Overtraining Syndrome

What is Overtraining Syndrome?

The list of health benefits of exercise seems endless. Exercise improves mood, helps with weight management, and reduces the risks of acquiring heart disease, diabetes, high blood pressure and many cancers. Exercise boosts the immune system, improves sleep quality and improves memory and cognitive function. If there is a so-called “Fountain of Youth,” exercise is it. Those who exercise regularly have a longer life expectancy, as well as a better quality of life, than those who are sedentary.When is too much of a good thing not so wonderful? When it causes more harm than good. Overtraining Syndrome, or OTS, is one such thing.

Over Training Syndrome (1)

Overtraining Syndrome is not as simple as it may sound. It is more serious than simply exercising too much, pulling a muscle or developing tendonitis from overuse. It is not cured by a day or two of rest or a couple of tablets of ibuprofen. It is not about a sore muscle or temporary fatigue.

Overtraining Syndrome is, instead, the body’s response to excessive exercise (without adequate recovery) that it has deleterious effects on multiple body systems. In turn, there is diminished athletic performance and impaired daily functioning.

Over Training Syndrome Picture 2 (1)

Risk Factors

The decrease in performance caused by undiagnosed OTS often prompts increased intensity, duration and frequency of training, in hopes of stimulating performance. In OTS, this increase in training will only have the opposite effect.

Overtraining Syndrome is unlikely to occur due to regular exercise, a few times a week or even for a short period daily. OTS is most common in elite athletes – those for whom athletic activity is a career, who train five or more hours per day, most days of the week.

OTS is more common in women than in men. It is more common among those participating in individual sports than in team sports. It is not uncommon in high school and college athletes who are under pressure by their parents, teammates and coaches (not to mention the possibility of a coveted collegiate athletic scholarship) to excel.

Overtraining Syndrome is more likely to occur in those with repetitive, monotonous workouts, with little variability in activity type from day to day. OTS is more likely to occur during periods of increased emotional stress due to work, school, family and other relationships. Those training at higher altitudes or resuming training immediately after recovery from illness are also at higher risk for OTS.

Risk Factors Of Over Training Syndrome


The hallmark of Overtraining Syndrome is decreased athletic performance despite what would otherwise be considered adequate rest (weeks or even months) accompanied by psychological symptoms, including depression and irritability.

The athlete with OTS may experience chronic fatigue, chronic muscle soreness, and be increasingly susceptible to infection and repetitive injury.

Over Training Syndrome symptoms


Overtraining Syndrome seems to be multifactorial, occurring only in the presence of more than one condition (extreme physical exertion and psychological factors).

The symptoms of OTS are not specific to the condition, so a diagnosis of OTS can only be made when other conditions with similar symptoms (ie. thyroid dysfunction, diabetes, malnutrition and eating disorders) have been ruled out.

The pathophysiology of Overtraining Syndrome is not clear. There is some evidence to suggest that the depletion of glycogen stores (glycogen is what provides energy to our muscles) leads to OTS. This can trigger a metabolic process that destroys muscle tissue, which would, theoretically, have a negative impact on athletic performance.

Glycogen depletion also increases the production of stress hormones, such as cortisol. Cortisol is produced in the adrenal glands (attached to the kidneys) and has a complex interaction with hormone production and regulation not only within the adrenal glands, but also within the pituitary (a small but important gland in the brain), the hypothalamus (another structure in the brain) and reproductive organs.

A lack of understanding of the pathophysiology of OTS means that there is not an available diagnostic test for Overtraining Syndrome. Instead, the diagnosis is dependent on symptomatology and the exclusion of other medical conditions.


Any overtraining is best treated with rest. The recuperation period from Overtraining Syndrome may require months or years. Because there is a psychological component to Overtraining Syndrome, psychiatric treatment, with either talk therapy or medications (especially the selective seratonin reputake inhibitors), may facilitate recovery.

Rest, healthy sleep habits and adequate nutrition also contribute to recovery. Complimentary therapies, such as massage can be helpful as well.


Some steps to prevent Overtraining Syndrome include:

  • Maintaining adequate nutrition and hydration.
  • Cross training by incorporating various physical activities into training for a specific sport, thus preventing monotony – a known contributor to OTS.
  • Getting adequate rest. This means both getting good sleep every night and having a “rest” day one day a week during which there is no intense physical activity. This serves not only to rest and recover physically, but also to allow time for other, more passive activities that contribute to a better rounded life.
  • Keeping a training journal, with details about the type of training done, the duration of the training session, the quality of the training session, and the physical and emotional responses to training. This journal can be shared with health care providers to facilitate the diagnosis of OTS.

Recovery and Recurrence

As mentioned, full recovery from OTS may require months to years. Some athletes may be able to resume activity at a lower lever of intensity during recovery. For others, even a lower level of activity may initiate a relapse of OTS. The risk of recurrence is high. Full recovery from OTS, coupled with prevention strategies, will lower the risk of recurrence.


  1. Kreher, J. B., & Schwartz, J. B. (2012, March). Overtraining Syndrome: A Practical Guide. Retrieved March 19, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435910/
  2. Meeusen, Romain, et al. (2013). Prevention, Diagnosis, and Treatment of the Overtraining Syndrome. Medicine & Science in Sports & Exercise,45(1), 186-205. doi:10.1249/mss.0b013e318279a10a

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