RideLondon 2022 medical advice
Before taking part in any of the RideLondon events, please read the following advice from Professor Sanjay Sharma carefully.
It is your responsibility to make sure you are fit and well on Ride Day in order to enjoy your experience as safely as possible and not put yourself at risk.
Discuss any medical problems you have with your general practitioner (GP). The advice here supplements anything they say. See your GP if you have a medical problem that makes it a risk to cycle.
If you have a serious medical condition and are considering riding you should get your GP and/or specialist’s agreement first and then send us details of your condition, treatment and GP’s contact details, along with your rider number by completing the form at ridelondon.co.uk/help/contact-us.
We can’t give individual cyclists advice but are happy to advise your GP.
If you have a medical problem that may lead to you having a blackout, such as epilepsy or diabetes, please put a cross on the front of your body number and write the details, especially your medication, on the reverse of the number. Please read the following useful advice from our medical team carefully.
Fit to take part
Cycling is good for the heart but in any strenuous endurance event there are occasionally fatalities from serious heart disease in athletes apparently unaware that they had a problem. Their condition may have been detected if they had received medical advice and undergone the relevant heart tests.
A ‘fitness test’ is not sufficient to detect these problems. If you have a family history of heart disease or sudden death – or have a high risk from high cholesterol or high blood pressure – but particularly if you have symptoms of heart disease, such as chest pain or discomfort on exertion, sudden shortness of breath or rapid palpitations, see your GP who will be able to arrange for you to have a proper cardiac assessment.
Such an assessment may not be instantly available but continuing to ride with these symptoms may shorten your cycling career catastrophically!
If you have ’flu, a feverish cold or a tummy bug, do not train until you have fully recovered, then start gently and build up gradually. Do not attempt to catch up on lost mileage after illness or injury – this may cause further damage or illness. If you have ’flu it can take as much as a month to recover, so consider whether you should take part in the event this time.
The RideLondon-Essex events are not races and individuals with a previous history of heat-related illness or heatstroke are especially advised not to ride in a competitive fashion to avoid overheating. Over the past few years at mass participation events, there have been some very serious cases of heatstroke among individuals with a previous history of such problems.
Please do not participate in the event if you test positive for, or have any symptoms of, Covid-19. In the event of recent infection, do not train until you have fully recovered, then start gently and build up gradually.
Drinking in training
Alcoholic drinks, tea and coffee are dehydrating. Take plenty of non-alcoholic drinks on board, especially when training in hot weather.
Drinking on the bike needs practice. You should aim to practise drinking while cycling on longer training rides and make sure you are used to the drinks available on the day.
Drinking on the day
Make sure your water bottles are full before the event. Sip some water or sports drink in the half hour before the start so that you begin the event reasonably well hydrated. Water will be available at the four Welfare Stops.
Drink when you feel the need and do not gulp large volumes of fluids before, during or after the event. Your needs vary with your build, your speed and, above all, the weather.
After the finish rehydrate (replace lost fluids) gradually over the next 24 to 48 hours. Do not drink large volumes of fluid after finishing – listen to your thirst and drink accordingly.
Eat some salty food as well as spacing out your drinks. This way you will not get hyponatraemia, a serious medical condition where sodium levels in the bloodstream are diluted, and you will still replace the water, salt and glycogen lost in riding during the event.
Think before you drink
Remember: you need to replace some of the fluid lost in sweat, otherwise your body becomes dehydrated and less efficient. However, drink when you feel the need and do not drink water excessively before, during or after the sportive as you may develop hyponatraemia.
Cyclists who overdrink are at risk of this condition, which has resulted in a number of deaths in endurance events over the last few years, but it is entirely avoidable by not over-drinking.
To reduce your injury risk, vary the pace and distance of your training rides. Wear a helmet and be visible – wear bright or reflective clothing.
Muscular aches and pains often occur after an increase in training. Try to gradually increase your training so you do not suffer prolonged periods of exhaustion. Separate days of heavy mileage with one or two days of lighter training, or rest days, so that your body can refuel your muscles with muscle glycogen.
If you cannot ride at least half your total event distance comfortably three weeks before the sportive, you are unlikely to safely manage the full amount on Ride Day. We do not recommend you ride on this occasion if you have not trained properly.
Large doses of supplementary vitamins and minerals (such as iron) are not essential and produce no benefit if you are on a good mixed diet, but additional vitamin C in small doses is reasonable when fresh fruit and vegetables are in short supply.
Training (with adequate rest) helps you to sustain a high level of muscle glycogen if you eat enough carbohydrates. If you can, eat within two hours of your long rides. This helps replace muscle glycogen quickly and also speeds recovery.
In the last few days before the event, eat more carbohydrates (pasta, bread, potatoes, cereals, rice and sweet things) and less protein (meat, eggs, tofu, for example) at the same time as reducing your training. This loads your muscles with glycogen, which will delay, or even prevent, ‘bonking’ on Ride Day.
On the day
Wear appropriate clothes for the weather but be prepared for all conditions. Do not ride if you feel unwell or have just been unwell, even if you are riding for charity. Most medical emergencies occur in people who have been unwell but do not wish to miss the event.
If you feel feverish, have been vomiting, have had severe diarrhoea or any chest pains, or otherwise feel unwell, it is unfair to you, your family and your sponsoring charity to risk serious illness and become a medical emergency. You are unlikely to do yourself justice. There will be many other mass participation events.
Adequate preparation for a cycling event requires appropriate nutrition, hydration and rest. Athletes often consume isotonic, carbohydrate and protein drinks as well as energy gels and bars purchased in sports and health food shops in preparation for the event, which is considered safe practice.
However, over the last two decades there have been an increasing number of commercially available compounds that claim to enhance performance.
Some of these have been found to contain substances banned in other countries, and other products (such as steroids) that are banned for use among competitive athletes. Such products are usually purchased via the internet and should not be used by anyone training for a sports event.
Cyclists using performance-enhancing compounds that have not been licensed and regulated properly may experience serious side effects and increase their risk of developing heart disturbances that culminate in sudden death.
For example, there have been well-publicised cases of cyclists inadvertently using compounds in an attempt to help them fight fatigue during endurance events, which have caused detrimental effects to their health, resulting in their death.
In one recent case, toxicology identified traces of DMAA, which is an amphetamine-like substance. Although banned in sport, the product was legally available at the time and advertised as a powerful performance-enhancing agent, and the warnings associated with the potential harmful ingredients were not highlighted on the product.
Cyclists should avoid consuming unregulated substances bought over the internet.
Professor Sanjay Sharma, BSc (Hons), MD, FRCP (UK), FESC is Professor of Cardiology at St George’s, University of London and the Medical Director of the Vitality London 10,000, the TCS London Marathon and the RideLondon festival of cycling.