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overtraining, underperformance syndrome

Overtraining: Here's how to deal with a new problem 'unexplained underperformance syndrome'

Athletes can suffer from dips in form, periods where they compete poorly or struggle to train well. At such times, they will probably feel tired and may lack their normal enthusiasm for training; they may also have picked up a cold. Usually these are signs that they need to ease back on the training or take a rest. After one or two easy weeks, the athlete recovers and is back to peak fitness.

The scenario described above is considered a normal ‘over-reaching’ response to hard training. Evidence shows that endurance athletes are particularly prone to over-reaching dips in form that require rest. A prolonged period of tough workouts, particularly high-volume workouts, can result in reduced vigour and increased tension or depression in mood states. Muscle glycogen stores are depleted and resting heart rate rises. The testosterone/cortisol ratio is reduced due to lower testosterone and high cortisol levels. Microscopic damage to muscle also leads to raised creatine kinase levels, especially if there is eccentric exercise. These are all physiological responses to training. With rest, these changes go back to normal and athletes can even ‘super-compensate’, which means they recover from the stresses to develop even higher fitness levels than before.

And if they don’t recover?

Unfortunately, some athletes do not recover from these periods of ‘over-reaching’, even after two weeks of rest. When loss of form and unexpected difficulty of training continue for a number of weeks, the problem is most likely the familiar ‘over-training syndrome’ (see also SIB issue 16). The symptoms of OTS are varied, but usually involve frequent infections, changed mood states and fatigue, along with the reduced performance.

The problem with the phrase ‘over-training’ is that it implies the condition is caused by too much training. While this may be the obvious answer, it is not necessarily the correct one. If the problem was simply caused by heavy training loads, then a period of rest would allow the athlete to regain fitness. However, this is not what happens with long-term OTS athletes – otherwise they would simply recover after the normal over-reaching rest.

At a round-table discussion at St Catherines College, Oxford, top British sports scientists and medics Budgett, Newsholme, Lehmann and Sharp, redefined the symptoms as the ‘Unexplained Underperformance Syndrome’. (Budgett et al. ‘Redefining the overtraining syndrome as the unexplained underperformance syndrome’. Br J Sports Med 2000; 34:67-68. )

So what is it, exactly?

Unexplained Underperformance Syndrome (UPS) is defined as: ‘a persistent, unexplained performance deficit (recognised and agreed by coach and athlete) despite two weeks of relative rest. This contrasts with the definition of chronic fatigue syndrome, where symptoms must last at least six months. In addition to fatigue and an unexpected sense of effort during training, the following symptoms have been reported in UPS:

  • history of heavy training and competition
  • frequent minor infections
  • unexplained or unusually heavy, stiff, and/or sore muscles
  • mood disturbance
  • change in expected sleep quality
  • loss of energy
  • loss of competitive drive
  • loss of libido
  • loss of appetite.

This is a broad definition, which is useful since the symptoms of the problem are not exact and usually vary between different cases. The ‘reduced performance’ is normally defined by the athletes themselves, as they are usually constantly monitoring their own training or competitive performances.

‘Relative rest’ means that the athletes have significantly reduced their training load – for example, the kind of reduction in training volume that would occur before a big competition. The definition does not include the normal ‘over-reaching’ response to training.

If the athlete’s problems are associated with a diagnosed disease or clinical problem, then the UPS diagnosis cannot be made. In such cases, the athlete must rest until the illness has been cured or treated.

Who is most at risk of UPS?

Endurance athletes undertaking prolonged periods of high volume and monotonous training are at most risk. It would seem that lack of variation and lack of recovery are the two of the biggest training-related risk factors. For example, an athlete who also has a full-time job will have less recovery time available between training sessions. Oddly, high-intensity training seems to be less of a problem than high-volume training. Fry et al attempted to induce over-reaching in a group of athletes by putting them through a series of high-intensity interval workouts which produced high lactate levels. However, the athletes did not suffer any problems and so the researchers concluded that high-intensity type training was ‘safe’. (Fry RW, Morton AR, Keast D. ‘Periodisation and the prevention of overtraining.’ Can J Sports Sci 1992; 17:241-248.)

This conclusion is supported by the fact that sprinters and power athletes rarely suffer from UPS.

The athlete’s emotional state and lifestyle may contribute significantly to the risks of UPS. Often, the life outside sport can cause tension, anxiety or depression that make training and competing all the more stressful. Studying for exams is an obvious example of a non-sport stress, but difficulties with relationships (partners/families) must also be considered. Sport psychologist Amanda Owens is studying the relationship between psychological mood and UPS in elite endurance athlete for her PhD thesis. Her early findings (private communication) suggest that the UPS-suffering athlete displays symptoms very similar to clinically depressed patients. Using a supportive approach to her psychological intervention, Owens has had success in cases of athletes with UPS by treating the depression and solving the ‘life issues’ that create the negative stresses. The approach here is that the athlete needs to resolve emotional or life problems as well as allowing the body to physically recover.

Multifactorial in its causes

UPS has also been associated in the research with changes in hormonal levels and immune system depression. However, these are also the kinds of changes that could relate to normal over-reaching and so are not conclusive as possible causes.

In a manner that is similar to chronic fatigue syndrome in the normal population, UPS in elite athletes seems to be multifactorial in its possible causes. Whether it is the training load, emotional stress, hormone profile or weakened immune system or a complex combination of any of these is hard to pinpoint. What is clear is that, due to excess systemic stresses which reduce the athlete’s ability to withstand his/her training load, the athlete with UPS needs an extra period of recovery beyond that of the normal response to heavy training.

Dealing with UPS

Dr Richard Budgett at the British Olympic Medical Centre has had much experience in helping athletes with UPS. He warns that, if told to rest for several weeks, athletes are unlikely to comply. Thus they should be given positive advice and told to exercise aerobically at a pulse rate of 120-140 beats per min for five to 10 minutes each day, ideally in divided sessions, and slowly build this up over six-12 weeks.

The training plan must allow for plenty of recovery, progressing slowly back to full training volume. The use of cross training is a useful strategy that prevents the athletes pushing themselves too hard on their competitive activity too early.

Incorporating sprint workouts, short maximal efforts (10 seconds) with full recovery (2-3 minutes) allow the athlete to work hard and develop anaerobic power in a way that seems to be stress-free and safe. In general, the idea that athletes should focus on high intensity training and not rely on high volume for fitness improvements should be encouraged. Many athletes believe that going for a long steady effort is a suitable way to train, but this monotonous high volume training seems to be the most risky.

All other common-sense planning and practices must be observed. These include complete rest days in the training cycle, alternating hard and easy training days, sufficient carbohydrates to maintain muscle glycogen stores, good nutrition with a full variety of fresh vegetables, fruits and quality proteins, and allowing for relaxation time in one’s lifestyle. (R Budgett. ISMJ, 1(3), August 2000, ‘Overtraining and Chronic Fatigue: The Unexplained Underperformance Syndrome (UPS)’.

Raphael Brandon

overtraining, underperformance syndrome