The ‘worn-out athlete’: A clinical approach to chronic fatigue in athletes

Abstract

Chronic fatigue in the athletic population is a common but difficult diagnostic challenge for the sports physician. While a degree of fatigue may be normal for any athlete during periods of high-volume training, the clinician must be able to differentiate between this physiological fatigue and more prolonged, severe fatigue which may be due to a pathological condition. As chronic fatigue can be the presenting symptom of many curable and harmful diseases, medical conditions which cause chronic fatigue have to be excluded. The clinician must then be able to differentiate between chronic fatigue associated with training or chronic fatigue from other medical causes, and also between the chronic fatigue syndrome and the overtraining syndrome. Once the clinician has excluded all of the above medical conditions which cause chronic fatigue in athletes, a significant proportion of fatigued athletes remain without a diagnosis. Novel data indicate that skeletal muscle disorders may play a role in the development of symptoms experienced by the athlete with chronic fatigue. The histological findings from muscle biopsies of athletes suffering from the 'fatigued athlete myopathic syndrome' are presented. We have designed a clinical approach to the diagnosis and work-up of the athlete presenting with chronic fatigue. The strength of this approach is that it hinges on the participation of a multidisciplinary team in the diagnosis and management of the athlete with chronic fatigue. The athlete, coach, dietician, exercise physiologist and sport psychologist all play an important role in enabling the physician to make the correct diagnosis.

Interassociation Recommendations for Developing a Plan to Recognize and Refer Student-Athletes With Psychological Concerns at the Secondary School Level: A Consensus Statement

“…The student-athlete is exposed to a predictable pattern of lack of sleep and underrecovery, putting him or her at risk for anxiety and depression. [41][42][43][44][45][46][47][48][49][50][51][52][53] Recovery is closely related to well-being and performance, yet many student-athletes are mired in persistent cycles of chronic fatigue. 46 For studentathletes, the complex combination of long-term training and uncontrollable life variables often leads to overtraining, putting them at risk for physical, mental, and emotional health problems.…”

Non-allergic activation of eosinophils after strenuous endurance exercise

“…The second explanation was that ECP has been shown to participate in muscle/tissue repair processes by modifying the production of glycosaminoglycans by human fibroblasts. 35 These two explanations are feasible for the present study as strenuous endurance exercise has been reported to cause muscle / tissue damage 2,9,15,41 that requires removal and repair. The acute phase response (APR) to muscle/tissue damage, specifically the activation of complement components C3, C4 and C5 fragments, may be a possible mechanism for activating eosinophils.…”

“…Strenuous endurance exercise and long-term endurance training are associated with muscle adaptations and damage, with reports of ultrastructural and morphological changes 2,9,15 as well as a systemic inflammatory response. 39 Research has reported mobilization and activation of neutrophils, 4,19 heightened leucocyte turnover, 4 and a complex pattern of pro-and anti-inflammatory cytokine release related to muscle or tissue damage.…”

Causes of extreme fatigue in underperforming athletes - a synthesis of recent hypotheses and reviews

“…12 Specific fatigue-related symptoms reported by UPS athletes include feeling continuously tired despite adequate rest, as well as waking tired and unrefreshed despite an adequate duration of undisturbed sleep. 12 In addition to these generalised reports of fatigue, the athlete complains extensively of local fatigue usually in the exercising muscles, and frequently describes the feeling of 'heavy legs' during exercise.…”