Overtraining Syndrome

    Many dedicated athletes utilize an exhausting training program to enhance their skill level. Occasionally, athletes push their bodies beyond a healthy threshold that leads to under-performance and sickness. This study takes a look at the management of overtraining syndrome. There are three terms that, while similar, are quite different in describing the state of the athlete: functional overreaching, nonfunctional overreaching, and overtraining syndrome. Symptoms commonly seen in these disorders include:
    -fatigue                           -hypertension
    -depression                     -restlessness
    -bradycardia                    -anorexia
    -loss of motivation           -weight loss
    -insomnia                        -lack of mental concentration
    -irritability                        -heavy, sore, stiff muscles
    -agitation                         -anxiety
    -tachycardia                    -awakening unrefreshed

    Functional overreaching involves training at a higher intensity, so that performance decreases for a limited time and is improved following a rest period. This is commonly seen in training methods everywhere. Nonfunctional overreaching is similar to functional overreaching, except a longer period of rest is required for recovery. Sometimes there are psychologic and/or neuroendocrinologic symptoms experienced as well. Overtraining syndrome is differentiated from nonfunctional overreaching with an even longer period of time with decreased performance, usually greater than 2 months. It is associated with psychologic, neurologic, endocrinologic, and immunologic symptoms and another stressor that cannot be explained by another disease. The article examines many possibilities that could potentially explain these disorders: glycogen hypothesis, central fatigue hypothesis, glutamine hypothesis, oxidative stress hypothesis, autonomic nervous system hypothesis, hypothalamic hypothesis, and cytokine hypothesis.
    Patients typically have a history that involves decreased performance even with a lengthy rest period, changes in mood, and no indication of another cause to the symptoms. Some people state that nonfunctional overreaching is diagnosed if symptoms disappear following less than 21 days of rest and overtraining syndrome is diagnosed if it has been longer than 21 days of rest with symptoms persistent. Since some pathologies can present similarly as overtraining syndome, it is important to listen for cues, such as lots of mood changes or having the ability to start a workout but missing the "finishing kick." There are many lab tests that can be performed to determine the likelihood of a contribution from a non-musculoskeletal source. According to Dr. Noakes, some early signs to keep an eye out for are progressive loss of weight, an increased fluid intake (especially in the evening), a progressively later bedtime each evening, a decreased number of hours of sleep, and a persistent increase of 5-10 beats per minutes in early morning pulse rate. Dr. Noakes references a study by Waitzthat states if a positive answer to 3+ of the questions below could indicate the need to decrease training:
    -Does your normally comfortable pace leave you breathless?
    -Do your legs feel heavy for far longer than usual after a hard workout or a race?
    -Do you find it especially hard to climb steps?
    -Do you dread the thought of training?
    -Do you find it hard to get out of bed in the morning?
    -Do you have a persistent lack of appetite?
    -Are you more susceptible to colds, flu, headache, or infections?
    -Is your resting heart rate 5-10 beats higher than usual?
    -Is your heart rate during exercise higher than usual?

    Treatment recommendations are quite varied with no proven findings as of yet. Some suggest relative rest, while others suggest complete rest from the sport (Dr. Noakes suggests 6-12 weeks of rest). It is important to take a look at the motivating factors of the athlete. With decreased performance, some athletes try to compensate with increased training levels, which can worsen the problem. Additionally, with the association of mood alterations a sports psychologist consultation should be considered. Others have recommended the use of selective serotonin reuptake inhibitors to alleviate some of the symptoms. The best course of managing overtraining syndrome is prevention. Athletes should increase their training load prior to increasing their intensity, giving their bodies ample time to adjust. One of the studies referenced in this article found a decrease in "burnout" for collegiate swimmers when training levels were adjusted based on mood (lower load with low mood state).

References:
Kreher JB, Schwartz JB. "Overtraining syndrome: a practical guide." Sports Health. 2012 Mar;4(2):128-38. Web. 10/08/2012.

Noakes, Tim. Lore of Running. 4th. Southern Africa: Oxford University Press, 2001. 484-510. Print.