• Chronic Fatigue in Athletes


    A few years back I wrote a two-part column on Chronic Fatigue Syndrome in Athletes. Part I is here and Part II is here.

    The links to more information about each individual athlete are no longer working at the Active Network, so I am reposting all stories here.

    Cyclist H.A.

    The similarities between H.A. and R.C. include going to college in a tough study program and also being a very gifted cyclist. She was producing top-shelf results and was invited to be a resident at the Olympic Training Center (OTC). While at the OTC, she got pneumonia. Unfortunately, she was misdiagnosed and continued to train at a high level for two weeks, digging a deeper hole, before a proper diagnosis was given.

    After treating pneumonia, she tried for the next eight months to train, but she was just tired all the time. She described the same tired and low-level sickness feeling that R.C. described. As hard as she tried to train, she just got worse.

    She got pneumonia again.

    She started napping and napping turned into sleeping some 18 to 20 hours per day, literally. She didn’t remember what it felt like to not feel tired. She started to wonder, “What if this is what the rest of my life will look like?”

    Unlike R.C., who had some rocky relationship issues, she had a very stable relationship with her husband and he helped her tremendously. He wanted her to heal and get better. She said he was a critical component to her getting healthy again. When others might have doubted she had any real illness at all, he knew she was sick and she would get better. He commented, “When you get better…”

    She visited an immunologist and he told her to get on the bike every day and ride just a little and at low intensity. Not more than an hour in the beginning. He believed that this low-level of exercise gave her an endorphin hit and helped rebuild her immune system. On some days she had to drag herself onto the trainer for an easy 30-minute session, but the low-intensity rides did seem to help.

    Doctors wanted to put her on anti-depressants, but she refused.

    She also worked with an internal medicine specialist that told her CFS tends to last for five years, in his opinion. He said she could begin training again for competitive racing, but the training structure had to be very loose. If a tough session was scheduled and she felt bad, she skipped it. She had to train according to how she felt. Fast on the days that she felt good, take it easy on days she didn’t feel good.

    She did get back to the highest level of cycling again, but one frustration was her performance was unpredictable. In one stage race, she was dropped from the main group on the first day. On the second day of the same race she was on the podium.

    In reflection, she says she believes that it is hard for competitive athletes to be honest about how they really feel. They can tolerate such high levels of pain and discomfort in order to race at top levels, that this tolerance blessing for training and racing is also a curse. Ignoring or minimizing how you really feel can lead you down a dark road.

    Her husband’s support and others believing in her was critical to regaining her health. She carefully monitors the intensity of a common cold and immediately reduces training. She does a better job of resting and taking care of herself.

    She was once on an extremely low-fat diet, that is no longer the case. She eats primarily fruits, healthy.


    Triathlete G.D.

    G.D. was similar to the cyclists in the story in that he was going to school and performing very well in the sport of triathlon. His success came earlier than the others, he was under 18 when he began to recognize his talent for sport. He too performed well enough to get an invitation to the Olympic Training Center.

    He started high-level training for triathlon at age 15 and was badly injured by the time he was 18. The injury was multiple stress fractures caused, in his estimation, by training inappropriately for someone his age. Too much too soon. He read a Triathlete magazine column about Lance Armstrong’s training and tried to replicate it.

    The success, however, was coming concurrently with the injuries. He had won a Junior National title at age 17, along with other races, and planned on being a pro at age 19. When he was 20 years old, he set numerous course records across the Midwest, racing nearly every weekend all summer.

    Traveling to races, scoring podium spots and going to school made for an incredible lifestyle. Perhaps an intoxicating lifestyle.

    The excitement and lifestyle so intoxicating that he did not recognize he was sick enough to be hospitalized while driving to a race. Rather, he planned to be on the podium at the race. His physical symptoms of unfathomable fatigue and boils on his body became so worrisome that instead of driving to the race venue, he drove himself to the hospital emergency room. He spent the night in the hospital and was in bed for a week before being strong enough to do a return drive home.

    Like the others we’ve met, he was, and is, an achievement-oriented person. He is gifted in sport and outside of sport. Achieving success in sport and outside of sport was the motivation that gave him permission, self-permission, to drive himself hard. He worked hard at anything that drew his passion and somewhat enjoyed juggling many spinning plates at the same time.

    He says that he believes three things contributed to his Chronic Fatigue Syndrome. The first was consistent stress for years, not months, wore him to a nub. There was no time off of that stress at all.

    For the training, he believes that it was the high intensity, and volume of high-intensity training, that did him in. In his estimation, the long workouts can contribute to overall fatigue, but it was the intensity that pushed him over the edge.

    The third item that contributed to his illness was spending time with a really cute girl that was a rampant pot smoker and perhaps gave him a virus. He has heard that most everyone carries Epstein Barr Virus, but only certain people manifest the symptoms. In either case, given by the cute girl or lying dormant, he was attacked by a virus.

    His attempts to get healthy meant going through multiple cycles of rest, ramp-up, crash, repeat. He did this multiple times until he began to get a handle on the triggers for his illness. He said, “I've never gotten back to a point where I feel indestructible, but I feel like I have a pretty good handle on things now. Mostly, I just readjusted my expectations of what was possible for me.”

    He, as well as a couple of the others, commented that the hardest part of dealing with the illness is trying to convey the symptoms to athletes that have not had the disease.

    The main residual issue is fear. He was not the only one to use that four-letter word.

    He said, “So much of the endurance mindset is about blasting through fatigue and pushing on no matter what. It is truly debilitating to learn your own limits through such a painful lesson. I personally believe this is the most painful part of CFS.

    It is important to understand the difference between “reps to success” and “reps to failure.”

    After you get sick, it is crucial to get a grip mentally as quickly as possible. Unfortunately, in my personal experience, this process can take years. I do believe that it is incredibly important to talk to other people so you don't feel alone. Especially other athletes.”

    Every athlete commented to me that avoiding the old traps is a life-long challenge.


    Cyclist R.C.

    R.C. was the oldest of the athletes I interviewed and had the deepest history of dealing with CFS. Many of the threads in his story were common to the others. But, no two stories for getting CFS or for overcoming the disease were the same.

    R.C. left home to attend college and live in the dorm at age 19. He was a fulltime student and cycling too. His cycling mileage was not that high compared to others. He estimated weekly mileage at around 200 and a moderate amount of intensity. He was riding well, starting to get noticed, and studies were going well too.

    Dorm life, however, was not conducive to good rest. He found it nearly impossible to get good rest and he found it frustrating. In addition to rest being tough to come by, the college culture was ripe for spreading mononucleosis.

    In September of his sophomore year at college, he got sick. The first problem he found was through a blood test that determined his liver enzymes were out of tolerance. In October he got Chicken Pox and in December it was mononucleosis. He quit school and moved in with his girlfriend to recover.

    After a round of prednisone and getting his liver enzymes back to normal, he went back to school part-time in the spring. He also started riding and racing again. He didn’t feel that great but was riding really well. He was a little worried about getting sick again.

    His junior year he was going full speed, feeling confident on the bike and with his fitness. That winter he was selected to the U.S. Olympic Training Center resident collegiate program. The summer between his junior and senior year he raced a lot and was flying on the bike.

    He was training with a coach that didn’t do big mileage, R.C. estimates only about 250 miles per week, but every workout included very high intensity. He was responding to the training with great results. He was selected for the 1980 Olympic Long Team; however, that was the year the U.S. did not send a team to the Olympics.

    The spring of the following year he was back home, going to school and riding great. He was riding fantastically with light training volume. Communication from the Olympic Training Center continued and his hopes of being on the National Team were coming to fruition. At the same time, he began feeling bad. Riding well, but feeling bad.

    He said, “School pressures, relationship stress, worry, and performance anxiety did me in. I started feeling really bad. But oddly, I could still ride well. It wasn’t until I felt terrible, that I quit riding.”

    A doctor misdiagnosed him with blood pressure problems. He worked for an entire year to rest and get healthy again.

    He moved to the east coast to go to school and began riding again. It wasn’t long before he was riding very well and winning races. He moved back to the west and continued to get great results on the bike while attending a new college. Though he was riding well, he didn’t get recognition from the Olympic Training Center and no selection chance for the next Olympic team.

    He continued to ride and race well. A full eight years after his freshman year of college, he was flying on the bike again; but he started to feel that old sickness creep back.

    Growing tired, he lost his power and speed on the bike. He felt sick. He said, “I felt the way you feel when you’re just about to get the flu or a cold. No energy, weak, tired and just sick. But the feeling lingers and just won’t go away…for weeks and weeks on end.”

    After a battery of tests from a general practitioner, he was finally diagnosed with Chronic Fatigue Syndrome. The doctor put him on an antiviral medication, Zovorix. He began to feel better, but it would be two years before he felt good on the bike again.

    He rode consistently well for seven years and then began to feel unstable again. Looking back at that time, he says that a stressful relationship was the root of his emotional stress. He tried Zovorix again, but this time there were no positive results. 

    Another four years of struggling to get healthy produced limited results. After extensive testing to eliminate a battery of illnesses, he was diagnosed with CFS for the second time. An immunologist suggested he work to rebuild his immune system with healthy foods and acupuncture.

    It took two years for him to get healthy again.

    In reflection, he commented that when outside stresses began to pile up on him, he didn’t change his riding. He didn’t reduce intensity or volume and that was a mistake. Relationship issues were major stressors for him; however, because he was riding well, he didn’t feel like he needed to change anything about the bike.

    The bike was a place to find peace and pleasure when other things were not got going well. He knows now, that keeping the same volume and intensity on the bike when life stresses pile up is a mistake.

    He also knows that riding the bike in extremely windy, wet and cold conditions further stresses his body. In the past, no weather condition would keep him off the bike. Now he knows staying off the bike on some days will keep him healthy for the long haul.


    Triathlete W.H.

    W.H. was different than the others in that he was not attending school at the same time he was participating in sport at a high level. His time was spent at more training, high volume and high intensity.

    Prior to the months leading up to when the illness struck him, he was traveling the globe training and racing professionally. He was among a handful of top triathletes in the world. What if he could be better? Perhaps the best?

    With two years of reasonably successful racing under his belt, he returned home for a break. With no races or travel for a six-week block, he decided to take advantage of that and train, train, train. He was logging 25 to 28 hours per week and many of those workouts, multiple workouts per day and multiple days in a row, were at very high intensities.

    Following this big training block, he went into a big racing block where he traveled to and competed in seven races over nine weeks. This included travel overseas. His performances were soaring and he was achieving personal best placements in the field, consistently. He was on top of the world. 

    He trained hard between the races, so he wouldn’t lose any fitness. He returned home for a two-week break in racing. When he returned home, a fellow racer was there too, staying with him for six weeks. Training sessions became races of sorts, each one pushing the other.

    Like most achievement-oriented people, there is a foundation concept that the more you work, the more you are rewarded. This concept was paying in spades for W.H. as he accepted invitations from more race directors to race at their events.

    He was beginning to feel tired, though. He decided to take his training easy before the next race. At that race, he crashed on the bike. Accepting that it was just an off race, he continued to rest and heal his wounds.

    Heading into the next big race, he found the media was his friend. There were lots of interviews and predictions that he would be the big race winner. The spotlight was on him.

    As much as he tried to psych-up for the race, he felt tired. His body was tired all over. He ignored the feelings, passing them off as part of the normal cycle.

    At the race he had an average swim; but, he planned to make his move on the bike. Putting the hammer down in the first 10K of the ride, he was surprised that he wasn’t dropping people. In fact, people were catching up. This wasn’t normal.

    Not to worry. His run was his new weapon and surely this is where he would seal his fate on the podium. Out of the second transition and off to the run where he felt he was moving…backwards. Screaming fans urging him on, but he just couldn’t move faster. No energy in his legs.

    With one disappointing race behind him, he looked ahead to the next opportunities to race. Plenty of races and travel were lined up. At the next race, he was still tired, so tired that he dropped out. It was the first time he didn’t finish a race in his career.

    While traveling to the next race, he realized something was terribly wrong and canceled plans for upcoming races. He said this was one of the lowest points of his career.

    He consulted nutritionists, internists, acupuncturists, Chinese medicine specialists, took vitamins and herbal teas. Piles of tests and consultants, he did research and did what he thought was right for him.

    He did low-intensity training limited to four to six hours per week. For six weeks, nothing changed. His muscles ached and through his own research, he determined that CFS was the culprit, though no “expert” diagnosed him with the disease.

    At night he couldn’t fall asleep, though he was completely exhausted. Once asleep, he would wake up and remain awake for several hours. During the day, exhausted, he felt like he could fall asleep, literally, while riding his bike.

    Because he was in the Pro Tour Series, he felt that he needed to race to maintain his points standing.

    With little intensity training and lots of rest, he did a race. He placed reasonably well in the race and was surprised. Seven weeks after his initial fall into the chasm of fatigue, he seemed to recover and began racing again – though he would never be as strong and as fast as he was before he was struck with CFS.



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