Download PDF
Int J Sports Med 2000; 21(Supplement 1): 51-60
DOI: 10.1055/s-2000-1452
Georg Thieme Verlag Stuttgart · New York

Training Strategies to Maintain Immunocompetence in Athletes

D. B. Pyne1, 4 ,  M. Gleeson2, 3 ,  W. A. McDonald1, 4 ,  R. L. Clancy2, 3 ,  C. Perry Jr1 ,  P. A. Fricker1, 4
  • 1 Sports Science and Sports Medicine Centre, Australian Institute of Sport, Canberra, ACT, Australia
  • 2 Hunter Immunology Unit, Hunter Area Pathology Service, Newcastle, NSW, Australia
  • 3 Faculty of Medicine and Health Sciences, University of Newcastle, Newcastle, NSW, Australia
  • 4 GADI Research Centre, University of Canberra, Canberra, ACT, Australia
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Also available at
    Permissions and Reprints

Clinical experience and empirical evidence have led to the modeling of exercise and training as a form of stress on the immune system. Coaches, athletes, and medical personnel are seeking guidelines on ways to reduce the risk of illness that compromises training or competitive performance. The immune system is influenced by a wide range of physical, environmental, psychological, and behavioural factors which, combined with clinical assessment, collectively form the basis of the following intervention strategies: 1) training: careful management of training volume and intensity, variety to overcome training monotony and strain, a periodised approach to increasing loads, and provision of adequate rest and recovery periods; 2) environmental: limiting initial exposure when training or competing in adverse environmental conditions (heat, humidity, altitude, air pollution) and acclimatising where appropriate; 3) psychological: teaching athletes self-management and coping skills and monitoring of athletes' responses to the psychological and psychosocial stresses of high-level training and competition; 4) behavioural: adopting a well-balanced diet with adequate intake of macro- and micro-nutrients, limiting transmission of contagious illnesses by reducing exposure to common infections, airborne pathogens, and physical contact with infected individuals; and 5) clinical considerations: medical screening, pathology testing, immunization and prophylaxis, and routine management of illness-prone athletes. Future experimental studies are required to develop and enhance the effectiveness of these strategies in reducing illness in athletes.

Key words:

Immunity, athletes, training, environment, medical intervention.

References

  • 1 Adams S H, Boyce T W. Stress, personality, and infectious illness: an integrative approach.  Med Ex Nutr Health. 1995;  4 146-156
    PubMedGoogle Scholar
  • 2 Antonio J, Street C. Glutamine: a potentially useful supplement for athletes.  Can J Appl Physiol. 1999;  21 1-14
    PubMedGoogle Scholar
  • 3 Bailey D M, Davies B, Budgett R, Gandy G. Recovery from infectious mononucleosis after altitude training in an elite middle distance runner.  Brit J Sports Med. 1997;  31 153-154
    PubMedGoogle Scholar
  • 4 Banister E W. Modeling elite athletic performance. In: Green HJ, McDougall JD, Wenger H (eds) Physiological testing of elite athletes. Champaign, IL; Human Kinetics Publishers 1991: 403-424
    Google Scholar
  • 5 Banister E W, Calvert T W. Planning for future performance: implications for long term planning.  Can J Appl Spt Sci. 1980;  5 170-176
    PubMedGoogle Scholar
  • 6 Banister E W, Morton R H, Clarke J R. Clinical dose-response effects of exercise. In: Steinacker JM, Wand SA (eds) The Physiology and Pathophysiology of Exercise Tolerance. New York; Plenum 1997: 297-309
    Google Scholar
  • 7 Bond J. The individual athlete. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 163-181
    Google Scholar
  • 8 Bouchama A, Hussein K A, Adra C, Rezeig M, Shail E A, Sedairy S A. Distribution of peripheral blood leukocytes in acute heatstroke.  J Appl Physiol. 1992;  73 405-409
    PubMedGoogle Scholar
  • 9 Brenner I, Shek P N, Zamecnik J, Shephard R J. Stress hormones and the immunological responses to heat and exercise.  Int J Sports Med. 1998;  19 130-143
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Brown R, Pang G, Husband A J, King M G, Bull D F. Sleep deprivation and the immune response to pathogenic and non-pathogenic antigens. 1992
    Google Scholar
  • 11 Butcher J D, Lillegard W A. Sinusitis, otitis media, otitis externa, and conjunctivitis. In: Fricker PA, Fields KB (eds) Medical Problems in Athletes. Melbourne; Blackwell Science 1997: 21-25
    Google Scholar
  • 12 Cannon J G. Exercise and resistance to infection.  J Appl Physiol. 1993;  74 973-981
    PubMedGoogle Scholar
  • 13 Casey J M, Dick E C. Acute respiratory infections. In: Casey JM, Foster C, Hixson EG (eds) Winter sports medicine. Philadelphia; F. A. Davis 1990: 112-128
    Google Scholar
  • 14 Chandra R K. 1990 McCollum Award Lecture: nutrition and immunity - lessons from the past and new insights into the future.  Am J Clin Nutr. 1991;  53 1087-1101
    PubMedGoogle Scholar
  • 15 Chandra R K. Nutritional regulation of immunity and risk of infection in old age.  Immunol. 1989;  67 141-147
    PubMedGoogle Scholar
  • 16 Chapman R F, Stray-Gundersen J, Levine B J. Individual variation in response to altitude training.  J Appl Physiol. 1998;  85 1448-1456
    PubMedGoogle Scholar
  • 17 Chicharro J L, Lucia A, Perez M, Vaquero A F, Urena R. Saliva composition and exercise.  Sports Med. 1998;  26 17-27
    CrossrefPubMedGoogle Scholar
  • 18 Coen B, Schwarz L, Urhausen A, Kindermann W. Control of training in middle and long-distance running by means of the individual anaerobic threshold.  Int J Sports Med. 1991;  12 519-524
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Cohen S, Tyrrell D AJ, Smith A P. Psychological stress and susceptibility to the common cold.  New Eng J Med. 1990;  325 606-612
    PubMedGoogle Scholar
  • 20 Currie A, Potts S G, Donovan W, Blackwood D. Illness behaviour in elite middle and long distance runners.  Brit J Sports Med. 1999;  33 19-21
    PubMedGoogle Scholar
  • 21 Dick E C, Jennings L C, Mink K A, Wartgow C D, Inhorn S L. Aerosol transmission of rhinovirus colds.  J Infect Dis. 1987;  156 442-448
    CrossrefPubMedGoogle Scholar
  • 22 Eichner E R. Infection, immunity and exercise: what to tell patients?.  Phys Sportsmed. 1993;  21 125-135
    CrossrefPubMedGoogle Scholar
  • 23 Foster C. Monitoring training in athletes with reference to overtraining syndrome.  Med Sci Sports Exerc. 1998;  30 1164-1168
    CrossrefPubMedGoogle Scholar
  • 24 Foster C, Daines E, Hector L, Snyder A C, Welsh R. Athletic performance in relation to training load.  Wisc Med J. 1996;  June 1996 370-374
    PubMedGoogle Scholar
  • 25 Fricker P, McDonald W, Pyne D, Perry C. Exercise, mood states and immunity in elite swimmers during an intensive 12-week training cycle. Montreal; Annual Conference of the Association for the Advancement of Applied Sports Physiology 1993
    Google Scholar
  • 26 Fricker P A. Infectious problems in athletes: an overview. In: Fields K, Fricker P (eds) Medical Problems in Athletes. Malden; Blackwell Science 1997: 3-5
    Google Scholar
  • 27 Fricker P A, McDonald W A, Gleeson M, Flanagan A, Pyne D B, Clancy R L. Incidence of respiratory and gut infections in elite swimmers.  Int J Sports Med. 2000;  21 S 76
    PubMedGoogle Scholar
  • 28 Friman G, Ilback N-G. Acute infection: metabolic responses, effects on performance, interaction with exercise, and myocarditis.  Int J Sports Med. 1998;  19 S172-S182
    PubMedGoogle Scholar
  • 29 Friman G, Ilback N-G. Exercise and infection - interaction, risks and benefits.  Scand J Med Sci Sports. 1992;  2 177-189
    PubMedGoogle Scholar
  • 30 Gabriel H, Kindermann W. The acute immune response to exercise: what does it mean?.  Int J Sports Med. 1997;  18 S28-S45
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Gabriel H W, Urhausen A, Valet G, Heidelbach U, Kindermann W. Overtraining and the immune system: a prospective longitudinal study in endurance athletes.  Med Sci Sports Exerc. 1998;  30 1151-1157
    PubMedGoogle Scholar
  • 32 Gleeson M. Elite athlete immunology: the importance of nutrition.  Int J Sports Med. 2000;  21 S 44-S 50
    PubMedGoogle Scholar
  • 33 Gleeson M, Cripps A W, Clancy R L. Modifiers of the human mucosal immune system.  Immunol Cell Biol. 1995;  73 397-404
    CrossrefPubMedGoogle Scholar
  • 34 Gleeson M, McDonald W A, Cripps A W, Pyne D B, Clancy R L, Fricker P A, Woldarczyk J W. Exercise, stress and mucosal immunity in elite swimmers. In: Mestecky J, Russell M, Jackson S, Michalck S, Hogenova H, Sterzl J (eds) Advances in Mucosal Immunology. New York; Plenum Publishing Corporation 1995: 571-574
    Google Scholar
  • 35 Gleeson M, McDonald W A, Pyne D B, Cripps A W, Francis J L, Fricker P A, Clancy R L. Salivary IgA levels and infection risk in elite swimmers.  Med Sci Sports Exerc. 1999;  31 67-73
    PubMedGoogle Scholar
  • 36 Gong H, Krishnareddy S. How pollution and airborne allergens affect exercise.  Phys Sportsmed. 1995;  23 35-42
    PubMedGoogle Scholar
  • 37 Gray A B, Telford R D, Collins M, Weidemann M J. The response of leukocyte subsets and plasma hormones to interval exercise.  Med Sci Sports Exerc. 1993;  25 1252-1258
    PubMedGoogle Scholar
  • 38 Grove J R, Gordon A MD. The psychological aspects of injury in sport. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 194-205
    Google Scholar
  • 39 Health G W, Macera C A, Nieman D C. Exercise and the upper respiratory tract infections: is there a relationship?.  Sports Med. 1992;  14 353-365
    PubMedGoogle Scholar
  • 40 Hoffman-Goetz L, Pedersen B K. Exercise and the immune system: a model of the stress response?.  Immunol Today. 1994;  15 382-387
    CrossrefPubMedGoogle Scholar
  • 41 Hooper S L, Mackinnon L T, Ginn E M. Effects of three tapering techniques on the performance, forces and psychometric measures of competitive swimmers.  Eur J Appl Physiol. 1998;  78 258-263
    CrossrefPubMedGoogle Scholar
  • 42 Hooper S L, Mackinnon L T, Howard A, Gordon R D, Bachmann A W. Markers for monitoring overtraining and recovery.  Med Sci Sports Exerc. 1995;  27 106-112
    PubMedGoogle Scholar
  • 43 Jansky L, Pospisilova D, Honzova S, Ulicny B, Sramek P, Zeman V, Kaminkova J. Immune system of cold-exposed and cold-adapted humans.  Eur J Appl Physiol. 1996;  72 445-450
    CrossrefPubMedGoogle Scholar
  • 44 Konig D, Weinstock C, Keul J, Northoff H, Berg A. Zinc, iron, and magnesium status in athletes - influence on the regulation of exercise-induced stress and immune function.  Exer Immunol Rev. 1998;  4 2-21
    PubMedGoogle Scholar
  • 45 Kutsar K. Some aspects of altitude training.  Mod Ath Coach. 1983;  21 27-28
    PubMedGoogle Scholar
  • 46 Lehmann M, Baumgartl P, Wiesenack C, Seidel A, Baumann H, Fischer S, Spori U . et al . Training-overtraining: influence of a defined increase in training volume vs training intensity on performance, catecholamines, and some metabolic parameters in experienced middle- and long-distance runners.  Eur J Appl Physiol. 1992;  64 169-177
    CrossrefPubMedGoogle Scholar
  • 47 Lehmann M, Dickhuth H H, Gendrisch G, Lazar W, Thum M, Kaminski R, Aramendi J F . et al . Training-overtraining. A prospective, experimental study with experienced middle- and long-distance runners.  Int J Sports Med. 1991;  12 444-452
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Lehmann M, Foster C, Dickhuth H H, Gastman U. Autonomic imbalance hypothesis and overtraining syndrome.  Med Sci Sports Exerc. 1998;  30 1140-1145
    CrossrefPubMedGoogle Scholar
  • 49 Lehmann M, Foster C, Keul J. Overtraining in endurance athletes: a brief review.  Med Sci Sports Exerc. 1993;  25 854-862
    CrossrefPubMedGoogle Scholar
  • 50 Lehmann M, Foster C, Netzer N, Lormes W, Steinacker J M, Liu Y, Opitz-Gress A . et al .Physiological responses to short- and long-term overtraining in endurance athletes. In: Kreider RB, Fry AC, O'Toole ML (eds) Overtraining in Sport. Champaign, IL; Human Kinetics 1998: 19-46
    Google Scholar
  • 51 Levine B D, Stray-Gundersen J. 'Living high-training low': effect of moderate-altitude acclimatization with low-altitude training on performance.  J Appl Physiol. 1997;  83 102-112
    PubMedGoogle Scholar
  • 52 Mackinnon L T. Immunity in athletes.  Int J Sports Med. 1997;  18 S62-S68
    PubMedGoogle Scholar
  • 53 Mackinnon L T. Immunoglobulin, antibody and exercise.  Exer Immunol Rev. 1996;  2 1-35
    PubMedGoogle Scholar
  • 54 MacLaren D P, Reilly T, Campbell I T, Frayn K N. Hormonal and metabolite responses to glucose and maltodextrin ingestion with or without the addition of guar gum.  Int J Sports Med. 1994;  15 466-471
    PubMedGoogle Scholar
  • 55 Mast E E, Goodman R A. Prevention of infectious disease transmission in sports.  Sports Med. 1997;  24 1-7
    CrossrefPubMedGoogle Scholar
  • 56 McCarthy D A, Dale M M. The leucocytosis of exercise - a review and model.  Sports Med. 1988;  6 333-363
    PubMedGoogle Scholar
  • 57 McDonald W A. Upper respiratory tract infections. In: Fields KB, Fricker PA (eds) Medical Problems in Athletes. Malden; Blackwell Science 1997: 6-10
    Google Scholar
  • 58 McKenzie D C. Markers of excessive exercise.  Can J Appl Physiol. 1999;  24 66-73
    CrossrefPubMedGoogle Scholar
  • 59 McLatchie G R. Infections in sport. In: McLatchie GR (ed) Essentials of Sports Medicine. Edinburgh; Churchill Livingstone 1993: 112-125
    Google Scholar
  • 60 Meehan R T. Immune suppression at high altitude.  Ann Emerg Med. 1987;  16 974-979
    PubMedGoogle Scholar
  • 61 Meehan R T, Duncan U, Neale L, Taylor G, Muchmore H, Scott N, Ramsey K . et al . Operation Everest II. Alterations in the immune system at high altitudes.  J Clin Immunol. 1988;  8 397-403
    CrossrefPubMedGoogle Scholar
  • 62 Meyers A W, Whelan J P. A systemic model for understanding psychosocial influences in overtraining. In: Kreider RB, Fry AC, O'Toole ML (eds) Overtraining in Sport. Champaign, IL; Human Kinetics 1998: 335-369
    Google Scholar
  • 63 Miller B P. Team athletes. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 182-193
    Google Scholar
  • 64 Mitchell J B, Costill D L, Houmard J A, Flynn M G, Fink W J, Beltz J D. Influence of carbohydrate ingestion on counterregulatory hormones during prolonged exercise.  Int J Sports Med. 1990;  11 33-36
    PubMedGoogle Scholar
  • 65 Morgan W P, Brown D R, Raglin J S, O'Connor P J, Ellickson K A. Psychological monitoring of overtraining and staleness.  Brit J Sports Med. 1987;  21 107-114
    CrossrefPubMedGoogle Scholar
  • 66 Morton R H, Fitz-Clarke J R, Banister E W. Modeling human performance in running.  J Appl Physiol. 1990;  69 1171-1177
    PubMedGoogle Scholar
  • 67 Mujika I. The influence of training characteristics and tapering on the adaptation in highly trained individuals: a review.  Int J Sports Med. 1998;  19 439-446
    Article in Thieme ConnectPubMedGoogle Scholar
  • 68 Mujika I, Busso T, Lacoste L, Barale F, Geyssant A, Chatard J-C. Modeled response to training and taper in competitive swimmers.  Med Sci Sports Exerc. 1996;  28 251-258
    CrossrefPubMedGoogle Scholar
  • 69 Nehlsen-Cannarella S L, Nieman D C, Balk-Lamberton A J, Markoff P A, Chritton D BW, Gusewitch G, Lee J W. The effects of moderate exercise training on immune response.  Med Sci Sports Exerc. 1991;  23 64-70
    PubMedGoogle Scholar
  • 70 Nieman D C. Exercise immunology: practical applications.  Int J Sports Med. 1997;  18 S91-S100
    Article in Thieme ConnectPubMedGoogle Scholar
  • 71 Nieman D C. Immune response to heavy exertion.  J Appl Physiol. 1997;  82 1385-1394
    PubMedGoogle Scholar
  • 72 Nieman D C. Influence of carbohydrate on the immune response to intensive, prolonged exercise.  Exer Immunol Rev. 1998;  4 64-75
    PubMedGoogle Scholar
  • 73 Nieman D C, Nehlsen-Cannarella S L, Markoff P A, Balk-Lamberton A J, Yang H, Chitton D BW, Lee J W . et al . The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections.  Int J Sports Med. 1990;  11 467-473
    PubMedGoogle Scholar
  • 74 Pedersen B K. Immune responses to acute exercise. In: Hoffman-Goetz L (ed) Exercise and Immune Function. Boca Raton; CRC Press 1996: 80-92
    Google Scholar
  • 75 Pedersen B K, Ullum H. NK cell response to physical activity: possible mechanisms of action.  Med Sci Sports Exerc. 1994;  26 140-146
    PubMedGoogle Scholar
  • 76 Peters E M. Immunology and upper respiratory tract infections.  Int J Sports Med. 1997;  18 S69-S77
    PubMedGoogle Scholar
  • 77 Peters-Futre E M. Vitamin C, neutrophil function and upper respiratory tract infection risk in distance runners: the missing link.  Exer Immunol Rev. 1997;  3 32-52
    PubMedGoogle Scholar
  • 78 Pyke F. Sport in the cold.  Sports Coach. 1986;  9 36-38
    PubMedGoogle Scholar
  • 79 Pyke F S, Sutton J R. Environmental stress. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 129-149
    Google Scholar
  • 80 Pyne D B. Immune function and exercise. In: Fields K, Fricker P (eds) Medical Problems in Athletes. Malden; Blackwell Science 1997: 266-269
    Google Scholar
  • 81 Pyne D B. Regulation of neutrophil function during exercise.  Sports Med. 1994;  17 245-258
    PubMedGoogle Scholar
  • 82 Pyne D B, Baker M S, Telford R D, Weidemann M J. Exercise and neutrophil oxidative activity: experimental and biological variability.  Eur J Appl Physiol. 1996;  74 564-571
    CrossrefPubMedGoogle Scholar
  • 83 Pyne D B, Gleeson M. Effects of intensive exercise training on immunity in athletes.  Int J Sports Med. 1998;  19 S183-S194
    Google Scholar
  • 84 Pyne D B, Gray A B, McDonald W A. Exercise, training and immunity. In: Bloomfield J, Fricker P, Fitch K (eds) Textbook of Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 602-615
    Google Scholar
  • 85 Pyne D B, Morton D S, Foster M, Smith J A, McDonald W A, Sonnenfeld G. Effects of altitude exposure and physical training on cytokine production. J Appl Physiol 1999 under review
    Google Scholar
  • 86 Rhind S G, Shek P N, Shephard R J. The impact of exercise on cytokines and receptor expression.  Exer Immunol Rev. 1995;  1 97-148
    PubMedGoogle Scholar
  • 87 Rhind S G, Shek P N, Shinkai S, Shephard R J. Effects of moderate endurance exercise and training on in vitro lymphocyte proliferation, interleukin-2 production, and IL-2 receptor expression.  Eur J Appl Physiol. 1996;  4 348-360
    PubMedGoogle Scholar
  • 88 Rohde T, Krzywkowski K, Pedersen B K. Glutamine, exercise and the immune system - is there a link?.  Exer Immunol Rev. 1998;  4 49-63
    PubMedGoogle Scholar
  • 89 Rowbottom D G, Keast D, Morton A R. The emerging role of glutamine as an indicator of exercise stress and overtraining.  Sports Med. 1996;  21 80-97
    PubMedGoogle Scholar
  • 90 Rowbottom D G, Keast D, Morton A R. Monitoring and preventing of overreaching and overtraining in endurance athletes. In: Kreider RB, Fry AC; O'Toole ML (eds) Overtraining in Sport. Champaign, IL; Human Kinetics 1998: 47-66
    Google Scholar
  • 91 Sando B G. The team physician. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 478-493
    Google Scholar
  • 92 Severs Y, Brenner I, Shek P N, Shephard R J. Effects of heat and intermittent exercise on leukocyte and sub-population cell counts.  Eur J Appl Physiol. 1996;  74 234-245
    CrossrefPubMedGoogle Scholar
  • 93 Shephard R J, Rhind S, Shek P N. Exercise and the immune system: natural killer cells, interleukins and related responses.  Sports Med. 1994;  18 340-369
    PubMedGoogle Scholar
  • 94 Shephard R J, Shek P N. Acute and chronic over-exertion: do depressed immune responses provide useful markers?.  Int J Sports Med. 1998;  19 159-171
    PubMedGoogle Scholar
  • 95 Shephard R J, Shek P N. Exercise training and immune function. In: Hoffman-Goetz L (ed) Exercise and Immune Function. Boca Raton; CRC Press 1996: 93-119
    Google Scholar
  • 96 Shephard R J, Shek P N. Immunological hazards from nutritional imbalance in athletes.  Exer Immunol Rev. 1998;  4 22-48
    PubMedGoogle Scholar
  • 97 Shephard R J, Shek P N. Interactions between sleep, other body rhythms, immune responses and exercise.  Can J Appl Physiol. 1996;  22 95-116
    PubMedGoogle Scholar
  • 98 Sherman A R. Zinc, copper and iron nutrition and immunity.  J Nutr. 1992;  122 604-609
    PubMedGoogle Scholar
  • 99 Shinkai S, Shore S, Shek P N, Shephard R J. Acute exercise and immune function: relationship between lymphocyte activity and changes in subset counts.  Int J Sports Med. 1992;  13 452-461
    Article in Thieme ConnectPubMedGoogle Scholar
  • 100 Simon H B. Exercise and infection.  Phys Sportsmed. 1987;  15 135-141
    PubMedGoogle Scholar
  • 101 Smith J A. Guidelines, standards, and perspectives in exercise immunology.  Med Sci Sports Exerc. 1995;  27 497-506
    PubMedGoogle Scholar
  • 102 Smith J A, Baker M S, Gray A B, Pyne D B, Telford R D, Weidemann M J. Submaximal exercise triggers both priming and activation of neutrophils.  Am J Physiol. 1996;  270 R838-R845
    PubMedGoogle Scholar
  • 103 Smith J A, Pyne D B. Exercise, training and neutrophil function.  Exerc Immunol Rev. 1997;  3 96-117
    PubMedGoogle Scholar
  • 104 Smith R S. The immune system is a key factor in the etiology of psychosocial disease.  Medical Hypotheses. 1991;  34 49-57
    CrossrefPubMedGoogle Scholar
  • 105 Snyder A C. Overtraining and glycogen depletion hypothesis.  Med Sci Sports Exerc. 1998;  30 1146-1150
    PubMedGoogle Scholar
  • 106 Snyder A C, Jeukendrup A E, Hesselink M KC, Kuipers H, Foster C. A physiological/psychological indicator of over-reaching during intensive training.  Int J Sports Med. 1993;  14 29-32
    PubMedGoogle Scholar
  • 107 Snyder A C, Kuipers H, Cheng B, Servais R, Fransen E. Overtraining following intensified training with normal muscle glycogen.  Med Sci Sports Exerc. 1995;  27 1063-1070
    PubMedGoogle Scholar
  • 108 Sonnenfeld G, Morton D, Swigget J, Foster M, Smith J, Pyne D, Watson S . et al . High altitude and intensive training affect immunological parameters of elite swimmers.  Int J Sports Med. 1998;  19 S214
    PubMedGoogle Scholar
  • 109 Steinacker J M, Lormes W, Lehmann M, Alternburg D. Training of rowers before and championships.  Med Sci Sports Exerc. 1998;  30 1158-1163
    PubMedGoogle Scholar
  • 110 Swain R A, Kaplan B. Upper respiratory infections: treatment selection for active patients.  Phys Sportsmed. 1998;  26 85-96
    PubMedGoogle Scholar
  • 111 Takahashi M, Fukuda H, Arito H. Brief naps during post-lunch rest: effects on alertness, performance, and autonomic balance.  Eur J Appl Physiol. 1998;  78 93-98
    CrossrefPubMedGoogle Scholar
  • 112 Urhausen A, Gabriel H HW, Weiler B, Kindermann W. Ergometric and psychological findings during overtraining: a long-term follow-up study in endurance athletes.  Int J Sports Med. 1998;  19 114-120
    Article in Thieme ConnectPubMedGoogle Scholar
  • 113 Viru A, Viru M. Adaptivity changes in athletes.  Coach Sport Sci J. 1997;  2 26-35
    PubMedGoogle Scholar
  • 114 Walsh N P, Blannin A K, Robson P J, Gleeson M. Glutamine, exercise and immune function - links and possible mechanisms.  Sports Med. 1998;  26 177-191
    PubMedGoogle Scholar
  • 115 Weidner T G. Sport and exercise participation during a common cold.  Athletic Therapy Today. 1996;  1 5-8
    PubMedGoogle Scholar
  • 116 Wilber R. Altitude training for the enhancement of sea level endurance performance.  Olymp Coach. 1995;  5 6-10
    PubMedGoogle Scholar
  • 117 Young M, Fricker P, Maughan R, MacAuley D. The traveling athlete: issues relating to the Commonwealth Games, Malaysia 1998.  Clin J Sports Med. 1998;  8 130-135
    PubMedGoogle Scholar

Ph.D. D. Pyne

Sports Science and Sports Medicine Centre Australian Institute of Sport

PO Box 176 Belconnen A.C.T. 2616 Australia

Phone: Phone:+ 61 (2) 62141356

Fax: Fax:+ 61 (2) 62141603

Email: E-mail:david.pyne@ausport.gov.au

      >