*UPDATE* Psychological Effects of Heart Rate Monitor Use Study

12/21/2010: Preliminary results were reported at Indoor Cycle Instructor in October 2010. Manuscript in preparation. Once published, results will be made available on this site and at ICI.

Saturday, October 10, 2009

Medical Signs & Symptoms of Overtraining: How to Know When You're Working Too Hard

You're tired. You're sluggish. You're sick all the time. Your sleep is screwed up. You snap at your kids, your coworkers. The only time you're generally motivated to do ANYTHING is your 45 minutes on your Spinning bike, when you push yourself to "give it your all" (groan - one of my least favorite cliche expressions in life), get your scheduled endorphin rush, then go back to the real world in all its glory.

Like pornography, overtraining is something wherein I "know it when I see it." I know it because I a) see it all the time; and b) experience it all the time. In my medical world, the phenomenon of overtraining is not on the radar of most doctors. As an athlete, I know that my own primary care doctors over time have had NO idea how my training impacts my body. They're content that I exercise regularly, and that's all they think they need to know about me. They have no idea how intensity affects fitness (i.e., the person who goes to the gym to lose weight inadvertently spending 95% of her time working anaerobically, yet is surprised when she feels lousy AND doesn't lose weight), and how certain approaches to exercise can be counterproductive. It's SO underappreciated, in fact, that we're actually not taught this in medical school. But because I am fortunate enough to know better, I consider it one of my person life missions to educate my colleagues, my riders, and even patients (who teach ME so much about from their experiences) about this overtraining phenomenon.

The medical consequences of training too hard with insufficient recovery are well-described, and appreciated in sports medicine circles. It's just a matter of translating this knowledge into a form that is meaningful to people outside that circle.

I wrote an article for IndoorCycleInstructor about recognizing overtraining and what to do about it that was published today.

CLICK here to read an excerpt. In order to read the full article, follow the easy directions to sign up for ICI's free weekly mailings (an incredible resource to help you translate technical content to your classes, develop your own trainings, and keep your classes/music/themes fresh!).

Saturday, October 3, 2009

Building Confidence on a Spinner - with a 45 min profile, to boot

I've never met anyone who believes that confidence ISN'T important. I'm not investing time to even look for literature to support my assertion because I'm CONFIDENT that you all believe me when I say that confidence is an important predictor of performance.

When I began my journey as a Spinning instructor, I didn't have any confidence. And I sucked -- not ONLY because I wasn't confident, of course, but that didn't help either. I mean, I REALLY sucked. I sucked so badly that I didn't even KNOW how badly I sucked. And that's the point. One can look at the endpoint of the trajectory from "sucking" to "not sucking," appreciate the powerful emotional transformations that occurred along the way, and call it a day. But I think it's more useful to analyze the fuel -- the motivation -- behind the process.

Was it the pursuit of "not sucking" -- that is, avoiding failure? Or was the pursuit of "being awesome?" Most certainly the latter. It meant something to me to learn enough, listen enough, think enough, and otherwise "be" enough to earn people's trust to help guide them through their own personally meaningful improvements.

Think about it. When you work hard at your job, do you do it primarily to avoid being fired -- or because you genuinely want to do excellent work? When you do something nice for your kids or your spouse, do you do it primarily to avoid pissing them off -- or because you genuinely want to do something nice for them? Extending the framework: Do you hold a 30 minute training interval at lactate threshold primarily because you'd feel weak/inadequate if you didn't finish it? Or because you appreciate that the difference between 29:00 and 30:00 is a moment you can hold onto as long as you want to, to represent your confidence, your self-efficacy, your belief that you have and are everything you need to conquer the challenges of your world?

Maybe you didn't think to make that interval mean more than that interval. Maybe you didn't have to. But if you framed it that way: would it have made a difference? Would equating an off-bike purpose to your on-bike task mean anything 'extra' to you? Would it have made the time pass more quickly, more enjoyably? Would you have been more likely to accomplish your specific, concrete physical goal? Would it have left you feeling any different when you did? Would you have taken that feeling with you?

Last weekend, I rode my third Century (yes, I'm done now...), which prompted me to ask myself why the hell I've made time to train for and ride three 100-mile epic conquests within an eight-week period. There are a lot of other ways that second-year medical students can spend their free time. I may now be someone who "does" Centuries -- but Centuries aren't something that people just "do." How I've always seen it was that training for a Century (or two, or three...) equated with Operation: Real Cyclist. I never saw myself as a real cyclist before; I saw myself as someone who only started trying to do this thing a year ago, who doesn't know how to do really important things (i.e., changing a flat), who has memorable episodes of failure (i.e., hitting her head on concrete), who despite knowing a shit ton of useful technical things about being a real cyclist has no useful construct with which to translate this knowledge into self-confidence and self-efficacy. Oh my gosh. That sounds exactly like... being a second-year medical student.

So, yes, training to be a Real Cyclist was meant to parallel training to be a Real Doctor. Except this seemed more manageable. I knew exactly HOW to accomplish this kind of training. I knew exactly what I needed to learn, what I needed to practice. I had complete control over my physiological response to challenge, I had immediate feedback on my skills and adaptations (i.e., from my heart rate monitor), and measurable, objective ways to evaluate my progress. So it paralleled my larger life challenge -- yet was more "masterable." When I finished my first Century, I felt awesome. I felt like I could take over the world. I got a tattoo to commemorate the joy and confidence that comes from continuous incremental improvement ("Kaizen"). When I then encountered stressful circumstances in my medical training, I called up that feeling. "If I can do X, I can do Y," if you will.

As Y got more demanding (i.e., helping to take care of real patients), I needed X to be more dramatic. So I did Centuries #2 and #3. But by the end of last weekend's undertaking (with shooting pain from my re-torn tibialis anterior tendon and my spasming hamstring), I wasn't riding for the pursuit of self-confidence to accomplish some unknown future Y anymore. I was riding because I thought I'd feel lousy/inadequate if I didn't finish. I envisioned myself, not triumphant at the finish line, but back at the hotel sulking or driving home 3 hours thinking about how I wasted my time. There was no doubt about it: I was riding to avoid failure.

At the end of the day, I finished. But it was a miserable ride -- and when it was all over, I wasn't even all that proud. "Good job, Self," I said. "Way to not fail." Is that what I'm going to remind myself when I'm standing at the foot of a man with crashing blood pressure whose acute pancreatitis was about to kill him (which is a situation in which I found myself a few days later)? "Come on, Self, you can do this. That time when you rode that bike 100 miles and... uh... didn't fail?" Will THAT calm me down, and empower me to take a step back and use my brain to confidently save a human being's life? Hell no it won't.

It matters. The way you frame it absolutely matters. "Avoid failure: Check" is not the same as "Conquer Challenge: Check." The former doesn't build confidence. It doesn't last, and it doesn't translate. So you know what? When I drove 3 hours to ride a bike 100 miles and drive 3 hours home, I really DID waste my time.

That's not to say that athletic feats, when framed appropriately, can't translate into non-athletic confidence. I will never, ever forget a particular moment in April 2009 during Spinning MI Caroline Dawson's class in NYC, looking down at my heart rate monitor and realizing that I was about to hit my 30th minute of sustaining a 184 bpm heart rate -- which, to my knowledge, was 10 beats above the last time I'd had lactate threshold measured. I will never, ever forget that moment of appreciating the efficacy of my training to increase LT that much in a year, and the global appreciation of my strength and power. I *think* about that moment literally ALL the time in my non-fitness life. Not because it was actually a big deal. But because I framed it in such a way to make it a big deal to me. I chose to make it mean something.

I use that moment as my gold standard by which to compare every Spinning class I ever coach. My personal life mission is to inspire a human being to feel like THAT, the way Caroline's class made me feel. That's the goal. My "formula" these days for achieving said goal is to take solid scientific training principles and fit them into a "theme" for some psychological/emotional concept that I'm exploring in the rest of my life -- something that I want to explore further by devising questions and thoughts and pathways for people to ponder, something that I believe other people will find useful to explore.

If you've been following this blog for a little while, you'll remember that I've had this grand-scale life-improvement mission to get comfortable with discomfort. The past few months have been all about that, with a reasonable level of success. I can screw up an interpretation of a chest film in front of 115 people and be awkward and inadequate in an emergency department, and breathe through a peaceful acceptance that I'm ok and that the world will continue to rotate. Mindful acceptance, devoid of negative, defeating self-talk, is SO much more helpful. I'm glad that I invested so much energy actively exposing myself to uncomfortable situations to be able to practice my responses to them. And I'm glad that I successfully used more than 15 Spinning training sessions based exclusively on key sub-subconcepts of this larger point (i.e., taking stock of physiological sensations of discomfort, equating on-bike discomfort with an off-bike purpose, etc. etc. etc.) to help other people work through these challenges.

But now it's time to build on acceptance of discomfort and self-compassion, and start building confidence. Confident PURSUIT of something, not mere avoidance of failure.

I coached a ride about this the other night that went REALLY well. Here goes...

Note: I'm going to write up the training parameters as a 0-10 RPE scale here (and going forward) to be most useful to most people. I've taught my riders with heart rate monitors to equate 8/10 with Lactate Threshold and 5/10 as 80% LT as their anchoring points.

MHR formulas do not work. And since can't accurately measure MHR in most people, using MHR as an anchor point from which to take percentages is inherently inaccurate. The way I have been using % MHR is to set 85% MHR = Lactate Threshold, and reverse-calculate a MHR to use for further calculations. But by doing that, we are effectively anchoring training parameters to Lactate Threshold ANYWAY. So why pretend otherwise? I use % LT parameters in my own training, and have started using it in my classes.
This "note" is getting really long -- I eventually need to write a separate post about how I'm integrating % LT parameters into classes of mixed HRM- and non-HRM wearers. But for a truly well-written article about why MHR formulas (i.e., 220-age and 226-age) are inaccurate, I encourage you to read Gene Nacey's brilliant piece that also links to a full-text excellent, digestible account of the research behind these formulas' inadequacies that I liked so much that I disseminated it to the students taking the Intro to Heart Rate Training course I am teaching at UVM.

If you ARE going to assume that your measured LT = 85% MHR, solve the equation for a fake MHR, and use those numbers for Spinning Energy Zones, etc., here's a chart that helps to explain equating verbal descriptors with RPE, with these heart rate training parameters.
I rewrote the intro (from July 2008, when I was underappreciative of RPE) - if you've seen this before, might be worth another peek.

Now, really, here goes:

Premise: Sometimes it's tempting to believe that there is only one way to build confidence. On the bike, sometimes we think that the only way to build confidence is to push as hard as we can, for as long as we can. But in reality, there are a lot of ways to build confidence. Sometimes the most confidence-inspiring training session can be the one where you discipline yourself to maintain 80% LT in the saddle, appreciating the strength of your rhythmic, controlled breathing to modulate your response to challenge. It's all about deciding WHAT is going to bring YOU confidence in that moment, and giving yourself permission to go for it.

Structure: Climb, 6 surges -- each surge will be a change in the rhythm, where you will choose to respond in a specific way that makes you confident. Based on that newfound confidence, climb again -- with 1 more surge to the finish line

WARMUP: 4 minutes
Cue breathing. Cue form. Describe ride and expectations.

Progressive load seated to 80% LT ("5 out of 10"). Progressive load to "6 out of 10." Progressive load to "7 out of 10" (10 beats below LT). Pay attention to breathing, physiological sensations. Start to think about what brings you confidence, in various realms of your life. How do your physiological sensations reflect those experiences? Do they heighten your confidence? Distract? At what intensity do you feel most empowered, in control, alive? In the seat? Out? Where are you best focused and primed to meet your needs?

SURGES: 12 minutes
30 seconds x 3
1 minute x 3
90 seconds x 3

Let every surge equate with an opportunity to build confidence. When the rhythm changes, make a choice that will allow you to experience the specific conditions that you need in order to directly speak to your appreciation of your abiliities, strength, and power. Surge to the intensity you selected in the initial climb as your confidence-building zone.

POWER CLIMB: 8 minutes
Progressive load to chosen intensity, and your job is to sustain it. Empowered by your breathing, empowered by your belief that sustaining this effort directly translates to your enhanced belief in yourself for navigating the challenges of your world once you leave this room.

FINAL SURGE: 3 minutes
What's it going to take to translate your confidence on the bike to your world off the bike? Surge in such a way to structure an experience for yourself that will last, that you can call up when you need it most. A surge that reminds you that you are strong, that you are powerful. A moment you choose to mean something. A moment you choose to mean EXACTLY what you need it to mean.


It wasn't anything fancy -- it was plain and simple. And it worked. And you know what? Most of my class stayed seated, closed their eyes, and afterwards told me that they worked at their "5 out of 10" the whole time because that's what they decided that they needed.

Nothing could have made ME more confident to hear. It meant that they "got" that their purpose was to feel empowered to make their own choices to meet their own needs, and that those choices had no requirements other than to be deliberate, purposeful, and specific. They needed to mean something. And they did.