Martine Duclos

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.

Fat distribution in obese women is associated with subtle alterations of the hypothalamic–pituitary–adrenal axis activity and sensitivity to glucocorticoids

OBJECTIVES Obesity with abdominal body fat distribution (A‐BFD) and hypothalamic‐pituitary‐adrenal (HPA) axis activity are somehow linked, but the exact interactions still need clarification. Obese subjects display normal circulating plasma cortisol concentrations with normal circadian rhythms. However, when the HPA axis is pharmacologically challenged, body fat distribution matters and then A‐BFD obese women differ from those with subcutaneous body fat distribution (P‐BFD). We hypothesized that lower dose provocative and suppressive tests than those used to diagnose hypercortisolism of tumour origin or adrenal insufficiency would shed some light on the characteristics of the HPA axis activity in relation with body fat distribution.

Prevention, Diagnosis, and Treatment of the Overtraining Syndrome: Joint Consensus Statement of the European College of Sport Science and the American College of Sports Medicine

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 confirmor 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.

Neuronal activation and corticotropin-releasing hormone expression in the brain of obese (fa/fa) and lean (fa/?) Zucker rats in response to refeeding

The present study was conducted to investigate the pattern of neuronal activation and corticotropin‐releasing hormone (CRH) expression in fed, food deprived and refed lean (Fa/?) and obese (fa/fa) Zucker rats. The pattern of neuronal activation was studied by measuring the expression of the immediate‐early gene c‐fos. Expression of c‐fos and CRH mRNA was determined by in situ hybridization histochemistry. In both lean and obese rats, one hour of refeeding led to a transient increase in c‐fos mRNA levels which was detected in the paraventricular hypothalamic nucleus (PVH), the dorsomedial hypothalamic nucleus, the supraoptic nucleus, the paraventricular thalamic nucleus, the central nucleus of amygdala (CeA), the lateral and medial parabrachial nuclei, the nucleus of the solitary tract, and the area postrema. In addition, refeeding led to strong activation of the arginine‐vasopressin neurons located in the magnocellular part of the PVH. Following 24 h of food deprivation, CRH expression in the parvocellular division of the PVH was significantly higher in obese rats compared to lean animals. During refeeding, PVH CRH mRNA levels in obese rats decreased to reach control values. The decrease in CRH expression in obese rats was accompanied by the alleviation of the hypercorticosteronemia that characterized obese Zucker rats. CRH mRNA levels in the central nucleus of the amygdala were significantly higher in lean rats than in obese animals, when the rats were fed ad libitum During food deprivation, CeA CRH mRNA levels decreased in lean rats and gradually returned to predeprivation values during refeeding. In refed obese rats, CeA levels of CRH mRNA were higher than those of ad libitum fed or food‐deprived obese mutants. In the perifornical region of the lateral hypothalamic area (LHA), the expression of CRH mRNA rose significantly in response to refeeding in lean rats, but not in obese animals. Following the first hour of refeeding, the number of neurons expressing CRH mRNA in the LHA in lean rats almost doubled. The present results demonstrate that refeeding has a stimulating effect in obese Zucker rats in a pattern of activation similar to that seen in lean Fa/? rats. They also demonstrate differences in CRH expression between Fa/? and fa/fa rats after refeeding. The most apparent of these differences was seen in the lateral hypothalamus in which refeeding failed to up‐regulate CRH expression in obese rats.

Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE* randomized trial

BACKGROUND Opinions differ over the exercise modalities that best limit cardiovascular risk (CVR) resulting from visceral obesity in individuals with metabolic syndrome (MetS). As little is known about the combined effects of resistance and endurance training at high volumes under sound nutritional conditions, we aimed to analyze the impact of various intensities of physical activity on visceral fat and CVR in individuals with MetS. METHODS 100 participants, aged 50-70 years, underwent a diet restriction (protein intake 1.2g/kg/day) with a high exercise volume (15-20 h/week). They were randomized to three training groups: moderate-resistance-moderate-endurance (re), high-resistance-moderate-endurance (Re), or moderate-resistance-high-endurance (rE). A one-year at-home follow-up (M12) commenced with a three-week residential program (Day 0 to Day 21). We measured the change in visceral fat and body composition by DXA, MetS parameters, fitness, the Framingham score and carotid-intima-media-thickness. RESULTS 78 participants completed the program. At D21, visceral fat loss was highest in Re (-18%, p<.0001) and higher in rE than re (-12% vs. -7%, p<.0001). Similarly, from M3, visceral fat decreased more in high-intensity-groups to reach a visceral fat loss of -21.5% (Re) and -21.1% (rE)>-13.0% (re) at M12 (p<.001). CVR, MetS parameters and fitness improved in all groups. Visceral fat loss correlated with changes in MetS parameters. CONCLUSION Increased intensity in high volume training is efficient in improving visceral fat loss and carotid-intima-media-thickness, and is realistic in community dwelling, moderately obese individuals. High-intensity-resistance training induced a faster visceral fat loss, and thus the potential of resistance training should not be undervalued (ClinicalTrials.gov number: NCT00917917).

The 24-h Urinary Cortisol/Cortisone Ratio for Monitoring Training in Elite Swimmers

PURPOSE The effect of training variations on 24-h urinary cortisol/cortisone (C/Cn) ratio was investigated in highly trained swimmers to determine whether it could be a good marker of training stress and performance. METHODS Fourteen swimmers (five female and nine male) were tested after 4 wk of intense training (IT), 3 wk of reduced training (RT), and 5 wk of moderate training (MT). At the end of each period, the swimmers performed in their best event at an official competition. Individual performances were expressed as a percentage of the previous seasons best performance. The fatigue state was evaluated with a questionnaire. RESULTS The C/Cn ratio was statistically different for the three periods (IT: 1.10 +/- 0.7, RT: 0.64 +/- 0.3, and MT: 0.57 +/- 0.2). The differences in the C/Cn ratio between two consecutive performances were related to the differences in performance (r = -0.52, P < 0.01), and the C/Cn ratio was significantly related to the total training (r = 0.32, P < 0.05) and total score of fatigue (TSF) (r = 0.35, P < 0.03) over the follow-up period. Cn levels were related to the dryland training (r = -0.46; P < 0.01) and TSF (r = -0.40; P < 0.02). During IT, variations in the C/Cn ratio were related to the changes in the mean intensity (r = -0.67; P < 0.02) and to TSF (r = 0.69; P < 0.01). CONCLUSION The 24-h C/Cn ratio was moderately related to both training and performance whereas Cn levels were only related to training. The C/Cn ratio could be a useful indicator for monitoring the overreaching state in elite swimmers.

Abdominal obesity increases overnight cortisol excretion

Although plasma and 24 h urinary free cortisol (UFC) levels are normal in obese subjects, pharmacological investigations have identified minor hypothalamo-pituitary-adrenal axis differences in patients with abdominal body fat distribution (A-BFD) vs peripheral BFD (P-BFD). Using recent tools such as saliva cortisol or overnight urinary free cortisol upon creatinine ratio (UFC/UC) determinations, we have investigated a population of obese females according to their body fat distribution. In-patients subjects (no.=82) were subjected to routine biochemical testing, 24 h and overnight UFC/UC, basal and post-1mg overnight dexamethasone-suppressing test plasma and saliva cortisol determinations. Central obesity defined by a waist-to-hip ratio (WHR) >0.85 was found in 64% of the subjects vs 87% when defined by waist girth (WG) corrected for age. Despite identical body mass index, A-BFD subjects were more prone to hypertension using both classifications and had higher triglycerides (WHR classification) or higher triglycerides, cholesterol and glycemia (WG classification). Plasma cortisol levels were similar but saliva cortisol levels were lower in the A-BFD group using the WG classification. The 24 h UFC/UC were similar but the overnight UFC/UC were higher in the A-BFD group using the WHR classification. These mild differences in cortisol nocturnal secretion and free cortisol indexes in subjects with different body fat mass distribution suggest that their hypothalamo-pituitaryadrenal axis has a spontaneously subtly different regulation.

Bone health during late adolescence: Effects of an 8-month training program on bone geometry in female athletes

OBJECTIVES This study investigated the short term changes in hip structural parameters in high level adolescent soccers and swimmers. METHODS Twenty-six girl swimmers (15.9±2 years) and 32 girl soccer players (16.2±0.7 years) were investigated before and after 8 months of training. Fifteen non-active age-matched adolescents were enrolled at baseline to serve as a reference group. The geometric contributions to bone strength in the proximal femur were quantified using the hip structural analysis technique. RESULTS Eight months of training had increased the bone density in soccer players but not in swimmers. At the total hip, swimmers conserved their baseline low Z-score values while soccers remained above the normal. At the femoral shaft, the cross sectional area had increased for the two groups with a higher magnitude in soccers (3.17% vs 2.31%; P<0.05). The sub-periosteal width had increased in soccer players (P<0.01) but not in swimmers. The Z-score showed an improvement of cross sectional moment of inertia and section modulus at femoral shaft section for soccers (P<0.001), without any change in swimmers. Remarkably, swimmers had improved the Z-score of buckling ratio (P<0.005), while soccers did not. DISCUSSION/CONCLUSION A season of training for sport characterized by impact had induced significant bone geometry improvement in late adolescent females despite expectations that this period of growth represents a plateau in bone maturation. This study adds to the existing literature describing intensive swimming practice as lacking an osteogenic effect when assessed by dual energy X-ray absorptiometry.

Cortisol and GH: odd and controversial ideas.

Activation of the hypothalamo-pituitary-adrenal (HPA) axis and of the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis represents a physiological response to the energetic, metabolic, vascular, and sometimes neurophysiologic or psychological needs of exercise. Long-lasting increased and (or) decreased secretion of cortisol (the end-product of the HPA axis) or of GH is detrimental to health. This suggests that the activity of these hormonal axes is finely tuned toward homeostasia, tolerating limited prolonged homeostatic disruption. However, the relationships between exercise training and cortisol and GH secretion are full of odd and controversial ideas. In this review, the relationships between HPA axis adaptation to exercise training or disadaptation with overtraining will be discussed, with an emphasis on the limitation on the current measures used to profile hormonal activity. Knowledge of these relationships between cortisol and GH responses to exercise is an important tool to fight against doping with glucocorticoids and GH, and their health-damaging consequences.

Overnight urinary free cortisol determination: A screening test for the diagnosis of Cushing's syndrome

The collection of urine over 24 h to measure free cortisol (UFC) is used to diagnose Cushings syndrome. However, a complete collection of urine is not easy to achieve and the sampling is frequently inaccurate, so a 24 h collection for the determination of UFC excretion is used as a confirmatory rather than a screening test for Cushings syndrome. Our objective was to evaluate a more convenient urine collection for screening patients suspected of Cushings syndrome.