If you are preparing for the Melbourne Marathon, no doubt your training has been in full swing. If however, instead of getting fitter and stronger, you are feeling more tired and lethargic and your performance is deteriorating, you may be suffering from Overtraining Syndrome. This is a disorder of the nervous and hormonal systems of the body which is caused by inadequate recovery of the body following intense training.1
Intense training = Intense Stress, Prolonged Training = Chronic Stress
You see, intense training puts intense stress on all the systems of your body. The emphasis of the body's functioning is shifted away from growth and repair to optimising physical performance. The need for energy stimulates the release of cortisol from your adrenal glands.
Cortisol, a stress hormone, stimulates all the physiological processes of your body to give you the "get up and go" to perform everyday tasks. It does this by causing your muscles to be broken down to release sugar for energy but at the expense of suppressing your immune and digestive systems.2
Stress = Tissue breakdown and suppression of Your Immune and Digestive Systems
Essentially, therefore training breaks down (catabolic process) your body's tissues so that they can rebuild (anabolic process) to be better, stronger or faster. The problem with overtraining syndrome is that your body's systems don't get sufficient time or have an adequate environment to regenerate before the next intense training stimulus is delivered leading to further breakdown and muscle weakness.
Any perceived demand for energy will cause the release of cortisol. We are the only living thing that can activate the stress response by thought alone.2 Work deadlines, home demands, financial stresses, relationship issues, poor eating habits and lack of sleep all cause the release of cortisol. Add to this an intense, prolonged training program and you can see how easily overtraining syndrome can develop. Disorders then occur when a person's perceived stress levels get beyond coping.
Initially, your adrenal glands are stimulated into producing increasing amounts of cortisol which may lead to metabolic disturbances such as:
- Lack of quality sleep (Important not to exercise at night as cortisol breaks down Tryptophan an amino acid that is an ingredient in Serotonin that is a precursor to melatonin the sleep hormone)
- Inability to concentration and sugar cravings (due to dysfunctional sugar regulation)
- Headaches (due to increased muscle tension)
- Loss of appetite and poor digestion (due to shut down of digestive enzymes)
- Gut disturbance – constipation or diarrhoea (Imbalance between good bugs Vs bad bugs)
- Malabsorption of essential nutrients (due to decreased gut permeability)
- Increased vulnerability to disease and infections (due to decreased number and function of immune cells)
- Sexual dysfunction and low libido (cortisol is made instead of sex hormones)
- Muscle weakness and aches and pain (cortisol made instead of testosterone)
- Heightened sensitivity to pain (cortisol impedes Serotonin production, the happy hormone that inhibits pain)
- Learning and memory impairment( as excessive cortisol damages the brain’s hippocampal cells)
- Exaggerated inflammation throughout your body.1
Eventually your adrenal glands become exhausted leading to insufficient cortisol being produced resulting in extreme fatigue.2
Diagnosis of Overtraining
Whilst there are many symptoms associated with overtraining, only a few have been shown to be valid and reliable indicators of this syndrome. These include:
- Performance deterioration
- Persistent, severe fatigue
- Decreased maximal heart rate
- Reported high stress levels
- Sleep disturbances
- Changes in blood Lactate threshold
- Elevated resting adrenaline levels1
- Other reported signs and symptoms for which there have been conflicting studies include:
- Increased early morning heart rate or resting blood pressure
- Frequent illness such as colds and chest infections
- Persistent muscle soreness
- Loss of muscle
- Apathy, lack of motivation
- Loss of appetite
- Irritability or depression1
Many of the signs and symptoms of overtraining syndrome are remarkably similar to those of depression, fibromyalgia and chronic fatigue syndrome.1
Prevention of Overtraining
The most important factor in treating overtraining is preventing it in the first place. Having a correctly planned training program which incorporates adequate time for rest, recovery and regeneration as well as employing techniques to enhance recovery will go a long way to preventing overtraining.
Techniques such as ice baths, mindfulness meditation, remedial massage, exercise in water and Bodyflow therapy have all been proven to enhance recovery and regeneration.
Likewise, getting at least 7 ½ hours' sleep (and being asleep before 11pm!) as well as taking time out to laugh and enjoy life away from the pressures of your life are important to reducing the build-up of stress and tension that may lead to less than optimal health. 3
To prevent overtraining syndrome from a nutritional standpoint, you need to consume adequate amounts of:
- fluid (1.5 to 2 litres of water per day)
- protein (grams = body weight in kg x 0.9 x 1.5 each day if exercising at a high intensity 3-6 times each week)
- carbohydrates (7-12 g per kg of body weight each day)
- micronutrients such as activated vitamin B, magnesium (need to check zinc levels), iron and coenzyme Q104
At the same time, you should reduce your alcohol following exercise intake as this adversely affects muscle function and glycogen storage.1
Treatment of Overtraining Syndrome
Immediately after being diagnosed with overtraining syndrome, it is important to have complete rest and to sleep as much as possible over the next 48 hours. If acted on early enough, this may be sufficient for you to recover and perform at an even higher level (super-compensation).1
However, if this rest period does not reduce your tiredness, overtraining syndrome may be entrenched and it may take weeks or months to resolve. Treatment then consists of rest as well as nutritional and psychological support.
The starting point for all treatment programs is a comprehensive medical, nutritional and physical assessment. This will give clues as to the important factors that may have contributed to the development of overtraining syndrome such as viral illness, nutritional deficiencies, glycogen depletion, inadequate protein intake, sleep disturbances and anxiety / stress levels.
Viral illness is a common cause of persistent tiredness in sportspeople. Prolonged intense exercise depresses your immune system, leaving you vulnerable to viral illness, especially chest infections.
If you have a viral illness with a raised temperature, it is important for you not to continue with intense training as it has the potential to either prolong your illness or cause a more serious illness such as myocarditis or post viral fatigue syndrome. Similarly, if you have a viral illness along with systemic symptoms such as muscle pain, training is prohibited.
If however, you have a mild temperature, light training that keeps your heart rate below 70% of your maximum heart rate (220 – age), may actually have a positive effect. To ensure that you are not at risk of worsening your condition, it is important to get a medical clearance before continuing with training if your general health is not 100%.
A common cause of tiredness among endurance sportspeople is depletion of iron stores. Menstruating women, adolescent sportspeople and athletes who diet are especially susceptible to iron deficiency due to either inadequate iron intake, increased iron loss and / or inadequate absorption of dietary iron.
If you have been training intensely and are suffering from tiredness and weariness, you would be well advised to seek a medical examination from a sports physician and have your iron levels checked as well as be tested for digestive and kidney function. Following this referral to a dietitian, nutritionist or naturopath may be required.
Glycogen is the storage form of carbohydrate and the major source of energy for activity. Intense bouts of exercise drain glycogen stores and if they are not replenished prior to the next training session, they will become further depleted. If this pattern continues glycogen depletion will result leading to fatigue and a deterioration in sports performance.
In times of intense training, consuming at least 1-1.2g of carbohydrate per kg of body weight within the first hour immediately following exercise is especially important as this is when the rate of glycogen production is greatest.1
Finally, not only has it been shown that consuming carbohydrate during and following prolonged intense exercise prevents the depletion of energy stores, but it has also been proven that carbohydrate enhances the immune system’s ability to ward off infectious illness.
Protein replacement is critical for good health because prolonged intense exercise causes a substantial breakdown of muscle tissue, protein contains the building blocks (amino acids) which enable it to be rebuild in the next 24 hours and beyond. This process is optimised, if 10-20 g of high quality protein (containing the essential amino acids) is consumed within an hour following exercise. Eating protein after this time still promotes tissue regeneration, it just occurs at a slower pace.
Adequate protein replacement is also important to reduce pain and enhance sleep.1
The strategies listed for preventing overtraining syndrome will also assist in its treatment. Other treatment tips might include:
Other treatment tips for Overtraining Syndrome
- Avoid exercising if you have a virus and a high temperature. If you are not sure, seek a medical opinion
- Whenever you can, allow yourself to sleep in until 8 or 9am
- Take time out for massage, meditation, yoga and other relaxing activities to "quieten" your mind and body
- Avoid strenuous exercise at night as excess cortisol makes it difficult to sleep
- Take a nap in the afternoon if you are tired. 20 to 30 minutes is great value
- Avoid working late and burning the midnight oil
- Eat protein at every meal avoid high carbohydrate foods to optimise your insulin and blood sugar levels
- Eat 5 to 6 servings of vegetables each day and avoid fruit early especially those high in potassium
- Take fish oil to reduce tissue inflammation and prevent hippocampal damage
- Avoid hydrogenated fats, caffeine, chocolate, refined sugars, sugary drinks, processed foods and those that create allergic reactions
- Optimise vitamin D levels
- Get regular exercise2
It is important to realise that it is not just elite athletes who are at risk of overtraining. Even more vulnerable are people who lead highly stressed lives who then undertake intense, prolonged training programs. For these people it is especially important to organise their home, work and training schedules in ways which prioritise adequate rest and recovery.
"Listening" to your body, finding balance, training smarter not harder and understanding that "less may be more" may not only help you stave off overtraining syndrome as well as many other injuries and pain syndromes, they may just help you to achieve your "personal best". Good luck and until next time!
Be Bodywise and enjoy the best of health.
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1. Brukner and Khan and Colleagues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.
2. Chek, Paul. How to Eat, Move and Be Healthy. California: C.H.E.K. Institute, 2006
3. Chadwick V. Mcphee R. Ford A. a Practical Guide to Clinical Nutrition for Allied Health Professionals. May 2014
4. Chadwick V. How to Live a Life Without Pain. Global Publishing Group. 1st Edition, 2012