British Cycling Level Three Coach, Rob Mortlock, helps Tim Burrows who is concerned about when he should push after conflicting advice regarding his CT scan

I took up cycling after a 
30-year lay-off last year. I was getting quite fit until I got knocked off my bike.

I was rushed to hospital; the doctor said I had not broken anything but the CT scans had shown up aneurysms on my iliac aortas, which freaked me out.

I’ve asked the vascular specialists how much I can exert myself. They say, carry on as normal. I’m really stressed how much I push myself, but I’m still not sure if they comprehend what I do, or my worries.

I am even more worried now; two weeks ago, just as I was leaving the vascular specialist, the doctor said I should avoid raising my blood pressure for too long and increase exercise gently. Bearing in mind I ride 12 miles to get out of London before I start my ride proper, by the doctor’s reckoning, I’ll be OK to get as far as Ealing Common and back.

I’ve asked several BC coaches and they are no more help than my doctor. Not many coaches appear to understand injuries 
or how to work around them — they usually confine themselves to prime athletes — who 
actually need little help compared to us oldies.
Tim Burrows

A key feature of a coach’s job is to understand a rider’s individual characteristics and how things like illness and injury can be overcome or accommodated. However, most medical conditions should be advised on by your doctor initially, before the coach can safely prescribe exercise.

What I usually do in these cases is ask the rider to get as much information as possible from their doctor, and in your case I would want to know what intensity of exercise would be considered ‘safe’. Try to get your doctor to indicate exercise duration and intensity rather than saying “10km”; some cyclists cover that distance far faster than others.

Although I would always recommend that riders with cardiovascular conditions use a good-quality heart-rate monitor, a rising heart rate does not cause your blood pressure to increase at the same rate.

Heart.org advises that it may be possible for your heart rate to double safely, while your blood pressure may respond by only increasing a modest amount. As your doctor has said, try not to raise the blood pressure for “too long”. I would want to know how you are expected to measure this and what would be considered an acceptable reading.

Studies have suggested that mild exercise may positively alter the haemodynamic (blood flow) conditions that are thought to induce aneurysm growth, so it’s entirely possible that you will be OK to steadily increase the duration of your rides over a period of time, and with careful monitoring, also be able to increase the intensity.

A starting point, if your doctor agrees to it, could be to aim to keep the exercise intensity below 70 per cent of your maximum heart rate for rides of around 30-45 minutes, gradually increasing the duration with time — and your doctor’s say-so.

Rob Mortlock British Cycling Level Three Coach

  • Thomas Lachlan

    It may be possible to ask your GP if they could refer you for an exercise tolerance test. This involves running on a treadmill with ECG heart monitoring as well as frequent blood pressure monitoring. This may give some indication of your blood pressure response to exercise, although like all of the solutions mentioned it is a rather imprecise science.
    Probably the most important advice would be to carefully monitor for any pain in the iliac/groin region and learn to check for the pulses behind your medial (inside) ankle bone. If you have pain or you become unable to feel those pulses, it’s probably a good idea to have a check up of the aneurysms.
    All that said, many aneurysms detected on modern CT scanners are very small and very stable and may not ever cause problems.

    • Motdoc

      I am a gp who has done vascular surgery as well, listen to the surgeon. Gps have very limited expertise in such specialist areas. We are generalists not specialists. Iliac aneurysms are, as a rule, extremely unlikely to burst. Clotting is more of an issue and exercise is unlikely to induce an arterial clot.

      If in doubt ask for a second opinion from another vascular surgeon.

      It is helpful for the doctors dealing with you to know your specific concerns. If you can consider this before tour appointment it will probably mean you leave more satisfied.