Tag Archives: cycling


DMacA_ski_resizeDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK


Some years ago, out walking along the river, I met an ex-athlete friend . “I gave up running at 50,” he told me. "Too many of my friends were having heart problems”. This didn’t fit with what I believed about the benefits of exercise, so I didn’t give it a lot of thought.

More recently, however, when preparing a talk on sudden cardiac death, I came across a research paper from Sweden that followed up 52, 755 athletes who had completed the Vasaloppet a long distance cross country ski race (90k) and, curiously, showed that those who raced more often and faster, were more likely to have hospital admissions for cardiac arrhythmia. This seemed counter-intuitive. ...continue reading

DMacA_ski_resizeDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. This week he is attending the CASEM-OMA Sports Medicine symposium in Ottawa.


Edu-tainment is how we need engage audiences, according to Andrew Pipe, chair of the opening session of the CASEM-OMA 2015 meeting in Ottawa. And what a superb opening session. Ian Shrier and Pierre Frémont introduced their five key sports medicine papers and debates of the last year. From a CMAJ perspective, it was great to hear Ian cite our systematic review on arthroscopic surgery for degenerative tears of the meniscus as a key paper. He made a very important point that the outcome was the minimally important difference to patients. The authors had used the average but, looking at the minimally important difference distribution, this may not be entirely reflective, and some people may have had a benefit in the short term although, in the long term, there was no effect.

Concussion is a major issue and Pierre reminded us of a paper emphasising that concussion management protocols should include cervicovestibular evaluation ...continue reading

TGreenhalgh_picTrisha Greenhalgh is Professor of Primary Health Care and Dean for Research Impact at Barts and the London School of Medicine and Dentistry, London, UK

The Professor of Trauma Surgery texted me: “Can I come and see you today please?”

I had started work at 8 am and it was already 4.30 pm. I had four more meetings in my diary. But he had never asked before, so I decided it must be important. I texted back: “6.30 in my office, if you’re still around.”

He was early. I buzzed him in, and asked wearily, “How can I help?”. We overlapped on a committee so I assumed he wanted to talk business.

“Actually, I came to ask about you,” he said

“Huh? I’m fine.”

“I had a tip-off that you weren’t fine.”

“Who told you that?” ...continue reading

GranFondoLast summer, for the third year in a row, more than 4,000 people (mostly middle-aged men) pedaled their ultralight road bikes from downtown Vancouver to downtown Whistler, BC, a whopping 122 kilometers, uphill.   If anything, the Whistler Gran Fondo (Italian for “Big Ride”) is evidence that cycling is soaring in popularity and a sure cure for middle-aged mens’ need for speed, social contact and exercise. Group road riding is the fastest growing sport for men between 40 and 60, a groove where the economics of middle age maleness fits, almost perfectly, the tempo and limits of their middle-aged bodies.

Cycling’s accelerating popularity is easy to explain. Many men approaching their 40’s who were physically active in their youth, playing soccer or hockey, running marathons, and after kids, start developing nagging joint or other musculoskeletal problems. But they still have their mojo to want to run with the pack. They just need a new pack. It helps, as well, that by the time the body is wearing down, and the kids are growing up, there is a bit of extra cash in the wallet. This demographic doesn’t get too winded by plunking down $4000 or so for a decent carbon fibre bike, a cycling computer to collect, store and post personal cycling ‘data’ and a closet full of tight, ridiculously coloured cycling apparel.

But if you think high speed cycling and colourful lycra is harmless, we middle-aged men need to ask one question: Are we ready for the urodynamic changes which await us?

An innocent question, right?

We’ve all heard rumours of rampant impotence spreading through the peloton like a nasty virus, but are the side effects of this sport that hazardous to our nether regions?  According to a very reliable source of information (the pharmaceutical industry) 40% of men in our demographic suffer from low testosterone, 25% of us from premature ejaculation and 12% from erectile dysfunction, so being perched on bikes for hours on end, attacking hills with our buddies, may only be adding to our toll of 'urowoes'.

All the sitting is actually a godsend (made easier by a featherweight $150 seat that cradles your prostate like a baby in a hammock) because compared to the pounding of feet on pavement, pushing pedals is relatively forgiving on the hips, knees and Achilles Heels that are slowly breaking down.

You might intuit that Newton’s 3rd law must have a say in all this, where the ‘action’ of pedaling for hours on end can create a new batch of ‘reactions’, including prostatitis, hemorrhoids, urinary leakage, and saddle sores. But you’d be wrong. In fact, according to some studies “bicycle riding as exercise or hobby has no negative effect on LUTS (lower urinary tract symptoms) and erectile function in healthy men.”

Let me point out the operative words in this study are “exercise or hobby,” because different effects are seen if you studied “bicycle riding as obsession.” Research has shown the overly fixated will tend to see more adverse effects in their personal relationships and their gluteal regions, especially near the buttock cheek that holds the wallet.

Relationships may suffer when men spend precious weekend hours on crazily long rides, and the mandatory post-ride caffeinated debriefings. Then there’s the whining, where the most common complaint is around how heavy the bike is. The cyclist’s obsessive search for feather-weight cycling components can present itself as both pathological and expensive because nothing on God’s green planet is more important to the middle-aged man new to road cycling than spending money to get bike parts so light the bike floats up the mountains by itself.

By way of example let’s take the German-engineered, Edelhelfer (which means “Precious Helper”) an uber-lightweight water bottle cage. A mere 18 grams, this little bit of cycling slickness is one of the lightest water-bottle cages in the world, mirroring the carbon-fibre lightness of an embarrassingly expensive wheel.

And the price? Well, let’s not quibble but weighing in at around 65€, (about $95 Canadian) the Edelhelfer may save you at least 21 grams off a plastic bottle holder that costs $5. (Note: Don’t tell the wife 20 paper clips weigh about 20 grams).

Are these things worth it? Well, that’s for the man and his new obsession to decide. Paying all that money for super-light bike parts may not make you lighter or faster. But we all know how good it feels to be trying to do what we can, even if it only makes your wallet that much lighter.

Happy riding.

by Alan Cassels, a pharmaceutical policy researcher in Victoria who has just turned 50, has ridden the Whistler Gran Fondo twice and is currently saving for an Edelhelfer.


DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

The photograph in the Globe and Mail was impressive. Thousands on the Ride to Conquer Cancer bike ride in Toronto reflects both the current popularity of cycling and people's willingness to support cancer charities. According to the photo caption, it had raised over $119 million; 20 million dollars this year alone. An immense achievement. Cycling has of course, been long linked with cancer fundraising through Lance Armstrong, long time champion for cancer sufferers who gave so many people hope and inspiration and raised millions for his cancer charity. Sadly, his doping admission destroyed his personal reputation and popularity, did untold damage to his cancer work, and disappointed millions of cancer patients.

Doping seems inextricably linked with cycling and will be once again in Canadian consciousness with the release on Friday June 13th of “La Petite Reine”, a biographical film about Genèvieve Jeanson. Its timely release will reprise the pressure on athletes to perform, the role of parents and coaches, and our own expectations of top athletes. The doping story in cycling doesn’t seem to have dimmed public interest however and, as the Tour de France begins in a few weeks, cycling fans will look forward once again to watching the pain, suffering, and glory of the heroes and villains of the cycling world and still hoping to believe.

Cycling is more popular than ever, in spite of the seemingly relentless adverse publicity—even if we allow ourselves a quiet smile at the modern cycling phenomenon, the MAMILs (middle-aged men in lycra). Doctors are not immune and, if coffee room chat is an accurate measure, may be particularly vulnerable to the MAMIL phenomenon. It is easy to forget the risks, however, when thinking of the considerable health benefits. To give this a medical context, do read this Australian newspaper article based on the crash injuring Sydney Medical School Professor Paul Haber when a 4x4 vehicle ploughed into their group of seven cyclists.

What can we do? We need to keep in perspective the public health benefits of physical activity and the wider benefits of this cycling movement. Serious road crashes are relatively rare, but they are preventable. There is no medical solution, its about the environment, the law, and society. Doctors may not have a direct part to play in changing government transport policy, the legal system, nor road design but they can give leadership, highlight the risk of injury and advocate for change.

DMacA_3Domhnall MacAuley is a CMAJ associate editor and a professor of primary care in Northern Ireland, UK

The circus came to town. The Giro d’Italia, one of the world’s great cycle races, started on Friday with a feel good story for Canadian fans. Svein Tuft, a 37 year old from British Columbia, crossed the line first in the team time trial which allowed him to start the next day’s racing wearing the pink jersey (Maglia Rosa) of race leader. In the post-race interview he revealed that the team had gifted him the lead as it was his birthday. A rare gesture in the ruthless world of cycle racing.

The “Grande Partenza” was in Belfast. Another feel good story as the city embraced the event, painted the town pink, and thousands of spectators lined the route. As part of the overall Giro fest, there was a film preview of “The accidental death of a cyclist”, on the life of Marco Pantani a celebrated Italian cyclist who captured the hearts and minds of cycling fans in the late 90’s (pantanifilm.com). His life had many medical references, the cycling haematocrit rule, his link with the Italian sports doctor and scientist Francesco Conconi, and the retrospective confirmation of EPO use. A troubled teenager with an immense talent, he achieved cycling’s greatest heights but tumbled from stardom and, as his sporting life disintegrated, he fell into drug abuse and eventually died after a two week cocaine binge. It was difficult not to feel some sympathy for this sad hero from a small Italian coastal town who embraced sporting greatness. The film, like the similarly named play by Dario Fo, leaves us to make up our own minds. Was Pantani, known as “the pirate”, a victim or villain?

Psychology and psychiatry now seem to form an essential component of improving sporting performance. In the post film discussion, James Erksine the director, gave an interesting perspective. Sport is about winning and losing. But, if you define your life in such absolute terms of winning or losing, then life can never be a success because real life is about losing. And, so it is with all elite sport. We fete the heroes, damn to dopers and forget the winners when they step off the podium. Surfing a wave of adulation, a career inevitably comes to a disappointing end. One Monday morning they awaken and it’s all over. Many of us involved in sports medicine know of athletes who cannot put their lives together again and whose subsequent life is a chaotic chronicle of dysfunction, divorce, drugs, or drink. They step off the podium into an abyss. Who is there to help them? Sport and exercise medicine is now intricately involved in helping people get to the top. But, where is the medical support when they are heading towards the bottom?