Where is Your Mojovation?

imagesI know…it’s not a word.  But it should be.  Especially if you have CF and you deal with the ups and downs of exacerbations followed by hospitalizations and the frustrating loss of all of your hard-earned fitness gains, there needs to be a unique word to describe what enables you to keep on plugging away at the goal to be fit.  I call it “mojovation.”  I define it as the desire to get your mojo back.

I know you can relate to the following:  There you are lying in your hospital bed, all packed up and ready to go home, waiting the inevitable extra hour or two for some random event to happen before you can leave (a wheelchair that you don’t need but is mandated by the hospital gods, your discharge meds that somehow ended up on the wrong floor, a nurse who needs to come in and “teach” you how to administer you IV’s even though you are 10,000 times more qualified than she is to teach this shit, etc), bored to tears wondering what to do?  I have a great idea.  This is the time for building your mojovation.

Face it, you lost your mojo as soon as you had to put the gown on backwards.  After a day or two of lying flat on your back, your quads probably started shaking when you got up to pee, even though you squated 180 lbs the week before you got sick.  You have likely lost five pounds of muscle in a fraction of the time it took to accumulate it, and your skin has taken on the color of hospital eggshell white.  You want to smash the tiny mirror above the tiny sink in the tiny bathroom and scream at the unfairness of it all, but you know this would result in further delay of your discharge as you would then have to wait for the psych consult. I say, harness this anger and grab a pen and paper…or your iphone if you are younger than 40 years of age and have forgotten how to use a pen.  Your mojo is not gone forever…you just need to locate it.

I learned the following exercise from Dr. Heidi Grant Halvorson, a social psychologist who researches, writes, and speaks about the science of motivation. Since we are speaking of regaining your fitness mojo temporarily lost in Tropical Storm CF, I’ll use a related goal in my example using Dr. Halvorson’s techniques.  The first thing to do is write down your goal.  Make it specific and make sure it is something that you not only really WANT to achieve, but also something that you are confident you CAN achieve.  Then ask yourself, “how will I know when I have reached this goal?”  If you don’t know, go back and work on it until you can answer this question.  Assume, for example, that my goad is “I want to squat 180 lbs again.” This is specific…I will know when I’ve done it (ouch).  I both want to do it (to prove I am bigger and badder than CF) and know that I can do it (I already have).

Now that the goal is defined, Halvorson suggests doing something called “mental contrasting.” I list 4 reasons this goal is important to me, in order of magnitude of importance. Then, I’m to write 4 obstacles, again in order of their obstacle-ness.  New word.  The hardest obstacle to overcome is number one, next hardest number two, etc.  This is easy enough.  Then I write a paragraph expanding on the number one reason this goal is important.  I go for it and just write whatever comes to mind.  Next, I do the same thing for obstacle number one.  Then, again I write about reason to do this goal number two, followed by obstacle number two.  So, four paragraphs in total.  I can stop here.  According to the research, this exercise makes my brain able to hold two ideas at once!  Who knew?  I am able to face an obstacle squarely when it arises, but still retain that little voice telling me why my goal is important and not run and hide at the first indication that life is not always a piece of cake.

The next idea is the gem and really the best part of this whole article.  There is a very simple planning task that, if you do, increases your chance of reaching your goal (assuming it is a goal that you really want and one that is achievable) by 150%, according to numerous research studies.  It is so simple that when you read it, you will say, “no way that is going to work.”  I know, that is what I said too.  But the fact that I am actually writing this is proof that it works!  The exercise is called “if/then” planning. Very simply, I come up with the time and place I plan on accomplishing the task I want to achieve, and write it down.  That’s it.  My first attempt at this was very small–and I suggest you do the same thing.  I decided that “when (you can substitute when for if) the coffee is brewing, then I will do my morning stretching.”  Morning stretching is something I know works well for me, but I often forget…or am too lazy… to do.  My if/then plan worked like a charm on this first test drive.  I was successful every day for a week, seemingly without any effort on my part.  It just happened.

Next, I tried, “when I drink my first cup of coffee, I will write in my journal.”  Again, it worked like a charm.  Magic.  In the past, my journaling efforts have gone roughly the same as my old Buick Skylark, which tended to die every time I turned left. Suddenly, I now automatically sit down with my Bulletproof coffee and write away.

My current if/then strategy is, “if I am Vesting, I will also be writing something in my blog.”  Oddly, this works in the morning (now), but I am having trouble with it at night.  So, this will be the topic of my next blog post…willpower, use it and/or lose it.

So now, back to the exercise goal you want to create while you are waiting to rolling out of the hospital.  First, try the mental contrasting writing exercise about why you want to regain your lost fitness, and what obstacles you will need to overcome.  Then, use the magic if/then technique.  Remember to start very small…test the waters a bit.   Take a tiny baby step in the direction incredible Superman/woman fitness levels. Something like, “when I wake up in the morning, I will do ten pushups,” is a great example.  Remember, make it very easy!  Then, after it becomes automatic, add something that is a bit harder…just a tiny bit.  These little steps build confidence in yourself, which remember is very important when it comes to setting and achieving goals.

Give it a try, and let me know how it works for you!

 

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A Word About Exercise: YES

There is little controversy regarding the importance of exercise to children and adults with cystic fibrosis.  In the twenty years since Nixon et al showed that higher levels of aerobic fitness was associated with a significantly lower risk of dying[1] numerous studies have documented the benefits of exercise, including: improved airway clearance, weight gain, improved cardiorespiratory fitness, increased work capacity, improved bone density, increased exercise tolerance, decreased feeling of breathlessness, and improved body image and quality of life.  Even those who are awaiting transplantation are encouraged to exercise as tolerated, since studies have shown that exercise both before and after lung-transplant surgery tends to make cardiopulmonary function more efficient, strengthen respiratory muscles, and ensure good bone density.

But perhaps the most significant reason to incorporate exercise in the CF care regimen was shown in the longest published study to date regarding this issue.  A three-year home based program including aerobic exercise three times weekly concluded that “pulmonary function declined more slowly in the exercise group than in the control group”.2  Certainly with the exciting prospect of CFTR correctors and potentiators around the corner, it is extremely important to maintain as much lung function as possible until the day comes when CF becomes a controllable disease.

Undoubtedly, we (adults with CF) should exercise regularly, and parents and clinicians should do what they can to encourage children with CF to introduce this healthy habit as soon as possible.  But just as in the case of CFTR-able people, it is no easy task to convince those with lung disease to comply with an exercise prescription.  The first obstacle is one of motivation, and the second is the very real issue of time-management.  Neither of these are simple problems with simple resolutions; indeed, possible solutions change with the age of the patient and with the severity of the illness.  Additionally, the recommendations for mode of exercise are slightly amended as a patient ages.3

Pre-Adolescents  

The good news about young children is there is never an easier time to get them to move.  Furthermore, a caregiver’s power to promote long lasting behaviors at this stage is enormous.  Children are wired to be active in short bursts; they play “anaerobically.” They love to sprint or climb or do explosive movements, and then walk around to recover.  This is a perfect for children with cystic fibrosis, because research has shown that this type of exercise trains both the anaerobic and aerobic energy systems.  This type of play can also be performed for longer periods of time, due to the frequent rest periods.  This is significant because the most recent research in exercise physiology shows that it seems to be total volume of daily activity that has the strongest effect on maintaining lung function.  In other words, the more daily physical activity that a child is involved in, the slower their lung function will decline. Encourage anything that your child thinks is fun, and if possible, expose them to as many forms of exercise and sport as you can.  This not only keeps it interesting for them, it also is beneficial to train their growing bodies in multiple ways.  Some favorites are swimming, soccer, basketball, biking, jumping rope, rollerblading, games like tag or capture the flag, jumping on a pogo stick (one of my favorites), or a rebounder  (mini-trampoline).  The critical thing is consistent daily participation.  The recommendation for children with CF is no different from that for healthy children, at least 60 minutes accrued throughout the day.  At this age, it is also important that the intensity of the exercise be relatively high, as in a sport such as soccer, where there are frequent bursts of intense running, followed by longer periods of a walking recovery.

Motivation is usually not an issue with this age group, but if it is, delaying favored activities (screen time, reading, shopping) until after playtime works wonders.  Some children are extremely motivated by team sports and group activities, while others shy away from them.  If a child falls into the latter group, a pedometer may do the trick, or giving them exercise “points” or stickers and offering a great prize for accumulating a target number.  It is also very helpful (and healthy for everyone) to establish family rituals that involve exercise.  Weekend family hikes or bike rides are not just good for the children, they also establish exercise and time together as family values.

Adolescents

In both girls and boys, aerobic capacity begins to plateau during adolescence.  For this reason, it is important to train the aerobic energy system during this stage of development.  Aerobic exercise works the lungs, heart, and muscles, thus having a very powerful effect on the oxygen delivery systems in the body.  Historically, girls have been at a greater risk for a sudden drop in FEV1 during adolescence, so while exercise is important for both sexes, this is a critical period for girls in terms of health maintenance.  Unfortunately, it is also during adolescence that a significant difference in activity level develops between children with CF and healthy children, and this difference is even more marked in girls than boys. Low-level aerobic exercise, such as walking, biking, or leisurely swimming, can be extremely beneficial for building aerobic capacity.  In addition, this type of exercise can increase mucus clearance by up to 30%.  This type of aerobic activity can be increased substantially by simply having teens walk or ride bikes to school, or to a friend’s house or other planned activity. Fitting as much simple, low-level activity into daily life as possible can slow lung function decline.  This is both time-efficient and can be a motivating fact to share with a teenager.

Exercising at a higher intensity is also beneficial, and can be much more tolerable and even enjoyable if done with interval training.  This is characterized by two to three minutes of exercise at a moderate intensity, such as jogging quickly or swimming a few laps, followed by a short period of rest for the heart rate and breathing to return back towards baseline, and then repeating this for several intervals.  This has the benefit of shortening the exercise session, a very important factor for busy teenagers.

Anaerobic training is also beneficial for adolescents.  In sports like soccer or basketball, there are periods of intense exercise (anaerobic) followed by lower level recovery periods (aerobic), so both energy systems are being stressed and therefore, trained.  Interestingly, adherence to this form of exercise has been shown to be very high, so kids actually enjoy this type of activity.

Finally, I would be remiss not to mention the myriad benefits of strength training for young men and women with CF. A study recently completed at the Hospital for Sick Children in Toronto shows that upper body strength and anaerobic capacity are significantly related to FEV1.3  Increased muscle mass, which results from weight training, leads to positive health benefits, both physical and psychological.  Just as in anaerobic-based sports described above, when lifting weights, the anaerobic system is tasked during the lifting set, and the aerobic system is pushed during the rest phase between sets.  On a personal note, it was when I discovered strength training as a young college student that my lifelong “addiction” to exercise took root.  Understanding that this was one area where I felt control over my body, where my cystic fibrosis could not hold me back, was by far the strongest motivator to exercise I have ever felt.  And I am female, lacking the benefit of testosterone!  Imagine how significant it could be for a young man, perhaps smaller than his peers, to discover an activity that he could do to reliably increase strength and muscle mass.  As I’m sure we all painfully remember, self-esteem is at its most vulnerable state during adolescence, and when you have a chronic illness, this is magnified.  Depression and increased stress are definitely issues to contend with as teens with CF navigate increased time pressures, possible delayed puberty, and increasing health challenges.  Exercise is known to increase self-esteem in children with cystic fibrosis, and is also a very effective way to deal with depression and stress.

Just as with younger children, variety improves the interest level and the overall benefits of an exercise program.  If a teenager is inclined toward team or individual sports, this is ideal.  If not, encouraging as much low-level activity in daily life, introducing interval training, and encouraging resistance training is my recommendation.  Whatever the choice of activity, adolescence is the time to emphasize the importance of habitual, daily exercise as a central component to the routine management of their cystic fibrosis.  Hopefully, as they notice that they feel and look better when they exercise, your teenager will develop the internal motivation to continue this habit into adulthood.

Adulthood

The most exciting piece of information I’ve seen in researching this topic comes from Toronto, where new interesting and not yet published research that shows that in a seven year follow-up, FEV1, lung function, and habitual physical activity are closely related, and the people with the highest levels of physical activity have a 50 percent slower rate of decline of lung function (emphasis mine).3 For adults with CF, this means one thing:  move more!  Incorporating physical activity into your daily routine should be as important as your other therapies.  Walk as much as you can.  Ride a bike.  Swim.  All of these activities have well-documented positive effects, both CF-specific and non-CF specific.  For example, regular exercise both helps with airway clearance and has been shown to be as effective as medication in treating depression and anxiety.  For women especially, weight bearing exercise such as walking, jogging, or weight lifting can help stave off osteoporosis.  In non-CF subjects, weight lifting improves insulin sensitivity. It isn’t known if this is true in CF, but it certainly could be. Most importantly, regular exercise improves the quality of life and perception of well being, and what can be more important as an adult with CF?

For adults with CF, the exercise recommendation is for “concurrent exercise,” which is medical-speak for cross training.  This means it is best to incorporate many different forms of exercise throughout your week.  Strength train at least twice a week, work aerobically, at both low and moderate intensity as tolerated, at least three or four days a week, and try to incorporate flexibility and mobility work into your routine on several days.  I recommend that people aim for 30 minutes per exercise session, but then also incorporate more movement throughout the day.  Obviously, if you have more severe lung disease, you should consult with your doctor as to the need for O2 supplementation or any contraindications to exercise.

There are three important exercise considerations that apply to all age groups.  First, if you are sick, don’t workout.  While it may seem macho to do so, and healthy people can get away with it, exercise would be an added stressor to an already-taxed system.  If you can, continue with low-level activity such as walking, so that you don’t decondition quite as much, and then begin again when you are healthy.  Secondly, make sure that with increased physical activity, you or your child with CF are also taking in enough good quality calories to maintain the appropriate body-mass index.  Even though exercise correlates strongly with lung function, so does nutritional status, and it would be counterproductive to sacrifice an optimal BMI in your pursuit of fitness. Finally, with increased exercise comes the need for fluid and electrolyte replacement. Especially when exercising in heat or for a long duration, this cannot be overstressed.

Clearly, I am a big fan of exercise.  I firmly believe that one of the reasons I have enjoyed such good health as a DDf508 is that I made it a daily habit over 35 years ago.  But now, it is not just me and other adults with CF who have seen exercise change their lives, preaching about the need for everyone with CF to add this to their treatment regimen. Research is proving us right, and even giving clues into the mechanisms of the benefits of exercise.  As a fifteen-year-old, I didn’t know that my jogging was causing my ENAC channels to be down regulated, thereby increasing airway surface liquid. All I knew was that it made me feel great!  I became hooked, and I’m still here, writing about it.



[1] Nixon, et al, N Engl J Med 1992; 327: 1785-8.

2 Schneiderman-Walker, J Pediatr 2000, 136: 304-10.

3 eCystic Fibrosis Review, March 2012: Vol 3, Number 8.

 

 

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The Slight Edge

I’m currently reading a book called “The Slight Edge,” by Jeff Olson. The basic message is that significant change is made quite easily if taken one small and consistent step at a time. As a wellness coach, I have read quite a bit about change psychology, and the directness and simplicity of this author’s approach is very appealing to me. I’ve decided to take it on a test drive, and am trying to revive my blog with this approach. When I first started blogging, I loved doing it and felt like it was an awesome way to get my message(s) out about living well despite having ongoing and serious health concerns. Then, life got in the way, and blogging took a back seat to just about everything else that I could think of. Enter the Slight Edge.  I will be posting more.

It seems to me that life is somewhat unfair in that good habits seem to require effort to develop, while bad habits form quite easily simply by being unconscious about choices we make.  The Slight Edge basically refutes this, by making the very obvious point that over time, simply taking one small action each day will compound into huge and lasting change.  On the other hand, not taking that one action will also compound.  Unfortunately, compounding in this negative sense can be disastrous.

A very clear example for the cystic fibrosis peeps out there is doing your daily aerosol treatments.  These are very easy to do (note that I didn’t say “convenient” or “pleasant”).  Seriously…you just sit and inhale stuff.  It’s not like you aren’t going to inhale anyway!  And sitting in a chair holding a nebulizer is not exactly manual labor.  So it’s easy to do treatments.

But it is also very easy to blow them off.  There are a myriad of things that, in the moment, seem way more important than that hypertonic saline, right?  Sleeping in, stopping for coffee before work, playing with your cat, browsing favorite websites, cleaning your closets, plucking your eyebrows…you name it.  Who wants to sit and cough?

But now imagine what happens if that decision to blow off your treatments is compounded, day after day.  Then compare that image to what it looks like if you make that simple decision to do the treatments every day.  Stretch your imagination out to a month or two (here is where I wish you were a pathologist, because my mental image is a slide of healthy, pristine lung tissue vs. nastiness on a slide).  Two very, very different images as a result of two sides of a decisional coin, compounded over time.

Of course, this relates to just about any area of life…not just medical treatments.  Decisions about fitness habits, what you eat or drink, how you relate to people, how you work, and how you deal with stress all compound over time this way.  On a day-to-day basis, it doesn’t matter in a huge way whether you take your daily walk or sit for your meditation.  Not doing them ONE day is easy, and it won’t make a dent in your overall fitness or stress level.  Alternately, actually doing these things probably aren’t going to matter a huge amount on that particular day. But compound these decisions over time and see what happens.

What one life-enhancing thing, something that is both very easy to do but also very easy to blow off, can you to do, today and every day?  Gotta go do my saline now.

 

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Time To Start Writing About Exercise Again!

It has been a very long time since I have written a word on this blog.  I don’t know why.  Sometimes, I just don’t have much to say.  But now I do.  Life is good. I am healthy and fit (for me), and I want to talk about why this might be true.

In brief, I have quit trying to kill myself with intensely hard workouts, day after day.  You would think after living with cystic fibrosis for 51+  years, I might have embraced the wisdom of this before now, but alas…

What has caused this epiphany, you ask?  After attending a four day Z Health course last month, I’ve begun to re-train my nervous system as part of my overall exercise program.  By necessity, this means I am being nicer to myself.  I’ve learned that my brain doesn’t like to be whipped into an endorphin frenzy every single day…and neither does my body.  Oddly, I’m 1) in better shape than I’ve been in years, and 2) not injured.

“OMG,” I can hear you now.  “First, I have to take a million medications, AND I have to do hours and hours of daily treatments,  AND I have to wear a vibrating vest for an hour a day, AND I need to go outside and walk or lift weights every day,  AND I need to get 8-9 hours of sleep, AND I need to eat 5-6 times a day (add more pills), AND I need to work, AND I need to raise kids and be a spouse or partner and dog mom, AND I have to fit in a few home (best case scenario)  IV sessions each year, and NOW I HAVE TO RE-TRAIN MY NERVOUS SYSTEM, TOO???”

Only if you want to minimize pain and injury and maximize your movement excellence.  I’ll write more about Z and what it is doing for me in subsequent posts.  Oh, and just a side note:  if you move well and without pain, you move more.  When you move more, you increase your fitness.  And when you have CF, it’s not fitness, it’s life.

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Step Five of the Perfect Workout: Strength Training

I almost forgot I had a few steps to go in describing my perfect workout.

Here is why (David Letterman style) I think strength training needs to be a key component in your workout–especially if you have CF:

10) You can seriously increase your appetite, especially if you are doing a heavy lifting program.  Lifting heavy and the consequent eating like a horse is how I gained six pounds in six weeks.  Doesn’t sound like much, I know, but it’s about 6% of my body-weight (you do the math).  The only time I’ve ever been able to gain that much weight was the first year of college.  Man did I love that all-you-can-eat cafeteria.

9) It’s great to beat your son at arm-wrestling.  OK, so he’s only 12.

8) Maintaining bone density is pretty important, unless you want to crumble into a heap of skin and bones in your old age.  Yes, I did say ‘old age.’  It will happen.

7) In CFTR-able people (code name for those without CF), lifting weights increases insulin sensitivity.  There is no reason to think this won’t be true in CF as well.  If you CFRD or are on the verge, or, if you don’t want to develop CFRD, a little weight training can absolutely not hurt!

6) You get to buy new clothes when you ‘outgrow’ your old shirts, pants, etc.  Ladies, don’t worry–I’m kidding.

5) Who wants to be soft?  Weight training will firm up those abs and legs and arms in very little time.  Try it.  You will be amazed.  In addition, who wants to be skinny and wimpy?  This will not be the case if you adhere to a regular lifting schedule.

4) Being stronger will make the regular chores of life easier.  Easier means requiring less energy.  Requiring less energy means requiring less oxygen.  Less oxygen required means even if you have sucky lungs–that’s a technical term–you will still be able to carry on, soldier.

3) Coughing is easier and more effective if you have strong abdominal muscles.  This is just true.  Given that we cough, and the effectiveness of our coughs is directly proportional to our health…strong abs are very important.

2) Let’s face it, body image can be impaired in CF.  It’s not hard to imagine why this is true, but this is a very important issue, especially in kids. One very good way to improve body image is to develop muscle.  Development of muscle is not impaired in CF (as long as you eat and digest food).  We can ALL do it.  And when you do develop muscle that is visible to the naked eye…you feel better about the way you look.  Even if you cough.  Even if your fingernails look funny.

1)  I left this for last because it is my favorite reason to lift.  You are in control when you lift.  Not CF.  CF doesn’t affect your strength.  CF doesn’t stop you from developing strong muscles.  There is absolutely no difference between you and normal Joe GymRat, when it comes to getting strong.  Booyah.

These are good reasons to add resistance training to your workout.  The next post will discuss how to design your program.

 

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