Training Center: The annual exam for cyclists

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Maintaining optimal health is a key component to the guarantee of continued success and enjoyment in the saddle. A central tenet of keeping tabs on your health is the annual exam by a health care professional.

The annual exam should include routine age-appropriate health screens, as well as more specific evaluations for the endurance athlete. Age-appropriate screens include cholesterol, blood pressure, diabetes, colon cancer, and sexually transmitted disease testing for at risk individuals of both sexes. Women should keep up to date on pap smears, mammograms, and breast exams, while men should have discussions with their provider regarding the merits of prostate screening.

Considerations in the approach to annual screening may vary based on competitive level and may include Screening Blood Tests — by performing screening blood levels in athletes that are riding well, it becomes much more informative when a comparison can be made to levels drawn when fatigue is the presenting complaint in the clinic.

Screening Blood Tests:
• Complete Blood Counts — to screen for anemia and other blood dyscrasia
• Iron Profile — a key physiologic component for oxygen transport/extraction and deficiencies are prevalent in endurance athletes (notably females)
• Vitamin D — more evidence points to its importance in optimal muscle function and performance, and the rate of deficiency is very high at large

Additional, potentially beneficial annual assessments:
• Skin Screening — exercising athletes have increased level of sun exposure and evaluating for suspicious lesions is a key in the early detection and treatment of malignancy
• Nutritional Assessment — disordered eating/calorie restriction is high among endurance athletes
• Menstrual History — many females will experience irregularity or complete loss of menstrual cycle (amenorrhea) secondary to energy intake imbalance
• Functional Exam — focused musculoskeletal screen for common problems areas in cyclists, e.g. Iliotibial band and hamstring tightness
• Pharmacy Review — for athletes subject to testing by USADA/WADA it is important to identify and avoid banned substances and to rectify the need for Therapeutic Use Exemptions and or Declaration of Use for current medications
Choosing the appropriate medications for athletes with co-morbidities is important. A good example would be an athlete that was started on medication for hypertension complaining of an inability to achieve the same intensity they could prior to treatment. Usually we would find this athlete was started on a beta-blocker which lowers heart rate, which can cause poor performance on the bike. A better alternative may be an ACE inhibitor or a calcium channel blocker to treat this individual’s hypertension instead.

The annual exam, when performed by the appropriate individual, can go a long way in keeping the athlete fit both on and off the bike. Choosing a personal physician can and should be a very personal matter. As cyclists, it is important to find a provider that not only understands the population at large, but also has a firm grasp on the rigors involved in the sport of cycling as it pertains to your health. For those of you out there in the market looking for a provider, I would suggest seeking out a primary care doctor who is fellowship-trained in sports medicine as a good place to begin.

Dr. Glowney is a staff physician at Boulder Center for Sports Medicine and triple board certified in Sports Medicine, Internal & Emergency Medicine. He also serves as team physician for Garmin-Transitions U23 cycling team and provides primary care services to athletes of all levels.