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racing after hip replacement?
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bobrobert
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PostPosted: Sun Sep 09, 2012 3:12 pm GMT +0000    Post subject: racing after hip replacement? Reply with quote

On 27 June 2012 I had my right hip replaced after 15 years of pain......the reason I took up bicycling was to lessen the "impact" on bone on bone from playing too many years of squash. I raced mtb back in 1999,2000 & 2001 however after 911 stopped racing and started organizing for peace. So, now with new hip I feel compelled to start racing again or at least start training again. My doctor advise is to be very careful of where the tip of the new titanium joint ends......that would be where bone would be weakest.....and more likely to break, although I never fell in my previous racing am wondering how much risk I would be taking to start racing again?
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The Bike Doc
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PostPosted: Mon Sep 10, 2012 11:11 am GMT +0000    Post subject: Reply with quote

bobrobert:

Your ortho doc is right about the weak point at the end of the insertion of the artificial hip in the femur shaft. The tough part is giving you an accurate prognositication better known as a SWAG (those in the military and scientific community know this). Bicycle riding and racing can be done after hip replacement. Ask Texas' own Fred Schmid Multi State, National and World Champion in 70+ age group. http://bicyclesoutbackracing.net/2011/12/silver-cyclist-in-texas-parks-and-wildlife-magazine/

You and Mr. Bill both may want to be like Fred. http://www.tmbra.org/board/viewtopic.php?t=12073

Another famous (infamous) cyclist who had a hip replacement and returned to racing was Floyd Landis. http://velonews.competitor.com/2010/03/news/floyd-landis-to-ride-for-bahati-foundation-team_107543

Bottom line is it has been done and can be done. But there are risks in everything in life. Remember, in all you do, you have a sexually transmitted disease acquired from your parents that is 100% fatal. Its called life! Grab it with gusto. If you want to be like Fred... it is your choice.

Visit with your ortho doc about your plans further and ask if there are certain things you should, or should not do. Look at your bike setup to makesure the seat position and height works for your "million dollar" man rebuilt leg (showing my age here). You pre-repaired leg likely was shorter than your post-repaired leg.

Thanks,
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bobrobert
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PostPosted: Tue Sep 11, 2012 1:12 am GMT +0000    Post subject: racing with new hip Reply with quote

dear doc,

thanks for responding but who is Mr. Bill? In all my racing mtb I only hit my head on that low leaning branch at the Rocky Hill Ranch......nearly knock me off my bike and that was my first race.........so I am unlikely to fall but in your professional opinion could I direct enough force on that spot on my femur to fracture by peddling? And does a full suspension bike offer less impact........I do notice that my hard-tail is stiffer and have to get off the saddle when encountering a bump. As of now my new hip feels better and longer than my natural hip.......the reason going into bicycling was/is to avoid impact.......would that include avoiding bumps?

Did I mention my age? 66. I was told that the only way to build bone is to "pound" them and bicycling seems to be easier on the impacting than walking. Seems like all I am doing when bicycling is cardiovascular and by racing would be taking a risk of falling but don't I take a greater risk by driving(car) to the race track and having some drunk crash into me?
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Scott S
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PostPosted: Tue Sep 11, 2012 7:19 am GMT +0000    Post subject: Reply with quote

My two cents. I got hit by a car in 2004 and now have a permanently installed IM rod in my right tibia. Theoretically, it could cause complications if I were to suffer a similar injury again. On the other hand, other than a small bit of extra swelling, there's been no lasting effects from it, my leg is as strong as it ever was.
Cycling is great for general health and cardio/aerobic capacity, but it is suggested by many sources that weight lifting, running, or walking should be added to get in some bone building impact as well. I walk a lot, and briskly, and even try a bit of running (although it's more shuffling for me.)
I'd say go out and try racing. If it hurts too much, back off a notch, but if I was always worried about falling on my leg again, I'd never leave the couch.
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The Bike Doc
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PostPosted: Tue Sep 11, 2012 5:36 pm GMT +0000    Post subject: Reply with quote

bobrobert:

bobrobert:

Mr. Bill is a much loved, mountain biking character (aren't we all) who has several posts on the TMBRA forum of old (back in the 90s) and fewer on the current forum but they are always insightful, humorous, and/or barbed in a good way. He commented on the link I provided on "be like Fred". He was a member of "Team Smack" of years gone by, a group of good olí boy mountain bikers, many of whom are still about on the forum and still hammering the pedals. Team Smack smackers kept the funny side up on the forum and on the trail.

If you were to fall and take a direct blow to the femur shaft where the titanium rod inserts, yes you could break the femur. It is highly unlike that just pedalling without falling would cause your repaired femur to break. You can strengthen leg bones more with impact exercises such as running and jumping calisthenics as well as with weight training of your leg muscles. Road bicycling and swimming, however have been shown to reduce bone mineral density (nonimpact exercises with reduced load bearing), but this is much less of an issue for mountain biking because of the pounding, bounding and repeated impacts that mountain bikers experience on their bikes.

Look at adding cross training in your rehab. Do weight training of your legs, under the direction of your Ortho Doc, and possibly with the guidance of a Physical Therapist who works with rehab of patients with hip replacements. Add jogging a couple days a week, as your Ortho Doc recommends when it is safe, to improve your axial loading and resultant strengthening of the femurs and other leg/foot bones aw well as the spinal vertebra. When you get on your mountain bike, consider getting some downhill specific padded bicycle shorts or motorcross padded undershorts with hip padding down the femur to help protect your femur in the event of a fall. I use these when I ride now (mountain bike and motorcycle), as I like my bones intact and the skin left on.

In regards to full suspension, if you can afford it, get one that fits you and your riding style well. You will maintain better control on rougher courses with full suspension and be less likely to take a dive. The comfort will be and added bonus. You will till get a good deal of impact exercise to your legs when you ride.

Yes, drunk drivers maim and kill way more cyclists, motor and man powered, motor vehicle drivers/passenger and pedestrians than mountain bike riders/racers ever have or will.

Keep the rubber side down and the fun side up.

Thanks,
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bobrobert
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PostPosted: Thu Sep 13, 2012 12:18 am GMT +0000    Post subject: Reply with quote

thanks for responding,

After advise.......I think I will start training again. Here is my next concern: when I raced before in the 50+ class Sport I trained 100 miles per week in 30 mile increments......trained with a hr monitor and usually kept average around 158 range and in a race average 175-178.....I know this sounds high for a 52 yo. And now at 66 I am riding about the same 100/wk but shorter increments and averaging in the 135 range thinking that I should not take heart higher until I get more fit. My question is: how am I to determine my maximum heart rate.......all I can find online is real confusing......recently I have seen 169bpm......so....why shouldn't that be number of standing? When riding mostly flat and exert enough energy to breathe through my mouth around 137-140bpm. Oh, one more number that I am unsure of is my resting hr at around 76bpm......the chart suggested that that was below average.....I don't know what resting hr was before. Is resting hr relevant to fitness of concern?
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The Bike Doc
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PostPosted: Thu Sep 13, 2012 7:50 pm GMT +0000    Post subject: Reply with quote

bobrobert:

To find your max heart rate for a specific type of athletic activity, in your case bicycling, you will want to build up a base of conditioning which it sounds like you have a good start on. Depending on where you live AND with the blessings of your ortho doc, AND at your age with your regular doctor to make sure your ticker is in good shape, there are a couple of ways you can do this.

Given your age, the safest way is to have an exercise stress test with bicycle ergonometry under the supervision of an Adult Cardiologist. This will allow close monitoring of your ticker and can give you an accurate measurement of your VO2 max, the heart rate at which you achieve maximal oxygen uptake.

The way less expensive way and with far greater potential for danger, if your ticker is not up to it, is the hill method. If you live near some long hills, you will want to give yourself a good 15 minute warm up on the flats, then, with your heart rate monitor on, approach a long hill and start off at a good pedal spin of 90-100 RPM or higher if you are a fast pedal spinner. As you get into the hill instead of shifting to a lower gear, shift to the next higher gear and try to maintain your cadence, every 30 seconds or so shift to the next higher gear, when you get to the point you will not be able to keep the cadence up and your lungs will feel like you cannot get enough air to meet you needs, check your heart rate and head back down hill to recover. That heart rate at your maximal exertion is your maximal heart rate.

If you live in the flat country find a long road with a stiff head wind, warm up with a few minutes riding with the tail wind to limber your legs up then turn back into the wind, still taking it easy till you have a 15 minute warm up. The key is not MPH but RPM of your pedals. Again shoot for around 90-100 or higher. Start shifting up a gear every 30 seconds while trying to maintain the RPM. Your speed will initially climb but as you start working your way up the gears, you will find your MPH start to drop when the wind starts winning the resistance game. Again when you feel like your legs canít go any harder and lungs canít keep up with oxygen demands of the intense work out, check your heart rate, you have reached your max.

I would err on the side of doing number one. I donít want to read your obituary here.

Your resting heart rate is best measured in the early morning after a good nightís sleep while wearing your heart rate monitor. Do not use an alarm to wake yourself, the startle from the alarm will trigger a release of adrenalin and crank up your heart rate. Check the heart rate on awaking naturally, not from some noise, phone ring or sudden startle. That early morning peaceful awakening is your resting heart rate when you are totally relaxed and not stressed. I would expect it to be lower than 76 bpm and you may find doing it this way that it is quite a bit lower than you realized. Aerobically conditioned athletes can have resting heart rates well below 60. During my regular racing and long distance cycle touring days, I would have a resting heart rate around 40 when I was racing in my 40s.

Thanks,
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bobrobert
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PostPosted: Fri Sep 14, 2012 10:35 pm GMT +0000    Post subject: racing after hip replacement? Reply with quote

dear doc,

It was a little awkward, wearing hr monitor all night and then waking up at 4:45 am to take a measurement.......the monitor went to sleep and could not get the light to come on so went back to sleep till the alarm went off and after fiddling with it a while got a 70bpm reading.......that is much better than resting on the couch.....the lowest I could get was 78bpm. 70bpm tells me that I am it better shape than I thought but not fit enough to race yet.

From what you suggested about getting a maximum hr number.......what would be getting a number off a ride when trying to stay up with a roadie at a time when he asked "I thought you were going to pass" and "I reply I was just trying to get a maximum heart rate number".........169 was my max at that time.......should I go with that and what will happen if I go higher? Will I pass out? or read about me in obits tomorrow. Seems to me if I can do 169bpm and I had to back off.....knew my limit, so to speak. Isn't mhr self-limiting? Feels like I can't get enough air.......so I have to back off.

So, with a resting heart rate of 70bpm and a max 169 for maximizing my training what should I try to average? In order to get to racing fitness.....as before when I was racing I could average 178bpm @ 55years old. Tens years =10bpm? 168bpm average? So, for training should I try to replicate race pace? or keep it aerobic range? Before I would train by trying for a 'personal best' every time I went for a ride......was this contra indicated? Would like to train smarter this time......I can't complain about results before but seems excessive now.
And, would like to train "smarter" and refuse to take anything stronger than a multivitamin and aspirin. I believe we should get everything we need by the food(real) we eat.
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PostPosted: Sun Sep 16, 2012 8:16 pm GMT +0000    Post subject: Reply with quote

bobrobert:

You have likely found your max heart rate chasing down the roadie. A heart rate of 169 for a 66 y/o man was excellent. The base formula for calculating maximal heart rate is 220 Ė age in year. So in your case it would be 220 - 66 = 154. But that is based on the general population which is composed mostly of competitive remote control operators. So you are well above the general population. Maximal heart rate is both genetic and condition dependent.

Your shooting for a personal best with every ride is a fast route to over training. Muscles are built up by being stressed during intense work out which causes microtears in the muscles followed by resting. It is during the resting that the muscles then begin to hypertrophy (increase in size) and new blood vessels develop to these muscles. You are wise in avoiding taking analgesics (pain medications) such as nonsteroidal anti-inflammatory medications as these impair the new blood vessel formation to the training muscles. Additionally, the pain is a way to remind you to ease off and recover. Mask the pain, then you risk an over training injury, such as a full blown muscle tear, a tendon rupture or joint injury. However, do keep up one aspirin a day to help protect your heart.

You should limit your intense days of training rides to two a week with rest days following or easy spin days on the subsequent day. If you find you cannot spin easy on your off day then make your off day a day off the bike or find partner who will help keep you going at an easy pace. Professional cycling teams do this together to help avoid over training. The results of over training are muscles that get progressively broken down without adequate time to repair and do the compensatory building up of the muscles.

Once a week, throw in some endurance rides where you maintain your heart rate between 70-85% of your max heart rate where you build up your distance to that which you will be racing at but not at race pace. This will help build your aerobic endurance. Increase you distance no more than 10% a week to avoid over training.

Twice a week (your intense days) do sprint training where, after a 15 minute warm up you, go hard for 30-60 second trying to get to 90% or higher of your max heart rate (your anaerobic zone), then recover for 1-2 minutes, with longer recovery for the longer sprints, getting your heart rate back down to 70% or less. Do around 10 Ė 15 reps of these on your sprint training days. The great thing about mountain biking is that the off road riding is essentially a series of sprint and recovery: climb the hill, ease off on the downhill side, spin and recover on the flats and repeat multiple times on a trail ride. So, use an offroad ride for your sprint day. Look at doing two of those a week (your two intense days). When you start racing, your race day will count as a sprint training day. Be sure to take a rest day off or an easy spin day, after your racing day or your intense sprint training day. Let those muscle recover and rebuild. Resting is in your training equation.

One day a week do some weight training under the guidance of a trainer to help build your leg muscles to give your hips and femur more protection. A day of jogging can help in this area as well as help increase the bone density of your feet, legs and back bones.

Remember in all your training, keep the line of communication open with your Ortho Doc and utilize the assistance of a Physical Therapist your Ortho Doc recommends to help with muscle specific training of your leg muscles.

Who knows, maybe someday Mr. Bill will say, ďI want to be like bobrobert!

Thanks,
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PostPosted: Mon Sep 17, 2012 12:30 am GMT +0000    Post subject: racing after hip replacement? Reply with quote

Dear Doc,
Your advice is valued, extremely insightful and now implemented. Will cherish your suggestions greatly.

Now, I know that my previous training was possibly harmful.....have noticed my atrophied right calf has increased in size 20% hope it is not just full of lactate acid. Speaking of lactate acid......what tactic would you try to eliminate the build-up of lactate acid......have tried to alkalize but seems impossible...... should eliminate sugar? Have been vegetarian since 1984 but I do enjoy late night dessert.

Thank you so much for your spending your time answering my concerns,

bobrobert
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The Bike Doc
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PostPosted: Mon Sep 17, 2012 6:28 pm GMT +0000    Post subject: Reply with quote

Bob:

The progressive conditioning (the previously described workout program) will raise your lactate threshhold and help your body clear the lactate more rapidly. After an intense work out, such as a race or an intense interval day, massage your muscle of your legs, take warm bath to help dilate the blood vessels and increase the blood flow to the muscles. The next day do an easy spin ride (90-100 rpm pedal cadence at a slow speed and at a heart rate below 70% of your max so you are not pushing yourself, for 30 to 60 minutes to help the muscle recover.

As far as supplements, taking bicarbonate supplement may theoretically help you neutralize the lactate but you would have to take so much you would get diarrhea and likely become sodium or calcium over loaded, so just stick with healthy eating. The sugars you eat likely won't increase the lactate in your body but too much simple sugar leads to higher insulin levels to bring the resultant spike in the blood back down to normal and that in turn can lead to rebound low blood sugars and you wind up craving more sugars. Additionally, that can lead to higher body fat accumulation. Keep the carbohydrates in your diet in the complex, whole grain form and reduce the simple sugars in your diet when you are not working out. The simple sugar, glucose, when mixed with electrolytes and water, speed the absorption of them; the whole principle in the science of sport drinks. Plus when you are working out intensely, you will burn through your stored sugars in your body and will then have to go into a gluconeogenetic state (making glucose from scratch) and the body will break down fat leading to increased accumulation of acid byproducts (ketoacids) futher increasing the acid load in the muscles. Additionally muscle can then begin to break down to provide aminoacids that are then converted into gluose to meet the bodyís and the brainís demand for glucose. Therefore, it is a good idea to have a glucose source, such as a sports drink, when you are working out.

Now for the readers who are actively trying to loose fat weight, the above process of gluconeogenesis is one of the reasons why exercising will help a person loose fat weight, so for those individuals wanting to achieve this goal, then avoiding the sugar containing drinks and energy gels is preferable. However, during an intense work out such as racing, these individuals should still consume the sugar containing sport drink, as the total amounts of calories burned during an intense work out will far exceed the calories consumed in a sport drink, so there will still be a net caloric burn. It is far more important to stay well hydrated, keep the electrolytes balanced and keep the blood sugar stable to avoid the drop in the blood sugar when the body is forced into the gluconeogenesis state which lags behind the glucose being burned. This is what athletes on the west side of the big pond call the ďbonkĒ. Folks on the east side of the big pond (Great Brittain and east) use that expression for something else that might embarrass their children who would be aghast to learn that their parent athletes were bonking during a race. Embarassed Though for those of us who have finished DFL, some might think we were bonking during the race on this side of the pond. Wink
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PostPosted: Thu Sep 20, 2012 12:44 am GMT +0000    Post subject: racing after hip replacement? Reply with quote

Dear Doc,

last night with my newly discovered heart rate numbers I tried the intense training program by 15 min warm up then sprint one minute spin two minutes and repeat x 10. Noticed that heart rate during sprint never got over 160 (max 169) and heart would go back in zone (124-141) within 30-40 sec. However, had hard time with sleep, even though, started ride before 8PM, but Tuesday is my fast day and usually eat after ride then sleep comes easy (ier) Then tonight did a recovery ride, object to not go above zone, and noticed that I was spending almost half the time below zone. I feel results already (I think) legs and heart felt stronger.....insert happy face here

much better training method than previous over training method (going fast as I could for as long as I could)

question......recovery beverage?......during ride I take coconut juice with a little gatorade. and I take some right before bed "Sleepingtime Extra" as a sometime sleep aid. Seems like my body/mind is craving/missing something.

robert

thanks again
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PostPosted: Fri Sep 21, 2012 1:50 am GMT +0000    Post subject: racing after hip replacement? Reply with quote

Dear doc,

Ran out of SleepyTime Extra tonight and had to settle for some milky tea instead hoping it works........still on the side of sleep deprivation......still very much awake after ride this evening......the temperature was perfect for sprints.......did x10. Noticed at the beginning of sprint my heart rate would take maybe 20 seconds to go above zone and then I would level out around 152-154bpm therefore not even getting close to maximum (169bpm).....trying to say that during sprint felt that maximum sustainable efficiency was around 150-156 anything more than that and I would be overreaching and would not recover quickly as it turned out that after one minute of over 150 it would take almost a minute to get back in zone. Tonight I focused on speed during sprint......getting up to a proper speed (max=19.7mph) instead of max hr. whereas previously I focused on acceleration and right off felt left knee pain. Left knee is next to be replaced x-rays indicate 0.0020" cartilage and doctor said bicycling would be great exercise to build strength.

milky tea must be working........

more later

robert(bob)
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PostPosted: Wed Sep 26, 2012 6:04 am GMT +0000    Post subject: Reply with quote

Bobrobert:

You may want to do an adjustment on your training time. A hard workout a hour or two before going to bed will lead to an increase in your fight or flight hormonal response, which, in turn, cranks up the brainís alertness to fight or flight state so things donít shut down in the brain. Look at doing your intense workout in the early morning to get you cranked up for the day.

Look also at your consumption of substances that can also keep the brain going. Foods and drinks that contain caffeine may be contributing to you difficulty falling asleep. There are the obvious sources of coffee and caffeinated teas but there are other less obvious sources such as chocolate and energy drinks with caffeine added. Plus there are herbal substances that contain caffeine such as guarana, mate, and cola nut. Cough/cold remedies that contain decongestant ingredients such as ephedrine, pseudoephedrine, phenylephrine and oxymetazoline, can wire the brain in the on mode and make it difficult to fall asleep. Some individuals have adverse reactions to antihistamines that make them wired instead of feeling sleep. Some herbal substances contain ephedra which is a precursor for epinephrine (adrenalin) which then turns on the fight or flight response. Supplements with ephedra should not be used and in fact the FDA banned the sale of substances containing Ephedra effective April 2004. Herbal substances with ephedra included Desert Herb, Ephedra, Herbal Ecstasy, Jointfir, Ma Huang, Ma-huang, Mahuang, Mahuanggen (Ma huang root), Popotillo, Sea Grape, Teamsterís Tea, Yellow Astringent, Yellow Horse

Alcohol though it can make a person feel sleepy and help the person fall to sleep, the quality of the sleep is reduced. There can be increase snoring, upper airway obstruction from excess relaxation of the upper airway muscles, increase periodic limb movement which can cause awakening, and less time in quality sleep phases called slow wave sleep and rapid eye movement (REM) sleep.

Warm milk helps release the tryptophan in the milk which can help a person to fall asleep so you warm milk tea (decaffinated I trust) may help. Turn down the lights in the evening 2 hours before going to bed. Bright light pushes the circadian rhythm of the body to stay awake longer. I have found, using minimal lights in the evening helps my body get into sleep mode. If you have to out in bright light at the end of the day, wear dark sunglasses to help the circadian rhythm get back into wind down mode.

Years ago I worked in a jungle village in Hondoras in Central America. There was no electricity, kerosene for lamps was scarce and expensive, batteries for flash lights were hard to come by. Sun up was at 6:00AM; sundown was at 6:00PM. We lived and worked by the sun. By 7:00PM pretty much everything was shut down, my body included and I was fast asleep and would awake with the roosters around 5:30 am, well rested and refreshed. Our modern conveniences of TVs, computers, bright lights and loud music were not there to mess up my circadian rhythm. I was back the way my body was intended to work. Try to replicate what the human body was designed for and shut down the evening external stimulators, including websurfing in the late hours.

These are all things to look at in addressing your difficulty falling asleep. Visit with your doctor if you continue to have problems and consider a referral to a Board Certified Sleep Medicine specialist if you continue to have problems.

Thanks,
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PostPosted: Tue Oct 14, 2014 11:30 pm GMT +0000    Post subject: two years after hip replacement Reply with quote

dear doc,

just an update after two years(27 June 2012) after hip replacement. First year was dedicated towards getting fit enough to race, like finding maximum heart rate (especially after not exercising since 2003 because hip pain).....after your consultation found 180 maximum heart (actually saw 180 during 2013 Huntsville Classic)......after this race I was advised to join group rides(West End, Blue Line, Bike Barn) to increase intensity. Sunday I raced the Huntsville Classic again with the following numbers: 19.1 miles, av 11.9mph, max 24.5mph, av hr 152bpm, max hr 171, time 1:33:53, kcal 638cal., av 99 watts, total watts 638, 3rd CAT1 over 60. note: same distance as last year's race (counter clock wise) yet this year 10 minutes faster. I believe that riding these high intensity group rides have improved my performance.......while being a lot of fun have left me 10 pounds lighter......and see no real end in site as to why I can't keep improving on my performance.
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