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Overtraining syndrome
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{'''Overtraining syndrome''' or '''OTS''' occurs in athletes when amount or intensity of training exceeds the body's ability to recover. It is common in nearly every sport, with typical symptom patterns differing according to whether the sport is mainly aerobic or mainly anerobic in nature.<ref name="Kreher2019" /> OTS can also occur in children and adolescents.<ref name="Kreher2019" /> ==Overreaching== Overreacting is a normal part of athletes' training, causing a temporary decline in performance followed by a reduction in training, which should then lead to adaption and improved performance.<ref name="Kreher2019" /> <blockquote>Athletes experience minor fatigue and acute reductions in performance as a consequence of the normal training process. When the balance between training stress and recovery is disproportionate, it is thought that overreaching and possibly overtraining may develop. However, the majority of research that has been conducted in this area has investigated overreached and not overtrained athletes. Overreaching occurs as a result of intensified training and is often considered a normal outcome for elite athletes due to the relatively short time needed for recovery (approximately 2 weeks) and the possibility of a supercompensatory effect. As the time needed to recover from the overtraining syndrome is considered to be much longer (months to years), it may not be appropriate to compare the two states. It is presently not possible to discern acute fatigue and decreased performance experienced from isolated training sessions, from the states of overreaching and overtraining. This is partially the result of a lack of diagnostic tools, variability of results of research studies, a lack of well controlled studies and individual responses to training.The general lack of research in the area in combination with very few well controlled investigations means that it is very difficult to gain insight into the incidence, markers and possible causes of overtraining. There is currently no evidence aside from anecdotal information to suggest that overreaching precedes overtraining and that symptoms of overtraining are more severe than overreaching. It is indeed possible that the two states show different defining characteristics and the overtraining continuum may be an oversimplification. Critical analysis of relevant research suggests that overreaching and overtraining investigations should be interpreted with caution before recommendations for markers of overreaching and overtraining can be proposed. Systematically controlled and monitored studies are needed to determine if overtraining is distinguishable from overreaching, what the best indicators of these states are and the underlying mechanisms that cause fatigue and performance decrements. The available scientific and anecdotal evidence supports the existence of the overtraining syndrome; however, more research is required to state with certainty that the syndrome exists.<ref name="Halson2004" /></blockquote> <blockquote>OTS remains a clinical diagnosis with arbitrary definitions per the European College of Sports Science’s position statement. History and, in most situations, limited serologies are helpful. However, much remains to be learned given that most past research has been on athletes with overreaching rather than OTS.<ref name="Kreher2019" /></blockquote> ==Nonfunctional overreaching== '''Nonfunctional overreaching''' or '''NFO''' is similar to overtraining syndrome, but less severe and quicker to recover from.<ref name="Kreher2019" /> ==Terms== The terms overtraining syndrome, burnout and chronic fatigue syndrome are often incorrectly used.<ref name="Derman2000" /><ref name="Kreher2019" /> ==Causes== The causes of overtraining syndrome are not clearly established, and may involve a combination of factors.<ref name="Cadegiani2019">{{Cite journal | last = Cadegiani | first = Flavio A. | last2 = Kater | first2 = Claudio E. | date = 2019-09-18| title = Novel causes and consequences of overtraining syndrome: the EROS-DISRUPTORS study|url=https://doi.org/10.1186/s13102-019-0132-x|journal=BMC Sports Science, Medicine and Rehabilitation|volume=11|issue=1|pages=21|doi=10.1186/s13102-019-0132-x|issn=2052-1847|pmc=PMC6751688|pmid=31548891}}</ref> Overtraining is the "breaking-down rather than building-up; usually as a result of improper rest intervals between exercise sessions."<ref>{{Cite book | url =https://books.google.com.ua/books?id=YnoEdRqG_nQC&pg=PA53&redir_esc=y#v=onepage&q&f=false| title = Exercise Motivational Triggers: Be Your Own Personal Trainer | last = Baldwin | first = Dave R. | date = 2002|publisher=iUniverse|isbn=9780595216031|editor-link=|location=books.google.com | pages = 58|language=en|chapter=|quote=Over-training: breaking-down rather than buidling-up; usually as a result of improper rest intervals between exercise sessions.|editor-last2=|editor-link2=}}</ref> ==Diagnosis == There is no [[diagnostic biomarker]] or test for overtraining syndrome. Diagnosis consists of history, symptom profile, and excluding other causes for the symptoms.<ref name="Kreher2019" /> ==Overtraining syndrome vs ME/CFS == Overtraining syndrome is marked with prolonged [[fatigue]] which can result in it investigations for [[chronic fatigue syndrome]] (CFS), or other fatiguing illnesses, as there are no laboratory tests to confirm OTS. However, [[chronic fatigue syndrome]] is a distinct neurological disease with symptoms affecting many bodily systems, and should not be confused with [[idiopathic chronic fatigue]], which is long-lasting fatigue with no known cause.<ref name="who">{{Cite web|url=https://icd.who.int/browse10/2016/en#/G93| title = ICD-10 Version:2016 | website = icd.who.int|access-date=2019-07-13}}</ref> ==Chronic fatigue syndrome erroneously diagnosed == A large number of different sets of [[:Category:Definitions|diagnostic criteria]] exist for [[myalgic encephalomyelitis]] and [[chronic fatigue syndrome]], which can cause confusion in excluding many other conditions that are potential causes of [[chronic fatigue]] and other symptoms. Some clinicians also use the terms [[chronic fatigue syndrome]] to incorrectly refer to [[idiopathic chronic fatigue]], which is not a neurological disease but a term for any long-term unexplained fatigue. Medical tests are needed to diagnose [[ME/CFS]] - while no particular test can diagnose it, tests are needed to investigate other possible causes of the symptoms.<ref name="niceng206">{{Cite web|url=https://www.nice.org.uk/guidance/ng206| title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last=NICE Guideline Development Group | first = | authorlink = |publisher=[[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref> A large UK study of 377 patients referred to a specialist ME/CFS treatment found many patients were wrongly diagnosed: {{quote frame|text=Half of all the referred patients to a specialist CFS clinic had alternative medical and psychiatric diagnoses... The commonest alternative medical diagnoses of those assessed were [[:Category:Sleep disorders|sleep disorders]] and the commonest alternative psychiatric diagnosis was [[depression|depressive illness]]. Altogether 184 of 377 (49%) patients had alternative diagnoses to CFS. | author = Devasahayam at al. (2012)<ref name="Devasahayam2012">{{Cite journal | last = Devasahayam | first = Anoop | author-link = | last2 = Lawn | first2 = Tara | authorlink2 = | last3 = Murphy | first3 = Maurice | authorlink3 = | last4 = White | first4 = Peter D | authorlink4 = | date = Jan 2012| title = Alternative Diagnoses to Chronic Fatigue Syndrome in Referrals to a Specialist Service: Service Evaluation Survey|url=https://journals.sagepub.com/doi/epub/10.1258/shorts.2011.011127|journal=JRSM Short Reports|volume=3|issue=1|pages=1–5|doi=10.1258/shorts.2011.011127|issn=2042-5333|pmc=PMC3269106|pmid=22299071|access-date=|quote=|via=}}|source=Alternative Diagnoses to Chronic Fatigue Syndrome in Referrals to a Specialist Service: Service Evaluation Survey</ref>}} ==Media reports of athletes and CFS== There have been unverified media reports of athletes diagnosed with [[myalgic encephalomyelitis]] (ME) or CFS who have recovered in a relatively short period of time after rest, supplementation, and diet changes.<ref>{{Cite web|url=https://inews.co.uk/news/health/marathon-runner-quit-work-me-cfs-diet-change/| title = Marathon runner housebound after developing ME claims diet change gave him his life back | last = Tanner | first = Claudia | date = 2018-07-13 | website = inews.co.uk|language=en-GB|access-date=2019-02-28}}</ref><ref>{{Cite news | url=https://www.thetimes.co.uk/article/muslim-fighter-with-me-who-left-an-arranged-marriage-to-win-world-title-svxhhzt57| title = Muslim fighter with ME who left an arranged marriage to win world title | last = Broadbent | first = Rick | date = 2017-12-02|work=The Times|access-date=2019-02-28|language=en|issn=0140-0460}}</ref><ref>{{Cite news | url=http://www.abc.net.au/7.30/committee-reviews-potentially-harmful-and-old/10010408 |at=6mins 18s| title = Committee reviews 'potentially harmful and old fashioned' chronic fatigue treatments|publisher=ABC News | first =Andy|last = Park | first2 = Clare | last2 = O'Halloran}}</ref><ref>{{Cite web|url=http://www.abc.net.au/7.30/committee-reviews-potentially-harmful-and-old/10010408| title = Committee reviews 'potentially harmful and old fashioned' chronic fatigue treatments | last = | first = | authorlink = | date = Jul 18, 2018 | website = abc.net.au|archive-url=|archive-date=|url-status=|access-date=|quote=LAYNE BEACHLEY, FMR WORLD CHAMPION SURFER: Well, at first I just thought it was a natural part of being fatigued and being an extreme athlete.}}</ref><ref>{{Cite news | url=https://www.thetimes.co.uk/article/nathan-douglas-london-2012-was-the-darkest-period-of-my-life-vxt5gftcx| title = Nathan Douglas: London 2012 was the darkest period of my life | last = Broadbent | first = Rick | date = 2019-02-27|work=The Times|access-date=2019-02-28|archive-url=|archive-date=|url-status=|language=en|issn=0140-0460|quote=}}</ref> However, scientific studies and case reports on this are lacking. Dietary changes and rest have not been found to be a cure for ME/CFS, and no dietary changes or supplements have been found to be an effective treatment in clinical trials.<ref name="ICP2011primer" /><ref name="canadianconsensus" /> In ME/CFS, a healthy balanced diet is suggested and nutritional tests should be run prior to diagnosis to identify any alternative causes of fatigue or impairment.<ref name="ICP2011primer" /><ref name="fukuda1994" /> ==Symptoms== ===Physiological=== *Altered [[resting heart rate]] - either bradycardia or raised heart rate at rest *[[Fatigue]] *Decreased physical performance *Decreased [[lactate]] response *Decreased [[maximum work capacity]] *Frequent [[Gastrointestinal system|gastrointestinal]] upsets *[[Headache]]s *[[Hormone]] imbalance includes elevations of [[cortisol]] with secondary lowering of [[testosterone]] and [[Dehydroepiandrosterone|DHEA]] levels *A decrease in [[muscular strength]] *[[Insomnia|Early waking and sleep problems]] *Lack of appetite *Lower percent of [[body fat]] than pre-illness levels *[[Amenorrhea]] is common in women and teenager girls *[[Myalgia|Muscle soreness]] and tenderness, or tight muscles<ref name="Undermining" /><ref name="jointstatement2012" /><ref name="Kreher2019" /> ===Psychological=== *Decreased motivation to train *Difficulty concentrating during work, school, or training *Mood changes, especially feelings of sadness and [[depression]] or clinical depression<ref name="Undermining">{{Cite journal|url=https://www.unm.edu/~lkravitz/Article%20folder/overtraining4.html| title = Overtraining: Undermining Success|access-date=2019-02-28 | last = Kinucan | first = Paige | authorlink= | last2 = Kravitz | first2 = Len|journal=ACSM's Health & Fitness Journal|volume =11|issue=4 | date = 2007 | pages = 8-12 | authorlink2 = |archive-url=|archive-date=|url-status=}}</ref><ref name="jointstatement2012" /><ref name="Kreher2019" /> ==Differences from CFS== Overtraining syndrome includes a much narrower group of symptoms, can only be caused by repeatedly overexercising, and unlike CFS, is not either neurological in nature or a common cause of significant and long term disability affecting all aspects of life. ===ME/CFS symptoms not present in overtraining syndrome === * [[post-exertional malaise]], which is not limited to exercise, is the hallmark symptom of ME/CFS, and may be delayed by up to 3 days * [[chronic pain]], which is pain lasting for over six months, is common in ME/CFS, and may include [[joint pain]] or [[nerve pain]] rather than just [[muscle pain]] * the minimum level of impairment for diagnosis is typically only being able to function at 50% of their previous level in everyday day, although this depends on the diagnostic criteria used * some patients are housebound or bedbound, and the 25% of ME/CFS patients with [[severe and very severe ME]] are wheelchair users or bedbound * typically functioning is lower than that patients [[multiple sclerosis]] and class 3 heart failure * [[co-morbidities]] frequently occur, including [[Postural orthostatic tachycardia syndrome|POTS]], [[irritable bowel syndrome|IBS]], [[fibromyalgia]], [[Hashimoto's thyroiditis]], and [[migraine]]s * [[:Category:digestive_signs_and_symptoms|digestive symptoms]], which are persistent and may include [[nausea]] or vomiting, even at rest, new onset [[irritable bowel syndrome]] or [[gluten sensitivity]]; in particularly severe cases some patients require a feeding tube * endocrine symptoms may include [[thyroid]] problems, inability to regulate body temperature, and unexplained weight loss or gain * [[:Category:Sensitivity signs and symptoms|sensory overload]] symptoms, including [[photophobia]], [[hyperacusis]], touch sensitivity and even [[allodynia]] are fairly common in ME/CFS *[[exercise]] or over-exertion causes noticeable [[cognitive dysfunction]] *[[concentration]] is significantly impaired, and too much mental activity causes [[post-exertional malaise]] and an increase in symptoms such as pain, [[muscle weakness]], dizziness and gastrointestinal symptoms; some patients with [[ME/CFS]] are unable to watch TV due to severe cognitive dysfunction * [[Severe and very severe ME#verysevere|Very severe ME/CFS]] can be life-threatening and a number of people have died * Prognosis is very poor, most people do not fully recover from ME/CFS; in overtraining syndrome most recover within weeks or months<ref name="Derman2000" /> * ME/CFS can occur in sedentary people * ME/CFS is a [[Female predominant diseases|female predominant disease]] * [[ME/CFS]] is most commonly caused by a virus or bacterial disease, although severe injury and other events are also common * overtraining, inadequate food intake and poor [[nutrition]] are not among the many pre-onset [[:Category:Triggers and risk factors |triggers or risk factors]] commonly reported; nutritional deficiencies must be ruled out as a possible cause before diagnosis * significant brain and spinal cord changes have been found in patients with [[ME/CFS]], including in autopsies of patients who have died from the illness * [[paralysis]] is reported in some patients *symptoms may not be diagnosed unless present for at least 6 months, in the most commonly used diagnostic criteria<ref name="canadianconsensus">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02 | url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf }}</ref><ref name="ICP2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012 | isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref><ref name="fukuda1994">{{Cite journal | last = Fukuda | first = K. | authorlink = Keiji Fukuda | last2 = Straus | first2 = S.E. | authorlink2 = Stephen Straus | last3 = Hickie | first3 = I. | authorlink3 = Ian Hickie | last4 = Sharpe | first4 = M.C. | authorlink4 = Michael Sharpe | last5 = Dobbins | first5 = J.G. | authorlink5 = James Dobbins | last6 = Komaroff | first6 = A. | authorlink6 = Anthony Komaroff | date = 1994-12-15| title = The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group | url =https://www.researchgate.net/profile/Michael_Sharpe2/publication/247808895_The_Chronic_Fatigue_Syndrome_A_Comprehensive_Approach_to_Its_Definition_and_Study/links/0c96053201643bfc4b000000/The-Chronic-Fatigue-Syndrome-A-Comprehensive-Approach-to-Its-Definition-and-Study.pdf|journal=Annals of Internal Medicine|volume=121|issue=12 | pages = 953–959|issn=0003-4819|pmid=7978722|via=|publisher=American College of Physicians}}</ref><ref name="who" /><ref name="Chu">{{Cite journal | last = Chu | first = Lily | authorlink = Lily Chu | last2 = Valencia | first2 = Ian J. | authorlink2 = Ian Valencia | last3 = Garvert | first3 = Donn W. | authorlink3 = | last4 = Montoya | first4 = Jose G. | authorlink4 = Jose Montoya | authorlink5 = | date = Jan 14, 2019| title = Onset patterns and course of myalgic encephalomyelitis/ chronic fatigue syndrome|url=https://www.frontiersin.org/articles/10.3389/fped.2019.00012/abstract|journal=Frontiers in Pediatrics|volume=|issue=|pages=|doi=10.3389/fped.2019.00012|quote=|via=}}</ref> [https://www.frontiersin.org/articles/10.3389/fped.2019.00012/abstract (Full text)] ===Overtraining signs symptoms not present in ME/CFS === * mood changes - these are not a diagnostic symptom of ME/CFS,<ref name="ICP2011primer" /> and not any more common than in ME/CFS compared to other chronic illnesses.{{citation needed | date = 2021}} In overtraining syndrome, mood changes are a key indicator.<ref name="jointstatement2012" /><ref name="Kreher2019" /> == Syndrome recognition == Overtraining syndrome remains poorly defined.<ref name="Derman2000" /> In 2012, the European College of Sport Science (ECSS) and the American College of Sports Medicine published a joint statement to help clarify OTS.<ref name="jointstatement2012" /> *[https://www.unm.edu/~lkravitz/Article%20folder/overtraining4.html Overtraining: Undermining Success?]<ref name="Undermining" /> == Notable studies and articles == * 1998, The case history of an elite ultra-endurance cyclist who developed chronic fatigue syndrome<ref name="Rowbottom1998">{{Cite journal | last = Rowbottom | first = D.G. | authorlink = | last2 = Keast | first2 = D. | authorlink2 = | last3 = Green | first3 = S. | authorlink3 = | last4 = Kakulas | first4 = B. | authorlink4 = | last5 = Morton | first5 = A.R. | authorlink5 = | date = Sep 1998| title = The case history of an elite ultra-endurance cyclist who developed chronic fatigue syndrome|url=https://pubmed.ncbi.nlm.nih.gov/9741601/|journal=Medicine and Science in Sports and Exercise|volume=30|issue=9|pages=1345–1348|doi=10.1097/00005768-199809000-00001|issn=0195-9131|pmc=|pmid=9741601|access-date=|quote=|via=}}</ref> [https://pubmed.ncbi.nlm.nih.gov/9741601/ (Abstract)] * 1998, Overtraining in sport.<ref name="Kreider1997">{{Cite book | url =https://psycnet.apa.org/record/1997-36577-000| title = Overtraining in sport.|location=Champaign, IL, US |publisher=Human Kinetics | editor-last = Kreider|editor-first = Richard|editor-last2=Fry|editor-first2 = Andrew | date = 1998 | language=en|archive-url=|archive-date=|url-status=|access-date=2019-02-28|editor-last3 = O'Toole|editor-first3 = Mary Louise | last = | first = |isbn=|editor-link=|pages=|chapter=|quote=|editor-link2=}}</ref> [https://psycnet.apa.org/record/1997-36577-000 (Abstract)] *2000, The Differential Diagnosis and Clinical Approach to the Athlete With Chronic Fatigue<ref name="Derman2000">{{Cite journal | last = Lambert | first = M. I. | last2 = Derman | first2 = W.E. | date = 2000-01-01| title = The differential diagnosis and clinical approach to the athlete with chronic fatigue|url=https://www.researchgate.net/profile/Wayne_Derman/publication/304013746_The_Differential_Diagnosis_and_Clinical_Approach_to_the_Athlete_With_Chronic_Fatigue/links/5762fb7e08aecb4f6fee0463/The-Differential-Diagnosis-and-Clinical-Approach-to-the-Athlete-With-Chronic-Fatigue.pdf |journal=International SportMed Journal|language=en|volume=1|issue=3|issn=1528-3356}}</ref> *2004, Does overtraining exist? An analysis of overreaching and overtraining research.<ref name="Halson2004">{{Cite journal | last = Halson | first = Shona L. | last2 = Jeukendrup | first2 = Asker E. | date = 2004 | title=Does overtraining exist? An analysis of overreaching and overtraining research|url=https://www.ncbi.nlm.nih.gov/pubmed/15571428|journal=Sports Medicine (Auckland, N.Z.)|volume=34|issue=14 | pages = 967–981|doi=10.2165/00007256-200434140-00003|issn=0112-1642|pmid=15571428}}</ref> [[pubmed:15571428|(Abstract)]] *2005, Reversal in fatigued athletes of a defect in interferon γ secretion after administration of Lactobacillus acidophilus<ref name="Henriksson2006">{{Cite journal | last = Henriksson | first = A. | last2 = Fricker | first2 = P. | last3 = Pyne | first3 = D. | last4 = Pang | first4 = G. | last5 = D’Este | first5 = C. | last6 = Dorrington | first6 = M. | last7 = Callister | first7 = R. | last8 = Cox | first8 = A. | last9 = Gleeson | first9 = M. | date = 2006-04-01| title = Reversal in fatigued athletes of a defect in interferon γ secretion after administration of Lactobacillus acidophilus|url=https://bjsm.bmj.com/content/40/4/351|journal=British Journal of Sports Medicine|language=en|volume=40|issue=4|pages=351–354|doi=10.1136/bjsm.2005.024364|issn=0306-3674|pmc=2577537|pmid=16556792}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2577537/ (Full Text)] <blockquote>This is the first evidence of a [[T cell]] defect in fatigued athletes, and of its reversal following [[Probiotic]] therapy.<ref name="Henriksson2006" /></blockquote> *2012, Overtraining Syndrome - A Practical Guide<ref name="Kreher2019">{{Cite journal|url=https://doi.org/10.1177%2F1941738111434406| title = Overtraining Syndrome: A practical guide|website=SAGE Journals|language=en|doi=10.1177/1941738111434406|pmc=3435910|pmid=23016079|access-date=2019-02-28 | date = 2012 | last = Kreher | first = Jeffrey | authorlink= | last2 = Schwartz | first2 = Jennifer B. | authorlink2 = |archive-url=|archive-date=|url-status=|volume=4|issue=2|pages=128-138}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435910/ (Full Text)] * 2012, Prevention, diagnosis and treatment of the overtraining syndrome: Joint consensus statement of the European College of Sport Science (ECSS) and the American College of Sports Medicine (ACSM)<ref name="jointstatement2012">{{Cite journal | last = Meeusen | first = Romain | last2 = Duclos | first2 = Martine | last3 = Foster | first3 = Carl | last4 = Fry | first4 = Andrew | last5 = Gleeson | first5 = Michael | last6 = Nieman | first6 = David | last7 = Raglin | first7 = John | last8 = Rietjens | first8 = Gerard | last9 = Steinacker | first9 = Jürgen | date = 2013-01-01| title = Prevention, diagnosis and treatment of the overtraining syndrome: Joint consensus statement of the European College of Sport Science (ECSS) and the American College of Sports Medicine (ACSM)|url=https://doi.org/10.1080/17461391.2012.730061|journal=European Journal of Sport Science|volume=13|issue=1|pages=1–24|doi=10.1080/17461391.2012.730061|issn=1746-1391}}</ref> [https://dspace.lboro.ac.uk/dspace-jspui/bitstream/2134/17104/1/ECSS-ACSM%20Overtraining%20consensus%20ACCEPTED.pdf (Full text)] == See also == *[[Exercise]] *[[Burnout]] *[[Post-exertional malaise]] *[[Canadian Consensus Criteria]] for ME/CFS *[[Fukuda criteria]] for chronic fatigue syndrome *[[Oxford criteria]] == Learn more == * [https://dspace.lboro.ac.uk/dspace-jspui/bitstream/2134/17104/1/ECSS-ACSM%20Overtraining%20consensus%20ACCEPTED.pdf Joint College's Statement (2012)] * [https://www.researchgate.net/profile/Wayne_Derman/publication/304013746_The_Differential_Diagnosis_and_Clinical_Approach_to_the_Athlete_With_Chronic_Fatigue/links/5762fb7e08aecb4f6fee0463/The-Differential-Diagnosis-and-Clinical-Approach-to-the-Athlete-With-Chronic-Fatigue.pdf The Differential Diagnosis and Clinical Approach to the Athlete With Chronic Fatigue] * [http://theargusreport.com/us-nih-report-calls-uk-definition-mecfs-scrapped/ US NIH Report Calls for UK Definition of ME/CFS to be Scrapped]<ref name=":0">{{Cite web|url=http://theargusreport.com/us-nih-report-calls-uk-definition-mecfs-scrapped/| title = US NIH Report Calls for UK Definition of ME/CFS to be Scrapped | last = Swift | first = Penny | date = 2015-01-16 | website = The Argus Report|language=en-US|access-date=2019-02-28}}</ref> ([[Oxford criteria]]) <blockquote>The [[United States]] [[National Institutes of Health]] (NIH) has issued a draft report that highlights the dire need for scientific research that will help find a cure for the millions of people suffering from [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]] (ME/CFS) worldwide. The report also highlights the fact that the decades-old [[United Kingdom|UK]] [[Oxford criteria]] for [[ME/CFS]] are severely “flawed,” and that continuing to use these criteria may “cause harm.” Further, the [[National Institutes of Health|NIH]] report says that the Royal Society definition should “be retired” and replaced with a single case definition agreed to by the ME/CFS community.<ref name=":0" /></blockquote> ==References== {{Reflist}} [[Category:Diagnoses]]
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