Dr.  Who's  Advices:

- What Every Athlete Should Know -

One common problem when prescribing resistance exercise is determining the appropriate combination of training volume and intensity. Excessive volume or intensity may produce less than optimal results, and may actually create a situation where performance is impaired. If physical performance is depressed for extended periods of time, and requires long recovery periods, overtraining has occurred. This situation may result in a decreased desire to exercise, and can also increase the risk of illness or injury. Such a situation can be avoided through proper prescription of volume and intensity. It must be noted that increasing training volume or intensity is not necessarily bad. There may even be phases of training where an individual experiences short-term performance decrements that are easily recovered from with several days of decreased exercise stress. This is called overreaching, and when carefully prescribed can contribute to long-term progress.

 The typical overtraining scenario, however, occurs when either training volume or intensity is excessive for too long. It is also important to note that training volume and intensity are inversely related. In other words, when training volume is greatest, intensity must be relatively low, and vice versa. Unfortunately, many individuals prescribing resistance exercise programs fail to realize this, and simply follow the axiom that "more is better" for both volume and intensity. The net result is that performance is either impaired or at best is less than optimal.

One type of overtraining can occur when training volume is excessive for prolonged periods. This can occur by increasing training frequency, adding exercises, or performing more exercise sets. It appears that this type of overtraining manifests many signs/symptoms similar to those seen with overtraining with endurance exercise. Two hormones often impacted by overtraining are testosterone and cortisol, and overtraining due to high training volumes often results in a decrease in the ratio between resting concentrations of these hormones (testosterone/cortisol). While this ratio may not be directly responsible for the performance decrements observed, it has been repeatedly shown that this ratio decreases as training volume increases. It also appears that the use and mobilization of free fatty acid, which expends more fat by using energy in the metabolic cycle, increases during high volume phases of resistance exercise. This may contribute in part to decreases in body fat with this type of training stress. Although it has been theorized that the sympathetic nervous system may become exhausted with this type of training (the parasympathetic overtraining syndrome), this has yet to be demonstrated with resistance exercise.

At the other end of the training spectrum is the effect of excessive training intensity; that is, using too heavy a resistance for extended periods of time. This scenario seems to present a physiologically different profile than high volume overtraining. The limited data available indicate that the testosterone/cortisol ratio is not altered with this type of overtraining, even when strength performance is dramatically impaired. Exercise-induced concentrations of catecholamines, on the other hand, are markedly elevated with this type of overtraining. This suggests a sympathetic overtraining syndrome where increases in sympathetic activity in the nervous system may be an attempt to compensate for decreases in muscle strength capabilities.

It is believed that most real-life overtraining scenarios are due to a combination of excessive volume and intensity. Furthermore, many exercise programs include not only resistance exercise, but also some form of exercise for cardiovascular fitness. Such a combination presents a very complex setting from a physiological standpoint. The few data available on this type of training suggest that both the resistance exercise and the cardiovascular exercise components may have to be modified somewhat to allow the individual to tolerate such combination training.

 Performance decrements may also occur through pathological mechanisms such as joint overuse. When this occurs, strength and power decrements may be due to afferent inhibition from the affected joints rather than due to decreases in muscular capabilities. Perhaps the most intriguing area of research is the evaluation of psychological states accompanying overtraining. Although most data on the psychology of overtraining are from other types of exercise, it appears that a decreased desire to train often occurs with resistance exercise overtraining. Furthermore, measures of self-efficacy (confidence in performance) appear to be adversely affected with some forms of resistance exercise overtraining.

Numerous signs and symptoms of overtraining have been suggested. It should be noted that not all of these symptoms will be present, and that the presence of some of these symptoms does not automatically mean an individual is overtrained. The ultimate determination of overtraining is whether performance is impaired or plateaued. Listed below are some frequently cited signs of overtraining:

Performance-

• Decreased performance (strength, power, muscle endurance, cardiovascular endurance)

• Decreased training tolerance and increased recovery require ments

• Decreased motor coordination

• Increased technical faults

• Physiology-

• Altered resting heart rate (HR), blood pressure and respiration patterns

• Decreased body fat and post-exercise body weight

• Increased VO2, VE , and HR during submaximal work

• Decreased lactate response

• Increased basal metabolic rate

• Chronic fatigue

• Sleep and eating disorders

• Menstrual disruptions

• Headaches, gastrointestinal distress

• Muscle soreness and damage

• Joint aches and pains

Physiological-

• Depression and apathy

• Decreased self-esteem

• Decreased ability to concentrate

• Decreased self-efficacy

• Sensitive to stress

Immunological-

• Increased occurrence of illness

• Decreased rate of healing

• Impaired immune function (neutrophils, lymphocytes, mitogen responses, eosinophils)

Biochemical-

• Hypothalamic dysfunction

• Increased serum cortisol and SHBG

• Decreased serum total and free testosterone, testosterone/cortisol ratio

• Decreased muscle glycogen

• Decreased serum hemoglobin, iron, and ferritin

• Negative N2 balance

The majority of these signs and symptoms are derived from endurance exercise overtraining research. Not all of these signs and symptoms have been linked with resistance exercise overtraining, due partly to a lack of relevant research on the topic, and to the fact that resistance exercise presents different physiological stress compared to endurance exercise.

If overtraining from resistance exercise has occurred, several simple steps can be taken, including:

• One or more recovery days should be added to each training week.

• Periodized training programs can provide the necessary training variety to avoid overtraining.

• Avoid monotonous training.

• Check that training volume and training intensity are inversely related.

• Avoid too great a relative intensity (percent 1RM) for extended periods.

• Avoid too great a training volume (number of sessions, exercises, sets and reps) for extended periods.

• Avoid performing every set of every exercise of every session to absolute failure, with no variation.

• Avoid incorrect exercise selection (overuse of certain muscles or joints).

• Avoid excessive use of eccentric muscle actions.

• Take into account the cumulative training stresses from other forms of exercise (i.e., cardiovascular training, sport-specific training, etc.)

Overtraining is of growing concern. More research is necessary for full understanding. It is clear that the exercise prescription is critically important to avoid a problem. Periodized training allows variation and is important for best results. Periodization includes phases of high training stress and planned periods for recovery and restoration. This applies to elite athletes well as to individuals exercising for general health and fitness.

Written for the American College of Sports Medicine by Andrew C. Fry, Ph.D..

Reprinted with permission of the American College of Sports Medicine

SUMMARY

Despite repeated warning by the medical community, weight cutting (rapid weight reduction) remains popular among amateur wrestlers. Weight cutting has significant adverse consequences that may affect competitive performance, health, and normal growth and development. To enhance the educational experience and reduce the health risks for the participants, the American College of Sports Medicine (ACSM) recommends the education of coaches and wrestlers toward sound nutrition and weight control behaviors to curtail weight cutting and the enactment of rules that limit weight loss.

INTRODUCTION

For more than a half century, rapid weight loss in wrestling has remained a concern among educators, health professionals, exercise scientists and parents. Since ACSM first published the Position Stand "Weight Loss in Wrestlers" in 1976, numerous research articles have been published on this topic. On a weekly basis, rapid weight loss in high school and collegiate wrestlers has been shown to average 4-5 lbs. and may exceed 6-7 lbs. among 20% of the wrestlers. One-third of high school and collegiate wrestlers have been reported repeating this practice more than 10 times in a season. These practices have been documented over the past 25 years, and during that time, there appears to be little change in their prevalence.

Wrestlers often justify their choice of weight class with the belief that they have excess fat to lose. However, studies show that in the off-season, high school wrestlers have 8-11 percent body fat, well below their high school peers who average 15 percent. In season, wrestlers typically have 6-7 percent body fat. Consequently, loss of fat would contribute minimally to the rapid weekly weight reduction while the primary methods for weight loss (e.g., exercise, food restriction, fasting, and various dehydration methods) affect body water, energy stores, and lean tissue. These weight loss techniques are used by one-quarter to two-thirds of wrestlers.

Most wrestlers practice these weight-loss techniques believing their chances of competitive success will increase. Ironically, weight cutting may impair performance and endanger the wrestler's health. The combination of food restriction and fluid deprivation creates an adverse physiological effect on the body, leaving the wrestler ill-prepared to compete. In addition, forms of dehydration, such as sweating and catharsis (laxatives and forced vomiting), contribute to the loss of electrolytes as well as water. Wrestlers hope to replenish body fluids, electrolytes, and glycogen in the brief period between the weigh-in and competition. Reestablishing bodily fluids, however, may take 24-48 hours; replenishing muscle glycogen may take 72 hours, and replacing lean tissue might take even longer. In short, weight cutting appears to influence the wrestler's energy reserves, fluid levels, and electrolyte balances.

CONCLUSIONS AND RECOMMENDATIONS:

Because of the questionable benefits and the potential health risks caused by the procedures used for weight cutting by wrestlers (particularly adolescents), ACSM makes the following recommendations:

1)    Educate coaches and wrestlers about the adverse consequences of prolonged fasting and dehydration on physical performance and physical health.

2)    Discourage the use of rubber suits, steam rooms, hot boxes, saunas, laxatives and diuretics for weight cutting.

3)    Adopt new state or national governing-body legislation that schedules weigh-ins immediately prior to competition.

4)    Schedule daily weigh-ins before and after practice to monitor weight loss and dehydration. Weight loss during practice should be regained through adequate food and fluid intake.

5)    Assess the body composition of each wrestler prior to the season using valid methods for this population. Males 16 years old and younger with body fat below 7 percent or those over 16 with a body fat below 5 percent need medical clearance before being allowed to compete. Female wrestlers need minimal body fat of 12-14 percent.

6)    Emphasize the need for daily caloric intake obtained from a balanced diet high in carbohydrates (>55% of calories), low in fat (<30% of calories) and adequate protein (15-20% of calories, 1.0- 1.5 g/kg body weight) determined on the basis of RDA guidelines and physical activity levels. The minimal caloric intake for wrestlers of high school and college age range from 1,700 to 2,500 kcal/day. Rigorous training may increase the requirement by an additional 1,000 calories per day. Wrestlers should be discouraged by coaches, parents, school officials, and physicians from consuming less than their minimal daily needs. Combined with exercise, this minimal caloric intake will allow for gradual weight loss. Once the minimal weight has been attained, caloric intake should be increased to support the normal development needs and training of the young wrestler.

The American College of Sports Medicine Encourages:

• Permitting more participants per team to compete by adding weight classes between 119 and 151 lbs. or by allowing more than one representative at a given weight class just as in swimming and track meets.

• Standardizing the eligibility rules for championship tournaments so that severe, rapid weight loss is discouraged at the end of the season (e.g., a wrestler dropping an extra weight class).

• Cooperative efforts between coaches, exercise scientists, physicians, dietitians and wrestlers to use research and education to determine the best medically sound system for selecting a weight class.

Through this Current Comment, ACSM hopes to further the sport of wrestling by providing a positive educational environment for the primary, secondary, or collegiate wrestler. ACSM believes these recommendations will enable the athlete to better focus on skill acquisition, fitness enhancement, psychological preparation, and the social interactions offered by the sport.

Prepared for the American College of Sports Medicine by H. Samuel Case, Ph.D.; Craig A. Horswill, Ph.D.; Gregory L. Landry, M.D.; Robert A. Oppliger, Ph.D. (Chair); and, Ann C. Shetler, M.S., R.D.

Reprinted with permission of the American College of Sports Medicine

The underlying factors governing the initiation of EIB are not clearly understood. Changes in airway temperature (cooling and rewarming), alterations in mucosal osmolarity (airway drying), and congestion of the bronchial arteries, resulting in bronchial mucosal vascular engorgement, have all been suggested as causes. At present, it seems that the bronchial blood flow/ bronchial heat exchange relationship influences the development of airway narrowing following exercise-related overbreathing. EIB typically occurs after ventilation with large quantities of air, especially cold, dry air that contains environmental pollutants and/or allergens. The frequency and severity of the reaction reflects the underlying allergic predisposition of the individual, the degree of overbreathing, coldness and/or dryness of inspired air, the burden of environmental agents inhaled, and the intensity of exercise. As a result, seasonal fluctuations in the bronchospastic response have been identified. After the occurrence of an EIB episode, approximately 50 percent of patients experience a relative refractory period lasting for up to two hours wherein another exercise challenge will fail to produce EIB or will produce a lesser reaction. Late asthmatic responses occurring six to eight hours after the initial bronchospasm also occur in about 50 percent of the EIB population, but are typically mild.

The method used to detect the EIB response critically affects the estimates of prevalence. Although the convenient peak flow meter is adequate for use with highly reactive and symptomatic individuals, it is relatively insensitive in mildly affected persons or elite athletes in whom small reductions in bronchial airflow may lead to a significant decrease in performance. In addition, peak flow measurements are critically effort-dependent, so this diagnostic technique may not be absolutely reliable. Spirometric measurements and maximal mid-expiratory flow rates are acceptably accurate and reproducible, as effort variation is detectable from the configuration of the tracings.

The intensity of the exercise challenge used to induce the EIB response is another important variable. Standard clinical protocols to provoke EIB apply exercise bouts of five to eight minutes at a level just below the lactate threshold (LT), 70-85 percent of maximal heart rate reserve. This work rate has been selected because the subject may not complete the exercise challenge at a higherintensity, and a more severe test promotes catecholamine release producing bronchodilation. A major problem with this standard protocol is identifying the LT for an individual, given the wide range of fitness levels in the general population. With elite athletes, sub-LT exercise is typically not sufficient to produce EIB. Additionally, laboratory-based exercise challenges are rarely performed in the environmental circumstances (e.g. cold, dry air) that produced the symptoms suggesting EIB.

As a result, the prevalence of EIB is reported to be ten to 50 percent, depending upon the study population, exercise protocol, detection measurement and environmental conditions. For the general population, an incidence of ten to 15 percent is a reasonable figure. Most moderately to severely allergic subjects will demonstrate some level of EIB. Recent studies show the frequency to be 20 to 75 percent (depending upon the sport) among elite cold weather athletes. The majority (73 percent) of the athletes who met diagnostic criteria during "field evaluations" did not meet the criteria when retested using the standard laboratory protocol.

Medications to modify or prevent the EIB response include bronchodilators, anti-inflammatory compounds such as inhaled cromolyn, nedocromil, and corticosteroids, and a variety of medications including antihistamines, calcium channel blockers, and inhaled heparin. More recently, immune system modifiers are available, including leukotriene or neurokinin receptor inhibitors and lipoxygenase inhibitors.

An important question to study in view of the wide use of pharmacological prophylaxis by elite winter sports athletes is whether or not bronchospasm is a natural phenomenon that serves as a physiological mechanism to protect the lower airways from the noxious insult of exposure to large volumes of cold dry air. Similar airway-narrowing is a common response to inhalation of such irritant gases as sulfur dioxide (SO2) and nitrogen dioxide (NO2), both of which can occur in high concentrations in ice rinks.

For most asthmatic patients, and the majority of people who do not suffer clinical asthma but exhibit EIB, individualized prophylactic treatment is safe and effective, allowing full participation in sports activities. In addition, proper timing of preparticipation warm-up exercise enables some athletes to utilize the refractory period to attenuate the bronchospastic response during exercise and achieve optimal performance.

 Written for the American College of Sports Medicine by Lester B. Mayers, M.D., FACSM, and Kenneth W. Rundell, Ph.D., FACSM

Reprinted with permission of the American College of Sports Medicine