ADA - Registered Dietitians

from the association
American Dietetic Association Standards of Practice

and Standards of Professional Performance for
Registered Dietitians (Generalist, Specialty, Advanced)
in Sports Dietetics
The 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
T
he Sports, Cardiovascular, and
Approved November 2008 by the Quality Management Committee of the
Wellness Nutrition Dietetic Prac-
American Dietetic Association House of Delegates and the Executive Com-
tice Group (SCAN DPG) of the
mittee of the Sports, Cardiovascular, and Wellness Nutrition Dietetic Prac-
American Dietetic Association (ADA),
tice Group (SCAN DPG) of the American Dietetic Association. Scheduled
under the guidance of the ADA Quality
review date: March 2014. Questions regarding the Standards of Practice and
Management Committee, has devel-
Standards of Professional Performance for RDs in Sports Dietetics may be
oped Standards of Practice (SOP) and
addressed to Sharon McCauley, MS, MBA, RD, FADA, Director of Quality
Standards of Professional Performance
Management at ADA at smccauley@eatright.org; or Cecily Byrne, MS, RD,
(SOPP) for Registered Dietitians (RDs)
Manager of Quality Management at ADA at cbyrne@eatright.org.
in Sports Dietetics (See the Web site
exclusive Figures 1, 2, and 3, at www.
adajournal.org). These documents are tion Care address the four steps of the RDs and others about the CSSD cer-
built upon the ADA Revised 2008 SOP Nutrition Care Process (NCP) and ac- tification, guide the development of
for RDs in Nutrition Care and SOPP tivities related to patient/client care continuing education materials and
for RDs (1). As part of ADA’s Scope of during the NCP (6). They are designed programs, and conduct and publish
Dietetics Practice Framework (2), the to promote the provision of safe, effec- outcomes research.
2008 SOP in Nutrition Care and SOPP tive, and efficient food and nutrition The indicators for the SOP and
for RDs, and ADA’s Code of Ethics (3), services, facilitate evidence-based prac- SOPP for RDs in Sports Dietetics
guide the practice and performance of tice, and serve as a professional evalu- were developed with input and con-
RDs in all settings. The concept of ation resource, enabling RDs to assess sensus of content experts represent-
scope of practice is fluid (4), changing in their current level of practice in meeting diverse practice and geographic
response to the expansion of knowl- ing the Standards and to determine the perspectives and were reviewed and
edge, the health care environment, and training required for advancement to a approved by the Executive Commit-
technology. Recognizing advancements higher level of practice. The SOPP are tee of the SCAN DPG, the Scope of
in the practice of sports dietetics, the authoritative statements that describe Dietetics Practice Framework Sub-
Commission on Dietetic Registration a competent level of behavior in the Committee, and ADA’s Quality Man-
(CDR) established the Board Certified professional role. Categorized behav- agement Committee. A 2005 job anal-
Specialist in Sports Dietetics (CSSD) iors that correlate with professional ysis survey for sports dietitians
credential in 2006. performance are divided into six sepa- conducted by CDR provided informa-
The 2008 SOP for RDs in Nutrition rate standards. Together, the SOP and tion to support the standards devel-
Care and the SOPP for RDs are the SOPP comprehensively depict the min- oped for sports dietitians. These stan-
result of a review and update of the imum expectation for competent pa- dards are a guide for self-evaluation
2005 ADA SOP in Nutrition Care and tient/client care and professional be- and improving practice, a means of
Updated SOPP (5). The SOP in Nutri- havior for RDs. identifying areas for professional de-
SCAN DPG advocates that the afore- velopment, and a tool for demonstrat-
mentioned standards also be used to ing competence in delivering sports
0002-8223/09/10903-0020$36.00/0
enhance recognition of the skills and nutrition services.
doi: 10.1016/j.jada.2009.01.015
expertise of sports dietitians, educate Three levels of practice in sports di-
544 Journal of the AMERICAN DIETETIC ASSOCIATION © 2009 by the American Dietetic Association
etetics care, generalist, specialty and professional practices outlined in the Activity Guidelines Report is the first
advanced, are defined. An entry-level SOPP. report ever issued by the US govern-
practitioner has less than 3 years of Other practice guidelines that build ment specifically for the American
registered practice experience and on the NCP are evidence-based sport public with regard to the health ben-
demonstrates a competent level of die- nutrition guidelines, the established efits of physical activity that is accom-
tetics practice and professional perfor- medical nutrition therapy (MNT) pro- panied by a summary of the science
mance. A general practitioner (or tocols for general dietetics care, and supporting these recommendations.
generalist) is an individual whose prac- best practice as determined by those In addition, the Food and Nutrition
tice includes responsibilities across sev- with clinical expertise and extensive Board issued Dietary Reference In-
eral areas of practice including, but not experience in sports dietetics in a takes (DRIs) for energy intake, which,
limited to, more than one of the follow- variety of settings. While these stan- for the first time, specifically includes
ing: community, clinical, consultation dards are intended to serve as a pro- recommendations for the level of
and business, research, education, and fession evaluation resource, the MNT physical activity required for weight
food and nutrition management. A protocols are established practice maintenance and weight loss (15).
specialty practitioner is an individ- tools that provide the specific content Obesity and many chronic diseases
ual who concentrates on one aspect of to use with a patient/client when pro- (eg, cardiovascular disease, hyperten-
the profession of dietetics. This spe- viding nutrition care using the NCP. sion, diabetes, and some cancers) are
cialty may or may not have a credential These standards cover the continuum associated with physical inactivity
and additional certification, but it often of care that primarily takes place in and poor dietary habits (16). RDs,
has expanded roles beyond entry level an outpatient setting and can be ex- especially those who are skilled in
practice. An advanced practitioner tended to interactions with the sports nutrition, exercise, and weight man-
has acquired the expert knowledge science researchers and medicine pro- agement, are needed to assist indi-
base, complex decision-making skills, viders, support staff (eg, coaches, ad- viduals, communities, organizations,
and competencies for expanded prac- ministration), and/or other health and governments in realizing the
tice, the characteristics of which are professionals. MNT protocols are to value of an integrative approach to
shaped by the context in which he or be used when the athlete or active nutrition and physical activity in pro-
she practices. Advanced practitioners individual (patient/client) requires moting overall health and wellness.
may have expanded or specialty roles treatment for a nutrition-related dis- In addition, there is great interest in
or both. Advanced practice may or may ease or condition that is negatively utilizing the interactions of food, nu-
not include additional certification. affecting overall health or perfor- trition, and physical activity to de-
Generally, the practice is more com- mance. velop behavioral strategies that can
plex, and the practitioner has a higher reduce the risk of chronic diseases.
degree of professional autonomy and For individuals interested in recre-
responsibility. In addition, it is recog- OVERVIEW ational sports and fitness, sports die-
nized that sports dietetics care is most Public interest in nutrition and exer- titians provide counseling in what,
effectively undertaken with a multidis- cise has dramatically increased over how much, and when to eat to main-
ciplinary focus and at a level beyond the last 20 years. This interest has tain good health, appropriate body
that practiced by an entry-level RD. been fueled by factors such as the ris- weight and composition, and to prop-
These standards, along with the ing incidence of obesity and chronic erly fuel the body for activities en-
ADA’s Code of Ethics (3), answer the disease and recognition that nutrition joyed by this population. Correspond-
questions: “Why is an RD uniquely is integral to health and sport perfor- ingly, interest in the purported
qualified to provide sports nutrition mance. With 66% of the US adult pop- benefits of widely promoted sports
services?” and “What knowledge, ulation estimated to be overweight or foods, drinks, dietary supplements,
skills and competencies does an RD obese, it is not surprising the interest popular diets, and quick-fix exercise
need to demonstrate for the provision in nutrition and exercise has in- plans continues to grow. Sports dieti-
of safe, effective, and quality sports creased (7,8). The role physical activ- tians provide sound food and nutri-
dietetics care at the generalist, spe- ity plays in preventing weight gain, tion advice appropriate for an individ-
cialty, and advanced levels?” These promoting weight loss, and prevent- ual’s current level of fitness and sport/
standards incorporate the principles ing weight gain subsequent to weight physical activities, assist individuals
of ADA’s NCP. The outcomes (eg, loss is well documented (9-11). The in evaluating sports foods, drinks,
health of physically active people, en- importance of physical activity and and dietary supplements, and help
ergy and fluid balance, appropriate nutrition for attaining optimal weight clients meet their goals for healthy
fueling and hydration for training and overall health has also been high- body weight and physical activity or
and competition, achieving and main- lighted in a number of recent US De- sport.
taining appropriate body weight and partment of Health and Human Ser- For competitive or elite athletes,
body compositions goals, facilitating vices (DHHS) and US Department of sports nutrition guidance can enhance
athlete compliance with rules and Agriculture documents. These in- training capacity, improve exercise per-
regulations of sports organizations clude the Dietary Guidelines for formance, reduce the risk of injury, pro-
regarding sport/dietary supplements) Americans 2005 (12); Healthy People mote appropriate body weight and
to be monitored and evaluated are the 2010 (13), with 11 goals specific to composition, and strengthen the im-
outcomes of dietetics professionals nutrition and exercise; and the 2008 mune system. Applying sound nutri-
practicing in sports dietetics related Physical Activity Guidelines Advisory tion strategies can also facilitate re-
to each step of the NCP along with Committee Report (14). The Physical covery from strenuous exercise by
March 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 545

refueling and rehydrating the body, portance of nutrition for soldiers per- the sports dietitian works closely with
providing nutrients to build and re- forming high levels of physical exer- coaches, physiologists, and other mem-
pair muscles, and preparing athletes tion in harsh environments (25-28). bers of the multidisciplinary team.
for the next training session or com- Without question, the application of Once an individual’s nutrient needs are
petition. This is especially important sports nutrition principles plays a vi- established, the sports dietitian devel-
for competitive athletes who compete tal role in exercise training and per- ops a plan for the patient or client to
multiple times per day or participate formance, weight management, and meet those nutritional goals with ap-
in tournaments and for individuals maintaining health of the athlete. propriate quantity; quality; and timing
who engage in strenuous, repetitive The field is advanced by ongoing re- of food, fluid, and intake of dietary
exercise training one or more times search in sports nutrition. supplements when appropriate. Daily
per day. The sports dietitian working with schedule demands, environmental fac-
Proper nutrition can help speed the athletes and active individuals in tors, and cultural influences should
healing process for injured athletes. practice settings needs to develop the also be considered. Finally, in addition
Recovery from muscle or bone injuries appropriate knowledge, skills, and to performance outcomes, it is essential
or from surgery requires extra energy competencies to provide safe and ef- for sports dietitians to provide services
and nutrients, including protein, vita- fective care. In addition, every effort that promote the overall health and
mins, and minerals. Sound nutrition is taken to assure confidentiality and wellness of the athlete or active indi-
contributes to appropriate manage- compliance with the regulations and vidual.
ment of body weight and body compo- standards of the Health Insurance Sports dietitians have traditionally
sition. Utilizing individualized ap- Portability and Accountability Act of worked with elite and recreational
proaches to weight maintenance, 1996 (HIPPA). To provide sports nu- athletes who are members of colle-
weight/muscle gain, or weight loss trition guidance that addresses the giate, club, and professional sport
can significantly improve health and diverse needs of athletes and active teams and in settings such as health
reduce stress. Sports dietitians edu- individuals, the sports dietitian must clubs, corporate wellness centers, and
cate athletes regarding individual- possess a breadth of knowledge and Olympic training centers. Sports die-
ized menu planning, recipe modifica- skills that can be applied to varied titians are also being recruited to
tion, grocery shopping, and food and complex situations. The key to work with the military, military affil-
preparation and storage. In addition, optimal nutrition for athletes is indi- iates and with occupational groups
sports dietitians educate on the use of vidualization. The sports dietitian such as police and fire fighters where
sports foods, drinks, and dietary sup- must recognize the demands of the human performance as well as phys-
plements in compliance with the rules athletes’ annual training and compe- ical fitness is required. Moreover, de-
and regulations of sports organiza- tition plans as well as the specific mand is growing for sports dietitians
tions and governing bodies, such as needs of other patients/clients and to be employed in a number of areas,
the National Federation of High work to meet those needs with a per- such as private companies specializ-
School Associations (NFHS), the Na- sonalized approach. Patients or cli- ing in sport performance by parents
tional Collegiate Athletic Association ents deserve individualized and spe- for their children’s health or sport
(NCAA), the US Olympic Committee cific nutritional guidance related to performance, and to work with ath-
(USOC), the United States Anti-Dop- optimizing body weight and composi- letes who have disabilities and other
ing Agency (USADA), the World Anti- tion; recommendations for energy, special needs. Sports dietitians are
Doping Agency (WADA), and profes- nutrient, and fluid intake before, dur- also hired as consultants by research-
sional sports organizations such as ing, and after exercise; guidance in ers to assist in selecting appropriate
the Major League Baseball (MLB), planning, selection, and preparation assessment methods such as dietary
the National Basketball Association of meals and snacks; and use of sports intake, nutritional status, energy ex-
(NBA), and the National Football foods, drinks, and dietary supple- penditure, and body composition. The
League (NFL). ments in a variety of settings, includ- clinical skills of sports dietitians are
A strong body of research evidence ing traveling for competitions. increasingly required to provide MNT
demonstrating these benefits has The sports dietitian delivers nutri- for active and athletic patients or cli-
been compiled over the last 2 decades tion information specific to various ents diagnosed with medical condi-
(17-19). This research has provided a sports or activities and has a thor- tions (eg, diabetes, gluten intoler-
foundation for evidenced-based gov- ough understanding of how energy ance, food allergies, Crohn’s disease)
ernment reports and position papers and nutrient needs change during the and in situations such as post– cancer
providing specific nutrition guide- various phases of training and compe- treatment and post-bariatric surgery.
lines for individuals participating in tition. Equally important is the abil- Clearly, sports dietetics is a growing
strenuous exercise. Examples are the ity to effectively educate athletes, and demanding new field of study and
following: the joint position paper on coaches, athletic trainers, and others practice that requires the integration
Nutrition and Athletic Performance regarding compliance with the rules of nutrition science and exercise prin-
by the ADA, the American College of and regulations of sports organiza- ciples and corresponding research
Sports Medicine (ACSM), and the Di- tions (eg, NCAA, NFHS, USOC, into a variety of settings where active
etitians of Canada (20-24). In addi- USADA, WADA, MLB, NBA, NFL) and athletic populations participate
tion, there are numerous reports by specific to sports foods, drinks, and in sports or workers engage in physi-
the Committee on Military Nutrition dietary supplements. To integrate nu- cally demanding occupations.
Research (CMNR) of the Institute of trition effectively into the athlete’s One’s level of physical fitness and
Medicine (IOM) emphasizing the im- annual training and competition plan, sport performance is determined by a
546 March 2009 Volume 109 Number 3

number of factors including genetic job analysis survey for sports dieti- ing the levels of practice described in
characteristics that influence physical tians and contributed to developing the SOP and SOPP in Sports Dietet-
abilities, appropriate exercise training the certification. A sports dietitian ics. In ADA SOP and SOPP, the
aimed at optimizing physical potential, who is a CSSD has met minimum stages are represented as generalist,
and developing specific skills and diet practice experience requirements and specialty, and advanced practice lev-
behaviors. Appropriate food choices can has successfully completed the CSSD els (Figure 4).
lead to improved performance and abil- examination. Eligibility criteria for All RDs, even those with significant
ity to train, while inadequate nutrition the credential, applications, and experience in other practice areas, be-
practices can be detrimental to health other information are available from gin at the Novice level (generalist
and performance outcomes. Beyond un- CDR (www.cdrnet.org). A sports die- level) when practicing in a new set-
derstanding how research findings in titian’s job description, consistent ting. At the Novice level (generalist
nutrition and exercise sciences are with specialty level practice, devel- level), the RD in sports dietetics is
translated into nutrition guidelines for oped by SCAN members is published learning the principles that underpin
athletes and active individuals of all in Job Descriptions: Models for the the practice and is developing skills
sports, ages, sexes, and competitive lev- Dietetics Profession, 2nd ed, 2008 for effective sports dietetics practice.
els, sports dietitians must integrate (29). The CSSD certification, ADA This RD, who may be an experienced
these guidelines into the provision of sports dietitian job description, and RD or may be new to the profession,
high-quality sports dietetics care. the SOP and SOPP for RDs in Sports has a breadth of knowledge in nutri-
Dietetics are components of a system tion overall and may have specialty or
that assists sports dietitians in gaug- advanced knowledge/practice in an-
ADA SOP AND SOPP FOR RDs ing their level of practice and provid- other area. However, the RD new to
(GENERALIST, SPECIALTY, AND ing a pathway for advancement by the specialty of sports dietetics may
ADVANCED) IN SPORTS DIETETICS defining sports dietetics practice, doc- experience a steep learning curve due
The sports dietitian uses the ADA SOP umenting skill levels, and establish- to the wide range in demands posed
and SOPP (Generalist, Specialty, and ing benchmarks. During the develop- by different sports and their special-
Advanced) for RDs in Sports Dietetics ment of these standards, several ized annual training and competition
(see the Web site exclusive Figures 1, 2, issues unique to nutrition interven- plans, the need for individualized
and 3 at www.adajournal.org) to: tion in sports dietetics settings were sports dietetics approaches, and the
identified. complexity of sports dietetics services.
● identify the competencies needed to At the Proficiency stage (specialty
provide sports dietetics care; ● Principles of exercise science and level), the RD has developed a deeper
● self-assess whether they have the exercise physiology are integrated understanding of sports dietetics care
appropriate skill and knowledge into the application of the sports and is much better equipped to apply
base to provide safe and effective dietetics care. evidence-based guidelines and best
sports dietetics care for their level ● A nutrition approach matched to practices. This RD is also able to mod-
of practice; the athlete’s annual training and ify practice according to unique situ-
● identify the areas in which additional competition plan is an essential ations (eg, integrating environmental
knowledge and skills are needed to component of sports dietetics care. factors such as heat, cold and altitude
practice at the generalist, specialty, ● Exercise/athletic performance para- in the evaluation of an athlete’s en-
or advanced level of sports dietetics meters are considered in the man- ergy, fluid, and nutrient needs).
practice; agement of body weight and body At the Expert stage (advanced prac-
● provide a foundation for public and composition of the target population. tice level), the RD thinks critically
professional accountability in sports about sports dietetics, demonstrates a
dietetics care; more intuitive understanding of
● assist management in the planning Application to Practice sports dietetics care and practice, and
of sports dietetics services and re- Indicators described as specialty level displays a range of highly developed
sources; of practice designations in this docu- clinical and technical skills (which
● enhance professional identity and ment are not equivalent to the CSSD may include but is not limited to per-
communicate the nature of sports certification. Rather, the CSSD desig- forming sports-directed nutrition as-
dietetics; nation refers to an RD who has devel- sessment) and formulates judgments
● guide the development of sports di- oped sports dietetics nutrition knowl- acquired through a combination of ex-
etetics-related education programs, edge, skill, and application beyond perience and education. Essentially,
job descriptions, and career path- the entry-level or the generalist prac- practice at the advanced level re-
ways; and titioner. An RD who has earned the quires the application of composite di-
● assist preceptors in teaching stu- CSSD certification is an example of etetics knowledge, with practitioners
dents and interns the competencies an RD who has demonstrated, at a drawing not only on their clinical ex-
and skills needed to work in sports minimum, specialty level skills as perience, but also on the experience of
dietetics and the understanding of presented in this document. the sports dietitians in various disci-
the full scope of this profession. The Dreyfus model (30) identifies plines and practice settings. Experts,
levels of proficiency (novice, specialist, with their extensive experience and
CDR launched the CSSD certifica- advanced) during the acquisition and ability to see the significance and
tion for RDs in 2006. Members of the development of knowledge and skills. meaning of sports dietetics within a
SCAN DPG assisted CDR in writing a This model is helpful in understand- contextual whole, are fluid and flexi-

Specialty RDa Advanced Practice RD
A specialty level RD has acquired the proficient specialized An advanced practice level RD has acquired the expert knowledge,
knowledge base, complex decision-making skills, and clinical complex decision-making skills, and clinical competencies for
competencies for specialty level practice which are shaped by expanded practice, the characteristics of which are shaped by the
the context in which an RD practices. context in which an RD practices.
Specialty RDs practice from both expanded and specialized Advanced practice RDs practice from both expanded and specialized
knowledge, skills, competencies, and experience. knowledge, skills, competencies, and experience.
Specialization is concentrating or delimiting one’s focus to part of Expansion refers to the acquisition of new practice knowledge and
the whole field of dietetics (eg, ambulatory care, long-term care, skills, including the knowledge and skills that legitimize role
diabetes, renal, pediatric, private practice, community, nutrition autonomy within areas of practice that may overlap traditional
support, research, sports dietetics). boundaries of dietetics practice.
Expansion refers to the acquisition of new practice knowledge and Advanced level practice is characterized by the integration of a broad
skills, including the knowledge and skills that legitimize role range of unique theoretical, research-based, and practical
autonomy within areas of practice that may overlap traditional knowledge that occurs as a part of training and experience
boundaries of dietetics practice. beyond entry level. Advanced practice RDs are either certified or
Specialty level RDs are either certified or approved to practice in approved to practice in their expanded, specialized roles.
their expanded, specialized areas. Advanced practice does not always include an additional certification
Specialization does not always include an additional certification beyond RD certification. Certification may be one way of
beyond RD certification. demonstrating advanced practice competency.
Specialty certification may or may not require evidence at Advanced Practice Certification typically implies a postgraduate
postgraduate level. degree level.
The Commission on Dietetic Registration (CDRb) offers five Advanced Practice implies that the individual has the specialization
specialty certifications: knowledge, skills, competencies, and experience, and the
● Board Certified Specialist in Pediatric Nutrition (CSP) expanded knowledge, skills, competencies, and experience of
● Board Certified Specialist in Renal Nutrition (CSR) Advanced Practice.
● Board Certified Specialist in Sports Dietetics (CSSD) Specialty Certification is not a prerequisite for Advanced Practice
● Board Certified Specialist in Gerontological Nutrition (CSG) Certification
● Board Certified Specialist in Oncology Nutrition (CSO) CDR does not currently offer any Advanced level certifications.
Examples of other specialty certifications currently available to the RD Example of other advanced level certifications for RD:
● Certified Diabetes Educator (CDE) ● Board Certified in Advanced Diabetes Management (BC-ADM)
● Certified Nutrition Support Clinician (CNSC) Educational Preparation (one or more of the following characteristics):
Educational Preparation (one or more of the following characteristics) ● Educational preparation at the advanced level
● Educational preparation at the specialty level ● May include a formal educational program preparing for
● May include a formal educational program preparing for advanced practice
specialty practice ● Dietetics practice roles accredited or approved
● Dietetics practice roles accredited or approved ● May include a formal system of certification and credentialing
● May include a formal system of certification and credentialing
Nature of Practice
Nature of Practice ● Integrates research, education, practice, and management
● Integrates research, education, practice and management ● High degree of professional autonomy and independent practice
● Moderate degree of professional autonomy and independent ● Case management/own case load
practice ● Advanced health assessment skills, decision-making skills, and
● Specialized assessment skills, decision-making skills, and diagnostic reasoning skills
diagnostic reasoning skills ● Nonclinical advanced practice (eg, business, communications)
● Nonclinical specialty practice (business and communications may not include all characteristics; however, the complexity of
for example) may not include all characteristics; however, the the nature of practice will be comparable
complexity of the nature of practice will be comparable ● Recognized advanced clinical competencies
● Provision of consultant services to health providers
Experience ● Plans, implements, and evaluates programs
Experience beyond entry level is recommended or required.
Experience is required for specialty certification. Experience
Experience beyond entry level is required.
Figure 4. American Dietetic Association (ADA) definition of terms from the ADA Scope of Dietetic Practice Framework. aRD⫽registered dietitian.
b
CDR⫽Commission on Dietetic Registration.
ble and, to some degree, autonomous ence and medicine teams, and lead online at www.adajournal.org) are ac-
in practice. They not only implement the advancement of sports dietetics tion statements that illustrate how
sports dietetics practice, they also practice. each standard may be applied in prac-
drive and direct clinical practice, con- Indicators for the SOP (Figure 2, tice. Within the SOP and SOPP in
duct and collaborate in research, con- available online at www.adajournal. Sports Dietetics, an “X” in the gener-
tribute to multidisciplinary sport sci- org) and SOPP (Figure 3, available alist column indicates that an RD

How to Use the Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty,
and Advanced) in Sports Dietetics as part of the Professional Development Portfolio Processa
1. Reflect Assess your current level of practice and whether your goals are to expand your practice or maintain
your current level of practice. Review the Standards of Practice and Standards of Professional
Performance document to determine what you want your future practice to be, and assess your
strengths and areas for improvement. These documents can help you set short- and long-term
professional goals.
2. Conduct learning needs Once you have identified your future practice goals, you can review the Standards of Practice and
assessment Standards of Professional performance document to assess your current knowledge, skills,
behaviors, and define what continuing professional education is required to achieve the desired
level of practice.
3. Develop learning plan Based on your review of the Standards of Practice and Standards of Professional Performance, you
can develop a plan to address your learning needs as they relate to your desired level of practice.
4. Implement learning plan As you implement your learning plan, keep reviewing the Standards of Practice and Standards of
Professional Performance document to re-assess knowledge, skills, and behaviors and your
desired level of practice.
5. Evaluate learning plan Once you achieve your goals and reach or maintain your desired level of practice, it is important to
process continue to review the Standards of Practice and Standards of Professional Performance document
to re-assess knowledge, skills, and behaviors and your desired level of practice.
Figure 5. Application of the Commission on Dietetic Registration Professional Development Portfolio process. aThe Commission on Dietetic
Registration Professional Development Portfolio process is divided into five interdependent steps that build sequentially upon the previous step
during each 5-year recertification cycle and succeeding cycles.
who is caring for patients or clients is Bolded standards and indicators RDs are encouraged to pursue addi-
expected to complete this activity originate from ADA’s 2008 SOP in tional training, regardless of practice
and/or seek assistance to learn how to Nutrition Care and SOPP for RDs (1) setting, to expand their personal scope
perform at the level of the standard. and should apply to RDs in all three of sports dietetics. Individuals are ex-
The generalist in sports dietetics categories. Several unbolded indica- pected to practice only at the level at
could be an entry level RD or an ex- tors are identified as applicable to all which they are competent, and this will
perienced RD who has newly as- levels of practice. Where “X”s are vary depending on education, training
sumed responsibility to provide placed in all three categories of prac- and experience (32). Sports dietitians
sports dietetics care of active or ath- tice, it is understood that all RDs in are encouraged to pursue additional
letic patients or clients. The general- sports dietetics are accountable for knowledge and skill training regard-
ist could also be an experienced indi- practice within each of these indica- less of practice setting and to pursue
vidual who has changed the focus of tors. However, the depth with which CSSD certification to promote consis-
his or her sports dietetics practice to an RD performs each activity will in- tency in practice and performance and
another group (eg, children to adult) crease as the individual moves be- continuous quality improvement. See
or to another specialty (eg, endurance yond the generalist level. Level of Figure 6 for case examples of how RDs
sports to strength/power sports) (see practice considerations warrant that in different roles, at different levels of
Figure 4). An “X” in the specialty col- a holistic view of the SOP and SOPP practice, may use the SOP and SOPP
umn indicates that an RD who perfor RDs in Sports Dietetics be taken. in Sports Dietetics.
forms at this level has a deeper un- It is the totality of individual practice In some instances, components of
derstanding of sports dietetics and that defines the level of practice and the SOP and SOPP in Sports Dietet-
has the ability to modify therapy to not any one indicator or standard. ics do not specifically differentiate be-
meet the needs of patients/clients in RDs should review the SOP and tween specialty and advanced level
various situations (eg, caring for a SOPP in Sports Dietetics at regular in- practice. In these areas, it was the
young athlete who is participating in tervals to evaluate their sports nutri- consensus of the content experts that
preseason conditioning and is suffer- tion knowledge, skill, and competence. the distinctions are subtle— captured
ing from dehydration; helping an ath- Regular self-evaluation is important in the knowledge, experience, and in-
lete with hypoglycemia to choose the because it helps identify opportunities tuition demonstrated in the context of
right foods and fluids at the right to improve and/or enhance practice practice at the advanced level, which
time before, during, and after exer- and professional performance. This ap- combines dimensions of understand-
cise). An “X” in the advanced column praisal also enables sports dietitians to ing, performance, and value as an in-
indicates that the RD who performs better utilize CDR’s Professional Devel- tegrated whole (33). A wealth of un-
at this level possesses a comprehen- opment Portfolio for self-assessment, tapped knowledge is embedded in the
sive understanding of sports dietetics planning, improvement, and commit- experience, discernment, and practice
and exercise physiology and a highly ment to lifelong learning (31). These of advanced-level sports dietetics prac-
developed range of skills and judg- standards may be used in each of the titioners. The knowledge and skills ac-
ments acquired through a combina- five steps in the Professional Develop- quired through practice will continu-
tion of experience and education. mental Portfolio process (Figure 5). ally expand and mature. They will be

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 roles
including 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 multidisciplinary
sports medicine team that serves individuals receiving rehabilitation, physical activity guidance, and/or
exercise training. Related to the practice of sport dietetics, this RD would review available resources
for this patient/client population. The RD recognizes a need for specific knowledge and skills that are
not routine to general dietetics practice. The RD reviews the SOP and SOPP to evaluate individual
skills and competencies before providing nutrition care to individual patients/clients with clinical
issues involved in exercise and sport and sets goals to improve competency in this area of practice
before initiating patient/client care.
Manager An advanced-level sports dietitian oversees a number of RDs providing sports dietetics care to
individuals with various performance and health needs. The manager recognizes the SOP and SOPP
as important tools for staff to use to assess their own competencies and to use as the basis for
identifying personal performance plans.
Individual not currently After several years out of clinical practice, an RD decides to establish an active practice with one of the
employed focus areas being sports dietetics. Prior to accepting referrals, the RD uses the SOP and SOPP as an
evaluation tool to determine what is needed to competently provide quality sports dietetics care and
patient/client education prior to seeking continuing education and skill-building opportunities.
Public health practitioner/ An RD working in a public health or wellness setting notices an increase in the number of overweight
Corporate wellness clients with type 2 diabetes who are advised by their doctor to begin an exercise program. The RD
uses the SOP and SOPP to evaluate the level of competence needed to provide quality medical
nutrition therapy to diabetic clients initiating an exercise program. The RD also determines what level
of practitioner the patient/client needs and to whom to refer individuals who require a level of care
higher 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 the
impact of sports dietetics care provided by RDs on performance and health outcomes. The RD uses
the 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 for
clubs and teams, health and wellness fairs) targeted to specific audiences/groups reflecting
applications of the SOP and SOPP.
An RD faculty member lecturing at an institution uses the SOP and SOPP to integrate sports dietetics
practical 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. The
RD uses the SOP and SOPP to learn about the multidisciplinary approach when providing sports
dietetics care to elite athletes.
An RD who provides a broad range of services to active and athletic individuals uses the SOP and SOPP
to 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 personal
training services with sports dietetics care. He or she uses the SOP and SOPP to obtain guidance on
integrating dietetics care into the client’s exercise programs and goals to improve fitness components
such as strength, endurance, flexibility, and speed.
Other Settings An RD employed in a collegiate athletic department, with a professional sports team, or private company
specializing in sport performance uses the SOP and SOPP to implement safe, effective, quality
dietetics 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 uses
the SOP and SOPP as a guide for delivering dietetics care in non-traditional settings (eg, combat or
disaster).
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 a
sport nutrition program for a female high school team and initiate screening for the Female Athlete
Triad; complement his or her knowledge on rules and regulations regarding sport/dietary supplements
for athletes; plan, implement, and communicate dietetics care for elite athletes as part of a
multidisciplinary approach.
An RD who is also a clinical exercise physiologist uses the SOP and SOPP in a health care setting to
combine medical nutrition therapy with exercise prescription in the treatment of patients with
hypertension, cardiovascular disease, diabetes, and obesity.
Figure 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.
captured in refined indicators as ad- practice. As a quality initiative of ADA Disease Control and Prevention, National
vanced-level RDs systematically record and the SCAN DPG, these standards Center for Health Statistics Web site. April
2006. http://www.cdc.gov/nchs/products/pubs/
their own experience using the concept are an application of continuous qual- pubd/hestats/overweight/overwght_adult_03.
of clinical exemplars. The experienced ity improvement and represent an im- htm. Accessed September 2008.
practitioner observes clinical events, portant collaborative endeavor. 8. Galusky DA, Gillespie C, Kuester SA, Mokdad
analyzes them to make new connec- AH, Cogswell ME, Philip CM. State-specific
prevalence of obesity among adults—United
tions between events and ideas, and Special acknowledgement to Roberta States, 2007. MMWR Weekly. 2008;57:765-
produces a synthesized whole. Clinical Anding, MS, RD, CSSD, CDE; Karen 768.
exemplars provide outstanding models Daigle, MS, RD, CSSD; Tara Coghlin- 9. Jakicic JM, Clark K, Coleman E, Donnelly
of the actions of individual sports dieti- Dickson, MS, RD, CSSD; and Ingrid JE, Foreyt J, Melanson E, Volek J, Volpe SL.
American College of Sports Medicine Posi-
tians in clinical settings and the profes- Skoog, MS, RD, CSSD, who reviewed tion Stand. Appropriate intervention strate-
sional activities that have enhanced these standards. gies for weight loss and prevention of weight
patient or client care. They include a regain for adults. Med Sci Sports Exerc.
brief description of the need for action 2001;33:2145-2156.
10. Amati F, Dube JJ, Shay C, Goodpaster BH.
and the process used to change the out- These standards have been formu- Separate and combined effects of exercise
come (34-36). lated to be used for individual self- training and weight loss on exercise effi-
evaluation and the development of ciency and substrate oxidation. J Appl
Physiol. 2008;105:825-831.
practice guidelines, but not for in- 11. Donnelly JE, Blair SN, Jakicic JM, Manore
FUTURE DIRECTIONS stitutional credentialing or for ad- MM, Rankin JW, Smith BK. Update of the
The SOP and SOPP for RDs in Sports verse or exclusionary decisions re- 2001 American College of Sports Medicine
Dietetics are innovative and dynamic garding privileging, employment (ACSM) Position Stand. Appropriate inter-
documents. Future revisions will re- opportunities or benefits, disciplin- vention strategies for weight loss and pre-
flect changes in practice, dietetics ed- vention of weight regain for adults. Med Sci
ary actions, or determinations of Sports Exerc. 2009;41:459-478.
ucation programs, and outcomes of negligence or misconduct. These 12. Dietary Guidelines for Americans, 2005. Ex-
practice audits. The authors acknowl- standards do not constitute medi- ecutive summary. Washington, DC: US De-
edge that the three practice levels re- cal or other professional advice, partment of Health and Human Services,
quire more clarity and differentiation US Department of Agriculture Web site.
and should not be taken as such. 2005. http://www.health.gov/dietaryguidelines/
in content and role delineation and The information presented in these dga2005/document/html/executivesummary.
that competency statements that bet- standards is not a substitute for htm. Accessed September 2008.
ter characterize differences among the exercise of professional judg- 13. Healthy People 2010: The cornerstone for
the practice levels are needed. Cre- prevention. Office of Disease Prevention
ment by the health care profes- and Health Promotion, US Department of
ation of this clarity, differentiation, sional. The use of the standards for Health and Human Services Web site. 2005.
and definition are the challenges of any other purpose than that for http://www.healthypeople.gov/Publications.
today’s sports dietitians to better which they were formulated must Accessed September 2008.
serve tomorrow’s practitioners and 14. Physical Activity Guidelines Advisory Com-
be undertaken within the sole au- mittee, Physical Activity Guidelines Advi-
their patients, clients, and customers. thority and discretion of the user. sory Committee Report, 2008. Washington,
DC: US Department of Health and Human
Services, 2008.
SUMMARY 15. Institute of Medicine (IOM), Food and Nu-
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Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty and Advanced) in
Sports Dietetics
Standards of Practice in Nutrition Care are authoritative statements that describe a competent level of practice demonstrated through
nutrition assessment, nutrition diagnosis (problem identification), nutrition intervention (planning, implementation), and nutrition outcomes
monitoring and evaluation (four separate standards) and the responsibilities for which registered dietitians (RDs) are accountable. The
Standards of Practice in Sports Dietetics presuppose that the RD uses critical thinking skills, analytical abilities, theories, best available
evidence-based guidelines, current accepted dietetics and medical knowledge, and the systematic holistic approach of the nutrition care
process as they relate to the standards. Standards of Professional Performance in Sports Dietetics are authoritative statements that describe
a competent level of behavior in the professional role, including activities related to provision of services; application of research;
communication and application of knowledge; utilization and management of resources; quality in practice; and continued competence and
professional accountability (six separate standards).
Standards of Practice and Standards of Professional Performance for RDs in Sports Dietetics are complementary sets of standards— both
serve to describe the practice and professional performance of sports dietetics. All indicators may not be applicable to the practice of all
RDs or to all practice settings and situations. RDs must be aware of federal and state laws affecting their practice as well as organizational
policies and guidelines. The standards are a resource but do not supersede laws, policies, and guidelines.
The term patient/client is used in these standards as a universal term. Patient/client could also mean customer, participant, consumer, or
any individual or group who receives sports dietetics care. Sports dietetics services are provided to individuals of all ages. These Standards
of Practice and Standards of Professional Performance include clinical, outpatient, community, and other settings. To integrate nutrition
most effectively into the training and competition plan for athletes, the sports dietitian works as part of a multidisciplinary team. A
multidisciplinary team within athletic performance/sports settings may include any or all of the following: physician, registered dietitian,
physical therapist, physiologist, biomechanist, psychologist, athletic trainer, strength and conditioning coach, massage therapists,
head/assistant coaches, and team administrators/managers. 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, and
statisticians. In addition, it is recognized that the family and primary caregiver(s) of patients/clients of all ages, including individuals with
special health care needs, play critical roles in overall health. The term “appropriate” is used in the standards to mean: Selecting from a
range of evidence-based guidelines and best practices, one or more of which would give an acceptable result in the circumstances.
Evidence-based guidelines are determined by scientific evidence or, in the absence of scientific evidence, expert opinion or, in the
absence of expert opinion, professional standards (NCQAa).
Each standard is equal in relevance and importance and includes a definition, a rationale statement, indicators, and examples of desired
outcomes. A standard is a collection of specific-outcome focused statements against which a practitioner’s performance can be assessed.
The rationale statement describes the intent of the standard and defines its purpose and importance in greater detail. Indicators are
measurable action statements that illustrate how each specific standard can be applied in practice. Indicators serve to identify the level of
performance of competent practitioners and to encourage and recognize professional growth.
Standard definitions, rationale statements, core indicators, and examples of outcomes found in American Dietetic Association Standards of
Practice in Nutrition Care and Standards of Professional Performance have been adapted to reflect three levels of practice (generalist,
specialty, and advanced) of sports dietetics care. In addition, the core indicators have been expanded upon to reflect the unique
competence expectations of the RD in sports dietetics care.
Figure 1. Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty and Advanced) in Sports
Dietetics. aNCQA⫽National Committee for Quality Assurance (www.ncqa.org).
March 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 552.e1

Standards of Practice for Registered Dietitians in Sports Dietetics
Standard 1: Nutrition Assessment
The RDa in sports dietetics uses accurate and relevant data and information to identify nutrition-related problems that affect health, fitness,
exercise, and sport performance.
Rationale: Nutrition assessment is the first of four steps of the Nutrition Care Process. Nutrition Assessment is a systematic process of
obtaining, verifying, and interpreting data in order to make decisions about the nature and cause of nutrition-related conditions or problems.
It is initiated by referral and/or screening of individuals or groups for nutritional risk factors. Nutrition Assessment is an ongoing, dynamic
process that involves not only initial data collection, but also reassessment and analysis of patient/client or community nutritional needs. It
provides the foundation for Nutrition Diagnosis, the second step of the Nutrition Care Process.
The “X” signifies the indicators for

Indicators for Standard 1: Nutrition Assessment the level of practice
Bold Font Indicators are ADAb Core RD Standards of Practice Indicators Generalist Specialty Advanced
1. Each RD:
1.1 Assesses dietary history and current intake for factors that affect exercise/athletic X X X
performance and recovery, health, and conditions including nutritional risk.
Assesses
1.1A Adequacy and appropriateness of food, beverage, and nutrient intake/nutrient X X X
delivery (eg, macro and micronutrients; meal patterns; food allergies)
1.1A1 Energy and nutrient intake, including before and during training and/or X X X
competition, and post-exercise recovery
1.1A2 Food allergies/intolerances X X X
1.1A3 Energy balance using routine measures of intake and expenditure X X X
1.1A4 Daily fluid balance X X X
1.1A5 Energy balance and availability appropriate for various states of training X X
and competition
1.1A6 Special nutrient needs or requirements (eg, carbohydrate, protein, fat, X X
vitamins, minerals, electrolytes, fluid)
1.1A7 Sweat rate, advanced fluid balance assessment methods (eg, urine X X
specific gravity) and patterns of fluid replacement (eg, during and after
exercise and/or competition)
1.1A8 Changes in appetite or usual intake (eg, as a result of weight control, X
alteration in body composition/physique, change in training volume/
intensity, travel/jet lag, unfamiliar environments, competition phase,
medical conditions, illnesses and injuries, treatment and rehabilitation,
and psychological issues (eg, stress, trauma, depression)
1.1A9 Changes in usual intake as a result of dietary manipulation to optimize X
training/competition (eg, tapers, carbohydrate loading, glycogen
restoration, rehydration, precompetition weigh-in)
1.1A10 Current and past use of specialized diets, sport foods/drinks, liquid X
meal replacements, sport/dietary supplements and/or ergogenic aids
1.1A11 Develops and supervises nutrition assessment protocols X
1.1B Adequacy and appropriateness of current diet prescription X X X
Figure 2. Standards of Practice for Registered Dietitians in Sports Dietetics.
552.e2 March 2009 Volume 109 Number 3

1.2 Assesses health, exercise/athletic training and performance, and medical X X X

condition(s) for nutrition-related consequences
Assesses:
1.2A Medical and family history and medical conditions X X X
1.2A1 Family history of and risk factors for medical conditions and chronic X X X
diseases (eg, diabetes, cardiovascular disease, hypertension,
osteoporosis, dyslipidemia, obesity, disordered eating)
1.2A2 Exercise training/competition issues that alter ingestion, digestion, X X X
absorption, metabolism, utilization of nutrients, appetite, and eating
behaviors and patterns
1.2A3 Effect of patient/client condition on ingestion, digestion, absorption and X X
metabolism of nutrients, including food allergies/intolerances
1.2A4 History of metabolic and hormonal conditions (eg, diabetes, metabolic X X
syndrome, polycystic ovary syndrome, thyroid abnormalities, exercise-
induced asthma) or chronic diseases
1.2A5 Clinical factors (mechanical, physiological, or psychological) that may X X
interfere with the ingestion, digestion, absorption, metabolism and
utilization of nutrients
1.2A6 Past and recurrent illnesses (eg, upper respiratory tract infections, X X
mononucleosis) and injury history
1.2B Physical findings (eg, physical or clinical exam) X X X
1.2B1 Anthropometric measurements (eg, current weight and/or growth X X X
history, current and past body composition, and BMIc, and/or waist
circumference, as appropriate)
1.2B2 Nutrition-related findings of physical examination that includes, but is X X
not limited to: fluid balance, clinical signs of malnutrition and under-
nutrition (eg, dehydration, fatigue, inability to complete training, loss in
performance, muscle cramps, muscle aches and pains, mental well-
being, sleep and insomnia)
1.2B3 Physical performance measures (eg, VO2maxd, lactate threshold, X X
anaerobic performance, strength and power)
1.2B4 Menstrual history and status X X
1.2C Assesses, as part of the multidisciplinary team: medication/supplement X X X
management (eg, prescription, over-the-counter, sport/dietary supplements,
ergogenic aids, and herbal products; medication allergies; medication/food
interaction; and adherence)
1.2C1 Sport/dietary supplement evaluation (safety, efficacy, quality, application X X X
to sport)
1.2C2 Drug/nutrient interactions X X X
1.2C3 Knowledge and experience with the antidoping rules, regulations, and X X
procedures of sports organizations and governing bodies (eg, NCAAe,
NFHSf, IOCg, USADAh, WADAi , professional sports)
1.2C4 The need to add or discontinue sport/dietary supplements X X
Figure 2. Continued

1.2C5 Knowledge of dose and timing of medication/supplements relative to X X

meals, training, competition, travel schedules, and time zone changes
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, X X X
metabolic, infectious, musculoskeletal, hormonal)
1.2D2 Actual or risk of developing chronic complications (eg, poor bone X X
health, menstrual dysfunction, disordered eating, anemia and iron
depletion and deficiency, dyslipidemia)
1.2D3 Appropriateness of current energy, nutrient, and sport/dietary X X
supplement intake for special conditions (eg, intense training,
environmental extremes, competition/traveling challenges)
1.2D4 Indicators of complications and risks related to ingested foods, fluids, X X
sports/dietary supplements, ergogenic aids, or other substance in
relationship to athletic training and/or competition
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, indirect X X
calorimetry measurements (RMRj), DXAk, EEEl, NEATm, gastrointestinal
diagnostic tests, iron status, metabolic panel, blood lipids, endocrine
indices) in relation to sports/exercise
1.2E4 Need for additional diagnostic tests (eg, gluten intolerance, malabsorption X X
studies) or therapeutic procedures (eg, management of clinical problems
such as anemia, diabetes, dyslipidemia in association with exercise/sport)
1.2E5 Appropriateness and validity of tests to evaluate nutritional status, energy X X
balance and energy availability, fluid balance, and body composition
1.2E6 Appropriateness and validity of tests: a) for specific populations (eg, X X
adolescent athletes, older athletes); b) for selection of best-fit equations in
producing measurement results; and c) to manage complications (eg, pre-
exercise and post-exercise glycemic control in athletes with diabetes)
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 during X X
recovery from illness/injury
1.2F3 Effect of past dietary interventions on exercise/athletic training and X X
competition
1.2F4 Annual and monthly training plan, competitions, additional exercise X X
outside of training plan
1.2F5 Training state/fitness level, competitive status, and goals X X
1.2F6 Integration and coordination of nutrition into the annual X
training/competition plans for various teams and sports
1.2G Population-based surveys X X X
Figure 2. Continued

1.3 Assesses psychosocial, socioeconomic, functional and behavioral factors related to food X X X
access, selection, preparation, timing of intake, and understanding of health condition
Assesses
1.3A Uses validated tools to assess developmental, functional and mental status, X X X
and cultural, ethnic, and lifestyle factors
1.3B Barriers to adequate food access (eg, economic, transportation, training schedule, X X X
foodservice schedule, travel schedule, cooking proficiency, living situation such as
dorm, apartment, hotel)
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, weight X X
history, physical activity, previous weight management methods, sport-specific
culture of weight management)
1.4 Assesses patient/client knowledge, readiness to learn, and potential for behavior X X X
changes
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, X X
knowledge, intentions, readiness and willingness to change, perceived social
support, pressures)
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) X X
that relate to the potential for behavior change
1.4E Personal and lifestyle skills and behaviors (eg, appropriateness of eating schedule X X
related to training and competition, weight goals, coping strategies, and life,
school, work and social influences and obligations)
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 specialized X X X
sports/exercise training, competition
1.5B Type, frequency, duration of planned intervention X X
1.5B1 Effect of planned intervention on the ingestion, digestion, absorption, X X
appetite, metabolism, and utilization of nutrients
1.5B2 Effect of planned intervention to meet nutrient and fluid requirements X X
to support sport/exercise training and competition
1.5B3 Effect of planned intervention to support adaptation to training, recovery X X
between training sessions, and performance enhancement
1.5B4 Effect of planned intervention to support achieving and maintaining an X X
optimal physique for patient/client’s specific sport and health
Figure 2. Continued

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, X
the effectiveness of intervention
1.6 Identifies standards by which data will be compared X X X
1.6A Energy balance, macro- and micronutrient intake, hydration guidelines, and X X X
weight management as per the most current ADA, Dietitians of Canada, ACSMn
joint position on nutrition and athletic performance, and other evidence-based
guidelines and guidance on these topics
1.6B Hydration, fluid balance, and electrolyte balance as per the most current ADA, ACSM, X X X
and NATAo positions and other evidence-based guidelines and guidance on this topic
1.6C Treatment and prevention of the female athlete triad as per the most current X X X
ADA, ACSM, NATA, and IOC positions on this, and other evidence-based
guidelines and guidance on this topic
1.7 Identifies possible problem areas for determining nutrition diagnoses X X X
1.7A General dietetics complications such as food allergies, intolerances, preferences, X X X
and issues of clinical significance in exercising individuals
1.7B More complex issues related to food intake and clinical complications in X X
individuals exposed to variable exercise training and competition situations
1.7C Most complex issues related to food intake and clinical complications in one or X
more individuals or teams and their management within the multidisciplinary
treatment or performance enhancement team
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 presenting X X X
conditions or problems
1.8D Changes in patient/client’s perceptions, values and motivation, food and X X X
sports/dietary supplement-related behaviors, and other outcomes related to
presenting conditions or problems
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 Outcomes
Standard 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
Figure 2. Continued

Standard 2: Nutrition Diagnosis
The 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 other
members 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 involves
assembling, analyzing, and evaluating data to formulate a specific nutrition diagnosis statement. A nutrition diagnosis evolves or develops
as the client response changes, whereas a medical diagnosis does not change as long as the medical condition or disease exists. There is
a firm distinction between a nutrition diagnosis and a medical diagnosis. Nutrition diagnosis is the identification and labeling that describes
an actual occurrence of a nutritional problem that dietetics professionals are responsible for treating independently. The RD may also
indicate 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 in
attaining those expected outcomes.

Indicators for Standard 2: Nutrition Diagnosis the 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, X X X
and behavioral-environmental assessment
2.1E Demonstrates understanding of appropriate diagnostic criteria (eg, hyperlipidemia, X X X
hypertension, DSM IVq for eating disorders)
2.1F Uses complex information and data (eg, biochemical, body composition, DXA, X X
fitness assessment, diagnostic and therapeutic procedures) obtained from
assessment
2.1G Systematically compares and contrasts findings in formulating a differential X X
nutrition diagnosis (eg, involuntary weight loss associated with increased training
volume versus purposeful weight loss via energy restriction)
Figure 2. Continued

Indicators for Standard 2: Nutrition Diagnosis the 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 possibilities X X X
with additional consideration to exercise/athletic performance, fitness, and health)
when ranking nutrition diagnoses in order of importance and urgency for the patient/
client
2.2B Uses specialty level clinical judgment (eg, selects from a range of possibilities X X
with additional consideration for exercise/athletic performance, fitness, and health)
to rank nutrition diagnoses in order of importance and urgency for the patient/
client
2.2C Uses advanced reasoning and judgment which reflects the broad differences X
between active individuals and various levels of athletes (eg, beginner,
competitive, or elite) when ranking nutrition diagnoses in order of importance and
urgency for the patient/client
2.3 Validates the nutrition diagnosis(es) by consultation with clients/community family X X X
members, members of the multidisciplinary team, or other health care professionals
when possible and appropriate
2.4 Documents the nutrition diagnosis(es) using standardized language and written X X X
statement(s) that include problem (p), etiology (e) and signs and symptoms (s) [PES]
statement(s) when appropriate (eg, in clinic/office records and when medical
charting is part of the patient/client care)
2.5 Re-evaluates and appropriately revises nutrition diagnosis(es) when additional X X X
assessment data become available
Examples of Outcomes for Standard 2: Nutrition Diagnosis

● Nutrition Diagnostic Statements are:
䡩 Clear and concise
䡩 Specific—client or community centered
䡩 Accurate—relates to the etiology
䡩 Based on reliable and valid assessment data
䡩 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
Figure 2. Continued

Standard 3: Nutrition Intervention
The RD in sports dietetics identifies and implements appropriate, purposefully planned actions designed with the intent of changing a
nutrition-related behavior, risk factor, aspect of physique or health status for an individual, target group, or the community at large with the
goals 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: planning
and implementation. Planning involves prioritizing the nutrition diagnoses, conferring with the patient/client and/or others, reviewing practice
guides and policies, and setting goals and defining the specific nutrition intervention strategy. Implementation of the nutrition intervention is
the action phase that includes communicating and carrying out the plan of care, continuing data collection, and revising the nutrition
intervention strategy, as warranted, based on the patient/client response. The RD performs the interventions or assigns the nutrition care
that others provide in accordance with federal, state, and local laws and regulations and within the regulations of national and international
sport governing bodies and associations. Interventions are based on scientific principles and rationale and are supported by evidence-based
guidelines.
The RD works collaboratively with the patient/client to create a realistic plan that has a good probability of positively influencing the
diagnosis/problem. This client-driven process is a key element in the success of this step, distinguishing it from previous planning steps
that may or may not have involved the client to this degree of participation.

Indicators for Standard 3: Nutrition Intervention the level of practice
3. Each RD:
Plans the Nutrition Intervention
3.1 Prioritizes the nutrition diagnosis based on problem severity, safety, patient/client X X X
needs, likelihood that nutrition intervention will affect problem and patient/client
perception of importance
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, eating X X X
disorders, low bone mass, anemia, gastrointestinal conditions and disease,
autoimmune disease, musculoskeletal injury)
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, X X
glycogen depletion, diminished mental/physical performance, nutrient/dietary
supplement-drug interactions, late-effects of treatments such as weight loss/gain,
compromised immune system, sub-optimal training adaptation)
3.2 Bases intervention plan on evidence-based guidelines (eg, ADA EALr) and position X X X
papers (eg, ADA, ACSM, IOC)
3.3 Refers to policies and program standards X X X
3.3A Develops expected outcomes in observable and measurable terms that are clear X X X
and concise; client-centered, tailored to what is reasonable to the patient/client’s
circumstances; and appropriate expectations for treatments and outcomes
3.3B Maintains confidentiality with regard to medical information X X X
3.4 Confers with patient/client, multidisciplinary team, support staff, management as X X X
appropriate, and family as appropriate
Figure 2. Continued

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; muscle X X
cramping; inadequate recovery, exercise/athletic performance improvement and
training adaptation; diarrhea and other gastrointestinal issues; illness; injury;
eating disorder and female athlete triad; dietary and sports/dietary supplement
use, or other clinical issues)
3.5B Anticipates barriers to successful implementation (eg, patient/client compliance, X X
timing of intervention relative to annual training/competition and travel plans, food
availability and preparation issues, financial issues, regulations of sport governing
bodies and associations, issues related to team-athlete-coach-family dynamics)
3.5D Anticipates issues related to off-season/transition weight change, detraining, and X X
scheduled and unscheduled breaks in training such as holidays)
3.5E Anticipates ways to minimize barriers and other issues, prevent treatment delays, X X
reduce relapse, and reduce the need for more advanced/involved treatment options
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 the X X
problem, that are effective, and based on evidence, best practices, professional
experience, and time constraints (ie, sufficient time to make meaningful changes
before a competition deadline)
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/or X X X
performance enhancement team
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, X X X
multidisciplinary team, and/or patient/client
3.12 Initiates the nutrition intervention plan X X X
3.12A Utilizes appropriate behavior change theories (eg, motivational interviewing, X X X
behavior modification, modeling) to facilitate self-management self-care strategies
3.12B Uses critical thinking and synthesis skills to guide decision-making in X
complicated, unpredictable, and dynamic situations
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 and X X X
method of communication and culture of the sport
Figure 2. Continued

3.14C Uses critical thinking and synthesis skills for combining multiple intervention X X
approaches as appropriate
3.14D Draws on experiential knowledge and current body of scientific evidence about X
the patient/client population to individualize the strategy for complex interventions
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 team X X X
to verify progress
3.15B Collaborates with multidisciplinary team and/or performance enhancement team X X
to verify progress and adjust strategies
3.15C Directs the integration of the athlete’s progress within the multidisciplinary team X
and/or performance enhancement team
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 micronutrient X X X
needs, hydrations guidelines) according to annual training/competition plan
3.16B Adjusts nutrition intervention (eg, energy balance, macro- and micronutrient X X
needs, hydrations guidelines for high intensity training and recovery, meeting
weight class goals, adjusting to environmental extremes) according to annual
training/competition plan
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:
䡩 Comprehensive
䡩 Specific
䡩 Accurate
䡩 Relevant
䡩 Timely
䡩 Dated and Timed
● Documentation of nutrition intervention is revised and updated
Figure 2. Continued

Standard 4: Nutrition Monitoring and Evaluation
The RD in sports dietetics monitors and evaluates outcome(s) directly related to the nutrition diagnosis and the goals established in the
prescribed intervention plan. This will assist in determining if the goals or expected outcomes of nutrition care are being met. Through
monitoring and evaluation, the RD uses pertinent outcome indicators (markers) that are relevant to the patient/client-defined needs, nutrition
diagnosis, and nutrition goals. Progress should be monitored, measured, and evaluated on a timely, planned schedule until
discharge/discontinuation.
Rationale: Nutrition monitoring and evaluation is the fourth step in the Nutrition Care Process. Progress should be monitored, measured and
evaluated on a timely, planned schedule. Alterations in outcome indicators (eg, undesired body weight changes, illness or injury, comprised
exercise recovery) require reevaluation of the nutrition care process. Monitoring specifically refers to the review and measurement of the
patient/client’s status at a scheduled (pre-planned) follow-up consultation. The follow-up would relate to the nutrition diagnosis, intervention
plans/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 Evaluation the 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, body X X X
composition goals
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 on X X X
patient/client tolerance, response, and outcome measures with regard
to documented goals and objectives
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 and X X X
competitive athletes relative to general sports performance issues
4.1B2 Evaluates intervention plan implementation in competitive athletes X X
balancing multiple situations (eg, environmental extremes, rapid weight
changes, travel and events, and/or clinical complications)
4.1B3 Develops appropriate outcomes and assessment plan to determine if X
the goals of the intervention are being met
Figure 2. Continued

4.1C Provides evidence of effectiveness of the plan/intervention strategy in X X X

influencing change in patient/client behavior or status
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 of X X X
fluid, energy, and/or nutrition depletion or excess)
- 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 in X X
development and implementation of care plan
- evaluates fluid and electrolyte balance X X
- evaluates effects of intervention on exercise/athletic training and X X
performance
- evaluates effects of intervention on recovery following exercise/athletic X X
training and competition
- 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 may X X X
influence response to nutrition intervention
4.1D Identifies positive or negative outcomes X X X
4.1D1 Demonstrates understanding of intended effects and potential adverse X X X
effects of intervention
4.1D2 Anticipates and assesses intended effects and potential adverse effects X X
(eg, not meeting set weight class goal for competition) of intervention
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 weight X X X
and body composition changes, laboratory values)
4.2A2 Impact on physical measures (eg, weight maintenance, body weight X X
and body composition changes, laboratory values, fluid and electrolyte
balance, bone density)
4.2A3 Impact on treatment outcome (eg, minimize barriers, prevent treatment X X
delays, reduce relapse and the need for more advanced/involved
treatment options)
4.2A4 Quality of life and athletic performance (eg, absence of fatigue, X X
absence of muscle cramping, avoidance of gastrointestinal issues)
4.2A5 Quality of life and athletic performance (eg, full sport participation, X
progress in rehabilitation, absence of fatigue, absence of muscle
cramping avoidance of gastrointestinal issues)
4.2B Uses standardized nutrition care outcome indicator(s) X X X
Figure 2. Continued

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 health X X
and exercise/athletic performance outcomes
4.3C Establishes desired outcomes and develops evaluation plans to determine if goals X
of program or facility are being met
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, X X X
evidence-based guidelines, reference standards, or national and international
guidelines such as, ADA, Dietitians of Canada, ACSM, IOMs, IOC)
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/ X X X
discontinuation, or referral
Standard 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:
䡩 Nutrition outcomes (eg, change in knowledge, behavior, food, or nutrient intake)
䡩 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)
䡩 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 eating
and the female athlete triad, diarrhea and other gastrointestinal issues, illness, diabetes, dyslipidemia, or other clinical issues
䡩 Minimization of barriers (eg, patient/client compliance, timing of intervention relative to the annual athletic training/competition and
travel 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)
䡩 Health care utilization and cost effectiveness outcomes (eg, decreased need for medications (iron), shortened recovery time from
injuries, decreased incidence of injuries, few illnesses)
● Documentation of the monitoring and evaluation is:
䡩 Comprehensive
䡩 Specific
䡩 Accurate
䡩 Relevant
䡩 Timely
䡩 Dated and Timed
䡩 Signed
Figure 2. Continued

Definitions:
Evidence-based guidelines are determined by scientific evidence or, in the absence of scientific evidence, expert opinion or, in the absence
of expert opinion, professional standardst.
A multidisciplinary team within athletic performance/sports settings may include any or all of the following: physician, RD, physical
therapist, 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, which
may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea, and osteoporosis.
a
RD⫽registered dietitian.
b
ADA⫽American Dietetic Association (www.eatright.org).
c
BMI⫽body mass index.
d
VO2max⫽maximal aerobic capacity, maximal rate of oxygen consumption, or maximal oxygen uptake.
e
NCAA⫽National Collegiate Athletic Association (www.ncaa.org).
f
NFHS⫽National Federation of High School Associations (www.nfhs.org).
g
IOC⫽International Olympic Committee (www.olympic.org).
h
USADA⫽US Anti-Doping Agency (www.usantidoping.org).
i
WADA⫽World Anti-Doping Agency (www.wada-ama.org).
j
RMR⫽resting metabolic rate.
k
DXA⫽dual energy x-ray absorptiometry.
l
EEE⫽exercise energy expenditure.
m
NEAT⫽non-exercise activity thermogenesis.
n
ACSM⫽American College of Sports Medicine.
o
NATA⫽National Athletic Trainers’ Association (www.nata.org).
p
HIPPA⫽Health Insurance Portability and Accountability Act of 1996 (http://www.hhs.gov/ocr/hipaa).
q
DSM IV⫽Diagnostic and Statistical Manual of Mental Disorders.
r
EAL⫽Evidence Analysis Library (www.eatright.org).
s
IOM⫽Institute of Medicine (www.iom.edu).
t
Source: National Committee for Quality Assurance. QI 9: Clinical Practice Guidelines, Element A: Evidence-based guidelines. 2009 Standards and Guidelines for Accreditation of Health
Plans. Washington, DC: National Committee for Quality Assurance; 2009.
Figure 2. Continued

Standards of Professional Performance for Registered Dietitians in Sports Dietetics
Standard 1: Provision of Services
The 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, and
understanding of patient/client needs and expectations.
The “X” signifies the indicator for

Indicators for Standard 1: Provision of Services the 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-related X X X
settings
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 policies X
and protocols
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 access X X X
to sports dietitians
1.3A Receives referrals for services from and makes referrals to sports medicine and X X X
other sports staff (ie, physician, psychologist, physical therapist, physiologist,
athletic trainer, strength coach, other coaches)
1.3B Evaluates the effectiveness of sports dietetics referral tools (eg, “Find a SCANc X X
Dietitian” feature on SCAN’s Web site and state, local affiliate, and other referral
mechanisms)
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 to X X X
set priorities, establish goals, and create individualized action plans
1.4A Demonstrates understanding of behavior change and counseling theories and X X X
applies theories (eg, motivational interviewing, stages of change) in practice
1.4B Recognizes how the athletic environment, culture, health literacy, and socioeconomic X X
status may influence exercise/athletic training and performance, health/wellness, and
patient/client use of health care services
1.4C Adapts practice to meet the needs of ethnically and culturally diverse populations X X
(eg, uses interpreters, selects appropriate levels of interventions, adapts sports
nutrition education/counseling approaches and materials)
1.4D Provides leadership in documenting and evaluating outcomes of using various X X
intervention models and techniques (eg, health belief model, social cognitive
theory/social learning theory, stages of change)
1.4E Directs and manages systematic processes to identify, track, and update patient/ X
client resources; documents patient/client use of sports nutrition, and health care
and services
1.5 Informs and involves patients/clients and their families, when appropriate, in decision- X X X
making
Figure 3. Standards of Professional Performance for Registered Dietitians in Sports Dietetics.

1.6 Recognizes patient/client concepts of illness, injury, and rehabilitation and their cultural X X X
beliefs
1.7 Applies principles of sports nutrition in relation to exercise training, performance X X X
enhancement, health promotion, and behavior change appropriate for diverse
populations
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, other X X X
health care providers, and ancillary referral sources
1.8C Serves as a consultant for medical management of nutrition-related illnesses and X X X
conditions
1.8D Develops and delivers nutrition education and services that integrate nutrition X X X
with exercise/athletic performance, health promotion, and wellness
1.8E Develops and manages sports nutrition programs and educational materials based on X X
patient/client needs, culture, evidence-based guidelines, and available resources
1.8F Plans, develops, and implements systems of sports dietetics care and services X X
using evidence-based guidelines and best practices
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 and X X X
action plans
1.9B Applies knowledge and skills at the specialty level (eg, functional working X X
knowledge of sports dietetics, evidence-based guidelines, best practices, and
clinical experience) to determine the most appropriate action plan
1.9C Applies knowledge and skills at the advanced level (eg, advanced and X
comprehensive knowledge of sports dietetics, evidence-based guidelines, best
practices, and clinical experience) to determine the most appropriate action plan
1.10 Develops policies and procedures that reflect best evidence and applicable laws and X X X
regulations
1.10A Collects data and documents outcomes relative to evidence-based guidelines and X X X
best practices
1.10B Participates in developing and updating policies and procedures and evidence- X X X
based sports dietetics practice tools in the work site.
1.10C Develops strategies for quality improvement tailored to the needs of the X X
organization and patient/client populations, (eg, identifies/adapts evidence-based
practice guidelines/protocols/tools, skill training/reinforcement, and organizational
incentives and supports)
1.10D Develops and manages sports dietetics education programs in compliance with X X
evidence-based guidelines and national and international guidelines and standards
(eg, ADA, Dietitians of Canada, ACSMd, NATAe, IOMf, IOCg)
1.10E Leads the process of developing, monitoring, evaluating, and improving X
protocols, guidelines, and practice tools (eg, ADA, Dietitians of Canada);
implements changes as appropriate
Figure 3. Continued

1.11 Advocates for the provision of food and nutrition services as part of performance X X X
enhancement, health promotion and public policy
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 training X X
and athletic performance and health promotion; participates in legislative and
policy-making activities that influence sports dietetics services and practices
1.11D Provides leadership in advocacy activities/issues; authors articles and delivers X
presentations on topic; networks with other advocacy-oriented parties and organizations
1.12 Maintains records of services provided X X X
1.12A Maintains written documentation as mandated by applicable regulatory agencies, X X X
accrediting/credentialing bodies, local, state, and federal regulations and/or laws,
and consistent with the Nutrition Care Process where appropriate
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 international X X X
guidelines (eg, ADA, Dietitians of Canada, ACSM, NATA, IOM, IOC) in the delivery of
nutrition services
1.13B Develops nutrition programs, protocols, and policies based on evidence-based X X
guidelines, best practices, and national and international guidelines (eg, ADA,
Dietitians of Canada, ACSM, NATA, IOM, IOC)
1.13C Directs the development of nutrition programs, protocols, and policies based on X
evidence-based guidelines, best practices, and national and international
guidelines (eg, ADA, Dietitians of Canada, ACSM, NATA, IOM, IOC)
1.14 Implements food/nutrient delivery systems in terms of nutrition status, exercise/ X X X
athletic performance parameters, health, and well-being of target populations
1.14A Participates in foodservice planning and delivery for sporting events (eg, community X X X
sporting events, training tables, eating out or eating on the road while traveling for
competition)
1.14B Provides guidance to local and regional active and athletic communities regarding X X X
sport/dietary supplements and food products and pertinent regulatory issues
1.14C Provides guidance regarding sport/dietary supplements and food products that are in X X
compliance and those that do not comply with anti-doping rules, regulations, and
procedures of sports organizations and governing bodies (eg, NCAAh, NFHSi, IOC,
USADAj, WADAk, professional sports)
1.14D Interacts with national and international sports governing bodies (eg, NCAA, X
NFHS, IOC, USADA, WADA , professional sports) regarding anti-doping rules,
regulations, and procedures (eg, facilitates communication between USADA and
elite athletes, contributes to anti-doping policy review and evaluation)
Standard 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
Figure 3. Continued

Standard 2: Application of Research
The 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 and
services.

Indicators for Standard 2: Application of Research the 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 dietetics X X X
practice
2.1A Demonstrates an understanding of research design and methodology, and use of X X X
the EALl
2.1B Demonstrates an understanding of data collection, interpretation of results, and X X X
application
2.1C Identifies key health and performance questions and uses systematic methods to X X
apply evidence-based guidelines to answer questions
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 position X
papers.
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 physically X X X
active individuals
2.2C Follows evidence-based practice guidelines at the specialty level to provide safe, X X
effective, sports dietetics care specific to age, sex, sport, training level, and
environment
2.2D Follows evidence-based practice guidelines at the advanced practice level (ie, X
considering the complexity of care for competitive athletes balancing multiple
situations and complications)
2.3 Integrates evidence-based guidelines and patient/client values into clinical and X X X
managerial practice
2.3A Identifies and utilizes evidence-based policies and procedures for sports dietetics X X X
practice
2.3B Develops and implements evidence-based policies and procedures for sports X X
dietetics practice
2.3C Directs the integration of evidence-based policies and procedures into sports X
dietetics practice
Figure 3. Continued

Indicators for Standard 2: Application of Research the level of practice.
2.4 Promotes research through alliances and collaboration with food and nutrition and X X X
other professionals and organizations
2.4A Identifies research issues/questions X X X
2.4B Participates as a member/consultant to collaborative research teams that X X X
examine relationships among nutrition, exercise/athletic performance, and health
2.4C Serves as an investigator in collaborative research teams that examine X X
relationships among nutrition, exercise/athletic performance, and health
2.4D Serves as a primary or senior investigator in collaborative research teams that X
examines relationships among nutrition, exercise/athletic performance, and health
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 collaborative X X X
research team
2.5B Participates in practice-based research networks (eg, ADA’s Dietetics Practice X X
Research Network)
2.5C Initiates research related to sports dietetics as the primary investigator or co- X
investigator with other members of the multidisciplinary research team
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, and X X
evaluate outcomes
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 and X X X
colleagues
2.7B Presents at professional meetings and conferences (local, regional, national, X X
international)
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 program X X
planning at conferences (local, regional, national, international)
2.7E Translates research findings for incorporation into the development of policies, X
procedures, and guidelines for sports dietetics practice at national and
international levels
2.7F Directs collation of research data into publications and presentations X
Standard 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
Figure 3. Continued

Standard 3: Communication and Applications of Knowledge
The 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 their
unique knowledge and skills in food, human nutrition, exercise science, and management services.

Indicators for Standard 3: Communication and Application of Knowledge the 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; X X X
uses evidence-based guidelines and related resources
3.1B Demonstrates understanding of current research, trends, and epidemiological surveys X X X
in sports dietetics, sports nutrition education, and related areas of exercise science
3.1C Contributes to the body of knowledge for the profession X X X
3.1D Is familiar with regulatory, accreditation, and reimbursement programs and X X X
standards that apply to sports dietetics care and sports/dietary supplements
3.1E Operates under regulatory, accreditation, and reimbursement programs and X X
standards that apply to sports dietetics care, including rules and regulations of
sports organizations and governing bodies (eg, NCAA, NFHS, IOC, USADA, WADA,
professional sports) regarding sports/dietary supplements
3.1F Interprets current research in sports dietetics and related areas and applies to X X
professional practice as appropriate
3.2 Communicates and applies scientific principles, research, and theory X X X
3.2A Demonstrates critical thinking, reflection, and problem-solving skills at the X X
specialty level (eg, uses evidence-based guidelines and selects best format for
presentation) in communications
3.2B Demonstrates critical thinking, reflection, and problem-solving skills at the X
advanced practice level (eg, uses a comprehensive approach to translate
evidence-based guidelines into practical application) in communications
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 of X X X
exercise/athletic performance, exercise science, health, social sciences,
communication, and management theory
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 in X X
sports dietetics care into practice at the specialty level (eg, in new and varied contexts)
3.4C Leads the integration of new scientific knowledge and the collected knowledge from X
experience in sports dietetics care into practice at the advanced practice level (ie, for
the most complex and exceptional problems) or in new research methodologies
Figure 3. Continued

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 to X X X
health and wellness (eg, health fairs, wellness days)
3.5B Authors texts and authoritative articles for consumers and for sports- and health X X
care professionals
3.5C Serves as invited reviewer, author and/or presenter at local, regional, national, X X
and/or international meetings and to the media
3.5D Serves in leadership role for publications (eg, editor, editorial advisory board), X X
review of textbooks and articles for journal publications; participates on program
planning committees
3.5E Serves as local, regional, national, and international sports dietetics media X X
spokesperson
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, X X
and sports- and health care professionals through formal and informal teaching and
mentoring
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 policy X X
development and to translate evidence-based guidelines into sports dietetics
practice
3.7C Demonstrates the experience and critical thinking skills required to review original X
research and evidence-based guidelines relevant to sports dietetics practice
3.8 Contributes to the development of new knowledge X X X
3.8A Serves on planning committees/task forces to develop continuing education, X X X
activities, and programs in nutrition and/or sports dietetics for students and
practitioners
3.8B Serves as a consultant to organizations (eg, business, industry, government, health, X X
fitness, exercise/sports, sports dietetics) to address the needs of consumers, sports
care professionals, and health care providers for sports nutrition education
3.8C Uses evidence-based guidelines, best practices, and clinical experience to X
generate new knowledge and develop guidelines, programs, and policies in
advanced sports dietetics practice
Figure 3. Continued

3.9 Uses information technology to communicate, disseminate knowledge, and support X X X

decision-making
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/ X X X
client care
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, and X X
web-based tools
3.9E Leads in the advancement of technology/informatics (eg, information technology X
research, software program design) in sports dietetics
3.10 Contributes to the multidisciplinary approach by promoting food and nutrition X X X
strategies that enhance exercise/athletic performance, health, and quality of life
outcomes of target populations
3.10A Communicates with the multidisciplinary team regarding nutritional strategies to X X X
optimize exercise/athletic performance and health
3.10B Communicates with the multidisciplinary team to provide evidence-based guidelines X X X
that integrates food and nutrition with exercise/athletic performance and health
3.10C Consults with physicians and other health/sports professionals (eg, physician, physical X X X
therapist, psychologist, athletic trainer) on clinical and other health-related issues
3.10D Participates in multidisciplinary collaborations at a systems level (eg, X X
incorporating sports dietetics within programs aimed at optimizing
exercise/athletic performance)
3.10E Contributes nutrition-related expertise to national projects and professional X
organizations as needed (eg, ACEm, ACSM, NATA, NCAA, NFHS, NSCAn, IOC,
USADA, WADA)
3.11 Establishes credibility as the sports nutrition resource within multidisciplinary X X X
sports/athletic, health care, or management teams
3.11A Educates members of multidisciplinary teams regarding the specialized X X
knowledge and skills of the sports dietitian and the Board Certified Specialist in
Sports Dietetics
Standard 3: Communication and Application of Knowledge
● Expertise in food, nutrition, and management is shared
● Individuals and groups:
䡩 Receive current and appropriate information
䡩 Understand information received
䡩 Know how to obtain additional guidance
Figure 3. Continued

Standard 4: Utilization and Management of Resources
The RD in sports dietetics uses resources effectively and efficiently
Rationale: Mindful, efficient, and effective management of time, money, facilities, and other resources demonstrates organizational
citizenship.

Indicators for Standard 4: Utilization and Management of Resources the 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 X X X
(eg, meals and menu planning, food service consultation, Nutrition Care Process,
MNTo, nutrition education, program planning, and development)
4.2B Manages effective delivery of nutrition programs and services (eg, business and X X
marketing planning, program administration, Nutrition Care Process, delivery of
education programs, materials development) related to sports programs
4.2C Directs or manages business and strategic planning for the design and delivery X
of nutrition services in sports-related programs operating in various settings (eg,
clinic, cafeteria, corporate, research)
4.3 Evaluates safety, effectiveness, and value while planning and delivering services X X X
and products
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/dietary X X
supplements, sports nutrition products) in a cost-effective manner
4.3C Participates in management of budgeted funds for nutrition education services, X X
foodservice, dietary/sports supplements, and sports nutrition products
4.3D Evaluates the following at the systems level: safety, effectiveness, and cost in X
planning and delivering nutrition services and products
Figure 3. Continued

Indicators for Standard 4: Utilization and Management of Resources the level of practice.
4.4 Participates in continuous quality improvement and documents outcomes relative to X X X

resource management
4.4A Practices in accordance with the goals and objectives of continuous quality X X X
improvement
4.4B Utilizes contemporary business skills relating to budget management, inventory X X
tracking, ordering and distribution, negotiations for compensation and additional
resources
4.4C Anticipates needs, identifies goals and objectives, and engages in long-term X X
strategic planning
4.4D Anticipates outcomes and consequences of different approaches and makes X X
necessary modifications to achieve desired outcomes
4.4E Directs the development and management of continuous quality improvement X
systems
4.5 Assists individuals and groups to identify and secure appropriate and available X X X
resources and services
4.5A Participates in programs that employ legal and sound business practices and X X X
ensure goal-oriented outcomes
4.5B Establishes administratively sound programs (eg, Nutrition Care Process X X
protocols, MNT service delivery, sports and wellness counseling and education)
4.5C Participates in achieving desired outcomes, securing resources and services, and X X
collaborating with medical, sports, administrative, and food service staffs
4.5D Directs achieving desired outcomes, securing resources and services, and X
collaborating with medical, sports, administrative, and food service staffs
Standard 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
Figure 3. Continued

Standard 5: Quality in Practice
The RD in sports dietetics systematically evaluates the quality of services and improves practice based on evaluating clinical/dietary and
physical performance outcomes
Rationale: Quality practice requires regular performance evaluation and continuous improvement.

Indicators for Standard 5: Quality in Practice the level of practice.
Each RD:
5.1 Knows, understands and complies with federal, state, and local laws and X X X
regulations related to sports dietetics and nutrition care
5.1A Complies with HIPPAp regulations and standards X X X
5.2 Demonstrates understanding of pertinent national quality and safety initiatives (eg, X X X
ACSM, IOM, IHIq, NCQAr, NQFs)
5.3 Implements an Outcomes Management System to evaluate the effectiveness and X X X
efficiency of practice
5.3A Participates in and/or uses collected data as part of a quality improvement X X X
process relative to outcomes, quality of care, and services rendered
5.3B Advocates for and participates in developing clinical, operational, and financial X X
databases upon which outcomes in sport dietetics care can be derived, reported,
and used for improvement
5.3C Directs the development, monitoring, and evaluation of practice-specific benchmarks X
(eg, appropriate hydration practices, weight management strategies) relevant to
national initiatives (eg, ADA, ACSM, Healthy People 2010, sports organizations and
governing bodies) and to impact program planning and development
5.4 Understands and continuously measures quality of dietetic services in terms of X X X
process and outcomes
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
Figure 3. Continued

Indicators for Standard 5: Quality in Practice the 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 evaluation X X X
process for quality sports dietetics care
5.7B Recognizes potential drug-nutrient interactions, drug-sport/dietary supplement X X X
interactions, and potential interactions between scheduled interventions, other
therapies, and exercise training and competition; provides education and
counseling as appropriate
5.7C Recognizes problematic sports/dietary supplement products and manufacturing X X
practices, quality control, and error prevention recommendations (eg, as provided by
ISMPt, FDAu, USPv), and anti-doping rules and regulations of sports organizations and
governing bodies (eg, NCAA, NFHS, IOC, USADA, WADA; provides education and
counseling as appropriate
5.7D Develops protocols to identify, address, and prevent errors and hazards in the X
delivery of sports dietetics services
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 workplace X X X
performance and expected outcomes
5.12 Continuously evaluates and refines services based on measured outcomes related to X X X
sports dietetics practice
5.12A Evaluates and improves professional performance in relation to established X X X
outcomes of quality sports dietetics care and services
5.12B Directs improvements in sports dietetics care and services X X
5.12C Directs the development and management of systems, processes, and programs that X
advance best practices and the core values and objectives of sports dietetics care
Standard 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)
Figure 3. Continued

Standard 6: Competence and Accountability
The 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 Accountability the 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 performance X X X
outcomes
6.1B Evaluates professional practice consistent with evidence-based guidelines, best X X X
practices, and current research findings
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, X X X
clinical chart review, professional practice, and performance evaluations, as
applicable
6.3B Participates in scholarly review including but not limited to professional articles, X X X
chapters, books
6.3C Serves as reviewer or editorial board associate for professional organizations, X X
journals, and books
6.3D Leads an editorial board for scholarly review including but not limited to X
professional articles, chapters, books
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 and X X
mentoring opportunities for sports- and health care professionals, as appropriate
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 related X X X
areas according to his or her professional development plan
6.5B Develops and implements a professional development plan for specialty practice X X
specific to employment/workplace setting
6.5C Develops and implements a professional development plan for advanced practice X
specific to employment/workplace setting
6.6 Documents professional development activities X X X
6.6A Documents, in professional development plan, activities that demonstrate X X X
professional responsibilities at the generalist level practice
6.6B Documents, in professional development plan, activities that demonstrate the X X
professional responsibilities of specialty practice
6.6C Documents, in professional development plan, activities that demonstrate the X
expanded professional responsibilities of advanced practice
Figure 3. Continued

Indicators for Standard 6: Competence and Accountability the 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 Professional X X X
Performance into self-assessment and development plans
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 development X X X
plan to enhance practice and performance
6.9C Utilizes the ADA Standards to develop and implement a professional development X X X
plan to advance practice and performance to a higher level
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- and X X X
health care providers
6.10E Serves as a presenter for state/national professional organizations; authors X X
sports nutrition and related publications for professionals
6.10F Directs and manages professional meetings, workshops, and conferences X
6.11 Obtains occupational licensure and certifications in accordance with federal, state, X X X
and local laws and regulations and work-environment specific policies
6.11A Attains and maintains certifications accredited by the NCCAw, as appropriate to X X X
practice setting
6.11B Attains and maintains Board Certification as a Specialist in Sports Dietetics, as X X
appropriate to practice setting
6.12 Seeks leadership opportunities X X X
6.12A Exhibits effective interfacing (eg, communication, information gathering, role X X X
modeling) in sports dietetics practice, research, and/or education
6.12B Serves on sports nutrition or related committees/task forces (local, regional) for X X X
sports- and health care professionals and industry
6.12C Serves on sports nutrition or related committees/task forces (national, X X
international) for sports- and health care professionals and industry
6.12D Seeks and generates opportunities (local, regional, national, international levels) X X
to integrate sports dietetics practices and programs within larger systems (eg,
ACSM, IOC, NCAA)
6.12E Develops innovative approaches to complex practice issues X
6.12F Manages and directs the integration of sports dietetics principles within larger X
systems (eg, ACSM, IOC, NCAA)
Figure 3. Continued

Standard 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 absence
of expert opinion, professional standardsx.
The Female Athlete Triad refers to the inter-relationships among energy availability, menstrual function and bone mineral density, which
may 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, physical
therapist, 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.
a
RD⫽registered dietitian.
b
ADA⫽American Dietetic Association (www.eatright.org).
c
SCAN⫽Sports, Cardiovascular, and Wellness Nutrition (www.scandpg.org).
d
ACSM⫽American College of Sports Medicine (www.acsm.org).
e
NATA⫽National Athletic Trainers’ Association (www.nata.org).
f
IOM⫽Institute of Medicine (www.iom.edu).
g
IOC⫽International Olympic Committee (www.olympic.org).
h
NCAA⫽National Collegiate Athletic Association (www.ncaa.org).
i
NFHS⫽National Federation of High School Associations (www.nfhs.org).
j
USADA⫽US Anti-Doping Agency (www.usantidoping.org).
k
WADA⫽World Anti-Doping Agency (www.wada-ama.org).
l
EAL⫽Evidence Analysis Library (www.eatright.org).
m
ACE⫽American Council on Exercise (www.acefitness.org).
n
NSCA⫽National Strength and Conditioning Association (www.nsca-lift.org).
o
MNT⫽medical nutrition therapy.
p
HIPPA⫽Health Insurance Portability and Accountability Act of 1996 (http://www.hhs.gov/ocr/hipaa).
q
IHI⫽Institute for Healthcare Improvement (www.ihi.org).
r
NCQA⫽National Center for Quality Assurance (www.ncqa.org).
s
NQF⫽National Quality Forum (www.qualityforum.org).
t
ISMP⫽The Institute for Safe Medication Practices (www.ismp.org).
u
FDA⫽Food and Drug Administration (www.fda.gov).
v
USP⫽US Pharmacopeia (www.usp.org).
w
NCCA⫽National Commission for Certifying Agencies (http://www.noca.org/Resources/NCCAAccreditation/tabid/82/Default.aspx).
x
Source: National Committee for Quality Assurance. QI 9: Clinical Practice Guidelines, Element A: Evidence-based guidelines. 2009 Standards and Guidelines for Accreditation of Health
Plans. Washington, DC: National Committee for Quality Assurance; 2009.
Figure 3. Continued

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American Dietetic Association Standards of Practice

March 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 545

546 March 2009 Volume 109 Number 3

March 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 547

548 March 2009 Volume 109 Number 3

March 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 549

March 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 551

552 March 2009 Volume 109 Number 3

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

The “X” signifies the indicators for

Figure 2. Standards of Practice for Registered Dietitians in Sports Dietetics.

552.e2 March 2009 Volume 109 Number 3

1.2 Assesses health, exercise/athletic training and performance, and medical X X X

March 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 552.e3

1.2C5 Knowledge of dose and timing of medication/supplements relative to X X

552.e4 March 2009 Volume 109 Number 3

March 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 552.e5

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The “X” signifies the indicators for

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

Examples of Outcomes for Standard 2: Nutrition Diagnosis

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

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Examples of Outcomes for Standard 3: Nutrition Intervention

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4.1C Provides evidence of effectiveness of the plan/intervention strategy in X X X

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4.3 Evaluates outcomes X X X

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

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3.9 Uses information technology to communicate, disseminate knowledge, and support X X X

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4.4 Participates in continuous quality improvement and documents outcomes relative to X X X

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

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6.7 Adheres to the ADA Code of Ethics X X X

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