Hi this is Dr. John Martinez, Medical Director of Coastal Sports and Wellness Medical Center in San Diego, California.

Today, we’ll be talking about some myths and facts about both lactate testing as it applies to our endurance training—we’re talking about:

• The lactic acid myth
• The muscle burn myth and lactic acid
• The muscle pain myth
• The lactic threshold myth

Now the first myth is about “lactic acid” and that lactic acid actually appears during exercise, so it’s really the true things, it’s more of a misnomer and that lactate is actually the proper term and it’s actually a by-product of glucose utilization and a lot of coaches and athletes are taught or told that lactic acid is something that’s actually bad, when in fact that if we look at the whole breakdown of exercise metabolism, it’s that as glucose breaks down, it’s broken down to a by-product called pyruvate and eventually into a pathway that produces lactate.

There may be some true lactic acid that’s formed very briefly, but then the lactate is actually a salt by-product that’s produced and importantly, for athletes and coaches to understand is that lactate is actually used by the body specifically, the brain and the heart for fuel and this falls into a concept termed the lactate shuttle as first proposed by Dr. George Brooks up in University of California, Berkley who’s done a lot of research on this concept.

The next myth that we’re going to talk about is that muscle burn myth and this is something that I think most athletes have been told, if you’ve ever been in a spin class, ever gone out to the track and done track workout or a speed workout and told that that burn is that that lactic acid building up and again, if you go back to that first myth that we’d already talked about, the true term we should be using is lactate, but it’s actually also false that lactic acid build up causes that muscle burn that athletes experience at the high intensity exercise.

The fact is that that muscle burn is actually more of an acidosis that occurs when hydrogen ion build up and probably some other by-products in the intense exercise. Lactate itself doesn’t seem to cause that muscle burn and if you look at the research studies, we have athletes that have much different levels of blood lactate levels that have different experiences or different complaints as far as how much muscle burn and muscle discomfort there is.

So again, that lactic acid or that lactate build up doesn’t cause that muscle burn.

The third myth we’ll be talking about is muscle pain myth and that lactate or lactic acid build up causes the muscle pain most athletes experience 24 to 48 hours after a hard workout. Well, the truth is that, lactate is actually cleared from the muscles usually within an hour of most exercise, even the more high intensity exercises, and we know this because when we do a lactate testing on our athletes, we plot out the increase in the lactate levels as we increase the exercise intensity and then as we have a recovery period after exercise, we actually do a recovery lactate test to watch how quickly the athlete’s body is able to metabolize that excess lactate.

So the truth is that, a lot of that muscle damage and muscle pain that occurs 24 to 48 hours actually probably do more to micro tearing of muscle and usually, we see more muscle pain and more micro tears when there is more eccentric muscle contraction and this should be something, as far as downhill running and the eccentric lengthening of the quadriceps muscle and if you’re in the gym during a bicep curl, this would be the negative that a lot of body builders do when they slowly extend out the bicep under a heavy weight and you get more micro tearing and therefore, more inflammation and damage to the muscle and that’s what we think that delayed onset muscle soreness is that occurs, a couple of days after a hard workout.

The final myth we’ll talk about is the lactic threshold myth and that myth is that there’s a defined point where the body switches from an aerobic to anaerobic metabolism called the lactate threshold. Well, the truth is that there’s really no defined switch from aerobic to anaerobic metabolism. There’s actually more of a mixture of aerobic and anaerobic metabolism in most exercise intensities and if you think about this at a lower intensity, you do use mostly fat as your main source of energy.

But there’s always just a little bit of glucose metabolism that’s occurring and as you slowly increase your exercise intensity, there’s more of a slow transformation or slow transition to a more heavily anaerobic metabolism, but there’s no true flip of the switch where you go completely aerobic to completely anaerobic, it’s more of a transition zone that we hit.

One of the other things that we try to measure with our athletes is what we call the maximum lactate steady state, which is that steady state exercise level for either running or cycling where the athlete can maintain a constant lactate production and lactate metabolism and that’s probably the level that most athletes can race a long distance, race out over an hour.

Interested in finding out out more about blood lactate testing?

We offer blood lactate testing in San Diego at our sports medicine center and sports medical director.

Give us a call at 858-678-0300

Upon moving to San Diego just over a year ago I was surprised at how many people were into work early so that they could be out enjoying Mother Nature in the afternoon. Being an exercise enthusiast from the North East I’ve had a blast either running 8+ miles around La Jolla cove, hopping on my bike for 40+ miles, or even the dreaded JCC Master’s swims led by full time masochists Chad, Nikee, and Rachel. The combination of any of these workouts and the preceding workday resulted in both physical and mental exhaustion, not to mention quite an appetite, which may explain why some people don’t lose as muc weight as they expect on an exercise program. And, if anyone out there has attended one of the San Diego Triathlon Club Aquathons you can attest to the caloric explosion that can occur after 30 – 50 minutes of lung burning activity followed by one of the finest post-race food spreads in the history of after-race parties.

However, a recent article in the New York Times about the timing of meals made me re-think my typical post-workout feed bag routine.

The New York Time article “Late Night Eating Linked to Weight Gain” comments on a medical study performed at Northwestern University and will be published in the peer reviewed journal Obesity next month. Researchers at the university found that mice whose feeding was restricted to daylight hours (the equivalent of our night time for our squeeky, furry, nocturnal friends) gained 28% more weight than the group that ate during their regular feeding times during the night as they instinctively do.

At first thought, you would think that the obvious reason for the weight gain in the first group of mice was because they ate more calories. Guess what? You’d be wrong! The researchers found that both groups consumed nearly equal number of calories and exercised for similar duration on each day, making the only difference between the groups the meal timing.

Now, granted this is an animal study and the results should not be immediately directed towards humans but it does give some guidance to those athletes looking to shed a few pounds.

I’m not suggesting that we all eliminate eating after our evening workouts, since re-fueling is an important part of proper recovery after a hard workout. Getting the correct amounts of protein and carbohydrates within 30 to 60 minutes after a workout (known as the glycogen window) is proven to increase muscle glycogen storage and provides a larger energy source for your next workout. However, for most of us the total calories that needs to be consumed for this effect is only around 500 calories – that maybe 2 bagels, or a turkey sandwich with a side of veggies.

I’m sure that on a semi-regular basis I approach the 1500 calorie range with my post-work meal, especially after a long workout. I have to admit, that previously I had been under the impression that in order to reduce weight, calories in had to be less than calories out. However, this new research may suggest that simply changing the time of day when these calories are consumed could help to reduce excess weight. I am even more convinced of these findings after thinking of previous research that has shown lower body weights for those individuals who ate breakfast every morning when compared to those that routinely skipped breakfast. I am sure that I’m not the only one who has over-eaten after an evening workout to the degree where breakfast isn’t even appetizing.

So once again, I’m not saying that we should stop eating when the sun goes down (we’re athletes, we need to eat). I’m saying that for the majority of us who aren’t training 30 hrs a week like the pros with a body fat percentage hovering around 6% it might be a good idea to re-distribute some of the calories. Instead of gorging yourself at the all you can eat buffet after beating yourself up with 10 x 400m with a 1 mile warm up and cool down on the track, save some of those calories for breakfast the next morning.

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Evan Johnson is a San Diego personal trainer with a Master’s Degree in Exercise Science. If you’d like a fitness consultation with Evan, give us a call at 858-678-0300

If you missed part 1 of this San Diego sports doctor’s response to the Time Magazine article “Why exercise won’t make you thin”, you can find it on our sports medicine blog.

“Yes, although the muscle-fat relationship is often misunderstood. According to calculations published in the journal Obesity Research by a Columbia University team in 2001, a pound of muscle burns approximately six calories a day in a resting body, compared with the two calories that a pound of fat burns. Which means that after you work out hard enough to convert, say, 10 lb. of fat to muscle — a major achievement — you would be able to eat only an extra 40 calories per day, about the amount in a teaspoon of butter, before beginning to gain weight. Good luck with that.”

While Mr Cloud is technically correct about the 40 calorie difference between 10 pounds of muscle and 10 pound of fat at rest, he doesn’t take into consideration two important calculations – the initial energy expenditure someone would need (that means exercise) to lose 10 pounds of fat while building 10 pounds of muscle and the daily difference that the extra ten pounds of muscle adds when the muscle is active during exercise. The study Mr Cloud quotes talks about the energy expenditure difference when at rest (sleeping, sitting, etc) but there may be a noticable increase in energy expenditure once you start using that added 10 pounds of muscle during daily movement or exercise depending on your view of the research. A study published in the Journal of Applied Physiology from the University of Alabama in 2000 looked at the effects of 26 week resistance training on older adults found that even after correcting for the energy expenditure during the resistance workout, there was still an increase in the total daily energy expenditure of about 178 extra calories per day.

Mr Cloud continues…”All this helps explain why our herculean exercise over the past 30 years — all the personal trainers, StairMasters and VersaClimbers; all the Pilates classes and yoga retreats and fat camps — hasn’t made us thinner. After we exercise, we often crave sugary calories like those in muffins or in “sports” drinks like Gatorade. A standard 20-oz. bottle of Gatorade contains 130 calories. If you’re hot and thirsty after a 20-minute run in summer heat, it’s easy to guzzle that bottle in 20 seconds, in which case the caloric expenditure and the caloric intake are probably a wash. From a weight-loss perspective, you would have been better off sitting on the sofa knitting.”

One rough rule of thumb is based on a 2004 study on the energy expenditure of walking and running published in the journal Medicine & Science in Sports and Exercise which found the total number of calories burned from walking 1 mile was equal to 0.53 x the person’s body weight (in pounds) and the total number of calories used during running was approximately 0.75 x the person’s body weight (in pounds). So for the above example of a 20 minute run, if we assume a slow jog at 10 minute per mile pace (or 2 miles in 20 minutes), a 155 pound person would still burn (0.75 x 155)

There are several readily available activity-calorie guides at http://www.nutristrategy.com/activitylist3.htm and http://www.healthdiscovery.net/links/calculators/calorie_calculator.htm that calculate calories burned for various exercises and exercise intensities. Looking at values from the above on-line calorie guides, running 20 minutes at a fast jog (2 miles at a 10 minute per mile pace) would require about (704 calories/ hr * 0.333 of an hour) 234.6 calories of energy expenditure in a 155 lbs person. In a 190 lbs person, that 2 mile jog would burn about 287 calories – even if we took a light weight 130 pound Kenyan marathoner on a really, really slow day for him, we’d still be looking at a caloric burn of roughly 196 calories, still more that the 130 calorie Gatorade that the author blames for adding the extra poundage to Americans.

Yes, obviously chugging the 130 calorie Gatorade wouldn’t result in as much of a calorie-deficient from the 20 mintues of exercise that just drinking plain water, but that short time duration of exercise is also why sports medicine societies like the American College of Sports Medicine don’t start recommending a carbohydrate and electrolyte sports drink unless the exercise is an hour or more.

How about the psychology of self-control? – Or the comment that self control is like a muscle that gets weaker each time you use it? There is actually a lot of interesting published research on the science of “self-control” behavior as it relates to a lot of different areas; diet, addiction, criminal activity, etc. The study that the Time Magazine article referred to appeared to find that in the group of test subjects that demonstrated diminishing “self-control” with exercise or food selections may also have had a less intense sense or feeling of motivation towards reaching weight loss goals in comparison to the group of test subjects that did not exhibit a diminishing level of “self-control.” This finding may have more to do with the role of fitness and health professionals role in identifying and improving the level of motivation among weight loss and fitness clients. Some people approach exercise, fitness and weight loss with a negative attitude (like one patient of mine that commonly pointed out that “diet” was a painful four letter word, just “die” with a “t” added at the end. So the role of motivation towards any goal is paramount to success. Want to become an Olympic gold medalist? Want to be successful in the work place? Want to reach your goal of running a 5k, 10k, marathon or Ironman triathlon? Motivation is a key personality ingredient that can determines a person’s success with the goals they set for themselves and challenges that they face.

Memory recall of a recent meal may actually play a larger role in appetite suppression than previously thought. A series of studies published in 2008 by University of Birmingham’s School of Psychology looked at the effect of having test subjects recall what they ate just before their next meal or snack and found that the test group that did participate in the part of the study where they recalled what they ate for lunch actually ate less food for an afternoon snack. The research seemed to indicate that the phenomenon was time-dependent, meaning that the larger inhibitory effect was seen in test subjects that recalled their most recent meal rather than a meal from the previous day.

Is this the Homer Simpson theory? – could my one of my favorite shows have actually gotten it all wrong along with Time magazine? All those times that Homer J. Simpson daydreams of donuts, chocolate, Duff beer, etc were actually dietary mind control tricks acting to suppress his actual appetite? Well, according to this research, the memory effect only applies to food eaten that day. So you can think about what you had for lunch today and it will decrease your appetite for that later afternoon snack, but thinking about yesterdays lunch doesn’t have the same impact on appetitie control.

This concept of “appetite mind control” may seem like some pop psychology trick, but in fact may be related to the influence of the hormone gherlin, which influences not only the control of hunger, but also possibly cognitive function and learning ability. Animal studies have shown better performance on learning specific tasks for animals that are unfed versus those that have recently been fed, supposedly due to the effect of gherlin concentrations on the hippocampus portion of the brain. Which would explain the “Fat, happy rats don’t run mazes” theory…

I’ve had several people ask me if I felt that the writer wrote the article in this manner to be intentionally controversial. Overall, I think the Time Magazine writer didn’t intentionally try to misrepresent the research. I feel that he simply didn’t understand the research that he was attempting to use to support his theory in the article. He did manage to energize quite a response from the medical and fitness fields, however, based on the number of follow up blog posts and website articles that have been posted. Hopefully people look deeper into the issue and realize the importance of exercise not only for weight loss and weight mantenance, but for overall health

Its an unfortunate misrepresentation of some good research by some talented scientists.

I’ll be spending the week picking apart the problems with the Time Magazine article, simply because it ignores a large body or research out there.

In the first section of the Time article, Mr. Cloud references a recent research study published by scientists at Louisiana State University and The Cooper Institute (Dr Kenneth Cooper is the physician that coined the term “aerobics” back in the 1960′s). You can get a copy of the article here. The study looked at the effected of different weekly amounts of moderate exercise (cycling or treadmill) on weight loss and waist size in fairly inactive, older, post-menopausal women (average age of 57 with an average weight of 185 lbs and a body fat percentage of almost 29%)

The reality of this exercise study is that the researchers found that all three exercise groups lost weight. Interestingly, the group that exercised the most, did not lose weight at the researchers’ predicted rate – however, that group still lost weight. Here’s a look at the data from the first two exercise groups (4KKW and 8 KKW) below. These two exercise amounts are equal to 72 minutes (4 KKW group) and 134 minutes (8 KKW group) of exercise per week based on current national exercise duration recommendations by organizations like the American College of Sports Medicine.

The data from these two exercise groups actual show that both groups loss more weight than predicted by the researchers, and the 8 KKW group lost more weight that the 4 KKW group, as seen in the two graphs below:

The researchers did find that the 12 KKW group (exercising at 194 minutes per week) did not lose as much weight as predicted based on their exercise calorie expenditure. Looking at the data on the graph below, it seems that the 12 KKW group had a much slower rate of weight loss that the other two groups even in the first 4 weeks of the study. Why is that slower rate of weight loss in the first 4 weeks significant? It’s based on the study design. Since the researchers started with an older group of subjects, they started each group out at 72 minutes of exercise per week for the first week. The two middle and higher exercise groups then had roughly 18 minutes of exercise added to their weekly exercise time until they reached the maximum exercise duration for each group. So the 8 KKW and 12 KKW groups would have been increasing their exercise durations at the same pace for weeks 2 through 4 (where the 8 KKW group would stay at the 134 minutes and the 12 KKW group would continue to add time each week until they reached the 194 minutes of weekly exercise at week 8 of the study.

To their credit, the researchers acknowledge that the point of their study was to determine whether or not there was a linear dose (or time)-dependent relationship between the amount of weekly exercise and the amount of weight loss by their test subjects. They also clearly state during their discussion of their findings that:

Our findings should not be interpreted as suggesting that lower doses of exercise are more effective in producing weight loss than higher doses. We emphasize that DREW was not a weight loss study and it was not designed to examine the nuances of exercise induced weight loss.

The authors of the research paper also note the a good portion of the 12 KKW (higher duration exercise group) continued to loss weight at the predicted rate (27% of the 12 KKW participants according the the data). So the reality is that while a subgroup of the higher amount of weekly exercise group didn’t lose weight at the predicted rate, another group did match the predicted weight loss.

One reason suggested for the lack of weight loss in the higher time-duration exercisers from the Time article was the possibility that the high exercise-time group were less activity during their non-exercise time away from the research lab. A credible reason, except that the researchers controlled for this variable by having all groups wear pedometers, including the control group that did not exercise at all. What kind of difference did they find in the outside activity levels between all groups?

None. That’s right. All four groups (the non-exercising control group and the three exercise groups) had roughly the same activity levels outside of the research lab when they were performing their exercises for the study. So the high exercise group didn’t go home and lay around on the couch after their workouts, or limit their walking or other activities any more that the other groups.

Further studies have also demonstrated that people that have lost a substantial amount of weight (think the Biggest Loser) usually exercise 45 minutes a day in order to maintain their weight loss. Exercising 45 minutes a day for 4 days a week would put that prior weight loss group at roughly the 8 KKW group exercise duration.

Unfortunately for Manny Ramirez, HCG was added to Major League Baseball’s banned substance list in May 2008 and Ramirez received a 50 game suspension as a first-time offender of MLB drug-testing program. Further reporting by Sports Illustrated and the Los Angeles Times now suggest that Ramirez’s urine sample tested positive for synthetic forms of testosterone and no presence of HCG was found. This latest finding of  synthetic testosterone would be suggestive of someone that was taking or recently taking anabolic steroids, which are also on MLB banned substance list.

What is HCG and why take a fertility drug?

The obvious question most people are asking is why would Ramirez take a fertility drug and what benefit would he gain?

When anabolic steroids are used to increase muscle mass, the pituitary gland often shuts down production of luteinizing hormone (LH) which controls testosterone production by the testis. When an anabolic steroid user comes off a cycle of steroid use, there is a need to quickly restart the body’s natural testosterone production. Since there can be a significant delay in the pituitary gland’s response to restarting luteinizing hormone (LH) release and therefore, testosterone production by the testes, often times HCG is used instead to increase natural testosterone production.

The benefit to an athlete would be an increase in testosterone production which would increase muscle mass,  drop healing time from muscle damage and decrease body fat.

Did he test positive for steroids?

Current reports on the case only mention Ramirez testing positive for an elevated level or ratio of testosterone to epitestosterone in his urine. The typical male will have aprroximately a 1:1 ratio, with Major League Baseball using a cut-off of a 4:1 ratio of testosterone to epistesterone as an abnormal test. Ramirez’s urine sample from March allegedly tested higher than the 4:1 ratio and repeat testing reportedly has found the presense of synthetic testosterone, which would indicate Manny Ramirez was taking some type of performance-enhancing drug that is banned by MLB.

Additionally, since no HCG was found in the urine sample, Ramirez’ original arguement that the elevated levels of testosterone where due to his use of HCG for a medical condition is moot. No HCG present in the urine would suggest that the elevated testosterone levels were not due to his HCG prescription.

Furthermore, even if Manny Ramirez’ elevated testosterone levels were due to his HCG prescription, he and his doctor did not file a therapuetic exemption form with Major League Baseball outlining his need to take a substance on the MLB’s banned substance list for a medical condition currently under treatment by a physician.

The next question that arises is if Manny Ramirez is guilty of using testosterone or other performance enhancing drugs – then for how long? Should there be an asterix next to the 2004 and 2007 World Series Championships by the Boston Red Sox that Ramirez was an integral part of?

Looking at Ramirez’s career batting statistics from his stints with the Cleveland Indians (from 1993 to 2000), the Boston Red Sox (2001-2008) and the Los Angeles Dodgers (2008-present), there has been a significant uptick in Ramirez’s batting average (.312 with Boston and .13 with Cleveland to an amazing .380 in 80 games with the Dodgers.) and slugging percentage (a superhuman .710 with the Dodgers compared to simply an All-Star level of .592 with Cleveland and .588 with Boston).

SANTALLA, NARANJO, J and  TERRADOS, N, Muscle Efficiency Improves over Time in World-Class Cyclists , Medicine & Science in Sports & Exercise. 41(5):1096-1101, May 2009.

Goes to show that even at the elite/profression level of cycling, performance gains can still be made by improving the basics.

A new study out of the University of Birmingham, (England – not Alabama) may have found another reason for the performance boost. Researchers published a paper in the Journal of Physiology that looked at the effect on cycling time trial performance in trained cyclists that simply rinsed their mouth with either a sports drink containing carbohydrates or water with added artificial sweeteners for 10 seconds before spitting out the solution.

Surprising, there was a 2-3% improvement in performance in the sports drink “swish and spit” group compared to the water and artificial sweetener group. The researchers hypothesized that there may be separate receptors in the mouth that are specific to carbohydrates. The researchers also studied the brain activity response to the different solutions and discovered that the carbohydrate solutions triggered increased activity in the part of the brain associated with pleasure and reward.

Apparently this is the same area of the brain that lights up in triathletes when the cash register drawer at B&L Bikes or Nytro opens up during a purchase. Not surprisingly, its also the same area of the brain in triathletes that leads to later targeting for elimination by upset non-triathlete spouses reviewing the monthly credit card purchases…

Looking for another way to improve your cycling performance? Check out our San Diego indoor cycling classes.

It may not be just to prevent potential caffeine withdrawal in one of the java-junkies on the ride.

Researchers at the University of Illinois have published a study in this month’s issue of the International Journal of Sport Nutrition and Exercise Metabolism looking at the effect of caffeine on muscle pain and soreness after exercise.

The researchers studied 25 healthy college students and measured the amount of quadriceps (thigh) muscle soreness after a 30 minute high intensity cycling session. The cyclists were given either no caffeine or a caffeine tablet equivalent to about 2-3 cups of coffee (5 mg caffeine/kg) 60 minutes before the exercise session. 

The interesting finding was that both students that never drank caffeine on a regular basis and those that were routine caffeine drinkers both noted a decrease in muscle soreness compared to when performing the cycling test without caffeine. This finding suggests that there may not be much habituation to chronic caffeine use.

How much of a reduction in pain was noted? 

A previous 2006 study in the journal of Pain looking at caffeine and its effects on muscle soreness after eccentric (muscle lengthening) exercises reported a 48% decrease in the level of pain reported on a 0 to 100 point scale when compared to a placebo. How does that stack up to the typical pain medicines like  naproxen (Aleve), aspirin and ibuprofen?

Use of naproxen resulted in a 30 per cent decrease in soreness, aspirin use reduced in a 25 per cent decrease and ibuprofen produced inconsistent results.

Written while sitting in a coffee shop…

-Doc John

PS – My favorite coffee shop in San Diego? Zumbar Coffee and Tea in Sorrento Valley.

What’s your favorite coffee shop for the pre and post-ride caffeine consumption?

Let us know by posting a comment.

Many news agencies are reporting on a research study  presented at the American College of Cardiology annual meeting that suggested that triathletes have a significantly higher risk of heart attacks (myocardial infarctions) while participating in a triathlon. Having had a chance to read a copy of  the presented study, the news accounts are a little misleading. The actual study looked at the incidence of sudden death in triathletes, not “heart attacks” as is being widely reported.

The study looked at reported deaths at USA Triathlon-sanctioned races over a two year period (2006 and 2007). Out of 922,810 triathletes in 2,846 triathlons there were a total of 14 deaths – roughly an incidence of  15 in 1 million participant. According to the study, 13 of these deaths occurred during the swim while the fourteenth fatality occurred due to a bike accident. Out of the 14 deaths, autopsies were performed on only 6 of the triathletes, and from that group of 6, four of the triathletes were found to have underlying heart disease. The other two autopsies reported normal hearts with no evidence of heart damage.

The lead study author commented that the cause of the fatal cardiac events may be due to coronary artery vasospasm, potentially a combination of the high intensity effort during the swim and cold water temperatures. However, its not evident if the water temperatures of the events were the fatalities occured were compared to the water temperatures at triathlons where there were no fatalities, or if the deceased triathlete’s open water or cold water swimming experience was also compared to the rest of the triathletes participating in the races during that same time.

I think that the reality is that some of the deaths are due to the “cold shock” response which is more of a respiratory problem – that gasp that you get when you jump into cold water and has been well-studied in dive medicine. For some people, they have a more severe breathing response to cold water and start gasping and lose control of their normal breathing. In the chaos of a mass triathlon start, that could result in aspiration of water and drowning without any significant cardiac involvement. Additionally, a recent study out of Penn State suggests that coronary blood flow is actually increased during cold water exposure, which would contradict the coronary vasospasm/constriction hypothesis of the triathlon heart attack researchers.

If you want to find out more about the effects of cold shock, the US Coast Guard has a great YouTube video

How does the number of triathlete fatalities compare to other sporting events? The incidence of fatal events at marathons has been estimated to be between 4 to 8 marathon runners per 1 million race participants.

Another study in the medical journal Circulation looked at the impact of training volume of marathon runners on heart function and found that runners with lower weekly running volume (less than 35 miles/wk) had a higher incidence of elevated proteins in the blood that may indicate heart muscle damage compared to marathon finishers that trained more than 45 miles/week leading up to the race.

What does the American Heart Association have to say about the risk of  heart attacks during exercise? Check out the American Heart Association Scientific Statement on Exercise and Acute Cardiovascular Events.

If you’re still looking for more information, check out this editorial in the European Heart Journal that looks more in depth at possible reasons for some of the increased cardiac events seen in marathon runners.

The Peak Performance web site also has a good review about the risk of dying from a heart attack during exercise.

What’s my take?

Any death is tragic.

The fact that someone dies during an event that promotes exercise and a healthy lifestyle (well, if reading Slowtwitch.com all day at work and worrying about the aerodynamics of the latest tri-bike to be released is considered “healthy”) doesn’t make it any less (or more) tragic.

However, the reality is that these individuals that did have cardiac events during the triathlon probably had significant cardiac disease despite their triathlon lifestyle – similar to Jim Fixx’s too early death, the author of the Complete Book of Running that many credited with kicking off the running and health revolution during the 1970′s.

While they may have shuffled off this mortal coil before their time, hopefully they enjoyed the experience beyond what they would have if they had never found triathlons.

-Doc John

San Diego-based Hall of Fame cyclist John Howard, the three-time Olympian and Ironman triathlon champion, who set the cycling speed record of 152 mph, has introduced a new bike fit system designed to instantly improve the efficiency of all cyclists.

The new bike fit system, called PowerFiTTE, combines mechanical and biomechanical adjustment to help cyclists get more out of their bikes and their bodies. This novel bike fitting system was developed over three decades by John Howard, and pioneering sports chiropractor and Olympic trainer Dr. Ernie Ferrel.

“Most people are measured for a bike but not really fit,” says Howard, who still wins championships as a Masters competitor. “PowerFiTTE brings bike and rider into a perfect biomechanical union.”

The PowerFiTTE bike fit session typically takes two hours and involves a series of measurements and re-adjustments based on computer analysis, and an assessment of flexibility strength to produce greater efficiency. Through careful micro-adjustment to the bike, and soft tissue adjustments to the rider, an ideal bike fit position is achieved. Howard’s before-and-after documented measurements typically show immediate boosts of 15-20% boost in cycling power output, which continues to grow as riders practice personalized stretching exercises provided during the bike fit session.

“That’s just the beginning,” Howard says. “Riders see continued improvement in endurance and strength with reduced risk of injury” after their bike fit.

Howard has begun to train and certify bike FiTTE System practitioners around the country. To earn certification, they must first be sports-physiology professionals—coaches, trainers, chiropractors, physical therapists or physicians. “We want this to be the gold standard (of bike fitting)” says Ralph Walker, CEO of John Howard Performance Sports.

PowerFiTTE is part of the FiTTE System, which stands for Fitness, Techniqe, Training and Equipment. It also includes BodyFiTTE, a program of flexibility and strength conditioning, and PedalFiTTE, which stabilizes the key interface of rider-to-bike power transfer with custom fitted Shimano cycling shoes and Speedplay pedals.

John Howard Performance Sports is a leading performance improvement company for cyclists and triathletes, counting many champions among their clients.

Coastal Sports and Wellness Medical Center is pleased be the San Diego location for John Howard’s PowerFiTTe bike fit system. His bike fit system is guaranteed to improve your cycling power and comfort. Interested in finding out more about our San Diego bike fit services, contact us today at (858) 678-0300.