May 18, 2021 – Gyms and fitness centers typically see a rush of new customers in January and also when the weather starts to improve in the spring. This year, after a year of pandemic-related disruptions, these two trends could combine: people wanting to get back in shape and lose “COVID-19” just in time to look their best by the pool and beach .
But experts say exercisers and instructors need to be careful, otherwise it could lead to a spike in cases of a rare but serious, even fatal condition called rhabdomyolysis.
“We have a huge number of people who have become less physically active over the past year or more,” says Eric Rawson, PhD, professor of health, nutritional and exercise sciences at Messiah University. in Pennsylvania and a fellow of American College. of sports medicine.
“We have the possibility that bad things are happening in terms of increased cases” of the disease, popularly known as rhabdo. “We have never had such a massive reduction in physical activity like this for such a long time.”
What is Rhabdo?
Rhabdomyolysis is a disorder involving muscle breakdown and damage. When muscles are injured, they release their contents, including a muscle enzyme, into the bloodstream. The enzyme can damage the kidneys and cause kidney failure in up to 40% of cases.
The disorder is dangerous but rare. In one study, 22 people out of 100,000 had it. It is easy to treat but in rare cases can lead to death if not detected.
The three main symptoms are:
- Muscle swelling
- Muscular weakness
- Dark urine or less urination
Other symptoms may include:
In addition to extreme exercise, it can be caused by trauma, drug use, severe dehydration, statins, and extreme temperatures.
This often happens when people do more repetitive resistance exercise than they are used to. And now, too many athletes could come back and not realize that they are not as strong or as fit as they were before COVID-19 sent them home last March. Instructors and trainers should make it clear to newcomers that they need to relax, stay hydrated, and get in shape.
“ My arms were like jelly ”
Marc Nair thought he would try something different to ring in the New Year: a gymnastics workout.
He and a friend were the only newbies in a seasoned regulars class, and the instructor didn’t change their workout, which included 45 pull-ups in 30 minutes.
“It was tough, to say the least,” recalls Nair, who had previously run and did high-intensity interval training.
“The day after training I couldn’t straighten my arms,” he says. “Two days later, my arms started to swell. As the day wore on they hurt and I started to feel extremely dehydrated. That’s when I knew something was seriously wrong.
Nair, a photographer and poet living in Singapore, went to a hospital. Her urine was dark and blood tests revealed rhabdomyolysis. It took a week of intravenous treatment in the hospital to reduce the swelling and remove toxins from her bloodstream.
“My arms were like jelly,” he says. “I went to calisthenics training because I wanted to push myself a little harder. But clearly, it was not structured at all at a beginner level.
Nair’s rhabdo happened a few years ago. He struggled at the gym for a few months but regained his strength – and even installed a pull-up bar at home.
“I’m definitely stronger than before, but I don’t think I’ll be going back to a calisthenics class. The problem, for me, was not the training, but the trainer unable to adjust the intensity of the training according to the needs of the participants. And that’s a bigger story about regulation in the fitness industry. “
Marcelo Campos, MD, of Boston, agrees that trainers and class instructors need to change their approach for people who are not used to difficult and repetitive workouts, even if they were before COVID.
“I wish coaches were more aware of explaining to people so they can adapt better and go slow and prepare your body,” he says.
Some clubs favor an aggressive, “get in shape quickly” approach, and newcomers need to be careful not to jump into something that is too early.
“The other day I saw someone wearing a shirt that said, ‘Push to Rhabdo’.” Campos wrote for Harvard Medical School. “It made me cringe. And I realized that although it is rare, some people don’t understand how bad rhabdo can be.
“There is a genetic predisposition for some people,” he says. “Add to that poor hydration. Add in some intense training – either strength training, usually, but it can also be cardio and cycling … and you increase your chances. People need to watch closely… when they come back after a break. They think they can do more intense workouts the first time around, and that’s what puts them at risk.
He and other experts advise:
- Start slowly
- Build on goals as you gain strength, endurance and confidence
- Stay well hydrated before, during and after exercise
- Not to be too hot
- Take breaks
- Avoid anti-inflammatory drugs like ibuprofen
- Avoid alcohol, which contributes to dehydration
“If you’re starting a new job, learning a language, trying to play a musical instrument, it takes time,” he says. “Our muscles are no different.”
And remember that if the rhabdo is serious, it usually only happens after very intense and repetitive workouts. So know your limits and listen to your body, not peer pressure or a coach’s instructions to a group.
“People shouldn’t be afraid to start physical activity,” says Campos. “They just need to be aware of what they’re doing. It’s great that people are thinking about moving more. We need it. But just do it in such a way that they can take a closer look at what’s going on in their body and prepare their body for it.
‘Don’t overdo it’
Rick Mayo is a seasoned trainer and gym owner, and he remembers having rhabdo decades ago, before he heard of it.
“I was in my early twenties, really into bodybuilding and heavy lifting,” he recalls. “And these guys bet me I couldn’t do 225 pounds for 100 squat reps without a break.
“Everyone is screaming and screaming, and the music is so loud, and I just had a cup of coffee, and I was like, ‘Alright, let’s do this.’
“So I did 100 squats in a row. I felt like it was going to kill me. I was on the floor exhausted. The leg pump was just awful.
Over the next few days, his legs swelled and ached, and his urine was cloudy and rusty in color.
“I wasn’t treated, which in hindsight is a terrible idea,” Mayo recalls. “Fortunately, I didn’t have kidney failure, but I could have. I was lucky that something worse didn’t happen to me.
Mayo urges newcomers to take it slow and start slow. “Don’t overdo it,” he said. “You want to be pushed. But putting yourself in the hospital for trying to get in shape is ridiculous. It is simply not necessary.
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