As a family physician dealing with a wide spectrum of clinical problems, including STD screening, HIV testing, and HIV PEP in central Singapore, sports related problems are commonly encountered in the younger aged group of patients, as well as the young-at-heart weekend warriors. In today’s zeitgeist of lean models and buff Hollywood stars, over-zealous self-made athletes and fitness enthusiasts exercise daily in an attempt to reduce their body fat percentage to a single digit level.
Many athletes and fitness devotees fail to realize that more is not always better. Pushing oneself hard at the gym is a good thing up to a certain point. Our muscles need time to recover and grow. If one works out two hours a day, six days a week, one might be overtraining. This can negatively affect our physical performance and cause muscle loss, not gain.
- Question: Can I exercise while on HIV PEP (Post Exposure Prophylaxis)?
- Answer: Antiretroviral drugs can make a person feel more tired than usual. Yes, you can exercise, but listen to your body, and do what feels right for you at that time.
What Is Overtraining?
Overtraining is very common among endurance athletes and bodybuilders. Many highly motivated runners, swimmers, and fitness models spend hours in the gym, with little or no rest. This causes an imbalance between stress and recovery, which is known as overtraining. In the long run, it can lead to the overtraining syndrome, which is a group of symptoms caused by excessive physical exercise. Symptoms include chronic tiredness, fatigue, mood swings, difficulty in sleeping, persistent muscle stiffness and soreness, poor immunity (often manifesting as frequent upper respiratory tract infections), and decreased sports performance.
Overtraining is different from the normal fatigue that follows exercise. It may be a result of too frequent or too intense workouts, a lack of time for recovery, or a combination of these factors. Overtraining can cause endocrine (hormonal), psychological (mental), and muscular (physical) symptoms and problems. Its effects should never be underestimated. If sufficient rest and recovery is not included in a workout plan, our sports performance will suffer. If we do not plan to rest and recover, we plan to overtrain.
- Question: What exercises can I do while on HIV PEP (post exposure prophylaxis)?
- Answer: You can do almost any exercise you feel like doing. If you are feeling a little more tired than usual, do light cardio or an easy circuit training in the gym. You might want to delay high intensity interval training to a later time.
Many gym goers and fitness enthusiasts have a hard time figuring out the appropriate combination of training volume and intensity. As a result, they work out too hard or for too long. Besides a resultant lack of motivation in high-level training, pushing oneself too hard can significantly increase the risk of various injuries.
Recovering from true overtraining can take months and even years. This can be challenging for someone whose life has revolved around exercise. The best way to prevent overtraining is to listen to your body and increase workout volume or training intensity gradually. Seek your doctor’s advice when it comes to an appropriate training schedule and plan.
Overtraining will also make you weaker and smaller. Getting proper rest is essential to muscle growth and overall performance. What’s more, a poor diet can make things worse. Your body needs quality nutrition and rest to function at peak levels. Whether you want to get stronger, build muscle, or gain endurance, it is essential to find a balance between overloading and recovery. When it comes to exercise, forget the old saying “go hard or go home.” Rest is just as important as working out.
- Question: So if I’m on HIV PEP, do I still get results from physical training?
- Answer: You will get results from physical training as long as there is a balance between working out and recovery. Even if you are on HIV PEP, you will definitely get results as long as you are following good medical advice.
Signs and Symptoms of Overtraining Syndrome
The most common symptom of overtraining is fatigue. If you’re working out too hard, you’ll feel “burnt out” at some point. You’ll also become moody, depressed, and tired. Overtraining can affect every aspect of your life, including your physical performance, relationships, career, and health.
The overtraining syndrome usually presents insidiously, and has various complex presentations and symptoms. It’s slow presentation and varied clinical picture might serve to delay its diagnosis in the athlete. The more common symptoms are:
- Elevated resting heart rate
- Reduced heart rate variability
- Persistent muscle aches and pain
- Prolonged general fatigue or a lack of energy
- Irritability and mood swings
- Performance plateaus
- Delay in recovery from training
- Decreased motivation for training
- Disturbed sleep patterns such as insomnia or interrupted sleep
- Weakened immune system
- Decreased appetite and poor food intake
- Decreased sports performance
Other symptoms include gastrointestinal disturbances such as constipation or diarrhea, increased susceptibility to injuries, restlessness, emotional instability, weight loss, amenorrhea, and decrease in training intensity. Overtraining is also a risk factor for many forms of tendonitis, stress fractures, and medial tibial stress syndrome.
- Question: Since HIV PEP drugs can make me feel more tired than usual, how would I know if I’m overtraining? It could just be the HIV PEP drugs.
- Answer: The timing of the onset of fatigue could be a clue. After commencement of HIV PEP, the symptoms of tiredness might coincide with the initiation of HIV post exposure prophylaxis. If you have been following good training advice and periodization, you shouldn’t fall into over-reaching or over-training.
Other important physiological changes include lowered testosterone levels and increased cortisol levels. A lowered testosterone level decreases muscle gains and sports performance. It also leads to poor libido and virility. Increased cortisol levels negatively affect immunity and recovery, delay cellular regeneration, increases belly (visceral) fat, and results in chronic insomnia.
Due to changes in the neuro-endocrine system, overtraining also produces psychological symptoms that will affect your everyday life. Such emotional changes include irritability and anger, general apathy, feelings of sadness, difficulty concentrating at work, poor self-esteem, and even clinical depression.
How to Prevent Over-reaching and Overtraining
Over-reaching is a pre-overtraining condition. In sports medicine, over-reaching is early overtraining, which usually takes days to weeks to recover from. True overtraining typically takes months or even years to recover from. The symptoms of early overtraining (over-reaching) are similar to true overtraining, except that true overtraining symptoms are more severe in nature.
The onset of over-reaching is typically subtle and gradual. One of the best ways to detect this is by measuring your resting heart rate first thing in the morning when you wake up. With a simple stopwatch or digital watch, take your carotid or radial pulse rate, and record it daily. A rise of 5 to 7 beats from the baseline heart rate usually indicates insufficient recovery from training and an increased risk of over-reaching (a pre-overtraining condition).
To prevent over-reaching, vary your workout routine (such as cross-training) and exercise techniques, use the training periodization methodology, and allow for adequate recovery time in between workout sessions.
If you experience the symptoms listed above, you need to take some time off the gym immediately and consult your doctor. The presence of several symptoms all at once usually indicates that over-reaching or overtraining is probable. An urgent recovery plan must be thought out to prevent further damage and injury to the body, and to allow healing to begin.
- Question: If I think I’m over-reaching or over-training, can I still take HIV PEP?
- Answer: Overtraining or over-reaching is not a known contraindication for HIV PEP. Consult your doctor for more specific advice.
Recovering from Over-reaching
If you’ve been pushing yourself too hard lately, or if you have not taken a break from training for many months, take one week off from training. Get plenty of rest, eat well, and increase your carbohydrate intake. Self-massage, cold therapy, and physiotherapy can help too. Try to sleep more than usual, avoid stressful events, and maintain a suitable macronutrient ratio. Consider taking dietary supplements to fix nutritional deficiencies. Over-reaching, when detected early, can be treated with a few weeks of rest and recovery.
When you do start working out again, do so with proper planning and nutrition. Rest well between heavy workout sessions, and vary the intensity of training from one week to another. Take into account the cumulative stress from your job, physical training, and everyday life. Avoid overusing certain muscle groups or joints. If you are doing weights training, monitor the number of sets and repetitions for each muscle group. Reduce or eliminate certain foods that may cause inflammation in the body, such as gluten-rich food and dairy products. Include moderate amounts of protein and healthy fats in your diet.
With training periodization and proper nutrition, over-reaching can be avoided. Remember that rest is as important as the workout itself. Our Family Physician has a keen interest in Sports Medicine, sports injuries and physiology. He has competitive participation in several sports, including some extreme sports. Feel free to consult him concerning training periodization and schedules, sports injuries, and sports nutrition. He will only be too glad to share some tips with you.
Also, consult our Family Physician if you have any questions concerning HIV PEP (post exposure prophylaxis) in Singapore, HIV test algorithms, or STD testing.
