Cardiological aspects of fatigue states in athletes

The physical load increase during training can lead to the development of clinical patterns of intolerance differing according to their severity, prognosis and reversibility. However, they always include fatigue as a key symptom. The aim of this paper is to review recent data on fatigue states in sportsmen, their clinical presentation and diagnostic orientations. A continuum exists, from acute fatigue states after one or several highly-intensive training sessions, to overreaching, associated to performances alteration which can be easily reversed, and to overtraining, representing a severe clinical pattern which can hardly be reversed. Overreaching and overtraining are characterized by a persisting fatigue state, associated to performances alteration and mood disorders. In an athlete with unexplained alteration of performances associated to physical fatigue, the medical interrogation is critical, in order to check the durable character of sportive performances alteration, to describe the fatigue and identify risk factors of occurrence of overtraining (training program intensity, mental stress, diet factors, hypoxic training, etc.). The use of a validated and adapted questionnaire as the one proposed by the French Society of Sports Medicine is valuable. In majority, in athletes and those doing sports regularly, the cardiological alert signs are rare, and the clinical examination by a specialist is poorly contributive, except for eliminating an organic cause of fatigue.