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10NEWS CORNERDr. TAM John-Hugh, Specialist in Family MedicineMr. Mak Cheuk-Hang, Registered PhysiotherapistIntroductionIn recent years, the proliferation of 24-hour self-service gymnasiums in Hong Kong has mirrored a global surge in health consciousness, driven by urban lifestyles that demand flexibility. These facilities, often embedded in residential estates and commercial buildings, offer unrestricted access, appealing to busy professionals who exercise at dawn or midnight.While this model promotes physical activity amid sedentary routines, it poses unique challenges. Family physicians must advise patients on the physiological risks associated with untimely workouts, particularly for those with chronic conditions. Understanding circadian rhythms and individual health profiles is crucial to maximising benefits while minimising harm, ensuring exercise remains a pillar of preventive care rather than a hazard.The theory and evidence%u2026The advent of 24-hour gymnasiums has democratised fitness, allowing individuals to integrate exercise seamlessly into hectic schedules. However, this convenience belies potential health pitfalls, especially during early morning or late-night sessions. From a physiological standpoint, the human body adheres to a circadian rhythm that influences physical performance and injury susceptibility.3-5 In the early hours, core body temperature is lower, and muscle and joint flexibility is reduced, heightening the risk of strains or sprains during vigorous activity. Conversely, late-night exercise occurs after a day of accumulated fatigue, impairing coordination, focus, and recovery due to diminished sleep quality.Patients with chronic illnesses require particularly tailored guidance. Cardiovascular conditions warrant caution; guidelines from the American Heart Association (AHA) and the American College of Sports Medicine (ACSM) recommend avoiding high-intensity exercise in the morning for those with coronary artery disease or heart failure.1 This period coincides with the peak occurrence of cardiovascular events, exacerbated by fluctuations in blood pressure and heart rate, potentially triggering angina or arrhythmias. Hypertensive patients face the %u2018morning surge%u2019 phenomenon, where blood pressure naturally elevates upon waking; intense workouts can amplify this, escalating stroke risk.1Resistance training poses additional concerns for hypertensives. Valsalva manoeuvres%u2014holding one%u2019s breath during lifts%u2014can cause intrathoracic pressure spikes, leading to acute blood pressure surges.1 Pre-exercise blood pressure monitoring is essential: systolic readings above 160 mmHg or diastolic above 100 mmHg necessitate postponement until control is achieved; levels exceeding 200 mmHg (systolic pressure) or 110 mmHg (diastolic pressure) signal an emergency requiring immediate medical attention.1For individuals with diabetes, we should bear in mind the potential of exercising during extreme hours disrupting glycaemic stability. Late-night sessions may induce delayed hypoglycaemia in insulin users, while morning fasted workouts risk low blood sugar if control is suboptimal.1Self-monitoring is imperative, with exercise advisable only when blood glucose falls between 5.6 and 13.9 mmol/L.1Joint and musculoskeletal issues compound these risks; arthritis sufferers experience heightened morning stiffness, increasing flare-up likelihood during abrupt activity.2 Asthmatics, particularly in Hong Kong%u2019s variable climate, may encounter exacerbations from diurnal temperature shifts in early workouts.Optimal timing for chronic disease patients typically favours daytime hours when staffed facilities offer supervision and personal energy levels peak.1, 2 Yet, lifestyle constraints often dictate otherwise. In such cases, commencing with low-intensity activities, such as stretching and flexibility exercises, walking or light cycling, allows gradual adaptation. Anticipatory Care - 24-Hour Gymnasiums: Considerations for Safe Exercise in Extreme Hours?