Form & Fitness Q & A
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Fitness questions and answers for July 8, 2008
The Cyclingnews form & fitness panel
Carrie Cheadle, MA (www.carriecheadle.com)
is a Sports Psychology consultant who has dedicated her career to helping
athletes of all ages and abilities perform to their potential. Carrie
specialises in working with cyclists, in disciplines ranging from track
racing to mountain biking. She holds a bachelors degree in Psychology
from Sonoma State University as well as a masters degree in Sport Psychology
from John F. Kennedy University.
Jon Heidemann (www.peaktopeaktraining.com)
is a USAC Elite Certified cycling coach with a BA in Health Sciences from
the University of Wyoming. The 2001 Masters National Road Champion has
competed at the Elite level nationally and internationally for over 14
years. As co-owner of Peak to Peak Training Systems, Jon has helped athletes
of all ages earn over 84 podium medals at National & World Championship
events during the past 8 years.
Dave Palese (www.davepalese.com)
is a USA Cycling licensed coach and masters' class road racer with 16
years' race experience. He coaches racers and riders of all abilities
from his home in southern Maine, USA, where he lives with his wife Sheryl,
daughter Molly, and two cats, Miranda and Mu-Mu.
Kelby Bethards, MD received a Bachelor of
Science in Electrical Engineering from Iowa State University (1994) before
obtaining an M.D. from the University of Iowa College of Medicine in 2000.
Has been a racing cyclist 'on and off' for 20 years, and when time allows,
he races Cat 3 and 35+. He is a team physician for two local Ft Collins,
CO, teams, and currently works Family Practice in multiple settings: rural,
urgent care, inpatient and the like.
Fiona Lockhart (www.trainright.com)
is a USA Cycling Expert Coach, and holds certifications from USA Weightlifting
(Sports Performance Coach), the National Strength and Conditioning Association
(Certified Strength and Conditioning Coach), and the National Academy
for Sports Nutrition (Primary Sports Nutritionist). She is the Sports
Science Editor for Carmichael Training Systems, and has been working in
the strength and conditioning and endurance sports fields for over 10
years; she's also a competitive mountain biker.
Eddie Monnier (www.velo-fit.com)
is a USA Cycling certified Elite Coach and a Category II racer. He holds
undergraduate degrees in anthropology (with departmental honors) and philosophy
from Emory University and an MBA from The Wharton School of Business.
Eddie is a proponent of training with power. He coaches cyclists (track,
road and mountain bike) of all abilities and with wide ranging goals (with
and without power meters). He uses internet tools to coach riders from
David Fleckenstein, MPT (www.physiopt.com)
is a physical therapist practicing in Boise, ID. His clients have included
World and U.S. champions, Olympic athletes and numerous professional athletes.
He received his B.S. in Biology/Genetics from Penn State and his Master's
degree in Physical Therapy from Emory University. He specializes in manual
medicine treatment and specific retraining of spine and joint stabilization
musculature. He is a former Cat I road racer and Expert mountain biker.
Since 1986 Steve Hogg (www.cyclefitcentre.com)
has owned and operated Pedal Pushers, a cycle shop specialising in rider
positioning and custom bicycles. In that time he has positioned riders
from all cycling disciplines and of all levels of ability with every concievable
cycling problem. Clients range from recreational riders and riders with
disabilities to World and National champions.
Current riders that Steve has positioned include Davitamon-Lotto's Nick
Gates, Discovery's Hayden Roulston, National Road Series champion, Jessica
Ridder and National and State Time Trial champion, Peter Milostic.
Pamela Hinton has a bachelor's degree in Molecular
Biology and a doctoral degree in Nutritional Sciences, both from the University
of Wisconsin-Madison. She did postdoctoral training at Cornell University
and is now an assistant professor of Nutritional Sciences at the University
of Missouri-Columbia where she studies the effects of iron deficiency
on adaptations to endurance training and the consequences of exercise-associated
changes in menstrual function on bone health.
Pam was an All-American in track while at the UW. She started cycling
competitively in 2003 and is the defending Missouri State Road Champion.
Pam writes a nutrition column for Giana Roberge's Team Speed Queen Newsletter.
Dario Fredrick (www.wholeathlete.com)
is an exercise physiologist and head coach for Whole Athlete™. He is a
former category 1 & semi-pro MTB racer. Dario holds a masters degree in
exercise science and a bachelors in sport psychology.
Scott Saifer (www.wenzelcoaching.com)
has a Masters Degree in exercise physiology and sports psychology and
has personally coached over 300 athletes of all levels in his 10 years
of coaching with Wenzel Coaching.
Kendra Wenzel (www.wenzelcoaching.com)
is a head coach with Wenzel Coaching with 17 years of racing and coaching
experience and is coauthor of the book Bike Racing 101.
Steve Owens (www.coloradopremiertraining.com)
is a USA Cycling certified coach, exercise physiologist and owner of Colorado
Premier Training. Steve has worked with both the United States Olympic
Committee and Guatemalan Olympic Committee as an Exercise Physiologist.
He holds a B.S. in Exercise & Sports Science and currently works with
multiple national champions, professionals and World Cup level cyclists.
Through his highly customized online training format, Steve and his handpicked
team of coaches at Colorado Premier Training work with cyclists and multisport
athletes around the world.
Richard Stern (www.cyclecoach.com)
is Head Coach of Richard Stern Training, a Level 3 Coach with the Association
of British Cycling Coaches, a Sports Scientist, and a writer. He has been
professionally coaching cyclists and triathletes since 1998 at all levels
from professional to recreational. He is a leading expert in coaching
with power output and all power meters. Richard has been a competitive
cyclist for 20 years
Andy Bloomer (www.cyclecoach.com)
is an Associate Coach and sport scientist with Richard Stern Training.
He is a member of the Association of British Cycling Coaches (ABCC) and
a member of the British Association of Sport and Exercise Sciences (BASES).
In his role as Exercise Physiologist at Staffordshire University Sports
Performance Centre, he has conducted physiological testing and offered
training and coaching advice to athletes from all sports for the past
4 years. Andy has been a competitive cyclist for many years.
Michael Smartt (www.wholeathlete.com)
is an Associate Coach with Whole Athlete. He holds a Masters degree
in exercise physiology, is a USA Cycling Level I (Elite) Coach and is
certified by the NSCA (Certified Strength and Conditioning Specialist).
Michael has more than 10 years competitive experience, primarily on the
road, but also in cross and mountain biking. He is currently focused on
coaching road cyclists from Jr. to elite levels, but also advises triathletes
and Paralympians. Michael is a strong advocate of training with power
and has over 5 years experience with the use and analysis of power meters.
Michael also spent the 2007 season as the Team Coach for the Value Act
Capital Women's Cycling Team.
Earl Zimmermann (www.wenzelcoaching.com)
has over 12 years of racing experience and is a USA Cycling Level II Coach.
He brings a wealth of personal competitive experience to his clients.
He coaches athletes from beginner to elite in various disciplines including
road and track cycling, running and triathlon.
Advice presented in Cyclingnews' fitness pages is provided for educational
purposes only and is not intended to be specific advice for individual
athletes. If you follow the educational information found on Cyclingnews,
you do so at your own risk. You should consult with your physician before
beginning any exercise program.
Blood in urine, gross hermaturia
Sugar and honey
Question on rhabdomyolysis
Pain between the shoulder blades
Blood in urine, gross hermaturia
I'm a 42 year old male who is a weekend warrior type rider from the Seattle
Tacoma area. I mostly ride for fun and exercise, when I'm not training for anything
specific I usually ride 40 to 60 miles without much thought. Lately I have been
training for a 150 mile 10,000 vertical ride around Mount Rainier some friends
and I are planning. My training rides have been somewhat sporadic 40 to 60 miles
here or there usually incorporating large hills, plus a couple 100 milers. For
the most part the spring in the northwest has been cold 50-60F and wet. Last
Saturday after 2 weeks of only minimal riding I did a 107 mile with two big
climbs of about 3000 feet and 2000 feet, with a total of about 7000 vertical.
The weather was much hotter than it had been 80F in town.
I felt pretty good on the first climb and climbed at my usual long climb output
of about 180-184bpm, although staying hydrated was difficult. The second climb
was more exposed to the sun, after about mile one out of six on the second climb
I started to feel bad (a little worse than usual), so I dropped my speed substantially
lower than previous times (15%) and tried to keep my heart rate below 180bpm.
I ate a little while still on the bike and kept drinking as much as I could
tolerate while resisting the temptation to get off the bike or turn around,
I really craved shade.
I just ground it out and at the top I got off the bike and started sweating
profusely. I felt pretty uncomfortable and my heart rate was a little rapid,
which isn't uncommon for me in high heat and exertion situations, but it seemed
a little worse than usual. My riding companions reported my face to be flush.
I definitely felt on the edge of a heat related event. We took an hour break
or so, during which I almost called for a pick-up; I wasn't able to eat much,
just some chips and a little pasta. Lack of appetite is pretty normal for me,
but I drank a soda and some water.
Since it was 40 miles mostly downhill to the car, and most of the general discomfort
had gone away I decided to continue. I cut my pace to below 170bpm and slugged
it out. My legs felt better than they had at that point on previous rides and
even had a bit of a kick at the end. When I got home I had lost 4 pounds. I
felt I ate as much as I normally do, drank as much as I could take in (maybe
a little more earler in the ride), and went to the bathroom a little more frequently
than usual, but felt I needed to do better with electrolytes. The next day I
noticed some blood in my urine and my lower back had a dull ache.
I contacted a Dr who told me to drink a half a gallon of energy type drink
and if it didn't go away, go to t he ER and get a CPK test to evaluate muscle
break down. I drank as directed plus some more water and the pink colour went
away within a couple hours. Tomorrow I am going to consult with my regular Dr.
My questions for you are:
Based on research on the internet this seems common among long distance runners
and strenuous exercise, but no mention of cycling, I think it was referred to
as exercise hermaturia. Is this common in cyclists?
What can causes blood in the urine with these types of circumstances? Was it
the kidney shutting down or not working properly due to dehydration or heat
How serious of trouble was I in?
What are the short and longer term ramifications?
Can I resume my training as long as the symptoms don't return?
Other than stopping when I feel bad what can I do to prevent this type of problem?
Scott Saifer replies:
You were right to contact the doctor with this issue. I've worked with more
than 1,000 cyclists (road and MTB racers, ultra-endurance, century and even
BMX) and not run into blood in urine before. That doesn't mean it doesn't
happen in cyclists (I'm sure 20 or 30 are getting ready to write me as they
read this), but it does mean it's very rare.
The rest of your questions about training and long-term implications should
be directed to your doctor.
Sugar and honey
I limit my sugar intake but am perplexed as to why I keep being told I can
eat honey. Does the source of the sugar affect its effect on the body?
Doesn't honey have tons of calories and almost the same glycemic index as white
sugar? Why would it not act the same on the body? Would honey not count on that
magic 'calories in vs calories out' balance?
In the same vein wouldn't the sugar in fruit also count as sugar?
As an aside I find that my mind crashes after eating white sugar. I have to
have a very brief cat nap to restore function. Honey doesn't do that? Can you
explain that phenomenon? That's how I can tell if I've had white sugar by accident.
If it was in something but not listed or in someone's home made dish at the
pot luck I can tell afterwards.
Is there some article that explains the effect of sugar at the cellular level
and the differences in effect of the sources and types of sugar?
Pamela Hinton replies:
Not all sugars are created equal. The most basic sugars consumed by humans
are glucose, fructose, and galactose. Glucose is actively absorbed in the
intestine, so ingestion of glucose causes a rapid increase in blood glucose
levels. In turn, an elevation in blood glucose stimulates insulin release
to promote glucose uptake by liver and fat cells. Glucose is the standard
by which the glycemic index of other foods is evaluated.
The glycemic index, which reflects the magnitude of the increase in blood
glucose, is set at 100 for glucose. Fructose is absorbed by a different mechanism
than glucose and the magnitude of its effects on blood glucose is much less.
The glycemic index of fructose is ~20. Similarly, fructose does not stimulate
secretion of insulin from the pancreas. Unfortunately, large amounts of fructose
entering the liver promotes fat synthesis and increased release of triglycerides
from the liver.
Table sugar is sucrose - one molecule of glucose bound to one molecule of
fructose. As a result, the digestion and absorption of sucrose and its effects
on blood glucose are intermediate to those of glucose and fructose. The glycemic
index of sucrose is ~60. The sugar in honey is about half glucose, half fructose.
As a result, honey as a lower glycemic index than table sugar (sucrose) at
~50. It's important to remember that the glycemic index is for the food consumed
alone. Consumption of a high-glycemic-index food with fat or protein lowers
the glycemic index of the meal.
Although honey has a slightly greater caloric content than table sugar (22
vs. 16 kcal/teaspoon), honey also tastes sweeter than table sugar, so you
may not need to consume as much of it to achieve the desired sweetness.
Question on rhabdomyolysis
I have a dear friend (and tremendous cycling buddy) who is now struggling with
rhabdomyolysis, and has brought him to the point that he cannot ride or perform
any physical exertions without hard cramping in his leg muscles. To be honest,
we're kind of scared about this because of the perceived risk of irreversible
kidney and heart damage.
His medical attention has been unsatisfactory thus far. He's on the standard
military medical treatment system where generalists give uncaring general answers
and send the soldier back to work. The doc's have given the standard responses
for what caused this condition:
1. Dehydration, or
2. Getting crushed by a building. Neither of those happened.
This is a military guy who is in his early 40's, has competed in loads of triathlons
and road races, and does the electrolyte & hydration balance equations in his
head. This is the guy who looks at the snacks in my pockets and stuff in my
water bottle and hands me extra goodies he brought along because he knew I wouldn't
do the nutrition/electrolyte/hydration calculations. And he hasn't been crushed
by any buildings.
On the first go-round his protein counts were 3000-7000, and the fine military
healthcare system treated him with an IV to hydrate him and oxycontin for discomfort.
That was over a year ago and it took months for his protein levels to drop and
for him to be able to walk across the room without cramps. Quite a setback for
a guy who could average 26 mph+ on the bike split in a triathlon.
Now it's back, and the doc's are claiming the same thing: dehydration or traumatic
injury. Neither is even remotely possible. He gained over 10 lbs the first day
So, a couple of questions:
1) What kind of specialist would know most about this?
2) Where to get good information for support?
3) Are there known case histories of other endurance athletes where this has
Kelby Bethards replies:
So, I agree with you. something is wrong. He needs further testing and this
needs looked into.
Questions a doc should ask (at a minimum). Is he on medications (cholesterol
meds in particular)? Does his urine change colour with this? Do all of his
muscles hurt everyday?
CPK (muscle breakdown indicator)
ESR (inflammatory marker)
CRP (inflammatory marker)
Creatinine and BUN levels (simple blood test for kidney function)
Urine tests (myoglobin, protein, etc)
This, to me, is a starting point. He probably needs to go see a Rheumatologist.
They will order a whole other battery of test and so on.
In my humble opinion, your friend needs to pursue this further and find out
what is wrong. I would be worried about an autoimmune inflammatory myopathy
or something along those lines, but without seeing your friend its hard to
pin down. IT definitely need looked into further.
As a rule, I try to avoid taking new-age supplements and pills. That being
said, I am very interested in appetite suppressants. I feel like I am doing
everything on the bike I can to achieve race weight, but the pounds are still
not coming off. I ride hours of tempo at 45-55% MHR. I take a spin in the morning
to get my heart rate up before going to work. Sometimes I take a nap in the
afternoon to get an extra burst of HGH.
I have even started taking green tea supplements, a general vitamin, and omega-3s.
This is all on top of drinking water like it's my full-time job. I think I know
my downfall: I love carbs, and lots of them. Would any of the over the counter
appetite suppressants be a safe/effective addition to my daily routine?
Richard Stern replies:
Are you sure that you mean 45 - 55% MHR? That would seem like a rather low
Lastly, carbohydrates would not be your downfall. They're pretty much essential
for fuelling so that you can exercise. However, incorrect weight management
would be down to an excess of energy rather than any particular macronutrient.
That is, if you consume too much energy for the work that you do you'll ending
up gaining weight (fat mass) (irrespective of what the fuel source was that
Pain between the shoulder blades
I'm a 36yo male, who is probably best described as a runner who loves cycling.
At the moment I ride 5~8000km/yr and the only racing I've done is triathlon/multisport.
My issue is the gradual onset of a pain between my shoulder blades on longer
rides. I have no hint of it for the first couple of hours, and then it gradually
creeps up on me over the next hour or so. After 3hrs it's usually pretty bad,
and by 4hrs its pretty much all I'm thinking about.
At first I suspected bike position, but over the past year or so I've being
doing some riding on an mtb, and I've found the problem persists. While my seat
height/angle measurements are identical on both bikes, the reach and drop to
the handlebars is much reduced on the mtb, leading me to wonder whether bike
position isn't the issue, or at least not the only issue. (BTW, I've used Steve's
balance test to assess my road bike position and have no trouble taking my hands
off the bars.)
I'm guessing a couple of things could be contributing: on the longer, cruisy
rides I tend to relax down onto the bars a bit, which tends to hunch my shoulders.
Also, I don't tend to vary my position much (sit up, stretch, etc) until I notice
the pain. Could either or both of these be contributing? And are there any stretches,
or exercises, or weights I should be doing that could help reduce the problem?
Scott Saifer replies:
When you say "between the shoulder blades", is that low or high? I've seen
pain low between the shoulder blades when the bars are too wide, which might
explain why you have it on both the road and MTB even though the positions
are very different. On the road bike the center-to-center spacing of the drops
should match your "acromion process spacing."
You'll need an assistant to measure this. Have them stand behind you and
measure the distance between the outermost bony spots on the top of your shoulders
(not the tops of your arm bones which are a bit lower).
Pain high between the shoulder blades often comes from craning the neck up
to see down the road with bars too low. Most likely this is not your issue
since you have the pain on the MTB, but you can test to be sure.
As you are riding along on the drops or on the MTB in normal position in
some large, open safe place or on a trainer, look down at the ground, then
slowly raise and lower your head to identify how high you can look with no
tension in the back of your neck. Then roll your eyes up and down to find
the highest you can look without straining your eyes. Now look down the road
the highest you can with no neck or eye strain. If you are looking high enough
to comfortably see where you are going, your bars are high enough. If not,
low bars are probably the cause of at least some of your pain.
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