Fitness
You Can Actually Be Allergic to Exercise — and It Can Get Serious
Not everyone is a fan of exercise, and you’ve probably heard more than a few jokes from people who say they’re “allergic” to working out. But despite the quips, an exercise allergy is a real thing — and it can be serious.
The official name for this allergy is exercise-induced anaphylaxis, and it’s a rare disorder where someone develops a hypersensitivity to physical activity, leading to a life-threatening allergic reaction known as anaphylaxis, which can involve scary symptoms like trouble breathing.
The lifetime prevalence of experiencing exercise-induced anaphylaxis is about 0.05%. But it can and does happen — and it can develop later in life, even if you’ve never had issues working out before.
“There’s a lot we don’t know about exercise-induced anaphylaxis, including the mechanism behind why this happens,” says Roula Altisheh, MD, an allergist and immunologist with the Cleveland Clinic. Still, researchers and doctors in the field have learned how to properly diagnose the condition, as well as how to manage it. These are the biggest signs you might be dealing with exercise-induced anaphylaxis, plus what to do next, if you are.
What Is Exercise-Induced Anaphylaxis?
Exercise-induced anaphylaxis is “a disorder characterized by a range of symptoms occurring during exercise or physical activity,” says Peter J. Carek, MD, researcher and chair of the department of Family Medicine at Clemson University’s School of Health Research.
During an allergic reaction, a type of white blood cell in your immune system, known as mast cells, releases certain compounds, including tryptase and histamine. These compounds are what can cause symptoms of an allergic reaction, Dr. Altisheh says. In the case of exercise-induced anaphylaxis, something about physical activity causes the mast cells to release large amounts of these compounds, leading to severe symptoms that can even be life-threatening, she says.
What it is about exercise that triggers this response isn’t known. One study in the Journal of Asthma and Allergy notes that exercise increases gut permeability, and therefore may allow toxins to escape from the gut into the bloodstream, triggering the immune system and the mast cells. Another theory is that exercise causes blood flow to be directed from visceral organs to the muscles, skin, and heart, and that blood can carry allergens with it.
But in many cases, it isn’t exercise alone that causes an allergic reaction, but a combination of exercise and something else. For instance, there’s also a variant of the condition known as food-dependent exercise-induced anaphylaxis. In this type, people only experience a reaction if they exercise within three or four hours of eating a specific food, such as wheat, shellfish, or nuts, Dr. Altisheh says. As many as 30 to 50 percent of exercise-induced anaphylaxis cases are food dependent, according to the journal Canadian Family Physician.
In other cases, a person must be exercising in a warm or cold environment, after having taken medications like NSAIDs, or while menstruating in order to experience an allergic reaction, according to the aforementioned study in the Journal of Asthma and Allergy.
Symptoms of Exercise-Induced Anaphylaxis
Symptoms can vary from person to person, but doctors say they generally can include:
- Coughing
- Trouble breathing
- Wheezing
- Flushing
- Feeling itchy
- Facial swelling
- Hives
- Feeling like your throat is closing
Some people may feel light-headed and pass out, Dr. Carek says. A drop in blood pressure and gastrointestinal symptoms like nausea and an upset stomach can happen, too, Dr. Altisheh says.
How Is Exercise-Induced Anaphylaxis Diagnosed?
Testing for exercise-induced anaphylaxis can be tricky. It usually starts with doctors taking a detailed history about how your symptoms started, what you were doing when you experienced them, and what you ate before experiencing them, Dr. Altisheh says. “We try to tease out if there are co-factors that might have lowered the threshold to break into anaphylaxis,” she says. “It’s a clinical diagnosis where we try to rule out other disorders that can mimic the symptoms.”
Your doctor may also recommend doing a scratch test to look for possible triggers based on your medical history, Dr. Altisheh says.
From there, doctors may do an “exercise challenge,” where they closely monitor you in a lab setting as you exercise, usually on a treadmill, Dr. Carek says. “This testing has not been standardized,” Dr. Altisheh says. Regardless of how it’s done, doctors should have medications available to treat you if you develop anaphylaxis.
How to Manage and Treat Exercise-Induced Anaphylaxis
Management really depends on the person. “It depends on the activity and the exercise exertion level that the patient had,” Dr. Altisheh says. Doctors say you don’t necessarily need to avoid all physical activity if you have exercise-induced anaphylaxis, but you may need to take some extra precautions.
“We always advise the patient to stop the exertion immediately at the first sign of symptoms — we never recommend pushing through,” Dr. Altisheh says. It’s also important not to exercise alone and to make sure you have an epinephrine auto-injector with you, like an EpiPen, Dr. Carek says.
“Patient education may include abstaining from exercise four to six hours after eating, avoiding aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) before exercise, and others,” Dr. Carek says. Doctors may also suggest using a long-acting antihistamine to lower the risk of symptoms, Dr. Altisheh says.
Exercise-induced anaphylaxis tends to be most common in people who do vigorous workouts with sudden bursts of speed, which is why doctors may recommend that you avoid those, Dr. Altisheh says. But overall, if you suspect that you have exercise-induced anaphylaxis, it’s important to seek care. “This can be treated,” Dr. Altisheh says.
Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women’s Health, Self, Health, Forbes, and more.
Fitness
What is Americans’ favorite exercise? New study reveals a surprising trend in fitness habits
A study published in the open-access journal PLOS ONE analyzed data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, drawing on survey responses from almost 400,000 U.S. adults. The objective was to know which leisure-time physical activities people prefer and whether those options align with federal activity guidelines.
Walking is most popular but not the most effective for fitness goals
The results were notable. Walking appeared as the most frequently reported leisure-time physical activity across both urban and rural groups. In fact, roughly 44.1% of adults indicated that walking was their main form of exercise.
However, popularity did not translate into achieving recommended health standards. Based on the analysis, individuals who primarily walked had the highest likelihood of not meeting either aerobic or muscle-strengthening guidelines compared with other exercise categories. Even more significant, only about one in four walkers (25%) satisfied both recommended benchmarks, while approximately 22% failed to meet either requirement at all. In contrast, participants who reported running, resistance training, or conditioning workouts as their primary activities were considerably more likely to achieve federal physical activity targets.
What the guidelines actually require
The American College of Sports Medicine recommends that adults get:
- At least 150 minutes per week of moderate-intensity aerobic activity
- Plus muscle-strengthening exercises on two to three days per week
While walking can contribute to aerobic activity mainly if done briskly, it generally does not fulfill the strength-training requirement on its own.
Rural vs urban differences in activity patterns
The study also revealed geographic variations in exercise behavior. Rural residents were more likely to participate in activities such as gardening, hunting, and fishing, whereas urban residents showed higher engagement in running, cycling, dancing, and weight training. Despite differing preferences, urban participants were overall more likely to meet both aerobic and strength-based guidelines compared to rural populations. Researchers suggest that access to facilities, infrastructure availability, and cultural influences may contribute to these differences.
Why this matters: muscle is a key part of health
A key takeaway from the study is that physical activity guidelines are not just about movement, but about different types of movement. Walking supports cardiovascular fitness and daily activity levels, but it does not significantly develop or preserve muscle mass. This distinction is important because muscle deterioration begins gradually with age. Research indicates that adults may lose around 3% to 8% of muscle mass per decade after age 30, a condition known as sarcopenia. This decline is associated with slower metabolism, increased fat storage, reduced mobility, and higher risk of falls and fractures in later life.
Resistance training helps counteract this decline. Studies show it can increase lean muscle mass, boost resting metabolic rate by approximately 7%, and reduce body fat. A large meta-analysis also found resistance training linked to:
- 15% lower risk of all-cause mortality
- 19% lower cardiovascular disease mortality
- 14% lower cancer mortality
The most notable benefits were observed with around 60 minutes per week of resistance exercise, making it a time-efficient health strategy. Additionally, resistance training supports mental well-being by improving mood and increasing BDNF (brain-derived neurotrophic factor), which promotes brain health and neural growth.
What truly makes the difference
The study aligns with broader longevity research suggesting that higher-effort activities tend to deliver stronger physiological benefits.
Running, weight training, and conditioning workouts share a common feature: they sufficiently challenge the body to trigger adaptation. Walking, although beneficial, generally remains in a lower-intensity range that may not fully satisfy all fitness requirements on its own.
In practical terms:
- Walking supports general cardiovascular health, mental well-being, and daily movement
- Resistance training builds and preserves muscle, supports metabolism, and reduces age-related decline
- Higher-intensity cardio (running, cycling, HIIT) improves cardiovascular fitness more efficiently and helps meet aerobic goals faster
Expert perspective from the study
The researchers emphasized that the findings are not meant to discourage walking but to emphasize gaps between perception and results.
As lead researcher Christiaan Abildso explained:
“We expected to see that walking would continue to be the most common physical activity. However, it was surprising to see that nearly one in four adults who walk as their main activity did not meet either of the physical activity guidelines. That is, they reported less than the recommended 150 minutes per week of moderate-intensity aerobic activity and fewer than the recommended two days per week of muscle-strengthening activity, such as yoga or exercises with resistance bands,”
He also pointed to wider environmental and structural elements influencing activity levels:
“What we might be seeing in these rural–urban differences in preferences may just reflect what people have access to or what is culturally supported. In our work, we see a need to continue to support our partners in small towns and rural places by creating physical, social, and cultural conditions that support physical activity. This could mean creating a wide shoulder on a country road for running and cycling, helping a senior centre with their chair exercise programming, creating or improving park spaces, expanding the national network of rail trails, renovating abandoned and dilapidated structures (brownfields) into viable activity centres, keeping school facilities open to the public, and many other strategies. Everyone needs to ask, ‘how does what we’re doing affect physical activity?’, in order to help get people more active, more often, in more places,”
FAQs:
1. Is walking good for health?
Yes, walking supports heart health and general well-being. It is a low-impact activity suitable for most people.
2. Can walking replace all exercise?
Not entirely, because it does not build muscle strength effectively. A balanced routine usually includes strength training.
Fitness
Exercise improves fitness for kids, adults with FA, study finds
A combination of exercise and an energy-boosting supplement may improve physical fitness in children and adults with Friedreich’s ataxia (FA), although the added benefit of the supplement over exercise alone remains unclear, according to results from a clinical trial.
Those who participated in a 12-week program combining aerobic and strength training with nicotinamide riboside supplementation saw a significant increase in cardiopulmonary fitness, the body’s ability to supply oxygen to muscles during physical activity, compared with trial participants who did not exercise and received a placebo.
However, researchers found no significant difference between the combination group and participants who followed the same exercise program without supplementation, indicating the study did not show a clear added benefit of the supplement beyond exercise alone.
“The combination of nicotinamide riboside plus exercise for 12 weeks was safe and increased cardiopulmonary fitness in children and adults with Friedreich’s ataxia,” the researchers wrote. “Longer studies are needed to establish whether adding nicotinamide riboside to exercise could be considered as part of a long-term, comprehensive treatment approach.”
The study, “Safety and efficacy of individualised exercise and NAD+ precursor supplementation in patients with Friedreich’s ataxia in the USA: a single-centre, 2 × 2 factorial, randomised controlled trial,” was published in The Lancet Neurology.
Fatigue, safety worries limit participation
FA is caused by mutations that reduce the production of frataxin, a protein needed for cells to generate energy. When frataxin levels are too low, cells in energy-demanding tissues, such as the nervous system, heart, and muscles, gradually deteriorate, leading to FA symptoms including impaired coordination, fatigue, muscle weakness, and difficulty walking. People with FA also have markedly reduced cardiopulmonary fitness.
Although current guidelines recommend exercise to help manage symptoms, clinical evidence in people with FA is limited, and participation is often low due to barriers such as fatigue and safety concerns, the researchers noted.
Studies in other conditions have shown that supplementation with NAD+ precursors — compounds that raise levels of NAD+, a molecule involved in cellular energy production — can improve muscle function. These findings have raised the possibility that increasing NAD+ might complement or enhance the benefits of exercise alone. However, there’s limited research on whether these therapies might improve FA patients’ ability to exercise.
The team of researchers in the U.S. conducted a 12-week clinical trial (NCT04192136) involving 66 people with FA enrolled at a single center in Philadelphia from September 2020 to April 2025.
Half of the participants were children, ages 10 to 17, and half were adults, ages 18 and older. Most (56%) were male. The overall mean age was 20.3. At the start of the study, participants generally had lower-than-average muscle mass and slightly higher body fat compared with reference values for the general population.
Participants were randomly assigned to one of four groups: 17 received a placebo and served as controls, 17 received only the NAD+ precursor nicotinamide riboside, 16 followed a structured exercise program and were given a placebo, and 16 followed the exercise program in addition to supplementation with nicotinamide riboside. All participants completed the study.
The exercise program consisted of three aerobic and two resistance training sessions per week, performed at home under remote supervision. Participants took nicotinamide riboside or placebo orally each day using weight-based dosing: one capsule (300 mg) for patients weighing 24-48 kg (about 53-110 lbs) and three capsules (900 mg) for patients weighing more than 72 kg (about 159 lbs). The study’s main goal was to assess changes in peak oxygen uptake (VO₂), a key measure of cardiopulmonary fitness.
At the end of the 12-week program, participants who received both exercise and nicotinamide riboside showed the greatest improvements in cardiopulmonary fitness. Peak VO₂ increased by 13.2% in the combination group, compared with a 3.9% decline in the control group.
VO₂ rose by 9.5% with exercise alone and 5% with nicotinamide riboside alone, but those changes were not statistically significant compared with controls.
The combination was not significantly more effective than exercise alone, indicating no clear added benefit from the supplement.
Some secondary measures improved. Compared with controls, the combination group reached higher maximum workloads during exercise, and oxygen pulse — a measure of how efficiently the body uses oxygen — improved in both the combination and exercise-only groups. Participants in the combination group also reported spending more time in physical activity and leisure exercise.
The interventions were generally safe and well-tolerated. No serious adverse events were reported, and all side effects were mild or moderate. The most common ones were skin problems (53%), gastrointestinal symptoms (45%), upper respiratory infections (35%), and falls (20%).
Falls, a known barrier to exercise in FA, occurred at similar rates across all groups, and no increase in heart-related or other adverse events was seen in participants assigned to exercise.
In an accompanying commentary, “Targeting exercise, energy, or both in Friedreich’s ataxia,” published in The Lancet Neurology, two researchers in Germany highlighted the study’s implications.
The trial’s findings extend existing clinical evidence on the benefits of exercise in FA by using an objective measure of fitness, such as peak VO₂, and by demonstrating that a home-based intervention is feasible, they wrote. Further studies “are needed to determine durability and clinical significance of fitness gains and to clarify any incremental contribution of nicotinamide riboside beyond structured exercise,” they said.
Fitness
Diane Sawyer uncovers ‘The Mystery of Richard Simmons,’ the famed fitness guru, in latest special
Known for his energetic and positive persona, fitness instructor and TV personality Richard Simmons led a captivating life, until his puzzling disappearance in 2014 and sudden death a decade later.
Emmy Award-winning journalist Diane Sawyer digs into it all in “The Mystery of Richard Simmons: A Diane Sawyer Special.”
Phillip Palmer spoke with Sawyer about the special – and her personal involvement in the story.
Simmons rose to fame in the late ’70s and early ’80s. After developing a love for fitness, he opened his own exercise studio where he led a series of motivational and aerobics classes. Eventually, he landed a recurring role on “General Hospital,” portraying himself, and then his own show “The Richard Simmons Show.” Simmons also led some of the most popular exercise videos of the ’80s, including “Sweatin’ to the Oldies.”
Sawyer explains, “He came with a great purpose, which was to reach out to everybody of all sizes. And somebody said, ‘love them back to health.’ And that was his mission, and it fueled him night and day.”
Uncover the magic and mystery of Richard Simmons in the new Diane Sawyer special “The Mystery of Richard Simmons,” airing tonight at 9/8c on ABC and streaming next day on Disney+ and Hulu.
“You couldn’t go anywhere without seeing Richard Simmons,” Palmer adds.
“Yes, and he was hilarious and surprising. And he kind of lit up the room every time he arrived – surprised everybody,” says Sawyer.
And surprise everybody he did.
10 years after his sudden seclusion, which began in 2014, Sawyer received a message from Simmons.
“I get a phone call, and he sends me an incredible number of flowers. Each had the same card on it, ‘I trust you.’ And we talked on the phone, and he said he was ready to come tell his story,” Sawyer tells Palmer. “It was the old Richard. And then, as we know, not long after, he died.”
Shortly after his death, Simmons’ brother reached out to Sawyer to finish telling his story, along with those closest to the star.
Sawyer compared the experience to “a mosaic. (It) gave me tiles and pieces of the mosaic to put together who he was before he decided to go into hiding, who they think he was during it, and what might have happened if he had come back.”
“The Mystery of Richard Simmons: A Diane Sawyer Special” premieres tonight, May 12, at 9/8c on ABC and streams the next day on Disney+ and Hulu.
The Walt Disney Company is the parent company of ABC, Disney+, Hulu and this ABC station.
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