Quakinghouse Lane

This morning I ran up Quakinghouse lane with the dogs and one of my kids. For about the first time in a while I enjoyed it. At the top of the hill the sun was rising, the wind had dropped, and I could see out over the vale of Taunton. There was a chance I would get home with warm, dry feet.

It’s been a long hard winter, and running up and down that hill hasn’t been pleasurable. But people who run (or cycle) are addicted to running (or cycling), and I am now a slave to it. And it is an addiction.

There is a long-running study looking at Ultra marathoners (the ULTRA study). It takes a little finding. There is a study on the treatment of fibroids known as Ultra, and project MKUltra is also known as the CIA mind control program – allegedly.

The signup for the study is here if you are interested. It’s an ambitious project to determine whether running long distances is healthy. If you are one of the many who has done an Ultra, then go and sign up.

But the interesting thing about people who do Ultras (people can enrol in the study if they have run an event of more than 50K) is that they don’t care if it’s healthy or not. Participants in the study were asked to answer “yes” or “no” to the question “If you were to learn, with absolute certainty, that ultramarathon running is bad for your health, would you stop your ultramarathon training and participation?” Of 1349 who answered the question, almost ¾ answered “no”. My guess is that this would hold true for cyclists and triathletes too. The Pubmed link is here if you want to read a bit more.

I see people with heart trouble every day of the week, that may be due to exercise. I haven’t stopped yet and won’t for as long as my health and my joints can keep going.

It absolutely p****d down as I ran down Quakinghouse lane. The shoes are on the Aga. I’ll be out again tomorrow.

Strava have lost Friends

Recently Strava’s API for getting Friends has stopped working. This hasn’t only affected Crickles: numerous other app developers are reporting the same problem. There is no information about this on the Strava developers site, which still reports the same protocol for accessing Friends data, so there is no way of knowing if it’s an unintended bug or a planned removal of functionality. Strava are not replying to Support queries on the topic.

Whether/how Friends-style comparisons will be supported if Strava don’t fix their API remains to be seen. Please let me know if you have views on its desirability.

UPDATE – Strava are not restoring this functionality hence the Friends groupings in Crickles are, for the time being, stuck with only the friends known as of the date before this was withdrawn.

Thanks, Ian

I don’t know what to call this one.

It’s been one of those weekends which haven’t been full of joy. At one stage yesterday, with the rain pouring and the wind blowing, I asked myself what I was doing out running up a muddy hill with the dogs. The answer was of course to take my mind of the Bawa-Garba case.

For those of you who don’t know, Dr Bawa-Garba was found guilty of manslaughter and struck off by the GMC after the tragic death of a child under her care. She made a mistake – that is clear – and it had terrible consequences. But there were, as there usually are with mistakes, also problems with the system in which she worked. She had just returned from maternity leave, was working in an unfamiliar environment, the IT system was playing up and she had with junior doctors supporting her with little experience. It has been reported that she was covering for absent colleagues, including the consultant as well. Is it any wonder that a mistake happened?

This winter in the NHS has left many of us rushing around, managing a much higher number of patients than usual, and consequently making hurried judgements. But what is the alternative – to say you will only see a certain number of patients, or down tools if members of the team are off with flu? The case has made many of us feel vulnerable. All doctors make errors at times. We know we make more errors when under pressure.

The practice of medicine relies on judgement and intuition – which is why it is error prone. It is not an exact science, and never will be.

It is that very lack of hard data that inspired Crickles. I was asked “how much exercise is too much”, and I couldn’t give an exact answer. Crickles draws on the wisdom of the crowds. You can look at your exercise volume and see where you are relative to others. You can look at your fitness and fatigue levels. As of this evening, I am fatigued according to my data. So, it’s a day off training tomorrow, thank God, as the weather looks crap.

 

 

Logging on to Crickles

Prominent amongst the latest batch of enhancements to Crickles is the introduction of user credentials: you now need a password to access the Navigator. The log-in screen looks something like this

save_password

On your first visit, you’ll only see the Username (Strava ID): field at first. The Strava ID that is needed is not the email address or Facebook ID that you use to log onto Strava but the number that Strava uses to key your data. In my case, for example, it’s 301194, as in the figure. To find your Strava ID, go to the Strava website and find “My Profile”. On the Strava website, it’s currently found in the pull-down menu next to your photo on the top right of the screen.

Once you have selected this, the top of the browser window will look like this:

strava address

You can see from the figure that the Strava ID (301194 in my case) is at the end of the URL in the address bar.

Once you enter your Strava ID, if you haven’t yet authorised Crickles to access your Strava data a link will appear where you can do this. Alternatively, you can do so at:

signup.crickles.org

Then, if you haven’t got a password yet, hit the Request password button. A password will be emailed to you and it should arrive more or less instantly.

If you wish, once you’ve logged on you can create your own password. As well as being potentially more memorable, this is also more secure. Although the password generated by Crickles is encrypted, it has necessarily passed through email servers en route to you, unlike a password that you choose for yourself.

You change password using this screen:

change_password

You get to it by checking the Change password? checkbox in the side panel. If you’re on the screen and decide that you don’t want to create a new password, simply uncheck the box. Once you’ve changed the password you’ll need to re-enter it to log in.

After you have logged in you should not usually need to do so again on the same device. (If, though, you have disabled all cookies in your browser you’ll need to log in every time.) The way that credentials are shared between devices, and whether and how passwords are cached, will depend upon your device, your browser and your settings.

Significantly, no one can now see your data on Crickles without logging in as you. Your Strava Friends who are also on Crickles can compare various aggregate CSS measures and compare charts of activities that have not marked as Private on Strava, but the detailed information that you can see is now just your own.

Crickles Charts now in the Navigator

Crickles Activity Charts has up until now (only) been available as a standalone app at charts.crickles.org. From today, Crickles Charts are integrated in the Navigator and the separate app has been retired. Here’s an example of how it looks now:

new_charts.png

For the time being, this functionality joins HR Zones and Regularity as a beta feature and thus requires a log-in.

Functionally, the only significant change is that the set of Athletes whose activities you can choose to chart against your own is now picked from amongst your Strava friends who are on Crickles rather than the entire Crickles population. If you need a refresher, a description of the functionality as it was before is available here.

Hopefully, now that charts are integrated with the rest of the Navigator functionality, you’ll find it more convenient.

More Good News If You Are

An elite athlete.

Shortly after writing my previous post, suggesting Tour de France riders live longer than normal people, I came across another study published in the British Journal of Sports Medicine. It was entitled “Mortality and health-related habits in 900 Finnish former elite athletes and their brothers”. The link is here.

 

They looked at male Finnish elite athletes who represented Finland between 1920 and 1965 and their age-matched brothers (not identical twin brothers necessarily). Fortunately having brothers seems common in Finland where it is often dark and cold.

They followed them from the start of their career up to 31st December 2015. 1296 of the 1800 died during the study period. The median age at death was as follows:

 

  Elite Athlete Brother
Endurance 79.9 77.5
Mixed Sports 75.9 73.7
Power Sports 72.2 72.2

Elite athletes smoked less and were more physically active in general. We don’t know why elite athletes live longer, but their overall lifestyle, which includes exercise, seems to be protective.

This is an observational study, and not an experiment. It remains possible that the difference in smoking rates or some other lifestyle factors made the difference, and the excess exercise narrowed the gap – the study does not exclude the possibility that exercise is harmful in excess. It also doesn’t tell you that endurance sports make you live longer than power sports – just that those that tended to do endurance sports came from families that tended to live longer.

But I’m still doing some triathlons this year. And I will still be advising my patients to exercise. I’ll dig out the paper, hopefully, and see if there are any more details buried within it that are important.

 

 

 

 

A New Post for 2018

I just thought I would share this question we were asked recently:

“Do you have any data on the incidence of AFib in people who say competed in the Tour de France in past years to see how the risks in this population compare with the public as a whole.”

There is no doubt that I see a lot of people with atrial fibrillation (AFib, AF). Most of the people I see are cyclists. And that makes me think that there is something about cycling that leads to AF. But, it could be a sampling error – all the people who get AF from other sports might go and see someone else. It doesn’t feel like that though. As I supervise the nurse led AF clinic. There are plenty of people who run too in Somerset – I only see a few of those.

Tour De France cyclists are an unusual breed. They may well be genetically different to you and I. Or at least me. And remember, at least (hopefully) until recent times, these riders were (probably) systematically doped. There were probably teams in France doping kids from the age of 11 (according to some of my French contacts), and many domestiques had to take drugs or be dropped. It started with amphetamines in the 1900s.

There are descriptions of arrhythmias in former cyclists (e.g. Europace. 2015 Mar;17(3):387. doi: 10.1093/europace/euu399. Epub 2015 Feb 12.); A left atrial tachycardia is often the start of AF. But, there are  no systematic studies that I am aware of. Overall, however, being a TdF cyclist seems beneficial to health however – they seem to live longer at least. See Eur Heart J. 2013 Oct;34(40):3145-50. doi: 10.1093/eurheartj/eht347. Epub 2013 Sep 3 and Int J Sports Med. 2011 Aug;32(8):644-7. doi: 10.1055/s-0031-1271711. Epub 2011 May 26. 

That doesn’t mean it’s the cycling though. It could be the diet, the genes, or even the drugs. We perceive drugs as harmful, but that doesn’t mean they are. When the stigma dies down, we should probably try them in the elderly. It might improve the quality of their life – sarcopenia (a loss of muscle) and a loss of cardiovascular fitness really hits the elderly hard in a variety of ways.

I’m afraid that endurance exercise does appear to predispose to AF – at least in men. The paradox is that those who exercise appear to live longer, which can get lost in all the concerns.

So AF may need to be reconsidered as one of those things that happens – like tendonitis, stress fractures and muscle strains (although a bit more serious, in my view).

If I don’t get AF this year, I’ll be doing the Dublin Marathon again in October.

Who does what on Crickles / Strava

You may have noticed on Strava that there is quite an extensive list of Sports into which activities can be categorised. Here, for no reason other than curiosity, is a chart showing relatively how many of each activity we have on Crickles:

count_by_sport.png

Since the number of activities in each Sport ranges from Rides, which is in six figures, down to Handcycles, for which we only have one, I’ve used a log scale.

Cardiac Stress Score can be calculated for any of these Sports in which a heart rate monitor is used (and estimated imprecisely even if one isn’t).

UPDATE: the algorithm for calculating CSS in the absence of heart rate data has been significantly enhanced since the time of writing.

End of the year

I think most of us reflect on what we have achieved in the past year. For me, it’s been a mixed year with regards to exercise. I did my first sprint and Olympic distance triathlons. I completed my first marathon for 16 years (I only ran one before) – in just under 4 hours.

But I didn’t get my sub 20 minute 5K time. Close at 20:38. And my cycling went to pieces with the focus on running.

Just recently I spent some time looking at my run data on Crickles. Taking a few of the runs I plotted out the relationship between heart rate, speed and gradient. It’s a bit messy (although I have some ideas to tidy that), but the curve/surface is quite interesting. I plotted the curves initially to help statistically create a normal range for my running conditions, with a longer term view to help track abnormal heart rates for a given situation.

MATLAB Handle Graphics

I then limited the curve to gradients of +/- 2 degrees gradient initially. And I was struck by what it showed, but not entirely surprised.

my running

As I start to run my heart rate speeds up. No great insights there. There is then a plateau until just over 11Km/h. That fits with what I experience. I know from my Garmin that up to 11-11.5Km/h I can sustain. It’s comfortable. My legs wear out first.

Go too much above that speed and everything becomes harder. That is my lactate threshold for running. That’s where the pain starts and I have to breathe harder to clear the carbon dioxide generated by lactic acid in the muscles from my system. They have to work anaerobically at these sorts of speeds.

The curve kicks up again just over 14Km/h. That’s the respiratory compensation point. Beyond that I can’t clear the lactic acid from my system by breathing and I am on borrowed time.

And that is why I can’t do a 5K in under 20 minutes yet. Sometimes you hit psychological blocks as a runner. I have watched my son streak away in the last few months having joined a running club. He was stuck, probably because of his brain, but his heart rate data suggested he could run much faster. And they unlocked that speed in him. But I am stuck by physiology at the moment.

So, I’ll be sprinting and running up hills in the new year. And working on some algorithms to track my progress. My Garmin says I can do sub 20. I know I can’t. Yet.

Have a great Xmas. And good luck for 2018.

Let us know your goals and what you want to see from the site.

Mark