New Year’s Fitness Goals Have Very Real Health Risks

By William E. Morgan

Every January gyms across the world are jammed with new members. New Year’s resolutions, along with Christmas gym membership gifts, swell the gyms with people who have committed themselves to making a new start for fitness in the new year. Many of these are newcomers to an exercise program who throw themselves into their new regime with reckless abandon, causing injury and infirmities which lead them to abandon their quest for fitness.

A gradual ramping up of exercise intensity is far more beneficial and safer than jumping into a hardcore cross-fitness or extreme fitness form of exercise. Moderation and steady progression are the keys to beginning a new fitness plan, especially when compared to the tendency toward hapless disregard and abandon.

Below is a chapter from my eBook Hero Workouts: Hardcore Functional Workouts Dedicated to the Heroes of U.S. Special Warfare Units (Kindle Edition)

In this chapter, I share the very real risks of injury and even death from pursuing an overly aggressive program of exercise.

Chapter Four:

The Dangers of Extreme Exertion

 Rhabdomyolysis

Extreme physical exertion can result in severe illness, permanent impairment, organ failure, and death. Exceptional metabolic injuries can occur in the young and old, as well as in very fit individuals. While there are many potential causes of exertional injury (heart failure, stress fractures, heat stroke, acute dehydration, kidney failure, compartment syndrome, and stroke), this chapter will focus on a condition known as rhabdomyolysis or “rhabdo” as it is often referred to for short.

Rhabdomyolysis is a condition characterized by muscle breakdown which releases the intercellular components of muscle cells into the blood stream (where they do not belong). One of those components, myoglobin, is particularly damaging to the kidneys and will result in dark urine. The kidneys are designed to filter small substances from the blood stream. However, the contents of these damaged muscle cells are relatively large and will clog the kidneys which can result in devastating illness and death. Liver damage has also been cited as a result of overexertion.

Sudden increases in physical exercise can result in the muscle breakdown that causes rhabdomyolysis. While swimming, running, calisthenics, football, soccer, and virtually any kind of fitness endeavor can cause rhabdomyolysis, high intensity workouts that combine weights, gymnastics, running, and calisthenics in timed events are particularly risky. 

Athletes who may be fit and high performers in conventional fitness programs might find that their particular type of fitness does not translate to the type of fitness that is found in special operational workouts or in cross-fitness centers. Being a good swimmer, runner, and weightlifter can give athletes a false sense of security and tempt them to jump into an exercise program for which they are not prepared. No one, no matter how fit they believe themselves to be, should radically change their workout program. Gradual changes over time will allow the body to adapt to new stresses. Maintaining adequate hydration and resting sufficiently between workouts are also protective measures that will help prevent rhabdomyolysis.

 Being fit has its own risk factors. Someone who is competitive and fit may be inclined to jump into a new workout program with vigor. To adapt to the demands of a new program or training methodology (like performing workouts for time or as many repetitions as possible) may take several weeks or months depending on your level of fitness. The danger with those who are fit, proud, and competitive is that they will ignore warnings and over-train. Additionally, those who have a history of high levels of fitness, but have let their fitness wane, may attempt to jump back into a fitness program at the same level of exertion as they had once attained.

 The Signs and Symptoms of Rhabdomyolysis

 1.             Muscle pain (which may be severe)

2.             Dark urine

3.             Confusion

4.             Fever 

5.             Rapid pulse

6.             Nausea

7.             Vomiting

8.             Abdominal pain 

9.             Swelling

10.         Weakness

11.         Loss of consciousness

12.         Kidney failure and the inability to urinate 

Steps to Prevent Rhabdomyolysis

1. Get medical approval before beginning any exercise program. Be honest with your physician when explaining the type of program you intend to pursue.
2. Stay hydrated. Drink plenty of water.
3. Gradually add high intensity components to your workouts over weeks and months.
4. Rest between high intensity workouts. Mingle light workouts and days of total rest between days with rigorous workouts.
5. Do not perform high intensity workouts if you are taking statins, antipsychotics, or other drugs that have been linked to causing rhabdomyolysis.
6. Receive professional coaching from a certified health and fitness expert. 

Take Action if someone has Signs of Rhabdomyolysis

Anyone showing signs of rhabdomyolysis needs to hydrate and get to an emergency room as soon as possible.

Other Causes of Rhabdomyolysis

1.             The use and abuse of drugs and alcohol

2.             Crush injuries to muscles

3.             Excessive or prolonged muscle compression

4.             Seizures

5.             Infections (both viral and bacterial)

6.             Hyperthermia (high body temperature)

7.             Muscular dystrophy

8.             Electrical shock

Exertion injuries are real and dangerous. Sensible and gradual introduction of progressively higher levels of fitness are protective, but there are some people who should never perform high intensity exercise. Obtaining a physical examination and medical approval from a physician is mandatory before beginning any exercise program or substantially changing your exercise program.

Figure 1. This image depicts the color of urine. Every athlete should be educated on observing the color of their own urine and be able to detect dehydration and a possible medical emergency.

 Note: Those taking statin drugs (medications intended to control high levels of cholesterol in the blood) are at a much higher risk for developing rhabdomyolysis.

 Stress Fractures 

Bones become stronger when loads are placed upon them, but the increase in load must be gradual and implemented over time. A sudden increase in load, be it from increased running, marching, loading by compressive weight, or other physical stresses can lead to stress fractures and bony edema (swelling and inflammation) within the marrow of the bone. 

To reach elite levels of fitness is a process that is years in the making. Training (running and marching) mileage should be increased gradually over months and years. Cardiovascular fitness, exertional stamina, and muscular strength can increase relatively quickly while bone, joints, tendons, and ligaments are slower to strengthen and adapt to an increase in training loads.

 Tendonitis

 Tendons, like bones, respond best to a gradual increase in training load. Sudden increases in workload can cause inflammation and pain in the tendons.

 Vertebral Endplate Fractures

 The bones of your spine are susceptible to injury much like stress fractures. The endplates of the vertebra may develop microfractures and result in bony edema within the vertebra. These end plate fractures may not be visible on X-rays.

 Figure 2. Microfractures of the vertebral endplates can occur as a consequence of a sudden increase in repetitive compressive forces upon the spine, a fall, or a sudden or excessive loading of the spine with weights.

  

 Figure 3. Endplate fractures and the resulting bony edema can lead to a deep bony ache which may persist for months after an injury.

Figure 4. Excessive sudden loads on the spine, like an inappropriately executed box squat, can cause an overt injury to the vertebral endplate which can be painful and undetected on X-ray.

Dehydration

 Dehydration occurs when the body lacks sufficient fluid to complete normal physiologic functions. Dehydration results from consuming insufficient water to replace the fluids excreted. Dehydration can occur with extreme or prolonged exertion especially when performed in a warm environment. Athletes should drink plenty of water, particularly when exercising in hot weather.

 Heat Stroke

 Heat stroke is an extreme heat injury which can lead to brain injury and death. It occurs when the body’s core temperature is elevated. A clinical diagnosis of heat stroke is made when the core temperature (rectal thermometer) measures at least 105 degrees Fahrenheit. Heat stroke occurs when exercising in hot weather. One of the warning signs of heat stroke is the lack of sweating. The likelihood of having heat stroke is elevated in persons who are dehydrated.

The symptoms of heat stroke include:

1.            Headache

2.             Disorientation

3.             Dizziness

4.             Hot, dry, red skin

5.             Nausea and vomiting

6.             Weakness

7.             Rapid shallow breathing

8.             Unconsciousness

Heat stroke is a medical emergency which requires medical treatment and cooling of the core temperature.

 Conclusion

 While moderate exercise has been shown to have significant health benefits, extreme exercise has the potential to cause bodily harm. Athletes should gradually advance the tempo, duration, and intensity of exercise as they advance toward their performance goals. Overexertion injuries are real, and every athlete should be mindful of potential harm.