Stress and its relationship to swimming
by Bernie Wakefield
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Burned-out, Stressed-out, Over-worked, Over-trained and Chronic Fatigue Syndrome are some of the designer terminologies used to describe the chronically exhausted athlete. Are they signs of an emerging illness or are they just euphemisms for sheer laziness or, taken to extreme levels, cop-outs for dodging the hard yakka?
Here are some others: Over-reaching, Staleness, Flattened and "Down the Mine." Are these terms solid evidence of severe fatigue, stress or impending illness? To the swimmer suffering those accruing symptoms they certainly are genuine! Every day the daily paper carries reports of sporting people engaged in intensive competition, in anguish from similar manifestations that have seriously affected them for a period of time. There appears to be some misunderstanding on two of the most common idioms in usage, over-training and over-reaching. This is the official medical explanation of both terms.
Over-reaching, is simply a planned overload program combined with rest periods designed to enable the athlete to adapt fully or partly, depending on the ultimate goal. During this period it is possible for that person to sustain excessive fatigue. Regeneration processes such as spas and massage will hasten restoration when in this mode.
To use the expression "over-training syndrome" is to describe a pathological state that is rapidly approaching an immunological disaster! This could mean months of rest and recuperation.
Scientists tell us that the devastating glandular fever bug (Epstein-Barr) is almost certainly a by-product of the over-training syndrome. The question is, and should be on the lips of every coach, is science any closer to solving the mystery of these debilitating illnesses? The answer is, yes!
Hans Selye, earlier this century, explained the far reaching effects of stress in all its ugly forms in his learned book on this subject. Much later, Theodore Bompa (1983) delved into the stress factor in swimming with some startling conclusions - but no tangible proof, Billings, Parry et. al. (1992) attacked the subject with much enthusiasm and demonstrated that an inefficient immune system was the running mate of a broken-down athlete.
More recently some revealing evidence has arrived from the UK from one E.A. Newsholme who observed that a glutamine deficiency in the body of the tired athlete heralded the origin-in of the over-training enigma. (Nat. Coaching Foundation 1995) He offered this hypothesis for consideration.
Amongst all the cells in the immune system, the lymphocyte cell is the one identified as the catalyst that invokes a deadly response to the invading bacteria. Specifically lethal is the lymphocyte cell known as the T-helper. These cells are the little ‘warriors’ which multiply rapidly to repel the intruding organism. The process that requires this defined increase in numbers is called synthesisation. In the presence of the amino acid, glutamine, new precursor molecules are formed inside the T-helper and these little trailblazers synthesize into molecules of RNA and DNA. In these optimal conditions, duplications of the new cells take place.
Our hero, glutamine, is in heavy demand during this process; indeed, it is required in huge amounts for the creation to occur. Furthermore, and this is an important link in the chain of cellular activity as Parry-Billings et. al. 1992, report: a decrease in the availability of glutamine will result in a low multiplication of cells and in consequence, a poor defense against bacteria and viruses.
As the demand for glutamine in the exercising athlete soars, it follows that storage of this substance is a necessity to deflect the ever present threat of illness. If it were stored in one area it would require an organ the size of the liver to house it.
Now, glutamine generally enters the body from the ingestion of proteins but the intestines absorb most of these so further supplies have to be synthesized by the body. This action occurs, logically enough, in the skeletal muscle which also stores and releases it on an as-required basis. In view of this dramatic evidence, the muscle has to be considered an integral part of the immune system. Is the picture coming into focus?
Newsholme postulates that a lack of glutamine would produce a suppressive effect on the immune system if the athlete has entered an over-training phase. Inevitably, this is confirmed by a slow response of the lymphocytes to infection. Another victim of Glandular Fever bites the dust! In other studies supporting the theory of glutamine deficiency in the blood of over-trained athletes it has been shown that marathoners demonstrated reduced levels that remained low for several weeks after the event (Parry-Billings, Budgett, Koutedakis, Blomstrand, Brooks & Williams 1992).
Newsholme, likewise maintains that mental fatigue in the athlete also may be a product of amino acid activity. Among the 20 odd amino acids found in proteins is one called Tryptophan. When it enters the brain it converts to a neurotransmitter serotonin, known to medicine as 5-HT. These are simply chemical messengers and one of their functions is the control of sleep patterns.
The belief is, that during exercise, especially of the intensive endurance type, fat stored in the tissues releases free fatty acids into the blood. A chemical reaction then takes place in the brain releasing a marked increase of tryptophan which in turn results in increased proportions of 5-HT. The suspicion exists that unexpected brain fatigue in the active athlete may result from this procedure.
Still on the subject of amino acids, there exists a group of branched chain amino acid ‘champions’ known as Leucine, Isoleucine and Valine. Sounds like Roman gladiators! These ‘goodies’ compete with the ‘baddies’ like tryptophan for entry into the brain. Now, if the blood levels of branched chain amino acids were elevated during training or competition there would be a marked decrease in the extent of 5-HT and Tryptophan. This, Newsholme assures, would counter the effect of fatigue.
There is research being carried out at this time to reduce the degree of fatigue by drinking certain fluids containing branched chain amino acids. (Newsholme, Leech & Deuster 1994). It may be of interest that Australian swim teams on tour are advised by the accompanying sports scientists to ingest isotonic drinks not only in training situations but also during race swim-downs. The question is, do they contain the necessary branch chain amino acids required for recovery or are they simply loaded with carbohydrates?
So we have two possible scenarios involving stressing of swimmers that demand a normal restoration of glutamine and tryptophan levels. Simplified, one is the fatigue syndrome within the brain and the other, and perhaps a worse situation, an immune system dysfunction.
Both these problems are alleviated or even cured by rest and medication, but sometimes this can be a very real dilemma if the condition becomes chronic, requiring complete rehabilitation. Even a mild to moderate situation can result in loss of form and speed, so we need a simple and fast acting remedy.
Is it possible that the glycogen loaded sport drinks now being ‘flogged’ can be of assistance? There remains serious doubt on that issue but it is probable that sometime in the near future a fluid of complex compounds will be marketed that can assist in keeping those glutamine levels normal.
Within the last year an intensive study of the over-training problem was carried out by scientists from the University of Western Australia. (Rowbottom, Keast, Goodman and Morton Nov. 94) A wide range of parameters was measured on 10 athletes who were apparently suffering from this symptom. The data obtained makes for fascinating reading. So intense was the research that many parameters once considered responsible for distress within training schedules were claimed to be dismissed as likely candidates.
It was suggested that the OTS was unrelated to the traditional villains normally associated with over-training. Some of those little nasties found innocent of producing havoc in the immune system were: low ferritin concentrations and elevated uric acid and phosphokinase and cortisol levels. After eliminating these false prophets of doom as flawed material, they queried the possibility of decreased concentrations of glutamine as the real culprit. Using Newsholme’s theory that glutamine was a key substrate for cells of the immune system, essential for an immune response and therefore resulting in a defective immune function if the levels were inadequate, they clinically measured plasma glutamine concentrations in the OTS subjects.
The information revealed in this study showed that a lower concentration of glutamine levels could be a negative result of either excessive exercise or over-training and could lead to illness or burn-out. They concluded also that elevated levels in the well-trained athlete represented a positive adaptation to a well-balanced program. Now that opens up some possibilities! From this observation it would be reasonable to assume that auditing plasma glutamine production could be an excellent marker for future diagnosis of this condition. Yes!
OVER-TRAINING AND EARLY DETECTION
Bompa (1983) described in some detail the concept of an optimal training, program. Simplified, it followed this format; Stress - Overload - Adaptation. If we followed that policy to the letter it means that the athlete would be in a constant state of stress as all the work would be hovering close to toleration limits, that is, just a tick or two outside complete breakdown.
Up until recently, it has been most difficult evaluating the predicament of decline. Sudden decreases in performance for no apparent reason are shell-shocking to all associated with the concerned person. The dilemma in obtaining a precise diagnosis when this occurred, was setting up a standardized test methodology to obtain information under laboratory conditions. Testing for a satisfactory result meant setting the anaerobic performance indicators at an intensity around 10% above their maximal lactate steady state and testing to exhaustion. This posed some problems. The idea of this exercise was to examine hormonal concentrations in the over-trained state. More later.
Experience tells us that some swimmers can endure more severe workloads than others. Those others often have good reasons why they cannot perform to the same standard. Astute coaches are aware of these people and modify the work so they can gain optimal benefits. Usually they have suffered a physical problem in the past such as a serious illness, or they simply just don’t have the innate ability to work to that high degree.
These swimmers need careful attention for it is often they who frequently fall ill. Blood tests sometimes tell a vivid story (viral, low iron etc.) but often not, and their inability to work hard may ever remain a mystery. We can all tell stories of swimmers who would certainly have reached the top but were prevented from doing so by unexplained sickness.
The workers, those who blast through every session in a big hurry to reach elite class, also need a cautious approach. When they fall, they go fast and fall a long way and usually take a long time to recover. The answer to all these vexing problems is to closely monitor and measure the swimmers’ profiles. What are the measuring devices?
Heart rate monitors can sometimes be a valuable tool in assessing a swimmer. Not only is it a measure of their fitness condition but can even detect infection or illness. A high heart pulse while doing medium work is a certain sign of a problem brewing in the immune system. A low response to a given workload may indicate an incomplete recovery. A readout remaining high for longer than normal is a dead give away that something is amiss. The old reliable stopwatch may be one of the best tools available. Couple times with the work response and only blind Freddie could miss the connotations.
Monitor the swimmer at all times for perception of stress and how they are handling it. View anything outside normal behavior with utmost caution. Evaluating your swimmer visually is almost an exact science - if you are attentive. In the water, check times for a certain effort, listen to the breathing, the color of the skin, their reactions to other ‘squadies’ times and their emotive actions at critical speeds. Out of the water, look at eyes, personality changes, reluctance at entering water, mood swings etc. At home, parents can monitor sleep patterns, eating habits, irritability, low enthusiasm and school results. Any irregular conduct that remains constant for 3 or 4 days could be considered abnormal and require further investigation.
Probably the most critical factor in supervising progress is estimating sufficient recovery before advancing up the workload ladder. Recovery itself is often a time consuming exercise and one that has attracted little scientific research. Consequently the coach is much on his own in this area and each swimmer has to be appraised separately. Perceptions of soreness, fatigue, times for efforts, enthusiasm, heart rate responses and many more are the tools we have at our disposal. How we use them just about describes our success or failure at coaching. If you have the talent available and don’t succeed, perhaps this zone is the one to look at closely. Swimmers should be encouraged to keep log books. Often this can be a real pain in the ‘you know where’ if the squad is large but it is worth the effort even if only to gauge progress. If information on the swimmer’s body weight, diet and health is collected in this log book over a period of time, the coach can then discuss any present shortcomings, looming, problems and perhaps prevent a possible slide ‘down the mine.’
The effectiveness of the program can also be calculated if the swimmer notes the body and mind responses to certain sets and how it affected them. Correctly identifying negative thought patterns could be a plus. Perceiving progress in terms of times as a result of training intensity is vital for further improvement. If the program you have constructed on a "scientific" basis from dogmatic regimens in popular use is causing your swimmers to self-destruct by over-training, then it is time to change to a more common sense approach.
So what happens if your swimmer does come down with one of these symptoms? Most medics would suggest a period of rest and recuperation of not less than 6 weeks. That is, complete rest. There is however some evidence to support the theory that a diet of very light exercise may hasten recovery. The workload must not go beyond the aerobic stage and begins with just a few minutes per day. Of course, recovery depends on the severity of the condition but it could possibly extend to 3 months.
Some regeneration processes such as massage, hydrotherapy and relaxation techniques coupled with floating in salt water tanks shut off from all outside influences have been tried with success. It may be expedient at this time to summarize some of the factors that are suspect in the over-training, syndrome. These are not in order of importance.
Stress or competition
Intensive training of the interval type.
Sudden increases in the training load.
Long, repetitive, boring sets.
Stress at home, school or work.
Insufficient rest or sleep.
Incomplete recovery between hard sets or sessions.
Organ related complaints where no disease exists.
Early warning signs are:
(a) Poor performance - training or competing.
(b) Heart rate responses - active and resting.
(c) Mood changes
(d) Swollen lymph glands.
Log books, as mentioned previously, are certainly one way of maintaining a careful watch on a swimmer’s condition in this regard if notations of well being, thoughts and effects of certain sessions are entered. Another, possibly more effective method of detection of these symptoms is the completion of Psychological Test Questionnaires.
The biggest problem with these test sheets is obtaining truthful and honest answers. There is a tendency to answer the questions simply to please the examiner or to second guess the answer they think is required of them. However, if they are well constructed and most are these days, it is possible to observe patterns of abnormality emerging which may indicate an imminent plight.
Other studies abound on this subject of over-training. Urhausen, Gabriel and Kinderman entertained suspicions that hormonal disturbances had links to immune system break down. They speculated that the hormone ‘heavies’ like adrenaline and cortisol were responsible for disruptive inflammatory processes in the exercising athlete.
Adrenaline (epinephrine) and noradrenaline have been shown to increase significantly as the aerobic/anaerobic transition is reached (threshold). The shorter and more intensive the exercise, the higher the ratio of Adrenaline/Noradrenaline.
The metabolic increase rates of cortisol levels appear to be important when the exercise is endurance oriented. Cortisol is suspected of having some chemical control on the release of fatty acids. It is also known that during the post exercise period, cortisol has a role in the resynthesis of muscle glycogen.
Much ado has been made over testosterone levels in both male and female swimmers and how it affects their supply of energy. Research data suggests that it does increase the muscle’s capacity to top up its glycogen storage in the anabolic process of recovery. Which, of course, means faster recovery.
With just these few paragraphs it can be seen that this is a well-researched area. It would be immensely difficult to detail to any degree the research into the pathways of the various systems in this brief article. These systems would include: Peripheral Metabolic, Immunologic, Hormonal and Neuroendocrine systems - way past this author’s capabilities to understand the biological vernacular let alone interpret them! However, it is known that some of the hormones under investigation would include, Testosterone, Cortisol, Adrenaline (epinephrine) and Insulin.
It would be safe to say that although there are indications that a hormonal imbalance is a well-known condition in the intensely trained athlete, it cannot yet be established that it is responsible for the over-trained syndrome or immunological disorder.
Intensive experiments have been carried out on humans and animals without any substantial conclusions on the subject. However, Urhausen et. al. ended their study with the explanation that the most likely cause of swimmers succumbing to infections is related to the complex interaction of both immune and hormonal pathways.
Even with this evidence there is still some thought that repetitive hormonal stressors could lead to a reduced glutamine synthesis in the muscles and this may have a strong bearing on the duplication response of lymphocyte cells.
One more item for discussion: the ground we have just covered relates almost entirely to the over-trained swimmer. But there is another problem that resembles the symptoms of immune dysfunction and occurs when you would least expect it. Probably every coach has experienced this frustrating impasse more than once or twice in their careers. It happens, at the beginning of taper: within a four to six day period of starting the taper. Mostly it is an upper respiratory infection, but often a gastrointestinal condition may also exist.
Why this is so remains a mystery. Over the years dozens of plausible explanations have been offered, any of which could be accurate assessments but again - nothing proven. It appears to affect 10 to 20% of teams in training. Even at the highest level of National teams, with medical staff in abundance, swimmers still fall ill at this particular time. We really can’t afford such waste - at any stage of development and our hard working scientists should pursue this specific bogey with great alacrity. It has now been well-established that these complaints stem from over-training. Why then do they strike at a time when the athlete appears to be in adaptation? That is, when all recovery processes are in full cry? Has the immune system been badly weakened by over intensive exercise? Is it possible that the vital organs are in a kind of toxic shock?
INTO THE FUTURE
What does the future hold? Research into over-training has to be an urgent priority. In the matter of hormonal measurements it is possible that the field of endocrinology may play an important role with a systematic plan of research. A simple diagnostic method of early detection of immune dysfunction is long overdue. Is it too much to hope for a non-invasive process? Or even a micro method of blood withdrawal? If this were possible, a more frequent examination and systematic form of standard testing could be carried out. The role of the sports scientist has never been under such pressure to perform.
It is this writer’s opinion that far too many years were wasted chasing lactate bunnies down their holes for too many dead ends. It still is a useful training tool but have we pursued lactate research as an exercise device as far as we need? Like all criteria of this nature, it requires frequent testing to obtain accurate data and to form a conclusion.
Coupled with the initial setup, it is still too expensive a process for the struggling squad. Nevertheless, it is known to be a profitable method of detecting abnormal lactate concentrations at certain speeds that could indicate an immune problem exists. Take care though, as muscle glycogen depletion also is believed to initiate this condition. Heart Rate monitors likewise, are not cheap and while providing more than helpful information, cannot always give an accurate, individual readout. For training purposes, hand timed counts are probably precise enough to give a clear picture. Much has been written and claimed about heart rate training programs. To a certain extent the claims on critical training speeds are questionable but in an over-training situation as detailed earlier, the monitoring results are priceless. There are other indicators that are alleged to divulge over-training; most are expensive and few provide proven or accurate measures.
Certain enzymes discovered in muscle tissue after heavy exercise were thought to be ‘Indicators of tissue damage and a pointer that over-training was imminent. However, the belief is now that these enzyme increases may be just a harmless part and parcel of the normal training routine.
Other physical factors measured by researchers in an effort to discover the origins of the over-training syndrome include blood pressure, saliva, oxygen consumption and blood and urinary proteins. There is no confirmation that these measures were confirmed guilty of being part of any immune decline. Even more certainly, neither could they be considered as a quick poolside investigation during workouts!
Perhaps it is not only time to explore and medicate the more destructive developments of over-training but likewise continue to research for valid recovery processes - not just after sets and sessions but also micro and macro periods.
What else do we require? We need a better understanding of over-training and that means a reliable gauge, and that relates to an efficient and accurate model of assessing just where the swimmer’s tolerance limit of each energy system is. Experience is a great tool to possess when visually evaluating a swimmer’s condition but it is not infallible and we all make mistakes. We need to minimize if not entirely eliminate those errors. Perhaps someday ...