Hormonal responses in athletes: the use of a two bout exercise protocol to detect subtle differences in (over)training status Evidence of disturbed sleep and increased illness in overreached endurance athletes. Can we detect non-functional overreaching in young elite soccer players and middle-long distance runners using field performance tests? Physiological, biochemical and psychological markers of strenuous training-induced fatigue. Impaired pituitary hormonal response to exhaustive exercise in overtrained endurance athletes. Evidence of parasympathetic hyperactivity in functionally overreached athletes. Monitoring changes in performance, physiology, biochemistry, and psychology during overreaching and recovery in triathletes. Monitoring for overreaching in rugby league players Mental Fatigue and Physical and Cognitive Performance During a 2-Bout Exercise Test. The effect of brief exercise cessation on pain, fatigue, and mood symptom development in healthy, fit individuals. The effect of physical training on hormonal status and exertional hormonal response in patients with chronic congestive heart failure. Decreased nocturnal catecholamine excretion: parameter for an overtraining syndrome in athletes? Amino-Terminal Fragment of Pro-Brain Natriuretic Hormone Identifies Functional Impairment and Right Ventricular Overload in Operated Tetralogy of Fallot Patients Monitoring performance, pituitary–adrenal hormones and mood profiles: how to diagnose non-functional over-reaching in male elite junior soccer players Mental fatigue induced by prolonged self-regulation does not exacerbate central fatigue during subsequent whole-body endurance exercise Association of the Functional Movement Screen with injuries in division I athletes. Exercise training effect on obstructive sleep apnea syndrome.
In overtrained athletes , several signs and symptoms have been associated with the imbalance between training and recovery . However , reliable diagnostic markers for distinguishing between well-trained , overreached ( OR ) and overtrained ( OT ) athletes are lacking . A hallmark feature of overtraining syndrome ( OTS ) is the inability to sustain intense exercise and recover for the next training or competition session . We therefore devised a test protocol utilizing two bouts of maximal work . With this test protocol we tried to establish a difference in hormonal responses between the training status of T and OR athletes . Seven well-trained cyclists participated in this study and were tested before and after a training camp . We also present the data of one OT motocross athlete who was clinical ly diagnosed as overtrained . All athletes performed two maximal exercise tests separated by 4 h. Blood was analyzed for cortisol , adrenocorticotrophic hormone ( ACTH ) , growth hormone and prolactin ( PRL ) . Performance decreased by 6 % between the first and the second exercise test in the OR group and by 11 % in the OT subject . Moreover , during the second exercise test there were more marked differences between the T and OR athletes ; in particular , the OT subject did not show an increase in some of the hormonal responses . PRL increased only by 14 % in the OT subject ’s second test and there was a 7 % decrease in ACTH . The two exercise approach enables us to detect subtle performance decrements that will not be identified by one exercise trigger . The hormonal responses to the second exercise test were different between the T and OR athletes ( the increase in the T group was higher than in the OR that was higher than in the OT ) . The results of the case presentation of an overtrained athlete provide evidence of an altered and dysfunctional hypothalamic – pituitary axis response to two bouts of maximal exercise . These findings can be used to develop markers for diagnosis of OTS and to begin to address the pathologic mechanism operative in the syndrome , as well as providing an outcome measure to evaluate possible therapeutic regimes PURPOSE This study aim ed to examine whether ( i ) objective markers of sleep quantity and quality are altered in endurance athletes experiencing overreaching in response to an overload training program and ( ii ) potential reduced sleep quality would be accompanied with a higher prevalence of upper respiratory tract infections in this population . METHODS Twenty-seven trained male triathletes were r and omly assigned to either overload ( n = 18 ) or normal ( CTL , n = 9 ) training groups . Respective training programs included a 1-wk moderate training phase followed by a 3-wk period of overload or normal training , respectively , and then a subsequent 2-wk taper .  Maximal aerobic power and oxygen uptake ( VO2max ) from incremental cycle ergometry were measured after each phase , whereas mood states and incidences of illness were determined from question naires . Sleep was monitored every night of the 6 wk using wristwatch actigraphy . RESULTS Of the 18 overload training group subjects , 9 were diagnosed as functionally overreached ( F-OR ) after the overload period , as based on declines in performance and VO2max with concomitant high perceived fatigue ( P < 0.05 ) , whereas the other 9 overload subjects showed no decline in performance ( AF , P > 0.05 ) . There was a significant time-group interaction for sleep duration ( SD ) , sleep efficiency ( SE ) , and immobile time ( IT ) . Only the F-OR group demonstrated a decrease in these three parameters ( -7.9 % ± 6.7 % , -1.6 % ± 0.7 % , and -7.6 % ± 6.6 % for SD , SE , and IT , respectively , P < 0.05 ) , which was reversed during the subsequent taper phase . Higher prevalence of upper respiratory tract infections were also reported in F-OR ( 67 % , 22 % , and 11 % incidence rate for F-OR , AF , and CTL , respectively ) . CONCLUSION This study confirms sleep disturbances and increased illness in endurance athletes who present with symptoms of F-OR during periods of high volume training Objective To study whether field performance tests can make a valid distinction between non-functionally overreaching ( NFO ) athletes and control athletes . Design Monthly field performance tests were used to determine a performance decrement ( PD ) throughout a season . Athletes with a minimum of 1 month PD were compared with control athletes without a PD on mood characteristics and resting levels of stress hormones . Setting Sporting field and sports medical laboratory . Participants 129 young elite athletes , 77 soccer players and 52 middle-long distance runners were followed prospect ively during the 2006–2007 season . Fifteen of them were invited to the laboratory . Eight athletes showed a performance decrease lasting longer than 1 month , and seven athletes without a performance decrease acted as their controls . Main outcome measures Performance changes over time were measured using field tests .  Profile of Mood States and resting levels of adrenocorticotrophic hormone ( ACTH ) and cortisol in blood were measured in the laboratory . Results PD athletes showed several symptoms typical of the non-functional state of overreaching ( OR ) . The PD group scored higher on depression and anger than controls . They also showed a specific pattern of correlations between negative mood subscales ( tension , fatigue and depression ) , which was absent in controls . ACTH levels at rest were similar , but lower cortisol levels in PD athletes pointed at a blunted cortisol response . Cortisol levels were decoupled from ACTH levels only in PD athletes . Conclusions Implementing performance-related criteria in field tests can help coaches and sports physicians to distinguish NFO athletes from athletes with balanced workload and recovery The purpose of the study was to investigate whether severe fatigue , possibly leading to overreaching , could be diagnosed at an early stage by a combination of parameters . Seven well-trained male subjects ( age [ mean + /- SD ] : 25.3 + /- 4.7 yr ; body mass : 76 + /- 6.6 kg ; VO2max : 61.1 + /- 7 ml.kg(-1).min(-1 ) ) increased their training load by doubling their training volume and increasing the intensity by 15 % over a period of two weeks . Before and after this intensified training period subjects underwent a series of tests including a maximal incremental cycle ergometer test ( Wmax ) with continuous ventilatory measurements and blood lactate values , time trial , basal blood parameter tests ( red and white blood profile ) , hormones [ growth hormone ( GH ) , insulin-like growth factor 1(IGF-1 ) , adreno-corticotropic hormone ( ACTH ) , cortisol ] , neuro-endocrine stress test [ short insulin tolerance test ( SITT ) , combined anterior pituitary test ( CAPT ) and exercise ] , a shortened Profile of Mood State ( POMS ) , the estimated rate of perceived exertion ( RPE ) and a cognitive reaction time test . The intensified training period result ed in a significant increase of the training load ( p < 0.01 ) , training monotony ( p < 0.01 ) and training strain ( p < 0.01 ) . The RPE during training increased significantly ( p < 0.01 ) during the intensified training period . Total mood score obtained from the POMS tended to increase ( p=0.06 ) , reflecting an increase in worse mood state . A novel finding was that reaction times increased significantly , indicating that overreaching might adversely affect speed of information processing by the brain , especially for the most difficult conditions . After the intensified training period , neither changes in exercise-induced plasma hormone values , nor SITT values were observed . During the CAPT only cortisol showed a significant decrease after the intensified training period . Hemoglobin showed a significant decrease after the intensified training period whereas hematocrit , red blood cell count ( RBC ) and MCV tended to decrease . The intensified training had no effect on physical performance ( Wmax or time trial ) , maximal blood lactate , maximal heart rate and white blood cell profile . The most sensitive parameters for detecting overreaching are reaction time performance ( indicative for cognitive brain functioning ) , RPE and to a lesser extend the shortened POMS . This strongly suggests , that central fatigue precedes peripheral fatigue . All other systems , including the neuro-endocrine , are more robust and react most likely at a later stage in exhaustive training periods The aim of the present prospect i ve longitudinal study was to investigate the hormonal response in overtrained athletes at rest and during exercise consisting of a short-term exhaustive endurance test on a cycle ergometer at an intensity 10 % above the individual anaerobic threshold . Over a period of 19+/-1 months , 17 male endurance athletes ( cyclists and triathletes ; age 23.4+/-1.6 yr ; VO2max . 61.2+/-1.8 mL x min(-1 ) x kg(-1 ) ; means+/-SEM ) were examined five times on two separate days under st and ardized conditions . Short-term overtraining states ( OT , N=15 ) were primarily induced by an increase of frequency of high-intensive bouts of exercise or competitions without increase of the total amount of training . OT was compared with normal training states intraindividually ( NS , N=62 ) . During OT , the time to exhaustion of the exercise test was significantly decreased by 27 % on average . At rest and during exercise , the concentrations in plasma and the nocturnal excretion in urine of free epinephrine and norepinephrine were not significantly changed during OT . At physical rest , the concentrations of ( free ) testosterone , cortisol , luteinizing hormone , follicle-stimulating hormone , adrenocorticotropic hormone , growth hormone , and insulin during OT were comparable with those during NS . A significantly ( P < 0.025 ) lower maximal exercise-induced increase of the adrenocorticotropic hormone and growth hormone , as well as a trend for a decrease of cortisol ( P=0.060 ) and insulin ( P=0.036 ) , was measured . The response of free catecholamines as well as the ergometric performance of an all-out 30-s test was unchanged . Serum urea , uric acid , ferritin , and activity of creatine kinase showed no differences between conditions . In conclusion , the results confirm the hypothesis of a hypothalamo-pituitary dysregulation during OT expressed by an impaired response of pituitary hormones to exhaustive short-endurance exercise PURPOSE We analyzed HR variability ( HRV ) to detect alterations in autonomic function that may be associated with functional overreaching ( F-OR ) in endurance athletes . METHODS Twenty-one trained male triathletes were r and omly assigned to either intensified training ( n = 13 ) or normal training ( n = 8) groups during 5 wk . HRV measures were taken daily during a 1-wk moderate training ( baseline ) , a 3-wk overload training , and a 1-wk taper . RESULTS All the subjects of the intensified training group demonstrated a decrease in maximal incremental running test performance at the end of the overload period ( -9.0 % ± 2.1 % of baseline value ) followed by a performance supercompensation after the taper and were therefore diagnosed as F-OR . According to a qualitative statistical analysis method , a likely to very likely negative effect of F-OR on HR was observed at rest in supine and st and ing positions , using isolated seventh-day values and weekly average values , respectively . When considering the values obtained once per week , no clear effect of F-OR on HRV parameters was found . In contrast , the weekly mean of each HRV parameter showed a larger change in indices of parasympathetic tone in the F-OR group than the control group in supine position ( with a 96%/4%/0 % chance to demonstrate a positive/trivial/negative effect on Ln RMSSD after the overload period ; 77%/22%/1 % on LnHF ) and st and ing position [ 98%/1%/1 % on Ln RMSSD ; 99%/0%/1 % on LnHF ; 95%/1%/4 % on Ln(LF + HF ) ] . During the taper , theses responses were reversed . CONCLUSIONS Using daily HRV recordings averaged over each week , this study detected a progressive increase in the parasympathetic modulation of HR in endurance athletes led to F-OR . It also revealed that due to a wide day-to-day variability , isolated , once per week HRV recordings may not detect training-induced autonomic modulations in F-OR athletes The present investigation compared responses in previously identified physiological , biochemical , and psychological markers of overreaching in triathletes . Sixteen experienced male triathletes ( .VO(2max ) [ mean + /- SD ] = 55.7 + /- 4.9 mL . kg ( -1 ) . min ( -1 ) , age = 31.3 + /- 11.7 yr ) were divided into matched groups according to physical and performance characteristics , and were r and omly assigned to either intensified training ( IT ) or normal training ( NT ) groups . Physiological , biochemical , and psychological measures were taken at baseline , following four weeks of overload training and following a two-week taper . The IT group completed 290 % greater physical training load than the NT group during the overload period . The subjects completed a 3-km run time trial ( 3-km RTT ) each week in order to assess the time course of change in endurance performance . 3-km RTT performance was significantly reduced ( 3.7 + /- 7.5 % ; p < 0.05 ) following four weeks of overload training in the IT group confirming a state of overreaching . During the same period , 3-km RTT performance significantly improved in the NT group ( 3.0 + /- 1.1 % ; p < 0.05 ) . Following the two-week taper , 3-km RTT performance significantly improved in the IT group ( 7.0 + /- 5.6 % ; p < 0.05 ) . Hemoglobin concentration significantly decreased and urea increased in both groups during the overload period ( p < 0.05 ) . During the taper hemoglobin normalized with a greater increase in the IT group compared to the NT group ( p < 0.05 ) . A significant increase in free testosterone to cortisol ratio was also observed in the IT group compared to the NT group during the taper ( p < 0.05 ) . No significant changes were observed for any other biochemical variables during the period of investigation . The RESTQ-76 Sport question naire showed an impaired recovery-stress state with increased training load , which improved following the taper in the IT group ( p < 0.05 ) . These present results suggest that none of the physiological and biochemical variables measured in this study were effective for the early identification of overreaching in experienced triathletes . However , the RESTQ-76 Sport question naire may provide a practical tool for recognizing overreaching in its early stages . These findings have implication s for monitoring training status in athletes in a practical training setting The aim of this study was to identify indicators of non-functional overreaching ( NFOR ) in team sport athletes undertaking intensive training loads . Eighteen semi-professional rugby league players were r and omly assigned into two pair matched groups . One group completed 6 weeks of normal training ( NT ) whilst the other group was deliberately overreached through intensified training ( IT ) . Both groups then completed the same 7-day stepwise training load reduction taper . Multistage fitness test ( MSFT ) performance , $ $ \ifmmode\exp and after\dot\else\exp and after\.\fi{V}{\text{O}}_{{2\max } } $ $ , peak aerobic running velocity ( Vmax ) , maximal heart rate , vertical jump , 10-s cycle sprint performance and body mass were measured pre- and post-training period and following the taper . Hormonal , haematological and immunological parameters were also measured pre-training and following weeks 2 , 4 and 6 of training and post-taper . MANOVA for repeated measures with contrast analysis indicated that MSFT performance and $ $ \ifmmode\exp and after\dot\else\exp and after\.\fi{V}{\text{O}}_{{2\max } } $ $ were significantly reduced in the IT group over time and condition , indicating that a state of overreaching was attained . However , the only biochemical measure that was significantly different between the IT and NT group was the glutamine to glutamate ( Gln/Glu ) ratio even though testosterone , testosterone to cortisol ( T/C ) ratio , plasma glutamate , and CK activity were significantly changed after training in both groups . Positive endurance and power performance changes were observed post-taper in the IT group confirming NFOR . These changes were associated with increases in the T/C ratio and the Gln/Glu ratio and decreases in plasma glutamate and CK activity . These results indicate that although there was no single reliable biochemical marker of NFOR in these athletes , the Gln/Glu ratio and MSFT test may be useful measures for monitoring responses to IT in team sport athletes PURPOSE The 2-bout exercise protocol has been developed to diagnose nonfunctional overreaching and the " overtraining syndrome . " It consists of 2 maximal exercise bouts separated by 4 hours . Mental fatigue negatively influences performance , but the effects of its occurrence during the 2-bout exercise protocol have never been investigated . The aim of this study was to examine whether mental fatigue ( induced during the rest period ) influences physical and cognitive performance during/after the second exercise bout of the 2-bout exercise protocol . METHODS Nine healthy , well-trained male cyclists participated in a single-blind , r and omized , placebo-controlled crossover study . The intervention consisted of either 1.5-hour rest ( control ) or performing a computer-based Stroop task to induce mental fatigue . Cognitive ( Eriksen Flanker task ) , physiological ( lactate , maximum heart rate , and maximum wattage ) , and subjective data ( mental fatigue-visual analog scale , Profile of Mood States , and rating of perceived exertion ) were gathered . RESULTS Ratings of fatigue , tension , and mental fatigue were affected in the mental fatigue condition ( P < .05 ) . Neither physiological nor cognitive differences were found between conditions . Ratings of mental fatigue were already affected after the first maximum exercise test ( P < .05 ) . CONCLUSIONS Neither physical nor cognitive performance was affected by mental fatigue , but subjective ratings did reveal significant differences . It is recommended to exclude mentally challenging tasks during the 2-bout exercise protocol rest period to ascertain unaffected subjective test results . This study should be repeated in athletes diagnosed with nonfunctional overreaching/overtraining syndrome OBJECTIVE Abnormalities of the biological stress response ( hypothalamic-pituitary-adrenal axis and the autonomic nervous system ) have been identified in both fibromyalgia ( FM ) and chronic fatigue syndrome ( CFS ) . Although these changes have been considered to be partly responsible for symptom expression , we examine an alternative hypothesis that these HPA and autonomic changes can be found in subsets of healthy individuals in the general population who may be at risk of developing these conditions . Exposure to " stressors " ( e.g. , infections , trauma , etc . ) may lead to symptom expression ( pain , fatigue , and other somatic symptoms ) in part by precipitating lifestyle changes . In particular , we focus on the effect of deprivation of routine aerobic exercise on the development of somatic symptoms . METHODS Eighteen regularly exercising ( > /=4 h/week ) asymptomatic , healthy adults refrained from physical activity for 1 week . We predicted that a subset of these individuals would develop symptoms of FM/CFS with exercise deprivation , and this manuscript focuses on the baseline HPA axis , immune , and autonomic function measures that may predict the development of symptoms . RESULTS Eight of the subjects reported a 10 % increase in one or more symptoms ( pain , fatigue , mood ) after 1 week of exercise deprivation . These symptomatic subjects had lower HPA axis ( baseline cortisol prior to VO2max testing ) , immune ( NK cell responsiveness to venipuncture ) , and autonomic function ( measured by heart rate variability ) at baseline ( prior to cessation of exercise ) when compared to the subjects who did not develop symptoms . CONCLUSIONS A subset of subjects developed symptoms of pain , fatigue , or mood changes after exercise deprivation . This cohort was different from the individuals who did not develop symptoms in baseline measures of HPA axis , immune , and autonomic function . We speculate that a subset of healthy individuals who have hypoactive function of the biological stress response systems unknowingly exercise regularly to augment the function of these systems and thus suppress symptoms . These individuals may be at risk for developing chronic multisymptom illnesses ( CMIs ) ( e.g. , FM or CFS among others ) when a " stressor " leads to lifestyle changes that disrupt regular exercise BACKGROUND Physical training improves exercise capacity in patients with chronic heart failure . It decreases plasma noradrenaline at rest , which may be prognostically favourable . The effect on atrial natriuretic peptide , another prognostic factor , and on catabolic and anabolic hormones remains unknown . Furthermore , to our knowledge , the contribution of exertional hormonal responses to the improved exercise capacity has not been evaluated . METHODS 27 patients with stable chronic heart failure ( New York Heart Association class II-III ) were r and omized to training ( n=12 ) and control  ( n=15 ) groups . The training group exercised on a bicycle ergometer for 30 min three times a week for 3 months . The load corresponded to 50 - 60 % of their peak oxygen consumption . For the next 3 months they exercised at home according to personal instructions . The control group did not change its physical activities . The levels of hormones regulating the cardiovascular system and metabolism were determined at rest and after grade d maximal exercise and during exercise with constant submaximal workload . RESULTS Submaximal exercise capacity increased significantly and peak oxygen consumption tended to improve by 12 % in the training group . The plasma noradrenaline at rest tended to decrease by 19 % . The plasma level of N-terminal pro atrial natriuretic peptide did not change . Serum cortisol , a catabolic hormone , was normal at baseline and remained unchanged . The serum levels of anabolic hormones , growth hormone and insulin , as well as dehydroepi and rosteronesulfate and free testosterone were within a normal range at baseline . They were not altered by training . The dehydroepi and rosteronesulfate/cortisol , and the free testosterone/cortisol ratios , reflecting anabolic/catabolic balance , did not change , either . Training result ed in a higher peak noradrenaline response during grade d maximal exercise . The rise in serum cortisol during exercise tended to attenuate . CONCLUSION Physical training , which improves exercise capacity , does not have an unfavourable effect on anabolic/catabolic balance or neurohumoral activation in patients with congestive heart failure . It decreases plasma noradrenaline at rest . Minor changes in hormonal responses during exercise emerged after physical training which unlikely contribute to the improved exercise capacity The effectiveness of  high performance training  should be examined at short intervals in order to recognize overtraining promptly . Field or laboratory tests can usually not be performed with such frequency . Easy-to-measure biological , training-relevant parameters are being sought to use in their place . Since the importance of the sympathetic nervous system for adaptation of stress and the relationship between physical training and the activity of the sympathetic nervous system are well accepted , and since an impairment of the sympathetic nervous system is assumed in an overtraining syndrome , we examined the relevance of nocturnal " basal " urinary excretion of free catecholamines with respect to its practical application : 1 . during a pilot study ( training of road and track cyclists before the 1988 Olympic Games in Seoul ) , 2 . through a 4-week prospect i ve , experimental study in 1989 and 1990 ( middle- and long-distance runners ) , 3 . during the competitive season and winter break of a soccer team between August 1990 and April 1991 . The following hypothesis was made : An overtraining or exhaustion syndrome in athletes may usually be accompanied by at least a 50 % decrease in basal dopamine , noradrenaline and adrenaline excretion . When training is effective or the athletes are not exhausted , the decrease of the excretion rate -- with the exception of dopamine -- is more likely to be lower ( noradrenaline , adrenaline ) . Generalization of these results requires further expansion of the experimental basis To evaluate the relationship between plasma concentration of amino-terminal fragment of pro-brain natriuretic peptide ( NT-proBNP ) , functional capacity , and right ventricular overload in survivors of tetralogy of Fallot ( TOF ) repair , we prospect ively studied 70 operated TOF patients ( 44 males , 21 ± 1 years old ; mean ± SEM ) who underwent , during the same day , echocardiography , cardiac magnetic resonance imaging , neurohormonal characterization ( plasma NT-proBNP , catecholamines , plasma renin activity , and aldosterone assay ) , and cardiopulmonary exercise testing . Forty-eight age- and sex-matched healthy volunteers served as the control group . Compared to controls , maximal workload and peak oxygen consumption ( VO2/kg ) were lower in operated TOF patients ( p < 0.001 ) , whereas NT-proBNP concentration was elevated ( p < 0.001 ) . No difference was found among the other neurohormones . In operated TOF patients , NT-proBNP showed a significant positive correlation with right ventricular ( RV ) end systolic and end diastolic volumes and RV systolic pressure , and it showed a negative correlation with peak VO2/kg and RV ejection fraction . From multivariable analysis , NT-proBNP concentration was found to be an independent predictor of peak VO2/kg , RV end systolic volume , and RV systolic pressure . These results show an association among RV overload , decrease in functional capacity , and cardiac natriuretic peptide expression in operated TOF patients . NT-proBNP plasma assay may be a useful tool for diagnostic purpose s and for decision making in this setting Objective To verify if in male elite junior soccer players a minimum 1-month performance decrease is accompanied by a mood profile and hormone levels typical of non-functional over-reaching ( NFOR ) . Design A prospect i ve case-control study using a monthly performance monitor with a st and ardised field test to detect the performance changes . Players with a performance decrease lasting at least 1 month were compared with control players without a performance decrease on mood scores and pre-exercise and postexercise levels of stress hormones . Setting Sporting field and sports medical laboratory . Participants Ninety-four young elite soccer players were monitored during the 2006–2008 seasons . Twenty-one players were invited to the laboratory , seven of whom showed a significant performance decrease . Main outcome measures Performance change over time , scores on the profile of mood states and premaximal and postmaximal exercise serum levels of adrenocorticotropic hormone ( ACTH ) , growth hormone ( GH ) and cortisol . Results Players with a performance decrease showed psychological and hormonal changes typical of the non-functional state of over-reaching . Scores were higher on depression and anger , whereas the resting GH levels and ACTH levels after maximal exercise were reduced . ACTH and GH were capable of classifying all but one player correctly as either NFOR or control . Conclusions Performance-related criteria in field tests are capable of identifying players with worsened mood and adaptations of the endocrine system that fit the definition of NFOR . Performance , mood and hormone levels may therefore be considered as valid instruments to diagnose NFOR in young elite soccer players It has been shown that the mental fatigue induced by prolonged self-regulation increases perception of effort and reduces performance during subsequent endurance exercise . However , the physiological mechanisms underlying these negative effects of mental fatigue are unclear . The primary aim of this study was to test the hypothesis that mental fatigue exacerbates central fatigue induced by whole-body endurance exercise . Twelve subjects performed 30 min of either an incongruent Stroop task to induce a condition of mental fatigue or a congruent Stroop task ( control condition ) in a r and om and counterbalanced order . Both cognitive tasks ( CTs ) were followed by a whole-body endurance task ( ET ) consisting of 6 min of cycling exercise at 80 % of peak power output measured during a preliminary incremental test . Neuromuscular function of the knee extensors was assessed before and after CT , and after ET . Rating of perceived exertion ( RPE ) was measured during ET . Both CTs did not induce any decrease in maximal voluntary contraction ( MVC ) torque ( p = 0.194 ) . During ET , mentally fatigued subjects reported higher RPE ( mental fatigue 13.9 ± 3.0 , control 13.3 ± 3.2 , p = 0.044 ) . ET induced a similar decrease in MVC torque ( mental fatigue –17 ± 15 % , control –15 ± 11 % , p = 0.001 ) , maximal voluntary activation level ( mental fatigue –6 ± 9 % , control –6 ± 7 % , p = 0.013 ) and resting twitch ( mental fatigue –30 ± 14 % , control –32 ± 10 % , p < 0.001 ) in both conditions . These findings reject our hypothesis and confirm previous findings that mental fatigue does not reduce the capacity of the central nervous system to recruit the working muscles . The negative effect of mental fatigue on perception of effort does not reflect a greater development of either central or peripheral fatigue . Consequently , mentally fatigued subjects are still able to perform maximal exercise , but they are experiencing an altered performance during submaximal exercise due to higher-than-normal perception of effort CONTEXT The Functional Movement Screen ( FMS ) evaluates performance in 7 fundamental movement patterns using a 4-point scale . Previous studies have reported increased injury risk with a composite score ( CS ) of 14/21 or less ; these studies were limited to specific sports and injury definition . OBJECTIVE To examine the association between  FMS CS and movement pattern scores and acute noncontact and overuse musculoskeletal injuries in division I college athletes . An exploratory objective was to assess the association between injury and FMS movement pattern asymmetry . DESIGN Prospect i ve cohort . SETTING College athletic facilities . PARTICIPANTS 167 injury-free , college basketball , football , volleyball , cross country , track and field , swimming/ diving , soccer , golf , and tennis athletes ( males = 89 ) . INTERVENTION The FMS was administered during pre-participation examination . MAIN OUTCOME MEASURE Noncontact or overuse injuries that required intervention from the athletic trainer during the sport season . RESULTS FMS CS was not different between those injured ( n = 74 ; 14.3 ± 2.5 ) and those not ( 14.1 ± 2.4 ; P = .57 ) . No point on the ROC curve maximized sensitivity and specificity ; therefore previously published cut-point was used for analysis with injury ( ≤ 14 [ n = 92 ] ) . After adjustment , no statistically significant association between FMS CS and injury ( odds ratio [ OR ] = 1.01 , 95 % CI 0.53 - 1.91 ) existed . Lunge was the only movement pattern that was associated with injury ; those scoring 2 were less likely to have an injury vs those who scored 3 ( OR = 0.21 , 95 % CI 0.08 - 0.59 ) . There was also no association between FMS movement pattern asymmetry and injury .  CONCLUSION FMS CS , movement patterns , and asymmetry were poor predictors of noncontact and overuse injury in this cohort of division I athletes The role , if any , of exercise training in the management of individuals with obstructive sleep apnea syndrome ( OSAS ) is unclear . Anecdotally , patients have reported improvement in symptoms with regular participation in an exercise regime . In this study , we evaluated the effects of an exercise training program and weight loss on physical and subjective measures associated with OSAS . Nine subjects with mild to moderate OSAS completed a six month supervised exercise program . Pre and post-training measures on polysomnographic testing , physical training , anthropometric measures , quality of life ( QOL ) , daytime somnolence and mood states were assessed . A significant decrease in the AHI ( p=0.002 ) was noted along with improvements ( p<0.05 ) in total sleep time , sleep efficiency , number of awakenings/hour , arousals/hour , apnea index and mean exercise training workloads . Significant decreases ( p<.001 ) in weight ( -6.2 kg ) and body mass index ( -1.6 ) were observed . Evaluation of QOL measures by the Health Status Question naire , Profile of Mood States and Epworth Sleepiness Scale showed significant changes in health status , affective state , and a decrease in daytime somnolence . Regular exercise training had a positive impact on the AHI , aerobic capacity , body mass index and QOL . However , exercise training alone was not an adequate intervention strategy for most individuals with OSAS but may serve well as an adjunct treatment strategy in the conservative management of individuals with mild to moderate OSAS
Basal levels of hormones were mostly normal in athletes with OTS/FOR/NFOR compared with healthy athletes .
Distinctly , stimulation tests , mainly performed in maximal exercise conditions , showed blunted GH and ACTH responses in OTS/FOR/NFOR athletes , whereas cortisol and plasma catecholamines showed conflicting findings and the other hormones responded normally .
Conclusion Basal hormone levels are not good predictor but blunted ACTH and GH responses to stimulation tests may be good predictors of OTS/FOR/NFOR
Background Overtraining syndrome ( OTS ) , functional ( FOR ) and non-functional overreaching ( NFOR ) are conditions diagnosed in athletes with decreased performance and fatigue , triggered by metabolic , immune , hormonal and other dysfunctions and result ed from an imbalance between training stress and proper recovery .
Despite previous descriptions , there is a lack of a review that discloses all hormonal findings in OTS/FOR/NFOR .
The aim of this systematic review is to evaluate whether and which roles hormones play in OTS/FOR/NFOR .