evaluate and improve performance

igure 3. Continued


F


Standard 3: Communication and Applications of KnowledgeThe RD in sports dietetics effectively applies knowledge and communicates with others

Rationale: RDs in sports dietetics work with and through others to achieve common goals by effective sharing and application of theirunique knowledge and skills in food, human nutrition, exercise science, and management services.

Indicators for Standard 3: Communication and Application of KnowledgeThe “X” signifies the indicators forthe level of practice.


Each RD:

3.1 Exhibits knowledge related to a particular aspect of the profession of dietetics X X X

3.1A Reads major peer-reviewed publications in sports dietetics and related areas;uses evidence-based guidelines and related resources

X X X

3.1B Demonstrates understanding of current research, trends, and epidemiological surveysin sports dietetics, sports nutrition education, and related areas of exercise science

X X X

3.1C Contributes to the body of knowledge for the profession X X X

3.1D Is familiar with regulatory, accreditation, and reimbursement programs andstandards that apply to sports dietetics care and sports/dietary supplements

X X X

3.1E Operates under regulatory, accreditation, and reimbursement programs andstandards that apply to sports dietetics care, including rules and regulations ofsports organizations and governing bodies (eg, NCAA, NFHS, IOC, USADA, WADA,professional sports) regarding sports/dietary supplements

X X

3.1F Interprets current research in sports dietetics and related areas and applies toprofessional practice as appropriate

X X

3.2 Communicates and applies scientific principles, research, and theory X X X

3.2A Demonstrates critical thinking, reflection, and problem-solving skills at thespecialty level (eg, uses evidence-based guidelines and selects best format forpresentation) in communications

X X

3.2B Demonstrates critical thinking, reflection, and problem-solving skills at theadvanced practice level (eg, uses a comprehensive approach to translateevidence-based guidelines into practical application) in communications

X

3.3 Selects appropriate information and best method or format in communications X X X

3.4 Integrates knowledge of food and human nutrition with knowledge ofexercise/athletic performance, exercise science, health, social sciences,communication, and management theory

X X X

3.4A Applies new scientific knowledge of sports dietetics care into practice X X X

3.4B Integrates new scientific knowledge and the collected knowledge from experience insports dietetics care into practice at the specialty level (eg, in new and varied contexts)

X X

3.4C Leads the integration of new scientific knowledge and the collected knowledge fromexperience in sports dietetics care into practice at the advanced practice level (ie, forthe most complex and exceptional problems) or in new research methodologies

X

igure 3. Continued


F

5



3.5 Shares knowledge and information with patients/clients, colleagues, and the public X X X

3.5A Presents to individuals and groups in local communities on topics related tohealth and wellness (eg, health fairs, wellness days)

X X X

3.5B Authors texts and authoritative articles for consumers and for sports- and healthcare professionals

X X

3.5C Serves as invited reviewer, author and/or presenter at local, regional, national,and/or international meetings and to the media

X X

3.5D Serves in leadership role for publications (eg, editor, editorial advisory board),review of textbooks and articles for journal publications; participates on programplanning committees

X X

3.5E Serves as local, regional, national, and international sports dietetics mediaspokesperson

X X

3.5F Functions as an opinion leader within the scope of sports dietetics practice X

3.6 Guides students, interns and patients/clients in the application of knowledge and skills X X X

3.6A Participates as a mentor or preceptor to dietetic students/interns X X X

3.6B Contributes to the education and professional development of dietitians, students,and sports- and health care professionals through formal and informal teaching andmentoring

X X

3.6C Mentors RDs interested in pursuing specialty certification in sports dietetics X X

3.6D Develops educational programs that promote safe, effective sports dietetics care X X

3.6E Develops mentor and preceptor programs in sports dietetics X X

3.7 Seeks current and relevant information related to practice X X X

3.7A Attends professional meetings and obtains continuing education in sports dietetics X X X

3.7B Builds relationships among researchers and decision-makers to influence policydevelopment and to translate evidence-based guidelines into sports dieteticspractice

X X

3.7C Demonstrates the experience and critical thinking skills required to review originalresearch and evidence-based guidelines relevant to sports dietetics practice

X

3.8 Contributes to the development of new knowledge X X X

3.8A Serves on planning committees/task forces to develop continuing education,activities, and programs in nutrition and/or sports dietetics for students andpractitioners

X X X

3.8B Serves as a consultant to organizations (eg, business, industry, government, health,fitness, exercise/sports, sports dietetics) to address the needs of consumers, sportscare professionals, and health care providers for sports nutrition education

X X

3.8C Uses evidence-based guidelines, best practices, and clinical experience togenerate new knowledge and develop guidelines, programs, and policies inadvanced sports dietetics practice

X

igure 3. Continued


F



3.9 Uses information technology to communicate, disseminate knowledge, and supportdecision-making

X X X

3.9A Utilizes electronic health records within the worksite as appropriate X X X

3.9B Uses the Nutrition Care Process and EAL when making decisions about patient/client care

X X X

3.9C Participates in updating the EAL in sports dietetics and related areas X X

3.9D Updates sports dietetics educational materials, including books, manuals, andweb-based tools

X X

3.9E Leads in the advancement of technology/informatics (eg, information technologyresearch, software program design) in sports dietetics

X

3.10 Contributes to the multidisciplinary approach by promoting food and nutritionstrategies that enhance exercise/athletic performance, health, and quality of lifeoutcomes of target populations

X X X

3.10A Communicates with the multidisciplinary team regarding nutritional strategies tooptimize exercise/athletic performance and health

X X X

3.10B Communicates with the multidisciplinary team to provide evidence-based guidelinesthat integrates food and nutrition with exercise/athletic performance and health

X X X

3.10C Consults with physicians and other health/sports professionals (eg, physician, physicaltherapist, psychologist, athletic trainer) on clinical and other health-related issues

X X X

3.10D Participates in multidisciplinary collaborations at a systems level (eg,incorporating sports dietetics within programs aimed at optimizingexercise/athletic performance)

X X

3.10E Contributes nutrition-related expertise to national projects and professionalorganizations as needed (eg, ACEm, ACSM, NATA, NCAA, NFHS, NSCAn, IOC,USADA, WADA)

X

3.11 Establishes credibility as the sports nutrition resource within multidisciplinarysports/athletic, health care, or management teams

X X X

3.11A Educates members of multidisciplinary teams regarding the specializedknowledge and skills of the sports dietitian and the Board Certified Specialist inSports Dietetics

X X

Examples of OutcomesStandard 3: Communication and Application of Knowledge

● Expertise in food, nutrition, and management is shared● Individuals and groups:

� Receive current and appropriate information� Understand information received� Know how to obtain additional guidance

igure 3. Continued


F

5


Standard 4: Utilization and Management of ResourcesThe RD in sports dietetics uses resources effectively and efficiently

Rationale: Mindful, efficient, and effective management of time, money, facilities, and other resources demonstrates organizationalcitizenship.

Indicators for Standard 4: Utilization and Management of ResourcesThe “X” signifies the indicators forthe level of practice.


Each RD:

4.1 Uses a systematic approach to maintain and manage resources X X X

4.2 Quantifies management of resources in the provision of dietetic services X X X

4.2A Participates in operational planning of food and nutrition programs and services(eg, meals and menu planning, food service consultation, Nutrition Care Process,MNTo, nutrition education, program planning, and development)

X X X

4.2B Manages effective delivery of nutrition programs and services (eg, business andmarketing planning, program administration, Nutrition Care Process, delivery ofeducation programs, materials development) related to sports programs

X X

4.2C Directs or manages business and strategic planning for the design and deliveryof nutrition services in sports-related programs operating in various settings (eg,clinic, cafeteria, corporate, research)

X

4.3 Evaluates safety, effectiveness, and value while planning and delivering servicesand products

X X X

4.3A Participates in evaluations of services and products (eg, surveys, data collection) X X X

4.3B Manages the distribution/delivery of products (eg, food, team meals, sport/dietarysupplements, sports nutrition products) in a cost-effective manner

X X

4.3C Participates in management of budgeted funds for nutrition education services,foodservice, dietary/sports supplements, and sports nutrition products

X X

4.3D Evaluates the following at the systems level: safety, effectiveness, and cost inplanning and delivering nutrition services and products

X

igure 3. Continued


F

Indicators for Standard 4: Utilization and Management of ResourcesThe “X” signifies the indicators forthe level of practice.


4.4 Participates in continuous quality improvement and documents outcomes relative toresource management

X X X

4.4A Practices in accordance with the goals and objectives of continuous qualityimprovement

X X X

4.4B Utilizes contemporary business skills relating to budget management, inventorytracking, ordering and distribution, negotiations for compensation and additionalresources

X X

4.4C Anticipates needs, identifies goals and objectives, and engages in long-termstrategic planning

X X

4.4D Anticipates outcomes and consequences of different approaches and makesnecessary modifications to achieve desired outcomes

X X

4.4E Directs the development and management of continuous quality improvementsystems

X

4.5 Assists individuals and groups to identify and secure appropriate and availableresources and services

X X X

4.5A Participates in programs that employ legal and sound business practices andensure goal-oriented outcomes

X X X

4.5B Establishes administratively sound programs (eg, Nutrition Care Processprotocols, MNT service delivery, sports and wellness counseling and education)

X X

4.5C Participates in achieving desired outcomes, securing resources and services, andcollaborating with medical, sports, administrative, and food service staffs

X X

4.5D Directs achieving desired outcomes, securing resources and services, andcollaborating with medical, sports, administrative, and food service staffs

X

Examples of OutcomesStandard 4: Utilization and Management of Resources

● Documentation of resource use is consistent with plan● Data are recorded and used to promote and validate services● Desired outcomes are achieved and documented● Resources are effectively and efficiently managed

igure 3. Continued


F

5


Standard 5: Quality in PracticeThe RD in sports dietetics systematically evaluates the quality of services and improves practice based on evaluating clinical/dietary andphysical performance outcomes

Rationale: Quality practice requires regular performance evaluation and continuous improvement.

Indicators for Standard 5: Quality in PracticeThe “X” signifies the indicators forthe level of practice.


Each RD:

5.1 Knows, understands and complies with federal, state, and local laws andregulations related to sports dietetics and nutrition care

X X X

5.1A Complies with HIPPAp regulations and standards X X X

5.2 Demonstrates understanding of pertinent national quality and safety initiatives (eg,ACSM, IOM, IHIq, NCQAr, NQFs)

X X X

5.3 Implements an Outcomes Management System to evaluate the effectiveness andefficiency of practice

X X X

5.3A Participates in and/or uses collected data as part of a quality improvementprocess relative to outcomes, quality of care, and services rendered

X X X

5.3B Advocates for and participates in developing clinical, operational, and financialdatabases upon which outcomes in sport dietetics care can be derived, reported,and used for improvement

X X

5.3C Directs the development, monitoring, and evaluation of practice-specific benchmarks(eg, appropriate hydration practices, weight management strategies) relevant tonational initiatives (eg, ADA, ACSM, Healthy People 2010, sports organizations andgoverning bodies) and to impact program planning and development

X

5.4 Understands and continuously measures quality of dietetic services in terms ofprocess and outcomes

X X X

5.5 Identifies performance improvement criteria to monitor effectiveness of services X X X

5.6 Designs and tests interventions to improve processes and services X X X

igure 3. Continued


F

Indicators for Standard 5: Quality in PracticeThe “X” signifies the indicators forthe level of practice.


5.7 Identifies and addresses errors and hazards in dietetic services X X X

5.7A Identifies and addresses errors and potentials hazards as part of the evaluationprocess for quality sports dietetics care

X X X

5.7B Recognizes potential drug-nutrient interactions, drug-sport/dietary supplementinteractions, and potential interactions between scheduled interventions, othertherapies, and exercise training and competition; provides education andcounseling as appropriate

X X X

5.7C Recognizes problematic sports/dietary supplement products and manufacturingpractices, quality control, and error prevention recommendations (eg, as provided byISMPt, FDAu, USPv), and anti-doping rules and regulations of sports organizations andgoverning bodies (eg, NCAA, NFHS, IOC, USADA, WADA; provides education andcounseling as appropriate

X X

5.7D Develops protocols to identify, address, and prevent errors and hazards in thedelivery of sports dietetics services

X

5.8 Identifies expected outcomes X X X

5.9 Documents outcomes X X X

5.10 Compares actual workplace performance to expected outcomes X X X

5.11 Documents action taken when discrepancies exist between actual workplaceperformance and expected outcomes

X X X

5.12 Continuously evaluates and refines services based on measured outcomes related tosports dietetics practice

X X X

5.12A Evaluates and improves professional performance in relation to establishedoutcomes of quality sports dietetics care and services

X X X

5.12B Directs improvements in sports dietetics care and services X X

5.12C Directs the development and management of systems, processes, and programs thatadvance best practices and the core values and objectives of sports dietetics care

X

Examples of OutcomesStandard 5: Quality in Practice

● Performance indicators are measured and evaluated● Results of quality improvement activities direct refinement of practice● Outcomes meet pre-established criteria (goals/objectives)

igure 3. Continued


F

5


Standard 6: Competence and AccountabilityThe RD in sports dietetics actively engages in lifelong learning

Rationale: Competent and accountable practice includes continuous acquisition of knowledge and skill development.

Indicators for Standard 6: Competence and AccountabilityThe “X” signifies the indicators forthe level of practice.


Each RD:

6.1 Conducts self-assessment at regular intervals X X X

6.1A Engages in self-assessment to ascertain progress in meeting desired performanceoutcomes

X X X

6.1B Evaluates professional practice consistent with evidence-based guidelines, bestpractices, and current research findings

X X X

6.2 Identifies needs for professional development from a variety of sources X X X

6.3 Participates in peer review X X X

6.3A Participates in peer evaluation, including but not limited to peer supervision,clinical chart review, professional practice, and performance evaluations, asapplicable

X X X

6.3B Participates in scholarly review including but not limited to professional articles,chapters, books

X X X

6.3C Serves as reviewer or editorial board associate for professional organizations,journals, and books

X X

6.3D Leads an editorial board for scholarly review including but not limited toprofessional articles, chapters, books

X

6.4 Mentors others X X X

6.4A Participates in mentoring dietetics professionals in sports dietetics practice X X X

6.4B Develops mentoring or internship opportunities for dietetics professionals andmentoring opportunities for sports- and health care professionals, as appropriate

X X

6.4C Directs and implements internships and mentoring programs X

6.5 Develops and implements a plan for professional growth X X X

6.5A Engages in continuing education opportunities in sports nutrition and relatedareas according to his or her professional development plan

X X X

6.5B Develops and implements a professional development plan for specialty practicespecific to employment/workplace setting

X X

6.5C Develops and implements a professional development plan for advanced practicespecific to employment/workplace setting

X

6.6 Documents professional development activities X X X

6.6A Documents, in professional development plan, activities that demonstrateprofessional responsibilities at the generalist level practice

X X X

6.6B Documents, in professional development plan, activities that demonstrate theprofessional responsibilities of specialty practice

X X

6.6C Documents, in professional development plan, activities that demonstrate theexpanded professional responsibilities of advanced practice

X

igure 3. Continued


F

Indicators for Standard 6: Competence and AccountabilityThe “X” signifies the indicators forthe level of practice.


6.7 Adheres to the ADA Code of Ethics X X X

6.8 Assumes responsibility for actions and behaviors X X X

6.9 Integrates the ADA Standards of Practice and Standards of ProfessionalPerformance into self-assessment and development plans

X X X

6.9A Utilizes the ADA Standards to assess performance at the appropriate level of practice X X X

6.9B Utilizes the ADA Standards to develop and implement a professional developmentplan to enhance practice and performance

X X X

6.9C Utilizes the ADA Standards to develop and implement a professional developmentplan to advance practice and performance to a higher level

X X X

6.10 Integrates evidence-based guidelines into practice X X X

6.10A Reads and utilizes major peer reviewed sports nutrition and related publications X X X

6.10B Demonstrates skills in accessing and critically analyzing research X X X

6.10C Uses evidence-based guidelines and best practices to provide quality care X X X

6.10D Serves as a presenter on sports nutrition topics for consumers, sports- andhealth care providers

X X X

6.10E Serves as a presenter for state/national professional organizations; authorssports nutrition and related publications for professionals

X X

6.10F Directs and manages professional meetings, workshops, and conferences X

6.11 Obtains occupational licensure and certifications in accordance with federal, state,and local laws and regulations and work-environment specific policies

X X X

6.11A Attains and maintains certifications accredited by the NCCAw, as appropriate topractice setting

X X X

6.11B Attains and maintains Board Certification as a Specialist in Sports Dietetics, asappropriate to practice setting

X X

6.12 Seeks leadership opportunities X X X

6.12A Exhibits effective interfacing (eg, communication, information gathering, rolemodeling) in sports dietetics practice, research, and/or education

X X X

6.12B Serves on sports nutrition or related committees/task forces (local, regional) forsports- and health care professionals and industry

X X X

6.12C Serves on sports nutrition or related committees/task forces (national,international) for sports- and health care professionals and industry

X X

6.12D Seeks and generates opportunities (local, regional, national, international levels)to integrate sports dietetics practices and programs within larger systems (eg,ACSM, IOC, NCAA)

X X

6.12E Develops innovative approaches to complex practice issues X

6.12F Manages and directs the integration of sports dietetics principles within largersystems (eg, ACSM, IOC, NCAA)

X

igure 3. Continued


F

5

Examples of OutcomesStandard 6: Competence and Accountability

● Self-assessments are completed● Development needs are identified● Directed learning is demonstrated● Practice reflects the ADA Code of Ethics● Practice reflects the ADA Standards of Practice and Standards of Professional Performance● Practice reflects evidence-based guidelines and professional standards● Relevant certifications are obtained and maintained● Commission on Dietetic Registration recertification requirements are met

Definitions

Evidence-based guidelines are determined by scientific evidence or, in the absence of scientific evidence, expert opinion or, in the absenceof expert opinion, professional standardsx.

The Female Athlete Triad refers to the inter-relationships among energy availability, menstrual function and bone mineral density, whichmay have clinical manifestations including eating disorders, functional hypothalamic amenorrhea and osteoporosis.

A multidisciplinary team within athletic performance/sports settings may include any or all of the following: physician, RD, physicaltherapist, physiologist, psychologist, athletic trainer, strength and conditioning coach, massage therapist, other coaches.

A multidisciplinary research team within athletic performance/sports settings may include any or all of the following: principal investigator,co-principal investigators, project consultants, lab technicians, statisticians.

aRD�registered dietitian.bADA�American Dietetic Association (www.eatright.org).cSCAN�Sports, Cardiovascular, and Wellness Nutrition (www.scandpg.org).dACSM�American College of Sports Medicine (www.acsm.org).eNATA�National Athletic Trainers’ Association (www.nata.org).fIOM�Institute of Medicine (www.iom.edu).gIOC�International Olympic Committee (www.olympic.org).hNCAA�National Collegiate Athletic Association (www.ncaa.org).iNFHS�National Federation of High School Associations (www.nfhs.org).jUSADA�US Anti-Doping Agency (www.usantidoping.org).kWADA�World Anti-Doping Agency (www.wada-ama.org).lEAL�Evidence Analysis Library (www.eatright.org).mACE�American Council on Exercise (www.acefitness.org).nNSCA�National Strength and Conditioning Association (www.nsca-lift.org).oMNT�medical nutrition therapy.pHIPPA�Health Insurance Portability and Accountability Act of 1996 (http://www.hhs.gov/ocr/hipaa).qIHI�Institute for Healthcare Improvement (www.ihi.org).rNCQA�National Center for Quality Assurance (www.ncqa.org).sNQF�National Quality Forum (www.qualityforum.org).tISMP�The Institute for Safe Medication Practices (www.ismp.org).uFDA�Food and Drug Administration (www.fda.gov).vUSP�US Pharmacopeia (www.usp.org).wNCCA�National Commission for Certifying Agencies (http://www.noca.org/Resources/NCCAAccreditation/tabid/82/Default.aspx).xSource: National Committee for Quality Assurance. QI 9: Clinical Practice Guidelines, Element A: Evidence-based guidelines. 2009 Standards and Guidelines for Accreditation of HealthPlans. Washington, DC: National Committee for Quality Assurance; 2009.

igure 3. Continued



http://www.scandpg.org

http://www.acsm.org

http://www.nata.org

http://www.iom.edu

http://www.olympic.org

http://www.ncaa.org

http://www.nfhs.org

http://www.usantidoping.org

http://www.wada-ama.org


http://www.acefitness.org

http://www.nsca-lift.org

http://www.hhs.gov/ocr/hipaa

http://www.ihi.org

http://www.ncqa.org

http://www.qualityforum.org

http://www.ismp.org

http://www.fda.gov

http://www.usp.org

http://www.noca.org/Resources/NCCAAccreditation/tabid/82/Default.aspx

from the association - SCAN the association ... for RDs in Nutrition Care and SOPP ... Nutrition...

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