How important is non-training stress in the development of the overtraining syndrome?
At some point during their career, a number of endurance athletes report experiencing a suppressed athletic performance, often in conjunction with one or more other physiological and/or psychological symptoms. Among others, these symptoms may include chronic fatigue, disturbed mood states, increased susceptibility to upper respiratory tract infections, changes in resting heart rate and disturbances in sleep patterns. Athletes experiencing such symptoms may be suffering from, or are at increased risk of developing, the overtraining syndrome.
At times, the symptoms associated with the overtraining syndrome can be severe (Meehan, 2000) and full recovery may take a number of weeks or months (Kuipers and Keizer, 1988). For some athletes, the outlook may be even bleaker. Athletes involved in our recent investigations reported suffering from symptoms of the overtraining syndrome for as long as two years. In such cases, athletes have been unable to continue participating in their sport (Meehan, 2000; Meehan et al., 2000, 2001).
Despite being recognised as a serious problem for endurance athletes (O'Toole, 1998), understanding of the overtraining syndrome is limited. A number of difficulties exist with regard to the recognition and diagnosis of the overtraining syndrome, and uncertainty exists in relation to its cause. The aim of this article is to consider the causes of the overtraining syndrome, in particular, the role that non-training stress may play in the development of the syndrome. In doing so, an overview of the possible causes of the overtraining syndrome will be provided, together with the presentation of two case studies of athletes diagnosed with the overtraining syndrome. Practical information will then be provided to aid athletes and coaches in its prevention.
Too much training, too little recovery?
Historically, training stress has been reported to be the major cause of the overtraining syndrome. Overtraining, a process that involves performing an excessive training load, coupled with inadequate recovery, is frequently suggested to be the major cause (Budgett, 1994, 1998). This is often thought to result from a poorly planned training programme (eg, Foster and Lehmann, 1999). Foster and Lehmann report that no cases of the overtraining syndrome have been diagnosed in athletes undergoing a period of 'easy' training.
Evidence to suggest that training stress may play a role in the development of the overtraining syndrome is provided by the findings of studies that have been carried out in an attempt to investigate the process of overtraining and also from anecdotal reports (eg, Barron et al., 1985; Hooper et al., 1993; Ryan et al., 1983). Essentially, these studies have focused on manipulating athletes' training loads. Some have increased the intensity of the training load, whereas others have increased the training volume. Generally, the findings from these studies suggest that athletes may be at an increased risk of developing the overtraining syndrome following a training overload (increased intensity or volume) of three weeks or more. Despite these findings, a number of problems exist. These studies have essentially been single disciplined in nature, predominantly from the physiology discipline. Furthermore, findings from such studies have demonstrated that individual differences exist in response to the training load. What constitutes overtraining for one athlete may constitute optimal training for another. Possible explanations for such differences have not been explored.
'There is some evidence to suggest that the overtraining syndrome may be a response to an accumulation of both training and non-training stress'
Recently, it has been suggested that non-training stress in the form of environmental and lifestyle stressors, such as examination and relationship stress, may contribute to the development of the overtraining syndrome (Budgett, 1994). It is proposed that the overtraining syndrome may be a response to an accumulation of both training and non-training stress (eg, Kentta and Hassmen, 1998). Although limited at present, some evidence does exist to support this suggestion. Evidence is provided from those studies that demonstrate the existence of individual differences in response to the training load. Some of these studies have reported that a small number of such athletes were experiencing additional non-training stress at the time of the study (eg, Gabriel et al., 1998). As well as supporting the claim that non-training stress, together with
the stress of training, may lead to the development of the overtraining syndrome, these findings may go some way to explaining the individual differences that have been unexplored in other studies. Due to the dominance of single disciplined work in investigating the overtraining syndrome, little further evidence exists to support the notion that non-training stress may be
a precursor to the syndrome. However, an abundance of literature exists that provides evidence to suggest that life stress and daily hassles may increase the incidence of illness and athletic injury (eg, Bramwell et al., 1975; Chen et al., 1995; DeLongis et al., 1988), and although limited, research also exists that suggests social and lifestyle factors may be involved in the development of the chronic fatigue syndrome (eg, Clements et al., 1997).
Symptoms of the chronic fatigue syndrome are similar to many of those reported by athletes diagnosed with the overtraining syndrome. Although further work needs to be carried out, evidence of this relationship between life stress and health outcome, together with the existence of individual differences in training load tolerance, may go some way to suggesting that non-training stress does contribute to the development of the overtraining syndrome.
Because of the uncertainty that exists in relation to the recognition, diagnosis and cause of the overtraining syndrome, our recent investigation took a more individual and holistic approach to investigate the syndrome (Meehan, 2000; Meehan et al., 2000, 2001). Findings from the investigation highlight the role that non-training stress may play in the development of the overtraining syndrome. Following diagnosis by a sports medic, five endurance athletes presenting with symptoms of the overtraining syndrome were given two psychological questionnaires: The Coping Response Inventory (Moos, 1992) and The Athlete Daily Hassle Scale (Albinson and Pearce, 1998). On completion of the inventories, each athlete was interviewed in depth about their experiences of the syndrome. Based on the information gathered, a case study of the overtraining syndrome experience was written for each athlete. Two of these case studies are presented below.
Case study 1: Steve
Steve was 30 years old. He had been a competitive runner since the age of 16. He had previously been the national cross-country champion and had represented Great Britain in the world cross- country championships. He was a fitness manager in a gymnasium. He had been suffering from symptoms of the overtraining syndrome for four months at the time of the investigation.
Steve trained twice a day, seven days a week. His rest day was a 12 -mile steady run. In terms of mileage this amounted to approximately 80 miles per week. Within these 80 miles Steve carried out approximately 13 sessions each week. He rated the majority of these sessions as being of 'average' intensity. Three sessions per week were rated as being 'hard', 'very hard' or 'very, very hard'. Steve's life was structured to accommodate these training needs. He had been carrying out the same amount of training that he had been doing in the previous year in the six months prior to his symptoms presenting.
Steve's job and social life had to fit in with his training He was not very ambitious at work and his social life was minimal. Steve had been in the same job for three years. He was promoted at work about six months prior to his symptoms presenting. His responsibilities shifted from being a duty manager to being manager.
Steve's marriage broke up in the year leading up to the overtraining syndrome. This had caused Steve a lot of stress. He attributed the break-up to his running involvement. Although she was supportive of his running at first, his wife had begun to resent it. At the time of the investigation, Steve had a new partner. Although she was supportive of his running, he was unsure as to whether her feelings would remain the same.
Five months prior to his symptoms presenting, Steve suffered an injury to his quadriceps femoris. This prevented him from carrying out his usual training and the preparation that he had intended to do before the national cross country championships that were to take place two months later. Following his injury, Steve's fitness returned quite quickly and he was running reasonably well. However, he did not feel that his winter training and the cross-country season had been particularly successful. Despite these feelings, Steve was reasonably successful at the national cross-country championships. Following this, he represented Great Britain in the world cross-country championships a month later.
Although Steve's steady runs felt okay at this stage, he did not think that his training sessions were going particularly well. Steve started to notice differences in his performances a month after competing in the world cross-country championships. Initially, it was his performances in competition that were noticeably poor. He then began to struggle in his training sessions.
In addition to his suppressed performances, additional symptoms that Steve experienced included chronic fatigue, exercise-induced asthma, delayed recovery from training and competition, loss of enjoyment in running, muscle pain, muscle weakness, headaches, sleep disturbance and cognitive complaints.
Steve's experiences of the overtraining syndrome were rather detrimental to his life as an athlete. As a result of his symptoms, Steve had not been able to achieve the goals that he had set at the beginning of the season. That is, he had been unable to represent Great Britain at the European Athletic Championships and the Commonwealth Games. He was unsure as to what had caused his symptoms.
Case study 2: Tim
Tim was a competitive runner and triathlete. He was 36 years old. He had been involved in running and triathlon for 17 years. He had been suffering from symptoms of the overtraining syndrome for over two years at the time of the investigation. Tim was married and had two children. He was a self-employed IT contractor. Although not very ambitious at work, Tim described himself as being competitive in and out of sport.
A typical training week for Tim would involve two sessions per day. He worked very hard in all of his sessions. On average, he cycled 200 miles, did three swim sessions (amounting to approximately four-and-a-half hours) and ran 50 miles per week. Tim did not have a coach.
Tim took redundancy from his job in the months leading up to his symptoms presenting. Since then he had become self-employed. Because of his self-employment Tim felt it was important to keep abreast of the developments in the IT world. In order to do this he would often study in the evenings on returning home from work.
The year before his redundancy, Tim and his wife had their first child. Their second was born two years later. During the first 20 months, the eldest child had had sleepless nights. As a consequence neither Tim nor his wife had slept very well. Tim commented that he in particular had found those 20 months very troublesome. Tim found that having children had altered his lifestyle considerably. He no longer felt that he had any time on his own and found it difficult to find quiet times when he could concentrate on his work. Furthermore, he found it hard knowing that many of his friends were leading a lifestyle that he was no longer able to.
Initially Tim developed flu-like symptoms and myalgias. He stopped training as a result of these symptoms. He felt well enough to begin running after a period of two months rest. Following these initial symptoms, Tim had a relapse after competing in a 14-mile cross-country race. He had developed a sore throat the day before the event and had then begun to feel unwell during the race. In the week that followed he felt very unwell. The myalgia that he was experiencing was so severe he was unable to carry out the simplest of daily tasks. These symptoms troubled him for more than six months. In addition to these symptoms Tim experienced a number of others. These included chronic fatigue, retrosternal burning (usually after exercise), sore throat, muscle weakness, joint pain, headaches, prolonged post-exercise fatigue, sleep disturbance, poor concentration, poor memory, an increase in resting pulse rate and an increase in body mass.
Although troubled by his symptoms, there were times when Tim felt well. Often his symptoms would subside following a couple of weeks rest. During these times he would feel well enough to run again. However, on a number of occasions he had begun to feel very ill while training, usually to the point where he would have to return home.
Tim felt that his symptoms had had a marked impact upon his life. First, they meant that he required a lot more sleep. He would find himself needing to go to bed on returning home from work in the evenings or during the afternoon at weekends. These sleeping patterns meant that he interacted with other people less often. Second, being unable to train had meant that Tim was unable to have any time to himself. He found that he had little space and was no longer able to get excited about his life. This made Tim question the way he was living.
Although only two case studies have been presented here, each one highlights the role that non-training stress may play in the development of the overtraining syndrome. Contrary to the literature that suggests training stress is its major cause, Steve and Tim had been carrying out the same amount of training as they had done in previous years. Neither athlete reported a significant increase in his training load in the six months leading up to their symptoms presenting. However, despite their training loads remaining unchanged, both athletes experienced some form of non-training stress prior to their symptoms. Steve's marriage had broken up and he had also been promoted at work. Tim had been made redundant and become self-employed. He had two young children, one that had not slept well for 20 months. The birth of his children had also led to Tim feeling that he no longer had any time alone. Both athletes reported these experiences to have caused them varying amounts of stress. The experiences of Steve and Tim are consistent with the other three cases in our investigation. Although further work is required, these findings suggest that, when combined with the stress of training, non-training stress may have contributed to the development of the overtraining syndrome in the athletes in our investigation. It is possible that the accumulation of training and non-training stress that the athletes experienced may have led to them developing an intolerance to their normal training load and thus ultimately to overtraining syndrome itself.
In terms of practical application, these findings suggest that
athletes should not always be considered in the narrow confines of their training and competitive environment. When planning an athlete's training regimen and competitive season, a coach should consider all aspects of the athlete's life. In terms of non-training stress, it is imperative that coaches consider modifying their athletes' training loads when they are experiencing periods of non-training stress (eg, examinations, relationship difficulties). Modifying the training load may enable an athlete to accommodate the accumulation of stress that he/she is experiencing, ensuring that their ability to adapt is not compromised in any way and thus possibly preventing the development of the overtraining syndrome.
Albinson, J.G. and Pearce, W. (1998). 'The Athlete Daily Hassles Scale (4th version)'. Queens University, Ontario, Canada.
Barron, J.L., Noakes, T.D., Levy, W., Smith, C. and Millar, R.P. (1985).'Hypothalamic dysfunction in overtrained athletes.' Journal of Clinical Endocrinology and Metabolism 60 (4): 803-806.
Bramwell, S.T., Masuda, M., Wagner, N.N. and Holmes, T.H. (1975). 'Psychosocial factors in athletic injuries: development and application of the social and athletic readjustment rating scale (SARRS)'. Journal of Human Stress 1: 6-20.
Budgett, R. (1994). 'The overtraining syndrome.' British Medical Journal 309: 465-468.
Budgett, R. (1998). ' Fatigue and underperformance in athletes: the overtraining syndrome.' British Journal of Sports Medicine 32: 107-110.
Chen, C.C., David, A.S., Nunnerley, H., Michell, M., Dawson, J.L., Berry, H., Dobbs, J. and Fahy, T. (1995).
' Adverse life events and breast cancer: case-control study.' British Medical Journal 311: 1527-1530.
Clements, A., Sharpe, M., Simkin, S., Borrill, J. and Hawton, K. (1997).
' Chronic fatigue syndrome: a qualitative investigation of patients' beliefs about the illness.' Journal of Psychosomatic Research 42: 615-624.
DeLongis, A., Lazarus, R.S. and Folkman, S. (1988). ' The impact of daily stress on health and mood: psychological and social resources as mediators.' Journal of Personality and Social Psychology 54 (3): 486-495.
Foster, C. and Lehmann, M. (1999). 'Overtraining syndrome.' Insider 7(1): 1-6.
Gabriel, H.H.W., Urhausen, A., Valet, G., Heidelbach, U. and Kindermann, W. (1998). ' Overtraining and immune system: a prospective longitudinal study in endurance athletes.' Medicine and Science in Sports and Exercise 30 (7): 1151-1157.
Hooper, S.L., Mackinnon, L.T., Gordon, R.D. and Bachmann, A.W. (1993). ' Hormonal responses of elite swimmers to overtraining.' Medicine and Science in Sports and Exercise 25 (6): 741-747.
Kentta, G. and Hassmen, P. (1998).
' Overtraining and recovery: a conceptual model.' Sports Medicine 26(1): 25-39.
Kuipers, H. and Keizer, H.A. (1988).
' Overtraining in elite athletes: review and directions for the future.' Sports Medicine 6: 79-92.
Meehan, H.L. (2000). ' The overtraining syndrome: A multi-contextual assessment.' Unpublished MPhil Thesis, University of Gloucestershire.
Meehan, H.L., Bull, S.J. and James, D.V.B. (2000). 'The overtraining syndrome: A multi-contextual assessment.' Paper presented at the annual conference of the Association for the Advancement of Applied Sport Psychology.
Meehan, H.L., Bull, S.J. and James, D.V.B. (2001). 'The role of non-training stress In the development of the overtraining syndrome.' Paper presented at the annual conference of the British Association of Sport and Exercise Sciences.
Moos, R.H. (1992). 'Coping Responses Inventory Manual.' Florida: Psychological Assessment Resources, Inc.
O'Toole, M.L (1998). 'Overreaching and overtraining in endurance athletes.' In Krieder, R.B., Fry, A.C. and O'Toole, M.L. (Eds) Overtraining in Sport. Champaign, IL: Human Kinetics.
Ryan, A.J., Brown, R.L., Frederick, E.C., Flasetti, H.L. and Burke, E.R. (1983). 'Overtraining of athletes: a round table.' The Physician and Sports Medicine 11(6): 93-110.