Possible dangers of CrossFit and other ECPs

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eme
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Possible dangers of CrossFit and other ECPs

Postby eme » Tue Sep 04, 2012 6:38 pm

The CF has stated that it does not endorse ECPs (Extreme Conditioning Programs) due to the health risk.

I had no idea that this was possible :shock:

https://public.cfpsa.com/en/AboutUs/PSP/DFIT/DFIT_Newsreel/Pages/News-Reel-3.aspx

Extreme Conditioning Programs and Exertional Rhabdomyolysis
Public Health Advisory from the Director of Force Health Protection
On 18 May 2012, a Base Surgeon notified the Directorate Force Health Protection (D FHP) of three cases of rhabdomyolysis requiring hospitalization; one case required dialysis for acute renal failure. Two of three cases reported doing “CrossFit®”, a type of Extreme Conditioning Program (ECP), prior to their diagnosis. The three cases originated from the same base and presented to the medical clinic over a short time period between March and May, 2012.

Exertional rhabdomyolysis (ER) has been reported most commonly in weight lifters, endurance athletes, and military personnel (particularly at the recruit level). It is associated with considerable morbidity in terms of lost duty time, hospitalization, and medical treatment. Although few studies have examined the burden of this illness in civilian and military populations, a recent descriptive study using hospital and administrative data of the active component of the U.S. Armed Forces found the diagnosis of ER increased by 70 percent from 2006 to 2010. This study noted that personnel were more likely to develop ER if they were male, less than 26 years of age, were African-American, had a length of service of less than 90 days, suffered from a previous heat injury and had not deployed during the study period. (reference A).

As ER can be associated with potentially life threatening complications, a preliminary investigation was initiated to identify other possible cases of rhabdomyolysis in CF personnel to determine the magnitude of the problem. Laboratory reports with an elevated creatine kinase (CK) level of greater than 4,000 U/L from the Canadian Forces Health Information System (CFHIS) were used to identify additional cases. Twenty-one cases were identified between April 2011 and May 2012. Health record review found 18 of these 21 cases had participated in some form of exercise/fitness program, workout, or competition. Documentation in 10 of 18 health records specifically mentioned CrossFit® as a possible risk factor. These numbers likely represent an underestimate of the true incidence of rhabdomyolysis since only the most severe cases were captured (i.e., the cases had a CK value greater than 4,000 U/L, sought medical attention at a CF medical treatment facility and discrete laboratory data is only available at about half of all CFHIS sites).

ECPs, such as CrossFit®, P90x®, and Insanity®, have increased in popularity over the past few years. These programs are characterized by frequent, repetitious, high intensity exercises with very short rest periods between sets/cycles and little recovery time between workouts. Some ECPs do not encourage participants to progressively increase their workloads in an effort to allow for training adaption. CF personnel who participate may not have the requisite knowledge to properly set the required work to rest ratios to offset injury or illnesses possibly associated with ECPs. A disproportionate number of injuries such as muscle strains, sprains, stress fractures and rhabdomyolysis associated with ECPs have been cited in anecdotal reports and case studies, however, few studies have looked at the relationship between ECPs and injuries to date. (reference B)

ECPs are not endorsed by Personnel Support Programs (PSP), Directorate of Fitness (DFIT) or D FHP for reasons noted in para 4. DFIT has reviewed ECPs and has incorporated some of the recognized benefits into their physical fitness programs. To reduce the risk of injuries, DFIT has also developed a Tactical Athlete User Clinic, which educates and trains CF personnel on how to safely perform complex weight lifting techniques commonly found in ECPs (e.g., clean and squat). In addition, two courses (the Basic Fitness Training Assistant (BFTA) and the Advanced Fitness Training Assistant (AFTA)) are offered to CF personnel who are interested in leading safe and effective unit physical training. Local PSP fitness personnel are also available to provide information and guidance on safe training principles and other conditioning programs that incorporate accepted training doctrine.

Based on the results of this initial investigation, it is recommended that patients presenting with muscle pain and/or weakness, swelling, limited range of motion or tea coloured urine be asked about the type, amount and start date of any recent strenuous physical activity including engaging in ECPs, such as CrossFit®. In patients presenting without the cardinal sign of tea coloured urine, a differential diagnosis of ER should still be considered if they have a history of recent intense physical activity (including CrossFit®), especially in patients reporting a sudden increase in activity. Appropriate diagnostic blood work, including serum CK, should be drawn. (reference C and D).

It is recommended that patients be counselled regarding the dangers of ECPs and that they are informed of mitigating factors that can help prevent ER (e.g., gradual training progression, adequate hydration, appropriate rest periods, factoring in the effects of heat and humidity, and individualized training) for preventing ER. Patients should also be referred to their local PSP fitness personnel for guidance on safe and effective fitness training. (reference B, E and F)

CF Health Services Group will continue to gather more detailed information on current ER cases. New cases should be reported to D FHP by email at +DFHP Iinquiries@CMP DGHS@Ottawa-hull.

Enquiries related to this advisory should be directed to D FHP as follows:
a. e-mail: +DFHP Inquiries@CMP DGHS@Ottawa-hull
b. telephone: 613-945-6607

References:
A. Hill OT, Wahi MM, Carter R 3rd, Kay AB, McKinnon CJ, Wallace RF. Rhabdomyolysis in the US active duty army, 2004-2006. Med Sci Sports Exerc. 2012. 44(3):442-9.

B. Bergeron MP, Bradley CN, Deuster PA, Baumgartner N, Kane SF, Kraemer WJ et al. Consortium for health and military performance and American College of Sports Medicine consensus paper on extreme conditioning programs in military personnel. Current Sports Medicine Reports. 2011. 10:383-89.

C. Khan FY. Rhabdomyolysis: a review of the literature. Neth J Med. 2009;67:272-83.

D. Huerta-Alardin AL, Varon J, Marik PE. Bench-to-bedside review : rhabdomyolysis – an overview for clinicians. Crit Care. 2005.9;158-69.

E. U.S. Army Public Health Command. What army leaders should know about extreme conditioning programs. PHN No: 0312-01 http://phc.amedd.army.mil/PHC%20Resourc ... y_2012.pdf
F. USU Consortium for Health and Military Performance, Human Performance Resource Center, Uniformed Services University of Health Services, and American College of Sports Medicine. April 2011. CHAMP/ACSM executive summary: High-intensity training workshop. http://hprc-online.org/files/hit-executive-summary

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Re: Possible dangers of CrossFit and other ECPs

Postby Tori » Tue Sep 04, 2012 8:07 pm

:shock: a new crossfit place opened up by me and I saw on their FB wall that a woman ended up in the hospital with Rhabdo a couple weeks after they opened from one of the workouts. I have a groupon from there so hopefully no issues arise! I had never even heard of kidney issues from a short workout before!

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Re: Possible dangers of CrossFit and other ECPs

Postby Ironboy » Tue Sep 04, 2012 8:07 pm

It's definitely a risk.

That's why it's important to find a good gym, with good competent coaches. A new gym here in Ottawa has already sent a new recruit to the hospital with Rhabdo.

The highest risk is to new comers who don't know their limits and coaches that assume athlete should know their limits. If it's done gradually, systematically, with scaled progression the risk is very low.

Some exercises are more likely to cause Rhabdo than other. Sometimes its because of the duration of the exertion.

The other high risk is type A athletes who are new to crossfit, or have done crossfit but have been on extended break and take off like it's the Crossfit games or something.
(these ones should know better and know their limits, but common sense doesn't always prevail).

I've been at it almost a year and half and have only heard of one case (and it was clearly bad coaching). It may be a risk, but it's not very prevalent.

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Re: Possible dangers of CrossFit and other ECPs

Postby Ironboy » Tue Sep 04, 2012 8:13 pm

Tori wrote::shock: a new crossfit place opened up by me and I saw on their FB wall that a woman ended up in the hospital with Rhabdo a couple weeks after they opened from one of the workouts. I have a groupon from there so hopefully no issues arise! I had never even heard of kidney issues from a short workout before!


The woman in question is my friend's (and fellow Crossfitter) sister in-law.

It was a workout that was posted on main site and was too advanced even for scaling (which he didn't do) and involved GHD sit ups, an extremely advanced exercise that Crossfit HQ recommends going only to horizontal, and maybe 4-5 reps total for a beginner. He had them do a WOD with 3 rounds of 10. To the floor. Then claims she should've known her limits.

If the workout for a first timer is more than 10 minutes, don't do it. Try the groupon since you've paid for it, but please, if you want to join somewhere, come to Physics at St-Joseph and Trim.

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Re: Possible dangers of CrossFit and other ECPs

Postby Ironboy » Tue Sep 04, 2012 8:15 pm

Essentially Rhabdo is like a really bad case of DOMS but the damage to the muscle tissue is to extensive for a localized response and the muscle tissue ends up in the blood stream, which is bad news for your kidneys.

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Re: Possible dangers of CrossFit and other ECPs

Postby fe.RMT » Wed Sep 05, 2012 5:30 am

I believe that in what we are going to refer to as ECPs the onus should NEVER be on the participant to know their limits and this is especially true with those new to the program. If I were joining a strength training program that had higher risk than your average gym class I would expect the class to already be scaled for my level of experience and competence. I would expect the instructor to have screened me prior to participating (in a orientation like setting either alone or in a very small group where my function movement could be evaluated and my suitability determined). I would expect that the classes remain small and the instructor make suggestions for load for the exercises being done that day and allow increases to weight only after observing the quality of movement at the suggested load.

The group mentality in ECPs brings out the competitive spirit in even the most non Type A personalities and many of these programs actual foster this during the classes. For this reason I don't think that participants should be trusted to make the best decisions about their abilities.

I also think that as long as these programs use # of Reps within allotted time frame as the measure of success movement quality will always suffer.
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Re: Possible dangers of CrossFit and other ECPs

Postby La » Wed Sep 05, 2012 6:52 am

Quite coincidental timing as I'd just read the following article about rhabdo yesterday!
http://saveyourself.ca/articles/poisoned-by-massage.php

It's not just ECPs, but anything that causes trauma to the muscle tissue can cause it. In an example given in the article, an older man got it from having an intense 2-hour massage with two RMTs working on him at the same time.
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Re: Possible dangers of CrossFit and other ECPs

Postby fe.RMT » Wed Sep 05, 2012 7:46 am

La wrote:Quite coincidental timing as I'd just read the following article about rhabdo yesterday!
http://saveyourself.ca/articles/poisoned-by-massage.php

It's not just ECPs, but anything that causes trauma to the muscle tissue can cause it. In an example given in the article, an older man got it from having an intense 2-hour massage with two RMTs working on him at the same time.


I was going to post this too, mainly because his explanation about what it actually is is good for the lay person
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Re: Possible dangers of CrossFit and other ECPs

Postby DonnaRigs » Wed Sep 05, 2012 10:12 am

Ironboy wrote:
Tori wrote::shock: a new crossfit place opened up by me and I saw on their FB wall that a woman ended up in the hospital with Rhabdo a couple weeks after they opened from one of the workouts. I have a groupon from there so hopefully no issues arise! I had never even heard of kidney issues from a short workout before!


The woman in question is my friend's (and fellow Crossfitter) sister in-law.

It was a workout that was posted on main site and was too advanced even for scaling (which he didn't do) and involved GHD sit ups, an extremely advanced exercise that Crossfit HQ recommends going only to horizontal, and maybe 4-5 reps total for a beginner. He had them do a WOD with 3 rounds of 10. To the floor. Then claims she should've known her limits.

If the workout for a first timer is more than 10 minutes, don't do it. Try the groupon since you've paid for it, but please, if you want to join somewhere, come to Physics at St-Joseph and Trim.


Absolutely agree. When I started CrossFit with my coach, my workout was what is now my warmup. It was gradual and steady and he is very careful to watch my form and exertion. If my form drops, we move on.
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Re: Possible dangers of CrossFit and other ECPs

Postby Ironboy » Wed Sep 05, 2012 1:04 pm

fe.RMT wrote:
La wrote:Quite coincidental timing as I'd just read the following article about rhabdo yesterday!
http://saveyourself.ca/articles/poisoned-by-massage.php

It's not just ECPs, but anything that causes trauma to the muscle tissue can cause it. In an example given in the article, an older man got it from having an intense 2-hour massage with two RMTs working on him at the same time.


I was going to post this too, mainly because his explanation about what it actually is is good for the lay person


Others have gotten if from running a marathon.

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Re: Possible dangers of CrossFit and other ECPs

Postby daddy_runner » Mon Sep 10, 2012 11:38 pm

Is this the same CF that advocated the 5BX and XBX plans? :wink:
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Re: Possible dangers of CrossFit and other ECPs

Postby Ironboy » Tue Sep 11, 2012 9:02 am

daddy_runner wrote:Is this the same CF that advocated the 5BX and XBX plans? :wink:


Um.. no. :P

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Re: Possible dangers of CrossFit and other ECPs

Postby CAW » Tue Sep 11, 2012 9:29 am

Ironboy wrote:
daddy_runner wrote:Is this the same CF that advocated the 5BX and XBX plans? :wink:


Um.. no. :P


The 5BX plan was, clearly, developed by the RCAF based on extensive research and is eerily similar to those movements pilots undertake when waking up first thing in the morning...at a 5 star hotel...and their co-pilot is already sitting on the toilet.

The 5BX plan

The 5BX Plan is composed of six charts arranged in increasing order of difficulty. Each chart is composed of five exercises that are performed within 11 minutes. The first four exercises are calisthenics, and the last an aerobic exercise. As the individual progresses within the system, the number of each type of exercise that must be performed increases and the difficulty of each exercise increases.
[edit]Exercises
Throughout the charts and levels, the five exercises are the same, but more difficult variations are introduced:
Stretching
Sit-up
Back extension
Push-up
Running in place
A walk or run may be substituted for the final exercise; the distances to be covered and the time to be taken are also specified in the plan.
[edit]History

The RCAF asked Orban to develop a fitness program for their pilots, a third of whom were not considered fit to fly at the time. The plan was innovative in two respects. Firstly, it did not require access to specialized equipment. Many RCAF pilots were located in remote bases in northern Canada, with no access to gymnasium facilities, so it was important to offer a means of keeping fit without their use. Secondly, the plan only required 11 minutes per day to be spent on the exercises.


Stretching: reaching for the alarm clock (at 09:00)
Sit-up: self explanatory (but with the puzzled look of "why is there a half-drunk umbrella drink on the night stand?")
Back extension: grand yawn
Push-up: Rolls over to push one's self out from beneath the heavy duvet
Running in place: "Gotta go, gotta go, gotta go...c'mon man, unlock the door...I gotta pee!"


:P

We determined these to be accurate as Scotty re-enacted the sequence for me from memories of other Air Force personnel he has met over the years.

Just sayin' :P
~Kara~

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Re: Possible dangers of CrossFit and other ECPs

Postby eme » Tue Sep 11, 2012 9:32 am

CAW wrote:
Ironboy wrote:
daddy_runner wrote:Is this the same CF that advocated the 5BX and XBX plans? :wink:


Um.. no. :P


The 5BX plan was, clearly, developed by the RCAF based on extensive research and is eerily similar to those movements pilots undertake when waking up first thing in the morning...at a 5 star hotel...and their co-pilot is already sitting on the toilet.

The 5BX plan

The 5BX Plan is composed of six charts arranged in increasing order of difficulty. Each chart is composed of five exercises that are performed within 11 minutes. The first four exercises are calisthenics, and the last an aerobic exercise. As the individual progresses within the system, the number of each type of exercise that must be performed increases and the difficulty of each exercise increases.
[edit]Exercises
Throughout the charts and levels, the five exercises are the same, but more difficult variations are introduced:
Stretching
Sit-up
Back extension
Push-up
Running in place
A walk or run may be substituted for the final exercise; the distances to be covered and the time to be taken are also specified in the plan.
[edit]History

The RCAF asked Orban to develop a fitness program for their pilots, a third of whom were not considered fit to fly at the time. The plan was innovative in two respects. Firstly, it did not require access to specialized equipment. Many RCAF pilots were located in remote bases in northern Canada, with no access to gymnasium facilities, so it was important to offer a means of keeping fit without their use. Secondly, the plan only required 11 minutes per day to be spent on the exercises.


Stretching: reaching for the alarm clock (at 09:00)
Sit-up: self explanatory (but with the puzzled look of "why is there a half-drunk umbrella drink on the night stand?")
Back extension: grand yawn
Push-up: Rolls over to push one's self out from beneath the heavy duvet
Running in place: "Gotta go, gotta go, gotta go...c'mon man, unlock the door...I gotta pee!"


:P

We determined these to be accurate as Scotty re-enacted the sequence for me from memories of other Air Force personnel he has met over the years.

Just sayin' :P


AIR CREW, not all RCAF pers!

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Re: Possible dangers of CrossFit and other ECPs

Postby Habs4ever » Mon Dec 17, 2012 3:02 pm

Ironboy wrote:
fe.RMT wrote:
La wrote:Quite coincidental timing as I'd just read the following article about rhabdo yesterday!
http://saveyourself.ca/articles/poisoned-by-massage.php

It's not just ECPs, but anything that causes trauma to the muscle tissue can cause it. In an example given in the article, an older man got it from having an intense 2-hour massage with two RMTs working on him at the same time.


I was going to post this too, mainly because his explanation about what it actually is is good for the lay person


Others have gotten if from running a marathon.


My nephew was hospitalized this morning for this very thing. This is the third time in about 18 months. They have no idea what his is caused by as he doesn't "do" what usually causes this. He's on IV right now. Very, very dangerous (and scary).
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Re: Possible dangers of CrossFit and other ECPs

Postby CAW » Mon Dec 17, 2012 3:34 pm

Hugs and thoughts coming to you Habs!
~Kara~

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