Your heart’s beating fast, your lungs are working at full capacity, and your muscles and joints are in full swing—take advantage of your workout by evaluating anything that feels off
By: Hollis Templeton
Exercise is healthy in more ways than one. Regular sweat sessions can keep you slim and your immune system strong, but your workout can also be used as a screening tool for medical conditions that may not make an appearance while you’re sitting still.
“As an internist, I often see people who are tired or short of breath, and nothing shows on initial evaluation,” says Fred Ralston, Jr., MD, president of the American College of Physicians. “I often say that that person should gradually begin exercise. If fatigue or shortness of breath worsens, then it may be a sign of something more significant and I will pursue evaluation for heart or lung issues, like coronary artery disease or asthma.”
But you don’t necessarily need to make a beeline for the ER next time you’re huffing and puffing your way through a step class. As much as they can signal a serious medical condition, symptoms like dizziness, nausea, and shortness of breath during exercise are also signs of dehydration or overexertion, or even the result of eating too many refined carbs preworkout.
Experts say the key to distinguishing between the serious and the short-lived is knowing your baseline. “If you know how your body typically responds to exercise, anything that is out of the norm should be a red flag,” says Alice Burron, a spokesperson for the national American Council on Exercise and author of Four Weeks to Fabulous. “And what’s normal for one person isn’t normal for another.” Here, experts weigh in on what to look for when it feels like your workout is working against you.
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Runner’s knee, tennis elbow, swimmer’s shoulder, Achilles tendinitis, shin splints—chances are, your sport has a bad rap for putting wear and tear on a certain part of the body. Overuse injuries—repetitive trauma to a tendon, bone, or joint—are often the result of overtraining or training errors, like increasing mileage too quickly during marathon preparation.
If you experience light swelling, mild soreness, or stiffness during a workout and can’t attribute it to a single event, you’re probably suffering an overuse injury, not a traumatic injury, like a fracture, sprain, or dislocation, says Anthony Luke, MD, director of primary care sports medicine at the University of California-San Francisco and founder of the RunSafe sports medicine clinic. While traumatic injuries are characterized by four signs of inflammation—swelling, redness, warmth, and sudden pain, overuse injuries are harder to diagnose since the pain is typically too mild to keep you from continuing your activity, he says.
Proper training is important to prevent musculoskeletal problems, says Luke, who suggests following the 10% rule: Week to week, don’t increase your intensity or frequency by more than 10%. For example, if your running totaled 35 miles this week, don’t bump up to more than 38.5 miles the next. Luke also stresses the importance of proper nutrition and adequate rest during a training program. “Don’t wake up exhausted at 5 a.m. and attempt to carry out your desired workout,” he says.
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Excessive sweating, shortness of breath, dizziness, and nausea during exertion can all be signs of decreased blood flow to the heart, caused by blockages that can trigger a heart attack, says Bimal Ashar, MD, an associate professor of medicine at Johns Hopkins University Medical School, who says it’s commonplace to take into account a patient’s response to physical activity as a starting point for diagnosis.
“I always ask patients, ‘Has your exercise tolerance changed at all?’” he says, recalling a time a patient who regularly exercised on the treadmill reported that he couldn’t go as far as usual, that he was getting tired and winded, and that he just didn’t feel right. “This was an early sign that he had blockages in his heart. He had a stress test and ended up needing bypass surgery,” says Ashar.
In older exercisers, especially males in their 50s who are at higher risk than women of the same age, typical red flags for blocked blood vessels are chest pain and pain in the arm or jaw, says Luke. Not sure when to be concerned? Other factors, such as a family history (including ages at which relatives developed a heart condition or suffered a heart attack), previous heart problems, and whether or not you smoke, have diabetes, or high cholesterol also figure into the diagnosis.
Arrhythmia—disordered heart rate or rhythm—can also make an appearance following a workout, says Ashar. “Heart rate should return to normal after no more than 4 to 5 minutes,” he says. “If it’s staying up there, this could be a sign of an irregular heartbeat.”
The heart isn’t the only organ affected by a lack of oxygen-rich blood. “Dizziness or blurred vision with exertion can be a sign of blockages of blood flow to the head,” says Ashar, adding that these blockages typically occur in the large carotid arteries in the front and back of the neck—the back more likely to cause dizziness or vertigo. “These blockages can lead to stroke down the line,” says Ashar.
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Upper-respiratory illness, pollution, or improper breathing technique can leave you gasping for air during a workout. But if a jog also fires up a cough, chest tightness, and wheezing that lasts several minutes, the culprit could be asthma brought on by aerobic activity, says Nathanael Horne, MD, a clinical assistant professor of medicine at New York Medical College and New York University School of Medicine. “Symptoms may resemble those of classic asthma, or may be vague and thus go unrecognized, resulting in underreporting of the disease, and perhaps making a sufferer less likely to participate in exercise,” he says.
“Exercise-induced asthma [EIA] can also be hard to distinguish from deconditioning, especially if the only symptom is shortness of breath or chest tightness,” says Horne, explaining that a doctor will perform challenge tests and consider factors like athletic underperformance, excessive fatigue, and prolonged recovery time to formulate a diagnosis.
According to Horne, exercise-induced asthma, like traditional asthma, can occur at almost any age, and exposure to cold air or chemicals (think ice hockey or swimming in heavily chlorinated water), can leave the lungs vulnerable to developing the condition.
To treat EIA, a doctor will prescribe an inhaler and possibly suggest a breathing technique, says Horne, explaining that breathing through the nose instead of the mouth warms and humidifies the air before it reaches the lungs.
You can also pick a sport that will take it easy on your lungs. Walking, leisure biking, and hiking are activities that are less likely to trigger EIA, says Horne.
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While we typically think of arthritis as an older person’s disease, degenerative joint disease affects people of all ages—even children. Almost two-thirds of suffers are younger than 65, according to the Centers for Disease Control, which also cites women and the overweight or obese as higher-risk groups for joint pain and swelling.
“Typically, the first sign of arthritis of the knees is pain [experienced while] going up the stairs,” says Ashar. “Similarly, when patients start using the StairMaster, their knees hurt, creak and swell at times,” he says.
Arthritis may present itself as an overuse injury and is not always obvious to an exerciser, says Luke. “Osteoarthritis represents degenerative changes in the joints and cartilage. If you overuse that joint, it can become painful.” Luke’s advice: Know how your arthritic joint behaves. “Understand what your arthritis pain feels like and watch for signs of inflammation,” he says. Also keep in mind a family history of joint problems, as arthritis can be inherited.
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“Having blood sugar that is either too high or too low during exercise definitely affects performance,” says Sheri Colberg, PhD, author of Diabetic Athlete’s Handbook. “With highs, the exerciser usually feels sluggish or lethargic and has trouble moving at a normal pace. With lows, the person suddenly starts to feel very tired and slows down. Lows can also cause lack of coordination,” she says.
But a workout slump doesn’t necessarily spell a serious condition, as diabetes or hypoglycemia won’t typically make their first appearances during exercise, says Colberg. “The symptoms of highs or lows can also be caused by a lot of other conditions, so it’s hard to know that they’re related to diabetes or hypoglycemia unless you already know that you have either of these,” she says.
In fact, exercise naturally lowers blood glucose levels as muscles take up glucose and fat for fuel. “Getting low during exercise is not a sign of having diabetes necessarily—it happens to long-distance athletes on many occasions, and they don't have diabetes,” says Colberg.
Of course, using caution is always a safe bet: “Once unusual symptoms occur, it’s wise to bring them up to a doctor at the next checkup, if not sooner,” says Colberg.
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If you haven’t slipped on gym shorts or laced up sneakers since you made your New Year’s resolution—for 2010—your workout’s bound to be a little rough.
“When you begin exercising, the cardiovascular response is to get blood flowing to places it’s needed right away,” says Burron, explaining that excessive sweating, shortness of breath, nausea, and exhaustion can be responses to the body’s increased demand for oxygen. “If you’re not used to regular exercise, your body may not be as efficient in adapting to that demand.”
Excess body weight can also make a new exercise regime harder, as extra pounds can increase core body temperature during exercise and result in profuse perspiration, says Burron.
To ease into exercise without beating up your body, Burron, who works as a personal trainer with clients of all ages and fitness levels, suggests starting slowly. Exercise at moderate intensity 1 or 2 days a week to learn your body’s natural response to physical activity. “If you can talk while exercising, you’re fine,” she says. “If not, you’re pushing too hard.” Rate your level of intensity on a scale of 1 to 10, Burron suggests. “If you feel you’re at a seven or above, back down or stop.”
Fitness newbies should also keep in mind that many things can affect your body’s response to exercise: Illness or infection, medication, acid reflux, allergies, pregnancy, menopause, dehydration, hunger, overcaffeination, anxiety, rapid changes in body composition, sleep deprivation, and even the contents of your last meal can slow you down.
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