Overtraining



Ovid: 5-Minute Sports Medicine Consult, The


Overtraining
W. Scott Black
Robert G. Hosey
Basics
Description
  • Overreaching:
    • The accumulation of training and/or nontraining stress, which results in a short-term decrease in performance capacity and may be accompanied by psychological symptoms. Recovery of performance capacity and resolution of psychological symptoms can take from several days to several weeks to occur (1).
  • Overtraining:
    • The accumulation of training and/or nontraining stress, which results in a long-term decrease in performance capacity and may be accompanied by psychological symptoms. Recovery of performance capacity and resolution of psychological symptoms can take from several weeks to several months to occur. When being used to describe a clinical entity, this is often referred to as the “overtraining syndrome” (OTS). Synonym(s) include “unexplained underperformance syndrome,” “staleness,” and “burnout” (1).
Epidemiology
  • Overreaching is common and may be intentionally induced as part of a training regimen (1,2).
  • The prevalence of overtraining is not known, but it is thought to be uncommon (2) given the large number of athletes participating in training programs at any given time. It is thought to be most common among endurance athletes.
Risk Factors
  • Highly motivated athletes who respond to poor athletic performance by increasing training loads
  • Athletes subjected to generic overload stimuli, without individualized training
  • Additional “nonathletic” stressors (social, economic, scholastic, relationship, etc.)
General Prevention
  • Daily training logs:
    • Helpful in determining the cumulative strain involved with training
    • To be useful in early detection of OTS, systematic documentation of subjective and objective factors must be completed at baseline (when the athlete has no signs or symptoms) and reevaluated regularly.
    • Although small daily variations occur in athletes, training logs can identify an individual athlete's abnormal response to training at an early stage.
    • Once identified, interventions can be made to prevent further deterioration of performance and normalization of subjective and objective criteria.
    • Training logs should include:
      • Daily workout schedule (including intensity, duration, and mode of training)
      • Rating of perceived exertion (RPE) for the entire training session on a specific day. This can be done using the modified (category-ratio) Borg scale, which rates perceived effort from 0 (nothing at all) to 10 (almost maximal) (3)
      • The product of the session RPE and session duration can be recorded and represents an objective measurement of daily “training load” (3).
      • Some general description of sense of fatigue or overall state of well-being of the athlete
  • Proper coaching and training techniques:
    • Recognize overtraining early and intervene.
    • Avoid monotony in training.
    • Avoid punishing poor training performance with higher levels of training.
    • Training goals should be formulated on a week-to-week basis during times of increased training.
    • Training loads should display day-to-day variability.
    • Alternate hard day/easy day and include 1 rest day per week (hard day = RPE >5; easy day = RPE <5)
    • If athlete begins to show strain (performance decrements, increasing RPE at low-level training), reduce training to a lower level.
Etiology
  • Historically, multiple pathophysiologic mechanisms have been proposed as causes for OTS: Dysfunction of the autonomic nervous system (sympathetic or parasympathetic forms of OTS), hypothalamic dysfunction (hypothalamic-pituitary-adrenal axis and hypothalamic-pituitary-gonadal axis), reduced blood glutamine levels, decreased blood levels of branched-chain amino acids, and glycogen depletion (1,4)
  • More recently, muscle trauma with resulting cytokine-mediated systemic inflammation has been implicated (5).
  • Currently, there is no universally accepted hypothesis as to the cause of OTS.
Diagnosis
  • There is no single diagnostic test for OTS.
  • Blood testing if clinically indicated to rule out organic disease/“other” causes of fatigue
  • Profile of Mood States questionnaire may show an “inverse iceberg profile” (2).
  • Standardized Overtraining Questionnaire from the French Society for Sports Medicine scores >20 are suggestive of overtraining. An English translation of this questionnaire has been published (6).
  • P.437


  • Reduced performance on speed-endurance or short, high-intensity exercise tests (decreased performance on time trials) is consistently found (1,2).
  • VO2MAX may be reduced, but unchanged values are not unusual.
  • Blood lactate at submaximal steady-state exercise and at maximal exercise may be reduced from baseline.
  • Performance cerements when evaluating maximum sport-specific performance.
  • Increased perceived exertion at given workload
  • Decreased coordination
History
Consider:
  • Current training load: Intensity, frequency, duration, and/or mode of training
  • Historical training load over past several months
  • Any changes in “nonathletic” stressors (eg, financial problems, family illness, relationship problems, scholastic concerns)
  • Any changes in sleep pattern
  • Recent exposure to infection
  • Changes in menstruation
Physical Exam
  • Because OTS is a spectrum of diseases, the clinical presentation varies among individual athletes.
  • Subjective complaints of fatigue or “heavy legs”
  • Sleep disturbance
  • Oral temperature to rule out systemic infection
  • Evaluate resting heart rate and BP, including orthostatics.
  • Head/eyes/ears/nose/throat exam to evaluate possible upper respiratory infection/infectious mononucleosis
  • Neck exam for adenopathy or thyroid abnormalities
  • Chest auscultation to evaluate for cardiopulmonary disease
  • Abdominal examination to evaluate spleen and liver
  • Neurologic examination to evaluate for neuromuscular disease
Differential Diagnosis
  • Major depression or other psychologic disorder
  • Eating disorder
  • Organic disease (mononucleosis, hypothyroidism, anemia)
  • Drug abuse
Codes
ICD9
780.79 Other malaise and fatigue


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