Rhabdomyolysis Cases Surge 32% With High-Intensity Exercise

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Last week, 40-year-old Ryu, who works for the government, was rushed to a hospital in Seocho-gu, Seoul. He started his 24 hours of marathon training one day after he had started to have a belly fat, and the next day he had to complain about having excruciating pain in his legs, while his urine was dark brown. He was terrified and brought to the hospital where he was diagnosed with rhabdomyolysis. I would have thought I'd be able to run as much as I did as a kid, but I haven't been active for a long time and ended up in the hospital after too much exercise in my 40's, he told me, "I never thought I'd be faced with this again in my 40's after being diagnosed years ago during military service.

Admission of patients to hospital for "rhabdomyolysis", the damage to muscle cells, has increased by over 30% in the last four years, the increase corresponding with the increasing popularity of extreme physical activity, such as marathons and spinning. Of note, > 50% of patients hospitalized last year were in their 20s-30s. It can be a result of over-exercising and in severe cases lead to acute kidney failure and death.

Patient numbers for rhabdomyolysis inpatients have increased by 32.3% from 3,619 people in 2021 to 4,788 people last year, according to the People Power Party's Lee Man-hee who received the data from the Health Insurance Review & Assessment Service. In the same time period, total patients jumped from 15,499 to 19,296, an increase of 24.5%. Inpatients surged to a record high last year and inpatients slightly decreased, but total patients increased to 20,653 in 2023. This means there are more severe illness cases that require prompt treatment such as monitoring kidney function and treatment of fluids.

Rhabdomyolysis is associated with a build-up of muscle cell damage due to intense exercise or infection which results in the muscle contents leaking into the blood. Muscle proteins may cause damage to the kidneys. Symptoms are often cola colored urine, severe muscle pain and weakness. Affected areas can swell greatly, making it hard to move. If there is a severe case of acute kidney failure, the patients may need dialysis or even die.

Experts say the increase in patients is due to increased interest in high intensity exercise and awareness of the condition. The disease is thenceforth known to be risky, as the death of a military trainee in 2012 after a 32 km night march in Gangwon Province due to rhabdomyolysis and acute kidney failure.

There was a significant improvement in young patients. Last year, 1,478 of them, 50.9% of the inpatients, were in their 20s and 957 were in their 30s. Notably, patients in their 30s surged by 76.2% from 543 in 2021 to 957 last year. A total of 78.8% of inpatients were male, with the majority being in their 20s-30s.

Damage to the muscle tissue that leads to kidney failure is known as rhabdomyolysis.Many people are adopting new fitness programs like “Steel Corps” and “Physical: 100” and doing too much of it, making them more prone to presenting with rhabdomyolysis at the ER, Lee Kyung-won, professor from the Emergency Medicine Department at Yongin Severance Hospital, said.

If young people do high-intensity exercise without any physical activity, it can result in rhabdomyolysis, Yoo Mi-jeong, professor at Ewha Womans University Mokdong Hospital's Nephrology Department, said. In addition to marathons and spinning, outside of her limits strength training can be dangerous, she said.

The number of inpatients is still increasing this year. The total number of patients admitted to hospital (3,194) rose 9.1% compared to the same period last year (2,927). The number of inpatients was highest in the summer, the average number of inpatients was 532 in July 2021-2025, this was 77% higher than the average number of inpatients in February. The peak number of inpatients occurred in the previous month of the survey (601) in July.

There was also a dramatic increase in the number of children treated. Those aged 19 or younger increased from 1,267 in 2021 to 1,754 last year (38.4%). The number of inpatients in this group increased from 386 to 705 (82.6%) – an increase of 30.8% on the previous year's 539.

Viral infection is the other significant cause in children besides exercise. Young people are frequently affected by rhabdomyolysis as a result of infection – for example, influenza – and damage to the muscle cells. Infections accounted for 39% of the 880 cases of pediatric rhabdomyolysis that were studied in 23 domestic hospitals from 2007 to 2016, with influenza being the most prevalent cause. Acute kidney injury was seen in 11.3% of these patients.

Professor Kim Ji-hyun, from the Pediatric Nephrology Department at Bundang Seoul National University Hospital, said that children are susceptible to viruses. Parents should take their child to the emergency room if they suddenly stop moving after developing a “cola” colored urine from an illness such as the flu, she said. Damage to the muscle, caused by the fever temperature during the seizure can also cause the condition.

Another risk factor among adolescents is overexercising. Many are not sufficiently fit, as a result of being sedentary, and a single exercise of any intensity could be dangerous. Kim shared an example of a youth that did not engage in any physical activity before and experienced rhabdomyolysis following one hour of weight loss personal training.

While most people with rhabdomyolysis will recover with rest and fluids, early treatment is crucial to prevent kidney damage, experts say. If an exercise area becomes excessively swollen or urine becomes cola colored, “get to a hospital right away,” Yoo said. Kim said parents should keep an eye out for the same symptoms following the infection.

It is important to learn that health-oriented exercise can be too strenuous and to have systematic education and early response mechanisms to reduce the risk of young adults and children.