The unknown mechanism of the overtraining syndrome: clues from depression and psychoneuroimmunology

The Effect of a 100-km Ultra-Marathon under Freezing Conditions on Selected Immunological and Hematological Parameters

Although moderate exercise is beneficial for the human body and its immune system, exhaustive ultra-endurance performance in cold conditions might be harmful. The aim of this study was to examine the effect of a 100-km ultra-marathon under cold conditions (temperatures from −1°C to +1°C) on selected immunological, biochemical and hematological parameters. Participants were 15 runners (12 men and three women, age 40.3 ± 9.7 years, body mass 67.3 ± 9.0 kg and body height 1.74 ± 0.10 m, mean ± standard deviation). Leukocytes increased (p < 0.01) and, particularly, the number of leucocytes doubled in seven out of 15 athletes. Immature neutrophils, mature neutrophils and monocytes increased (p < 0.02), whereas lymphocytes and eosinophils did not change. IgG increased (p < 0.02), but IgA and IgM remained unchanged. Platelets increased (p < 0.01), whereas red blood cells, hematocrit and hemoglobin did not change. lactate dehydrogenase (LDH) and creatine kinase (CK) increased (p < 0.01), but alanine aminotransferase (ALT) did not change. There was an association between the markers of the acute inflammation of the organism (i.e., neutrophils, immature neutrophils, platelets, and monocytes) and the markers of muscle damage (i.e., CK, platelets, and LDH). There were no relationships among all the markers in relation to upper respiratory tract infections and liver damage. The highest change was noted in the increase of the number of immature neutrophils (1,019.2%) and CK levels (1,077.6%). In summary, this is the first study investigating immunological, hematological and biochemical parameters and showing that running a 100-km ultra-marathon under cold conditions leads to changes in several immunological, biochemical and hematological parameters indicating a severe stress on the body associated with increasing susceptibility to the development of infections.

Skeletal Muscle Hypertrophy with Concurrent Exercise Training: Contrary Evidence for an Interference Effect

Over the last 30+ years, it has become axiomatic that performing aerobic exercise within the same training program as resistance exercise (termed concurrent exercise training) interferes with the hypertrophic adaptations associated with resistance exercise training. However, a close examination of the literature reveals that the interference effect of concurrent exercise training on muscle growth in humans is not as compelling as previously thought. Moreover, recent studies show that, under certain conditions, concurrent exercise may augment resistance exercise-induced hypertrophy in healthy human skeletal muscle. The purpose of this article is to outline the contrary evidence for an acute and chronic interference effect of concurrent exercise on skeletal muscle growth in humans and provide practical literature-based recommendations for maximizing hypertrophy when training concurrently.

Resting Heart Rate Variability Among Professional Baseball Starting Pitchers

Cornell, DJ, Paxson, JL, Caplinger, RA, Seligman, JR, Davis, NA, and Ebersole, KT. Resting heart rate variability among professional baseball starting pitchers. J Strength Cond Res 31(3): 575-581, 2017-The purpose of this study was to examine the changes in resting heart rate variability (HRV) across a 5-day pitching rotation schedule among professional baseball starting pitchers. The HRV data were collected daily among 8 Single-A level professional baseball starting pitchers (mean ± SD, age = 21.9 ± 1.3 years; height = 185.4 ± 3.6 cm; weight = 85.2 ± 7.5 kg) throughout the entire baseball season with the participant quietly lying supine for 10 minutes. The HRV was quantified by calculating the natural log of the square root of the mean sum of the squared differences (lnRMSSD) during the middle 5 minutes of each R-R series data file. A split-plot repeated-measures analysis of variance was used to examine the influence of pitching rotation day on resting lnRMSSD. A statistically significant main effect of rotation day was identified (F4,706 = 3.139, p = 0.029). Follow-up pairwise analyses indicated that resting lnRMSSD on day 2 was significantly (p ≤ 0.05) lower than all other rotation days. In addition, a statistically significant main effect of pitcher was also identified (F7,706 = 83.388, p < 0.001). These results suggest that professional baseball starting pitchers display altered autonomic nervous system function 1 day after completing a normally scheduled start, as day 2 resting HRV was significantly lower than all other rotation days. In addition, the season average resting lnRMSSD varied among participants, implying that single-subject analysis of resting measures of HRV may be more appropriate when monitoring cumulative workload among this cohort population of athletes.

Levels of Hepatic Activating Transcription Factor 6 and Caspase-3 Are Downregulated in Mice after Excessive Training

Recently, we demonstrated that different running overtraining (OT) protocols with the same external load, but performed downhill (OTR/down), uphill (OTR/up), and without inclination (OTR), led to hepatic fat accumulation. As the disruption of endoplasmic reticulum (ER) homeostasis is linked to animal models of fatty liver disease, we investigated the effects of these OT models on the proteins related to ER stress (i.e., BiP, inositol-requiring enzyme 1, protein kinase RNA-like endoplasmic reticulum kinase, eIF2alpha, ATF6beta, and glucose-regulated protein 94) and apoptosis (C/EBP-homologous protein, Caspase-3, 4, and 12, Bax, and tumor necrosis factor receptor-associated factor 2) in livers of C57BL/6 mice. Also, aerobic training can attenuate cardiac ER stress and improve exercise capacity. Therefore, we investigated whether the decrease in performance induced by our OT protocols is linked to ER stress and apoptosis in mouse hearts. The rodents were divided into six groups: naïve (N, sedentary mice), control (CT, sedentary mice submitted to the performance evaluations), trained (TR), OTR/down, OTR/up, and OTR groups. Rotarod, incremental load, exhaustive, and grip force tests were used to evaluate performance. After the grip force test, the livers and cardiac muscles (i.e., left ventricle) were removed and used for immunoblotting. All of the OT protocols led to similar responses in the performance parameters and displayed significantly lower hepatic ATF6beta values compared to the N group. The OTR/down group exhibited lower liver cleaved caspase-3 values compared to the CT group. However, the other proteins related to ER stress and apoptosis were not modulated. Also, the cardiac proteins related to ER stress and apoptosis were not modulated in the experimental groups. In conclusion, the OT protocols decreased the levels of hepatic ATF6beta, and the OTR/down group decreased the levels of hepatic cleaved caspase-3. Also, the decrease in performance induced by our OT models is not associated with ER stress and apoptosis in mice hearts.

Diagnosis and prevention of overtraining syndrome: an opinion on education strategies

Overtraining syndrome is a condition of maladapted physiology in the setting of excessive exercise without adequate rest. The exact etiology and pathogenesis are unknown and being investigated. Symptoms are multisystem in nature and often representative of underlying hormonal, immunologic, neurologic, and psychologic disturbances. Unfortunately, systematic review of the literature does not clearly direct diagnosis, management, or prevention. However, given the severity of symptoms and impairment to quality of life, prevention of overtraining syndrome should be considered by all who interact with endurance athletes. This article will provide suggestions for management of at-risk athletes despite absence of validated diagnostic tests and preventative measures.

Current Scientific Evidence for a Polarized Cardiovascular Endurance Training Model

Recent publications have provided new scientific evidence for a modern aerobic or cardiovascular endurance exercise prescription that optimizes the periodization cycle and maximizes potential endurance performance gains in highly trained individuals. The traditional threshold, high volume, and high-intensity training models have displayed limited improvement in actual race pace in (highly) trained individuals while frequently resulting in overreaching or overtraining (physical injury and psychological burnout). A review of evidence for replacing these models with the proven polarized training model seems warranted. This review provides a short history of the training models, summarizes 5 key studies, and provides example training programs for both the pre- and in-season periods. A polarized training program is characterized by an undulating nonlinear periodization model with nearly all the training time spent at a "light" (≤13) and "very hard" (≥17) pace with very limited time at "hard" (14-16) or race pace (6-20 Rating of Perceived Exertion [RPE] scale). To accomplish this, the polarization training model has specific high-intensity workouts separated by one or more long slow distance workouts, with the exercise intensity remaining below ventilatory threshold (VT) 1 and/or blood lactate of less than 2 mM (A.K.A. below race pace). Effect sizes for increasing aerobic endurance performance for the polarized training model are consistently superior to that of the threshold training model. Performing a polarized training program may be best accomplished by: going easy on long slow distance workouts, avoiding "race pace" and getting after it during interval workouts.

Comparison of Athletes' Proneness to Depressive Symptoms in Individual and Team Sports: Research on Psychological Mediators in Junior Elite Athletes

Depression among elite athletes is a topic of increasing interest and public awareness. Currently, empirical data on elite athletes’ depressive symptoms are rare. Recent results indicate sport-related mechanisms and effects on depression prevalence in elite athlete samples; specific factors associated with depression include overtraining, injury, and failure in competition. One such effect is that athletes competing in individual sports were found to be more prone to depressive symptoms than athletes competing in team sports. The present study examined this effect by testing three possible, psychological mediators based on theoretical and empirical assumptions: namely, cohesion in team or training groups; perception of perfectionistic expectations from others; and negative attribution after failure. In a cross-sectional study, 199 German junior elite athletes (M_age = 14.96; SD = 1.56) participated and completed questionnaires on perfectionism, cohesion, attribution after failure, and depressive symptoms. Mediation analysis using path analysis with bootstrapping was used for data analysis. As expected, athletes in individual sports showed higher scores in depression than athletes in team sports [t(197) = 2.05; p < 0.05; d = 0.30]. Furthermore, negative attribution after failure was associated with individual sports (β = 0.27; p < 0.001), as well as with the dependent variable depression (β = 0.26; p < 0.01). Mediation hypothesis was supported by a significant indirect effect (β = 0.07; p < 0.05). Negative attribution after failure mediated the relationship between individual sports and depression scores. Neither cohesion nor perfectionism met essential criteria to serve as mediators: cohesion was not elevated in either team or individual sports, and perfectionism was positively related to team sports. The results support the assumption of previous findings on sport-specific mechanisms (here the effect between individual and team sports) contributing to depressive symptoms among elite athletes. Additionally, attribution after failure seems to play an important role in this regard and could be considered in further research and practitioners in the field of sport psychology.

Multifactorial monitoring of training load in elite rugby sevens players: cortisol/cortisone ratio as a valid tool of training load monitoring

The effectiveness of selected physiological and perceptual measures for monitoring training load and fatigue was studied in 16 male elite rugby sevens players during a 6-week intense training block (IT) and 2-week tapering (TAP). Daily training load (TL) and strain (TS) as well as weekly total score of fatigue (TSF) were quantified respectively by the session-rating of perceived exertion (RPE) method and an 8-item questionnaire. Also, testing was performed and 24 h urinary cortisol (C), cortisone (Cn), adrenaline (A) and noradrenalin (NA) excretion was measured before (T0) and after the IT (T1) and after the TAP (T2). The TL, TS and TSF increased during the IT and decreased during the TAP, in conjunction with a significant drop and improvement, respectively, of performance standards during the two periods. At T1, C and Cn levels increased while A and NA levels decreased, resulting in a higher C/Cn ratio and lower A/NA ratio, respectively. At T2, both C/Cn and A/NA returned to baseline values. The changes in C/Cn ratio, after the 6-week IT, were more closely related to mean TL, TS and TSF (r=0.75-0.76 vs. r=0.48-0.58, p<0.01) and to changes in the majority of performance measures than to A/NA ratio. Only the changes in C/Cn ratio after the 2-week TAP were related to mean TL, TS and TSF (r=0.61-0.68, p<0.01). The changes in hormone levels, training strain and performance standards reflected the physical and mental stressors of training, with complete recovery, as indicated by physiological homeostasis, achieved after an appropriate tapering period.

Perfectionism and training distress in junior athletes: a longitudinal investigation

Perfectionistic athletes may train harder and for longer than non-perfectionistic athletes, leaving them susceptible to elevated levels of training distress. So far, however, no study has investigated the relationships between perfectionism and training distress, a key indicator of overtraining syndrome. Furthermore, no study has determined psychological predictors of overtraining syndrome. Using a two-wave design, the present study examined perfectionistic strivings, perfectionistic concerns and training distress in 141 junior athletes (mean age = 17.3 years, range = 16-19 years) over 3 months of active training. Multiple regression analyses were employed to test cross-sectional and longitudinal relationships between perfectionism and training distress. In all analyses, perfectionism emerged as a significant predictor, but strivings and concerns showed differential relationships. When the cross-sectional relationships were regarded, perfectionistic concerns positively predicted training distress (P < .001), whereas perfectionistic strivings negatively predicted training distress (P < .01). When the longitudinal relationships were regarded, only perfectionistic concerns predicted increases in training distress (P < .05), whereas perfectionistic strivings did not (P > .05). The findings suggest that sports scientists who wish to identify athletes at risk of overtraining syndrome may monitor athletes' perfectionistic concerns as a possible risk factor.

Excessive eccentric exercise-induced overtraining model leads to endoplasmic reticulum stress in mice skeletal muscles

AIMS

The present study verified the responses of selected endoplasmic reticulum (ER) stress proteins (i.e., BiP, ATF-6, pIRE1, pPERK, and peIF2alpha) in mice skeletal muscles after three different running overtraining (OT) protocols with same external load (i.e., intensity vs. volume), but performed in downhill, uphill and without inclination.

MATERIALS AND METHODS

The rodents were randomly divided into control (CT; sedentary mice), overtrained by downhill running (OTR/down), overtrained by uphill running (OTR/up) and overtrained by running without inclination (OTR) groups. The incremental load test and exhaustive test were used as performance parameters. Forty hours after the exhaustive test performed at the end of the OT protocols (i.e., at the end of week 8) and after a 2-week total recovery period (i.e., at the end of week 10), the extensor digitorum longus (EDL) and soleus muscles were removed and used for immunoblotting.

KEY FINDINGS

For both skeletal muscle types, the OTR/down protocol increased the pIRE-1, pPERK and peIF2alpha, which were not normalized after the total recovery period. At the end of week 8, the other two OT protocols up-regulated the BiP, pPERK and peIF2alpha levels only for the soleus muscle. These ER stress proteins were not normalized after the total recovery period for the OTR/up group.

SIGNIFICANCE

The above findings suggest that the OTR/down protocol-induced skeletal muscle ER stress may be linked to a pathological condition in EDL and soleus muscles.

Long-term athletic development, part 2: barriers to success and potential solutions

The first installment of this two-part commentary reviewed existing models of long-term athletic development. However, irrespective of the model that is adopted by practitioners, existing structures within competitive youth sports in addition to the prevalence of physical inactivity in a growing number of modern-day youth may serve as potential barriers to the success of any developmental pathway. The second part of this commentary will initially highlight common issues that are likely to impede the success of long-term athletic development programs and then propose solutions that will address the negative impact of such issues.

Carbohydrate supplementation attenuates decrement in performance in overtrained rats

Carbohydrate ingestion at the end of a single exercise is recognized as delaying fatigue and accelerating recovery, but whether chronic ingestion can prevent overtraining during periods of intense training has not yet been elucidated. This study aimed to determine whether carbohydrate supplementation minimizes overtraining in Wistar rats. The animals underwent 11 weeks of training (running) on a treadmill, and the last 3 weeks were designed to induce overtraining. One group was supplemented with carbohydrates (EX-CHO) (n = 13), 1 group had no supplementation (EX) (n = 10), and a third group remained inactive (C) (n = 9). Performance tests were given before training (Pr1) and at the 8th (Pr2) and 11th (Pr3) training week. Food intake, body weight, testosterone, cortisol, malondialdehyde, creatine kinase, and activities of the PI3-K, Akt-1, mTOR, and GSK-3 enzymes were measured. In the EX group, there was a significant 32.6% performance decrease at Pr3 when compared with Pr2. In addition, at protocol completion, the EX-CHO group had a greater gastrocnemius weight than did the C group (p = 0.02), which the EX group did not. Training caused anorexia, decreased testosterone (p = 0.001), and increased malondialdehyde (p = 0.009) in both exercise groups compared with the C group, with no influence of carbohydrate supplementation on these variables (p > 0.05). Compared with in the C group, the activity of Akt-1 was higher in the EX-CHO group but not in the EX group (p = 0.013). Carbohydrate supplementation promoted an attenuation in the performance decrement and maintained gastrocnemius muscle mass in animals that had undergone overtraining protocols, which was accompanied by increased activity of the Akt-1 molecular indicator.

Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review

Background

Monitoring athlete well-being is essential to guide training and to detect any progression towards negative health outcomes and associated poor performance. Objective (performance, physiological, biochemical) and subjective measures are all options for athlete monitoring.

Objective

We systematically reviewed objective and subjective measures of athlete well-being. Objective measures, including those taken at rest (eg, blood markers, heart rate) and during exercise (eg, oxygen consumption, heart rate response), were compared against subjective measures (eg, mood, perceived stress). All measures were also evaluated for their response to acute and chronic training load.

Methods

The databases Academic search complete, MEDLINE, PsycINFO, SPORTDiscus and PubMed were searched in May 2014. Fifty-six original studies reported concurrent subjective and objective measures of athlete well-being. The quality and strength of findings of each study were evaluated to determine overall levels of evidence.

Results

Subjective and objective measures of athlete well-being generally did not correlate. Subjective measures reflected acute and chronic training loads with superior sensitivity and consistency than objective measures. Subjective well-being was typically impaired with an acute increase in training load, and also with chronic training, while an acute decrease in training load improved subjective well-being.

Summary

This review provides further support for practitioners to use subjective measures to monitor changes in athlete well-being in response to training. Subjective measures may stand alone, or be incorporated into a mixed methods approach to athlete monitoring, as is current practice in many sport settings.

Monitoring athletic training status using the maximal rate of heart rate increase

OBJECTIVES

Reductions in maximal rate of heart rate increase (rHRI) correlate with performance reductions when training load is increased. This study evaluated whether rHRI tracked performance changes across a range of training states.

DESIGN

Prospective intervention.

METHODS

rHRI was assessed during five min of cycling at 100W (rHRIcyc) and running at 8km/h (rHRIrun) in 13 male triathletes following two weeks of light-training (LT), two weeks of heavy-training (HT) and a two-day recovery period (RP). A five min cycling time-trial assessed performance and peak oxygen consumption (V˙O2peak).

RESULTS

Performance likely decreased following HT (Effect size±90% confidence interval=-0.18±0.09), then very likely increased following RP (0.32±0.14). rHRIcyc very likely decreased (-0.48±0.24), and rHRIrun possibly decreased (-0.33±0.48), following HT. Changes in both measures were unclear following RP. Steady-state HR was almost certainly lower (-0.81±0.31) during rHRIcyc than rHRIrun. A large correlation was found between reductions in performance and rHRIrun (r±90%; CI=0.65±0.34) from LT to HT, but was unclear for rHRIcyc. Trivial within-subject correlations were found between rHRI and performance, but the strength of relationship between rHRIrun and performance was largely associated with V˙O2peak following LT (r=-0.58±0.38).

CONCLUSIONS

Performance reductions were most sensitively tracked by rHRIrun following HT. This may be due to rHRIrun being assessed at a higher intensity than rHRIcyc, inferred from a higher steady-state HR and supported by a stronger within-subject relationship between rHRIrun and performance in individuals with a lower V˙O2peak, in whom the same exercise intensity would represent a greater physiological stress. rHRI assessed at relatively high exercise intensities may better track performance changes.

Resistance training with excessive training load and insufficient recovery alters skeletal muscle mass-related protein expression

The aim of this study was to investigate the effects of a resistance training program with excessive training load and insufficient recovery time between bouts on muscle hypertrophy- and atrophy-related protein expression. Male Wistar rats were randomly assigned to either a trained (TR, N = 9) or a sedentary (SE, N = 9) group. The TR group was subjected to a 12-week resistance training program with excessive training load and insufficient recovery between bouts that was designed to induce plantaris muscle atrophy. After the 12-week experiment, the plantaris muscle was collected to analyze the cross-sectional area (CSA) of the muscle fibers, and MAFbx, MyoD, myogenin, and IGF-I protein expression (Western blot). The CSA was reduced significantly (-17%, p ≤ 0.05) in the TR group compared with the SE group. Reciprocally, there was a significant (p ≤ 0.05) 20% increase in MAFbx protein expression, whereas the MyoD (-27%), myogenin (-29%), and IGF-I (-43%) protein levels decreased significantly (p ≤ 0.05) in the TR group compared with the SE group. In conclusion, our data indicated that muscle atrophy induced by resistance training with excessive training load and insufficient recovery was associated with upregulation of the MAFbx catabolic protein and downregulation of the MyoD, myogenin, and IGF-I anabolic proteins. These findings suggest that quantitative analysis of these proteins can be important and complementary with other biochemical markers to confirm a possible overtraining diagnosis.

Influência do exercício físico na cognição: uma atualização sobre mecanismos fisiológicos

Embora um crescente corpo de literatura corrobore o papel benéfico do exercício sobre a cognição, não há consenso sobre os mecanismos que norteiam as adaptações cerebrais agudas e crônicas ao exercício. A presente revisão narrativa tem como objetivo apresentar e discutir os mecanismos pelos quais o exercício afeta o desempenho cognitivo. Agudamente, especula-se que os efeitos do exercício sobre a resposta cognitiva sejam mediados por aumentos no fluxo sanguíneo cerebral e, por conseguinte, no aporte de nutrientes, ou por um aumento na atividade de neurotransmissores. Cronicamente, especula-se que o exercício possa promover adaptações em estruturas cerebrais e plasticidade sináptica que culminariam com melhoras cognitivas. Tais hipóteses são discutidas à luz das evidências científicas disponíveis, tanto em modelos animais quanto em humanos.

Humanized animal exercise model for clinical implication

Exercise and physical activity function as a patho-physiological process that can prevent, manage, and regulate numerous chronic conditions, including metabolic syndrome and age-related sarcopenia. Because of research ethics and technical difficulties in humans, exercise models using animals are requisite for the future development of exercise mimetics to treat such abnormalities. Moreover, the beneficial or adverse outcomes of a new regime or exercise intervention in the treatment of a specific condition should be tested prior to implementation in a clinical setting. In rodents, treadmill running (or swimming) and ladder climbing are widely used as aerobic and anaerobic exercise models, respectively. However, exercise models are not limited to these types. Indeed, there are no golden standard exercise modes or protocols for managing or improving health status since the types (aerobic vs. anaerobic), time (morning vs. evening), and duration (continuous vs. acute bouts) of exercise are the critical determinants for achieving expected beneficial effects. To provide insight into the understanding of exercise and exercise physiology, we have summarized current animal exercise models largely based on aerobic and anaerobic criteria. Additionally, specialized exercise models that have been developed for testing the effect of exercise on specific physiological conditions are presented. Finally, we provide suggestions and/or considerations for developing a new regime for an exercise model.

Crawling to the finish line: why do endurance runners collapse? Implications for understanding of mechanisms underlying pacing and fatigue

Effective regulation of pace enables the majority of runners to complete competitive endurance events without mishap. However, some runners do experience exercise-induced collapse associated with postural hypotension, which in rare cases results from life-threatening conditions such as cardiac disorders, cerebral events, heat stroke and hyponatraemia. Despite the experience of either catastrophic system failure or extreme peripheral muscle fatigue, some runners persist in attempting to reach the finish line, and this often results in a sequence of dynamic changes in posture and gait that we have termed the 'Foster collapse positions'. The initial stage involves an unstable gait and the runner assumes the 'Early Foster' collapse position with hips slightly flexed and their head lowered. This unstable gait further degrades into a shuffle referred to as the 'Half Foster' collapse position characterized by hip flexion of approximately 90° with the trunk and head parallel to the ground. At this point, the muscles of postural support and the co-ordination of propulsion begin to be compromised. If the condition worsens, the runner will fall to the ground and assume the 'Full Foster' collapse position, which involves crawling forwards on knees and elbows towards the finish line, with their trunk angled such that the head is at a lower angle than the hips. Upon reaching the finish line, or sometimes before that, the runner may collapse and remain prone until recovering either with or without assistance or medical treatment. The Foster collapse positions are indicative of a final, likely primordial, protective mechanism designed to attenuate postural hypotension, cardiac 'pump' insufficiency or cerebral blood flow deficiency. Continuing to attempt to reach the finish line in this impaired state is also perhaps indicative of a high psychological drive or a variety of neurological and psychological pathologies such as diminished sensitivity to interoceptive feedback, unrealistic situational appraisal or extreme motivational drives. A better understanding of the physiological, neurological and psychological antecedents of the Foster collapse sequence remains an important issue with practical implications for runner safety and theoretical understanding of collapses during exercise.

Susceptibility for depression in current and retired student athletes

Background:

Depression, a disabling mental disorder, adversely affects work, sleeping and eating habits, and family. Research does not exist on depression among athletes who have recently graduated from college and retired from their sport after exhausting their collegiate eligibility.

Hypothesis:

Changes in lifestyle and loss of personal identity, which follow college athletics, would put former college athletes at an increased risk for depression.

Methods:

A survey was sent to former (n = 163) and current (n = 117) college athletes to correlate depression and retirement from athletics.

Results:

Depression levels were significantly higher (P = 0.03) in current college athletes (16.77%, n = 27) compared with former, graduated college athletes (8.03%, n = 9).

Conclusion:

Completion of college sports may not increase levels of depression. There is a need for increased awareness, education, screening, and intervention for depression in college athletes.

Clinical Relevance:

This study suggests that student athletes’ depression levels should be monitored during their participation in college sports.

Eating disorders, physical fitness and sport performance: a systematic review

Background: Eating disorders are health problems that are particularly prevalent in adolescents and young adults. They are associated with considerable physical health and psychosocial morbidity, and increased risk of mortality. We set out to conduct a systematic review to determine their effect on physical fitness in the general population and on sport performance in athletes. Methods/Design: A systematic review of the relevant peer-reviewed literature was performed. For inclusion, articles retrieved from PubMed had to be published in English between 1977 and 2013. Wherever possible, methods and reporting adhere to the guidelines outlined in the PRISMA statement. Some additional studies were retrieved from among those cited in the reference lists of included studies and from non-electronic databases. Literature searches, study selection, method and quality appraisal were performed independently by two authors, and data was synthesized using a narrative approach. Results: Of the 1183 articles retrieved, twenty-nine studies met the inclusion criteria and were consequently analysed. The available data indicate that eating disorders have a negative effect on physical fitness and sport performance by causing low energy availability, excessive loss of fat and lean mass, dehydration, and electrolyte disturbance. Discussion: Although the paucity of the available data mean that findings to date should be interpreted with caution, the information collated in this review has several practical implications. First, eating disorders have a negative effect on both physical fitness and sport performance. Second athletics coaches should be targeted for education about the risk factors of eating disorders, as deterioration in sport performance in athletes, particularly if they are underweight or show other signs of an eating disorder, may indicate the need for medical intervention. However, future studies are needed, especially to assess the direct effect of eating disorders on sport performance.

Sport specificity of mental disorders: the issue of sport psychiatry

The prevalence of psychiatric conditions among elite athletes is still under debate. More and more evidence has accumulated that high-performance athletes are not protected from mental disorders as previously thought. The authors discuss the issue of the sport specificity of selected mental diseases in elite athletes. Specific aspects of eating disorders, exercise addiction, chronic traumatic encephalopathy and mood disorders in the context of overtraining syndrome are examined. In particular, the interrelationship between life and work characteristics unique to elite athletes and the development of mental disorders are reviewed. Differences of clinical presentation and some therapeutic consequences are discussed. The authors suggest that the physical and mental strains endured by elite athletes might influence the onset and severity of their psychiatric disorder. Beside the existing research strategies dealing with the amount of exercise, its intensity and lack of recreation experienced by athletes, further research on psycho-social factors is needed to better understand the sport-specific aetiology of mental disorders in high-performance athletes.

Overtraining is associated with DNA damage in blood and skeletal muscle cells of Swiss mice

BACKGROUND

The alkaline version of the single-cell gel (comet) assay is a useful method for quantifying DNA damage. Although some studies on chronic and acute effects of exercise on DNA damage measured by the comet assay have been performed, it is unknown if an aerobic training protocol with intensity, volume, and load clearly defined will improve performance without leading to peripheral blood cell DNA damage. In addition, the effects of overtraining on DNA damage are unknown. Therefore, this study aimed to examine the effects of aerobic training and overtraining on DNA damage in peripheral blood and skeletal muscle cells in Swiss mice. To examine possible changes in these parameters with oxidative stress, we measured reduced glutathione (GSH) levels in total blood, and GSH levels and lipid peroxidation in muscle samples.

RESULTS

Performance evaluations (i.e., incremental load and exhaustive tests) showed significant intra and inter-group differences. The overtrained (OTR) group showed a significant increase in the percentage of DNA in the tail compared with the control (C) and trained (TR) groups. GSH levels were significantly lower in the OTR group than in the C and TR groups. The OTR group had significantly higher lipid peroxidation levels compared with the C and TR groups.

CONCLUSIONS

Aerobic and anaerobic performance parameters can be improved in training at maximal lactate steady state during 8 weeks without leading to DNA damage in peripheral blood and skeletal muscle cells or to oxidative stress in skeletal muscle cells. However, overtraining induced by downhill running training sessions is associated with DNA damage in peripheral blood and skeletal muscle cells, and with oxidative stress in skeletal muscle cells and total blood.

Night and postexercise cardiac autonomic control in functional overreaching

The purpose of this study was to evaluate the effect of a 2-week overload period immediately followed by a 1-week taper period on the autonomic control of heart rate during the night or after exercise cessation. Eleven male endurance athletes increased their usual training volume by 100% for 2 weeks (overload) and decreased it by 50% for 1 week (taper). A maximal graded exercise test and a constant-speed test at 85% of peak treadmill speed, both followed by a 10-min passive recovery period, were performed at baseline and after each period. Heart rate variability was also measured during a 4-h period in the night or during estimated slow-wave sleep. All participants were considered to be overreached based on performance and physiological and psychological criteria. We found a decrease in cardiac parasympathetic control during slow-wave sleep (HFnu = 61.3% ± 11.7% vs 50.0% ± 10.1%, p < 0.05) but not during the 4-h period, as well as a faster heart rate recovery following the maximal graded exercise test (τ = 61.8 ± 14.5 s vs 54.7 ± 9.0 s, p < 0.05) but not after the constant-speed test, after the overload period. There was a return to baseline for both measures after the taper period. Other indices of cardiac autonomic control were not altered by the overload period. Care should be taken in selecting the most sensitive heart rate measures in the follow-up of athletes, because cardiac autonomic control is not affected uniformly by overload training.

A new overtraining protocol for mice based on downhill running sessions

1. The purpose of the present study was to verify whether a downhill running protocol was able to induce non-functional overreaching in > 75% of mice. 2. Mice were divided into control (C), trained (TR) and overtrained (OTR) groups. Bodyweight and food intake were recorded weekly. The incremental load test (ILT) and the exhaustive test (ET) were used to measure performance before and after aerobic training and overtraining protocols. 3. Although the bodyweight of the OTR group was lower than that of the C group at the end of Week 7, the food intake of the OTR group was higher than that of the C and TR groups at the end of Week 8. Evaluation of results from the ILT and ET revealed significant intra- and inter-group differences: whereas the parameters measured by both tests increased significantly in the TR group, they were significantly decreased in the OTR group. 4. In conclusion, this new overtraining protocol based on downhill running sessions induced non-functional overreaching in 100% of mice.

A multidisciplinary approach to overreaching detection in endurance trained athletes

In sport, high training load required to reach peak performance pushes human adaptation to their limits. In that process, athletes may experience general fatigue, impaired performance, and may be identified as overreached (OR). When this state lasts for several months, an overtraining syndrome is diagnosed (OT). Until now, no variable per se can detect OR, a requirement to prevent the transition from OR to OT. It encouraged us to further investigate OR using a multivariate approach, including physiological, biomechanical, cognitive, and perceptive monitoring. Twenty-four highly trained triathletes were separated into an overload group and a normo-trained group (NT) during 3 wk of training. Given the decrement of their running performance, 11 triathletes were diagnosed as OR after this period. A discriminant analysis showed that the changes of eight parameters measured during a maximal incremental test could explain 98.2% of the OR state (lactatemia, heart rate, biomechanical parameters and effort perception). Variations in heart rate and lactatemia were the two most discriminating factors. When the multifactorial analysis was restricted to these variables, the classification score reached 89.5%. Catecholamines and creatine kinase concentrations at rest did not change significantly in both groups. Running pattern was preserved and cognitive performance decrement was observed only at exhaustion in OR subjects. This study showed that monitoring various variables is required to prevent the transition between NT and OR. It emphasized that an OR index, which combines heart rate and blood lactate concentration changes after a strenuous training period, could be helpful to routinely detect OR.

Overtraining syndrome: a practical guide

CONTEXT

Fatigue and underperformance are common in athletes. Understanding overtraining syndrome (OTS) is helpful in the evaluation, management, and education of athletes.

EVIDENCE ACQUISITION

Relevant articles in English were searched with OVID (1948-2011) and PubMed using the following keywords: overtraining syndrome, overtraining, overreaching, unexplained underperformance, staleness, pathophysiology, management, treatment, evaluation. Bibliographies were reviewed for additional resources.

RESULTS

OTS appears to be a maladapted response to excessive exercise without adequate rest, resulting in perturbations of multiple body systems (neurologic, endocrinologic, immunologic) coupled with mood changes. Many hypotheses of OTS pathogenesis are reviewed, and a clinical approach to athletes with possible OTS (including history, testing, and prevention) is presented.

CONCLUSIONS

OTS remains a clinical diagnosis with arbitrary definitions per the European College of Sports Science's position statement. History and, in most situations, limited serologies are helpful. However, much remains to be learned given that most past research has been on athletes with overreaching rather than OTS.

Monitoring training load and fatigue in rugby sevens players

Purpose

Trainers and physical fitness coaches’ need a useful tool to assess training loads to avoid overtraining. However, perceived scales or questionnaires were required. Therefore, the purpose of this study was to assess whether a short 8-item questionnaire of fatigue could be a useful tool for monitoring changes in perceived training load and strain among elite rugby Sevens (7s) players during preparation for a major competition.

Methods

Sixteen elite rugby 7s players completed an 8-week training program composed of 6-week intense training (IT) and 2-week reduced training (RT). They were tested before (T0), after the IT (T1) and after the RT (T2). The quantification of the perceived training load and strain were performed by the session-RPE (rating of perceived exertion) method and concomitantly the 8-item questionnaire of fatigue was administered.

Results

Training load (TL) and strain (TS) and total score of fatigue (TSF from the 8-item questionnaire) increased during IT and decreased during RT. Simultaneously, physical performances decreased during IT and were improved after LT. The changes in TL, TS and TSF correlated significantly over the training period (r=0.63-0.83).

Conclusions

These findings suggest that the short questionnaire of fatigue could be a practical and a sensitive tool for monitoring changes in training load and strain in team-sport athletes. Accordingly, the simultaneous use of the short questionnaire of fatigue along with the session-RPE method for perceived changes in training load and strain during training could provide additional information on the athletes’ status, allowing coaches to prevent eventual states of overreaching or overtraining.

Coaching communication issues with elite female athletes: two Norwegian case studies

The aim of this study was to examine the careers of two successful female elite athletes who later stagnated, and to identify possible factors that might have led to their demotivation. Individual interviews and a focus group interview were conducted. Using a multidisciplinary approach, the stories of April and Hazel raised several issues related to coaching, coach education, and the development of female athletes. Their individual profiles revealed that their perception of the lack of long-term development was caused by coach miscommunication, having to cope with sudden fame, and injuries provoked by overtraining. The coach-athlete relationship was discussed with a focus on the inexperience of some coaches, the number of coaches the athletes had to deal with, sociolinguistic issues, and the differing criteria of success communicated. Finally, the importance of their national governing bodies to focus on knowledge transfer, the supervision of coaches, and the infrastructure to monitor athletes were discussed.

Changes in physical fitness, bone mineral density and body composition during inpatient treatment of underweight and normal weight females with longstanding eating disorders

The purpose of this study was to examine changes in aerobic fitness, muscular strength, bone mineral density (BMD) and body composition during inpatient treatment of underweight and normal weight patients with longstanding eating disorders (ED). Twenty-nine underweight (BMI < 18.5, n = 7) and normal weight (BMI ≥ 18.5, n = 22) inpatients (mean (SD) age: 31.0 (9.0) years, ED duration: 14.9 (8.8) years, duration of treatment: 16.6 (5.5) weeks) completed this prospective naturalistic study. The treatment consisted of nutritional counseling, and 2 × 60 min weekly moderate intensive physical activity in addition to psychotherapy and milieu therapy. Underweight patients aimed to increase body weight with 0.5 kg/week until the weight gain goal was reached. Aerobic fitness, muscular strength, BMD and body composition were measured at admission and discharge. Results showed an increase in mean muscular strength, total body mass, fat mass, and body fat percentage, but not aerobic capacity, among both underweight and normal weight patients. Lumbar spine BMD increased among the underweight patients, no changes were observed in BMD among the normal weight patients. Three out of seven underweight patients were still underweight at discharge, and only three out of nine patients with excessive body fat (i.e., >33%) managed to reduce body fat to normal values during treatment. These results calls for a more individualized treatment approach to achieve a more optimal body composition among both underweight and normal to overweight patients with longstanding ED.

Psychiatric and neuropsychological issues in sports medicine

This article reviews psychiatric/psychological issues in the athletic training room, including recognition of these issues and a framework for management. Because the majority of research has been conducted in college settings, most of the issues discussed are presented in the context of college sports, although the results generalize to other athletic arenas. Greater awareness of psychological issues, empirical research, and education about mental health issues in the sports medicine community are clearly needed.

Sport psychiatry and psychotherapy. Mental strains and disorders in professional sports. Challenge and answer to societal changes

Professional athletes are subject to massive somatic, social, and mental stress. Despite great public interest for athletic achievements, the emotional strains thereof are very poorly investigated and discussed. The main reason for this is the widespread assumption that only emotionally very strong athletes are able to compete at the highly professional level and therefore mental disorders do not exist in professional sports. But available research data about the prevalence of mental disorders in this area suggest that this hypothesis must be revised. With respect to depression and the overtraining syndrome, attempts have been made to demonstrate the difficulties with etiology, diagnostics, and treatment for sports psychiatry and psychotherapy. Scientifically, sport psychiatry and psychotherapy can be defined as a discipline, whose focus is the investigation, treatment, and prevention of the extreme and sports-specific emotional strains and disorders. In addition to sport psychology, which focuses mainly on performance enhancement, mental stress, and disorders can hereby be recognized, disorders be treated and the athletic performance sustained. With the foundation of the Task Force for Sports Psychiatry and Psychotherapy at the German Association for Psychiatry and Psychotherapy, scientific research, further education, prevention, and treatment for mental disorders in professional sports will be improved.

Prevalence of nonfunctional overreaching/overtraining in young English athletes

PURPOSE

Nonfunctional overreaching and overtraining (NFOR/OT) in adults can lead to significant decrements in performance, combined with physical and psychological health problems. Little is known about this condition in young athletes by comparison; thus, the aim of the study was to assess the incidence and symptomatology of NFOR/OT in young English athletes.

METHODS

Three hundred seventy-six athletes (131 girls and 245 boys, age=15.1±2.0 yr) completed a 92-item survey about NFOR/OT. The sample included athletes competing at club to international standards across 19 different sports. Athletes were classified as NFOR/OT if they reported persistent daily fatigue and a significant decrement in performance that lasted for long periods of time (i.e., weeks to months). Data were analyzed using the Mann-Whitney U and the Kolmogorov-Smirnov nonparametric tests. Significant predictors of NFOR/OT were identified using logistic regression analysis.

RESULTS

One hundred ten athletes (29%) reported having been NFOR/OT at least once. The incidence was significantly higher in individual sports (P<0.01), low-physical demand sports (P<0.01), females (P<0.01), and at the elite level (P<0.01). Training load was not a significant predictor of NFOR/OT; however, competitive level and gender accounted for a small (4.7% and 1.7%, respectively) but significant explanatory variance of NFOR/OT (P<0.05).

CONCLUSIONS

Approximately one-third of young athletes have experienced NFOR/OT, making this an issue for parents and coaches to recognize. OT is not solely a training load-related problem with both physical and psychosocial factors identified as important contributors.