Are my clients overtraining?

02 November 2017

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Whether you’re an athletic coach, personal trainer or medical professional, it is imperative to constantly monitor, detect and address the signs and symptoms of non-functional over-reaching and overtraining in clients and athletes.

Overtraining defined

Functional over-reaching (FO) is the short term imbalance between training adaptation and recovery, in which appropriate rest will allow adaptation to allow the body to gain higher levels of fitness/preparedness. Non functional over-reaching (NFO) is defined when training exceeds the bodies ability to recover, resulting in declined physical and athletic performance. IT may take few days to weeks to recover from NFO. Overtraining syndrome (OTS) is defined by similar symptoms to NFO but may take months to years to gain full recovery.

Unfortunately we don’t have conscious awareness of the underlying physiological changes that happen within our body, until we reach a non-functional overreaching state. It is when symptoms of NFO express themselves, we are able to become aware of them. The time in which we sense these feelings is never to late, because the brain wouldn’t register or alert us at a time where it wouldn’t be possible to revert to a neutral zone of homeostatic control. when neutral homeostatic control mechanisms are constantly and increasingly “outweighed” by the need for constant physiological adaptation, a threshold is reached. As soon as this threshold is reached, we then start to perceive the symptoms of over-reaching.

Crux of the problem

The problem arises whereby the athlete or client choose to ignore or believe that there fitness levels (1RM bench press or squat, 4 mile running or sprint time) have declined due to not committing hard or long enough to there increasingly and progressive intensity and volume of training. Therefore, clients will counteract this by training harder which may lead to OTS. On the contrary, the trainer notices declination of performance and associates this decline with a lack of commitment on the client’s behalf. In this case, the trainer “REVS” up the intensity and volume which can also lead to NFO and OTS.

What does the evidence say?

A paper published by the British Journal of sports medicine objectively distinguished between those with NFO and OT. Patients diagnosed with OTS and NFO participated in 2 incremental exercise tests with an interval of 4 hours apart.

Those with OTS showed significant suppression in prolactin and adrenocorticotrophin (ACTH) releasing hormone immediately after the second bout of exercise, whereby those with NFO exhibited an increase in these hormones. This suggests that patients with OTS have impaired communication between the hypothalamus, pituitary and adrenal gland. it is the adrenal gland which enables the body to increase and maintain adequate exercise tolerance.

What is epinepherine and norepinepherine?

Changes to blood biochemistry during the onset of exercise signals the brains hypothalamus to secrete Corticotropin releasing hormone (CTRH). CTRH signals the anterior pituitary gland to release ACTH which acts on the adrenal gland. the adrenal gland releases adrenaline and cortisol which have multiple effects during exercise which include:

1. Increase forceful contraction of heart rate to pump more oxygenated blood to muscles in demand

2. Convert stored carbohydrate in liver to glucose in the bloodstream to generate more cellular energy for the nervous system and muscles.

3. Constriction of blood vessels to Gastrointestinal tract and other non essential organs and arterial dilation to muscles demanding oxygen and glucose.

As you can see, impairment of the brain to send signals to the adrenal gland, will lead to a reversal of the above effects, leading to an inability to carry out a particular exercise workload with ease. Continued bouts of physical activity during this fatigue state over months, can lead to a chronic fatigue maladaptation in the brain.

Fatigue is in the brain!?

Overtraining syndrome involves alteration to the central nervous system (CNS). The Central governor model states that fatigue is a behavioural strategy that is expressed based on the brains evaluation of the complex interaction between physiological, biochemical and sensory feedback systems, and not just simply a correlative and linear response to fatigue at a peripheral cellular level. Even at maximal exercise to fatigue, ATP levels never fall below 50% and not all motor units are activated. This suggests that those with overtraining syndrome might have a set-point threshold that is determined by an unusual increase in % of ATP availability and motor unit reserve, that is the main driver for the expression of “fatigue”.

Therefore, subjective and objective measures should take precedence over objective measures of fitness parameters alone, as its the brain that calculates peripheral organ tissue biochemistry and determines when the perception of ‘fatigue’ will set in.

Symptoms of non-functional over-reaching

1. Increasing and constant fatigue

2. Unrefreshing sleep

3. Chronic injury due to altered sequential muscle activation patterns

4. Heart palpitations that immediately come on standing upon rising from a lying down position.

5. Significant decline in cardiovascular performance

6. Significant reduced threshold during a strength workout, whereby a rapid build up of “heaviness” is perceived in the working muscle, that may come on during or immediately after, and may take few hours to resolve.

7. Decline in reaction time

8. Sugar cravings

9. Prolonged unusual recovery

10. Muscle and joint aches

11. Slow recovery and increased incidence of infection

Differential diagnosis of non progressive over-reaching and over-training syndrome can be challenging for the health practitioner with a limited scope of practice and understanding in pathophysiology. Therefore, Other various pathologies or syndromes must be ruled out by a medical doctor.

These include:

– Addison’s disease

– Hypothyroidism

– Mitochondrial disease

– Various types of Anaemia

– McArdle syndrome

– Pituitary gland tumour causing hypopituitarism

– Other various metabolic, nutritional & endocrine disorders

Further medical examination testing, typically involve blood measures which would include Full blood count, Salivary tesosterone to cortisol ratio, ACTH, CTRH, TSH, T3, T4, myoglobin enzyme, Troponin, Creatine kinase enzymes, C-Reactive protein, ESR.

As health professionals in gym settings or private practice, we don’t have access to advanced testing equipment for measuring blood hormone biochemistry and other markers of over-training. Therefore we must constantly look out for symptoms of over-reaching and over-training in athletes.

So what examination tests can I deliver, that are practical for my client?

– Ask your client to perform two incremental aerobic tests of four hours apart and to self monitor perceived levels of exertion and heart rate at each increment in speed or power output. If during the second exercise test, there is significant increase in perceived exertion levels, heart and breathing rate at the same exercise setting, then it is highly probable that the client or athlete is bordering between an over-reaching and over-trained state.

– Blood pressure difference between supine to standing. A drop of 20 millimeters of mercury (mm Hg) in your systolic blood pressure or a drop of 10 mm Hg in your diastolic blood pressure within two to five minutes of standing up.

– Blood glucose level during and after exercise. impaired increase during exercise indicates impaired adrenal gland responsiveness to nerve signalling from the brain.

– Heart rate variability between mid inspiratory to full expiratory breathing. This should be measured daily to record a basic norm. Significant increase in the difference indicates an athlete is in a NFO or overtrained state .

– Administer a profile of mood states questionnaire score (POMS) daily.
As health professionals, we have an important role to play in managing the health in our clients and athletes, to ensure optimal and maximum performance without inducing the risk of overtraining syndrome. If your patient exhibits the typical symptoms or signs, then it is imperative to refer to a medical doctor or sports physician.

References:

1. Meusen.R., Nederhof.E., Buyse.L., Roelands.B., De Schutter.G. & Piacentini.M.F (2010). Diagnosing Overtraining in athletes using the two-bout exercise protocol, British Journal Of Sports Medicine, 44, 642-648.

2. Budgett, R. (1998). Fatigue and underperformance in athletes: The overtraining syndrome, British Journal Of Sports Medicine, 32, 107-110.

3. Brooks, K.R. & Carter J.G (2013). Overtraining, exercise and adrenal insufficiency, National Institute of health, 3(125), 1-10.

4. Noakes, T.D., St Claire Gibson, A. & Lambert, E.V (2004). From catastrophe to complexity: a novel model of integrative central neural regulation of effort and fatigue during exercise in humans, British Journal of Sports Medicine, 38, 511-514.

5. Weir, J.P., Beck, T.W., Cramer, J.T. & Housh, T.J (2006). Is fatigue all in your head? A Critical review of the central governor model, British Journal Of Sports Medicine, 40, 573-586.[/vc_column_text][/vc_column][/vc_row]