Athlete at Age

Scientists discover clues to what makes human muscle age

MAPK and Notch pathways apparently age human (and all other) muscle

Working in collaboration with Dr. Michael Kjaer and his research group at the Institute of Sports Medicine and Centre of Healthy Aging at the University of Copenhagen in Denmark, the UC Berkeley researchers compared samples of muscle tissue from nearly 30 healthy men who participated in an exercise physiology study. The young subjects ranged from age 21 to 24 and averaged 22.6 years of age, while the old study participants averaged 71.3 years, with a span of 68 to 74 years of age.

In experiments conducted by Dr. Charlotte Suetta, a post-doctoral researcher in Kjaer's lab, muscle biopsies were taken from the quadriceps of all the subjects at the beginning of the study. The men then had the leg from which the muscle tissue was taken immobilized in a cast for two weeks to simulate muscle atrophy. After the cast was removed, the study participants exercised with weights to regain muscle mass in their newly freed legs. Additional samples of muscle tissue for each subject were taken at three days and again at four weeks after cast removal, and then sent to UC Berkeley for analysis.

Morgan Carlson and Michael Conboy, researchers at UC Berkeley, found that before the legs were immobilized, the adult stem cells responsible for muscle repair and regeneration were only half as numerous in the old muscle as they were in young tissue. That difference increased even more during the exercise phase, with younger tissue having four times more regenerative cells that were actively repairing worn tissue compared with the old muscle, in which muscle stem cells remained inactive. The researchers also observed that old muscle showed signs of inflammatory response and scar formation during immobility and again four weeks after the cast was removed.

"Two weeks of immobilization only mildly affected young muscle, in terms of tissue maintenance and functionality, whereas old muscle began to atrophy and manifest signs of rapid tissue deterioration," said Carlson, the study's first author and a UC Berkeley post-doctoral scholar funded in part by CIRM. "The old muscle also didn't recover as well with exercise. This emphasizes the importance of older populations staying active because the evidence is that for their muscle, long periods of disuse may irrevocably worsen the stem cells' regenerative environment."

At the same time, the researchers warned that in the elderly, too rigorous an exercise program after immobility may also cause replacement of functional muscle by scarring and inflammation. "It's like a Catch-22," said Conboy.

The researchers further examined the response of the human muscle to biochemical signals. They learned from previous studies that adult muscle stem cells have a receptor called Notch, which triggers growth when activated. Those stem cells also have a receptor for the protein TGF-beta that, when excessively activated, sets off a chain reaction that ultimately inhibits a cell's ability to divide.

The researchers said that aging in mice is associated in part with the progressive decline of Notch and increased levels of TGF-beta, ultimately blocking the stem cells' capacity to effectively rebuild the body.

This study revealed that the same pathways are at play in human muscle, but also showed for the first time that mitogen-activated protein (MAP) kinase was an important positive regulator of Notch activity essential for human muscle repair, and that it was rendered inactive in old tissue. MAP kinase (MAPK) is familiar to developmental biologists since it is an important enzyme for organ formation in such diverse species as nematodes, fruit flies and mice.

For old human muscle, MAPK levels are low, so the Notch pathway is not activated and the stem cells no longer perform their muscle regeneration jobs properly, the researchers said.

When levels of MAPK were experimentally inhibited, young human muscle was no longer able to regenerate. The reverse was true when the researchers cultured old human muscle in a solution where activation of MAPK had been forced. In that case, the regenerative ability of the old muscle was significantly enhanced.

"The fact that this MAPK pathway has been conserved throughout evolution, from worms to flies to humans, shows that it is important," said Conboy. "Now we know that it plays a key role in regulation and aging of human tissue regeneration. In practical terms, we now know that to enhance regeneration of old human muscle and restore tissue health, we can either target the MAPK or the Notch pathways. The ultimate goal, of course, is to move this research toward clinical trials."

Solution for Tennis Elbow!

The NY Times just ran a short piece on a new treatment for tennis elbow: PhysEd: A New Treatment for Tennis Elbow .

...researchers from the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City announced last month that they’ve developed an effective and supremely cheap treatment for chronic tennis elbow. Huddling a while back to brainstorm about inexpensive methods for combating the injury, the scientists glanced around their offices and noticed a homely, low-tech rubber bar, about 8 inches long, which, at the time, was being used for general physical therapy programs. The researchers wondered whether the ribbed, pliable bars, available for less than $20, might be re-purposed to treat tennis elbow. The answer, it soon become clear, was a resounding yes.

...
in the past two or three years, doctors and researchers have begun focusing on a particular kind of exercise that has shown promise against other achy tendons, especially the Achilles. The program involves eccentric exercises, which aren’t oddball moves but those in which the muscle lengthens as it tenses. Think of a biceps curl. When you raise the dumbbell, your bicep shortens and tightens. That’s a concentric contraction. When you lower the weight, the muscle lengthens, straining against the force of the weight. That’s eccentric.
...

“There’s a growing body of research showing that eccentric exercises are quite effective in treating Achilles tendonosis” and other tendon problems, Tyler says.

One of those studies was a well-designed 2007 experiment centered on tennis elbow. Conducted in Belgium, it found that eccentric exercises provided considerable relief. But the exercises had to be performed on expensive machines under medical supervision during repeated office visits. “We looked at those results and thought, there has to be an easier, more cost-effective way,” Tyler says.

Which is how they arrived at the rubber bar technique. He and his colleagues realized that a single, unhurried exercise using a tensile bar that looks like an oversized licorice stick could create an eccentric contraction all along the forearm. In the exercise, a person holds the bar upright at his or her side using the hand connected to the sore elbow, then grasps it near the top with the good hand. The top hand twists as the bar is brought around in front of the body and positioned perpendicular to the ground; the sore hand then takes over, slowly untwisting the bar by flexing the wrist. “Afterward, you should be sore,” Tyler says. “That’s how we know it’s effective.”

Eccentric contractions require the muscle to work against a force, in this case the coiled bar. “You can load a tendon so much more eccentrically” than with concentric exercises, Tyler says. “So we think the process may be remodeling the tendon.” Ultrasound studies by other researchers, including the group in Belgium, have shown that damaged tendons typically become less thick, indicating they are less damaged, after a course of strenuous eccentric exercise.

Tyler reported his findings at the July annual meeting of the American Orthopedic Society for Sports Medicine and has been deluged ever since with requests from doctors, physical therapists and patients for more information about how to perform the exercise and where to buy the bar. (Called the Thera-Band Flexbar, it’s available on Amazon.com; the manufacturer donated products for the study, but didn’t otherwise fund it; Tyler is not affiliated with the company.) “It’s not a difficult exercise but it is unique, so I would advise people to be taught by a physical therapist, if possible,” Tyler says. If not, proceed on your own — after, of course, an examination by a doctor; elbow pain can have many causes, not just tennis elbow. “In my opinion, you’re not going to hurt yourself,” Tyler continues, although you should be prepared for a commitment. His patients did three sets of fifteen repetitions every day. Beginners should start with three sets of five repetitions, adding more as the repetitions get easier, Tyler says.

The article has an instructional video, also available on YouTube Isolated eccentrics with flexbar:

I ordered a flexbar at Amazon.  $17.17 + shipping.  Given the tendonitis I've worked around for years, it seems like a bargain.

Can we get some CrossFitters or other trainers to apply this idea of "isolated eccentrics" to other tendons?

Alpha^2

To Improve Fitness, Try Sleep

Tara Parker-Pope writes about a small study on sleep and fitness for the NY Times.

To Improve Fitness, Try Sleep

Most people training for a race or sport focus on adding more miles, workouts or weight training to improve their fitness. But new research suggests that simply getting more sleep can improve athletic performance.

The small study included five members of the Stanford women’s tennis team. For two to three weeks, the athletes maintained their regular schedules, sleeping and working out as usual. They took part in sprinting and hitting drills to measure their performance. Then the players were told to extend their sleep to 10 hours a night for five to six weeks.

After increasing sleep, the athletes performed better on all the drills. Sprinting drill times dropped on average to 17.56 seconds from 19.12 seconds. Hitting accuracy, measured by valid serves, improved to 15.61 serves, up from 12.6 serves, and a hitting depth drill improved to 15.45 hits, up from 10.85 hits.

Nice to see these ideas hitting the mainstream press.

Alpha^2

Sprints may be best for diabetes prevention

The title may overstate the case, but Reuters Health reports via Yahoo's Sprints may be best for diabetes prevention:

A few minutes of intense exercise a week is just as good as a half-hour of moderate physical activity a day for reducing a person's risk of developing type 2 diabetes -- and may actually be even more effective, new research hints.

"It is possible to gain significant health benefits from only 7.5 minutes of exercise each week -- if that is all that you find the time to do," Dr. James A. Timmons of Heriot-Watt University in Edinburgh, one of the researchers on the study, told Reuters Health.

"This is a dramatically different view from current thinking," he admitted.

Timmons and his team found that young sedentary men who did just 15 minutes of all-out sprinting on an exercise bike spread out over two weeks substantially improved their ability to metabolize glucose (sugar). Traditional aerobic exercise programs can boost sensitivity to the key blood-sugar-regulating hormone insulin. The high-intensity program did this too, but it also directly reduced the men's blood sugar levels -- something that standard exercise programs have not been shown to do.

Current exercise guidelines recommend at least 30 minutes of exercise a day at least five days a week, but "the general population fails to follow such regimes due to lack of time, motivation and adherence," the investigators note in the journal BMC Endocrine Disorders. They hypothesized that high intensity exercise might improve insulin sensitivity more efficiently.

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Fountain of Youth

Doug McGuff, MD has an interesting new article, Fountain of Youth posted on his Ultimate Exercise site.

On May 23, 2007 a major stride in the quest for life extension occurred.  Researchers Simon Melov et al announced a treatment that successfully reversed aging. (www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000465).   This reversal occurred not in worms, fish, or rats; but actually occurred in human subjects.  More importantly, this reversal was not simply a marker of aging, but an actual reversal toward normal youthful function at the genetic level.  The researchers tested 596 genes that appeared to be markers of declining function as a result of age.  Most of these genes were associated with mitochondrial function.  This is important for two reasons.  First, the mitochondria are the powerhouses for the cells of your body, they are the engine that makes us run.  Secondly, mitochondrial DNA is easier to study with greater certainty of accuracy because all of your mitochondrial DNA comes only from your mother.  As a consequence, differences in expression cannot be accounted for by the contribution of another person’s (i.e.-father’s) DNA that may react differently under experimental conditions.   The study definitively identified 179 genes that were reversed by the intervention, and  as the study stated “the transcriptional signature of aging was markedly reversed back to that of younger levels for most genes that were affected by both age and exercise”.   what was this miracle treatment?  The answer is STRENGTH TRAINING.  Strength training performed twice a week for a period of 26 weeks.  Even more amazing is that by standards of most people who participate in training facilities such as Ultimate Exercise, it was strength training that was done relatively poorly on substandard equipment.  The researchers had subjects perform leg press, chest press, leg extension, leg flexion, shoulder press, lat pull-down, calf raise, abdominal crunch and back extension for 3 sets of 10 reps, and arm flexion and arm extension for 1 set of 10 reps.  The equipment was Universal Gym, Inc. equipment.  Resistance was based on 50% of a 1 rep max and progressed to 80% of a 1 rep max.  Over the study period the subjects increased their strength by 50% which made them only 38% weaker than 25 year old cohorts.  

Further down in the article Doug connects these ideas with Arthur Devany's:

A New Definition of Aging  

What is interesting about this landmark article is the genes that were identified to be related to aging were genes that were largely involved in synthesizing enzymes of anaerobic metabolism or transporting anaerobic substrate for aerobic use.  What therefore appears to be a marker of youth, and consequently what gets lost with aging, is the ability to perform high-intensity anaerobic work.  This fits well with a concept proposed by Dr. Arthur Devany (www.arthurdevany.com) .  Dr. Devany is an economist who developed the concept of Evolutionary Fitness.  While I differ in specific details of his exercise recommendation, I believe his notions regarding diet, exercise and how they effect the expression of genes handed down to us by evolution are absolutely brilliant. The concept that Dr. Devany coined is Physiologic Headroom. Physiologic headroom is basically described as “the difference between the most you can do and the least you can do”.  Dr. Devany notes that when the difference between the most you can do and the least you can do becomes zero, you are dead.  Consequently, it is easy to extrapolate that the process whereby the most you can do and the least you can do decreases could be called aging.  What determines the most you can do is basically aneaerobic metabolism.  Anaerobic metabolism precedes aerobic metabolism and can cycle much more quickly. This makes sense from an evolutionary standpoint because anaerobic metabolism is much more primitive than aerobic metabolism which was a much later evolutionary development.  It therefore makes sense that aerobic metabolism requires substrate from the anaerobic metabolism to run.  Once the ability to deliver that substrate declines, aerobic metabolism must decline as well, and the amount of output that can be generated from any kind of exercise will approach zero.

Doug ties a lot of this to HIT and SuperSlow training and I give him tremendous credit as perhaps its most articulate and thoughtful proponent.  A bit further in the article he continues with:

If we embrace this concept of aging (the gap between maximal and minimal output), and the type of training that enhances this capability; then we must acknowledge that there is a type of exercise which can produce the opposite result.  Low intensity, steady state exercise will actually accelerate aging by this definition.  When exercise is of low intensity, the slow and intermediate fibers are called upon at a rate that does not result in fatigue and does not stimulate rapid cycling of anaerobic metabolic pathways.  As a result, anaerobic enzymes down-regulate and fast twitch fibers are never called upon.  An adaptive response then occurs whereby the fast twitch fibers are allowed to atrophy and die.  This is because, if they are never used in the face of this activity, they are simply dead weight which must be carried along.  While one may argue that this is an adaptation, we must remember that not all adaptations are beneficial.  In the process of losing our fast twitch fibers, we do not just lose physiologic headroom.  We begin to lose the largest glucose sink in our body.  Glucose is stored as glycogen (long chains of glucose strung together like a tinker-toy model).  About 70 grams of glycogen can be stored in the liver and 220 grams can be stored in the skeletal muscle.  The glycogen in the liver is used mainly to maintain a stable blood glucose level.  The glycogen stored in the muscle is used as emergency on-site fuel for bursts of high intensity muscular work.  The majority of the glucose stored in muscle is in the fast-twitch fibers, because that is where the fuel is needed for emergency anaerobic metabolism.  When we jettison these fast-twitch fibers, we set up a scenario for a rapid decline in metabolic health.  By losing the largest storage warehouse for glucose in our body, we begin to lose insulin sensitivity.  We already only have a storage capacity of 290 grams at baseline (which is way less carbohydrate than the average American consumes in a given day).  As we lose the glucose storing capability of these fast-twitch fibers, we have nowhere for our dietary glucose to be stored and glucose stacks up in the bloodstream.  The liver and muscles become completely full and decrease the number and sensitivity of their insulin receptors to protect themselves from excess glucose being transported into the cell (excess glucose binds to metabolic proteins and enzymes in a process called glycosylation—imagine pouring pancake syrup on your keyboard).  Glucose then begins to stack up in the blood which in turn stimulates the pancreas to make more insulin.  This creates a stimulus for continued decreases in muscle insulin sensitivity.  The body tries to protect itself by increasing insulin sensitivity in other areas, most notably your fat cells.  A circuitous metabolic process then occurs where excess glucose is circulated to the liver where it is converted to Triacylglycerol (triglycerides) and is circulated to the fat cells for assembly and storage.  The relative increase in glucose metabolism through aerobic pathways produces oxidative free radicals that produce inflammation and accelerate the aging process.  The details of all of this downstream metabolic mayhem will be the subject of future articles and are discussed in further detail (with supporting literature) in Body by Science. Interestingly, if you ever get yourself into this predicament and visit your doctor, you will be told to eat a high carbohydrate/low fat diet and to take up steady state activity.  If you are lucky, you may get started on meds that kill your testosterone production and produce weakness in what little muscle you still have left.  What will really turn around this metabolic process is high intensity strength training combined with a diet based on evolutionary principles.  

Another vote for strength training + paleo, and a warning about statins that "...kill your testosterone production...".  Well worth the read.

Alpha^2

Osteoarthritis help

I received the following email from a friend of my wife's family:

I met J... in Toronto she told me that you were very informed about nutritional supplements etc. I thought I would ask your advice and find out what you would suggest. I travel a lot and had a few accidents (car, falling off horses) and have started to develop osteoarthritis in my neck. I also start to get very stiff when I sit still for a long time, like on long distance flights. It helps when I can do regular exercise at home, yoga and working on my land which is physically hard work, for example cutting fire wood which I am doing right now) but when I am in some got forsaken place to work and can not wonder the streets easily (no time or for security reasons) I am usually taking major meds like ibuproven I wonder if you have any other suggestions, perhaps in terms of herbal supplements on what else I can do. Thanks and hope to hear from you soon,
S

I found this funny, because my wife (fully encouraged by our devious children) takes endless pleasure in making fun of all the things I do to take care of myself.  All the crueler because the luck of her genetics makes keeping fit and healthy a breeze.  Ah well...

My response to S summarized a lot of my thoughts so I thought to post it here:

S.....,

Ha! I know the feeling. As I get older, I feel fine, except my parts keep going. Jane may have overstated my expertise, but I can suggest things that seem to work for me.  First take a look at my blog www.AthleteAtAge.com.  I try to keep it up to date on my latest thinking and sources, although events in the financial world and the elections have distracted me.

Aging (at least the bad things that come with it) appears to arise from several processes in the body. These include:

• Dehydration,
• Oxidation,
• Calcification,
• Inflammation (arthritis), and
• One other that I can't remember right now. 

Diet, exercise, supplements, and in some cases drugs can moderate all of these. Some think that problems in one area can amplify others.

Diet solutions for inflammation seem straight forward (although they differ drastically from conventional wisdom). You need to address 3 areas:

• Food quality - a Paleolithic diet works best. It includes protein sources (meat, poultry, fish, eggs), fats (nuts, seeds, olive oil, nut oils, avocados), fibrous vegetables, and some fruits. NO grains, legumes, starchy vegetables, sugar, milk products, honey, bread, pasta, or processed foods. A little wine everyday might even help.

• Food quantity - look at "The Zone diet" it provides a baseline for determining quantity and proportion of macro nutrients (protein, fat, and carbohydrates) relative to your lean body mass.

• Intermittent fasting - for periods between 12 and 16 hours per day (including sleeping hours) can have a very beneficial affect on metabolism, inflammation, insulin regulation (which aggravates inflammation). This appears to have the same affect as restricted calorie diets relative to life extension and retaining quality of life as we age. You need to consume the same number of calories as you otherwise would (or zone diet "blocks" if you go that way), just do it in the shorter feeding window. Drink lots of water even while you fast.

Any one of these will help, together they can provide remarkable affects in inflammation, hormone regulation, body composition, physical performance, and well being. Also note, almost all spices have anti-oxidant, anti-inflammatory, and insulin regulatory properties. If you drink coffee, stop.

Supplements:

• fish oil - good for everything, TAKE LOTS! Much better than taking ibuprofen (which can throw off insulin regulation).
• cinnamon - put it on everything you can. It regulates insulin and helps inflammation.
• glucosamine & chondroitin with MSM - important for your joints. You need to take this on an empty stomach.
• anti-oxidants: green tea, turmeric, resveratrol,
• buffered vitamin C before bed offsets cortisol,
• vitamin D3 (lots, you probably don't get enough exposure to the sun up north)

Water - drink lots 2 to 4 liters per day, great for everything but in your case it especially helps synovial fluid generation to lubricate joints.

I do joint mobility exercise before physical activity to wash the joints with synovial fluid, this lubricates them and prepares them for whatever else you do. Scott Sonnon has developed a lot of this work:

• Intu-flow (joint mobility exercises) https://agelessmobility.3dcartstores.com/Intu-Flow_p_0-8.html get the video, you can do these anywhere.
• Good YouTube video of Scott at http://www.youtube.com/watch?v=G6uK76TQYig&eurl=http://www.rmaxinternational.com/home/

Add short, intense, weight bearing exercise and you've got most of what you need to do to keep moving (for a long long time).

Finally for acute pain and inflamation I use DMSO topically. Use only 99.9% pure DMSO in water. Don't use any DMSO with aloe or anything else in it. No gels. Wash the area (your neck) with soap and water, wipe it with alcohol, then apply DMSO. It smells terrible, the smell lingers, it can give you a yucky garlic taste in your mouth, but it does remarkable things for inflammation from arthritis and injuries.

Good luck. Feel free to ask any other questions or request clarifications.

Best,
---

Alpha^2

"Stretching: The Truth"

The New York Times has an interesting if somewhat late article, "Stretching: The Truth"

"The old presumption that holding a stretch for 20 to 30 seconds — known as static stretching — primes muscles for a workout is dead wrong. It actually weakens them."

Worth the read.

Alpha^2

Cool invention

The San Francisco Chronicle has a story about a body temperature cooling device, the "Glove" which appears to have a stunning affect on performance.

The Glove works by cooling the body from inside out, rather than conventional approaches that cool from outside in. The device creates an airtight seal around the wrist, pulls blood into the palm of the hand and cools it before returning it to the heart and to overheated muscles and organs. The palm is the ideal place for rapid cooling because blood flow increases to the hands (and feet and face) as body temperature rises.

"These are natural mammalian radiators," said Dennis Grahn, who invented the device with Stanford colleague Craig Heller.

Grahn and Heller also found that cooling overheated muscles dramatically improved physical performance, allowing athletes to work out harder and longer, and hold on to their gains.

"We learned that you can actually reverse that muscle fatigue in a short amount of time," Heller said. "And if you cool muscles during rest, you get a much greater recovery than if you rested without cooling."
...
Their first "aha" moment in cooling came after they talked their assistant Vinh Cao into doing his regular workouts in the lab instead of at the gym. His routine included 100 pull-ups. One day, Grahn and Heller started using an early version of the Glove to cool him for 3 minutes between rounds of pull-ups. They saw that with the cooling, his 11th round of pull-ups was as strong as his first. Within six weeks of training with the cooling breaks, Cao did 180 pull-ups a session. Six weeks later, he went from 180 to 616.
...

"I'll never forget the number 616," said Heller. "He tripled his capacity in six weeks. We were like, 'Wait a minute, this is crazy!' "

While a set of pull-ups might take less than a minute, it's enough for the temperature of those muscles to rise, Heller said. "We learned that you can reverse that muscle fatigue in a short amount of time. And if you cool muscles during rest, you get a much greater recovery than if you rested without cooling."

Soon, members of the Stanford football team began paying visits to the Grahn and Heller lab. "After a while, we were watching these guys and saying, 'Oh gee, he only did 700 sit-ups today,' " Grahn said.
---
Heller, 65, on the other hand, is upbeat, organized and exceedingly fit. He dipped into the lab's candy jar - using the Glove to work up to 1,000 pushups on his 60th birthday.

Impressive.  Most impressive.

Alpha^2

Exercise and Fat Gain

Robb Wolf has two very interesting posts: one from 24 October 2007 titled, Exercise: Ineffective for Weight Loss  and one posting today titled, Exercise: Effective for Fat Gain.  Briefly for weight loss (by which he really means body composition) address food quality, quantity, and timing of its consumption.  No mystery here.  Paleolithic diet + Zone (or modified Zone) proportions coupled with intermittent fasting may have a greater impact on body composition than exercise.  Robb generally advises to shift a lot of one's daily carbohydrate intake to a post workout meal (but typically only after a grueling glycogen depleting workout).  His diet recommendations go to regulating insulin levels.  Nothing particularly new in this, but Robb does an excellent job of assembling all the pieces in a kind of synergistic optimization.

The newer of the two posts focuses on how over-training - too much volume and intensity - can elevate cortisol levels and aggravate insulin sensitivity, thereby wrecking havoc with the most careful diet regimen.

If you train long and hard and eat well and your body composition and performance don't reflect what you believe you can achieve try this (paraphrasing from Robb):

• Cut back on your volume of exercise;
• Move 1/2 your day's carbs to a post work out meal;
• Eat a little less protein and carbs,  but compensate in total calories by upping your fat intake;
• Sleep more, 9+ hours per night or take naps.  Practice good "sleep hygiene".
• Take buffered vitamin C before bed to moderate cortisol.

I'd add:

• Drink 1/2+ gallon(s) of water to maintain hydration and
• Take fish oil to fight inflammation.

Alpha^2

Overtraining - Maybe, Maybe not

The NY Times features an article today by Gina Kolata When Training Backfires: Hard Work That’s Too Hard.

The article describes a 15-year old runner who trains hard for a long period than experiences long term fatigue and degeneration of performance.

She attributes this, with some minor caveats, to over-training.  Maybe.  Maybe not.  Kolata provides no analysis of obvious variables that could also have affected the young athlete's (or ANY athlete's) condition: 

• No discussion of hormonal changes in a 15 year old?  When my stepson hit 15 he wanted to sleep 13 or 14 hours a day.  Then he grew almost 4 inches in one summer.  His body's resources obviously turned to growth.  Can a 15 year old expect to continue to make performance gains during such a period?

• No discussion of diet or nutrition.  What did the kid eat?  Did he change what he ate before his performance declined.  What about food or seasonal allergies?

• No discussion of hydration.

• No discussion of the kind of training regimen the runner followed or even his training goals.  This last point seem most important.  One can easily mistake ill considered training for over-training, especially when doing long single modality low-intensity training rather than short, varied, high-intensity training.

To her credit Kolata cites sources who see over-training as over-diagnosed.

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