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Can You Train After Rhabdomyolysis? The Novelty-Dose Audit: The Door Where Both of the Gym's Default Scripts — Push Through, Soreness Is Weakness Leaving the Body, Tea-Colored Urine Is a Badge, and HIIT/Spin Shred Kidneys So Never Start Anything New Hard — Fail the Reader (the Definitions File at 5,632 Articles Screened: CK Five Times the Upper Limit Is the Field's Working Line, and Not One RCT Has Ever Compared Fluid Strategies; the Surveillance Column: 377 US Air Force Cases Across a Decade — 55% of the Chart-Reviewed Hospitalized, 7 in the ICU With 4 on Hemodialysis and 1 Fasciotomy, Every One of Those Seven Sickle-Trait Negative; the First-Class Column: the Korean Series Where One Spinning Class Sent All 11 Healthy Women to the Ward, and the New York File Where 15 Minutes Sufficed and a Regular Exerciser Still Ended Up on Dialysis; the CK-Context Column: Brazilian Marines Riding 259 Days at Peak CK 3,156–9,720 U/L Without Renal Disaster — the Number Is Not the Diagnosis, the Syndrome Is; the Prevention Column: the Eccentric File Where the Repeated-Bout Effect Is a Vaccine Administered by the Previous Session, and the NCAA's Natural Experiment Where Sickle-Trait Screening Cut Division-I Football Deaths From 1:28,145 to 1:250,468 Athlete-Years, an 89% Fall; the Return Column: Graded Clearance on the Falling CK Trend, and the 2025 Case Where the MRI Was Still Positive Three Months After the Blood Went Quiet) — the Answer Is After, Not Through: the Hospital Owns the Acute File, the Calendar Owns the Return, and Familiar, Progressive, Hydrated Training Owns the Prevention

By RightRep AI Assistant · · 22 min read

Rhabdomyolysis is the file where the internet's two default scripts — the push-through script: soreness is weakness leaving the body, the dark urine is a badge of a real session, hydrate and go again tomorrow and the fear script: HIIT and spin classes shred kidneys, the first class is a roulette wheel, never start anything new hard — both fail the reader at the exact door she walked in through, because this reader is one of two people: the one on day two after her first spin class, looking at tea-colored urine and a thigh too swollen to bend, or the recovered one holding a normal blood test and asking when the barbell comes back. The push-through script dies on the surveillance column, because the tea-colored urine is muscle contents in the blood and the kidney is the organ that pays: of 377 US Air Force exertional-rhabdo cases across a decade, 55% of the chart-reviewed were hospitalized, and the seven who reached the ICU included four on hemodialysis and one fasciotomy [2] — this is the one door in the injury wing where "train through it" is not a mindset error but an emergency-medicine error. The fear script dies on the same file's context column, because dose is not the variable that separates the wards from the workouts: Brazilian Navy marines rode 259 days of brutal operational training at peak creatine kinase of 3,156 to 9,720 U/L — and finished, conditioned, without renal disaster [11]. What separates the casualty from the survivor is novelty: the unaccustomed eccentric dose, the first spinning class [6][7], the sudden leap — which is why the audit names this door the way the file reads it. So the fences come first. First: the emergency fence — cola- or tea-colored urine, a muscle group grossly swollen, painful and weak, vomiting, confusion or fever after a hard session is the emergency department today, not a hydration question and not a training question [2][6]. Second: the sick-and-stacked fence — heat, dehydration, illness and NSAIDs stack the same dose; the file's worst cases arrive stacked, and the when-you're-ill and painkiller doors govern those variables before any session does. Third: the trait fence — sickle-cell-trait carriers training at intensity should know their status and coach accordingly; screening and precaution cut Division-I football associated deaths 89% [4][5]. Fourth: the recurrence fence — a second unexplained episode, a CK that never settles, rhabdo from accustomed exercise, or a family history routes to the metabolic workup (the RHABDO criteria), not to another deload [10]. With the fences standing, the file underneath is one of the cleanest inversions in this library's injury wing: the riskiest session in your program is not the heaviest — it is the newest, and the training itself, familiar and progressive and hydrated, is the prevention column [6][7][9][11].

The short answer: yes — after, not through; and the prevention is ordinary programming

Strip the file to its spine. The definition: pooled across the field's systematic review — 5,632 articles screened down to 56 — most studies define rhabdomyolysis as creatine kinase above five times the upper limit of normal, in the context of muscle symptoms; and the same review's honest footnote: no randomized trial has ever compared fluid strategies for it [1]. The severity spectrum: the US Air Force decade file counted 377 exertional cases among active airmen; of 200 chart-reviewed, 110 (55.0%) were hospitalized; seven reached intensive care — four needed hemodialysis, one a fasciotomy — and every one of those seven was sickle-trait negative, with blood chemistry changes statistically equivalent between trait-positive and trait-negative airmen [2]. The novelty column: the Korean series — eleven healthy women, ages 15 to 46, all admitted after their first spinning class, all recovering without complications [7]; the New York file — three cases including one after 15 minutes of spinning and one biopsy-proven kidney injury that reached hemodialysis [6]. The context column: the Brazilian Navy followed 35 marines through 259 days of operational training — peak CK of 3,156 U/L in the tropical mission and 9,720 U/L after a 100-km high-altitude march, subclinical damage in conditioned men who kept training [11]. The prevention column: the eccentric-damage file names the mechanism — unaccustomed lengthening contractions — and the modifier that protects: the repeated-bout effect, the adaptation by which one prior session blunts the damage response of the next [9]; and at population scale, the NCAA's screening era cut Division-I football associated deaths from 1:28,145 to 1:250,468 athlete-years (RR 0.112, an 89% fall, P=.022) [4]. The return column: clearance is graded and individualized, anchored to the falling CK trend and full symptom resolution [3] — with the 2025 MRI case as the file's humility: three months after a half-marathon-induced episode, a symptom-free runner with a normal CK still carried MRI lesions, and imaging deferred his return [8]. That is the audit in one paragraph: the acute file belongs to the hospital, the return belongs to a calendar that outlasts the symptoms, and the prevention belongs to programming that never lets enthusiasm outrun familiarity [3][8][9].

What the condition actually is: contents spilling, plumbing clogging — and the dose is measured in novelty

The mechanics in a paragraph: rhabdomyolysis is the death of skeletal-muscle cells at a scale the blood notices — the cell membranes fail, and creatine kinase, myoglobin, potassium and phosphate pour into the circulation [1][2]. The kidney is the organ that pays twice: myoglobin clogs and poisons the tubules as it is filtered, and the shock-prone, dehydrated state the damage creates starves them; that is how a hard session becomes a dialysis ward [2][6]. The field's working definition, per the definitions review, is CK more than five times the upper limit of normal with the clinical picture — muscle pain, weakness, and the classic dark urine [1]. Two properties of the mechanism matter to the training reader. First, the damage is dose-dependent on novelty, not on absolute load: eccentric (lengthening under load) contractions of unaccustomed muscle are the canonical trigger — the descending-lunge-heavy class, the first spin ride, the downhill marathon — because the braking fibers absorb forces they have never been structurally prepared for [9][11]. Second, CK elevation alone is not the disease: conditioned men under sustained brutal training run CK in the thousands while training on [11] — the syndrome (symptoms, urine, function loss, organ injury) is the diagnosis, which is exactly why the definition is a context definition, not a number [1]. The reader who fears that hard training corrodes kidneys has the direction backwards: the marathon runner's second 100 km is safer than her first, and the Marine's ninth mission safer than his first [9][11].

The surveillance column: a decade of the hardest-working population, counted

The best single epidemiology file this door owns is the US Air Force: 377 diagnosed exertional-rhabdo cases among active-component airmen between January 2009 and December 2018, 200 with charts reviewable, 185 with known sickle-trait status [2]. The severity ladder the file builds: 110 of 200 (55.0%) hospitalized; 98 of the 174 trait-negative (56.3%) admitted; of the 7 who reached intensive care — 4 requiring hemodialysis, 1 a fasciotomy — all 7 were trait-negative; and across CK, potassium, creatinine, troponin and hemoglobin, the chemical course of the illness ran statistically identical in trait-positive and trait-negative airmen [2]. Two readings for this reader. The reassuring one: even in this hot-climate, high-intensity population, exertional rhabdo was rare enough to count in the hundreds across a decade and a service — and most of it resolved with ward-level care [2]. The sobering one: the tail is real — dialysis and fasciotomy live in this file — and the tail arrived for ordinary people on ordinary days, which is why the emergency fence leads every section of this door [2][6]. The trait nuance matters most of all: sickle trait changed who was at risk of collapse, not how bad the rhabdo got once it happened [2][5].

The first-class column: the spin files, and the freebie economy

Every condition door in this library has an archetype case, and this door's is the first spinning class. The Korean series: eleven women, 15 to 46 years old, all previously healthy, all admitted two to three days after their first spin class, all treated successfully — the only residue mild, asymptomatic hypocalcemia [7]. The New York nephrology file: three cases from one practice — the first after 15 minutes of spinning, the second in a young regular exerciser, the third with biopsy-proven acute kidney injury severe enough for hemodialysis — and the authors' framing that the high-intensity class format carries "significant risks to newcomers" [6]. The pattern is the mechanism wearing gym clothes: a novel, eccentric-heavy modality (the weighted flywheel's descending strokes), high enthusiasm, group pacing that ignores the individual dose, often heat and dehydration on top [6][7]. The audit's name for it is the novelty dose — and its gym translation is unglamorous: the first session of any new modality is a dose-setting session, not a performance; intensity belongs to the familiar, and the warm-up file and honest self-selection govern the first day far more than fitness does [6][7][9]. Nothing in the file indicts spinning itself — the Marines' data and the repeated-bout effect both protect the second class [9][11]; what the file indicts is the first class treated like the tenth.

The CK-context column: the number is not the diagnosis

The door's most misread number is creatine kinase, so the Brazilian Navy study deserves its own column: 35 marines through 259 days of operational selection across six missions — sleep-deprived, heat-exposed, marching and drilling — with blood drawn at baseline and after each mission [11]. The numbers that reframe the panic: CK stayed elevated through the entire program, peaking at a median 3,156 U/L after the tropical mission and 9,720 U/L after the 100-km high-altitude march — values many times the 5× ULN line — as subclinical exertional damage in conditioned men who kept operating [11]. The same file that counts dialysis tails [2] also counts thousands of U/L riding along with healthy adaptation [11], and the reconciliation is the definition column: rhabdomyolysis is CK elevation plus the clinical syndrome — the symptoms, the dark urine, the function loss, the organ injury — never the number alone [1]. Practical translations: a single post-marathon CK tells you almost nothing about kidney risk without symptoms and urinalysis; "my CK was 4,000 and I felt fine" is a normal training-week line for an endurance athlete, not a silent catastrophe; and the trend — CK falling over days while urine clears and function returns — is the variable the return-to-training calendar actually reads [1][3][8][11].

The prevention column: the repeated-bout effect is a vaccine you administer with the previous session

The eccentric-damage review gives this door its most useful idea: the damage response to lengthening exercise is trainable — a single prior bout of the same movement blunts the damage, soreness and CK response of the next bout, the classical repeated-bout effect, and the protection is specific to the trained movement and angle [9]. That is a vaccine with a dosing schedule, and its programming translation is the ordinary progressive-overload ladder applied to novelty itself: introduce new modalities at deliberately low dose, repeat the same movement within the week while the protection window is open, and expand volume before intensity [9]. Beside it run the stacking variables the worst cases share: heat, dehydration, illness, NSAIDs, and caloric or sleep deficit — the levers the hydration and sick-day doors already govern [1][2][6]. And at population scale the prevention column has its natural experiment: after the NCAA began requiring sickle-trait screening, education and precautions in 2010, Division-I football deaths associated with the trait fell from 1:28,145 to 1:250,468 athlete-years — RR 0.112, an 89% reduction (P=.022), with a matching 89% fall in African-American DI football athletes (1:12,519 → 1:118,464, RR 0.106, P=.017) [4]. Mitigation works when it is installed — which is the fence, not the fear [4][5].

The trait column: sickle trait is a risk-of-event file, not a severity file

Roughly 300 million people worldwide carry sickle-cell trait, most of them training through life entirely unaware and unharmed [5]. The trait's honest file at this door has three lines. First, the association is real: exertional collapse and death associated with the trait are why the screening era exists, and why the summit consensus recommends knowledge, acclimatization, rest breaks and activity modification rather than exclusion [4][5][12]. Second, the natural experiment says the mitigation works: the 89% fall in associated deaths after screening legislation, printed with its honest footnote — across all NCAA athletes the same comparison missed significance (RR 0.288, P=.146); the signal lives in Division-I football, where the exposure concentrates [4]. Third, the severity null: in the decade of Air Force cases, the trait predicted neither ICU course nor chemistry — every dialysis and fasciotomy in the file happened to trait-negative airmen [2]. For the training reader who knows she carries the trait, the file's translation is precise: train, compete, and load — and treat the first hot, all-out, novel session of any new cycle the way this whole audit treats it, with the fences up and the dose respectful [2][5]. The dedicated sickle-cell door carries the full condition file; this door borrows only its emergency column.

The treatment-honesty column: what the hospital file cannot yet promise

This library's audits earn their keep on the nulls, and the hospital file's biggest one is structural: across the definitions review's 56 included studies, no randomized controlled trial has ever compared intravenous fluid alone against fluid plus bicarbonate and/or mannitol for rhabdomyolysis — the aggressive saline that is standard care rests on physiology and cohort logic, not on trial proof [1]. The definitions heterogeneity is the second null: "5× ULN" is the plurality line, not a consensus [1]. The NCAA all-athletes screening comparison is the third (RR 0.288, P=.146 — direction right, power short) [4]. The Air Force severity null is the fourth — trait status predicted nothing about course [2]. And the MRI case is the fifth, aimed at the return: a single patient, symptom-free and CK-normal at three months, whose imaging said not yet [8]. What is not a null: the emergency fence itself — the dialysis and fasciotomy tail is real, and every column in this file routes the cola-colored urine to the emergency department on the day it appears [2][6].

The return column: the calendar, the trend, and the MRI's caution

The return-to-play review for exertional rhabdo is blunt about the stakes: these are conditions where premature return risks repeat organ-system damage, evidence is thin, and clearance is individualized — graded, supervised, and anchored to the resolving picture [3]. The practical ladder the file and the case literature build together: first, the blood — CK falling over serial checks, kidney function stable, urine clear; second, the body — full pain-free range of motion, no swelling, strength symmetrical; third, the ramp — graded re-entry beginning far below the pre-episode dose, in familiar movements first, with heat and dehydration respected for weeks [3][8][11]. The MRI case adds the humility column: the half-marathoner recovered by every blood test at three months, yet still carried the lesions on imaging — one patient, printed as a caution rather than a rule, that the calendar outlasts the symptoms and the trend outranks the single green number [8]. And the return's most important rule is the one this whole audit wrote: do not re-run the same novelty at the same dose — the session that caused the episode is the last movement pattern to be reintroduced, at a fraction of the volume, after the familiar work is painless [8][9].

The recurrence fence: the RHABDO criteria, and the genetic half of the Brazilian file

For most readers exertional rhabdo is a one-off, dose-explained event. The Brazilian series from UNICAMP defines the reader for whom it is not: 20 patients worked up after rhabdomyolysis episodes, 9 of them (nearly half) with a monogenic cause — PYGM the most frequent gene, then CPT II, ACADS, ACADM, ANO5, DYSF and FKTN — with mean age at first episode of just 19.5 years [10]. The RHABDO referral criteria the study runs on are the fence this door borrows: R — recurrent episodes; H — CK still elevated more than 8 weeks after the event; A — rhabdo from accustomed exercise; B — CK above 50× the upper limit; D — drugs or supplements cannot explain the severity; O — affected family members or other exertional symptoms [10]. The predictors that separated the genetic half in the Brazilian data: persistent CK elevation (P=.0081), myalgia (P=.028), objective weakness (P=.049) and parental consanguinity (P=.0090) [10]. Gym translation: one clearly dose-explained episode needs no genetics referral; a second, or an episode that violates the dose logic, does — and until that workup is done, the fence stands.

The program in gym terms: what stops, what ramps, what never changes

Stops and refers, today: cola- or tea-colored urine, grossly swollen painful muscle, weakness, vomiting, confusion or fever after a session — the emergency department, and if it is rhabdo, the ward-level file says most cases are exactly that: ward-level [2][6].

Ramps on the calendar, not the feeling: after the blood trend clears, re-entry starts at familiar movements, low dose, cool conditions — the overload ladder restarted from light, with the episode's own modality reintroduced last and smallest [3][8].

Doses novelty like a variable: first sessions of new modalities are dose-setting sessions — low intensity, self-paced, hydrated, out of the heat; the second session of anything is dramatically safer than the first, and that is physiology, not motivation [6][7][9][11].

Never changes: hydration around sessions (the water file), the sick-day and painkiller rules when stacked with hard training, and honest soreness-reading — DOMS is symmetric, peaks at 48 hours and never turns the urine dark; when it does, it stops being DOMS.

Keeps one dated ledger: session, modality, novelty flag, symptoms, urine color — the columns this file's surveillance runs on [2][11]. Trait carriers add the status line to the coach's file, not the rumor mill [4][5].

The Brazil anchors: UNICAMP's genetic half, and the Navy's 259 days

The pt-BR twin of this file exists for a Brazilian reader training in heat the surveillance files would recognize as a risk variable year-round, and both Brazil anchors are institution-led. The genetic anchor: UNICAMP's series — 20 patients, monogenic cause in 9, the RHABDO referral criteria, and the predictors (persistent CK, myalgia, weakness, consanguinity) — published in Arquivos de Neuropsiquiátrica [10]. The dose anchor: UFRJ and the Brazilian Navy's 259-day marine cohort — peak CK 3,156–9,720 U/L across tropical and high-altitude missions, subclinical damage in conditioned survivors — published in BMJ Military Health [11]. Together they give the Brazilian reader the door's two centerpieces domestically: the recurrence workup that half of unexplained cases deserve, and the CK-context column that keeps a high number from being misread as catastrophe [10][11].

So what do you actually do? The practical file

Six rules, every one sourced from the columns above:

  1. Route the dark urine today. Tea- or cola-colored urine after a session, with swollen painful muscle or weakness, is the emergency department — the file's dialysis and fasciotomy tail is how "push through" ends [2][6].
  2. Treat the first session of anything as dose-setting. The spin files are the archetype — 11 of 11 healthy women admitted after one class [7], 15 minutes sufficing in another file [6]; the repeated-bout effect makes the second session the safer one [9].
  3. Read the syndrome, not the number. CK runs into the thousands in conditioned men training through 259 hard days [11]; the diagnosis is CK plus symptoms, urine and function [1].
  4. Return on the trend, then a ramp. Falling CK, clear urine, full pain-free motion — then familiar movements at low dose, the episode's modality last [3][8]; and respect the MRI's caution that three months of normal blood can still hide unfinished repair [8].
  5. Know the trait lines. Sickle trait is a risk-of-event file, not a severity file [2] — screening-era precautions cut associated deaths 89% [4]; carriers train and compete with the fences installed [5][12].
  6. Take the recurrence fence seriously. A second episode, an accustomed-exercise episode, CK that never settles, or family history — the RHABDO criteria earn a metabolic workup; nearly half of one Brazilian series had a monogenic cause [10].

How RightRep fits into this

The rhabdo file is, at its core, a dose-management question disguised as a willpower question — a door where the program's structure (novelty, progression, recovery) is the entire prevention column, and where the reader's own logged history is the best dose instrument she owns:

  • The novelty ledger made visible. Every session logged with its modality and load is the dose history the first-class files lacked — the difference between "new to me, week one" and "familiar, week ten" is a recorded fact, not a feeling [6][7][9].
  • The progression ladder enforced. The repeated-bout effect is an argument for scheduled repetition before volume jumps [9] — a progressive, counted program is the vaccine's dosing schedule.
  • The symptom line, dated. Soreness that peaks, plateaus and resolves is DOMS; soreness that escalates, localizes or darkens the urine is the fence — a dated symptom log is how one gets distinguished from the other before the emergency does it for you [2][11].
  • The comeback steered, not guessed. A graded return on recorded loads — restarted from light and re-ramped — is exactly the calendar the return file describes [3][8].
  • The habit the prevention file prices. Trained, tracked, progressive training is the protective column at this door — the receipt the surveillance files wish every casualty had kept [4][9][11].

The bottom line

  • The definitions column: 5,632 articles screened, 56 included — CK >5× ULN the plurality definition, and no RCT has ever compared fluid strategies [1].
  • The surveillance column: USAF 2009–2018 — 377 exertional cases; 55.0% of 200 chart-reviewed hospitalized; 7 ICU (4 hemodialysis, 1 fasciotomy), all 7 sickle-trait negative; chemistry equivalent by trait [2].
  • The first-class column: 11 healthy women, one spinning class each, 11 admissions [7]; 15 minutes sufficed in the New York file, which also reached biopsy-proven dialysis AKI [6].
  • The CK-context column: Brazilian Navy, 259 days — peak CK 3,156 (tropical) to 9,720 U/L (100-km march), subclinical, conditioned men training on [11].
  • The prevention column: repeated-bout effect — one prior session blunts the next's damage [9]; NCAA screening era — DI football associated deaths 1:28,145 → 1:250,468 AY, RR 0.112, an 89% fall (P=.022); all-athletes comparison honest-null at RR 0.288, P=.146 [4].
  • The trait column: ~300M carriers worldwide [5]; the trait predicted event risk, not severity [2]; the summit mitigation is knowledge and pacing, not exclusion [4][5][12].
  • The return column: graded, individualized clearance on the falling CK trend [3]; the MRI case — symptom-free and CK-normal at 3 months, imaging still positive, return deferred [8].
  • The recurrence fence: UNICAMP — 9 of 20 patients monogenic (PYGM first), RHABDO criteria, predictors persistent CK/myalgia/weakness/consanguinity [10].
  • The honest nulls: no fluid-strategy RCT [1]; the NCAA all-athlete power shortfall [4]; the trait severity null [2]; the MRI case is one patient [8].

Train like the file reads: familiar first, progressive always, hydrated always — and let the camera count the reps of the comeback at rightrep.app.

This post was written by the RightRep AI Assistant — the same AI that counts and scores your reps at rightrep.app.

Sources

  1. Chavez LO, Leon M, Einav S, Varon J. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Critical Care, 2016;20:135. pubmed.ncbi.nlm.nih.gov
  2. Webber BJ, Nye NS, Covey CJ, Harmon KG, Ruiz SA, O'Connor FG. Exertional rhabdomyolysis and sickle cell trait status in the U.S. Air Force, January 2009–December 2018. MSMR (Medical Surveillance Monthly Report), 2021;28(1):15–19. pubmed.ncbi.nlm.nih.gov
  3. Asplund CA, O'Connor FG. Challenging return to play decisions: heat stroke, exertional rhabdomyolysis, and exertional collapse associated with sickle cell trait. Sports Health, 2016;8(2):117–125. pubmed.ncbi.nlm.nih.gov
  4. Buchanan BK, Siebert DM, Zigman Suchsland ML, Drezner JA, Asif IM, O'Connor FG, Harmon KG. Sudden death associated with sickle cell trait before and after mandatory screening. Sports Health, 2020;12(3):241–245. pubmed.ncbi.nlm.nih.gov
  5. O'Connor FG, Bergeron MF, Cantrell J, et al. ACSM and CHAMP summit on sickle cell trait: mitigating risks for warfighters and athletes. Medicine & Science in Sports & Exercise, 2012;44(11):2045–2056. pubmed.ncbi.nlm.nih.gov
  6. Brogan M, Ledesma R, Coffino A, Chander P. Freebie rhabdomyolysis: a public health concern. Spin class-induced rhabdomyolysis. American Journal of Medicine, 2017;130(4):484–487. pubmed.ncbi.nlm.nih.gov
  7. Kim D, Ko EJ, Cho H, et al. Spinning-induced rhabdomyolysis: eleven case reports and review of the literature. Electrolytes & Blood Pressure, 2015;13(2):58–61. pubmed.ncbi.nlm.nih.gov
  8. Hamdan R, Guyotat N, Mahéo P, et al. Contribution of medical resonance imaging in the return to physical activity after exertional rhabdomyolysis: a case report. The Physician and Sportsmedicine, 2025;53(1):97–101. pubmed.ncbi.nlm.nih.gov
  9. Hyldahl RD, Hubal MJ. Lengthening our perspective: morphological, cellular, and molecular responses to eccentric exercise. Muscle & Nerve, 2014;49(2):155–170. pubmed.ncbi.nlm.nih.gov
  10. Martins AP, Martinez ARM, Nucci A, França Júnior MC. When to think of genetic causes for rhabdomyolysis? A Brazilian single-center exploratory study. Arquivos de Neuropsiquiatria, 2026;84(8):1–7. pubmed.ncbi.nlm.nih.gov
  11. Ponce T, Carneiro A, Lucena CV, Aquino Neto FR, Pesquero JB, Viana-Gomes D. Muscle, liver and kidney biomarkers in military training: a 37-week comparative study of dropouts and finalists. BMJ Military Health, 2025 (online ahead of print). pubmed.ncbi.nlm.nih.gov
  12. O'Connor FG, Franzos MA, Nye NS, et al. Summit on exercise collapse associated with sickle cell trait: finding the "way ahead." Current Sports Medicine Reports, 2021;20(1):47–56. pubmed.ncbi.nlm.nih.gov