Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers
Abstract Background Athletic underperformance is characterized by fatigue and an inability to sustain a consistent exercise workload. We describe five elite swimmers with prolonged fatigue and athletic underperformance. Based on our work in myalgic encephalomyelitis /chronic fatigue syndrome, we foc...
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Sports Science, Medicine and Rehabilitation |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13102-022-00529-8 |
| _version_ | 1828328535235756032 |
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| author | Lindsay S. Petracek Ella F. Eastin Ian R. Rowe Peter C. Rowe |
| author_facet | Lindsay S. Petracek Ella F. Eastin Ian R. Rowe Peter C. Rowe |
| author_sort | Lindsay S. Petracek |
| collection | DOAJ |
| description | Abstract Background Athletic underperformance is characterized by fatigue and an inability to sustain a consistent exercise workload. We describe five elite swimmers with prolonged fatigue and athletic underperformance. Based on our work in myalgic encephalomyelitis /chronic fatigue syndrome, we focused on orthostatic intolerance as a possible contributor to symptoms. Methods Participants were referred for evaluation of fatigue and underperformance to the Chronic Fatigue Clinic at the Johns Hopkins Children’s Center. All patients were evaluated for overtraining syndrome, as well as for features commonly seen in myalgic encephalomyelitis/chronic fatigue syndrome. The latter included joint hypermobility, orthostatic intolerance, and non-IgE mediated milk protein intolerance. Orthostatic intolerance was tested by performing a ten-minute passive standing test or a head-up tilt table test. Results Orthostatic testing provoked fatigue and other symptoms in all five swimmers, two of whom met heart rate criteria for postural tachycardia syndrome. Treatment was individualized, primarily consisting of an increased intake of sodium chloride and fluids to address orthostasis. All patients experienced a relatively prompt improvement in fatigue and other orthostatic symptoms and were able to either return to their expected level of performance or improve their practice consistency. Conclusions Orthostatic intolerance was an easily measured and treatable contributor to athletic underperformance in the five elite swimmers we describe. We suggest that passive standing tests or formal tilt table tests be incorporated into the clinical evaluation of athletes with fatigue and underperformance as well as into scientific studies of this topic. Recognition and treatment of orthostatic intolerance provides a new avenue for improving outcomes in underperforming athletes. |
| first_indexed | 2024-04-13T20:10:40Z |
| format | Article |
| id | doaj.art-65533a4f891847bcb02800f3706d96dc |
| institution | Directory Open Access Journal |
| issn | 2052-1847 |
| language | English |
| last_indexed | 2024-04-13T20:10:40Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Sports Science, Medicine and Rehabilitation |
| spelling | doaj.art-65533a4f891847bcb02800f3706d96dc2022-12-22T02:31:50ZengBMCBMC Sports Science, Medicine and Rehabilitation2052-18472022-07-0114111110.1186/s13102-022-00529-8Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmersLindsay S. Petracek0Ella F. Eastin1Ian R. Rowe2Peter C. Rowe3Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine BaltimoreDivision of Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine BaltimoreDivision of Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine BaltimoreDivision of Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine BaltimoreAbstract Background Athletic underperformance is characterized by fatigue and an inability to sustain a consistent exercise workload. We describe five elite swimmers with prolonged fatigue and athletic underperformance. Based on our work in myalgic encephalomyelitis /chronic fatigue syndrome, we focused on orthostatic intolerance as a possible contributor to symptoms. Methods Participants were referred for evaluation of fatigue and underperformance to the Chronic Fatigue Clinic at the Johns Hopkins Children’s Center. All patients were evaluated for overtraining syndrome, as well as for features commonly seen in myalgic encephalomyelitis/chronic fatigue syndrome. The latter included joint hypermobility, orthostatic intolerance, and non-IgE mediated milk protein intolerance. Orthostatic intolerance was tested by performing a ten-minute passive standing test or a head-up tilt table test. Results Orthostatic testing provoked fatigue and other symptoms in all five swimmers, two of whom met heart rate criteria for postural tachycardia syndrome. Treatment was individualized, primarily consisting of an increased intake of sodium chloride and fluids to address orthostasis. All patients experienced a relatively prompt improvement in fatigue and other orthostatic symptoms and were able to either return to their expected level of performance or improve their practice consistency. Conclusions Orthostatic intolerance was an easily measured and treatable contributor to athletic underperformance in the five elite swimmers we describe. We suggest that passive standing tests or formal tilt table tests be incorporated into the clinical evaluation of athletes with fatigue and underperformance as well as into scientific studies of this topic. Recognition and treatment of orthostatic intolerance provides a new avenue for improving outcomes in underperforming athletes.https://doi.org/10.1186/s13102-022-00529-8Athletic underperformanceOvertrainingPostural tachycardia syndromeOrthostatic intolerancePost-exertional malaiseChronic fatigue syndrome |
| spellingShingle | Lindsay S. Petracek Ella F. Eastin Ian R. Rowe Peter C. Rowe Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers BMC Sports Science, Medicine and Rehabilitation Athletic underperformance Overtraining Postural tachycardia syndrome Orthostatic intolerance Post-exertional malaise Chronic fatigue syndrome |
| title | Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers |
| title_full | Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers |
| title_fullStr | Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers |
| title_full_unstemmed | Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers |
| title_short | Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers |
| title_sort | orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers |
| topic | Athletic underperformance Overtraining Postural tachycardia syndrome Orthostatic intolerance Post-exertional malaise Chronic fatigue syndrome |
| url | https://doi.org/10.1186/s13102-022-00529-8 |
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