Stress and Overtraining: A Cycling Case Study

FUNCTIONAL SPORTS NUTRITION - NOVEMBER/DECEMBER 2010

Lee was a 42-year old competitive cyclist who, despite having a well-designed training programme (from his club coach) and being very dedicated to his sport, had experienced deterioration in performance over the past 2 seasons. 

He had been putting the same effort into his training but gaining less of a training-effect than previous years and now found that he wasn’t as competitive as in his 30’s. He picked up frequent colds and stomach bugs, which were obviously highly disruptive. Additionally, in pursuit of a good London-Brighton race in 3 months time, he had now reached the part of the pre-season where his overall training-intensity would be raised, putting more of a strain on his body.

Cyclists are an extremely hard working group of athletes: many of the cycling fraternity follow a routine of getting up early in the morning, clocking up potentially big miles plus working a long day as well as attending to family and social life. What can then happen is that they gradually become low on sleep hours, depleted in energy at certain times of the day, perhaps deprioritise the healthy food choices due to lack of time and start to pick up more colds & infections than previous years. Athletes are then quick to blame their kids or work-mates for the infection, but it is their immune system that let the bugs in! After all, eminent scientists like Exercise Immunologist David Nieman (1) have shown that competitive athletes are more likely to become ill than lazy-Joes – in simplistic terms, it appears that the immune system of somebody who exercises moderately is the strongest, followed by the sedentary population, followed by top endurance athletes. So, what can athletes do – give up their job so that they can ride full-time? Its worth dreaming about, but the point is that precious few cyclists or other sports people have that luxury. They could bin the cycling and just head out on weekend family rides once the sun comes up, but that would be denying their passion (which is a strong driver in sport). Or, athletes could aim to create more balance in their busy life and seek physiological support from good nutritional choices.

Lee, the Cyclist, the Banker, the Husband, the Father...

Lee came to see me in April of 2008 with the goal of competing well in the 54 mile London-Brighton race in mid-June. As noted, despite training hard and following a logical training programme that had brought him results in the past, his performances were getting worse. Upon questioning him, he revealed an interesting group of signs and symptoms:

  • - he seemed depressed at times, especially around any lost training
  • - stresses in his life were plentiful:
    • - he was a Banker in the City, working 12 hour days
    • - he was married with 2 young children
    • - he had a large mortgage and his income depended on the financial markets which were problematic at that time
    • - he faced a 2hr daily commute to work in heavy traffic or crowded trains
  • - recurrent colds and stomach bugs which were more frequent when training hard
  • - digestive upsets especially when immune compromised
  • - fluctuating energy and mood
  • - deep sleep and hard to get up in the morning
  • - occasional dizzy spells when standing up too quickly
  • - the urgent need to eat frequently

Lee trained for 2 hours before work 3 days/wk (on the road at 5am); used his turbo trainer for a 1 hour interval session 1 day/wk; cycled with his club 3 hours on a Saturday and 4 hours on a Sunday. In terms of diet, he ate little and often in a very snacky pattern. With dietary analysis, I determined that Lee consumed about 2500 Cals/day (21% of energy from protein: 44% from carbs: 35% from fat), whereas I estimated that he would need an average of 3500-4000 Cals/day to meet his training demands. This may seem like a strange observation in the world of ‘we are fat because we eat too much’, but I frequently find that endurance athletes eat less than they need.

Assessments of Lee

Okay, so what was my prognosis? You have probably guessed most of his imbalances by now, but many athletes just need somebody to tell them! It’s like having a coach – you might have the knowledge in your own head, but you can be too emotionally connected to your own body, whereas an external observer can provide a more rational insight to your health and training. I thought that Lee had an unsustainable lifestyle – he trained too much based on working long hours as a banker plus supporting a family. He didn’t eat enough food and he didn’t eat the best foods – he was trying to put basic supermarket-brand oil in his Porsche body. In my mind, he was over-trained to some degree. Overtraining is most frequently defined as a loss of performance despite the maintenance or increase of training load. It has been reported to be more common for athletes engaged in heavy training for individual sports compared to team or less physically demanding sports. (2) Over-trained athletes appear to be more susceptible to illness, depression, headaches, muscle tenderness, tightness and injury. (2) Overtraining can be affected by the sum of stresses in your life, not just the overall mileage that you’re doing – this is a common mistake of many athletes.

To assess the condition of Lee’s stressed adrenal glands, I measured the levels of two stress hormones (cortisol & DHEA, the precursor of sex hormones). This is a saliva-test called the Adrenal Stress Index, which is available to physicians and Nutritional Therapists (3) in the UK. (4) It assesses cortisol at 4 times during the day, which provides a picture of the person’s circadian rhythms. There are many ways of assessing overtraining and beyond daily heart-rate and body-weight checks, this is the most representative test that I’ve experienced. It is appropriate for athletes and also for assessing adrenal fatigue (or burn-out) in general population. If cortisol and DHEA are both high, it generally indicates the early stages of overtraining – training will be good, but recovery delayed, sleep might be disrupted and the person possibly anxious. If one or both stress hormones are low, the athlete is going towards chronic overtraining, when performance is likely to suffer, anxiety may turn to depression and disrupted sleep may turn to heavy sleep. 

Returning to Lee, if you take a look at test results, cortisol levels were low for samples 1, 2 and 3 and only just in the range for sample 4. Total daily output of cortisol was massively below reference range. DHEA was also very low for both samples. It was one of the worst test results that I’d ever seen, so it was amazing that he was still moving! I also measured his immunoglobulin sIgA levels, which is an indication of general immunity. This was a low 56 μg/ml with a reference range of 102 - 471. It could certainly go some way towards explaining his frequent infections, especially during the stress of heavy training. These were the suggestions that I made to Lee:

Training

I discussed the results with his coach and we agreed that he should delay his first important race by one month and cut 1-2 sessions per week from his schedule – instead, lying longer in bed. We would also monitor the effect with a training diary – this would record how he feels each training session and to write a score for the questions displayed here. If he was hitting scores of over 20, it would generally indicate that recovery was good; but if below 20, tapering back on the training should be considered.

Training Wellbeing Quiz (5)

1) I slept really well last night

2) I am looking forward to today's workout

3) I am optimistic about my future performance(s)

4) I feel vigorous and energetic

5) My appetite is great

6) I have very little muscle soreness.

Each statement is rated on a 1-5 scale as follows:

1 = Strongly Disagree; 2 = Disagree; 3 = Neutral; 4 = Agree; 5 = Strongly Agree.

Nutrition

I increased his daily calorie intake to over 3000 to try and match his current requirements. This involved increasing protein, fat and carbohydrate intake, along with a substantial boost in vegetable and fruit consumption. His wife was happy to help him to prepare a lunch and snacks to take to the office with him – he was to aim to eat every 2-3 hours with good protein-carb balance to support blood sugar levels. Protein intake and blood sugar control are vitally important for adrenal support.

I also reviewed his sports drinks taken and ensured that each training session was preceded by a light snack and accompanied by a quality sports drink or diluted fruit juice. His post-exercise snack was whey protein powder and some fruit juice to support repair of broken down muscle fibres and to replenish depleted carbohydrate stores.

For supplements, I recommended a multi-nutrient high in chromium and B-vitamins for blood sugar control, extra Vitamin C and magnesium for adrenal health. He also took some amino acid (protein building blocks) powders for adrenal support (l-tyrosine) and immune function (l-glutamine), along with a probiotic for digestive and immune health. 

Lifestyle suggestions:

  • - Delegate and let other people help him out
  • - Take the train to work – less stressful than driving in London!
  • - Establish a planned, monotonous routine at least for a while
  • - Do some walking meditation each time he walks to a meeting – focusing on breathing is very replenishing to the body

The Outcome ….

Lee took the advice seriously like he normally did for training and after a couple of months of the lessened work-load, his training actually started to become stronger. He had a mediocre performance in his July race, but by the end of August, he was starting to sit on the heels of riders that had easily beaten him the previous year. One year forward and a lot of health-based work later and his 2009 season was actually his best since his mid 30’s. He was becoming a lot more aware of his own body and when he should ease off training, take a lie-in and refocus on healthy nutrition.

This Case Study has been a quick view of a common over-training example. More extensive papers have already been published on the subject: 6, 7.

References 

  1. Nieman (1994). Exercise, infection and immunity. Int J Sports Med. 15: S131-S141.
  2. Kuipers (2000). Overtraining: Nutritional Intervention. Chapter 37. Nutrition in Sport. The Encyclopaedia of Sports Medicine (IOC Publication). Blackwell Science
  3. British Association for Applied Nutrition and Nutritional Therapy (BANT). Welcome to the Professional Body for Practitioners of 21st Century Nutrition. www.bant.org.uk (accessed Oct 2010).
  4. Genova Diagnostics Europe. www.gdx.uk.net (accessed Oct 2010).
  5. Anderson (2007). Swimming, Overtraining, Recovery and Norepinephrine. Body Building.Com http://www.bodybuilding.com/fun/peak34.htm (accessed Oct 2010).
  6. Craig I, Overtraining as a model of overtraining. Nutrition Practitioner, 2007, 8(2): Autumn, 1-10.
  7. Lovell M, Adrenal Fatigue & Overtraining in the Athlete: a Nutritional Perspective on Pathology and Treatment of Overtraining Syndrome: an “exhaustive” review. Nutrition Practitioner, 2010, 11(1): Spring, 1-10.