The purpose of this study was to determine the nature and prevalence of NFOR/OT in young English athletes. The main finding is that almost a third of young athletes (29%) have experienced NFOR/OT at least once during their sporting life. These data agree with two other surveys of older adolescent athletes (age = 15-21 yr) who reported similar incidence rates of 35% and 37%, respectively (19,35). Our data also compare closely to the results of Morgan et al. (30), who found a 33% incidence of OT for nonelite adult women distance runners. The convergent validity of these new study data gives support to the notion that retrospective survey data acquired from young people are indeed valid sources of information.
The rate of NFOR/OT was higher in individual sports (37%) compared with team sports (17%); this finding is similar to that reported by Kenttä et al. (19) in youth athletes-48% individual sports versus 30% team sports. It is argued that OT is more common in individual sports because of the higher daily training hours, resulting in greater time and physical demands on the athlete (5,19). The results from this survey support this idea, with NFOR/OT individual athletes engaging in >2 h of training per day and 6-7 d of practice per week, which was significantly more than that reported by the NFOR/OT team-sport-playing athletes. Clearly, training load may play a greater role in the development of NFOR/OT for individual-sport athletes compared with team-sport athletes; Morgan et al. (30) also found that OT incidence was higher in elite female runners compared with nonelite athletes, the latter performing lower training loads.
Training load alone, however, may not be the sole reason behind the greater incidence rate observed in individual-sport athletes, with the data showing that individual-sport athletes are more occupied with their sport and dedicate less time to other school or social activities. The amount of individual-sport athletes who spend <5 h·wk−1 in other activities apart from their sport was significantly higher compared with team-sport athletes (P ≤ 0.05). These athletes complained of being unable to recover fully from previous training loads or after competition and of not coping well with schoolwork and training demands; similar results have also been found in the surveys of Kenttä et al. (19) and Raglin et al. (35). Our findings support the notion that they are at risk of developing a unidimensional identity, something identified as a potential risk factor in the development of OT (4,17,19). Identities are claimed and constructed through social relationships experienced throughout life (4); therefore, if sport/training provides the sole opportunity for social interaction, it is unsurprising that the young athlete may develop a single identity. Self-esteem, identity, and self-worth become intertwined and become dependent on sporting success, which is fine when success is forthcoming but can lead to stress and anxiety when failure/injury is present, possibly contributing to the development of NFOR/OT (4). When an athlete focuses all his/her efforts into his/her sport, he/she can become defined by it. The development of self-complexity and multiple identities has been shown to provide a cushion or outlet for the stress related to training and seemed to dampen the swings in self-belief/doubt arising from their sport performance-resulting in a more balanced and better coping young athlete (4). As such, those working with elite young athletes should help provide the opportunities and time for the development of a multidimensional identity in the athletes in their care and encourage them to have a range of hobbies/interests alongside their sport.
A significantly higher incidence of NFOR/OT was found in low-physical demand sports (34%), suggesting that alternative factors can influence the development of NFOR/OT in some young athletes (4,16,20,32). Also, no significant differences were reported between the NORM and NFOR/OT groups in relation to the amount of training load currently undertaken. Two child-based studies have reported OT in young golfers (5,19), and it has been suggested that NFOR/OT may be present in athletes playing sports that involve low intensities, i.e., golf or cricket, because of factors such as training time commitments, multiple back-to-back competitions, travel schedules, and, at the elite level, pressure for financial rewards, professional contracts, or sponsorship deals; all combine to provide a combination of associated stressors that, if badly managed, may result in an NFOR/OT state (19,36). The finding that training load is not always the main or sole factor for the development of NFOR/OT in children is important, and these data add to the evidence that reveal that NFOR/OT can occur at high rates even in athletes who are not exposed to high training loads (12,16,19,26,35).
A greater percentage of girls (36%) were NFOR/OT compared with boys (26%), a finding that contradicts the results in adults (16) but mirrors that reported previously in other young athlete studies-30%-35% (19,35). Although it has been suggested that the sporting female has to cope with conflicts related to the feminine cultural role ideals that may lead to identity confusion (28), further work is required to confirm these findings and uncover the unique sources of stress experienced by the sporting female that may lead to NFOR/OT.
An advantage of our study was that it sampled children from different competitive levels rather than just the elite youth athlete. The results showed that the incidence rate of NFOR/OT was increased in national and international athletes but that a significant minority of subnational child athletes also had experienced NFOR/OT. The incidence rate reported in our national- and international-level athletes (37% and 45% incidence, respectively) agree with those reported for elite child athletes by Raglin et al. (35) (37%), Kenttä et al. (19) (35%), and Kenttä and Hassmén (17) (47%). Our data therefore provide new evidence that OT is an issue not just seen in elite athletes because approximately 20% of children who play at local to regional levels may also experience the condition at some point in their careers.
At the elite level, athletes are expected to train more (19) in addition to the quest for prizes, sponsors' contracts, media attention, and the extra traveling for different competitions (36), most of which are not evident at the lower competitive levels; thus, the elite child athlete faces a range of extra external pressures that may underlie the greater incidence in OT. However, children playing sport at the lower representative standards are also reporting external pressure from schoolwork, relationship stresses, and pressure from parents and/or coaches, which, in the individual child, may conspire to bring about an NFOR/OT state. This underlines that NFOR/OT is as much an issue for the schoolteacher or the local club coach to consider as for those involved with high-level young performers, something that is often overlooked in the education and advice that adults receive before their involvement.
Motivational issues with the NFOR/OT athletes.
An important finding from the present study was that there were no differences in the issues that were reported by the athletes who were remembering retrospective episodes of NFOR/OT with those who were in this state at the time of completing the survey. The latter findings suggest that the athletes' ability to recall important past events is not affected and consequently reinforces the confidence in the findings. However, one issue where they did differ was in regard to the loss of motivation to train and compete. The current NFOR/OT athlete reported a reduced motivation to continue compared with the retrospective reports. The latter is understandable because 62% of NFOR/OT athletes reported a loss of motivation to continue training/competing during the NFOR/OT episode. This indicates that the motivation to continue training during an OT period is an essential factor to differentiate between the seriousness of the episode because the loss of motivation is thought to be a crucial factor in the development of burnout and in the consequent dropout from sport (8,12). It is important to recognize that the loss of motivation in overtrained athletes may not be sufficient to lead them to withdraw from their sport; i.e., athletes in an OT state often have motivation to keep training (19), whereas athletes experiencing burnout are on the verge of losing or have lost the motivation to continue training (8,33). Kenttä et al. (19) suggested that the number of bouts of OT is an important predictor of quitting sport (19). OT and burnout seem to develop as an accumulation of discreet episodes that tend to worsen until the athlete eventually decides to drop out from the sport. The young athletes who reported a loss of motivation during NFOR/OT had a higher number of episodes that had lasted longer compared with the athletes whose motivation continued. The loss of motivation is thought to arise because athletes feel mentally and physically exhausted and moody with low confidence. Athletes who feel they are not contributing to the team/club feel undervalued and isolated, resulting in a lack of control over their lives (4).
Many of the symptoms described by Raglin et al. (35) and Kenttä et al. (19) were present in young English athletes: frequent losses of appetite during periods of hard training and/or competition, increase in perceived training effort, feelings of muscle heaviness, and frequent sleep problems; the same symptoms have also been reported elsewhere (6,15,16,36). Interestingly, the symptoms reported by the young athletes with NFOR/OT were similar to those seen in adults: frequent occurrence of injuries, feeling tired the day after competing, and high occurrence of upper respiratory tract infections (2,6,7,13,18,23,24,32,33,38). Athletes with NFOR/OT are thought to have a depressed immune function secondary to the chronic physical and mental stress (2,37), resulting in a concomitant disturbed neuroendocrine function (2,23,25,32) that is reflected by the symptomatology previously described (7,30).
The NFOR/OT athletes reported specific psychological symptoms during their episodes that may be useful markers of the overtrained state: feeling apathetic during periods of hard training, often in bad moods, and feeling sad or like crying during periods of hard training. The surveys by Raglin et al. (35) and Kenttä et al. (19) also found that overtrained athletes exhibited greater mood disturbances compared with healthy individuals. Adult research has shown that mood disturbances are increased during periods of intensified training and tend to be greater in OT athletes (29,30,34). Furthermore, the NFOR/OT athletes complained of feeling intimidated by their opponents in competition, with a lack of confidence in their future as athletes and in competitions and showing reduced enjoyment for training sessions. It is known that excessive signs of anxiety and emotional stress are symptoms associated with mood changes and with the development of OT (21); thus, a similar etiology seems to be evident in young athletes.
Psychosocial factors were also associated with NFOR/OT in young athletes. The findings show that athletes are putting a lot of pressure on themselves to meet or exceed their parents' or their own expectations, which increases the risk of OT (2,23,36,38). When expectations are high, not achieving these can make the athletes feel guilty, which in turn can act as a stress factor exacerbating the situation (9).
The NFOR/OT athletes reported that their sport was the most important thing in their life and that the amount of time that these individuals are dedicating to other activities outside their sport is very limited, suggesting the development of a unidimensional identity (4). Comparable results were found in Swedish competitive athletes where the incidence of burnout was strongly linked to the development of a unidimensional identity (17). Kenttä et al. (19) found that 20% of overtrained athletes devoted <5 h·wk−1 to activities outside of their sport and around 40% who did nothing else but their sport. The negative consequences of concentrating on sport too intensely, especially at a young age, translate into the development of a unidimensional identity that does not allow a buffering of the negative effects of stressful events (4). Also, the NFOR/OT group reported a lack of ability to cope between the demands from school and/or work and the tiredness derived from training, which has previously been reported as a contributing factor to the development of OT (2,23,36). Because the majority of young athletes are involved in compulsory education, the physical and time demands of their training schedule may negatively affect their school-based work. We suggest that the young athletes be supported in developing time management skills to help them control the competing demands of their lives and that their teachers/coaches/parents support them in this. In contrast, Coakley's (5) view is that the problem is not a personal failure of an individual's coping strategies but is embedded in the structures of competitive sport. Coakley (5) entitled it psychodoping, whereby the young athlete is made dependent on others and is discouraged from asking critical questions about his/her involvement in sport. Ensuring that young athletes are involved in the decision-making processes affecting their lives, on both a micro and macro scale, is important, and opportunities for this dialogue to occur should be given.
A potential limitation to this study is that it is a self-administered survey, a subjective measure that is prone to participant bias and poor memory recall. However, these types of research instruments not only are common in medical research but also can yield important information so as long as questions are clear and respondents have the resources to answer (11), which we assessed through a pilot study. There was no evidence of poor memory recall because of the similarity in responses between the current and historical NFOR/OT athletes' responses. Finally, the results of this survey mirror that of previously published works (19,35), giving confidence to the validity of the findings.
In conclusion, this study assessed the current state of NFOR/OT in young English athletes. By using a method that examined athletes' physical, psychological, and cultural issues, a more complete and broader understanding of the problem was achieved. Approximately 29% of young English athletes had experienced NFOR/OT in their past, with elite performers and those in individual sports most at risk. The symptomatology of NFOR/OT in children reflects closely that seen in adults but varies widely between individuals. Importantly, both training and nontraining stressors are reported as significant elements in the profile of the NFOR/OT child, and this is not just an issue of excessive training load. NFOR and OT are a serious issue for young athletes, and coaches, parents, medics, and athletes are advised to view the problem as multifactorial and multidimensional. This deeper understanding is essential to develop new and effective strategies to protect athletes from experiencing the negative consequences of NFOR/OT during their sporting careers.
No financial support was received from any external organizations such as the National Institutes of Health, Wellcome Trust, Howard Hughes Medical Institute, and other(s).
The study was funded by the Foundation for Science and Technology, Portugal, Lisbon, and the School of Sport and Health Sciences, University of Exeter.
The authors thank all coaches and athletes for their time and support in completing this project.
There is no conflict of interest.
Results of the present study do not constitute endorsement by the American College of Sports Medicine.
1. Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy cost of human physical activities. Med Sci Sports Exerc
2. Armstrong LE, VanHeest JL. The unknown mechanism of the overtraining syndrome: clues from depression and psychoneuroimmunology. Sports Med
3. Budgett R. Fatigue and underperformance in athletes: the overtraining syndrome. Br J Sports Med
4. Coakley J. Burnout among adolescent athletes: a personal failure or social problem? Sociol Sport J
5. Cohn P. An exploratory study on sources of stress and athlete burnout in youth golf. Sport Psychol
6. Derman W, Schwellnus MP, Lambert MI, et al. "The worn-out athlete": a clinical approach to chronic fatigue in athletes. J Sports Sci
7. Fry RW, Morton AR, Keast D. Overtraining in athletes: an update. Sports Med
8. Gould D, Dieffenbach K. Overtraining, underrecovery, and burnout in sport. In: Kellman M, editor. Enhancing Recovery: Preventing Underperformance in Athletes
. Champaign (IL): Human Kinetics; 2002. p. 25-35.
9. Gould D, Jackson SA, Finch LM. Sources of stress in national champion figure skaters. J Sport Exerc Psychol
10. Gould D, Lauer L, Rolo C, Jannes C, Pennisi N. Understanding the role parents play in tennis success: a national survey of junior tennis coaches. Br J Sports Med
11. Greenwald HP, Hart LG. Issues in survey data on medical practice: some empirical comparisons. Public Health Rep
12. Gustafsson H, Kenttä G, Hassmén P, Lundqvist C. Prevalence of burnout in competitive adolescent athletes. Sport Psychol
13. Hollander D, Meyers M, Leunes A. Psychological factors associated with overtraining: implications for youth sport coaches. J Sport Behav
14. Hooper SL, Mackinnon LT, Hanrahan S. Mood states as an indication of staleness and recovery. Int J Sport Psychol
15. Kellman M. Underrecovery and overtraining: different concepts-similar impact? In: Kellman M, editor. Enhancing Recovery: Preventing Underperformance in Athletes
. Champaign (IL): Human Kinetics; 2002. p. 3-24.
16. Kenttä G, Hassmén P. Overtraining and recovery: a conceptual model. Sports Med
17. Kenttä G, Hassmén P. Incidence of staleness and burnout in competitive athletes in relation to self-identity. In: The Third World Congress on Mental Training; 1999 July 1-3
. Salt Lake City (UT): Salt Lake University; 1999. p. 1-3.
18. Kenttä G, Hassmén P. Underrecovery and overtraining: a conceptual model. In: Kellman M, editor. Enhancing Recovery: Preventing Underperformance in Athletes
. Champaign (IL): Human Kinetics; 2002. p. 57-80.
19. Kenttä G, Hassmén P, Raglin JS. Training practices and overtraining syndrome in Swedish age-group athletes. Int J Sports Med
20. Kenttä G, Hassmén P, Raglin JS. Mood state monitoring of training and recovery in elite kayakers. Eur J Sport Sci
21. Kindermann W. Overtraining: an expression of misdirection of the vegetative nervous system. Germ J Sport Med
22. Krane V, Greenleaf CA, Snow J. Reaching for gold and price of glory: a motivational case study of an elite gymnast. Sport Psychol
23. Kuipers H, Keizer HA. Overtraining in elite athletes: review and directions for the future. Sports Med
24. Lehmann M, Foster C, Keul J. Overtraining in endurance athletes: a brief review. Med Sci Sports Exerc
25. Lehmann M, Schnee W, Schneu R, Stockhausen W, Bachl N. Decreased nocturnal catecholamine excretion: parameter for an overtraining syndrome in athletes? Int J Sports Med
26. Meehan HL, Bull SJ, Wood DM, James DV. The overtraining syndrome: a multicontextual assessment. Sport Psychol
27. Meeusen R, Duclos M, Gleeson M, Rietjens G, Steinacker J, Urhausen A. Prevention, treatment and diagnosis of the overtraining syndrome. Eur J Sport Sci
28. Messner M. When bodies are weapons: masculinity and violence in sport. Int Rev Sociol Sport
29. Morgan WP, Brown DR, Raglin JS, O'Connor PJ, Ellickson KA. Psychological monitoring of overtraining and staleness. Br J Sports Med
30. Morgan WP, O'Connor PJ, Sparling PB, Pate RR. Psychological characterization of the elite female distance runner. Int J Sports Med
. 1987;8(2 suppl):124-31.
31. O'Connor PJ, Morgan WP, Raglin JS, Barksdale CM, Kalin NH. Mood state and salivary cortisol levels following overtraining in female swimmers. Psychoneuroendocrinology
32. O'Toole M. Overreaching and overtraining in endurance athletes. In: Kreider R, Fry A, O'Toole M, editors. Overtraining in Sport
. Champaign (IL): Human Kinetics; 1998. p. 3-18.
33. Raglin JS. Overtraining and staleness: psychometric monitoring of endurance athletes. In: Singer RN, Murphey M, Tennant LK, editors. Handbook of Research Psychology
. New York (NY): Macmillan; 1993. p. 840-50.
34. Raglin JS, Morgan WP, Luchsinger AE. Mood state and self-motivation in successful and unsuccessful women rowers. Med Sci Sports Exerc
35. Raglin J, Sawamura S, Alexiou S, Hassmén P, Kenttä G. Training practices and staleness in 13-18-year-old swimmers: a cross-cultural study. Pediatr Exerc Sci
36. Richardson S, Anderson M, Morris T. Overtraining Athletes: Personal Journeys in Sport
. Champaign (IL): Human Kinetics; 2008. p. 15-46.
37. Silva J. An analysis of the training stress syndrome in competitive athletes. J Appl Sport Psych
38. Uusitalo AL. Overtraining: making a difficult diagnosis and implementing targeted treatment. Phys Sportsmed
Keywords:© 2011 American College of Sports Medicine
MALADAPTATION; TRAINING LOAD; SYMPTOMATOLOGY; PSYCHOSOCIAL ISSUES; RISK FACTORS