Let’s start with my basic “Rules of Lifting”

First, begin by working the biggest muscles first, then moving to smaller ones.  If you are going to include your legs into your lifting that day, start with squats or deadlifts.  If you are giving your legs a day off, start with back exercises.

Second, focus on complex moves.  Complexity is in…isolation is out.  A “complex” lift is one that uses several muscle groups, and as a consequence, movement occurs at multiple joints.  A squat is a perfect example of a complex lift. In the squat, you not only use the gluteals and hamstrings to extend the hips, but you also use the quadriceps, hip flexor group, and the stabilizing muscles of the entire core.  Compare this to the knee extensor machine, a classic isolation movement occurring at a single joint. In this move, you sit on a chair, hook your ankles under a pad, and extend your lower legs.  This is an isolation move occurring across the knee..not only that, but it is an isolation move that you almost never do in real life.  Below is a sampling of both types of lifts.  An isolation move or two won’t hurt, but focusing on the complex moves is better overall approach.  Additionally, if you are going to do both types of lifts, do the complex moves first. The biceps curl can wait till the end (for all of you mirror gazers…).

Complex lifts (multiple joints move): Squat, Deadlift, Lunges, Bench press, standing military (overhead) press, Horizontal rowing, pull ups

Isolation lifts (single joint movement): biceps curls, adductor/abductor machines, triceps extension, leg extension, seated hamstring curl

Third, learn perfect technique.  If you do this first and foremost, and you focus continually on technique (even when you fatigue) you will not get injured.  On the other hand, if you are sloppy, it is very possible that you will hurt yourself as you lift heavier loads.  This cannot be over-emphasized.  We are not talking rocket science, though.  I learned by reading books and watching others.  These days, not only can you read, but YouTube makes it easy to learn the basics. Just make sure you are watching a trained professional, not an actor/actress from a reality TV show (you know who I’m talking about).

Begin lifting light.  For the first few weeks, you get stronger NOT by lifting heavy, but simply by training your nervous system how to do the moves.  Once you have good form and the movement patterns are grooved into your brain, it’s time to get serious.  Begin light for a warm up set or two, and then work hard! You will not “bulk up.”  The last repetition of your work sets should be difficult.  If the final repetition is easy, or even moderately easy…go heavier!

Take a day or two off between lifting for the same muscle group.  You have made teeny little tears in the muscle fibers by asking them to lift heavy weights.  But don’t panic…this is good.  If you feed your muscles and rest them appropriately—they heal and come back even stronger.  This is the whole point of weight lifting.  It is called Specific Adaptation to Imposed Demand (SAID principle for you exercise physiology nerds).  Your body adapts to what you ask it to do.  If you want it to get stronger, you must ask it to lift heavier objects than it is used to lifting.  It then adapts, and, poof, you are stronger.

Now that the basics are covered, how about the more specific questions of what moves, how many exercises to do, how many reps and sets to do, with what frequency should I lift, and how hard should it feel.  How will I know if I am doing too much?  Too little?

A beginner should try to work every muscle group at least twice a week.  Once a week…not good enough unless you are just trying to maintain the muscle mass you already have (and even then, twice/week is better).  Three times a week is even better, but only by a little bit, so if you are really working hard to fit it in, at least get in two workouts per week.  What are the muscle groups to target?

Legs: Both front (quadriceps) and back (hamstrings) of the thighs.  Think lunges, squats, stability ball hamstring curls, step-ups, and more lunges

Hips: Extensors (that would be the butt, Bob), and flexors (these are usually very tight and mostly need to be stretched).  Think squats, more squats, deadlifts,  kettlebell swings, lunges again

Back: Huge muscle groups!  Latissimus dorsi is the big one (lat pull downs, pull ups, rowing movements), anything where you pull something toward the center of your body either horizontally or vertically

Chest: Pectorals and anterior shoulder:  Think push ups, bench press (flat, inclined), dumbbell flies

Shoulders: Three heads to your deltoid muscles, so they like to be worked at different angles.  Exercises here include vertical pressing moves like the military press, with bar or dumbbells,  lateral raises (bend over an inclined bench for a different angle), dumbbell forward raise, and my favorite, kettlebell clean and press.

Abdominals:  Plank holds (front and side), bicycle, stability ball curls, regular curls, dumbbell or kettlebell renegade row (killer), Russian twist

Arms: both front (biceps): rows, pull ups, biceps curls, and back (triceps): triceps press or kickback, pushups, horizontal and vertical pressing moves

Is your head spinning?  Like I said, it is NOT COMPLICATED!  Pick one move from each group (some exercises overlap groups because they are complex, and therefore work across multiple joints).  Study the precise form from books, YouTube, friends who know, or a trainer before you try each exercise. Start light.  Warm up first.  Then gradually add weight until the last repetition is fairly difficult.  In the beginning, strive for two sets of 10-15 repetitions of each exercise.  In exercises where you hold for time, aim to increase your time by 5 seconds each time you do the move.

KEEP TRACK OF YOUR PROGRESS.  I know it looks silly.  But if you don’t know what you did the last time, how can you progress?  You have to challenge yourself by doing a tiny bit more or holding for a few seconds longer than the last time.  I carry a workout log around with me.  I look to see what I did on that exercise the last time I did it.  Then I will either increase the weight, or the number of reps, or decrease the rest between sets.  Only a tiny bit.  It’s all about baby steps and consistency.

Related Posts:

• Step Five of the Perfect Workout: Strength Training
• Step Four of Perfect Workout: Movement Preparation
• Step One of Perfect Workout: Rolling
• How to Raise Your PFT’s
• Step Three of Perfect Workout: Corrective Exercises

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.

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.

Related Posts:

• Step One of Perfect Workout: Rolling
• How to Structure Your Weight Lifting Routine
• Step Four of Perfect Workout: Movement Preparation
• Step Three of Perfect Workout: Corrective Exercises
• The Perfect Workout

Remember back in the days when you would hold static stretches before you exercised?  I still see people doing this…going straight from the locker room to the stretching mat and doing seated forward bends and holding calf and quad stretches before going to the elliptical machine or treadmill. We know better now.  First, it’s not good to stretch cold muscles.  If you must do static stretches, it’s much better to do five minutes of jumping rope or fast walking first, as the increased blood flow to the muscles helps to warm them up and may increase their elasticity.  It also turns out that stretching a muscle statically (holding the stretch for 20-30 seconds) may actually decrease its ability to perform strength and power moves.  So if you are intending to lift weights, it will benefit you  to find better ways to stretch prior to your workout, and do the static stretches at the end.

A better way to stretch cold muscles and get them ready to work is to stretch them actively.  This simply means to stretch your muscles while they are in the act of moving.  This is a dynamic process. Nothing is held for time.  You simply wake your muscles up by asking them to move into stretched positions.  A great example of this is the “inchworm,” one of my favorites.  Here is a great example of this.  Notice that the hamstrings and calves get a great stretch as they are working.

Click here to view the embedded video.

Another great exercise for the upper body targets the front of the shoulders and the upper back.  This is much harder than it looks, especially when you keep your butt, upper back, head, forearms, and wrists touching the wall the entire time.  Check it out here:

Click here to view the embedded video.

Walking lunges are a great way to warm up for running or lower body weight lifting.  To increase the stretch in the hip flexors, add a twist in the direction of the forward lunging leg.  Check this out here:

Click here to view the embedded video.

These are some of my favorite movement preparation exercises.  I will also do a few sets (if I am lifting weights) or a few minutes (if I am doing cardio) at a much lighter intensity level than what I do normally as more movement prep.  After all, the best way to prepare to do something is to do it…with a very light load.  This tells both your muscles and your brain to get ready for what is to come.

Related Posts:

• Step Two of The Perfect Workout: Just Move It
• Step One of Perfect Workout: Rolling
• First Sick and Happy Video!
• How to Structure Your Weight Lifting Routine
• Step Five of the Perfect Workout: Strength Training

Let me start by saying that by some grace of God or Universe or Source or whatever you want to call it, despite being a DD508, I have decent PFT’s at age 51.  I know that part of that is because I am now and always have been (since age 13 anyway) a total exercise fanatic-bordering-on-nerd.  There is rarely a day where I don’t do something…even if it is only a walk with my dog…as long as I am not on IV’s.  In fact, even when I am on IV’s, I have been caught jogging or at least doing leg weights.  My motto has always been, If You Can Breathe, You Can Exercise, which by the way, was the tagline of a CF Exercise Program I helped design and run at Stanford Medical Center.

But today in clinic, my FEV1 was down 15 percentage points from the last visit.  Bummer.  I’m not sick, but this is not my Cayston month, and it shows.  In addition, I’ve been on a major weight gain kick, which has involved eating a ton and lifting very heavy weights.  Almost all of my exercise time, except for dog walking, has been spent in the gym, not on machines, but doing deadlifts, bench presses, kettlebell squats and presses, etc.  I leave exhausted and feeling great.  Indeed, I have gained 6 lbs in two months.  But I could tell yesterday while playing tennis with my son that my aerobic conditioning was off.  I was sucking air and dreading today’s pulmonary function testing.

Isn’t it ironic that I actually started to write this article before the clinic visit?  Subconsciously, I must have known that I was going to have to revisit this issue, as I have done so many times in the past.  That’s just the reality of CF, as I’m sure you all know.  For me, return to the land of living (and breathing) after an exacerbation always begins first with a heavy sigh, and then a muttering of something along the lines of, “Ok, Julie, here we go again.  Back to Day One of getting back into shape.”  So far (fingers crossed), I’ve always been successful.  This article is a chance to remind myself (and you) how I’ve done it.

But before that, I know there is more to the fact that I exercise that has lead to my luck with the disease.  Exercise is absolutely necessary! Don’t get me wrong.  But it is not sufficient.  Although most of this article will deal with the types of exercise that I think are the most important, there are two more areas of self-care that cannot ever be overlooked if you want your lung function to improve:

1) Be absolutely unrelenting when it comes to treatments, including aerosols (antibiotics, mucolytics, and hypertonic saline) and airway clearance techniques (for me, the Vest).  How many times a day?  As many as it takes!  For me lately, it has been two.  After my experience today, that number is going to increase to three for as long as it takes to get those numbers back up.

2) Keep your weight up, no matter what it takes.  This has been my Achilles heel, but it is very clear to me that I am healthiest when I am heaviest.  I’m not talking Biggest Loser heavy here, obviously.  Overweight is as bad as underweight, just in different ways.  But then, I don’t know too many people with CF who are overweight.

Now on to the NUMBER ONE WAY TO RAISE YOUR PULMONARY FUNCTION TESTS:  EXERCISE

I used to think you couldn’t really increase your baseline PFT’s.  As a pathologist, it made complete sense to me that once your lung was scarred from chronic infection, there wasn’t much you could do.  In medical school, we learned that in CF, PFT’s just go down, and the goal is simply decrease the rate at which they go down.

You know what else we learned?  We were told that the brain could not make new neurons; that after losing neurons to stroke or injury, the patient was destined for life to be disabled.  This is completely false, as the evidence over the last two decades has shown that the brain is “plastic” and forms new cells and new connections throughout life.  Now I don’t really think scar tissue is turning into lung tissue, but something vitally important is happening in the lung tissue that remains with exercise.  We don’t know exactly how, but it gets better at what it is supposed to do.

My epiphany about exercise and PFT’s came after a round of P90X, and has been confirmed by many people I know who have raised their PFT’s with exercise.  I’ve written about my P90X experience elsewhere on my blog, so I won’t go into detail here, but after one round of this 90 day program of intense exercise, the volume of air I blew out in one second (FEV1) increased by 39% since the previous, and the small airway number (the FEF25-75%) improved by 70%! As I said in the blog, I didn’t believe it at first, so I went home and compared the actual volumes of air blown with previous tests.  At age 47, I was suddenly blowing what I blew in my 20’s.  Weird…and definitely not what I learned in medical school.

Since then, I have seen similar results after hard-core training with kettlebells, in combination with starting Cayston.  Yes, Cayston is a miracle drug, and I’m sure I would have improved immensely with it alone.  But you can’t convince me that my VO2 max training with kettlebells didn’t provide a major assist.

THE BIG FIVE

Aerobic Base

Even though this can be somewhat boring, it is important to establish a good aerobic base before moving on to more challenging interval and plyometric training.  This simply means that you are able to maintain an aerobic exercise (walking, jogging, cycling, swimming, etc) continuously at a moderate exertion level of 6-7/10 (where 10 is how you would feel if you were sprinting as hard as you can, and 1 is how you feel sitting on your couch) for 20 minutes.  As I’ve said before, it doesn’t matter what it looks like to be at this exertion level (a 6 for me would involve doing what would feel like a 2 to my son).  What is important is getting to that feeling of a 6-7.

Training for this base simply means starting where you are, whether that is walking around the block or cycling for a mile, and gradually building distance or time at a moderate exertion level.

Interval Training

Once you’ve reached the point where you can exercise continuously at a moderate pace for 20 minutes, you can add some excitement to your training.  Interval training is very simple.  You simply increase the intensity of whatever exercise you are doing for a given amount of time (i.e. 30 seconds), followed by a much slower recovery period for as long as you need it, and repeat this cycle several times.  When I am starting to jog again after a break (for IV’s or while dabbling in another form of exercise), I will begin with a jogging interval (very short at first) followed by a walking interval (until I can breathe relatively normally again) and repeat this five or six times.  In the beginning, my work:rest ratio will be at least 1:2 (for example one minute jogging followed by two minutes of walking).  Over time, I will increase the time of work and slowly decrease the time of walking.  This takes a lot of time (and patience), but it works every time.

Plyometric Exercises

If you haven’t checked out P90X, allow me to provide a short description.  It’s home based program where you watch and follow along as best as you can to a DVD showing unbelievably fit people exercising their a*^&’es off.   Three of the days per week, you do a DVD of circuit weight training, using weights or bands and bodyweight only exercises.  These are tough, but there are rest breaks (thank God) and each of the three “weight days” you work different muscle groups, so you have time to get over being sore before you do the same DVD again.

Another day is devoted to a Kenpo karate workout (my favorite), and another to a 90-minute yoga practice.

None of these are easy, but the real killer day (and the one that I think popped open my airways the most) is the dreaded “plyometrics” day.  Plyometrics is simply jump training.  So, you jump around…a lot…without much of a break…for a solid 45 minutes or so after the warm up.  This, of course, causes big time airway clearance.  It’s a bit like riding a racehorse while wearing the Vest, and being the racehorse at the same time.  Never once could I do this without stopping before the maniacs on the screen did.  But I know that this day was the one that did the trick for my lungs.

Are there less masochistic ways to do plyometrics?  Of course.  Jumping rope or jumping on a trampoline (mini or full size) is a start.  Of course, if you have arthritis or another contraindication to jumping, don’t do it.  But if you can, pick just one day a week, and do some jumping!

Weight Training

I don’t really know if weight training can improve lung function.  My guess is that it won’t. Apparently, my experiment of the last two months doing predominately weight training confirms this.

But I still include weight training as a valuable tool to increase lung function because, in my opinion, the results it brings provide important positive reinforcement and motivation to keep exercising!  Think about it, you don’t see the end result of your aerobic work, when it is by far the hardest to do.  You may see it on your next PFT blow, but those are few and far between.

On the other hand, weight training provides visible results (in addition to simply getting stronger).  You also can train just like anyone else, as the anaerobic exercise of lifting is not limited by oxygen supply.  You are in control here…not cystic fibrosis. This is rewarding, motivating, and, for me at least, makes me feel somewhat normal.

Posture Work

I’ve written quite a bit about this before, but in brief, if you are slumped forward at the shoulders and have a rounded back (a position many with CF assume after years of coughing), you are not able to use all of the available lung tissue.  Simply put, increasing the flexibility of your thoracic spine has the potential to improve lung function.  Read here how to do this.

That’s it!  That’s all you have to do to know that you are doing everything you can to increase your pulmonary function:  1) treatments religiously, 2) maintain a good weight, 3) achieve a good aerobic baseline and then start with some interval training, 4) throw in some weekly plyometric training to shake it up and out of you (gross), 5) work to increase strength and watch your body morph before your very eyes, and finally, 6) work on good posture.

Easy peezy, right?

Related Posts:

• Discover Your Strengths and USE Them Every Day
• How to Structure Your Weight Lifting Routine
• Step Five of the Perfect Workout: Strength Training
• Step Four of Perfect Workout: Movement Preparation
• Step One of Perfect Workout: Rolling

Corrective exercises are meant to do exactly what you would guess, namely to “correct” any structural imbalances which lead to vulnerable muscle groups. These types of exercises have also been termed “prehab,” with the idea that if you do them, you avoid injury, pain, and the need for “rehab.”  Why would imbalance lead to injury?  I’m glad you asked.

As I mentioned in the previous post, we all (and by “we” I mean those of us with CF) tend to develop a somewhat kyphotic (hunched forward) upper back, and usually the end result of this is an overarched, or “lordotic,” lower spine.  This lordosis combined with  hours and hours of sitting lead to tight hip flexors (the muscles that work to hinge your hips forward—think bringing your thighs to your belly-button).  Tight hip flexors tend to go along with weak gluteal muscles. This stick figure here shows the problem.  Tight low back and hip flexor muscles along with weak abdominals and gluteals.   The picture of imbalance.  This is a set up for low back pain.

These are the areas that I focus on in my “prehab” work.  I do exercises to strengthen my gluteals and abdominal muscles, and work to stretch and strengthen my hip flexor group and low back extensors.  In the YouTube video below, I go through a few of my favorite “glute” activators, and some good abdominal exercises using a stability ball.  Try these, and let me know what you think.

In the next post, I’ll talk about some corrective exercises for that pesky hunchback.

Click here to view the embedded video.

Related Posts:

• Step One of Perfect Workout: Rolling
• Almost Six Months Later….
• Step Five of the Perfect Workout: Strength Training
• Step Four of Perfect Workout: Movement Preparation
• Step Two of The Perfect Workout: Just Move It

Now it is time to move on to Step Two, which is all about improving mobility.  Mobility is becoming one of my favorite subjects lately, and I have been working diligently to improve my own.  It is not a complex subject; mobility is simply the ability to move.  As it relates to exercise, mobility is about the ability of every joint in your body to move through its natural range of motion.  Now, there are many, many joints in your body…somewhere between the mid 200’s to mid 300’s (the definition of “joint” is a bit fuzzy).  Most of those don’t need a lot of your attention. But before you stress your body with exercise, it is good to circulate a bit of synovial fluid (the stuff that lubricates joints) and wake up the millions of mechanoreceptors that live around your major joints…especially the ones you plan on taxing during your workout.

I have many tight and not so smoothly moving areas that I like to focus on, but the one area I’d like to talk about at length here, because I am certain that we all share this issue, is the thoracic spine.

Think about your posture.  Adults with CF very commonly have poor posture, and most of us with poor posture know that it is a problem.  The causes of the problem are many.  First, we are getting older, and with age comes increasing reinforcement of poor movement patterns.  The body adapts perfectly to what is asked of it.  If you start slumping your shoulders when you sit at the computer, or drive, or breathe, the body decides this is the position it is to always assume. Second, with age comes bone loss (especially in CF), which can lead to osteoporosis and subsequent hunching of the upper spine (technically called kyphosis).  Finally, as breathing mechanics change with increasing lung disease, there is consequential structural alteration of the thoracic cavity that worsens kyphosis.

Why is this?  Because the body tries to offset or balance the  increased hunching (kyphosis) of the thoracic spine with an over-pronounced swayback of the lumbar spine, also known as lordosis.  This leads to pelvic and hip problems, and the result is a mess. Sounds bad, right?  It is, and the worst part is that all of this leads to a very common problem in adults with CF, back pain.  The picture below illustrates this problem.

The thoracic spine is actually supposed to be very flexible.  It is supposed to flex, to extend and to rotate.  In contrast, the lumbar spine is designed more for stability and less for flexibility.  Sadly, most people have this backwards, and tend to use the lumbar spine more than the thoracic and hips for bending and rotating.  This often leads to pain, and commonly to injury.  Because the thoracic spine in CF tends to be even more “frozen” in place because of the above-mentioned issues, pain is extremely common.

But wait, there’s more.  Pain is bad enough, but what is worse is that the combination of poor posture and pain leads to inhibited airway clearance, less expansion of lung tissue and deteriorating lung function. Stiff and unmoving thoracic vertebrae also increase the work of breathing (isn’t it hard enough?).  None of this is good.  Not good at all.

But here is the good news:  Some of the postural problems in CF can be corrected.  Those having to do with muscle  and soft tissue tightness are reversible!  Stiff joints can be mobilized with specific exercises and soft tissues can be stretched to allow for normal alignment and movement.

This is why at least 10 minutes of your workout should be spent waking up and moving your thoracic spine.  If you are like me, you literally need to teach your brain exactly where this part of your back is, and how to move it because of something called sensory-motor amnesia.  This is exactly what it sounds like:  When you don’t move a body part much, the brain 1) forgets where it is, and 2) forgets how to move it.

I’m Convinced.  What Should I Do?

First, take a breath and don’t panic.  Then, check with your doctor and make sure these are safe for you, especially if you have osteoporosis. Next, to get a rough assessment of the amount of kyphosis in your upper spine, do this test.

Lie down on your back with your feet on the floor, knees bent to about 90 degrees.  Now press your low back into the ground and keep it there as you do the following:  bring your arms up and over your head, keeping them straight with your biceps muscles close to your ears.  Don’t move into pain, but see if you can bring your wrists and back of hands to the ground above your head.  If you have normal thoracic mobility, this is a breeze.  If you can’t, you are like me and have some pretty stiff and sticky thoracic vertebrae.  The following exercises are for you.  If you can, and want to keep it this way, the following exercises are for you.

1)Spend quality time with your double tennis ball contraption (link) every day…before your workout as I discussed in the previous article, and also throughout the day, especially if you sit at a desk a lot.  If you are bigger and have more muscle mass, you might graduate to double lacrosse balls.  This is not in my future.

2) Roll your upper back with a foam roller.  As you do this, bring your hands behind your head and keep your elbows close together (this gets your shoulder blades out of the way).  Slowly roll up and down the spine, stopping at the neck above, and the lowest rib below.  Try to “curl” yourself around the roll by aiming the top of your head to the ground.  If you have tight spots that are slightly uncomfortable, spend some time there.

3) Get on hands and knees and push your butt slightly back toward your heels.  Now take one hand (for example, the right) and place it behind your head by bending your elbow.  Now, keeping your butt back, rotate your spine by reaching the right (bent) elbow toward your left knee.  Come back up and do this several times, slowly.  Repeat on the other side.

4) Stay on hands and knees, but  this time sit all the way back onto your heels.  Take right hand again behind your head, and now rotate it up, toward the ceiling, trying to open your chest to the ceiling as well.  Don’t move your butt–this is keeping the lumbar from moving, thus isolating the upper back.  Repeat on the other side.

The sensory-motor amnesia problem is a bit more complicated, but can also be remedied with some drills taken from a system called Z-health.  I am currently immersed in learning Z-health and will write more about it in future posts, but these are some basic exercises that will begin waking up and mobilizing the spine.  Try them and then retest with the “raising the hands over the head” exercise.  My bet is that it will improve.  I don’t start my workout until I can do this without discomfort (but it has taken awhile to get there).  Start slowly, but be persistent and patient.  Your spine and lungs (and posture) will thank you.

Related Posts:

• Step Four of Perfect Workout: Movement Preparation
• First Sick and Happy Video!
• Step Three of Perfect Workout: Corrective Exercises
• Step One of Perfect Workout: Rolling
• The Perfect Workout

Unless you are a newborn, when you walk into a gym — quite a feat for a newborn — you are going to have some muscular tightness…some tension or “knots” in muscles that occur from chronic movement patterns that are less than ideal.  We all have less than ideal movement patterns.  This is not a judgment…it’s just a fact.

Those of us with chronic coughs especially develop tightness and tension in the thoracic spine, and neck.  Those who sit at work or at home at a computer for many hours a day can also develop muscular tension in the neck and back, as well as tightness in hip flexor muscles and hamstrings.  A good way to think about this is that over a long time sitting in a chair, your body tends to become “chair-shaped,” i.e. short and tight hamstrings and hips.  If that’s not scary enough to imagine (a chair-body), the ugly truth is that muscles don’t live in isolation from their neighbor muscles.  The entire soft tissue system (muscles, ligament, tendons and fascia) is all interconnected.  So a tight, knotted muscle in one area very definitely affects muscles, tendons, etc. both upstream and downstream from it.

This is why a knot in the middle of your back can cause pain all the way up into the back of your head.  Or in my case, this explains why spending a few minutes rolling the bottom of my foot around on a lacrosse ball can help me loosen up my ankles and calves.

So why do we care?  We care because it isn’t just that pain in one area leads to pain in another, but muscular weakness (resulting from those painful knotted tissues) leads to imbalance and weakness elsewhere, which leads to improper movement.  Somebody famous once said, “The body does what it does perfectly.”  So if the body moves imperfectly, it then perfectly continues to move imperfectly.  And if we, for instance, go for a walk or add resistance to imperfect movement, we solidify that pattern in our brains, and become nicely set up for injury…and more pain!

So what’s a (tight and knotted up) body to do? Well, before asking the body to work, it is nice to do whatever you can to lengthen and unknot the muscles that need attention.  This does not have to be a long process, and you don’t need to spend 30 minutes on your foam roller, thus using up your workout time allotment.

I have three favorite tools that I use for this purpose.  First, the aforementioned lacrosse ball is a must for my feet, and occasionally for very tight knots in my back.  If a lacrosse ball is too hard (and you will definitely know this), you can start with a tennis ball and move to a harder ball as your tissue gets more pliable and your nerve endings get used to the process.  For my feet, I simply stand up and put one foot on top of the ball and roll it around.  You will automatically gage how much weight to put on the rolling foot (by how much pain you can tolerate).  When I started this process, I could barely tolerate any pressure—I have very tight feet. But I persisted, 5 minutes every day.  After a couple of weeks, I didn’t mind it at all.  Now this actually feels good.  I don’t usually do this at the gym.  Instead, I have found that the easiest time to do it is when I do my treatment every morning.  It’s like giving myself a foot massage!  I also keep a lacrosse ball in the bathroom.  You figure it out.

The second tool I use is the foam roller.  You’ve probably seen these around.  Most are about six inches in diameter and about three feet long.  They are made of Styrofoam, and have lived in the gym scene for years now as a favorite instrument of torture.  I say this because they are used for “self-myofascial release,” a process that is slightly uncomfortable, especially when it is really needed.  I roll my calves, hamstrings, gluteals, and if I’m really feeling masochistic, my quadriceps over such a roller.  You will know what you need to roll by how painful it is.  The more it hurts, the more you need it.  You simply modify the move to a tolerable level of pain by taking some of the weight off the body part being rolled.  I generally spend five minutes or so rolling as the very first part of my workout.

Tool number three is a very expensive, intricate and complicated instrument.  Kidding.  It’s called a “peanut,” and is comprised of two tennis balls duct taped together to form a peanut-shaped duo.  This handy little tool sets my thoracic spine back to where it’s supposed to live every single day.  The maneuver is simply to place the peanut on the floor under your lower ribcage, and lay back on it so that the groove in the peanut is directly under your spine.  This places each ball of the peanut perfectly under the bundle of muscles that lie adjacent to your spinal column.  You simply roll back and forth on the peanut several times in the position, then move it up the spine about an inch and repeat.  Moving this way all the way up to the level of the big protuberant bone at the bottom of your neck takes only a couple of minutes, and is one of the best things you can do for knots along the spine as well as mobility of the spine (to be discussed in a later post).

That’s it!  Soft tissue rolled out…now it’s time to move on to mobility work.

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• Step Four of Perfect Workout: Movement Preparation
• Step Three of Perfect Workout: Corrective Exercises
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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)

nutrition

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!

Related Posts:

• Control Trumps Fear When it Comes to Adherence to Exercise in Cystic Fibrosis
• Step Five of the Perfect Workout: Strength Training
• Step Four of Perfect Workout: Movement Preparation
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weekend constant companions

Today is a new day, and instead of focusing on what isn’t working (most of me), I am going to write about my experience at the RKC in Minnesota just two weeks ago (it seems like two years ago at this point).

For those who don’t know, RKC stands for Russian Kettlebell Challenge, and the weekend certification is an intense three day immersion into technique and proving that one is “worthy” of the title “RKC Instructor.”  It is not for wimps.

Kettlebells have been around for hundreds of years in Russia, but are relatively new to the scene here in the US. They were brought here by the Evil Russian, Pavel Tsatsouline, a former Soviet Special Forces physical training instructor.  He is known now as the modern King of Kettlebells, and it is his methodology that is taught by “official RKC’s.”  Since bringing the kettlebell to this country, Pavel’s proteges are found on the Secret Service, Counter Assault Team, among US Navy SEALS and Force Recon Marines.  And then, there’s Julie.

Now you may wonder, why would a 50-year-old woman with cystic fibrosis want to be in the company of men and women who are either hard core trainers or athletes or counter-terrorism experts?  Kidding on that last one…

Yeah…I wondered that, too.  Especially at the meet and greet that happened the night before it all began.  I was there by myself, of course (who would accompany me to this?).  I stood in the room looking around at the healthy, muscular men, all many many years younger than I, and the equally healthy and fit, excited young women…I was looking for some older faces.  Please God, don’t let me be the only old person AND the only half-assed lung person.

Don’t get me wrong.  People were friendly.  Everyone was incredibly friendly to me.  Not just friendly, but reassuring me that I wasn’t crazy to be there (oh, what they didn’t know).  Many, many older people come to these certifications, they assured me, and some even came just to meet a personal goal, like me, rather than to be over-prepared for their upcoming SEAL training.

Needless to say, I went to bed with just a mild bit of trepidation.  Would I pass?  Pass…hell, would I live through this?

When I say, “pass,” what I mean is to meet all of the requirements of the weekend.  This is not just to pass the dreaded “snatch test,” (A snatch is a move where the bell is brought -with one hand-from between the legs to over the head with a strait arm in one fluid motion. My challenge was to snatch a 12 kg kettlebell 100 times in 5 minutes, switching arms as needed.  BTW–12 Kg = 26 lbs).  Just FYI, if I were to go to the garage right now and try to snatch my 12 kg bell for reps, I might get in 3 or 4 before I had to stop and gasp for air).  The snatch test is what everyone fears.  It sucks.  Seriously…even for healthy people.  It is a test of muscular endurance and aerobic capacity for which one must train for months in advance.  It’s also a test of sheer will, and the ability to endure pain.

But wait, that’s not all.  In addition to the snatch test, women must do the arm hang for 15 seconds (cake), and a woman of my size has to show perfect technique in the double kettlebell  (52 lbs) swing, double clean, double squat, double press, and the  single snatch…all for five consecutive reps. In addition, one must show perfect technique on an unusual exercise with an equally unusual name, the Turkish Get-Up.  None of these were cake.  Instructors were very picky about perfect form…for good reason–if they were to send people out to teach with sloppy form, the whole RKC brand would be harmed.  Form is everything…it prevents injury and promotes safety.  Nobody passes without perfect form.

But even that is not all that is necessary to pass.  The hardest thing required is that you actually have to get through each day of grueling practice, random “punishments” for the whole group if someone messes up by wearing the wrong shoes or sitting with a flexed spine.  I’m serious…they are very serious.  The first of such punishments come early on Day One, when we had to walk around the block carrying our snatch test bell.  This is way harder than it looks. Here we go, with yours truly leading the pack:

yep, that's me in front

And finally, there were “workouts” scattered throughout each day.  Each were short, only 10 to 20 minutes, but can you spell i-n-t-e-n-s-e?  I’m  blanking on most of them…I’m sure my brain is trying to spare me the memories.

Another requirement for passage was to demonstrate on the last day that we were capable of teaching what we had learned to bussed in “victims.”  These were volunteers from the community who “wanted” (read: they were bribed by great discount prices on Dragon Door products) to learn from newbie instructors about the latest greatest exercise craze.  We each got a victim to teach for 45 minutes, and then to workout for 10 minutes.  I had a great guy who already knew a fair amount.  I got lucky.

Finally…the last requirement…the “graduate workout.”  If you don’t complete it, you don’t pass.  It can take you all day if you need it, but you and your kettlebell (now your best friend) make your way up and back a huge field, stopping to swing and snatch away.  It took 40 minutes.  It was cold…I swear I saw snow (May 1, in St. Paul, MN).  I couldn’t feel my feet.  But when I completed that last swing, I was the happiest girl in Minnesota.  Heck, I wasn’t even the last one to finish!

Following the Grad Workout, we all waited with baited breath for our one-on-one meeting with our team instructors, for overall evaluation and the final decision…pass or “you’re fired!” (not really, if you don’t pass, you get a chance to work on your flaws and send in a video of you correctly performing the required exercise).  About 30% don’t pass.  These are athletes!  Seriously.

So, long story short:  Here is the evidence that I gave it my all:

This is after Day One.  I read somewhere that we did about a thousand swings on Friday.  I didn’t count, but I would believe it.  After I took this picture, I ordered room service because I literally could not move from the chair.  The bummer was that I could not sleep, 1) because I was on California time, and 2) I went into the weekend thinking the snatch test was on Day One.  Turns out they moved it to Day Three…so I was still nervous about whether I could do it…even more so actually, because I knew that by Sunday I might not be standing.

The morning of Day Two, I got out of bed with nary a single silent muscle fiber.  They were all screaming at me.  It reminded me of the day after the first day of basketball practice when I was in high school…only worse because I don’t believe I was fifty years old back then.  It didn’t help that I had to get up an hour early to do my treatment.  Yes…I did them all … except one.

Day Two went from 8 am to 7:30 pm.  Yes it did.  There was a 45 minute break for lunch and scattered water breaks through the day.  Also scattered through the day were more workouts, and more punishments.  Is this what military boot camp feels like? Learn and practice, all day, the clean, the press, the front squat, the snatch.  A favorite workout of mine this day (not) was called the “breathing ladder.”  Basically, it consisted of swinging the kettlebell for a given number of reps and then only resting for as long as it took to take a given number of breaths.  The reps increased, as did the number of breaths allowed, until we were all dying (not really). The purpose was to teach you how to slow down your breathing when stressed and breathe from the diaphragm.  A laudable goal, yet I don’t recommend this for anyone with a lung disease.  I did it, but the whole time I was wondering if I was about to desaturate right there on the floor.  I collapsed in the bathtub that night, wondering why the Holiday Inn bathrooms didn’t have those little strings you could pull for help, like they have in hospitals and assisted living centers.  I had only myself to blame.  No sleep again, but this time it was due to Prom night, and the collection of very drunk women who wanted to party in my hallway at 3am.  They were actually yelling.  I hope I never acted like that.

Day Three was there before I knew it.  I woke up determined to tape my hands in a way that would protect them from inevitable tearing during the snatch test.  I had read about this technique, and had brought with me all the requisite medical equipment.  I was a doctor, dammit.  I could help myself out a little.  Here is my beautiful tape job, done while inhaling salt (this is tricky, if you think about the number of hands required to 1) get taped, 2) do the taping, and 3) hold a nebulizer).

Do you realize how long this took?

So when the day starts, we all gather in our teams, and our Team Leader, Andrea Chang, says, “I need to see all hands.”  I hold mine up, proudly.  She looks at me and says, “Take it off, I have to see the skin.”  What?  I was chagrined. My masterpiece…in the garbage.  Apparently, they needed to see intact skin before the testing was to commence.  If anyone had an open wound, they had to be taped.  This is where you might say…but you were taped, Julie.  Yes…  It didn’t help that when she looked at my hands, she said, “You don’t need tape…you’re good.”  Ha!  Good… At this point of the weekend, I was not good.  My lungs were GREAT, but everything else hurt like hell.

Go lungs.  And they did.  The tests came, and went.  Technique tests were a bit nerve-wracking, because you know they are watching every single hair on your head, every angle, every point of contact with the ground, every joint position.  It was more of a mental test than physical.  But, then came the moment of truth.  I run outside to do the snatch test…remember, 100 in 5 minutes.  I had done this once before, so I had a modicum of confidence.  Yet, this had been before my most recent bout of pneumonia, so it was a very tiny modicum.  I really didn’t know if I could.  I remember thinking as I bent down to get set up to start, (and I know this sounds corny, but it’s true), Kathy…Tom…I’m doing this for you guys, too.  And I started.  I don’t remember it really.  What I remember is that with 10 seconds left, I had to go ALL OUT to get the 100th done.  But, I did…there was no way I was going to end up with 97, or 98, or,God forbid, 99. And then I seriously sucked air for many, many minutes.

When the Graduate Workout time came later that day, I knew I could do it.  If I could pass the snatch test, I could do anything.  I had a lot of folks cheering me on, by this point.  It felt unbelievable.  I was strong. I was woman.  Did you hear me roar?

The whole thing was surreal.  The feeling of pride that came over me after the last swing was more immense than when I graduated from medical school.  It was the hardest thing I have ever asked my body, and my will, to do.  And I did it as a 50-yr-birthday present to myself.  When times get tough, as they kind of are now, even reading what I have written cheers me up.  I am tough.  I am a fighter.  CF will never win.  I will decide when to go back to my corner.

R…K…C!!!!

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This is what happened:  In short, I went, I conquered, I returned to crash and burn with pneumonia.

My mother was right, and so was my father, sister, partner, and probably even my dog.  You really can have too much of a good thing…even exercise.

Someday, some post, I will relay my experience at the RKC.  It was one I will always remember, and that I will never regret doing.  It was amazing to feel strong, to realize that I was as tough as the next guy, even though my lungs suck (ha, no pun intended).  It was humbling to realize how much I didn’t know, but equally gratifying to complete something I had set as a truly ridiculous goal for a 50 year old with CF.  I met great people, friendly people, scary strong people, and a few people who were there, like me, just to push themselves.  I was forced to “come out of my shell” in a sea of strangers (I really am shy), to explain my cough to people who worried for me, to assure people that I wasn’t really going to leave a lung on the floor–it just sounded that way.

I wore a Life Is Good shirt this, the first day, because it was really how I felt…happy to be there even though it was 35 degrees outside…happy to be swinging kettlebells with the best of the best…happy that my body was cooperating (well…it was at that moment)…just happy.

So I learned my lesson.  No more Navy Seal-like goals for Julie.  But, man was it a blast.

Back to Boot Camp posts.

Related Posts:

• How to Structure Your Weight Lifting Routine
• Step Five of the Perfect Workout: Strength Training
• Step Four of Perfect Workout: Movement Preparation
• Step Three of Perfect Workout: Corrective Exercises
• Step Two of The Perfect Workout: Just Move It