The Active Female: Health Issues Throughout the Lifespan 2008th Edition

23. Exercise Precautions for the Female Athlete: Signs of Overtraining

Jacalyn J. Robert-McComb  and Lauren Gates 


Department of Health, Exercise, and Sports Sciences, Texas Tech University, 3204 Main Street, Lubbock, TX 79409, USA


Department of Health, Exercise and Sport Sciences, Texas Tech University, 50 W. Lakemist Cir, The Woodlands, TX 77381, USA

Jacalyn J. Robert-McComb (Corresponding author)


Lauren Gates



Athletes are constantly aiming to be the best they can be by incorporating a strict nutritional and training schedule into their daily lives. When athletes push themselves further than their bodies will allow, a state of staleness will occur. Overreaching, overtraining, and the overtraining syndrome are three different levels of staleness possible if an athlete does not take the proper precautions to prevent these conditions from occurring. Within these conditions, functional, metabolic, psychological, and physiological limitations are commonplace. A full recovery can last anywhere from a few days to years in the most extreme cases. In the past, these three terms were considered one and the same; however, recent research findings have split them into three distinct conditions with defining signs and symptoms. Some of these signs and symptoms overlap with those of clinical depression, so it is imperative for an athlete to be medically evaluated in order to determine the actual cause of their symptoms. If an athlete is diagnosed with overtraining, their symptoms can be used to determine which physiological pathway is causing the condition. Research has discovered a couple of possible new mechanisms for overtraining: the negative feedback system and protein deficiency. It is important to catch overreaching and overtraining in their early stages so that athletes and their coaches can implement a plan of prevention rather than treatment. Coaches and parents need to regularly communicate with their athletes and help maintain a safe and healthy training regimen.


OverreachingOvertrainingHypo-arousalHyperarousalOvertraining syndromeNegative feedbackProtein

23.1 Learning Objectives

·               The terms overreaching, overtraining, and the overtraining syndrome

·               The differences between the symptoms of overtraining and depression

·               Hypo- and hyperarousal overtraining states

·               The current perception of overtraining and the appropriate prevention and treatment strategies

·               Future areas of research

23.2 Introduction

Athletes are always striving to do their best and sometimes are willing to put their bodies through arduous amounts of stress and overload to achieve their goals. Most of the time it is athletes focused on endurance sports, such as cross-country running, swimming, or cycling, that push their bodies to extremes in order to attain that top level of performance. However, athletes alone are not always to blame for their sometimes far-reaching goals. Parents, coaches, and peers can put a great deal of pressure on athletes, causing stress and the constant willingness to please and succeed. Athletes should strive for their best effort but should also know the boundaries between safely training and overtraining.

It is important for athletes to know their full potential, but the consequences to overtraining can be significant. Functional, metabolic, psychological, and physiological limitations are commonplace in athletes who have gone beyond their potential and are suffering from staleness. When these limitations are in place and an athlete’s performance is compromised, the athlete either may give up entirely or may see this as a weakness and try to push themselves even harder to compensate for their reduced abilities. Once any of the abovementioned limitations have occurred due to an increase in training, overtraining has occurred. It is important for coaches and athletes to recognize the signs and symptoms of overtraining to prevent this illness from fully developing.

There are different levels of overtraining depending on how long after the first sign of symptoms the athlete continued to train. The term overtraining relates to a decrease in performance despite continuing or an increase in training [2]. Overtraining usually occurs when an athlete is exposed to high volumes of training with inadequate periods of rest. This ultimately can lead to an altered mood and reduced exercise performance. The collective impairments an athlete experiences during overtraining are also sometimes referred to as the overtraining syndrome.

23.3 Research Findings

23.3.1 The Terms Overreaching, Overtraining, and the Overtraining Syndrome

The terms overreaching, overtraining, and the overtraining syndrome were once used interchangeably; however, the present understanding is that these three terms are different based on their physiological characteristics. There are a few key differences between overreaching and overtraining that can be explained by grouping athletes into one of three categories: functional overreaching, nonfunctional overreaching (more commonly known as overtraining), and the overtraining syndrome [5]. See Table 23.1 for a review of these terms.

Table 23.1

Overreaching, overtraining, and the overtraining syndrome



Time to recovery

Signs and symptoms

Normal or abnormal part of training

Functional overreaching

Condition that occurs quickly due to an increase in training volume or intensity

Short term: a few days to a few weeks

• Slight fatigue

• Slight decrease in work capacity


Nonfunctional overreaching (overtraining)

Condition that occurs slowly over 1–2 months due to an increase in training volume with inadequate time for recovery

Moderate: several weeks to months

• Increase in resting heart rate

• Fatigue during training

• Decreased work capacity

• Increase in heart rate during submaximal workloads

• Increase in thirst

• Loss of muscle strength and coordination


The overtraining syndrome

Severe case of overtraining due to an increase in training volume or intensity with inadequate time for recovery

Long term: several months to years

• Premature fatigue

• Decrease in performance

• Mood changes

• Emotional instability

• Decreased motivation

• Loss of appetite

• Sleep disturbances

• Altered cortisol levels

• Decreased VO2 max


Adapted from (1) Bandyopadhyay, A, Bhattacharjee, I, et al. Physiological perspective of endurance overtraining—a comprehensive update. AJMS. 2012; 5: 7–20.; and (2) Ehrman, JK, deJong, A, Sanderson, B, et al., eds. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010: 246, 486, 543

Functional overreaching is the appropriate term to use when an athlete is in the stages just prior to overtraining [1]. This type of overreaching can be a normal variant of athletic training. While functional overreaching does also originate from a training load that exceeds and athlete’s capabilities, the effects are short lived lasting approximately a few days to a few weeks for a full recovery. The symptoms associated with functional overreaching include an amplified resting heart rate, a lowered work capacity, unusual fatigue during training, an increase in thirst, and an increase in submaximal heart rate. If an athlete does not acquire an appropriate amount of time for rest and recovery, they could develop into a state of overtraining, or nonfunctional overreaching. The terms nonfunctional overreaching and overtraining can be used interchangeably. Overtraining is simply the term used to describe when an athlete’s training load surpasses their ability to recover from that load. This type of overtraining may last from several weeks to several months, and performance capacity is usually restored with adequate amounts of rest.

Lastly, the overtraining syndrome is a serious condition that consists of not only the physical consequences of overtraining but the emotional and behavioral conditions as well [1]. The overtraining syndrome is a chronic condition lasting for weeks or months at a time. Some of the symptoms associated with the overtraining syndrome are a poor performance in competitions, chronic fatigue, an inability to maintain training intensities, reduced immune function, sleep disturbances, an altered mood state, and a reduction in catecholamine production. If not recognized in its early stages, the overtraining syndrome could last anywhere from several months to years. It is important for coaches and athletes alike to be able to recognize these conditions so that the athlete has sufficient time to recover.

23.3.2 Overtraining or Depression?

The signs and symptoms of overtraining and the overtraining syndrome may seem to be easily recognizable, but major depression exhibits many of the same signs and symptoms [2]. In some cases, it is hard to differentiate between these conditions. In order for someone to be diagnosed with major depression, they must have the signs and symptoms for at least 2 weeks [5]. The condition of overtraining, or nonfunctional overreaching, also begins at around 2 weeks of exhibiting signs and symptoms. Some of the overlapping signs and symptoms between these two medical conditions include sleep deprivations, a loss of appetite, a change in mood state, a reduced body weight, and an overall loss of motivation. The overtraining syndrome and major depression additionally share common central nervous system structures, endocrine, and immune pathways that could confuse the two conditions. Because many times athletes of the same sport show different signs and symptoms from their peers, diagnosing them as having symptoms of overtraining versus major depression can be challenging.

It has been reported that about 80 % of athletes with any form of overtraining had a similar makeup as those with major depression [5]. Many athletes, especially those at the elite level, are highly motivated and will put their bodies through almost any form of stress in order to be the top performer in their sport. When these athletes begin to show signs of overtraining, they may not realize they have a medical condition and attribute their poor performance to under-training. With so much pressure to do well, athletes will typically increase their training regimen even further in order to counteract their loss of momentum. However, in an attempt to increase their capabilities, the opposite effect occurs; physical and emotional fatigue is increased, and their performance continues to diminish. Eventually, this cycle of constantly needing to improve causes mood, sleep, and appetite disturbances and could eventually lead to a diagnosis of major depression in addition to overtraining or the overtraining syndrome.

23.3.3 Hypo-arousal and Hyperarousal Overtraining States

The overtraining syndrome is a very serious condition, and researchers are now proposing that there may be two distinct forms of the disorder. The first of these newly proposed states is termed the hyperarousal, or sympathetic, overtraining syndrome [3]. This form occurs mainly in “power” or anaerobically centered athletes such as sprinters and weight lifters. The sympathetic form is considered to occur only in rare circumstances due to an increase in sympathetic tone, or an increased activation of the sympathetic nervous system, during rest [1]. Some signs and symptoms of sympathetic overtraining include fatigue, sleeplessness, weight loss, night sweats, palpitations, an increased basal metabolic rate, a delayed recovery of pulse rate, an increase in ventilation during exercise, reduced coordination, and restlessness.

The hypo-arousal, or parasympathetic, state is much more prevalent and occurs in endurance or aerobically centered athletes such as swimmers and cyclists [3]. In the same manner as the sympathetic state, the parasympathetic overtraining state is a result of increased parasympathetic tone, or an increased activation of the parasympathetic nervous system, during rest and exercise [1]. There are fewer signs and symptoms for the parasympathetic state including fatigue and apathy, depression, an increased number of infections, a decreased lactate response to exercise, and possible amenorrhea in female athletes [13]. It is still unclear from the present research whether or not the hyper- and hypo-arousal syndromes are caused by neurological and endocrine pathways or are simply symptoms of other mechanisms. Yet there is some research emerging linking the overtraining syndrome to neuroendocrine and immune systems [8].

23.4 Contemporary Understanding of the Issue

Athletes many times pursue extreme measure to improve their performance with athletes of many sports training twice a day for hours a time [4]. These twice-a-day practices do not always allow for ample recovery and lead to a state of overtraining. Since overtraining has become more and more apparent, different mechanisms have been hypothesized as to the origin of overtraining. One hypothesis is that the body is using the state of overtraining as a negative feedback mechanism for the constant state of overload without recovery [1]. Because of negative feedback, there is a decrease in neuromuscular excitability as well as a decrease in adrenocorticotropic hormone (ACTH) sensitivity. This ultimately results in a decrease in cortisol release and a lowered metabolic response.

A second possible mechanism related to overtraining has been suggested as protein deficiency [1]. It has been observed that with overtraining, even though amino acids are consumed, the relationship between supply and demand is unbalanced. Amino acids are used more quickly than they are supplied. A suggestion could be made that increasing protein consumption could counteract the effects of overtraining [4]. With the addition of protein to a predominantly carbohydrate-rich meal, enhanced glycogen synthesis and exercise performance have been witnessed as compared to a carbohydrate-only meal. Because athletes and coaches rely on a carbohydrate-rich meal pre-competition to better performance, adding small amounts of protein may help to relieve the negative effects associated with overtraining.

It is essential that coaches and athletes are able to recognize the signs and symptoms of overtraining so that they can assist in preventing and treating this condition [13]. The ever-emerging understanding of this condition is that it is not only a physical manifestation, as previously thought, but a psychological and behavioral condition as well. See Table 23.2 for a list of prevention strategies and treatment options.

Table 23.2

Prevention strategies and treatment options for overtraining [136]

Strategies for prevention

Strategies for treatment

• Individualized training protocols

• Allow ample time for recovery

• Progressive increases in training load by about 10 % per week

• Reduce training volume and/or intensity

• Training volume and intensity should be inversely related

• Work different sets of muscles on alternating days

• Resist performing every exercise session to absolute exhaustion

• Increase the amount of sleep

• Maintain appropriate technique with the appropriate number of repetitions for specific muscle and joint exercises

• Get a deep-tissue or sports massage for affected muscles

• Take frequent breaks during the training session

• Cryotherapy or thermotherapy

• Switch up the training sessions to avoid monotony

• Temperature or contrast therapy

• Maintain a balanced diet with adequate carbohydrates, proteins, fats, nutrients, and electrolytes

• Hydrotherapy

• Maintain proper hydration

• Make sure calories taken in matches calories expended

• Have regular medical examinations administered

• Maintain a balanced diet with the appropriate macronutrient ratios

• Administer an interactive coaching style

• Take daily vitamins for any vitamin deficiencies

• Athletes should listen to their bodies

• Cross-training

Adapted from (1) Bandyopadhyay, A, Bhattacharjee, I, et al. Physiological perspective of endurance overtraining—a comprehensive update; (2) Hackney, AC, Battaglini, C. The overtraining syndrome: neuro-endocrine imbalances in athletes. BRJB. 2007; 34–44; and (3) Overtraining and athletes: Learn the signs and symptoms of overtraining syndrome in athletes. http://​sportsmedicine.​about.​com/​cs/​overtraining/​a/​aa062499a.​htm. Accessed April 18, 2012

If early stages of overreaching are seen, it is important for the athlete to take immediate measure to prevent the overtraining syndrome rather than start treatment after signs and symptoms have emerged [13]. For coaches and athletes, it is imperative to not only look at the training preventions but preventions in the athlete’s home and social life as well. The signs and symptoms can be difficult to recognize since the normal symptoms of training may mask any adverse signs. Also, because each individual athlete progresses at a different rate, individualized training programs are necessary to help prevent overtraining. As such, interactive coaching is essential. Coaches must talk to their athletes on a daily basis to see if they are progressing and improving at a healthy pace. Many times athletes will give small clues that they are frustrated or unhappy with their performance which could lead them to try even harder for success. In the same way, it is just as important for the athlete to listen to his or her own body and speak up if they feel they are being overworked or are starting to feel an unusual amount of fatigue.

23.5 Future Directions

The understanding of overtraining has steadily become clearer with new appreciation about this serious condition. While the current physical and physiological prevention and treatment strategies are up to date, emotional considerations should be the focus of current research efforts [5]. The use of questionnaires is an easy and efficient way to determine an athlete’s emotional standing and capabilities. Questionnaires such as the Profile of Mood States (POMS), Training-Induced Stress Scale, and other overtraining questionnaires are recommended. In addition, the additional testing of physiological markers can assist in the recognition of overtraining. Markers such as immunoglobulins (IgA), testosterone and cortisol levels, heart rate variability, and heart rate recovery are just a few. The combined results from emotionally based questionnaires and physiological markers can provide a better insight into how emotional, mood variations, and physiological markers work together.

23.6 Concluding Remarks

From the current research, it is becoming apparent that overtraining is not simply a physical condition but a condition that includes relationships, diet, sleep, and various other behavioral connections [7]. Early recognition of the signs and symptoms of overreaching and the beginning stages of overtraining are essential to prevent an athlete from developing the overtraining syndrome. Because the overtraining syndrome can take months to years to overcome, if an athlete does exhibit the signs and symptoms, the coach should immediately implement treatment strategies. An athlete may not be willing at first to lower their level of training, but rest and recovery is crucial to their healing. As the research surrounding overtraining carries on, further understanding and possible new prevention and treatment strategies will transpire.



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Ehrman JK, deJong A, Sanderson B, et al., editors. ACSM’s resource manual for guidelines for exercise testing and prescription. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010. p. 246. 486, 543.


Hackney AC, Battaglini C. The overtraining syndrome: neuro-endocrine imbalances in athletes. Braz J Biomotricity. 2007;1:34–44.


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