top of page

The 4 Stages of Overtraining - why adequate nutrition is important for performance and health (REDs)

Hannah Presswood

Photo courtesy of Shutterstock


We're mostly all familiar with REDs, right?  Relative Energy Deficiency in Sport was first introduced in 2014 by the International Olympic Committee, when they identified a syndrome of deleterious health and performance outcomes experienced by athletes with prolonged exposed to low energy availability (LEA).  The opposite of LEA is optimal energy availability (optimal EA), and is the ideal state in which endurance and elite athletes should be aiming for throughout a training block and on race day. 

 

Overtraining syndrome and REDs occurs due to an increase in exercise energy expenditure without a corresponding increase in energy intake.  Initially, this may lead to performance improvements due to a combination of training adaptations and changes in body composition i.e. increase in muscle or reduction in fat mass.  But be warned: this doesn't last, and if allowed to go on, can develop into overtraining syndrome. 

 

This unimaginative picture demonstrates how overtraining progresses to REDs - it's dry, but a picture paints a thousand words!

 

(Adapted from Stellingwerff et al. 2021 by the Sports Nutrition Association (SNA))

 

The 4 stages of overtraining are:

  1. Acute training fatigue: part of a normal training programme, and is associated with an increase in performance over time if recovery is adequate.  Short-term LEA isn't problematic here. 

  2. Functional Overreaching: Accumulation of training and/or non-training stress (yes, life stress can affect your health and contribute to overtraining as well!) resulting in a short-term (1-2 weeks) performance decrease.  Increase in performance usually occurs within 2 weeks.  This is a normal part of a training programme.

  3. Non-functional overreaching: Accumulation of training and/or non-training stress resulting in a long-term (3-8 weeks) stagnation or decrease in performance capacity.  This stage of overtraining takes weeks to months to recover from.  Performance decreases usually resolve in less than 3 months. If you're experiencing overtraining symptoms and have been for 3-8 weeks, then you need to take immediate action to protect your health. 

  4. Overtraining syndrome: Accumulation of training and/or non-training stress resulting in a long-term (>2 months)  decrease in performance.  Recovery takes months to years.  If left unchecked, irreversible damage to bone health can occur (congratulations, you now have REDs and your sporting career is on hold) - hello stress fractures and simple slips and trips leading to broken bones. 

 

Athletes with high training loads actually have to eat way more food than they realise, or that most think is even possible.  Most endurance athletes probably operate in a state of non-problematic or sub-clinical low energy availability, leaving their best performances unrealised and stunting their longevity in the sport. 

 

Coaches should be aware of how to incorporate functional overreaching into a training block, and ensure that adequate recovery time and strategies are also programmed.  If training load is only progressing in one direction (up), it can easily lead to overtraining the athlete. 

 

As an athlete, you should not be afraid to take the programmed recovery periods, and should be incorporating strategies to maximise recovery and match energy intake to energy expenditure so that problematic overtraining does not develop. 

 

Prolonged overtraining can lead to REDs.  The stages of overtraining exist on a continuum, from acute training fatigue to overtraining syndrome.  The only difference in symptoms between overtraining syndrome and REDs is that bone health is compromised with REDs, but not with overtraining syndrome. 


In case you need more convincing that this is a real problem, overtraining syndrome and REDs has negative impacts on:

  • Sex hormones (e.g. low libido, no 'morning wood' for blokes)

  • HPA or HPG axis (stress and hormone management)

  • Immune function (recurring sickness)

  • Hematological or biochemistry markers (e.g. low iron)

  • Metabolic or cardiovascular markers (RMR, HRV etc.)

  • Bone health (REDs only) (stress fractures, broken bones)

  • Mood, emotional state, sleep quality, perceived fatigue, appetite (i.e. a terrible person to be around).

 

Source: Mountjoy M, Ackerman KE, Bailey DM, et al 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)British Journal of Sports Medicine 2023;57:1073-1098


And these physiological aspects are negatively affected:

  • Endurance

  • Strength, speed or power

  • Injury or illness

  • Training adaptation (i.e. training dumb, not smart)

  • Glycogen and protein synthesis (poor recovery)

  • Judgement or reaction time.

 

Source: Mountjoy M, Ackerman KE, Bailey DM, et al 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)British Journal of Sports Medicine 2023;57:1073-1098

 

REDs is a diagnosis by exclusion i.e. other factors such as endocrinological disorders (thyroid function, diabetes), iron deficiency with anaemia, infectious diseases (myocarditis, hepatitis, glandular fever) and other major disorders such as anorexia and bulemia need to be ruled out first.  Because of this, if REDs is suspected, a multi-pronged approach should be taken to help the athlete i.e. medical support from a doctor or sports doctor, nutrition support from sports nutritionist or sports dietician, psychological support from a counsellor or therapist, and collaboration and cooperation from both the coach and the athlete. 

 

If low energy availability and overtraining syndrome is suspected or present, the first step is to restore energy availability to optimal, and ensure there is adequate carbohydrate availability.  This will look like an increase in energy intake and carbohydrate intake on the advice of a sports nutritionist or sports dietician, and a decrease in energy expenditure (i.e. a reduction in training). 

 

Your key takeaways from this article should be:


  1. An increase in activity should always be accompanied by an increase in energy intake.

  2. The longer overreaching or overtraining is allowed to occur, the more impact it has on health and the longer it takes to recover from.

  3. The first step for any athlete who has had a sustained decrease in performance for longer than 2 weeks and is starting to show signs of overreaching/overtraining is to assess their energy availability.  If restoring EA does not start to help within 2 weeks, then referral to a sports doctor or similar to rule out other factors is required. 

13 views0 comments

Recent Posts

See All

Comments


bottom of page