Jürgen M. Steinacker

Prevention, diagnosis and treatment of the Overtraining Syndrome ECSS Position Statement 'Task Force'

Abstract Successful training must involve overload but also must avoid the combination of excessive overload plus inadequate recovery. Athletes can experience short term performance decrement, without severe psychological, or lasting other negative symptoms. This Functional Overreaching (FOR) will eventually lead to an improvement in performance after recovery. When athletes do not sufficiently respect the balance between training and recovery, Non-Functional Overreaching (NFOR) can occur. The distinction between NFOR and the Overtraining Syndrome (OTS) is very difficult and will depend on the clinical outcome and exclusion diagnosis. The athlete will often show the same clinical, hormonal and other signs and symptoms. A keyword in the recognition of OTS might be ‘prolonged maladaptation’ not only of the athlete, but also of several biological, neurochemical, and hormonal regulation mechanisms. It is generally thought that symptoms of OTS, such as fatigue, performance decline, and mood disturbances, are more severe than those of NFOR. However, there is no scientific evidence to either confirm or refute this suggestion. One approach to understanding the aetiology of OTS involves the exclusion of organic diseases or infections and factors such as dietary caloric restriction (negative energy balance) and insufficient carbohydrate and/or protein intake, iron deficiency, magnesium deficiency, allergies, etc. together with identification of initiating events or triggers. In this paper we provide the recent status of possible markers for the detection of OTS. Currently several markers (hormones, performance tests, psychological tests, biochemical and immune markers) are used, but none of them meets all criteria to make its use generally accepted. We propose a “check list” that might help the physicians and sport scientists to decide on the diagnosis of OTS and to exclude other possible causes of underperformance.

Overweight Prevention Implemented by Primary School Teachers: A Randomised Controlled Trial

Objective: To describe the effects of URMEL-ICE, a German school-based intervention for overweight prevention, on children’s BMI and other measures of fat mass. Methods: A cluster-randomised controlled design was used. The intervention which focused on physical activity, TV time and soft drink consumption was integrated into a second-grade curriculum and was implemented by classroom teachers themselves. It comprised 29 teaching lessons, 2 short exercise blocks per day and 6 family homework lessons. BMI was assessed as primary outcome measure, waist circumference and skinfold thickness as secondary outcomes. Data of 945 children were analysed. Results: Multivariate analyses adjusted for baseline values showed no statistically significant effect of the intervention on BMI, but on waist circumference (–0.85; 95% confidence interval (95% CI) –1.59 to –0.12) and subscapular skinfold thickness (–0.64; 95% CI –1.25 to –0.02). After additional adjustment for individual time lag between baseline and follow-up, these effects were reduced to –0.60 (95% CI –1.25 to 0.05) and –0.61 (95% CI –1.26 to 0.04) and lost their statistical significance. Conclusion: This study contributes to the field of randomised school-based studies on overweight prevention and shows that within a 1-year, integrated intervention no effect on BMI, but a tendency towards effects on fat mass can be achieved.

Long term effects of comprehensive cardiac rehabilitation in an inpatient and outpatient setting

OBJECTIVES To compare the long-term effects of comprehensive outpatient versus inpatient rehabilitation with respect to morbidity and mortality, as well as to changes in physical performance and physical activity. DESIGN A total of 163 consecutive patients were enrolled for comprehensive cardiac rehabilitation (CCR) following a recent coronary event, to outpatient or inpatient CCR according to treatment preference because randomisation was accepted by only 4 patients. CCR was six hours per day for 4 weeks and consisted of exercise training, education, psychological support, and nutritional and occupational advice. Examinations were before, after and 12 months after CCR. Primary outcome measures were event-free survival with or without interventions, EFS-I or EFS, respectively, 12 months after rehabilitation. RESULTS Main patient characteristics were distributed equally in the cohorts. Results were adjusted by logistic regression for age, BMI, LV-function, exercise capacity and physical activity before the event. Adjusted EFS, EFS-I , overall survival and other morbidity outcome measures did not differ significantly. During CCR, physical activity was higher in outpatients, but this difference was not maintained in the follow up. Average physical activity was increased 12 month after CR with no difference between groups. CONCLUSION Although influenced by patient preference, participation in either inpatient or outpatient CCR led to comparable results in terms of all-cause or cardiac overall survival, event-free survival and other secondary outcome measures like cardiac morbidity, physical performance and increased physical activity.

Determinants of diet and physical activity (DEDIPAC): a summary of findings

The establishment of the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, 2013–2016, was the first action taken by the ‘Healthy Diet for a Healthy Life’ European Joint Programming Initiative. DEDIPAC aimed to provide better insight into the determinants of diet, physical activity and sedentary behaviour across the life course, i.e. insight into the causes of the causes of important, non-communicable diseases across Europe and beyond. DEDIPAC was launched in late 2013, and delivered its final report in late 2016. In this paper we give an overview of what was achieved in terms of furthering measurement and monitoring, providing overviews of the state-of-the-art in the field, and building toolboxes for further research and practice. Additionally, we propose some of the next steps that are now required to move forward in this field, arguing in favour of 1) sustaining the Knowledge Hub and developing it into a European virtual research institute and knowledge centre for determinants of behavioural nutrition and physical activity with close links to other parts of the world; 2) establishing a cohort study of families across all regions of Europe focusing specifically on the individual and contextual determinants of major, non-communicable disease; and 3) furthering DEDIPAC’s work on nutrition, physical activity, and sedentary behaviour policy evaluation and benchmarking across Europe by aligning with other international initiatives and by supporting harmonisation of pan-European surveillance.

Transcutaneous Monitoring of PO2 and PCO2 During Running — A Noninvasive Determination of Gas Transport

Transcutaneous pO2 and pCO2 (tcpO2 and tcpCO2) were measured during running with stepwise increased velocities and with constant speed, under both aerobic and anaerobic conditions, for the determination of blood gas transport during exercise. Arterial and transcutaneous blood gas values correlated significantly (pO2 r = 0.87, p less than 0.001, pCO2 r = 0.91, p less than 0.001 respectively). Transcutaneous pCO2 is a noninvasive method of monitoring arterial pCO2 and lactate formation during exercise. When athletes run, arterial pO2 falls to a specific limit depending on the intensity of work. This seems to be characteristic for maximum oxygen transport capacity. The aerobic endurance measured by the aerobic-anaerobic threshold may be dependent on the possibility of sustaining low arterial pO2 during high working levels at high oxygen consumption.

The Overtraining Syndrome – facts & fiction

Vrije Universiteit Brussel, Department of Human Physiology and Sports Medicine, Brussels, Belgium, Laboratory Neurogenetic and Stress, INRA-UMR 1243, University Bordeaux 2 and Sport-Health Department, CHU, Bordeaux: France, School of Sport and Exercise Sciences, Loughborough University, LE11 3TU, UK, Netherlands Olympic Committee, Netherlands Sports Confederation (NOC/NSF), Arnhem, The Netherlands, Sektion Sports and Rehabilitation Medicine University of Ulm, Germany, and Centre de l’Appareil Locomoteur, de Me?decine du Sport et de Pre?vention, Centre Hospitalier de Luxembourg

Transcutaneous Po2 During Exercise

During the performance of work, the energy needed for muscle concentration is mainly provided by the metabolism of glucose or fats with oxygen. For that reason the oxygen uptake VO2 is closely related to physical working capacity. During long-lasting exercise VO2 can increase 15–20 times compared to the value at rest. The maximal Vo2 obtained, is defined as the aerobic capacity of an athlete. During strenuous and short duration exercise there are increasing lactic acid concentrations observed in the blood (Margaria and Edwards, 1933). These lactic acid concentrations indicate a high energy demand, which is not immediately provided for by oxygen uptake, so that the percentage of glycolysis in total energy production must increase. The balance between this anaerobic and aerobic energy production is influenced by muscle tissue, cardiopulmonary function and neuromuscular coordination (Margaria and Edwards, 1933; Astrand, 1952; Keul and Doll, 1973). Oxygen transport in the blood is another factor, therefore, the Po2 was observed in arterial blood samples. This method only allows discontinuous measurements to be made. Arterial puncture is necessary, because samples from capillary blood are of limited value (Siggard-Andersen, 1968). Continuous measurement has been attempted, using intravascular measuring probes or by continuously analyzing blood sucked out from the indwelling canula (Schwarz and Fabel, 1976). All these methods require well-trained personnel and/or expensive equipment, they are invasive and are, therefore, not recommended for routine use in exercise testing.

Sedentary Behavior among National Elite Rowers during Off-Training—A Pilot Study

The aim of this pilot study was to analyze the off-training physical activity (PA) profile in national elite German U23 rowers during 31 days of their preparation period. The hours spent in each PA category (i.e., sedentary: <1.5 metabolic equivalents (MET); light physical activity: 1.5–3 MET; moderate physical activity: 3–6 MET and vigorous intense physical activity: >6 MET) were calculated for every valid day (i.e., >480 min of wear time). The off-training PA during 21 weekdays and 10 weekend days of the final 11-week preparation period was assessed by the wrist-worn multisensory device Microsoft Band II (MSBII). A total of 11 rowers provided valid data (i.e., >480 min/day) for 11.6 week days and 4.8 weekend days during the 31 days observation period. The average sedentary time was 11.63 ± 1.25 h per day during the week and 12.49 ± 1.10 h per day on the weekend, with a tendency to be higher on the weekend compared to weekdays (p = 0.06; d = 0.73). The average time in light, moderate and vigorous PA during the weekdays was 1.27 ± 1.15, 0.76 ± 0.37, 0.51 ± 0.44 h per day, and 0.67 ± 0.43, 0.59 ± 0.37, 0.53 ± 0.32 h per weekend day. Light physical activity was higher during weekdays compared to the weekend (p = 0.04; d = 0.69). Based on our pilot study of 11 national elite rowers we conclude that rowers display a considerable sedentary off-training behavior of more than 11.5 h/day.

Eleven-Week Preparation Involving Polarized Intensity Distribution Is Not Superior to Pyramidal Distribution in National Elite Rowers

Polarized (POL) training intensity distribution (TID) emphasizes high-volume low-intensity exercise in zone (Z)1 (< first lactate threshold) with a greater proportion of high-intensity Z3 (>second lactate threshold) compared to Z2 (between first and second lactate threshold). In highly trained rowers there is a lack of prospective controlled evidence whether POL is superior to pyramidal (PYR; i.e., greater volume in Z1 vs. Z2 vs. Z3) TID. The aim of the study was to compare the effect of POL vs. PYR TID in rowers during an 11-wk preparation period. Fourteen national elite male rowers participated (age: 20 ± 2 years, maximal oxygen uptake (V˙O2max): 66 ± 5 mL/min/kg). The sample was split into PYR and POL by varying the percentage spent in Z2 and Z3 while Z1 was clamped to ~93% and matched for total and rowing volume. Actual TIDs were based on time within heart rate zones (Z1 and Z2) and duration of Z3-intervals. The main outcome variables were average power in 2,000 m ergometer-test (P2,000 m), power associated with 4 mmol/L [blood lactate] (P4[BLa]), and V˙O2max. To quantify the level of polarization, we calculated a Polarization-Index as log (%Z1 × %Z3 / %Z2). PYR and POL did not significantly differ regarding rowing or total volume, but POL had a higher percentage of Z3 intensities (6 ± 3 vs. 2 ± 1%; p < 0.005) while Z2 was lower (1 ± 1 vs. 3 ± 2%; p < 0.05) and Z1 was similar (94 ± 3 vs. 93 ± 2%, p = 0.37). Consequently, Polarization-Index was significantly higher in POL (3.0 ± 0.7 vs. 1.9 ± 0.4 a.u.; p < 0.01). P2,000 m did not significantly change with PYR (1.5 ± 1.7%, p = 0.06) nor POL (1.5 ± 2.6%, p = 0.26). V˙O2max did not change (1.7 ± 5.6%, p = 0.52 or 0.6 ± 2.6, p = 0.67) and a small increase in P4[BLa] was observed in PYR only (1.9 ± 4.8%, p = 0.37 or −0.5 ± 4.1%, p = 0.77). Changes from pre to post were not significantly different between groups in any performance measure. POL did not prove to be superior to PYR, possibly due to the high and very similar percentage of Z1 in this study.

Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics

The fascial system builds a three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissue that permeates the body and enables all body systems to operate in an integrated manner. Injuries to the fascial system cause a significant loss of performance in recreational exercise as well as high-performance sports, and could have a potential role in the development and perpetuation of musculoskeletal disorders, including lower back pain. Fascial tissues deserve more detailed attention in the field of sports medicine. A better understanding of their adaptation dynamics to mechanical loading as well as to biochemical conditions promises valuable improvements in terms of injury prevention, athletic performance and sports-related rehabilitation. This consensus statement reflects the state of knowledge regarding the role of fascial tissues in the discipline of sports medicine. It aims to (1) provide an overview of the contemporary state of knowledge regarding the fascial system from the microlevel (molecular and cellular responses) to the macrolevel (mechanical properties), (2) summarise the responses of the fascial system to altered loading (physical exercise), to injury and other physiological challenges including ageing, (3) outline the methods available to study the fascial system, and (4) highlight the contemporary view of interventions that target fascial tissue in sport and exercise medicine. Advancing this field will require a coordinated effort of researchers and clinicians combining mechanobiology, exercise physiology and improved assessment technologies.