Healthy hearts: why the UCI's mandatory medical checks are important

In preparation for their 2015 season, Orica-GreenEdge last week held a training camp that saw much of the team ride from Central Victoria up to Canberra. As part of that training camp, the riders visited the Australian Institute of Sport (AIS) in Canberra to undertake the UCI’s mandatory annual health checks.
Aaron S. Lee went along to the AIS to learn what the UCI requires of WorldTour teams when it comes to health checks, and to learn more about the elite cyclist’s most important asset: a big, healthy heart.

Mandatory testing

Each year under the UCI’s comprehensive Medical Monitoring Programme every ProTeam and Pro Continental team must provide, at its own expense, a battery of obligatory examinations for all licensed professionals expected to race on the squad for the following season.

The annual health check must be conducted a minimum of 30 days before competition, and must include a cardiological examination with a 12-lead electrocardiogram (ECG), as well as an echo-Doppler (an ultrasound of the heart) and a stress-electrocardiogram. These last two exams must be done alternately: an echo-Doppler one year, the stress-electrocardiogram the next.

Other tests include a urine test, a vision test, a sport medicine interview and clinical examination, and a blood test to check a large number of compounds, including sodium, potassium, reticulocytes (immature red blood cells), testosterone and basal cortisol.

Following the initial testing, three follow-up exams are conducted throughout the year, each containing more blood tests to examine an abridged list of properties from the initial health check.

Any cyclist who joins a team for the first time is obliged to undergo a biannual examination, which consists of a duplication of the initial exam, plus an annual pulmonary function test for riders with a history of asthma. Sound expensive?

According to Jonathan Breekveldt, general manager of Australian Professional Continental team Drapac Pro Cycling, the annual financial burden for his team in required testing totals AU$250,000. This includes the Medical Monitoring Programme and the cost of the UCI’s mandatory Athlete Biological Passport (ABP). That sum equals – if not exceeds – the entire budget of the nation’s Continental teams racing the Subaru National Road Series.

At their annual screening at the AIS, the Orica-GreenEdge riders underwent the echo-Doppler (ultrasound), an ECG, vision test, blood test, as well as discretionary lung function tests and bone density scans.

Team Medical and Athlete Welfare Director, Dr Peter Barnes oversaw the procedures, while cardiologists Dr André La Gerche and Dr Maria Brosnan, both of St Vincent’s Hospital in Melbourne, conducted the cardiological examinations. We took the opportunity to speak to the doctors to learn more about the hearts of elite cyclists and to understand the reasoning behind the UCI’s heart testing requirements.

The heart of the matter

According to Dr André La Gerche, only a small number of cyclists develop a serious heart problem, but the goal of the UCI’s Medical Monitoring Programme is to pick up any potential hazards or warning signs and either modify the athlete’s training or, in rare circumstances, persuade them to retire.

“In the time we have been testing a number of professional teams we have fortunately not had to exclude anyone,” says La Gerche. “But what we do find consistently is that cyclists have very large hearts and very healthy hearts.”

La Gerche told CyclingTips that it is not uncommon for cyclists to possess resting heart rates as low as 35 beats per minute, and hearts up to twice the size of a normal heart of a sedentary person.

“The benefit of a larger heart is obviously the ability of the heart to pump large amounts of blood throughout the body during exercise,” he said. “A normal person will average five to 10 litres of blood pumped per minute, while some pro cyclists can measure up to 40 litres per minute.”

La Gerche claims that, during exercise, there is little difference between a fit and an unfit person in regard to maximum heart rate — the difference lies in the ‘stroke volume’; how much blood the heart can pump with every beat. There is a direct correlation between stroke volume and the size of the heart.

“We see very large hearts in these athletes,” he says. “Very large, healthy, rubbery and compliant hearts that pump very well particularly during exercise.”

Interestingly, La Gerche believes that, contrary to the limited research in this area, there’s little difference between male and female cyclists in terms of heart size and performance.

“Literature suggests that women do not develop as much of an athlete’s heart as men, but we don’t really find that,” he tells CyclingTips. “We find that antiquated notion is more of reflection that most of the studies have been done on non-endurance athletes rather than elite women cyclists.

“Our findings show that the heart size of women cyclists are quite similar to their male counterparts of similar body size.”

As far as any noticeable differences between the different disciplines of road and track cycling, La Gerche asserts the variances are negligible.

“A person can’t really pick a difference in looking at the ECG and ultrasound,” he says. “I think because even [when] we call someone a sprinter in road cycling, he still rides 200 kilometres before he has an opportunity to sprint for the finish. Even sprinters are aerobic animals.

“That being said, I wouldn’t be surprised if a pure track sprinter like Anna Meares has a slightly smaller heart, but even track cyclists require significant aerobic training.

“However sprinters in running have smaller hearts,” adds La Gerche. “For instance, Olympic sprinter Usain Bolt only runs for 100 metres and would not have or need a heart the size of cyclist as he does not require a big cardio output. Bolt does not reach or use his VO₂ max.”

According to La Gerche, the amount of blood a running sprinter’s heart can pump does not determine how fast they go, as speed is instead related with skeletal muscle development. The speed at which a cyclist rides up Alpe d’Huez, on the other hand, is dependant on how much blood is pumped to their muscles.

One observation that sticks out to Dr Maria Brosnan is the proportionate size of the heart’s left and right ventricles in an elite endurance athlete.

“The right ventricle is quite [a bit] smaller than the left in a sedentary person,” says Brosnan. “But with the athletes we are testing on Orica-GreenEdge, [the] right ventricle is just as large, if not slightly larger and serves as an aid to the left side during extreme exercise.”

The need for heart testing

According to Dr André La Gerche, the UCI’s mandatory heart testing protocols are a bit of overkill for elite cyclists.

“The odds are very slim we ever find any issues with athletes the calibre of Orica-GreenEdge cyclists,’ La Gerche says.

“Probably in about 90 per cent of people that do develop heart issues, the problem is preceded by some sort of symptoms such as dizziness, palpitations and/or chest pain.”

A long season

In addition to his role as Team Medical and Athlete Welfare Director Dr Peter Barnes is medical director for the South Australian Institute of Sport (SASI) and race doctor for the Tour Down Under. He told CyclingTips that the role of the medical monitoring program and of sports doctors in general, is, clearly, to keep the athletes fit and healthy, but also to anticipate problems that might arise.

“The WorldTour calendar is certainly very long and demanding and health of the athlete is certainly affected if they are overloaded,” added Barnes.

“This stress is a consideration that the sports directors, coaches and management are very aware of and allows us to modify their training and competition programs to allow enough recovery.”

“If they just keep hammering away endlessly they will eventually succumb to fatigue, low immune function and potentially that can ruin a season.”

Further reading:

• Exercise is good for the heart… but is there a limit?
• Q&A With Dr. Andre La Gerche
• Behind the scenes of Drapac’s big step up