Rhabdomyolysis due to unaccustomed exercise: experiences from a multidisciplinary clinic

Purpose

The Highly Specialised Service (HSS) for McArdle disease and related disorders in the United Kingdom receives many referrals to investigate the cause of exercise-induced pain and rhabdomyolysis, a complex medical condition involving rapid breakdown of damaged skeletal muscle. An increasing number of these referrals are following unaccustomed exercise. Since January 2017 twenty two such patients have been assessed in clinic. A typical history reveals either a period of inactivity followed by an intense training session at the gym, often with a personal trainer, prior to an episode of rhabdomyolysis. The aim of this service evaluation is to highlight the need for caution in training individuals returning to exercise, particularly after a break from exercise of at least two months.

22 referrals received
in the period, January 2017 to August 2019
23% of those new patients referred
had experienced rhabdomyolysis following unaccustomed exercise.

Approach

A retrospective service evaluation was carried out of the referrals made to the HSS for McArdle disease and related disorders from January 2017 to August 2019. Patients were considered to have experienced rhabdomyolysis due to unaccustomed exercise if there was a history of at least one episode of rhabdomyolysis following exercise and there was no known genetic cause.

Outcomes

Results: A significant proportion (23%) of new patients had experienced rhabdomyolysis following unaccustomed exercise. Twenty seven percent of these patients had exercised with a personal trainer prior to their episode of rhabdomyolysis. The mean distance walked on the 12 minute walk test was 1006.25m (range: 890m-1150m).

Conclusion(s): Prior to referral patients had often been extensively investigated. Therefore a thorough exercise history should be taken from all patients who have experienced rhabdomyolysis. Frequently, when restarting following a break in exercise, the exercise was undertaken at an inappropriate intensity, often for too long and with insufficient rest periods. More than a quarter of patients had exercised with a personal trainer, which resulted in an episode of rhabdomyolysis. All individuals who have had a hiatus from exercise should begin conservatively and this is especially important for those with neuromuscular disease where appropriate preconditioning is essential.

Cost and savings

No further information. 

Implications

All healthcare and exercise professionals should be aware that rhabdomyolysis can occur if exercise training is undertaken at an inappropriate intensity and for too long, particularly if the patient is returning from a break in exercise.

Top three learning points

No further information. 

Funding acknowledgements

This project was not funded.