Overtraining Syndrome

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Overtraining Syndrome is where a lack of recovery from training stress results in underperformance, often combined with Mood Disturbances such as reduced Motivation, depression and anxiety. The imbalance between training and recovery is exacerbated by Training Monotony and other life stresses. Overtraining Syndrome is not limited to high volume athletes, but can affect recreational athletes as well. I believe it would be better to rename Overtraining Syndrome to "Training Induced Depression."

1 Introduction

As training load increases there is an initial rapid improvement in fitness. Further increases produce diminishing returns until a optimum training is reached. Further training beyond this point produces less than optimal results until overtraining is reached when fitness is dramatically diminished. However, "Overtraining" and "Overtraining Syndrome" are rather different.

Overtraining Syndrome where a lack of recovery from training stress results in underperformance. Recovery is often impaired by other life stresses and these life stresses add to the stress of training. Overtraining Syndrome is sometimes called 'burnout', 'staleness', 'state of chronic fatigue', or 'unexplained under performance syndrome'[1]. The 'Overtraining' part of Overtraining Syndrome is somewhat of a misnomer, as generally the causes lie as much with poor recovery and non-training stresses[2][1]. Overtraining Syndrome is estimated to effect 65% of competitive long distance runners at some point[3]. While some levels of Overtraining Syndrome can be easily overcome, extreme Overtraining Syndrome can take years to recover from. The elite marathon runner Alberto Salazar suffered from Overtraining Syndrome that lasted for 10 years[4]. Stories from China suggest that Overtraining Syndrome has been an issue for at least 1500 years[5]. While there is a lot of research around Overtraining Syndrome, there is no common or consistent terminology, nor is there a clear standard for the diagnosis of Overtraining Syndrome[6].

2 Overtraining and Overtraining Syndrome

Overtraining does not always result in Overtraining Syndrome. A short period of mild Overtraining can be part of Overload training, which can result in improved performance. Acute Overtraining tends to produce Too Much Too Soon and a lack of active recovery can produce Overuse injuries. However, Overtraining Syndrome involves a decrease in performance and usually has negative Mood State changes. Because Overtraining Syndrome is the balance between all stresses (training + life stress) and recovery from all stresses, it can affect even lower volume athletes.

2.1 Overtraining Syndrome Subtypes

Main Article Overtraining Syndrome Subtypes

Overtraining Syndrome has been categorized into subtypes based on the associated symptoms[2]. The subtypes are similar to those seen in the DSM Adjustment Disorder and Major Depression. These types include "Overtraining with depression", "Overtraining with anxiety", "Overtraining with disturbances of conduct", and others. Personally, I believe that Overtraining Syndrome should be called 'Training Related Major Depression' due to the overwhelming similarity with other types of Major Depression.

3 Causes of Overtraining Syndrome

Main Article Causes of Overtraining Syndrome

This chart shows how low life stresses allow for good recovery, resulting in Supercompensation and improved performance. The same training stresses combined with other life stresses increase the impact of training and reduce the recovery between exercise bouts.

While Overtraining Syndrome involves training stress, the real cause is lack of recovery from training and other stresses. Stresses can be categorized as physiological, psychological and social in origin[2]. All the causes except Training Monotony are also symptoms, which make them particularly problematic as they tend to be self-reinforcing, creating a positive feedback cycle. There are several proposed Mechanisms of Overtraining Syndrome, but none have widespread acceptance or scientific support[7].

  • Training monotony[6][4][8]. Overtraining Syndrome is an imbalance between training and recovery which can be measured as Training Monotony. Training Monotony is simply a measure of similar each workout is. Having a mixture of hard workouts and easy days (or rest days) reduces monotony and allows for good recovery. It seems that athletes can train remarkably hard provided they have sufficient recovery. Therefore, training hard every day or even having easy days that are not sufficiently easy appears to be a primary cause of Overtraining Syndrome.
  • Lack of sleep[6]. Most healing and recovery from training stress occurs while we sleep, so any reduction in the length or quality of sleep may have a disproportionately large impact on the overall stress levels. This can be a particular problem for athletes who have to choose between training and sleep.
  • Life Stress[6][4]. Any life stress, including interpersonal relationships or work stress can compound training stress and reduce the quality of recovery.
  • Poor performance due to Overtraining Syndrome can often create additional stress. All too often an athlete responds to Overtraining Syndrome by believing that they are not training hard enough, and so work harder. If an athlete becomes aware of Overtraining Syndrome by failing in competition this can be emotionally devastating[4]. One study[9] of high school athletes noted the negative sporting experiences can create feelings of inadequacy, helplessness, hopelessness, and lead to major depression.
  • Infection or illness[6][4]. An illness or infection puts additional stress on the body. If the athlete continues to train with an illness this can dramatically increase the stress of training.
  • Poor diet[6][4]. Reduced calorie intake also reduces our ability to recover and deal with stress, both training stress and non-training stress. A poor quality diet that is lacking in essential nutrients can also have a negative impact on recovery. Two particular deficiencies to note are Magnesium[6] and Iron[6]. A symptom of Overtraining Syndrome is reduced appetite, making the quality of the diet worse.

4 Symptoms and Detection

Main article: Overtraining Syndrome Symptoms

There is no clear diagnostic to identify Overtraining Syndrome, therefore Overtraining Syndrome can only be proven after all other possible explanations of the symptoms have been ruled out[6]. Early confirmation of Overtraining Syndrome is almost impossible because the only key symptom is underperformance, usually combined with Mood State changes[6]. It is important to understand that Overtraining Syndrome is not just a physiological problem, but includes aspects of psychology. An overtrained athlete is unlikely to have all of the symptoms, but they may have several. A more comprehensive list can be found at Overtraining Syndrome Symptoms.

  • Unexpected underperformance. An unexplained reduction in performance is a key symptom[6][2][1] of Overtraining Syndrome. This underperformance can also manifest as an inability to maintain training loads[1], an increase in the effort required to maintain training load.
  • Mood State changes[6][2][1]. Changes in Mood State are one of the key characteristics of Overtraining Syndrome. In many ways Overtraining Syndrome is remarkably similar to major depression[4]. In fact, increased training stresses can produce a relatively rapid change in Mood State. One study[10] showed significant changes in Mood State after only 3 days of increased training.
  • General fatigue[4]. This fatigue could be seen as a general feeling of weariness, or the desire to sleep more. This could be fatigue due to an illness, depression, or muscular fatigue.
  • Infection or illness[1][6][2]. Like a major depression, Overtraining Syndrome tends to suppress the immune system resulting in more infections, illnesses, and a slower healing of minor cuts[2][1]. However, many of the symptoms of Overtraining Syndrome could be due purely to an illness, so it can be unclear if the illness is a symptom of Overtraining Syndrome or the symptoms of Overtraining Syndrome are actually just symptoms of the illness.
  • Insomnia or disturbed sleep[1]. Overtraining Syndrome tends to interfere with sleep, which in turn impairs recovery and rest, leading to a positive feedback cycle.
  • Unexplained weight loss. Changes in Mood State can often result in a loss of appetite leading to a drop in body weight.

5 Alternative explanation of the symptoms

There are various other problems that could cause the symptoms of Overtraining Syndrome[6]. Because these problems share the symptoms of Overtraining Syndrome, diagnosis of Overtraining Syndrome typically requires a process of elimination.

  • Infectious diseases, such as hepatitis or glandular fever (AKA mononucleosis or simply mono).
  • Non-infectious disease, including diabetes, thyroid dysfunction, adrenal gland problems.
  • Eating disorders such as anorexia nervosa or bulimia.
  • Anemia or other severe nutritional deficits.

6 Recovery

Main article: Recovering from Overtraining Syndrome

Because of the complexity of Overtraining Syndrome, and the ethical issues in performing scientific studies, there is no clear prescription for recovery. The advice below is the aggregation of the available advice.

  • Because there is no clear diagnostic for Overtraining Syndrome, it is difficult to determine when recovery has occurred. One metric that should be focused on should be Mood State and enthusiasm for training.
  • A reduction in training load is required, and this often needs to be a dramatic reduction. While complete rest may be warranted, this could be counterproductive[1]. Given the importance of Training Monotony, it seems reasonable to include greater periods of recovery. Rather than complete rest, I would recommend light training every other day, alternating with complete rest. The light training should be limited in duration, and should only be as much as is enjoyable.
  • Rest time should be more than simply not training. Instead, some of the time freed up due to the reduction in training load should be dedicated to focused relaxation, such as gentle Yoga, meditation or times of prayer.
  • Extra sleep[1] is likely to be required for recovery.
  • Diet is an important part of recovery. The correct calorie balance and a diet with a balanced ratio of carbohydrates/protein/fat is highly recommended[1]. The change in training load requires that the diet is carefully evaluated.
  • There are reports of successfully treating Overtraining Syndrome with serotonergic antidepressants[11] and SSRI antidepressants [4].

7 Prevention

Obviously, prevention is better than cure, but there is currently no known way of preventing Overtraining Syndrome for an athlete who wishes to training optimally.

  • Individual variability means there is no clearly defined way of preventing Overtraining Syndrome[1]. What works for one athlete may cause Overtraining Syndrome in another athlete.
  • It's been said that you can't control what you can't measure. Therefore keeping a record of training is a core part of preventing Overtraining Syndrome. See The importance of a training log. A GPS watch with a Heart Rate Monitor to accurately record training stresses combined with a training log the provides a long-term record.
  • Ensuring adequate rest is obviously critical[1] and avoiding Training Monotony is key.
    • Make easy days extremely easy, or take them off completely.
    • Focus on explicit relaxation and 'decompression' as part of training[1].
    • Maintain accurate records of training and performance.
  • Ensure optimal nutrition, hydration, and sleep[1].
  • The volume of training and the intensity of training should not both be increased. In fact, increasing one should generally have a proportionate decrease in the other[1].
  • Be aware of the sum of all of life's stresses and adjust training stress accordingly. If there is an increase in a life stress, such as a new baby, moving house, changing job, training stress should be reduced, especially any training that occurs on 'easy' days.
  • Mood State questionnaires may be one of the more useful techniques for detecting Overtraining Syndrome. Mood State has been shown to be changed within a few days of an increase in training load.
  • Measure Training Monotony, which is a key cause of Overtraining Syndrome[6][4].
  • Establish and maintain a good social network as support group[1].

8 Training monotony

Main article: Training Monotony

It is long been recognized the athletes cannot train hard every day. Modern training plans recommend a few hard days per week, with the other days as easier or rest days. A lack of variety in training stress, known as Training Monotony, is considered a key factor in causing Overtraining Syndrome[6][4]. There is also evidence[12] that increased training frequency results in reduced performance benefits from identical training sessions as well as increased fatigue.

9 References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 Physiological Perspective of Endurance Overtraining – A Comprehensive Update http://ajms.alameenmedical.org/article_vol05-1-jan-mar-2012/AJMS.5.1.2012%20P%207-20.pdf
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Taylor & Francis Online :: Adjustment Disorder: a new way of conceptualizing the overtraining syndrome - International Review of Sport and Exercise Psychology - Volume 2, Issue 2 http://www.tandfonline.com/doi/abs/10.1080/17509840903110962
  3. Markers of Excessive Exercise - Canadian Journal of Applied Physiology http://www.nrcresearchpress.com/doi/abs/10.1139/h99-007
  4. 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 The unknown mechanism of the overtraining syndrom... [Sports Med. 2002] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/11839081
  5. Overtraining research advances in China http://www.scsepf.org/doc/pdf/no2/Paper_6.pdf
  6. 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 6.13 6.14 6.15 Prevention, diagnosis and treatment of the Overtraining Syndrome http://www.ingentaconnect.com/content/tandf/tejs/2006/00000006/00000001/art00001
  7. Overtraining In Sport, Kreider, Fry, O'Toole, Human Kinetics
  8. Monitoring training in athletes with re... [Med Sci Sports Exerc. 1998] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/9662690
  9. Depression and chronic fatigue in the high school ... [Prim Care. 1991] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/1876614
  10. Psychobiologic effects of 3 d of increa... [Med Sci Sports Exerc. 1991] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/1943626
  11. The stigmatisation and denial of mental illness in athletes -- Schwenk 34 (1): 4 -- British Journal of Sports Medicine http://www.msscentershop.info/content/34/1/4.extract
  12. Variable dose-response relationship bet... [Med Sci Sports Exerc. 2003] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/12840641