I spent the latter half of the summer of 2018 chasing down heart problems. Motivated by a drop in max heart rate over the previous years, a corollary lack of performance, and stories of guys my age dropping dead, I curtailed all my high-intensity training and made an appointment with the MGH Cardio Performance Program. It can be tricky to debug heart issues with medical professionals. Unless they’re well versed in the physiology of endurance athletes, it can lead you down a rat hole.
The last time I tried to chase down similar issues was in the late 90’s, after I had retired from full-time racing. I was having trouble breathing, getting dizzy with hard efforts and overall having a difficult time adjusting to “civilian” life as a non-racer. I ended up on a treadmill in a doctor’s office in New York City, for a cardio stress test. The patient before me was in his 80’s and had needed help stepping on and off the treadmill. On the other hand, I was in my 20’s, and running so fast that the techs were getting concerned if their apparatus could handle the speed.
As soon as I hit my “peak” heart rate — I still had room to go higher but they were worried about the treadmill — they laid me down on an exam table and scanned my heart with an ultrasound device. Within 30 seconds my heart rate had returned to a normal rhythm and they were stuck. There hadn’t been enough time to really see much of what the heart was doing when it was working hard and the levels I had reached were far beyond what they would typically see. After a few moments, the tech said, “I think we figured it out! When you reach your max heart rate, it crashes. Like your heart can’t handle the workload.”
“Are you talking about the recovery once I’m on the table?” I asked.
“Yeah, as soon as you hit your max, it’s like your heart rate plummeted.”
“Isn’t it a sign of fitness that you can recover to your resting heart rate really quickly?”
The tech pondered a moment. “Um…yeah…you’re right.”
Eventually, I moved out of NYC, got more sleep and less alcohol, and the problems largely resolved.
But here I was again, many years and many miles later, wondering why my body didn’t seem up to the task. I had done plenty of exploration and analysis on my own. I had put together a list of hypotheses and was working through them one by one, as best I could.
- Getting old
- Weak/inefficient legs
- Poor base
- No high end
- Incomplete diet
- Undiagnosed heart problems
Part of the challenge was in isolating the variables and trying to control for them.
I couldn’t do anything about getting old. Some of the possible explanation contradicted each other. I was doing strength workouts for my legs which could contribute to overtraining if that was the issue. Or maybe I just wasn’t doing enough miles but I had a huge aerobic base from all the training hours. I always ate a balanced diet, my weight was stable and was wasn’t training so hard or so long that I was undernourished.
The potential heart problem was the most concerning and the hardest for me to figure out.
There was a family history of heart disease. My brother, also an endurance athlete, had tachycardia issues in the past. And as I looked back over the decades of training and racing I had done, I started to wonder what damage I may had done to my cardiovascular system.
It took nearly two months to get an appointment which would involve a physical exam and a VO2 max test in the lab. I trained and even raced a bit in that interval, unreasonably suspicious that that my heart would go haywire, and so holding back from any really intense efforts.
Seeds of doubt flourish in unknown lands and mine were blossoming into thorny bushes.
Finally the day arrived. I packed my gear bag with trepidation, navigated the Boston traffic and Mass General labyrinthine parking complex to arrive, a bit winded, at the appointment.
The first part was a consultation with the fellow, Dr. Guseh. We reviewed my medical history, my family history, symptoms and notable changes over the years. I had pages of notes and training logs. I had accounted for recorded max heart rates, including the ones that shot above 200 bpm which I had always attributed to interference with the heart rate monitor but…you never know.
Next was an electrocardiogram laying down the the table which was all normal except for an inverted wave that suggested a potential issue but was largely inconclusive prior to an exercise test.
Finally, onto the VO2 max test, the mother of all physiological stress tests, and the lab assistant, Garret, who would put me through my paces. The lab was intimidating with racks of test fixtures, jerseys signed by professional athletes mounted on the wall, and exercise rigs that seemed reminiscent of mediaeval torture devices. I felt out of place, an imposter, as a middle-aged man trying to rule out a weak heart or age as limiting factor in athletic performance.
My bike setup measurements were transferred to the ergometer. My pedals were screwed on. My skin was sandpapered and leads were attached all around my chest and back, a bundle of about a dozen wires that connected to a halter strapped to my back. Finally, the breathing tube and face mask that would measure the amount of oxygen consumed and CO2 released during the effort.
I started pedaling to warm-up. The initial workload was set to one watt per kg of bodyweight, then ramped up one watt every two seconds. It was deceptively easy at first. The wattage was low. I wasn’t breathing hard and the face mask seemed more of a novelty than a nuisance. Garret was calm, alternately looking down at his clipboard, checking the readout on the computer screen, the wattage display on the ergometer, and inspecting the leads to make sure they were attached.
After 10 minutes, I was breathing hard, sweating hard, but still under control. The mask was getting warm and humid. The ergometer was humming and the watts incremented towards their inevitable peak.
I hit ventilatory threshold at 235 watts and 128 bpm. I was breathing for real now and it was all I could focus on, trying to take deep efficient breaths but with each second and every additional two watts, it was getting more and more difficult to do so. But I was still comfortably below anaerobic threshold.
Most of the previous exercise stress tests I had done stepped up wattage rather than an incremental ramp. There was always a looming psychological wall every 3-4 minutes and 30-40 watts of increase. This was mostly due to the lack of sophisticated hardware; we were tested on whatever we could find — exercise bikes in school gyms, electronic trainers in bike shop basements. I liked the ramp protocol. It was more subtle, no huge steps, but also no plateaus to “rest”.
I was rapidly approach AT and my breathing showed it. My legs were starting to load up and burn. The mask was becoming claustrophobic. I was inhaling my own dank, fetid breath; the mouthpiece filled with spit and dignity was quickly fading. I was aware of the sweat pouring off of my entire body. There may have been a fan blowing on me but at this point, it did little to relieve the discomfort.
After about 13 minutes, I reached anaeroibic threshold at 250 watts and 150 bpm.
I entered the pain tunnel from there. The legs were loading up. My breathing was becoming ragged. I was focused on the watt meter and watching it increment. Garret became more interested and started shouting intermittent urgings of encouragement. Time warped. The seconds ticked away but they felt like hours. The end was approaching and with it an exponential increase in pain and suffering.
I pushed on.
I was well over 300 watts now, something I’m able to sustain quite well under normal circumstances, but ramping into over the last 15 minutes was something new. I was so focused on the effort I wasn’t even thinking about my heart. Just my legs. And my breathing. I was getting dizzy now. I wanted to tear off the mask and breath fresh, clean air but the only way to get there was to reach a point of total exhaustion.
In my head, I set 400 watts as the target. I was within 30 seconds of it, but starting to bog down, cadence dropping, pedaling squares. Garret was now full-on shouting at me to keep going, to keep pushing. He had also intuited the 400 watt goal and urged me to it.
At 402 watts, 170 bpm, 16 minutes and 29 seconds, I stopped.
I was done. The room was spinning. I was nauseous.
I pedaled another 2 minutes for recovery through the end of the test. Then we tried some max power efforts to see if we could tigger some of the side and chest pain I had been feeling, but the ergometer couldn’t ramp up quickly enough so we called in quits.
The analysis came fairly quickly thereafter. Everything looked “normal” for VO2 max which, in some ways, was inconclusive. I was hoping to find something that would explain the limitations I was feeling. Dr. Guseh and Dr. Baggish came in to review.
“Everything looks good. No cardiac issues. If anything, you’ve got some excess capacity you’re not taking advantage of,” explained Dr. Baggish.
“How do I do that?” I asked. “Train harder or recover more?”
“Well, we don’t have an answer for that,” he returned.
There were charts and graphs and intercepts and peak performance numbers. My VO2 max was 63, which was respectable for an athlete, and exceptional for “one of my age.” This wasn’t really helping to rebuild my confidence. But the doctors confirmed age wasn’t a limitation. Not yet, at least. There would still be a follow up for an echocardiogram to take some measurements of the heart wall. Just to be safe. I had somehow hoped they would find something so I could put the mystery to rest but in the bigger picture, I was much better off with this result. More importantly, I was clear to train. Hard.
But just how should I be training now?
I spent a few days pondering. I had been able to rule out most of the possible causes on my list, including the most serious ones. I was down to training as the final answer. I thought I had done a good job balancing intensity and recovery, planning for a good amount of base miles. One major outlier was a total lack of off-season. I had trained year round for the last several years, going from bike racing to ski racing, with a string of Boston marathons thrown in there, too. But I had spent the last 6 weeks going easy, so I at least had that.
Finally, I called Adam at Cycle-Smart.
Adam was an accomplished cycling coach, former professional racer and long-time friend. I asked him if he’d every seen anything like my situation.
“Not a lot of guys at your age racing at your level,” was his response. “What are you feeling?”
In summary, I explained that I felt pretty good up to threshold, but once I reached it, I was in trouble. I couldn’t produce any more power, I couldn’t elevate my heart rate. I was basically stuck with no high-end.
He was looking through my TrainingPeaks while we talked.
“Wait a minute,” he started. “I’m looking at your workouts and you have, like, no intensity.”
Really? I felt like I had been riding with intensity. I was racing and suffering while I raced. Didn’t that count?
We talked at length about anaerobic efforts, lactate shuttling, VLAmax and how your body will optimize to use the aerobic energy system or the anaerobic system.
“Guys like the Tour superdomestiques will train for very high threshold power so they can set the pace on the long climbs. They can’t accelerate but they can go hard for a very long time. What you’re describing about how you feel in a race and your workouts show you’ve optimized for threshold. And once you’re there, you’re limited by it. So if you want to change that, you have to do a lot more intensity. A lot.”
Then all the pieces started to click together.
The last five years had been ski marathons, running marathons, one-hour pro crits where I hung on for dear life, cyclocross races where I was basically at threshold the entire time. All long duration, threshold level efforts. All reinforcing performance at threshold. And nothing beyond that.
I had done intensity workouts. Sprints. VO2 max intervals. But when I went back and looked at my training log, I found it was never for more than a few successive weeks. That wasn’t nearly enough time spent training. I needed at least 10-12 weeks of VLAmax training before I’d even begin to see an impact.
I went home that night and got started. Six 30-second all-out efforts on the trainer in the basement. I was dizzy. I was nauseous. I was ready to quit by the third one. It was more than I could handle. I could not see how this would workout.
After 3 weeks, I was able to tolerate a full set of 6 efforts. 30 seconds on/30 seconds off. Rinse. Repeat. After 6 weeks, I was able to add more repetitions. At 8 weeks, I was able to add another set of 6 repeats. My power numbers and heart rate were the same, but I was starting to build up a tolerance to the lactate production.
I also changed how I would race the cyclocross races and focused on how to maximize the training effect by lots of short bursts and recovery rather than racing to threshold and staying there. That changed my race results immediately, more tactics than performance, by allowing me to bridge from one rider to the next, recover, and do it again.
At 10 weeks, I won Shed Park, riding it the way I had been training, with short bursts that coincided with hills or full-gas straightaways, then recovering through the technical sections. Rinse. Repeat.
I started to peak in early December, near the end of the `cross season, with two solid top-10’s at NBX in the Masters 40+ race. I would have been flying a week later. But it was time to switch to the ski season.
I kept doing the 30/30 VLAmax intervals through the winter, on the trainer in the basement beneath the fluorescent lights. My vision would white out, to the point where I had to shut off the lights and ride in the dungeonesque darkness. I grunted through dry heaves and my wife, who could hear my efforts from upstairs, said she was worried. “When you don’t hear the grunting anymore is when you need to start worrying,” I told her.
I did the 30/30s on the snow at the ski track, extending the efforts and the burn beyond my legs to my core and upper body. The slightly sick feeling from too much lactate remained constant. These were hard workouts. Each one completed felt like a substantial accomplishment. I think I was even starting to enjoy them.
My perspective was shifting. At the outset, the 30-second effort terrified me, especially with the continuous repeats. On the recovery interval, I would still be gassed after 25 seconds, but I would somehow be ready to go for the next one.
This changed my attitude in races. Over the previous seasons, I had reached a détente with the pain of high intensity race efforts and I had backed off going beyond theshold and into the red zone. I had settled for what a little less effort and little more comfort could produce. But as the VLAmax training effect kicked in, I was finding an extra gear. I was racing harder AND more comfortably. I was able to attack in the later stages of ski marathons, knowing even if I felt like I was cracking, I would be able to recover. And do it again within 30 seconds. Rinse. Repeat.
I did a few road rides over that winter, too. I felt like I had a motor in the bike. I did some rides where I’d swear I had a tailwind the entire time. I could punch over the short, steep hills and not even be winded. It was a completely different experience.
Spring rolled around. The snow melted away and I was bike racing again. In mid-April, I had a fantastic week. I set new FTP numbers without even trying. I set 1-minute and 5-minute power records. I raced Mix Tape, in the front group until I double-punctured. I raced Hatfield, at the front, covering moves in wet, windy conditions, until I flatted, but chased back on. The chase back was the hardest part of the race for me. A year before, I would have been dropped. By the time I got back to the front, the winning move had gone. But I felt I had already won the day.
I saw Adam in the parking lot after.
He stared at me and said, “What. The. Fuck. You were racing out there.”
“Right,” I grinned. “And I have you to thank for it. Our conversation about lactate training. That changed everything.”
The interesting thing with peaking in sports is that you sometimes don’t realize you’ve done it until you’ve passed it. And that’s what happened with me. I had two more good weeks. I spent most of Myles Standish in the break. I made a beautiful attack in the closing km’s of Quabbin, but got caught at the line. Still, I wasn’t getting the results I felt I deserved. My legs were still cramping up in the last few miles. I was botching the sprints. I still wasn’t 100% confident in my ability.
And so I made the mistake of trying to extend it with more intensity training, on top of the racing, and only managed to make myself tired. In hindsight, I should have taken a nice recovery in early May and then re-start hard training. I eventually got sick in the middle of June, recovered enough to race Crit Week, but far from my peak. It would take the rest of the summer to get back on track. But I’ve been training hard again. Doing the 30/30’s again. Feeling the power come back. This time I’m convinced I can get even stronger, just in time for ‘cross season. It all makes sense now.
There are lessons I’ve learned in 30 years of this sport but I’m not done learning them yet.