Overtraining Syndrome

We at the Princeton Longevity Center encourage and support efforts of individuals to
begin and/or include regular physical activity into their lives.  However, it is possible to be too active and become overtrained.   Overtraining syndrome (OTS) is a condition characterized by a long list of physical and psychological symptoms.

Physical
symptoms include:

  • Decreased performance
  • Loss of coordination
  • Prolonged recovery
  • Elevated resting heart rate
  • Headaches
  • Loss of appetite
  • Muscle soreness/tenderness
  • Gastrointestinal disturbances
  • Weakened immune system
  • Insomnia

Psychological
symptoms include:

  • Depression
  • Apathy
  • Difficulty concentrating
  • Increased anxiety and irritation
  • Decreased self-esteem

Though some symptoms of exercising too much or too hard may appear obvious, such as muscle soreness/ tenderness and decreased performance, other symptoms, may not be so.   Psychological symptoms such as depression or increased anxiety and irritation may not be obvious associations with working out too much.  In fact, the line between clinical depression and OTC is blurred (Armstrong, L. and VanHeest, J. (2002) Sports Medicine 32, 185-209) as some researchers have pointed out.  Meaning the physical symptoms, which include immune system behavior, neurotransmitters (chemical messengers in the brain), as well as structural (organization of nerve tissue or “wiring”) in those with OTC and those with clinical depression being similar.  Nonetheless, recognizing symptoms of OTC is paramount to its prevention.  Untreated OTC leads not only to undesirable symptoms but can eventually lead to injury and/or illness.

The causes of OTC include:  Inadequate nutrition, psychological stress, abnormal environmental stress such as heat, cold, or humidity, excessive exercise coupled with inadequate rest, a lack of variety in the exercise routine, and /or a sudden increase in exercise intensity or volume.  The assortment of causes suggests everything, or every facet of your lifestyle is related and may contribute to OTC.  So the stress you have been tolerating at work (or other non-exercise events) may expedite a path to OTC.  Though conventional wisdom suggests a hard workout can mitigate stress, repeated stress will likely not be vanquished by repeated hard workouts.  Both require adequate rest to recover.

So how does one know if they are overtrained?  Check your mental or emotional state.  Muscle stiffness and soreness occurring as a result of a hard workout ought to be ameliorated by a few days’ rest.  However, with OTS feelings of irritability, lack of interest, or motivation often appear a few days following exercise, even if physical symptoms have abated. Such feelings occurring a few days following a workout do suggest you are overtrained.

One can also check their resting heart rate.  Does it run higher than usual?  Check it in the morning when you first are awake and in bed.  Check it again after getting out of bed a few minutes later (while standing).  Heart rate should be the same, if it’s not, OTS may be imminent.

Another way is to observe those around you.  Do they often think you exercise too
much?  Do you have a reputation for working out a lot? It’s hard to take it seriously but if others think you exercise a lot, and they think it enough to voice that opinion, they may be
right.

If early warning signs are ignored, injury, and or sickness, may occur.  One way or another, your body will make you stop if you don’t listen. There are steps one can take to prevent OTC

Keep a log.  You may already do that, diligently recording mileage, routes, dates, or sets, reps, weight lifted.  This is helpful to note performance decrements.  If decreased performance is consistent, it may be a sign you are heading for OTS.  Mental state is as important.  Consider adding additional info to your log such as how you felt before and after the workout.

Note your exertion level during your aerobic workouts.  You may already be checking your HR, it should be the same for the same level of exertion.  For example if you are walking on the treadmill at a 4% grade and your HR after 10 minutes begins trending higher
than usual, this could indicate OTC.  If you can’t check your HR, use one of the rate of perceived exertion (RPE) scales http://ahsmail.uwaterloo.ca/kin356/rpe/rpe/Borg%20RPE%20Scale.html.  If it is trending higher than usual at the same level of exertion, may be time for a break.

Periodize your workout.  Periodiaztion is a way to “manage” your exercise program.  Briefly, plan out your workouts in blocks of 6-12 weeks, where each block you have a different routine, or you change the exercise (such as stationary bike to elliptical
trainer).  Schedule a “light” week every month, where you exercise at a lower intensity than usual.  Build in days off, I recommend a week for every 10-12 weeks of exercise.  Or try
something like 2 days per month (days you would normally work out).  Finally, don’t compete with your workout partner, or rather, don’t take it too seriously.  We all know
the person who works out 6 days per week, intensely and never seems to have any
problems.  Keep in mind that each person has his or her own limits; just because someone you know works out at the crack of dawn each day for two hours doesn’t mean you should be able to as well.  As mentioned earlier, other aspects of life may be interfering with your
exercise performance (remember stress at work) differently than your workout partner.   Consequently, give them a few weeks; they may be realizing OTC symptoms of their own.

What to do if your suspect OTC.  First and foremost, take time off!  Rest for a few days; be sure you get adequate food/nutrition as well as sleep.  Also, try to change-up your routine by adjusting sets, reps, intensity, miles, frequency or the mode.  If you’re an endurance
athlete, try some cross training.  For instance try biking instead of running, hiking instead of biking, swimming instead of rowing.  If you are weight lifting, change the exercises, or try circuit training.  If it’s a sport, maybe it’s time to start the off-season, use the gym to keep in shape.  If it’s a racquet sport, try playing doubles instead of singles for a
while.  Also of importance, be sure once you start on a new routine, start implementing some of the aforementioned preventive measures.

Symptoms of OTC are simply your body’s way of telling you to take a break.  If symptoms are ignored, sooner or later you will likely be taking a break anyways, due to injury or
illness.  Also keep in mind, as mentioned earlier, the symptoms and etiology of OTC closely resembles that of clinical depression.  That being the case, if rest, changing your routine, or any of the other suggested treatments do not help, consider seeking farther help from a doctor or counselor.

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Workplace cited as source of increasing obesity

This article briefly summarized the accumulating research suggesting that exercise coupled with diet modification may not be enough to stem the tide of overweight and obesity currently being experienced in the US and worldwide.   Sitting for extended periods of time has recently been found to be linked to chronic disease regardless of the amount of recreational activity (i.e. exercise).   The changes need to be made in the workplace, where folks spend the majority of their time.  As the article states, the majority of that time in the workplace is spent in sedentary activity.  Read on as researchers chime in on this important topic.

Workplace Cited as a New Source of Rise in Obesity

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Can’t move your muscles?

This article provides good advice for recovering from exercise induced muscle soreness. The advice is especially useful for those who exercise infrequently (“weekend warriors”). An intense bout of physical activity (hard workout at the gym, or game of basketball or tennis, for example) should always be followed on subsequent days by a lighter workout, if nothing to prevent stiffness and hopefully allow muscles to better prepare for the next workout. Even so, intense workouts should be separated by a minimum of two to three days to allow for recovery.

Can’t move your muscles?

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The ‘new’ controversy about Niacin to treat heart disease

Everybody seems to know the importance of cholesterol and preventing heart disease.  Although getting the ‘total cholesterol’ into a healthy range is a common goal for you and your doctor – it is mostly about two major component of the total cholesterol – the ‘good’ or HDL cholesterol and the ‘bad’ or LDL cholesterol.  Up with the ‘good’ and down with the ‘bad’ is the slogan that applies.

The LDL cholesterol seems to accumulate in the heart vessel walls and contributes to local inflammation with formation and progression of atherosclerotic plaque.  Dietary and medication therapies concentrate on lowered the circulating LDL in the blood stream.  Lower LDL may cause less plaque progression and inflammation.  Multiple published studies have shown that all of the ‘statin’ medications, in conjunction with lowering circulating LDL also reduce the future development of heart attacks (and even strokes) by about 30-40%.  The HDL cholesterol works in a manner to ‘pick up’ (like a dump trunk) some of the LDL that has accumulated in the plaque and return it to the liver, where it is metabolized and excreted.  The process of plaque development is a balance of LDL getting into the wall of an artery and the HDL trying to pick it up and take it back to the liver for processing.

Niacin (vitamin B3) has been known for years to lower circulating LDL (but NOT to the degree that statins do) and to increase circulating HDL (which statins in general do not do as consistently).  A prescription Niacin (represented by the product Niaspan) was developed years ago and shown to slowly release Niacin into the body.  Some years ago, a well known research study done in Seattle (the HATS trial) showed a 35% reduction in future heart attacks with a low dose statin – but a 70% reduction in heart attacks if the patient took BOTH a statin and Niaspan.  That study seemed to indicate that lowering LDL and raising HDL provided a synergistic benefit.  Unfortunately other similar trials failed to produce such spectacular results.

In a recent study, named AIM-HIGH and supported by the NIH, 3,314 individuals with known cardiovascular disease were first treated very aggressively with statins resulting in a major reduction in LDL levels and then were randomized to treatment with or without Niacin.  During the 32-month follow-up period, there were 28 strokes (1.6%) in the Niacin group vs 12 strokes (0.7%) in the control group.  But, nine of the strokes in the niacin group occurred after the drug had been discontinued.  The safety monitoring board about a month ago then stopped the trial.  A press conference on the ‘reasons’ to stop the trial resulted in sales for Niaspan plummeting in the next several weeks.

A press conference and the eventual rigorously reviewed publication of a scientific investigation are not the same thing.  As a consequence, many experts in cholesterol management have unanswered questions about the data and are not willing to accept the ‘court of public press’.

Just the same, many of these experts suggest that they may have to at least think a bit harder about adding Niacin to a statin drug IF the LDL has already been reduced to a very low level (now considered to be <70 mg/dl).  However, they all agree that if such an LDL goal cannot be attained in patients with known cardiovascular disease through diet and statins alone – they see no problems with adding on Niacin to assist lowering the LDL and potentially increasing the HDL.

The goal of lowering an individual’s risk to of plaque development and slowing down plaque progression is done with multiple angles of attack – proper diet, attaining a proper weight and body composition, regular aerobic and resistance training, and treating to appropriate cholesterol levels.  The primary goal is to get the LDL cholesterol as low as possible and if that is achieved many experts suggest that adding Niacin may not provide added benefit; however, if the LDL goal cannot be achieved that adding on Niacin to assist with further lowering LDL (and perhaps raising HDL) is still quite clinically appropriate.

John A. Rumberger, PhD, MD, FACC

Director of Cardiac Imaging &
Director of the Lipid Management Program
The Princeton Longevity Center

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Cut Your Alzheimers Disease Risk in Half

A study published this week in the Lancet Neurology indicates that up to half of the cases of Alzheimers Disease may be related to just seven risk factors.  The implication is that avoiding or improving these risk factors in your life could substantially reduce your risk of developing Alzheimers Disease in your future years.

The seven risk factors are:

1. Education- the more you have (and presumably the more you keep learning throughout life) the more neurons and connections you build in your brain and the lower your risk

2. Smoking – Quit smoking and your risk of Alzheimers Disease starts to drop

3. Exercise- The more sedentary your lifestyle, the greater your risk. In the USA, this is one of the most common risk factors for Alzheimers Disease.

4. Hypertension- Keeping your blood pressure in good control (which includes healthy eating and exercise in addition to medication) lowers your risk.

5. Diabetes- Developing Type II Diabetes raises your Alzheimers risk.  Treating it can lower your risk.  But, the same healthy living patterns of improving your diet, weight and exercise can help to delay or avoid Type II Diabetes

6. Obesity- Being overweight increases Alzheimers risk.  It also increases your risk of hypertension, diabetes and being sedentary.  So putting on the pounds is really a triple whammy.

7. Depression- Untreated depression has long been known to be linked to increased risk of Alzheimer’s Disease.

The number of cases of Alzheimers Disease is expected to triple over the next 40 years.  But the researchers estimated that reducing these risk factors by just 25% could prevent nearly half a million cases in just the USA.

David Fein, MD
Medical Director
Princeton Longevity Center

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Give the rower a chance

I can honestly count on one hand how many of our patients over the last 9 years have used the rowing machine for their cardio exercise.  Think about it for a moment…when’s the last time you actually witnessed a person on the “erg” (as it is often referred to) getting in their workout?  Does your fitness center even have a rowing machine?  Chances are if it does, there are only 2-3 of them at most.  Usually only a handful of people out of thousands of members at a club are in on a tiny little secret…it may be the best cardio machine in the club!  So why doesn’t anyone use it? The most common reason for the popularity of the treadmill and stationary bikes over the rowing machine is quite simple…we all know how to walk, run and bicycle, but very few of us row or were on the crew team in high school or college.  Truth be told, even most health professionals learned the proper mechanics of rowing and never use it with their clients for that very reason.  Once people find out that some of the highest aerobic capacities ever recorded belong to rowers and the rowing machine can be a great tool to help improve upper body posture, plenty of people will want to give it a try.

Check out this article and start learning about the best kept secret of cardio exercise equipment.

Chris Volgraf, CSCS

Exercise Physiologist

Princeton Longevity Center

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Interval Training Infographic

As the Senior Exercise Physiologist at the Princeton Longevity Center, it is my job to design exercise programs that take into consideration the patient’s often hectic family/work schedule.  The number one excuse we hear is…”I don’t have enough time in my day or schedule to fit exercise in”.  Well with several different interval training methods using cardiovascular and resistance training equipment, one can fit their exercise into their day in as little as 4 min!

We already know that interval training takes less time (as if that were not reason enough!); interval training also increases metabolic rate, help us retain lean mass while losing weight, increases aerobic capacity more than steady state exercise and provides us with a higher caloric, fat burn and afterburn than steady state exercise.

For some great tips on how to incorporate interval training into your workout, click on the link below:

http://www.greatist.com/fitness/interval-training-complete-guide/

Chris Volgraf, CSCS
Senior Exercise Physiologist
Princeton Longevity Center

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Simple exercises for office induced neck and shoulder pain.

By now we all know that long sedentary hours at the desk and long hours staring at your screen are bad for your heart and weight, but how bout your neck and shoulders?

Try the exercises from this recent study to help combat common office pains.

http://www.prweb.com/releases/prweb2011/6/prweb8230960.htm

Thomas O’Connor, ACSM-RCEP, CSCS

Registered Clinical Exercise Physiologist

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Top 10 Exercise Myths

As silly as it sounds, many people still treat exercise myths as absolute facts when it comes to their fitness program. If only the public were more educated on exercise, getting results would not be such a challenge. More times than not, active people are sabotaging their fitness program with their beliefs in myths that have seemed to stick around for years. Staying informed and on the cutting edge of new research is so important as we find easier ways to achieve a healthy lifestyle. This article lists the most popular exercise myths that exist today.

Top 10 Exercise Myths

Chris Volgraf, CSCS

Senior Exercise Physiologist

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Nix the soda, protect your heart

A new study published in the American Journal of Clinical Nutrition shows that even low consumption of sugar-sweetened beverages can contribute to an increased risk of cardiovascular disease.
Sugary drinks such as soda, sports drinks and other sugar-sweetened beverages have been associated with weight gain in children and adults for the past decade. Currently, the overweight and obesity rate in the United States is over 68% of the total population. There is a well-established link between obesity and increased risk of cardiovascular disease, but not much research has been done to evaluate the link between sugary drinks and cardiovascular disease risk in people that are not obese.
The study aimed to assess how the intake of sugary drinks in varying sugar doses impacted the cardiovascular health of normal weight people (those with a BMI of 19-25). This randomized controlled trial included 29 men ages 20-50 years old, who participated in a 3 week intervention. Laboratory tests were conducted at the end of the trial to assess the outcome. The study revealed that even at the lowest clinically tested dose, 40 grams sugar per day, cardiovascular risk factors including fasting glucose and waist-to-hip ratio were all elevated. C- Reactive protein, a marker in blood for inflammation that has been associated with numerous health conditions such as diabetes and heart attack, showed a statistically significant increase in all men that participated in the trial. As a reference marker, 40 grams of sugar per day is equal to 12 fl oz bottle of Coke or an 11oz chocolate flavored breakfast drink.
Cardiovascular disease is the number one cause of death for both men and women. It is an umbrella term used to describe all diseases that impact the cardiovascular system and includes stroke, heart disease, and hypertension. This study reinforces the need for all people, of normal weight or overweight, to eliminate their intake of added sugar from sugar sweetened beverages. Be sure to read food labels carefully when purchasing drinks to ensure that no sugar has been added. Natural sugars, such as those found in fruits, do not count as a sugar sweetened beverage, but make sure that all juices are 100% fruit juice with no added sugar. Click on the link to read more about this study http://www.medscape.com/viewarticle/745597_print

Catch the PLC on the Rachael Ray Show!
http://www.rachaelrayshow.com/show/segments/view/skinny-fat-person/

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