Entries in Overreaching (2)

Tuesday
Feb042014

Unexplained Underperformance Syndrome

UUPS - unexplained underperformance syndrome - Rod Jaques

The ‘unexplained underperformance syndrome’ (UUPS) is defined as a history of objective loss of performance, without a medical cause and despite two weeks of rest. This definition was arrived at by a group of experts in Oxford in 1999. They chose to call the syndrome UUPS as opposed to ‘over training’ to avoid restricting the cause to training per se.

UUPS is almost exclusively a condition of endurance athletes, commonly occurring after a period of heavy training and competition. There is often a his-tory of frequent minor infections.

Anecdotally it is thought that between 2% and 10% of elite endurance athletes suffer significant episodes of UUPS during their sporting careers. Often the condition occurs insidiously and remains undiagnosed for many weeks. The athlete typically will have sought advice from many quarters and have tried short periods of rest without success. Ideally the diagnosis of UUPS should be one that both athlete and coach agree upon.

Fatigue is the key presenting symptom. This fatigue persists despite rest and leads to underperformance. The athlete may lose motivation and often complains of sore muscles and poor sleep. Sometimes they may experience a loss of libido and appetite. They also often become depressed, and when this is clinically significant, it requires pharmacological treatment. It is often difficult for the athlete to determine whether the depression is the cause or the effect of the UUPS, but in my experience, if you do not treat the depression, you are likely to delay the resolution of the syndrome.

The onset of UUPS may coincide with upper respiratory tract infections, particularly viral. It is common, in taking the patient’s history, to find that they have trained intensively through a viral upper respiratory tract infection, leading to symptoms of fatigue.

Less common symptoms of UUPS include:

  • stiff, sore muscles
  • nocturnal hot sweats
  • minor changes in bowel habit
  • an elevated heart rate at a given intensity of training
  • an elevated resting heart rate.
  • an inability to alter pace at the end of a race.

Sometimes the athlete has difficulty in raising his/her heart rate in exercise and a profound loss of motivation. It is important to stress that none of these symptoms are diagnostic or consistent across all UUPS subjects. Chronic fatigue syndrome is distinct from UUPS in that it is a more severe condition in which sufferers usually cannot even contemplate doing sport, and they recover less quickly.

Despite much ongoing excellent research work, there are as yet no unequivocal diagnostic serological (blood analysis), physiological or psychological markers for UUPS. Observations have included raised stress hormones and reticulocyte (immature red blood cell) counts, increased cortisol to testosterone ratios, raised neutrophil to lymphocyte ratios and lower branch chain amino acids. Some researchers have shown a relative loss of sympathetic neural tone in athletes with UUPS; this is the part of the nervous system which, among other things, increases heart rate. A loss of heart rate variability (HRV) occurs during morning postural testing and this reflects the loss of sympathetic neural tone. This may be useful in monitoring rehabilitation intensity during recovery from UUPS because the loss of HRV can be quantified and recovery thereby monitored.

Mood scores, whilst a helpful psychological tool in confirming the diagnosis, are neither sensitive nor specific. Serological markers may in future help provide a more accurate clinical diagnosis.

UUPS must not be confused with other medical causes of under performance. There is an extremely long list of differential diagnoses for fatigue in athletes, many of which can be excluded by taking a good history and (less importantly) examination of the athlete. Over the last 13 years I have seen 83 cases of athletes presenting with symptoms of UUPS, of which five (6%) had other medical causes. (Some clinicians report higher figures , but this may reflect the fact that many athletes I see have been through a medical screen prior to their consultation with me.) These included two cases of Epstein Barr infection (glandular fever), a Coxsacchie B myocarditis, an iron deficiency anaemia and a non-Hodgkin’s lymphoma. As a consequence of this I regularly perform a full blood count, ferritin, thyroid function test, ESR, urea and electrolytes and other blood tests as indicated by the history and examination. A pre- and post-exercise flow loop spirometry test, if the athlete can manage it, is helpful in the initial battery of tests.

The key to managing UUPS lies in a multi-disciplinary approach by a team of sports specialists, including physician, nutritionist, psychologist and physiologist. An experienced nutritionist should analyse a nutritional diary and the athlete’s carbohydrate ingestion before, during and after exercise. It is important to be able to rule out an eating disorder: the SCOFF questionnaire may be useful(1).

Many athletes with UUPS have coincident social, financial, domestic and career stresses, which a psychologist will need to explore. Physiologists with experience in heart rate variability monitoring can lead athlete and coach through the pulse-dependent rehabilitation that follows, and an early meeting between them is good practice.

The successful resolution of UUPS depends on clear communications between the multidisciplinary team and the athlete, their coach and family. It is really important to give the athlete a clear understanding of what is happening, and to make time to answer their questions throughout treatment and rehab. In my experience, recovery to full training often takes 10 to 15 weeks, during which time there should be regular team meetings, and meetings with the athlete and coach.

Psychological support throughout the whole process is very important to address the concerns of the athlete, family and coach. It is difficult for the athlete to accept that there is no ‘quick fix’ for UUPS and experienced consultation skills are required to address questions on the aetiology of UUPS where our know-ledge is, at best, incomplete. The multidisciplinary team must reflect regularly on the athlete’s clinical status, changing management swiftly when appropriate.

Table 1 Score symptoms
DateFatigueMuscle achesMotivationUpper respiratory tract symptomsOtherTotal
Range 0-10 0-10 0-10 0-5 0-10  
1.02.03 5 5 6 5 8 29
2.02.03 5 6 5 4 6 26
3.02.03 5 6 4 4 5 24
14.02.03 2 1 1 0 1 5

There is no published evidence (to date) that one programme of management of UUPS is better than another. What follows is a pragmatic approach that has been adopted in the south-west region of the EIS, and which is regularly revised. Our strategy is based on symptom scoring and pulse-dependent rehabilitation (PDR). The athlete is asked early to score his/her symptoms in certain key areas (see Table 1). Significant symptoms are scored 1 – 10, less significant symptoms are given less weighting and are scored 1 – 5. Daily totals are collated (high is ‘bad’, low is ‘good’) and used to determine the progression of the PDR programme. We leave one column for ‘other’ symptoms that may be specific to the individual athlete’s history.

The PDR programme is agreed with the athlete and coach, and starts with a few weeks of complete rest, during which time the nutritionist and psychologist work with the athlete. The rate of progress thereafter is governed by improvements in the heart rate during exercise. The physician incrementally increases the volume and intensity of exercise based on heart rate response (see table 2).

Table 2 Pulse-dependent rehab programme for a triathlete
WeekPlan
1 Rest
2 Rest
3 HR <120; 20 mins turbo training; 2 days off
4 HR <130; 20-25 mins TT; 2 days off
5 HR< 140; 30 mins TT; alternate days run 20 mins; 1 day off
6 HR < 150; 30 mins TT; run 20-30mins, swim 2k; 1 day off
7 HR 150-160 add short sprints (<10 secs)

 

In institutes of sport and high performance centres the prevention of UUPS should be high on the agenda. A detailed review of the prevention of UUPS is beyond the scope of this article but the main issue is education of athletes and coaches. Overall attention to the ‘basics’ of sports exercise physiology; periodised training, carbohydrate and fluid replenishment and a holistic approach to athlete-centred training intensity are fundamental to maintaining the good health of the athlete.

Reference

  1. 1. Morgan JF, Reid F, Lacey JH, The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999 Dec 4;319(7223): 1467-8.
Thursday
Aug112011

Monitoring of Stress in Trained Male Rowers

By: Jaak Jurimae, Priit Purge, Jarek Maestu, Terje Soot, Toivo Jurimae.
From: Journal of Human Kinetics Volume 7, 2002
Site Link: International Association of Sports Kinetics
Article Link: Monitoring of Stress in Trained Male Rowers


The effect of rapidly increased training volume on performance and recovery stress state over a six-day training camp was investigated in trained male rowers (n=17). The training regimen consisted mainly of low-intensity on-water rowing and resistance training, in total 19.6±3.8 h, corresponding to an approximately 100% increase in training load. 2000 meter rowing ergometer (Concept II, Morrisville, USA) performance time increased from 396.9±10.8 to 406.2±11.9 s (p<0.05) as a result of this training period. The Recovery-Stress-Questionnaire for Athletes revealed an increase in somatic components of stress (Fatigue, Somatic Complaints, Fitness/Injury) and a decrease in recovery factors (Success, Social Relaxation, Sleep Quality, Fitness/Being in Shape, Self-Efficacy). Relationships were observed between increased training volume, and Fatigue (r=0.49), Somatic Complaints (r=0.50) and Sleep Quality (r=-0.58) at the end of the training camp. In summary, rowing performance decrement indicated a state of short-term overreaching at the end of a six-day high load training period.

Overreaching was further diagnosed by changes in specific stress and recovery scales of the RESTQ-Sport for athletes. The RESTQ-Sport for athletes could be used to monitor heavy training stress in trained rowers.

Key Words: rowing, performance, overreaching, recovery-stress questionnaire

Introduction

It has been demonstrated that there is a dose-response relationship between training stress and performance (Steinacker et al. 1998). Furthermore, it is evident that underestimation or overestimation of trainability and recovery will lead to inappropriate training response or overtraining of the athlete. Optimal performance is only achieved when athletes optimally balance training stress with adequate recovery (Steinacker et al. 1999, 2000). However, the impact of recovery has received comparatively little attention (Kellmann & Günther 2000).

The existence of dose-response relationship has also been demonstrated between training volume and mood disturbances (Raglin 1993). Increases in training volume correspond to elevations in mood disturbances (Morgan et al. 1987). Mood improvements occur when training volume is decreased (Morgan et al. 1987; Raglin 1993). Psychometric monitoring of endurance athletes has mostly focused on the relationship between overtraining and mood (Raglin 1993). However, one approach to monitor training is the measurement of the athletes view of stress and recovery at the same time and to examine the balance/imbalance between these two aspects as restricting the analysis to the stress dimension alone could not be sufficient for elite athletes (Kellmann & Günther 2000; Steinacker et al. 1999). The recovery-stress state indicates the extent to which someone is physically and/or mentally stressed as well as whether or not the person is capable of using individual strategies for recovery and which strategies are used (Kellmann & Günther 2000). Recovery and stress should be treated using a multilevel approach, dealing with psychological, emotional, cognitive behavioral/performance and social aspects of the problem, considering these aspects both separately and together (Kellmann & Günther 2000).

The purpose of the present study was to monitor the relationship between rapidly increased training volume, rowing performance and the recovery-stress state perceived by the Estonian male rowers.

Material and Methods

Seventeen national level male rowers volunteered to participate in the study (18.6±2.0 yrs; 186.9±5.7 cm; 82.4±6.9 kg). The subjects had trained regularly for the last 4.7±2.2 years. The training period constituted their first training camp on water after the winter training period. The rowers were fully familiarized with the procedures before providing their written informed consent to participate in the experiment as approved by the Medical Ethics Committee of the University of Tartu.

The training during the six-day training period amounted to 19.6±3.8 h, which was equivalent to an average increase in training load by approximately 100% compared with their average weekly training during the preceding four weeks. In total, 12 training sessions were completed during the heavy training period compared to six training sessions during previous four weeks. The training load included 85% of low-intensity endurance training (rowing or running), 5% high-intensity anaerobic training (rowing) and 10% resistance training. Rowing performance and recovery-stress state of rowers were assessed before (Test 1) and after (Test 2) the six-day training period. Maximal 2000 metre rowing ergometer test was performed on a wind resistance braked rowing ergometer (Concept II, Morrisville, USA). The Recovery-Stress-Questionnaire for Athletes (RESTQ-Sport) (Kellmann & Kallus 2000) was used to measure the level of current stress of rowers taking recovery-associated activities into consideration (Kellmann & Günther 2000) before and after the heavy training period. The RESTQ-Sport is constructed in a modular way including 12 scales of the general Recovery-Stress-Questionnaire and additional seven sportspecific scales (Kellmann & Günther 2000, Kellmann & Kallus 2000). The RESTQ-Sport consists of 77 items (19 scales with four items each plus one warm-up item) and the 24 hour test-retest reliability has been reported to be above r=0.79 (Kellmann & Kallus 2000). Therefore, it is assumed that inter-individual differences in the recovery-stress state can be well reproduced and the results of the RESTQ-Sport are stable regarding short-term functionary fluctuations and short-term changes of state (Kellmann & Kallus 2000). The 24-hour test-retest reliability of the Estonian version of RESTQ-Sport was also relatively high (r>0.74; n=17). The inter-correlation of the scales indicates that stress and recovery can be seen as two partly independent factors, which allows to analyze the data on the basis of single scales as well as on the factors of stress and recovery (Kellmann & Günther 2000). The first seven scales cover different aspects of subjective strain (General Stress, Emotional Stress, Social Stress, Conflicts/Pressure, Fatigue, Lack of Energy, and Somatic Complaints) as well as the resulting consequences. Success is the only resulting recovery-oriented scale, which is concerned with performance in general but not in a sportspecific context. Social Relaxation, Somatic Relaxation, General Well-Being, and Sleep are the basic scales of the recovery area. Sport-specific details of stress (Injury, Emotional Exhaustion, and Disturbed Breaks) and recovery (Being in Shape, Personal Accomplishment, Self-Regulation, and Self-Efficacy) are examined in scales 13 to 19 (Kellmann & Günther 2000, Kellmann & Kallus 2000). A Likert-type scale is used with values ranging from 0 (never) to 6 (always) indicating how often the respondent participated in various activities during the preceding three days/nights. The mean of each scale can range from 0 to 6, with high scores in the stress-associated activity scales reflecting intense subjective strain, whereas high scores in the recovery-oriented scales mirror plenty recovery activities (Kellmann & Günther 2000, Kellmann & Kallus 2000).

Mean values and standard deviations (SD) were determined. Paired t-tests (two-tailed) were used comparing results from Test 1 to Test 2. Pearson correlation coefficients were calculated between dependent variables and changes in dependent variables during the heavy training period. For all tests, the level of significance was set at 0.05.

Results

2000 metre rowing performance time was significantly increased after the heavy training period (396.9±10.8 vs. 406.2±11.9 s; p<0.05). The recovery-stress state of rowers changed significantly during the heavy training period (Fig. 1). An increase (p<0.05) in Fatigue, Somatic Complaints, and Fitness/Injury from stress-related scales, and a decrease (p<0.05) in Success, Social Relaxation, Sleep Quality, Fitness/Being in Shape and Self-Efficacy from recovery-associated activities were observed (Table 1). Increased training volume (19.6±3.8 h) of rowers was significantly related to the 2000 metre performance time measured in Test 2 (r=0.59). Significant relationships were observed between increased training volume, and Fatigue (r=0.49), Somatic Complaints (r=0.50) and Sleep Quality (r=-0.58) scales of the recovery-stress questionnaire at the end of heavy training period.

Table 1. Significant changes in the scales of RESTQ-Sport for athletes after the training period compared to the results obtained before the training period.

RESTQ-Sport Scales O N Example Question P-value
Fatigue S 4 I was overtired 0.008
Somatic Complaints S 4 I felt physically exhausted 0.004
Success R 4 I was successful in what I did 0.031
Social Relaxation R 4 I had a good time with my friends 0.026
Sleep Quality R 4 I fell asleep satisfied and relaxed 0.03
Fitness/Injury S 4 Parts of my body were aching 0.014
Fitness/Being in Shape R 4 I was in good condition physically 0.047
Self-Efficacy R 4 I was convinced that I had trained well 0.049

O, scale orientation; N, number of questions in each scale; S, stress, R, recovery.

Discussion

The present study investigated whether psychometric parameters could be used to assess short-term overreaching in competitive rowers. The regimen of extremely heavy training period followed by a period of sufficient rest is widely practiced in different endurance events (Jeukendrup et al. 1992, Steinacker et al. 1998). Furthermore, overreaching has been reported to be an integral part of a successful training program (Steinacker et al. 1998, 1999, 2000). Success in rowing is characterized by the amount of time spent on water as low-intensity endurance training (Jürimäe et al. 2001, Steinacker et al. 1998). The increased training volume of 19.6±3.8 h per week performed by our subjects has been reported to be typical in high load training phases for well trained rowers (Steinacker et al. 1998).

The RESTQ-Sport for athletes has been used to assess the subjective stress and recovery during training cycles for major competitions in German rowers (Kellmann & Günther 2000, Steinacker et al. 2000). The Estonian version of the RESTQ-Sport also allowed the psychometric assessment of competitive rowers during rapidly increased training volume in preparation camp when the focus was only on low intensity rowing. The results of this study suggest that a dose-response relationship exists between training volume and the subjective assessment of somatic components of stress and recovery. High duration was indicated by the elevated levels of stress and simultaneous lowered levels of recovery in trained rowers (Fig. 1). This is in line with other investigations (Kellmann & Günther 2000, Morgan et al. 1987), which have found that increases in training volume correspond to increases in mood disturbances and mood improvements occur when training volume is reduced. The results of the current study demonstrated that the RESTQ-Sport for athletes objectively reflected the state of rowers during the short-term overreaching period.

The psychometric scales of stress such as Fatigue and Somatic Complaints were significantly increased after the heavy training period and related to the increased training volume (r>0.49), suggesting a dose-response relationship between training volume and mood disturbance during basic low-intensity endurance training period. Similarly to the results of our study, the values of the Fatigue and Somatic Complaints scales have been reported to increase relatively early in parallel with increased training volume, while the scores of General Stress are quite stable and low for a relatively long period (Steinacker et al. 1999).

The lowered levels of Success, Social Relaxation, Sleep Quality, Fitness/Being in Shape and Self Efficacy from recovery-associated scales demonstrated that emotional, physical and social aspects of recovery were not adequate during this training camp when training volume was rapidly increased.

For example, a significant decrease in Social Relaxation scale demonstrated a drop in social activities during the heavy training period. However, it should always be considered that recovery is a process to reestablish psychological and physical resources (Kellmann & Günther 2000). Athletes should be aware of the importance of active recovery in the training process. This is even more crucial during preparation camps in rowers, when the focus is mostly on low-intensity, high volume training (Kellmann & Günther 2000). Adequate recovery during phases of heavy training allows for the adaptation of the athlete to stress and prevent from overtraining (Raglin 1993). The results of this study demonstrate that the RESTQ-Sport for athletes reflects the extent of different aspects of recovery in addition to stress during the monotonous heavy training of the preparatory period in highly trained rowers.

Conclusions

The monitoring of training adaptation and the adaptation state of an athlete appears to be a very complex task. The results of this study demonstrated performance incompetence by the end of a six-day overreaching training period and were interpreted to reflect a state of short-term overreaching. Overreaching was further diagnosed by changes in specific stress and recovery scales of the RESTQ-Sport for athletes.

REFERENCES

JEUKENDRUP A.E., HESSELINK M.K.C., SNYDER A.C., KEIZER H.A.
1992. Physiological changes in male competitive cyclists after two weeks of intensified training. Int. J. Sports Med. 13: 534-541.

JÜRIMÄE J., JÜRIMÄE T., PURGE P. 2001. Plasma testosterone and cortisol responses to prolonged sculling in male competitive rowers. J. Sports Sci. 19: 893-898.

KELLMANN M., GÜNTHER K.D. 2000. Changes in stress and recovery in elite rowers during preparation for the Olympic Games. Med. Sci. Sports Exerc. 32: 676-683.

KELLMANN M., KALLUS K.W. 2000. Der Erholungs-Belastungs-Fragebogen für Sportler [The Recovery-Stress-Questionnaire for Athletes]. Frankfurt: Swets and Zeitlinger, pp. 48.

MORGAN W.P., BROWN D.R., RAGLIN J.S., O’CONNER P.J., ELLICKSON K.A.1987. Psychological monitoring of overtraining and staleness. Br. J. Sports Med. 21: 107-114.

RAGLIN J.S. 1993. Overtraining and staleness: psychometric monitoring of endurance athletes. In: Handbook of Research on Sport Psychology, R.B. Singer, M. Murphey, and L.K. Tennant (Eds.). New York: Macmillan, pp. 840-850.

STEINACKER J.M., KELLMANN M., BÖHM B.O., LIU Y., OPITZ-GRESS A., KALLUS K.W., LEHMANN M., ALTENBURG D., LORMES W. 1999. Clinical findings and parameters of stress and regeneration in rowers before world championships. In: Overload, Performance Incompedence, and Regeneration in Sport. M. Lehmann, C. Foster, U. Gastmann, H.A. Keizer, and J.M. Steinacker (Eds). New York: Kluwer Academic/Plenum Publishers, pp. 71-80.

STEINACKER J.M., LORMES W., KELLMANN M., LIU Y., REISNECKER A., OPITZ-GRESS A., BALLER B., GÜNTHER K., PETERSEN K.G., KALLUS K.W., LEHMANN M., ALTENBURG D. 2000. Training of junior rowers before world championships. Effects on performance, mood state and selected hormonal and metabolic responses. J. Sports Med. Phys. Fitness. 40: 327-335.

STEINACKER J.M., LORMES W., LEHMANN M., ALTENBURG D. 1998. Training of rowers before world championship. Med. Sci. Sports Exerc. 30: 1158-1163.