Overnight Urinary Cortisol and Cortisone Add New Insights into Adaptation to Training

ArticleinMedicine & Science in Sports & Exercise 37(7):1157-67 · August 2005with 282 Reads 
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Abstract
To examine the effects of training on the HPA axis using two new noninvasive tools: salivary cortisol response to awakening and overnight urinary cortisol and cortisone excretion, and on the sympathoadrenal system using overnight catecholamines excretion. To dissociate the effects of training to those of seasonal hormonal variations, endurance-trained men were compared with sedentary men. Nine untrained (UT) men and 10 triathletes were followed during a 10-month season. Clinical (total score of fatigue, total training load, and performances during the competition period) and hormonal parameters (overnight excretion of glucocorticoids and catecholamines, increment of saliva cortisol response to awakening) were measured. Significant seasonal variations in overnight urinary glucocorticoids (decreased in June) and catecholamines (increased in June) concentrations and in saliva cortisol response to awakening were depicted in the two groups. Whereas urinary cortisol excretion was similar between both groups, overnight urinary cortisone excretion was significantly higher in triathletes compared with UT men (ANOVA: training effect: F(2,45) = 9.50, P = 0.0003), suggesting that during a resting day there is a higher inactivation of cortisol into cortisone in highly trained men. Two triathletes developed an overtraining syndrome and presented an increased urinary cortisol/cortisone ratio (>1) due to lower cortisone inactivation compared with the triathlete group. : When not taken into account, seasonal variations may induce errors in the interpretation of hormonal variations with training. The increased intracellular inactivation of cortisol during the night in endurance-trained men uncovers subtle changes in HPA function during training. We show in this study the interest of noninvasive biological markers of the activity of the neuroendocrine system to monitor the repercussion of training load during longitudinal follow-up of athletes.

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  • ... There is a circannual rhythmicity of 24-h CA excretion, with an increase in 24-h EPI excretion in June and July (northern summers) compared to the rest of the year, whereas no variation of NOR occurred 16 . Therefore, neglecting the hormonal seasonal variations may introduce errors in conclusions about the hormone responses to training and/or overtraining 17 . Some but not all studies 16 have also shown a gender effect (urinary NOR has been found to be significantly higher in women than in men, and in women, NOR levels may vary during the menstrual cycle). ...
    ... Conversely, saliva cortisol concentrations are independent of CBG concentrations and thus closely reflect the free -biologically activeplasma cortisol 43 . Duclos et al. 17,19,35,36 have investigated how free cortisol responseswhich actually affect target tissues -may differ in endurance-trained men and sedentary men, both at rest and during exercise: i.e. no differences were found as a result of endurance training. ...
    ... Using this new approach, the 24-h urinary cortisone/cortisol ratio was reported to be positively related to the total training load in a population of swimmers 46 . In another study, as the nocturnal period is essential for exercise recovery 9 , Gouarne et al. 17 have focused on overnight glucocorticoids output for monitoring the delicate balance between cumulative fatigue in triathletes resulting from exercise training and its recovery period over a tenmonth season. To dissociate the effects of training from those of seasonal hormonal variations, endurance-trained men were compared to untrained (UT) men in this study. ...
    Article
    Objective: To assess and discuss the effects of exercise training on hormonal concentrations. Data sources: Papers were identified through MEDLINE (keywords: hormones and exercise, overreaching, overtraining). Study section and data extraction: The selected papers examined were from established sports sciences/endocrine/physiology journals, and specifically related to hormones and exercise. Conclusions: Optimal hormonal assessment requires that the physiological, technical and analytical variables that can influence the measured hormonal values are understood by those performing the interpretation of hormonal values. Knowledge of these factors will allow a better hormonal follow-up of athletes, and a higher efficiency in detecting and preventing abnormal fatigue and the overtraining syndrome (OTS), as well as preventing hormonal doping.
  • ... The stress response adapts, indicated by the finding that following a rest day, cortisol levels of frequent endurance exercisers upon awakening are similar to those of the sedentary, both in urine and in saliva (Gouarné et al., 2005;Labsy et al., 2013). The inactivation of cortisol into cortisone increases proportionally to the amount of exercise (and so to cortisol increase, Gouarné et al., 2005). ...
    ... The stress response adapts, indicated by the finding that following a rest day, cortisol levels of frequent endurance exercisers upon awakening are similar to those of the sedentary, both in urine and in saliva (Gouarné et al., 2005;Labsy et al., 2013). The inactivation of cortisol into cortisone increases proportionally to the amount of exercise (and so to cortisol increase, Gouarné et al., 2005). However, this is not the case for chronic psychological stress, which leads to an increased cortisol response upon awakening, without increased inactivation of cortisol (Wüst et al., 2000a,b). ...
    ... Hence, what makes physical stress different from psychological stress is the increased inactivation of the active steroid (cortisol) into the inert steroid (cortisone). This mechanism is crucial because it protects trained individuals against the deleterious effects of prolonged increased cortisol secretion (Gouarné et al., 2005), which include hypertension, hyperglycemia (Whitworth et al., 2005), major depressive episode and anorexia nervosa (Ehlert et al., 2001). ...
    Article
    Full-text available
    Running, and aerobic exercise in general, is a physical activity that increasingly many people engage in but that also has become popular as a topic for scientific research. Here we review the available studies investigating whether and to which degree aerobic exercise modulates hormones, amino acids, and neurotransmitters levels. In general, it seems that factors such as genes, gender, training status, and hormonal status need to be taken into account to gain a better understanding of the neuromodular underpinnings of aerobic exercise. More research using longitudinal studies and considering individual differences is necessary to determine actual benefits. We suggest that, in order to succeed, aerobic exercise programs should include optimal periodization, prevent overtraining and be tailored to interindividual differences, including neuro-developmental and genetically-based factors.
  • ... Subsequent decreased sensitivity of monocytes to glucocorticoids 24 h following exercise may act to protect the body from prolonged, exercise-induced cortisol secretion (172). Inactivation of cortisol into cortisone acts as another mechanism to protect tissues and cells from the deleterious effects of exercise-related cortisol secretion (175). Inactivation of cortisol to cortisone appears to be an adaptation to exercise, given that athletes display a higher inactivation of cortisol into cortisone (175). ...
    ... Inactivation of cortisol into cortisone acts as another mechanism to protect tissues and cells from the deleterious effects of exercise-related cortisol secretion (175). Inactivation of cortisol to cortisone appears to be an adaptation to exercise, given that athletes display a higher inactivation of cortisol into cortisone (175). However, overtraining appears to impair the inactivation of active cortisol to cortisone in athletes (175), and may impair anabolic processes as high levels of cortisol decrease skeletal IGF-I synthesis by reducing IGF-I transcript levels (176). ...
    ... Inactivation of cortisol to cortisone appears to be an adaptation to exercise, given that athletes display a higher inactivation of cortisol into cortisone (175). However, overtraining appears to impair the inactivation of active cortisol to cortisone in athletes (175), and may impair anabolic processes as high levels of cortisol decrease skeletal IGF-I synthesis by reducing IGF-I transcript levels (176). ...
    Article
    Full-text available
    Hormones are largely responsible for the integrated communication of several physiological systems responsible for modulating cellular growth and development. Although the specific hormonal influence must be considered within the context of the entire endocrine system and its relationship with other physiological systems, three key hormones are considered the “anabolic giants” in cellular growth and repair: testosterone, the growth hormone superfamily, and the insulin-like growth factor (IGF) superfamily. In addition to these anabolic hormones, glucocorticoids, mainly cortisol must also be considered because of their profound opposing influence on human skeletal muscle anabolism in many instances. This review presents emerging research on: (1) Testosterone signaling pathways, responses, and adaptations to resistance training; (2) Growth hormone: presents new complexity with exercise stress; (3) Current perspectives on IGF-I and physiological adaptations and complexity these hormones as related to training; and (4) Glucocorticoid roles in integrated communication for anabolic/catabolic signaling. Specifically, the review describes (1) Testosterone as the primary anabolic hormone, with an anabolic influence largely dictated primarily by genomic and possible non-genomic signaling, satellite cell activation, interaction with other anabolic signaling pathways, upregulation or downregulation of the androgen receptor, and potential roles in co-activators and transcriptional activity; (2) Differential influences of growth hormones depending on the “type” of the hormone being assayed and the magnitude of the physiological stress; (3) The exquisite regulation of IGF-1 by a family of binding proteins (IGFBPs 1–6), which can either stimulate or inhibit biological action depending on binding; and (4) Circadian patterning and newly discovered variants of glucocorticoid isoforms largely dictating glucocorticoid sensitivity and catabolic, muscle sparing, or pathological influence. The downstream integrated anabolic and catabolic mechanisms of these hormones not only affect the ability of skeletal muscle to generate force; they also have implications for pharmaceutical treatments, aging, and prevalent chronic conditions such as metabolic syndrome, insulin resistance, and hypertension. Thus, advances in our understanding of hormones that impact anabolic: catabolic processes have relevance for athletes and the general population, alike.
  • ... 14,20,45 However, not all studies find this trend. 12,20 A decreased organ sensitivity to catecholamines may also be responsible for symptoms of decreased sympathetic activation. 22 Heart rate variability (HRV) has also been used as an indicator of autonomic function. ...
    ... 14 Cortisol has a peak during the day with nadir during night. 12 Morning cortisol does not accurately reflect levels of free cortisol. 12 Free cortisol is filtered by the kidney at a constant rate; therefore, 24-hour and overnight urinary-free cortisol have been more studied. ...
    ... 12 Morning cortisol does not accurately reflect levels of free cortisol. 12 Free cortisol is filtered by the kidney at a constant rate; therefore, 24-hour and overnight urinary-free cortisol have been more studied. 12 However, even overnight excretion shows high interindividual variability. ...
    Article
    Full-text available
    Fatigue and underperformance are common in athletes. Understanding overtraining syndrome (OTS) is helpful in the evaluation, management, and education of athletes. Relevant articles in English were searched with OVID (1948-2011) and PubMed using the following keywords: overtraining syndrome, overtraining, overreaching, unexplained underperformance, staleness, pathophysiology, management, treatment, evaluation. Bibliographies were reviewed for additional resources. OTS appears to be a maladapted response to excessive exercise without adequate rest, resulting in perturbations of multiple body systems (neurologic, endocrinologic, immunologic) coupled with mood changes. Many hypotheses of OTS pathogenesis are reviewed, and a clinical approach to athletes with possible OTS (including history, testing, and prevention) is presented. OTS remains a clinical diagnosis with arbitrary definitions per the European College of Sports Science's position statement. History and, in most situations, limited serologies are helpful. However, much remains to be learned given that most past research has been on athletes with overreaching rather than OTS.
  • ... The OC + subjects participated in five different laboratory sessions, always under OC regimen (days 7-20) (Fig. 1). Two preliminary sessions familiarized the subjects with the procedures and determined their maximum oxygen consumption (VO 2 max) and maximum braking force (F0) (23,24). Fasting height, body mass and percentage of fat mass [method of skinfolds using a Harpenden Skinfold Caliper (25)] were determined. ...
    ... Salivary concentrations of cortisol (F sal ) were measured by radioimmunoassay (RIA) (Cortisol TKCO, Dade Behring, Paris, France) as previously described (23). Saliva samples were assayed in duplicate (intra-assay and inter-assay coefficients of variation were <3%). ...
    ... The F ur /E ur ratio is negatively related to the total training load in a population of swimmers suggesting that any significant increase in 24-h cortisol secretion is balanced by its parallel inactivation into cortisone (36). As the nocturnal period is essential for exercise recovery, Gouarne et al. (23) have studied the overnight glucocorticoid output to assess the delicate balance between cumulative fatigue resulting from exercise training and its recovery period over a 10-month season in triathletes. In endurance-trained men and sedentary men, overnight urinary cortisol excretion showed seasonal variations whereas for F ur /E ur ratio remained stable. ...
    Article
    Full-text available
    Background: In females, estrogen is a potential modulator of cortisol response to stressors. The aim of this study was to determine the influence of menstrual cycle phase, oral contraception (OC) use and exercise training on hypothalamo-pituitary-adrenal (HPA) axis activity and reactivity after physical stress. Aim: We investigated the effects of the menstrual cycle and OC use on exhaustive exerciseinduced changes in free salivary cortisol concentrations and free urinary cortisol/cortisone excretion in healthy young women. Materials and subjects: Twenty-eight women were allocated to an untrained group (no.=16) or a trained group (no.=12), depending on their physical training background. The untrained group was composed of nine OC users (UNTOC+) and seven eumenorrheic women (UNT-OC-) tested in the follicular and luteal phases, while the trained group was entirely composed of OC+ subjects (T-OC+). Methods: Three laboratory sessions were conducted in a randomised order: a prolonged exercise test, a short-term exercise test, and a control session. For each session, urine and saliva specimens were collected at rest (09:00 h) and then, 30, 60 and 90 min later. Results: Estradiol fluctuation during the menstrual cycle phase did not alter free cortisol baseline values and responses to exercise. OC use was associated with increased free resting salivary concentrations and urinary cortisol excretion with blunted salivary cortisol response to prolonged exercise stimulation. No training effect was noted. Conclusions: OC but not menstrual cycle phase is associated with increased free cortisol levels and low HPA axis reactivity.
  • ... Au repos, à distance de tout exercice, il n'existe pas de différence entre les concentrations plasmatiques d'adrénaline et noradrénaline entre les sujets sédentaires et les sujets entraînés [40]. La sécrétion nocturne de catécholamines (urines recueillies de 22 à 8 heures au décours d'une journée sans exercice) est également identique entre sédentaires et entraînés [77] (Fig. 2). ...
    ... Le profil plasmatique et urinaire des catécholamines en cas de surentraînement est mal défini : augmentation [208], diminution [121,130,208] voire absence de modification des concentrations plasmatiques ou urinaires de catécholamines [77,206,208] ont été associées au surentraînement. De nombreux facteurs peuvent induire des variations des concentrations de catécholamines et donc utiliser ce dosage pour affirmer le surentraînement implique d'obéir à des règles rigoureuses. ...
    ... De plus, une diminution de plus de 50 % de la concentration de noradrénaline urinaire a été mise en évidence chez quatre femmes non surentraînées dont trois appartenaient au groupe témoin. Dans le travail de Gouarné et al. [77], dix triathlètes ont été suivis pendant une année et deux ont développé un surentraînement : le premier présentait une augmentation et l'autre une diminution de l'excrétion urinaire nocturne des catécholamines, soulignant la grande variabilité de réponse catécholaminergique et son absence d'intérêt dans le diagnostic d'overreaching [208] ou de surentraînement [77]. ...
    Article
    Objectives To provide a complementary tool to clinical examination for the sport physician and to determine the indications and the limits of the prescription of the blood analyses performedat rest in the athletes, who present clinical signs evocative of overtraining.
  • ... However, the literature on cortisol effects in athletes has been controversial with regard to the type and intensity of the exercise. For instance, studies with different type of sport and cortisol measurement have shown increase [12,13] or nonsignificant differences [14,15] between athletes and nonathletes. This indicates that different cortisol responses can be expected due to differences in the design research (acute vs. chronic), type of sports and stimulus, amongst other confounding factors, such as athlete psychological aspects, injury, and the sports calendar [7]. ...
    ... The formula applied on the data was Cohen's d = M1-M2/σ pooled; where σ pooled = √[(σ1 2 + σ2 2 )/2]; rγλ = d/√(d 2 + 4); M1 = salivary cortisol level of the athletes and M2 = salivary cortisol level of the nonathletes (sedentary or physically active). The salivary cortisol data were provided by articles [14,[22][23][24][25] or by e-mail [13,15,[26][27][28] through contact with the authors. Missing values are due to graphic representations in the articles and mismatched data received by e-mail [12,29]. ...
    ... On the other hand, 3 studies showed lower salivary cortisol levels in athletes compared to sedentary individuals [15,26,28], while comparisons with physically active individuals showed differences in only one study [27], even though no statistically significant difference was observed between these groups. In addition, one study showed similar levels in both groups [29] while another showed controversial results comparing athletes and sedentary individuals, depending on the athletes' training phase [14]. Rimmele et al. [28] compared groups of athletes, physically active and sedentary individuals, but did not find differences among these groups (p = 1.95). ...
    Article
    Full-text available
    High performance athletes are constantly facing different situations involving stress. Salivary cortisol has been used as a physiological measure to verify high performance athlete and mental health, in spite of research that has shown that comparisons between cortisol levels in athletes and nonathletes are inconclusive. The purpose of this study was to review articles that investigated salivary cortisol levels at rest in high performance athletes in comparison to physically active or sedentary nonathlete individuals. PubMed, ISI Web of Knowledge, SciELO, LILACS, and Scopus databases were searched for studies on salivary cortisol in athletes and the size effect was calculated. Although 3 articles reported higher salivary cortisol levels in female athletes compared to a control group, the results showed homogeneity among baseline groups or groups in resting conditions, suggesting a lack of discriminative capacity. These results should be interpreted with caution, due to the presence of substantial methodological bias.
  • ... However, some patterns did become evident. For example, Gouarne et al. [42], Minetto et al. [40], and Park et al. [43], all showed an increase in CAR following training (triathlon, soccer, and mountain climbing, respectively). More specifically, Gouarne et al. [42] demonstrated that elite-level triathletes will exhibit an increase in CAR % following the onset of training but will stabilize at a higher level even as the season progresses, which appears to mirror the findings in mountain climbers [43]. ...
    ... For example, Gouarne et al. [42], Minetto et al. [40], and Park et al. [43], all showed an increase in CAR following training (triathlon, soccer, and mountain climbing, respectively). More specifically, Gouarne et al. [42] demonstrated that elite-level triathletes will exhibit an increase in CAR % following the onset of training but will stabilize at a higher level even as the season progresses, which appears to mirror the findings in mountain climbers [43]. It is important to note here that although Park et al. framed this particular study in terms of altitude exposure, it is reasonable to include mountain climbing as a form of prolonged exercise. ...
    ... That is, if the training load is too great for an individual's fitness level, they may present an inverse response (decreases in CAR), relative to another athlete who responds to the same training load in the opposing direction (increases in CAR). In support of this rationalization, Gouarne et al. [42] observed that two triathletes developed the overtraining syndrome across the course of the triathlon season, as determined both by a decrease in athletic performance, as well as decreases in subjective fatigue scores [46]. In those overtrained athletes, and juxtaposed with the non-overtrained athletes, CAR % showed a decline in response to the training, eventually stabilizing in one of the athletes, but not the other. ...
    Article
    Full-text available
    Background: The cortisol awakening response (CAR) has been used as a biomarker of stress response in a multitude of psychological investigations. While a myriad of biochemical responses have been proposed to monitor responses to exercise training, the use of CAR within the exercise and sports sciences is currently limited and is a potentially underutilized variable. Therefore, the purpose of this review was to collate studies that incorporate both exercise and CAR, in an effort to better understand (a) whether CAR is a useful marker for monitoring exercise stress and (b) how CAR may be most appropriately used in future research. Methods: A systematic review of the literature was conducted, following PRISMA guidelines. Searches were conducted using PubMed, SportDISCUS, Scopus, and PsychInfo databases, using search terms related toCAR and exercise and physical activity. Results: 10,292 articles were identified in the initial search, with 32 studies included in the final analysis. No studies investigated the effects of laboratory-controlled exercise on CAR. Variable effects were observed, possibly due to inconsistencies in study design, methodology, population, and CAR analysis. The available literature suggests a threshold of exercise may be required to alter the HPA axis and affect CAR. Moreover, CAR may represent a combination of previous exercise load and upcoming stress, making current interpretation of field-based observational research challenging. Conclusions: More research is needed to fully elucidate the influence of exercise on CAR and address a number of gaps in the literature, including controlling exercise load, consistent sample collection, and CAR calculation and analysis.
  • ... 18 However, one may be able to estimate training load and the body's response with the following: salivary immunoglobulin A, 19,20 serum testosterone:cortisol, 11,18 and overnight urinary cortisol:cortisone ratio. 21 In addition, the ...
    ... 8,9,11 Two studies have shown value in assessing the training load through testosterone:cortisol ratio 11,18 and overnight urinary cortisol:cortisone ratio. 21 However, neither test has been proven to differentiate among functional OR, nonfunctional OR, and OTS. ...
    Article
    Full-text available
    Jeffrey B Kreher Department of Orthopaedics, Division of Pediatric Orthopaedics, Massachusetts General Hospital and Massachusetts General Hospital for Children, Boston, MA, USA Abstract: Overtraining syndrome is a condition of maladapted physiology in the setting of excessive exercise without adequate rest. The exact etiology and pathogenesis are unknown and being investigated. Symptoms are multisystem in nature and often representative of underlying hormonal, immunologic, neurologic, and psychologic disturbances. Unfortunately, systematic review of the literature does not clearly direct diagnosis, management, or prevention. However, given the severity of symptoms and impairment to quality of life, prevention of overtraining syndrome should be considered by all who interact with endurance athletes. This article will provide suggestions for management of at-risk athletes despite absence of validated diagnostic tests and preventative measures. Keywords: overreaching, unexplained underperformance, burnout, muscle failure syndrome
  • ... The involvement of a complex regulatory network, which includes biological clocks that control circadian rhythms of hormonal secretions, renders the analysis of hormonal effects difficult, and even the analysis of seasonal rhythms is challenging [9]. ...
    ... The possible hypercortisolism due to sport training could indicate a condition with negative effects on health. However, some studies did not observe these effects related to 24-h urinary free cortisol excretion and morning plasma cortisol concentrations in resting endurance-trained men compared with age-matched sedentary subjects [9,62,63]. This brings the doubt if the men well trained to some modalities of sports can develop a chronic hypercortisolism. ...
    Article
    Full-text available
    This critical review discusses the use of the testosterone/cortisol ratio in the studies of athletic performance and sports physiology. Although in most of the time physical exercise is beneficial to health, it can also be seen as a “stressor” both in men and in women. It is not completely known at what level this “physical stress” ends up its beneficial effects and begins to impair health status. In search for this putative turning point, several markers have been put forward in the last decades. One of these markers is the ratio between testosterone, considered as an anabolic hormone, and cortisol, considered as a catabolic one. Whether in search for an anabolic internal environment for strength training or to avoid performance decline during aerobic workout, the testosterone/cortisol ratio has been considered as an important physiological variable to gauge individual conditioning and responses.
  • ... It has been reported that during a day of rest, there is greater inactivation of cortisol into cortisone in highly trained men compared to the untrained group [207]. Unlike physical stress, individuals with chronic psychological stress show increased cortisol response to awakening (an index of the adrenocortical activity), without increased inactivation of cortisol [208]. ...
    ... Unlike physical stress, individuals with chronic psychological stress show increased cortisol response to awakening (an index of the adrenocortical activity), without increased inactivation of cortisol [208]. Therefore, efficient inactivation of the stress hormones in physically active individuals protects them against the harmful effects of prolonged release of cortisol ( [207]; for review, see [209]). Regular exercise is shown by us to normalize the elevated corticosterone levels seen in sleep-deprived rats [210] and by others in aged transgenic mouse model of Alzheimer's disease [211]. ...
    Article
    Full-text available
    Various forms of exercise have been shown to prevent, restore, or ameliorate a variety of brain disorders including dementias, Parkinson’s disease, chronic stress, thyroid disorders, and sleep deprivation, some of which are discussed here. In this review, the effects on brain function of various forms of exercise and exercise mimetics in humans and animal experiments are compared and discussed. Possible mechanisms of the beneficial effects of exercise including the role of neurotrophic factors and others are also discussed.
  • ... However, it should be emphasized that during a resting day, in endurance-trained athletes, 24 h of cortisol secretion under nonexercising conditions is normal (28,30,82). Accordingly, morning plasma cortisol concentration and 24-h urinary free cortisol excretion in resting endurance-trained men are similar to those of age-matched sedentary subjects (29,53,74). Because urinary free cortisol represents an integrated measure of the 24-h cortisol secretion, this is in accordance with the previously reported normal diurnal HPA axis rhythm in endurancetrained men (28,29). ...
    ... Because urinary free cortisol represents an integrated measure of the 24-h cortisol secretion, this is in accordance with the previously reported normal diurnal HPA axis rhythm in endurancetrained men (28,29). Finally, endurance-trained men maintain the seasonal rhythmicity of cortisol excretion; as in sedentary men, the highest concentrations of urinary cortisol, morning plasma cortisol, and saliva cortisol are observed during autumn and winter compared with spring and summer (53). Therefore, it can be concluded that resting cortisol is not a useful measurement. ...
    Chapter
    Full-text available
    From an operational standpoint, overtraining can be defined as stress > recovery (regeneration) imbalance, that is, too much stress combined with too little time for regeneration –In this context, stress summarizes all individual training, non-training, and competition-dependent stress factors,–Particularly, additional exogenous non-training stress factors, such as social, educational, occupational, economic, nutritional factors, travel, and endogenous factors (genetic predisposition) exacerbate the risk of a resulting overtraining syndrome in a completely individual manner .The term overtraining syndrome describes an impaired state of health which is caused by overtraining and characterized by particular findings.
  • ... However, it should be emphasised that during a resting day, in endurance-trained athletes 24 h cortisol secretion under non-exercising conditions is normal (Duclos et al., 1999; Lancaster et al., 2003 Lancaster et al., , 2004 ). Accordingly , morning plasma cortisol concentration and 24-h urinary free cortisol (UFC) excretion in resting endurance-trained men are similar to those of agematched sedentary subjects (Duclos et al., 1997; Gouarne, Groussard, Gratas-Delamarche, Delamarche, & Duclos, 2005; Kern, Perras,Wodick, Fehm, & Born, 1995). Since UFC represents an integrated measure of the 24-h cortisol secretion, this is in accordance with the previously reported normal diurnal HPA axis rhythm in endurancetrained men (Duclos et al., 1997, Duclos, Guinot, & Le Bouc, 2007). ...
    ... Since UFC represents an integrated measure of the 24-h cortisol secretion, this is in accordance with the previously reported normal diurnal HPA axis rhythm in endurancetrained men (Duclos et al., 1997, Duclos, Guinot, & Le Bouc, 2007). Finally, endurance-trained men maintain the seasonal rhythmicity of cortisol excretion ; as in sedentary men the highest concentrations of urinary cortisol, morning plasma cortisol and saliva cortisol are observed during autumn and winter compared with spring and summer (Gouarne et al., 2005). Therefore, it can be concluded that resting cortisol is not a useful measurement. ...
    Article
    Full-text available
    Successful training must involve overload, but also must avoid the combination of excessive overload plus inadequate recovery. Athletes can experience short-term performance decrement, without severe psychological, or lasting other negative symptoms. This Functional Overreaching (FOR) will eventually lead to an improvement in performance after recovery. When athletes do not sufficiently respect the balance between training and recovery, Non-Functional Overreaching (NFOR) can occur. The distinction between NFOR and the Overtraining Syndrome (OTS) is very difficult and will depend on the clinical outcome and exclusion diagnosis. The athlete will often show the same clinical, hormonal and other signs and symptoms. A keyword in the recognition of OTS might be ‘prolonged maladaptation’ not only of the athlete, but also of several biological, neurochemical, and hormonal regulation mechanisms. It is generally thought that symptoms of OTS, such as fatigue, performance decline and mood disturbances, are more severe than those of NFOR. However, there is no scientific evidence to either confirmor refute this suggestion. One approach to understanding the aetiology of OTS involves the exclusion of organic diseases or infections and factors such as dietary caloric restriction (negative energy balance) and insufficient carbohydrate and/or protein intake, iron deficiency, magnesium deficiency, allergies, etc., together with identification of initiating events or triggers. In this paper, we provide the recent status of possible markers for the detection of OTS. Currently several markers (hormones, performance tests, psychological tests, biochemical and immune markers) are used, but none of them meets all criteria to make its use generally accepted.
  • ... 11b-HSDs related) after an acute exercise, and that the responses of GC metabolites to exercise have been mainly evaluated in urine, often by using prolonged urinary sample collections [16][17][18][19]. For example, the evaluation of F/E ratio in a 24-h urine sample has been proposed to monitor training adaptation in athletes [20]. ...
    ... In fact, we cannot adequately compare our results with existing studies in humans, mainly because they showed different and often conflicting GC metabolites modifications in urine collected many hours after acute exercise (e.g. unmodified/increased E, increased THF and THF/THE ratio, and so forth) [16][17][18][19][20]. In addition, in animals (e.g. ...
    Article
    Endogenous glucocorticoids (GC) rapidly increase after acute exercise, and the phosphodiesterase's type 5 inhibitor (PDE5i) tadalafil influences this physiological adaptation. No data exist on acute effects of both acute exercise and PDE5i administration on 11β-hydroxysteroid dehydrogenases (11β-HSDs)-related GC metabolites. We aimed to investigate the rapid effects of exercise on serum GC metabolites, with and without tadalafil administration. A double blind crossover study was performed in eleven healthy male volunteers. After the volunteers randomly received a short-term administration of placebo or tadalafil (20 mg/die for 2 days), a maximal exercise test to exhaustion on cycle ergometer was performed. Then, after a 2-week washout period, the volunteers were crossed over. Blood samples were collected before starting exercise and at 5 and 30 min of recovery (+5-Rec, +30-Rec). Serum ACTH, corticosterone (Cn), cortisol (F), cortisone (E), tetrahydrocortisol (THF), tetrahydrocortisone (THE), cortols, cortolones and respective ratios were evaluated. Pre-Ex THF was higher after tadalafil. Exercise increased ACTH, Cn, F, E, THE, cortols and cortolones after both placebo and tadalafil, and THF after placebo. The F/E ratio increased at +5-Rec and decreased at +30-Rec after placebo. Compared to placebo, after tadalafil lower ACTH, F and Cn, higher THF/F and THE/E, and not E (at +5-Rec) and F/E modifications were observed. Acute exercise rapidly influences serum GC metabolites concentrations. Tadalafil influences both GC adaptation and 11β-HSDs activity during acute exercise. Additional researches on the effects of both exercise and PDE5i on tissue-specific 11β-HSDs activity at rest and during physiological adaptation are warranted.
  • ... Moreover, overtraining causes physiological alterations including reduction of muscle glycogen [7] and in the circulating levels of catecholamines [2], lactate [2,8], and free testosterone (FT) [1,2,9,10]. On the other hand, it increases the circulating levels of urea (U) [2,9,10], creatine kinase (CK) [4,11], oxidative enzymes [12], and cortisol (C) [2,9,11,13]. Excepting one study showing a decrease in the levels of lactate dehydrogenase (LDH) [14], other groups have shown an increase in the levels of this enzyme, when taper was used [8,15]. ...
    ... However, after 8 weeks of training, Hb levels showed a trend to increase in proportion in the Und-Und group in comparison with the other training groups: Und-Und: 13 (Table 1). ...
    Article
    Full-text available
    Taper is considered as a strategy to avoid overtraining and increase peak performance in athletes. Because aerobic exercise increases the level and duration of independence during the lifespan, the participation of recreational athletes has increased in running events around the world. However, the effects of using load reduction in their training and aerobic performance are still not well known. Our goal was to compare load manipulations, using tapering-like periods in the end of recreational athletes training evaluating alterations in oxygen supply, muscle injury, and metabolism markers. Healthy males (n = 88, 20–35 years old) were randomly distributed in groups using a combination of two mesocycles of 4 weeks, undulatory and staggered, with two daily microcycles, undulatory and linear. Undulatory-undulatory (Und-Und) and undulatory-linear (Und-Lin) groups had load reduction in the final week of training while the staggered-undulatory (Sta-Und) and staggered-linear (Sta-Lin) groups did not. Cardiorespiratory capacity (V̇O2max), body mass index (BMI), and body fat % were evaluated. Blood samples were also collected to analyze hematocrit (Ht), mean corpuscular hemoglobin (MCHC), circulating levels of hemoglobin (Hb), creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea (U), cortisol (C), free testosterone (FT), and free T/C ratio. After 8 weeks of training, Und-Und had the highest trend to increase V̇O2max. Both Und-Und and Sta-Lin reduced body fat %. Und-Und showed a significant increase in MCHC, T and Free T/C ratio, a positive trend to increase Ht% and Hb levels, and a trend to decrease CK, LDH, and C circulating levels. Sta-Lin presented a trend to decrease Ht% and Hb levels, a significant increase in CK, LDH, AST, ALT circulating levels, and a decrease in Free T/C ratio. The use of daily undulatory training load provides better gains for aerobic fitness while the use of staggered load, mainly associated with linear load, promotes inadequate recovery in recreational runners.
  • ... Some studies have documented the increase in plasma ACTH level during acute physical stress, followed by unchanged cortisol [26,47,84] while others have shown the increase of both ACTH and cortisol during dynamic and static physical stress, depending on its intensity and duration [28,41], which is consistent with our findings. Our results also revealed higher plasma levels of ACTH and lower plasma levels of cortisol in athletes in basal conditions and during acute physical stress comparing to controls, and are in accordance to previous studies which demonstrated that chronic physical stress may alter basal levels of HPA hormones [8,33,50]. Static training of high intensity increases basal cortisol, whereas static training of low intensity and long duration decreases basal cortisol [3,29]. Intensive aerobic training increases basal levels of both ACTH [35] and cortisol [8,74]. ...
  • ... However, some studies have shown the increase of both ACTH and cortisol during dynamic and static physical stress, even in anticipation of the test [92], depending on its intensity and duration [28,49], and the results from our study are consistent with these findings. Due to repeated HPA axis activation, chronic physical stress may alter basal levels of HPA hormones [10,38,58]. Static training of high intensity increases resting cortisol, whereas static training of low intensity and long duration decreases resting cortisol [3,32] . ...
  • ... Some studies have documented the increase in plasma ACTH level during acute physical stress, followed by unchanged cortisol [26,47,84] while others have shown the increase of both ACTH and cortisol during dynamic and static physical stress, depending on its intensity and duration [28,41] , which is consistent with our findings . Our results also revealed higher plasma levels of ACTH and lower plasma levels of cortisol in athletes in basal conditions and during acute physical stress comparing to controls, and are in accordance to previous studies which demonstrated that chronic physical stress may alter basal levels of HPA hormones [8,33,50]. Static training of high intensity increases basal cortisol, whereas static training of low intensity and long duration decreases basal cortisol [3,29]. Intensive aerobic training increases basal levels of both ACTH [35] and cortisol [8,74] . ...
    Article
    Full-text available
    The usage of alcohol is widespread, but the effects of acute alcohol ingestion on exercise performance and the stress hormone axis are not fully elucidated.We studied 10 healthy white men, nonhabitual drinkers, by Doppler echocardiography at rest, spirometry, and maximal cardiopulmonary exercise test (CPET) in two visits (2-4 days in between), one after administration of 1.5 g/kg ethanol (whisky) diluted at 15% in water, and the other after administration of an equivalent volume of water. Plasma levels of NT-pro-BNP, cortisol, and adrenocorticotropic hormone (ACTH) were also measured 10 min before the test, at maximal effort and at the third minute of recovery. Ethanol concentration was measured from resting blood samples by gas chromatography and it increased from 0.00 ± 0.00 to 1.25 ± 0.54‰ (P < 0.001). Basal echocardiographic and spirometric parameters were normal and remained so after acute alcohol intake, whereas ACTH, cortisol, and NT-pro-BNP nonsignificantly increased in all phases of the test. CPET data suggested a trend toward a slight reduction of exercise performance (peak VO2 = 3008 ± 638 vs. 2900 ± 543 ml/min, ns; peak workload = 269 ± 53 vs. 249 ± 40 W, ns; test duration 13.7 ± 2.2 vs. 13.3 ± 1.7 min, ns; VE/VCO2 22.1 ± 1.4 vs. 23.3 ± 2.9, ns). Ventilatory equivalent for carbon dioxide at rest was higher after alcohol intake (28 ± 2.5 vs. 30.4 ± 3.2, P = 0.039) and maximal respiratory exchange ratio was lower after alcohol intake (1.17 ± 0.02 vs. 1.14 ± 0.04, P = 0.04). In conclusion, we showed that acute alcohol intake in healthy white men is associated with a nonsignificant exercise performance reduction and stress hormone stimulation, with an unchanged exercise metabolism.
  • ... Due to repeated HPA axis activation, chronic physical stress may alter basal levels of HPA hormones [10,38,58]. Static training of high intensity increases resting cortisol, whereas static training of low intensity and long duration decreases resting cortisol [3,32]. ...
    Article
    Full-text available
    Brain natriuretic peptide (NT-pro-BNP) was implicated in the regulation of hypothalamic-pituitary-adrenocortical (HPA) responses to psychological stressors. However, HPA axis activation in different physical stress models and its interface with NT-pro-BNP in the prediction of cardiopulmonary performance is unclear. Cardiopulmonary test on a treadmill was used to assess cardiopulmonary parameters in 16 elite male wrestlers (W), 21 water polo player (WP) and 20 sedentary age-matched subjects (C).Plasma levels of NT-pro-BNP, cortisol and adrenocorticotropic hormone (ACTH) were measured using immunoassay sandwich technique, radioimmunoassay and radioimmunometric techniques, respectively, 10min before test (1), at beginning (2), at maximal effort (3), at 3rd min of recovery (4). In all groups, NT-pro-BNP decreased between 1 and 2; increased from 2 to 3; remained unchanged until 4. ACTH increased from 1 to 4, whereas cortisol increased from 1 to 3 and stayed elevated at 4. In all groups together, ΔNT-pro-BNP2/1 predicted peak oxygen consumption (B=37.40, r=0.38, p=0.007); cortisol at 3 predicted heart rate increase between 2 and 3 (r=-0.38,B=-0.06, p=0.005); cortisol at 2 predicted peak carbon-dioxide output (B=2.27, r=0.35, p<0.001); ΔACTH3/2 predicted peak ventilatory equivalent for carbon-dioxide (B=0.03, r=0.33, p=0.003).The relation of cortisol at 1 with NT-pro-BNP at 1 and 3 was demonstrated using logistic function in all the participants together (for 1/cortisol at 1 B=63.40, 58.52; r=0.41, 0.34; p=0.003,0.013, respectively).ΔNT-pro-BNP2/1 linearly correlated with ΔACTH4/3 in WP and W (r=-0.45, -0.48; p=0.04, 0.04,respectively).These results demonstrate for the first time that HPA axis and NT-pro-BNP interface in physical stress probably contributing to integrative regulation of cardiopulmonary performance.
  • ... r traumatic stress seems to be associated with a blunting of the cortisol levels after awakening (Huber et al., 2006; Ginty and Conklin, 2011). In sport, Georgopoulos et al. (2011) demonstrated that both male and female elite artistic gymnasts' intensive exercise had a profound effect on salivary cortisol as reflected by the loss of diurnal rhythm. Gouarne et al. (2005) , who evaluated longitudinally a group of 10 triathletes , found a progressive CAR reduction during the 10-month study period in relation with overtraining syndrome. In addition , Bono et al. (2002) found a negative correlation between amount of training and cortisol levels after a 4- month training period. Besides modifications of cort ...
  • ... Between 6.30am, 7.00am, subjects rested in a supine position, and at 07:00, a second saliva sample (2 ml) was collected. Saliva concentrations of cortisol were measured by radioimmunoassay (Cortisol TKCO, Dade Behring, Paris, France) as previously described (Gouarne et al., 2005). Saliva samples were performed in duplicate and intra-assay and interassay coefficients of variation were <3%. ...
    Article
    Purpose: This study determined the impact of menstrual status on bone tissue in elite post-pubertal female soccer players over an entire season. Methods: Fifty-one elite female soccer players participated. At baseline, forty-one were assigned to the low hormonal androgenic profile (low-HAPL) and 10 to the high hormonal androgenic profile (high-HAPL). Results: An 8-month training program led to increased bone mineral density content (p<0.05). The low-HAPL athletes improved the Narrow neck average cortical thickness (ACT) by 1.4% and reduced the corresponding Buckling ratio (BR) by 2.6%, thus decreasing the fracture risk (p<0.05). The high-HAPL athletes decreased the Narrow neck ACT by 5.4% and increased the BR by 2.6%, increasing fracture risk (p<0.05). Differences were assigned as being “very likely beneficial” for the low-HAPL athletes, supported by very large (d=3.41) and large (d=1.58) effect sizes for the Narrow neck ACT and BR, respectively. Conclusion: A season of soccer training has induced bone geometry improvements in adolescent females. Bone health parameters improved in the two clusters. However, high-HAPL athletes decreased its resistance to loading compare to low-HAPL athletes. Even if female players do not present clinical symptoms related to their hormonal status, sport medicine physicians should pay attention to their structural bone fragility.
  • ... Some studies have documented the increase in plasma ACTH level during acute physical stress, followed by unchanged cortisol [26,47,84] while others have shown the increase of both ACTH and cortisol during dynamic and static physical stress, depending on its intensity and duration [28,41], which is consistent with our findings. Our results also revealed higher plasma levels of ACTH and lower plasma levels of cortisol in athletes in basal conditions and during acute physical stress comparing to controls, and are in accordance to previous studies which demonstrated that chronic physical stress may alter basal levels of HPA hormones [8,33,50]. Static training of high intensity increases basal cortisol, whereas static training of low intensity and long duration decreases basal cortisol [3,29]. Intensive aerobic training increases basal levels of both ACTH [35] and cortisol [8,74]. ...
  • ... According to Hill et al. [26], the exercise intensity necessary to provoke a significant increase in circulation cortisol is 60% maximum rate of oxygen consumption (VO 2max ), which shows an increase of + 39.9% in circulating cortisol levels. In general, untrained participants had lower VO 2max levels, significantly higher responses to cortisol post exercise, and lower hair-cortisol levels compared to participants who exercised regularly [27][28][29]. In regard to the chronic effects of exercise, it turned out that a higher training volume (measured in kilometers run per week) was associated with an increase in cortisol levels in young healthy men [29]. ...
    Article
    Full-text available
    Abstract Background: Latest research demonstrates a significant improvement in stress-related symptoms in psychological disorders as a result of exercise training (ET). Controlled clinical trials further validate the significance of ET by demonstrating lower salivary cortisol levels in patients with post-traumatic stress disorder (PTSD) after intervention. A significant change in cortisol and dehydroepiandrosterone (DHEA) levels can already be found after an 8–12-week ET program. The proposed study aims to investigate the impact of an 8-week ET on PTSD symptoms and changes in cortisol levels in a juvenile refugee sample from the Democratic Republic of the Congo (DRC) at an Ugandan refugee settlement. It is the first to implement an ET intervention in a resource-poor, post-conflict setting. Methods/design: In a randomized controlled trial, 198 adolescent participants aged 13–16 years from the DRC who, suffer from PTSD, will be investigated. The participants are based at the Nakivale refugee settlement, an official refugee camp in Uganda, Africa, which is among the largest in the world. The participants will be randomized into an Exercise Training (ET) group with a maximum heart rate (HRmax) of > 60%, an Alternative Intervention (AI) group with low-level exercises, and a Waiting-list Control (WC) group. After the 8-week interventional phase, changes in cortisol awakening response (CAR) and DHEA in the ET group that correspond to an improvement in PTSD symptoms are expected that remain at follow-up after 3 months. Discussion: To date, there is no controlled and reliable longitudinal study examining the effects of an ET program on symptom severity in individuals with PTSD that can be explained with a harmonization of cortisol secretion. The presented study design introduces an intervention that can be implemented with little expenditure. It aims to provide a promising low-threshold and cost-effective treatment approach for the application in resource-poor settings. Trial registration: German Trials Register, ID: DRKS00014280. Registered prospectively on 15 March 2018. Keywords: Post-traumatic stress disorder (PTSD), Exercise training, Juvenile refugees, Cortisol, Dehydroepiandrosterone (DHEA), Hypothalamic-pituitary-adrenal (HPA) axis
  • ... Exercise is one of the known stimulators of the HPA axis. Recognized factors that can affect the extent of HPA stimulation in relation to exercise include timing of prior meals, gender, ethnicity, body composition, and athletic fitness level [12][13][14][15][16]. Exercise of sufficient intensity and duration may produce a different response to HPA axis testing [17][18][19]. ...
  • ... According to Hill et al. [26], the exercise intensity necessary to provoke a significant increase in circulation cortisol is 60% maximum rate of oxygen consumption (VO 2max ), which shows an increase of + 39.9% in circulating cortisol levels. In general, untrained participants had lower VO 2max levels, significantly higher responses to cortisol post exercise, and lower hair-cortisol levels compared to participants who exercised regularly [27][28][29]. In regard to the chronic effects of exercise, it turned out that a higher training volume (measured in kilometers run per week) was associated with an increase in cortisol levels in young healthy men [29]. ...
    Article
    Full-text available
    Background: Latest research demonstrates a significant improvement in stress-related symptoms in psychological disorders as a result of exercise training (ET). Controlled clinical trials further validate the significance of ET by demonstrating lower salivary cortisol levels in patients with post-traumatic stress disorder (PTSD) after intervention. A significant change in cortisol and dehydroepiandrosterone (DHEA) levels can already be found after an 8-12-week ET program. The proposed study aims to investigate the impact of an 8-week ET on PTSD symptoms and changes in cortisol levels in a juvenile refugee sample from the Democratic Republic of the Congo (DRC) at an Ugandan refugee settlement. It is the first to implement an ET intervention in a resource-poor, post-conflict setting. Methods/design: In a randomized controlled trial, 198 adolescent participants aged 13-16 years from the DRC who, suffer from PTSD, will be investigated. The participants are based at the Nakivale refugee settlement, an official refugee camp in Uganda, Africa, which is among the largest in the world. The participants will be randomized into an Exercise Training (ET) group with a maximum heart rate (HRmax) of > 60%, an Alternative Intervention (AI) group with low-level exercises, and a Waiting-list Control (WC) group. After the 8-week interventional phase, changes in cortisol awakening response (CAR) and DHEA in the ET group that correspond to an improvement in PTSD symptoms are expected that remain at follow-up after 3 months. Discussion: To date, there is no controlled and reliable longitudinal study examining the effects of an ET program on symptom severity in individuals with PTSD that can be explained with a harmonization of cortisol secretion. The presented study design introduces an intervention that can be implemented with little expenditure. It aims to provide a promising low-threshold and cost-effective treatment approach for the application in resource-poor settings. Trial registration: German Trials Register, ID: DRKS00014280 . Registered prospectively on 15 March 2018.
  • ... 'Stress' has been assessed in urine through cortisol [298], testosterone [299], epitestosterone [300] and tetrahydrobiopterin (BH4) [240]. Steroidal compounds including natural and synthetic varieties are filtered through the glomerulus without any limitation. ...
    Article
    Full-text available
    Accurate monitoring of homeostatic perturbations following various psychophysiological stressors is essential in sports and exercise medicine. Various biomarkers are routinely used as monitoring tools in both clinical and elite sport settings. Blood collection and muscle biopsies, both invasive in nature, are considered the gold standard for the analysis of these biomarkers in exercise science. Exploring non-invasive methods of collecting and analysing biomarkers that are capable of providing accurate information regarding exercise-induced physiological and psychological stress is of obvious practical importance. This review describes the potential benefits, and the limitations, of using saliva and urine to ascertain biomarkers capable of identifying important stressors that are routinely encountered before, during, or after intense or unaccustomed exercise, competition, over-training, and inappropriate recovery. In particular, we focus on urinary and saliva biomarkers that have previously been used to monitor muscle damage, inflammation, cardiovascular stress, oxidative stress, hydration status, and brain distress. Evidence is provided from a range of empirical studies suggesting that urine and saliva are both capable of identifying various stressors. Although additional research regarding the efficacy of using urine and/or saliva to indicate the severity of exercise-induced psychophysiological stress is required, it is likely that these non-invasive biomarkers will represent "the future" in sports and exercise medicine.
  • ... Furthermore, exercise augmented exposure therapy for PTSD has been shown to improve symptoms and increase brain-derived neurotropic factor (BNDF), which modulates synaptic plasticity of the brain and has been associated with improved cognitive functions and abilities, such as learning and memory (Hides, Jull & Richardson, 2001). Cortisol responses to a dexamethasone suppression test in resting, endurance-trained participants are similar to responses from untrained participants (Duclos, Gouarne & Bonnemaison, 2016;Gouarne, Groussard, Gratas-Delamarche, Delamarche & Duclos, 2005). Moreover, endurance-trained athletes have similar resting HPA activity as untrained healthy men and exercise training does not induce hypercortisolism. ...
    Article
    Full-text available
    Objective: The hypoalgesic effect of acute bouts of exercise on healthy participants has been well documented across a variety of exercise modalities. However, the effects of a long-term exercise regimen on nociception is fairly unknown. Furthermore, it is unclear if exercise can be an effective treatment for disorders such as posttraumatic stress disorder, which can be characterized by hyperalgesia. The purpose of the current study is to investigate the effects of chronic exercise on thermal nociception before and after a traumatic stressor.Methods: Twenty-four C57/B6 mice were separated into two groups with 12 animals performing voluntary wheel running over a 5 week period. All mice were assessed weekly to determine the effects of chronic exercise or rest on thermal nociception. After 4 weeks, animals were further divided into 4 groups according to exercise and traumatic stress exposure. All mice were exposed to a 15 minute predator odor paradigm with “no stress” animals being exposed to ambient air and “stress” animals exposed to bobcat urine. All mice were tested 48 hours post exposure for changes in thermal nociception.Results: Findings from this study yield support that chronic, voluntary exercise decreases thermal nociception in mice over a 4-week period before a traumatic stressor and 48 hours after exposure to the stressor.Conclusion: In conclusion, voluntary, long-term exercise has been shown to elevate nociceptive thresholds, providing support for these exercise programs in the treatment of stress-induced hyperalgesia.
  • ... Habitual exercise leads to a blunting of the cortisol response that may reflect increased HPA resilience ( Heijnen et al., 2016). Endurance runners show a normalising of awakening cortisol levels following a rest day ( Gouarné et al., 2005), compared to chronic psychological stress where cortisol levels remain elevated ( Wüst et al., 2000). In one study, a 10-week exercise intervention combined with meta-chlorophenylpiperazine to exert neuroendocrine stress, resulted in a blunted cortisol response following the training period, compared to placebo ( Broocks et al., 2001). ...
    Article
    Full-text available
    Physical activity can treat and prevent depressive symptoms, but its antidepressant mechanisms are yet to be established. In this review, we comprehensively assess key biological and psychosocial mechanisms through which physical activity exerts antidepressant effects, with a particular focus on exercise. Exercise, a subset of physical activity, influences a range of biological and psychosocial processes also implicated in the pathophysiology of depression. We focus on the capacity for exercise to elicit changes in neuroplasticity, inflammation, oxidative stress, the endocrine system, self-esteem, social support and self-efficacy. We also discuss how a better understanding of these mechanisms can inform the way we design and implement exercise-based interventions to maximise their antidepressant effects on an individual basis. We conclude by presenting a conceptual framework of the key biological and psychosocial mechanisms underlying the relationship between physical activity and depressive symptoms, and the moderators and confounders that may influence it.
  • ... Whenever hormonal dysfunction causes the performance to deteriorate we cannot define an OTS condition; on the contrary, OTS can lead to dysfunctional hormones, as a result, [45] the diagnosis of OTS can only be made after exclusion of the much more common medical conditions of athletes. However, some preventive strategies such as training periodization, RPE monitoring, volume and intensity of training regulation, adequate caloric intake, hydration, sleep, and constant psychological monitoring, can be applied [45][46][47][48][49][50]. Overtraining is often associated with another disorder: The Exercise Addiction. ...
    Article
    Full-text available
    We are glad to introduce the seventeenth Journal Club. This edition is focused on several relevant studies published in the last years in the field of Overtraining and Exercise Addiction, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.
  • ... El análisis de sangre actualmente es el método más efectivo para diagnosticar OTS mediante la relación cortisol-testosterona (Kreher & Schwartz, 2012), aunque los análisis de orina también son válidos analizando el cortisol urinario nocturno (Gouarné, 2005). Otro método aplicable sería analizar la frecuencia cardiaca máxima en umbral de lactato (Meeusen et al., 2013). ...
    Thesis
    Full-text available
    El objetivo principal es analizar cómo afecta a nivel agudo una sesión fatigante de electroestimulación, mediante pruebas funcionales (equilibrio monopodal, propiocepción, fuerza máxima isometrica) utilizando instrumentos de análisis biomecánico (dinamómetro isocinético y plataformas de fuerza)
  • ... In the noradrenergic system, PA's neuroprotective effects stem from an adaptive response [145] wherein upregulated galanin expression hyperpolarizes noradrenergic neurons and thereby inhibits excessive norepinephrine release from the locus coeruleus [161][162][163][164]. Moreover, PA increases the conversion of cortisol to its inactivated form (cortisone) [165] to dampen an individual's reactivity to stress [166][167][168]. ...
    Article
    Full-text available
    Mood disorders (MDs) are chronic, recurrent mental diseases that affect millions of individuals worldwide. Although the biogenic amine model has provided some clinical utility, a need remains to better understand the interrelated mechanisms that contribute to neuroplasticity deficits in MDs and the means by which various therapeutics mitigate them. Of those therapeutics being investigated, physical activity (PA) has shown clear and consistent promise. Accordingly, the aims of this review are to (1) explicate key modulators, processes, and interactions that impinge upon multiple susceptibility points to effectuate neuroplasticity deficits in MDs; (2) explore the putative mechanisms by which PA mitigates these features; (3) review protocols used to induce the positive effects of PA in MDs; and (4) highlight implications for clinicians and researchers.
  • ... Many authors agree that OS is associated with the adaptability of hypothalamic axes, especially the hypothalamic-pituitary-adrenal axis. 22,23,24,25 However, tests such as those for morning serum cortisol and 24-hr urinary cortisol concentration do not provide important information regarding OS. 26,27 There is also a lack of consensus regarding tests involving catecholamines, including plasma catecholamine, or any other urinary measurement. 28 Measurement of salivary immunoglobulin A levels was also ineffective for diagnosing OS. ...
    Article
    Full-text available
    Overtraining syndrome (OTS) is a condition associated with diminished sports performance due to an increase in the volume and/or intensity of physical activity without adequate rest, and/or due to an inadequate diet. The condition often involves hormonal, nutritional, emotional, muscle, immune and neurological imbalances. Epidemiology varies considerably, affecting both sexes in different age groups. Diagnosis is still a challenge, as the syndrome resembles different diseases. The lack of specific symptoms requires a meticulous investigation in all athletes, which is often multidisciplinary. OTS can have an important repercussion on sports performance and on the quality of life of athletes. Methods: This is a mapping of scientific literature along the lines of the Systemic Review. The databases investigated were: MEDLINE and Latin American and Caribbean Health Sciences Literature – LILACS and EMBASE, in addition to printed documents. Studies describing OTS were included, prioritizing articles that report the efficacy of the different diagnostic methods, be they clinical, laboratory, or imaging. Results: We found 83 articles, of which 30 were selected. Conclusion: The only symptom present in all the different forms of manifestation of OTS is loss of performance. However, some tests assessing oxidative stress levels seem promising, even though they are not specific. Revision article.
  • ... These results suggest that initially (a) with exercise training there is an increased sensitivity to ACTH (explaining the increased cortisol response with lower ACTH levels in 2 weeks of exercise); however, sensitivity is restored with longer training periods (b). From Campbell et al. (2009a, b) groups (Gouarne et al., 2005). As it is during sleep that many anabolic processes occur, it is noteworthy that during this time, cortisol levels are not increased in endurance-trained athletes. ...
    Chapter
    The body’s main stress axis, the hypothalamic-pituitary–adrenal (HPA) axis, has profound effects on growth and immune function that can impact health well into adulthood. In the short term, elevations in cortisol, the main stress hormone in humans, promote a catabolic state to allow for short-term defense against stressors that may be psychological or physiological in nature. In the long term, however, elevations in glucocorticoids from either endogenous or exogenous sources promote reductions in bone mass, bone density, stature, muscle mass, and an increase in central adipose gain in children and adolescents. These deleterious effects can also set the stage for numerous chronic diseases. Exercise is a potent activator of the HPA axis in humans and in rodents, yet regular exercise is not associated with chronic elevations in circulating GCs or the detrimental effects of elevated GCs, likely because of several adaptations to the HPA axis. In some cases of excessive exercise and overtraining, the detrimental effects of chronic elevations in GC levels that impact normal growth can be observed. The cellular, molecular, and physiological interactions of exercise, stress, and immune function in the context of normal and abnormal growth are highlighted in this chapter.
  • ... 16 In addition, triathletes have demonstrated alterations in CAR in response to a full season of training, with CAR emerging as a potential marker for monitoring training status. 17 With the above points in mind, the purpose of this study was to assess whether training loads observed during regularly scheduled training periods (ie, not during periods of overload or overtraining) in endurance athletes were associated with CAR on the following morning. ...
    Article
    Full-text available
    Purpose: Therefore, the purpose of this study was to assess the relationship between training load and CAR. Methods: Recreational endurance athletes were recruited from local club running groups. Subjects (n = 15) completed training logs for two weeks, with various training loads, including psychometric analysis (RESTQ-Sport). Subjects provided saliva samples each day immediately after waking ([C0]) and 30 mins post-waking ([C30]). Samples were analyzed for cortisol concentration via ELISA and subsequently analyzed for CAR and CAR%. Daily training load was calculated and analyzed as training impulse (TRIMP). Simple linear regression was used to assess the relationship between CAR and TRIMP. Results: CAR (r2= 0.352, p = 0.025) and CAR% (r2= 0.373, p = 0.012) both showed a significant negative relationship with training load. Conclusions: These results suggest that CAR is affected by regular exercise training loads in recreational athletes. It is recommend that future CAR research control for fitness level and exercise training load in physically active populations.
  • ... Part of these changes can be understood in terms of their direct metabolic consequences, and both physical and psychological factors seem to play a role as causal factors (1). Although physical exercises are beneficial to health, such activities can generate harmful effects in both men (3) and women (4), a situation that is aggravated by excessive physical exercise (5,6). However, it is not fully known how the beneficial health and fitness-related effects of exercise come to end, subsequently becoming harmful to the human body. ...
    Article
    Full-text available
    Objective: The testosterone:cortisol ratio (T:C) is suggested to be used in order to examine whether physical exercise generates either a "catabolic environment" or an "anabolic environment". The present study aims to evaluate the acute time-course profile of cortisol and testosterone due to an episode of physical exercise. A biphasic profile in the T:C ratio response was hypothesized. Materials and methods: Morning sessions of treadmill running at two different intensities (Heart Rate at 65% and 80% of the maximum cardiac reserve) were performed by 6 male non-runners (NR) and 12 trained male runners (subdivided into trained runners T1 and T2). Cortisol and testosterone were measured in saliva. NR and T1 ran for 30 minutes at both intensities, and T2 ran for 46 minutes (± 4.1) at 65% and 42 minutes (± 3.5) at 80%. Results: In the 80% heart rate target, both groups of runners showed the biphasic time-profile, while the non-runners group did not. However, at the 65% level, none of the groups presented the hypothesized biphasic response. Conclusions: A biphasic time-profile in the testosterone:cortisol ratio can be seen in short-bout, high intensity exercise (treadmill running) during the morning in men trained for this specific physical activity.
  • Article
    Full-text available
    Aim: Different studies find that hormonal profile specifically varies depending on the type of exercise and its magnitude. Mood state has been studied using different tools in relation to training load, the most used one is POMS (Profile of Mood States) questionnaire. This research studies the response of total testosterone (TT), cortisol (C) and total testosterone-to-cortisol ratio (RTTC) in relation to mood state (POMS subscales) in a professional basketball team during a season. Methods: Blood samples were taken every 4-6 weeks (7 samples), at 8:00-9:00 AM, in fasting state and after 24 to 36 hours post-game, on a professional basketball team of the Spanish 1st Division (n=10; 26.0 ± 4.6 years; 90.9 ± 9.7 kg; 195.7 ± 8.4 cm; BMI 23.7 ± 1.2; 13.1 ± 2.2% fat). Results: We obtained a significant increase in TT and C in September -2nd sample- compared to august -1st sample- (TT: +2.8 nMol·L- 1, p=0.030; C: +0.093 μMol·L-1, p=0.040). No significant changes were observed in any of the POMS subscales, and in the correlation between subscales analysis, and no correlation coefficient greater than 0.7 was obtained among subscales and hormonal variables. Conclusions: No relationship was found between the studied hormonal variables and the POMS subscales. We consider the POMS questionnaire an inadequate tool to evaluate the athletes recovery state, but a really good one to control the psychological stress level.
  • Article
    Full-text available
    Nowadays, in elite basketball, the high demands of competition and training require a detailed follow-up of the effects on the player's performance and health. Controlling these effects could improve the knowledge about the players' recovery process and allow a better design of their individual workloads. Aim: To describe the behavior of the total testosterone serum levels (T), Cortisol (C) and T/C ratio. Methodology: 8 blood samples were collected during the whole season of an elite basketball team (n=8) of the First Spanish Division (ACB). The samples were taken every 4-6 weeks, at 8:00 AM, after 24-36 hours of post-game recovery. Results: T decreases significantly at the end of the season in concentration values, 8th vs. 2nd (-4.4 nMol/1, p=0.010), 8th vs 3rd (-49 .,Mol/1, p=0.004) and S* vs. 6th (-6.8 nMol/1, p=0.013), as well as in percentage (%) of variation, 8th vs. 2nd (-0.221%, p=0.034), 8th vs. 3rd (-0.239, p=0.010). C and T/C ratio do not show significant variations along the season. Conclusions: Concentration values as well as percentages of variation are useful indicators to describe the studied parameters. T could be used as a recovery state indicator and could even induce, in conjunction with other indicators, necessary actions to optimize individual workloads. Future investigations should compare these variations to objective workload parameters and/or other hormonal modulators.
  • Article
    Objectives: Despite considerable knowledge regarding the importance of stress in coronary artery disease (CAD) pathogenesis, its underestimation persists in routine clinical practice, in part attributable to lack of a standardized, objective assessment. The current study examined the ability of stress hormones to predict CAD severity and prognosis at basal conditions as well as during and following an exertional stimulus. Materials and methods: Forty Caucasian subjects with significant coronary artery lesions (≥50%) were included. Within 2 months of coronary angiography, cardiopulmonary exercise testing (CPET) on a recumbent ergometer was performed in conjunction with stress echocardiography (SE). At rest, peak and after 3 min of recovery following CPET, plasma levels of cortisol, adrenocorticotropic hormone (ACTH) and NT-pro-brain natriuretic peptide (NT-pro-BNP) were measured by immunoassay sandwich technique, radioimmunoassay, and radioimmunometric technique, respectively. Subjects were subsequently followed a mean of 32 ± 10 months. Results and discussion: Mean ejection fraction was 56.7 ± 9.6%. Subjects with 1-2 stenotic coronary arteries (SCA) demonstrated a significantly lower plasma cortisol levels during CPET compared to those with 3-SCA (p < .05), whereas ACTH and NT-pro-BNP were not significantly different (p > .05). Among CPET, SE, and hormonal parameters, cortisol at rest and during CPET recovery demonstrated the best predictive value in distinguishing between 1-, 2-, and 3-SCA [area under ROC curve 0.75 and 0.77 (SE = 0.11, 0.10; p = .043, .04) for rest and recovery, respectively]. ΔCortisol peak/rest predicted cumulative cardiac events (area under ROC curve 0.75, SE = 0.10, p = .049). Conclusions: Cortisol at rest and following an exercise test holds predictive value for CAD severity and prognosis, further demonstrating a link between stress and unwanted cardiac events.
  • Article
    Full-text available
    Aim. This study correlated the base concentrations of testosterone, cortisol, and T/C ratio with the speed endurance performance (SE) of swimmers during a 15-week training season (M0-M15). Methods. An assessment of the base concentration of hormones (M0, M2, M4, M9, and M12) and SE performance (M2, M 4, M9 e M12) of eight swimmers was performed. Testing consisted of 4 x 50 m crawl-style swimming, at 10 seconds intervals, where the time for each partial (CT1, CT2, CT3, and CT4) and the mean completion time (MCT) were recorded. Results. The mean values found at all of the evaluated moments were 591.42±131.69 nmol/L for cortisol, 16.66 nmol/L for testosterone, and 0.029 for T/C. Significant correlation between cortisol and MCT (r = - 0.39 and P=0.026), between testosterone and CT1 (r = - 0.48 and p = 0.005) and CT 2 (r = - 0.36 and P=0.04), between cortisol and CT4 (r =-0.46 and P=0.007), and between T/C and CT1 (r=-0.47 and P=0.007) were found. Higher base concentrations of testosterone and cortisol were favorable to SE performance. Conclusion. Despite cortisol being a catabolism-associated hormone, higher base concentrations of cortisol were not found to be harmful to athletes when there was a positive T/C ratio.
  • Chapter
    In diesem Kapitel wird dargestellt, unter welchen Symptomen Betroffene mit einer Depressionen, einem Burnout oder einer Angsterkrankung leiden. Die Störungsbilder gehen häufig mit einer Einschränkung im Aktionsradius und im Verhaltensrepertoire einher und führen zu erheblichem Leiden bei den Betroffenen.
  • Article
    Full-text available
    Although the sport of triathlon provides an opportunity to research the effect of multi-disciplinary exercise on health across the lifespan, much remains to be done. The literature has failed to consistently or adequately report subject age group, sex, ability level, and/or event-distance specialization. The demands of training and racing are relatively unquantified. Multiple definitions and reporting methods for injury and illness have been implemented. In general, risk factors for maladaptation have not been well-described. The data thus far collected indicate that the sport of triathlon is relatively safe for the well-prepared, well-supplied athlete. Most injuries ‘causing cessation or reduction of training or seeking of medical aid’ are not serious. However, as the extent to which they recur may be high and is undocumented, injury outcome is unclear. The sudden death rate for competition is 1.5 (0.9–2.5) [mostly swim-related] occurrences for every 100,000 participations. The sudden death rate is unknown for training, although stroke risk may be increased, in the long-term, in genetically susceptible athletes. During heavy training and up to 5 days post-competition, host protection against pathogens may also be compromised. The incidence of illness seems low, but its outcome is unclear. More prospective investigation of the immunological, oxidative stress-related and cardiovascular effects of triathlon training and competition is warranted. Training diaries may prove to be a promising method of monitoring negative adaptation and its potential risk factors. More longitudinal, medical-tent-based studies of the aetiology and treatment demands of race-related injury and illness are needed.
  • Article
    Overtraining syndrome (OTS) is a major threat for performance and health in athletes. OTS is caused by high levels of (sport-specific) stress in combination with too little regeneration, which causes performance decrements, fatigue an possibly other symptoms. Although there is general consensus about the causes and consequences, many different terminologies have been used interchangeably. The consequences of overreaching and overtraining are divided into three categories: (i) functional overreaching (FO); (ii) non-functional overreaching (NFO); and (iii) OTS. In FO, performance decrements and fatigue are reversed within a pre-planned recovery period. FO has no negative consequences for the athlete in the long term; it might even have positive consequences. When performance does not improve and feelings of fatigue do not disappear after the recovery period, overreaching has not been functional and is thus called NFO. OTS only applies to the most severe cases. NFO and OTS could be prevented using early markers, which should be objective, not manipulable, applicable in training practice, not too demanding, affordable and should be based on a sound theoretical framework. No such markers exist up to today. It is proposed that psychomotor speed might be such a marker. OTS shows similarities with chronic fatigue syndrome and with major depression (MD). Through two meta-analyses, it is shown that psychomotor slowness is consistently present in both syndromes. This leads to the hypothesis that psychomotor speed is also reduced in athletes with OTS. Parallels between commonly used models for NFO and OTS and a threshold theory support the idea that psychomotor speed is impaired in athletes with NFO or OTS and could also be used as an early marker to prevent NFO and/or OTS.
  • Thesis
    Contexte : Le syndrome de surentraînement (OTS) est défini comme une diminution persistante des performances sportives malgré une diminution de la charge d'entraînement pendant au moins deux semaines. La physiopathologie n'est pas claire malgré l'élaboration de nombreuses hypothèses. Il n'existe aucun examen biologique permettant de faire le diagnostique qui est avant tout clinique, avec l'utilisation du questionnaire de la Société Française de Médecine de l'Exercice et du Sport (SFMES). L'anxiété n'est pas une donnée prise en compte dans le diagnostique de l'OTS.Matériel et méthodes : Notre étude porte sur 100 sportifs de niveau hétérogène et consiste au remplissage du questionnaire de la SFMES et du State Trait Anxiety Inventory (STAI) pour évaluer le niveau d'anxiété. Le recueil s'est déroulé sur une année au sein de type de sport différent.Résultats : 9% des sportifs présentent un OTS dont deux sportifs loisir et aucun sportif de hautniveau, les sportifs présentent une anxiété trait « moyenne » et une anxiété Etat «élevé ». Nous trouvons une corrélation entre le score du questionnaire de la SFMES et le STAI (p#lt#0.0001). Les sujets présentant un OTS ont une anxiété Trait plus élevée que les sujets sains (p#lt#0.0001)Conclusion : L'OTS concerne les sportifs de tout niveau et l'anxiété peut être considérée comme un facteur de risque de survenue d'un OTS. L'utilisation du questionnaire de la SFMES est un excellent outil de dépistage en cabinet de Médecine Générale
  • Hormonal following of athletes In: Fight against Doping with Physical Recovery Managing. Publications of The University of Saint-Etienne
    • And M Duclos
    CHATARD, J. C., AND DUCLOS. M. Hormonal following of athletes. In: Fight against Doping with Physical Recovery Managing. Publications of The University of Saint-Etienne. 2003, pp. 129-135.
  • Hormonal secretion during nighttime sleep indicating stress of daytime exercise Salivary cortisol in psychoneuroendocrine research: recent developments and applications
    • B Perras
    • R Wodick
    • H L Fehm
    • J Born
    KERN, W., B. PERRAS, R. WODICK, H. L. FEHM, and J. BORN. Hormonal secretion during nighttime sleep indicating stress of daytime exercise. J. Appl. Physiol. 79:1461-1468, 1995. 17. KIRSCHBAUM, C., and D. H. HELLHAMMER. Salivary cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology 19:313-333, 1994.
  • Hormonal following of athletes
    • J C Chatard
    • M Duclos
    CHATARD, J. C., AND DUCLOS. M. Hormonal following of athletes. In: Fight against Doping with Physical Recovery Managing. Publications of The University of Saint-Etienne. 2003, pp. 129 -135.
  • Hypothalamo-pituitary-adrenal axis adaptation to repeated and prolonged exercise-induced cortisol secretion in endurance training: physiology is the first target
    • M Duclos
    DUCLOS, M. Hypothalamo-pituitary-adrenal axis adaptation to repeated and prolonged exercise-induced cortisol secretion in endurance training: physiology is the first target. In: Focus on Exercise and Health Research. (in press).
  • Article
    11β-hydroxysteroid dehydrogenases (11β-HSDs) catalyze the interconversion of active glucocorticoids (cortisol, corticosterone) and inert 11-keto forms (cortisone, 11-dehydrocorticosterone). 11β-HSD type 2 has a well recognized function as a potent dehydrogenase that rapidly inactivates glucocorticoids, thus allowing aldosterone selective access to otherwise nonselective mineralocorticoid receptors in the distal nephron. In contrast, the function of 11β-HSD type 1 has, until recently, been little understood. 11β-HSD1 is an ostensibly reversible oxidoreductase in vitro, which is expressed in liver, adipose tissue, brain, lung, and other glucocorticoid target tissues. However, increasing data suggest that 11β-HSD1 acts as a predominant 11β-reductase in many intact cells, whole organs, and in vivo. This reaction direction locally regenerates active glucocorticoids within expressing cells, exploiting the substantial circulating levels of inert 11-keto steroids. While the biochemical determinants of the reactio...
  • Article
    The multitude of publications regarding overtraining syndrome (OTS or ‘staleness’) or the short-term ‘over-reaching’ and the severity of consequences for the athlete are in sharp contrast with the limited availability of valid diagnostic tools. Ergometric tests may reveal a decrement in sport-specific performance if they are maximal tests until exhaustion. Overtrained athletes usually present an impaired anaerobic lactacid performance and a reduced time-to-exhaustion in standardised high-intensity endurance exercise accompanied by a small decrease in the maximum heart rate. Lactate levels are also slightly lowered during submaximal performance and this results in a slightly increased anaerobic threshold. A reduced respiratory exchange ratio during exercise still deserves further investigation. A deterioration of the mood state and typical subjective complaints (‘heavy legs’, sleep disorders) represent sensitive markers, however, they may be manipulated. Although measurements at rest of selected blood markers such as urea, uric acid, ammonia, enzymes (creatine kinase activity) or hormones including the ratio between (free) serum testosterone and cortisol, may serve to reveal circumstances which, for the long term, impair the exercise performance, they are not useful in the diagnosis of established OTS. The nocturnal urinary catecholamine excretion and the decrease in the maximum exercise-induced rise in pituitary hormones, especially adrenocorticotropic hormone and growth hormone, and, to a lesser degree, in cortisol and free plasma catecholamines, often provide interesting diagnostic information, but hormone measurements are less suitable in practical application. From a critical review of the existing overtraining research it must be concluded that there has been little improvement in recent years in the tools available for the diagnosis of OTS.
  • Article
    The assessment of cortisol in saliva has proven a valid and reliable reflection of the respective unbound hormone in blood. To date, assessment of cortisol in saliva is a widely accepted and frequently employed method in psychoneuroendocrinology. Due to several advantages over blood cortisol analyses (e.g., stress-free sampling, laboratory independence, lower costs) saliva cortisol assessment can be the method of choice in basic research and clinical environments. The determination of cortisol in saliva can facilitate stress studies including newborns and infants and replace blood sampling for diagnostic endocrine tests like the dexamethasone suppression test. The present paper provides an up-to-date overview of recent methodological developments, novel applications as well as a discussion of possible future applications of salivary cortisol determination.
  • Article
    The salivary cortisol concentration is an excellent indicator of the plasma free cortisol concentration. To establish its normal and pathological ranges, salivary cortisol concentrations were measured in 101 normal adults, 18 patients with Cushing's syndrome, and 21 patients with adrenal insufficiency. The normal subjects had a mean (+/- SEM) salivary cortisol concentration of 15.5 +/- 0.8 nmol/L (range, 10.2-27.3) at 0800 h and 3.9 +/- 0.2 nmol/L (range, 2.2-4.1) at 2000 h (n = 20). The mean value 60 min after ACTH administration in 58 normal subjects was 52.2 +/- 2.2 nmol/L (range, 23.5-99.4), and it was 1.4 +/- 1.1 nmol/L (range, 1.6-3) at 0800 h in 23 normal subjects given 1 mg dexamethasone 8 h earlier. In patients with primary or secondary adrenal insufficiency (n = 21) the mean salivary cortisol level was 7.5 +/- 0.4 nmol/L (range, 1.9-21.8) 60 min after ACTH. In patients with Cushing's syndrome (n = 7), the mean value after the 1-mg dexamethasone suppression test was 16.1 +/- 7.8 nmol/L (range, 5.8-66.8). No overlap was found between the values in the normal subjects and those in the patients during the dynamic tests. Discrepancies between salivary and total plasma cortisol were found in 8 patients with adrenal insufficiency, which may be explained by the effects of drugs such as thyroid hormones, Op'-dichlorodiphenyldichloroethane, and psychotropic agents. We conclude that salivary cortisol measurements are an excellent index of plasma free cortisol concentrations. They circumvent the physiological, pathological, and pharmacological changes due to corticosteroid-binding globulin alterations and offer a practical approach to assess pituitary-adrenal function.
  • Article
    Some athletes who undertake strenuous training programs for a prolonged period of time develop the overtraining syndrome. The pathophysiology of the condition is unknown. Hypothalamic-pituitary function was studied by determining the hormonal responses to insulin-induced hypoglycemia in five asymptomatic male marathon runners during a 4-month period in which they ran 42-, 56-, and 92-km races and in four overtrained male athletes. The response of the asymptomatic runners was not different when tested 1 month before and within 48 h after the 42- and 92-km races. All four overtrained athletes presented with impaired training and racing times, apathy, and a heavy-legged feeling and were tested when overtrained and again after 4 weeks of rest. The plasma cortisol, ACTH, GH, and PRL responses to insulin-induced hypoglycemia in the four overtrained athletes were lower than their responses after the rest and lower than the responses of the asymptomatic runners. In both groups, the LH, TSH, and PRL responses to LHRH and TRH were normal. The impaired hormonal responses to insulin-induced hypoglycemia, with recovery after 4 weeks of rest, indicate hypothalamic dysfunction and may be a diagnostic marker of the overtraining syndrome.
  • Article
    We examined the catecholamine excretion and its performance-diagnostic relevance in athletes of the German National Team during ski-flying and cross-country skiing. Five athletes were examined during the 1986 World Championship ski-flying competition and eight athletes during a 24-km cross-country qualification test. There is little doubt that the special competitive conditions have considerable influence on the usefulness of these data. We decided to publish the results anyway since the results may expand our knowledge about the performance-diagnostic relevance of catecholamine excretion under competitive conditions. During cross-country skiing, the average noradrenaline elimination (1166 pmol·min⁻¹) was about 150% higher and the average adrenaline elimination (243 pmol·min⁻¹) about 30% lower than during ski-flying. The noradrenaline-adrenaline ratio was about 4.8 in cross-country skiing and 1.3-1.5 in ski-flying. Catecholamine excretion does, as expected, therefore permit differentiation of the various strains on the organism. The impression with respect to performance-diagnostic relevance arises that successful athletes show a more stable and lower excretion of noradrenaline under competitive conditions. This can only be a preliminary statement; it should serve to stimulate discussion and further investigations of the problem.
  • A low hemoglobin level or even frank anemia is common among female endurance runners; controversy presently exists on the effectiveness of iron supplementation. In the past inadequate descriptions of training and too infrequent measurement of iron indices over a sufficiently long period, have made it difficult to establish any relationship between iron status and training upon which to base a rational iron therapy. In this study 5 young women distance runners age 18-25 years have been studied for 300 days. A numerical index was used to quantify the extent of an individual's daily training effort and a conceptual model of the effect of training allowed definition of the extent of consequent fatigue, to be calculated. Red blood cell number and hemoglobin concentration were measured regularly throughout, and during the last 200 days serum iron, ferritin, total iron binding capacity and percent transferrin saturation were also measured. It has been shown in most subjects that serum iron and transferrin saturation varied in phase with training and the fatigue index, throughout the period while serum ferritin varied out of phase. It is suggested that supplementing iron intake may be of little use during heavy training and concomitant high fatigue because transferrin saturation is also very high at this time and ineffective in promoting absorption of dietary iron.
  • Article
    1. Skinfold thickness and body density were measured on 105 young adult men and women and 86 adolescent boys and girls.2. The correlation coefficients between the skinfold thicknesses, either single or multiple, and density were in the region of −0.80.3. Regression equations were calculated to predict body fat from skinfolds with an error of about ±3.5%.4. A table gives the percentage of the body-weight as fat from the measurement of skin-fold thickness.
  • Article
    To investigate whether measurements of cortisol responses to exercise are confounded by neglect of the hormone's circadian rhythm, we measured the serum and salivary cortisol responses of eight women to 40 min of 70% maximal oxygen consumption treadmill exercise beginning at 0800 and 2000. Responses were calculated relative to the usually employed preexercise concentrations and also to concentrations at the same times of another day while subjects were at rest. Compared with areas under response curves (AUCs) calculated relative to their circadian baselines, AUCs for serum and salivary cortisol calculated by reference to preexercise concentrations were underestimated (serum, P < 0.001; salivary, P < 0.01) by 93 and 84% in the morning and by 37 and 35% in the evening, respectively. Calculated by the usual preexercise baseline method, rises in serum and salivary cortisol were similarly underestimated. More accurately calculated relative to their circadian baselines, serum and salivary cortisol AUCs were similar (P = 0.63 and P = 0.37, respectively) in the morning and evening, as were their rises (P = 0.23 and P = 0.70, respectively). In future investigations of the existence and magnitude of cortisol responses, those responses must be calculated relative to the hormone's circadian baseline.
  • Article
    In an accompanying study, we reported a very poor correlation between the magnitude of a continuous cortisol infusion in dexamethasone-suppressed adults and the resultant steady state plasma cortisol concentration (r2 = 0.13). The concentration of corticosteroid-binding globulin (CBG) was found to explain an additional 39% of the variance in cortisol response. We hypothesized that CBG might act by altering kinetic parameters of cortisol transport. According, the rate of cortisol disappearance (Kd), volume of distribution (V), and pool size (P) were determined after bolus injection of a stable isotope of cortisol in two groups of healthy female subjects with both normal and elevated CBG concentrations. The bolus studies were performed during continuous cortisol infusion and steady state conditions of plasma cortisol concentration. Two models were used to generate the kinetic parameters. The kinetic parameters thus generated were able to predict the known cortisol infusion rate with 4-16% error. The goodness of fit of modeled to experimental data was excellent in all cases (> 0.93). In both models, Kd had a negative correlation to the CBG concentration (P < 0.05), a negative correlation to the volume of distribution (P < 0.03), and a positive correlation (P < 0.03) to pool size. Excellent correlations were noted between both models in estimates of kinetic parameters (r2 = 0.82-0.97; P < 0.01). We conclude that CBG, in addition to its role of transport protein, plays an active role in determining the disposition of cortisol in humans.
  • Article
    Few data are available on the reliability of measurements of adrenocortical and corticotroph hormones for use in clinical pharmacology. Two placebo controlled cross-over trials in 20 normal healthy male subjects offered the opportunity to perform three repeat samplings of adrenocortical and corticotroph hormones at 1 to 5 week intervals during the placebo periods. Measurements of baseline levels of plasma, salivary and urinary cortisol, plasma adrenocorticotroph hormone (ACTH), lipotrophic hormone (LPH), beta-endorphin, post tetracosactrin levels of plasma and salivary cortisol, post corticotrophin releasing hormone (CRH)-lysine vasopressine (LVP) levels of plasma cortisol, ACTH and LPH; and post metyrapone levels of plasma cortisol and 11-deoxycortisol (compound S), ACTH, LPH, beta-endorphin were performed in the same laboratory. The reliability of the measurements was estimated by computing the intraclass correlation coefficient (R) and by using Altman-Bland graphical method. The Rs of baseline parameters varied from 0.18 (for 08.00 h salivary cortisol) to 0.55 (for 08.00 h plasma cortisol and nocturnal urinary cortisol). In contrast, parameters obtained after direct stimulation or inhibition of the producing targets were much more reliable: Rs were above 0.80 for post tetracosactrin levels of plasma and salivary cortisol, post CRH-LVP levels of plasma ACTH and LPH. The Rs were below 0.50 for post metyrapone levels of plasma 11-deoxycortisol, ACTH, LPH and beta-endorphin. The interval between sampling did not affect R estimates. These data show that peak levels of plasma cortisol and ACTH after direct stimulation are highly reliable whereas baseline and main post-metyrapone levels are not.(ABSTRACT TRUNCATED AT 250 WORDS)
  • Catecholamines in plasma may be measured to assess sympathoadrenal activity. Numerous assay methodologies have been published, illustrating the fact that there are many analytical problems. Different methodologies are discussed briefly. A plea for better validation, especially with regard to specificity (which should not be confused with sensitivity or reproducibility), is made. Plasma NA is a frequently used marker for sympathetic nerve activity in humans, but the data obtained are often misinterpreted due to lack of appreciation of the physiological determinants of the NA concentration measured. NA overflow from an organ gives a good reflection of nerve activity in that organ. However, sympathetic nerve activity is highly differentiated, particularly during stress, and conventional plasma NA levels (usually forearm venous samples) cannot be taken as an indication of 'sympathetic tone' in the whole individual. NA is rapidly removed from plasma, resulting in meaningless net veno-arterial concentration differences over organs unless its removal from arterial plasma is taken into account. In the forearm, for example, 40-50% of catecholamines are removed during one passage; about half of the NA in a venous sample is derived from the arm and half from the rest of the body. Therefore, conventional venous sampling overemphasizes local (mainly skeletal muscle) nerve activity. Whole-body sympathetic nerve activity may be monitored in arterial or mixed venous (i.e. pulmonary arterial) samples, which reflect NA overflow from all organs in the body. NA levels are determined both by overflow to plasma and clearance from plasma. NA turnover studies with 3H-NA infusions may be needed to assess clearance, but the simpler concentration measurements usually yield adequate information if the sampling site is relevant. NA overflow from an organ can be assessed (using 3H-NA or ADR as a marker for NA extraction in the organ) and provides valuable information on local sympathetic activity. Mental stress elicits marked circulatory responses, with mainly cardiorenal sympathetic activation and minor elevations of conventional venous plasma NA levels, thus illustrating the differentiated firing pattern of the sympathetic nerves. Circulating ADR is less important than neurogenic mechanisms in the responses to stress. Concentration-effect studies for infused catecholamines may be used for receptor sensitivity studies in vivo, but reflexogenic contributions to responses need to be determined. However, prejunctional mechanisms cannot be assessed without knowledge of the nerve activity present; for example, ADR infusion leads to increased nerve activity. When correctly sampled, measured and interpreted, plasma catecholamines can yield very valuable information on sympathoadrenal activity.
  • Article
    We tested the hypothesis that long-duration exercise (LDE) of moderate intensity, but not LDE of low intensity, during the daytime changes the typical temporal patterns of hormone release during subsequent nocturnal sleep. Ten trained healthy men participated in a balanced crossover study including three conditions: 1) no exercise, 2) LDE of low intensity (biking 40 km; 1800-2030), and 3) LDE of moderate intensity (biking 120-150 km; 1600-2030). During the subsequent night (2300-0700), somnopolygraphic sleep recordings were obtained, and concentrations of cortisol, growth hormone (GH), and testosterone were measured every 15 min. During the no exercise nights, the typical secretory patterns were present with peak concentrations of GH but nadir concentrations of cortisol during the first half of sleep but increased cortisol levels and minimum GH levels during the second part of sleep. Testosterone concentrations increased during the second half of sleep. LDE of moderate intensity reduced rapid-eye-movement sleep [13.9 vs. 16.9% (no exercise); P < 0.01]. Levels of testosterone decreased with increasing intensity of daytime exercise (P < 0.05). Moderate-, but not low-intensity, LDE decreased GH levels in the first half (P < 0.05) and increased GH levels in the second half (P < 0.005) of sleep. Also, LDE of moderate intensity but not LDE of low intensity increased cortisol levels during the first half (P < 0.005) and decreased cortisol secretion during the second half (P < 0.05) of sleep. Results suggest that nocturnal profiles of GH and cortisol concentrations may serve to indicate the disturbance of normal anabolic functions of sleep due to daytime exercise.
  • Article
    Full-text available
    To determine the efficacy of cortisol and its metabolite, cortisone, measured simultaneously by high performance liquid chromatography (HPLC) in the diagnosis of Cushing's syndrome, we retrospectively reviewed the histories of 29 surgically proven Cushing's syndrome patients (20 Cushing's disease, 5 ectopic ACTH syndrome, and 4 adrenal Cushing's syndrome) and 6 patients with exogenous Cushing's syndrome. These 35 patients had urinary free cortisol determined by both HPLC and competitive binding methods. The efficacy of the HPLC assay using cortisol alone was equivalent to that of the competitive binding assay; 22 of 29 (76%) patients had increased cortisol. Cortisone also aided in the diagnosis; 25 of 29 (86%) had increased cortisone. Twenty-seven of the 29 (93%) patients had either both cortisone and cortisol (n = 19) or at least 1 of the 2 (n = 8) increased. All 6 patients with exogenous Cushing's syndrome had suppressed urinary free cortisol, cortisone, and the presence of prednisone and prednisolone. In the competitive binding assay, all exogenous Cushing's patients had falsely increased cortisol results. In conclusion, urinary free cortisol plus cortisone determined simultaneously by HPLC added a new dimension to the diagnosis of Cushing's syndrome. It should be considered when exogenous Cushing's syndrome is suspected or when only one urinary cortisol test is allowed to be ordered.
  • Article
    Full-text available
    Overtraining can be defined as "training-competition > > recovery imbalance", that is assumed to result in glycogen deficit, catabolic > anabolic imbalance, neuroendocrine imbalance, amino acid imbalance, and autonomic imbalance. Additional non-training stress factors and monotony of training exacerbate the risk of a resulting overtraining syndrome. Short-term overtraining called overreaching which can be seen as a normal part of athletic training, must be distinguished from long-term overtraining that can lead to a state described as burnout, staleness or overtraining syndrome. Persistent performance incompetence, persistent high fatigue ratings, altered mood state, increased rate of infections, and suppressed reproductive function have been described as key findings in overtraining syndrome. An increased risk of overtraining syndrome may be expected around 3 weeks of intensified/prolonged endurance training at a high training load level. Heavy training loads may apparently be tolerated for extensive periods of time if athletes take a rest day every week and use alternating hard and easy days of training. Persistent performance incompetence and high fatigue ratings may depend on impaired or inhibited transmission of ergotropic (catabolic) signals to target organs, such as: (I) decreased neuromuscular excitability, (II) inhibition of alpha-motoneuron activity (hypothetic), (III) decreased adrenal sensitivity to ACTH (cortisol release) and increased pituitary sensitivity to GHRH (GH release) resulting in a counter-regulatory shift to a more anabolic endocrine responsibility, (IV) decreased beta-adrenoreceptor density (sensitivity to catecholamines), (V) decreased intrinsic sympathetic activity, and (VI) intracellular protective mechanisms such as increased synthesis of heat-shock proteins (HSP 70) represent a complex strategy against an overload-dependent cellular damage.
  • Article
    Glucocorticoid receptors (GR) are ubiquitous molecules and are present also in the hippocampus and in several other nervous and immune tissues. Peripheral blood mononuclear cells (PBMCs) are a good model for studies of GR in humans. Glucocorticoids are important for maintaining cellular and humoral homeostasis and are key mediators of neuroendocrine-immune regulatory interactions. The increase of cortisol is immunosuppressive and reduces GR concentration both in nervous and immune systems. Variation of glucocorticoids in healthy aged subjects and athletes has been shown. Prompted by these results, we have investigated in man a possible relationship between GR binding capacity in the PBMCs and age, in relation also to plasma testosterone and cortisol. The same parameters have been examined in a group of soccer players for comparison with the sedentary group. GR binding capacity was higher in younger subjects than in older ones, and lower in the group of athletes than in the younger and older sedentary subjects. In the sedentary group a negative correlation was present between GR binding capacity and age. Plasma cortisol was higher and testosterone lower in the athletes; they were negatively correlated in athletes and positively correlated in the sedentary subjects. The results for athletes agree with their lower anabolic/catabolic balance. The mechanism of reduced GR levels in relation to age and sport activity could involve a loss or an involution of receptor synthesis. However other possibilities, such as altered distribution of lymphocyte subpopulations with different receptor concentrations and with different cytokine production, cannot be excluded. Several neuroendocrine-immune interactions could be responsible for reduced GR levels with age and sport activity in man.
  • Article
    Full-text available
    Many endocrine systems are subject to seasonal variation. However, studies of the hypothalamic-pituitary-adrenal axis in man have been limited to patients with psychiatric illness with conflicting results. We studied 105 healthy men, age 24-33 yr, during a 15-month period that included two winters. We measured cortisol and its metabolites by gas chromatography/mass spectrometry in plasma and urine and the intensity of dermal blanching after overnight topical application of beclomethasone dipropionate. There were no differences between subjects studied during the two winter periods, but marked differences between subjects studied in winter and summer. In winter, 0900-h plasma cortisol concentrations were higher (73 +/- 10 ng/mL, n = 41 vs. 35 +/- 4, n = 25 in summer; P < 0.01), total cortisol metabolite excretion was lower (678 +/- 67 micrograms/mmol creatinine vs. 900 +/- 98; P < 0.05), the ratio of metabolites of cortisol to those of cortisone was higher (3.0 +/- 0.2 vs. 2.1 +/- 0.1; P < 0.01), and dermal glucocorticoid sensitivity was higher (7.2 +/- 0.4 arbitrary units vs. 5.6 +/- 0.5; P < 0.02). Although blood pressure and fasting insulin/glucose relationships were not measurably different between seasons, these correlated with dermal vasoconstriction and cortisol metabolite excretion rate. We conclude that plasma cortisol and tissue sensitivity to glucocorticoids are higher in winter, but cortisol production rate is reduced. This could be explained by a reduction in cortisol clearance rate: urinary free cortisol/cortisone ratios were not different but A-ring-reduced metabolites of cortisol were higher in winter, suggesting that conversion of cortisone to cortisol by hepatic 11 beta-hydroxysteroid dehydrogenase 1 is enhanced. It is an intriguing possibility that increased glucocorticoid activity contributes to the increased prevalence of disease during the winter.
  • Article
    The purpose of this study was to compare the responses of selected hormonal, immunological, and hematological variables in athletes showing symptoms of overreaching with these variables in well-trained athletes during intensified training. Training volume was progressively increased over 4 wk in 24 elite swimmers (8 male, 16 female); symptoms of overreaching were identified in eight swimmers based on decrements in swim performance, persistent high ratings of fatigue, and comments in log books indicating poor adaptation to the increased training. Urinary excretion of norepinephrine was significantly lower (P < 0.05, post hoc analysis) in overreached (OR) compared with well-trained (WT) swimmers throughout the 4 wk. There were no significant differences between OR and WT swimmers for other variables including: concentrations of plasma norepinephrine, cortisol, and testosterone, and the testosterone/cortisol ratio; peripheral blood leukocyte and differential counts, neutrophil/lymphocyte ratio, and CD4/CD8 cell ratio; serum ferritin and blood hemoglobin concentrations, erythrocyte number, hematocrit, and mean red cell volume (MCV). MCV increased significantly over the 4 wk in both groups, suggesting increased red blood cell turnover. These data show that, of the 16 hormonal, immunological, and hematological variables measured, urinary norepinephrine excretion appears to be the only one to distinguish OR from WT swimmers during short-term intensified training. Low urinary norepinephrine excretion was observed 2 to 4 wk before the appearance of symptoms of overreaching, suggesting the possibility that neuroendocrine changes may precede, and possibly contribute to, development of the overreaching/overtraining syndromes.
  • A simplified liquid chromatographic method for the simultaneous determination of free or total catecholamines and methoxycatecholamines in rat and pig urine is presented. The extraction procedure involves a two-stage batch extraction, with successive adsorption on cation- (catecholamine elution) and anion-exchange columns (methoxycatecholamine elution). The column eluates are successively monitored by reversed-phase high-performance liquid chromatography (HPLC) with electrochemical detection. The proportion of conjugates for each compound was assessed in both species, through the comparison of concentrations with or without hydrolysis pretreatment. Conjugates were found to account for a small fraction of total catecholamines and methoxycatecholamines excretion (0 to 35%). The free fraction of each compound was highly correlated with the total amount. Furthermore, the hydrolysis procedure leads to partial degradation of metanephrine (25%) and to the production of compounds giving artefactual peaks. Thus, we do not recommend hydrolysis of rat and pig urines for catecholamine and methoxycatecholamine determination.
  • A sensitive assay was developed for the determination of low levels of free (unconjugated) glucocorticoids in human, swine (cortisol and cortisone) and rat urine (corticosterone and 11-dehydrocorticosterone), using solid-phase extraction and HPLC with UV absorbance detection (254 nm). Precise quantitation is allowed by the use of internal standards (dexamethasone for swine urine and Reichstein's substance S for rat urine). This simple method allows the use of small urine samples (less than 2 ml), and is suitable for a wide range of applications in human and animal clinical and physiological studies.
  • Article
    The present study was conducted in order to describe human hypothalamo-pituitary adrenal (HPA) axis adaptation in a model of repeated physical stress (endurance training) that causes a moderate increase in cortisol levels. We performed the same stimulation tests (adrenal stimulation with ACTH or pituitary stimulation with combined CRH/LVP) in a population of 8 endurance-trained athletes in two distinct situations: resting (baseline cortisol values) and 2 h after the end of strenuous exercise (increased cortisol values) to evaluate the HPA axis sensitivity to endogenous sustained increases in cortisol concentrations. During these tests, saliva and plasma cortisol (Fs and Fp, respectively) were assessed and compared. Cortisol values in both plasma and saliva at the end of 2 h of exercise were significantly higher than in rested controls: Fs 11.5 +/- 1.3 vs 6.5 +/- 0.8 nmol.l-1 and Fp 428 +/- 36 vs 279 +/- 27 nmol.l-1 (post exercise vs post rest sessions, respectively, P < 0.001 for both). After either hormone test (CRH/LVP or ACTH), cortisol levels in plasma and saliva increased similarly when rest was compared to post exercise. Saliva variations (delta %) under exogenous hormone stimulation were dramatically greater than plasma variations. For example, under ACTH stimulation, the relative increments in cortisol were on control day: delta Fs 980 +/- 139 vs delta Fp 218 +/- 43% (saliva vs plasma, respectively, P < 0.05) and on exercise day: delta Fs 605 +/- 89 vs delta Fp 102 +/- 14% (saliva vs plasma, respectively, P < 0.05). In endurance-trained athletes, displaying a moderate but sustained endogenous cortisol increase: (1) ACTH responses following pituitary stimulation are not blunted, (2) cortisol responses following maximal adrenal stimulation are not blunted. Our results favour the hypothesis of a decreased pituitary sensitivity to cortisol negative feedback whereas the hypothesis of a major decreased adrenal sensitivity to ACTH was discarded. The greater ability of saliva assays to detect a cortisol increase strongly supports its use in the study of HPA physiology, whether under basal or dynamic conditions.
  • Article
    The parasympathetic, Addison type, overtraining syndrome represents the dominant modern type of this syndrome. Beside additional mechanisms, an autonomic or neuroendocrine imbalance is hypothesized as underlying. Several findings support this thesis. During heavy endurance training or overreaching periods, the majority of findings give evidence of a reduced adrenal responsiveness to ACTH. This is compensated by an increased pituitary ACTH release. In an early stage of the overtraining syndrome, despite increased pituitary ACTH release, the decreased adrenal responsiveness is no longer compensated. The cortisol response decreases. In an advanced stage of overtraining syndrome, the pituitary ACTH release also decreases. In this stage, there is additionally evidence for decreased intrinsic sympathetic activity and sensitivity of target organs to catecholamines. This is indicated by decreased catecholamine excretion during night rest, decreased beta-adrenoreceptor density, decreased beta-adrenoreceptor-mediated responses, and increased resting plasma norepinephrine levels and responses to exercise. However, this complete pattern is only observed subsequent to high-volume endurance overtraining at high caloric demands. The described functional alterations of pituitary-adrenal axis and sympathetic system can explain persistent performance incompetence in affected athletes.
  • Article
    To examine different hormonal responses to heavy endurance training and overtraining in female athletes. Submaximal and maximal treadmill tests, self-report mood measures, and stress hormone analyses were repeated at baseline, after 4 weeks and at the end of 6 to 9 weeks of experimental intensive training and after 4 to 6 weeks of recovery. Fifteen healthy female endurance athletes increased their intensive training volume by 130% and base training volume by 100% (ETG, n = 9) or served as controls (CG, n = 6). Maximal oxygen uptake (VO2max), mood dynamics, blood catecholamines, cortisol and testosterone at rest and after submaximal and maximal exercise, and nocturnal urine catecholamines. Five females from the ETG demonstrated an over-training state (OA subgroup) at the end of the training period. Their VO2max decreased (mean +/- SEM) from 53.0 +/- 2.2 ml.kg-1.min-1 (range, 46.8-59.2) to 50.2 +/- 2.3 ml.kg-1.min-1 (range, 43.8-56.6) (p < 0.01). Maximal treadmill performance expressed as oxygen demand decreased (mean +/- SEM) from 56.0 +/- 1.6 ml.kg-1.min-1 (range, 51.5-60.5) to 52.2 +/- 1.1 ml kg-1.min-1 (range, 49.1-55.3) (p < 0.01). Maximal heart rate also decreased (mean +/- SEM) from 190 +/- 1 bpm (range, 185-197) to 186 +/- 2 bpm (range, 184-193) (p < 0.05), and the athletes experienced mood disturbances. Plasma adrenaline levels at maximal and noradrenaline at submaximal work rate decreased during the last 2 to 5 training weeks (p < 0.05), and serum cortisol levels at maximal work rate decreased during the first 4 training weeks (p < 0.05) in the ETG. Plasma adrenaline at maximal work rate decreased during the first 4 training weeks (p < 0.05) in the OA subgroup. There were no changes in the CG. Individual hormonal response types to heavy training and overtraining were found. Hormone responses to exercise load are superior in indicating heavy training-induced stress when compared with resting hormone levels. These responses indicated decreased sympathoadrenal and/or adrenocortical activity (or exhaustion of the adrenal gland or the central nervous system). Individual hormonal profiles are needed to follow up training effects. Marked individual differences were found in training- and overtraining-induced hormonal changes.
  • Article
    Recent studies have shown that cortisol levels rapidly increase within the first 30 minutes after awakening. This response is rather robust over weeks or months and is altered by chronic stress and burnout. The present study investigated to what extent the cortisol response to awakening relates to responses following hCRH, ACTH(1-24), or psychosocial stress challenges in 22 healthy subjects. Furthermore, a 12-hour circadian cortisol profile was obtained to compare the morning response with cortisol levels obtained throughout the day. Results show that the morning cortisol response was of similar magnitude to that following injection of 1 microg/kg h-CRH or exposure to a brief psychosocial stressor (TSST). All of these were significantly smaller compared to maximal stimulation of the adrenal cortex by ACTH(1-24). Correlation analyses revealed that the morning cortisol response was closely related only to the cortisol response following 0.25 mg ACTH(1-24) (r=0.63, p=0.002). We conclude that the morning cortisol response to awakening can provide important information on the (re)activity of the HPA axis in addition to more 'traditional' methods like hCRH or Synacthen challenge tests. The sensitivity/capacity of the adrenal cortex appears to play a crucial role for the magnitude of cortisol responses observed after awakening.
  • Article
    Full-text available
    The secretion of glucocorticoids (GCs) is a classic endocrine response to stress. Despite that, it remains controversial as to what purpose GCs serve at such times. One view, stretching back to the time of Hans Selye, posits that GCs help mediate the ongoing or pending stress response, either via basal levels of GCs permitting other facets of the stress response to emerge efficaciously, and/or by stress levels of GCs actively stimulating the stress response. In contrast, a revisionist viewpoint posits that GCs suppress the stress response, preventing it from being pathologically overactivated. In this review, we consider recent findings regarding GC action and, based on them, generate criteria for determining whether a particular GC action permits, stimulates, or suppresses an ongoing stress-response or, as an additional category, is preparative for a subsequent stressor. We apply these GC actions to the realms of cardiovascular function, fluid volume and hemorrhage, immunity and inflammation, metabolism, neurobiology, and reproductive physiology. We find that GC actions fall into markedly different categories, depending on the physiological endpoint in question, with evidence for mediating effects in some cases, and suppressive or preparative in others. We then attempt to assimilate these heterogeneous GC actions into a physiological whole.
  • Article
    11beta-hydroxysteroid dehydrogenases (11beta-HSDs) catalyze the interconversion of active glucocorticoids (cortisol, corticosterone) and inert 11-keto forms (cortisone, 11-dehydrocorticosterone). 11beta-HSD type 2 has a well recognized function as a potent dehydrogenase that rapidly inactivates glucocorticoids, thus allowing aldosterone selective access to otherwise nonselective mineralocorticoid receptors in the distal nephron. In contrast, the function of 11beta-HSD type 1 has, until recently, been little understood. 11beta-HSD1 is an ostensibly reversible oxidoreductase in vitro, which is expressed in liver, adipose tissue, brain, lung, and other glucocorticoid target tissues. However, increasing data suggest that 11beta-HSD1 acts as a predominant 11beta-reductase in many intact cells, whole organs, and in vivo. This reaction direction locally regenerates active glucocorticoids within expressing cells, exploiting the substantial circulating levels of inert 11-keto steroids. While the biochemical determinants of the reaction direction are not fully understood, insights to its biological importance have been afforded by use of inhibitors in vivo, including in humans, and the generation of knockout mice. Such studies suggest 11beta-HSD1 effectively amplifies glucocorticoid action at least in the liver, adipose tissue, and the brain. Inhibition of 11beta-HSD1 represents a potential target for therapy of disorders that might be ameliorated by local reduction of glucocorticoid action, including type 2 diabetes, obesity, and age-related cognitive dysfunction.
  • Article
    There is a significant circadian and seasonal periodicity in various endocrine functions. The present study describes the within-day and seasonal fluctuation for urinary catecholamines and cortisol and estimates the within- (CV(i)) and between-subject (CV(g)) coefficients of variation for healthy women undertaking their routine work. In addition, index of individuality (I(i)) and power calculations were derived. Eleven healthy females undertaking their routine life-style at work participated in the study. Each subject collected six samples during 24 h 15 days over a year, giving a total number of 990 samples. Using a random effect analysis of variance, we estimated CV(g) and total within-subject variation (CV(ti)), i.e. combined within-subject and analytical variation, from logarithmically transformed data. Analytical variation was subtracted from CV(ti) to give CV(i). CV(i) was estimated from samples collected monthly during 1 year (CV(iy)), weekly during 1 month (CV(im)), and six to eight times/day (CV(id)). A seasonal variation was demonstrated for excretion of epinephrine, norepinephrine, and cortisol standardized with creatinine. Concentrations of urinary epinephrine were higher during June and July compared to the rest of the year, whereas concentrations of urinary cortisol were higher during December and January compared to the rest of the year. Excretion of norepinephrine was lower during working hours and higher during hours off work for June and July compared to the rest of the year. There was a high within- and between-subject variation, which could not be explained by menstrual cycle, behavioral, emotional, or cognitive stress reactions. Despite high biological variation a reasonably low sample size, e.g. 10-50 individuals, is adequate for practical applicability, i.e. studying differences above 150%. The present study recommends to include the sampling time in the statistical evaluation of data and to be aware of the changes in diurnal variations over seasons. When single measurements are to be evaluated, reference intervals are recommended.
  • Article
    Objective techniques to determine whether an athlete is optimally prepared for a competition are virtually nonexistent. Preparedness for sports competition is commonly judged through the experience of the athletes and their coaches. Evidence from overtraining studies suggests that catecholamine (Cat) excretion rates may correlate with performance in athletes. We therefore attempted to determine whether a relationship existed between performances of world-class cross-country skiers and basal nocturnal Cat excretion (BNCE). During the Cross-Country Skiing World Championships, we determined BNCE in nine cross-country skiers of the Swiss national team by measuring free Cat concentration (dopamine = D, norepinephrine = NE, epinephrine = E) in morning urine samples, using high performance liquid chromatography. Expert judgments of competition performance (ECP) were assessed by two experienced professional coaches of the national team by using an 11-step scale. The BNCE correlated significantly with ECP in cross-country skiers (r2 = 0.84 and P < for NE; r2 = 0.86 and P < 0.001 for D). Athletes who had their best absolute competition results (ACR) showed the highest NE and D concentrations. These data suggest that competitive cross-country skiers with higher D and NE excretion may reach better competition levels compared with those with lower levels. Measures of BNCE provide objective information about competition performance, which may benefit athletes in their precompetition preparation.
  • Article
    The multitude of publications regarding overtraining syndrome (OTS or 'staleness') or the short-term 'over-reaching' and the severity of consequences for the athlete are in sharp contrast with the limited availability of valid diagnostic tools. Ergometric tests may reveal a decrement in sport-specific performance if they are maximal tests until exhaustion. Overtrained athletes usually present an impaired anaerobic lactacid performance and a reduced time-to-exhaustion in standardised high-intensity endurance exercise accompanied by a small decrease in the maximum heart rate. Lactate levels are also slightly lowered during submaximal performance and this results in a slightly increased anaerobic threshold. A reduced respiratory exchange ratio during exercise still deserves further investigation. A deterioration of the mood state and typical subjective complaints ('heavy legs', sleep disorders) represent sensitive markers, however, they may be manipulated. Although measurements at rest of selected blood markers such as urea, uric acid, ammonia, enzymes (creatine kinase activity) or hormones including the ratio between (free) serum testosterone and cortisol, may serve to reveal circumstances which, for the long term, impair the exercise performance, they are not useful in the diagnosis of established OTS. The nocturnal urinary catecholamine excretion and the decrease in the maximum exercise-induced rise in pituitary hormones, especially adrenocorticotropic hormone and growth hormone, and, to a lesser degree, in cortisol and free plasma catecholamines, often provide interesting diagnostic information, but hormone measurements are less suitable in practical application. From a critical review of the existing overtraining research it must be concluded that there has been little improvement in recent years in the tools available for the diagnosis of OTS.
  • Article
    Full-text available
    The aim of this study was to address the effect of endurance training on tissue sensitivity to glucocorticoids (GC) in both resting and exercising conditions. In vitro dexamethasone inhibition of LPS-induced interleukin-6 secretion in cultures of peripheral monocytes was compared in untrained subjects (UT) and in endurance-trained men (ET) at the end of a 2-h run and during exercise recovery. We demonstrated an in vitro plasticity of sensitivity of monocytes to GC in ET men, superimposed to changes in systemic cortisol concentrations (plasma and saliva). Compared with sedentary men, similar resting cortisol levels in ET men are associated with decreased sensitivity of monocytes to GC 8 and 24 h after the end of the last training session (P < 0.05, ET vs. UT). Moreover, in these ET subjects, an acute bout of exercise increased the sensitivity of monocytes to GC (at 1000 and 1200; ET vs. UT, P > 0.05). This acute exercise-induced increase in tissue sensitivity to GC, which is synchronous with activation of the hypothalamo-pituitary adrenal axis, may act to shut off muscle inflammatory reaction and cytokine synthesis and then decrease exercise-induced muscle damage or inflammatory response. By contrast, the decreased sensitivity of monocytes to GC reported in ET men 24 h after the last bout of exercise may be related to the process of desensitization that may act to protect the body from prolonged, exercise-induced cortisol secretion. These acute and chronic effects of exercise on tissue sensitivity to GC demonstrate an adaptation of the hypothalamo-pituitary adrenal axis to repeated and prolonged exercise-induced increases in GC secretion.
  • Article
    Full-text available
    In several recent investigations it could be demonstrated that the free cortisol response to awakening can serve as an useful index of the adrenocortical activity. When measured with strict reference to the time of awakening the assessment of this endocrine response is able to uncover subtle changes in hypothalamus-pituitary-adrenal (HPA) axis activity, which are, for instance, related to persisting pain, burnout and chronic stress. Furthermore, it has been suggested that the HPA axis might serve as an indicator of allostatic load in subjects exposed to prolonged environmental noise. In the present paper four separate studies with a total of 509 adult subjects were combined in order to provide reliable information on normal values for the free cortisol response to awakening. Corresponding with earlier findings, a mean cortisol increase of about 50% within the first 30 minutes after awakening was observed. The intraindividual stability over time was shown to be remarkably high with correlations up to r=.63 (for the area under the response curve). Furthermore, the cortisol rise after awakening is rather consistent, with responder rates of about 75%. Gender significantly influenced early morning free cortisol levels. Although women showed a virtually identical cortisol increase after awakening compared to men, a significantly delayed decrease was observed. Confirming and extending previous findings, the present study strongly suggests that neither age, nor the use of oral contraceptives, habitual smoking, time of awakening, sleep duration or using / not using an alarm clock have a considerable impact on free cortisol levels after awakening. The cortisol awakening response can be assessed under a wide variety of clinical and field settings, since it is non-invasive, inexpensive and easy-to-employ. The present data provide normal values and information on potential confounds which should facilitate investigations into the endocrine consequences of prolonged exposure to environmental noise.
  • Article
    The effect of training variations on 24-h urinary cortisol/cortisone (C/Cn) ratio was investigated in highly trained swimmers to determine whether it could be a good marker of training stress and performance. Fourteen swimmers (five female and nine male) were tested after 4 wk of intense training (IT), 3 wk of reduced training (RT), and 5 wk of moderate training (MT). At the end of each period, the swimmers performed in their best event at an official competition. Individual performances were expressed as a percentage of the previous season's best performance. The fatigue state was evaluated with a questionnaire. The C/Cn ratio was statistically different for the three periods (IT: 1.10 +/- 0.7, RT: 0.64 +/- 0.3, and MT: 0.57 +/- 0.2). The differences in the C/Cn ratio between two consecutive performances were related to the differences in performance (r = -0.52, P < 0.01), and the C/Cn ratio was significantly related to the total training (r = 0.32, P < 0.05) and total score of fatigue (TSF) (r = 0.35, P < 0.03) over the follow-up period. Cn levels were related to the dryland training (r = -0.46; P < 0.01) and TSF (r = -0.40; P < 0.02). During IT, variations in the C/Cn ratio were related to the changes in the mean intensity (r = -0.67; P < 0.02) and to TSF (r = 0.69; P < 0.01). The 24-h C/Cn ratio was moderately related to both training and performance whereas Cn levels were only related to training. The C/Cn ratio could be a useful indicator for monitoring the overreaching state in elite swimmers.