Member Case Study: Overtraining Syndrome

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Member question from bezbit

"I have been training pretty hard in the past 2-3 weeks, included is a Duathlon (500swim, 5k run) and a 5k time trial run. I have not tapered or taken many rest days and generally I am doing 8-10 hours per week of training. Diet has been good, but I  am probably running on a calorie deficit, although not big. During the last few days I have noticed these symptoms:

1. Resting heart rate around 60 (usually is around 43-46)

2. Increased Stress (I feel stressed although I have no reason to)

3. Trouble getting to sleep, and I wake up in the middle of the night.

What should I do so that I can resume training for my first IM in August? Are there any research studies done monitoring only resting heart rate as an overtraining guide?"

Answer from Benjamin A. Hasan, MD
Member AMSSM

Coaches, athletes, and physicians are well-aware that athletes can develop a syndrome of overtraining. This is known also as “staleness” and “burn-out.” Symptoms differ, but there are patterns. They include fatigue, a higher than usual resting heart rate, mood changes, persisting muscle soreness after training, poor race performance, poor workout quality, and others.
 
Some refer to the muscle soreness after an increase in a workout routine as “overreaching.” Some believe that overreaching leads to overtraining. Others feel that the existence of some soreness after nearly every workout is to be expected, especially for athletes that pursue intense training regimens and expect results.

Former Ironman champion and author Dave Scott explained: "The term over-reaching was adopted by exercise scientists to describe the short-term overload that can be managed within a few days. However, over-reaching can develop into over-training (from which it can be more difficult to recover) if the athlete does not mitigate the factors that caused the over-reaching or fails to allocate proper recovery time." 1
 
Deciding how to allow intense training without falling into the abyss of “overtraining syndrome” or “staleness” is a question that needs to be answered. The answer is different for each athlete.
 
Training benefits that contribute to performance occur over time. Improvements result from gradually over-taxing our bodies. These sessions lead to improvements in race times only after our tissue has had the opportunity to recover from actual tissue breakdown. This recovery is termed rest. “Rest” is the concept of physiologic recovery as well as simple down-time for an athlete. Sleep is one component of rest. When the period of rest is insufficient to allow an over-taxed body to recover to the point of better performance, “overtraining” symptoms often follow.
 
Athletes want to go faster and win. They also want to feel good. Coaches want teams and individuals to perform. Physicians serve the medical needs of their patients. For most, the importance of this condition is clear and defined. For the researcher, however, the specific chemistry and hormonal changes remain a mystery. A search for chemical markers of overtraining is ongoing. A person’s blood lactate threshold has been used to identify a point of maximal aerobic benefit during endurance training. Similarly, markers of over training have been sought by exercise scientists. Studies have been published. Researchers at the University of Tartu in Estonia have recently published an article in the journal “Metabolism” reporting on the concept of utilizing blood chemistry tests for “peripheral signals as markers of training stress (and possible overreaching/overtraining) in elite athletes.”
 
Coaches know that the solution to overtraining syndrome is rest. The syndrome is defined by symptoms and morning resting heart rate (and not yet by blood chemical markers). Alterations in a training regimen can be guided by their improvement. The racing season is upon us. Rest is critical to avoid “burnout.”

Benjamin A. Hasan, MD
Director of Sports Medicine and Associate Residency Director
Glenbrook Hospital Family Medicine Residency
NorthShore University Health System
Assistant Clinical Professor of Family Medicine, University of Chicago, 2050 Pfingsten Road, Suite 200
Glenview, IL 60026
(847) 657-1810


References

Dave Scott, How to Tell When You're Over-Reaching or Over-Training - Active.com

Metabolism. 2010 Mar 19. [Epub ahead of print]

Peripheral signals of energy homeostasis as possible markers of training stress in athletes: a review.
Jürimäe J, Mäestu J, Jürimäe T, Mangus B, von Duvillard SP.
Institute of Sport Pedagogy and Coaching Sciences, Center for Behavioral and Health Sciences, University of Tartu, Tartu, Estonia.

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date: April 14, 2010

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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