For centuries, the notion that abstaining from sex increases physical performance has been widely debated. From ancient Greek athletes to modern-day boxing legends such as Muhammad Ali and Mike Tyson, have practiced sexual restraint in the expectation of increasing strength, stamina, and hope. The famous scene in Rocky where trainer Mickey Goldmill tells Rocky Balboa to "lay off that pet shop dame", “women weaken legs,” further fueled this belief, reinforcing the belief that sex before competition weakens the body. But does science back this up, or is it merely an outdated myth?

The theory that sex saps energy and impairs performance goes back almost 2,000 years. Abstaining, ancient Greek athletes believed, would enhance aggression and concentration, leading them to become stronger competitors. Even today in the world of sports, people stick to this hypothesis despite the changing scientific findings. But during the Rio 2016 Olympics, officials gave away a staggering half a million condoms to participants—far from a indication that sex was being thought of as a performance-sapping activity.

Although some continue to abstain prior to major events, the real effect of sex on sports performance is still controversial. Is there any basis to the belief that sex inhibits strength and endurance, or is it merely an old wives' tale?

Role of Testosterone in Athletic Performance

Testosterone is an essential hormone that is essential for muscle growth, power, and overall athletic performance. Although men naturally produce more than women, both sexes need testosterone for energy and recovery. Some athletes think not having sex maintains their testosterone levels, providing them with an advantage in the gym or on the field. But is this statement scientifically accurate?

Studies indicate that testosterone levels are not consistent throughout the day but are constantly being produced in the body. Unlike glycogen, which can be stored and used as energy, testosterone is controlled according to the needs of the body. Research does not indicate that having sex depletes testosterone levels significantly—if anything, it can increase them slightly through endorphin and dopamine release.

Does Abstinence Make One Stronger and More Enduring?

Some fitness enthusiasts skip sex before hard workouts because they think it takes away their energy. Although intense physical exercise (including sex) can cause temporary tiredness, there is no scientific evidence to support that sex deteriorates long-term strength or endurance.

A 2016 review article in Frontiers in Physiology reviewed nine studies of sex and performance in sports, and concluded there was no basis to believe sexual activity prior to competition would cause the body to be weakened. Another study, published in 2019 in the Journal of Sexual Medicine, found no statistically significant effect of sex on performance.

Whereas sex shortly before intense exercise may make you momentarily lethargic, it will not impair general performance, stamina, or muscular power. As an alternative, taking sufficient rest, eating appropriately, and exercising with a standard program are many more significant variables.

Can Men 'Save' Their Testosterone Through Abstinence?

It is long believed by some men that ejaculation abstinence will result in a dramatic increase in testosterone. In 2003, researchers from China claimed that men who did not ejaculate for seven days experienced a short-term 45% rise in testosterone. Yet this response was not found to last past the seventh day, and subsequent experiments have been unable to duplicate this effect regularly.

Conversely, some studies show that testosterone levels actually increase slightly after sex, undermining the idea that abstinence is required for optimal performance. The bottom line? The body has a fine balance of hormone production, and sex abstinence is not likely to give any real athletic benefit.

Even though there is no scientific basis, most athletes still feel that sex impacts their performance. It may be because of the placebo effect—if a player believes that not having sex makes him or her stronger, he or she will be more confident and play better. Some players may also feel relaxed and more alert after sex, and this clears their minds for the competition.

Finally, the psychological effect of sexual activity can differ from individual to individual. Sports persons who believe abstinence allows them to remain aggressive may decide to abstain from sex prior to a big event. There are others who believe that sex helps in reducing stress and enhancing sleep and may gain from intimacy pre-competition.

So, Should You Avoid Sex to Enhance your Performance at Gym?

Although the concept of forgoing sex to enhance gym performance has been around for generations, new research indicates that it does not have any noticeable effect on physical ability. Strength, stamina, and overall performance are more affected by training, nutrition, recovery, and psychological readiness than by sex.

If you think that abstinence makes you more aggressive and focused, you can do so without any ill effects. If sex makes you sleep better and relax, you might be increasing your performance rather than diminishing it. The message here is that there's no one-size-fits-all principle—players have to listen to their bodies and play in whatever way best suits them.

Ultimately, there is no scientific rationale for not having sex before you go to the gym or to compete. Whether you abstain or not, therefore, the outcome of your workout will come down to the effort you make, not the activity in the bedroom.

A 24-year-old marathon runner, Rachel Apa, collapsed and died two miles from the finish line at the New York City Marathon. In Hyderabad, 36-year-old IBM software engineer Kommineni Gopi died after suffering a heart attack shortly after completing a marathon.

Apa's death was attributed to rhabdomyolysis, a condition involving severe muscle breakdown, while Gopi died following a heart attack.

According to The New York Times, Apa was a former Division I field hockey player at Bucknell University who had trained for months. Gopi was an experienced amateur runner who had undertaken intensive training and multiple endurance runs.

Although such deaths are rare, the incidents highlight the physical demands of endurance running.

How Common Are Deaths During Marathons?

A study published in JAMA, involving 29.3 million US marathon and half-marathon finishers between 2010 and 2023, found:

• Cardiac arrest: 0.54 per 100,000 participants (1 in 185,000).
• Cardiac death: 0.20 per 100,000 (1 in 500,000).

Dr Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, said survival has improved with better on-site CPR and defibrillation.

Also read: Water Or Electrolytes? Biggest Hydration Mistakes First-Time HYROX Athletes Make

Who Is At Greater Risk?

According to Dr Sudhir, risk factors include:

• Male sex: Cardiac arrest rates are approximately six times higher in men.
• Older age: Risk rises after 40–50 years.
• Underlying heart conditions: Including coronary artery disease, cardiomyopathy and myocarditis.
• Race distance: Full marathons carry higher cardiac arrest risk than half-marathons.
• Environmental stress: Heat, humidity, dehydration and illness.

Can Extreme Running Affect Heart Health?

Regular running is associated with lower cardiovascular and all-cause mortality and better blood pressure and glucose control.

However, prolonged extreme endurance training may increase the risk of atrial fibrillation, coronary artery calcification in some athletes and myocardial fibrosis in a small subset. These risks remain low for most runners.

What Causes Cardiac Arrest During A Marathon?

Read More: Lancet Study: 1 In 4 Adolescents Worldwide Report No Active Days Every Week: What Are The Health Risks?

Causes vary by age. Younger runners (below 35–40 years):

• Hypertrophic cardiomyopathy
• Arrhythmogenic cardiomyopathy
• Congenital coronary anomalies
• Myocarditis
• Inherited arrhythmias

Middle-aged and older runners:

Coronary artery disease is a major cause and can trigger heart attacks or dangerous heart rhythms.

Other causes include heat stroke, severe hyponatremia, aortic dissection, pulmonary embolism and complicated rhabdomyolysis.

What Is Rhabdomyolysis And Why Is It Dangerous?

Rhabdomyolysis occurs when damaged muscles release myoglobin and potassium into the bloodstream. Excess potassium can trigger dangerous heart rhythms, while myoglobin can damage the kidneys.

Warning signs include severe muscle pain, weakness and dark urine.

“A marathon is not ‘normal’ exercise. It is EXTREME exercise. While most people don’t develop a problem, deaths occur rarely too,” said Dr Rajeev Jayadevan, former president of IMA Cochin.

“Rhabdomyolysis (muscle breakdown) releases potassium into the bloodstream that causes cardiac arrest. Later events include BP crash and kidney shutdown,” he added on X.

Cardiac arrests often occur in the final quarter of a race, near the finish line or shortly after completion.

Why Is Marathon Training Important?

Attempting a marathon without adequate preparation can be dangerous.

“If you are not a trained runner, don't run. Running without understanding the science of it, running without being fit, running without having a baseline health check, running without proper stamina and endurance are all recipes to disaster,” warned Dr Deepak Krishnamurthy, director and lead cardiologist at KIMS Hospital, on X.

People over 40, those with diabetes or hypertension, smokers and individuals with a family history of premature heart disease should consider cardiovascular evaluation before intensive training.

How Can Runners Reduce The Risks?

During training:

• Increase mileage gradually.
• Avoid running during illness.
• Stay hydrated and include recovery days.
• Avoid excessive NSAID use.

• Acclimatise to the weather.
• Start at a manageable pace.
• Hydrate according to thirst.
• Stop for chest pain, fainting, unusual breathlessness or palpitations.

What To Do If A Runner Collapses

• Call emergency services.
• Start CPR if the runner is unresponsive and not breathing normally.
• Use an automated external defibrillator (AED) as soon as possible.

Early CPR and defibrillation can improve survival.

Marathons offer health benefits, but runners need adequate preparation and should recognise warning signs rather than push through them.

With Delhi's air quality nearing 400, doctors have advised people to reconsider their morning workout routines. Outdoor activities such as walking, jogging and cycling can increase exposure to harmful pollutants, particularly when air quality levels are poor.

While regular exercise is important for good health, exercising outdoors when pollution levels are high can affect respiratory and cardiovascular health.

Experts told HealthandMe that adjusting workout timings and choosing indoor alternatives can help reduce exposure.

Delhi's air quality deteriorated to the very poor category on Friday morning, with an Air Quality Index (AQI) reading of 391, just days before Diwali.

Forecasts indicate that the AQI could exceed 400 and enter the severe category between Friday and Sunday, with no immediate relief expected. Around 30 of the 59 monitoring stations across the national capital recorded severe pollution levels on Friday morning, with Rohini reporting an AQI of 475.

Should You Change Your Morning Workout Routine?

Dr Arunesh Kumar, Director and HOD, Pulmonology, Paras Health, Gurugram, told HealthandMe that when AQI levels are high, outdoor activities such as morning walks, jogging and cycling increase exposure to pollutants, particularly because breathing becomes faster during exercise.

Experts recommend moving workouts indoors when pollution levels are high. Yoga, stretching, weight training and low-intensity exercises can help you maintain your fitness routine.

"It's important to check the daily AQI before you go out and to consider moving your exercise indoors when the air quality is poor. You can maintain your exercise regime indoors with yoga, stretching, light strength training and the like. A well-ventilated indoor space is preferable and of course you should avoid doing your exercise near major traffic routes," Dr Arunesh said.

Also read: With Delhi AQI Nearing 400, Pollution & Flu Loom Ahead Of Diwali: What Happens When Both Hit Your Lungs?

What Indoor Exercises Can You Do When AQI Is High?

If air pollution levels are high, you can maintain your fitness routine by moving your workouts indoors. Some alternatives include:

• Yoga: Practise yoga indoors to stay active.
• Stretching: Include gentle stretching exercises in your daily routine.
• Weight training: Opt for indoor strength-training exercises.
• Low-intensity exercises: Choose light workouts that can be done indoors.

How Does PM2.5 Affect Your Health?

"Your breathing rate increases whilst working out, meaning that the pollutants you're breathing can get further into your lungs. This can lead to issues with your breathing and heart over time. Checking your AQI before going on a run/walk/cycle can help create a healthy lifestyle," Dr Rajesh Kumar Gupta, Director, Respiratory Medicine and Interventional Pulmonology, Yashoda Medicity, told HealthandMe.

People with asthma or heart conditions, children and older adults should be particularly careful about exposure on days with high pollution.

Read More: Air Pollution In Delhi: Experts Warn Of Red Eyes, Itching, Watering In Children

How Can You Maintain A Healthy Fitness Routine?

Poor air quality does not mean you need to stop exercising altogether. Experts recommend adapting your routine according to pollution levels.

• Check the AQI: Monitor daily air quality levels before planning outdoor activities.
• Move workouts indoors: Choose yoga, stretching, weight training or other indoor exercises when pollution levels are high.
• Avoid traffic-heavy areas: If you exercise outdoors, avoid major roads and congested areas.
• Stay hydrated: Drink enough water throughout the day.
• Eat a balanced diet: Include fruits, vegetables and whole grains in your meals.
• Prioritise sleep: Get sufficient rest.
• Avoid smoking: Smoking can further affect your health.

Lifestyle choices such as eating a balanced diet, staying hydrated, sleeping well and avoiding smoking support overall well-being, although they cannot prevent the harmful effects of air pollution.

The aim is not to stop exercising but to modify physical activity according to air quality conditions, said the experts. People with respiratory conditions, heart disease, older adults and children should be particularly mindful of their exposure on high-pollution days.

Physical activity is essential for physical and mental health. The World Health Organization (WHO) recommends at least 60 minutes of moderate-to-vigorous physical activity (MVPA) daily for adolescents.

However, a new study has found that one in four (25%) adolescents worldwide – around 240 million young people – reported no active days every week.

An active day is defined as one involving at least 60 minutes of MVPA, including activities that raise the heart rate or breathing rate, such as walking, cycling and sports.

Published in The Lancet Global Health, the global analysis found that adolescent physical activity levels have remained persistently low over the past 15 years.

Key Findings: Adolescent Physical Activity Remains Low

Also read: 24-Year-Old Marathon Runner Dies Before Finish Line Due To Muscle Breakdown: What Is Rhabdomyolysis?

The study analysed 389 population-based surveys from 140 countries and territories, involving 3.2 million adolescents.

In 2025, adolescents averaged just 2.7 active days per week, with only 14% being active every day. The proportion reporting fewer than seven active days has remained unchanged since 2010, and no country is on track to meet the 2030 global target.

Most low- and middle-income regions had higher proportions of adolescents reporting no active days. Some high-income regions recorded small improvements.

The proportion of adolescents reporting no active days ranged from 4% to more than 40% across countries.

Daily activity levels also varied. Finland (28%) and Canada (25%) were above the global average of 14%, while Sweden and Norway stood at 17%, Germany at 13%, France at 11% and Italy at 9%.

"One in four teens worldwide are not active for even one hour on any day of the week. We know this affects their physical and mental health today and for the rest of their lives. We have the power to change this as a society. We can empower teens to be active every day and create inclusive policies to reach that 25% of teens who are not active on any day," said Professor Seth Flaxman from the School of Geography and the Environment, University of Oxford/RPTU University Kaiserslautern-Landau.

Gender Gap: Why Are Girls Less Physically Active?

Read More: Want to Live Longer? Here's How Much Exercise You Should Do

Girls were found less active than boys. Globally, 28% of girls reported no active days, compared with 22% of boys. Only 11% of girls were active every day, compared with 17% of boys. Their weekly average was also lower at 2.4 days, compared with three days among boys.

The study pointed out to restrictive gender norms, safety concerns and a lack of suitable activities as barriers to girls' participation in physical activity.

It calls for gender-responsive programmes and government policies that make schools and neighbourhoods safer and more conducive to physical activity.

What Are The Health Risks Of Physical Inactivity?

Regular physical activity during adolescence helps establish healthy habits that can protect against chronic diseases later in life. Physical inactivity can increase the risk of obesity, heart disease and type 2 diabetes. It can also affect bone development, mental health and cognitive function.

WHO recommends an average of at least 60 minutes of moderate-to-vigorous physical activity daily for children and adolescents.

On the other hand, the benefits include better physical health, improved mental well-being, enhanced learning and educational outcomes, and greater social connection and inclusion in the short term.

Over time, physical activity can lower the risk of noncommunicable diseases, promote healthier adult lifestyles, and improve productivity and quality of life. For the next generation, it can contribute to healthier families, stronger communities and reduced future health burdens.

WHO Calls For Stronger Action

WHO says encouraging adolescents to move more is not enough. Governments must create environments that make physical activity an accessible part of everyday life.

The organisation is calling for action across education, transport, urban planning, sport and health.

"We need to make being active the easy and enjoyable choice. Adolescents need safe routes to walk, cycle, wheel or scoot to school. They need green spaces to explore. They need opportunities to be active throughout the school day, not just in PE," said lead author Dr Tessa Strain from the University of Edinburgh.