Overtraining Syndrome Research Articles

Serum Sex Hormone–Binding Globulin and Cortisol Concentrations are Associated With Overreaching During Strenuous Military Training

The purpose was (a) to study the effect of an 8-week Finnish military basic training period (BT) on physical fitness, body composition, mood state, and serum biochemical parameters among new conscripts; (b) to determine the incidence of overreaching (OR); and (c) to evaluate whether initial levels or training responses differ between OR and noOR subjects. Fifty-seven males (19.7 ± 0.3 years) were evaluated before and during BT. Overreaching subjects had to fulfill 3 of 5 criteria: decreased aerobic physical fitness (VO2max), increased rating of perceived exertion (RPE) in 45-minute submaximal test at 70% of VO2max or sick absence from these tests, increased somatic or emotional symptoms of OR, and high incidence of sick absence from daily service. VO2max improved during the first 4 weeks of BT. During the second half of BT, a stagnation of increase in VO2max was observed, basal serum sex hormone-binding globulin (SHBG) increased, and insulin-like growth factor-1 and cortisol decreased. Furthermore, submaximal exercise-induced increases in cortisol, maximum heart rate, and postexercise increase in blood lactate were blunted. Of 57 subjects, 33% were classified as OR. They had higher basal SHBG before and after 4 and 7 weeks of training and higher basal serum cortisol at the end of BT than noOR subjects. In addition, in contrast to noOR, OR subjects exhibited no increase in basal testosterone/cortisol ratio but a decrease in maximal La/RPE ratio during BT. As one-third of the conscripts were overreached, training after BT should involve recovery training to prevent overtraining syndrome from developing. The results confirm that serum SHBG, cortisol, and testosterone/cortisol and maximal La/RPE ratios could be useful tools to indicate whether training is too strenuous.

Electrocardiographic abnormalities and diagnostic criteria in athletic overtraining

The overtraining syndrome describes the condition of prolonged imbalance between training load and recovery, with increased incidence in high level performance sports. Is very important to manage this syndrome not...

Blood rheology and body composition as determinants of exercise performance in male soccer players

The aim of this study was to assess on a large series of soccer players our previous reports on blood rheology and exercise performance. In 99 soccer players (Age 24,17 ± 0,42 yr; weight 75,87 ± 0,89 kg; VO2max 46,86 ± 0,95 mL/min/kg) an exercise test was performed for measuring maximal aerobic capacity and we measured blood viscosity at high shear rate (MT90 viscometer) and RBC aggregation (Myrenne MK1). The French questionnaire developped by the consensus group on overtraining of the French Society of Sports Medicine (SFMS) was also employed. The only hemorheologic statistical determinant of VO2max was hematocrit (Hct r = -0.2439; p = 0.0303). The lactate threshold 2 mmol/l was negatively correlated to M1 (r = -0.43224; p = 0.00847). There was a borderline correlation between the overtraining score at the questionnaire of the SFMS and plasma viscosity (r = 0.3080; p = 0.0532). Therefore, our study confirms that aerobic capacity in this sport is negatively correlated to hematocrit, that RBC aggregation is positively associated with blood lactate accumulation in blood during exercise, and that plasma viscosity is one of the parameters that increase when the athlete is on the edge of the overtraining syndrome. These data are consistent with previous reports about soccer players but caution is needed to extrapolate to other sports.

Sport Psychiatry

Sport psychiatry focuses on diagnosis and treatment of psychiatric illness in athletes in addition to utilization of psychological approaches to enhance performance. As this field and its research base are relatively new, clinicians often deliver psychiatric care to athletes without a full understanding of the diagnostic and therapeutic issues unique to this population. In this systematic review, we discuss published findings relating to psychiatric diagnosis and medical treatment of mental illness in athletes. There have been several studies looking at the prevalence of some psychiatric disorders in various athlete populations. Eating disorders and substance abuse are the most studied of these disorders and appear to be common problems in athletes. However, to provide informed understanding and treatment, we especially need more research on overtraining syndrome, bipolar disorder, suicidality, anxiety disorders, attention-deficit hyperactivity disorder (ADHD) and psychosis in athletes. Research is needed in the areas of prevalence, risk factors, prognosis and the unique experiences facing athletes with any of these disorders. Additionally, there have not been any large, systematic studies on the use of psychotropic medications in athletes. Small studies suggest that some medications may either be performance enhancing or detrimental to performance, but we need larger studies with rigorous methodology. Higher level athletes suffering from psychiatric symptoms often have reservations about taking medications with unknown performance and safety effects, and methodological issues with the current literature database preclude any definitive conclusions on performance effects of psychiatric medications. We need many more, higher quality studies on the use by athletes of antidepressants, mood stabilizers, anxiolytics, stimulants and other ADHD medications, sedative-hypnotics and antipsychotics. Such studies should utilize sensitive performance measures and involve longer term use of psychotropic medications. Furthermore, study subjects should include athletes who actually have the psychiatric disorder for which the medication is proposed, and should include more women.

Physiological and Psychological Fatigue in Extreme Conditions: Overtraining and Elite Athletes

Abstract This article will review relevant mechanisms and markers associated with overtraining syndrome (OTS), and discuss signs and symptoms, differential diagnosis, and current assessment tools for fatigue within the context of overtraining. The findings are drawn from original research and review articles referenced by PubMed and ScienceDirect databases. Sources were selected for their contributions to the current knowledge of biological, psychological, and molecular mechanisms. Data were reviewed for relevance to OTS and then evaluated against criteria that included significant OTS outcomes and findings. Information was systematically analyzed to identify patterns, dependencies, connections, and causal factors. Comparative analysis was confounded by inconsistent metrics, terminology, and variable methodology; potential biomarkers, treatment and prevention approaches, and future research directions are identified. Diagnosing OTS is difficult because underlying cause(s) are unknown; one must exclude other factors that degrade performance and mood status. Many studies are confounded by inadequate experimental designs, poor measures of performance, and different methods for characterizing OTS. OTS is complex because the demands of excessive training in combination with other biologic, psychological, and social stressors are difficult to quantify. However, changes in mood are always noted. Interrelations among dietary patterns; social, psychological and physiological profiles; and the neuroendocrine, immune, and central nervous systems are complex and not adequately elucidated.

Altered oxidative stress in overtrained athletes

The purpose of the present study was to examine the relationship between oxidative stress and overtraining syndrome. Indicators of oxidative stress (plasma protein carbonyls, nitrotyrosine, and malondialdehyde) and antioxidant status (oxygen radical absorbance capacity) were measured in severely overtrained (two women, five men) and control athletes (five women, five men). Samples were collected from both groups at baseline (i.e. in the overtraining state of overtrained athletes) and after 6 months of recovery, both at rest and immediately after an exercise test to volitional exhaustion. At baseline, overtrained athletes had higher plasma protein carbonyls at rest than controls (mean difference 0.03 nmol · mg−1, 95% CI = 0.01–0.05 nmol · mg−1, P = 0.003, effect size = 0.40). Both at baseline and after recovery, exercise to exhaustion led to an increase in oxygen radical absorbance capacity and malondialdehyde (P = 0.001–0.006) in the controls but not in the overtrained athletes. Furthermore, at baseline, only overtrained athletes showed negative correlations between oxygen radical absorbance capacity at rest and protein carbonyls after exhaustive exercise (r = −0.98, P = 0.0001). These results suggest that increased oxidative stress has a role in the pathophysiology of overtraining syndrome. The attenuated responses of oxidative stress and antioxidant capacity to exercise in the overtrained state could be related to an inability to perform exercise effectively and impaired adaptation to exercise.

Absence of the predisposing factors and signs and symptoms usually associated with overreaching and overtraining in physical fitness centers

OBJECTIVE:The aim of this study was to evaluate the occurrence of the well‐known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil.METHOD:A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1‐7) or signs and symptoms (8‐13) was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching). A mean score was calculated ranging from 1 (completely absent) to 5 (severe) for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups.RESULTS:The psychological evaluation by POMS Mood State Questionnaire indicated a normal non‐inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60).CONCLUSION:According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60).

Épidémiologie du syndrome de surentraînement chez le sportif : étude pilote sur 176 sportifs amateurs et professionnels

Overtraining syndrome is classically seen among athletes. It is characterized by a decrease in performance despite training, mood changes, and a chronic fatigue. With the aim to determine its prevalence, a validated questionnaire (French Society of Sport Medicine) completed with a panel of subsidiary questions was given to 176 Swiss athletes between May and June 2009. The results showed a prevalence of 13% (±5%) in this sample of athletes. We found a statistically significant relationship between overtraining and existence of menstrual disturbances, antecedents of overtraining or illness in the last six months. This very high prevalence has to encourage all the medical staff around athlete to increase their knowledge for this pathology. The prevention has to become the key-element. In fact, when overtraining is installed, its management includes over all a prolonged interruption of physical and sport activities.

Adjustment Disorder: a new way of conceptualizing the overtraining syndrome

It is proposed that an athlete's overtrained state is more perceptible in its etiology, diagnosis, treatment and prevention if considered from the context of a biopsychosocial disorder of adjustment. By shifting focus from a limited notion of excessive training loads and inadequate recovery schedules onto a comprehensive model of maladjustment, the full scope of the phenomenon becomes clearer. Specifically, the overtrained state is reconceptualized as an Adjustment Disorder and thus should be treated from the perspective of this diagnosis. Adjustment Disorder is viewed as a response to an identifiable stressor or stressors that results in clinically significant symptoms, and ‘can be triggered by a stressor of any severity and may involve a wide range of possible symptoms’ (DSM-IV-TR, 2000, p. 682). A rationale for the adoption of this definition is proposed. Included in this rationale is a comprehensive model of maladjustment with an overview of relevant subtypes to clarify the complex interaction of variables involved in the etiology, diagnosis, treatment, and prevention of the athlete's maladjusted state.

A Meta-analysis Of Biomarkers Associated With The Overtraining Syndrome

Int J Exerc Sci 2(1): S2, 2009. Overtraining (OT) syndrome has been investigated extensively with little agreement as to reliable markers for detection. A meta-analytic review is a procedure designed to compile studies in an area with hopes of reaching a consensus view. PURPOSE: The purpose of this meta-analysis was to provide summary quantitative findings of biomarkers (i.e., blood) associated with the overtraining syndrome. METHODS: A meta-analytic research design was utilized to investigate selected studies allowing for a coding process to record data. Thirteen studies met inclusion/exclusion criteria. Biomarkers included samples taken with subjects in normal (N) condition and during OT. These biomarkers were the following: glutamine (um), glutamate (um), cortisol (nmo*l-1), IL-6 (nm), testosterone (mg*dL-1), total cholesterol (mg*dL-1), glucose (mg*dL-1), leptin (ng*mL-1), hematocrit (%), hemoglobin (g*L-1), norepinephrine (pg*mL-1), epinephrine (pg/ml), creatine kinase (u*L-1) To determine magnitude of difference between N and OT, the effect size calculation of M2M1/SD1 was used where M2 is the mean of the OT sample, M1 was the mean of the N sample and SD1 is the standard deviation of the N sample. RESULTS: Combined sample size (N) was 238 subjects with the mean time in OT of 6.6 (weeks). The following are mean (SD) of combined subject demographics: height (cm) 175.4 (2.4); weight (kg) 71.7 (2.6); body fat (%) 11.8 (0.9); age (y) 23.5 (2.03); VO2max (ml*kg -1*min -1) 55.4 (0.8). Mean (SD) biomarker changes from N to OT were the following: Glutamine -56.3 (-2); glutamate 49.7 (2); cortisol -89.7 (-12.2); IL 6 -0.52 (0.12); testosterone -88.9 (-30); cholesterol 4.6 (-1.6); glucose -13.3 (1.9); leptin 0.15 (-0.11); hematocrit -0.83 (-0.4); hemoglobin -20; norepinephrine 36 (-4.1); epinephrine -2.2 (-3.5); creatine kinase 29.2 (8.5). Effect size calculations for the above biomarkers were considered large for the following: glutamine (-4.02), glutamate (8), cortisol, (-1.4), IL 6 (-5.2), glucose (-1.1). CONCLUSION: From this analysis, the noted biomarker changes and direction of change (+, -) indicates considerable immune-suppression and increased stress with athletes experiencing the OT syndrome. TEXAS AMERICAN COLLEGE OF SPORTS MEDICINE 2009 CONFERENCE

Causes of extreme fatigue in underperforming athletes - a synthesis of recent hypotheses and reviews

The underperformance syndrome (UPS), previously known as the overtraining syndrome (OTS), has been defined as a persistent decrement in athletic performance capacity despite 2 weeks of relative rest. Clinical research has suggested that cytokines play a key role in fatigue in disease and chronic fatigue syndrome. Furthermore, it has recently been demonstrated that exogenous administration of interleukin-6 (IL-6) increases the sensation of fatigue during exercise. In light of current cytokine and chronic fatigue syndrome research, this article reviews and updates the cytokine theories that attempt to explain the aetiology of the debilitating fatigue experienced in OTS/UPS. Initially, it was proposed that UPS may be caused by excessive cytokine release during and following exercise, causing a chronic inflammatory state and ‘cytokine sickness'. More recently, the hypothesis was extended and it was proposed that time-dependent sensitisation could provide a model through which the aetiology of UPS may be explained. According to this model, the principal abnormal factor in UPS is an intolerance/heightened sensitivity to IL-6 during exercise. South African Journal of Sports Medicine Vol. 18 (4) 2006: pp. 108-114

Unexplained underperformance syndrome in sport horses: Classification, potential causes and recognition

When inadequate training stress is applied and recovery time is insufficient, performance reduction and chronic maladaptation occurs. Known as overtraining syndrome (OTS), this complex condition afflicts horses in top training. The name of the syndrome implies causation and it is necessary to differentiate it from over-reaching, a term used in horses that, after suffering a loss of performance without an obvious clinical reason, recover their performance within 1 or 2 weeks. The term OTS should be used for horses in heavy training losing performance without an obvious clinical reason and which is sustained for > 2 weeks. Despite considerable scientific investigations, the underlying mechanisms are still poorly understood and there are no objective biomarkers for OTS. An imbalance between training and recovery seems to be the primary cause of this dysfunction. However, other factors such as transport, feeding, subclinical disease and general management may play a role. There is now sufficient evidence that red cell hypervolaemia is not a mechanism for the OTS in horses. A dysfunction of the hypothalamo-pituitary-adrenocortical axis is momentarily the only mechanism that may be related to the development of this syndrome. In the absence of a scoring system to assess the psychological status of horses, the most effective method for diagnosis is the thorough assessment of the history and presenting complaint (length of unexplained performance deficit, weight loss despite adequate feed intake, concurrence of unspecific subclinical problems, unsuccessful treatments and changes of behaviour). Standardised exercise tests are suggested to provide a way to detect subtle changes in hormonal responses in the individual, which may make an important contribution to the detection of early overtraining. But further longitudinal studies are needed to clarify mechanism(s) underlying OTS and to establish the potential for the use of a physiological test as a predictive tool of this disorder.

An elite endurance athlete's recovery from underperformance aided by a multidisciplinary sport science support team

Overload training resulting in an overreached state is common in elite sports, and if undetected can develop into an overtraining syndrome. This risk is accentuated by the lack of reliable measures of overreaching. Coaches and scientists therefore have to use a combination of tests in the monitoring process. This article presents a case study of the recovery from underperformance of a young elite endurance athlete and the work of a multidisciplinary sport science support team. When it was determined that the athlete's performance had deteriorated, and that this was due solely to the stress of training, training load was radically reduced for a period of 14 days. A combination of physiological, biochemical, and psychological measurements were then used to monitor the recovery process. The purpose of this article is to describe how coaches and sport science teams can help in monitoring training and recovery in practical settings, allowing detection of the early signs of overreaching before a more serious overtraining syndrome develops.

How do we solve the puzzle of unintended consequences of inflammation? Systematically

the odds are high that the inflammatory process will play a key role not only in protecting us from harm over the course of our lives, but also in triggering our deaths. The benefits of the inflammatory process lie in its ability to respond to a variety of stresses and to promote adaptation. The

Diagnosing overtraining in athletes using the two-bout exercise protocol

ObjectiveIn this work, whether a two-bout exercise protocol can be used to make an objective, immediately available distinction between non-functional over reaching (NFO) and overtraining syndrome (OTS) was studied.DesignUnderperforming athletes...

Présentation clinique, biologique et ergométrique de six cas d’ overtraining syndrome

Introduction This work aimed at describing clinical and laboratory characteristics of the overtraining syndrome in its chronic form (staleness). Summary of facts We present six cases of chronic overtraining syndrome that have undergone an in-depth survey. Response to the standardized questionnaire for overtraining of the SFMS appears remarkably monomorphic. Patients often exhibit low IGFBP-3 and lower maximal heart rate at exercise, as well as low value of the constant γ2 of postexercice lactate decrease and a lowered ability to oxidize fat during exercise. Conclusion Clinical and biological presentation of the overtraining syndrome is highly variable, but the SFMS questionnaire is actually the most relevant approach. Decreases in IGFBP-3 and maximal heart rate are found in agreement with previous literature. A lowered γ2 constant and a “glucodependance” at exercise calorimetry may represent new interesting markers.

Diagnosing Emotional Disorders in Athletes: A Sport Psychiatrist’s Perspective

Like the sports medicine physician, the sport psychiatrist plays an important role in the sports medicine team (SMT). A specialist in diagnosing emotional disorders can increase the diagnostic and treatment capabilities of the SMT. The goal of this article is to increase awareness of the psychiatric disorders commonly occurring among athletes and highlight the value of accurate psychiatric diagnosis. Using vignettes involving established athletes, the article examines anxiety and mood disorders, eating disorders, substance use disorders, and attention deficit disorder as they occur in athletic settings, as well as other syndromes with particular relevance to athletes, such as overtraining and postconcussion syndrome. Other clinical issues encountered while working with athletes, including learning disabilities and career termination concerns, are also discussed. Finally, the basic concepts of transference and countertransference are reviewed to highlight important relational dynamics between the athlete and the SMT.

Overtraining syndrome in horses

Overtraining is a significant cause of poor athletic performance in both human and equine athletes. In humans, overtraining syndrome has been defined as an imbalance between training and recovery manifesting as a syndrome of chronic fatigue and poor performance that may be accompanied by physiological and psychological changes. A similar syndrome has been described in horses using both cross-sectional observations and longitudinal studies with progressively increasing training loads until signs of overtraining were observed. The original cross-sectional studies of overtraining in horses linked the syndrome to increased red cell volume. However, more recent longitudinal studies revealed that overtraining is not always associated with increased red cell volume. Once other causes of poor performance have been ruled out, overtraining syndrome should be suspected in horses with evidence of sustained decreased performance in association with one or more physiological or psychological (behavioural) signs. While no single physiological marker is able to identify the syndrome, accompanying physiological signs in horses may include a decrease in body weight, elevated heart rates during exercise, lower plasma cortisol response to exercise, or elevated muscle enzymes or gamma glutamyl transferase concentrations. Behavioural signs were consistent and an early marker of overtraining syndrome in longitudinal studies in horses, and more research on developing behavioural scores to assist in early detection of overtraining syndrome in horses -as has been achieved for humans- is warranted. Two successful models of overtraining syndrome in horses have been developed, both of which appear to meet the criteria of overtraining syndrome rather than overreaching. Overtraining syndrome in horses is real, reproducible and future research should ensure the criteria for diagnosis of overtraining syndrome are met.

Specificity of training adaptation: time for a rethink?

The key components of any training programme are the volume (how much), intensity (how hard) and frequency (how often) of exercise sessions. These ‘training impulses’ determine the magnitude of adaptive responses that either enhance (fitness) or decrease (fatigue) exercise capacity (Hawley, 2002). A long held view is that the training response/adaptation is directly related to the volume of exercise undertaken (Fitts et al. 1975). However, there is obviously a threshold volume/duration beyond which additional stimuli do not induce further increases in functional capacity. This ‘biological ceiling’ is important because it implies that the regulatory control mechanisms signalling adaptive responses are ultimately titrated by exercise duration (Booth & Watson, 1985). Competitive athletes are all too aware of this phenomenon: many elite performers walk a tightrope between chronic intensive training and inadequate recovery that can culminate in decrements in performance and the ‘overtraining syndrome.’ Biological scientists are also mindful that training volume and adaptation can be dissociated. Over 35 years ago Dudley et al. (1982) demonstrated that rats undertaking intense workbouts for shorter time induced similar increases in the maximal activities of several oxidative enzymes (i.e. cytochrome c) to those observed after more prolonged submaximal exercise training.

Brain neurotransmitters in fatigue and overtraining

Since the publication of the serotonin hypothesis, numerous theories involving the accumulation or depletion of different substances in the brain have been proposed to explain central fatigue. Although the theoretical rationale for the "serotonin-fatigue hypothesis" is clear, several seemingly well-conducted studies have failed to support a significant role for 5-hydroxytryptamine in the development of fatigue. As brain function appears to be dependent upon the interaction of a number of systems, it is unlikely that a single neurotransmitter system is responsible for central fatigue. Several other mechanisms are involved, with evidence supporting a role for the brain catecholamines. Fatigue is therefore probably an integrated phenomenon, with complex interaction among central and peripheral factors. When prolonged and excessive training happens, concurrent with other stressors and insufficient recovery, performance decrements can result in chronic maladaptations that can lead to the overtraining syndrome (OTS). The mechanism of the OTS could be difficult to examine in detail, perhaps because the stress caused by excessive training load, in combination with other stressors, might trigger different "defence mechanisms" such as the immunological, neuroendocrine, and other physiological systems that all interact and probably therefore cannot be pinpointed as the "sole" cause of the OTS. It might be that, as in other syndromes, the psychoneuroimmunology (study of brain-behavior-immune interrelationships) might shed a light on the possible mechanisms of the OTS, but until there is a definite diagnostic tool, it is of utmost importance to standardize measures that are now thought to provide a good inventory of the training status of the athlete. It is very important to emphasize the need to distinguish the OTS from overreaching and other potential causes of temporary underperformance such as anemia, acute infection, muscle damage, and insufficient carbohydrate intake.