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Thread: Rest and Overtraining

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    Rest and Overtraining

    From IB via ASN
    Thought it was a great read.

    Rest & Overtraining
    By: Jeff Behar

    In order to improve performance (gain size, strength and/or definition) you've got to work hard. However, hard training (be it heavy training, training with less rest between sets, more sets per work, or less days off) will break down your muscles and in the very short term, make you weaker.

    To grow and to get stronger, the most important part of this equation is not necessarily how hard you train. To make the huge gains we all desire lifting success can not be thought of in a vacuum. An experienced athlete, who does include weightlifters and bodybuilders, understands the importance of proper nutrition and rest.

    However, there are still many bodybuilders who do not realize (or at least underestimate) the important role rest plays in obtaining maximum performance and results from the hours spent in the gym.

    The Value Of Rest

    It is rest that makes you stronger, because it is the rest that allows the muscles that you have broken down to heal and recover. It is the rest that allows you to recover so you can be strong, and thereby handle the increased weight, and increased number of sets and reps needed to gain further.

    Why does rest play such an important role in muscle recovery? It is during sleep where Growth Hormone (GH) levels are at their highest. Physiologic improvement in bodybuilding can only occur during the rest period following hard training. This is also why consuming the proper foods and supplements immediately following such training is key.

    "...if proper recovery time (rest) is not given then the body can not regenerate."

    Hard intense training (whether it is aerobic training which will challenge the cardiovascular system or weight training which will challenge the cardiovascular system to an extent and the muscular systems) conditions the body. Such workouts will improve efficiency of the heart, increase capillaries in the muscles bringing greater blood flow (more oxygen and nutrition), and increase glycogen stores and mitochondrial enzyme systems within the muscle cells (resulting in a much fuller look).

    Immediately following a workout, during a recovery period these systems build to greater levels to compensate for the stress that you have applied. The result is that you are now at a higher level of performance. However, if proper recovery time (rest) is not given then the body can not regenerate.

    The body will store less glycogen which is why you will look flat when you overtrain. If this imbalance between intense excess training and inadequate recovery (rest) time persists then performance will decline.

    Without proper recovery time, not only will you reach a performance plateau, but you also will run the risk of injury, and may even experience reduced performance (less strength, less endurance, etc.).

    Needed Rest Or Are You Just Being Lazy?

    It is important to be able to discern the difference between needed rest and just laziness. There are a lot of factors that can contribute to how you are feeling and how your body will respond.

    These Factors Include:

    Stress
    Sleep
    Nutrition
    Physical condition
    Emotional state
    Recuperation time; not necessarily in order of importance.
    Regardless of whether I have a show or not I will always listen to my body when it comes to training and recuperation.

    "The amount a rest and recovery time an individual needs will vary from person to person."

    Having been training for over 25 years I follow instinctive training to gauge whether or not I need rest. How much I train, how often, how fast, how long and how heavy will all depend on my energy levels and how I feel.

    Sometimes, I will opt to take a day off in the middle of my training split; sometimes I may slide a body part to the next day if my energy is off. Sometimes I won't even take a day off and I might cycle through my routine 2x before taking the day off. It will all depend as to how I feel.

    Because the mind can sometimes be tricky, in many cases I will always drive to the gym and attempt my workout to see if my lethargy is real. I have found that approximately 50% of the time once I get to the gym and start my workout I not alone have an amazing workout but I actually feel better (endomorphin release). Making myself go to the gym prevents my mind from psyching me out of a workout because I know I am forcing myself there.

    Defining Overtraining

    So what exactly is overtraining for a bodybuilder? Overtraining can best be defined as the state where your body has been repeatedly stressed by training (weight training and/or cardio) to the point where rest is no longer adequate to allow for recovery.

    There Are Two Main Types Of Overtraining:

    Localized
    Systemic overtraining
    Both can occur as a result of too much exercise/stress without enough recover time/rest and proper nutrition. Localized overtraining is the most common. As the name implies, localized overtraining effects a specific muscle or muscle group without affecting other muscle groups.

    The most common cause of localized overtraining is when the same muscle group is trained on successive days or with too much frequency without adequate amounts of rest. This can also occur when supporting muscle groups are trained on separate days, thereby never given these muscles a chance to recover.

    "It is very common for bodybuilders, power lifters and fitness competitors to experience localized overtraining."

    Systemic overtraining occurs must less frequently and is potentially the more serious of the two types of overtraining. Systemic overtraining will affect the entire body causing the body to enter a negative nitrogen balance (a catabolic state). As the body enters this state the body also produces an increased amount of cortisol.

    Cortisol is a hormone secreted by the adrenal cortex in response to stress. Cortisol impedes muscular repair and function, decreases testosterone production, inhibits protein synthesis, accelerates proteolysis (protein breakdown) and inhibits muscular growth. Making matters worse it also reduces the body's ability to use fat as an energy source, increasing the amount of stored fat within the body.

    Signs Of Overtraining

    There are many signs of overtraining. Physical symptoms include elevated morning pulse (10 beats more than normal), consistently elevated blood pressure, lack, persistent muscular soreness, increased frequency of common illnesses, like colds, increased incidence of injuries, and decreased appetite and weight loss. The effects from overtraining may not only by physiological.

    Emotional & Behavioral Symptoms Can Also Occur Such As:

    Irritability
    Mood swings
    Insomnia
    Depression
    Loss of desire to train (or do other things formerly enjoyed).
    Emotional and behavioral symptoms typically will only occur as a result of chronic (long term) overtraining (weeks to months). This condition is best known as "burnout"."

    This condition is different from short term overtraining in that post exercise fatigue and emotional swings persist even after recovery periods that are taken.

    The Overtraining Threshold

    The exact threshold for overtraining will vary among individuals, as everyone responds differently to exercise and stress. Some weightlifters can tolerate large volumes of sets and heavy weights while others can tolerate much less.

    "Regarding training volume the number of sets should be reasonable as not overtax your neuromuscular system and deplete your energy reserves."

    Several factors such as nutrition sleep quality, hormonal and enzymatic concentrations, muscle fiber composition, and previous training experience can impact recuperative capacity and, therefore effect when overtraining will occur.

    Although everyone has varying recuperative abilities, a period of 48 to 72 hours is usually required for adequate recovery between strength training sessions.

    For most people 8 hours of GOOD sleep is also a safe bet. Even the most experienced bodybuilders typically do not train large muscle groups more than ten to twelve total sets while subjecting smaller muscle groups to only eight to ten sets.

    Studies

    There have been several clinical studies done regarding overtraining. One interesting finding is that in many individuals overtraining increased the body's cortisol levels and dehydroepiandrosterone (DHEA). DHEA and cortisol are the body's long-acting stress hormones and are antagonistic to each other to some degree.

    DHEA has an anabolic or building influence, while cortisol has a catabolic or tearing down effect on the body. Normally these hormones are in balance.

    They become imbalanced during chronic overtraining. After proper rest and recovery, the body will reduce its output of cortisol and DHEA to resting levels. This is what happens with short episodes of stress. However, if proper recovery is not obtained such as in chronic overtraining conditions, the body will continue to make increasingly greater amounts of cortisol, while reducing the amount of DHEA produced.

    Elevated Levels Of Cortisol Can:

    Cause you to crave carbohydrates excessively especially in the evening

    Make you feel fatigued and exhausted

    Increase cholesterol and triglyceride production

    Decrease serotonin levels in your brain which can trigger depression.

    Deplete vital vitamins and minerals the body needs for proper function such as the B (aka, stress vitamins), Calcium and magnesium
    The consequences of elevated cortisol and reduced DHEA can be devastating. Although the effects from high cortisol and low DHEA levels will vary with each individual and will also be dependent upon genetics, lifestyle and environmental factors.

    The Negative Effects May Include:

    Reduced growth hormone (GH) release, which related to reduced muscle mass and strength, increased fat tissue, a weakened immune system and other health declines.

    Reduce protein synthesis.

    Increased protein breakdown, which can lead to muscle loss, bone loss, arthritis, and overall muscle weakness.

    Immune system compromise with increased risk to infections, certain and disease.

    Thyroid function impairment resulting in decreased metabolism, and increased fat storage.

    Glucose utilization and insulin function impairment resulting in higher blood sugar levels.

    Salt and water are retention, which can raise blood pressure (this can be deadly if anabolic aids which can also raise blood pressure through fluid retention are also used).

    Increased blood cholesterol and triglyceride levels increasing the risk for heart disease.

    Disrupted sleep patterns.

    Reduced R.E.M. (rapid eye movement)
    Overtraining has also shown to cause an increase in the amount of free radicals within the body. This can serve to exacerbate the catabolic effects of overtraining, making symptoms worse.

    Treatment For Overtraining

    The treatment for the overtraining sounds very simple - rest and proper nutrition. However, there are many different opinion regarding what is proper rest and what is proper nutrition. The can be further complicated for the pre-contest competitive bodybuilder who is increasing training while trying to control caloric intake.

    Rest & Relaxation

    There are many ways a bodybuilder can rest and reduce elevated cortisol levels. The most obvious method is to increase sleep (and I mean good quality R.E.M. sleep). This will increase GH levels and reduce cortisol levels.

    There are also other positive methods to reduce stress and aid in recovery. Such methods may include massage (which also increases blood flow to the muscle to aid in recovery), meditation, and yoga.

    "Reducing caffeine and other stimulants is also important since they negatively affect sleep patterns."

    Caffeine also stimulates the pituitary gland which also can raise cortisol and dopamine levels, which are the same neurotransmitter that makes heroin, amphetamines and cocaine which is one reason why some find caffeine addicting (some have found success using tyrosine supplementation to raise dopamine levels in the absence of caffeine).

    Rest - How Much Is Enough?

    To make gains a bodybuilder must straddle the line between challenging (stress) the body and rest. Unfortunately the amount of rest each person needs is also once again dependent upon genetics, lifestyle and environmental factors.

    Studies show that as we age we need less rest, but those studies are not geared towards competitive bodybuilders. The best recommendation I could give to a bodybuilder regarding what is the proper amount of rest is to advise him to listen to his/her body.

    The real key to success is to be able to detect the signs of overtraining early and to take the needed rest. This needs to happen even if you believe you do not have the time, and "your body is not ready for your contest". It is important to remember that in many cases more training will not be best, and will only result in a worse appearance. What is important is to train hard while you are in the gym, get the best nutrition and rest when you are out of the gym, and the rest (no pun intended) will follow.

    Nutrition & Supplementation

    Regarding nutrition, nothing beats a good balanced diet. Consuming quality carbohydrates, especially post-workout, helps to replenish glycogen stores and provide sufficient energy for intense training. It is also imperative to maintain an adequate amount of good quality protein.

    There is an abundance of evidence that weightlifters need up to 2x the amount of protein than the average person. As a minimum, serious weightlifters should consume approximately one gram of protein per pound of bodyweight to maintain a positive nitrogen balance. This means that a 200 pound bodybuilder should consume 5 protein meals of approximately 40 grams of protein.

    Protein Calculator
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    Results - Protein Per Day And Per Meal:
    For a bodyweight of pounds, take in grams of protein per day, and split it into five meals of grams of protein each.

    It is understood that this can be difficult sometimes do to today's fast paced environment, as well as during pre-contest time. Therefore the use of high quality supplements can be useful in preventing protein breakdown.

    Overtraining can deplete minerals such as zinc, magnesium, manganese, calcium, and vitamins B6, Pantothenic Acid (B5) and vitamin C. Additional supplementation of these vitamins and minerals are highly suggested.

    Anti-oxidants such as Vitamin C, Vitamin E, co-enzyme Q10, alpha-lipoic acid, and selenium should also be used since they have been proven effective in combating free radicals that form as a result of overtraining.

    A DHEA supplement is also desirable because DHEA is antagonistic to cortisol. 7-Keto DHEA is preferred by many bodybuilders because it is considered a more potent form of DHEA that will not be converted to active androgens (testosterone) and estrogens which will cause further water retention and a "soft" look.

    Glutamine supplementation should also be considered to replace glutamine stores used during the workouts, boost the immune system and to prevent protein breakdown. Arginine and ornithine supplementation is suggested to increase growth hormone levels.

    Conclusion

    The best defense to overtraining is a proper combination of good rest and proper nutrition. A well-planned training program will include adequate recovery time and proper nutrition, including proper supplementation.

    Most importantly listen to your body when you see the early warning signs of overtraining. Be flexible and adjust your workout, your sleep and your diet accordingly.

    Understanding the signs of overtraining and responding accordingly will help you reach your goals faster. See ya in the winners circle!
    Created by God, Enhanced by chemicals!!!
    www.bodybuildersreality.com


    "All your life you are told the things you cannot do. All your life they will say you're not good enough or strong enough or talented enough; they will say you're the wrong height or the wrong weight or the wrong type to play this or be this or achieve this. THEY WILL TELL YOU NO, a thousand times no, until all the no's become meaningless. All your life they will tell you no, quite firmly and very quickly.
    AND YOU WILL TELL THEM YES."


    In faith there is enough light for those who want to believe and enough shadows to blind those who don't.

    Being a Christian is like being a pumpkin. God lifts you up, takes you in, and washes all the dirt off of you. He opens you up, touches you deep inside and scoops out all the yucky stuff, including the seeds of doubt, hate, greed, etc. Then He carves you a new smiling face and puts His light inside you to shine for all the world to see.

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    Rocky's Avatar
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    Nice article man. You sure do find some good reading.
    We all have our challenges. What makes us who we are is how we rise to them.





    SHUT UP FOOL!


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    Quote Originally Posted by Rocky
    Nice article man. You sure do find some good reading.
    thanks brother.. i want this forum to have as much information as possible..
    Created by God, Enhanced by chemicals!!!
    www.bodybuildersreality.com


    "All your life you are told the things you cannot do. All your life they will say you're not good enough or strong enough or talented enough; they will say you're the wrong height or the wrong weight or the wrong type to play this or be this or achieve this. THEY WILL TELL YOU NO, a thousand times no, until all the no's become meaningless. All your life they will tell you no, quite firmly and very quickly.
    AND YOU WILL TELL THEM YES."


    In faith there is enough light for those who want to believe and enough shadows to blind those who don't.

    Being a Christian is like being a pumpkin. God lifts you up, takes you in, and washes all the dirt off of you. He opens you up, touches you deep inside and scoops out all the yucky stuff, including the seeds of doubt, hate, greed, etc. Then He carves you a new smiling face and puts His light inside you to shine for all the world to see.

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    BigBen is offline Banned
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    Great post serb

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    Why am I so tired?

    by Jody Welborn, M.D.


    Fatigue is a very common complaint and affects athletes of all ages, sizes and abilities. It is one of the most common complaints in the physician’s office, with one in every four patients stating that fatigue is disrupting his or her life.

    What is Fatigue?

    Fatigue is a subjective condition in which a person feels tired before beginning an activity, lacks the energy to accomplish tasks requiring sustained effort and attention, and becomes unduly exhausted after normal activities. It can range from pervasive and overwhelming to subtle, felt only during all-out competition. Fatigue, as a symptom, is vague and can be wide-ranging in its implications.

    What are the most common causes of fatigue? For the friends and family in our lives, it is obvious that the reason we are tired is the fact that we get up at 4:30 in the morning to exercise strenuously prior to starting the work day. How would that have an impact? It is important to remember that the human body requires 7-10 hours of sleep in a 24 hour period. When there is not enough time, the first place typically cut back is sleep time. If you are getting up early to exercise, or staying up late, it is important to adjust your sleep time accordingly. If continuous sleep is not possible, a 20-40 minute nap during the day may help.

    Insomnia

    Sometimes the problem isn’t lack of sleep, but the inability to fall asleep. Everyone has problems with insomnia at some time, typically associated with a change in the daily routine such as travel or a new job. Others have more persistent trouble sleeping.

    There are a variety of causes for insomnia. These include illness, medications, or depression and should be discussed with a physician. Many times the exact cause of the insomnia cannot be identified. However, there are a variety of things to try in order to improve sleep.

    It is important to go to bed at the same time each night and to get up at the same time each morning. Napping in the middle of the day should be avoided. A regular exercise routine should be followed and it may be of benefit to exercise in the late afternoon or early evening. At bedtime, the room should be dark and quiet and extremes of temperature should be avoided.

    If you find yourself unable to fall asleep, after 30 minutes get up, do some quiet activity and return to bed when you are sleepy. Avoid caffeinated foods or beverages after 4 p.m. and remember that although alcohol is a sedative, it also prevents deep, restful sleep and should be avoided if sleeping is a problem.

    Overtraining

    An overlooked cause of fatigue in the athletic adult is overtraining. One of the hardest things for an athlete to do is rest. The mind set is to push harder to get stronger and faster. We forget that it is possible to get too much of a good thing, even exercise, and that rest is an important part of training.

    Rest and Recovery

    What is rest? Rest can be the time when no strenuous activity is performed such as in sleep time or days off. It can also be more active and involve low intensity exercise, allowing a small amount of increased blood flow to reach the muscles. Both types of rest allow recovery to occur.

    Recovery is what the body does during rest periods to repair the damage to muscle cells after strenuous activity. If the body is given enough rest to allow adequate recovery, the body will completely repair the broken-down muscle cells and even build them up a little stronger, resulting in a stronger and faster athlete.

    Balancing act

    Exercise needs to have a balance between training and recovery. If an imbalance occurs and is allowed to persist, overtraining results. The athlete, and those around them, will notice lingering fatigue, mood changes, irritability, altered sleep and persistent soreness. Performance in workouts or competition may deteriorate. Frequent respiratory illnesses or even an overuse injury may occur.

    The cure for overtraining is rest. The more severe the problem, the more rest needed to fix it. This can be very difficult to do until illness or injury forces the rest to occur. Prevention can help the adult athlete avoid this problem. Programming rest into the training can help. It is also important to be aware of how the body is responding to training. Some, particularly those who are prone to overdoing it, find it beneficial to keep a fatigue score, ranking the cumulative “feel” during the day from 1-5. If this score goes up over days to weeks, it may be time to decrease the intensity of training. Another way to track overtraining is to measure morning heart rate. If the measured pulse increases progressively, it may be a sign that the body has not had ample time for recovery. Both the fatigue scale and the morning heart rate can be recorded in a training log.

    It is also important for the adult athlete to factor in the outside stresses of real life, job and family. Anticipate times of increased stress and adjust the workout schedule accordingly.

    There are many causes of fatigue in the athletic adult. It is important to listen to your body and heed your body’s warning signs. It is also important to remember that unrelenting fatigue may be a sign of underlying illness and you should consult with your physician if this occurs.

    Jody Welborn is a cardiologist from Portland, Oregon. Her medical experience includes a B.A. from the University of Oregon, M.D. from Oregon Health Sciences University, internal medicine residency at University of Texas, San Antonio, and Cardiology fellowship at the University of Alabama, Birmingham. Jody is a member of three USMS national committees, including Sports Medicine, Fitness and Planning. She is also a Masters swimmer who swims with the Metro YMCA Masters in Portland.

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    Overtraining Syndrome
    A Guide to Diagnosis, Treatment, and Prevention
    Christopher J. Hawley, MD; Robert B. Schoene, MD

    Practice Essentials Series Editors:
    Kimberly G. Harmon, MD; Aaron Rubin, MD

    THE PHYSICIAN AND SPORTSMEDICINE - VOL 31 - NO. 6 - JUNE 2003



    --------------------------------------------------------------------------------

    In Brief: Overtraining syndrome is a common cause of underperformance in athletes. Symptoms such as persistent fatigue, muscle soreness, reduced coordination, weight loss, mood changes, and frequent illness may accompany performance decrements, but they may also be signs of underlying medical conditions. Reliable and practical diagnostic laboratory tests for overtraining have not yet been identified. Clinicians can prescribe relative or complete rest and strive to identify and correct the training, nutritional, and psychosocial factors that contributed to the athlete's condition.

    Overtraining syndrome can be a devastating condition for any athlete, because recovery requires an extended period away from training and competition. Evaluating and treating a persistently fatigued and underperforming athlete for overtraining syndrome can be challenging. Frequently, overtraining syndrome is not recognized until months of poor performance and fatigue have occurred. The diagnosis is difficult, because numerous other medical and psychological conditions have similar symptoms. Overtraining syndrome can only be diagnosed after other causes have been excluded.

    The existence of the condition has been well documented in the scientific literature and in many excellent reviews.1-4 However, reliable and clinically practical tests for diagnosis have not been established, and the underlying mechanism for the performance decrements is not known.5,6 Further research is needed to provide evidence-based diagnostic, treatment, and return-to-play approaches to this complex condition.

    Definitions
    Vigorous training, followed by recovery, is essential for improving athletic performance. Some level of fatigue, depression, feelings of burnout, anxiety, irritability, and difficulty concentrating or sleeping is normal for athletes undergoing heavy training or competition. Athletes may also experience persistent muscle soreness, decreased coordination, reduced libido, and frequent upper respiratory infections.7 This training state is termed "overreaching" and is an expected part of vigorous training.

    The symptoms and reduced performance capacity of an overreached athlete resolve quickly if followed by a period of lighter training, often referred to as tapering. During tapering, the athlete's performance capacity will increase beyond the pretraining baseline, and this response is called "supercompensation." If overreaching continues for too long, overtraining syndrome can develop, and the symptoms and decreased performance ability can last for weeks to months (figure 1).




    Overtraining syndrome has been defined as persistent underperforming, with or without other accompanying psychological and physical symptoms, despite 2 weeks of lighter training or complete rest.7 Overtraining syndrome develops when excessive physical and psychological stress are combined with inadequate recovery time. Immunosuppression, neurohormonal imbalances, and chronic inflammation may account for the observed symptoms, but the underlying mechanism is not known.5,6

    The syndrome has been documented in a wide variety of both endurance and strength or power sports. Morgan et al8 reported that overtraining syndrome developed in more than 60% of elite distance runners at least once in their careers. Other prevalence studies demonstrated that overtraining syndrome developed in 21% of the Australian swimming team after 6 months of training for a national competition, 33% of an Indian basketball team during a 6-week training period, and more than 50% of soccer players on a team monitored after the competitive season.9

    Detailed History
    Evaluating a fatigued athlete requires a comprehensive history and physical exam to narrow the differential diagnosis. The history should include a review of systems to screen for symptoms that could indicate life-threatening cardiac, respiratory, or infectious illnesses. Red flags include chest pain, syncope, palpitations, fevers, dyspnea, or family history of sudden cardiac death. When overtraining syndrome is suspected, the history should include the athlete's training and recovery patterns, an inventory of psychosocial stressors, and an assessment of nutritional practices.

    Training and recovery. When applicable, the athlete's coach should be involved in the history taking process, evaluation, and treatment planning. Familiarity with training programs specific to a sport and the athlete's physical needs, psychological capacity, and skill level are valuable in identifying an athlete who might be training excessively. Consulting other physicians, coaches, and exercise physiologists is useful for clinicians who are unfamiliar with training patterns relevant to the athlete's situation.

    Documenting the volume and intensity of training at daily, weekly, monthly, and yearly intervals is important to assess for risk factors of overtraining syndrome. Lack of recovery time in the training schedule is the most important risk factor.3 Chronologically documenting objective performance indicators will also help identify when stagnation or performance decrements began.

    A daily training log to track subjective symptoms is sensitive and specific for predicting which athletes will develop overtraining syndrome.2-4,10 Sleep quality, stress levels, fatigue, and muscle soreness are rated to monitor training responses (see the Patient Adviser, "Overtraining Syndrome: Why Training too Hard, too Long, Doesn't Work"). One study10 quantified these ratings on a 1 to 7 scale in elite swimmers. Higher scores on individual items indicated a poor response to training. Rising scores predicted overtraining syndrome 1 to 2 weeks before the actual performance declined.

    Psychosocial factors. Because both sport- and non-sport-related psychological stressors contribute to overtraining syndrome, a detailed psychosocial history is necessary. Sport-related factors can include conflict with teammates, coaches, or staff and fear of competition or poor performance. Elements not related to sport include concerns regarding employment, academic studies, and family or social relationships. The amount of required sleep and other time commitments of the athlete should also be considered.

    Subjective symptoms remain the most sensitive indicators of overtraining syndrome.2-5 A variety of psychological assessment tools have been applied to overtraining syndrome. The Profile of Mood States (POMS) has been the test most frequently studied. This 65-question test provides a mood profile with scores in seven different domains: tension-anxiety, depression, anger, vigor, fatigue, confusion, and total mood.11 Athletes with overtraining syndrome have higher scores for total mood disturbance, depression, tension, and decreased vigor.2,4,8,10 The POMS test doesn't diagnose overtraining syndrome but does provide a validated method for documenting mood changes consistent with the condition.

    When maintained over a season, training logs and POMS can be useful tools for athletes and coaches. Significant changes in scores and performance may indicate overtraining, but other factors such as illness, injury, technique or equipment changes, diet, travel, and psychosocial issues must also be considered. The athlete's response to a few days of rest or recovery training can often help clarify whether symptoms represent short-term overreaching, overtraining syndrome, or another cause for mood and performance changes.

    Diet. Nutritional factors that contribute to the development of fatigue include dehydration and inadequate intake of complex carbohydrates, protein, vitamins, or minerals.2 The history should include present and past use of medications, supplements, and ergogenic aids and screen for disordered eating patterns. Dieting practices (eg, low-carbohydrate, vegetarian, or high-protein diets) should be reviewed. A dietary record can be requested from the athlete and analyzed by the clinician or nutritionist or relevant software package.

    Environment. Common causes of fatigue (table 1) include factors not related to illness. Recent travel, increases in academic or employment workload, insufficient sleep, equipment changes, and changes in training environment (eg, extreme heat, cold, or altitude) should be considered.


    TABLE 1. Causes of Persistent Fatigue and
    Underperformance in Sports


    --------------------------------------------------------------------------------

    Common
    Caffeine withdrawal
    Environmental allergies
    Exercise-induced asthma
    Infectious mononucleosis
    Insufficient sleep
    Iron deficiencies with or without anemia
    Overtraining syndrome
    Performance anxiety
    Primary mood disorder:
    Anxiety, depression, adjustment reaction
    Psychosocial stress
    Upper respiratory infection

    Less Common
    Dehydration
    Diabetes mellitus
    Eating disorders
    Hepatitis A, B, or C
    Hypothyroidism
    Inadequate carbohydrate or protein intake
    Lower respiratory infection
    Medication or supplement side effect:
    Antidepressants, antihistamines, anxiolytics, beta-blockers
    Postconcussive syndrome
    Pregnancy
    Substance abuse

    Relatively Rare, but Important
    Adrenocortical insufficiencies or excess
    Addison's disease
    Cushing's syndrome
    Tumors or hyperplasia
    Congenital or acquired heart disease
    Arrhythmias
    Bacterial endocarditis
    Congestive heart failure
    Coronary artery disease
    Hypertrophic cardiomyopathy
    Myocarditis or pericarditis
    Human immunodeficiency virus
    Intestinal malabsorption
    Lung disease
    Chronic obstructive pulmonary disease
    Restrictive disease
    Lyme disease
    Malaria
    Malignancy
    Neuromuscular disorder
    Renal disease
    Syphilis



    Risk factors. Some common mistakes in training include lack of periodicity and rest days, year-round competition, and monotonous training routines. Athletes who train according to a published program of a top athlete, train without a coach or partner, or train with significantly more skilled or physically fit athletes may be headed for trouble. Frustration may tempt athletes to train more vigorously in response to plateaus or declines in performance or to train while experiencing significant psychosocial stressors. A thorough history will screen for these factors.

    Thorough Physical Exam
    A complete physical examination should address any underlying causes of fatigue not related to overtraining syndrome. Characteristic physical exam findings in overtraining syndrome have not been documented; however, common findings include resting heart rate changes, decreased body fat, cervical lymphadenopathy, and exaggerated blood pressure and heart rate responses to postural changes.2-4 These findings are not consistently evident in athletes with overtraining syndrome and occur in many other medical conditions as well.

    Laboratory Testing
    Unfortunately, there are no sufficiently sensitive and specific diagnostic tests for overtraining syndrome. Many biologic markers for overtraining syndrome require serial measurements and comparison to baseline data. Collection must be well controlled, which is often achievable only under research conditions. Changes in laboratory parameters often don't distinguish between overreaching and overtraining syndrome.

    Initial laboratory testing is useful, however, to screen for other causes of fatigue. Testing should include a complete blood count, thyroid-stimulating hormone level, iron studies, serum electrolytes, blood urea nitrogen, and creatinine levels. Pregnancy testing, liver function tests, urinalysis, serum cortisol levels (after stimulation testing) and serologies for Epstein-Barr, hepatitis, or human immunodeficiency virus are frequently indicated. Other studies may be needed based on the clinical situation.

    If baseline measurements (eg, maximal oxygen consumption, heart rate, and workload) are known, exercise testing may demonstrate a reduced physical performance capacity. These changes are not consistently present in overtraining syndrome and are not specific for the diagnosis. Documenting a reduced physical capacity could be helpful, however, if other objective indicators of performance decrements are not found in the athlete's history. Continuous electrocardiography and pre- and posttest spirometry can also be used to evaluate exercise-induced bronchospasm and other pulmonary conditions, cardiac ischemia, and arrhythmias.

    Overtraining or Fatigue?
    When evaluating a fatigued athlete during a vigorous training or competition cycle, the line between overreaching and overtraining syndrome is often difficult to discern. The response of the athlete to a 2-week trial of lighter training or rest can help sort out difficult cases. The symptoms of an athlete who has overtraining syndrome will not resolve during a short-term reduction of training, unlike many other causes of fatigue that may improve significantly.

    When fatigue has been present more than a few weeks, overtraining syndrome becomes a more likely diagnosis. The initial symptom is often an increased level of fatigue during usually well-tolerated workouts. As the syndrome progresses, chronic fatigue at rest and other symptoms commonly develop (see table 1).

    Diagnosis
    Currently, overtraining syndrome remains a clinical diagnosis that has no laboratory, exercise, or psychological testing criteria. Testing is useful but should not be relied upon for diagnosis. A constellation of subjective physical and psychological symptoms are frequently present but are not included as part of the diagnostic criteria. Diagnosis of the syndrome requires exclusion of other causes of underperforming and persistence of performance impairment after more than 2 weeks of relative or complete rest.

    Treatment
    Since little data exist to guide the clinician in the treatment of overtraining syndrome, we will discuss practical approaches for developing treatment programs that have been successful in our experience and are consistent with other published methods.2-4,12

    Rest. Rest is the foundation of treatment for overtraining syndrome, because the condition represents an imbalance of stress and recovery. Koutedakis et al13 found that underperforming Olympic athletes in a variety of sports had improvements in maximal oxygen consumption, body weight, lactate threshold, and psychological factors after 3 to 5 weeks of rest. A well-performing control group of athletes had no change in parameters during the same period.

    Prescribing prolonged rest to elite athletes who have a clinical syndrome, rather than a specific physical injury, can present challenging situations for the clinician. Resistance may arise from athletes, coaches, or administrators who are not familiar with the condition or have differing opinions on the cause of the athlete's fatigue and underperformance. Establishing an ongoing dialogue with interested parties and forging a trusting doctor-patient relationship with the athlete will improve the chances for a successful outcome.

    Therapeutic exercise. No randomized controlled trials compare recovery patterns in athletes who are prescribed a significant decrease in training versus complete rest. Competitive athletes usually prefer a treatment plan based on "therapeutic exercise" rather than complete rest. The prescription should be tailored according to the degree of fatigue, duration of overtraining, and preference of the patient.

    Relative rest consists of light aerobic exercise using a modality not related to the athlete's sport (eg, a swimmer may use an exercise bicycle, a runner may use an eliptical cross-trainer). This helps curb the temptation to compare their current volume and intensity of exercise to previous training experiences. Cross-training also increases the likelihood that they will adhere to a plan of exercise for therapy purposes, rather than return to training for performance enhancement.

    Starting with 5 to 20 minutes of aerobic exercise at a heart rate less than 140/min ensures a light training load. Frequent discussions with the athlete and daily training diaries are useful for monitoring recovery. Simple dairies can include quantifying exercise volume and intensity with subjective scores for fatigue, sleep quality, stress levels, mood, and muscle soreness.

    Mood monitoring. The POMS questionnaire is another option for monitoring recovery. As with any subjective feedback mechanism, be aware that some athletes may manipulate symptoms or responses. If scores or athletes' symptoms are steadily improving, exercise volume can be increased each week. Athletes should progress slowly, adding 5 to 10 minutes per week, until an hour of exercise is well tolerated. Six to 12 weeks is typically required before symptoms resolve and an hour of light exercise is tolerated.12 Months or years of rest are required in a small number of patients.

    Significant sports-related and non-sports-related psychosocial stressors should be adequately addressed. This may require coordination of care with a sports psychologist or other mental health professional familiar with the unique challenges of competitive athletics.

    Athletes should be reassessed relatively soon after prescribed training reductions to assess compliance with rest and to monitor the psychological impact. Underlying mood state changes that accompany overtraining can initially worsen with recommended rest. No data are available to guide the decision for pharmacologic treatment of anxiety and depression symptoms. We recommend delaying treatment unless an underlying primary mood disorder is strongly suspected. Mood levels should slowly improve as physical recovery occurs.

    Other modalities. Anecdotal adjuncts to rest include massage and hydrotherapy for persistent muscle soreness and stress reduction.4,12 Nutritional practices should be optimized, with an emphasis on a balanced diet and proper hydration. Referral to a sports nutritionist can be beneficial.

    Return to Play
    Before advising a return to training or competition, mood state, fatigue, sleep quality, and muscle soreness should have normalized. A careful analysis of training factors that led to the syndrome should be identified. Training should be organized around principles of periodization (figure 2) to minimize the risk of the patient's having a relapse.2-4,14,15 This should include at least 1 day a week of complete rest to allow for recovery. Monthly schedules should also have 1 lighter training week in the midst of heavier training weeks.




    Training schedules should also be organized on a yearly calendar to ensure that adequate tapering time is available before competition. Olympic-level athletes may need to organize training on a 4-year schedule to peak at the desired times. Many excellent resources are available for further details on periodization of training.14,15 Training cycles will differ by sport and by athletes' goals.

    In team sports or group training situations, individual flexibility in workload is necessary to accommodate the different responses athletes have to the same training load. Clinicians may need to direct athletes toward consultation with expert coaches or exercise physiologists who are experienced in analyzing the periodization principles of the training program.

    Monitoring. As the training levels begin to increase, athletes should be monitored for signs of maladaptation to training. Maintaining a training log and periodic POMS testing are relatively easy ways to evaluate training effects. A consistent downward trend in scores should prompt a reevaluation of the balances of stress and rest. Objective performance indicators and exercise testing may also be used to detect incomplete recovery or excessive training.

    Clinician, coaches, and athletes will need to negotiate their respective roles in monitoring for excessive training. While instituting a formal monitoring program may provide additional information, no foolproof system exists that will guarantee against overtraining. Formal monitoring programs cannot serve as a substitute for good communication between the athlete and coaching staff in assessing the response to vigorous training.

    Prevention Benefits
    Because overtraining syndrome can prematurely end an athlete's season or career, prevention remains the ideal goal. The diagnosis is based on clinical assessment, since highly sensitive and specific tests are not yet available. The foundations of treatment are rest, minimizing psychosocial stressors, and improving nutrition. Identifying the training excesses that led to the athlete's declines will help prevent recurrence.


    References
    Kreider RB, Fry AC, O'Toole ML (eds): Overtraining in Sport. Champaign, IL, Human Kinetics, 1998
    Mackinnon LT, Hooper SL: Overtraining and overreaching: causes, effects, and prevention, in Garrett WE, Kirkendall DT (eds): Exercise and Sport Science. Philadelphia, Lippincott Williams & Wilkins, 2000, pp 487-498
    Fry RW, Morton AR, Keast D: Overtraining in athletes: an update. Sports Med 1991;12(1):32-65
    Uusitalo AL: Overtraining: making a difficult diagnosis and implementing targeted treatment. Phys Sportsmed 2001;29(5):35-50
    Urhausen A, Kindermann W: Diagnosis of overtraining: what tools do we have? Sports Med 2002;32(2):95-102
    Armstrong LE, VanHeest JL: The unknown mechanism of the overtraining syndrome: clues from depression and psychoneuroimmunology. Sports Med 2002;32(3):185-209
    Kreider RB, Fry AC, O'Toole ML: Overtraining and overreaching in sport: terms, definitions, and prevalence, in Kreider RB, Fry AC, O'Toole ML (eds): Overtraining in Sport. Champaign, IL, Human Kinetics, 1998, pp vii-ix
    Morgan WP, Brown DR, Raglin JS, et al: Psychological monitoring of overtraining and staleness. Br J Sports Med 1987;21(3):107-114
    Lehmann M, Foster C, Netzer N, et al: Physiological responses to short and long-term overtraining in endurance athletes, in Kreider RB, Fry AC, O'Toole ML (eds): Overtraining in Sport. Champaign, IL, Human Kinetics, 1998, pp 19-47
    Hooper SL, Mackinnon LT, Howard A, et al: Markers for monitoring overtraining and recovery. Med Sci Sports Exerc 1995;27(1):106-112
    McNair DM, Lorr M, Droppleman LF: POMS Manual: Profile of Mood States. San Diego, Educational and Industrial Testing Service, 1992
    Budgett R: Fatigue and underperformance in athletes: the overtraining syndrome. Br J Sports Med 1998;32(2):107-110
    Koutedakis Y, Budgett R, Faulmann L: Rest in underperforming elite competitors. Br J Sports Med 1990;24(4):248-252
    Fry RW, Morton AR, Keast D: Periodisation and the prevention of overtraining. Can J Sport Sci 1992;17(3):241-248
    Rowbottom DG: Periodization of training, in Garrett WE, Kirkendall DT (eds): Exercise and Sport Science. Philadelphia, Lippincott Williams & Wilkins, 2000, pp 499-512

  7. #7
    philosopher's Avatar
    philosopher is offline Banned
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    just helping you out serb

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    Q80_MuscleHed is offline Banned
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    thx guys .. great articles

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    Quote Originally Posted by philosopher
    just helping you out serb
    thanks man.. its all good bro
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    MaKaVeLi is offline IFBB Superheavyweight
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    took some time but well worth the read!
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