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Exercise Physiology, MD

Is Every Workout Pulling its Weight?

A chinese lion statue

Hi, and welcome to Exercise Physiology, MDTM. My name is Suzanne and in addition to being an athlete myself, I am also a certified triathlon coach, bicycling coach and an emergency Medicine Physician. With advanced training in Exercise Physiology I am able to apply a number of scientific principals to the training plans for myself and my athletes. With this website, I hope that I can share these principals with you as well. Some might call this Evidence Based Coaching.

If you cannot honestly answer "Yes" to the question, "Is Every Workout Pulling its Weight?" then perhaps this web site is just what you were looking for.

5 Ways to Become a Better Hill Climber - Bike Training

admin March 18th, 2009

Recently an athlete asked me the following question:

I’ve noticed that I can pretty much keep up with
people on rides. Except when we hit a hill, I hit a wall.  Thank god
my descending skills are great otherwise I wouldn’t catch up with the

Any recommendations in terms of training for climbs?  I would like to
work on those at least once a week.

Here is my answer:

You can do several things to train for climbs.

#1 More Overall Power equals Better Climbing

The first is to climb,climb, climb!  Climbing is all about strength to weight (or power to
weight) ratio.  So the more overall power you have the better you will
do on climbs.  Thus any sort of traiing that raises your threshold
will help with climbing (sweet spot, threshold, VO2).

#2 Climbing Short Fast Hills

Shorter climbs are frequently about anaerobic efforts and the ability
to recover frm them quickly.  Especially in pittsburgh most hills are
only a few minutes long or shorter.  This taps into anaerobic energy
stores.  So doing hill “sprints” at various lengths from 30 seconds up
to 3 minutes with FULL RECOVERY will add an aspect of fitness.
#3 Training to Recover from Short Efforts

As far as recovery from hill climbing, doing sprints with short
recovery will help you learn to “tolerate” lactic acid and keep riding
when your legs are cooked.

So you can craft a number of different workouts to improve at hills.
#4 Overall Leg Strenght Work (Bodyweight Trianing)

I think it is also beneficial to work on sheer muscular
strength with bike specific leg work in a weight room or with body
weight.  Lunges, bulgarian split squats (rear leg up on a chair, other
leg forward, squat down and up, step ups, deadlifts, one legged
deadlifts, etc).

#5  Develop a Solid Core for Climbing 

Don’t forget solid core work.  When climbing the upper body often
comes into play and without a strong core to transmit energy and
stabilize the upper & lower body with one another you’ll just be a
floppy noodle on the bike.  Sue’s “Core and More” exercises are great
for this. (She also covered the good leg work).

Mixing it all together

I would do core 2-3 times per week, body weigth leg strength 1-2 times
a week, even progressing to some plyometrics, and finally at least one
day a week focusing on on the bike climbing and strength work, with at
least one long hilly ride on the weeked.

That’s enough workout ideas to keep you busy for awhile.
Finally, I’ve talked to many cyclists who simply say that “one day”
they were suddenly good climbers.  It comes as the years of riding add
up and you get stronger and more efficient. Unfortunately there is no
fast way to become a better climber, but if you are consistant in your
trianing you will get there!

How long does it typically take to adjust to altitude?

admin January 22nd, 2009

The first physiologic change happens within hours of arrive at altitude…you begin to breathe faster to compensate for less oxygen tension in the air. This helps up to a point where your ventilation lowers your CO2 level too much. Your brain says WHOA, stop breathing so fast!

At this point, the CO2 builds back up, but you are still not getting enough O2. The kidneys start to kick in by trying to get the PH of the blood back in order and start secreting bicarbonate ions, so the first few days yoru brain is fighting your lungs and your kidneys are trying to keep the peace.

all along your heart is trying to pump more blood to get more O2 around, and your vascular system responds by filling with more fluid that it sucks from the rest of your body. So you get a triple whammy of deydration…the air is dryer, you are breathing faster, and your vascular system pulls fluid out of yoru body into the blood vessels.

So, the FIRST thing you can do to help acclimitize is to drink TONS of water. I need 3-5 liters a day in teh first few days I go to altitude.

The worst days for most people are generally days 2-5. Day one feels OK, and after a week you start to feel better.

But the real long term adaptation is generating new red blood cells, which is a hormonal response to the decreased O2 tension. EPO is secreted by the kidneys which stimulates the growth of new baby red blood cells in your bone marrow. A previous poster was correct that this takes about 3 weeks to get into full force. Needless to say that in order to build blood cells you need to have the building blocks which includes adequate iron intake, folic acid and b vitamins, so nutrional support during this time is key. I get buffalo cravings during my first week at altitude (local pub serves yummmmy buffalo stew!)

You can speed this up by blood doping or taking EPO injections, but that’s not really advisable! LOL.

Legitimate, legal, medical ways to ease the transition include a variety of medications that assist along the pathways I mentioned above to help yoru body acclimate, but full acclimitization will not occur until the red blood cell production is back up to speed. Those medications include diamox, viagra (yes!), and ginko.

It takes me about 6 weeks to feel 100% at altitude, and even then I’m not as fast as I am at sea-ish level. The last 2 weeks I am there (I spend 2 months in the summer) I feel great, and wish I could stay longer.

What are some good VO2 Max Workouts?

admin January 6th, 2009

This question was posed on the wattage forum recently. Here is my response.

VO2 max is typically achieved in an all out effort of 3-8 minutes
depending on your genetics and fitness. Outstanding athletes may be
able to hold their true VO2 max for a full 8 minutes, but most people

The whole idea of interval work (at any intensity) is to use shorter
sets with rests to add up to a total of more work that you would
otherwise be able to do as a continuous effort. You can reach your
VO2 max after about 30 seconds of starting an interval at the
appropriate intensity, but after you stop or slow down, your oxygen
needs diminish and your heart rate slows, and you are no longer at
your VO2 max. When you start your next interval, your “bucket” has
only partially emptied depending on the intensity of your rest
interval (how low your HR or Power or Vo2 drops during the
rest)…which determines how far you need to fill the bucket up again
to be back at your Vo2 Max.

So if the goal is to get as much work in as possible at VO2 max
efforts, you can see how shorter, more intense rest intervals would
let you reach your VO2 max effort more quickly once you re-start a
given interval.

So the next question is how long should the intervals be?

Tabata intervals (10 sec max, 20 sec rest) will hit a component of VO2
eventually, but they are really best for anaerobic conditioning.
Billat’s intervals (30 at vo2 max-30 at “rest”) are great for an
introduction to VO2 max efforts for either newbies, or early in the
season, with little worry for injury. In addition, her work has shown
that after a 4-6 week block of VO2 interval work, only 2-3 minutes of
VO2 work per week are required to sustain your gains before they drop
off to far. So you can cycle your VO2 work early in the season and
see some benefits, taper them off in the spring time and resume them
prior to or during race season. Of course, if you can tolerate the
longer intervals (2, 3, 5 mnutes or more) at your VO2 max power, you
will pack in the most time at VO2 max.

Finally, about what power to do your intervals at…since by
definition, your 5 minute power is going to be close to your VO2 max
effort (and could only be confirmed with expired gas testing in a
lab), you might as well use that 5 minute power as your target power
for your VO2 intervals.

There’s no right or wrong as long as you are applying physiology
appropriately. The most important part is to have a plan to follow
and be able to measure your progress. Ways of measuring your progress
could be to do a block of VO2 intervals for 4-6 weeks as part of your
regular training with a progression that makes sense, and then measure
either your all out 5 min power again, OR hold your 465W and see how
long you can hold it after the training block.

Hope that gives you some more ideas.

Suzanne Atkinson, MD

Will Training with Paddles and Fins improve my Triathlon Swim?

admin December 18th, 2007

Should I use paddles to help with my pulling drills?? Also should I wear fins when I am doing my kicking drills??

That’s a big “It depends”. That’s a big “It depends”. The use of aids in swimming changes the nature and benefit of the drill you are doing. Paddles and fins can be used for strength, flexibility or technique improvement depending on how they are integrated with your workout.

Paddles for strength…
The use of aids in swimming changes the nature and benefit of the drill you are doing. Using paddles, for example, can help you in performing a force or strength workout, where the purpose of the drill is specifically to get stronger. More surface area requires more force production to perform the stroke. The benefit is that your shoulders/lats, etc get a better strength workout, but the downside is that it can increase the risk of injury if done excessively.

Paddles for technique…

Paddles can be used for certain types of technique workouts…if you let your hand slip or spill water, or you drop your elbow during your pull, this effect is magnified when you have paddles on. In this case, the paddles can help refine technique, but should then be used sparingly, say 25-50 with paddles to get an idea of the stroke areas that need work, then 25-50-100 without to practice newfound skill and repeat. You can see how this workout with paddles would help with technique and skill, whereas a workout of 5×100 with paddles on would more more geared towards strength development. The bottom line is that paddles are a versatile adjunct to swim training, but need to be used appropriately within a specific training plan.

Using Fins for stroke drills
Fins can be useful in several ways as well. One of the ways I enjoy using them is when I’m doing a new stroke drill where my speed may be too slow so that I’m sinking while doing the drill and therefore unable to concentrate on the drill because I’m underwater! An example for me was when I started doing one arm stroke drills. I was so bad at them that I was really slow and sinking. By putting fins on, my speed was up and I was staying on the surface of the water, and therefore got more benefit out of practicing the one arm drills. So the fins were helpful not for my kick, but so that I got benefit out of a new drill. Now I am much better at the one arm drills and don’t need fins to help me get through them.

Fins for flexibility
Fins can help some people develop ankle flexibility. They can also help with leg/kicking strength in a similar way that paddles help with arm strength. Since it requires more force to move a larger surface area through the water, wearing fins helps develop strength in the legs, in particular the hamstrings and gluteus muscles. For people with a weak extensor group, this is a fantastic addition to your swim training that helps your overall athletic development.

But in triathlon, we are not really relying on kicking for speed or power production. The large muscles of the legs consume a lot of energy that is not adequately recouped in the swim leg of a triathlon for two reasons. The swim leg is relatively short compared to the bike & run, and the amount of propulsion added by legs only is not nearly as much as that provided by arms and trunk rotation.

I am still a big fan of kicking drills without fins to improve your kick… but I don’t think that fins are a requirement for this aspect alone..

Fins for balance…

One more example is using fins for people working on balance drills. By keeping speed up just a little, you can practice/experiment with horizontal balance if it is still a new skill. But ultimately, you need to be able to swim with good technique without the use of paddles, floats or fins. The use of these swimming adjuncts should be deliberate, with a purpose, and limited in your total workout. Your aim is to reproduce the benefit you get from them (balance or technique for example) without having to use the aids.

The points regarding conserving leg strength and keeping HR down during the swim are debatable, and were debated on another popular triathlon site. My personal thought is that each person needs to find their own break even point between good technique, the contribution of kicking to their total swimming speed in any given triathlon distance, and their personal energy reserves. All of this will depend upon your personal background, strengths and training focus in each of the 3 sports and is something that your coach can help you sort out individually.

How much sleep do you need?

admin September 25th, 2007

There is a book called “The Promise of Sleep”, an excellent read and highly recommended. The book was written by the MD who discovered REM sleep as a medical student and devoted his life to sleep research. The book presents scores of research information that will blow your mind and change the way you think about sleep.

Studies done on people without time constraints of family, workouts, work, crying babies, sleepovers, etc … OK, mostly 20 something army recruits and college aged kids… showed that the vast majority of people need very close to 8 hours of sleep per night with very little variance, mabye plus or minus 15 minutes. But informal polls (like this one) will reveal most people saying they only need 7 hours of sleep per night. The truth is that they “Function” on 7 hours a night, but they need more.

Sleep debt is cumulative and for every hour under 8, you need to make that hour up. Top end studies on sleep debt were done only for 2 weeks (imagine the logistics of doing a sleep study on a confined group of people for longer than 2 weeks), and it held tru for the duration of the 2 week study….miss a few hours of sleep, and even 2 weeks later, your body still craves the need to make it up, and when given a chance, it will do so, hour for hour. (so if you lose some sleep one night, plan to go to bed x hrs earlier the next night and you should feel great)

Sadly, most people get far less than this and have learned to tolerate it. They may say that they only need 5, 6 or 7 hours of sleep, but they have only just learned to function that way. THey really need right round 8 hours of sleep.

Ever notice how if you go on vacation, or say get a 4 day weekend off or whatever, you are capable of sleeping 10-12 hours each night? It’s your body trying to catch up…yes, you CAN catch up on missed sleep.

My father retired a few years ago, formerly got about 6 hours of slepe a night and thought that was all he needed. He now routinely sleeps 10 hours a night without difficulty with the time constraints of work removed…and he feels much better than he used to.

A seventeen year study of 10,000 government workers in Britain, just released yesterday from London associated increased risks of heart disease with getting fewer than 7 hours of sleep per night.

Lack of Sleep May be Deadly

So you may all wonder, if I’m so knowledgable about sleep, what in the world am I doing up at 2:30 AM? I do shift work and just came off night shifts..trying to flip back to days.

Can I use my new Max Heart Rate for training zones?

admin September 24th, 2007

A recent question about Maximum Heart rate involved a rider who sprinted through an intersection at the last second while going downhill.  His question was whether or not this heart rate caputured on his monitor (189) was valid, and why it appeared while riding downhill.   Most coaches suggest that there is no real value in identifiying your maximum heart rate.  After one forum member suggested that Max Heart Rate served no purpose, I replied with the following:

Max HR doesn’t serve NO purpose, but it serves no useful purpose for designing a training plan using HR zones.

Max HR is pretty much fixed and non-trainable and declines steadily with age, while your fitness continues to improve if you are training, even as you get older. So it doesn’t make any sense to use your Max HR, weather by testing or by equation, to figure into a training program.

Your SUB Max HR, however, is extremely valuable in determining yoru responses to a training plan, your response ot a particular workout, or your results of a particular test.

There is no value in going to a MAX Hr during testing as the submax HR tells you MORE, including an estimation of your VO2 Max.

Max HR efforts are great for research studies, and add to the wealth of information that show the sub max HR is a great predictor of aerobic fitness, and a great indicator of our response to aerobic training.

Should you Bonk on Purpose?

admin September 22nd, 2007

I say why not? Go ahead and bonk on purpose, in a controlled environment, where someone is with you or knows where you are if you don’t show back up. Here’s an article by Matt Fitzgerald that discusses a physiologic adaptation that occurs after bonking, which may make you better prepared to handle endurance sports.

I’ll let you read the original article here, entitled Should you bonk on purpose

An exerpt:

“Believe it or not, one highly respected exercise scientist has suggested that it may be beneficial to bonk regularly in training. Her name is Bente Klarlund Pedersen, Ph.D., and she’s a researcher at the University of Copenhagen, Denmark.

Klarlund recently explained her rationale for “intentional bonking” in a lecture entitled “Signaling the Muscles to Adapt: Train Low, Compete High?” which was delivered at the 53rd Annual Meeting of the American College of Sports Medicine.

Benefits to under-fueling workouts

In this provocative lecture, Pedersen made the case that athletes — and especially endurance athletes — stand to gain greater fitness by performing some of their workouts in a glycogen-depleted state than by trying to perform all of their workouts in a glycogen-replete state.

In practical terms, she said, they should do some workouts within hours of having completed their last workout, such that there’s not enough time to replenish muscle glycogen stores between workouts, and they should also leave their sports drinks and gels at home for some workouts (that is, intentionally under-fuel their muscles during training).”

Read. Digest. Discuss.

When to introduce “Speed Play”?

admin September 19th, 2007

A new triathlete asks:

When I look at my training plan it seems that Fartliks are sprints in a foundation run, and Lactate thresholds are sprints in a race tempo run?

I run 12 min. miles, I don’t have a tempo run yet. And I’m not very fast on sprints. What does any of this mean for me? What should I be shooting for?

and, what is VOmax something or other?

Fartlik is a Swedish word for “speed play”.

In practice, it just refers to random short increases in pace during an otherwise moderately slow run. THere is no specific speed or pace associated with it. They do not have to be sprints.

I am also a slow runner and remember the feeling of having only “one speed”. Fartleks or pickups or strides are a nice way to increase your pace briefly (even 10-20 seconds will feel like a lot at first) to introduce your body to the idea of a faster pace.

You should only begin to add these if you have been consistently running at least 3 times a week for a month or so for 30+ minutes at a time. That’s not a hard rule, but just a suggestion. Then you can start adding in short fartleks during a run, say 4-6 total for 10-20 seconds. Don’t do it more than once a week for the first 4 weeks, and then re-evaluate things.

Lacate threshold and VO2 max workouts are based on your specific physiology and are much more specific than a “sprint during a tempo run”. It sounds like you don’t quite need to worry about those yet, but educating your self about physiology and fitness will benefit you in your overall training.

Here is a great article from Running Planet that explains several types of running drills that you can integrate into your base training period.

Heart Rate Management for a Beginner?

admin July 15th, 2007

I ran today 1/2 mile and then took my HR. It was 154. I then walked for five minutes at a normal pace and HR was 120. I again walked 5 minutes at a normal pace and it was 115. I then ran another 1/2 mile and it was 151.

So if I’m trying to increase both speed and distance how should I work this? Should I run a bit harder in an attempt to get my HR closer to my max?

You are better off to run by perceived exertion than by heart rate at this point. The tables in the article you link to are adequate for the general description of training at different intensities. But HR zones using formulas have too much error to be useful to the majority of people. You might be someone who falls into the correct zone by usign teh formula, but you won’t know until after you’ve done some training that’s not going well.

Bottom line is to run at a pace where conversation is easy, this accomplishes the tasks described in the page you linked to described here:

“Most effective for overall cardiovascular fitness. Increases your cardio-respitory capacity: that is, the your ability to transport oxygenated blood to the muscle cells and carbon dioxide away from the cells. Also effective for increasing overall muscle strength.”

You don’t need to take your HR to figure out if you are in the right zone if you follow the “conversation” guideline in the first paragraph. There are also percieved exertion tables where you assign a number to your effort. I prefer the 6-20 scale, but there are also 1-10 scales in use that others find simpler.

Don’t get me wrong, I am a big advocate of HR training. But I hate to see people get too caught up in numbers especially when starting off witha formula based plan and without a good understanding of the benefits that you get from training at different intensities.

Too many people think that in order to have quick improvement, you have to go hard. Quite the contraray. From what you describe as your exercise background, slow and stead for several months is the way to go in order to get yoru body acclimated ot exercise, get your cardiovascular system used ot the idea of working harder and to avoid early injury.

I firmly believe that the single most important factor in lifelong improvement is consistancy. If you have to take 1-2 weeks off every few months due to nagging injuries, or if you start out too hard and too fast and develop smaller injuries that you try to train through, you are really sabataging your potential for development.

Joe Friel advocates for an easy Zone 1/2 endurance based approach for up to 2 full years before beginning anything more intense. Many folks on this board hvae stories of amazing improvements in pace as well as comfort by doing nothign but LSD (long slow distance).

Warnings on over-exercising

admin July 11th, 2007…

The info about temporary cardiac muscle enzyme elevation after endurance events is not new. However, I believe that the “conclusions” by the author, and as reported in this article in the last 2 paragraphs are irresponsible.

Certainly the hypothesis that temporary enzyme release represents muscle damage that could result in scarring is one that should be investigated. But to suggest in a paper, and have it picked up in the press and exposed ot the general public that endurance athletes are dying due to arrhythmias produced by scar tissue as a result of exercising over 3 hours a week is bad science and bad journalism.

Without electrophysiologic or autoposy data about the causes of death, these are just speculations and it’s far more likely they die from the much more common coronary artery disease.

THoughts & comments?

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