Over-training Syndrome

By Dr Ghislaine Robert MD

Published in the Bicycle Paper
April, 2006

Is it just normal soreness or fatigue? Am I doing too much? Am I over-trained? This article will provide clues about when to suspect Overtraining Syndrome, and what to do to treat and prevent it.

There is a misconception that overtraining only effects elite athletes. However, it can happen to anybody, and as a matter of fact, it is frequently seen in beginners who do too much too soon.

What is overtraining? It’s a reaction to prolonged stress. The syndrome commonly takes one of two forms. The sympathomimetic form, which is more frequent in young people and/or in anaerobic sports, includes symptoms like “hyper-awakening” (insomnia, irritability and tachycardia), while the parasympathomimetic form (described as apathy), occurs more often in older athletes and in endurance sports, and causes fatigue. Some researchers believe that there is a continuum between the conditions.

Why does it happen? To understand it, we must review the principles of training.

In order to improve performance, one begins with a certain training load that depletes the body’s resources. Then, the rest period allows the body to recover and “overcompensate” by providing more resources than it originally used, permitting the athlete to work with a greater load. With a proper recovery time, performance improves as this process repeats. If the athlete doesn’t allow adequate recovery time, overcompensation will not happen, resulting in fatigue. If one continues to apply the same charge without enough rest, Overtraining Syndrome occurs. Increasing the intensity or volume too rapidly can precipitate the syndrome. Also, any other stressful factor, parallel to training, might contribute to its emergence (ex: work, family, school, finance…). Other predisposing elements include too many competitions back-to-back, bad nutrition, altitude training, and traveling (jet lag, dehydration, fatigue).

The main symptoms consist of fatigue, muscle pain (feeling of heavy legs) and decreased performance. Other symptoms are sleeping problems (light sleep, frequent awakenings, and nightmares), increased sweating (during exercise or at night), loss of appetite, decreased libido, augmentation of the heart rate upon waking up, increased susceptibility to upper respiratory track infections (URI) and increased size of lymph nodes. The psychological manifestations involve apathy, anxiety, aggression, irritability, trouble concentrating and depression.

There is no test to confirm Overtraining Syndrome, but if a two to three week rest fails to resolve the symptoms, it’s important to get a blood test to rule out anemia, iron deficiency, thyroid problems, and other less frequent diseases. A good tool to confirm overtraining is the POMS (Profile of Mood States), since the psychological symptoms are almost always present. Also, the Testosterone/Cortisol ratio will often decrease, but it needs to be compared to previous values obtained when the athlete was performing well.

Another diagnostic tool is to keep track of the heartbeat upon waking. An augmentation of five or more heartbeats/minute for many days in a row, in addition to fatigue and decreased performance, indicates a possible beginning of the syndrome. However, rule out infection, dehydration and lack of sleep first.

If you have access to a VO2max test, the length of time you can sustain 110% of your VO2max will decrease with Overtraining Syndrome. Obviously, frequent testing improves the chances of catching the early signs of overtraining.

Rest is the best treatment. Two to three weeks of complete rest are recommended. If symptoms disappear completely, resume training, but include more recuperation time. If symptoms don’t fade, prolong the rest, sometimes for up to a few months. Following three to four weeks of recovery, the athlete can switch to active rest, which involves training but no competition. Practicing a different sport will decrease the pressure to reach former performance standards.

Plenty of carbohydrates, to replenish glycogen reserves, and adequate sleep are integral to recovery. Also, find and treat depression disorders, since a decrease in performance is often seen as a failure for the athlete. Massages, hot tubs and saunas also aid recovery. Acupuncture helps as well, especially for fatigue and insomnia.

Because Overtraining Syndrome might put you at rest for many weeks, and because the diagnosis is not easy, prevention is of great importance. Minimize all stress, whether it is related to training or not. Sleeping is important and during increased intensity phases, add naps. A healthy diet contains 15% protein, 30% lipids and 55% carbohydrates. Good hydration is mandatory.

Training programs should consider sources of stress, and be modified as needed. Recuperation time and a transition period are very important. Finally, a training log helps to monitor improvement, and detect the first signs of overtraining. Record sleeping time, quality of the sleep, wake up heart rate, motivation to train, mood, weight, training, results, effort perception, pain and injuries.

In conclusion, Overtraining Syndrome can happen to any active person. The risk of getting it increases when there are additional stressors and not enough recovery time. There is no specific diagnostic test, and the athlete may need many months to recover. Prevention is the goal.