Why seemingly healthy people collapse in the gym
That day, Vishal began his fitness session by jogging on a treadmill. And then, without taking a break, he moved on to multiple sets of pull-ups and push-ups. Next came stretching exercises, the CCTV footage from the gym shows. He did a ‘standing forward bend’, where he touched the floor with his palms while bending at the hips. Things went wrong from here on.
While trying to straighten up, he grabbed the equipment next to him for support but fell down unconscious. It was 8:05 pm.
“The trainer there tried to perform cardiopulmonary resuscitation (CPR), and blow air into his mouth, but his body did not respond. It was already becoming cold,” remembers Arjun Anand, the owner of H20 Fitness Pro.
CPR is an emergency lifesaving procedure of repeated and fast chest compressions to maintain blood and oxygen flow after a cardiac arrest, or when the heart malfunctions and suddenly stops beating.
The ambulance arrived at 8:11 pm, and the staff who came could not find a pulse. He was taken to Yashoda Hospital in the city, a drive of 5-10 minutes from the gym, but was declared dead on arrival.
The primary cause of death, as reported by examining doctors, was sudden heart failure, Srinivas, in-charge of Asif Nagar police station in Hyderabad, and Vishal’s boss, says. The post-mortem examination report is still pending, as it has been sent for experts’ opinion on histopathology.
Vishal was a “jolly” man and had never experienced any bout of serious sickness before, Srinivas says. He started as a constable in October 2020, after finishing a year of induction. He was just 27.
Vishal’s is not a one-off case. Several such incidents, of sudden heart emergency during or after a strenuous exercise, often in a gym, have been reported in the recent past. They mostly grip national attention when a celebrity is involved. Popular Kannada actor Puneeth Rajkumar, comedian Raju Srivastav, and television actor Siddhaanth Vir Surryavanshi all suffered cardiac arrests while or after working out.
Cardiac arrests and heart attacks (blood flow to the heart is blocked) are common in India. In fact, cardiovascular diseases, or diseases related to heart and blood vessels, are the biggest killer, accounting for 27.4% of total deaths in 2019, shows estimates from the Global Burden of Diseases, an epidemiological study to assess the mortality and morbidity from major diseases and injuries. In the last three decades, the number of such deaths has risen from 1.2 million to 2.6 million, with its share nearly doubling from 14.5% in 1990 in all causes of deaths in India.
Historically, heart attacks have always been associated with old age. But the recently reported cases involved those in their 30s, 40s or 50s. While Raju was 58 when he died, both Rajkumar and Surryavanshi were 46 years old. This has resulted in a sense of fear among many families whose members regularly work out in the gym.
So young, so sudden
The risk of a heart attack goes up with each decade of age, at a population level. But the incidence of heart attacks among the young is on the rise globally, says Dr K Srinath Reddy, a cardiologist, epidemiologist and the former president of Public Health Foundation of India, a non-profit into health research and advocacy.
“Various changes in our living habits, such as diet, smoking, increasing air pollution, stressful lifestyle, compromised sleep (because of digital addiction) are putting the young at risk, damaging their blood vessels faster than say 30 or 40 years ago,” he adds.
Indians are at a greater risk for genetic reasons as well. “Indians, or the Indian subcontinent population, are more susceptible to developing heart diseases at a younger age because of their smaller coronary arteries (which supply blood to the heart) among other factors,” says Dr Udgeath Dhir, director and head of cardiovascular and thoracic surgery at Fortis Memorial Research Institute in Gurugram, a hospital. The arteries are more likely to get blocked because of cholesterol or fat deposition (called plaque), he adds, which eventually leads to a heart attack. Persons of Indian ethnicities are also more likely to suffer heart diseases because their body fat content is more.
What about the suddenness of these incidents?
Many experts say that heart attacks are never sudden. They are a manifestation of a disease or anomaly existing from before, with blood vessels (such as coronary arteries) progressively developing blockages and damages.
Dr Reddy concurs with the above view but adds a caveat. “Coronary blockages (or build-up of a plaque) of 70% or more can cause obstruction to blood flow to the heart, usually when demand for blood flow increases during periods of exercise, severe stress, or after a meal,” he explains. This is how the disease pans out in a chronic case.
However, there are cases of acute coronary syndrome. “Even a soft plaque (say 30% build-up) can rupture and cause clotting and obstruction to blood flow as well,” he says.
A person who is seemingly fit and active, without prior symptoms or warning of a chest pain, can suddenly get a heart attack through this second mechanism if their body has a high level of catecholamines (such as adrenaline) as a result of excess stress, lack of sleep or excessive exercise.
Vishal, whose complete pathological details are still awaited, could very well have been such a case. There are other possibilities, such as arrhythmia, where the heart’s electrical system gets disturbed, affecting the blood supply to key organs. “Excessive adrenaline generated during vigorous exercise can trigger electrical instability and create a fatal arrhythmia,” Dr Reddy says.
In short, exercise performed in moderation is beneficial for the body. However, when performed recklessly or excessively, it can be harmful, even fatal.
How much is too much?
Last year, in August, comedian Raju Srivastav had an accident while jogging on a treadmill at a CultFit gym in Delhi. CultFit is a fitness services chain.
Srivastav fell off the treadmill after a cardiac arrest and became unconscious. He was rushed to the All India Institute of Medical Sciences (AIIMS) within 10-15 minutes, informs Nayan Soni, his manager back then. Doctors at AIIMS performed an angioplasty (a minimal invasive procedure to widen a narrowed or obstructed blood vessel), and he was put on a ventilator for 42 days. However, he couldn’t be saved.
A few months before, Srivastav had visited Anytime Fitness, another health and fitness club chain. A staff at Anytime Fitness told Mint that he jogged for more than an hour on the treadmill that day. A trainer had suggested he cut down on his treadmill exercise but he didn’t listen.
Recent research suggests that vigorous exercise, particularly when repeated often, may increase plaque build-up. Trying to achieve too much too soon can backfire.
Experts strongly caution against ignoring red alerts our body signals when we overexert ourselves: if you ever experience excruciating back pain, dizziness, chest pain or heartburn while exercising, get yourself examined, they suggest. These could very well be symptoms of a heart ailment. If you have a family history of heart disease or palpitations, you should consult a physician before taking on heavy gym workouts.
A fatal accident, on the day it happens, is usually triggered by a combination of factors, suggests Sikander Madan, an expert in exercise and nutrition sciences. “If we truly want to explain a fatal gym accident, we need to look at the routine of the person from three-four days ago,” he explains.
Was the person drinking enough water? Was he sleeping alright? Was he overworked or stressed? Was he downing multiple cups of coffee to stay energetic?
“Lack of sleep and high caffeine will increase blood pressure,” says Madan. Getting blacked out, fainting, or even vomiting can happen in gyms. But those who die were perhaps pushing themselves too hard—not just in exercise but in their lifestyle as well.
Let’s circle back to Vishal’s case again. A few things stand out based on the available information.
An abnormal sleep cycle, for a prolonged period, was likely considering the night duty. Secondly, his workout session did not have adequate breaks or rest. He performed one push-up almost every second, as seen in the CCTV footage. He was pushing himself hard.
Anand, the owner of H20 Fitness Pro, told Mint that Vishal was on a supplement—it can raise blood pressure levels and heartbeat.
Supplements, beware!
Indian diet is typically deficient in protein. Those who want to build muscles therefore turn to supplements, usually whey protein—a powdered form of protein extracted from the leftover of cheese making.
“Excess protein, consumed in form of whey protein, eggs or chicken by gym-goers, strains the kidneys, harming the kidney filters. High protein load can also lead to high uric acid levels and kidney stone formation,” says Dr Alka Bhasin, director of nephrology at Max Smart Super Specialty Hospital, Saket, Delhi. She recommends one gram of protein per kg of body weight per day, preferably taken through diet, not artificial sources.
Gym trainers don’t necessarily agree with doctors. Take the case of Mayank Sarwana, a gym trainer at Outwork Fitness Studio in Delhi. He suggests two grams of protein per kg a day—double of Bhasin’s recommendation—to his clients who want to be fit and athletic.
Sikander Madan says that young gym goers, at times, misunderstand instructions on whey protein packets, which can be confusing. If it’s recommended “two scoops in a day”, which should usually be consumed in two doses, they start consuming two scoops twice a day, increasing their dose, say from 40 grams to 80 grams per day.
No wonder Dr Bhasin regularly sees patients in the age bracket of 19-20 years, with damaged kidneys.
Creatine is another popular workout supplement—it promotes endurance performance, overcoming lactic acid build-up during intense workout. Our body converts creatine consumed through food into creatinine and excretes it. “Consuming more creatine may lead to more creatinine formation, again overloading your kidneys,” says Dr Bhasin.
Kidney diseases are strongly associated with heart diseases, research shows.
In addition, gym-goers take pre-workout drinks, which contain high levels of caffeine that act as a stimulant. One scoop of a pre-workout drink can contain up to 500 milligrams of caffeine, equivalent to five cups of coffee, all at once.
Mayank Nailwal, a 25-year-old trainer at Fitness Step Gym in Delhi, says he consumes 200 milligrams of caffeine, in the form of a pre-workout drink, before his daily exercise. Caffeine consumed in such high doses keeps the heart rate or blood pressure elevated for a prolonged period and can cause complications such as arrhythmia.
The science on supplements, including excess protein, is ambiguous. Go easy on them, many experts advise.
Gyms’ fitness test
This brings us to how gyms conduct themselves.
As per Fitternity, a web aggregator for fitness outlets, India had about 24,000 gyms in 2019. Many of them would have closed shop during the covid years but many new ones would have emerged as the economy opened up post the lockdowns.
While large chains operate in the metros, part of the gym industry is unorganized. In these unorganized shops, malpractices are common—from trainers not being certified to the use of steroids.
“A high-end gym will not enroll you without a thorough fitness evaluation, detailed health history and so on. But others (the unorganized) can enroll just anybody,” says Sikander Madan. The unorganized gyms can’t deal with emergency situations either.
Ideally, all gym trainers should be trained to perform CPR in an emergency situation. But that is not the case with many trainers.
Mayank Nailwal of Fitness Step Gym, for instance, does not even know what CPR means, let alone performing it. When asked what he would do if an emergency were to happen, he says, “We would do our best.”
Interestingly, nobody at CultFit performed CPR on Srivastav when he had a cardiac arrest, alleged Soni. CultFit did not respond to Mint’s queries.
Another important emergency intervention is automatic external defibrillator (AED), which is used to revive someone from a sudden cardiac arrest. The device analyzes the heart rhythm and as needed, can deliver an electrical shock to the heart, which restores the normal rhythm.
Dr Dhir of Fortis believes AED could have been helpful in the case of Vishal. Of the five gyms this writer visited in Delhi, during the course of his reportage, only one had an AED installed at its premises. All these gyms said they rely on their proximity to hospitals during emergencies. No one has a doctor or a cardiologist on call. In an emergency, each moment counts.
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That day, Vishal began his fitness session by jogging on a treadmill. And then, without taking a break, he moved on to multiple sets of pull-ups and push-ups. Next came stretching exercises, the CCTV footage from the gym shows. He did a ‘standing forward bend’, where he touched the floor with his palms while bending at the hips. Things went wrong from here on.
While trying to straighten up, he grabbed the equipment next to him for support but fell down unconscious. It was 8:05 pm.
“The trainer there tried to perform cardiopulmonary resuscitation (CPR), and blow air into his mouth, but his body did not respond. It was already becoming cold,” remembers Arjun Anand, the owner of H20 Fitness Pro.
CPR is an emergency lifesaving procedure of repeated and fast chest compressions to maintain blood and oxygen flow after a cardiac arrest, or when the heart malfunctions and suddenly stops beating.
The ambulance arrived at 8:11 pm, and the staff who came could not find a pulse. He was taken to Yashoda Hospital in the city, a drive of 5-10 minutes from the gym, but was declared dead on arrival.
The primary cause of death, as reported by examining doctors, was sudden heart failure, Srinivas, in-charge of Asif Nagar police station in Hyderabad, and Vishal’s boss, says. The post-mortem examination report is still pending, as it has been sent for experts’ opinion on histopathology.
Vishal was a “jolly” man and had never experienced any bout of serious sickness before, Srinivas says. He started as a constable in October 2020, after finishing a year of induction. He was just 27.
Vishal’s is not a one-off case. Several such incidents, of sudden heart emergency during or after a strenuous exercise, often in a gym, have been reported in the recent past. They mostly grip national attention when a celebrity is involved. Popular Kannada actor Puneeth Rajkumar, comedian Raju Srivastav, and television actor Siddhaanth Vir Surryavanshi all suffered cardiac arrests while or after working out.
Cardiac arrests and heart attacks (blood flow to the heart is blocked) are common in India. In fact, cardiovascular diseases, or diseases related to heart and blood vessels, are the biggest killer, accounting for 27.4% of total deaths in 2019, shows estimates from the Global Burden of Diseases, an epidemiological study to assess the mortality and morbidity from major diseases and injuries. In the last three decades, the number of such deaths has risen from 1.2 million to 2.6 million, with its share nearly doubling from 14.5% in 1990 in all causes of deaths in India.
Historically, heart attacks have always been associated with old age. But the recently reported cases involved those in their 30s, 40s or 50s. While Raju was 58 when he died, both Rajkumar and Surryavanshi were 46 years old. This has resulted in a sense of fear among many families whose members regularly work out in the gym.
So young, so sudden
The risk of a heart attack goes up with each decade of age, at a population level. But the incidence of heart attacks among the young is on the rise globally, says Dr K Srinath Reddy, a cardiologist, epidemiologist and the former president of Public Health Foundation of India, a non-profit into health research and advocacy.
“Various changes in our living habits, such as diet, smoking, increasing air pollution, stressful lifestyle, compromised sleep (because of digital addiction) are putting the young at risk, damaging their blood vessels faster than say 30 or 40 years ago,” he adds.
Indians are at a greater risk for genetic reasons as well. “Indians, or the Indian subcontinent population, are more susceptible to developing heart diseases at a younger age because of their smaller coronary arteries (which supply blood to the heart) among other factors,” says Dr Udgeath Dhir, director and head of cardiovascular and thoracic surgery at Fortis Memorial Research Institute in Gurugram, a hospital. The arteries are more likely to get blocked because of cholesterol or fat deposition (called plaque), he adds, which eventually leads to a heart attack. Persons of Indian ethnicities are also more likely to suffer heart diseases because their body fat content is more.
What about the suddenness of these incidents?
Many experts say that heart attacks are never sudden. They are a manifestation of a disease or anomaly existing from before, with blood vessels (such as coronary arteries) progressively developing blockages and damages.
Dr Reddy concurs with the above view but adds a caveat. “Coronary blockages (or build-up of a plaque) of 70% or more can cause obstruction to blood flow to the heart, usually when demand for blood flow increases during periods of exercise, severe stress, or after a meal,” he explains. This is how the disease pans out in a chronic case.
However, there are cases of acute coronary syndrome. “Even a soft plaque (say 30% build-up) can rupture and cause clotting and obstruction to blood flow as well,” he says.
A person who is seemingly fit and active, without prior symptoms or warning of a chest pain, can suddenly get a heart attack through this second mechanism if their body has a high level of catecholamines (such as adrenaline) as a result of excess stress, lack of sleep or excessive exercise.
Vishal, whose complete pathological details are still awaited, could very well have been such a case. There are other possibilities, such as arrhythmia, where the heart’s electrical system gets disturbed, affecting the blood supply to key organs. “Excessive adrenaline generated during vigorous exercise can trigger electrical instability and create a fatal arrhythmia,” Dr Reddy says.
In short, exercise performed in moderation is beneficial for the body. However, when performed recklessly or excessively, it can be harmful, even fatal.
How much is too much?
Last year, in August, comedian Raju Srivastav had an accident while jogging on a treadmill at a CultFit gym in Delhi. CultFit is a fitness services chain.
Srivastav fell off the treadmill after a cardiac arrest and became unconscious. He was rushed to the All India Institute of Medical Sciences (AIIMS) within 10-15 minutes, informs Nayan Soni, his manager back then. Doctors at AIIMS performed an angioplasty (a minimal invasive procedure to widen a narrowed or obstructed blood vessel), and he was put on a ventilator for 42 days. However, he couldn’t be saved.
A few months before, Srivastav had visited Anytime Fitness, another health and fitness club chain. A staff at Anytime Fitness told Mint that he jogged for more than an hour on the treadmill that day. A trainer had suggested he cut down on his treadmill exercise but he didn’t listen.
Recent research suggests that vigorous exercise, particularly when repeated often, may increase plaque build-up. Trying to achieve too much too soon can backfire.
Experts strongly caution against ignoring red alerts our body signals when we overexert ourselves: if you ever experience excruciating back pain, dizziness, chest pain or heartburn while exercising, get yourself examined, they suggest. These could very well be symptoms of a heart ailment. If you have a family history of heart disease or palpitations, you should consult a physician before taking on heavy gym workouts.
A fatal accident, on the day it happens, is usually triggered by a combination of factors, suggests Sikander Madan, an expert in exercise and nutrition sciences. “If we truly want to explain a fatal gym accident, we need to look at the routine of the person from three-four days ago,” he explains.
Was the person drinking enough water? Was he sleeping alright? Was he overworked or stressed? Was he downing multiple cups of coffee to stay energetic?
“Lack of sleep and high caffeine will increase blood pressure,” says Madan. Getting blacked out, fainting, or even vomiting can happen in gyms. But those who die were perhaps pushing themselves too hard—not just in exercise but in their lifestyle as well.
Let’s circle back to Vishal’s case again. A few things stand out based on the available information.
An abnormal sleep cycle, for a prolonged period, was likely considering the night duty. Secondly, his workout session did not have adequate breaks or rest. He performed one push-up almost every second, as seen in the CCTV footage. He was pushing himself hard.
Anand, the owner of H20 Fitness Pro, told Mint that Vishal was on a supplement—it can raise blood pressure levels and heartbeat.
Supplements, beware!
Indian diet is typically deficient in protein. Those who want to build muscles therefore turn to supplements, usually whey protein—a powdered form of protein extracted from the leftover of cheese making.
“Excess protein, consumed in form of whey protein, eggs or chicken by gym-goers, strains the kidneys, harming the kidney filters. High protein load can also lead to high uric acid levels and kidney stone formation,” says Dr Alka Bhasin, director of nephrology at Max Smart Super Specialty Hospital, Saket, Delhi. She recommends one gram of protein per kg of body weight per day, preferably taken through diet, not artificial sources.
Gym trainers don’t necessarily agree with doctors. Take the case of Mayank Sarwana, a gym trainer at Outwork Fitness Studio in Delhi. He suggests two grams of protein per kg a day—double of Bhasin’s recommendation—to his clients who want to be fit and athletic.
Sikander Madan says that young gym goers, at times, misunderstand instructions on whey protein packets, which can be confusing. If it’s recommended “two scoops in a day”, which should usually be consumed in two doses, they start consuming two scoops twice a day, increasing their dose, say from 40 grams to 80 grams per day.
No wonder Dr Bhasin regularly sees patients in the age bracket of 19-20 years, with damaged kidneys.
Creatine is another popular workout supplement—it promotes endurance performance, overcoming lactic acid build-up during intense workout. Our body converts creatine consumed through food into creatinine and excretes it. “Consuming more creatine may lead to more creatinine formation, again overloading your kidneys,” says Dr Bhasin.
Kidney diseases are strongly associated with heart diseases, research shows.
In addition, gym-goers take pre-workout drinks, which contain high levels of caffeine that act as a stimulant. One scoop of a pre-workout drink can contain up to 500 milligrams of caffeine, equivalent to five cups of coffee, all at once.
Mayank Nailwal, a 25-year-old trainer at Fitness Step Gym in Delhi, says he consumes 200 milligrams of caffeine, in the form of a pre-workout drink, before his daily exercise. Caffeine consumed in such high doses keeps the heart rate or blood pressure elevated for a prolonged period and can cause complications such as arrhythmia.
The science on supplements, including excess protein, is ambiguous. Go easy on them, many experts advise.
Gyms’ fitness test
This brings us to how gyms conduct themselves.
As per Fitternity, a web aggregator for fitness outlets, India had about 24,000 gyms in 2019. Many of them would have closed shop during the covid years but many new ones would have emerged as the economy opened up post the lockdowns.
While large chains operate in the metros, part of the gym industry is unorganized. In these unorganized shops, malpractices are common—from trainers not being certified to the use of steroids.
“A high-end gym will not enroll you without a thorough fitness evaluation, detailed health history and so on. But others (the unorganized) can enroll just anybody,” says Sikander Madan. The unorganized gyms can’t deal with emergency situations either.
Ideally, all gym trainers should be trained to perform CPR in an emergency situation. But that is not the case with many trainers.
Mayank Nailwal of Fitness Step Gym, for instance, does not even know what CPR means, let alone performing it. When asked what he would do if an emergency were to happen, he says, “We would do our best.”
Interestingly, nobody at CultFit performed CPR on Srivastav when he had a cardiac arrest, alleged Soni. CultFit did not respond to Mint’s queries.
Another important emergency intervention is automatic external defibrillator (AED), which is used to revive someone from a sudden cardiac arrest. The device analyzes the heart rhythm and as needed, can deliver an electrical shock to the heart, which restores the normal rhythm.
Dr Dhir of Fortis believes AED could have been helpful in the case of Vishal. Of the five gyms this writer visited in Delhi, during the course of his reportage, only one had an AED installed at its premises. All these gyms said they rely on their proximity to hospitals during emergencies. No one has a doctor or a cardiologist on call. In an emergency, each moment counts.
Catch all the Business News, Market News, Breaking News Events and Latest News Updates on Live Mint.
Download The Mint News App to get Daily Market Updates.
Download The Mint News App to get Daily Market Updates.
More
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