The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Is there such a thing as too much exercise?

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Thursday, Jan 04, 2018

Exertional Rhabdomyolysis: A Dangerous Consequence of Doing too much Exercise too Soon

It would be difficult to find a sane and rational person who disagreed with the statement that regular exercise is good for you, and that more is better within reasonable limits. For the beginner exerciser however, or for those who are unaccustomed to certain exercises, the question of ‘how much is too much?’ becomes extremely important. Two important principles in exercise programming are overload and progression.  Overload simply means that in order for a change in fitness to take place, the individual must perform more work than they are currently accustomed to performing. Take a beginner exerciser for example. Any amount of exercise would be considered overload because they have not been doing anything previously. However, when beginning a program, there is the risk of too much overload. That’s where the principle of progression comes into play. Progression means that in order for an exercise program to be safe and effective, the overload should be increased gradually over a period of several weeks. In other words, Rome wasn’t built in a day. It actually took two days. Just kidding!

In August of 2016, eight players from the Texas Woman’s University volleyball team were hospitalized with severe pain and swelling in the triceps muscle of both arms, as well as stiffness and weakness in those areas. Fortunately, all of the athletes recovered. A thorough investigation of the incident was launched, which led to an independent report stating that the cause was exertional rhabdomyolysis. We’ll just call it ‘rhabdo’ from this point forward.

Rhabdo begins with severe muscle damage, which comes about as a result of too much overload combined with the absence of progression. When muscle fibers experience such damage, they release a substance called myoglobin into the bloodstream. Myoglobin is a protein that is almost exclusively found in muscle tissue, and that’s where it should normally remain. When myoglobin finds its way into the blood, it eventually travels to the kidneys, where it can cause damage. If enough myoglobin is released from the injured muscles, this can lead to kidney failure, with an immediate need for dialysis.

So how did a group of University level volleyball athletes damage their muscles to such an extent that they were hospitalized with rhabdo?  The simple answer is that they did too many push-ups! Let me elaborate. For most people, the push-up is a safe and effective strength training exercise that incorporates several muscle groups including the pectoralis major (pecs), triceps, serratus anterior, and anterior deltoid. A variation of the traditional push-up is known as the triceps push-up, where the elbows are held closely to the sides of the body instead of flaring out. As its name implies, the triceps push-up utilizes the triceps to a much greater extent than the traditional push-up. During an August pre-season training session, the volleyball team was asked to complete the following series of exercises in less than 9 minutes during a fitness testing session:

Round Burpees Squat-Jumps Triceps Push-ups
1 5 10 15
2 6 10 14
3 7 10 13
4 8 10 12
5 9 10 11
6 10 10 10
Total 45 60 75

Since this was the pre-season, the athletes were in various states of conditioning; some had worked out regularly during the summer, while others had not. None of the players had put any particular emphasis on performing triceps push-ups during their workouts. So, the principle of progression was violated. Most players went from never or rarely performing triceps push-ups to performing 75 of them in a single training session! Within 72 hours, 8 of the players were hospitalized. The equation is simple: Too much overload + no progression =  exertional rhabdo.

So if you are just getting started on an exercise program or are about to incorporate a new exercise into your routine, easy does it! Your muscles need time to adapt to change. If you overdo it and experience the signs and symptoms summarized below, then you should seek immediate medical attention. Please note that these typically occur 24-72 hours following overexertion.   

Signs and Symptoms of Rhabdo

  • Cola-colored urine
  • Severe muscular pain accompanied by swelling
  • Stiffness and weakness in affected muscles

Note: The Cooper Institute has recently published a state of the art textbook titled Principles of Health and Fitness for Fitness Professionals. This book is an absolute must for fitness leaders or anyone in the general population who wants to learn more about health and physical fitness. The book is also a great resource for anyone who is seeking to earn a nationally accredited personal trainer certification! Click on the links above to learn more.