CHAPTER 38 • OVERTRAINING SYNDROME/CHRONIC FATIGUE 231Ferritin, serum β-human chorionic gonadotropin
(β-HCG), Monospot, and other specifically indicated
tests based on history, review of systems (ROS), and
examination.- Prescribe decrease in intensity or even absolute rest for
2 weeks. During that time consider cross training for
enjoyment and evaluation of other confounding stressors.
SECONDVISIT
•Review lab results, training over the past 2 weeks, and
symptoms.
- If improved consider the diagnosis of physiologic
fatigue (overreached) and focus on adjustments to the
training schedule with periodization, cross training,
and addressing other stressors identified. - If not improved consider the diagnosis of pathologic
fatigue or overtraining. They will require prolonged
relative rest from intense training and further work up.
Consider consultation with a sports psychologist,
dietician, and further evaluation to work through the
differential diagnosis.
MONITORING
- Poor markers for overtraining include body mass,
hemoglobin, ferritin, CPK. - Indicators of inadequate recovery, but not necessarily
overtraining include FTCR ratio decrease >30%, a
decrease in SHBG, and a glutamine to glutamate level
<3.58 (Smith and Norris, 2000; Halson et al, 2003). - Psychiatric indicators generally change before bio-
logic markers. - Good markers for monitoring:Athletes, trainers and
coaches often use baseline HR. A rise of >10 beats is
considered abnormal. This rise represents an imbalance
between sympathetic and parasympathetic systems
with heightened sympathetic tone (Dressendorfer,
Hansen, and Timmis, 2000). In the past this was not
considered to be a great monitoring toolbecause of
multiple confounding factors. - HR variability is another research tool that also mon-
itors the balance of parasympathetic and sympathetic
activity. Increase in HR variability indicates inade-
quate recovery (Pichot et al, 2002). - Performance in time trials and standard exercise chal-
lenges.
•Foster recently described a “session RPE,” or relative
perceived exertion, as the athlete’s self-described
intensity of the training session multiplied by the
duration of the session. Daily mean load and standard
deviation(SD) can calculated to quantitative monotony
(daily mean/SD) and strain (weekly load * monotony)
(Foster, 1998). - Psychologic tools: Profile of Mood State-a 65-item ques-
tionnaire assessing five negative (tension, depression,
anger, fatigue, and confusion) and one positive mood
state (vigor) (McNair, Lorr, and Dropplemann, 1992).- Total quality recovery(TQR) action and perceived
scales (Kentta and Hassmen, 1998)
a. Action: A total score in four major areas of recovery
(a) Nutrition/Hydration 10 pts
(b) Sleep/Rest 4 pts
(c) Relaxation/emotional support 3 pts
(d) Stretching/Active rest 3 pts
b. Perceived: A reverse Borg RPE scale of perceived
recovery (Table 38-1) - Recovery-stress-questionnaire for athletes (RESTQ-
Sport) (Kellman and Günther, 2000).
a. Ninety nine question survey tool answered on a
Likert-type scale to assess training stress and
recovery.
PREVENTION- Individualized and variable training programs
- Coaching and supervised training
- Periods of “time out”
- Cross training
- Reasonable goal setting (short and long term)
- Relaxation and visualization techniques or use of a
sports psychologist
REFERENCES
Davis MJ, Bailey SP: Possible mechanism of central nervous
system fatigue during exercise. Med Sci Sports Exerc 29(1):45,
1996.
Derman W et al: The worn-out athlete: A clinical approach to
chronic fatigue in athletes. J Sports Sci 15(3):341, 1997.TABLE 38-1 TQR Action
RATING OF PERCEIVED TOTAL QUALITY
EXERTION (RPE) RECOVER (TQR)
66
7Very, very light 7 Very, very poor recovery
88
9very light 9 very poor recovery
10 10
11 Faintly light 11 Poor recovery
12 12
13 Somewhat hard 13 Reasonable recovery
14 14
15 Hard 15 Good recovery
16 16
17 Very hard 17 Very good recovery
18 18
19 Very, very hard 19 Very, very good recovery
20 20SOURCE:(Foster, 1998).