Table 3.

Questions to Aid in Identifying EAMC Risk Factors^a

Question	Justification	Risk Factor
1. Do you have any illnesses, allergies, or medical conditions?	Muscle cramping may be associated with allergies or diseases.35	Underlying illness
2. Did EAMCs occur after a change or start of medication or drug use?	Muscle cramping may be associated with medication use (eg, β2-agonists).35	Medication side effect
3. Do you regularly cramp during exercise?	Muscle cramping has a genetic component. Asking about a history of EAMC is helpful for identifying recurrent crampers.4,29,48	Multiple mechanisms
4. How intensely and long were you exercising before you developed an EAMC?	Athletes with the fastest actual and predicted race times are most likely to experience EAMCs.2,22,30	Fatigue
5. When did the EAMC occur during exercise (ie, beginning, middle, or end)?	Near the end of exercise or competition is most common.1,20	Fatigue
6. How much sleep did you get the night before your exercise session when the EAMC occurred?	Sleep loss reduces muscle glycogen and time to exhaustion.49	Premature fatigue
7. How hot and humid was it when you developed the EAMC?	Though EAMCs occur most frequently in summer months (eg, August),7 they can occur under any environmental conditions.	Hypohydration, premature fatigue, unacclimatized to environment
8. Was the exercise session during which the EAMC occurred novel in any way?	Untrained individuals and those participating in events that are more strenuous than anticipated are more prone to EAMCs.2,31	Overexertion, fatigue, or both
9. What was your diet like in the days preceding the EAMC? Was your diet nutritious, balanced (ie, containing the major essential nutrients such as protein, fat, and carbohydrates), and varied (ie, nutrients coming from fruits, vegetables, meats)?	Diets low in carbohydrates may reduce muscle glycogen and the amount of work or exercise performed.38 Athletes' diets should be well balanced and include electrolytes and carbohydrates to stave off fatigue.35	Premature fatigue
10. Did you consume supplements or stimulants (eg, caffeine) before or during your exercise session?	Stimulants and supplements can increase the excitability of the nervous system.55	Overexcitation of nervous system
11. Were you recently injured?	Pain21 and prior injury30,31 predict cramping.	Overexcitation of nervous system
12. What was your psychological state during the exercise session when the EAMC developed?	Stress or unrealistic expectations may increase nervous system excitability.22,30	Overexcitation of nervous system
13. Did you consume enough fluids, electrolytes, or both to replace your sweat losses?	The contribution of sweat losses to EAMCs is minor for most athletes.13,14,16 However, American football players with an EAMC history may benefit from fluid and electrolyte monitoring.14	Hypohydration, premature fatigue
14. Did the EAMC tend to stop once you stopped the activity?	Activity cessation, reduced pace, or both can relieve EAMCs.1,3	Overexcitation of nervous system
15. Do the EAMCs tend to occur only in the muscles that are doing the most work?	Working muscles tend to be most affected, and EAMCs may be mitigated with reeducation of synergistic muscles.3	Overexcitation of nervous system
16. Did the EAMC occur during training or during competition?	Although EAMCs can occur at any time and in any sport, they tend to affect athletes who run faster or exercise harder during competitions than during training.2,22,30,31	Overexcitation due to stress of competition, premature fatigue due to overexertion

Abbreviation: EAMC, exercise-associated muscle cramp.

^aAfter questions 1 and 2, the items appear in no particular order or level of importance. Adapted from Miller.⁴