Novel Markers of Recovery From Overtraining Syndrome: The EROS-LONGITUDINAL Study

Int J Sports Physiol Perform. 2021 Aug 1;16(8):1175–1184. doi: 10.1123/ijspp.2020-0248. Epub 2021 Jan 5.


Purposes: Overtraining syndrome (OTS) is an unexplained underperformance syndrome triggered by excessive training, insufficient caloric intake, inadequate sleep, and excessive cognitive and social demands. Investigation of the recovery process from OTS has not been reported to date. The objective was to unveil novel markers and biochemical and clinical behaviors during the restoration process of OTS.

Methods: This was a 12-week interventional protocol in 12 athletes affected by OTS, including increase of caloric intake, transitory interruption of training, improvement of sleep quality, and management of stress, followed by the assessment of 50 parameters including basal and hormonal responses to an insulin tolerance test and nonhormonal biochemical markers, and body metabolism and composition.

Results: Early cortisol (P = .023), late ACTH (adrenocorticotrophic hormone) (P = .024), and early and late growth hormone (P = .005 and P = .038, respectively) responses, basal testosterone (P = .038), testosterone:estradiol ratio (P = .0005), insulinlike growth factor 1 (P = .004), cortisol awakening response (P = .001), and free thyronine (P = .069) increased, while basal estradiol (P = .033), nocturnal urinary catecholamines (P = .038), and creatine kinase (P = .071) reduced. Conversely, markers of body metabolism and composition had slight nonsignificant improvements.

Conclusion: After a 12-week intervention, athletes affected by actual OTS disclosed a mix of non-, partial, and full recovery processes, demonstrating that remission of OTS is as complex as its occurrence.

Keywords: athletes; burnout; paradoxical deconditioning syndrome; performance; underperformance.

MeSH terms

  • Biomarkers / metabolism
  • Estradiol
  • Humans
  • Hydrocortisone*
  • Longitudinal Studies
  • Syndrome
  • Testosterone*


  • Biomarkers
  • Testosterone
  • Estradiol
  • Hydrocortisone