# Cyclists' hearts: Why elite cyclists die in their sleep (7 min video)



## medlifecrisis (19 Jan 2018)

Hello everyone,

I hope you don't mind me posting this as I am new to the forum, a few people suggested I share it here (my channel is not monetised, just thought people would be interested).

This is a short video inspired by Marco Pantani and that amazing phrase many of you will've heard, about his heart rate being so slow he had to wake up in the night to pedal on an exercise bike: "During the day he lived to ride, but at night...he rode to stay alive". I'm a cardiologist (and lousy cyclist) and try to explain why a couple of dozen endurance athletes have died in their sleep over the last few decades.

Any thoughts sincerely appreciated and thank you for watching!


View: https://www.youtube.com/watch?v=hT8GZlBBv5k


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## Crackle (19 Jan 2018)

Good video and yes, you nailed it, drugs: One of the reasons that the UCI introduced the 50% haemotocrit level was due to a spate of deaths. They're still happening unfortunately, it's still drugs, although it's rumoured the drugs of choice these days are ones that cause weight loss and give a better power/weight advantage. And yes, elite athletes are freaks of nature.


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## jay clock (19 Jan 2018)

I have not watched (at work, open plan), but I am solid build, chubby top half, legs of muscle. Height 177 weight about 90kg. Not doing drugs of any sort (honest!) and resting HR of 45 average. At night it has gone down to 34 (watch tracks it all night)

So my question is am I about to die?


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## Drago (19 Jan 2018)

Well, I'm the most in elite cyclist ever, so should live to be 150.


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## Andrew_P (19 Jan 2018)

jay clock said:


> I have not watched (at work, open plan), but I am solid build, chubby top half, legs of muscle. Height 177 weight about 90kg. Not doing drugs of any sort (honest!) and resting HR of 45 average. At night it has gone down to 34 (watch tracks it all night)
> 
> So my question is am I about to die?


Go to sleep with one eye open. If you wake gasping for breath try two.


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## HLaB (19 Jan 2018)

jay clock said:


> I have not watched (at work, open plan), but I am solid build, chubby top half, legs of muscle. Height 177 weight about 90kg. Not doing drugs of any sort (honest!) and resting HR of 45 average. At night it has gone down to 34 (watch tracks it all night)
> 
> So my question is am I about to die?


As long as you're not an elite athlete youl be fine


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## Threevok (19 Jan 2018)

My resting HR is 75-85, can drop to 55 during sleep

Should I be worried ?

I also have a habit of stopping breathing for long periods of time during sleep. Luckily, Mrs V is there to "kick" start me


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## Heltor Chasca (19 Jan 2018)

medlifecrisis said:


> Hello everyone,
> 
> I hope you don't mind me posting this as I am new to the forum, a few people suggested I share it here (my channel is not monetised, just thought people would be interested).
> 
> ...




Love it. Your humour turns a relatively inane and even controversial issue into a fascinating subject. I have competed up to world championship level in sailing where basic nutrition and even more basic biology was covered, but it is only recently (while using TrainerRoad) I have become interested in the fundamentals of fit bodies. I never really considered capillary beds or lactic tolerance before. 

Also about the right length. Well done. Keep them coming.

Subscribed btw.


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## Slick (19 Jan 2018)

What about the footballers or even the more recent case of the rugby player? Is this specific to cyclists or does it effect all athletes?


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## Tin Pot (19 Jan 2018)

Threevok said:


> My resting HR is 75-85, can drop to 55 during sleep
> 
> Should I be worried ?
> 
> I also have a habit of stopping breathing for long periods of time during sleep. Luckily, Mrs V is there to "kick" start me



Your RHR is the rate when you sleep, not the rate when your up and about or sitting down. Measure either through the night, or when you wake up but before you sit up.


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## GrumpyGregry (19 Jan 2018)

Slick said:


> What about the footballers or even the more recent case of the rugby player? Is this specific to cyclists or does it effect all athletes?


Dopers? Not uncommon amongst such sports.


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## Alan O (19 Jan 2018)

medlifecrisis said:


> Hello everyone,
> 
> I hope you don't mind me posting this as I am new to the forum, a few people suggested I share it here (my channel is not monetised, just thought people would be interested).
> 
> ...



That's excellent, and very well presented, thanks - I've subscribed.


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## GrumpyGregry (19 Jan 2018)

Tin Pot said:


> Your RHR is the rate when you sleep, not the rate when your up and about or sitting down. Measure either through the night, or when you wake up but before you sit up.


I can get my resting heart rate down to, or just below sleep levels, when wide awake, sat in a chair, in the middle of the day.

I love doing so in the doctors or hospital when attached to a monitor. Only one doctor or nurse has ever sussed it. "Mr Grumpy is clearly one of the fat fit" he said, before ramming a camera up my 'arris.


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## Threevok (19 Jan 2018)

User said:


> The American Heart Association suggests taking it first thing in the morning before you get out out of bed.



That's usually what I do.


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## Alan O (19 Jan 2018)

User said:


> The American Heart Association suggests taking it first thing in the morning before you get out out of bed but there is no standard definition of 'resting heart rate' and none of the ones commonly in use by health professionals/researchers are linked to being asleep. Most are along the lines of "after 10 minutes of being seated, and not within two hours of strenuous exercise or within one hour of consuming caffeine".


Wikipedia says "_The basal or resting heart rate (HRrest) is defined as the heart rate when a person is awake, in a neutrally temperate environment, and has not been subject to any recent exertion or stimulation, such as stress or surprise_", but I'd expect if you measured it at multiple times in such conditions during the day, you'd get multiple different answers - and I wouldn't be surprised if the most representative time is different for different individuals.

I like using a fitness tracker to measure it, and I'm currently wearing my fitbit 24 hours a day so it gets plenty of data to use. I'd like to know how fitbit calculates it, but all they say is it's done "_by measuring your heart rate when it detects sleep, and by measuring it throughout the day while you are awake but inactive (no steps detected)_" and they keep the actual calculation secret.

The results will surely vary between different devices, but at least it means I'm getting consistent measurements _for me_, and that's what I really need to keep a track of things. Currently, fitbit has my rest HR around 60-62, with my sleep HR typically dropping to 57-59, and I'm hoping that will come down as I'm making a big effort this year to get my weight down and improve my fitness.

An interesting observation I've made is the effect of alcohol on my rest HR, and the length of time it takes to recover from it. I had a slightly reduced-exercise rest the last two weeks of December and didn't wear my tracker, during which time I partook of a quantity of fine beers and my homemade wines, before embarking on an alcohol-free January (and hopefully beyond). With the tracker back on, my rest HR was up in the high 70s in the last few days of the month, and it took two weeks from stopping the alcohol to get back down to my usual low 60s.

I've seen the same thing happen with similar events in the past, and my HR also rises noticeably if I'm ill, even with just a cold.

I'm someone who finds being able to count and measure things a great incentive, and I think my main measure is going to be rest HR - it does seem to be a very sensitive indicator.


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## ianrauk (19 Jan 2018)

Drago said:


> Well, I'm the most in elite cyclist ever, so should live to be 150.


Never knew you cycled


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## Slick (19 Jan 2018)

GrumpyGregry said:


> Dopers? Not uncommon amongst such sports.


I know it's not uncommon in other sports, but have yet to hear of one in recent times involving the premature death of the players. I also know, that doesn't mean there hasn't been any, but a genuine question if it was ever a suggestion with such cases.


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## jefmcg (19 Jan 2018)

Threevok said:


> I also have a habit of stopping breathing for long periods of time during sleep.





Threevok said:


> Should I be worried ?


Yes! Sleep apnea is a very serious condition, that is amenable to treatment. See your GP for referral to nearby sleep clinic.


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## GrumpyGregry (19 Jan 2018)

Slick said:


> I know it's not uncommon in other sports, but have yet to hear of one in recent times involving the premature death of the players. I also know, that doesn't mean there hasn't been any, but a genuine question if it was ever a suggestion with such cases.


I have heard it spoken of, and remember reading about the issue, in the specialist rugby (union) press reporting.

Not saying you think this, but anyone, especially any rugger bugger, who thinks every bulked-up union player on the planet gets that way purely by through free-weights, salad and mineral water is kidding themselves.


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## Ajax Bay (19 Jan 2018)

Miguel Indurain's resting heart rate. Cycling (magazine):"It seems only right to begin by discovering some truths behind the legendary figure, starting with that 28bpm resting heart rate. Is it true?"
'Some of the stories are true and some of them are a little bit exaggerated,’ says Indurain. ‘Normally I had a resting heart rate of 30 or 32bpm. The coaches used to measure it in the morning and in the afternoon to see if I was recovering. One day we did a medical test and it read 28, so there is some truth in it. But normally it was a little bit higher.’
My (heart rate ) experience (when 20 to 40 years old) is similar (low of 28, normally 29-31): Polar (chest strap) measurement at rest (ie on waking). Up in the mid 30s now, some quarter century on. Not dead yet - but had to reassure the medics in the ICU (during my short stay) and ask them to turn the alarm down to 35 if they didn't want it going off all the time.


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## User169 (19 Jan 2018)

Slick said:


> What about the footballers or even the more recent case of the rugby player? Is this specific to cyclists or does it effect all athletes?



In their sleep? The only football ones I think of were whilst they were playing


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## GrumpyGregry (19 Jan 2018)

Alan O said:


> I've seen the same thing happen with similar events in the past, and my HR also rises noticeably if I'm ill, even with just a cold.
> 
> I'm someone who finds being able to count and measure things a great incentive, and I think my main measure is going to be rest HR - it does seem to be a very sensitive indicator.


HR data is very insightful and can provide sound metrics and a decent fitness indicator. Being less fit than I was in 2015 I find looking at HR stats for the same 5km parkrun then and now fascinating. Way slower than 2015, much higher heart rate. But... same heart rate (ish) over last three weeks, getting faster each week.


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## Slick (19 Jan 2018)

GrumpyGregry said:


> I have heard it spoken of, and remember reading about the issue, in the specialist rugby (union) press reporting.
> 
> Not saying you think this, but anyone, especially any rugger bugger, who thinks every bulked-up union player on the planet gets that way purely by through free-weights, salad and mineral water is kidding themselves.


I'm not that naive. It was just a genuine question about an issue that for me seems to becoming not more common but I seem to be hearing more cases of heart issues but no mention of doping.


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## Slick (19 Jan 2018)

DP said:


> In their sleep? The only football ones I think of were whilst they were playing


Not sure about the recent case of the rugby player but yes your right about the footballers. I suppose they must have had underlying issues.


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## bpsmith (19 Jan 2018)

Not watched the video yet, but plan to do so later.

I have recently got more interested in HR. Measure mine sat at work and it sits between 45 and 55. Gets as low as 40 when I remember to check on waking up. Currently using the LED flash with an App on my phone.

When in the bike, it’s the opposite end of the scale. I can ride for an hour with a 182 average, maxing at 202. Can rarely get it lower than about 170 when on the bike, even when riding casually. That’s using Garmin chest strap. Is this stupidly high?

Keen on getting a watch to keep records and test when sleeping. What do you guys use btw?


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## GrumpyGregry (19 Jan 2018)

bpsmith said:


> Not watched the video yet, but plan to do so later.
> 
> I have recently got more interested in HR. Measure mine sat at work and it sits between 45 and 55. Gets as low as 40 when I remember to check on waking up. Currently using the LED flash with an App on my phone.
> 
> ...


How old?

I only record HR when running. Don't measure it when cycling or sleeping.


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## Slick (19 Jan 2018)

bpsmith said:


> Not watched the video yet, but plan to do so later.
> 
> I have recently got more interested in HR. Measure mine sat at work and it sits between 45 and 55. Gets as low as 40 when I remember to check on waking up. Currently using the LED flash with an App on my phone.
> 
> ...


We're obviously all different in every way, but for me that's very high although others have told me it's normal for them. I reckon your average would be close to my max. Any more and I really start to feel very uncomfortable.


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## bpsmith (19 Jan 2018)

40 years and 3 months @GrumpyGregry

Even the 202 max doesn’t make me feel particularly uncomfortable @Slick, which I find very odd tbh.

Have checked the HR strap with the phone App and they were within 2 beats of each other on 2 occasions, so rules out faulty kit somewhat.

I don’t like the chest strap tbh, so deciding between a Scosche Rhythm and a watch of some sort.


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## Slick (19 Jan 2018)

M


bpsmith said:


> 40 years and 3 months @GrumpyGregry
> 
> Even the 202 max doesn’t make me feel particularly uncomfortable @Slick, which I find very odd tbh.
> 
> ...


My rate was measured just using a fitbit. BIL, during a medical was told that his cheap fitbit was very accurate but not sure if that translates to during exercise. It maybe just means your very fit?


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## GrumpyGregry (19 Jan 2018)

bpsmith said:


> 40 years and 3 months @GrumpyGregry
> 
> Even the 202 max doesn’t make me feel particularly uncomfortable @Slick, which I find very odd tbh.
> 
> ...


So theoretical max = 220 - age = 180 but individuals vary by 20 bpm either way.
So 180 +/- 20 = MHR range of 160 - 200 bpm
So allow a small margin for error and a real max 202bpm is ok.

I can push mine well past 220 - age without ill-effect.


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## medlifecrisis (19 Jan 2018)

Thanks everyone! Really nice to read the kind comments and sorry I missed the discussion. 

For those that can't watch (I'd understand, I can't stand hearing my voice!) don't worry - your low resting heart rate is a good thing. The twist to this story which I didn't want to mention in advance is performance-enhancing drugs, specifically EPO. EPO increases your red cell count making your blood thicker. This can occur in people who move to high altitude, smokers or people with lung disease (ie all get lower oxygen than normal) and is called polycythaemia. It can predispose the person to clots forming but isn't a HUGE risk as most people's hearts are within 60-100bpm.

However, combine it with crazily low heart rates found in elite athletes and it can be a recipe for disaster. The reason they die in their sleep is that's when the basal metabolic rate drops lowest.

A few responses to people:


"Am I going to die?" - I guarantee it. But hopefully not for many years 

Footballers dying while playing - absolutely, another tragic cause of young deaths. However this is normally due to inherited conditions like hypertrophic cardiomyopathy (leading cause of death in athletes under 40), abnormal rhythm problems (Fabrice Muamba) or other structural and electrical problems (James Taylor (cricket)). All of these can be exacerbated by exercise, hence they tend to die/have a cardiac arrest while playing.

Resting heart rate I would normally take to mean HR while awake, at rest. Not while asleep - don't listen to those lying Fitbits which flatter you! Time it yourself over 30 seconds or so. I recommend everyone to track it (once a month is fine but obviously the quantified self and wearables has exploded) and assess response to exercise.
Fire away with any other queries and thanks again!


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## Levo-Lon (19 Jan 2018)

Bell on the toes..simples out and a fire extinguisher..Times have changed


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## Ajax Bay (19 Jan 2018)

Enjoyed watching the video @medlifecrisis 


bpsmith said:


> I can ride for an hour with a 182 average, maxing at 202. Can rarely get it lower than about 170 when on the bike, even when riding casually. That’s using Garmin chest strap. Is this stupidly high?


Those data are out of the ordinary, particularly for bike riding. Stupid? No. It's what your body does.


GrumpyGregry said:


> So theoretical max = 220 - age


That formula is widely discredited - in fact the doctor who mooted it has explicitly said that it is (I paraphrase) useless, particularly for active/fit people. Precis:
Devised in 1970 [Haskell&Fox] . . . it was based on data from [other studies] but gained widespread use through being used by Polar Electro in its heart rate monitors, which Dr. Haskell has "laughed about",[23] as the formula "was never supposed to be an absolute guide to rule people's training." It's easy to remember and calculate but is a poor predictor of HRmax - it has a large inherent error so has neither the accuracy nor the scientific merit for use in exercise physiology and related fields.[24]
Nes _et al_ (2012) found the best fit to be HRmax = 211 − (0.64 × age) with a 10 beat standard deviation (and you can do a few km on the road while you work that out).


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## bpsmith (19 Jan 2018)

Just watched the video now @medlifecrisis. I find some YouTube videos very annoying for no apparent reason other than peoples voice.

Your voice certainly doesn’t fall into that bracket I hasten to add. 

Very interesting video in fairness and, as mentioned already, I liked the humour at the end too.

My thumbs up takes you to 500. Subscribed too. Keep them coming.


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## Slick (19 Jan 2018)

bpsmith said:


> Just watched the video now @medlifecrisis. I find some YouTube videos very annoying for no apparent reason other than peoples voice.
> 
> Your voice certainly doesn’t fall into that bracket I hasten to add.
> 
> ...


So did I, but only because I fancied my chances on that road race he mentioned.


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## Alan O (19 Jan 2018)

Ajax Bay said:


> ...the best fit to be HRmax = 211 − (0.64 × age) with a 10 beat standard deviation.


Interesting. The 220-age one gives Max HR of 161 for me, which isn't that close as in reality my HR can get up to around 180. The 211 − (0.64 × age) one gives 173, so that fits me quite well.


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## bpsmith (19 Jan 2018)

Slick said:


> So did I, but only because I fancied my chances on that road race he mentioned.


I think he’s sharking tbh. His resting HR is ultra low, so I reckon he’s faster than he makes out.


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## Slick (19 Jan 2018)

bpsmith said:


> I think he’s sharking tbh. His resting HR is ultra low, so I reckon he’s faster than he makes out.


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## GrumpyGregry (19 Jan 2018)

User said:


> Thus far, and you've had a good innings.


I wonder if anyone has ever died at parkrun when determining their max HR from the 100 metres whilst going for a SB/PB?


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## Colin_P (19 Jan 2018)

GrumpyGregry said:


> I wonder if anyone has ever died at parkrun when determining their max HR from the 100 metres whilst going for a SB/PB?



No, not there doing that but I've died quite a few times in other intersting and not so interesting circumstances, all from cardiac arrest, and it ain't very nice.

Twice in bed
Once while driving
Once in an ambulance
Once whilst making bacon sandwiches for the family on a Sunday morning
Once on the sofa whilst watching the One show
and
About four times in A&E.

All due to a viral infection from many years before which scarred my heart muscle but unknown to me at the time. All was well until I overdid the training over a period of about a month which I'm convinced tipped things over the edge.

Be careful you lot, just because you can doesn't mean you should red-line your heart rate!

The other elite cyclist common heart condition is Atrial Fibrillation which can be quite nasty especially when it goes on to cause a stroke. (P.S. I've never been and never will be an elite cyclist).

Again, be careful and again just because you can doesn't mean you should. Build up slowly and don't go mad. Although not terribly scientific, the 220-age thing should be viewed as an absolute upper limit, not a target of barrier that should be broken unless you are a nutter.

A cardiac arrest is very sudden and most don't come back from them but for those nutters out there they are the ultimate KOM !


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## jefmcg (19 Jan 2018)

Colin_P said:


> No, not there doing that but I've died quite a few times in other intersting and not so interesting circumstances, all from cardiac arrest, and it ain't very nice.
> 
> Twice in bed
> Once while driving
> ...



OK. I'm calling shenanigans, because you are claiming to have survived 5 events each with a 18.5% chance of surviving and 5 more with a 26% chance of leaving hospital alive, which means your chances of being here to share that with us are 0.00003%.

How many medical journals have featured your case study?


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## classic33 (19 Jan 2018)

@medlifecrisis, worth a read?
http://www.thecormactrust.com/sudden-cardiac-death-ireland/

Edit to ask have you included height in your study?


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## Colin_P (19 Jan 2018)

jefmcg said:


> OK. I'm calling shenanigans, because you are claiming to have survived 5 events each with a 18.5% chance of surviving and 5 more with a 26% chance of leaving hospital alive, which means your chances of being here to share that with us are 0.00003%.
> 
> How many medical journals have featured your case study?



Because Implanted Cardioverter Defibrillator.

[edit] just the one medical journal


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## Slick (19 Jan 2018)

jefmcg said:


> OK. I'm calling shenanigans, because you are claiming to have survived 5 events each with a 18.5% chance of surviving and 5 more with a 26% chance of leaving hospital alive, which means your chances of being here to share that with us are 0.00003%.
> 
> How many medical journals have featured your case study?


I hate it when maths and facts get in the way of a good story.


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## Slick (19 Jan 2018)

Colin_P said:


> Because Implanted Cardioverter Defibrillator.
> 
> [edit] just the one medical journal


Scary stuff.


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## classic33 (19 Jan 2018)

jefmcg said:


> OK. I'm calling shenanigans, because you are claiming to have survived 5 events each with a 18.5% chance of surviving and 5 more with a 26% chance of leaving hospital alive, which means your chances of being here to share that with us are 0.00003%.
> 
> How many medical journals have featured your case study?


I've a Death Certificate in my medical records. Happened on the operating table.


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## Slick (19 Jan 2018)

classic33 said:


> @medlifecrisis, worth a read?
> http://www.thecormactrust.com/sudden-cardiac-death-ireland/


Every time I try to read anything of this nature I seem to come over all uncomfortable, not sure why.


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## Colin_P (19 Jan 2018)

Slick said:


> I hate it when maths and facts get in the way of a good story.



Yes, apparently the shock threshold algorithm uses lots of maths.


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## Slick (19 Jan 2018)

Colin_P said:


> Yes, apparently the shock threshold algorithm uses lots of maths.
> 
> View attachment 392252


Colin, that was a glib comment, please don't think for a minute I was disbelieving anything you posted. I know of one other guy who required this but he had to give up work and never goes out at all now.


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## classic33 (19 Jan 2018)

Slick said:


> Every time I try to read anything of this nature I seem to come over all uncomfortable, not sure why.


Facing up to the fact that we might one day no longer be here?

And I'm not being mean.


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## Slick (19 Jan 2018)

classic33 said:


> Facing up to the fact that we might one day no longer be here?
> 
> And I'm not being mean.


My family history is riddled with it, and it's a bit like your just waiting for your turn. 

I know you were not being mean.


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## classic33 (19 Jan 2018)

Slick said:


> My family history is riddled with it, and it's a bit like your just waiting for your turn.
> 
> I know you were not being mean.


Only one in the family that it's happened to, and I've had mine.


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## Slick (19 Jan 2018)

classic33 said:


> Only one in the family that it's happened to, and I've had mine.


Yeah, it doesn't always go the way you would expect. The body is a mysterious thing.


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## Slick (19 Jan 2018)

classic33 said:


> Only one in the family that it's happened to, and I've had mine.


My brother was always a bit of an athlete whilst I was the teenage rebel that carried on for far too many years, yet he was the first to suffer. I know he must question this in his own mind, as I know I do.


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## Colin_P (19 Jan 2018)

Slick said:


> Colin, that was a glib comment, please don't think for a minute I was disbelieving anything you posted. I know of one other guy who required this but he had to give up work and never goes out at all now.



It is tricky, there is the survivor guilt thing and also the what/when if's...

I still somehow manage to do about 2,000 (very slow) miles every year on the bike.

Again, to everyone.... just be careful and build up. Don't try and max you HR just because you can. A cardiac arrest is rare but if by some quirk you are suceptable there is normally no coming back, I am incredibly lucky.

However....... it is totally painless.


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## classic33 (19 Jan 2018)

Slick said:


> My brother was always a bit of an athlete whilst I was the teenage rebel that carried on for far too many years, yet he was the first to suffer. I know he must question this in his own mind, as I know I do.


And you could worry yourself to death, just thinking about it.


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## Slick (19 Jan 2018)

Colin_P said:


> It is tricky, there is the survivor guilt thing and also the what/when if's...
> 
> I still somehow manage to do about 2,000 (very slow) miles every year on the bike.
> 
> ...


Good man.


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## Slick (19 Jan 2018)

classic33 said:


> And you could worry yourself to death, just thinking about it.


Yeah I know, and maybe do a bit in quieter moments, but I keep it very much to myself. Well, I did until now.


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## Drago (20 Jan 2018)

Max HR? I'm happy to get home from a run and still have a pulse!


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## medlifecrisis (20 Jan 2018)

bpsmith said:


> I think he’s sharking tbh. His resting HR is ultra low, so I reckon he’s faster than he makes out.



Err..sure let's go with that


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## medlifecrisis (20 Jan 2018)

@Colin_P Thanks for sharing your story. A lot of the things we do in medicine offer small benefits but putting an ICD in someone like yourself is a genuine life saver, often many times over. Wishing you best of health.


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## Colin_P (20 Jan 2018)

[QUOTE 5122172, member: 9609"]was this all within a short space of time (months) and have they done stuff so that it won't be likely to happen again ? sounds just horrific, is this all related to your thrombosis thing ?[/QUOTE]

No, it has been going on for the last thirteen years. Just when I think I'm in the clear things have a nasty habit of turning into rat-shoot once again. Life and life confidence can be challenging and getting up out of the chair and doing anything can be difficult at times. Despite all that and once I'm out of said chair, cycling seems to work wonders with my mood, no matter how slow and short a distance.

They, the 'quacks' tried to do a procedure called an ablation which in simple terms is to burn the areas of heart muscle away that cause the issue away. Sadly that didn't work. After each time I've dropped dead (and been shocked back to life) they have changed / added / increased medicine. Each time to an increasingly more toxic and evil one along with increases of beta blocker dosage. Currently I'm on an elephant tranquilising dose of betas which limits my max heart rate to about 110bpm, cycling up hills is interesting to say the least. The antiarrhythmic I'm really is quite nasty in terms of side effects but the most effiective at peventing one dropping dead.


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## JtB (20 Jan 2018)

From my experience 3 years ago where out of the blue my heart started stopping every time I fell asleep, I think even lousy cyclists can die in their sleep.


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## bpsmith (20 Jan 2018)

Not everyone is trying to max their heart rate, it just happens to some of us @Colin_P. As before, my average is always above my theoretical max, which suggests it’s sctuslly not my max and the disproven algorithm doesn’t fit my heart.


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## Alan O (20 Jan 2018)

bpsmith said:


> Not everyone is trying to max their heart rate, it just happens to some of us @Colin_P. As before, my average is always above my theoretical max, which suggests it’s sctuslly not my max and the disproven algorithm doesn’t fit my heart.


Same with me - the 220-age thing suggests my max should be around 161, but even a gentle 15-mile pootle last week (ave speed 11.4 mph) got my HR up around 170 without really trying.


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## Ajax Bay (20 Jan 2018)

First: @Colin_P - well done surviving.


Colin_P said:


> Although not terribly scientific, the 220-age thing should be viewed as an absolute upper limit, not a target of barrier that should be broken unless you are a nutter.


What I say below is with the proviso/assumption that the athlete/cyclist has no underlying relevant medical condition.
I'm sorry, I absolutely don't think that "the 220-age thing" (see my earlier post on this formula's fallibility) "should be viewed as an absolute upper limit". One's HRmax is what it is. One will only discover it by pushing really hard (running will get one higher than riding) well warmed up. Outdoors the best way is to find a long hill that gets steeper at the end, run at increasing pace up it, sprinting in the final phase. The heart rate will be too high to measure by finger on wrist/temple so an HRM is needed. One's body/mind is self limiting. If one's not fit enough to push extremely hard and/or haven't the will/motive/mental strength to do so, then the HR will be lower (than actual max). Do you think hitting/achieving a high HR (by whatever formula) is 'bad' for you, nutter or not?


Colin_P said:


> just be careful and build up. Don't try and max you HR just because you can.


Why not? What damage will someone cause to their body or what risk do you envisage if someone pushes for their max? Can you give examples of athletes (any sport) that have dropped dead or caused themselves (CV) injury when pushing up to their max? Pulled hamstring or calf, maybe.


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## Colin_P (20 Jan 2018)

@bpsmith @Alan O @Ajax Bay

You are of course free to do whatever you wish. The 220 minus age thing is nothing more than a guide and I think it is very sensible.

I told my cautionary tale to demonstrate as did @medlifecrisis by starting this thread that there can be unintended consequences to our activities. Awareness and knowledge is everything.

My advice still stands that unless you are very confident about your health and /or are very fit that you should watch it and be careful. The accepted safe HR range is to be at 75%-85% of max. Obviously you first have to establish your own max and obviously from time to time you will push up a hill and go to max, just sit there all the time at max HR [edit] is NOT good. The Garmins are very good at providing amazingly good and detailed HR info on the fly.


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## Colin_P (20 Jan 2018)

[QUOTE 5122478, member: 9609"]how does that present itself ? as in what happens ? do the legs feel extra tired because of lack of blood flow, can you still get out of breath.[/QUOTE]

It is exactly the same as it is for everyone but for me, on a bike anyway, just I'm probably going 10-15 mph slower and on hills much much slower!

I can still get a decent turn of speed though but it is very shortlived, <10-15 seconds as I'm going anerobic. My sustainable speed on the flat is only about 10-12mph and if there is a head wind can go lower! I do tire though and my limit distance wise is about 30 miles which I rarely do as it takes so much out of me. What I typically do are short hops 10 miles and under but am out almost every day (or evening in the dark and wet as it is at this time of year). 

All things considered I think I do reasonably well but anxiety and confidence play a huge part. There is always the nagging doubt that if I push on I'll end up putting myself in hospital (again) after dropping dead (again) or worse still I drop dead and the ICD fails to do its job. The nagging doubt probably explains why I've been a bit authoritarian in this thread, I'd hate anyone else to suffer what I've been through, or worse.

Incidentally I never have issues whilst doing stuff, the dropping dead thing always seems to happen when my heart is at tickover. And due to the betas my resting heart rate can drop very low but never less than 40bpm as the ICD kicks in and acts like a normal pacemaker.

For one of the early cardiac arrest and shock events I was taken through the telemety of the event on screen at the hospital. Within one heartbeat the ICD started anti tachycardia pacing (ATP), on the second heartbeat I was in Ventricula Fibrillation (VF) and certain death. The ICD stopped the ATP and charged for 9 seconds before delivering a 41 joule shock and brought me back. For those nine seconds I was as good as dead. For subsequent events I've shyed away from all the gory details as sometimes not knowing is better than knowing.

As for a heart rate monitor on the bike, I don't bother with it these days as it just depresses and frightens me. Instead I go by "perceived effort".


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## Ajax Bay (20 Jan 2018)

@Colin_P Massively impressed with you getting out on your bike after that lot.


Colin_P said:


> The accepted safe HR range is to be at 75%-85% of max.


Please say where you get this arbitrary range from. Who/what institution is deeming this 'acceptably safe'?


Colin_P said:


> just sit there all the time at max HR [edit] is NOT good.


One can't "sit all the time at HRmax" - not possible, never mind "NOT good".


Colin_P said:


> The 220 minus age thing is nothing more than a guide and I think it is very sensible.


I've given you links upthread which show that even the doctor who posited it, decries it for exercise use.


Colin_P said:


> the dropping dead thing always seems to happen when my heart is at tickover.


So not when you're at HR max then. (I hope you don't get another of those 'things' any time soon, btw.)


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## Colin_P (20 Jan 2018)

@Ajax Bay

I'm no stranger to having a good old row and most certainly don't want, and have no intention of having one here.

Heart, heart health and everything heart has been, as I hope you can understand, a bit of an obsession of mine. As such I've researched and researched from mulitple sources over the years and have gleaned what I consider to be a reasonable view on things.

Of course there are untold conflicts of information online and I'm NO expert. I feel strongly about this and just wanted to impart some of my knowledge, rightly or wrongly. Everyone is different and everyone can do what they want.

Incidently I've JUST read in the news that the super endurance cyclist Lee Fancourt has suddenly died at the age of 40. I suggest that it is almost certainly heart related.

There are no right and wrong answers.


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## classic33 (20 Jan 2018)

@Colin_P, step away from Google!!


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## night cycler (20 Jan 2018)

meta lon said:


> Bell on the toes..simples out and a fire extinguisher..Times have changed



I have read this post and have no idea what it means.


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## Crankarm (20 Jan 2018)

Lee Fancourt the nutz endurance cyclist has suddenly died. The cause of his death is not yet known although it could be a heart attack.

http://www.gloucestershirelive.co.u...sters-world-record-breaking-endurance-1093197


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## jefmcg (20 Jan 2018)

Colin_P said:


> The accepted safe HR range is to be at 75%-85% of max. Obviously you first have to establish your own max



I hesitate to contradict you again (sorry 'bout that ), but surely one can use perceived exertion to keep within the "safe" range? I was going to recommend the talk test ("if you can carry on a conversation you are below the anaerobic threshold), and google turned up this interesting update to that.

https://well.blogs.nytimes.com/2011/09/21/rethinking-the-exercise-talk-test/

(safe in quotes because I have no opinion on what is safe. I'll leave that to the doctors and the students)


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## FishFright (20 Jan 2018)

Well we could ask a cardiologist but where on earth would we find one of those ?


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## medlifecrisis (20 Jan 2018)

There's a lot said about safe HR and I would try to get away from obsessing over your max HR. In your 20s it probably makes sod all difference but as we all get a bit older big spikes in HR and BP are *possibly* less desirable. I say possibly as most of the evidence is anecdotal. We see higher rates of blood pressure-related problems in older athletes who pursue very aggressive interval training with sudden changes in BP. Andrew Marr certainly attributes his stroke to this - who knows if that's true? (his stroke was caused by a dissection, ie the blood vessel lining tore, not the 'usual' stroke which is a blood clot) But I do know that there is not really any good evidence for very aggressive interval training over more conventional training regimens. Also, other things like fainting etc are more common with insane levels of exertion.

For long term health the priorities are to do an exercise that keeps your HR up, but not necessarily aiming for super high. 85% is a good target - no suggestion of an incremental benefit above this. I think it's good to cultivate habits you can maintain throughout life, even if you're currently young.

An alternative was proposed to 220-age which was 208 - (age x 0.7) which makes max HR above 40 a bit higher and below a bit lower.

EDIT: So to summarise, I don't think aiming for the highest max HR is unsafe for the vast majority of people, but it will increase risk of several problems in *some* people and there's no evidence it's beneficial vs HR ~85% max.


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## Ajax Bay (20 Jan 2018)

medlifecrisis said:


> I don't think aiming for the highest max HR is unsafe for the vast majority of people, but it will increase risk of several problems in *some* people and there's no evidence it's beneficial vs HR ~85% max.


Thank you, Doc.
I introduced a formula earlier in the thread: Nes _et al_ (2012) found the best fit to be HRmax = 211 − (0.64 × age) with a 10 beat standard deviation.
My aspect is that of an athlete, not one who's suffered heart problems. I would not expect the latter to be trying to test HRmax except under medical direction and supervision on a treadmill. 
Very few are going to 'aim for the max HR' except when they wish to test/check their HRmax and even then, you can't stay on HRmax - if you can it isn't your HRmax: you didn't try hard enough on the final stretch of hill. The reason for doing this is that an athlete can then use an HRM to guide them with their higher quality work (training). It is also more useful to use HR range (ie HRmax minus HRmin (basal)) and then apply 70% and 80% and whatever. A good proportion of the exercising community will benefit (once max twice a week, not on sequential days) from exercising at 85% of their HR range (eg resting 50, HRmax 190, range 140, 85% = 119, HR to aim at = 50 + 119 = 169). Such exercise will be close to (above or below) AT and will be good for short intervals (ie with rests in between). As with all hard exercise, work up to it (ie week by week) and warm up before it.


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## bpsmith (20 Jan 2018)

Can I assume that it’s not possible to ride at MaxHR for an hour and still feel fine?

At 40, the guided MaxHR calculation is 208 - (40 x 0.7), therefore 180. I can ride for an hour above this with no issues or high perceived exertion.

Just shows that there is no magic formula that fits everyone?


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## uclown2002 (21 Jan 2018)

bpsmith said:


> Can I assume that it’s not possible to ride at MaxHR for an hour and still feel fine?
> 
> At 40, the guided MaxHR calculation is 208 - (40 x 0.7), therefore 180. I can ride for an hour above this with no issues or high perceived exertion.
> 
> Just shows that there is no magic formula that fits everyone?


Your max HR can't be determined by a formula. @Ajax Bay suggested a method up-thread if you're curious. When you do hit it you won't be capable of continuing as you will be toast.

@Ajax Bay's formula works best for me, getting within 4bpm (54years old) of my real max HR.


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## bpsmith (21 Jan 2018)

uclown2002 said:


> Your max HR can't be determined by a formula. @Ajax Bay suggested a method up-thread if you're curious. When you do hit it you won't be capable of continuing as you will be toast.
> 
> @Ajax Bay's formula works best for me, getting within 4bpm of my real max HR.


Did read that in fairness. Planning to do some testing soon, but on my bike rather than running.


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## ColinJ (21 Jan 2018)

bpsmith said:


> Can I assume that it’s not possible to ride at MaxHR for an hour and still feel fine?


It's like the difference between a sprinter running 100 metres and an endurance runner doing a marathon. You can't run a marathon at 100 metre pace! 

I would imagine that a 100 metre runner trying hard will get very close to his/her maximum heart rate. If that distance is a bit too short, then I'm sure that a 400 metre run would be long enough.


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## bpsmith (21 Jan 2018)

ColinJ said:


> It's like the difference between a sprinter running 100 metres and an endurance runner doing a marathon. You can't run a marathon at 100 metre pace!


Which therefore disproves all of the above formulas being able to fit everyone single one of us.


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## screenman (21 Jan 2018)

[QUOTE 5123388, member: 9609"]what is the point in working out max heart rate ? if it is to somehow try and establish your aerobic/anaerobic threshold then considering the discrepancies and differences noted on here for MHR would the resulting figure just be a bit meaningless ?[/QUOTE]

80% of your max would still be 80% of your max though, others would maybe different but the same %


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## ColinJ (21 Jan 2018)

bpsmith said:


> Which therefore disproves all of the above formulas being able to fit everyone single one of us.


It is the absolute maximum. The sprinter running a marathon would not hit it, but the marathon runner sprinting flat out would.

A formula for MHR is only a guess. My HR hit 199 bpm on a steep climb when I was aged 35+. I was pretty much flat out so my MHR was probably around 200-202 bpm. 220-age would have suggested a MHR of <= 185 bpm. 208-(0.7*age) would have given a similar figure.


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## Crackle (21 Jan 2018)

Here's a different question for our welcome expert. In a trained elite athlete would you expect to see the same rhythm from an ECG as for an untrained athlete?


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## screenman (21 Jan 2018)

[QUOTE 5123413, member: 9609"]but if the calculation of max heart rate has such poor correlation with real world results then is the 80% figure to be relied upon?[/QUOTE]

You can do a test for mhr, I have done a few back in the past, it is not fun.


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## Slick (21 Jan 2018)

ColinJ said:


> It is the absolute maximum. The sprinter running a marathon would not hit it, but the marathon runner sprinting flat out would.
> 
> A formula for MHR is only a guess. My HR hit 199 bpm on a steep climb when I was aged 35+. I was pretty much flat out so my MHR was probably around 200-202 bpm. 220-age would have suggested a MHR of <= 185 bpm. 208-(0.7*age) would have given a similar figure.


Just out of interest, how do you know you hadn't already passed your Mhr?


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## ColinJ (21 Jan 2018)

Slick said:


> Just out of interest, how do you know you hadn't already passed your Mhr?


Because that would involve a completely new definition of the word 'maximum'! 

It isn't maximum safe, maximum sensible, maximum comfortable, maximum something else ... it is your absolute maximum busting-a-gut, agonising, unsustainable, scary, exhausting MAXIMUM! 

If you have to ask yourself if you could have tried harder, then that was NOT your maximum. It is the effort that you would make to escape a hungry predator that fancied having you for lunch, NOT the effort you would make when running to catch a bus!


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## Slick (21 Jan 2018)

ColinJ said:


> Because that would involve a completely new definition of the word 'maximum'!
> 
> It isn't maximum safe, maximum sensible, maximum comfortable, maximum something else ... it is your absolute maximum busting-a-gut, agonising, unsustainable, scary, exhausting MAXIMUM!
> 
> If you have to ask yourself if you could have tried harder, then that was NOT your maximum. It is the effort that you would make to escape a hungry predator that fancied having you for lunch, NOT the effort you would make when running to catch a bus!


Ok, I get that, so how does you hitting 199 mean your maximum is 202 or whatever. How does everyone measure busting a gut outside the lab?


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## jefmcg (21 Jan 2018)

[QUOTE 5123530, member: 9609"]is there not a test for max aerobic[/QUOTE]
https://www.brianmac.co.uk/mobile//hrm3.htm


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## ColinJ (21 Jan 2018)

Slick said:


> Ok, I get that, so how does you hitting 199 mean your maximum is 202 or whatever. How does everyone measure busting a gut outside the lab?


All I could say for sure was that it was at least 199. The hill was a 25% gradient and I was frightened that I would come to a standstill and fall off my bike, so I think I held back 1% or 2% of effort. On The safety of a turbo trainer, I might have been able to push just a little harder.

TBH, I wasn't actually trying to hit my MHR. I was wearing a monitor to provide data for my girlfriend's university project and I was pretty shocked when I saw that reading. TBH, it scared me!

What fascinated me was that on my 5 hour ride my HR averaged about 155 bpm and only dropped below 150 bpm when I was freewheeling on descents.


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## Slick (21 Jan 2018)

ColinJ said:


> All I could say for sure was that it was at least 199. The hill was a 25% gradient and I was frightened that I would come to a standstill and fall off my bike, so I think I held back 1% or 2% of effort. On The safety of a turbo trainer, I might have been able to push just a little harder.
> 
> TBH, I wasn't actually trying to hit my MHR. I was wearing a monitor to provide data for my girlfriend's university project and I was pretty shocked when I saw that reading. TBH, it scared me!
> 
> What fascinated me was that on my 5 hour ride my HR averaged about 155 bpm and only dropped below 150 bpm when I was freewheeling on descents.


Yeah, those numbers are more recognisable to me and what I do. I wore a fit bit for a while and I was comfortable up to around 180 to 185 but comfort is no measure of max. I wouldn't like to get anywhere near max, more for fear of having enough in the tank to get home.


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## screenman (21 Jan 2018)

My max in the testing was 189 my max on the top of a 90 second hill climb race was 191, which is what Peter Read said it would be.


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## Ajax Bay (21 Jan 2018)

[QUOTE 5123530, member: 9609"]but does that make the calculated max aerobic any more relevant?, since they can't predict MHR how can they accurately predict max aerobic ?
does the calculated point between max and resting not vary as much between individuals as it does with calculated max ?
seems pointless to know MHR even if it is measured professionally.
is there not a test for max aerobic
trying to establish max aerobic through max MHR seems as daft as[/QUOTE]
Any individual has an HRmax and a HRbasal ie taken at rest (best in bed contemplating the day (but not its excitement)).
You've used 'max aerobic'. I know this as HRAT - HR at anaerobic threshold (AT): roughly the HR an athlete can maintain for an hour. It is a percentage of the HR range (HRmax - HRbasal) and varies with individuals (as you say) but I think not as much as HRmax. I don't know what the mean percentage (in the athletic population) is but posit 85% and that won't be far (eg within an SD) off.
But most people do not have the motive/motivation to explore their HRmax ('cos it's hard hard) so to use the 80% effort to guide training intensity, a formula based on age is often used - and I've suggested the current 'best fit' one above (Nes et al).
I can't see a sprinter ever finding out their HRmax because a) they don't need to know - it will not inform their training and b) because they don't like to run further than 200m because after that racing starts hurting.
You can determine HRAT 'in a lab' using a treadmill and taking blood samples (base of thumbnail or earlobe) as the speed/gradient of the treadmill is cranked up (I did this in Walsall Uni(?) with Greg Whyte in charge (1998)) The bloods are then tested for lactate levels. This should give a better estimate of HRAT and allow one's coach to provide specific direction (for hard training sessions). Another method is to run (once well warmed up) on a treadmill with a set gradient (say 3%) and increase speed every 30 seconds (from 12kph, say). Record the HR at the end of each 30sec element and plot that graph. There will be a 'deflection' on the graph at AT and the HR this occurs at can be used as HRAT. I have done this Conconi Test several times and the results, for me, were very close (ie same HRAT estimate) as the lab lactate test. Having now clicked @jefmcg 's link above I see this is well described there, with graphs.


Slick said:


> How does everyone measure busting a gut outside the lab?


"One will only discover it by pushing really hard (running will get one higher than riding) well warmed up. Outdoors the best way is to find a long hill that gets steeper at the end, run at increasing pace up it, sprinting in the final phase. The heart rate will be too high to measure by finger on wrist/temple so an HRM is needed. One's body/mind is self limiting. If one's not fit enough to push extremely hard and/or haven't the will/motive/mental strength to do so, then the HR will be lower (than actual max)." For me I can't get to what I know (by the running test above) is HRmax when cycling, even up the hardest climbs (say Hardknott Pass) - for me about 10 beats lower.
HTH


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## screenman (21 Jan 2018)

You mention the deflection point, Peter Read graphed that out in a test I did 27 years ago it seemed like mumbo jumbo back then, nice to have it confirmed as his coaching improved me a lot.


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## bigjim (21 Jan 2018)

I recently had to attend hospital for a heart stress test. They put you on a treadmill and raise the speed and elevation. The thing is they do not let your heartrate go the max. They start to pull you back from aroung 144bpm even though you are quite comfortable. Why is that? Is taking you to the max so dangerous? Surely to stress the heart you would take it to the max?


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## Slick (21 Jan 2018)

bigjim said:


> I recently had to attend hospital for a heart stress test. They put you on a treadmill and raise the speed and elevation. The thing is they do not let your heartrate go the max. They start to pull you back from aroung 144bpm even though you are quite comfortable. Why is that? Is taking you to the max so dangerous? Surely to stress the heart you would take it to the max?


I had the same test and was stopped when I was quite comfortable. If you had a problem it would have surfaced almost immediately.


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## PK99 (21 Jan 2018)

Slick said:


> I had the same test and was stopped when I was quite comfortable. If you had a problem it would have surfaced almost immediately.



I had one some years ago, they were tracking blood pressure alongside heart rate and stopped the test when blood pressure started to rise, nothing to do with max heart rate.


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## jefmcg (21 Jan 2018)

bigjim said:


> I recently had to attend hospital for a heart stress test. They put you on a treadmill and raise the speed and elevation. The thing is they do not let your heartrate go the max. They start to pull you back from aroung 144bpm even though you are quite comfortable. Why is that? Is taking you to the max so dangerous? Surely to stress the heart you would take it to the max?


You were presumably taking the stress test for a reason. I'm sure maxing out is more dangerous for people with heart disease, and that group would be more common amongst people taking a heart test. 

Also unless there was a diagnostic reason to bring your heart to MHR, why would they?

Disclaimer: not a doctor, blah blah blah


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## Slick (21 Jan 2018)

PK99 said:


> I had one some years ago, they were tracking blood pressure alongside heart rate and stopped the test when blood pressure started to rise, nothing to do with max heart rate.


Never thought of that. The only reason I posted my experience was the text lasted for some time as I realised I wasn't in such bad shape. My brother, who did think he was fit, was stopped almost immediately and had 5 stents fitted.


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## bigjim (21 Jan 2018)

jefmcg said:


> You were presumably taking the stress test for a reason. I'm sure maxing out is more dangerous for people with heart disease, and that group would be more common amongst people taking a heart test.
> 
> Also unless there was a diagnostic reason to bring your heart to MHR, why would they?
> 
> Disclaimer: not a doctor, blah blah blah


I was having chest pains when hill climbing on the bike. Heart under stress so I assumed they would get as close to that scenario as possible. Evidently achieved " impressive 94% of 100% of maximum" on some scale or other. Consultant more or less told me to go away. Found ectopic heart beat which they did not see as a problem.


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## gavgav (21 Jan 2018)

I was diagnosed with a heart condition called Mahaim Fiber Tachycardia, 6 years ago, which interestingly the consultant believes I was born with, but following 12 months of training for and then completing the Great North Run, that the heart changed shape enough for it to start becoming symptomatic. Uncontrollable sudden bouts of 300bpm and irregular rhythm’s. Ablation has (touch wood) cured me and I’m still symptom free now and enjoying cycling.


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## gavgav (21 Jan 2018)

User said:


> Ah - my mother was diagnosed with the same thing about six months ago.


All the best to her Reg. Hope they can treat accordingly.


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## gavgav (21 Jan 2018)

User said:


> She’s was originally told that she would need an ablation but she’d have to be referred to Southampton. Then she was told they’d stopped doing it there and she’d need to be referred to Oxford. Then she was told her CCG wouldn’t Fund it, as she was too old.
> 
> I’m preparing to give her CCG an arse-kicking...


Don’t blame you one bit. Hope things improve.


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## medlifecrisis (22 Jan 2018)

Crackle said:


> Here's a different question for our welcome expert. In a trained elite athlete would you expect to see the same rhythm from an ECG as for an untrained athlete?



Good question. Highly trained athletes can develop unusual rhythms - but they're generally not of concern. Normal heart rhythm is called 'sinus rhythm' which is the normal anatomical way a heartbeat is created and travels through the heart. Athletes can get not only sinus bradycardia (slow heart) but 'heart block' which is an abnormality in the electrical pathway. The most trivial just means the electrical pulse moves slower through one of the junction boxes. If it moves even slower you can get dropped beats. Some also develop something called a bundle branch block which is another non-worrying electrical issue.

On scans the heart can be enlarged, thickened and it can be very hard to differentiate between a diseased heart and a fit one on scans and heart tracings. Sometimes even if you exercise someone hard it's not always apparent - someone could be very fit *and* have early stages of a disease. So it's a very interesting field.

The second part of the answer to your question is that later in life, endurance athletes have higher rates of something called atrial fibrillation - an irregular heart. This is important as it can predispose to a stroke. We're not entirely sure why this happens.


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## Crackle (22 Jan 2018)

medlifecrisis said:


> Good question. Highly trained athletes can develop unusual rhythms - but they're generally not of concern. Normal heart rhythm is called 'sinus rhythm' which is the normal anatomical way a heartbeat is created and travels through the heart. Athletes can get not only sinus bradycardia (slow heart) but 'heart block' which is an abnormality in the electrical pathway. The most trivial just means the electrical pulse moves slower through one of the junction boxes. If it moves even slower you can get dropped beats. Some also develop something called a bundle branch block which is another non-worrying electrical issue.
> 
> On scans the heart can be enlarged, thickened and it can be very hard to differentiate between a diseased heart and a fit one on scans and heart tracings. Sometimes even if you exercise someone hard it's not always apparent - someone could be very fit *and* have early stages of a disease. So it's a very interesting field.
> 
> The second part of the answer to your question is that later in life, endurance athletes have higher rates of something called atrial fibrillation - an irregular heart. This is important as it can predispose to a stroke. We're not entirely sure why this happens.


Very interesting. There have been a number of top cyclists treated for heart anomalies. One of those I can recall was Navaradauskas but there have been others. I also know a couple of people who've been flagged with an abnormal rhythm during routing tests but later told it was typical of highly trained athletes.

http://www.cyclingnews.com/news/navardauskas-back-to-100-per-cent-after-heart-surgery/


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## Ajax Bay (9 Apr 2018)

"The world of cycling has been paying tribute to Michael Goolaerts, the 23-year-old rider who lost his life after suffering a cardiac arrest at Paris-Roubaix yesterday."
http://road.cc/content/news/239896-cycling-world-pays-tribute-michael-goolaerts
Sporza reports (Belgian broadcaster) quotes the public prosecutor as saying: “According to initial findings, it seems to be a heart failure, after which he [Goolaerts] fell, and it was not the fall that led to his condition.”
Bump for @medlifecrisis's video.


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## Milzy (9 Apr 2018)

medlifecrisis said:


> Hello everyone,
> 
> I hope you don't mind me posting this as I am new to the forum, a few people suggested I share it here (my channel is not monetised, just thought people would be interested).
> 
> ...





medlifecrisis said:


> Hello everyone,
> 
> I hope you don't mind me posting this as I am new to the forum, a few people suggested I share it here (my channel is not monetised, just thought people would be interested).
> 
> ...



I thoroughly enjoyed your video. I’d like you to post more. I’d love to go for a ride with you but you’re probably not that local. Ohh well. Subscribed.


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## medlifecrisis (9 Apr 2018)

Ajax Bay said:


> @medlifecrisis
> "The world of cycling has been paying tribute to Michael Goolaerts, the 23-year-old rider who lost his life after suffering a cardiac arrest at Paris-Roubaix yesterday."
> http://road.cc/content/news/239896-cycling-world-pays-tribute-michael-goolaerts
> Sporza reports (Belgian broadcaster) quotes the public prosecutor as saying: “According to initial findings, it seems to be a heart failure, after which he [Goolaerts] fell, and it was not the fall that led to his condition.”



Very sad news. As I understand he suffered a cardiac arrest whilst actually riding, so it may be that he had some underlying heart condition which was revealed during exertion, as opposed to anything else (doping only tends to increase risk of cardiac complications at rest).


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## Ming the Merciless (9 Apr 2018)

It is important to distinguish the endurance cyclists the study conclusions come from. It is primarily about cyclists or other athletes who do high volume at high intensity. This is not the type of cycling most of us do. We may do some high volume, we may do some high intensity, but rarely are they combined. If you do the occassional long ride at moderate intensity you shouldn't let the elite endurance athlete studies worry you. Most of us will get nowhere near their volumes, and we do not ride close to out aerobic capacity for extended periods.


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## Milzy (10 Apr 2018)

[QUOTE 5210017, member: 43827"]Last year, while out for a ride, I took a coffee break and was sitting next to a man and his wife and we started chatting. He was about my age and was interested in my cycling and how it helped my fitness. He said he used to ride and run but hadn't done so for a while following a heart attack, although he still had a bike and was thinking about it.

A few weeks later I read that he had collapsed and died from a heart attack on a bike ride near his home after just starting cycling again.

I have worried that my enthusiasm for cycling and its beneficial impact on me influenced or contributed to his decision, and when I read threads like this it reminds me that we should not let our non medically qualified enthusiasm, based on our personal experience, be taken as expert advice about heart rates or any other medical issue. From now on my only advice would be to never give advice on medical matters......no matter how fit or unfit the recipient seems.[/QUOTE]
I’ve climbed up white horse bank at 200bpm fine but I worry that won’t be safe in a few years time. Who knows some peoples hearts are just very strong others flawed.


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## Alan O (10 Apr 2018)

[QUOTE 5210017, member: 43827"]Last year, while out for a ride, I took a coffee break and was sitting next to a man and his wife and we started chatting. He was about my age and was interested in my cycling and how it helped my fitness. He said he used to ride and run but hadn't done so for a while following a heart attack, although he still had a bike and was thinking about it.

A few weeks later I read that he had collapsed and died from a heart attack on a bike ride near his home after just starting cycling again.

I have worried that my enthusiasm for cycling and its beneficial impact on me influenced or contributed to his decision, and when I read threads like this it reminds me that we should not let our non medically qualified enthusiasm, based on our personal experience, be taken as expert advice about heart rates or any other medical issue. From now on my only advice would be to never give advice on medical matters......no matter how fit or unfit the recipient seems.[/QUOTE]
That's a sad story indeed, and it's very hard to generalize. And you can never know - it's possible the second heart attack was waiting to happen anyway, and he might have lived longer had he started sensible exercise earlier?

I had a heart attack 11 years ago, and I was strongly advised that exercise was the best thing I could do (and my GP is a cyclist and strongly supports my cycling). But, it was made clear to me that it's a balance... between the increase in fitness improving my chances of greater longevity, and the possibility of something excessive triggering a new attack. The doc reckons that balance is very much in my favour, but it clearly does depend on the individual.


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## Ming the Merciless (10 Apr 2018)

I can recommend "The Haywire Heart" if you are interested in this subject, but only if you do not over worry about such things. Makes for interesting reading on what is known and not known plus also the different categories of failure as heart attack only covers a subset of failure modes. Good if technical section on how the heart works as well.


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## PK99 (10 Apr 2018)

[QUOTE 5210017, member: 43827"]*From now on my only advice would be to never give advice on medical matters.*.....no matter how fit or unfit the recipient seems.[/QUOTE]

Amen to that.

It scares me to see the "medical advice" dolled out here sometimes.


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## Crankarm (11 Apr 2018)

Without the detailed autopsy report for the cause of death it is hard to speculate. A congenital heart defect, poor diet, smoking, drinking, etc? Live each day like it's your last and make a Will.


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## Ajax Bay (11 Apr 2018)

PK99 said:


> It scares me to see the "medical advice" dolled out here sometimes.


Hi @PK99. I thought I 'd see if I could find "medical advice [being] dolled out" that might scare you and be to the detriment of others. I don't visit the 'Training, Fitness and Health' sub-forum so perhaps such advice is widespread there but I trawled back through this 9 page thread and clipped some parts of comments which might be considered 'medical advice'. Please could you offer examples (anonymised if you prefer) which "scares [you]" because, by inference, you suggest such advice should not be offered on these fora.


jefmcg said:


> Sleep apnea is a very serious condition, that is amenable to treatment. See your GP for referral to nearby sleep clinic.


I note that Steve Abraham (highest mileage for a year challenger) discovered that his sleep (16 hours a day riding and 8 for everything else, for 365 days) was being disrupted by sleep apnea to the detriment of his daily 200+ average miles).


Colin_P said:


> Be careful you lot, just because you can doesn't mean you should red-line your heart rate!





Ajax Bay said:


> Why not? What damage will someone cause to their body or what risk do you envisage if someone pushes for their max? Can you give examples of athletes (any sport) that have dropped dead or caused themselves (CV) injury when pushing up to their max? Pulled hamstring or calf, maybe.





medlifecrisis said:


> For long term health the priorities are to do an exercise that keeps your HR up, but not necessarily aiming for super high. 85% is a good target - no suggestion of an incremental benefit above this.





medlifecrisis said:


> I don't think aiming for the highest max HR is unsafe for the vast majority of people, but it will increase risk of several problems in *some* people and there's no evidence it's beneficial vs HR ~85% max.


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## Alan O (11 Apr 2018)

PK99 said:


> Amen to that.
> 
> It scares me to see the "medical advice" dolled out here sometimes.


I have to agree with Ajax Bay here - I find this forum much better at the "I'm not a doctor, this is not medical advice" and "See your GP" approach than most.


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## Colin_P (11 Apr 2018)

@Ajax Bay @Alan O very nicely put.

@PK99 

It is like the instruction manual for some new hi-fi or assembly instructions for some flatpack, we have all left them in the box and cracked on regardless.

As has been said many times, anyone can do what they want and ignore any and all advice. Mountains would never have got climbed otherwise but a fair few died trying.

It is those who take that path who create the ultimate _*"Hold me beer and watch this..."*_ moments. And I salute you!

Did I mention that suffering a cardiac arrest is almost instantaneous and less than 5% come back from one. It doesn't hurt though.


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## Colin_P (12 Apr 2018)

User said:


> In out of hospital cardiac arrest, the English survival rate is around 8%. The in hospital cardiac arrest survival rate is 17-20%.



Great news, except it isn't.


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## ColinJ (12 Apr 2018)

User said:


> So the figures published in the National Framework (in respect of out of hospital cardiac arrest) and the UK National Cardiac Arrest Audit (in respect of in hospital cardiac arrests) are wrong and you're right? Really?


I think he means that someone suffering a cardiac arrest is still very likely to die. The numbers you posted are much better than the ones that he'd posted, but are still pretty grim!

It is tragic when a young person dies of a cardiac arrest, but it wouldn't be such a bad way for a very old person to go. I watched both of my parents go through slow, unpleasant deaths over a period of several years. Both said numerous times that they just wanted it over with.

I went through about 95% of a slow-death process myself in 2012/13 and it was horrible enough to convince me that I want to die suddenly when my time finally does come.

A friend of mine died of cardiac arrest in his sleep. (At least we think he did, since he was found dead in bed and had made no attempt to summon help.) It was a real shock to his family and friends, but it was comforting to know that he didn't suffer. The bad thing was that he was only 59 at the time. I'd like to get another 20+ years in before something like that happens to me!


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## straas (13 Apr 2018)

My resting HR is around 50-60, but even when 'moderately' exercising it shoots to 200+

I've been on a few bits of gym equipment that auto turned off because of it


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## palinurus (13 Apr 2018)

bigjim said:


> I recently had to attend hospital for a heart stress test. They put you on a treadmill and raise the speed and elevation. The thing is they do not let your heartrate go the max. They start to pull you back from aroung 144bpm even though you are quite comfortable. Why is that? Is taking you to the max so dangerous? Surely to stress the heart you would take it to the max?



Its possibly just not necessary or associated with some increase in risk, perhaps a bit of both. I had one yesterday- I'm currently under investigation for a genetic condition which affects the electrical function of the heart and which has a distinct ECG pattern, sometimes this pattern shows up a bit better under stress. Running tests at threshold is likely more appropriate when testing athletes.

I've had a whole bunch of testing done in the last couple of weeks including an MRI scan all because of a chance discovery that my ECG is a bit abnormal. All the plumbing and physical stuff looks good, haven't got a verdict yet.


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## Milkfloat (13 Apr 2018)

straas said:


> My resting HR is around 50-60, but even when 'moderately' exercising it shoots to 200+
> 
> I've been on a few bits of gym equipment that auto turned off because of it



Have you seen a doctor about it?


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## straas (13 Apr 2018)

Milkfloat said:


> Have you seen a doctor about it?



I mentioned it once and they didn't seem overly concerned.


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## bpsmith (14 Apr 2018)

straas said:


> My resting HR is around 50-60, but even when 'moderately' exercising it shoots to 200+
> 
> I've been on a few bits of gym equipment that auto turned off because of it


Pretty much the same with me. Often in the low 40’s while chilling on the sofa, but can average 185 for over an hour on the bike, with peaks up to 205. All the while still being able to hold a conversation.


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