Exercise-associated collapse: an evidence-based review and primer for clinicians

Area of Science:

• Sports Medicine
• Physiology

Background:

• Exercise-associated collapse (EAC) is a common event in endurance runners.
• It presents as a collapse in conscious athletes unable to stand or walk unaided post-exercise.
• Medical providers must differentiate EAC from life-threatening conditions like cardiac arrest or heat stroke.

Purpose of the Study:

• To review the evidence regarding the causes and treatment of EAC.
• To clarify the pathophysiology of exercise-associated collapse.
• To guide medical management of collapsed athletes at finish lines.

Main Methods:

• Review of existing scientific literature on exercise-associated collapse.
• Analysis of the proposed etiological factors and treatments for EAC.
• Comparison of current understanding with previous beliefs regarding EAC causes.

Main Results:

• EAC is primarily caused by transient postural hypotension due to lower extremity blood pooling and impaired baroreflexes after exercise cessation.
• Dehydration and hyperthermia are no longer considered the principal causes of EAC.
• Life-threatening conditions must be ruled out before managing EAC.

Conclusions:

• EAC is mainly due to impaired cardiovascular reflexes and blood pooling post-exercise.
• Symptomatic treatment, including oral hydration and Trendelenburg position, is generally sufficient for EAC.
• Aggressive cooling or intravenous hydration is typically unnecessary for uncomplicated EAC.