MONITORING AN ATHLETE'S WELL-BEING DURING TRAINING
William O. Roberts M.D., M.S, FACSM, ACSM President-elect

Coaching, much like parenting, involves guiding an athlete through the trials and tribulations of training. Instructions given to bring an athlete to peak performance can be misunderstood or ignored, similar to the parenting experience. Athletes who follow the instructions and work the individualized training program usually do well and live up to their genetic potential. Those who “fail” either do too little to advance, push beyond the prescribed training regimen, or misinterpret coaching instructions. Like parenting, part of coaching is the day-to-day field monitoring before, during, and after practice that helps optimize an athlete’s program and keeps the athlete on the path to top competitive form.

Field monitoring athletes is a process of close observation to assess the well-being or constitution of the athlete. Appearance tells a story regarding the athlete’s current condition, and the astute coach can use observation to monitor the progress of the athlete. Fatigue can lead to injury, and an athlete who appears fatigued or out of form should be checked for illness, lack of sleep, inadequate nutrition, and/or injury.

Running or competitive posture is a marker of energy level. A poor training posture or lack of focus may be an early indication of fatigue, and continued training with a poor competitive posture can develop bad habits for competition. When the shoulders, arms, and head drop, the stride length decreases, or simple mistakes appear, it may be time to increase the rest-to-work ratio for the day or even the week if the athlete does not respond to short-term intervention. Likewise, a change in gait or stroke pattern may signal injury pain that demands immediate intervention to prevent progression to a more severe injury state that can set back the overall training cycle.

When an athlete appears fatigued, there is usually a simple explanation like not enough sleep the previous night or two. The reason for sleep deprivation should be explored to find a solution to the problem. Other activities or stressors like school, family issues, or employment can be modified to increase sleep volume.

Depression and high stress situations that decrease quantity and quality of sleep may require deeper intervention with the athlete’s physician, and the coach should suggest that the athlete seek help. Fatigue can also be as simple as inadequate rest in the training program.

The athlete’s training program should be reviewed, and the athlete quizzed to assure that there are not extra sessions being added by an over-motivated or poorly advised (by parents, friends, or other confidants) athlete. The coach must often break the cycle of “some is good, so more must be better.” It is always important to remember that too much volume, intensity, or frequency can contribute to the overtraining syndrome and manifest as fatigue.

Loss of training vigor and increasing work-out fatigue can also be associated with inadequate nutritional intake to support the training program. This seems to be a more frequent problem in female athletes, but is by no means gender specific. If there is any question regarding food intake, a nutrition consultation should be suggested if simple advice to increase calories through meals or supplements does not change the energy level rapidly.

A diet that is insufficient to supply the iron needed to support the blood and energy systems will drastically, although often gradually, affect the athlete's ability to perform. This is especially prevalent in athletes who do not eat meat or who are on self-designed “fat restricted” diets.

A quick look at the inner side of the lower eyelid can point toward anemia or low hemoglobin. A normal hemoglobin produces a pink-red coloration of the mucosa on the inner lower lid. Anemic athletes will have a very pale appearance in the lower lid. It takes a good deal of normal observation to make this a useful field test, but after a bit of practice the differences become immediately apparent.

Included in the area of nutrition is the issue of hydration and fluid replacement. Athletes should ingest fluids at a level that maintains good fluid status without over or under-hydrating. The simple field test to have the athlete monitor is urine color. A urine color that looks like pale lemonade is probably an indication of adequate fluid intake.

Dark urine, like apple juice, is associated with inadequate fluid intake. Clear urine may indicate an athlete is taking too much fluid. Athletes who feel weak or woozy during hard practices or competition may not have an adequate salt intake. An athlete who saturates his or her workout clothes with salt from sweat during practices or competition may lose more than the average amount of salt in sweat and end up with lowered sodium levels. This is especially common in the early, hot season workouts, and increased dietary salt will usually solve the problem.

Simple vital signs like heart rate and respiratory rate are easily assessed in the field. An athlete will usually establish a consistent heart and respiratory recovery time interval as training progresses. The heart rate will usually drop below 100 beats-per-minute after an exercise bout in a relatively consistent time period. A lengthened recovery interval, especially combined with a rise in waking first morning heart rate, often signals inadequate short-term rest or impending illness.

The first morning heart rate in an athlete who is well trained and healthy will establish a baseline that can be used to monitor training and well-being. A highly trained endurance athlete will often have a baseline morning heart rate near or below 40 beats per minute that would be considered pathologic bradycardia, or a lower-than-normal heart beat, in an untrained individual.

Although first morning heart rate has not been shown in studies to have significance for overtraining syndrome, it is a useful measure for many athletes as a rise of 10-15 beats per minute above an established baseline often precedes symptoms of illness and is common if sleep rest is acutely inadequate. Cutting back the volume and intensity of workouts on those days may help avoid interruptions in effective training.

Practice performance times for distance or interval workouts are another simple measure of well-being. An athlete who is training effectively, eating and sleeping well, and is psychologically attuned should see improving times or abilities throughout the season. During the competitive season, the actual performance times are a measure of how the athlete is doing. In the heart of the pre-season, average training times should be trending toward the competition goal. A plateau or loss of improvement is an indicator of constitutional imbalance that deserves investigation.

There are chemistry field assessments that can be applied to the athlete during training, like measuring the blood lactate concentration following a fixed work volume. The lactate should decrease as conditioning improves through the season. This form of testing requires special equipment and training to use effectively in the field. The athlete can also be moved into the lab for periodic assessments of maximal oxygen uptake, respiratory exchange ratio, muscle biopsy, and other tests that are expensive and often not at the disposal of many coaches.

Coaches can monitor athletes with simple observation in the field to assess well being and training response. While there are more sophisticated lab assessment techniques, it is the response to daily training and evaluation of the training program that allows a coach and athlete to optimize training on a day-to-day basis. One of the joys of coaching is watching the progression of an athlete during the season and a keen eye to the athlete’s responses can enhance the coach-athlete relationship and the athlete’s peak performance.