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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