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Table 1 Markers included in the present analysis, among those evaluated by the EROS study

From: Novel causes and consequences of overtraining syndrome: the EROS-DISRUPTORS study

Study/Tests Markers
Total number of markers: 117
(Included:45)
Whether included or excluded (and if excluded, why)
EROS-HPA axis Total number of markers: 20 Included markers: 7
Basal ACTH and cortisol and their response to an insulin tolerance test (ITT) 1. Basal cortisol (μg/dL)
2. Cortisol during hypoglycemia (μg/dL)
3. Cortisol 30 min after hypoglycemia (μg/dL)
4. Cortisol increase during ITT (μg/dL)
5. Basal ACTH (pg/mL)
6. ACTH during hypoglycemia (pg/mL)
7. ACTH 30 min after hypoglycemia (pg/mL)
8. ACTH increase during ITT (pg/mL)
9 Basal ACTH/cortisol ratio
10. ACTH/cortisol ratio during hypoglycemia
11. ACTH/cortisol ratio 30 min after hypoglycemia
Similar levels between OTS and ATL
INCLUDED
INCLUDED
INCLUDED
Similar levels between OTS and ATL
Similar levels between OTS and ATL
INCLUDED
INCLUDED
Unsubstantiated marker
Unsubstantiated marker
Unsubstantiated marker (although different between OTS and ATL)
Cortisol response to a cosyntropin stimulation test (CST) 12. Cortisol at 30 min after synthetic ACTH shot (μg/dL)
13. Cortisol at 60 min after synthetic ACTH shot (μg/dL)
14. Difference between basal cortisol on day 1 (CST) and day 3 (ITT) (%)
Similar levels between OTS and ATL
Similar levels between OTS and ATL
Not diagnostic or helpful
Salivary cortisol rhythm (SCR) 15. Salivary cortisol at awakening (ng/dL)
16. Salivary cortisol 30 min after wakening (ng/dL)
17. Salivary cortisol at 4 PM (ng/dL)
18. Salivary cortisol at 11 PM (ng/dL)
19. Cortisol awakening response (CAR) (%)
20. Difference between 8 AM and 4 PM salivary cortisol (%)
Similar levels between OTS and ATL
INCLUDED
Similar levels between OTS and ATL
Similar levels between OTS and ATL
INCLUDED
Not diagnostic or helpful
EROS-STRESS Total number of evaluated markers: 12 Included markers: 7
GH and Prolactin response to an ITT 1. Basal (GH) (μg/L)
2. GH during hypoglycaemia (μg/L)
3. GH 30 min after hypoglycaemia (μg/L)
4. Basal prolactin (ng/mL)
5. Prolactin during hypoglycaemia (ng/mL)
6. Prolactin 30 min after hypoglycaemia (ng/mL)
7. Prolactin increase during ITT (ng/mL)
8. Basal serum glucose (mg/dL)
9 Serum glucose during hypoglycemia (mg/dL)
10. Capillary glucose during hypoglycemia (mg/dL)
11. Adrenergic symptoms during hypoglicemia (0–10)
12. Neuroglycopenic symptoms during hypoglicemia (0–10)
INCLUDED
INCLUDED
INCLUDED
INCLUDED
INCLUDED
INCLUDED
INCLUDED
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful (although different between OTS and ATL)
Not diagnostic or helpful
EROS-BASAL (total number of evaluated markers: 32) Included markers: 9
Hormonal markers 1. Total testosterone (ng/dL)
2. Estradiol (pg/mL)
3. IGF-1 (pg/mL)
4. TSH (μUI/mL)
5. Free T3 (pg/mL)
6. Total catecholamines (μg/12 h)
7. Total metanephrines (μg/12 h)
8. Noradrenaline (μg/12 h)
9. Epinephrine (μg/12 h)
10. Dopamine (μg/12 h)
11. Metanephrine (μg/12 h)
12. Normetanephrine (μg/12 h)
13. Catecholamine-to-metanephrine ratio
INCLUDED
INCLUDED
Similar levels between OTS and ATL
Similar levels between OTS and ATL
Similar levels between OTS and ATL
INCLUDED
Similar levels between OTS and ATL
Similar levels between OTS and ATL
Similar levels between OTS and ATL
INCLUDED
Similar levels between OTS and ATL
Similar levels between OTS and ATL
Not diagnostic or helpful (although diferente between OTS and ATL)
Biochemical markers 14. Erythrocyte sedimentation rate (ESR, mm/h)
15. Hematocrit (%)
16. C-reactive protein (CRP, mg/dL)
17. Lactate (nMol/L)
18. Vitamin B12 (pg/mL)
19. Ferritin (ng/mL)
20. Neutrophils (*mm3)
21. Lymphocyte (*mm3)
22. Eosinophils (*mm3)
23. Creatine kinase (CK, U/L)
24. Medium corpuscular volume (MCV)
25. Platelets (103/mm)
26. Low density lipoprotein cholesterol (LDLc) (mg/dL)
27. High density lipoprotein cholesterol (HDLc) (mg/dL)
28. Tryglicerides (mg/dL)
Similar levels between OTS and ATL
Similar levels between OTS and ATL
Similar levels between OTS and ATL
INCLUDED
Similar levels between OTS and ATL
Similar levels between OTS and ATL
INCLUDED
Similar levels between OTS and ATL
Similar levels between OTS and ATL
INCLUDED
Not diagnostic or helpful
Not diagnostic or helpful
Data missed in > 5% of participants
Data missed in > 5% of participants
Data missed in > 5% of participants
Ratios 29. Testosterone-to-oestradiol ratio
30. Testosterone-to-cortisol ratio
31. Neutrophil-to-lymphocyte ratio
32. Platelet-to-lymphocyte ratios
INCLUDED
Similar levels between OTS and ATL
INCLUDED
Similar levels between OTS and ATL
EROS-PROFILE (total number of evaluated markers: 53) Included markers: 21
Nutritional patterns (7-day diet record, prior and during OTS) 1. Calorie intake (kcal/kg/day)
2. Carbohydrate intake (g/kg/day)
3. % calories from carbohydrate (%)
4. Protein intake (g/kg/day)
5. % calories from protein (%)
6. Fat intake (g/kg/day)
7. % calories from fat (%)
8. Carbohydrate intake > 3 g/kg/day (Y/N)
9. Daily whey protein consumption (Y/N)
10. Followed a diet plan (Y/N)
11. Post-workout carbohydrate intake > 0.5 g/kg (Y/N)
INCLUDED (as a modifiable habita)
INCLUDED (as a modifiable habita)
Intrinsically linked to other parameters
INCLUDED (as a modifiable habita)
Intrinsically linked to other parameters
Similar levels between OTS and ATL
Intrinsically linked to other parameters
Qualitative marker
Qualitative marker
Qualitative marker
Qualitative marker
Psychological patterns (during OTS) 12. Profile of Mood State (POMS) questionnaire (total score: −32 to + 120)
13. Anger subscale (0 to 48)
14. Confusion subscale (0 to 28)
15. Depression subscale (0 to 60)
16. Vigour subscale (0 to 32)
17. Fatigue subscale (0 to 28)
18. Tension subscale (0 to 36)
19. How do you fell today? (0–10)
20. Have you been sick in the last two weeks? (Y/N)?
21. How was your last training session compared to the projected goals? (Extremely easy to extremely hard)
22. How do your muscles feel? (Nothing at all to extremely painful)
23. How friendly do you feel today? (0–6)
24. How worthless do you feel today? (0–6)
25. How miserable do you feel today? (0–6)
26. How helpful do you feel today? (0–6)
27. How bad-tempered do you feel today? (0–6)
28. How unworthy do you feel today? (0–6)
29. How peeved do you feel today? (0–6)
30. How cheerful do you feel today? (0–6)
31. How sad do you feel today? (0–6)
32. Number of hours of activities besides professional training (h/day)
INCLUDED
INCLUDED
INCLUDED
INCLUDED
INCLUDED
INCLUDED
INCLUDED
Not diagnostic or helpful (although different between OTS and ATL)
Qualitative marker
Not diagnostic or helpful (although different between OTS and ATL)
Not diagnostic or helpful (although different between OTS and ATL)
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful (although different between OTS and ATL)
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful (although different between OTS and ATL)
Not diagnostic or helpful
INCLUDED (as a modifiable habita)
Social patterns (during OTS) 33. Duration of night sleep (h)
34. Self-reported sleep quality (0–10)
35. Self-reported libido (0–10)
36. Initial imnsonia (Y/N)
37. Terminal imnsonia (Y/N)
38. More than two wake-ups during sleep (Y/N)
39. Work and/or study (Y/N)
40. Libido during resting periods / vacations (0–10)
Similar levels between OTS and ATL
INCLUDED (as a modifiable habita)
INCLUDED
Qualitative marker
Qualitative marker
Qualitative marker
Qualitative marker
Not diagnostic or helpful
Body metabolism analysis (indirect calorimetry) 41. Measured-to-predicted basal metabolic rate (BMR, %)
42. Percentage of fat burning compared to total BMR (%)
INCLUDED
INCLUDED
Body composition (Bod Pod, InBody770 and 3D body scanner) 43. Body fat percentage (%)
44. Visceral fat (cm2)
45. Muscle mass weight (%)
46. Body water percentage (BW, %)
47. Extracellular water compared to total BW (%)
48. Body weight (kg)
49.Chest to waist circumference
50. Waist circumference (cm)
51. Chest circumference (cm)
52. Biceps circumference (cm)
53. Hip circumference (cm)
INCLUDED
INCLUDED
INCLUDED
INCLUDED
INCLUDED
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful
Not diagnostic or helpful
  1. OTS Athletes affected by overtraining syndrome, ATL, Healthy athletes
  2. aFor statistical purposes, modifiable factors were considered as independent variables, from which the dependent variables were statistically evaluated