











































MANUSCRIPT TYPE


EVIDENCE-TO-PRACTICE REVIEW  

 

55 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 6 – Issue 1 – April 2023 

 
 

Burnout in Sport Specializers Versus Samplers: An Evidence-to-
Practice Review 
Katherine Godfrey, MS, ATC*; Justin DiSanti, PhD‡; Tamara Valovich McLeod, PhD, ATC, FNATA*† 
*Athletic Training Programs and School of Osteopathic Medicine, A.T. Still University, Mesa, AZ; ‡Rangos School of Health Sciences, 
Duquesne University, Pittsburgh, PA 
 

 
ABSTRACT 
The prevalence of sport specialization is a common concern in contemporary youth sports and has been linked to potential negative 
physical and psychological effects for developing athletes. While the evidence regarding negative physical effects, such as overuse 
injury, are consistent in the literature, the psychosocial outcomes are unclear due to the lack of published studies on the topic. 
Specialization is thought to lead to added stress, which may affect an athlete’s mental health, whereas athletes who sample multiple 
sports are believed to have a healthier psychosocial experience. Burnout is characterized as physical and emotional exhaustion, 
sport devaluation and a reduced sense of accomplishment in athletics. This guiding review evaluates the evidence regarding burnout 
levels between specializers and samplers. Two of the articles included in the review directly assessed burnout in samplers vs 
specializers and noted inconsistencies in higher burnout rates. The six other articles studied burnout only in specializers by indirectly 
assessing burnout through perfectionism, fear of failure, motivation, and drop out. The comparisons of these variables illustrated 
heightened burnout in athletes who specialize. The results from these studies provide moderate evidence for recommendations that 
athletes should delay specializing in one sport. 
Content Focus: Health Care Competency  
 
Correspondence 
Dr. Tamara C. Valovich McLeod, School of Osteopathic Medicine in Arizona, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 
85206. 
E-mail: tmcleod@atsu.edu 
Twitter: @ TamaraCVMcLeod 
 
Full Citation 
Godfrey K, DiSanti J, Valovich McLeod T. Burnout in sport specializers versus sampler: An evidence-to-practice review. Clin 
Pract Athl Train. 2023;6(1): 55-60. https://doi.org/10.31622/2023/0006.01.8.   
 

 
ORIGINAL REFERENCE 
Giusti NE, Carder SL, Vopat L, et al. Comparing Burnout in Sport-Specializing Versus Sport-Sampling 
Adolescent Athletes: A Systematic Review and Meta-analysis. Orthop J Sports Med. 
2020;8(3):2325967120907579. 
 
SUMMARY 
 
CLINICAL PROBLEM AND QUESTION 
 
Sports specialization is generally defined as year-round intensive training in a single sport at the exclusion 
of other sports,1 while athletes who participate in multiple sports are often labeled as sport samplers.2 There 
are concerns among healthcare providers that athletes who specialize early have increased potential for 
physical and psychological negative outcomes. While the link between sport specialization and negative 
physical outcomes (e.g., rates of overuse injuries) have been well-established,3 the relationships to 
psychosocial outcomes remain largely unclear. It is postulated that sport specialization introduces athletes to 
additional stressors (e.g., increased time demands, low quantity, quality sleep, and drive for elite status) that 
can negatively affect the mental health of these athletes,4  including loss of passion, burnout, and 
development of a unidimensional identity.5  

mailto:tmcleod@atsu.edu
https://doi.org/10.31622/2023/0006.01.8


Burnout in Sport Specializers Versus Samplers: An Evidence-to-Practice Review 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 6 – Issue 1 – April 2023 

Burnout refers to physical, emotional, and psychological withdrawal from sports that were once found 
enjoyable due to over training and chronic stress.6,7 The increase in training volume often associated with 
sport specialization may result in burnout, which may decrease an athlete’s likelihood to have the motivation 
or drive required to be successful in their sport.8  Unfortunately, there is very little published empirical 
evidence that directly correlates sport specializers and non-specializers with levels of burnout.9,10 Therefore, 
the purpose of this guiding meta-analysis and systematic review was to assess burnout among youth athletes 
who specialize compared to those who sample. 

SUMMARY OF LITERATURE 

To answer the clinical question, a literature search was conducted using various electronic databases, 
including PubMed, CINAHL, SportDiscus, and PsychInfo. Search terms included sport specialization; 
adolescent burnout; sport burnout; athlete burnout questionnaire to find relevant titles and abstracts to be 
screened. Full-text articles that passed the initial screening were assessed for eligibility using the following 
criteria: English language, adolescent athlete participants between 12 and 18 years of age, classification 
of samplers or specializers, and burnout was measured using the Athlete Burnout Questionnaire (ABQ). For 
data extraction the authors were primarily interested in the results of the ABQ. Patient demographics, sport 
demographics and specialization status were also extracted from each study. Sport specialization status was 
determined based on the Jayanthi scale which classifies athletes as “high, moderate, or low” specialized 
based on whether an individual has a main sport, competes for more than eight months of the year, and 
competes in the one sport at the exclusion of other sports.1 In the meta-analysis all levels of specialization 
were simply grouped as specializers. Additionally, athletes who were enrolled in schools or academies with 
a sport focus, engaged in their sport at least 8 months per year and participated in a single sport were 
included in the sport specializer group. The authors of the systematic review defined sport sampler as athletes 
who participate in multiple sports.2 Participants that were grouped into the sampler group participated in 
more than 1 sport per year or did not meet all 3 criteria of specialization. 

SUMMARY OF OUTCOMES 

The primary outcome measure assessed in this systematic review and meta-analysis was burnout, assessed 
through the ABQ. The ABQ has been shown to have acceptable construct validity across a number of athletic 
populations in similar ages.7 The ABQ measures three dimensions of burnout: emotional-physical exhaustion, 
reduced sense of accomplishment, and sport devaluation with five items included for each dimension. Each 
dimension is measured on a 5-point Likert scale (1 almost never to 5 almost always) and an average response 
score is calculated for each dimension. Athletes completing the ABQ are presented with statements about 
their sports and then asked to rate how often they feel that way. The ABQ is scored with a global score of 
the 15 items, as well as three dimension-specific subscale scores, that include 5 items for each of the 
respective subscales. Higher scores on the ABQ denote higher levels of burnout and lower scores on the ABQ 
denote lower levels of burnout. 

FINDINGS AND CLINICAL IMPLICATIONS 

There were seven cross-sectional studies and one longitudinal prospective survey study included in the meta-
analysis. Of the eight included studies, only two directly compared specializers vs samplers in regards to 
burnout and reported inconsistent findings. Specifically, levels of burnout were present in both samplers and 
specializers; however the burnout scores were not significantly different among female non-elite youth 
soccer, volleyball, and tennis athletes.10 In contrast, another study reported  higher levels of physical and 
emotional exhaustion and burnout among swimmers, gymnasts, and divers who specialized in their respective 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 6 – Issue 1 – April 2023 

sport.11 The other six studies assessed burnout only among specializers, directly or indirectly through the use 
of additional outcome measures, such as fear of failure, motivation, self-worth, and perfectionism. One study 
found no evidence of a link between early specialization and increased burnout and drop out,9 another 
noted a higher burnout profile was indicative of ceasing sport participation,12 and a third study identified 
athletes with higher symptoms of burnout tended to detach from their sport.13 Of the studies that used indirect 
additional outcome measures, the outcome measures were chosen based on their relationship with burnout. 
Specifically,  fear of failure was related to burnout and psychological stress in one study.14 Amotivation and 
intrinsic motivation were found to be mediators of perfectionism and burnout symptoms in another study.15 
Lastly, self-worth and perfectionism were noted to increase one’s vulnerability to burnout.16 

Collectively, the majority of participants were assigned to the sport specialization group (95.9%, n=1371) 
and 4.1% (n=58) to the sport sampling group. Almost all (99.5%, n=1422) participants completed the ABQ. 
The primary meta-analysis findings of the guiding review noted that specialized athletes reported higher 
levels of burnout on the ABQ compared to samplers. Specifically, all three ABQ dimensions were significantly 
higher in the specializers, who had a greater sense of reduced accomplishment [2.51±0.66 vs 1.64±0.60, 
Δ0.87 (95%CI: 0.67-1.08), p<.01], greater exhaustion [2.44±0.79 vs 1.99±0.71, Δ0.46 (95%CI: 0.24-
0.68), p<.01], and more devaluation (1.82±0.54 vs 1.40±0.54, Δ0.41 (95%CI: 0.22-0.60) p<.01]. This 
information is clinically meaningful in the sense that it gives clinicians the awareness and evidence that there 
is an increased rate of burnout within specialized athletes, which can then be translated into practical settings 
in which athletes specialize. 

Of note is that the highest mean ABQ score in the meta-analysis was 2.51, among the specializers for the 
reduced sense of accomplishment subscale. However, the ABQ is scored out of five for each section, suggesting 
that while there were significant group differences, even the specializers were not reaching the ceiling of 
the instrument. This finding aligns with previous studies in this area which have commonly found athletes to 
exhibit burnout scores on the lower half of the scales’ range.17 Practical interpretation of these scores remains 
a challenge in using this measure, as no explicit cutoffs have been provided to precisely classify an athlete’s 
severity of burnout.18 Therefore, athletes have tended to be classified as more “at risk” of burnout or 
“more/less” burned out than others, rather than classified as high, moderate, or low severity of burnout.18   

Based on these prior studies, the scores calculated through the meta-analysis are indicative of relatively 
lower burnout across all domains in the samplers in comparison to the specializers. While this means that 
specializers are more “at risk” of being burned out, since neither group reached levels that exceeded the 
midpoint of the scale, it appears that athletes who specialize are still able to maintain a relatively positive 
sport experience.  

While the findings of the guiding manuscript provide insight into the relationship between sports 
specialization and burnout, there are several limitations of the meta-analysis that should be considered. First, 
only two of the eight included studies had a sport sampler group, thus the distribution of athletes among the 
groups was skewed, with less than 5% of the total sample included in the sport sampler group and only 
those two studies had direct comparisons. Furthermore, only three studies directly assessed burnout, while the 
other five included secondary measures that were compared to burnout and specialization. Lastly, the athlete 
participants across the included studies varied in geographic location, sport, and level of competition and 
ranged from elite academy athletes to non-elite youth athletes.  

 

 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 6 – Issue 1 – April 2023 

CLINICAL BOTTOM LINE 

Evidence from this review suggests that athletes who specialize in their sport are likely to score higher on 
each of the three ABQ subscales compared to sport samplers, suggesting higher levels of burnout within 
athletes who specialize. It is noted that the values were only slightly higher, but did not hit the midpoint of 
the scale. Further guidance on interpreting the meaning of ABQ scores would aid in practical application. 
These findings provide a degree of evidence to support the notions regarding the potential psychosocial 
implications of sports specialization and the recommendations put forth by numerous medical associations to 
limit or delay specializing in one sport.5,6,19,20  

Athletic trainers and other healthcare professionals providing care to youth and adolescent athletes should 
ask questions regarding sport specialization practices during pre-participation physical examinations and 
during injury evaluations. These discussions should include questions regarding training load, volume, and 
intensity, rest days, time off throughout the year, and include patient-report outcome measures, such as the 
ABQ to assess psychosocial constructs that may impact sport participation and recovery following injury. 
Including questions regarding burnout or symptoms of burnout as part of the pre-participation physical 
examination or secondary to an injury should be included in clinical practice. Furthermore, athletic trainers 
and other clinicians can use the findings of the guiding manuscript to educate patients and other stakeholders 
and advocate for the inclusion of safe sport recommendations by schools and leagues. Specifically, education 
and advocacy around this issue should include recommendations to have two days off from sport per week, 
participate in sport-related activity for fewer hours per week than their age, and spend at least one month 
away from organized sport each year.20 These recommendations, along with encouragement to be a sport 
sampler, can assist athletes with the needed physical and mental recovery to reduce the risks of overuse 
injury and burnout risks.20  Lastly, clinicians should be knowledgeable regarding the signs and symptoms of 
burnout (Table 1) to be able to appropriately recognize athletes at risk and assist in proper treatment, 
management, and referral.  

Table 1: Physical and mental signs and symptoms of burnout 

Physical Mental Athletic 

Changes in eating Problems with concentration, 
memory, or ability 

Leveling off or diminished 
performance or conditioning 

Unable to complete tasks Feeling overly worried  Higher resting heart rate and/or 
blood pressure 

Sensitivity to sound, sight, 
smell, and touch 

Feeling sad, empty, hopeless, or 
worthless 

Cognitive issues  

Irritability and restlessness Loss of interest in activities you 
previously enjoyed  

Illnesses as result of suppressed 
immune system 

Changes in energy levels 
and sleep patterns 

Withdrawn or disconnected from 
others 

Emotional issues 

 
Feeling like your brain is playing 
tricks on you 

Low self esteem 

 
Loss of interest in activities Increased anxiety and depression 

 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 6 – Issue 1 – April 2023 

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All rights reserved. ISSN Online 2577-8188                                                                              Volume 6 – Issue 1 – April 2023 

18. Gerber M, Gustafsson H, Seelig H, et al. Usefulness of the Athlete Burnout Questionnaire (ABQ) as a 
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https://doi.org/10.4085/1062-6050-46.2.206

	ABSTRACT

