June 26, 2021
OVERTRAINING SYNDROME – REFRAMING THE MOST COMMON SPORTS-DERIVED, SPORTS-RELATED DISEASE
By addressing methodological issues on hormonal research, allowing the detection of causality relationship, rather than purely association, and aiming to answer the major questions on overtraining syndrome, Dr. Cadegiani conducted as the principal investigator amongst the largest clinical studies on the field of Endocrinology of Physical Activity, the Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study. Together with the answers to the gaps in the understanding of Overtraining Syndrome, the EROS study was also designed to determine potential difference between healthy athletes and healthy sedentary, in order to detect potential hormonal and metabolic physiological adaptative processes that athletes undergo that hadn’t been described until then. This could be done by comparing athletes affected by OTS with healthy athletes and healthy non-physically active subjects, simultaneously.
In total, the EROS study evaluated more than 100 parameters in more than 50 participants in three groups, that revealed more than 45 novel biomarkers and mechanisms not only in overtraining, but also in healthy athletes, has created the first validated scores for the diagnosis of Overtraining Syndrome, which have been published in more than 10 papers.
OVERTRAINING SYMDROME – THE PARADOXICAL DECONDITIONING SYNDROME (PDS)
Since both overtrained and healthy athletes were training exactly the same amount of volume, intensity, frequency, and type of training, excessive training was clearly not the cause of overtraining syndrome in these athletes, which is contra-intuitive since the name of this condition naturally makes us think that excessive training is the major cause of it. Instead, it was a combination of insufficient amount of caloric, carbohydrate, or protein intake, bad sleep quality, and/or relatively large amount of cognitive demands (too much stress in work, too many concurrent demands, etc) that was the main determinant of overtraining syndrome. Of course that the excessive training may be part of this combination, but alone was not able to cause overtraining syndrome.
Because of these novel findings, Dr. Cadegiani proposed a new model of understanding underperformance-related syndromes, coining the term 'Paradoxical Deconditioning Syndrome (PDS)'. The term PDS is based on the hallmark characteristic that Dr. Cadegiani identified in athletes that lost performance, which was the loss of the multiple hormonal and metabolic conditioning processes that typically occur in athletes, and help them to have progressive improvements in sports performance.
NOVEL HORMONAL MARKERS
Among his multiple discoveries, he found out that the testosterone-to-estradiol ratio, rather than testosterone or estradiol alone, may be a better predictor of many clinical and biochemical behaviors, opening doors to the hormonal balance era, instead of isolated analyzes of each hormone, just like what has been recently proposed by researchers of the steroid metabolomics.
He also unraveled that prompt hormonal responses to stimulations predict the ability for explosive physical responses, which means that the more an athlete release hormone in response to a stimulation, more likely will be the ability to have an explosive ability. Conversely, prolonged hormonal responses predict longer time-to-fatigue in sports, which means that the ability to maintain releasing hormones for a more prolonged period of time likely helps the athlete to maintain the sports performed even after longer periods of training or playing.