Other cases of fatigue


Persistent fatigue can occur in cases where fatigue is not caused by a medical condition but it is not of unknown aetiology either. Such cases are the burnout syndrome, overtraining syndrome, fatigued athlete myopathic syndrome and seasonal affective disorder.



Burnout syndrome, as implied by its name, is a syndrome with characteristics of physical and emotional exhaustion associated with work. It was first diagnosed in the 70's and it is described as the emotional inability to respond to job stress, especially when it is the result of a long-term situation [1-3]. The syndrome begins with a progressive loss of idealism, entrepreneurship, energy and work objectives and these lead to emotional overload and eventually the person is exhausted [4].

Physical symptoms that can develop are appetite disorders, fatigue, headache, tremor, feeling of choking, skin problems and others. Beyond the mental disorders that develop, such as apathy, anxiety, loss of motivation, feelings of ineffectiveness and depression, behavioural disorders also develop such as irritability, outbursts of anger, suspicion, aggression, social withdrawal and more. [2]. Stress can also affect perception, thinking and learning.


So burnout is a mental and physical exhaustion caused by the professional life of a person. Initially it was observed in health professionals, such as medical [5] and nursing [2] staff. In recent years it has been noticed in other health professions, such as physiotherapists [1], but also professionals in IT systems [3], teachers [6] and others. Extensive studies have been done lately on the appearance of burnout syndrome in high-level athletes, which in this case is known as athlete burnout [7,8].


Physical and psychological support is important for treating the symptoms and the consequences of this syndrome, with the purpose to rehabilitate patients and restore their quality of life.

Overtraining syndrome


Overtraining syndrome can often occur in athletes. It results from overtraining which last for weeks or months in athletes, especially those of high performance and includes a set of emotional, behavioural and physical symptoms [9].


Athletes present few or many of the following symptoms, such as:

  1. persistent fatigue,

  2. "heavy legs"

  3. increased heartbeats at awakening,

  4. painful muscles,

  5. frequent infections,

  6. weight loss,

  7. lack of motivation, decreased enjoyment of exercise,

  8. sleep disorders,

  9. depression / mood changes,

  10. increased effort during exercise without increasing the outcome,

  11. frequent infections [10]

  12. changes in blood and urinary tests and in heart rate and blood pressure.

Overtraining syndrome is, therefore, the body's response to its inability to adapt to the cumulative fatigue, which is the result of daily intense training that is not balanced by adequate rest [9]. In overtraining syndrome rest and gradual return to the sport are needed. The longer the time of overtraining, the greater the need for rest is. Overtraining syndrome can lead to the appearance of athlete burnout syndrome, if it is not promptly and properly treated.

Fatigued athlete myopathic syndrome


The fatigued athlete myopathic syndrome may be the reason why some athletes experience chronic fatigue and reduced exercise performance. They may have:

  1. history of many years of high volume of exercise,

  2. chronic fatigue, but also a clinical picture dominated by muscle problems such as stiffness, muscle tenderness, muscle cramps,

  3. their situation does not fit the image of the above mentioned causes of chronic fatigue,

  4. they do not meet the criteria for chronic fatigue syndrome

  5. they often consult many clinicians and have not been given a diagnosis.

Seasonal affective disorder (SAD)


Seasonal affective disorder is a condition in which there is a combination of organic and mood disorders with a seasonal pattern. It occurs mainly in autumn and winter, although it could occur at any time of the year. When it happens it can last up to 40% of the year and is, thus, considered an important situation.


The main biological mechanism associated with its possible appearance is the change in the circadian rhythm, which may be slower or faster [11]. Other mechanisms that contribute to its appearance are the sensitivity to light, serotonin levels and dysfunction of the neurotransmitters. Thus, it is considered that seasonal affective disorder is a complex condition that is affected by many factors [12]. Furthermore, psychological mechanisms such as vulnerability to stress can be implicated.


Patients can have some form of depression and when this is present it has to be confirmed that is relates to the season. Fatigue is one of the symptoms in this disorder. Moreover, memory and concentration problems, muscle and joint pain, and nutritional problems can appear [13].



  1. Pavlakis et al. Burnout syndrome in Cypriot physiotherapists: a national survey. BMC Health Services Research 2010;10:63.

  2. Poncet et al. Burnout Syndrome in Critical Care Nursing Staff. Am J Respir Crit Care Med 2007;175:98–704.

  3. Huarng. Burnout Syndrome among Information System Professionals, Information Systems Management 2001;18(2):15-20.

  4. Price and Murphy. Staff burnout in the perspective of grief theory. Death Educ. 1984;8(1):47-58.

  5. Ramirez et al. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet 1996;16(347)(9003):724-8.

  6. Betoret. Stressors, Self-Efficacy, Coping Resources, and Burnout among Secondary School Teachers in Spain. Educational Psychology 200;26(4):519–539. 

  7. Appleton. Perfectionism and Athlete Burnout in Junior Elite Athletes: The Mediating Role of Motivation Regulations. Journal of Clinical Sport Psychology 2012:6:129-145.

  8. Gustafsson et al. A qualitative analysis of burnout in elite Swedish athletes. Psychology of Sport and Exercise 2008;9:800–816.

  9. Mackinnon. Overtraining effects on immunity and performance in athletes. Immunology and Cell Biology 2000;78:502–509.

  10. Derman et al. The ‘worn-out athlete’: A clinical approach to chronic fatigue in athletes, Journal of Sports Sciences 1997;15:3, 341-351.

  11. Rohan et al. Biological and psychological mechanisms of seasonal affective disorder: a review and integration. Curr Psychiatry Rev. 2009;5(1):37-47.

  12. Kurlansik and Ibay. Seasonal Affective Disorder. Am Fam Physician 2012;86(11):1037-1041. 

  13. Terman et al. Chronic Fatigue Syndrome and Seasonal Affective Disorder: Comorbidity, Diagnostic Overlap, and Implications for Treatment. Am J Med. 1998;105(3A):115S–124S.