Overtraining and fatigue in the elite athlete

Overtraining and fatigue in the elite athlete
P. Fuller 1 , I. Gillam 2 & C. Goodman 3
1 Sports Physician, Lifecare, Ashwood, Victoria, Australia, 2 Private Practioner, Dr. Ian Gillam Consulting,
Victoria, Australia, 3 Sports Physician, University of Western Australia, Perth, Australia
The purpose of this Symposium is to discuss the application of recent research in the diagnosis, and clinical management of the chronically
fatigued and “overtrained” athlete using a team approach.
By reference to a number of case studies, this seminar will discuss how the clinical management of the suspected overtrained athlete can be
optimized by the use of appropriate interaction between a sports physician, exercise physiologist and a nutritionist. The co-ordinating role of the
consulting sports physician in the conduct of the initial medical history and physical examination and ordering of relevant tests where indicated
will be discussed. The exclusion of medical conditions (anemia. systemic disease, glandular fever and post viral syndromes) is central to
management of the athlete. On exclusion of any obvious pathology, other blood and urine tests may then be ordered in consultation with the
exercise physiologist, to assist with a diagnosis of overtraining and referrals organized as appropriate. These biochemical tests may include
(depending on the athlete’s presentation), a full blood examination, the measurement of a various blood metabolic parameters, plasma levels
of muscle and liver enzymes, blood antioxidant and mineral status, serum testosterone and cortisol, plasma Ig levels and urinary catecholamines.
On referral to a nutritionist, an assessment of the athlete’s energy and fluid balance. In addition, the athlete’s general dietary balance and
macronutrient and micronutrient intakes can be conducted. Importantly, the athlete’s pre-training and post-training fluid and carbohydrate
intake needs to be evaluated. A computerized dietary analysis may also prove to be of considerable value. In consultation with the sports
physician, any metabolic or hormonal disturbances and/or nutritional deficiencies can be examined in light of the athlete’s presentation and the
dietary analysis. The athlete’s training history and structure must be closely examined by the exercise physiologist in consultation with the
athlete and his coach.
Following a review of all the relevant findings, a comprehensive management plan can be developed by the team under the direction of the
sports physician and in consultation with the athlete’s coach. Advice on fluid and macronutrient intakes, and the timing of the athlete’s food
intake in relation to training needs to be provided where these practices are not optimum. Where specific micronutrient deficiencies are
identified (e.g. low serum ferritin, zinc or antioxidant status), then targeted nutritional supplementation programme should be considered.
Print
Index
Table of Contents
Quit

Overtraining and fatigue in the elite athlete
P. Fuller 1 , I. Gillam 2 & C. Goodman 3
1 Sports Physician, Lifecare, Ashwood, Victoria, Australia, 2 Private Practioner, Dr. Ian Gillam Consulting,
Victoria, Australia, 3 Sports Physician, University of Western Australia, Perth, Australia
Athletes with a history of chronic or repeated URTI’s in conjunction with low serum IgG subclasses may also benefit from nutritional
supplementation. Where there is evidence of elevated stress hormones or a low serum testosterone, the exercise physiologist must liaise with
the athlete’s coach to reduce the athlete’s training load, incorporate additional recovery sessions and to ensure appropriate modifications are
made to the athlete’s on-going training structure. Sometimes a period of complete rest and/or followed by a longer period of modified rest may
be required. The athlete’s lifestyle stresses (e.g. work, study and family commitments) may also need to be examined as a contributing cause
of the athlete’s fatigue.
Print
Index
Table of Contents
Quit

Overtraining and fatigue in the elite athlete
P. Fuller 1 , I. Gillam 2 & C. Goodman 3
1 Sports Physician, Lifecare, Ashwood, Victoria, Australia
2 Private Practioner, Dr. Ian Gillam Consulting, Victoria, Australia
3 Sports Physician, University of Western Australia, Perth, Australia
The purpose of this Symposium is to discuss the application of recent research in the diagnosis, and clinical management of
the chronically fatigued and "overtrained" athlete using a team approach.
By reference to a number of case studies, this seminar will discuss how the clinical management of the suspected
overtrained athlete can be optimized by the use of appropriate interaction between a sports physician, exercise physiologist and
a nutritionist. The co-ordinating role of the consulting sports physician in the conduct of the initial medical history and physical
examination and ordering of relevant tests where indicated will be discussed. The exclusion of medical conditions (anemia.
systemic disease, glandular fever and post viral syndromes) is central to management of the athlete. On exclusion of any
obvious pathology, other blood and urine tests may then be ordered in consultation with the exercise physiologist, to assist with a
diagnosis of overtraining and referrals organized as appropriate. These biochemical tests may include (depending on the
athlete's presentation), a full blood examination, the measurement of a various blood metabolic parameters, plasma levels of
muscle and liver enzymes, blood antioxidant and mineral status, serum testosterone and cortisol, plasma Ig levels and urinary
catecholamines.
On referral to a nutritionist, an assessment of the athlete's energy and fluid balance. In addition, the athlete's general dietary
balance and macronutrient and micronutrient intakes can be conducted. Importantly, the athlete's pre-training and post-training
fluid and carbohydrate intake needs to be evaluated. A computerized dietary analysis may also prove to be of considerable
value. In consultation with the sports physician, any metabolic or hormonal disturbances and/or nutritional deficiencies can be
examined in light of the athlete's presentation and the dietary analysis. The athlete's training history and structure must be
closely examined by the exercise physiologist in consultation with the athlete and his coach.
Following a review of all the relevant findings, a comprehensive management plan can be developed by the team under the
direction of the sports physician and in consultation with the athlete's coach. Advice on fluid and macronutrient intakes, and the
timing of the athlete's food intake in relation to training needs to be provided where these practices are not optimum. Where
specific micronutrient deficiencies are identified (e.g. low serum ferritin, zinc or antioxidant status), then targeted nutritional
supplementation programme should be considered. Athletes with a history of chronic or repeated URTI's in conjunction with low
serum IgG subclasses may also benefit from nutritional supplementation. Where there is evidence of elevated stress hormones
or a low serum testosterone, the exercise physiologist must liaise with the athlete's coach to reduce the athlete's training load,
incorporate additional recovery sessions and to ensure appropriate modifications are made to the athlete's on-going training
structure. Sometimes a period of complete rest and/or followed by a longer period of modified rest may be required. The athlete's
lifestyle stresses (e.g. work, study and family commitments) may also need to be examined as a contributing cause of the
athlete's fatigue.