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Overtraining

Commonly called staleness or burnout, overtraining syndrome is a potentially serious medical illness experienced by endurance athletes. It is characterized by a decline in athletic performance, fatigue, and emotional changes despite intense physical training. The physiological changes most often seen are reduced exercise time before exhaustion, reduced maximum performance (decreased lactate production and increased anaerobic threshold), and decrease in the maximum heart rate. In females, menstrual changes can be seen. Psychologically, athletes have complaints similar to those seen in depression, including severe fatigue, disturbed sleep, soreness and heaviness of muscles, concentration problems, decreased appetite, generalized depressed mood, and, in males, decreased sexual drive. The etiology is related to an imbalance between training and recovery and is likely multifactorial. The overall prevalence is not known, but it is more commonly seen in males and in athletes trained in endurance sports, such as running, cycling, and multisport events.

Causes

A significant amount of effort and resources have been invested in determining the etiology of overtraining syndrome. Unfortunately, the definitive cause has not been elucidated. We know that repeated intense physical training sessions stress the body and lead to tissue damage. The stress and tissue damage can be reversed with adequate periods of recovery and are often purposely incorporated into training programs because of their beneficial effects. The body has an impressive ability to adapt and regenerate after these episodes of intense exercise, and on recovery, the body has the ability to physiologically adapt to endure higher stress during future training. Unfortunately, for intensely trained individuals, there is a fine line that can be crossed from hard training with adequate recovery to training with inadequate recovery. If this line is crossed, it is called overreaching and is characterized by fatigue and decreased performance. Overreaching can be reversed by a short period of rest for up to 1 to 2 weeks.

Overtraining syndrome is at the extreme end of the continuum, including overreaching. The best evidence suggests that overtraining syndrome arises when there is a prolonged or significant imbalance in this training and recovery interaction. Despite continuing the same level of exercise, or often increased levels of exercise, performance measures decrease. Experts believe that during overtraining syndrome, there is an alteration of the normal chemical messages sent by the brain and glands to the body that signals tissue breakdown rather than the normal tissue regeneration and repair. Therefore, no matter how intense the training is, the body cannot recover and perform at its optimal level. Many athletes misinterpret these early signals, and rather than back off and rest, they further intensify their training. The structures believed to be the most involved are the hypothalamus (brain), pituitary gland (brain), and endocrine glands (which secrete chemicals and hormones). The chemical messengers that have been implicated in this syndrome most often include serotonin, tryptophan, cortisol, adrenaline, growth hormone, and testosterone.

Diagnosis

Diagnosis of overtraining syndrome is often difficult and can be delayed due to the lack of specific criteria and testing currently available. This diagnosis is made clinically and relies on excluding the many other overlapping diagnoses. Evaluation should start with a complete medical history and physical examination by a trained and qualified sports medicine provider. These exams are vital for the physician when making the diagnosis and excluding other causes for the athlete's physical and psychological complaints. Although nonspecific, laboratory evaluations including a complete blood count (for infection and anemia), chemical evaluation (which includes sodium, potassium, kidney function), thyroid studies, iron studies including ferritin (low ferritin represents low body stores of iron and may lead to decreased performance), and tests for infection (mononucleosis, human immunodeficiency virus [HIV] infection, hepatitis) may be performed. Other, more specialized laboratory testing can be ordered based on the individual situation and physician preferences.

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