AN OVERVIEW OF
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.
"Stress has a ripple effect, meaning it can effect areas of the body not directly related to the source of the stress. Examples include:
- Weight gain around the waist.
- Increased inflammation.
- Bone loss.
- Depression.
- Memory loss.
- Muscle loss.
- Decrease in immune system and detox capabilities.
- Loss of libido."
"The MAF test is explained in Dr. Maffetone's article, Want speed? Slow down.
The most famous student of the MAF method to date is Mark Allen, who is one of the most successful triathletes in the history of the sport. An excerpt from The Lore of Running book by Timothy Noakes includes a section of Mark Allen's shift to MAF training (p 454-460). One comment worth noting is what Mark Allen mentioned in an interview: In a discussion I had with him in Pajulahti, Finland, Allen added that the key to his longevity was the three months of gentle aerobic training in the Patience Phase. His belief is that once you begin speed training, the body enters a hyped-up state that wears you down, as you are unable to sleep properly and recover adequately during this period. Thus, in his opinion, intensive training produces a cumulative fatiguing effect, which is not due solely to the actual training performed but also to a residual effect that acts during the recovery period between training sessions."
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.
"Remember from my previous post, the sympathetic system works like a gas pedal in that it revs up your body. This is okay once and a while, but too much rev'ing could lead to lots of health problems."
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.
"A poor diet and hidden stresses such as food allergies/sensitivities and pathogens can also contribute to chronic stress"
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.
"Dr. Maffetone is spot on when he mentions hypothalamic-pituitary-adrenal (HPA) dysfunction usually begins in Stage 1. Most people will ignore the subtle symptoms of this dysfunction, considering them as merely background noise. There are other ways to test for dysfunction, such as a simple saliva test, which I will discuss below."
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.
"You can also measure your body temperature upon waking. A lower body temperature is further evidence that your body is out of balance."
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.
"A good test is the BioHealth Adrenal Stress Profile which provides 11 hormone measurements (7 hormones):
- Four (4) Cortisol - Morning, Afternoon, Dinner, Bedtime (Circadian Rhythm)
- Two (2) DHEA
- Estradiol
- Estriol
- Progesterone
- Testosterone
- Melatonin
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.)
"Elevated insulin levels are also rough on heart health. Serious stuff."
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.
"I should point out that there is no Stage 4. In other words, your body completely shuts down and you, well, die."
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.”
"This is exactly what happened to Geoff Roes."
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.
"You need to be on top of your macro- and micro-nutrient intake no matter what type of food camp you are in. I highly recommend Paul Jaminet's, Perfect Health Diet, if you are in the ancestral/whole food/paleo type camp. I spent some time in the vegan/vegetarian space, but felt I was never able to fully nourish my body."
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.
"There are several ways to handle external stress in a manner which leads to improved health. Yoga, mindful breathing, and meditation are some examples."
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.
"From Noakes book, Mark Allen mentions how he determined when he was done with the aerobic building phase: the key is to watch for a slowing of your pace at your maximum aerobic heart rate. When this happens, its time to go back to your base-building phase….It's very subtle, but if your heart rate starts going up for a given effort in workouts, you know that you're on the edge—just resting won't help; you have to modify your training."
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.
"I would remove all refined food from your diet even if you do not feel you are out of balance. These type foods are devoid of any meaningful nutrition and typically contain chemicals and toxins which will further add to your stress and poor health."
• 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.
"This should not be a problem if you are eating a diet containing nutrient dense foods. Extra points for consuming only eggs and meat from grass fed chickens and cows/pigs."
• 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.)
"Again, none of the processed oils are good for you. These Poly Unsaturated Fats, (PUFAs) are typically rancid by the time they hit the shelves and as Dr. Maffetone states above, are high in omega-6. Use coconut oil, palm oil, or butter, all of which are high in omega-3. Opt for organic oils and butter from grass fed cows (Ex. Kerrygold)."
• 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).
"Caffeine over stimulates your adrenals, so not the best thing if your adrenals are already in a fatigued state. Otherwise coffee and chocolate are high in anti-oxidants and have many other marvelous health benefits."
• 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.
"A full recovery often requires you look at your complete lifestyle. The main areas you should consider are:
- Diet - Ensure you are eating nutrient dense foods with a good balance of macro- and micro-nutrients.
- Rest - Make sure you get eight hours or so. This helps with recovery and helps you maintain a healthy immune system.
- Exercise - Build in adequate recovery and pursue tools which help you decide when you are overtraining. Remember, you can only manage those things you can measure.
- Supplements - I am a big believer in supplements. At a minimum I would take D3, B12, CoQ10, K2, Magnesium, C, A, and a multi-mineral. You should have your Vitamin D levels checked regularly to make sure you are dosing correctly. Other thorough lists of supplements are provided by Dave Asprey (Bulletproof Exec) and Paul Jaminet (Perfect Health Diet).
- Stress - You should strive to reduce all sources, both external and hidden.
- Adrenal Support or Adrenal Health (help with HPA dysfunction recovery)
- Pure ADR (advisable when in heavy training/racing period)
- Ramp up the Vitamin C
- B-Complex
- Bio-identical hormones (DHEA, Progesterone, Pregnenolone - work with a healthcare professional)"
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.
"I am over one year into my recovery and am still not feeling like I am back to where I need to be.
Overtraining is a serious problem, and one that can be successfully remedied. More importantly, it’s easily prevented.
"That is it for now. As always, I welcome feedback and questions."
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