Sick and Happy » motivation

How to Structure Your Weight Lifting Routine

Julie Desch — Tue, 20 Sep 2011 20:20:59 +0000

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

Julie Desch — Thu, 21 Jul 2011 21:45:06 +0000

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

Julie Desch — Mon, 16 May 2011 03:44:06 +0000

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!!!!

Almost Six Months Later….

Julie Desch — Wed, 13 Apr 2011 21:54:08 +0000

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

Julie Desch — Tue, 06 Oct 2009 18:38:33 +0000

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!

Five Reasons You Must Start Resistance Training Today!

Julie Desch — Thu, 30 Apr 2009 18:00:15 +0000

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

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

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

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

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

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

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

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

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

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

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

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

THE TRYING, I MEAN ADOLESCENT, YEARS

Julie Desch — Tue, 10 Mar 2009 04:47:45 +0000

My oldest son is about to turn 12, and I am getting a first taste of what is to come. This will require fortitude….and the ability to dance. No, I don’t mean really “dance,” I mean mentally and emotionally dance with him, as he comes into his own. Now, if he had CF and I were trying to get him to exercise as a method of airway clearance and self-esteem enhancement, I would:

Not exactly phrase it that way.
Make sure it included other peers (unless this causes additional discomfort, embarrassment, etc…).
Introduce weight training as soon as he/she is capable of following direction and mature enough to be safe.
Strictly enforce the bike/walk/scooter/skate to school, the store, a friend’s house, etc… rule.
Hope that he/she liked to play soccer, basketball, baseball, or whatever team sport was available, so that a “coach” ordered the training, and not me.
Continue to use enticement, aka bribery, to encourage daily exercise.

Let’s take them one at a time, shall we?

The Wording and the Timing of the Wording
First, the word “exercise” has unfortunately taken on a negative connotation among many of our youth these days. I don’t quite get it, frankly. When I was a kid, the trick was in getting me and my friends to come in at night. Now it is the exact opposite. I suppose it has something to do with the myriad forms of indoor entertainment these days. The problem has become that in trying to entice some form of movement away from electronic screens, we (and by we, I mean I) use the words “You need to get some exercise!” Instant negative reinforcement. “Exercise” is equated with the taking away of something good…screentime.

If you are a psychology buff, you know that this negative reinforcement is not going to promote the behavior (exercise) that you want. A more useful way to reinforce that behavior is to associate something positive with it. Like Pavlov and the dog! Remember, bell…food. So yes, get them away from the screen. By all means. But don’t repeat my mistake, and use getting exercise as the reason why. Bad idea.

How To Fit Exercise In

Julie Desch — Sat, 31 Jan 2009 04:17:35 +0000

In a previous post, I discussed time in a very esoteric way. Yes, Eckhart Tolle is right in a way…time only exists in a horizontal dimension, the one we are used to dealing with most of the time. CF and all of its accompanying “life situations” exist there, too. It’s enlightening to understand that we don’t have to be dictated by that dimension all of the time. We can practice entering the “now” and get vertical anytime we want…

Alas, one must also be practical in this world. So, let’s get real about time, shall we? Yesterday, when I finally got in the shower and first brushed my teeth at 3:30 pm…exactly 9.5 hours after awakening, I realized I needed to write this post. Mind you, none of those 9.5 hours were wasted. And I don’t even have a real job!

I don’t need to go into the specifics. If you are reading this, you already know the laundry list of things that must be done once, twice, or even three times daily regarding health care. The meds, the nebs, the Vest, the food, the insulin, the enzymes, the vitamins, the doctor’s appointments, the trips to the pharmacy, the uncomfortable moments (hours) where you just want to be left alone to deal with your digestive system…

This is all before “life” stuff…work, school, kids, spouses, friends, churches or spiritual activities, fun, Grey’s Anatomy….

My first point: “When in the WORLD is there time to exercise?” is a reasonable question.

My second point: It needs to be part of that first list…the essential health care activities, or else it just isn’t going to happen.

The number one reason CFTR-able people don’t exercise is TIME, so it stands to reason that the addition of hours of self-care does not make the problem any easier. Nobody has time. That is a given. Accept it as a given, and make time anyway.

I have coached and known many people with CF, and I have not once met someone who was not happy and proud of themselves for having started an exercise program. Yes, it is hard to fit in. Yes, it is frustrating to get sick and have to start over from what feels like ground-zero. But, it is always worth it.

HOW TO MAKE TIME ANYWAY

Tip number one: If you keep a scheduler, or planner, or palm, or iphone…whatever, schedule yourself in FIRST. Start with just 20-30 minutes. Go for a walk or do some yoga. Get into moving your body in some way, every day. Over time, splurge and give yourself an HOUR a day.

Tip number two: Schedule a reward for immediately after your exercise. Make it small, but something you really want…a latte, a nap, whatever. You have to really want it, and you DON”T get it unless you exercise.

Tip number three: Plan to exercise with someone else. Set a date, time and place. The accountability factor kicks in, and you tend to show up.

Tip number four: Try hard to establish the habit of doing your exercise first thing in the morning. This is the only way I made it through medical school/residency and stayed healthy. It was a grueling schedule, but I know that it was the early exercise (accompanied by the early to bed the previous night) that provided me the energy to live through it.

Tip number five: Set a goal. Make it appropriate for you, but also, set it high enough that it will force you to stretch yourself a bit. You don’t grow muscle mass or endurance or flexibility without stressing the system. If you are new to running, schedule a 5K. If you are new to yoga, try to make it through an entire class! If you are new to weight training, work up to your first unassisted pull-up.

Tip number six: When you reach your goal, tell everyone you know how great you are, and celebrate!

CF and Time

Julie Desch — Thu, 29 Jan 2009 03:02:03 +0000

I am researching for a talk I will give to a CF Education Day in a couple of weeks, and found this article that I wrote three years ago. The talk is going to be about exercise, of course, and how to find both time and motivation to move when you live with CF. But re-reading this made me slow down a bit (hard to do on Prednisone), and remember what this time thing is all about. I hope you enjoy:

CF and Time
As a fellow anatomic pathologist, I fully respect Dr. Dorothy Anderson’s description and naming of the constellation of signs and symptoms that we now call Cystic Fibrosis back in 1938. Her observations marked the beginning of several decades of medical research, the outcome of which allows me to sit at my computer at age 45 and write this. But for now, I would like to think way, way outside the box, and ask a question posed by one of my favorite spiritual teachers, Eckhart Tolle. Does chronic disease really exist? Does CF really exist?

In “The Power of Now”, Tolle differentiates your “life” from your “life situation”. He speaks of your “life” as this very ”moment”, as opposed to your “life situation”, which is comprised of the circumstances or conditions of your life. As such, your life situation is your “story”, which has a beginning, middle, and eventually, an end. It exists on the horizontal axis of time. However, there is a part of each of us that is unchanged over time and exists outside of time. Think back to that day you learned to ride a bicycle. Or think of throwing that high school graduation hat into the air with a big cheer. Or perhaps, think to the moment when you said, “I do”…. In each of these situations, there was an awareness of what was happening, and that same awareness, unchanged, is aware that you are reading this page now. That awareness is what Tolle would call “life”, and it does not exist in time. It is NOW. It does not change, because it lies on a “vertical” axis, with no past and no future.

Try not be offended by this (many of us are very attached to our CF), but imagine for a moment the possibility that CF is part of your “story”, existing on the horizontal axis of time. At some point you were diagnosed. In other words, a combination of sounds emitted from your doctor’s mouth (copied from the sounds Dr. Anderson decided best described this disease) was suddenly ascribed to YOU. Those sounds became part of “who you were”. The beginning of your CF story may have been when you were a baby, or later, but part of your identity was now as a “sufferer of” CF. The story then continued, with a different trajectory for each of us. For some of us, the story has already ended.

Your story isn’t just CF, of course. There is the story of what you do for a living, how your body has grown and changed, what you have learned over time, who you know, who is in your family, how many dogs you have loved and lost….If you think about it honestly, whenever you ask yourself the question “Who am I?”, the answer is usually just more of the story. “I am a lawyer”, you say. Then who were you before you got your JD? “I am a father and husband”. Who were you before you were married? “I am sick” really means the physical part of “you” is not completely healthy at this point on the horizontal axis of time. Yes, your body has weird and unusual chloride channels lining its epithelium. But is your brain “sick”? Is your heart “sick”? Are your bones intact? Can you see? Are you breathing? Can you love?

“I” (the author) am a 45-year-old female “sufferer” of CF, retired physician, mother of two, partner, wellness coach, friend, daughter, sister… Yeeeees, but other than being “female”, all of that has been variable throughout my life (and as I understand it, even being female could be changed, if I wished…). Who was I when I was 9 months old, and had no language yet?

But, you argue, my brain is the same…! No it isn’t. Neuronal pathways are always changing; cells are dying; plaques and tangles are forming (at least, in our “old survivor” brains). I’m sure you’ve heard that all of your cells are dying off and regenerating constantly. Nothing is constant on the horizontal axis of time. The “life story” is ongoing, and ever changing, just as the body is.

Do you see the point of this tirade? A part of you, and I would argue, the ”real” you, is the observer of your story, or as Tolle would say, “the awareness” within which your story unfolds. Does that “awareness” have CF? NO! The body in which the “awareness” resides has CF! So does CF really exist? Only in time! Only in the content of your life, the content that always changes and that describes you, but is NOT you. The content is your life story, but is not your LIFE. The real you is life itself, and that life is now, this moment. “CF,” then, in this moment, is really reduced to what you are actually experiencing now. Maybe that is a cough. Maybe it is rapid breathing. Perhaps it is pain in your joints as you walk. Or, possibly, in THIS MOMENT, it is nothing at all.

“Wow,” you say, “Julie has completely lost it!” But if it sounds kind of interesting to explore the idea of “this moment” where CF possibly doesn’t even exist, maybe you are asking, “How do I get there?”

I’m glad you asked. This is the cool part. Tolle describes “portals” into the NOW. Entering these portals is sort of like a meditation, yet it is not meditation in the way we usually think of it. I don’t know about you, but when I focus on my breath, I do NOT enter a state of bliss! These portals are much easier to use.

One portal, my personal favorite, is to become aware of the “inner body”. Another way to describe the inner body is your “life force”, or “life energy”. To do this, you simple sit or lie in a comfortable place, close your eyes, and ask yourself without moving it or looking at it, “Is there life in my left hand?” This may take a few moments. You probably will be tempted to move your hand, but don’t. Just sit or lie in stillness and find out, “How do I know that my left hand is there…without looking at it or moving it?” After awhile you become aware of the energy of your hand. That is your “inner body”. When you become aware of it in one hand, you then move your attention to the other hand. Then, when you can feel it there, you try to feel it in both hands at once. After that, you get adventurous, and move to your feet, and up your legs, to your torso, then arms, then neck and head. With some practice, you can soon, at will, become aware of the “inner body” within your entire “outer body” (the one you can see and move).

Here’s the catch: the only way to feel this “inner body” is in the NOW. You can’t do it if you are remembering the past, or worrying about or anticipating something in the future. You can only feel your inner body in THIS MOMENT. This technique essentially forces you into the “NOW,” the vertical, timeless dimension called awareness. In this space, I would argue that there IS NO CF. There may be a cough (see if you can maintain awareness of this life energy while you cough), but the energy is separate from the cough… from the body… from your thinking mind. It’s wild.

If you get really into it, you can practice this awareness throughout the day. You can do it during a treatment. You can practice while folding clothes, or while walking, or while in a particularly unpleasant conversation with an ex-partner. The more you practice, of course, the easier it becomes.

There are other portals, of course. But this is getting way too long. I would be happy to share my experiences with them (all very legal!). Just give me a call or email. Until next time: BE FIT…BE STRONG…BE WELL!

Five Steps to Re-Energize

Julie Desch — Sat, 24 Jan 2009 03:38:47 +0000

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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