The shocking truth: Are pro cyclists hiding dangerous heart rhythms?

In the world of competitive cycling, athletes push their bodies to the limits, often sacrificing personal health for the sake of victory.

It is not uncommon for the intense pressure to perform, fear of disqualification and the stigma associated with medical conditions to drive athletes to hide their symptoms. The concealment of heart arrhythmias, where the heart beats irregularly, either too fast or slow, is rumoured to occur in professional cycling pelotons where athletes might fear the repercussions of a bad medical report card, which can sometimes be contract-ending.

The pressure to perform

Cycling is an endurance sport that requires extraordinary cardiovascular fitness. Cyclists are conditioned to endure pain, exhaustion, and various physical challenges. The culture of toughness and resilience is deeply ingrained, and admitting to a weakness, particularly a heart condition, can be perceived as a sign of vulnerability.

The pressure to maintain a competitive edge and the fear of losing sponsorships, being sidelined or forced into early retirement – or simply personal pride – can cause athletes to ignore or hide their symptoms, sometimes with tragic consequences. Athletes may also fear potential criticism from onlookers who might accuse a cyclist with structural heart issues and arrhythmias of doping and blame drugs for causing the heart problems.

Cyclists have always had heart problems

Heart conditions are nothing new among top-level cyclists. In a 2020 review and meta-analysis published in the Journal of Progress in Cardiovascular Disease, Wundersitz et al. found that:

“Cardiac abnormalities were higher in cyclists compared to [non-athletic] controls, but the types of cardiac abnormalities in cyclists were not different to other athletes”.

Over the last decade, elite professional cycling has seen a number of riders sidelined either temporarily or permanently with cardiac conditions (Cycling News, 2017). Heart arrhythmias, including atrial fibrillation (an irregular and fast heart rate), ventricular tachycardia (a dangerously fast heart rate that starts in the ventricles of the heart), and bradycardia (a very slow heart rate), can pose serious health risks. Symptoms like palpitations, dizziness, shortness of breath, and fatigue are warning signs that a cyclist’s heart is under strain. However, these symptoms can also be attributed to intense physical exertion, making it easy for athletes to dismiss or downplay them.

The risks of concealment

Concealing heart arrhythmia or denying it might exist is incredibly dangerous. Arrhythmias can lead to stroke, heart failure or sudden cardiac death, particularly when combined with the intense physical stress of competitive cycling. The heart, already under significant strain during races or intense training sessions, may not be able to handle the additional burden of an irregular heartbeat. For some cyclists, the first indication of a severe problem might be a catastrophic event during a race or training.

Despite the known risks, some cyclists avoid seeking medical advice or disclosing their condition to their teams. The perception that revealing a heart condition might end a career is a powerful deterrent. Cyclists may resort to self-managing their symptoms, which can involve risky behaviours like altering medication doses, avoiding medical check-ups, or ignoring warning signs altogether.

A personal reflection: pro cyclist Will Walker

In a 2014 interview, former Australian pro cyclist, Will Walker, talked about the strategies he applied to manage his sometimes unpredictable heart rate during training; for example, by coughing to reset his heart rhythm, taking big deep breaths during an episode of tachycardia and stopping pedalling and then restarting. He admitted his collapse mid-race during the 2014 Australian National Cycling Championships came about in part because he was probably tired and not properly recovered from jet lag but still determined to push himself even when he “knew things weren’t right”. While Will was open about his pre-existing heart condition at the time of his collapse, he conceded that there were a number of athletes in the professional peloton who suffered from heart arrhythmias but were reluctant to reveal their condition to their teams and their team doctors.

Wills story highlights the importance of recognising and responding to warning signs concerning your body’s adaption to training and competition, regardless of whether you are aware or not of any underlying cardiac condition.

The role of teams and medical staff

Teams and medical staff play a critical role in addressing this issue. Regular health screenings, including electrocardiograms (ECGs), can help to detect arrhythmias early. Teams must foster an environment where health is prioritised over performance and athletes feel supported in addressing medical concerns without fear of retribution or stigmatisation.

Dr Kevin Sprouse talks about the challenges of supporting cyclists during the intensity of the Tour de France:

"I don't think there's often a conscious decision to hide an illness but typically there's a bit of a pressure to say, 'I feel great, I'm riding great'."

In today's era of wearable technology, metrics from the lab can be cross-checked with a cyclist's subjective assessment of their own physical condition, especially mid-tour, making it harder for a cyclist to downplay or hide an illness and giving the medical team more leverage in decisions on whether an athlete should be rested or permitted to continue. 

Education is also crucial. Cyclists need to understand that heart arrhythmias are treatable conditions, and that early intervention can prolong careers and save lives. The narrative needs to shift from one of concealment to one of proactive health management. Medical staff should be vigilant, not only during regular health checks but also in monitoring athletes’ behaviour and performance, which may indicate underlying health issues.

Conclusion

In summary, it is imperative that teams, medical professionals and athletes work together to prioritise health and safety. With the right approach, it is possible to manage heart arrhythmias effectively, allowing cyclists to consider the pros and cons of potentially continuing to compete while safeguarding their long-term health.

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References

Cycling News (2017, updated Jun 2024). Cardiac anomalies – is something going on or is this normal? (Fmk_Rol, Forums). https://forum.cyclingnews.com/threads/cardiac-anomalies-is-something-going-on-or-is-this-normal.33323/

Outside.online (2014, updated 2023, Oct 10). “I thought I was going to die” – Will Walker retires from pro cycling. https://velo.outsideonline.com/2014/01/i-though-i-was-going-to-die-will-walker-retires-from-pro-cycling/

Sprouse K (n.d.). Inside the life of a Tour de France team doctor (online blog). Rouleur Cycling Culture. https://www.rouleur.cc/blogs/the-rouleur-journal/inside-the-life-of-a-tour-de-france-team-doctor

Wundersitz DWT, Gordon BA, Lavie CJ, Nadurata V, Kingsley MIC. (2020). Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis. Prog Cardiovasc Dis.63(6):750-761. doi: 10.1016/j.pcad.2020.07.004. https://pubmed.ncbi.nlm.nih.gov/32663493/