INTRODUCTION

We present the report of a young male athlete who cycled 100+ miles·d⁻¹ for 50 consecutive days in the 50 United States. The purpose of this ultra-event, titled Ride for Your Life (RFYL), was to raise awareness and funding for cancer research and treatment. RFYL began August 18, 2007 in Connecticut and concluded October 6, 2007 in Hawaii (Figure). In total, the athlete cycled 5098 miles, climbed 261,077 ft, and expended 273,850 kcal while averaging a power output of 173.8 W, speed of 16.4 mph, and heart rate (HR) of 118.0 bpm. We know of no published reports describing a subelite athlete participating in such a demanding ultra-endurance cycling event. Thus, we preselected a representative sample of 13 of 50 rides to monitor and report the athlete's physiologic and psychological responses during RFYL to gain insight into limits of performance.

CASE REPORT

The athlete's typical training week for 3 months before RFYL consisted of road cycling 400-500 miles·wk⁻¹, running 10-20 miles·wk⁻¹, and resistance training 2 d·wk⁻¹. For the past several years, the athlete ran approximately seven marathons annually, four as competitive events and three as training runs for ultra-events; ran one to two ultra-events annually ranging in distance from 30 to 50 miles; and regularly performed Nordic skiing, alpine skiing, and snowboarding, including a yearly pentathlon. At the time of the event, the athlete was 28 yr old. He weighed 82.6 kg, was 180.3 cm in height (body mass index 25.5 kg/m²), and had a maximum oxygen consumption (V˙O_2max) of 50.4 mL·kg⁻¹·min⁻¹, indicating that he was in excellent fitness for a man of his age (¹).

Physiologic Measurements

The morning of each ride, weight was obtained with the athlete in shorts on a Tanita personal scale (model HD-334, Tanita Corporation, Tokyo, Japan). The athlete rated sleep quality on a scale from 5 "excellent" to 1 "poor" and recorded hours of sleep the previous night. Before and after each ride, the Borg Scale of Perceived Exertion estimated the athlete's overall perception of ride effort (²); a 10-cm visual analog scale assessed leg muscle soreness; perception of thirst was measured on a 9-point scale from 1 "not thirsty at all" to 9 "very, very thirsty" (³); and the Urine Color Chart was used to monitor hydration status on a scale of 1 "lightest" to 8 "darkest" urine color (⁴). While riding, the PowerTap SL (Saris Cycling Group, Inc., Madison, WI) recorded power output (W), speed (mph), cadence (rpm), and ride time (hr:min). The Garmin Forerunner 301® (Garmin International, Inc., Olathe, KS) measured HR bpm, elevation (ft), and calories expended (kcal).

Two weeks before and after RFYL, V˙O₂ was measured by breath-by-breath analysis of expired gases via an open circuit respiratory apparatus (TrueOne 2400 Metabolic Measurement System, Parvo Medics, Sandy, UT) on a cycle ergometer (Lode Excalibur Cycle Ergomter, Groingen, Netherlands). The protocol consisted of a 3-min warm-up, after which a 30-W·min⁻¹ continuous ramp protocol was performed at a self-selected cadence of 80 rpm. Exercise test end points were an overall rating of perceived exertion >18; no increase in V˙O₂ >150 ml with increasing exercise intensity; a respiratory exchange ratio >1.1; and the inability to maintain a cadence of 80 rpm (¹).

Cardiopulmonary data from the first exercise test were used to determine three HR zones programmed into the Garmin Forerunner 301® to profile the percentage of the HR response during a ride maintained within one of three levels of exercise intensity. HR_zone1 was the percentage of the HR response during a ride that was below an increase in the minute ventilation (V˙_E)/V˙O₂ ratio and no increase in V˙_E/carbon dioxide production (VCO₂) ratio corresponding to a HR range <111 bpm or ventilatory threshold one (VT1) (⁵). HR_zone2 was the percentage of the HR response during a ride that was between an increase in the V˙_E/V˙O₂ and V˙_E/VCO₂ ratios corresponding to a HR range between >111 to <141 bpm. Accordingly, HR_zone3 was the percent HR response >141 bpm or VT2.

Psychological Measurements

A shortened version of the Profile of Mood States (POMS) (⁶) was administered before and after every ride to assess immediately experienced mood states using five-point Likert scales ranging from 0 "not at all" to 4 "extremely." The six mood states included anxiety, depression, confusion, anger, vigor, and fatigue. The athlete's emotional and cognitive responses to the ride were assessed by a short open-ended questionnaire based upon the theoretical framework of Smith's cognitive-affective model of athletic burnout (⁷). Questions assessed the athlete's perceived physical, cognitive and emotional states, and perceived challenges pre- and post-ride.

Ride Profile

The challenges the athlete encountered were extraordinary in riding 100+ miles·d⁻¹ for 50 consecutive days in 50 states (Fig.). To ensure data were obtained without undue obtrusion to the athlete, we pre-selected 13 rides to be representative of RFYL. Consistent with the profile of the 50 completed rides, 30.1% of the 13 rides were ridden on weekends as part of organized events with a significant amount of social riding support, and 69.9% were completed on weekdays on organized routes during which the athlete rode solo or with a few individuals (http://www.healthyaltitudes.com). The states the 13 rides were ridden in along with the sequence ride number out of the 50 completed included: CT (1), VT (4), MA (8), VA (12), FL (17), KY (20), IN (23), MN (26), MO (30), LA (33), UT (40), OR (44), and ID (47) (Fig.). All rides were completed on a 2005 Lemond Alpe D'Huez bicycle (Trek Bicycle Corp., Waterloo, WI). The average ride distance of the 13 rides was 102.4 (standard deviation, 1.7) miles, time of completion was 5.48 (0.52) hr, elevation climbed was 5636.6 (1667.4) ft, ambient temperature was 65.4 (14.9) °F, percent humidity was 69.6 (17.7), and wind speed was 6.8 (3.5) mph. The athlete rated OR (44) as the most challenging (weekday ride of 100.0 mi completed in 6.13 hr, 7799.0 ft of elevation, 30°F, 95.3% humidity, and wind speed 7.1 mph) and MO (30) as his favorite (weekend ride of 106.0 mi completed in 5.25 hr, 7558.0 ft of elevation, 65.3°F, 66.9% humidity, and wind speed 11.5 mph) (Table 1).

Physiologic Responses

Table 2 displays the physiologic profile of the athlete's responses. Linear regression analyses (Microsoft® Office Excel 2003) were used to determine the direction of change of the slope of the physiologic measures obtained with the PowerTap SL (power output, speed, and cadence) and the Garmin Forerunner 301® (HR and calories expended) from the last of the 13 rides [ID(47)] compared with the first of the 13 rides [CT(1)]. Over the course of RFYL, the following physiologic measures declined: power output_max by 19.1%, percent HR_zone1 by 30.5%, and calories expended while riding by 20.6%. In addition, V˙O_2max declined 9.9% from 50.4 to 45.4 mL·kg⁻¹·min⁻¹, and sleep quality decreased from a rating of 4.1 U before CT(1) to 3.4 U before ID(47). In contrast, the following physiologic indicators increased: power output_ave by 16.4%, speed by 10.0%, cadence by 12.3%, percent HR_zone2 by 12.0%, and hours of sleep from 5.9 hr before CT(1) to 6.3 hr before ID(47). Over the course of RFYL, the average increase post- versus preride among the following measures was RPE 9.8U, rating of muscle soreness 21.8 mm, thirst perception 4.3 U, and rating of urine color 2.0 U. Body weight remained stable at 189 lb throughout RFYL.

Psychological Responses

Over the course of RFYL, average POMS responses before riding were consistent with the profile of a subelite athlete, extremely low on anxiety [0.85(0.69)], depression [0.00(0.00)], confusion [0.31(0.48)], fatigue [1.15(0.75)], and anger [0.00(0.00)], and high on energy [1.58(0.67)]. There was one notable spike in self-reported anger before OR (44). This spike was prompted in part by an increase in feeling "deceived" and appeared to be associated with the athlete's expressed concern that support personnel were argumentative, driving erratically, and "getting lazier by the day." The POMS mood states indicated that the athlete reported increased fatigue [2.17(1.01)] and reduced energy [0.83(0.75] after versus before riding. However, these differences were not related to ride progression, indicating that the changes in these mood states were not cumulative over time.

The athlete's responses to the open-ended questions indicated that burnout did occur during RFYL, beginning with FL (17) (Table 1). VT (4) responses revealed that the athlete was feeling overtrained; however, his perceived emotional and cognitive states remained stable thereafter. The athlete was able to positively adapt to these physiologic and psychological challenges by drawing support from individual riders who joined him and those who encouraged him at the end of various rides. Of note is that the athlete's significant sources of emotional and cognitive stress were the result of factors ancillary to riding, especially logistical problems and concerns about the dedication and reliability of various support personnel that escalated during the later stages of RFYL.

DISCUSSION

Over the course of RFYL, the physiologic (Table 2) and psychological (Table 1) stressors the athlete encountered increased. Of note, power output_max, V˙O_2max, and calories expended declined. The percentage of the HR response spent in HR_zone1 decreased, whereas the percentage of the HR response spent in HR_zone2 increased. Furthermore, hours of sleep, dehydration indicators, and perceptions of effort and muscle soreness increased, and sleep quality decreased. These alterations are indicative of progressive physiologic overtraining (^8,9). Although the athlete reported feeling overtrained at one point early in RFYL, his cognitive and emotional states were relatively stable thereafter (⁷). However, despite these indicators of physiologic overtraining and behavioral burnout, the athlete was able to demonstrate positive coping behaviors that aided him in completing RFYL. Of note was the support he drew from riders joining him and encouragement from onlookers. Surprisingly, over the course of RFYL, these physiologic and behavioral alterations did not correspond to changes in the athlete's POMS mood states. Although the athlete reported more fatigue and less energy after each ride, the magnitude of these changes did not increase as RFYL progressed. The one notable mood state spike was in anger and annoyance during UT (40) suggesting that anger might have served as a motivating factor, especially during the later stages of RFYL.

According to the teleoanticipation hypothesis (⁹), elite cyclists will spontaneously downregulate power output in order to regulate energy expenditure during ultra-events. In contrast, this sub-elite athlete appeared to compensate for the loss of power output_max and V˙O_2max by increasing cadence, speed, and power output_ave, while simultaneously increasing the percent HR response spent at higher exercise intensities and downregulating caloric expenditure during riding. It appears that this subelite athlete was not able to adjust power output_ave to regulate energy expenditure as occurs with elite athletes during ultra-cycling events. Furthermore, it appears that the athlete used anger and annoyance as motivating factors to overcome physiologic indicators of overtraining and behavioral burnout during RFYL. Additional study is needed to better delineate the physiologic and psychological responses of sub-elite athletes to ultra-events so that training regimens can be designed to maximize the efficiency, safety, and enjoyment of athletes participating in events such as RFYL.

Acknowledgments

We thank the following RIDE FOR YOUR LIFE team members: Steven Bouchard, Charlotte Demare, PhD, James Weinstein MS, RD, MBA, Joan Farcus, David Gianetti, Wann McNiff, and all the friends and families who provided moral, emotional, and financial support. We also thank the Lance Armstrong Foundation, Austin, TX, the bicycle ride directors and organizers, and all the hotels, restaurants, and supermarkets for support and donations along the roads of America. Additional acknowledgments can be found at http://www.healthyaltitudes.com.

We thank Saris Cycling Group, Inc., Madison, WI, for the PowerTap SL; Digital nVision Studios, Steamboat Springs, CO, for Web site design; Max-Air Trailers Fort Collins, CO, for the support trailer; The Jarstore, New Britain, CT, for luminary candles; Steamboat Ski and Bike Kare, Steamboat Springs, CO, for bicycle equipment; Honey Stinger, Steamboat Springs, CO, for nutrition bars; 5280 candles Littleton, CO, for assembling candles; Lisa Masters and The Fans of Jericho, Steamboat Springs, CO, for T-Shirts, Motionbased, Sausilito, CA, for the Garmin Pilot System software; and Eastern Mountain Sports, Peterborough, NH, for equipment and mechanical support.

We also thank Carl Foster, Ph.D., FACSM, professor, Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI, for his expert input into this case report.