Overtraining Syndrome

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Overtraining Syndrome Thomas M. Howard, M.D. Francis G. O'Connor, M.D., FACSM Sports Medicine

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Objectives Review the phrasing of overtraining. Survey the study of disease transmission and etiology of overtraining disorder. Depict the clinical presentation, determination, administration and anticipation of this issue.

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Terminology Training Adaptation Recovery Periodization Overwork/Overreaching Overtraining Syndrome

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Training Progressive over-burden to uproot homeostasis and make jolt for adjustment Improved execution

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Adaptation Physiologic reaction to stress (preparing burden) to better react to comparable worry later on.

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Recovery from Exercise Recovery is started by an unsettling influence in homeostasis; hazy when finish. The important procedure that connections preparing and adjustment. Singular limits/edges: Psychologic Physiologic Social

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Influences on the Athlete Coach Parent/mate SPORT HOME Team ATHLETE Sibling/youngster WORK/SCHOOL Teacher/Boss Peer

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Recovery Nutrition and hydration Rest and rest Relaxation and enthusiastic bolster Stretching and dynamic rest Inadequate Recovery = Fatigue

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Physiologic Fatigue Insufficient Sleep Nutritional Jet Lag Pregnancy Training instigated Excessive rivalry Overreaching

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Pathologic Fatigue Medical Infectious, Neoplastic, Hematologic, Endocrine, Toxic, Iatrogenic, Psychiatric Chronic Fatigue Syndrome Overtraining Syndrome Fatigued Athlete Myopathic Syndrome

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Periodization Planned sequencing of preparing burdens and recuperation periods inside a preparation program. Arrangement of microcycles (1 wk), mesocycles (4-12 wks), macrocycles (1 yr) and stages intended to accentuate one of a kind parts of preparing and adjustment. The last period of a macrocycle is the move stage which considers reclamation.

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Periodization Performance Capacity = Intrinsic Capacity + Accumulated Fitness - Accumulated Fatigue

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Overwork/Overreaching Acute stage amid which preparing load (force or volume) is essentially expanded Short-term weakening in execution Usually < 2 weeks

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Overtraining Maladaptive reaction to preparing from an augmented time of over-burden Usually > 2 weeks "Staleness" with inability to enhance execution Overuse wounds, disposition aggravation, blood science changes, insusceptible brokenness

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Overtraining Model

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Overtraining Progression Overreaching Decreased Performance Failure to Regenerate Panic Training Overtraining Syndrome

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Epidemiology of Overtraining Syndrome

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" Overtraining or staleness is the bug-a-boo of each accomplished mentor… it is a condition frequently hard to identify and still more hard to portray… consider sustenance, preparing load, rivalry push, and a psychologic inclination… go moderate and keep up harmony between rest, work, and amusement" Some therapeutic parts of the preparation of school competitors Parmenter, Boston Medical and Surgical Journal 1923

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Research Findings No indicative criteria Inconsistent information little numbers concentrated on hard to set up controls and lab models most concentrates too short Confounding impacts sickness, damage, monthly cycle, diverse preparing strategies for various games

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Overtraining Epidemiology Incidence 7-20% tip top competitors at any one time 2/3rds of world class runners throughout a profession Sports Endurance occasions Swimming, running, cycling Power lifting, ball "Cousin" to doctor "copy out"

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Overtraining Susceptibility Highly propelled, objective situated people POMS (Profile of Mood States) testing exhibits that competitors have a tendency to be to some degree engaged, traditional and preservationist Exercise regimens planned by the competitor Psychologic inclination?

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Risks of Overtraining Syndrome Prolonged poor execution Injury Illness Premature retirement

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Etiology of Overtraining Syndrome

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Current Hypotheses BCAA Hypothesis Autonomic Imbalance Hypothesis Glycogen Depletion Hypothesis Glutamine Deficiency Hypothesis Cytokine Hypothesis

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BCAA Hypothesis "Amino Acid Dysbalance Theory" Severe supported practice prompts to glycogen exhaustion BCAA devoured as fuel Increased cerebrum levels of tryptophan with an expanded blend of serotonin Fatigue BCAA:f-Try proportion

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Autonomic Imbalance Hypothesis Parasympathetic OTS is overwhelming structure, with diminished inborn thoughtful initiation. Drawn out strenuous practice prompts to an expanded grouping of free flowing catecholamines, Cortisol, T3, and ? Supported levels prompt to a down control of adrenoreceptors.

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Autonomic Imbalance Hypothesis Peripheral: This negative criticism brings about a bring down thoughtful resting volume Central: Increased cerebrum tryptophan additionally diminishes thoughtful tone

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Glycogen Depletion Hypothesis Inadequate vitality admission bringing about: diminished practice initiated ascend in pituitary hormones, cortisol, & insulin diminished resting testosterone diminished protein and glycogen combination Decreased RQ (expanded dependence on FFA) Poor ensuing reaction to preparing "Weariness"

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Glutamine Hypothesis Chronic practice with lacking recuperation makes a glutamine insufficient express This sets up immunologic "open windows" for disease that further anxiety the framework

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Glutamine Most plenteous AA in muscle and plasma Synthesized in muscle, lungs, liver, mind and fat tissues Maintains corrosive base adjust amid acidosis Glutamine=glutamate + NH 3 Nitrogen forerunner for amalgamation of nucleotides for cell replication Fuel for intestinal mucosal and invulnerable framework cells (Lymphocytes, Macrophages, NK Cells)

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Glutamine with Exercise Linear association with plasma glutamine and practice power Considerable time might be required between instructional courses to permit finish recuperation of plasma glutamine half lessening of resting levels in competitors following 10-day over-burden period

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Confounding elements to Interpretation of Glutamine Levels Diurnal cycles Max 10% more than 24hrs Dietary Increase up to 29% after dinners esp if high protein Infection Increased with viral or others

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Cytokine Hypothesis Adaptive Microtrauma Local Acute Inflammation Local Chronic Inflammation Systemic Immune/Inflammatory Response

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Stress Cytokines 26 French troopers 3 weeks of extraordinary battle preparing Increased IL-6 Decreased secretory IgA, DHEA, Prolactin, testosterone Mil Med, 168, 12:1034, 2003 From circling monocytes IL-6 , TNF- , IL-1 Induce fever, animate ACTH, empower arrival of intense stage proteins Activate thoughtful sensory system and H-P-A pivot and restraint of H-P-G hub Behavioral changes Lethargy, anorexia, sluggishness

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Cytokine Theory Cytokines and development components amid and in the wake of wrestling season in juvenile young men During season inc IL-1ra, IL-6, IGFBP-1&2, and BHBP w bounce back post season; irrelevant change in TNF-α and IL-1β Anabolic bounce back post-season MSSE, Vol 36(5);794-800, 2004 Influence of physical action on serum IL-6 and IL-10 levels in sound more seasoned men Inc IL-10 and dec IL-6 with adjusted practice program MSSE 36(6):960-4, 2004 Systemic fiery arbiters add to across the board impacts in business related musculoskeletal issue Repetitive, mighty hand-escalated word related errands Induction of a perpetual incendiary conditions from determined damage boost with hoisted IL-1& CTGF Ex Sp Sci Rev 32(4);135-42, 2004 Smith, MSSE 32(2): 317-331, 2000

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Clinical Presentation of Overtraining Syndrome

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Case Report 16 y/o runner Running 60+ miles for each week 6 days/week Working 2.5 hrs/day & going to class Family extremely objective situated; father is a General officer; applying to an administration institute c/o diminished execution, weakness, expanded URI recurrence

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Complaints Sport-Specific Performance failure to meet earlier execution benchmarks delayed recuperation time Physiologic weight reduction expanded resting heart rate wounds Subjective rest issue enthusiastic flimsiness aloofness

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Categories of Overtraining Sympathetic Parasympathetic

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Sympathetic Overtraining ? Early Overtraining "Exemplary Form" Increased resting HR & BP Decreased hunger Loss of body mass Irritability Loss of rest Poor execution and weariness

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Parasympathetic Overtraining ? Late Overtraining "Cutting edge Form" Impaired execution and effectively exhausted Low resting HR & BP Long times of rest and sorrow Normal craving and steady weight Decreased drive, amenorrhea, loss of aggressive yearning

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Diagnosis of Overtraining Syndrome

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Diagnostic Criteria No particular demonstrative criteria or valuable lab parameters for overtraining disorder. Finding of prohibition

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"The overtraining disorder alludes to a side effect complex portrayed by non-adjustment to preparing, diminished physical execution and perpetual exhaustion taking after high-volume and additionally high-power preparing and insufficient recuperation." Eichner 1995

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Differential Diagnosis Systemic Illness Mono, CMV, Hepatitis, Cancer, Post-viral, Fibromyalgia, Chronic Fatigue Syndrome, Collagen vascular confusion Metabolic Problem iron deficiency, hypothyroid, hypoglycemia, glycogen stockpiling infection Substance mishandle Primary psychiatric process Depression

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In a patient with extreme weakness that continues or backslides for 6 months, with 4 side effect criteria: Severe : weariness of new or positive onset, not eased by rest, bringing about a significant decrease in word related, instructive, or individual exercises. Indication Criteria : debilitated memory or