In addition to immediate diagnosis and treatment of elite athletes with injuries, medical imag- ing is vital in the continual monitoring of health, fitness and progress. Canon Medical’s systems play an important role in monitoring team health for the Soudal Quick-Step Pro Cycling Team in Belgium. Patrick Lefevere - CEO, Alessandro Tegner - Marketing and Communication Manager and Philip Jansen - Head Medical Team, spoke to VISIONS about their ambitions and aspirations for 2023 and how medical imaging support helps towards achieving them.

The Team’s 29 riders and 60 staff undergo medical checks throughout the year. Philip Jansen, Head of the Medical Team, explains how their health, fitness and progress are analyzed.

Preparation for the new season is in full swing. How many training camps will take place?
We carry out three training camps in preparation for the new season. The first training camp takes place in December, and is usually held in Calpe, in Spain. This is the only time during the year that the whole team spends two weeks together. The other two camps are in January but are missing the riders and staff who have left for races in Australia and South America. During the December camp, the riders are still building their condition, so the trainings are shorter.

That means there is more time for activities other than cycling. This is not as relaxed as it may sound. It is completely filled with photoshoots, interviews, tests (medical, nutritional, psychological, lactate, bike-fit, aerodynamic, saddle pressure, insoles, etc.), discussions about goals and programs, PR training, power training, core-stability sessions and a lot of meetings. At the second and third training camps, the focus is clearly on riding the bike, with longer training sessions and a heightened priority for complete recovery. So, we try to keep the additional activities to a minimum.

What does the medical screening of the cyclists involve?
Screening can be divided into two categories: general and specific. The majority of the screening performed in the training camps is general. Every rider in the team undergoes tests in the following categories: cardiology, dermatology, ophthalmology, and others.

General screening:

For cardiological screening, we work with the world-renowned expert, Professor Dr. Pedro Brugada. Heart screening is, for obvious reasons, the most exhaustive and strict examination. Cycling is one of the most demanding activities one can demand from the heart. Everything, therefore, has to be perfect. The riders undergo a blood pressure check, ECG in rest and during maximal exercise, 24-hour Holter monitor and cardio echography. We continue to monitor their heart rates closely throughout the season.

Dr. Johan Vandermaesen carries out the riders’ annual dermatological check. Spending so much time cycling outside increases the risk of skin cancer. We try to lower the risk by working hard on awareness and prevention. However, it isn’t always logistically and practically possible to re-apply sunscreen in the hectic final of a race. By having our riders professionally screened yearly, we can keep the risks as low as possible. They are checked with a dermatoscope, any abnormalities are documented, and we monitor the evolution of the lesions. There is a very low threshold to biopsy suspect naevi.

Core stability analyzed by our physiotherapists reduces the incidence of preventable injuries that a highly demanding sport like cycling can produce. Specific exercises are given where needed.

Other medical testing is also done at this camp. It is the ideal time to obtain the baseline for diverse parameters. Everyone undergoes a spirometry to test the lung function, concussion protocol, skinfold measurements, weight checks, hydration and sweat loss, dexa-scan, lactate testing and extensive bloodwork.

Individual screening:

Individual screening takes place when someone has/had a problem and is hyper-specific to the pathology. This can be extremely diverse. Sometimes specialized examinations that must be carried at certain locations, such as saddle pressure mapping with persistent saddle sores, or iso-metric strength testing after an injury. At other times, it can be on-site examinations that are more time-sensitive, like mobile echography after a crash or injury.

All these tests take a lot of time and energy from the riders. Therefore, we tend to work with the best in the world to ensure that we are as efficient and thorough as possible.

What is the added value of an examination for the riders during this training camp in Calpe?
Cycling is different to most sports. There is no ‘homebase’ where we come together regularly. We are more like a ‘travelling circus’ - Meeting almost exclusively at the races on location. As the riders are away most of the year at training camps, altitude camps and racing, free time is often a very scarce commodity and something they would rather spend with loved ones. Ensuring that vision is as good as possible should be on top of everyone’s priority list. This counts double for elite athletes who spend all day on a bike. Manoeuvring at insane speeds in a hectic peloton on narrow roads with even smaller defects while wearing nothing but lycra means that a crash can have extreme consequences for the rider, their colleagues riding behind, and their loved ones at home. Of course, you can’t eliminate the crash risk, even with perfect vision, but the goal should be to reduce it as much as possible. Therefore, we screen all of our riders and enhance their vision where it is possible. The first training camp is the ideal place to take care of things like this in a structured way. We can discuss each case with the eye specialist and give clear and tailor-made advice to each rider.

You also screen the staff of the Team. Do you carry out the same clinical investigations for the staff as for the riders?
For the staff, the situation of constant travel and little time at home is the same. Being able to provide high-quality medical screening on location is extremely convenient. Also because the calendar can change quite often, it isn’t easy for them to plan these things when you are home. It is not required for the staff to undergo these tests but it is very popular and much appreciated.

The staff receive exactly the same tests with the same protocol. However, the focus is a bit different. Age-related pathology becomes relatively more important as compared to younger riders. And we are also a bit less strict when it comes to striving for perfect vision.

Science behind success
Medical imaging provides detailed insights that enable the Team to manage the capabilities of the riders effectively and accurately as they work through the season, and strive for success in one of the world’s most demanding and competitive sports.

What is the importance of having a regular eye-check performed by an eye specialist?
Regular eye-checks are important to have your vision corrected to improve your quality of life, and to aid in detecting certain eye conditions such as cataracts, glaucoma and age-related macular degeneration that can lead to loss of sight.

What eye diseases can be detected in an early phase by an eye specialist?
The four most common eye-conditions leading to loss of vision or blindness are cataracts (a cloudy area in the lens of your eye, impairing vision), diabetic-retinopathy (high blood sugar levels damaging the back of the eye), glaucoma (optic nerve that becomes damaged, connecting the eye to the brain and resulting in loss of peripheral vision) and age-related macular degeneration (an eye disease that can blur your central vision, causing damage to the macula).

What are the most common, non-age-related eye diseases that are important to check for regularly?
A regular check for refractive errors is good for maintaining good vision and if necessary, to be corrected by glasses or contact lenses.

A check for Myopia (short-sightedness) amongst children is getting more important since they spend more time indoors doing near-focused activities on smartphones etc.

What are the most common symptoms to be aware of that could indicate a threat to vision?
The most common symptoms are red eyes, night blindness, headaches, light oversensitivity, floaters (jelly-like material inside your eyes, obstructing your vision), flashes (bright spots or points of light in your field of vision), dry eyes, excessive tearing, blurred or distorted vision.

What other non-eye-related diseases can be diagnosed with an eye examination?

Aneurysm, a bubble in the wall of a blood vessel can be detected in the eye.

Brain tumor, can create increased pressure in the brain that gets transmitted to the eye, causing changes to the optic nerve resulting in loss of peripheral vision and/or double vision.

Cancers of blood, tissue or skin can also affect the interior aspect of the eye like melanoma, leukaemia and lymphoma (also tumours in the breast and other areas can spread to the ocular structures).

Diabetes causes tiny blood vessels to leak yellow fluid or blood in the eye even before a person has been diagnosed with diabetes.

Heart disease by detecting microscopic marks left behind by an eye stroke.

High blood pressure by detecting unusual bends, kinks, or bleeding from blood vessels in the back of the eye.

High cholesterol by detecting a yellow- or blue ring around the cornea (transparent layer forming the front of the eye).

Stroke by detecting blood vessels that contain blockages or clots in the retina (back side of the eye), causing blind spots that can point to an increased risk for stroke.

Multiple Sclerosis - a degenerative disease that affects the nervous system, an inflammation that causes blurred vision, painful eye movement or even double vision.

Vascular disease by detecting clotting and bleeding in and around the eye that threatens vision by retinal haemorrhages.

How can the most prevalent eye diseases be prevented?
Eye disease, such as age-related macular degeneration, can be avoided by generally aiming to lead a healthy life by not smoking and avoiding ‘secondhand smoking’, to exercise regularly, keeping normal blood pressure and cholesterol levels and eating a healthy diet and the best way to prevent such an eye problem and/ or stopping it from progression is to make regular visits to your eye specialist.

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