Novel Markers of Recovery From Overtraining Syndrome: The EROS-LONGITUDINAL Study

Overtraining Syndrome Symptoms and Diagnosis in Athletes: Where Is the Research? A Systematic Review

CONTEXT

To understand overtraining syndrome (OTS), it is important to detail the physiological and psychological changes that occur in athletes.

OBJECTIVES

To systematically establish and detail the physiological and psychological changes that occur as a result of OTS in athletes.

METHODS

Databases were searched for studies that were (1) original investigations; (2) English, full-text articles; (3) published in peer-reviewed journals; (4) investigations into adult humans and provided (5) objective evidence that detailed changes in performance from prior to the onset of OTS diagnosis and that performance was suppressed for more than 4 weeks and (6) objective evidence of psychological symptoms.

RESULTS

Zero studies provided objective evidence of detailed changes in performance from prior to the onset of OTS diagnosis and demonstrated suppressed performance for more than 4 weeks accompanied by changes in psychological symptoms.

CONCLUSIONS

All studies failed to provide evidence of changes in performance and mood from "healthy" to an overtrained state with evidence of prolonged suppression of performance. While OTS may be observed in the field, little data is available describing how physiological and psychological symptoms manifest. This stems from vague terminology, difficulties in monitoring for prolonged periods of time, and the need for prospective testing. Real-world settings may facilitate the collection of such data, but the ideal testing battery that can easily be conducted on a regular basis does not yet exist. Consequently, it must be concluded that an evidence base of sufficient scientific quality for understanding OTS in athletes is lacking.

Diagnosing Overtraining Syndrome: A Scoping Review

Context:

Overtraining syndrome (OTS) is a condition characterized by a long-term performance decrement, which occurs after a persisting imbalance between training-related and nontraining-related load and recovery. Because of the lack of a gold standard diagnostic test, OTS remains a diagnosis of exclusion.

Objective:

To systematically review and map biomarkers and tools reported in the literature as potentially diagnostic for OTS.

Data Sources:

PubMed, Web of Science, and SPORTDiscus were searched from database inception to February 4, 2021, and results screened for eligibility. Backward and forward citation tracking on eligible records were used to complement results of database searching.

Study Selection:

Studies including athletes with a likely OTS diagnosis, as defined by the European College of Sport Science and the American College of Sports Medicine, and reporting at least 1 biomarker or tool potentially diagnostic for OTS were deemed eligible.

Study Design:

Scoping review following the guidelines of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews (PRISMA-ScR).

Level of Evidence:

Level 4.

Data Extraction:

Athletes’ population, criteria used to diagnose OTS, potentially diagnostic biomarkers and tools, as well as miscellaneous study characteristics were extracted.

Results:

The search yielded 5561 results, of which 39 met the eligibility criteria. Three diagnostic scores, namely the EROS-CLINICAL, EROS-SIMPLIFIED, and EROS-COMPLETE scores (EROS = Endocrine and Metabolic Responses on Overtraining Syndrome study), were identified. Additionally, basal hormone, neurotransmitter and other metabolite levels, hormonal responses to stimuli, psychological questionnaires, exercise tests, heart rate variability, electroencephalography, immunological and redox parameters, muscle structure, and body composition were reported as potentially diagnostic for OTS.

Conclusion:

Specific hormones, neurotransmitters, and metabolites, as well as psychological, electrocardiographic, electroencephalographic, and immunological patterns were identified as potentially diagnostic for OTS, reflecting its multisystemic nature. As exemplified by the EROS scores, combinations of these variables may be required to diagnose OTS. These scores must now be validated in larger samples and within female athletes.

Potential risk for developing severe COVID-19 disease among anabolic steroid users

A severe case of COVID-19 was observed in an otherwise healthy 28-year-old man who had taken oxandrolone 40 mg/day as an anabolic steroid. The patient had been taking oxandrolone for enhanced bodybuilding 30 days prior to presenting to an outpatient clinic with COVID-19 symptoms. The patient reported that his symptoms have rapidly worsened over the course of 4 days prior to presenting at the clinic. As part of an experimental antiandrogen treatment for hyperandrogenic men suffering from COVID-19, he was administered a single 600 mg dose of the novel antiandrogen proxalutamide. Twenty-four hours after administration of this dose, marked improvement of symptoms and markers of disease severity were observed. To our knowledge, this is the first case that potentially links anabolic steroid use to COVID-19 disease severity.