How to Structure Your Weight Lifting Routine

Nobody wants to walk into a gym to lift weights knowing nothing about weight training.  First of all, it is obvious, and who wants to look as clueless as they feel?  But you are not clueless if you have read my “perfect workout” series. You know to immediately roll and loosen up your joints, to then move into some corrective work, then to do movement preparation drills.  Now you are ready to lift…

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.

How to Raise Your PFT’s

I knew that would get your attention!

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?

 

My Weekend at the RKC

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:

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).

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!!!!

Almost Six Months Later….

Well, it has been a very long time, hasn’t it?  You may wonder where I’ve been…why no words of wisdom from the now 50-YEAR-OLD Julie?

The reason is that it has been a winter from Hell, and I will just leave it at that because my mother (RIP) always told me that if I didn’t have anything nice to say, I should just say nothing.

But, here I am, ready to begin this strange past-time of blogging again, wondering if anything will fall out of my brain.  I decided while on my walk today that I will begin by doing what is easy: posting what I have already written.  Lame, I know, but let me explain.

Two years ago, I decided I knew exactly what would be helpful to other adults with CF, and I set out to write it up.  I fondly titled this project my “CF Wellness Boot Camp.”  The idea stemmed from the fact that most people with CF, and certainly all adults with CF, are increasingly thrust into what I like to term “exacerbation exasperation.”  Say that five times as fast as you can.  You know the game:  you go about, living your life, doing what you do, feeling as good as you feel, and then WHAM, you are sick, need IV antibiotics, and essentially life must go on hold.  Your body-your master- revolts, and you are its slave.

Three weeks later (and can I just get a hand here for Western medicine?) you are better.  Your lungs are clear-or as clear as they get.  You now have enough energy to shower.  You look at your desk, your kids, your spouse/parter, your dog(s), your list of everything you were supposed to do back on the day before the aforementioned body revolt, the scale now reports that you are five lbs lighter…  You take this all in, and the only thing you want to do is crawl back under the covers.  Does this happen to you?  It’s all so overwhelming, this re-immersion into your life.  Whatever fitness progress you made before your illness is gone.  The stress of being completely knocked down is replaced with the stress of getting up.  At least, this has been my experience.

So, the plan for the Boot Camp was to outline a three-week plan (everything seems to come in blocks of three weeks) to begin anew and re-enter the world with some new, healthy habits to accompany those pristine (?) lungs.  So I put on my wellness coach hat and began to write.

This was quite a project for me.  I wrote for a couple of months until I was happy with the content.  I then began to research how to make it into an e-book, put it on the website, and, generally, do all of the technical stuff that one must do in such a project.  Roadblock.  Big time.  Julie is not “tech-y.”

Thank God for David Mahoney, though, because he really tried to help me.  I was just not able to keep the ball rolling, and the project sat for two years, lost but not forgotten, on my hard drive.

So that brings me to my walk this morning.  I want to blog again, so why not start by posting my 21-day plan?  Maybe when it’s all up, I’ll figure out how to bundle it into a pdf and send it out instead of the fizzled out newsletter promise in the opt in box?  Who knows?

So, as my favorite email come-on’s say, watch your inbox (for those who have opted in)!  Tomorrow we begin the CF WELLNESS BOOT CAMP!

To your health….

 

Control Trumps Fear When it Comes to Adherence to Exercise in Cystic Fibrosis

I’m getting a lot of ideas for posts as I prepare for this talk in a couple of weeks at the NACFC in Minneapolis.  I am speaking about motivation and exercise, one of my favorite subjects, and am quite happy to be doing it.

Today I reviewed an article published in Thorax 2004; 59: 1074-80, by Moorcraft et al, entitled Individualized Unsupervised Exercise Training in Adults with Cystic Fibrosis: a 1 year randomized controlled trial. Here are a few reasons why this is a well designed study and one to believe:  1) it is (in CF terms) a pretty long term study.  Most others are only weeks to a few months in duration. 2) It was randomized, a short-fall of many other exercise in CF studies. 3) After an initial training session, it was unsupervised and the exercises (though structured by a trainer) were done at home–so the positive results are  good news about adherence and sustainability of a program.  The patients were, however, given frequent contact by phone and/or clinic and were actively encouraged and motivated to continue.

The results were indeed positive.  After a year, a significant training effect was shown in the training group and there was a lesser decline in lung function in those trained when compared to controls. But, as important as that is, that is not why I am writing this.  The most important point of the article to me was in the summary, where the authors state:

“Every effort must be made to adapt the exercise to fulfill the wishes of the patients and integrate it with their lifestyle.  This study shows that benefit can be obtained with an individualized home-based programme.  In the long term, motivation must be sustained by the individual and the clinician must strive to engender an exercise habit.  A flexible approach to encouraging exercise and an enthusiastic approach from the staff should not be underestimated.  A feature that favours exercise adherence in CF is that the patients perceive it as an area over which they have control and that, unlike other treatments, fear of their disease does not drive adherence to exercise (my emphasis).  Instead, they have a positive outlook on exercise regarding it as a normal activity which they can enjoy.”

I don’t know about you, but I think that fear sucks.  It doesn’t feel good.  It incapacitates me when it comes to rational thinking, and over the long haul, it frankly shrinks my brain.  It is true that sometimes fear works to motivate.  If that weren’t true, I probably wouldn’t have made that phone call to my doctor when I coughed up blood.  I feared for my life, and a phone call was made.  Fear works in acute situations.  It is the flight aspect in the fight or flight response to the mountain lion on the bike path.  Ok, bad analogy.

The point is that as a long term motivator, fear is a BAD choice.  Chronic fear leads to increased stress hormones which lead to depression and brain shrinkage.  Neither helps with adherence to any kind of program, let alone one where you must insert significant energy, as in an exercise habit.

Control, however…now THAT is powerful.  To me, seeing and feeling my body respond to exercise over the long haul is not so much about control as it is empowerment.  I feel actual empowerment over at least part of my body…and this is not a common feeling for one living with a disease such as cystic fibrosis.  This empowerment leads to confidence in other areas as well, and makes one think twice about negating the effects of all that work by, for instance, missing treatments.

Thinking about going to the gym or going out for a run just like any other “normal” person makes me feel more “normal.”

Now think about a kid…an adolescent with body image issues and control issues who is angry and in denial about living with CF.  How helpful do you think a little dose of empowerment and normalcy might be?  Trying to instill a little fear into him or her would lead one direction…the one you don’t want to go.  Helping them to feel good about how well they respond to an exercise program and encouraging them to exercise because it is what we ALL should do…that works!

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