Dr Andy Franklyn-Miller

Specialist areas.

Fatigue Lab.

There are many terms used such to describe fatigue or a poor response to training – “over training’ or ‘under recovery’ or even “unexplained underperformance syndrome” but all result in you the athlete performing at a level lower than your training expectation.

We all train differently at various stages of the year, due to competition scheduling, work commitments such as shift work or travel or just trying to improve gains or progress, but often the main focus is on what we are doing in terms of programming and how do we identify risk of under recovery? Or recovery from it if we are in such a dip

There are many terms used such to describe fatigue or a poor response to training – “over training’ or ‘under recovery’ or even “unexplained underperformance syndrome” but all result in you the athlete performing at a level lower than your training expectation.

We all train differently at various stages of the year, due to competition scheduling, work commitments such as shift work or travel or just trying to improve gains or progress, but often the main focus is on what we are doing in terms of programming and how do we identify risk of under recovery? Or recovery from it if we are in such a dip.

Overreaching is a normal part of training and we use this to get better, faster and stronger – we push our bodies to failure so we can adapt and respond. When we get this overreach out of synchronisation, either due to training program design, lack of training teas diet, hormonal imbalance or fatigue we can see the development of underperformance

The body is a complex interlinked system of homeostasis (a multitude of highly complex interactions to maintain balance or return systems to functioning within a normal range) and the more you delve into the control mechanisms at a cellular muscle level – you would be forgiven in trying to ‘modify the unmodifiable’.  You also only have to ‘Google’ the concept of overtraining and no end of monitoring techniques of blood, saliva and now even testing your genetic make up are available to purchase online.

With respect to genetic profiling, as yet, no scientific evidence exists that this can in any way detect risk factors or create modifications that can give benefit – the companies selling these kits are making are huge leaps of faith from studies with no direct relevance

There is some good evidence in the role of blood and saliva monitoring, using IgA , salivary amylase, blood CK-MB, Glutamine/Glutamate ratios etc but these are only of use if you monitor them daily –  the day to day variation in levels is so great that most are useless as a snapshot,  and the cost which is outside the budget of even most professional athletes –save your money!

To get back to homeostasis, think of an analogy of a site foreman shouting instruction’s on a building site to keep it flowing. In the body this can represent the Pituitary gland – it  is small and sits at the base of the brain – and controls much of the neuroendocrine system and the other pathways – It releases or stimulates Prolactin ( controls testosterone release from testes in men) , ACTH (stimulates the production of cortisol from adrenal glands), Growth Hormone, Thyroid stimulating hormone, Follicle stimulating hormone and Leutensing hormone ( again stimulates testosterone production in men). The site foreman can shout instructions to increase or decrease production on secondary jobs – but it relies on having both enough builders and also materials in order to complete the task at hand – any slight shift will result in too many builders and not enough supplies or vice versa – too many supplies effects the price of goods, where as too many labourer’s and you start to incur debt and it is the balance between builders and materials that often are a problem in overload. If we look at Cortisol which normally raises and falls through the day, usually highest in the morning on waking, and lowest during the night between midnight and 4 am (of course shift work and time zone travel destroys this pattern). If the demands on the adrenal glands increase to try and stabilize this cycle, they indirectly effect insulin production from the pancreas, this can cause further falls in blood glucose overnight resulting in disturbed sleep – Low night time blood glucose can result from inadequate glycogen reserves in the liver, so not usually pathology, but you can see how this can disturb the homeostasis – and how this would directly effect training energy, glucose availability and hence performance in the gym. So what is the best approach to work this out and how can we measure response to training if the blood and saliva tests are too expensive or based on assumption or faulty pseudoscience?

Our approach is firstly to take a look at how the body is responding day to day over a two week period. We ask you to record, using phone based applications your diet, your mood, your sleep quality and your recovery. This gives us a picture of how your body is interacting .

We then will arrange a blood profile to look at the physiology of your endocrine system in detail and use this profile to shape our consultation, be in targeting further investigations or beginning a return to exercise

So let’s look at the big influence on that homeostasis – Sleep –  is the most often overlooked cause of underperformance, the benefits of extending sleep are well documented, in a study in basketballers[1], researchers  extended the duration of  sleep by approximately two hours over a period of 5-7 weeks. Instead of their usual 6 to 9 hours, the athletes were sleeping for at least 10 hours every night. The study compared the athletic performance, as well as indicators of reaction time, mood and sleepiness before and after this increase. All players improved sprint time, shooting accuracy, reaction time, mood scores and significant improvements in wellness and fatigue.  Of course we cannot usually sleep for 10 hours a day but another study which investigated the benefit of a 30 minute nap[2] in the afternoon – the researchers found increased alertness, lower heart rate, better reaction time, better short memory and better sprinting time compared to those who did not sleep in the afternoon – something that most of us could try to implement if we were struggling with overload We use SleepCycle which you can download on your phone to measuring sleep quality. It is not perfect and there are much more scientific methods available but they all require a much bigger investment and this gives us a great picture.  

[1] Mah CD, Mah KE, Kezirian EJ, & Dement WC (2011). The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep, 34 (7), 943-50

[2] Waterhouse, J., Atkinson, G., Edwards, B., & Reilly, T. (2007). The role of a short post-lunch nap in improving cognitive, motor, and sprint performance in participants with partial sleep deprivation Journal of Sports Sciences, 25 (14), 1557-1566

More recent approaches talk of the Relative Energy Deficiency which I think is certainly important and understating how you fuel your training is often critical. We ask you to use MyFitnessPal to record accurately everything you eat and drink in a two-week period,  of course this is not confined to a simple look at the macronutrient breakdown of the diet but allows us to understand possible reasons for any relative deficit, and also understand how you are fuelling your recovery.

At a more detailed level we know that heart rate variability, (HRV) the change in the time intervals between adjacent heartbeats, is directly related to the body’s control of the parasympathetic and sympathetic nervous systems.

Broadly, the greater the HRV, the better, but there are occasions where the wide variation is a problem, but it is too little variation which can be caused by stress, pathology, or under recovery. We can use this to identify your recovery without needing to do daily blood or saliva tests.

We recommend using a downloadable app HRV4 training which can both record your mood, daily training and measure HRV in an inexpensive way using the camera (http://www.hrv4training.com) This allows us to use a daily interpretation of readiness, which in combination with wellness can be an excellent tool.

The consultation begins with a detailed training, medical and performance history. We will highlight issues, successes, investigations and problems so far. We the carry out a physical examination as necessary and review the monitoring data. We will conduct stress anxiety and wellness questionnaires as required and start to formulate any further investigations as needed.

 

After the consultation

Dependant on the findings of the monitoring and blood data we will begin an exercise program and make changes to your program as individually prescribed. Some of our patients will undergo DEXA Body composition testing and or VO2 metabolic exercise testing to shape that program, such as SSC FitnessLab or PerformanceLab others will begin with a return to exercise ramp

sleep