A cautionary tale for cycling converts

A couple of months ago a colleague who knew I’d developed a serious obsession with cycling during the pandemic arranged for an advance copy of a book called The Midlife Cyclist to be sent to me. I was very much its ideal reader — middle-aged and full of what the author Phil Cavell calls the “zealotry of the convert”. 

There are lots of new converts out there. According to a report by the Bicycle Association, a UK trade body, bike sales in Britain grew by 60 per cent between March and December 2020, while data from Sport England show that 1.2m new cyclists took to the roads during the same period.

Unlike many of Cavell’s clients — he runs a bike-fitting business in London — I wasn’t quite ready to climb Alpe d’Huez.

But I was averaging between 100 and 150km a week in the saddle, taking long rides across London and beyond, and generally feeling fitter than I had done in years. 

One chapter of the book, though, briefly gave me pause. Entitled baldly “Will I die?”, it contains advice for the “returning or new mid-life cyclist”. This includes telling your doctor you’re planning an exercise programme, reviewing your family history of heart disease and regularly getting your cholesterol tested — none of which I’d bothered to do.

But there is some solace for the negligent neophyte in Cavell’s account of academic research which shows that damage to the coronary arteries declines as the weekly distance cycled increases from nothing up to 100km. 

In any event, I put all this to the back of my mind when I set off on a ride with an old friend one overcast day in early July. After all, as the surgeon René Lériche put it, “health is lived in the silence of the organs”, and my organs were quiet — I had experienced none of the symptoms Cavell warns about (fainting during exercise, angina or an irregular heart beat).

An hour or so later, I was cycling up a hill in Surrey when I found I couldn’t ignore any longer the tightness in my chest that had been bothering me since I left my home in south London.

Increasingly enfeebled and mindful that I was on a stretch of road that local cyclists have renamed in honour of a man who died on his bike a few years ago, I suggested to my companion that we cut things short and head back into town. 

By the time I got home, the unfamiliar sensation that someone was squeezing my shoulders like a pair of bellows hadn’t dissipated. After a brief struggle between my allergy to melodrama and the feeling that this was something more than a bad case of indigestion (my initial self-diagnosis), I decided to book an Uber to take me to the local hospital, ten minutes away.

Shortly after arriving in the accident and emergency department I underwent an electrocardiogram which a doctor told me showed that I’d had a heart attack. I used the phrase “cardiac arrest” when he asked me to describe what had happened, congratulating myself for still being capable of some modicum of verbal precision, despite everything. 

The doctor then briskly explained that what had actually occurred was a “myocardial infarction”, following one of my coronary arteries becoming blocked. If I’d had a cardiac arrest, he said, I wouldn’t have been able to cycle 30km home before taking myself to hospital. 

When a friend asked me later what were the big “philosophical” lessons of having a heart attack, I recalled this exchange and something the French thinker Georges Canguilhem said about the relationship between patient and physician.

From the perspective of modern medicine, Canguilhem observed, a pathology or disease is one thing, and the experience of falling victim to it is something else entirely. 

I can certainly testify to the alienating weirdness of being under local anaesthetic while a consultant conducts a running commentary on the performance of the surgeon who is inserting a stent into one of your coronary arteries via a tiny incision in your wrist.

However discombobulating, the procedure was a success. And this week I got back on my bike for the first time in almost two months. The only difference is that I now wear a heart-rate monitor.

jonathan.derbyshire@ft.com

Letter in response to this article:

Acclaim for a hardcore cycling performance / From John Sabalis, Richmond, VA, US