A Harmful Side Effect of High Intensity Exercise.

**This is a synopsis of an article first published in the New York Times

Two days after Christina D’ Ambrosio took her first spin class she was hospitalized due to excruciating pain in her legs, nausea and excretion of dark brown urine. She was diagnosed with rhabdomyolysis, “a rare but life-threatening condition often caused by extreme exercise. It occurs when overworked muscles begin to die and leak their contents into the bloodstream, straining the kidneys and causing severe pain.” Ms. D’ Ambrosio was hospitalized for two weeks and has since recovered fully. 

Ms. D’Ambrosio’s case along with two other cases of spinning induced rhabdomyolysis(rhabdo), were featured in The American Journal of Medicine. The report documented 46 other cases of spin-induced rhabdomyolysis (42 of the cases were first-time spin classes). The authors stated that the condition is rare and not a reason to avoid high-intensity exercise. The objective of the report was to bring awareness to the condition and educate trainers and exercisers of the risk of a jumping into a new high-intensity exercise program. The authors advise easing into a new exercise program in order to lower their risk of injury. 

In 2014, doctors at NewYork-Presbyterian/Weill Cornell Medical Center published a report on two patients who arrived at the emergency room with rhabdo shortly after their first spin class. One was a 24-year-old woman hobbled by pain, her legs swollen and feeling “as tight as drums.” She was rushed to surgery, where doctors sliced her thighs open to relieve a dangerous buildup of pressure. Another study found that between 2010 and 2014, there were 29 emergency room visits for exercise-induced rhabdo at NewYork-Presbyterian alone. Weight lifting, CrossFit, running and P90X were the reasons for some visits. But the most common one was spinning. Dr. Todd S. Cutler, an internist at Weill Cornell Medicine and NewYork-Presbyterian and lead author of the study, said the patients all fit a similar profile.

Rhabdo is documented among soldiers, firefighters and other physically demanding professions. A study in 2012 estimates 400 cases of rhabdo per year among active-duty soldiers. 

Certain medications (statins, stimulants and antipsychotics) and a genetic predisposition may contribute to the susceptibility of the condition. Experts explain that when people do not give their muscles enough time to adjust to new rigorous exercise programs, the muscle fibers will break apart and release compounds, such as myoglobin, which is harmful to the liver. This protein causes dark discoloration to urine, a typical symptom of rhabdo. 

In order to avoid rhabdo, Joe Cannon, an exercise physiologist recommends doing a less intense version of a new exercise program first. For example, ride a stationary bike at a moderate pace before attempting a spin class. He urges people to know their limits and say no if they are struggling to keep up and not be afraid to leave a class. 

“I would never discourage exercise, ever,” said Alan Coffino, the chairman of medicine at Northern Westchester Hospital and a co-author of the new study. “Spin class is a great exercise. But it’s not an activity where you start off at full speed. And it’s important for the public to realize this and for trainers to realize this.”

Read the full article here

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