
As Workouts Intensify, a Harmful Side Effect Grows More Common - robertgk
https://www.nytimes.com/2017/07/17/well/move/as-workouts-intensify-a-harmful-side-effect-grows-more-common.html
======
biesnecker
I think that the most important thing I've learned about exercise (and it's
taken me most of my almost 40 years to internalize it, and I'm still not great
at it by any stretch) is that it's probably the longest game of all. If you're
fortunate you're going to keep moving until the day you die, and the volume of
work you do over that time between now and that day is so far in excess of the
volume you can do on any given day that hurting yourself in an attempt to
maximize today's volume is just ridiculous. It's easy to use that as an excuse
to not do anything, unfortunately, but it's also a good reminder to slow down
when your body tells you to.

~~~
vm
Nailed it.

I used to do endurance sports (Ironman/triathlon, marathon, etc.) and now my
ONLY exercise goal is to move around for at least a few minutes every morning.
When I'm busy, it's just quick stretches for maybe 2 minutes. When I have more
time, it's a bike ride, jog, lifting weights at the gym, etc.

It might sound too simple but that's what made an easy daily habit to start.
And it makes me feel good, making me want to eat "clean" to keep feeling good
all day long.

Maybe some day I'll get more aggressive again but right now it works really
well and it's easy.

------
tcbawo
If there is one thing I've learned from friends and acquaintances who have
trained for and run marathons it is listen to your body. Stop when it starts
to hurt. If you try to push through pain, you are more likely than not winning
the battle but losing the war. Many people will suffer worse damage -- stress
fractures, sprained ligaments, or a torn meniscus.

~~~
chii
> listen to your body. Stop when it starts to hurt.

but isn't the point of training to push thru the pain barrier? When do you
actually stop and listen, vs when to ignore the pain and keep going?

~~~
tcbawo
Many beginners would be surprised how slow or lightly they should be going if
they monitored and targeted heart rate. There is discomfort and pain. If
you're feeling massive exhaustion and/or pain, you may be doing something
wrong.

~~~
Bartweiss
I think one big issue is that people who are new to an exercise (or exercise
at all) don't have a sense of scale, and don't realize quite how much progress
they'll make early on.

If you know some people can run marathons, it doesn't sound crazy to think
"well, I ought to be able to run for 10 minutes without any problems", but
there are a lot of people who would risk seriously injuring themselves with 10
minutes of quick-pace running. Not to the point of rhabdo, probably, but
certainly not a healthy experience.

It also doesn't sound crazy to think "Well, I'm in agony after two minutes,
but there's no way that means I should stop. I'll never get anywhere with only
two minutes of running!" But of course, 'beginner gains' are distinctive -
someone who hasn't done cardio in years might be at two minutes today and six
minutes next week.

The only universal answer I know to solve this is to take your first few
outings in a new thing lightly. Don't even set a training plan, just go out
until you're a bit uncomfortable, then stop and see how you feel the next day.

------
npsimons
Ah, the old Crossfit disease:

[https://medium.com/@ericrobertson/crossfits-dirty-little-
sec...](https://medium.com/@ericrobertson/crossfits-dirty-little-
secret-97bcce70356d)

I've been relatively active (compared to most people) for most of my life, and
I've never come anywhere close to rhabdomyolysis. It's incredibly rare. Hell,
I'd never heard of it until I heard of Crossfit. Once, my mountain rescue team
rescued a guy with a mild case; he had been lost in Death Valley for seven
days.

The key is two-fold: like biesnecker says, listen to your body and don't
overdo it, but secondly, you have to build up to these things. As secfirstmd
says, people are not backing up their goals with the hard work necessary to
achieve them. You can't just go from couch to marathon in one day. This isn't
helped by the spreading of the lie (mostly by fat acceptance bloggers) that
"fat people can do anything healthy weight people can!". If you're fat, you're
not fit.

The hard part is past a certain level of fitness/training, you _have_ to keep
pushing to improve. The key is knowing the difference between injury and just
normal aches and soreness. If you have to ask, you aren't at the level where
you need to keep pushing, and you should take a break.

~~~
watwut
Pretty much all examples of rhabdomyolysis I heard of were non-fat physically
very active people able to do hundreds of repetitions. Most examples involved
such people after few weeks break - no where near to become excessively fat.
If you are fat, you wont be able to do as much exercise rhabdomyolysis
requires to build. Your muscles will fail much sooner, so fat acceptance or
not, blaming fat people for condition that does not happen to them is odd.

~~~
npsimons
My apologies; perhaps I didn't make myself clear. I believe rhabdomyolysis is
like terrorism: scary enough to get you to clickthrough, but not really
something most people will ever have to worry about. In the vein of people
hurting themselves through exercise, it is extremely more likely that someone
will think "hey, I'm obese by muscle, I can deadlift 500lb!" or "I can run a
marathon without training!" and then end up injuring themselves permanently,
and even if they don't, they'll never take up physical activity again.

------
zackkrida
> The report cautioned that the condition was very rare, and not a reason to
> avoid high-intensity exercise.

end of discussion i guess?

~~~
jmull
Well, also:

> While almost any intense activity can cause rhabdo, it almost always strikes
> people who are doing something new. That is why people should always
> progress from light to moderate and then vigorous intensity when doing a new
> exercise

This is decent advice even without considering rhabdomyolysis.

------
ZenoArrow
Rhabdo is supposedly so common in CrossFit that they have a mascot called
'Uncle Rhabdo':

[https://medium.com/@ericrobertson/crossfits-dirty-little-
sec...](https://medium.com/@ericrobertson/crossfits-dirty-little-
secret-97bcce70356d)

'Pukie The Clown' is another:

[https://breakingmuscle.com/fitness/why-pukie-the-clown-
isn-t...](https://breakingmuscle.com/fitness/why-pukie-the-clown-isn-t-funny)

~~~
Bjorkbat
Yeah, personally I find it in poor taste on the part of Crossfit to promote
icons like Rhabdo the Clown. Granted, it's not official, but official enough
for a decent looking cartoon mascot to exist

They're raising awareness on a very serious problem, sure, but doing so by
portraying people who get injured in their classes as clowns.

To some degree the instructor is at fault here. After all, the point of
Crossfit is to get people into shape through very hard exercise. It's the
instructor's job to push people while somehow making sure that they don't push
people past an invisible line that exists in different locations for different
people.

I'm not saying the instructors are bad or irresponsible people, merely that
they have very strange and very hard jobs. Arguably even Crossfit isn't bad,
it's merely a symptom of the root cause. We're too busy and too undisciplined
to get into shape with a proper diet and sensible exercise spread throughout
the day, so we let "professionals" yell us into shape into a short yet intense
time window.

And two of the fruits of this insanity are higher numbers of the population
disabled by Rhabdo and this strange cartoon clown hooked up to a dialysis
machine.

~~~
Hasknewbie
>> I'm not saying the instructors are bad or irresponsible people

Isn't the most common criticism thrown at Crossfit (beside the cult mentality
thing) that their training/certification process for their instructors is
woefully amateurish compared to other, typically more responsible, programs?

~~~
jff
Yes. They also have a reputation for preferring quantity over quality (half-
assed pullups) and a generally sloppy approach to safety (yeah sure do squats
while balancing on an exercise ball). Check out the deadlift form in the
"crossfit games":
[https://youtu.be/0lr1p7f2P4Y?t=50s](https://youtu.be/0lr1p7f2P4Y?t=50s)

Or how they do "pullups":
[https://youtu.be/XQvSmqChm6M?t=1m40s](https://youtu.be/XQvSmqChm6M?t=1m40s)

~~~
Hasknewbie
>> "crossfit games"

Wow, that is scary. Considering that these are supposed to be their top
performers (and in a promoted event no less), that is quite a different level
of bad than just having some instructors that may not be up to snuff. It's
like they purposefully and actively promote bad form and health-damaging
training. So the opposite of 'fit' then.

------
40acres
I suffered from rhabdo about two years ago. I was doing 21s (3 sets of 21
barbell curls with a 7/7/7 split of different ROMs). A day or two later my
urine was brown and I could not not bend my arm. I ended up self treating by
drinking liters and liters of water instead of going to the ER.

It was a pretty scary experience, I would advise any one who hasn't worked out
in at least two weeks to start very light and work their way up to a routine.

~~~
tudorconstantin
I also suffered from rhabdo about 2 years ago after only a set of 80 squats. I
spent 5 days in the hospital, with daily perfusion of about 3L-5L of liquids.
And I also love doing 21s...great minds are doing rhabdo

~~~
pavel_lishin
> _great minds are doing rhabdo_

What?

~~~
mr_overalls
From the old saying, "Great minds think alike." It is a joking way to say that
you and another person have the same idea.

By saying "Great minds give themselves rhabdomyolysis," the person is making
fun of himself even harder.

------
driverdan
I got rhabdo in my arms a few years ago. It was _not_ an intense workout. I
had taken a few months off from the gym and was in my first week back. My
workout was much lighter and shorter than normal. Doctors suspected it was
caused by a combination of returning to the gym and under hydration.

Does anyone know if there has been research into rhabdo frequency? I suspect
it became more common as the population became more sedentary.

~~~
lostboys67
Interesting did you get your kidney function checked out afterwards?

my Surgeon commented I should exercise more as prep for the eventual kidney
transplant I will have to ask about the risks of rhabdo

------
avenoir
Just out of curiosity, can you even maintain proper form with any type of
intense workout training? I'm not a fitness guru by any means, but I've been
working out fairly consistently for almost 7 years now and, to me, anything
more than 4 or 5 proper sets will start taking toll on the form, at which
point it's best to switch to another muscle group or stop all together. If you
don't have the form, what are you training?

~~~
simonbarker87
Proper form is mainly to prevent injury and to move the most weight the most
efficiently but you can still get "gainz" by letting it slip slightly. A good
example is elite level power lifters on a deadlift, they round their spines
pretty awfully when they approach their 1 rep max but they are trading a
potentially slipped disc for CNS improvement and moving a greater load. The
trick is knowing when and how to let form breakdown just enough that it
doesn't destroy you.

Also there is merit in restricted range of motion training (such as stopping
short of chest and lock out on bench press) to increase time under tension and
"pump" \- not considered proper form but if you want to target a certain
muscle/group and really get it burning then it works very well.

~~~
scott_s
Powerlifting is one of my chosen sports. I follow a decent number of elite
powerlifters on various social media. I rarely see significant form breakdown
in elite lifters in contest footage. Small, yes, but not "pretty awfully."

~~~
simonbarker87
Fair enough, to me any flexation looks pretty awful when you're lifting as
much as they are - I focus more on the body building side of things than power
lifting.

------
dddddaviddddd
Less dramatic but also significant — higher intensity workouts can discourage
continued physical activity e.g.
[http://dx.doi.org/10.1037/0278-6133.21.5.452](http://dx.doi.org/10.1037/0278-6133.21.5.452)
[https://doi.org/10.1016/j.psychsport.2007.04.002](https://doi.org/10.1016/j.psychsport.2007.04.002).

~~~
darioush
This is a really underrated statement. All the conventional wisdom says go
intervals not the treadmill slug and make fun of "cardio bunnies" at the gyms.
This can be highly misleading to newcomers: turns out intervals aren't fun and
people just stop doing them, and exercise that you don't do doesn't count.

------
switchbak
A more appropriate title might be: "The danger of pushing too hard when
starting a new workout".

As it stands, this title seems to imply that progressively intensive workouts
are more dangerous, which the article wasn't saying. I don't think the world
needs another reason to avoid workouts, certainly when practiced safely.

------
djsumdog
I've never really taken classes at a gym, but I can see how people wanting to
plunge back into fitness could easily go way about their fitness level way too
fast.

It's like mountain biking. I remember my first time on a trail I barely made
it 1km before I was off the side of the trail feeling totally beyond my level.
Over the course of about two months though, I slowly built up my endurance
(street cycling casually during the week) until I could do 8km ~ 10km loops
without really noticing how far I've gone.

As with any workout, you need to build slowly and give your muscles time to
heal.

------
ArlenBales
I've seen a lot of people at my open gym get rhabdomyolysis. It almost always
afflicts fit newcomers, or people returning from a break, who push themselves
more than they should because they think they are fit enough for the
intensity. Like the article says, you need to ease into an exercise regime,
regardless of how fit you are.

------
gozur88
>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...

Eh... if your urine starts turning funny colors you should probably head off
to the hospital right then and not "eventually".

------
ssorallen
What a click baity title, especially for the New York Times.

~~~
kolbe
This.

Summary for people who don't want to deal with it: spin classes sometimes
cause rhabdomyolysis--especially in first timers.

~~~
bluejekyll
Exercise in general without a warmup up period. certain medications may make
it more likely. It could be genetic.

The article is good, and uses an example to show the issue.

~~~
kolbe
Yeah. It's actually not a bad article. Just annoying that NYT resorted to
doing title clickbait.

~~~
bluejekyll
I'm not as offended by this as most people I guess. It's the modern variation
of the headline.

------
bryanlarsen
For a more disturbing take on rhabdomyolysis, google for "Uncle Rhabdo".

It's no joke, but perhaps making it into one does increase awareness.

------
Theodores
I ride a real bicycle, plain utility cycling as I have no car and trains don't
go everywhere. I have never heard of this injury in the cycling context. I
also find it hard to believe that a spin workout is likely to be of higher
duration and ferocity than a bike ride. I do know people who go to the gym for
spinning classes - fat and female with crash diets and constant snacking on
diet foods. I wish I could say something different to that, so anecdotal. I
have offered to help them get cycling to work but they don't have the fitness
for that, realistically. It is an order of magnitude really.

I think there is a problem with how gyms give this false impression that a mad
workout in the gym will somehow work. If you genuinely care about the health
of your colleagues and want to ease them onto fruit and cycle commuting then
it is hard to do so and be heard. People go for the pretend of the gym and
stick with the alcohol. It is not that they don't know they are lying to
themselves.

------
boyaka
I've been doing a lot of running, and last night I was thinking about my
progression and how important it is to not push yourself too far/hard into
injury. I've gone through all sorts of bodily injury and growth, and have
gradually increased the intensity and duration of my runs over several years.

Here's the advice I decided on:

* First focus on duration. Exercise (cardio, I jog/run) at least 20 minutes. Go as slow as you need to be comfortable and dont worry about distance. Stop or slow down at any sign of injury, focus on good form.

* Gradually increase distance/duration goals. I started aiming for 3 miles or 30 minutes, then I increased gradually to 6 miles / hour (what I currently do). Continue paying attention to your form, and also to your breathing. Sometimes I get pains in the chest or feel short on breath, and if I try mixing up my breathing techniques I feel better. Try to breathe into your nostrils.

* Increase intensity. I commonly get advice from very fit people to do high intensity training. I tried to early on, but my body would just have a really hard time with it. I'm finally just starting to increase intensity, particularly toward the end of my run. Master good form and breathing before doing this, and preferably when your body doesnt hurt.

Speaking of pain, I've had a lot of growing pain through this process. There
are certainly different types of injuries in regards to whether you can
continue exercising on them. I don't know much about the technicalities here,
but if it feels better as you run (this happens with my feet/ankles) then it's
prbably good for you to exercise on (RICE vs MEAT or something). Don't run on
the injuries that need rest, but don't let the injuries that you can exercise
with hold you back.

Also speaking of motivation, I constantly have that lazy and tired feeling of
not wanting to go, but I always feel better when I do. Controlling yourself is
key for all of the things i mentioned, especially for getting out there and
doing it!

------
fokinsean
My sister recently had this in her arm. It swelled a lot and luckily my father
had the gut feeling to take her to the emergency room. I had never heard of it
nor would have thought it would be life threatening!

She had mentioned that her workout wasn't very intense, be careful out there.

------
goldfeld
In other news: as sedentary lifestyles intensify, a host of harmful side-
effects grow more common.

~~~
notacoward
It's not the sedentary lifestyle that causes rhabdo. In fact, your average
couch spud probably _can 't_ get rhabdo. Their heart and lungs will give out
long before that. They'll collapse into a puddle before their arm or leg
muscles are even fully warmed up. As others have pointed out, it's often the
_very_ active and fit who get rhabdo. It's the hyper-macho hyper-competitive
types. The people who brag about how sore they are, who look down their noses
at people who don't hit lift enough weight, hit the gym often enough, etc.
Maybe those who post in public forums about how unfit everyone else is. I see
there are people right here, in this thread, humblebragging about how they got
rhabdo. Those are the people for whom no level of fitness can match their need
for validation, and push themselves beyond _any_ sane limit.

------
ericdykstra
Poor diet and lack of exercise contributing to the obesity epidemic in the
United States is the biggest health issue of our time, and yet we get many
more articles about "fat acceptance" and "dangers of exercising" than about
the opposite.

Many of this comes from news sources that subscribe to the "I fucking love
science" ilk of scientism, yet when it comes to things like obesity, they
stick their head in the sand in favor of "feelz over realz."

~~~
tgb
If you read the article, you'll see that they still push for people to
continue exercising. They just recommend that you do a light or moderate form
of the exercise for the first time or two before committing to a strenuous
exercise that you've never done before. Moreover, New York Times specifically
has many articles promoting or discussing the benefits of exercise.

------
virtuexru
> 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.

Terrifying.

------
oandrei
exercise is great, but one has to be careful, and avoid doing stupid things:

[https://www.youtube.com/watch?v=DgdP5U28jHc](https://www.youtube.com/watch?v=DgdP5U28jHc)

------
jcahill
rhabdomyolysis.

[https://archive.fo/KqM4u](https://archive.fo/KqM4u)

------
breadmaster
Only the strong survive spin class.

------
shrikant
#SavedYouAClick:

The condition is 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.

~~~
RUG3Y
I knew it was going to be rhabdo.

I've done some extreme things and I've never experienced this. IMO you have to
ignore some pretty serious warning signs to even get close to having this
problem. Be sane, people.

