Rhabdomyolysis and Changes of Biochemical Markers in the Long-Distance Runners

Ahn, Seon Ho; Choi, Suck Chei; Kim, Tae Hyun; Na, Yong Ho; Song, Ju Hung; Lee, Young Jin; Cho, Ji Hyun; Choi, Suck Jun

Abstract

BACKGROUND: Exercise has almost always been intuitively considered beneficial, but although rewards greatly outweigh risks, exercise occasionally produces bad or even fatal outcomes such as acute renal failure or sudden death. Exertional rhabdomyolysis has been occasionally reported in adult patients following such strenuous activities as military basic training, weight lifting, and marathon running. The purpose of the present study was to investigate whether exertional rhabdomyolysis developed, and how exercise could influence biochemical markers of rhabdomyolysis during resting, exercise, and recovery period in long-distance runners.
METHODS
Twenty-four young long-distance runners who volunteered to participate in the study, trained with running over 200km every week for 2 to 3 years were studied. Levels of serum creatine kinase(CK), lactate dehydrogenase(LDH), asparatate amino-transferase (AST), and myoglobin, and urine myoglobin were measured at 24hr(pre-exercise period) before, immediately (post-exercise period), and at 24hr(recovery period) after 10km running. Ten long-distance runners who were randomly selected at 24hr after 10km running, including one complaining of calf pain, and age-matched nine young control students were subjected to bone scan with technetiun-99m methylene diphosphonate(99mTc-MDP)
RESULTS
Serum CK activities in pre-exercise period were higher than that of the upper normal range. Serum CK and LDH activities were significantly increased in post-exercise period compared with pre-exercise period(p<0.05), were not decreased to the level of post- exercise in recovery period. The level of serum myoglobin was increased and decreased significantly,(p<0.05, p<0.01, respectively) and urine myoglobin and serum AST activities were remained within nomal range in each period. The mean uptake count of 99mTc-MDP in both lower extremities of runners was significantly greater than that of the control group(p<0.001), and had good correlation with the serum CK activities of post-exercise, and recovery period(r=0.87 p<0.001, r=0.8 p<0.01, respectively).
CONCLUSION
This study suggests that rhabdomyolysis in the well trained long-distance runners may be developed in low grade, but ongoing injuries during each running. For the diagnosis of rhabdomyolysis in the well trained long-distance runners, serum CK levels are thought to be the most useful marker, and the cut- off value of serum CK levels should be lowered less than usual five times of normal value. A quantitative measurements of 99mTc-MDP uptake with serum CK levels can be more helpful in making the diagnosis of rhabdomyolysis in the well trained long-distance runners.