A Comprehensive Analysis of Overtraining Syndrome in Athletes and
                    Recreational Exercisers

Rauha Lucia Buchwald; Jadwiga Buchwald; Elias Lehtonen; Juha E. Peltonen; Arja L.T. Uusitalo

doi:10.1055/a-2611-3598

International Journal of Sports Medicine, Table of Contents

Int J Sports Med
DOI: 10.1055/a-2611-3598

Physiology & Biochemistry

A Comprehensive Analysis of Overtraining Syndrome in Athletes and Recreational Exercisers

Rauha Lucia Buchwald

¹Sports and Exercise Medicine, University of Helsinki Faculty of Medicine, Helsinki, Finland (Ringgold ID: RIN60655)

,

Jadwiga Buchwald

²Helsinki Institute of Life Science (HiLIFE), Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland (Ringgold ID: RIN3835)

³Department of Public Health, Biostatistics Unit, University of Helsinki, Helsinki, Finland (Ringgold ID: RIN3835)

,

Elias Lehtonen

¹Sports and Exercise Medicine, University of Helsinki Faculty of Medicine, Helsinki, Finland (Ringgold ID: RIN60655)

⁴Helsinki Sports and Exercise Medicine Clinic, Foundation for Sports and Exercise Medicine (HULA), Helsinki, Finland

,

Juha E. Peltonen

¹Sports and Exercise Medicine, University of Helsinki Faculty of Medicine, Helsinki, Finland (Ringgold ID: RIN60655)

⁵Clinical Physiology and Nuclear Medicine, Diagnostic Center, Helsinki University Central Hospital, Helsinki, Finland (Ringgold ID: RIN159841)

,

Arja L.T. Uusitalo

¹Sports and Exercise Medicine, University of Helsinki Faculty of Medicine, Helsinki, Finland (Ringgold ID: RIN60655)

⁴Helsinki Sports and Exercise Medicine Clinic, Foundation for Sports and Exercise Medicine (HULA), Helsinki, Finland

⁶Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki, Finland (Ringgold ID: RIN159841)

› Author Affiliations

Abstract

Overtraining syndrome (OTS) is characterised by persistent fatigue and performance decline, but it currently lacks specific diagnostic criteria and medical coding. Diagnosis is primarily based on a decline in maximal performance and a subjective feeling of ‘staleness', after ruling out other medical conditions. This study aimed to identify physiological and self-reported predictors of OTS by comparing individuals diagnosed with OTS (n=110; 2008–2022) with a healthy control group (n=447; 2005–2023). Both groups consisted of athletes and recreational exercisers assessed at the Helsinki Sports and Exercise Medicine Clinic (HULA). Data were collected through questionnaires and spiroergometric testing and subsequently analysed using logistic regression, adjusting for age and sex. The results of this study suggest that fatigue, dizziness and shortness of breath, along with decreased maximum oxygen uptake (V̇O2_max), peak blood lactate value (La_max) and oxygen uptake at both ventilatory thresholds (V̇O_2VT1 and V̇O_2VT2), are significant predictors of OTS (p<0.05/54). Among reported health conditions, asthma, allergy, anaemia and mental health issues were statistically significant predictors of OTS at the 0.05 level, but not after Bonferroni correction. In conclusion, regular spiroergometric testing and symptom monitoring may support earlier diagnosis and improved management of OTS in athletes and recreational exercisers.

Keywords

Staleness - Athletes - Exercise responses - Fatigue - Maximal oxygen uptake - Diagnosis

Full Text

References

References
1 Meeusen R, Duclos M, Foster C, Fry A, Gleeson M, Nieman D. et al. Prevention, diagnosis, and treatment of the overtraining syndrome: Joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Med Sci Sports Exer 2013; 45: 186-205
2 Matos NF, Winsley RJ, Williams CA. Prevalence of nonfunctional overreaching/overtraining in young English athletes. Med Sci Sports Exer 2011; 43: 1287-94
3 Halson SL, Jeukendrup AE. Does overtraining exist? An analysis of overreaching and overtraining research. Sports Med 2004; 34: 967-981
4 Urhausen A, Kindermann W. Diagnosis of overtraining: what tools do we have?/Diagnostic de surentrainement: quels moyens possedons nous?. Sports Med 2002; 32: 95-102
5 Budgett R. Fatigue and underperformance in athletes: The overtraining syndrome. Br J Sports Med 1998; 32: 107-10
6 Lehmann MJ, Lormes W, Opitz-Gress A. et al. Training and overtraining: An overview and experimental results in endurance sports. J Sports Med Phys Fitness 1997; 37: 7-17
7 Aubry A, Hausswirth C, Louis J, Coutts AJ, LE Meur Y. Functional overreaching: The key to peak performance during the taper?. Med Sci Sports Exercise 2014; 46: 1769-77
8 Uusitalo ALT. Urheilijan ylikuormitustila. Duodecim 2015; 131: 2344-2350
9 Armstrong LE, VanHeest JL. The unknown mechanism of the overtraining syndrome: Clues from depression and psychoneuroimmunology. Sports Med 2002; 32: 185-209
10 Kreher JB, Schwartz JB. Overtraining syndrome: a practical guide. Sports Health 2012; 4: 128-38
11 Cadegiani FA, Kater CE. Novel causes and consequences of overtraining syndrome: The EROS-DISRUPTORS study. BMC Sports Sci Med Rehabil 2019; 11: 21
12 Stellingwerff T, Heikura IA, Meeusen R, Bermon S, Seiler S, Mountjoy ML. et al. Overtraining syndrome (OTS) and relative energy deficiency in sport (RED-S): shared pathways, symptoms and complexities. Sports Med 2021; 51: 2251-80
13 Urhausen A, Gabriel HH, Weiler B, Kindermann W. Ergometric and psychological findings during overtraining: A long-term follow-up study in endurance athletes. Int J Sports Med 1998; 19: 19-20
14 Uusitalo ALT. Overtraining: Making a difficult diagnosis and implementing targeted treatment. Physician Sports Med 2001; 29: 35-50
15 Hynynen E, Uusitalo A, Konttinen N, Rusko H. Cardiac autonomic responses to standing up and cognitive task in overtrained athletes. Int J Sports Med 2008; 29: 29-8
16 Dressendorfer RH, Wade CE, Scaff JH. Increased morning heart rate in runners: A valid sign of overtraining?. Physician Sports Med 1985; 13: 77-86
17 Carrard J, Rigort AC, Appenzeller-Herzog C, Colledge F, Königstein K, Hinrichs T. et al. Diagnosing overtraining syndrome: a scoping review. Sports Health 2022; 14: 665-73
18 Joro R, Uusitalo A, DeRuisseau KC, Atalay M. Changes in cytokines, leptin, and IGF-1 levels in overtrained athletes during a prolonged recovery phase: A case-control study. J Sports Sci 2017; 35: 2342-9
19 Armstrong LE, Bergeron MF, Lee EC, Mershon JE, Armstrong EM. Overtraining syndrome as a complex systems phenomenon. Front Netw Physiol 2021; 1: 794392
20 Lehmann M, Gastmann U, Petersen KG, Bachl N, Seidel A, Khalaf AN. et al. Training - overtraining: performance, and hormone levels, after a defined increase in training volume versus intensity in experienced middle- and long-distance runners. Br J Sports Med 1992; 26: 233-42
21 Carlsen KH, Anderson SD, Bjermer L. et al. Exercise-induced asthma, respiratory and allergic disorders in elite athletes: Epidemiology, mechanisms and diagnosis: Part I of the report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA 2LEN. Allergy 2008; 63: 387-403
22 Uusitalo AL, Vanninen E, Valkonen-Korhonen M, Kuikka JT. Brain serotonin reuptake did not change during one year in overtrained athletes. Int J Sports Med 2006; 27: 27-8
23 Edvardsen E, Hem E, Anderssen SA. End criteria for reaching maximal oxygen uptake must be strict and adjusted to sex and age: A cross-sectional study. PLoS One 2014; 9: 85276
24 World Medical Association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 2013; 310
25 Rissanen AE, Mikkola T, Gagnon DD, Lehtonen E, Lukkarinen S, Peltonen JE. Wagner diagram for modeling O2 pathway—calculation and graphical display by the Helsinki O2 Pathway Tool. Physiol Meas 2024; 45: 055028
26 Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 1986; 60: 2020-7
27 Poole DC, Rossiter HB, Brooks GA, Gladden LB. The anaerobic threshold: 50+years of controversy. J Physiol 2021; 599: 737-67
28 Keir DA, Iannetta D, Mattioni Maturana F, Kowalchuk JM, Murias JM. Identification of non-invasive exercise thresholds: methods, strategies, and an online app. Sports Med 2022; 52: 237-55
29 Privitera A, Privitera S. Physical exercise in asthma adolescents: a concept review. Multidiscip Respir Med 2023; 18: 924
30 Pedersen L, Elers J, Backer V. Asthma in elite athletes: Pathogenesis, diagnosis, differential diagnoses, and treatment. Physician Sports Med 2011; 39: 163-71
31 Ora J, De Marco P, Gabriele M, Cazzola M, Rogliani P. Exercise-induced asthma: managing respiratory issues in athletes. J Funct Morphol Kinesiol 2024; 9: 15
32 Kuwabara AM, Tenforde AS, Finnoff JT, Fredericson M. Iron deficiency in athletes: A narrative review. PM R 2022; 14: 620-42
33 Peluso MAM, Guerra de Andrade LHS. Physical activity and mental health: the association between exercise and mood. Clinics (Sao Paulo) 2005; 60: 61-70
34 Morgan WP, Brown DR, Raglin JS, O'Connor PJ, Ellickson KA. Psychological monitoring of overtraining and staleness. Br J Sports Med 1987; 21: 107-14
35 Morgan WP, Costill DL, Flynn MG, Raglin JS, O'Connor PJ. Mood disturbance following increased training in swimmers. Med Sci Sports Exercise 1988; 20: 408-14
36 Wagner PD. Modeling O2 transport as an integrated system limiting V̇O2MAX. Comput Methods Prog Biomed 2011; 101: 109-14
37 Billat VL, Sirvent P, Py G, Koralsztein JP, Mercier J. The concept of maximal lactate steady state: A bridge between biochemistry, physiology and sport science. Sports Med 2003; 33: 407-26
38 Lehmann M, Schnee W, Scheu R, Stockhausen W, Bachl N. Decreased nocturnal catehcolamine excretion: Parameter for an overtraining syndrome in athletes?. Int J Sports Med 1992; 13: 13-42
39 Carfagno DG, Hendrix JC. Overtraining syndrome in the athlete: Current clinical practice. Curr Sports Med Rep 2014; 13: 45-51
40 Bassett DR, Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exercise 2000; 32: 70-84
41 Gibala MJ, MacInnis MJ. Physiological basis of brief, intense interval training to enhance maximal oxygen uptake: a mini-review. Am J Physiol Cell Physiol 2022; 323: 1410
42 Jamnick NA, Pettitt RW, Granata C, Pyne DB, Bishop DJ. An examination and critique of current methods to determine exercise intensity. Sports Med 2020; 50: 1729-56
43 Seiler S, Haugen O, Kuffel E. Autonomic recovery after exercise in trained athletes: Intensity and duration effects. Med Sci Sports Exercise 2007; 39: 1366-73
44 Anselmi F, Cavigli L, Pagliaro A, Valente S, Valentini F, Cameli M. et al. The importance of ventilatory thresholds to define aerobic exercise intensity in cardiac patients and healthy subjects. Scand J Med Sci Sports 2021; 31: 1796-1808
45 Rowbottom DG, Keast D, Green S, Kakulas B, Morton AR. The case history of an elite ultra-endurance cyclist who developed chronic fatigue syndrome. Med Sci Sports Exercise 1998; 30: 1345-8
46 Hedelin R, Kenttä G, Wiklund U, Bjerle P, Henriksson-Larsén K. Short-term overtraining: Effects on performance, circulatory responses, and heart rate variability. Med Sci Sports Exercise 2000; 32: 1480-4
47 Mustonen T, Kanerva M, Luukkonen R, Lantto H, Uusitalo A, Piirilä P. Cardiopulmonary exercise testing in long covid shows the presence of dysautonomia or chronotropic incompetence independent of subjective exercise intolerance and fatigue. BMC Cardiovasc Disord 2024; 24: 413