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Part I
Conceptualizing the problem
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1
Monitoring the Recovery-Stress State in Athletes
Jahan Heidari, Sarah Kölling, Maximilian Pelka, and Michael Kellmann
Introduction
Elite athletes form an unique sample of individuals with regard to their needs and abilities compared to the general population. In the following, an example of a prototypical year of a NFL (National Football League)-player is provided. The report is based on personal experiences by the authors and illustrations by Weinfuss (2014), who vividly described the physical and mental challenges NFL-players are confronted with during both season and offseason. The exemplary description of a season of an elite athlete should introduce the overall topic of monitoring stress and recovery which will be discussed in this chapter and throughout the book. Typical daily life situations and events of a NFL-player are delineated, indicating potential starting points for appropriate and effective monitoring in sports settings.
NFL-player, 5th season (with reference to Weinfuss, 2014):
As a NFL player, your season ideally lasts from July until the beginning of February, if you make the playoffs and proceed to the Super Bowl. During these seven months, you are exposed to a stressful and tough schedule, involving meetings, practice, weekly games, and off-the-field responsibilities. Apart from the intense physical demands you are constantly confronted with, also mental strains exist requiring your resources. It is a fast-paced life, leaving almost no room for detachment and cognitive processing of all the stimuli and experiences you have to deal with. Your focus and concentration are exclusively directed towards winning the next game in order to attain the overall goal: to win the Super Bowl. In the course of the season, family and social contacts come short and do not receive the attention they deserve, as travelling time, game preparation and tactical meetings consume a considerable amount of time. Unwinding takes place predominantly on a physical level, for example via stretching activities, massages, and ice bathes after a weekend’s game day. A regular week would then continue with the preparation for the next opponent, consisting of video analyses of games and specific plays. This theoretical information also needs to be addressed on the field during practice. Additionally, each position meets with the respective coach to obtain explicit input relevant for their own performance. On top, strength training sessions are implemented up to four times per week to prevent injuries and prepare for the physical challenges in the life of a NFL-player. But in the end, it was all worth it when you reach the ultimate goal, to win a Super Bowl. The longer the season lasts, the more you experience minor injuries due to an exhaustive season and the necessity to provide your mind and body with an extensive recovery period increases constantly.
At first glance, the offseason appears to be the long-desired and welcomed break allowing for comprehensive physical and mental recovery. But many of us fear the abrupt change from a structured and packed schedule to a daily routine without football-related obligations. Players frequently report a habituation process to the offseason life, which is accompanied by mental detachment from the season-specific rhythm and in particular, an adjustment to the family-related rhythm. We need to find our place in the daily routine of the family while recovering from the physical complaints that have accumulated over the season. After two to four weeks, this offseason ‘stress’ may be increased by slowly resuming offseason training in order to keep the physical fitness and prepare for the next season. For a football player, recovery represents a delicate and juggling act, consisting of both physical and mental strategies to be placed at the right time in a reasonable dose. In the end, the NFL is a business, which does not allow weaknesses and exceptions from your schedule in order to obtain your physical and mental balance.
The scenario describes the course of a typical year for a professional football player competing at the highest level. Regardless of sports type, strict schedules resembling those of NFL-players are on the agenda of elite athletes. In general, competitive athletes are constantly confronted with considerable physical and psychological strains, which may stem from training routines, pressure to perform, or self-inflicted expectations (Drew, Cook, & Finch, 2016; Markser, 2011). According to the scenario, athletes may consider this potpourri of sport-specific challenges and influences as stressful, which may result in a disturbance of the balance between stress and recovery. Nevertheless, an inference with the organismic equilibrium via challenging external and internal stimuli cannot be generalised as a genuinely negative event (Lazarus, 1999). For professional athletes with noble goals (e.g., Super Bowl, Champions League), certain stressors can be contemplated as adequately challenging, such as tactical or strength training sessions. They enable athletes to perform on a higher level in crucial situations, for example in the final minutes of a playoff game. Hence, it is the concept of distress which is characterised as an aversive, adverse state in which stimuli are perceived as stressors exceeding the personal coping resources.
Referring to the aforementioned NFL example, the susceptibility of players to potential stressors, such as media presence or training sessions, may vary significantly. While one player perceives the media as motivating and performance enhancing, another athlete might feel hampered by the environmental expectations and the pressure to perform. Notably, not only interindividual differences may be present, but each athlete experiences certain situations as varyingly stressful depending on his psychological resilience, which is modified by competitive, organisational, and personal factors (Sarkar & Fletcher, 2014).
The recovery-stress state
In response to these multi-faceted stressors, ensuring comprehensive recovery has emerged as essential strategy to establish a functional health condition and guarantee a continuous ability to perform in elite sports (Kellmann, 2002b; Kellmann & Kallus, 2016). Recovery can be defined as:
an inter- and intraindividual multilevel (e.g., psychological, physiological, social) process in time for the re-establishment of personal resources and their full functional capacity. Recovery includes a broad range of physiological processes like sleep, motivated behavior (like eating and drinking) and goal-oriented components (like relaxation or meeting friends). Recovery activities can be passive or active and in many instances recovery is achieved indirectly by activities, which stimulate recovery processes like active sports.
(Kallus, 2016, p. 42)
The basic concept of recovery consists of the idea that resources need to be restored to regain a homeostatic and biorhythmic balance. Essentially, recovery depends on a reduction of, a change of, or a break from stress and comprises a gradual and cumulative process that is dependent on previous activities or events (Kellmann, 2002b). A challenging event such as a NFL playoff game between two division rivals might exhibit considerable psychological and physical stress on the players and requires extensive recovery depending on the specific needs of each athlete. Peak performance is only achievable if athletes are recovered appropriately after exposition to demanding activities by optimally balancing stress with adequate recovery throughout a longer period of time, for instance an entire season of a NFL-player (Kellmann, 2010). Potential recovery strategies can be divided into active, passive, and pro-active methods (Kellmann, 2002b). Active recovery involves moderate exercise during the recovery process to eliminate the results of fatigue through a target-oriented physical activity (e.g., a cool-down programme directly after a match or on the following morning). A passive approach could consist of sauna, massages, or just sitting or lying quietly. Thereby, physiological reactions to physiological stimuli such as heat, cold, or pressure to restore pre-task performance states are initiated and are accompanied by psychological adaptations. In case recovery includes a purposeful, self-initiated, and self-determined action, it can be characterised as pro-active recovery (e.g., dynamic stretching or systematically breathing for just a few minutes during a half-time break). In addition, recovery is tightly linked to environmental circumstances. Exemplarily, athletes are frequently obliged to give interviews after demanding matches causing a postponement of the recovery process. A delay of only 10–15 minutes may result in disturbed or reduced recovery which negatively affects the homeostatic equilibrium (Reilly & Ekblom, 2005). Research in football (Fullagar et al., 2016), rowing (Kölling et al., 2016), strength training (Raeder et al., 2016), and cycling (Hammes et al., 2016) highlights the importance of the recovery process regarding injury and training monitoring in a variety of sports.
Consequences of a recovery-stress imbalance
In case demands become overwhelming and sufficient recovery is not applied, a return to a state of physiological and psychological homeostasis with a balanced recovery-stress state cannot be realised (Goldstein, 2009). This transition from a stable recovery-stress state to an imbalance of stress and recovery can be characterised as a gradual process, with stress and recovery representing intertwined and interdependent constructs. According to Kellmann (2002b), the complexity of fine-tuning recovery and stress can only be obtained when considering all factors that influence performance, such as training (e.g., extent, intensity, training techniques, periodisation), lifestyle (e.g., sleep, nutrition, recreational activities), state of health (e.g., cold, infections), or environment (e.g., family, team members, school/ university). A lack of awareness of the importance of the recovery-stress balance may lead to dysfunctional behaviour, such as inappropriate time management, excessive training and workloads, or ineffective priorities. A continuous exposition to this potpourri of dysfunctional demands may overwhelm the resources of athletes, ultimately causing hazardous health conditions such as underrecovery, the overtraining syndrome or even the burnout syndrome (Gustafsson, Hassmén, Kenttä, & Johansson, 2008; Meeusen et al., 2013). A constant downward spiral illustrates the relationship between these three states. At the outset, underrecovery establishes and serves as the antecedent of overtraining and burnout in terms of individual well-being, performance decrements, and influence on short- and long-term health development (Kellmann, 2002b).
Underrecovery is defined as an imbalance of recovery periods and daily life demands of an athlete (Kellmann, 2002b). If athletes reach the state of chronic underrecovery, short periods of rest or spontaneous recovery interventions appear to be ineffective. Longer rest periods (from several weeks to months) including professional help from medical doctors or psychologists are required for a re- establishment of the recovery-stress equilibrium. With additional training load, recovery demands increase proportionally. However, a short-term planned episode of recovery (e.g., a day off following a strenuous practise session) stimulates long-term restorative effects. On the contrary, an increase of training load and intensity over a longer time accompanied by inadequate or inappropriate recovery may end in long-term underrecovery followed by overtraining (Kellmann, 2010; Roose, de Vries, Schmikli, Backx, & van Doornen, 2009). At each stage, recovery can work as a regulatory mechanism. In principle, it is understood that the higher an athlete’s stress level, the higher the demands for recovery to reach an individual’s optimal recovery-stress state. Therefore, an exposition to high stress does not necessarily imply negative consequences as long as recovery demands are met accordingly (Kellmann, 2002b). These interconnections between stress and recovery reflect the central idea of the ‘scissor model’ established by Kellmann (2002b). Problematically, a lack of potent coping strategies in combination with chronic stress can lead to overtraining as an inevitable consequence (Gustafsson et al., 2008). Overtraining can be contemplated as the result of too much training and stress together with insufficient recovery (Meeusen et al., 2013). Therefore, underrecovery can be classified as a longer-lasting pre-condition to the overtraining syndrome. Overtraining has been primarily associated with physiological stress and represents a particular characteristic of sports. On the contrary, the burnout syndrome considers psychological factors to a greater extent (Gustafsson, Kenttä, & Hassmén, 2011) and is prevalent in various performance areas and disciplines (Leiter, Bakker, & Maslach, 2014; Maslach, Schaufeli, & Leiter, 2001). A sports-related integrated framework was developed by Gustafsson and colleagues (2011) for the purpose of directing future research in the sports domain. Burnout denotes a negative emotional reaction to sports participation and is defined by the three central attributes of exhaustion, cynicism, and inefficacy (Maslach et al., 2001). While it is known that overtrained athletes are still capable of maintaining their performance motivation to continue with training, a burned-out athlete will commonly lack the motivation to pursue his/her activity (Fry, Morton, & Keast, 1991). Similarly, burnout has been conceptualised as an exhaustive psychophysiological response to massive chronic stress that develops gradually (Gustafsson, Kenttä, Hassmen, Lundqvist, & Durand-Bush, 2007). Burnout has also been shown to provoke affective, cognitive, motivational, and behavioural consequences with chronic emotional and physical exhaustion as key components (Goodger, Gorely, Lavallee, & Harwood, 2007). A summary of the central characteristics and differences between underrecovery, overtraining, and burnout is provided in Table 1.1. Negative health-related outcomes due to augmented stress and reduced recovery are not limited to underrecovery, overtraining, or burnout. Health issues may also manifest in injuries, back pain, or psychiatric disorders (Glick, Stillman, Reardon, & Ritvo, 2012; Heidari et al., 2016; van der Does, Brink, Otter, Visscher, & Lemmink, 2017). The descriptions in the football scenario correspond to scientific findings reporting a trend to experience underrecovery towards the end of a season, which is accompanied by a higher proneness to injuries (Fau...
