Sports Med. 20 (5): 321 -327.

1995
LEADING ARTICLE o112-1642/95/001 1-0321 /S03.50/0
© Adis International limited. All rights reserved .

Monitoring Overtraining in Athletes

Recommendations
Sue L. Hooper and Laurel Traeger Mackinnon
Department of Human Movement Studies, The University of Queensland, Brisbane,
Queensland, Australia

While attempting to maximise training benefits, papers II -3] and this paper does not attempt to pres-
athletes may become overtrained, frequently ex- ent the current state of knowledge on this topic.
hibiting signs and symptoms of overtraining syn-
drome including chronic, high levels of fatigue, 1. Studies on Overtraining
stagnancy or deterioration in performance and
A wide range of physiological and psychologi-
mood changes.I I -3] Although there is no indication
cal measures have been investigated as possible
that overtraining causes irreversible damage to the
markers of overtraining syndrome.II - 3,8] These
athlete, the risk of injury, illness and premature re-
measures have largely shown inconsistent re-
tirement is increased.l4-6 ] Rest or greatly reduced sponses so that definitive conclusions are not yet
training over several weeks or months may be possible. As shown in table I, factors related to in-
needed for complete recovery.12,3,7] consistencies in the literature include a lack of in-
It is often difficult for the coach to intuitively ternationally standardised terminology and criteria
provide optimal work loads for every athlete based for the diagnosis of the disorder, the relatively
solely on perception of the athlete's training toler- small numbers of overtrained athletes studied and
ance and recovery capacity. Moreover, the highly the difficulty of delineating normal from abnormal
motivated athlete may intentionally mask the early training responses.
warning signs of imminent overtraining syndrome
in order to continue training. These highly compet- 1.1 Terminology
itive athletes are often prepared to risk the onset of
overtraining syndrome in order to achieve their Some of the uncertainty regarding the markers
of overtraining syndrome is due to a lack of inter-
goals.
national agreement on terminology. For example,
Identification of markers of overtraining would
the term 'overtraining' has been used to describe
allow coaches and athletes to confidently adjust
training which did not clearly result in overtraining
training loads to maximise training benefits yet
syndrome. The term 'overtraining' should be used
avoid overtraining, thereby, optimising perfor- to imply the process of excessive training by which
mance. The purpose of this leading article is to pro- the phenomenon of overtraining syndrome oc-
vide recommendations for the monitoring of over- curs. 13 ,9] Overtraining may therefore be defined as
training in athletes. In the process, this review will high volume and/or high intensity training, with
highlight some of the problems associated with de- inadequate recovery, resulting in non adaptation re-
termining the appropriate method for monitoring quiring several weeks or months of rest or greatly
athletes. Overtraining and overtraining syndrome reduced training for complete recovery,l3,9] In con-
have been extensively reviewed in several recent trast, the term 'overreaching' should be used to de-
322 Hooper & Mackinnon

Table I. Reasons for inconsistencies in research findings The use of subjective signs and symptoms such as
Small number of overtrained athletes studied: poor sleep and muscular soreness further compli-
Ethical problem of intentionally overtraining athletes
cate the issue of diagnostic criteria because similar
Diagnostic criteria:
Not reported or vary between studies
signs and symptoms are not demonstrated in all
No internationally accepted criteria or terminology overtrained individuals[I ,13,14] and may also appear
Difficulty delineating normal from abnormal responses as a result of other situations such as illness.
Comparison of athletes' data with population norms
Possible confounding influences:
Concurrent illness, injury, menstruation, different training
1.3 Limited Numbers of Overtrained
demands of different sports Athletes Studied

There are obvious ethical limitations associated

with intentionally overtraining athletes, and stud-
ies generally report on a limited number of individ-
scribe training which causes few of the signs and
uals. Purposefully intensified training has neces-
symptoms of overtraining syndrome but does pro-
sarily lasted only up to 4 weeks, often producing
duce short term fatigue and performance decre-
overreaching but not necessarily overtraining syn-
ments from which the athlete recovers after a few
days rest. [2,3,8J drome.l 15 ,16] Furthermore, the use of short term in-
tensified training (e.g. up to 4 weeks) may produce
responses which are different from those produced
1.2 Djagnostic Criteria after the long periods athletes typically overtrain
(e.g. months to years). Other studies have moni-
Before markers for prevention can be identified,
tored athletes during a normal season and com-
criteria for the diagnosis of the syndrome must be
pared overtrained with non-overtrained ath-
developed. There is a paucity of well-controlled
letes.[9.1I,17-19] With an expected incidence of
studies which have also reported criteria for the
overtraining syndrome of 7 to 20% of elite athletes
diagnosis of the disorder in their study participants.
at anyone time,[5,]],]9,20] few studies commence
Performance decrements together with chronic,
with sufficiently large sample sizes to permit de-
high levels of fatigue are the most obvious indica-
tailed statistical analysis.
tors of overtraining syndrome and have been used
to diagnose the disorder.l 6,1O,IIJ However, few at-
1.4 Delineation of Normal and
tempts have been made to quantify these factors
Abnormal Training Responses
and there is little consensus as to how much perfor-
mance must deteriorate before overtraining is diag- The difficulty of delineating normal from ab-
nosed. normal physiological responses to training pres-
Performance decrements which are clearly a re- ents another problem for investigators, particularly
sult of overtraining syndrome range from 0.7 to when changes in physiological measures are in the
15%.I7,11,]2J Several investigators have suggested same direction as expected with training, For ex-
that stagnancy in performance is sufficient to indi- ample, high serum creatine kinase (CK) levels, in-
cate overtraining syndrome when considered in dicating alterations to muscle cell membrane per-
conjunction with other signs and symptoms.[2,9,]2] meability resulting from intense exercise, were
Furthermore, daily variation in performance and once considered a good marker of overtrain-
some level of fatigue accompanying training are to ing.l IO,21,22J However, CK has been shown to be
be expected and these measures, by themselves, significantly elevated in the absence of overtrain-
have not been shown to be useful for monitoring ing syndrome[]7 J and within the normal range in
the disorder.l 9] Once performance is deleteriously athletes demonstrating the disorder,[IO] Hence, CK
affected and fatigue has become chronically high, is no longer considered an appropriate marker of
it is often too late to avoid overtraining syndrome. overtraining. Similarly, low erythrocyte counts,

© Adis International Limited. All rights reserved. Sports Med. 20 (5) 1995
Monitoring Overtraining 323

Table II. Suggested methods lor preventing overtraining syndrome one of these and it is debatable, at this time,
Identify susceptible athletes whether it is the most important one.
Minimise known causes such as sudden increases in training ,
lack ollayolls between seasons, poor nutrition
Individualise training in recognition that dillerent athletes have 2.1 Physiological Tools
dillerrent thresholds lor overtraining
Programme recovery as an integral component 01 training
Monitor athletes lor early warning signs 01 overtraining Investigators have been unable to confirm phys-
iological markers of overtraining.l I-3,28,29] Param-
eters which have been investigated include resting
haemoglobin and serum ferritin levels have also and/or post-exercise heart rate and blood pres-
been discarded as reliable markers, since these sure,[9,12,17,19,25,27] resting and exercise oxygen
have been shown to occur without the presence of consumption (\102),[9,12,25,27,30] and blood levels of
overtraining syndrome,[17,22] to be similar for over- red and white cells, haemoglobin, iron, ferritin,
trained and non-overtrained athletes[6,9, 10,23] or not glucose, urea and various enzymes and hor-
to change significantly with overtraining.l 23 ] mones.l6,7,10,11,13,18,21 ,23,25,27,30] Changes in these
Unexpected physiological changes may warrant parameters have been reported to occur with over-
further investigation. For example, an increase in training in some studies[7,11-13,19,21 ,23,25,30] but not
resting heart rate of 5 to 10 beats/min above normal in others.[6,9, 12,17,23,28]
values has been suggested to be a marker of over- Some investigators have accounted for the ap-
training.l 24 ] However, before overtraining can be parent contradictory effects by splitting the disor-
implicated, other possible causes such as infection, der into two types: sympathetic and parasympa-
emotional upset, insufficient or poor sleep, inade- thetic overtraining syndrome.!3,31] In sympathetic
quate dietary carbohydrate intake and dehydration overtraining syndrome, a predominance of sympa-
must be discounted. In addition, because research thetic activity is suggested, with increased resting
data are inconsistent, resting heart rate does not heart rate and blood pressure, decreased appetite,
appear to be a reliable monitoring tool for all indi- loss of body mass, disturbed sleep and irritabil-
viduals. Early studies showing significant in- ity.l2,3] Parasympathetic overtraining syndrome is
creases in resting heart rate with overtrain- suggested to reflect a predominance of parasympa-
ing[19,25.26] have not been duplicated in later thetic activity characterised by low resting heart
well-controlled studies.l9,23.27] rate and blood pressure, long periods of sleep and
The following recommendations for monitor- depression.l 2,3] Both types show deterioration in
ing overtraining in athletes are based upon the re- performance and persistent fatigue. It is possible
search findings to date. However, having high- that the overtraining response follows a progres-
lighted the difficulties encountered in studying sion, reflected by a predominance of sympathetic
overtraining, it is clear that much work remains followed by parasympathetic stimulation.[I] Alter-
before definitive recommendations can be given. natively, differences in the types of stress imposed
by different sports, for example, endurance versus
2. Recommendations for shorter, intense interval training may result in dif-
Monitoring Overtraining ferent physiological profiles,l2,13,31] Sympathetic
overtraining has been suggested to affect mainly
Since the risk of prolonged poor performance, speed and power athletes and parasympathetic
injury, illness and premature retirement is likely to overtraining mainly endurance athletes,l23,31]
be greatly increased with overtraining syndrome, However, in the literature, the symptoms of over-
prevention is paramount. Table II shows several training syndrome reported in endurance athletes
possible methods for preventing overtraining. tend to reflect sympathetic rather than parasympa-
Monitoring athletes for early warning signs is only thetic overtraining.[12,26,27] As yet, there is little

© Adis International Limited. All rights reserved. Sports Med. 20 (5) 1995
324 Hooper & Mackinnon

Table III. Decisions required lor monitoring overtraining and inconsistent changes have been re-
Decision Considerations ported,!9,30,33] Overtraining has also been shown to
Demands 01 the sport Skill requirement affect neuroendocrine control by altering blood
Energy demands
Training load
levels of hormones and neurotransmitters such as
Recovery programmed glutamine, dopamine, catecholamines and seroto-
Individual differences nin (5-hydroxytryptamine; 5_HT)[11,13,23] but the
Athletes to be monitored All squad members procedures and costs do not make these measures
Elite only
Those most susceptible an efficient, long term monitoring tool.
Responsibility for Athlete
monitoring Coach 2.2 Psychological Tools
Trainer
Physiologist
Psychologist Mood states such as tension, anger, depression,
Teammate/parenVlriendlspouse vigour, fatigue and confusion may be useful for
Frequency 01 monitoring Daily assessment of overtraining and to adjust training
Weekly
loads,!5,28,34] Several studies have shown increased
Fortnightly
Monthly mood disturbances coinciding with increased train-
Practicability of tool Budget available ing loads[5,13,17,18] and other work has indicated
Time required for assessment that self-reports of post-training fatigue may allow
Delay between test and results
Long term cosVinconvenience undertraining to be monitored,l35] Mood states
Reliability and validity such as those measured by the Profile of Mood
Expertise required States (POMS)[36] have been used to successfully
identify athletes showing signs of distress due to
intense training of high volume,!2o,37] However,
empirical evidence to support the classification of
they have yet to be shown to be reliable for differ-
overtraining syndrome into two types.
entiating between overtrained and intensely
Based upon the complexity of findings to date,
trained, but not overtrained, athletes[ 38 1 in all situ-
the recommendation for physiological monitoring
ations or for monitoring athletes who become over-
will largely depend on the demands of the sport and
trained from high intensity but low volume train-
the available resources. Table III provides consid- ing.[391
erations on which to base selection of monitoring
Case studies of athletes clearly demonstrating
tools.
overtraining syndrome have shown POMS total
Measurement of heart rate and heart rate recov-
mood disturbance (TMD) scores to be higher than
ery after standardised submaximal exercise is a vi- those of non-overtrained athletes,!5,381 Further-
able monitoring tool for daily titration of training more, significantly higher TMD scores have been
loads. Unfortunately, only one study to date sup- reported for 3 overtrained swimmers compared
ports the use ofthis tool.[12] Certainly, monitoring with 11 others undergoing the same training but not
blood parameters has yet to be shown to be effec- considered overtrained[18] and in 5 men who be-
tive for indicating that overtraining is immi- came overtrained after 10 days of intense interval
nent)3,9,17] For example, blood lactate level after training'! I 3] POMS assessment has also been
maximal exercise is thought to decrease with over- shown to be useful for predicting athletes predis-
training due to reduced muscle glycogen stores af- posed to overtraining,l371 While the POMS is a
ter repeated strenuous exercise, decreased sympa- promising monitoring tool, it is not yet clear
thetic drive, reduced plasma levels of, or sensitivity whether it will predict overtraining in all ath-
to, catecholamines or a combination of fac- letes[40] and whether it can be used during compe-
tors)32,33J However, factors unrelated to overtrain- tition phases. [37] Moreover, because significant dis-
ing may influence maximal lactate levels (e.g. diet) turbances in mood state have been observed in

© Adis International Limited. All rights reserved. Sports Med. 20 (5) 1995
Monitoring Overtraining 325

Table IV. Recommended items for daily training log[9.11,34) Research has shown a close relationship be-
Training details (distance, time, gym work. intensity) tween training stress and a self-rated complaint in-
Well-being ratings (scale: 1 = very low/good; 2 = low/good; 3 = dex[ 231 and self-ratings of well-being have been
average; 4 =high/poor; 5 =very high/poor) of fatigue, stress.
shown to successfully predict overtraining syn-
sleep, muscle soreness, enjoyment of training, irritability, health
drome,l9J For example, in a group of 14 swimmers,
Causes of stress and unhappiness
Incidence of illness, injury, menstruation
self-ratings of fatigue, stress, sleep and muscle
soreness predicted overtraining 6 weeks before de-
terioration in performance and other signs and
athletes after intensified training which did not re- symptoms became apparent.[9 J
sult in overtraining syndrome,[18,41] further re- Therefore, it appears prudent for athletes to
search is needed to determine under what circum- keep daily training logs which include measures
stances mood states may be a reliable monitoring such as those listed in table IV. These logs appear
tool. Since physiological mechanisms may medi- to provide a simple, inexpensive and time efficient
ate psychological responses in overtraining, it has tool for monitoring overtraining. However, use of
been suggested that psychological monitoring may such measures to identify athletes showing a ten-
be most beneficial when supported by physiologi- dency toward overtraining syndrome is very much
cal measurements.[13] dependent on interpretation by the reviewer (usu-
ally the coach).
2.3 Self-Analysis Tools
3. Conclusions
Several investigators have suggested that over-
training is most effectively monitored by the ath- A monitoring programme for overtraining may
letes themselves using self-analysis tools.l 8,9,24.34] be considered part of the effective professional
While no studies appear to have determined management of athletes during intensive training.
whether self-analysis by athletes accurately and re- However, the most appropriate tools for such a pro-
liably prevents overtraining, this type of tool may gramme are still debatable. Comprehensive physi-
be an efficient means to provide valuable informa- ological testing has not been shown to be better
tion about an individual's response to training. than non-invasive and less costly psychological
The Daily Analyses of Life Demands for Ath- testing using the POMS or self-analysis using sim-
letes is one questionnaire devised as a means of ple questionnaires or daily logs. The latter two
avoiding overtraining,1341 This tool requires ath- methods provide assessment results more quickly
letes to assess sources of stress in their life and rate but have the disadvantage of possible distortion of
symptoms of stress such as muscle soreness and responses by the athlete. At present, it appears that
irritability. Incorporated into a log book, this tool
has been used by Australian Olympic Teams to en- Table V. Markers for routine monitoring of overtraining
able coaches to monitor training responses.[3 41An- Possibly good markers:
other tool, the Psycho-Behavioral Overtraining Performance on standard exercise test
Scale, has been used with British athletes.l 421 Self·analysis of well-being by athlete
Effort sense or the athlete's perceived rating of Profile of mood states (POMS)
Submaximal, maximal and recovery heart rate, oxygen uptake
exercise intensity has also been suggested as a tool ('\102), blood lactate
for titrating training loads and preventing over-
Poor markers:
training.[29,4)] However, independent replications
Body mass
have not yet validated whether this type of self- Resting heart rate and blood pressure
analysis by athletes accurately and reliably differ- Haematology (e.g. erythrocy1e and leUCOCy1e counts,
entiates overtrained from intensely trained, but not haemoglobin
overtrained, athletes. Serum ferritin, creatine kinase, hormones

© Adis International Limited. All rights reserved. Sports Med. 20 (5) 1995
326 Hooper & Mackinnon

conscientious self-analysis by the athlete is the 12. Costill DL. Inside Running. Indianapolis: Benchmark Press,
1986: 123-34
most efficient method of monitoring overtraining 13. Fry RW, Grove JR, Morton AR, et al. Psychological and immu-
since long term, daily records can be kept with rel- nological correlates of acute overtraining. Br J Sports Med
1994; 28: 241-6
ative ease compared with the other two methods. 14. Hackney A, Pearman SN, Nowacki JM. Physiological profiles
Exercise scientists still have the task of validating of overtrained and stale athletes: a review. Appl Sports Psych
a sensitive, reliable and easily used method of mon- 1990; 2: 21-33
15. Fry RW, Kraemer WJ, Lynch JM, et al. Does short-term near-
itoring overtraining. maximal intensity machine resistance training induce over-
Given the availability of suitable resources, all training? J Strength Cond Res 1994; 8: 188-91
16. Warren BJ, Stone MH, Kearney JT, et al. Performance meas-
three tools are incorporated in the following rec- ures, blood lactate and plasma ammonia as indicators of over-
ommendation for monitoring overtraining: (i) a work in elite junior weightlifters. Int J Sports Med 1992; 13:
daily log kept by the athlete (table IV); (ii) weekly 372-6
17. Flynn MG, Pizza FX, Boone lB, et al. Indices of training stress
POMS assessment during overreaching periods; during competitive running and swimming seasons. Int J
(iii) a fortnightly maximal or standardised sub- Sports Med 1994; 15: 21-6
18. O'Connor PJ, Morgan WP, Raglin JS, et al. Mood state and
maximal effort for measurement of performance, salivary cortisol levels following overtraining in female
heart rate recovery and additional measures based swimmers. Psychoneuroendocrinology 1989; 14: 303-10
on table V. 19. Verma SK, Mahindroo SR, Kansal OK. Effect offour weeks of
hard physical training on certain physiological and morpho-
logical parameters of basket-ball players. J Sports Med 1978;
Acknowledgements 18: 379-84
20. Raglin JS, Morgan WP. Development of a scale for use in mon-
The authors gratefully acknowledge the continued sup- itoring training induced distress in athletes. Int J Sports Med
port of The Australian Sports Commission through the Ap- 1994; 15: 84-8
plied Sport Research Program which funded much of our 21. Carlile C, Carlile U. New directions in scientific training. Syd-
ney: Carlile and Carlile, 1978
work in this area.
22. Kirwan JP, Costill DL, Flynn MG, et al. Physiological responses
to successive days of intense training in competitive swim-
References mers. Med Sci Sports Exerc 1988; 20: 255-9
I. Fry RW, Morton AR, Keast D. Overtraining in athletes: an up- 23. Lehmann M, Dickhuth HH. Gendrisch G, et al. Training - over-
date. J Sports Med 1991; 12: 32-65 training: a prospective. experimental study with experienced
2. Kuipers H, Keizer HA. Overtraining in elite athletes. J Sports middle- and long-distance runners. 1m J Sports Med 1991 ; 12:
Med 1988; 6: 79-92 444-52
3. Lehmann M, Foster C, Keul J. Overtraining in endurance ath- 24. Brown RL, Frederick EC. Falsetti HL, et al. Overtraining of
letes: a brief review. Med Sci Sports Exer 1993; 25: 854-62 athletes: a round table. Physician Sportsmed 1983; 11: 93-110
4. Mackinnon LT, Hooper S. Mucosal (secretory) immune system 25. Wolf WA. Contribution to the question of overtraining. In: Lar-
responses to exercise of varying intensity and during over- son LA. editor. Health and fitness in the modem world. Chi-
training. IntJ Sports Med 1994; 15: S 179-84 cago: Athletic Institute. 1961: 291-301
5. Morgan WP, Brown DR, Raglin JS, et al. Psychological moni- 26. Dressendorfer RH, Wade CE, Scaff JH. Increased morning heart
toring of overtraining and staleness. Br J Sports Med 1987; rate in runners: a valid sign of overtraining? Physician
21: 107-14 Sportsmed 1985; 13: 77-86
6. Wishnitzer R, Berrebi A, Hurwitz N, et al. Decreased cellularity 27. Rusko HK. Rahkila P, Vihko V. et al. Longitudinal changes
and hemosiderin of the bone marrow in healthy and over- in heart rate and blood pressure during overtraining period.
trained competitive distance runners. Physician Sportsmed Proceedings IOC Conference: 1989; Colorado Springs, USA:
1986; 14: 86-95 45-6
7. Barron JL, Noakes TD, Levy W, et al. Hypothalamic dysfunc- 28. Verde T. Thomas S, Shepard R. Potential markers of heavy train-
tion in overtrained athletes. J Clin Endocrinol Metab 1985; ing in highly trained distance runners. Br J Sports Med 1992;
60: 803-6 26: 167-75
8. Stone MH, Keith RE, Kearney JT, et al. Overtraining: a review 29. Morgan WP. Psychological components of effort sense. Med Sci
of the signs, symptoms and possible causes. J Appl Sports Sci Sports Exerc 1994; 26: 1071-7
Res 1991; 25: 35-50 30. Kindermann W. Overtraining - expression of a disturbed auto-
9. Hooper SL, Mackinnon, LT, Howard A, et al. Markers for mon- nomic regulation. Dtsh Z Sportmed 1996; 8: 238-45
itoring overtraining and recovery. Med Sci Sports Exerc 1995; 31. VanBorselen F. Vos NH. Fry AC. et al. The role of anaerobic
27: 106-12 exercise in overtraining. Nat! Strength Cond Assoc J 1992;
10. Budgett R, Koutedakis R, Walker M, et al. Overtraining syn- 14: 74-9
drome/staleness. Proceedings of IOC Conference: 1989; Col- 32. Jeukendrup AE. Hesselink MK. Overtraining - what do lactate
orado Springs, USA, 118-9 curves tell us? Br J Sports Med 1994; 28: 239-40
II. Hooper SL, Mackinnon LT, Gordon RD et al. Hormonal re- 33. Lehmann M. Baumgartl P, Wiesenack C, et al. Training - over-
sponses of elite swimmers to overtraining. Med Sci Sports training: influence of a defined increase in training volume vs
Exer 1993; 25: 741-7 training intensity on performance. catecholamines and some

© Adis International Limited. All rights reserved. Sports Med. 20 (5) 1995
Monitoring Overtraining 327

metabolic parameters in experienced middle- and long-dis- 39. Fry RW. Kraemer WJ. VanBorselen F. et al. Performance dec-
tance runners. Eur J Appl Physiol 1992; 64: 169-77 rements with high intensity resistance exercise overtraining.
34. Rushall BS. A tool for measuring stress tolerance in elite ath- Med Sci Sports Exerc 1994; 26: 1165-73
letes. Appl Sport Psych 1990; 2: 51-66 40. Fleck SJ. The psychology of overtraining. Strength Cond 1994;
35. Prapavessis H. Berger B. Grove JR. The relationship oftraining 16: 39
and pre-competition mood states to swimming performance: 41. Morgan WP. Costill DL. Flynn MG. et al. Mood disturbance
an exploratory investigation. Aust J Sci Med Sport 1992; following increased training in swimmers. Med Sci Sports
24: 12-7 Exerc 1988; 20: 408-14
36. McNair DM. Lorr M. Droppleman LF. EDITS Manual for the 42. Collins D. Early detection of overtraining problems in athletes.
Profile of Mood States. San Diego: Educational and Industrial Coaching Focus 1995; 28: 17-20
Testing Service. 1971: 1-29
37. Berglund B. Safstrom H. Psychological monitoring and modu-
lation of training loads of world-class canoeists. Med Sci
Sports Exerc 1994; 26: 1036-40
38. Hooper SL. Mackinnon LT. Hanrahan S. Mood states as an Correspondence and reprints: Dr Sue Hooper, Department
indication of staleness and recovery. Int J Sports Psychol. In of Human Movement Studies, The University of Queens-
press land, Brisbane, Queensland 4072, Australia.

© Adis Intemotionollimited. All rights reserved. Sports Med. 20 (5) 1995