Stroke during gym workouts and emergency first aid

Exercise offers many health benefits, but it also carries potential risks, especially the risk of a stroke. In this article, let's join Dr. Huỳnh Minh Nhật, our Emergency Doctor at Family Medical Practice District 2, to explore the causes, warning signs, and essential first aid skills to protect your health and also those around you during the gym workout.

1/ What are the common causes of collapse during exercise?

Collapse during exercise can be caused by both traumatic and non-traumatic factors.

Reference:
Catastrophic sports injury research fortieth annual report (fall 1982-spring 2022). National Center for Catastrophic Sport Injury Research at the University of North Carolina at Chapel Hill. https://nccsir.unc.edu/wp-content/uploads/sites/5614/2023/11/2022-Catastrophic-Report-AS-40th-AY2021-2022-FINAL-WEB.pdf (Accessed on September 22, 2024).

According to the NCCSIR report:
Traumatic collapse during exercise severity depends on the nature of the sport and whether it involves contact. The highest injury rates are found in the spine and brain. The severity depends on the type of injury and the extent of the damage.

For non-traumatic exercise collapse, around 70% of cases are related to cardiovascular issues, 12% to heatstroke, and the remainder to other causes (e.g., anaphylaxis, acute asthma attacks, hyponatremia, hypoglycemia, orthostatic hypotension…). Severe cardiovascular causes (e.g., myocardial infarction, stroke…), severe anaphylaxis, critical asthma attacks, and prolonged severe hypoglycemia can lead to sudden cardiac arrest.

Depending on the cause, if the exerciser has corresponding risk factors, the likelihood of collapse increases. For example, individuals with a history of cardiovascular disease or diabetes are more likely to collapse due to acute cardiovascular conditions (e.g., myocardial infarction, stroke…). Those with a history of asthma or allergies are more likely to collapse due to an asthma attack or anaphylaxis.

If these risk factors are not identified and controlled, the risk of collapse due to acute illnesses increases.

Additionally, some individuals with underlying congenital conditions (e.g., hypertrophic cardiomyopathy, long QT syndrome, Brugada syndrome…) may be at risk of dangerous arrhythmias, fainting, and cardiac arrest during exertion.

2/ How can you recognize symptoms before collapse? Are there any potential warning signs that people often overlook?

Symptoms of collapse due to severe acute illness typically develop very quickly and suddenly, potentially leading to loss of consciousness and cardiac arrest. For example, a victim of acute myocardial infarction might experience sudden, severe chest pain; a stroke victim might show one-sided paralysis or coma; someone experiencing anaphylactic shock or acute asthma might struggle with rapid, severe difficulty breathing. In these cases, victims usually collapse during exercise.

Other conditions, such as heatstroke, hyponatremia, or hypoglycemia, may present symptoms more gradually: muscle pain, cramps, elevated body temperature, sweating, etc. In these cases, victims typically collapse after stopping exercise.

For victims, symptoms often occur suddenly and intensely. It’s very dangerous if the victim isn’t identified and helped in time, especially in confined spaces (e.g., restrooms, saunas) or if the victim loses consciousness while lying/sitting down between exercise sessions.

3/ What essential first aid steps should be taken before calling emergency services

The first aider must ensure the safety of the scene before performing any first aid, especially if the victim has collapsed in an unsafe location (e.g., running track, fallen into a river or lake).

When the victim is in a safe location, the first aider should check for responsiveness by tapping the victim’s shoulder and calling out loudly. If the victim is unresponsive, immediately shout for help, call emergency services, and get an AED (if available).

The first aider should quickly assess the victim’s breathing and pulse simultaneously:

• If the victim has no pulse or you’re unsure, perform chest compressions and alternately give rescue breaths at a 30:2 ratio.
• If the victim has a pulse but isn’t breathing or is gasping, perform rescue breaths every 6 seconds (10 breaths per minute). Check the pulse every 2 minutes.
  If an AED is available and the first aider knows how to use it, attach it to the victim.
  Continue performing CPR until emergency professionals arrive.

If there are injuries, such as suspected spine injuries, fractures, or bleeding, perform appropriate first aid with experience.

4/ How should people nearby respond and assist?

People nearby should ensure the safety of the scene for the first aider.

Those nearby can assist with first aid if they have knowledge of basic life support (BLS), as chest compressions can be physically demanding.

5/ What advice do doctors have for people who exercise regularly to avoid these risks?

Actually, regular exercise offers numerous benefits, such as reducing the risk of cardiovascular diseases, diabetes, Alzheimer's, and certain cancers; improving sleep, memory, weight control; and reducing anxiety and depression symptoms, among others.

• For professional athletes or those preparing for professional competition: undergo health exams as required by the sport and under the supervision of a coach.
• For non-professional exercisers: Have a regular health checkup at least once a year to screen for cardiovascular risk factors and other health issues. Manage risk factors and treat illnesses (if any) under a doctor’s guidance.

If you have a health condition or underlying illness, inform the gym staff and personal trainer. Choose exercises and intensity levels appropriate to your condition, as advised by your doctor.

Follow the safety guidelines of your sport, and wear the appropriate gear.

Avoid exercising on an empty stomach or immediately after eating. Stay hydrated and replenish electrolytes if needed. Don’t drink excessive amounts of water if you’re not thirsty, as it could cause hyponatremia.

Equip yourself with first aid skills, especially basic life support techniques.