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Übertrainiert - was tun ?

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BURNOUT

By Forbes Carlile, Australia

Assigning me the topic of burnout for the 1999 ASCTA Conference, no doubt the conveners believe that as a long-ago physiologist with a strong interest in testing athletes for signs and symptoms of breakdown in performance capacity, I may be able to shed some light on the problems of athletes who at least temporarily, seem to have reached the end of their tether, performing well below their best.

We know that rest, or at least greatly reduced training load, will generally restore the athlete. However, at times weeks, even months are required for complete recovery—and by then some athletes may have given up in despair.

Coaches need to intervene early.

Just what do we mean by burnout?
The Oxford and Macquarie dictionaries quite literally refer to the exhaustion of energy supplies, as seen in the eventual failure of rockets. This may be close to a good definition in many instances—something worn out, expended.

How can burnout be prevented?
With athletes who overreach (a relatively modern term) and those who overtrain, this being regarded as one step further down a slippery slope—there can often be other important factors concerned in the process besides the stress of exercise. One of these factors quite often is psychological stress. Common usage has given the term burnout an almost complete psychological dimension.

On the psychological level, not only athletes but non-athletes, including swimming coaches, can suffer burnout and some do not swim or run a meter more than they have to. However, I don’t think this is what the conveners wanted me to talk about. For coaches who may be interested, I seriously suggest they look up burnout on the internet. Here we can read, and I am sure all benefit, from some very good advice.

There can be little argument today that in all sports, for top performance, psychological factors play an important role in affecting athletic endeavor, positively or negatively. However when I was a student, more than 50 years ago, my teacher and mentor, the late Professor Frank Cotton (l890-1955) believed differently.

With a very modest budget Frank Cotton established Australia’s first Sport Science laboratory, during the mid- 1940s at the University of Sydney. The Professor was first and foremost a physiologist. Raise the possibility with him that there was a psychological explanation for diminished performance and he would silence me with a raised eyebrow and a stern look. This, he believed, was a "cop-out." Primarily, he would say, one must search for explanations based on a more "exact science," physiology. My apologies to the psychologists present.

I digress a little to comment that for far too long in swimming, and I am as much guilty as anybody, there has been undue concentration on strength, power and endurance, rather than on the biomechanics and hydrodynamics of effective stroke-making, on nutrition and psychology.

For many years we pursued the elusive end of the rainbow, seeking that "pot of gold" of valid physiological tests which would identify the fact that an athlete was passing from a well adapted to an overtrained state. We searched for objective tests which would reliably flag an alert which could prevent the overenthusiastic coach from driving an athlete into long-lasting, intransient staleness.

So far there are no such physiological tests, certainly no one test which can provide a reliable guide for the coach.

Competitive swimming today is as much an art as it is a science, with a background of scientific understanding. If coaches carefully read the logbook remarks of swimmers, listen to swimmers and learn from well-monitored trial swims, we can be aware early of what tests may later only confirm long after the horse has bolted.

Well-monitored trials can tell us more than physiological test results about performance capacity.

Scientists very often confirm what coaches have already found. For instance, coaches learned that in the crawlstroke, swimmers should move around the central axis of the body and that "miles make champions." It took many decades for coaches to learn this, but still there are some scientists who expound that in general, optimum performance will come with "less volume and more intensity." But ask leading coaches, especially Americans to comment on this today. They will nearly all tell you that "science" led many of them astray and they took the wrong turn. U.S. male distance performances since 1976 will indicate this.

At times scientists may have come close to finding useful prognostic tests but the conclusion is inescapable that there has not, and there is not likely to be found, any single physiological parameter which can be tested, and providing an athlete is not found to be suffering from a medically diagnosed illness, can reliably be demonstrated to flag imminent poor performance.

An athlete with a clean bill of health may be performing well below his/her best, feeling chronically tired and uninterested both in training and competing. Yet medically tests will not detect symptoms of illness.

The coach has a problem.

How is the coach to know when the swimmer is a candidate for the overtraining syndrome and greatly worsened performances?

As suggested, it is how the athlete feels, what the coach can learn from watching and listening to his swimmer, and being aware of training times and the effort expended which are the most important guides to assessing the effects of the training program.

The swimmer’s feelings and coach’s observations are often a long way ahead of any "scientific" test results.

So far, no common denominator has been discovered of any useful physiological tests which will identify with even reasonable reliability the over- stressed or the about-to-be stressed-out athlete who is not responding beneficially to training. As an assistant coach once said to me..."I can tell how much effort is going into repeat swims by observing the swimmer’s breathing and watching his face." He was right. What we should be looking for, with the cooperation of the athlete, is the matching of effort exerted and the times for test swims.

Combined with the result of monitored trials under as far as possible standardized conditions and hearing a report of the perceived effort, such swimmer observations are the best indicators of physical condition.

Being aware of diminution of performance capacity but accompanied by increased effort, and the coach taking appropriate action lies at the heart of good coaching. In this lies the art of good coaching, which in essence is knowing the athlete.

There is an industry carried out by many sport science laboratories within Australia and throughout the world where it is implied that the answer to understanding and optimally directing the training of athletes depends on constant physiological testing.

I believe that athletes, at considerable expense, are sometimes being measured with a "crooked ruler," often with invalidated tests. The fact that there is little consensus amongst sports scientists, with no wide agreement on testing protocols, should worry coaches.

We have to be very careful about "testing for testing’s sake" when all that may be happening is an amassing of more and more fodder for databanks. Reliability and validity of tests are of importance if finance and the athlete’s time and effort are to be conserved.

The Blood
Studying the various constituents of blood has long been the focus of the attention of sports scientists. Years ago my wife Ursula and I studied serial hemoglobin concentrations in athletes taken during the resting state. After hundreds of measurements when the level was distinctly below his/her established norm, performances invariably were poor. Usually without nearly complete rest (iron medication may have helped eventually), performances remained depressed.

Low serum ferritin (iron) levels are often associated with low performance levels, but then we find there are individuals who are normally on the low side of "normal" and these swimmers continue to feel and perform well.

Blood hemoglobin determinations in resting individuals remains a relatively simple, easily carried out, prognostic test. But hemoglobin and ferritin levels can, however, be completely normal but the swimmer may be performing badly!

For a while a high serum level of CPK (creatine phosphokinase) was believed to point to overtraining, until it was shown that high blood levels of this enzyme could be the natural result of intensive muscular exercise, but as a rule not a sign of overtraining.

Through the years measurement of one physiological parameter after another has been claimed to be a promising "marker." However the validity of most tests have not lived up to early hopes.

Nevertheless, as a result of about 10 years work, it seems more than possible that the trail Dr. David Pyne is following at the Australian Institute of Sport, assessing the production of antibodies, the various immunoglobulins produced by the immune system, may prove fruitful in providing information regarding the stressed body’s capacity to resist illness. This research appears to be yielding very promising results.

Such knowledge, and it seems soon that it will be relatively easily obtained from a saliva test, could well point to when failing adaptation is occurring, reflected by the functioning of the immune system, thus providing a valuable warning for the coach and athlete.

Adaptation.
This is an "in" word used in training circles today.....

"How is the swimmer adapting?" It is a good question.

Canadian Hans Selye in the late 1940s came up with his then revolutionary theory of The General Adaptation Syndrome (GAS) which looked at the sum total effect of a wide variety of stresses on the body, an overloading which could precipitate the onset of many diseases through failure and malfunctioning of various physiological processes.

Selye explained breakdown as very often due to the involvement of the adrenocorticotrophic hormone (ACTH) produced by the pituitary gland and in turn the effect of this hormone on the various hormonal secretions from the cortical (outer) cells of the adrenal glands.

I have long thought that the obvious varying capacities of individual athletes to bear training stress may be related to the productivity of the central hormone ACTH. Perhaps it is significant that the IOC includes ACTH on its list of prohibited substances.

It seemed clear to me that there was a direct application of the GAS theory of adaptation to stress and physiological breakdown, in the training of athletes.

In a series of papers written in 1955, on the Athlete and Adaptation to Stress (Journal of Physical Education, Melbourne, Feb.-March), appendix 1 and appendix 2, following the Selye model, I set out what may be regarded as a short list of the possible stresses acting on the athlete and postulated that signs and symptoms of failing adaptation could be commonly recognized in the overtrained athlete. Years later, I think in 1973, I introduced a frail Hans Selye at an ASCA Conference in Montreal and Selye surprised me when he said that he had not considered the application of his theory to the athlete in training.

Common stresses on the athlete
These include.....

(i) Muscular exercise of training.
(ii) Dietary inadequacy
(iii) Climatic conditions, heat and cold
(iv) Bacterial (and viral) infections and disease
(v) Emotional conflict and unrest
(vi) Insufficient rest and sleep
\(vii) Miscellaneous stress—everyday wear and tear of living.

Often more than one of these stresses can be seen to be acting on the athlete.

Signs and symptoms of failing adaptation
(i) Chronic loss of body weight
(ii) Joint and muscle pain not attributable to a local injury.
(iii) Recurring intestinal upsets
(iv) Swollen lymph glands (tonsils and inguinal glands)
(v) Blocked nose and one-day colds (rhinitis)
(vi) Skin rashes such as hives (urticaria)
(vii) Psychic unrest, irritability, insomnia, general fatigue often referred to as staleness.
(viii) General muscular tenseness.

These signs and symptoms of overtraining may vary from one athlete to another and a single or a multiple collection of effects may be observed.

You will see that the psychological dimension in the General Adaptation Syndrome is listed above as one of the possible results of failure of "adaptation energy" as Selye called it.

So you see that the ubiquitous psychic element can be considered to be part of cause and effect of the General Adaptation Syndrome..

Today it is generally accepted that the psychological aspects of overtraining are very important, Easily administered, and well validated and (this may be "the rub"), psychological testing would appear to warrant regular use with seriously training athletes. Psychological change often precedes physiological changes.

Flattened T waves.
In 1958 we thought we came close to making some extremely useful observations to indicate failing adaptation. It is a good example illustrating that "all that glitters is not gold," when it comes to physiological testing

My wife Ursula and I were at this time measuring as many physiological parameters as was possible with very limited equipment and resources. We were not on a university payroll.

Using an even then cast-off item of electronic equipment, an electrocardiograph of ancient vintage—and this was more than 40 years ago, we were excited to discover an interesting phenomenon that had not been reported in the scientific literature.

We observed on a daily basis swimmers coming out of their winter "off season." We also seized the opportunity to study top ranking cyclists in a 6-day bicycle race in Sydney.

We were able to demonstrate in both the swimmers who were training twice daily, they being driven to quickly reach competitive form, and in the highly stressed cyclists, that in all cases there occurred a diminution of the amplitude, considerable flattening of the T waves of the electrocardiograph. In everyday medicine the flattening of the T wave can have serious implications as it is associated with cardiac muscle damage and imminent "heart failure."

The swimmers we tested more than 40 years ago now were all "in the same boat". They were suddenly precipitated into hard training in October, in cold water, invariably less than 7OF (21C), down to 16C. This gave the swimmers no chance for gradual adaptation to a slowly increasing training load and the cold water.

In the cyclists, competing in a 6-day event as expected was a considerable stress.

Typical examples are given of the changes we found in all our subjects (appendix 1 and appendix 2). We still have hundreds of athletes’ ECGs taken at this time stored away in our home.

All the swimmers and cyclists tested showed the same changes in various degrees in the T wave on the chest leads, with the greatest flattening appearing in those who appeared most distressed. Several swimmers complained that they found great difficult in even walking up the steps of the old Drummoyne Pool. The swimmers complained constantly of feeling weak and very tired.

The cyclist whose electrogram is shown (in appendix 2) was taken to hospital during the competition in a state of exhaustion, but returned to finish the race.

A heart specialist to whom we later showed his tracing, which had an inverted T wave, a sign of imminent heart failure asked, "when did he die?". This cyclist later that year finished 4th in his event at the Commonwealth Games.

All the subjects, swimmers and cyclists, eventually, with less severe training and more rest later showed T waves returning more or less to their "normal" shape. However transition to the rested state was usually a slow process, often taking days or weeks.

Ursula and I thought we had discovered the definitive test, a basis for assessing fatigue. But it never turned out this way. Although we have since been told of similar findings in grossly overtrained athletes, few swimmers appear to show marked T wave changes today because they, as a rule, train year-round and do not jump into very hard training from a relatively untrained state.

In 1965 at Indiana University we tested "Doc" Counsilman’s NCAA champion team. There were practically no flattened T waves detected.

The "T wave test" appears to be useful in unusual situations to confirm gross overtraining. But coaches should be aware of this anyway from the athlete’s psychological state of well-being.

As a footnote to this story I should tell you that the gross T wave changes probably represent not a damaged heart but an "electrolyte imbalance," the result of maladaptation to exercise stress.

Heart rates and blood pressure
We have long known that early morning (basal) heart rate, which we believe should always be carefully monitored, should be noted in the swimmer’s logbook and anomalies reported to the coach. This increases with subclinical illness and often in the overtrained state.

Russian research from the 1950s and our observations reported in a study made during the 8-weeks training and testing study we made of the 1960 Australian Olympic team, indicated that abnormal blood pressure changes can occur following a standard exercise which reflect the trained state and failing adaptation.

Heart rate monitoring
The linking of heart rate response to performance effort goes back to the beginning of modern sport science. In my early days I was an avid heart rate counter.

Heart rate response can be a useful monitor of performance effort if limitations in the procedure are understood.

One swimmer’s "meat may be another’s poison." Burnout, overreaching, or overtraining, call it what we will, can occur with some earnest athletes when dutifully following what "science" has told their coach about monitoring heart rate for "correct" training speeds.

Anomalies using the heart rate response to indicate the intensity of training efforts occur because alterations in the stroke volume are not the same for all individuals. This is obviously a complicating factor in interpreting heart rate response because the amount of blood pumped out is a function of both rate and the changeable stroke volume.

There is a salutary reminder of this in an important study by Howat and Robson (Swimming Times, June 1992), referred to in Dr. Brent Rushall’s web-site under the heading Physiology of Training.

In this paper there is clear warning that if the coach doggedly insists on training at heart rates according to commonly accepted guides, up to 33% of swimmers will be undertrained and as many as 33% overtrained and may be working well beyond their aerobic capacities.

Although normally recommended "heart rate training" procedures would appear to have worked well with some, the method should be tailored to the individual (possibly matching heart rates with lactate responses or perceived exertion). Otherwise this "simple" method of training can with many, represent a seriously flawed procedure.

To sum up
There are no single physiological tests to reliably indicate overtraining.

The concept of burnout whilst having mainly psychological connotations can be considered to be part and parcel of the overtraining syndrome.

A disturbed mental state will often result in an unhappy and ineffective athlete which alone usually indicates overtraining.

Inappropriate use of heart rate in monitoring training can lead to both undertraining and overtraining.

On the basis of swimmer-observation by the coach and reliable psychological appraisement, the possibility of burnout/overtraining should be assessed early, and appropriate preventive actions taken.

THE ATHLETE AND ADAPTATION TO STRESS

(Parts II and III of an address delivered at a Symposium on Training, organized by the Educational and Coaching Committee of the N.S.W. Amateur Swimming Association, July 29, 1955, Sydney).

PART II.
APPLICATIONS OF THE STRESS CONCEPT  TO TRAINING

The particular aim of training is to stimulate specific adaptation of the body by continuously repeating physical exercise of a specialized nature. Harmful effects of exercise stress becomes a more likely condition nowadays that rewards for sporting success are many, and high training-mileage has become almost an obsession with many athletes and coaches.

Selye’s concept that the body has a finite quantity of Adaptation energy and that stresses should be summated when considering their effects on the organism, he has stated to be his most important idea gained from his many observations on stress research.

It was stated in Part I that an important result of chronic exposure of the organism to a particular stress is not only to increase the resistance to that stress but also to reduce the nonspecific resistance to other stresses. The implication of this for the athlete becomes apparent. The highly trained athlete may withstand a relatively great load of a particular exercise for which he has been trained, but more easily succumbs to other stressing agents such as chills and bacterial infection than the normal healthy person. This is not an uncommon observation.

Any stress, muscular exercise or otherwise, whether major or minor according to Selye, draws on the bank of adaptation energy, but the stresses for which the individual is less well adapted will draw the greatest debit and be most likely to hasten exhaustion reactions.

STRESSES ON THE ATHLETE
There are two important practical questions, firstly, what are the main stresses which may make a demand on an athlete’s adaptation and, secondly, what signs and symptoms are indicative of a failing store of adaptation energy? Here is a list of stresses which in the author’s experience. are common to many athletes --

(i) Muscular exercise,
(ii) Dietary inadequacy,
(iii) Climatic conditions, heat and cold,
(iv) Bacterial infections and disease,
(v) Emotional conflict and unrest,
(vi) Insufficient rest and sleep,
(vii) Miscellaneous stress-everyday wear and tear of living.

PART III
SIGNS AND SYMPTOMS OF STRAIN

When the sum total of stresses acting on an individual are such that the body is driven to show reactions of the stage of exhaustion, a few responses have been reported for humans.

The author’s observations on athletes in severe training for a variety of sports have confirmed Selye’s hypothesis that whether a person is ill from disease or stressed by other means such as exercise, he tends to show common reactions. A short list of the more usual signs and symptoms of failing.-adaptation includes the following:

(i) Chronic loss of body weight.
(ii) Joint and muscle pain not attributable to a particular local injury.
(iii) Chronically occurring intestinal upsets.
(iv) Swollen lymph glands (tonsils and inguinal glands).
(v) Blocked nose and one-day cold (rhinitis).
(vi) Skin rashes such as hives (urticaria).
(vii) Psychic unrest, irritability, insomnia, general fatigue often referred to as staleness.
(viii) General muscular tenseness.

Loss of weight in the training athlete, whether accompanied, or not, by poor appetite, may be considered as representing the general increased catabolism (destructive processes) of the body tissues which Selye says is characteristic of an advanced G.A.S. response. Some coaches and trainers of animals place considerable faith in the use of this sign as a guide. When visiting the Payne Whitney Gymnasium at Yale University, the author saw the 1952 American Swimming Team candidates under coach R. Kiphuth carefully recording their stripped weights on a chart. This was a daily practice.

Joint pains have for some time been recognized as a common symptom of various disease states. Such symptoms in the athlete in terms of the G.A.S. would be interpreted as representing a highly stressed state. The author had some personal experience in this regard. Months after training had commenced and a fairly good specific adaptation to running long distances was demonstrated by improving time-trial performances, joint and muscle pains became a regular occurrence. When these general pains (combined with other symptoms such as extreme irritability) were disregarded, and training load maintained, there was a culmination in breakdown after a marathon race. The chief sign of the physiological breakdown was acute renal failure.

Swollen lymph glands, both the tonsils and in the groin area, and urticarial rashes (hives) have been noticed many times by the author both in himself and in other individuals in hard training. Almost immediate relief has always followed when stresses, including muscular exercise, have been removed.

Sleeplessness and nervous irritability are classical signs of the condition.

Blank

Copyright © 1998-1999 American Swimming Coaches Association.

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