Associations between training load, heart rate variability, perceptual fatigue, sleep, and injury in endurance athletes during a 12-week training mesocycle

This study examined associations among training load (external and internal), heart rate variability (HRV), perceptual fatigue, sleep, and injury in endurance athletes during a 12-week training mesocycle. The aims were to (i) compare these parameters between injured and non-injured weeks and (ii) assess differences between high- and low-severity injuries. Fifteen endurance athletes (80% males; median age: 36.5 years; running experience: 5.5 years) participated. Injury severity was measured using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H). Training load (training stress score [TSS], Session-Rate of Perceived Exertion [sRPE]), HRV, perceptual fatigue (readiness to train and wellbeing), and sleep were collected through daily and weekly assessments over 12 weeks. The weekly injury prevalence over the 12-week period ranged from 7%–40%, with 47% classified as high severity. Injured weeks were characterised by significantly higher sleep-related impairment ( p = .004, Hedge's g = 0.704), while all other variables did not significantly differ. Athletes who sustained more severe injuries exhibited lower TSS ( p < .001, Hedge's g = 0.84), lower sRPE ( p = .029, Hedge's g = 0.705), poorer subjective wellbeing ( p = .003, Hedge's g = 0.753), and lower HRV ( p = .059, Hedge's g = 0.487) in the week preceding the injury. This exploratory study provides preliminary insights into the potential role of sleep-related impairment, training load fluctuations, and HRV in injury severity among endurance athletes. While findings suggest benefits of integrating these measures into monitoring strategies, the small sample size limits generalisability and should be interpreted with caution.