Intense exercise and collapsed lungs

Hi Zwifters,

I’m wondering if there are many Zwifters out there that have suffered collapsed lungs / pneumothorax? I’m especially interested in cases where these weren’t caused by accidents or some other form of chest trauma.

A bit of background - I’ve been a regular Zwift user for the last few years. I’ve progressed up to being a cat A racer (although it’s very rare I bother the top sections of leaderboards in those races!). On a regular week, I’d be doing 2-3 45min-1hr sessions with my HR at around 170bpm (max is around 190), plus lower intensity sessions

Earlier this week, I suffered a pneumothorax (which caused a hemothorax) brought on by a bleb (a sort of blister) on my lung. There doesn’t seem to be too much known about what causes these blebs but the research that I have found suggests that tall, thin men are most at risk of them occurring naturally.

I can’t find any suggestion that there’s a link between regular intense exercise (or even swift weight loss that might be brought on by such exercise) and these blebs but it also doesn’t seem to have been an area that has been particularly well studied. So, I’d be interested in what Zwifters know and what others have experienced.

Thanks for reading. Look forward to seeing some of you on Zwift when I’m fit to return. Ride on!


Hey Steve,

Hope you’re on your way to recovery.

I have just suffered a Primary Spontaneous Pneumothorax, which is the one with no underlying health issues. I don’t fit the description of tall thin male but it just happened.

As you mentioned, there isn’t much literature on the topic as it is rather rare (particularly on my age bracket). What I have found out from some European research is that reoccurring rates are quite high (40-50%) in the first month and up to 30% in the first year… so I’d be quite reluctant to get back on the bike soon and when I do (planning about 2 -3 weeks off after X-ray shows clear from symptoms) I’m planning to to just stay in Z2 for a few weeks, then slowly build up until I can tackle the terrain I normally ride on.

Would be keen to hear how you’re tracking and how are you getting on with training.

I wish you a speedy recovery.

I had one years ago swimming, same as you I’m tall & thin. I’ve haven’t had it reoccur and haven’t really thought about it for years. I race pretty intensely on zwift most days for the last 3 years or so.

I suffered a Secondary Spontaneous Pneumothorax when out on a run and my mate tripped in front of me. I reached down to pull him up and caused mine.

Was instantly in pain and couldn’t take a full breath.
Attended A&E and x ray showed a partial deflation. Was advised it would inflate itself so many percent per day/week.

Couldn’t exercise for a fortnight but added that it was fine.

Don’t think you’re more or less at risk through intense exercise, just one of those things.

Hadn’t had one before or after. I’m neither particularly tall or thin but have been told i have excellent lung capacity.

Hi Steve,
I write this both as a mid-50s male who has had about 5-6 spontaneous pneumothorax events in my life, but also as a medical doctor who some knowledge of the topic (and I’m an avid cyclist so I also get my heart rate up towards the 180s and have done higher elevation cycling around 14,000 ft in Colorado, etc.).
The incidence of SP is about 3-6x more common in men than women, definitely more common in tall/thin body types, and has regional variance (about 7.4 cases per 100,000 people per year in the US vs about 37 per 100,000 per year in the UK). Most occur from the age of 10 to 30 and thus the belief is that the bleb you mentioned is formed during growth spurts that stretch the tissue too much too fast, and leave that bleb (thin walled air sack) to eventually burst.
While it is NOT clear that exercise causes them (it is also not definite that it doesn’t), I will say that I’ve had an equal number of mine while exercising as I’ve had them sitting at a table eating dinner. I will say the generally speaking we do advise avoiding exercise for at least 2 weeks afterwards (if not longer, follow the advise of your treating medical team). And, no air travel for at least 2 weeks (the pressure in the airplane cabins can create real problems). And, you should really never do SCUBA, the pressure of the air tanks can burst any residual blebs you might have. Snorkeling is fine.
Longer term, we don’t really limit exercise or heart rates. I do generally advise avoiding extreme heavy lifting where you would hold your breath and really explode out of that breath, but aerobic exercise we don’t tend to limit. Again, there may be unique aspects to any individual story, so always listen to your own doctor. But as a general rule, long term after recovering from the events, we don’t restrict cardiovascular activity.
Lastly, always tell any anesthesiologist prior to any surgery, as it can affect the way we ventilate you and how we monitor you during and after surgery.
Hope all this is helpful!
Ride on

1 Like

Hi all.

Thanks for all of the responses to my original post. I hope all of you are recovering from or staying clear of pneumothoraxes! Jim - particularly helpful to have the perspective and advice of a doctor and cyclist.

I think I was probably quite unlucky that the pneumothorax that I had caused a hemothorax, with a pretty major bit of internal bleeding. It did mean, though, that the doctors undertook surgery on me to reduce the chance of a reoccurrence (in that lung at least). That was about a month ago. I now have my lung stuck to my chest cavity wall (following talc pleurodesis).

I’ve been told by the doctors that operated on me that there should be no reason why I can’t go back to cycling. I have been back on Zwift for a couple of 30/40 mins sessions at what would previously have been z1/z2. I don’t feel the need to push things harder than that at the moment but I’m sure that in time I’ll start to feel more confident about ramping things up slowly. I think it’ll be a while until I want to do an ftp test or time trial!



1 Like