Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies

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Abstract

Background Coaches, sport scientists, clinicians and medical personnel face a constant challenge to prescribe sufficient training load to produce training adaption while minimising fatigue, performance inhibition and risk of injury/illness. Objective The aim of this review was to investigate the relationship between injury and illness and longitudinal training load and fatigue markers in sporting populations. Methods Systematic searches of the Web of Science and PubMed online databases to August 2015 were conducted for articles reporting relationships between training load/fatigue measures and injury/illness in athlete populations. Results From the initial 5943 articles identified, 2863 duplicates were removed, followed by a further 2833 articles from title and abstract selection. Manual searching of the reference lists of the remaining 247 articles, together with use of the Google Scholar ‘cited by’ tool, yielded 205 extra articles deemed worthy of assessment. Sixty-eight studies were subsequently selected for inclusion in this study, of which 45 investigated injury only, 17 investigated illness only, and 6 investigated both injury and illness. This systematic review highlighted a number of key findings, including disparity within the literature regarding the use of various terminologies such as training load, fatigue, injury and illness. Athletes are at an increased risk of injury/illness at key stages in their training and competition, including periods of training load intensification and periods of accumulated training loads. Conclusions Further investigation of individual athlete characteristics is required due to their impact on internal training load and, therefore, susceptibility to injury/illness.

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Inverted-U-shaped dopamine actions on human working memory and cognitive control.

Roshan Cools, Mark D'Esposito (2011)

Brain dopamine (DA) has long been implicated in cognitive control processes, including working memory. However, the precise role of DA in cognition is not well-understood, partly because there is large variability in the response to dopaminergic drugs both across different behaviors and across different individuals. We review evidence from a series of studies with experimental animals, healthy humans, and patients with Parkinson's disease, which highlight two important factors that contribute to this large variability. First, the existence of an optimum DA level for cognitive function implicates the need to take into account baseline levels of DA when isolating the effects of DA. Second, cognitive control is a multifactorial phenomenon, requiring a dynamic balance between cognitive stability and cognitive flexibility. These distinct components might implicate the prefrontal cortex and the striatum, respectively. Manipulating DA will thus have paradoxical consequences for distinct cognitive control processes, depending on distinct basal or optimal levels of DA in different brain regions. Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

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Monitoring Training Load to Understand Fatigue in Athletes

Shona L. Halson (2014)

Many athletes, coaches, and support staff are taking an increasingly scientific approach to both designing and monitoring training programs. Appropriate load monitoring can aid in determining whether an athlete is adapting to a training program and in minimizing the risk of developing non-functional overreaching, illness, and/or injury. In order to gain an understanding of the training load and its effect on the athlete, a number of potential markers are available for use. However, very few of these markers have strong scientific evidence supporting their use, and there is yet to be a single, definitive marker described in the literature. Research has investigated a number of external load quantifying and monitoring tools, such as power output measuring devices, time-motion analysis, as well as internal load unit measures, including perception of effort, heart rate, blood lactate, and training impulse. Dissociation between external and internal load units may reveal the state of fatigue of an athlete. Other monitoring tools used by high-performance programs include heart rate recovery, neuromuscular function, biochemical/hormonal/immunological assessments, questionnaires and diaries, psychomotor speed, and sleep quality and quantity. The monitoring approach taken with athletes may depend on whether the athlete is engaging in individual or team sport activity; however, the importance of individualization of load monitoring cannot be over emphasized. Detecting meaningful changes with scientific and statistical approaches can provide confidence and certainty when implementing change. Appropriate monitoring of training load can provide important information to athletes and coaches; however, monitoring systems should be intuitive, provide efficient data analysis and interpretation, and enable efficient reporting of simple, yet scientifically valid, feedback.

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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.

Romain Meeusen, Martine Duclos, Carl Foster … (2013)

Successful training not only 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 will eventually lead to an improvement in performance after recovery. When athletes do not sufficiently respect the balance between training and recovery, nonfunctional overreaching (NFOR) can occur. The distinction between NFOR and 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 etiology 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, and others together with identification of initiating events or triggers. In this article, we provide the recent status of possible markers for the detection of OTS. Currently, several markers (hormones, performance tests, psychological tests, and biochemical and immune markers) are used, but none of them meet all the criteria to make their use generally accepted.