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Exercise-associated collapse: an evidence-based review and primer for clinicians
  1. Chad A Asplund1,
  2. Francis G O'Connor2,
  3. Timothy D Noakes3,4
  1. 1Department of Family Medicine, Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
  2. 2Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  3. 3MRC/UCT Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
  4. 4Department of Human Biology, Sports Science Institute of South Africa, Cape Town, South Africa
  1. Correspondence to Chad A Asplund, Department of Family Medicine, Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA; chad.asplund{at}


Exercise-associated collapse (EAC) commonly occurs after the completion of endurance running events. EAC is a collapse in conscious athletes who are unable to stand or walk unaided as a result of light headedness, faintness and dizziness or syncope causing a collapse that occurs after completion of an exertional event. Although EAC is perhaps the most common aetiology confronted by the medical provider attending to collapsed athletes in a finish-line tent, providers must first maintain vigilance for other potential life-threatening aetiologies that cause collapse, such as cardiac arrest, exertional heat stroke or exercise-associated hyponatraemia. Previously, it has been believed that dehydration and hyperthermia were primary causes of EAC. On review of the evidence, EAC is now believed to be principally the result of transient postural hypotension caused by lower extremity pooling of blood once the athlete stops running and the resultant impairment of cardiac baroreflexes. Once life-threatening aetiologies are ruled out, treatment of EAC is symptomatic and involves oral hydration and a Trendelenburg position – total body cooling, intravenous hydration or advanced therapies is generally not needed.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.