The Overtraining Syndrome - How can we diagnose and prevent it early on ?

The overtraining syndrome (OTS) is a disorder that is still hard to diagnose because of the lack of a golden standard in determining it. Functional overreaching, the short term performance decline, is a basic part of every training, as it’s the natural process of the body, to have reduced incline after a training and after a short period of rest this performance is brought back to normal levels. Moreover an overall performance decrease could be a multi-factor phenomenon not just caused from overtraining. Additionally there has not been extensive research in the OTS field because of the ethical conflict of inducing overtraining in athletes.

Indicators of the Overtraining Syndrome

The physiological markers of the OTS can be summed up in 5 categories and according to my judgement placed from the most reliable to least:

1. Performance testing
Reduced performance
Reduced Maximal Heart Rate

2. Physiology
Increased Resting and Exercising Heart Rate
Heart rate variability
Fat loss

3. Biochemistry
Accumulation of Catecholamines
Reduced Lactate, Urea and Creatine Kinase
Reduced Neuroexcitability

4. Hormones
Higher Cortisol Levels
Reduced sensitivity of the Adrenal Glands in Adrenocorticotrophic Hormone

5. Immune system
Weaker Constitution
Increase in Injuries

Causes of Appearance

The overtraining syndrome is a phenomenon not only concerning high level athleticism but also recreational training. It is the final stage of overtraining and it is accompanied by certain biological symptoms. Although there is not a golden standard to identify OTS yet, the causes of OTS are clearer. The causes of OTS can be summarized into two groups: Inability to rest from the training workload, and psychosocial factors.

- Inability to Rest
This group can be in turn, parted into two subgroups: Increasing workload and decreasing resting capability

Increasing workload: A continuous increase of the training workload (intensity, duration or frequency of training) without adequate resting relating to the workload increase could induce OTS (1). 

Decreasing resting capability: Resting and replenishment of nutrients are vital factors to performance and health in general. Dietary caloric restriction (negative energy balance) and deficiency of nutrients, and in general malnutrition factors can contribute greatly into OTS (1).

Impairment of resting after exercise results in decreased performance in short-term and various biological alterations in long-term.

- Psychosocial Factors: Psychological causes are a big factor in the appearance of OTS. A poor mental state (personal and emotional problems), monotony of training, and increased stress and demands in occupation are considered as determining factors (1). Moreover, in competitive athleticism, the length of the competitive season is another contributing factor in appearance of OTS (2), as prolonged and high competitive stress is accumulating without periods of rest and relaxation and can impair the mental state of the athlete.

Prevention

In an older article it is stated that upon recognizing the first stages of OTS a reduction or an abstain from training should commence to allow adequate recovery from fatigue and ailments such as stress fractures or lingering illnesses (2). They progress to inform that psychological overtraining is more difficult to prevent and treat, although the methods for prevention are not much different; taking time off training, and rescheduling the training program. Additionally it is mentioned that observable signs of overtraining syndrome can be used as guides for a gradual return to the athlete's previous training levels, meaning that the subsidence of the initial symptoms that were diagnosed in the athlete could act as a safety measure in order to return back to training.

In a more recent study (1) is presented that the four methods, most frequently used to monitor training and prevent OT are: retrospective questionnaires, training diaries, physiological screening, and the direct observational method. Also the psychological screening of athletes and the Ratings of Perceived Exertion (RPE) have received more and more attention.

It can be concluded from the two articles that at the time period before 2000 the ways to prevent OTS were as limited as the tools to indicate it. The prevention methods were limited into resting and rescheduling of the training program. Meeusen et al. (1) suggest more methods of preventing OTS, something that reflects the broaden in the knowledge of overtraining syndrome. Questionnaires, training recording and observation and psychological screening of athletes are means of preventing OTS faster and more accurately. Evaluation of performance, training workload and the recovery time should be an established process of training, not only for prevention of OTS.

In my own opinion OTS could be prevented by better planning of training. A correct model of periodization with values of intensity, duration and frequency could be able to maximize the performance and improvement of the athlete without overtraining him/her. Proper design of resting periods is also a part of periodization.Periodization concludes also the concept of personal training. An athlete’s self-esteem is boosted when he feels unique and individual, rather than being part of a team. Having a training plan that is exclusively designed for his needs and assets will give a certain feel of importance to the athlete thus making him more focused in his goal and render the training less monotonous.

Finally, it is clear that the everyday social and psychological environment of the athlete plays an important role in his mental state and thus in the development of OTS syndrome (1). Consequently a certain level of controlling the outer environmental factors of the athlete may contribute greatly into preventing OTS. The trainer is able to give help and support both friendly and professionally to the athlete and meet with his/her relatives to discuss problems and issues is something that could refresh and boost his/her state of mind. 

References

1. Meeusen R, Duclos M, Gleeson M, Rietjens G, Steinacker J, rgen, et al. Prevention, diagnosis and treatment of the Overtraining Syndrome. European Journal of Sport Science. 2006 //;6(1):1-14.

2. Johnson MB, Thiese SM. A review of overtraining syndrome-recognizing the signs and symptoms. Journal of athletic training. 1992;27(4):352-4. PubMed PMID: 16558192. Pubmed Central PMCID: 1317287.