During periods of intense training, athletes can experience unexplained levels of fatigue, as well as a decline in performance and physiologic function that cannot be restored by a few days of reduced training, total rest, or a carbohydrate-rich diet. These symptoms are collectively referred as overtraining syndrome, and it can last for weeks, months, or even years.13 When athletes are subjected to excessive training, they may eventually exceed their ability to cope with or adapt to the training stress. If the intensity is increased from session to session beyond the body's ability to adapt, and if full recovery is not allowed, the training becomes a source of long-term physical and psychologic stress. For example, runners who train more than 45 miles a week at moderate to high intensity are known to have chronically elevated cortisol levels and negative mood states.14
Overtraining syndrome is subjective and highly individualized, which makes it difficult for athletes and their coaches to identify it as the cause of a decline in physical performance and bodily function.
The primary signs and symptoms of the overtraining syndrome are as follows:
• General fatigue that does not respond to normal procedures
• Loss of motivation and lack of mental concentration
• Feelings of depression, anxiety, irritability, excitability, and restlessness, and sleep disturbance
• Lack of appreciation for things that are normally enjoyable
• Change in appetite and weight loss
• Loss of muscle strength and coordination
It has been noted that both overtraining syndrome and clinical depression involve similar symptoms, brain structures, neurotransmitters, endocrine pathways, and immune responses, which suggests that they have similar origins.15
Some experts in sports medicine distinguish two kinds of overtraining symptoms: "intensity related" and "volume related." Athletes in different sports may exhibit signs of overtraining that are related to their specific training regimens. In the following section, we discuss overtraining syndrome as it relates to the nervous, endocrine, and immune systems.
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