Tuesday, March 14, 2017

The Haywire Heart Book Review

By PCG Elite Coach David Ertl

I was invited to review the book The Haywire Heart, written by Dr. John Mandrola, Lennard Zinn and Chris Case, recently published by VeloPress. This book primarily addresses electrical problems in athletes’ hearts but also touches on plumbing issues (clogged arteries, or atherosclerosis).

The book’s cornerstone is the observation that lifelong endurance athletes seem to be developing heart arrhythmias, including the case of one of the authors, VeloNews tech editor Zinn, who was the focus of the cover story on the topic in VeloNews in 2015 that led to the writing of the book. The book investigates the question of whether continued exercise for sport, above and beyond what is good for health, is beneficial, or can it reach a point where it becomes detrimental?

Who should read this book? 
• Anyone who does intense or long endurance training, especially over many years
• Anyone who exercises and has a history or any sort of arrhythmia

As I started reading this book I had questions in mind around two of its central theses.

First, is the observation that more arrhythmias are appearing in lifelong athletes real, or is it simply that there are now more older endurance athletes? After all, more arrhythmias are observed in non-athletes as they age, as well. The 60- and 70-year-old athletes represent the first generation of people who have been lifelong athletes, and this may just be part of normal aging.

The second question has to do with how much exercise is too much. What is “extreme endurance training,” and am I doing it? Am I actually hurting my heart by being a lifelong recreational, yet competitive, cyclist. Should I back off?

Almost Like a Medical Journal
The book went into great detail explaining the various heart ailments that may show up in endurance athletes and reads like a medical journal at times. To greatly summarize, arrhythmias are any abnormal impulse in the heart, such as atrial flutters (very fast heart rate), atrial and ventricular arrhythmias (fast and irregular heartbeats), and tachycardia (fast heart rate).

These conditions may be caused by extreme endurance exercise, as such activity can lead to stretching, inflammation, scarring and enlargement of the heart tissue, which are all factors that can lead to arrhythmias. The authors make a fairly convincing argument that extreme endurance exercise causes these conditions that can then set the stage for arrhythmias.

Another factor that may lead to arrhythmias is the low heart rate experienced by many endurance athletes, which may lead to premature heart beats. Endurance athletes can experience a wide range of heart rates, from very high during exercise to very low at rest. The authors present information that indicates that endurance athletes appear to have a greater occurrence of arrhythmias than sedentary counterparts, thus answering my first question.

There are treatments for arrhythmias, which include drugs and surgical (ablation) procedures, where areas of the heart tissue are actually burned and destroyed. These treatments all contain side effects and risks and may not be completely effective in controlling the arrhythmias.

The book also touches on atherosclerosis and heart attacks. This was of particular interest to me as I have experienced a clogged coronary artery despite my fit lifestyle. As the authors point out, while “exercise is protective, it isn’t a panacea” and it doesn’t make athletes immune from atherosclerosis.

The second half of the book gets into symptoms of heart problems you can look for yourself to determine if and when you should seek medical help.  Some symptoms are less serious than others, such as palpitations. Others are much more serious, such as racing heart, chest pain and difficulty breathing. 

The book then discusses the sort of tests to expect if you do see a doctor, and the information you should take with you. It’s pointed out that athletes have a high pain threshold and tend to downplay pain and discomfort and may try to brush aside and ignore symptoms.

Being Fit Not the Same as Being Healthy
It’s important to realize that being fit is not necessarily the same as being healthy. (There are countless examples of extremely fit, well-known athletes who have died of heart attacks or other heart ailments they never knew they had; a commonality seemed to be the assumption on their part of good health and thus the lack of regular medical checkups.) And the book presents some evidence that long-term endurance training may not protect against atherosclerosis.

Answers to my second question – how much exercise is too much – are less clear, and the answers may not be known at this time.

Throughout the book the authors use terms such as “elite athletes,” “extremely intense” and “competitive.” They utilize several case studies highlighting very elite athletes who were on the U.S. national cycling team, U.S. Ski Team, competed in world running championships and masters athletic championships.

The non-elite athlete case studies involved athletes who were very driven, in some cases obsessed, exercisers who participated in multiple marathons or ultra-marathons and typically had type-A personalities both in sport and in other aspects of their lives. These case studies appear to be extreme examples.

For instance, one recreational athlete was an independent sales representative who worked and played hard, often on the same day. He admits he was burning the candle at both ends and that he was chronically overtrained. He would do a ski marathon on Saturday, drive to another on Sunday, and do some work in between. He experienced ventricular tachycardia followed by cardiac arrest at age 50. He was fortunate to survive. He admits he did it to himself through by letting his personality drive him to extremes in every aspect of his life.

I don’t put in nearly the quantity of training that the athletes in these case studies did, although I often do intense training along with long slower distance training, and have done so for 44 years. I was somewhat comforted by the statement: “These are a highly selected groups of athletes.... They represent a tiny fraction of elite athletes. The vast majority of endurance athletes do not develop severe ventricular arrhythmia.”
The book asks the question “So why do most endurance athletes not have arrhythmia? It is not known who will be affected, but overdosing on exercise appears to increase risk of arrhythmias.”

What To Do With This Information?

What we do with this information appears to be an open question that each of us must answer for ourselves. And most likely it is a very individual situation where some of us may be more immune and others more susceptible. What is too much for one person may be tolerable to another. We may not know until it is too late.

As I read this book I kept asking myself, “Does this describe me?” or “Could this happen to me?” The odds are in my favor that it won’t, but I thought the same about cardiovascular disease – and it did happen to me.
On the other hand, I recently read another book, also published by VeloPress, titled “Fast After 50,” by Joe Friel, which advocates for continuing to do intense training into old age to maintain fitness. Each of us must balance the risks and benefits and make our own decisions.

As a coach, I have worked with two cyclists who have had heart rhythm issues, including one in his 30s who ended up having an ablation procedure done, so I understand it does happen. The Haywire Heart does give us reason to pause and consider our circumstances.

For example, another thing the book considers is, if you are a middle-aged or older athlete who took up sport later in life, you may carry along years of accumulation of poor fitness and perhaps poor health (e.g. atherosclerosis), which may be exacerbated when taking up an endurance sport.

Suggestions From the Authors
The authors provide some suggestions to help avoid or detect problems.

One is to “rest as hard as you train.” Fatigue seems to be a central theme among athletes developing arrhythmias. Avoiding overtraining may be one key to staying healthy, as well as managing stress in all aspects of our lives while training.

Another suggestion is to wear a heart rate monitor at all times while training. This can help detect problems we may not be aware of, and can serve as useful information to a doctor should an episode occur.

So How Will This Book Affect Me?

I expect I will continue training and racing. I will likely wear my heart rate monitor more often now, and I will certainly be more cognizant of any irregular sensations related to heart rate. I don’t believe the authors are trying to get us all to stop our intense or competitive endurance training regimes (although sometimes it sounds like it). Instead, it seems, they do want to raise awareness of the issues, recognize problems when they occur, and provide some information about behaviors that may lead to problems down the road.

Republished with permission from www.RoadBikeRider.com .

Thursday, March 9, 2017

Winter Training for Juniors

By PCG Elite Coach David Tonello

Designing the optimal training plan for a Junior bike racer over the winter can be far more difficult than it is for an adult.  Well that isn’t a surprise because generally it is harder to design a training plan for a Junior no matter what time of year it is, especially with regards to intensity.

The first consideration is to assess both the emotional and physical maturity of the Junior.  While it may be obvious that there will be a huge difference between a 10-year-old and a 17-year-old, there can also be a significant range of physical and emotional maturity between kids of the same age.  To further complicate matters, the Junior may be advanced in one area, but not in the other.

I am using the term emotional maturity to discuss the ability of the Junior to understand the need for training at the higher intensity levels.  Do they see the benefit of training in those zones?  Do they have the motivation and self-discipline to do the work?  Do they have the maturity to understand and believe that training at that effort level is worth the discomfort?  Many of the answers to those questions will depend not only on the Junior’s physical age, but on experience in past competition.  Often, newer racers have a notion that they are naturally gifted and don’t need to train to be successful, while the experienced racer has learned that even the gifted must train hard to succeed.  That is why I can usually incorporate more high-intensity work into the training of the more experienced Junior.

Winter seems to be much longer to a teenager than it does to a middle-aged athlete.  The Junior often thinks that there is plenty of time before hard training really needs to start, whereas the adult knows that they will be racing again quite soon, and later will be too late to start serious training.

The importance of physical maturity is normally more obvious.  The more physically more mature Junior can withstand more high intensity training.  It is very important to keep the problem of overuse injuries in mind while coaching a Junior.  The American Academy of Orthopedic Surgeons reports an increase of overuse injuries in children, and that in most cases, those injuries are associated with sports-related activities.  Osgood-Schlatter Disease, an inflammation of the growth plate at the upper end of the tibia, is not uncommon in Junior cyclists during the adolescent growth spurt.

What?  Those complications aren’t enough to make you want to pull out your hair?  Let’s add in the Junior’s other activities!  On one hand, you may have a Junior who is participating in several other sports.  The kid who isn’t playing soccer, or some other team sport, during the off-season is rare, while those in colder climates may be participating in a winter sport such as cross-country skiing.  The coach needs to know what the Junior is doing for training for those sports too!

Cycling events for Juniors are normally much shorter than they are for adults.  Often, adults try to have the Junior train as they would for adult events, and that often results in training that may over-emphasize distance and under-emphasize intensity.

Just as a coach should do for any athlete, the coach needs to make a complete assessment of the athlete’s physical condition (including strengths and limiters), and the needs of the Junior’s important completive events in addition to the factors already discussed.

Generally, I find getting the Junior athlete to actually complete the higher intensity work is the most challenging part.  They usually find it harder to do those high intensity workouts on their own.  While an adult may possess the motivation to complete the workouts on their own, the Junior with that sort of drive isn’t as common.  I tend to have more success if the Junior can do the workout with an adult (especially a fit parent).
A phenomenon that makes me chuckle is that Juniors seem to have technical difficulties with their power meters and heart rate monitors more frequently than adults.  Could it be that these kids who grew up with high tech devices purposely have malfunctions to prevent the coach from getting data that would show they slacked off on that workout?

The good news is that kids seem to have less trouble with the very short high intensity intervals needed to work VO2, anaerobic capacity, and critical power, than they do with the longer, if lower, intensity intervals used to train functional threshold power.  I try to find methods to get in the longer FTP workouts, but using things such as prescribed cadence changes, or other methods of keeping the workout from being boring.
Finally, perhaps the most important difference in coaching a Junior is the need to keep it fun!

David Tonello is a PCG Elite Coach in Los Alamos, California

Friday, March 3, 2017

Training Peaks Run with Power Workout Export to Garmin Watch

By PCG Associate Coach Rachel Zambrano

This tutorial will take you step by step in creating a run workout with power targets, exporting the file, then importing it to a Garmin watch for use outside, or on a treadmill.

As of the writing of this article, there are two problems that, while this is still a viable solution, make this imperfect at best.  The first issue is that the Garmin does not display power from the Stryd foot pod while viewing the workout steps during the workout.  It does, however, display power from the IQ field from Stryd, so while it makes it a bit challenging, it is still usable data.  The second issue is that the power zones displayed on the watch itself are much wider than the actual run power zones are.  The zones on the watch reflect cycling power percentages rather than run percentages, and I suspect this may be due to a limitation with the Garmin software.  The workaround for this is to target the center of the zone displayed by the watch.  If you can work through these two issues while we wait for Garmin to upgrade their software to handle running with power, then continue reading through the rest of the article to find out how to write a workout and get it into your Garmin watch.

From your Training Peaks account on a computer, open a run workout.  You should see something similar to the screenshot below:

Click on “Build Workout” and it will bring up a few options for you to choose as to how you want to build your workout.  Select either time or distance for your intervals, but make sure that you select “% of Threshold Pace” and click “Continue.”

Start dragging and dropping from the blocks above with the blue squares to the line with the workout graphic on it.  It’s best if you play with this a while and get familiar with it before you decide exactly what kind of workout you want to write.

As you can see, you can change the variables and the percentages.  I use the Zambrano Run Power Training Zones for all my workouts.  They are:

     Z1 (recovery) < 82%

     Z2 (endurance) 82% - 88%
●    Z3 (tempo) 89 - 95%
●    Z4 (threshold) 96% - 104%
     Z5 (anaerobic) >104%

Keep dragging and dropping to build your workout.  Here, you can see I’ve inserted two step intervals and adjusted the percentage to represent low Zone 4 repeats.

Now, I’ve given my workout a warm down.

When you’re done writing the workout, and you’re happy with the way it looks, click “Save & Close.”  Then reopen the workout and you should have something similar to the screenshot below:

Immediately above the workout graphic, you can see the “Export Workout File” button. IMPORTANT - before you export the workout, make sure it has a name.  In this case (and not on the screen shot), I named this workout “Drill.”

When you click the button to export your workout file, you’ll be presented with the options below:

Since we’re transferring this file to a Garmin watch, you’ll need a .FIT file. Garmin has a link here where you can get some additional help beyond the scope of this article, but once you click the .FIT button, you’ll have a file download to your computer.

Leave your screen the way it is and plug your watch into the computer.  You won’t need to open Garmin Express just yet.  When the watch is plugged in, open your file explorer and navigate to the following pathway within your watch (see the address bar in the picture below):

Hover your mouse over the file at the bottom of the screen on your computer, grab it and copy it into the folder you see above.  If you know how, you can simply drag and drop it into the file explorer window.  When the file is done being moved or copied, leave your watch plugged in and open Garmin Express.

Make sure your watch says that you’re up to date.

At this point, you can eject your watch from the computer, and you should see your watch updating:

Before you select your workout, you’ll need to select your activity.  Make sure you’re in “Run” or “Run Inside” mode on the watch.  Once that’s done, go to your menu and select “Training.”

Go to “My Workouts.”

Select “Running.”

Then, choose your workout, in this case, I named it “Drill.”

Then, get ready to start.

Remember, in order to make this work, you’ll need to target the center of the power zone displayed.  In this case, 176 watts (if you go back and check, you’ll see that was the original power in the first step of the workout).  If you want to share this file with others, and have it share the proper way to change targets so it is appropriate for other athletes’ power zones, you’ll need to share the file from within Training Peaks itself.

Want to export the workout file to another program or computer than a Garmin? Use this link to help you get there!

Rachel Zambrano is a PCG Elite Coach