It's Not About the Bike was the title of Lance Armstrong's first autobiography, and in the light of subsequent allegations and admissions, it seems indeed that it was not.1 Armstrong's phenomenal Tour de France cycling success was of course multifactorial, an aggregation of gains in several aspects of performance, but an integral factor in his success appears to have been 'blood doping', a fast-track increase in haemoglobin achieved with erythropoietin and autologous blood transfusion.2 In the case of elite athletes, the advantage being sought is an increase in critical power, the highest work rate that can be sustained over a substantial amount of time without an appreciable contribution from anaerobic metabolism.3 Could a similar approach be employed clinically to improve the functional capacity of patients facing major surgery?
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