Fitness questions and answers for November 22, 2004

Form & Fitness Q & A

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.

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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.

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.They include World and National champions at one end of the performance spectrum to amputees and people with disabilities at the other end.

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.

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.

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.

I am entered to do the 2005 l'Etape du Tour. I know this will take me about 9 hours and that at an aerobic work rate I will consume c800-900 kcal per hour. This means I will burn between 7000-9000 kcal during the ride. I expect to replenish this with a combination of carb drinks and solid food stuffs. I will also be carbo loading before the event. My question is this, given that I will be carbo loading before, should I aim to replenish all the energy burnt during the event of just a percentage, as some will come from body stores, if so what percent should I aim to replace during the event?

The trick to surviving an endurance event like the Etape is to keep yourself fueled up as you ride so that you never burn all of your reserves and have to run on empty. You are following all of the recommended practices: carbo-loading before the event will top off your glycogen stores before you start the event; consuming carbohydrates during the event will prevent your tank from running all the way down to empty; and consuming a variety of beverages and solid foods will keep things palatable.

I am a 33 year old male USCF cyclist. My mileage typically is between 250-300 miles/week and usually consists of hard group rides and occasional racing. I recently ruptured my left Achilles tendon while attempting to push a car up a slight incline. I can no longer recommend such an activity. I have had my ruptured tendon repaired surgically and am waiting for the day when I can return to the bike. I am also an orthopaedic researcher and I have long been interested in studies which have shown diminished bone mineral density in competitive cyclists. I am of the belief that cycling does not induce sufficient stimulus to initiate bone remodeling as I believe has been clearly shown in the literature. I have to wonder whether the same thing could occur with regard to tendon strength/remodeling. I have two questions. First, I would be interested to know if there have been cases of cyclists who rupture their Achilles tendon and return to competition at a high level. From what I’ve read I am guessing that this is likely the case but I thought there might be some notable examples. My main concern is with increased pedal force during sprinting and hill climbing(very steep long hills and short steep hills in the big ring). Not that I would try any of this for a good while. Can you provide me with any cycling specific recommendations for returning to my previous fitness level. Any help would be greatly appreciated.

I would not worry in the least about any long term implications from your injury. While I have had the opportunity to work with a number of recreational cyclists that suffered this injury with no ill effects, I think that it is more worth looking at athletes from other sports that return from this injury. If a professional football or basketball player can return from this injury and tolerate aggressive jumping and cutting, there is no reason that a cyclist should have to do anything to alter their training or alignment on the bike.

I was told by a cyclist/scientist recently that including small quantities of Bi-carb soda into a pre-race/training meal can delay the onset of lactic acid build up. I guess the theory is that it will slightly increase the pH of the blood (making it basic) and when you start to push that lactic acid onset is slower, essentially allowing you to push harder giving you a greater threshold. I guess it makes sense scientifically but could it really be that good for you?

Congratulations on your large weight loss. That's quite an accomplishment. There are two distinct ways in which body fat is stored. Some fat is stored within muscles and is used as fuel for the muscles in which it is stored. Think of this as the marbling in a steak. The other kind of fat is deposited not particularly in association with any muscle and will only be mobilized for energy in large quantities when you have at least partially depleted the intramuscular fat in the muscles you use for exercise. Belly fat is in this category and cannot be worked off by working belly muscles. To lose belly fat, do aerobic exercise and continue your weight loss diet. It will slowly come off. It might take several years to really disappear.

I seem to have been responsible, in whole or part, for several of my mountain biking friends acquiring road bikes recently. None have regretted it. Even if you don't choose to race, a road bike is a tool for doing fitness-orientated riding in ways that are hard on a mountain bike - sustained, steady rides for example. It's also good to get some variety into your riding, and riding a road bike means you're not wearing out your proper bike!

Sure there are health benefits to donating blood — for the people who need your blood via transfusion. Accident victims, cancer patients, and people with blood disorders, such as sickle cell anemia, all require blood transfusions. Five million Americans receive blood transfusions every year and many of them would have a hard time living without your gift. That’s why they call it a gift of life, and you are to be commended for this unselfish act. But as an athlete, there are some issues to be mindful of with respect to blood donation.

A question regarding a right side Hip Flexor problem. I am a 27 year old mountain biker who does a lot of training and racing on the road. I find at very high intensity in cross country races I have severe pain in my right hip flexor, to the extent in some races it is hard to peddle by the end. I have dropped my seat height a little and have found some relief but still have problems. I have also noticed I am rotated towards my left hip on the saddle. I think it might be a leg length discrepancy problem? It's very frustrating because the power is still there but I just can't use it.

I've trained and raced MTB and road bikes for 10 years now on totally amateur basis and thought I'd check out recumbents for several reasons. I'm a 52 year old male putting in a little over 4000 miles a year, which is about all the time I can muster. I thought the 'bent might, among other things, help me keep up with the "pups" I ride with on occasion when we hit the flats or rollers here in East Tennessee - they're all 25 to 45 years old.... I've read your numerous essays on fitting the road bike to the body, which I've greatly appreciated along with everyone else that reads this forum - but I've never noticed you straying over into fitment of a 'bent to a person's physique. Do you have any references to point me to, or outright advice for pedal position/distance, seat position to avoid knee issues or other? My specific bike is the Lightning-P38, which seems to have good ergonomics for climbing as well as the other stuff. There seems to be very little info around in other forums focused on 'bents in this particular area of concern.

Do you have any suggestions on what/how to drink during winter rides? We are not into the coldest part of winter yet, and already my water bottles are getting too cold to drink from towards the latter part of my rides, even with having mixed the drink with warm water before riding. I currently use a regular powdered sports drink. I have not ridden in winter before, so any suggestions would be appreciated.

I wish to reply to the gentleman who wrote concerning the long term use of prednisone. After many years of headaches, night fevers, muscle and joint aches, chest pain, erythema nodosum (welts all over my body), I too was diagnosed with sarcoidosis. Fortunately for me, I had no evidence of lung scarring nor of atrial fibrillation (though I did have one scary episode while on a run). I too was told that the only treatment was long term prednisone therapy - and to tell the truth, when I was in the middle of a flare-up I was happy for it! Aware of some of the drawbacks of prednisone use, I chose not to go that route and used it sparingly only when symptoms manifested (mind you I was taking maybe 1500 mg ibuprofen a day to help ease the symptoms). I continued to train on the bike though it was difficult to ride through the aches and pains and fevers.

I feel fortunate that I have a doctor who took a special interest in my case. When my conditions first surfaced, I was initially diagnosed with lyme disease. I completed the antibiotic therapy successfully, so that when the symptoms returned, a new diagnosis was needed. That's when we started thinking sarcoidosis. The prednisone worked on the symptoms, so that was that. Recently, new information has been emerging about links between sarcoidosis and lyme disease (some research suggests that sarcoidosis may even be a particular strain of the Borrelia bug - see this link). In fact lyme has been linked to a whole host of other conditions: see this link. My doctor continued to follow the emerging research with interest.

Recently in several studies a new treatment has emerged for lyme. At first it seemed a little far-fetched to me (the treatment is uncaria tomentosa, a herbal extract) but once I got an assurance that it would not harm me I gave it a try. After the first week I experienced all the old sarcoid symptoms. My doctor assured me that this was quite normal and gave me a mild prednisone prescription for 5 days but cautioned me not to stop the treatment. After three days the prednisone had cleared the symptoms and I stopped taking it but continued on the uncaria tomentosa. That was in March - I have not had a flare up since - by far the longest healthy period of the last ten years. I am literally in the best shape of my life and at 39, that's saying a lot!

I'm not saying that this will be some magical cure for you. From what you have said, your symptoms seem more severe than mine. Please check out the literature, though, and do some searches of your own. The more I read about Lyme and Sarcoidosis the more I felt that they must be related - their symptoms are almost identical. I hope this can be of some help to you. Please fell free to email me about this.

I feel it is important to also clearly state in competitive athletes DHEA use is actually prohibited - it will cause a positive test and the rider would be banned from competition whether they have a prescription or not. All testosterone preparations are prohibited in or out of competition. Prednisolone preparations are banned in competition but permitted out of competition so long as the athlete has a prescription.

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