[For many years, I would go to Colorado in the summer to
climb a high mountain in the wilderness, after a generally sedentary year. In addition, I have an as yet undiagnosed
gradually progressive neuromuscular disease.
After these climbing experiences, I would invariably be quite stiff and
sore. I would pass darkened urine. One time, I prevailed on a former colleague
in Denver to obtain a CK on me, which was 6,174. The next year I would return to repeat the
same.]
Three years ago, Christina D’Ambrosio went to her first spin
class, pedaling fast on a stationary bike to the rhythms of popular music as an
instructor shouted motivation.
But Ms. D’Ambrosio, who exercises regularly, found the
hourlong class was harder than she anticipated. By the end her legs were sore
and wobbly.
“I thought my body just wasn’t used to that kind of muscle
ache because it was my first class,” said Ms. D’Ambrosio, a kindergarten
teacher from Pleasantville, N.Y.
Over the next two days, her legs throbbed with excruciating
pain, her urine turned a dark shade of brown, and she felt nauseated.
Eventually she went to a hospital, where she was told she had 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.
After a two-week hospital stay, Ms. D’Ambrosio was released
and has since recovered. Her case was highlighted in April in The American
Journal of Medicine along with two other cases of spinning-induced
rhabdomyolysis treated by the same doctors.
The report noted that at least 46 other cases of people developing
the condition after a spin class were documented in the medical literature, 42
of them in people taking their first class. The report cautioned that the
condition was very rare, and not a reason to avoid high-intensity exercise. But
the authors said their goal was to raise public awareness so that people who
begin a tough new workout program will ease into it to lower their risk of
injury…
Rhabdo, as many experts call it, has long been documented
among soldiers, firefighters and others whose professions can be physically
demanding. An Army study in 2012 estimated that about 400 cases of the
condition are diagnosed among active-duty soldiers each year. On occasion there
have also been large clusters of college athletes hospitalized with it after
particularly grueling workouts…
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 the hospital and lead author of the study, said the patients all fit a
similar profile.
“These are people who are not unfit,” Dr. Cutler said. “They
are being pushed too hard, and they’re not trained to do this, and so they get
really bad muscle trauma.”
There is some evidence that certain medications, including
statins, stimulants and antipsychotic drugs, as well as genetic
susceptibilities may contribute to the condition, said Patricia Deuster, a
professor of military and emergency medicine at the Uniformed Services
University of the Health Sciences.
But in general it occurs when people simply do not give
their muscles time to adjust to an aggressive new exercise, experts say. A
little damage to muscles is a good thing because that stimulates them to grow
and adapt to stress. But when the stress is too great, fibers are destroyed.
When that happens they break apart and release compounds that can be harmful to
the liver, such as a protein called myoglobin, which causes brown or tea-colored
urine, a classic symptom of rhabdo…
Even elite athletes are not immune. Amy Purdy, a
bronze-medalist Paralympic snowboarder and “Dancing With the Stars” contestant,
went to an exercise class last year after taking three weeks off from her
training regimen. The class consisted of a circuit of challenging exercises,
she said, including dozens of pull-ups.
“About halfway through I realized my arms were completely
fatigued,” she said.
The next morning she could not straighten her left arm. Then
it became sore, stiff and swollen, prompting her to go to a hospital. She
remained there for eight days as doctors flushed her kidneys with water, she
said. She was diagnosed with rhabdo, and when she wrote about the experience on
social media she was inundated with responses.
“Thousands of people have reached out to me on my Instagram
page who have had it as well,” she said. “Almost everyone was fit before, got
it from pull-ups and is trying to figure out the way to get back into fitness
without risking a recurrence.”…
Two things can help you avoid rhabdo, said Joe Cannon, an
exercise physiologist. Before starting a new program, do a less intense version
of it first. That means riding a stationary bike at a moderate pace before starting
a spin class, or doing just one set of a weight lifting exercise rather than
multiple sets and repetitions.
But the most important advice is to know your limits: Don’t
be afraid to leave a class or to say no to a trainer if you are struggling.
“One thing I’ve noticed when people tell me they’ve gotten
rhabdo in the gym is that they gave up their personal power,” said Mr. Cannon,
author of “Rhabdo: The Scary Side Effect of Exercise You’ve Never Heard Of.”
“They kept doing what the instructor told them to do because they did not want
to look weak.”
Brogan M, Ledesma R, Coffino A, Chander P. Freebie
Rhabdomyolysis: A Public Health Concern. Spin Class-Induced Rhabdomyolysis. Am J Med.
2017 Apr;130(4):484-487.
Abstract
BACKGROUND:
Rhabdomyolysis is a pathologic condition in which
intracellular muscle constituents leak into the blood circulation. It is
usually caused by muscle trauma. "Spinning" is an indoor form of
cycling where participants use a special stationary exercise bicycle with a
weighted flywheel and undergo high-intensity cycling classes focusing on
endurance. There have been several case reports in the literature of exertional
rhabdomyolysis following spin class.
METHODS:
Our nephrology practices have diagnosed a number of cases of
symptomatic patients presenting to our emergency departments following their
first spin classes, with histories and creatinine phosphokinase levels
diagnostic of exertional rhabdomyolysis.
RESULTS:
We present 3 unusual cases of exertional rhabdomyolysis,
each occurring after a first spin class. In the first case, rhabdomyolysis
developed following 15 minutes of spin class. In the second case, it occurred
in a young individual who exercises regularly. In the third case, the patient
developed biopsy-proved acute kidney injury secondary to exertional
rhabdomyolysis and required hemodialysis.
CONCLUSION:
The high-intensity exercise associated with "spin
class" comes with significant risks to newcomers.
Cutler TS, DeFilippis EM, Unterbrink ME, Evans AT.
Increasing Incidence and Unique Clinical Characteristics of Spinning-Induced
Rhabdomyolysis. Clin J Sport Med. 2016 Sep;26(5):429-31.
Abstract
OBJECTIVE:
To compare outcomes of spinning-induced rhabdomyolysis to
those with exertional rhabdomyolysis from other physical activities.
DESIGN:
Retrospective cohort study.
SETTING:
Academic medical center, single-center.
PATIENTS:
A retrospective chart review was conducted on patients
evaluated from December 2010 through November 2014. Patients were selected by
ICD-9 code for rhabdomyolysis. Patients were included if the reason for
admission was rhabdomyolysis caused by exertion. Cases of rhabdomyolysis caused
by trauma or drugs were excluded.
MAIN OUTCOME MEASURES:
Muscle group involvement, admission, and peak creatine
kinase levels, time from activity to hospitalization, length of hospital stay,
and incidence of complications.
RESULTS:
Twenty-nine cases were reviewed with 14 admissions secondary
to spinning. Median admission creatine kinase (73 000 IU/L vs 29 000 IU/L, P =
0.02) and peak creatine kinase levels were significantly higher in the spinning
group (81 000 IU/L vs 31 000 IU/L, P = 0.007). Hospital admissions for
spinning-induced rhabdomyolysis increased over time.
CONCLUSION:
Health care providers should be aware of the potential
dangers of spinning-related rhabdomyolysis especially in otherwise healthy
young people.
Courtesy of a colleague
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