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Context :  To understand overtraining syndrome (OTS), it is important to detail the physiological and psychological changes that occur in athletes.   Objectives :  To systematically establish and detail the physiological and psychological changes that occur as a result of OTS in athletes.   Methods :  Databases were searched for studies that were (1) original investigations; (2) English, full-text articles; (3) published in peer-reviewed journals; (4) investigations into adult humans and provided (5) objective evidence that detailed changes in performance from prior to the onset of OTS diagnosis and that performance was suppressed for more than 4 weeks and (6) objective evidence of psychological symptoms.   Results :  Zero studies provided objective evidence of detailed changes in performance from prior to the onset of OTS diagnosis and demonstrated suppressed performance for more than 4 weeks accompanied by changes in psychological symptoms.   Conclusions :  All studies failed to provide evidence of changes in performance and mood from “healthy” to an overtrained state with evidence of prolonged suppression of performance. While OTS may be observed in the field, little data is available describing how physiological and psychological symptoms manifest. This stems from vague terminology, difficulties in monitoring for prolonged periods of time, and the need for prospective testing. Real-world settings may facilitate the collection of such data, but the ideal testing battery that can easily be conducted on a regular basis does not yet exist. Consequently, it must be concluded that an evidence base of sufficient scientific quality for understanding OTS in athletes is lacking.

Overtraining Syndrome Symptoms and Diagnosis in Athletes: Where Is the Research? A Systematic Review