2.1. Study design and participants

This cross-sectional study was conducted in the form of a digital survey. It was performed within approval guidelines of the Ethics Committee of the Faculty of Medicine of the University of Duisburg-Essen (19-8947-BO). Prior to starting the survey, electronic informed consent was obtained from each participant. Participation was anonymous and voluntary. There was no form of reimbursement. The average time of completing the digital survey was 19:50 min. The standard deviation was 10:45 min and the range of time for completion amounted to 73:45 min. The Unipark software (Tivian XI GmbH) was used, and the survey was distributed from December 2021 to December 2022. The eligibility requirements included adult age (≥18 years), a good command of the German language, internet access, and being an elite athlete. An elite athlete was defined as a person who (1) aligns their life to sports, (2) strives for athletic excellence, and (3) participates in professional or Olympic competitions (Pfaff, 2004; Lämmle, 2011; Reardon et al., 2019). Sports federations (regional and national) and sports clubs (with elite athletes competing in regional and nationwide tournaments) of all sports were contacted via mail and social media. The criteria that had to be fulfilled in order to be considered an elite athlete and to be able to take part in the study were listed here. A total number of 382 participants answered the questionnaire. Out of these, 29 participants had to be excluded at the beginning of the survey because they were younger than 18 years. Another 78 participants were excluded from the study as they did not meet the criteria required for elite athlete status at the time of the survey. The final sample for data analysis consisted of N = 275 athletes.