It’s a new year, the gyms are unusually busy, and many of us started a new physical activity. Several health clubs are offering fun, interactive, and dynamic exercises such as whole-body workouts, functional training, CrossFit, high-intensity interval training, spinning, etc.

Some of these classes are incorporating intense workouts, which was a hot topic in exercise physiology in 2017. There is significant enthusiasm around these programs among my friends, family, and patients. Some of these classes have loud music, lights, and trainers whose job is to push you to a new level. Increasing the intensity of a workout may bring significant health benefits for some; however, lately we are starting to see cases of a potentially life-threatening disease as a result of these activities. It’s called rhabdo.

The other day I saw someone wearing a shirt that said “Pushing until Rhabdo.” That made me cringe. And I realized that, although rare, some people do not understand how serious rhabdo can be.


What is rhabdo?

Rhabdo is short for rhabdomyolysis. This rare condition occurs when muscle cells burst and leak their contents into the bloodstream. This can cause an array of problems including weakness, muscle soreness, and dark or brown urine. The damage can be so severe that it may lead to kidney injury. Intense physical activity is just one of the causes. Others include medication side effects, alcohol use, drug overdose, infections, and trauma/crush injury. Fortunately, most people who have rhabdo do not get sick enough to require hospitalization. But if you develop any of these symptoms after a hard workout, it’s a good idea to set up an appointment with your doctor. A simple blood and urine test could help establish the diagnosis.

How to avoid rhabdo

I know you are probably excited about your new exercise program, and you want to excel. And that’s great. But take it easy, especially if this is a new exercise routine. You want to challenge your body, but avoid extremes. If you are working with a trainer, make sure you tell him/her where you stand in terms of fitness level and health concerns. In addition:

  • Drink lots of water. That will help prevent problems and help flush your kidneys.
  • Avoid using anti-inflammatory medications such as ibuprofen and naproxen. These drugs may worsen kidney function.
  • Avoid drinking alcohol. Alcohol is a diuretic, which means it will make you more dehydrated. You need more fluids in your system, not the opposite.

If you experience intense pain and fatigue after your workout, you should call your doctor. Most cases of rhabdo are treated at home simply by increasing fluid intake. If muscle enzyme levels are high, or if there are signs of kidney problems, IV fluids may be needed. In some cases, we have to admit patients to the hospital and even to the ICU for close monitoring and further treatment.

Ramping up safely

Be smart and train your muscles to adapt to new activity. Exercise is better if it is enjoyable and entertaining, and I have to say that some of these classes are incredibly fun. But make sure that you listen to your body. Watch out for trainers who may push you too hard to the point of exhaustion. That should not be your goal when you are first starting a brand-new routine, especially if you haven’t been active for a while. A good trainer should get to know you and will tailor the exercise routine to your level of fitness. Adding a new workout to your day is probably one of the healthiest habits you can incorporate in 2018, but don’t “push until rhabdo.” Instead push slowly but consistently, challenging your body toward wellness and better function.

  • What is rhabdomyolysis?
  • Rhabdomyolysis causes
  • Rhabdomyolysis symptoms
  • Rhabdomyolysis prevention

What is rhabdomyolysis?

What Is Rhabdomyolysis?

When it comes to fitness, there might be too much of a good thing. Motivated people might be persuaded by coaches and personal trainers to push beyond their body’s limits, but not listening when the body rebels may lead to significant metabolic injuries that could be life threatening. Whether it is in a gym, training facility or in front of your television trying to keep up with a video, there are potential dangers from lifting, crunching, and straining too long and too hard. Lessons can be learned from elite athletes who have been known not to listen.

They might be called the unlucky 13. At the end of a strenuous workout, a baker’s dozen University of Iowa football players ended up in the hospital with rhabdomyolysis (rhabdo=skeleton +myo=muscle + lysis=breakdown), a condition in which muscles break down quickly and spill their contents into the blood stream. Myoglobin is a protein that is contained in muscle cells, and if enough is spilled into the blood stream, it can clog the kidney’s filtering system and lead to kidney failure and a variety of other serious medical consequences and complications. While muscles routinely get sore after physical activity, rhabdomyolysis takes that muscle injury to a higher level.

Rhabdomyolysis causes

Rhabdomyolysis is the result of massive muscle destruction, and there are many causes such as:

  • Extremely aggressive workouts lifting weights, extreme workout videos, or extreme cross-training. This is especially true if the participant goes from little activity to completing an hour or longer workout. Muscle cell damage causing kidney failure is possible for any person who overdoes an exercise program, and developing rhabdomyolysis should not be considered a badge of honor; nor should the wise decision to stop when appropriate be considered failure.
  • Injury suffered by victims of a blast injury from an earthquake, bombing, or lightning strike.
  • If a person falls and lies motionless for many hours (for example, due to a stroke , intoxication, or drug overdose) the weight of the body in effect crushes its own muscle and rhabdomyolysis occurs.
  • Non-injury causes include side effects of certain medications such as statins used to treat high cholesterol, and some psychiatric medications.

7 Strange Side Effects of Exercise

Fitness fanatics put up with problems other people never would: days of brutal soreness following an intense pump class, and intense, gnawing hunger after a long run. But since you’re so used to pushing your body to its limits, it can be tough to tell what’s simply a symptom of a hard workout, and what might need to a doctor’s attention. We asked Susan Joy, M.D., an orthopaedic surgeon at the Cleveland Clinic, about the seven most common tics and side effects that afflict gym-goers (and which ones to worry about).

Your Face Stays Red for Hours

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This is probably benign, says Joy. “Some people seem to be prone to facial flushing in response to ‘whole body heat stress,'” or the increased internal temp that occurs after exercise. As you get fitter, your may find that you lose the ruddiness faster. But if you start developing rashes or hives during or post-workout, see a dermatologist or allergist. It’s rare but possible to become allergic to exercise, a condition called exercise-induced anaphylaxis.

You Sweat-a Lot

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Taylor Swift, you’re not. But there’s no need to be concerned about the fact that even a “light” gym day leaves you drenched. Some people simply sweat more than others, says Joy. But your body gets better at cooling itself as you work out more, so keep up your fitness routine and you may stop having to wring out your sports bra after each workout. Check your meds too-some, like certain kinds of antidepressants-can contribute to an increase in sweat.

You Sometimes Feel Dizzy

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Play it safe and call your doctor, says Joy. Lightheadedness after exercise may just be a sign that you went from 60 to zero too quickly. “After running long distances, it’s important to walk at the finish line and not stop abruptly,” she explains. Coming to an abrupt halt can cause blood to rush to your legs and away from your brain, leading to dizziness or collapse. But the symptom can also be the first sign of concerning problems, like cardiac disease, so don’t take it lightly, Joy says. (Check out these Surprising Things that Put Your Heart at Risk.)

Your Joints Pop When You Move

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If it hurts or you notice swelling in the area, see a doctor stat, as that could indicate a potential problem, asserts Joy. Alone, however, “popping or ‘noisy’ joints aren’t unusual,” she says. Doctors aren’t sure exactly what causes the sounds: bone or tissue rubbing against itself, or pressure changes caused by fluid shifting through the joint as you walk. In most cases though, it’s harmless.

Your Urine Is Super-Dark

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This one might be serious, especially if it’s coupled with muscle aches. “It could be a sign that your body is breaking down muscle because you’re exercising too intensely,” says Joy. This condition, called rhabdomyolysis, can lead to kidney failure and even death. Get to an ER, urgent-care center, or doctor’s office immediately. At best, super-dark urine means you’re dangerously dehydrated, and probably still need medical attention. (Discover 6 Things Your Pee Is Trying To Tell You.)

You’re Weak or Slow Exercising in the Morning

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It’s probably nothing to be worried about. Many people have low blood sugar in the morning (you haven’t eaten all night long!), which can translate into weakness and fatigue. The result: Your workout suffers. Eat a small snack about a half-hour before working out and see how you feel. (Plus, figure out What to Eat Before a Morning Workout.) Or if your schedule allows, exercise later in the day. “Some people feel more comfortable exercising at different times a day, and quite frankly may not get the same vigorous morning workout as they might get later in the day,” notes Joy.

You Feel Fine the Day After Working Out-But Wrecked Two Days Later

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Delayed-onset muscle soreness (DOMS) is super-common, generally peaking around 48 to 72 hours post-sweat sesh. This is why you want to stagger hard workouts with easy ones or rest days, and avoid working out the same muscle groups multiple days in a row, explains Joy. (Check out these 6 Ways To Relieve Sore Muscles After Overtraining.)

  • By Mirel Ketchiff @mirelbee

Hannah asks: I ran my first half marathon last week and everything went fine until I crossed the finish line. After I stopped running, I got really lightheaded and felt like I might pass out. I sat down, and then about 15 to 20 minutes later this feeling passed. What would cause this? I never experienced this during training.

Feeling dizzy or lightheaded after exercising is not altogether uncommon.

Sudden stopping after running can cause a drop in blood pressure, which may induce dizziness, fainting, and/or nausea. That being said, it’s always best to check in with your physician and discuss these symptoms to alleviate any concerns you may have.

As you run, blood vessels dilate, muscles contract, and the heart pumps faster in order to meet the energy demand of running. In addition to providing movement, these muscle contractions also serve to pump blood back to the heart, assisting with the venous return of blood flow. This pumping cycle helps meet the increased oxygen demand running requires.

When you cross the finish line and stop, the heart loses the pumping assistance of these muscles. With blood vessels dilated and no return pumping action, blood quickly pools in your extremities, causing our blood pressure to drop.

RELATED: Fit but Fainting

Also, your race effort typically means a faster run pace than a training run, and this increased intensity means a higher heart rate and an increase in sweating. Race effort also may mean a lower fluid intake during the race as you speed through support stops, pushing for a PR. This minimal fluid intake combined with heavy sweating results in lower blood volume, which means lower blood pressure.

It’s best to keep moving after crossing the finish line. Keep walking if possible, and, if not, pick up your legs like you are marching or walk in place for several minutes. You can also contract your upper-body muscles by clenching your fists, or pressing the palms of your hands together.

Pick up water and sports drink in the finish chute and start drinking immediately to replace lost fluids and electrolytes. Also, wearing compression socks can assist with venous return to the heart, so you may want to consider giving them a try.

It’s always wise to include a cooldown phase after finishing any run to allow the body time to return to normal. A cooldown lets the heart rate slow down gradually, and most importantly, allows blood flow to be redistributed from an exercise state to a non-exercise state.

Going forward, if you feel dizzy after a run, lie down immediately and elevate your legs above your heart, putting your feet up on a chair or bench. (See why our resident Sports Doc says runners need to Get Those Legs Up.)

Finally, do not get in your car and drive until you are certain you are alright. Consider bringing a friend with you to your next race too, it’s always nice to have support with you and it’s a good safety measure as well!

Is it okay to feel lightheaded and dizzy after physical activity?

Dear Reader 1 and Reader 2,

Thank you for coming here — glad to help with any health concerns that may be running through your minds! As you both may already know, physical activity causes the heart to work faster, increasing the rate at which it pumps blood through the body. Abruptly stopping your activity (especially without cooling down) may cause a sudden drop in blood pressure, which may be the culprit behind feeling dizzy or faint. Luckily, there a few options to help with this, but it’s always a good idea to pay attention to your bodies as low blood pressure may be a sign of a more serious medical condition.

Some key factors contribute to lower blood pressure after a sudden stop in physical activity. While working out, the heart pumps oxygenated blood at a faster rate than typical to reach active muscles, and the muscles help squeeze deoxygenated blood through veins back to the heart. Blood vessels in the skin also expand to dissipate heat. When physical activity ends abruptly, the heart and muscles both slow down their rates while blood vessels may remain dilated. As a result, blood may stay longer in the lower extremities, returning to the heart (and subsequently the brain) at a slower rate. This drop in blood pressure may potentially make someone feel dizzy, lightheaded, or even faint.

If either of you find yourself feeling faint, you can try a few different strategies. One option is to place your head between your knees while sitting down. Another is to lie down so your head is level with your heart. Blood flow to the brain then increases, causing the feeling of faintness to stop. To help limit or prevent feeling dizzy or lightheaded after physical activity in general, cooling down adequately is key, coming to a full stop only after gradually decreasing activity. Slowing down in this way helps maintain heart rate and circulation by gradually reducing them. In your case, Reader 1, you already warm down before being still, but perhaps walking briskly is too sudden a decrease in movement; jogging slowly at first before dropping down to a brisk walking pace may do the trick. Reader 2, if you’re not warming down, you may want to try slowly decreasing your activity before stopping completely. If, however, this more incremental reduction in activity doesn’t improve how you feel after a run, or if this is a new development, it’s probably best to make an appointment with a health care provider for a check-up and consultation.

It’s common for someone to feel lightheaded or dizzy when they abruptly stop arduous physical activity. However, if a person feels lightheaded or faints during physical activity, that may indicate a serious medical condition. It’s recommended that they stop and seek medical attention. Some conditions that may cause low blood pressure include:

  • Certain heart conditions
  • Dehydration
  • Blood loss
  • Lack of nutrients in the diet
  • Endocrine problems (such as low blood sugar)

List adapted from Mayo Clinic.

Just as warming up helps prepare the body for physical activity, warming down helps prepare the body for rest, so taking the time to slow down may help prevent these dizzy or faint feelings. Hope this helps!


Dizzy During Workouts? When to See a Doctor

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I get really light-headed during workouts. Should I be worried?

Dizziness is one of the trickiest symptoms of all because it can be caused by a variety of things, both worrisome and not. It may just be a sign that you’re dehydrated; make sure you drink enough H2O throughout the day (which means at least eight glasses) in addition to having water on hand during your workout to replace any fluids you sweat out. It could also be that you’re overdoing it. It’s great to push yourself a little in your gym sessions, but it’s not wise to go so hard that your head whirls. Try easing off a bit during workouts—going at a slower pace or doing fewer reps—to see if that solves the problem.

RELATED: 14 Surprising Causes of Dehydration

If you’re becoming dizzy even during light exercise, however, that’s a sign you need to see your doctor. Feeling the spins at the gym can be related to exercise-induced asthma. This typically causes shortness of breath or chest tightness as well, but if these symptoms are mild enough, you may not notice them. (You are working out, after all.) For that, your doctor can test your breathing strength and prescribe an inhaler to use before you hit the treadmill.

Finally, dizziness during a workout could signal an underlying heart problem, one of which is an abnormal rhythm, called an arrhythmia. There are a variety of types of arrhythmias—some make the heart beat too slowly or too fast, while others make the beats irregular. Arrhythmias can be caused by a structural problem, heart disease or even an electrolyte imbalance resulting from dehydration or poor diet. Sometimes exertion is the only time you get symptoms.

RELATED: 15 Diseases Doctors Often Get Wrong

Depending on the type, arrhythmias are treated with prescription medications or surgery to implant a pacemaker. Another option is a procedure called catheter ablation, in which a series of flexible wires are inserted into your arm, upper thigh or neck and guided into your heart. Then radio waves are sent through the wires to destroy the heart tissue that may be causing the problem.

Some less serious arrhythmias can be managed with what’s known as vagal maneuvers, which are mini-exercises like coughing or holding your breath and bearing down. Done correctly, these moves can actually kick your heart back into a more regular beat.

Health’s medical editor, Roshini Rajapaksa, MD, is assistant professor of medicine at the NYU School of Medicine.

Meet Dr. Raj at the Health Total Wellness Weekend at Canyon Ranch in May 2015. For details, go to

If you’re feeling dizzy or light-headed after a workout, you could be over-exerting yourself.

It’s in the nature of a bodybuilder to push himself past his limits. But we should never get too comfortable in the gym, no matter how much time we spend there. The truth is working out can be extremely dangerous if we don’t make sure to take the proper safety measures.

Feeling dizzy or light-headed after a workout can be caused by a number of factors. Usually the culprit is dehydration, but sometimes it can be something more serious, such as a heart condition. Here are our top 5 tips for working out smarter, not harder, and taking care of your body even as you push yourself for maximum results:

5. Stay Hydrated

This one may seem like a no-brainer, but you would be surprised how easy it is to forget to hydrate, especially if you’re someone who spends a long time in the gym every day and start to move out of habit and repetition more than actual thought. You should always hydrate before and after a workout. Depending on the exercise, drinking small amounts of water throughout can also be beneficial, and keeps your muscles from dehydrating.

4. Warm Up Before You Work Out

It can be jarring to the body to suddenly leap into motion after a long time being still. This tip goes out especially to those of you who work out first thing in the morning, right after your body was essentially motionless for 8 hours! Think about it. Warming up helps ease the body into movement and it reduces the risk of injury, so, there’s really no reason ever not to do it.

3. Try Yoga, Hiking, or Swimming

Dizziness after a workout is sometimes caused by a lack of oxygen to the brain. This could be because your lungs aren’t working at full capacity and can’t keep up with the stress of an intense workout. Low-intensity activities like yoga or a going for a gentle hike have been shown to help regulate and strengthen breathing over time. If you take up a practice like this alongside doing heavier workouts in the gym, it will make you a much better athlete all around.

2. Don’t Smoke or Drink Too Much

Again, this one seems obvious, but you’d be surprised. Smoking is bad for you and hangovers leave you dehydrated and depleted. Take it easy on both, even on the weekends, if you’re serious about your cardiovascular health and avoiding dizziness in the gym.

1. See a Doctor if Something Seems Serious

You should never experience dizziness after working out consistently, even if you do sometimes over-exert yourself. If you feel dizzy and light-headed every single time you work out, consult with a doctor immediately. Many heart conditions go undiagnosed because the symptoms are hard to tell apart from the regular fatigue that sets in from working out.

Post Exercise Sickness, Dizziness, Fainting: The Sequel

By Dr Joe

You do recall my scary experience that I documented following an exercise regime. The experience was awful and indeed freaked out my Missus and my two sons.

My daughter was in University so was lucky to have escaped the drama that unfolded on the day. Lucky girl!

If you haven’t read about it, go here and satisfy that curiosity, otherwise this post won’t make much sense to you. Don’t worry, I won’t judge you.

No one is judging you on this website. See Part 1 of the story first and proceed back here.

Why am I sharing this post exercise sickness and dizziness experience with you?

Remember that acquainting yourself with my personal experience means if you ever hit a similar bump on your exercise routine, you won’t be too scared and will know what to do. It’s a learning exercise.

Now, I do just okay on the cardiac front. Not perfect but just okay. Even though I didn’t think the Part 1 of the drama was due to my heart complaining about the intensity of the exercise and reacting in a frightening way just to teach me a lesson, I still felt I needed to check things out.

The main reason is because I have and are trying to clear my cardiovascular risk factors out of my life. It might interest you know that I suffer from hypertension (high blood pressure), was overweight and also developed full blown metabolic syndrome. These are risk factors for heart attack.

It is the reason I embarked on a journey to change the way I live not by consuming more tablets, (Big Pharma would love that, won’t he) but by incorporating a lot of what you read about on this blog into my life.

Having those risk factors meant at the back of my mind, I needed to ensure I wasn’t making a potentially catastrophic assumption. I was also scarred from the event and had to scale back on the intensity of the exercise until I was doubly sure there was NOT a cardiac element to the Part 1 event.

So, what did I do next?

I went to see my Cardiologist. That’s what I did.

Told him what happened and straightaway he didn’t think the event was cardiac-related. We still needed to stress my heart to see if it was still coping well to workouts though.

I had to have a more recent ECG (EKG to my North American friends). Tick – It went fine.

Have an echocardiogram – Tick. Not perfect but hasn’t changed for the worse in the last 15 years. It was still exactly the same as it was 15 years ago.

I was glad about that actually. At my age, you’ve got to have some blemish, haven’t you? Mind you this is a body that has been battered with stress and it’s seen a couple of decades. So, can’t complain.

More importantly, I needed a more recent exercise-tolerance test which I did. Strapped to ECG (EKG) leads and a blood pressure cuff around my arm, off I went on to the treadmill.

Starts off gently and they gradually crank up the speed and the incline until you are out of puff. Kinda similar to what you do with High Intensity Interval Training workouts.

Secretly I think the folks who do the exercise-tolerance test actually enjoy what they do. It’s like being in charge of a “controlled torture chamber”.

“Think you are made of sterner stuff? Let’s crank it up and see how you cope then brother” is probably their mind-set every time someone steps on that treadmill wired up to their eyeballs.

Anyway, I coped well with the “torture” until I raised my hands up to signal fatigue and the treadmill was gradually brought to a halt. It so happened that my heart coped well.

> There were no unusual ECG (EKG) changes and my blood pressure response to exercise was good.Having said that, apparently my blood pressure does drop sharply after exercise and this important in grand scheme of things.

More about that later.

My exercise endurance was fine but a minute less than it was when I last did an exercise-capacity test 10 years earlier. Well, I am decade older now since that test and it is to be expected.

> All in all, it went great and I felt better reassured that the event was not cardiac in origin.

If it wasn’t cardiac what was it then…

What causes post exercise sickness, nausea, dizziness, lightheadedness?

Here is the skinny.

Feeling of nausea or being actually sick after exercise or workout can be caused by 2 main physiological explanations.

1. Blood supply changes
2. Blood pressure changes

Blood supply changes

I did mention this in the other post. Exercise places a huge demand on the human body. Muscles are at work and your brain too is seriously at work (you just don’t know it but your brain is). Your brain is responsible for your muscle coordination, regulation of your heart rate, regulation of your blood pressure and also heightening up your risk awareness.

On this account, both the muscles involved in the workout and your brain will demand that your heart supplies them with more blood. So will your heart itself (it’s got some more work to do remember) and your lungs – more oxygen is needed.

Your heart, brain, lungs and muscles effectively increase their blood supply in response to exercise at the expense of organs that don’t really need much supply at that point in time.

> Organs such as your bowel, kidneys and skin (initially) need little supply.

I say skin initially because as exercise progresses, supply to your skin increases as part of thermo-regulation to facilitate heat loss through sweat. Otherwise your body will overheat which is just as dangerous.

> The problem is that any slight demand on your bowels during or soon after the exercise can trigger a strong vasovagal response.

Symptoms of vasovagal response vary widely. I have culled the list of symptoms from this page for easy reference for you.

> “Episodes of vasovagal response are typically recurrent and usually occur when the predisposed person is exposed to a specific trigger. Prior to losing consciousness, the individual frequently experiences early signs or symptoms such as light-headedness, nausea, the feeling of being extremely hot or cold (accompanied by sweating), ringing in the ears (tinnitus), an uncomfortable feeling in the heart, fuzzy thoughts, confusion, a slight inability to speak/form words (sometimes combined with mild stuttering), weakness and visual disturbances such as lights seeming too bright, fuzzy or tunnel vision, black cloud-like spots in vision, and a feeling of nervousness can occur as well.The symptoms last for a few seconds before the loss of consciousness (if it is lost), which typically happens when the person is sitting up or standing.”

In my case I did not pass out or lose consciousness but felt lightheaded and dizzy. This is the result of the stimulation of the nerve we call, the Vagal Nerve. The vagal nerve exerts influence on the rate at which your heart beats amongst other functions.

When it is stimulated, the vagal nerve slows down your heart rate so much so you experience some of those symptoms mentioned above.

Here is a case reported in a Korean medical journal about a 39-year-old man who had a similar experience to mine. He was hypertensive and recently became diabetic. He was on medications similar to mine. In some respects, you would think we were twins only I am several years older. In his case though, he was actually fainting repeatedly.

The doctors in his case confirmed his diagnosis by giving him a very cold beverage. He experienced dizziness during the test after drinking the cold beverage.

With me, I had a very cold water soon after the exercise and that was the trigger for the vagal nerve stimulation moderated with the fact that my bowel blood supply was not optimal at the time. That’s one explanation.

Now the other:

Blood pressure changes during exercise, workouts or vigorous physical activity
One thing that is certain is that exercise whether aerobic or resistance workouts will always result in blood pressure changes.

When you start a workout your blood pressure will rise and it will keep rising to varying degrees depending on the type of workout or exercise until it plateaus. Then blood pressure falls after the vigorous physical activity is over.

During exercise, there is an override of sympathetic activity on the heart. Sympathetic nervous system is what drives heart rate up and also increases the strength of the pumping heart muscle.

Sympathetic activity makes the heart go faster and harder unlike the opponent the para-sympathetic which slows it down and quietens it. It will interest you to know that the para-sympathetic nervous system is mediated by the vagus nerve I talked about earlier.

An increase in sympathetic activity is necessary because of the increased demand from the organs directly involved in the workout. Increased demand for nutrients and oxygen which has to be met by increased blood supply.

> Both sympathetic and para-sympathetic cannot fire themselves up at the same. One has to dominate depending on what your body is doing. So, when more blood is needed by the relevant workout organs as happens during vigorous physical activity, sympathetic system goes into over-drive and the para-sympathetic cools off until exercise is over.

When you are done with your workout the para-sympathetic takes over and that is when blood pressure can drop, sometimes drop low enough to cause the phenomenon of Post Exercise Hypotension or in lay man’s terms post exercise low blood pressure.

This is a normal physiology. It’s just that in some individuals this after-work out drop in blood pressure is somehow exaggerated leading to symptoms of the vasovagal I talked about earlier.

If you want to get really geeky about the phenomenon of post work out blood pressure changes, here is a very good review of the topic

Post exercise hypotension (low blood pressure) is something that occurs across genders, races, healthy people and the not-so-healthy people.

This study compared healthy volunteers with individuals who have Stage 2 or 3 chronic kidney disease. The healthy subjects were in the control group. Both the chronic kidney disease sufferers and the healthy volunteers were subjected to random exercises and rest periods.

They found the blood pressure to be lower in both groups after the aerobic exercises than after the rest periods even in those individuals with the chronic kidney disease who usually have high blood pressure in tow as part of the package for chronic kidney disease.

Some differences in the degree of fall in blood pressure after vigorous physical activity can be seen between races.

These researchers looked at the blood pressure patterns after exercise between the Chinese race and the Caucasian race. They studied 62 individuals (30 Caucasians and 32 Chinese both sexes) assessing the blood pressure changes after 30 minutes and 60 minutes following an aerobic workout of 45 minutes.

The researchers found out the fall in blood pressure was lower in the Caucasians subjects than in the Chinese.

Even time of day does have an influence on exercise drop in blood pressure. One research did show that falls in blood pressure after a workout occurs at a bigger magnitude in the morning than in the evenings.

> Anyway, the point is blood pressure does fall after vigorous physical activity to varying degrees between individuals, between races, times of day, and state of one’s health too.It’s just that the drop can be dramatic enough in some individuals to cause symptoms like fainting, dizziness, light-headedness, nausea, vomiting, diarrhoea etc.

So how do you prevent post exercise symptoms like sickness, fainting, dizziness, light-headedness?

I should say this upfront. These tips are not for everyone. Most people do their aerobic and resistance training without any problems.

So the tips below may not apply to you if are not troubled by post workout nausea, fainting, dizziness, diarrhoea, light-headedness etc.

Just carry on as normal but if you belong to this unfortunate club, you may find the tips handy.

>> Ensure adequate hydration before starting a workout. Preferably at least 30 minutes before because if you hydrate too close to the beginning of the exercise, it can trigger a vagal response.

>> Delay drinking after your workout until your body has cooled off completely. I know you are thirsty but hold off for at least 15 minutes after your work out before drinking.

>> Do not eat too close to your workout sessions. Eating gives your bowels work to do when your body has other more pressing needs. A full stomach is an unnecessary demand on your heart when you have a workout around the corner.

>> When you drink, you may want to have isotonic drinks (drinks formulated with electrolytes and some sports drinks) as your main fluid for rehydration. These drinks are designed to help stabilize your blood pressure such that swings towards very low readings are avoided. Very low drops will lead to those symptoms.

>> Of course, you don’t have to invest in expensive sports drinks. Good ol’ plain water is just as good. However, avoid extremes of temperature. Don’t have very cold water or hot drink so soon after the workout especially if it was an exercise of high intensity. Learn from my experience. Not pleasant.

Room temperature water is fine. You can drink icy cold water later on say a good 30 minutes later after your exercise.

This tip will apply to those who experience symptoms after high intensity training exercise. High intensity workouts can be very demanding on your body.

> This means the blood pressure changes may be very dramatic. To prevent any undesirable side effects, you should not stop your exercise abruptly. Ease off gently to allow your body time to carefully adjust itself. This step prevents huge shock to your circulatory system and makes for an easier, gentler cooling off.

If you feel dizzy, faint, lightheaded, and you are in the upright position, quickly lower yourself onto the floor. The idea is to encourage blood flow to your brain plus being in the prone position also helps with stabilizing the blood pressure too.

If your heart is unable to pump sufficient blood to your brain because you are standing up, you may faint and become unconscious and probably have a seizure too. Best avoided.

After all said and done, if you have any doubts about how you feel following exercise, see your doctor for reassurance tests.

Suggested further reading:
1 Obscure Trick To Make ANY Exercise Program More Effective

3 Questions to Ask If You Get Dizzy During a Workout

Editor’s Note: We originally published this article in July 2015. We decided to update it to include more tips and helpful information. Enjoy!

Do you ever get dizzy during your workout? Don’t ignore it! There are things you can do to avoid getting lightheaded while exercising. We chatted with Miraval’s fitness supervisor Pam Trudeau, ACE, AFAA, PMA-CPT, to find some common reasons many of us experience a little lightheadedness during a workout.

Note: If you are feeling dizzy while working out, make an appointment with your doctor. There could be underlying issues causing you to feel faint. Feeling dizzy during any activity or inactivity is not normal and should be brought to your doctor’s attention immediately.

How to manage dizziness

Raise your hand if you’ve ever been the girl in the above photo – hunched over, wondering why you ate those donuts someone brought to the office (aside from the fact that they had sprinkles, which everyone knows are irresistible).

In all seriousness though, getting dizzy during any activity is not a good thing. There are a few things you can do right away to manage the dizziness.

If a feeling of lightheadedness strikes during your exercise, Pam Trudeau urges, “Stop exercising and find a cool spot. If exercising outdoors, find some shade and sit down.”

Try not to overexert yourself. It’s important to address dizziness during a workout. If you don’t, it could only get worse. Staying hydrated in warm weather is especially important.

While you take a breather and maybe some sips of water, ask yourself the following three questions:

Am I properly fueled?

“If you’re exercising first thing in the morning, don’t expect your dinner from the night before to act as fuel,” says Pam. That dinner was likely eaten more than 10 hours ago, so fuel up!

Even if your workout happens in the middle of the day or the evening, you still might need to grab a pre-workout snack to avoid getting dizzy. Pam suggests, “Eat a high-carb snack about an hour prior to exercising.”

Make sure you keep the snack light. Here are a few good ideas:

  • Seeds (pumpkin, sunflower, chia, etc.)
  • Low-sugar energy bar
  • Granola

A date an hour before or lightly salted almonds make for a good pre-workout snack, too.

Working out on an empty stomach could cause you to feel lightheaded. It’s important to fuel your body properly before hitting the gym, but get your snack in at least an hour before you start.

Along with a snack, it’s a good idea to invest in Alkaline water because it provides electrolytes and the proper hydration required for a good workout. That leads us to the next question.

Am I drinking enough water?

There’s no way around it. For our bodies to function well, we need to hydrate, hydrate, hydrate! “Dehydration can lead to low blood pressure, lightheadedness, even fainting,” warns Pam. “If you begin your workout slightly dehydrated, then add to that the loss of fluids through sweating, you very well could experience lightheadedness.”

Pam suggests sipping 4-6 ounces of water every 10-12 minutes during your workout. Just be careful not to drink too much water, as that can cause other problems like nausea.

It’s easy to get wrapped up in the workout. Just be mindful of staying hydrated!

If you’re on a low-sodium diet, try drinking electrolyte-enhanced water. Your sweat contains salt, and if you’re already lowering your sodium intake, dizziness while exercising can be a side effect.

Am I breathing?

“Sometimes we have a tendency to hold our breath or use a rapid, shallow breaths during exercise,” explains Pam, “and any of these can lead to feeling lightheaded. A simple tool we use often here at Miraval is a synchronized breath with your steps during walking or running. In for 4, out for 4. Inhale, Inhale, Inhale, Inhale – Exhale, Exhale, Exhale, Exhale in sync with your steps.”

Pam also warns, “Immediately seek medical attention if you feel pain in your chest, arms, jaw, or lungs. Before resuming exercising, seek medical attention to rule out an underlying health issues such as heart disease or a lung illness.”

How to avoid getting dizzy while exercising

Here are some quick tips to avoid that dreaded lightheaded feeling during a workout:

  • Eat a high-carb snack about an hour before your workout
  • Drink water throughout the day and during your workout
  • Breathe! Maintain regular breathing and try to synchronize your breathing with your movement

If you continue to be dizzy during a workout or dizziness occurs when you’re not working out, there may be something going on with your body. It could be low blood pressure or something else. We recommend this article from Cleveland Clinic for information on other causes of dizziness and what to do about it.


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What You Should Know About Exercise and Vertigo

Having vertigo is not fun. Vertigo, a sensation of movement—usually spinning—when you’re not actually moving, can cause dizziness, nausea, sickness, and loss of balance.

These symptoms can last for moments or be ongoing for months. It’s also the number 1 cause of broken bones and head injuries of people over 55. Doctors don’t really have a solution either, but recently there has been a breakthrough helping people get relief.

This weird “snoring” trick has helped thousands of people get a hold of vertigo for good.

There are many different causes and categories of vertigo, says Carol Foster, M.D., an associate professor in the Department of Otolaryngology at the University of Colorado.

It can be caused by inner ear viruses, Ménière’s disease, or conditions that require surgery. Try these exercises before going through with an expensive surgery.

But for the most common type of vertigo, benign paroxysmal positional vertigo (BPPV), certain exercises can cause it, whereas other movements (like the one mentioned above) can actually help treat it.

“BPPV is just a mechanical problem in the inner ear,” Dr. Foster explains. “The symptoms are very clear: short bursts of vertigo brought on by making a movement.”

BPPV occurs when calcium crystals from your inner ear break free and fall into a semicircular canal. The crystals are used to sense gravity. So when they get into the wrong part of your ear, your brain thinks you’re moving even if you’re not.

How does working out affect vertigo?

While there are undeniable benefits of staying fit, certain workouts can cause positional vertigo. While BPPV is most common among adults above age 60, anyone can experience it—especially if you regularly do activities that involve serious head movement. Because the inner ear crystals are not attached to anything, Dr. Foster says, shaking your head—much like a snow globe—can cause the crystals to move around.

“Positional vertigo is caused by putting your head relatively upside down or moving your head vigorously in the vertical plane,” Dr. Foster further explains. “So people like drill sergeants, who do tons of sit-ups and slam their head on the ground and then sit up again, get positional vertigo more than other people who don’t do that. People who do yoga and Pilates get it more than other people because they put their heads somewhat upside down, too.”

Dr. Foster says that swimming can also set off BPPV, as the constant turning of your head in the water can cause the crystals to move.

Did you know that meditation helps vertigo? as well as our other workouts.

What exercises can I do to treat it?

The good thing about positional vertigo is that it’s treatable with exercise. BPPV is commonly treated with the Epley maneuver. This a series of movements involving head rotations to get the ear crystals back to where they should be. It’s safe and effective and treats positional vertigo without medication.

Dr. Foster developed another exercise to help treat BPPV called the Half Somersault Maneuver that can be done at home without a medical professional. Like the Epley, the Half Somersault is a series of movements that involves tucking and rotating your head to get the crystals out of the canal. Though effective, Dr. Foster says if the maneuver doesn’t work, you should see your doctor for treatment. She also cautions that while doing any vertigo exercise, you may feel dizzy until it’s over.

“In order to get the crystals out from where they’re stuck, you have to feel vertigo as they go all the way around and out,” she says. “You feel spinning during it. But then that will be the last spinning you feel once you get them all out.”

Check out the meditation experience in the Aaptiv app here.

What should I do if I experience vertigo during a workout?

If you have positional vertigo and experience an attack in the middle of the workout, Dr. Foster says the best thing is to do a maneuver immediately. “If you’re at yoga class and you suddenly spin, you just do a maneuver and get up and proceed,” she says. “But don’t put your head back down again.”

If you’re really not feeling well, you should take a break from your workout. Never push your body if you’re ill or at risk of injury. Also, if you’re unsure about what you’re experiencing or you haven’t dealt with positional vertigo before, it’s best to listen to your body and consult a medical professional.

What should I consider when working out after treating vertigo?

BPPV is a mechanical problem, Dr. Foster says, so you should avoid making any vertical head movements for a few weeks after you treat it. This includes looking up, bending over forward, or rolling from side to side. You don’t need to cease working out entirely, but stay clear of downward dog, headstands, or any other upside-down movements. Avoid swimming as well until you’re better.

You should also take a break from putting your head lower than horizontal. “You can continue doing any other part of an exercise, but you want to keep your head relatively upright right after you’ve had a attack,” Dr. Foster says. “Otherwise, the crystals could easily fall back in.”

No matter what type of vertigo you experience, always consult with a medical professional before trying any treatment method or workout. He or she will best be able to identify the appropriate course of action for your personal situation.

What feeling dizziness during exercise means – by MD Thordis Berger


Dehydration occurs when the body loses too much fluid and can’t adequately replace it. With any form of exercise, fluid will be lost from sweating, however in moderate to intense physical activity, the fluid loss will be much greater. In addition to losing water, the body sweats out electrolytes, particularly sodium, that helps maintain water balance.

A general rule is to drink when you are thirsty, which many athletes don’t do. Finally, keep in mind that hydration effects muscle growth, recovery and weight loss in a big way.

Improper Breathing

Smooth and efficient breathing is crucial for delivering the oxygen our bodies need to perform functions properly. Proper breathing can also help athletes exercise longer with less effort, and even calm the mind. If you are overexerting yourself or are not used to exercising, your breathing may be too superficial and/ or too rapid. This can lead to dizziness, weakness or the feeling that you are going to faint.

Different activities require different breathing techniques. Consult a trainer certified in your field of activity for recommendations on proper breathing techniques.

Low Blood Sugar

Sugar in the form of glucose is the fuel that our body needs for most of its functions. If you don’t get enough to eat, your body will not have enough glucose, a condition referred to as hypoglycemia.

If you are exercising without eating enough, your blood sugar will usually be low, which can lead to dizziness. Other symptoms, such as nausea, increased heart rate and trembling may also occur. Eating at least two to four hours before exercising can help avoid low blood sugar.


If you experience dizziness during exercise, stop whatever you are doing and rest. Keep your head above your heart. If the dizziness does not respond to drinking fluids or eating something and does not go away after an hour, contact a doctor.

Seek immediate medical attention if you have dizziness along with one or more of the following symptoms: chest pain, heart palpitations, shortness of breath, weakness, inability to move an arm or leg or a change in vision or speech

Be sure to discuss any recurring problems with your doctor.

Dizziness hours after exercise

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