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Understand the risks of overtraining syndrome

This is an excerpt from NSCA's Essentials of Tactical Strength and Conditioning 2nd Edition by NSCA -National Strength & Conditioning Association,Brent A. Alvar,Katie Sell,J. Jay Dawes.

By Joel Martin and Todd Miller

Exercise programs that incorporate high training volumes or high training intensities, especially those focused on single training modalities without variation, can increase the risk of OTS. The cumulative effect of intense physical training combined with other stressors such as inadequate nutrition, lack of sleep, and psychological stress contributes to the development of OTS. The imbalance between training load and recovery can be further exacerbated by external factors like work, personal life stress, and environmental conditions. Additionally, inadequate calorie intake relative to energy expenditure, leading to conditions such as Relative Energy Deficiency in Sport (RED-S) (49), can contribute to OTS (38).

Tactical athletes face a unique set of challenges that increase their risk of developing OTS (58). These challenges include the following:

• High physical demands. The physical requirements of tactical athletes often involve repetitive, high-intensity activities. For instance, soldiers undergoing rigorous training or extended military operations are often pushed to their physical and mental limits and have limited recovery opportunities (58).
• Occupational-related fatigue and stress. Tactical athletes often have irregular work hours, insufficient sleep, and high levels of psychological stress (21), all of which contribute to inadequate recovery periods between intense training sessions or missions.
• Environmental extremes. Exposure to extreme temperatures, high humidity, or other harsh environmental conditions can exacerbate physical and mental stress, further increasing the risk of OTS (38).

OTS is preventable, and TSAC Facilitators play a crucial role in mitigating its risk. Preventing and mitigating OTS involve the following:

• Implementing periodized training programs to balance intensity and recovery
• Monitoring training load and physiological markers regularly
• Ensuring adequate nutrition and hydration
• Educating athletes and coaches about the signs and risks of OTS

Symptoms and Outcomes of Overtraining Syndrome

The symptoms of OTS are diverse, and the physiological markers of overtraining do not always parallel a decrease in performance (47). Such markers include increased resting heart rate, decreased maximal or submaximal exercise capacity, decreased immunoglobulin A (IgA) levels, changes in mood, and decreased testosterone-to-cortisol ratio. Due to the complexity and diversity of hormonal mechanisms and complications with their analysis, at present no definitive physiological markers can define OTS (38).

The outcomes of OTS can be severe and long-lasting. Full recovery often requires a substantial period of rest, ranging from several months to years (38). During this period, tactical athletes may experience persistent performance deficits, chronic health issues related to hormonal and immune function, and psychological disturbances such as depression and anxiety. Long-term outcomes of OTS may include the following:

• Persistent exhaustion, which reduces the ability to perform at previous levels (38)
• Increased susceptibility to infections, as immune suppression weakens the body’s defenses against illnesses (34)
• Disruptions in hormonal regulation, which can adversely affect overall health and performance (38)
• Higher incidence of musculoskeletal injuries, often resulting from repetitive strain and inadequate recovery, leading to prolonged healing times or chronic conditions (43)

Suspecting and Managing Overtraining Syndrome

For TSAC Facilitators who suspect OTS in a tactical athlete, referral to a health care provider, such as an athletic trainer or physician, is recommended. Many tactical athlete organizations, such as fire departments, have a supervising physician who oversees hiring and annual health assessments. Identifying OTS is challenging due to its multifaceted nature and the lack of specific evaluative tools. Key markers include persistent performance declines despite rest, mood disturbances and psychological symptoms, and hormonal imbalances, although these are not definitive (38). Due to the variability in symptoms and individual responses, no single assessment can confirm OTS conclusively. Notably, symptoms of RED-S overlap significantly with OTS, including impaired physiological function, decreased bone density, and hormonal disturbances (49). Longitudinal monitoring of performance and physiological parameters is essential for an accurate evaluation (38). TSAC Facilitators should refer an individual for professional medical evaluation if they observe persistent performance declines, unusual fatigue, mood changes, or physiological signs like elevated resting heart rate despite adequate rest. Despite the severity of OTS, recovery is achievable with appropriate management, which includes adequate rest, nutritional support, and psychological counseling. Effective management should prioritize the following:

• Immediate reduction in training intensity or complete rest
• Comprehensive medical evaluation to rule out other conditions
• Psychological support to address mood disturbances
• Gradual reintroduction of training under careful supervision

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