Cycling CME

A unique CME learning experience for physicians who love cycling

Active CME:  Combining Continuing Medical Education (CME) and Bicycle Touring for the Healthcare Provider

Science of Cycling Conference 2017

Science of Cycling Conference 2017

Terri and I, and a colleague, recently attended the Science of Cycling Conference in Dusseldorf, Germany.  This conference is held just prior to the Tour de France, which had the Grand Depart 2017 in Dusseldorf, Germany.  The conference brings together many of the leading scientists, coaches, and trainers involved in the world of cycling.

Three presentations really stood out during the conference.  The first involved a question and answer session with three of the top performance scientists from elite professional cycling teams, Scott Drawer, Louis Delahaije and David Bailey.  It was very insightful and interesting to hear their perspective on training, recovery, nutrition, and the psychology of athletes and cycling teams.  They all agreed on the importance of recovery and the need for further research and information on this topic.

Related to the topic of recovery, the second talk of interest, from Dr. Shona Halson, from the Australian Institute of Sport, reviewed both recovery and overtraining, especially the importance of sleep.  Their Institute feels this is an important factor in performance and one focus of their research.

The last presentation and the most entertaining, was from Phil Burt, a physiotherapist from British Cycling, who discussed bike and saddle fit.  He displayed a wide knowledge base, both academically and technically.

As a student and fan of cycling, the conference was interesting and exciting.  The fact that the Tour de France 2017 was about to start and we were there to be a part of it made for an incredible experience.

Cycling CME

 

Cyclists and Bone Health

Cycling and Bone Health

Should we be concerned about spending too much time on the bike saddle? As an avid cyclist and a physician interested in successful aging, I have followed the literature on bone health in cyclists.  Adult bone mineral density is dependent on many factors including genetics, nutrition, weight bearing exercise and other lifestyle factors.  One of the key determinants to bone health as you age is the peak bone mass achieved during adolescent years.  This has led to the description of Osteoporosis as a disease of adolescence, not aging.

Higher impact exercise leads to greater peak bone mass and in general, young athletes have greater bone density than their non-athletic counterparts.  However, there is a concern for younger endurance athletes, including cyclists.  There are several suggested etiologies for lower bone density in endurance athletes: genetics, nutritional errors or energy imbalances, training-related suppression of sex hormones, exertional loss of calcium and lack of sufficient mechanical stressors.

Related to the issue of the male endurance athlete, our Human Performance lab at Colorado Mesa University recently looked at the bone status using Quantitative Ultrasound (QUS) of 50 collegiate athletes from five sports.  There was significant difference in the stiffness index of bone between cycling and all weight bearing sports (soccer, football, cross-country) as noted in the figure below.

Bone Health Graph.png

 

Figure.  Comparison of stiffness index (SI) values between dominate foot for each sport. There was significant difference (p < 0.01) between all sports and cycling. Error bars indicate standard error. Each group listed in the graph consisted of 10 currently participating collegiate athletes from Colorado Mesa University.

As health care providers or concerned parents, this information leads to several recommendations:

1.     Avoid sports specialization in the young athletes

a.     Including activities with weight bearing and multidirectional movement is key

2.     Optimize nutrition – the Institute of Medicine recommends that adolescent athletes consume 1300 mg of calcium and 600 IU of Vitamin D daily. Achieving this through a balanced and varied diet would be ideal but the supplementation of Vitamin D may need to be considered.

3.     Maintain a positive energy balance to support musculoskeletal health.

4.     Consider screening for impaired bone health.

a.     Risk Factors per Barrack et al (2017):

                                               i.     Low body weight

                                             ii.     History of stress fractures

                                            iii.     High weekly mileage

                                            iv.     Consuming fewer than one serving of calcium containing foods per day

Although the overall effect of exercise is so positive, it is important to consider bone health in the adolescent and collegiate aged athletes in our roles as coaches, parents and health care providers.

Dr. Mike Reeder, Monfort Family Human Performance Lab, Colorado Mesa University

References:

Barrack MT, Fredericson M, Tenforde AS, et al. Evidence of a cumulative effect of risk factors predicting lower bone mass among male adolescent athletes. BJSM 2017 (in press)

Tenforde AS, Nattiv A, Ackerman K, et al. Optimizing bone health in the young male athlete, BJSM, 2016.

Beatty T et al. Bone density in competitive cyclists. Current Sports Medicine Reports, 2010.