This talk from SOA2018 brings adaptive physiology to life. Mel Wilson is an Olympic Rowing Medallist. Watch the Rio race here https://www.youtube.com/watch?v=paRQ7IgYLhk Tom Evens is an Emergency Physician at Imperial College Healthcare, and also a consultant in Prehospital Care at Barts Health and London’s Air Ambulance. He leads the Human Performance workstream at London’s Air Ambulance, and is a convenor of the London Performance Psychology Symposium for the Institute of Prehospital Care. With a background in the sport of rowing, he has coached elite athletes in Australia and the UK. He has coached a World Cup Silver medal, and his athletes have gone on to win Olympic and World Championship medals. In the course of this work, he developed an interest in sports physiology, performance psychology, and ergonomics. Tom now works with UK Sport, the FA and other elite organisations to support coaches to apply the performance lessons from successful medical teams to their own work. Mark Homer - Following a brief career in teaching, Mark has worked for British Rowing for 11 years, supporting the team as a physiologist through 3 Olympic cycles and directly at the Beijing, London and Rio Games. During this time he completed a PhD titled ‘Determinants of Rowing Performance – Implications for Developing Rowers’. He has recently become the Head of High Performance Science & Medicine, tasked with leading the various support services and coordinating the research and innovation strategy in preparation for the Tokyo Games. Melanie Wilson - is a double Olympian, and won an historic silver medal in the Rio Olympic Games, rowing as part of the women’s eight. She studied medicine alongside her training for both Olympics, and now works at a hospital in North West London, with aspirations to train in anaesthetics. She’s interested in the cross over between sports and medicine, in particular teamwork and performance under pressure. She has presented at conferences focusing on using skills from different industries and applying them to clinical performance.

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Real-time Extreme Exercise
Dr Mark Homer, Dr Melanie Wilson, Dr Tom Evens
@DocTomEvens
@MarkRHomer

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bit.ly/RealTimeExtremePhysiology

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Power x Technique x Performance = Results

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Power at VO2
Power at VO2max
Ergo Power
Ergo Rate

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Strength
Endurance

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Anaerobic Contribution
Aerobic Contribution
VO2 Kinetics
VO2max Anaerobic
Capacity

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Big Economical Engine
Big Uneconomical EngineSmall Uneconomical Engine
Small Economical Engine
8L / 15mpg
1.8L / 18mpg
2.7L / 35mpg
0.8L / 70mpg
3.5L / 28mpg

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pH 6.74
Lactate 32
Bicarb Undetectable
Nielsen, Acta Physiolog Scand
1999

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What’s going on in the unsustainable zone?
What does it feel like?
Why are they not dead?
What’s with the lactate?

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Central Peripheral
Chemoceptive and Nociceptive
Afferents
Sarcolemmal Pi
Seratonin effect Sarcolemmal H+
IL-6 Impaired Calcium re-uptake
Ammonia Muscle Contraction
Brain Glycogen Depletion Heat
After Boyas et al. Ann Phys Rehab. 2011

17. “Like you're in the
middle of a fire.
And someone is
still asking you to
row”

18. “My teeth feel like
they’re going to
fall out”

19. “like there is no
way out no
matter how hard
you pray”

20. “My legs feel
heavy and hard.
Like tree trunks”

21. “An overwhelming feeling that I might
poo myself”
“Never did”
Anon

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It’s probably not the lactate..

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It’s probably not the lactate..
Extra mitochondrial ATP hydrolysis / Glycolysis are the primary so

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It’s probably not the lactate..
Extra mitochondrial ATP hydrolysis / Glycolysis are the primary so
Lactate production consumes protons and yields NAD+
- Glucose - 2
- Glycogen -1

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It’s probably not the lactate..
Extra mitochondrial ATP hydrolysis / Glycolysis are the primary so
Lactate production consumes protons and yields NAD+
- Glucose - 2
- Glycogen -1
Lactate co-transported with a proton
- 75% oxidised in tissue / 25% gluconeogensis
Roth. Arch Biochem Biophis 1990

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Lactate is an advantage
/ AAm
Lactate/H+ pump increased 12%
MCT pump increased 65% Pilegaard Am J Phys. 1999

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Why don’t they die?

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Thank You