Overtraining in elite athletes. Review and directions for the future.

Overtraining is an imbalance between training and recovery. Short term overtraining or 'over-reaching' is reversible within days to weeks. Fatigue accompanied by a number of physical and psychological symptoms in the athlete is an indication of 'staleness' or 'overtraining syndrome'. Staleness is a dysfunction of the neuroendocrine system, localised at hypothalamic level. Staleness may occur when physical and emotional stress exceeds the individual coping capacity. However, the precise mechanism has yet to be established. Clinically the syndrome can be divided into the sympathetic and parasympathetic types, based upon the predominance of sympathetic or parasympathetic activity, respectively. The syndrome and its clinical manifestation can be explained as a stress response. At present, no sensitive and specific tests are available to prevent or diagnose overtraining. The diagnosis is based on the medical history and the clinical presentation. Complete recovery may take weeks to months.