ABC of Sports Medicine The overtraining syndrome

Athletes may experience chronic fatigue for many reasons, but it often results from the stress of training and competition-when it is called the overtraining syndrome.The primary complaint is of reduced per- formance, which is objective and can be measured.Many athletes train at an elite level even to compete domestically, so fatigue due to the stress of training is not confined to Olympic athletes; 1 0% of college swimmers in the United States are described as "burning out" each year.Wingate test using rowing machine.(Steve Redgrave, triple Olympic winner.)---------------The cause of the overtraining syndrome is not known and there is no diagnostic or warning test.Intensive interval work (high intensity exer- cise with little rest) is most likely to precipitate the syndrome, so it is extremely rare in sprinters because they train with large amounts of rest.Sprinters may, however, suffer from postviral and other forms of chronic fatigue.l ~~~~~~Contro'l athletes j -jjOvertmined athletes Wingate test showing lower peak power in overtrained athletes.* Stress of competition and selection * Physical stresses -Glycogen depletion -Dehydration -Other illness or injury -Psychological stress of life events (for example, moving house, exams, relationship problems) Symptoms of overtraining * Underperformance * Depression (loss of purpose, competitive drive, and libido) * Loss of appetite, and weight * Increased anxiety and irritability * Fatigue * Sleep disturbance (in over 90% of cases)-difficulty getting to sleep, waking in the night, nightmares, and waking unre- freshed * Frequent minor infections, particularly of the upper respiratory tract * Raised resting pulse rate * Excessive sweating Signs of over-reaching (which is normal if athletes recover quickly) * High serum creatine kinase concentra- tion * Low ratio of serum testosterone to corti- sol concentrations * Falls in muscle glycogen concentration * Raised resting heart rate * Mood deterioration * Raised serum cortisol concentrations * Low serum glutamine concentrations * Low salivary IgA concentrations Early detection of overtraining syndrome is difficult Monitor: Performance Mood state Resting heart rate* Relaxation strategies and rest, with regular very light exercise * Communication with the coach * Strong reassurance that the prognosis is goodOvertrained athletes v patients with chronic fatigue * Their primary presenting complaint is of underperformance, which is an objective measure of their condition * They present earlier, are less severely affected, and recover more quickly * The main stresses in their lives are exercise and competition, which can be controlled * The main problem in rehabilitation is in holding them back, rather than having to encourage appropriate exercise