Navigating Mental Health in Elite Cycling

Some details and thoughts from a mental health in cyclists presentation at the Science & Cycling conference in Lille, France in July.

Before I get into it - I am buzzing from the Tour de France Femmes… It was a rollercoaster of a race and I am in awe of Pauline Ferrand-Prévot’s performance.

Ok, lets get on topic.

For the last 10 years, there has been a cycling science conference a few days before the Tour de France starts, at the same location. For 9 years, I wanted to attend, but my summers are crazy busy and taking off for a week or so at the middle of the busy season seemed like bad decision making. Then last July, I had a (non work) opportunity to head to Greenland to experience midnight sun among the glaciers, and I just couldn’t say no… It was one of those things that felt like it was now or never. I worked 7 days a week + longer hours to make sure I don’t get too far behind and everything worked out (you can read about it and see the photos here if you’re curious).

Because everything turned out just fine with me being away for ~10 days last summer, this year, I finally took the time to attend the conference.

This years grand depart was in Lille (north of France), and so was the conference. I attended a half day saddle fitting masterclass as well as the two day conference and then stayed in Lille to watch the team presentations, and the first stage (It was great to be able to see both the start and finish of the stage). Side note - I will edit the photos I took and share them at some point, hopefully in the next few weeks.

I won’t go over everything that was covered in the conference (there was a lot), but over a series of posts, I want to get into a few things that spoke to me. The first one is a mental health topic, which I find very interesting even though it’s not a field I specialize in.

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The Mental Gearshift: Navigating Mental Health in Elite Cycling - Resilience, Risk, and Recovery Across the Peloton

This was the title of the presentation, by Michael Liebrenz from the University of Bern.

Below are some of the bits I found interesting from the presentation (in no particular order), and a bit of a brain dump of my thoughts. Click the button to read a recently published paper by the presenter, titled ‘The care episode of a young elite-level female cyclist with major depressive disorder and comorbid eating disorder: A sports psychiatry case report from Switzerland’.

The biggest take away for me was the need to fit sport psychiatry along side sport psychology as one does not seem to be enough and a combination of both might be needed in many cases.

Before I get into some of the presentation details, I want to share a person note. I started working with a sport psychologist as a teen in the mid 90’s, predominantly using biofeedback techniques, and it was incredibly helpful. Fun fact - Years later, when I was in university, we were assigned reading in the area for one of my sport psychology courses and I was somewhat surprised I had to read papers written by the sport psychologist I used to work with!

While working with a sport psychiatrist as a young athlete was very valuable, I now wish there was an opportunity to combine this work with a psychiatry assessment also. The reason for this, in my case, is ADHD that went undiagnosed until my early 40th (I sought diagnosis ~1.5 years ago).

The reason Liebrenz suggested that combining sport psychiatry with sport psychology is beneficial is somewhat similar - Due to the high rates of various conditions among the pro ranks including ADHD, eating disorders, anxiety, depression (he cited ~28%), substance use and sleep deprivation. As far as ADHD goes, the prevalence is unknown due to the low rates of treatment, but it is thought to be high.

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Does high training load become a risk factor in mental health?

This is a thought provoking question, isn’t it?

It seems that more hours = More risk. Could training more be a band aid solution that masks a much deeper issue? It is important to note that the risk is increased when training through pain.

Additional considerations include the barriers athletes face for coming forward. Who needs to know what? Who should they go to? And when they do seek help, typically from their coach and/or a sport psychologist, it is very unlikely they will share everything, making it even more important to involve psychiatry help.

Of course, there might stigma involved, which is why normalizing these conversations is even more important.

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Career longevity and career transition

Other points of consideration that were discussed were career longevity and career transition.

As far as career longevity goes, if there are signs of mental health considerations that need intervention at a young age, will the career last? Or if there is enough appropriate support early on, could that change the trajectory of the athletes career?

Longer contracts seem to help athletes perform better, as stress and anxiety levels are reduced. There is security, which is important, and it can also affect career longevity.

Career transition is an interesting topic (this is a whole topic on its own). The career timeline of athletes is short, relative to other career paths. I have seen many athletes transition from very high levels of racing to retirement, with very varied levels of smoothness.

It has been mentioned that completely stopping is worse case scenario for mental health and if there were no known mental health considerations before, this could bring them forward, mostly if the athlete has little outside of sport. This could be worse if stopping is not by choice but is forced, like in the case of an injury, illness, etc.

Having a career path outside of sport and/or having a plan B, can really help athletes in the long run and should be encouraged. This might seem like common sense, but I think it still needs to be said.

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This presentation and reading the case study I shared above, highlight something I have been thinking about for a while - This does not apply exclusively to the pro athletes.

What about how this applies to every day athletes? Those who ‘pay to play’, who have jobs, families, etc. The every day rider. I know plenty of non pro athletes who consistently train 25+ hours a week, or even pushing 30 hours a week, year round with little breaks and significant enough down time.

How will a forced break affect their mental health? Are they likely to seek help as needed? Should and will that involve psychiatric help? Are there differences between the pro athlete and everyday athlete?

Where is the line between something we do as a hobby, for fitness, fun, as a lifestyle and something that is potentially an escape to mask deeper mental health issues?

I am not here to claim I have the answers - I certainly do not. I do have questions, and I share them as food for thought… Mental health in athletes (of all ability levels) is something I think about often, so I found this presentation interesting and I would like to see a combination of sport psychiatry along side sport psychology become the norm.

If you have thoughts on this, I would love to hear them in the comments!