The Overtraining Syndrome
Dr. Philip Maffetone
Overtraining has been traditionally described as diminished performance that results from an increase in training volume and/or intensity. While workout volume (total weekly training) and intensity are associated with overtraining, recovery is a very important consideration. I have defined overtraining as a syndrome because it can have various signs and symptoms, depending on the individual. The overtraining syndrome is an imbalance in a simple equation: Training = Workout + Recovery.
The full spectrum of overtraining can result in hormonal, nutritional, mental/emotional, muscular, neurological and others imbalances. These, in turn, can cause fatigue, depression, injuries and poor performance to name a few problems.
Prevention and correction of the overtraining syndrome begins with assessment, something that should be an ongoing process for every athlete. Observing the subtle clues in their earliest stages are crucial to the prevention of further regression. The MAF Test may be the most powerful tool for assessing overtraining in the earliest stage, and may provide the first objective sign, even before symptoms begin. In order for this assessment to be effective, conducting the MAF Test about every three to four weeks is important.
The spectrum of overtraining syndrome can be described as having three stages:
Stage 1: Also called functional overtraining. The onset and earliest stage where very subtle signs and symptoms can indicate you’re starting to overtrain.
Stage 2: Also called sympathetic overtraining. A more obvious stage associated with specific nervous, hormonal and mechanical imbalances causing a variety of signs and symptoms.
Stage 3: Also called parasympathetic overtraining. A serious end-stage of overtraining associated with the exhaustion of neurological and hormonal factors, typically with serious physical, chemical or mental injuries.
The overtraining syndrome leads to poor athletic performance, structural injury secondary to muscle imbalance, and metabolic problems leading to fatigue, infection, bone loss, sexual dysfunction, altered mood states and other problems. These signs and symptoms not only affect training and competition, but all aspects of a person’s life.
While we think of overtraining as being sports related, other lifestyle factors may contribute to the cause. Increased work, family or job stress, social obligations, poor sleep habits and other non-sports factors can significantly and indirectly contribute to overtraining.
Stage 1: Functional Overtraining
The first stage of overtraining is not usually accompanied by classical problems but by very subtle or subclinical ones. This may include a seemingly minor plateau or slight regression in training performance most easily observed when measuring heart rate vs. pace (the MAF Test). Interestingly, this stage is sometimes accompanied by a sudden or dramatic improvement in competitive performance that may convince the athlete that training is progressing well. This temporary improvement may be due to an abnormal overactive sympathetic nervous system. (This may be followed by a physical injury, marking the start of the second stage of overtraining.)
A common problem in Stage 1 overtraining is a developing imbalance between the aerobic and anaerobic systems. While this may be determined by various laboratory tests, it is not difficult to generally compare maximum aerobic function versus maximum anaerobic function.
The aerobic system can be monitored with the MAF Test, while anaerobic function by competitive performance. An imbalance is evident, for example, if you can perform the MAF Test at 7 minutes per mile but run a 5 or 10K race under 5 minutes per mile. It is not uncommon for talented athletes in Stage 1 (or the start of Stage 2) to compete at high levels but have poor aerobic function. (However, decreased performance levels may not be evident until middle and later stages of overtraining.)
Stage 1 overtraining may be synonymous with overreaching, which has been shown in studies to boost performance but often turns into more obvious overtraining—it’s a fine line between optimal preparedness and the beginning of athletic decline.
Adrenal gland dysfunction (as part of the hypothalamic-pituitary-adrenal axis), very common in overtraining, usually begins in Stage 1. In addition, it typically parallels the start of aerobic deficiency. As this stage progresses, athletes may begin to develop fatigue, sleeping irregularities and abnormal hunger or cravings for sweets. They may be unable to lose that extra body fat, get sleepy after meals, and have an uncanny craving for caffeine.
Nutritional problems may include excess consumption of refined carbohydrates at the expense of healthy fats and protein. Common problems in the first stage of overtraining include:
• Back, knee, ankle, and foot injuries.
• Hormone imbalance includes elevations of cortisol with secondary lowering of testosterone and DHEA levels.
• Premenstrual syndrome and menopausal symptoms may be secondary complaints for women, but amenorrhea is a common problem.
• Sexual dysfunction may be a problem for both sexes, typically producing reduced sexual desire and sometimes infertility.
• Mental and emotional stress, including mild or clinical depression and anxiety is not uncommon.
When overtraining is not discovered and corrected, all these signs and symptoms merge into the second stage of the syndrome.
Stage 2: Sympathetic Overtraining
As overtraining progresses, the imbalances described above worsen. Specifically, the sympathetic part of the nervous system becomes overactive. This results in the classic sign of an increased resting heart rate. Many athletes become aware of this if they regularly measure their morning heart rate, or train with a monitor. Often associated with this is restlessness and over-excitability.
The increased training heart rate also influences the MAF Test results, i.e., training at the same pace results in a higher heart rate, or, training at a given heart rate slows your pace.
Hormone dysfunction also progresses during sympathetic overtraining. Early detection and treatment of adrenal dysfunction is vital to the prevention of overtraining (and is easily done with salivary testing). Specific adrenal problems include various hormonal imbalances, most commonly cortisol, which rises to abnormal levels. The keen awareness and fine hand-to-eye coordination required in some sports are adversely affected by these hormone problems. High cortisol levels have a catabolic effect on the system—this is comparable to that produced by exhaustive, prolonged training.
High cortisol can also increase insulin levels. Aerobic training usually suppresses insulin production during exercise, whereas studies show that maximal training intensities can increase the insulin response. This further raises the sympathetic nervous system activity and adds to the overtraining condition. In addition, elevated cortisol lowers testosterone and DHEA, both important for muscle recovery. (Those who waken in the middle of the night and don’t easily fall back asleep typically have high cortisol levels.)
Fortunately, hormone imbalances and other problems are relatively easily remedied through diet and lifestyle changes, including one’s training and racing schedule. If these corrections are not made, the athletes can enter the third stage of overtraining.
Stage 3: Parasympathetic Overtraining
Chronic overtraining can lead to more serious hormonal, neurological and mechanical imbalances, worsening aerobic function, athletic performance and other factors that impact overall health.
Eventually, the sympathetic nervous system becomes exhausted, and most if not all hormone levels are significantly reduced, including cortisol.
Stage 3 is typically accompanied by the lack of desire to compete (and sometimes train), depression, significant injury and most notably exhaustion. Performance may diminish considerably and many athletes in this state consider themselves “sidelined.”
The MAF Test has usually regressed dramatically to a poor level. This condition is associated with abnormally low resting heart rates and low heart-rate recovery from interval training or competition. (Some continue to misinterpret the low heart rate as a good sign.) The hormonal problems may result in increased sodium loss due to reduced aldosterone and may increase the athlete’s vulnerability to hyponatremia—a serious condition of low sodium (although this can also appear in Stage 2).
Athletes who are in the third stage of overtraining are seriously unwell. Recovery and return to previous optimal levels of performance is a very difficult task.
Remedies for Overtraining
In order to remedy a problem, it must first be properly assessed. When properly performed, the MAF Test is the most important evaluation an athlete can make to assess overtraining in its earliest stage. Also effective are hormone tests, such as the simple and accurate salivary cortisol, DHEA, and sometimes others as needed, such as testosterone, estrogen and progesterone.
Another important assessment tool is a good history—taken by a coach, a family member, or most accurately by a health care professional. The important questions that pertain to mood, energy levels, sleep quality, performance and infections are important to answer honestly.
A diet analysis, which can often be done free of charge on the Internet or for a nominal cost through a health professional, or with a simple computer program, is valuable in assessing the balance of macro- and micronutrients in the diet.
Correcting overtraining begins by immediately restructuring the training schedule, modifying lifestyle factors including diet and nutrition, and addressing all levels of stress. Finding a professional who can help is also a valuable adjunct.
Adjusting the training schedule is key in an athlete in any stage of overtraining. This should be based on the individual’s need. Some specific suggestions include:
• Decrease training time by 50 to 70 percent, or more if necessary.
• Immediately cease all anaerobic training and competition.
• A helpful remedy for an overtrained athlete is walking, which can gently stimulate circulation and aerobic muscle fiber activity, and offers mental benefits much like those of meditation. Walking also helps redevelop the aerobic system—the first phase of retraining.
• Retraining, that is, building the aerobic base, should last three to six months and does not include any anaerobic training or competition.
Diet and nutrition are important factors in the overtraining syndrome. While individualized nutritional recommendations are ideal, some important suggestions should be considered:
• Eliminate all high-glycemic foods, especially sugar and other refined flour. Moderating carbohydrate intake overall can also be helpful as high carbohydrate diets may further elevate cortisol levels.
• Consume smaller, more frequent meals to help control blood sugar and cortisol, especially for those with symptoms of depression, fatigue, hunger and poor sleep.
• Adequate caloric intake is very important—never get hungry. Include moderate amounts of protein (especially eggs and meats) and healthy fats.
• Overtraining may disrupt the normal balance of fats in the body, which help control inflammation, one reason why inflammatory-related injuries are common. Eliminate the intake of omega-6 vegetable oils (soy, peanut, safflower, canola, corn), which can promote inflammation. EPA (fish oil) supplements can help reduce inflammation. (If serious inflammation exists, reduce all dairy fats too, including milk, cream, butter and cheese.)
• Caffeine consumption may be contraindicated for overtrained athletes. Avoid stimulants such as coffee, tea, soda, and chocolate (beware of caffeine-containing, over-the-counter and prescription drugs).
• Zinc may help control the abnormally high levels of cortisol, but timing is important when supplementing with zinc. Cortisol should be measured throughout the day to determine abnormal peak levels; then the zinc supplements should be taken two to three hours prior to cortisol peaks.
When committed, athletes can often recover rapidly from the overtraining syndrome. In this first stage, modifying the training schedule, and making appropriate nutritional and dietary adjustments often provide improvements of symptoms and even training within two weeks. This rapid progress will be demonstrated in the MAF Test, including reductions in injuries and mental stress.
Athletes in the first and second stages of overtraining also respond quickly to proper recovery. Most important is obtaining at least seven to eight hours of uninterrupted sleep each night. Those with upcoming competitions may be required to modify or cancel those events to allow for a more complete recovery from overtraining. Building an acceptable aerobic base will take at least three to six months.
Athletes who are chronically overtrained—those in the third stage—generally respond much slower. They may need to cancel their next competitive season and spend time building the aerobic system, reducing stress and improving their nutrition. These athletes will require six months or more, and sometimes a year or two, before resuming effective competition.
Overtraining is a serious problem, and one that can be successfully remedied. More importantly, it’s easily prevented.