Form & Fitness Q & A

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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 any geography. 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.

Fitness questions and answers for February 18, 2009

Crohn's disease and cycling
Refuelling on the bike
Riding at altitude
Arch cleat positioning and shimming
In-shoe wedges
Recovering cardio function
Stationary bike

Crohn's disease and cycling

I'm a 28-year-old recreational rider who likes to ride four to five times a week, I start by building up easily and when I'm in shape, my longest rides are about 160 km (ore about 100 miles). I also like climbing the French mountains, but also at a recreational pace. As you notice, I'm not exactly a pro, but I always like to get in better shape.

I've been recently diagnosed with Crohn's disease, which is also a cause of anaemia (lowest hematocrit ever measured was 27, most of the time it's about 35). This of course doesn't help my riding. The doctors at the hospital were very helpful and gave me all the medicines I need to control my disease, but they couldn't give me much info about Crohn's and sports.

There are two big issues:

My body refuses to absorb iron. I take iron supplements (each day I take 3 times the dose a normal person should take and extra vitamin C, because it helps the iron absorption (both on doctors prescription), but my hematocrit and haemoglobin levels stay low

Because of the disease, my body doesn't absorb much proteins either. I take protein supplements after hard trainings, but would it help if I would drink protein drinks on a more regular (daily) basis?

So, apart from more training, what could help me to get in a better shape? Proteins? More iron supplements? Any other training tips for Crohn's patients?

Bram

Pam Hinton replies

As you are well aware, Crohn's disease is a type of inflammatory bowel disease. Although the inflammation and scarring can affect any region of the gastrointestinal tract, typically the ileum (part of the small intestine) and colon are affected. The inflammation caused by Crohn's disease damages the mucosa, where nutrient absorption occurs. As a result, the ability of the intestine to do its job is severely compromised.

Weight loss is common due to reduced intake because of abdominal pain, cramping, and diarrhoea. In addition, the ability of the intestine to absorb the energy-yielding macronutrients, in particular, protein and fat, may be reduced. Special liquid diet formulations are available that provide partially digested proteins, as amino acids (elemental diet) or small peptides (polymeric diet). These require a physician's prescription, but you can also buy liquid supplements with partially hydrolysed proteins that may increase the amount of protein you absorb. Consumption of small amounts of protein at higher frequency may also increase the amount absorbed.

Iron deficiency is common in individuals with Crohn's disease due to poor intake and blood losses via the gastrointestinal tract. Deficiency of vitamin B12 is also common, as it is absorbed in the ileum. Anaemia can result from deficiency of iron and/or vitamin B12. Both B12 and iron can be administered via injection if needed. Individuals with Crohn's are at risk for osteoporosis (loss of bone) because of both the disease and the corticosteroids that are used to treat the disease. Therefore, most individuals take supplemental calcium and vitamin D.

If you haven't already done so, you might talk to a dietitian who specialises in inflammatory bowel disease. Good luck!

Refuelling on the bike

I previously suffered tummy problems and declining levels in longer events (three hours), so for the last six months or so I've been mixing my own sports drink. Based in no small part on the advice provided on Cyclingnews by Pam Hinton (thanks Pam!).

Here's my recipe: 50g glucose powder, 1.25g white sugar, 1.25g salt and 50ml lemon juice, made up to 700ml with water. (The lemon juice is to make it drinkable.)

If I've got my sums right, that equates to between seven and eight percent carbohydrate (of which between two and three percent is fructose and the balance glucose) and 500mg of sodium per bidon. I try to down one bidon every hour (constant sipping). I also take 200mg of caffeine about five minutes before an event or hard ride and another 100mg every three hours thereafter.

Assuming I've done the maths correctly (which is far from a certainty), am I right in thinking that I'm taking in more-or-less as much as my body can handle while exercising? The reason I ask is that despite the amount (of fluid) in my gut, I find myself craving solid food. Is there anything I else I can eat/drink that isn't going to upset my carb uptake?

Any advice would be greatly appreciated.

Vince P
Melbourne, Australia

Scott Saifer replies:

It sounds like your mix contains about 200 Calories. You didn't say how big or fit you are, but most riders can absorb something closer to 250-325 Calories per hour, with larger and fitter riders able to absorb more, so you've made a good start but could indeed add some solid food to the regimen.

You didn't say if you have tummy problems in response to any particular food, so I'll give my general recommendation for during-ride food: You want foods that are mostly carbohydrate in readily digestible form. Foods that have worked for cyclists for years, aside from "energy" bars and gels, include: boiled red potatoes, yams cooked until soft, sandwiches, fig-bars, bananas, bagels, dried fruit...

Riding at altitude

I think to my general excitement I have successfully made it through the lottery and I am now entered in this year's Leadville 100 MTB race. The key distinguishing feature of the event is that it starts at 10,200ft above sea level, eventually hitting a max elevation of 12,600ft. While potentially desirable I cannot move to CO three weeks ahead of the race and acclimate nor will my will my wife let me modify our bedroom for a bariatric chamber.

In the past I have not had issues with altitude - whether biking or snowboarding - other than being careful to stay hydrated and that it is more difficult to sleep. I will be 50 on race day, I would be viewed as pretty fit for a serious recreation rider, I have broad experience with long distance rides involving numerous mountain climbs and I train in a very structured way using a power meter.

My questions are: given that I basically live at sea level, what can I do to either modify my training or otherwise prepare myself for the event and the unique challenges posed to athletic performance by the altitude of this race?

Mike Weinstein

Scott Saifer replies:

There are two issues here: Acute and chronic altitude adjustment: While three weeks of altitude exposure before the event might be ideal, as little as five days is enough to get you past the acute dehydration stage of altitude adjustment and improve your performance beyond what you can do if you arrive the day before the event. The acute dehydration stage takes about 18 hours to kick in so if you can't get there most of a week early, getting to altitude at the last possible moment, just hours before the race, is better than getting there a day or two before.

You can work on the chronic part without going to live at altitude permanently. Going to the mountains for a few weekends in the months before Leadville will stimulate an increase in hematocrit that will help you perform better at altitude whether you arrive early or late.

And by the way, you can't "keep hydrated" by drinking a lot when you arrive at altitude. When you get to altitude your body initially adjusts by reducing water content to thicken the blood. Certainly drink enough to keep peeing, but if you drink more, you'll just pee more.

Kelby Bethards replies

About the acute acclimation. Dehydration is a real problem, but within a day or so at altitude the body begins up-regulation (makes more) of a chemical 2,3-DPG. This is a chemical that allows the haemoglobin to hang on the O2 molecules with less affinity. Simply put, it allows the body to release more of the oxygen circulating bound to haemoglobin, "easier" to the tissues.

Subsequently, you feel better after and couple days at altitude, resting heart rate decreases. Headaches get better and as Scott has mentioned the body begins "allowing" itself to be hydrated again. The full hematocrit response starts in response to the decreased oxygen level at altitude, but it takes a full 3-6 weeks to maximise.

Arch cleat positioning and shimming

I think I've read every question and response on your site regarding arch cleats, and am looking at taking the plunge - or at least picking up the drill - to try it out myself. I am curious about several comments you've made about mid-foot positioning eliminating or significantly reducing the need for shimming or wedges.

I'm a 54 year-old male, 6'0" and 220 lbs. I'm using Shimano size 46 shoes with Speedplay cleats on the baseplate extender in the rearmost position. My left leg is 10 mm shorter than my right (lower leg disprepancy), and I have 6mm of shim underneath my left cleat, and I have custom orthotics (not cycling specific) in both shoes. I'm considering having a Specialized BG fit session done to see if shimming will provide more stability/power, but wonder about trying too many things at the same time.

I'd prefer to try midfoot positioning, but would like to understand more about what I might expect regarding my leg length discrepancy and stability on the pedal. What might I anticipate in terms of eliminating the need for leg length adjustment and wedging with a midfoot position?

Jeff Hahn

Steve Hogg replies:

You mention, "I'm considering having a Specialized BG fit session done to see if shimming will provide more stability/power..." Just so I know we're talking the same language, I know Specialized manufactures in-shoe wedges but wasn't aware that they make shims. Wedges cant the foot medially or laterally to correct foot plant on pedal, and shims lift the foot as a whole further from the pedal platform to accommodate measurable or functional leg length differences.

I'll clarify what you've attributed to me. There are a couple of reasons to shim a cleat. If a rider has a measurably shorter leg, my view is that a shim is a better solution than a differential cleat position alone for forefoot cleat position. Many people have no measurable leg length difference but are significantly tighter on one side in the hip, lower back, hamstrings etc. That causes them to not to be able to reach the bottom of the pedal stroke with the leg of the tighter side as fluently as they can on the less tight side. This can manifest as a hip drop on one side. It isn't the only reason for a dropping hip but it is one reason.

An appropriate-sized shim under the shoe of the tighter side can help improve the fluency of the pedal stroke on that side and can often help the rider sit more symmetrically. Even if there is no leg length difference, this can be a positive providing that:

a) Using a shim doesn't cause problems over the top of the pedal stroke, and
b) That the rider is strongly encouraged to address the root cause reasons for his/her pattern of asymmetric tightness and view the shim as a short to medium term measure.

In your case, a 10mm difference in lower limb length means that you would need a shim unless you have evolved an unusually effective way to compensate that isn't going to bite you at some stage, and you are currently using a shim

With a midfoot cleat position, the foot is more stable on the pedal than with a forefoot cleat position. For some people who use shims, any extra stability on seat that is a by product of that improved stability may (not will) mean that the rider needs a lesser shim stack or sometimes no shim stack. Individuals respond differently and so there is no 'rule of thumb' that I am prepared to use.

Wedging is another story again. I've noticed over a long time that as people change in their functional abilities, the need to wedge and to what degree can change on one or both feet. Again, no hard or fast rule but as with shims, the increased stability of foot on pedal that midfoot cleat position affords means that sometimes the amount of wedging can decrease.

There is one other thing that hangs off this. With forefoot cleat position, if a rider has two more or less similar-sized feet (less than one size difference) moving one cleat 2-3mm further forward or back relative to foot in shoe, can make a large difference in feel of each foot to the rider and the relative degree between left and right to which the rider perceives he is working the various muscles in the kinetic chain.

I don't like it because it causes injuries that otherwise would not occur and what we are all chasing on a bike is functional symmetry at whatever level we can achieve. Differential cleat position is antithetical to that process of acquiring a better level of symmetry. With midfoot cleat position the cleat is under a very stable area of the foot and in some cases moving one cleat slightly further forward or back relative to the other makes little discernible difference in feel and may mean the elimination of a small shim or a reduction in size of a larger shim is possible.

I know you're probably looking for a definitive yes or no answer but individuals respond individually and so I haven't got one. If you do go ahead with midfoot cleat position, experiment with the size of your shim stack and find out what you feel suits you.

In-shoe wedges

Quick question for Steve. I have found that using two cleat shims under Speedplay cleats and one Specialized varus shim IN my right shoe has made a huge improvement in my hip dropping and back pain. My question is, why are the Bike Fit In Shoe Shims better than the Specialized in shoe shims? I am not doubting you as I follow your fit advice and have helped with many fit issues, just curious what the difference is and if it is worth replacing the Specialized shim with the Bike Fit shim.

Dan R
Virginia, USA

Steve Hogg replies:

It depends on what you expect from an in shoe wedge. If you want to use an in shoe wedge to cant a foot, either brand of in-shoe wedge will do that. I expect more than that from a wedge though. There is a constant flow of proprioceptive feedback being generated by the body and sent to the brain. Far more arrives than can ever be processed in any given second .We apply force to a bike via our feet and so it makes sense to me that we need the proprioceptive feedback from the lower limb to arrive at our brain loudly and clearly instead of 'background noise' that we don't pay a lot of attention to moment to moment.

The degree of cant of the foot on the pedal has a pronounced effect on how clearly this process works and this can be tested. To me, the correct amount of wedging is the quantity that allows us to optimise the quality of feedback from lower limb to brain. When this happens we enhance our ability to coordinate our pedaling action and reduce our chances of injury.. What I have found, to my surprise, is that the correct number of BFS in shoe or cleat wedges will improve proprioceptive feedback from the lower limbs but the Specialized in shoe version, though very similar to the BFS in shoe wedge, evokes no response at all. The larger question is why. That is one of my areas of interest at the moment and I think I'm close to working it out.

I don't know how much wedging you need. I know that you've told me that two BFS external wedges and 1 Specialized in shoe wedge have been of benefit to you. In the testing I've done to date I haven't tried a combination of the 2 brands, only compared one to the other. That leads me to believe that you should be able to remove the Specialized wedge without ill effects but I can't say that with absolute certainty because I haven't experimented with mixing and matching brands at the same time. If you do remove the Specialized in shoe wedge, you may want to try a BFS one in its place and see if you discern any difference. Either way, I would be happy to hear about it.

You've given me some food for thought and so I will now start testing a combination of both brands rather than a wedge stack of one or the other and see if that makes any difference to what I've found to date.

Lastly, I use BFS in shoe and cleat wedges in my positioning business and BFS distributes products that I design in the U.S. I want to make it clear that nothing I've said above has anything to do with that business relationship but is the (surprising) result of testing that I have done with my clients.

Recovering cardio function

I stumbled across your site by accident and was impressed. Maybe you can give me some of that good advice, too...

I am 67 (female) and was a keen cyclist and hiker until a couple of years ago, when something went wrong in my lower back. Spinal claudication or some such condition fits all the symptoms, but unfortunately does not show up on the scan, so I cannot be physically attacked by people with sharp knives.

Upshot is that I can't now walk far without grinding to a halt and having to wait for legs to start working again. It is boring, but more importantly I am now aware that this lack of exercise has affected my cv function. I am about to start work on an exercise bike, as I have discovered that it allows me to give the legs (& more importantly, the heart) a workout without setting off the spinal probs brought on by walking.

I'd appreciate some advice on how to go about it. Obviously, I don't want to drop dead in the saddle (romantic as that might sound) and am planning to start very gently, but how gently is gently, and what would be the safest increment to aim at?

I'd love to be able to consult my doctor about such things, but all they seem to know about is medication in the form of pills, injections and horse liniment. Any advice most gratefully received.

Chris Madsen

Scott Saifer replies:

Since I don't know your total situation, I'll give the most conservative possible advice. No matter how unfit you are and how long it has been since you last exercised, if you have been cleared by a doctor you should be safe to do 15 minutes every other day the first week on the bike. Then add about 15 minutes to each session the second week. Same for the third so you are up to one hour per session, total of four hours per week. That's enough to improve and maintain cardiovascular health. If that is going well and you want to add more time, put in about 30 minutes on one of the in between days. The following week and after you can safely add 30 minutes per week somewhere, either as one longer ride or lengthening the shorter rides.

All the riding the first couple of months should be done at an intensity that allows you to continue to chat. Anything harder is potentially too hard. At first, if you are extremely unfit, you may have to stick to absolutely flat ground and may have to stop every so often to recover your breath. After a month or so you should be past that point if you are being consistent.

This routine is certified to meet the qualifications for a gentle return to training.

Stationary bike

I am a 49-year-old woman, 5'6" at 325 pounds. My left ankle is fused (only toes move) and I've had my left knee replaced (both due to a MVA). About all I can do for exercise is swim. But that costs for membership and it takes time to travel and I've difficulty getting in and out of the pool.

I think bariatric surgery is drastic. I'd like to exercise in my home and am considering the Schwinn 202 recumbent exercise bike. How can I get the fused ankle to push the pedal? Please say it's possible. Oh, my leg is also about 2.5 inches shorter than the other leg, due to bone loss from multiple surgeries and bone death. Should I consult with a physical therapist about their making me something? Go to an orthopaedic shoe specialist? Other than depression (understandable at this weight and situation), and a low thyroid, I have no additional health problems.

Sandra M. Welchert

Scott Saifer replies:

Good for you for deciding to do something about your overall health situation. I'd suggest you make sure you can get reasonably comfortable on the Schwinn 202 before buying it. If you can, it will be a good choice for you. Don't worry about the fused ankle. Pedaling with a fused ankle would not make you a great candidate for a win at the Olympics, but is fine for what you need to do.

The leg length difference means you'll need to build up a block either on the bottom of your shoe or the top of the pedal. You can use wood so anyone handy with a saw and screw-driver can help you there. Riding may be a bit awkward at first, but you can do it. Get supplemental thyroid medication if you're not already on it. The low thyroid can cause both depression and weight gain, or difficulty losing weight, so that may be a key to your whole situation.

If you get the bike, plan to start out very easy. Start with sessions of just a few minutes and assume you are learning to use the bike for a week or two. You may need to make adjustments to get comfortable and to learn how to pedal. Doing enough to exercise and lose weight will come later. Good luck. Write again if you get the bike and need more guidance.