Overzealousness and Rhabdo
It seems like anywhere you look in the media today fitness enthusiasts are embracing the next “extreme” exercise challenge. Traditional safe and effective exercise techniques have lost some luster, in exchange for “guru”-driven workouts that burn a purported >1000 calories an hour. To put it in perspective, a 200-lb man would have to train at 100% VO2max for the full hour to attain that value – sadly identifying once again the false advertising associated with many of these programs. Extreme exercise has now met extreme conditions as fitness enthusiasts train while wearing gas masks and wet suits, perform compound power exercises to high-rep volitional failure, and engage in jump volumes that exceedingly surpass anything ever found in sports. These programs clearly illustrate a lack of understanding of human physiology. The inherent problem with taking on a new exercise program without applicable knowledge or at least the supervision of a qualified personal trainer (or fitness instructor) is the physiological stress may end up creating severe negative responses. Whereas appropriate quantities of training stress result in positive adaptations such as improved neural efficiency, cardiovascular function, and/or musculoskeletal integrity; excessive training stress can result in negative responses. These may include a chronic elevation in serum cortisol, loss of the protein-sparing mechanism, immunosuppression, and in extreme cases, rhabdomyolysis. Rhabdomyolysis involves the actual breakdown of injured muscle and subsequent release of myoglobin into circulation, which can cause severe organ damage.
In the past, rhabdomyolysis was not a common word in the fitness industry. But surprisingly, life-threatening cases of rhabdomyolysis have become somewhat commonplace among fitness enthusiasts today. Most alarming may be the fact that individuals suffering from these conditions are training simply to meet a vanity-related goal or engage in a social “exercise”. Acute, intensity-driven trauma such as rhabdomyolysis was historically a result of extreme conditions mainly seen in the military or among competitive athletes that experienced high physical stress in hot environments. It now is becoming more common among individuals that simply do too much in too short a period of time, as evidence implicates excessive eccentric loading and high-volume training without physical readiness as a primary risk factor. Interestingly these cases are exertional in nature; occurring without the added heat or state of dehydration.
Recently Published Cases of Rhabdomyolysis:
- A healthy, well-trained 18-year old NCAA football player was diagnosed after executing a program that included 10 sets of 30 squats with 1-minute rest periods followed by 30 RDLs using 40 lb dumbbells
- A healthy, 19 year old NCAA Div 1 female tennis player was diagnosed following what the coach called a “traditional leg day”.
- An acutely-trained athlete was diagnosed after performing one high-intensity bout of weightlifting that consisted of 48 total sets of push-ups (24) and chin-ups (24) with no rest between sets
- A healthy male adolescent athlete who participated in a 3-day preseason wrestling camp was hospitalized after engaging in 60 minutes of short, intense intervals of wall-sits, squats, sit-ups, push-ups, lunges, and plyometric jumps
- A 46-year old male performed excessive high-volume training segments in a studio for bodybuilders over a 5-day period, and suffered acute renal failure two days after the last session
- A 51-year old female exerciser was diagnosed after a single bout of “boot camp” training for 50 minutes
- One of the latest to reach the national media was associated with the P90X at-home program ending in the emergency room after one “chest and back” training session
While these cases may seem isolated many of these issues are commonplace amongst uneducated consumers of extreme training. In a recent report in Florida, a 22-year old male became ill from the combination of a Paleo diet and alternating repeat sprints with pull-ups to failure in a warehouse with limited ventilation while wearing a gas mask to mimic altitude training. While he was exercising under an instructor’s lead he still experienced exertional injury. Clearly no one told him a gas mask does not change the pressure of oxygen in air at sea level. Personal trainers must try their best to offset the increased risk of injury associated with the infatuation for “new and extreme” exercise programs. Education and counseling on proper programming as well as how the body actually responds to stress can go a long way when backed by referent power. Of major relevance is ensuring proper hydration and acclimation to new exercise programs following appropriate clearance for the “new” training means.