Barry2 

I'm a 59yr old Type II diabetic.
I've have had a professional coach for 2+yrs and for the last year my FTP is stuck at 180W
I'm training 6 days a week & ~5000miles/year.

During this 12 month period my aerobic performance has significantly increased, but as soon as I go anerobic my legs fade.

When FTP Ramp Testing I would max out at 174bpm and then my legs would fade for a 180W result.
A year later, I still fade for a ~180W result, but at 160bpm.

My Primary Care, Endocrinologist and Sports Med Doc are all unable to address the issue and don't know where to send me.
Obviously I'm not expecting all you internet Doctors out there to diagnose me.
I'm just wondering where I should turn to in the medical world?

Thanks

Barry

MoAlpha

As a board-certified member of the medical establishment, I'm here to tell you to look elsewhere for answers. Of course there are MDs who are towering academic figures in physiology and metabolism, but they do or should defer to the PhDs on applied matters of athletic performance. My approach would be to switch to a coach with a different training and/or nutritional philosophy. 5000 mi/year also doesn't strike me as a whole lot of volume.

Dr. Iñigo San Millán at the university of Colorado, who coaches Tadej Pogacar and is frequently mentioned here, might be source for a local referral, especially if you tell him specifically about the T2DM. He and many other hotshots have an interest in insulin resistance and many coaches are also getting savvy about it.

Barry2 

I switched coach due to this issue last July. My original coach had early gains but then little impact aerobic or anaerobic.
New coach has made a significant aerobic impact but an anaerobic impact still escapes me.
I can’t credit both coaches with my apparent FTP ceiling.

You mention “insulin resistance”, guess or experience?

5000/year is all I can fit into my job/home life.
I’m a (somewhat serious) hobby fitness cyclist.

Thanks

Barry

MoAlpha

Yeah, okay. Maybe you're up against a hard ceiling. You might still send your numbers around. For instance, https://www.empiricalcycling.com, which seems like a pretty smart and well-credentialed coaching group, will do one-time consultations.

Insulin resistance is a normal and reversible state in non-exercising people, even fit ones, is almost universally present in obesity, becomes more or less fixed in metabolic syndrome, and culminates in the frank hyperglycemia of T2DM. I used it as an umbrella term here since there is active interest in every phase and the mechanisms likely overlap.

5000 mi/yr is a very respectable distance and there are many more important things than riding a bike. It's just easier to push the numbers when you've got time for more.

hayden52

I suggest you dump the ramp test and do a more traditional 20 minute FTP test. The ramp test is too dependent on your anaerobic capacity and can skew results accordingly. When I do a ramp test, because I'm able to produce a lot of anaerobic power, my FTP numbers are greatly inflated. It seems to be the opposite for you.

blacknbluebikes 

Do you also track your VO2 estimates? Do you look at how your power curves change over time? Maybe there are other indicators of progress that should be taken in context to the FTP.

On the other hand, are you getting the fitness objectives you want in general? Is there something that makes FTP particularly relevant?

Barry2 

I don't like asking a question that you need the answer to get the answer.
Let me explain...

With the 20min test, you have to already know where to pace at.
So your FTP history will govern your pacing and change the final result of the test.

With a Ramp test (indoors and ERG mode), you turn pedals until you can't.
No pacing, no prior FTP numbers required, no pacing.
I found that the numbers are very repeatable.
I agree this test might not be accurate but it has for me proven to be precise. **

** I weigh on a bathroom scale 3 times and get the following readings 505.001 LB , 505.005 Lb , 505.000 Lb. That scale sure isn't accurate but it sure is a precision instrument.

For FTP testing I only need to compare with my prior readings, the actual number does not matter.
I just need that number to increase. I'll take precision over accuracy please.

Barry

Barry2 

As I stated I'm seeing aerobic improvement and I'm very happy with that.
Yes, I do watch my other stats, I use Intervals.icu and Garmin Connect.
Why FTP... Because my available watts for climbing could use improvement.

Barry

hayden52

I agree that the ramp test is repeatable, but it may not be measuring your aerobic capacity accurately. If you are training to increase your aerobic capacity, then you need a test that measures this properly, and the ramp test, in my experience, does not due to the undue influence of your anaerobic capacity.

Barry2 

hayden52 I think you missed it... My aerobic capacity is coming along nicely. It's my frozen anerobic capacity that is the issue, and for this I'm using the Ramp test to keep track.
I'm not attempting to use a Ramp Test to track aerobic, I have other means.
As for my training, the rough rule of thumb likely applies 80% / 20% my coach manages that.

Barry

HeyItsSara

I'm also not improving. Is it so terrible to exercise and get sweaty? Do we have to break records?

GhostRider62

I'm guessing you ride 6-8 hours per week.

What is your total minutes per week of power output in the 180-210W range? You have to generate lactate in order to develop the transporters and enzymes to increase your aerobic functional capacity. Your type 2 muscle fibers are oxidizing glycogen (in addition to the type 1 of course) at those power levels and you have to develop the capability to transport lactate into the type 1 muscles for oxidation. Don't waste your time doing anaerobic work (sprints). The fact that your HR at threshold came down 14 bpm does indicate you have improved your aerobic base.

So, do your coaches have you doing any interval work? If so, how much and of what intensity?

Barry2 

GhostRider62
6-8 hours on average, maybe more during the better months sounds about right.
I seem to be averaging about 4,500 miles a year.

My current training it a little on the light side. I'm currently recovering from a long(ish) covid.
My indoor workouts do not target the 180-210w range, even prior to covid.

Despite my Ramp Tested FTP being 180W, my chances of actually holding 180W for an hour are truly Zero.
I tend to view the Ramp Test results as having more precision than accuracy.

I know I can hold 140W for an hour straight, I've done it just to see.
150W x 1h is a maybe and 160w x 1h is not gonna happen

In the 180-210w range, I fade fast.

Barry

GhostRider62

You did not answer my question at all.

I have long Covid, too.

I have not read it in a study or journal, so this is N = 1, long Covid F's up your mitochondria.

GL, hope you recover. I'm struggling a bit for 5 months now.

Barry2 

Looks answered to me

Barry

Edit: Intervals 3-4 X per week. Intensity is really tough to put a number on.