Diagnosing overtraining in athletes using the two-bout exercise protocol

Br J Sports Med. 2010 Jul;44(9):642-8. doi: 10.1136/bjsm.2008.049981. Epub 2008 Aug 14.


Objective: In this work, whether a two-bout exercise protocol can be used to make an objective, immediately available distinction between non-functional over reaching (NFO) and overtraining syndrome (OTS) was studied.

Design: Underperforming athletes who were diagnosed with the suspicion of NFO or OTS were included in the study. Recovery of the athletes was monitored by a sports physician to retrospectively distinguish NFO from OTS.

Setting: Sports medicine laboratory

Participants: The protocol was started and completed by 10 underperforming athletes. NFO was retrospectively diagnosed in five athletes, and OTS was diagnosed in five athletes.

Interventions: A two-bout maximal exercise protocol was used to measure physical performance and stressinduced hormonal reactions.

Main outcome measurements: Exercise duration, heart rate and blood lactate concentration were measured at the end of both exercise tests. Venous concentrations cortisol, adrenocorticotrophic hormone (ACTH), prolactin and growth hormone were measured both before and after both exercise tests.

Results: Maximal blood lactate concentration was lower in OTS compared with NFO, while resting concentrations of cortisol, ACTH and prolactin concentrations were higher. However, sensitivity of these measures was low. The ACTH and prolactin reactions to the second exercise bout were much higher in NFO athletes compared with OTS and showed the highest sensitivity for making the distinction.

Conclusions: NFO might be distinguished from OTS based on ACTH and prolactin reactions to a two-bout exercise protocol. This protocol could be a useful tool for diagnosing NFO and OTS; however, more data should be collected before this test can be used as the gold standard.

MeSH terms

  • Adolescent
  • Adult
  • Athletic Injuries / diagnosis*
  • Cumulative Trauma Disorders / diagnosis*
  • Exercise / physiology*
  • Exercise Test / methods*
  • Female
  • Heart Rate / physiology
  • Hormones / metabolism
  • Humans
  • Lactic Acid / metabolism*
  • Male
  • Middle Aged
  • Young Adult


  • Hormones
  • Lactic Acid