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      Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review

      systematic-review

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          Abstract

          Background

          Monitoring athlete well-being is essential to guide training and to detect any progression towards negative health outcomes and associated poor performance. Objective (performance, physiological, biochemical) and subjective measures are all options for athlete monitoring.

          Objective

          We systematically reviewed objective and subjective measures of athlete well-being. Objective measures, including those taken at rest (eg, blood markers, heart rate) and during exercise (eg, oxygen consumption, heart rate response), were compared against subjective measures (eg, mood, perceived stress). All measures were also evaluated for their response to acute and chronic training load.

          Methods

          The databases Academic search complete, MEDLINE, PsycINFO, SPORTDiscus and PubMed were searched in May 2014. Fifty-six original studies reported concurrent subjective and objective measures of athlete well-being. The quality and strength of findings of each study were evaluated to determine overall levels of evidence.

          Results

          Subjective and objective measures of athlete well-being generally did not correlate. Subjective measures reflected acute and chronic training loads with superior sensitivity and consistency than objective measures. Subjective well-being was typically impaired with an acute increase in training load, and also with chronic training, while an acute decrease in training load improved subjective well-being.

          Summary

          This review provides further support for practitioners to use subjective measures to monitor changes in athlete well-being in response to training. Subjective measures may stand alone, or be incorporated into a mixed methods approach to athlete monitoring, as is current practice in many sport settings.

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          Most cited references77

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          Cytokine hypothesis of overtraining: a physiological adaptation to excessive stress?

          Overtraining syndrome (OTS) is a condition wherein an athlete is training excessively, yet performance deteriorates. This is usually accompanied by mood/behavior changes and a variety of biochemical and physiological alterations. Presently, there is no global hypothesis to account for OTS. The present paper will attempt to provide a unifying paradigm that will integrate previous research under the rubric of the cytokine hypothesis of overtraining. It is argued that high volume/intensity training, with insufficient rest, will produce muscle and/or skeletal and/or joint trauma. Circulating monocytes are then activated by injury-related cytokines, and in turn produce large quantities of proinflammatory IL-1beta, and/or IL-6, and/or TNF-alpha, producing systemic inflammation. Elevated circulating cytokines then co-ordinate the whole-body response by: a) communicating with the CNS and inducing a set of behaviors referred to as "sickness" behavior, which involves mood and behavior changes that support resolution of systemic inflammation: b) adjusting liver function, to support the up-regulation of gluconeogenesis, as well as de novo synthesis of acute phase proteins, and a concomitant hypercatabolic state; and c) impacting on immune function. Theoretically, OTS is viewed as the third stage of Selye's general adaptation syndrome, with the focus being on recovery/survival, and not adaptation, and is deemed to be "protective," occurring in response to excessive physical/physiological stress. Recommendations are made for potential markers of OTS, based on a systemic inflammatory condition.
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            Psychological monitoring of overtraining and staleness.

            It is widely agreed that overtraining should be employed in order to achieve peak performance but it is also recognised that overtraining can actually produce decrements in performance. The challenge appears to be one of monitoring stress indicators in the athlete in order to titrate the training stimulus and prevent the onset of staleness. The present paper summarises a ten-year research effort in which the mood states of competitive swimmers have been monitored at intervals ranging from 2-4 weeks during individual seasons for the period 1975-1986. The training cycle has always involved the indoor season which extends from September to March and the athletes who served as subjects were 200 female and 200 male competitive swimmers. The results indicate that mood state disturbances increased in a dose-response manner as the training stimulus increased and that these mood disturbances fell to baseline levels with reduction of the training load. Whilst these results have been obtained in a realistic setting devoid of experimental manipulation, it is apparent that monitoring of mood state provides a potential method of preventing staleness.
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              Blood hormones as markers of training stress and overtraining.

              An imbalance between the overall strain experienced during exercise training and the athlete's tolerance of such effort may induce overreaching or overtraining syndrome. Overtraining syndrome is characterised by diminished sport-specific physical performance, accelerated fatiguability and subjective symptoms of stress. Overtraining is feared by athletes yet there is a lack of objective parameters suitable for its diagnosis and prevention. In addition to the determination of substrates (e.g. lactate, ammonia and urea) and enzymes (e.g. creatine kinase), the possibilities for monitoring of training by measuring hormonal levels in blood are currently being investigated. Endogenous hormones are essential for physiological reactions and adaptations during physical work and influence the recovery phase after exercise by modulating anabolic and catabolic processes. Testosterone and cortisol are playing a significant role in metabolism of protein as well as carbohydrate metabolism. Both are competitive agonists at the receptor level of muscular cells. The testosterone/cortisol ratio is used as an indication of the anabolic/catabolic balance. This ratio decreases in relation to the intensity and duration of physical exercise, as well as during periods of intense training or repetitive competition, and can be reversed by regenerative measures. Correlations have been noted with the training-induced changes of strength. However, it seems more likely that the testosterone/cortisol ratio indicates the actual physiological strain in training, rather than overtraining syndrome. The sympatho-adrenergic system might be involved in the pathogenesis of overtraining. Overtraining appears as a disturbed autonomic regulation, which in its parasympathicotonic form shows a diminished maximal secretion of catecholamines, combined with an impaired full mobilisation of anaerobic lactic reserves. This is supposed to lead to decreased maximal blood lactate levels and maximal performance. Free plasma adrenaline (epinephrine) and noradrenaline (norepinephrine) may provide additional information for the monitoring of endurance training. While prolonged aerobic exercise conducted at intensities below the individual anaerobic threshold lead to a moderate rise of sympathetic activity, workloads exceeding this threshold are characterised by a disproportionate increase in the levels of catecholamines. In addition, psychological stress during competitive events is characterised by a higher catecholamines to lactate ratio in comparison with training exercise sessions. Thus, the frequency of training sessions with higher anaerobic lactic demands or of competition, should be carefully limited in order to prevent overtraining syndrome. In the state of overtraining syndrome and overreaching, respectively, an intraindividually decreased maximum rise of pituitary hormones (corticotrophin, growth hormone), cortisol and insulin has been found after a standardised exhaustive exercise test performed with an intensity of 10% above the individual anaerobic threshold.(ABSTRACT TRUNCATED AT 400 WORDS)
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                Author and article information

                Journal
                Br J Sports Med
                Br J Sports Med
                bjsports
                bjsm
                British Journal of Sports Medicine
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0306-3674
                1473-0480
                March 2016
                9 September 2015
                : 50
                : 5
                : 281-291
                Affiliations
                [1 ]Centre for Exercise and Sport Science, Deakin University, School of Exercise and Nutrition Sciences , Burwood, Victoria, Australia
                [2 ]Centre for Physical Activity and Nutrition Research, Deakin University, School of Exercise and Nutrition Sciences , Burwood, Victoria, Australia
                Author notes
                [Correspondence to ] Anna E Saw, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; anna.saw@ 123456deakin.edu.au
                Article
                bjsports-2015-094758
                10.1136/bjsports-2015-094758
                4789708
                26423706
                ec17e578-6cfb-4566-8054-f59cb5530b5e
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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                Sports medicine
                questionnaire,well-being,overtraining,fatigue,recovery
                Sports medicine
                questionnaire, well-being, overtraining, fatigue, recovery

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