Recently, I have had a number of people report to my office with some surprisingly similar complaints: Fatigue, muscle tension and prolonged soreness, decreased appetite, sleep problems, and general feelings of malaise. After a through review of their history and symptoms, a physical exam, and an occasional laboratory study, I determined what I was seeing was not the winter blues or an unprecedented viral syndrome; it was a number of cases of overtraining. Overtraining syndrome, as it is referred to in the medical literature, is a serious problem marked most noticeably by a decrease in performance (strength, speed, endurance, or other), increased fatigue, persistent muscle soreness, mood disturbances, and feeling ‘burnt out’ or ‘stale.’ It is also apparent in the form of increased fat mass (and inversely decreased lean mass) even in the presence of extreme exercise. As a physician, the diagnosis of overtraining is usually complicated as there are no exact diagnostic criteria, and one must rule out other diseases before the diagnosis can be made. A number of ‘tests’ have been developed to help determine the overtrained state, however the history and reported symptoms of the patient are the best indicators. Prevention is still the best treatment, and certain subjective and objective parameters can be used by athletes and their trainers to prevent overtraining.

Causes of Overtraining
  Many factors set active people up for the overstraining syndrome. These include personal factors, such as general health and nutritional status, mood, personality type (type ‘A’ individuals seem to cope better with high stress states), age, and medical conditions. External factors involved in overtraining include intensity and amount of physical training, stressors (social, economic, and psychological), training history, environmental conditions and time of year (I believe I am seeing more of this right now due to the up and coming spring break), sleep (quality and quantity), and drugs (medication, alcohol, tobacco, or other substances).

  Of the personal factors, general health and nutritional status are the most easily adjusted. Improving overall health with nutritional intervention is one of the best preventative measures. A deficient calorie intake seems to decrease stress toleranceand set one up for overtraining. Of the external factors, a progressive increase in the intensity of training and an increase in the total training volume is the strongest cause, suggesting an imbalance between a person’s ability to adjust to the training load and the amount of recovery time required. Environmental conditions such as altitude, cold, or hot weather are additional stressors for the body, increasing vulnerability to the overtraining state. Sleep deprivation seems to affect the protective metabolic and endocrine functions needed to prevent overtraining.

Identification of Overtraining
  As mentioned above, self-identification of overtraining may be based on your personal symptoms. Fatigue, muscle tension and prolonged soreness, decreased appetite, sleep problems, and general ‘ill’ feelings in association with recent changes in your training regimen and/or decreased performance may be an indication. If these symptoms are present however, it is a good idea to visit your primary care doctor to rule out other potential causes such as metabolic or hormonal derangements (Addison’s Disease, hypo- and hyperthyroidism), anemia and/or other nutritional deficiencies, asthma and allergies, cardiac diseases, diabetes or glucose intolerance, infections, muscle diseases, and psychiatric disorders such as depression.

  Some objective findings may also aid in the identification of overtraining. Performance changes such as increased heart rate at a sub-maximal load (ie your heart rate is higher than normal while doing moderate exercise), decreased time to exhaustion during a constant velocity, and decreased power or strength during maximal effort can all be indications. Changes in morning heart rate upon awakening (more than normal variation) as well as increased or decreased weight (more than anticipated) can also be objective clues to the condition.

Prevention and Treatment of Overtraining
  Prevention is the best treatment for the overtraining state. Once any of the above subjective or objective symptoms start to appear, tapering the training regimen combined with rest, accurate nutrition, and sleep will help the body heal. Recognition and treatment of depression is of utmost importance. Periodization of training (correct amounts of training are combined with adequate recovery) helps prevent overtraining. Ensuring adequate nutrition is essential. If the diet is sufficient, supplements have not shown to prevent or speed recovery. Females are more likely to be lacking adequate iron (due to menstruation) and deficiencies in zinc, magnesium and calcium are common in active people especially when the diet is restricted. I like to make certain antioxidants are present both for prevention and treatment. Vitamin C and E, as well as Co-Enzyme Q 10 are my personal favorites (greater-than-recommended doses are not suggested even for overtrained individuals and can be harmful). Sleep is essential in the prevention and treatment as is recovery time and (people love this one) increased sexual activity may aid in recovery as it relaxes and adjusts neurotransmitters in a helpful way.

  Other interventions I utilize for the prevention and treatment of overtraining include a change of scenery (try a new gym for a few months) or type of exercise (change from a bike to running). I also make use of massage, saunas, ice and heat therapy and in some instances, physical therapy. When nothing else seems to work, taking a two-week break from any type of exercise is very beneficial in not only the prevention but also the treatment of this aggravating condition. Overall, my advice for the prevention and treatment of overtraining is to ‘train with your brain’. Exercise hard, but more importantly, exercise smart!

Dr. J. Warren Willey II, DO is a board certified Family Physician. His specialty interest is in preventative medicine and the use of exercise and nutrition in the treatment and prevention of disease. He graduated from the Mayo Clinic Graduate School of Medicine, with residency training in family medicine in 1999. Dr. Willey graduated Summa Cum Laude from The University of Health Sciences – College of Osteopathic Medicine in Kansas City, Missouri in 1996. He has a bachelors of science in exercise physiology from Colorado State University. He was a nationally competitive teen body builder and is currently starting to compete again. He is a patent holder on a number of fitness and medical devices. He has written textbooks and writes for a number of periodicals including Men*s Fitness. Dr. Willey has extensive knowledge of resistance training and exercise, and is currently working on a textbook for personal trainers, physical therapists, and physicians in the area of resistance and weight training. He also designs elite diet programs, nutritional strategies, and exercise routines for physic artist and bodybuilders. Dr. Willey is available for consultation and can be contacted at: docjww@hotmail.com