The Perfect Workout


After living 50 years as a fitness nerd, I have a few ideas about what constitutes a perfect workout for me.  Of course, this all depends on which “me” shows up to exercise that day.  Is it the “feeling great” me, the “getting back up on my horse after a round of IV’s” me, or the “not exactly sick, but not feeling at my peak” me?  The right workout for each situation will be vastly different, but the basic constituents of the hour or so at the gym are the same.

Is there a “perfect workout” for you?  Yes, but I guarantee it is unique to you, and unique to you on this particular day.  From the 10,000 ft point of view, the “perfect workout” is the one that you will do, consistently, and if not enjoy, at least not abhor. It should leave you feeling tired in a good way, so that you know you did some work, but not so exhausted that you dread the next encounter with your inner athlete.  And if you live with CF or some other chronic illness that waxes and wanes, the perfect workout is a moving target. Some days, 20 minutes on the elliptical is the right amount, while other days, 5 minutes on the stationary bike is what your body needs.  On really awesome days, a 5-mile hike in the woods fits the bill perfectly.

But whatever state your body is in, the components of each workout should be the same, modified to suit your body, with its particular issues.  Each component is important, and the order that you complete each component matters.  I’m going to run briefly through each, and offer some suggestions for specific exercises that work for me and might also benefit you.

The order is as follows:

soft tissue work

mobility exercises

corrective exercises or “pre-hab”

movement preparation or active stretching

strength training

cardio or “metabolic conditioning”

stretching (passive)



Yes, I put nutrition in there at the end, because at least for me, it is vitally important to feed my muscles nutritious food including both carbs and protein very soon after exercise.  Experts say a ratio of 4:1 carbohydrate to protein is what you should shoot for.  You can do this very easily by drinking some chocolate milk, or eating a peanut butter sandwich.  It doesn’t have to be complicated, but it does have to happen.

So, let’s go through the actual workout.

Soft Tissue:

This consists of a:bout 10 minutes of foam rolling or using a tennis or lacrosse ball in areas of muscle and connective tissue that is excessively tight.  You know an area needs to be rolled when it is uncomfortable to do so.  If you don’t feel discomfort, you are good to go on to the next spot.  I generally start with a ball to my feet (ouch), and then go to the foam roller for calves, hamstrings and glutes.   I then flip over and do my quadriceps.  Then I take out the magic “peanut,” my extremely complicated and expensive device that I now absolutely cannot live without.  With this, all my tension dissipates from my back, as it remembers how to extend after my day of sitting, coughing, and typing. That’s it!

As I said, I’m fifty.  I have accumulated a lot of tight areas.  You may not need this much, or you may need more.  Only you will know, by trial and error.

Mobility Exercises:

This is also not complicated and we are talking about joints here. Having good mobility simply means that you are able to take each joint through its natural range of motion.  Each joint is different, of course.  The knee joint shouldn’t be able to traverse a circle, while the ankle joint should (ha…tell that to my ankles!).  Take a survey of your body.  You will be able to tell which joints are tight.  Work on those.  Also, do some range of motion in the joints that you intend to use in your workout.

Corrective Exercises:

These are also referred to as “pre-hab” exercises, presumably because if you do them, you won’t ultimately require “rehab” exercises.  Simply put, the idea is to strengthen weak areas that contribute to unhealthy movement patterns or poor posture.  In my case, and likely in the case of anyone with CF, this is primarily my thoracic spine.  Lung disease and chronic coughing cause the biomechanics of the chest wall to get messed up (to use a technical term).  The result is the “hunched” back and rounded forward shoulders we commonly see in each other.  Corrective work for this focuses on opening the anterior chest and shoulders with active stretching, and strengthening the muscles of the back that pull the shoulder blades back and down.

Movement Preparation (AKA active stretching):

This is the “warm up” part of the workout.  The goal for this portion of time is to actively work the areas of your body that you are about to engage.  You slowly start asking more of the heart and lungs as you begin using large muscle groups in a similar way to what you are about to ask of them.  For example, if this is a leg workout day, you might begin with some lunges, or body squats and add in some walking hamstring stretches.  If you are going to focus on bench pressing, simply pressing a very light weight for a few sets of 5-8 would be a great warm up.  If you are going for a walk or jog, beginning to do that exercise at a slow rate for a few minutes is the way to go.  It all depends on what you plan to focus on that day.

Strength Training or Cardio (metabolic conditioning):

I put these in the same category because I would suggest focusing on one or the other during a workout.  You can do this by alternating lifting days with cardio days. Alternately, you can do both at the same time by doing weight training in a circuit fashion, with little rest between exercises.  My favorite way of doing this these days is with kettlebells, which I will discuss in another article.

The main thing to remember here is to start small and slowly progress as your body adapts to the challenge.  If you want to be able to run a 10K, that is awesome, and you can do it!  But start with walking/jogging intervals which feel like work, but also feel good!  There is no better way to sabotage yourself than to rush your body faster than it can go.  How will you know if you are?  You won’t want to keep doing it.  When you start dreading your daily jog, you know you are pushing too hard.  As you very slowly start adding time to your workout, or lesson the periods of rest (if you are doing intervals), you get stronger and stronger.

Stretching (Passive):

Ah…this is what you’ve been waiting for.  The end of the workout!  You’ve done your last set, or run your last interval.  You want to grab your stuff and go fall on your couch.  But wait!  There’s more…

This is the time to do just a little bit of flexibility training.  Your muscles are warm and pliable…a perfect set up for some passive stretching.  Passive stretching just means holding a muscle in the stretched state for about 20-30 seconds.  This is what we normally think of as stretching. Spend just 5 minutes stretching those areas on your body that tend to be tight.  You don’t need to go through a whole yoga series here.  You know what you need.  I almost always need low back and hamstring stretches at this point.  I also find that this is the perfect time to lay across the foam roller lengthwise (so it is under my spine from my head to my butt) and open my arms to the side and let gravity open my chest.  Some deep, meditative breathing in this position is the perfect way to conclude the workout.

And before you hit the couch, don’t forget to eat!






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Does Wellness Coaching Work If You Are Sick

It seems like years ago that I wrote about wellness coaching.  This was a general discussion of what wellness coaching is and how it works.  Today, I think it would be a good idea to focus a discussion more on how wellness coaching could help someone with a chronic illness.  Is the coaching process or the goal different for someone who is, by definition, sick?  Is there a point to wellness coaching if you carry a diagnosis that isn’t going away?  Is wellness coaching focused on making the illness go away?

One thing I want to point out up front is that when I do wellness coaching with someone who has a chronic illness, this is not the same thing as “chronic illness coaching.”  There is such a thing as a chronic illness coach.  They might help someone work with a specific illness in order to handle it better.  This type of coaching, to me, is very focused on the “illness,” and not the intact being who lives in a body that is not perfect.

The focal point of wellness coaching is not the illness and how you are in relation to it.   Instead, while a wellness coach will ask you to see clearly where you are right now, he or she will also ask you to envision where you want to be.  Then together you discover the path from A to B.  Yes, the fact that you live with an illness will come into play as you define your path, as will other obstacles.  None will be emphasized over the others. Certainly some may require some complex navigation strategies.

Instead, what is emphasized in a wellness coach/client relationship is that wellness is not a specific target point.  You don’t one day reach “wellness” and from then on, fight to stay there.  Rather, I like to think of wellness as a “frequency” that you tune into.  Regardless of the brand or power or age or color of your tuner…even if it has a broken knob or two…every tuner is capable of finding this frequency.

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Five Reasons You Must Start Resistance Training Today!

I love list posts.  They are so easy to write, and even easier to read.  If only adopting the habit they propose were so easy…

But in this case, it is!  Resistance training is not difficult to do.  You don’t need to join a gym.  There is no requirement for fancy equipment or expensive clothing.  While a routine does take a little bit of time, you will begin to see and feel significant results in as little as 20 minutes 2 or (ideally) 3 sessions per week.  You could multitask, and do your routine while watching Scrubs reruns.  How simple is that?

Your own body weight can provide all the resistance you want or need, or if you are so inclined, you can purchase some very reasonably priced resistance tubing to use in your living room.

Here’s the trick.  Don’t fall for the fitness magazine articles that suggest complex moves, or drop sets, or supersets, or unbelievably crazy-sets.  Pick exercises that target multiple muscle groups like squats, lunges, front and side plank, or good old fashioned push-ups, and just start doing them!  Here is why you should start today:

Reason 1) Resistance training is a friend of your metabolism.  Why is this?  As you begin to overload your muscles beyond what they are used to, you injure them slightly (don’t go for major injury…that doesn’t do any good at all).  You cause little tiny microtears in the muscle fibers, and this is why you are sore one or two days later.  But this is good news, because as your muscle fibers heal, they become stronger and bigger.  You add muscle mass, and over time, this increases your metabolic rate.

How does that work?  Body fat doesn’t do much.  It just sits there and looks back at you in the
mirror.  It doesn’t use up much energy.  Heck, it doesn’t even need much of a blood supply since it requires so little maintenance.  As a result, it burns very few calories.

On the other hand, muscle is very active.  It requires food (glucose and amino acids) and burns tons of calories by just being there.  Clearly, if you want to be a lean, mean, calorie burning machine, you want as much muscle as you can get.

Reason 2) Muscle, because it requires glucose and amino acids, is very sensitive to insulin.  Insulin opens the doorway to  to the little muscle cells, so glucose and amino acids can get in.  If you are insulin resistant, as in Type II diabetes  (and possibly CFRD), lifting weights will increase your insulin sensitivity as you build muscle mass.  A finely tuned insulin sensitivity mechanism is required for a stable blood glucose level, which leads to good health.

Reason 3) This is a big one for me, and maybe you can relate.  Building muscle and feeling and being strong physically is one area of my life where having cystic fibrosis doesn’t even matter!  My lungs may not be the best in the gym, but I will take on any woman my age in a push up or pull up contest!  This is a very empowering feeling…I have at least a modicum of control over my body which is otherwise at the mercy of my lung status.  Now, some days my lungs even interfere with my time at the gym, and that is OK.  I know that when I recover, I will be back, strutting around the gym with the big boys, knowing that my muscle fibers are no different than theirs:-)

If you have an illness other than CF, lifting may just provide the same benefit.  Lifting weights is a very black or white thing to do.  You do it and you see and feel results in as little as two or three weeks.  You have control of this.  It may not feel like you have control of much else, sometimes.  But you do have control over this.
Reason 4) More and more studies are showing that well-designed resistance training programs in post-treatment management of cancer patients and survivors are beneficial in improving health status and quality of life.   This is true in other chronic diseases as well.  Weight training is anabolic, meaning it builds up the body.  Often, treatment for illness is catabolic, or breaks down the body (think steroids or chemotherapy).  While these treatments are necessary, we can counter their bad side effect of breaking down tissue by weight training.

Reason 5) Weight training is fun!  Ok, maybe I’m in the minority thinking this, but stand by this statement.  When you get over the initial “I have no clue what I’m doing,” and move through the “Oh my God this huts,” you begin to see improvement!  And this is fun!

Are you ready to begin?  I’m starting a YouTube channel where I will teach easy, and very modifiable exercises that anyone can start doing today.  Check it out, and subscribe today!

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What is the Right Career?

How is a career choice related to wellness?  First, when I write about wellness with CF, I am not simply talking about physical health and wellness, but also emotional well being…a sense of contentment and fulfillment.  Many things are related to this sense of wellbeing, and fortunately, most have little to do with physical health.

I’ve been reading and thinking a lot about happiness lately.  If you’ve read my column before, you probably know that I find the field of positive psychology fascinating.  Essentially, it is the study of what causes people to be happy and to live rich and fulfilling lives.  Happiness is a popular topic these days.  You see happiness “secrets” revealed on book and magazine covers, on PBS specials, on happiness blogs, websites…you name it.

My purpose is to mine the field of positive psychology and happiness research to come up with scientifically validated ways to improve the subjective wellbeing of people with chronic illness, and of course, cystic fibrosis is a perfect example.

So what does this have to do with career choice?

The research tells us that one of the most important elements of living a good, fulfilling life, is the ability to use your strengths in a manner that serves a purpose that is larger than yourself…one that you believe in deeply and that aligns with your core values.  Those people for whom work is a calling feel the most fulfilled.  And there is a strong positive correlation between happiness and using your strengths every day.  Wouldn’t it be awesome if you could do that and get paid?  You can…and you should strive to do just that.

We all have strengths, and I’m sure you have a very good idea of what your particular strengths are.  It has only been a recent discovery that people who are the happiest immerse themselves in using their strengths rather than using their finite amount of time and energy to “shore up” their weaknesses.  I believe that the very first thing to take into account when deciding a career path is “What are you good at?”  Notice, I didn’t say, “What do you think you can handle, given CF?”

If you want to try a fun and often revealing exercise, take the VIA Signature Strengths Survey at  This is a series of 240 multiple-choice questions (it takes 45 minutes or so), and when you are done, you will immediately see which are your top five (or Signature) Strengths.   I thought I knew what my results would be, and I was close, but there were some that completely blew me away.  You will also get an interesting perspective on your own strengths by asking those that know you well what qualities they most admire in you.  Finally, make your own list of things you love to do and that you know you do well.  Try to narrow this down into five or six things in which you take great pride and satisfaction.  Combining all of these methods together will give you a very accurate map of the kind of career you will find most fulfilling.   It will be the one(s) where you see the need and the opportunity for these strengths at every turn.

Looking back to my decision to go to medical school to ultimately “cure cystic fibrosis,” I realize that I could have used this advice.  When one thinks of a good researcher, strengths like the capacity to love and be loved, humor, zest, curiosity and love of learning, and hope/optimism/future mindedness (my top five) are not the ones that first come to mind.   A great researcher would show strengths like industry, diligence, critical thinking, caution, judgment, ingenuity, and leadership (not even close to my top five).  While my passion was in the right place (curing CF), my strengths were not suited well to this career decision.

Now, this didn’t turn out all bad.  I loved going to medical school.  My love of learning and curiosity strengths were force-fed every day for 10 years of training.  I got to tell great pathology jokes.  But let’s just say that sitting around diagnosing cancer (after the intellectual thrill of figuring it out) did nothing for my zest, my hope and my optimism.  And who loves their pathologist?  Was I happy?  Not so much.  When it came time to retire to take care of my children and myself, I went through a slight existential crisis (well if I’m not a doctor, then who am I?), but then settled into post-physician existence quite happily.

Now I am entrenched in career number two, coaching and training wellness to people, who, like myself, live in less than perfect bodies that often require care and attention above and beyond the norm.  I use my strengths in a much more effective an ongoing way, and I am appreciated for them more than I ever was sitting at my microscope.  And, I care deeply about the meaning and usefulness of my work.  I feel that I am doing what I “should” be doing.  Given that I have always had a passion for fitness, nutrition and stress management, I get a kick out of sharing this with other people, and love learning even more about these topics.  This leads to a sense of fulfillment and contentment that I didn’t feel as a surgical pathologist.

So what can you learn from this story?  First, it pays to learn your strengths and give them serious consideration when choosing your career.  The same goes for following your passions, and figuring out a way to merge your core values with your daily job.  But finally, what you can learn from this story is that sometimes, despite your best intention, your “dream” job takes awhile to manifest.

You may decide on one path, and find out later that it doesn’t work out as well as you had hoped.  Or, you may love what you do for a time, and then physical challenges may force you to be more attentive to your own health needs than that particular job allows.  All of this happens…to everyone, really.  When you are first deciding on a career, in your early twenties, it may seem like you only get one chance, and you can’t afford to mess it up.

You might be making yourself crazy by thinking, I can do this now, but what if I get sick?  Sure, be practical.  You probably shouldn’t become a firefighter!  But why paralyze yourself by imagining what may happen in the future?

Barack Obama said something in his inaugural address that stuck me (actually, most of what he said struck me…but this I remember).  He said he rejected the notion that as a nation, we couldn’t both follow our values and be safe.  To paraphrase him, I reject the notion that as people with cystic fibrosis, we can’t both follow our passions and be well.

Your career is obviously a very personal choice…one that you will live with day in and day out.  Most people you talk to will give you practical advice:  Think about your health.  How stressed will you be?  Will you be able to care for yourself appropriately?  How healthy are you now?  What can you do now?

These are obviously important to consider.  But remember also to consider the following:  What are your strengths?  What are your values?  Is it more important to you to work your tail off doing what you love, or to work at a less stressful job so that you can place more energy and attention on your own health and family?  These aren’t right or wrong questions.  They are just questions…to which only you know the answers.

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Five Steps to Re-Energize

Sometimes it is easy to get bogged down on a project.  You let it “sit,” so you can think about it awhile, and before you know it, three other things have come up that need your attention, and your “big idea” starts gathering dust.

At least, that is how it often works for me.

This blog is a great example, but there have been others.  It has been a challenge to post lately.  Tom died.  Christmas happened.  I got sick.  I got busy.  Life happened.  Writing took a back seat.   In addition to writing, half-marathon training programs, book ideas, and piano lessons are also residing in the back seat.  Now don’t get me wrong…my motto for life in general––I get knocked down…but I get up again––applies to projects as well as it does to my health.  Usually I come back.  Like now, for example.

So I thought a good article to write might be one about just this:  How do you pick up where you left off, before life got in the way?  I’ve come up with a 5-step “Get Up Again” action plan to use when approaching that stack that is growing on your desk.

:  This is the most important one.   Get off your back already!  Unless you live alone, have no friends, have no other responsibilities, have only one interest, and generally have no life, things come up!  Life happens, and you get knocked off course now and then.  For most people I know, this is when the nasty little nagging voice speaks up.  “You are such a loser…!  Why aren’t you working on this?  You had such grand plans…such great ideas…Right.  What a lazy (%&#*!

First off, this is a true waste of energy and time.  It is, of course, much more efficient to use that energy in getting back up on the horse, to mix metaphors.  Everyone gets pulled off course, now and then.

STEP TWO:  Find your motivation!  If you are spinning your wheels, you need to get a grip on something, right?  The traction is found within something called motivation.  What lights your fire?  As much as possible, you need to recreate the energy you had when you began the project.  That’s a tall order, I know.  If I had the secret to that, I would be a bazillionairre.

Why did you want to do this project in the first place???  There must have been a really good reason.  The trick is to remember it. And get back into it!  Read about it again.  Read about how others have done or are doing what you want to do.  Talk to people about your idea.  Enlist their ideas…their help.

STEP THREE:  Set one goal.  This is obvious, but it is so overlooked.  You need a finish line.  It doesn’t have to be far away, but it needs to be a bit of a stretch for you.  It needs to be time-based and measurable.  You also need to really want it!  You need to be excited.  It helps to read the goal several times a day, imagining the feeling you will have when it is accomplished.  I know what you are thinking..”One goal?  But I have at least twenty to get back to!”  This may be true, but just pick one for now.  Just a little bit of traction goes a long way.

The most important aspect of setting a goal (to me) is setting a reward.  Seriously.  You need a carrot AND a stick.  If you are like me, the stick is taken care of.  It’s that voice in your head yelling all of the time.  The carrot is, of course, the reward you pick to give yourself when you’ve crossed that finish line.  Make the reward appropriate to the effort you need to put in to accomplishing the goal.  If you’re going to train for three months to run a 5K, give yourself something worth three months of hard training!

So let’s say, for instance, you had initiated a great workout program.  You were committed.  You had worked out all the details…and then…poof.  What program?

There are two ways to deal with this.  The usual way (for many) is to tell yourself you “don’t have it in you” to stick to a program, and then give up until the next time something wakes up your motivation again.

The second (better) way, is to get off your own back, remember your motivation, set a new and smaller goal (perhaps to just start to walk for 20 minutes a day)…add a carrot…and take STEP FOUR.

STEP FOUR:  Take a small step…every day.  Small is the important element here, especially at first.  The reason for this is that you will build on small successes.  If you do what you set out to do every day, then even if those action items are small, your confidence in yourself grows bigger and bigger.  Soon, you’ll start challenging yourself with larger daily action items without feeling overwhelmed.

STEP FIVE:  Stick to it until you can celebrate your achievement!  Your motivation may wax and wane a bit (have you noticed this?).  That’s ok…that’s just what it does.  If you have a day where you feel completely unmotivated, then make your daily action be to read about your goal.  Google it.  Find success stories.  Get your mojo back!  Tomorrow is a new day, and likely, you will feel more like playing.

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