Hans Selye (1936) was the first to describe the adaptive nature of a living organism in response to stress. Selye’s theory focused on the role of the adrenal cortex response as critical to both the adaptive and maladaptive responses to stressors. Cortisol, a glucocorticoid, is a steroid hormone produced by the zona fasiculata of the adrenal cortex of the adrenal gland (Hackney and Walz, 2013). The glucocorticoids play a role in maintaining a euglycemic state of blood glucose by stimulating gluconeogenesis, the synthesis of glucose from non carbohydrate sources like amino acids in the liver, stimulating the expression of enzymes involved in gluconeogenesis, mobilization of amino acids from non hepatic tissue, and the stimulation of lipolysis in adipocytes to spare glucose utilization in skeletal muscle. Cortisol is also a potent anti inflammatory and immunosuppressive agent. Excessive glucocorticoids inhibit bone formation (Marcotte, 2014), suppress calcium absorption, delay wound healing, increase risk of infection and have negative psycho-neurological effects (Duclos et al 2007; Kjaer, 1992).
Selye’s three stage response to nocuous agents; general alarm reaction, resistance and exhaustion, became known as the general adaptation syndrome (GAS) and has been used extensively in exercise science forming a central theory in the periodization of training (Haff 2016; Bompa and Haff 2009). The goal of a periodized training program is to balance periods of stress and recovery to improve performance. Unfortunately, the best laid plans can be thwarted when unexpected or unplanned stressors are introduced. The GAS describes the nonspecific response to a stressor and while the original work focused on environmental, physical and drug induced stressors (Selye 1936) emotional and psychological stressors can create a similar stress response (Selye 1950).
Athletes are faced with numerous stressors including training and competition, school, financial and social stressors, all of which contribute to the total stress load and affect the outcome of training and the risk of illness or injury. Strength and conditioning coaches need to be aware of the effects of psychosocial stress on training and performance outcomes and be prepared to adjust their programs accordingly to ensure an effective and healthy response to training.
Psychosocial Stress and Training Adaptations
Negative life stress events often result in prolonged periods of stress with no opportunity for recovery. Patients with anxiety disorders or excessive psychological stress have been found to have cortisol levels that exceed those seen following exercise (Boa et al 2008). The combination of training stress and life stress can potentially impair training adaptations and performance. A study of college-aged students weight training twice per week for twelve weeks found an average 15% strength improvement in bench press strength in a low stress group versus an average 12% improvement in a high stress group (Bartholomew et al 2008). The smaller improvement in strength may be due to the negative effect that life stress has on recovery following exercise (Stults-Kolehmainen et al. 2014; Stults-Kolehmainen et al 2012). In a study by Otter et al. (2016) using the RESTQ-Sport questionnaire on a group of competitive runners found that following a period of negative life stress general wellbeing and social and physical recovery decreased. As a result, running economy was impaired 3 weeks after the negative life event.
Psychosocial Stress and Illness
Acute illness is a source of significant lost competition and training time accounting for as much as a third of lost time in elite athletes (Schwellnus et al, 2016). While for the general population light to moderate exercise is generally consider beneficial in dealing with psychological stress, the addition of psychosocial stress on top of a high training load can lead to impaired sleep and suppressed immune function. Increased cortisol, training load and stress, as measured by the Daily Analysis of Life Demands for Athletes (DALDA) questionnaire have been linked to an increase in upper respiratory tract infections (Moreira et al 2011), which account for about 50% of illness in athletes (Schwellnus et al, 2016).
Psychosocial Stress and Injury
The relationship between psychological stress and injury rates has been researched since the early 1980’s (Codington, 1980; Cryan, 1983), with several models of the role of stress and coping with stress having since been developed (Ivarson, 2017). Both history of negative life stressors and stress response variables have been shown to be predictors of injury (Ivarson 2017). There is a strong body of evidence indicating that an increase in psychosocial stress also increases injury risk in athletes (Williams, 2001; Anderson and Williams, 1988) and reducing stress through stress-management interventions can decrease the chance of injury (Perna et al 2003).
Multiple mechanisms seem to be responsible including a decrease in attentional capacity, changes in the function of the brain’s neurological network, and decreased decision-making ability (Rogers, 2005; Fuchc 2003: McEwen 2000; McEwen 2008). One of the popular models of how stress affects injury potential is the “Stress and Injury” model proposed by Williams and Andersen (1988, 1998). According to the model the stress response increases general muscle tension in the body, which results in impaired motor coordination and flexibility, both of which influence fatigue and increase injury risk. The model also suggests that stress may diminish the visual field, reducing visual attention which may decrease the ability to use relevant peripheral information.
In elite cyclists, higher cortisol levels the morning following an exhaustive bought of exercise were found in a high stress group vs low stress group. While there was not an increase in injuries the high stress group experienced more muscle, cognitive and total injury symptoms that were correlated to the increase in post exercise cortisol levels (Perna and MacDowell, 1995).
Athletes in collision and contact sport often experience abrasions and other types of wounds during practice or competition. High levels of psychological stress can decrease the rate of wound healing, increasing the risk of infection.
Not only does psychosocial stress increase the risk of injury but injury increases the level of stress experienced by an athlete. Injured athletes report elevated stress because of worry about returning to pre-injury performance (Crossman, 1997), and isolation from teammates if the injury takes them away from the team and team mates for an extended period (Podlog and Eklund 2007). This can create a chronic level of stress that increases the time for recovery from injury and places the athlete at risk for reinjury if they return before dealing with both the physical and psychological sides of injury.
Predictable Stressful Periods
Stress is a response and whether an event is a stressor will vary from person to person (Ivarsson et al 2017). While there are many life events that could trigger a stress response there are some predictable, recurring periods of stress that the S&C coach can plan into their programming.
Team or squad selection can be a period of very high stress, particularly for those who are amongst the final picks or are deselected. Athletes who are deselected report feelings of anger, humiliation and anxiety, loss of athletic identity and decreased academic performance (Barnett 2007; Brown and Potrac 2009; Grove, Fish and Eklund, 2004). Selection periods can vary widely from sport to sport and at different levels of competition. Coaches bring different approaches to conducting selection and informing players of selection decisions (Seifred and Casey, 2012). While an S&C coach may not be directly involved in the selection process, they may need to be flexible with their training plan, balancing the stress and uncertainty of selection with the need to make sure the athletes are physically prepared to perform in upcoming competitions. This can be of particular importance in racing sports where final selections may involve race-offs between a limited number of athletes who would require program adjustments while others, who have made the team, may be ready for normal training.
In a survey of elite junior alpine skiers Davis et al (2019) found the academic requirements were the highest scoring source of stress of all variables and was most strongly correlated with perceived stress (r = 0.467). The athletes surveyed reported time management as being their biggest challenge related to academic performance. Hamlin et al (2019) subjectively monitored 182 university athletes over a 4-year period finding that stress increased as exam periods approached and resulted in decreased mood, energy levels, and sleep. Examination periods coincided with the highest levels of stress and were predictive of the development of illness and injury.
A variety of interventions, including cognitive, behavioural and mindfulness programs have all been shown to be effective at reducing stress in university students (Regher and Pitts, 2013), decreasing both indicators of psychological and physiological stress (Gaab et al 2003; Dawson et al, 2014). S&C coaches in educational institutions can take advantage of the programs offered to the whole student body to help their athletes deal with life stresses. The addition of 10-15 minutes of meditation or mindfulness training as part of a cool down may help with psychosocial stress.
The Role of the S&C Coach
Keep in mind that S&C coaches are not psychologists and need to be aware of their limitations in counselling athletes who are experiencing stressful periods. Everyone has bad days, knowing when to offer an empathetic or sympathetic ear and when to recommend an athlete see someone for help developing coping strategies comes with experience. It is always better to err on the safe side and have a network with several mental skills or mental health professionals available for referrals.
Mental health resources and training are available at the Canadian Centre for Mental Health and Sports (https://www.ccmhs-ccsms.ca) or from the Coaching Association of Canada (https://coach.ca). While not their primary role, S&C coaches still have a significant impact on how well an athlete will improve during periods of high stress.
Alter Training Programs
A flexible training schedule and individualized training plans will keep an athlete on track during periods of life stress. Plan de-load periods during known stress periods and give athlete permission to miss some workouts. Missing a couple of S&C sessions will not be the difference between winning and losing particularly during a time where the adaptations to training are blunted by high overall stress levels. During exams an individualized approach can be taken by knowing the exam schedule for each athlete and discussing how much studying time they need. Programs for athletes who have exams spread out over several weeks need to be different than the programs for athletes who have several exams compressed into a shorter time.
Scheduling fewer and shorter sessions has the dual benefit of decreasing total stress load and helping with time management, freeing some training time to focus on studying and exam prep.
Stress Education and Resources
Some athletes are conditioned to believe that more is always better and that any decrease in training load will prevent them from reaching their goals. Educating athletes on the effects of stress on training outcomes, illness and injury helps create a perspective around the role that stress plays in athletic performance and sets the stage for implementing stress interventions, making it OK to reduce training loads when psychosocial stressors are high.
Nutrition plays an important role in stress (Rucklidge and Kaplan, 2016). Periods of high stress tend to lead to poor eating as people turn to comfort foods like sugar sweetened beverages, baked good and other comfort food and decrease their intake of fruits and vegetables (Graber, 2021). Stress can also decrease the concentration of key micronutrients in the body (Lopresti, 2020). Additionally poor nutrition can increase stress responses, further exasperating periods of high stress (Graber, 2021). Planning meals and having good food high in vitamin C, tryptophan, and Omega3 fatty acids, which have all been shown to be stress fighting (Singh, 2016), available for snacks can keep athletes on track during exams and competition periods where stress is often highest.
Basic Psychological Skills
While not trained as counselors teaching basic mental performance and life skills like time management, goal setting, positive self talk, imagery, arousal control deep breathing, and confidence building is within the scope of practice of a strength and conditioning coach (Lopes Dos Santos et al. 2020). Working on these skills is important all year long but scheduled reminders and discussions of how to use them a couple of weeks prior to and during exam and selection periods may help some athletes cope better.
Measure overall stress not just training load
Many S&C coaches will use training load measures like RPE, GPS, and heart rate to measure training load. Supplementing these measures with athlete self report monitoring questionnaires (ASRM) will provide a more complete look at the stress levels experienced by athletes. ASRMs typically called “wellness” questionnaires, ask an athlete to rate their mood, stress, muscle soreness, fatigue, motivation, and sleep. A variety of validated questionnaires are available including mood state questionnaires like the Profile of Mood States (POMS) (McNair, Lorr and Droppleman, 1981) and Brunel Mood Scale (BRUMS) (Lan et al, 2012), the Training Distress Scale (TDS), Hooper Index (Hooper et al. 1993), Daily Analysis of Life Demands for Athletes (DALDA) (Rushall, 1990), and the Recovery Stress Questionnaire (REST-Q) (Kellman and Kallus, 2001).
When choosing an ASRM, consider the ease of use of the questionnaire. Saw et al.(2015a) found that the time to completion, question structure, mode of use, accessibility, and the user interface all play a role in how compliant athletes will be with and ASRM program. In some cases, you may not feel that published and validated questionnaires meet the needs of your athletes or sport. Survey data on high performance programs suggests that this is quite common with up to 80% of sport practitioners developing their own questionnaires (Taylor et al. 2012). The downside of this is without doing the work to validate or test the reliability of the questionnaire you may not be generating accurate or valid data, making interpretation difficult.
Given the growth in technology and the development of athlete monitoring Apps, ASRMs would appear to be a relatively simple way for an S&C coach to collect stress data. However, collection of the data is only part of the workflow required to make effective use of an ASRM tool. Data analysis and feedback can become time consuming if processes are not automated. The quality of the feedback and actionable insights that are delivered to both coaches and athletes will determine the compliance and usefulness of an ASRM program.
Compliance to an ASRM is crucial for the results to be meaningful and useful. Hopkins (1998) has suggested a compliance rate of at least 70% for questionnaire-based monitoring for analysis to provide meaningful information. Education of the athlete and coach is an important factor in creating compliance. Explain the purpose of the ASRM, the reason for the individual questions, who will look at the data and how the data will be used (Saw, Main, and Gastin, 2015a).
Compliance can vary widely depending on the level of play, sport context and whether the monitoring program is supported by a coach. Saw, Main and Gastin (2015b) examined the use of an ASRM in 16–18-year-old athletes. Of the 131 athletes in the study 53% chose to use the ASRM. Of that number 80% who were supported by a coach used the ASRM while only 50% of those who were self directed used the ASRM. They found compliance rates of 83.6±21.2% for team sport athletes who were supported by a coach compared to an overall compliance rate of 42.5±43.5%.
Psychosocial stress is a part of life and can add to the overall stress load experienced by athletes, increasing the risk of illness and injury and ameliorating the adaptations to all types of training. Some periods of stress are predictable around exams and selection. Strength and conditioning coaches, when aware of these periods, can modify their programs and provide support to help athletes get through stressful times while still performing at a high level.
Ed McNeely was a founding Director of the CSCA and a former Lead, Strength & Conditioning for the Canadian Sport Institute Ontario. He has worked with multiple Olympic medalists and serves as a mentor to rising practitioners.
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