Reality check
In the public eye, our sports stars are used to the spotlight. But being at the elite level can lead to fatigue and burnout in even the best athletes, writes Zoe¨ George.
‘‘Iam struggling’’. Those three words were written by one of the best rugby players in the country. Black Ferns centre Chelsea Alley laid out the reality many elite athletes face: having multiple jobs outside of sport to pay the bills, leaving home before the sun rises and getting in after it sets, trying to balance family with off-field sporting commitments, and the uncertainty resulting from Covid-19. It’s unrelenting. She is fatigued.
Fatigue is not simply exhaustion. Physically, it can be body aches, muscle weakness, poor concentration and excessive sleepiness. Psychologically, depression and anxiety can contribute to fatigue, too.
‘‘It’s not just physically tough. It’s emotionally hard as well. The way we live. For me to start feeling like that, feeling a bit of mental fatigue and physical fatigue, I thought ‘if I’m feeling like this, there must be others feeling like this as well’,’’ Alley said.
She is among the approximately 50 per cent of elite athletes currently struggling with fatigue and related health concerns, according to leading sports medical professionals.
Alley’s admissions follow White Ferns captain Sophie Devine and Pulse shooter Ameliaranne Ekenasio stepping aside because of fatigue. Alley’s teammate Kendra Cocksedge this week shared she was ‘‘mentally fatigued’’ and has stepped away from club rugby.
Then there is international cricketer Ish Sodhi. The Black Cap didn’t realise he was fatigued until he got injured.
Fatigue followed ‘‘not a great tournament’’ in the Caribbean, then time in MIQ away from his young family. Then he pulled a hamstring. That all happened just before the start of the 2020/21 domestic cricket season.
‘‘It was the biggest burnout I’ve ever felt,’’ he said.
‘‘Looking back I should have been more open with my domestic coaches and asked for a week or two off. If I ever got into that situation again, the most important thing is taking a break.
‘‘That was confirmed to me when I had seven weeks off with a hamstring injury. Although it was frustrating not to be playing, that time off was so crucial. Just being able to stay home, spend that time with my family and just start to figure out my priorities again.’’
Athletes sit alongside those in the education sector, doctors and carers, and the legal profession, who have reported rates of fatigue or burnout among staff as high as 75 per cent.
Leading sports physician Dr Sarah Beable said everyone gets fatigue, ‘‘but there’s a difference between general weariness versus that deep bonetired fatigue’’.
‘‘When tiredness and ‘doing too much’ is prolonged it can cause burnout. This is often seen in very driven, passionate, high-achieving individuals. Being chronically fatigued can push beyond exhaustion into indifference because they are so worn out and everything becomes a bit hard,’’ she said.
‘‘The fatigue can be insidious, and underrecognised.’’
Often, she said, your body starts to tell you that you are fatigued before you are conscious of it – a stress fracture, a recurring injury, psychological unwellness, an illness.
‘‘Fatigue is a symptom, a sign of something underlying and this occurs, not only in sportspeople, but in all of us. It may have a medical cause, or a disruption of the key pillars of health, for example being socially isolated, anxiety,
depression, grief – all of which is likely to be a factor in Covid times,’’ she said.
The uncertainty of Covid has seen an increase of ‘‘severe anxiety’’ among elite athletes, with statistics sitting around 50 per cent, said sports psychologist Rod Corban.
Covid delayed World Cups, the Olympic and Paralympic Games and disrupted sporting seasons.
‘‘For an athlete to commit to four years of training... it takes a massive emotional toll. We’ve extended it for a year, they’ve now had five years under this load,’’ he said.
‘‘[Covid] made people also question who they are and what they are doing with their lives… it’s created a massive sense of a lack of control in a lot of people.’’
Alley said the delay of the World Cup ‘‘pinnacle event’’ is contributing to her ongoing fatigue.
‘‘For that to get pushed back another year was tough mentally. It has contributed to the burnout some of us are feeling,’’ she said.
In ruling out medical issues, the number one cause of fatigue in female athletes is food or lack of it, Beable said. ‘‘Female athletes very frequently underestimate their energy requirements to meet the demands of their increasingly active lives.’’
Beable is a leading expert in RED-S, Relative Energy Deficiency in Sport. This is caused by lowenergy availability, a lack of energy being put into the body via food intake to counteract energy expenditure. This has a wide range of health and performance consequences, including fatigue, and impacted menstrual cycle.
The WHISPA group – Healthy Women in Sport who reports to High Performance Sport New Zealand – recently published research that found 47 per cent of elite female athletes in New Zealand were iron-deficient, and 50 per cent reported symptoms consistent with RED-S, a lot of which was likely undiagnosed. The international research suggested RED-S was even more common in the sub-elite athletes, Beable said.
Men can have RED-S too, although it’s harder to diagnose as men don’t have the ‘‘external barometer’’ of a menstrual cycle. She said it’s prevalent in endurance sports like rowing, distance running, cycling and sports with weight classes. In men, testosterone can be lowered but ‘fatigue and lack of performance’ may be their only symptom.
Leading physiologist and nutritionist Dr Stacey Sims said food also aids recovery, and if athletes aren’t fuelling within 45 minutes of physical activity, the body goes into an ‘‘intrinsic survival’’ mode.
‘‘And it really only takes four days of this before the body starts to really go down that path of downregulating everything,’’ she said.
‘‘That’s why… women who are doing early morning training; they get up, they do their class, then they get to work, and then they have food. After four days, they’re like, ‘I’m so tired. What is going on?’. It’s because their thyroid is slowing everything down.’’
To help stave off fatigue, Sims tells athletes not to starve themselves.
‘‘There’s that 1980s idea of ‘if I train more and eat less then I will get thin, and I will perform well’, but it’s simply not true. You have to eat more to hit that higher level of performance,’’ she said.
‘‘When we look from a metabolic standpoint, we don’t get fitter during exercise, we get fitter in the recovery. Putting it simply, fuel for what you’re doing, and recover with food from what you were doing. It really reduces the total stress, and the body… has enough food coming in to maintain general health and has enough food... to be resilient to training and stress.’’
This is all too familiar for Alley. Early in her career she felt pressure to get her weight down. It became an ‘‘obsession’’; an unhealthy one. She stopped menstruating, had low iron and low energy. Part of it was the testing athletes are expected to undertake, in particular skin fold testing. It’s adding to the overall anxiety felt by many, she said.
‘‘It wasn’t until later that I got more confident in myself and learnt about fuelling myself properly that I could combat it,’’ she said.
‘‘But it saddens me to see girls not enjoying their food or having the smallest plate... because they want to be in the best position to be selected. They think that is getting their skin folds down, or getting weight down to a position where someone else is.
‘‘In fact, actually fuelling yourself to be able to put the best performance out on the field is the most important thing.’’
Fatigue for women, in particular, is also linked to the traditional ‘‘masculine’’ structures of sport. That involves applying training methods that work for men, to women. But women aren’t little men, Sims said. ‘‘If it’s not working with a woman’s menstrual cycle or hormones... then she’s going to be stressed at points when the body can’t take on the stress, and not stressed at the points when bodies should be getting on the stress,’’ she said.
‘‘Until we start looking at the methodology of training our female athletes and allowing them to recover, as well as fuelling them appropriately, we’re missing the mark on achieving that untapped potential.’’
Women are also expected to do the same with less, Alley said.
‘‘We live in New Zealand, rugby is our national sport. So the moment you’re trusted to pull on a black jersey... there’s an immense amount of expectation and pressure there,’’ she said. ‘‘We are expected to play and train at our best, and we have expectations on ourselves to do that. It’s also a long [season] with not anywhere near as much resource as the men’s game.’’
The traditional traits of sport being ‘‘masculine, aggressive, powerful’’ also has a detrimental impact on male athletes too.
‘‘Fatigue and low testosterone, those are things that are taboo for men to talk about. From research, we know that male athletes have gotten cut from the system, because they’re not performing and ... they’re fatigued and burnt out,’’ Sims said. ‘‘That doesn’t come out. It’s being pushed under the rug in high-performance sport … like so many things.’’
Corban said female athletes are ‘‘better at articulating’’, while men ‘‘will put their head down and keep going’’. That’s associated with the ‘‘New Zealand male mentality’’.
Ish Sodhi said that mentality is changing within cricket, a sport where ‘‘60 to 70 per cent of the time you’re failing’’.
‘‘It’s a real Kiwi thing. The ‘she’ll be right, just get on with it’. Just the way society’s growing, it’s becoming more acceptable for people to have feelings and share those feelings,’’ he said.
Many Black Caps have started to share with each other the daily struggles they face. For Sodhi the challenge is being away from his young family a lot, while trying to navigate being on the fringes of squads, and constantly changing formats. It’s fatiguing, not just physically but mentally too.
‘‘In the last four years, the conversations around the mental side of the game… are becoming more frequent. Everyone’s been encouraged to seek help, but the conversations internally are increasing; with teammates, with coaches. It’s a more widely understood and appreciated part of sport,’’ he said. ‘‘I find if you don’t suppress it, it’s easier to deal with. Not that it’s ever easy to deal with. It’s a big challenge when you are under the microscope all the time.
‘‘When you’re touring… and on the fringes … it can be hard remembering what’s important to you. It’s often nice to have that break. If I ever get into that [fatigued] state again, I will... ask for a break.’’
Visiting a doctor and taking a break – ‘‘athlete or not’’ – is exactly what Dr Sarah Beable recommends for recovering from fatigue.
‘‘You need to break the cycle of the thing that’s causing you to feel tired. Sometimes it’s a health issue, sometimes it’s not enough food,’’ she said.
‘‘If your environment can’t change, maybe you need to leave. It’s like you’re driving a car and the cylinders are burning out. It needs a bit more than some time on the side of the road. Put it in the garage, give it some time, then restart it.’’
‘‘When tiredness and ‘doing too much’ is prolonged it can cause burnout. This is often seen in very driven, passionate, highachieving individuals. The fatigue can be insidious, and underrecognised.’’ Dr Sarah Beable
‘‘There’s that 1980s idea of ‘if I train more and eat less then I will get thin, and I will perform well’, but it’s simply not true. You have to eat more to hit that higher level of performance.’’ Dr Stacey Sims, above