If you’ve followed the last few posts, you know that I have been focusing on a problem that many people with cystic fibrosis face as they get older. First, let me say that it’s not just us! Even a “normal” person with no lung disease begins to lose muscle mass at a rate of about 1% per year in his or her 40’s. This loss (also called sarcopenia) then speeds up and can reach 2% per year in the 50’s and beyond. Of course, the more you start off with at year 40, the better off you will be at age 60 or 70. The causes of this muscle loss are numerous, and include lack of exercise, poor diet, inflammation, and hormonal changes. To this list, cystic fibrosis patients can add steroid use, poor absorption of nutrients, and numerous hospitalizations leading to even further lack of movement. So what’s a body to do?
Well, this is exactly why I am writing this series. It is important to take muscle gain seriously and in a timely fashion. Don’t wait until you are a skinny fifty year old! However, if you ARE a skinny fifty year old, first of all, congratulations! Second of all, it’s not too late. Get going now! At least you can slow the loss of muscle tissue by using it.
Alright, off the soapbox. On to the content… As you read here and here, rule number one if you want to gain muscle is to pick a good, well designed weight training program and follow it. Rule number two was to increase your caloric intake; specifically, to increase your protein intake. The last rule is to allow your muscles to recover!
There is no faster way to sabotage yourself that to decide that more must be better. More is definitely not better when it comes to lifting weights as a weight gain strategy. It is definitely the way to go if you want to overtrain and get so burned out that you either 1) get sick, or 2) end up hating the gym.
Your muscle tissue needs two things to recover from a resistance workout. It needs food, specifically carbohydrate and protein. It is best to get these in a ratio of 3 or 4 to 1. So for example, I drink a protein shake with 20 gm of whey protein and 60 to 80 gm of carbs in the form of berries, coconut milk and a banana. A simpler option is a big glass of chocolate milk. Ideally, you want to feed this delicacy to your starving muscles as soon as you can after a workout. I shoot for drinking my shake within 30 to 60 minutes after my last set. The reason for this is that the muscle cells are primed to transport both glucose and amino acids immediately following exercise. They are primed because they need these nutrients to recover; glucose to replace the lost glycogen stores, and amino acids to rebuild the contractile proteins that were damaged by the exercise (don’t worry, the damage is a good thing as the muscle is rebuilt stronger and bigger).
The other thing your muscle tissue needs is time off. This is why good programs tell you to rest at least one day between sessions that work the same muscles. You cannot work a muscle every day and expect it to grow. Muscle is built while you rest, not while you train. Therefore, no rest = no building…only tearing down. If you work legs on Monday, rest them on Tuesday. If you must do something, work your upper body instead. If you have a hard, full-body workout on Monday, take Tuesday completely off. It’s ok! Go for a walk. Walking doesn’t count…it is not resistance exercise. It is simply moving…which we are made for and need to do. Finally, if you do not get enough good quality sleep, forget it. Sleep is right up there with food. Sleep is when the cellular trash is taken out, and new proteins are built. It is the time to grow. It is also necessary to get enough sleep so that all of your hard work is not completely overruled by increased stress hormones as a result of too little sleep. Eight hours is a minimum!
Here’s the formula in a nutshell: Workout. Eat to recover. Chill out the next day (but go for a walk!). Sleep a TON. Repeat.
In the last post, I discussed the first of three very important essentials of gaining not just weight, but aesthetically pleasing and healthy weight, AKA muscle. If you missed that post, you can read it here. In part II, I’ll reveal the very basic and obvious second essential ingredient. While obvious, this is the one that I personally have the most trouble with. It’s another case of a habit being very simple, but not necessarily easy.
You have probably guessed Rule Number Two by now. If you are going to work your muscles with a well-designed resistance training program, you also need to feed them! Muscle tissue is largely protein, and to build it up, you need to consume…wait for it…protein! You very likely need to consume more protein than you are now. The target I shoot for is 0.8 to 1.0 grams of protein per pound of weight. But the weight number I will use is the weight that I’m aiming to reach. So if I want to weigh 115 lbs, I would eat 90-110 gms of protein each day.*
But it’s not just protein that is important. You also need to consume calories in the form of fat and carbohydrate. Basically, you need to eat more calories if you want to gain weight. It is not complicated. Sometimes, people get fancy, and calculate their exact resting energy expenditure, then multiply this by a factor that accounts for activity level, then add the exact amount that they expend in their workout, and then add the square root of the distance to the moon divided by pi. Are you dizzy yet?
These methods may work fairly well for the general population, but as you know, people with cystic fibrosis don’t follow the rules. Our resting energy expenditure is way higher than normal, so I have a better method. Write down EXACTLY what you eat for three straight days. These should be days where you are not trying to gain or lose weight, but are simply in maintenance mode. Record not just the type of food, but how much. Then find a good online calorie calculator and add up the calories for each day. Don’t forget to include what you drink as well! Those sodas add up. Now calculate your average daily calorie consumption. If the days are wildly different from each other, you may want to do this for a whole week to get a more accurate average intake.
Got it? Now add 500 calories per day, and this is your new target. So if I calculated that I eat 2000 calories per day, and I want to gain muscle in order to weigh 115 lbs, here is what I need to do. First, my new target is 2500 calories, and of those, 440 are going to be in the form of protein (110gm x 4 calories per gram of protein). So I also need to eat about 2000 calories—I’m rounding here–of fat (9cal/gm) and carbohydrate (4cal/gm). OK, no more math.
The reason I am bad at this, and something that you, too, might struggle with, is that it is HARD to eat this much. If you skip a meal, you get way behind on calorie intake and it can be nearly impossible to catch up. So, eat early and eat often. Never skip breakfast, or lunch, or dinner. Have a snack before bed. Drink calories. Read the “How to lose weight” articles and break every rule.**
It’s also hard to do this on the fly. I’ve figured out that if I plan what I’m going to eat and make sure my strategy includes enough calories beforehand, I am much more likely to be successful.
Finally, the bane of my existence…pancreatic supplementation has to be fine-tuned for this to work. Also, if you have CFRD, you will also have to figure out if and when you might need to adjust insulin dosages. Close monitoring of blood glucose and, in my case, er…..digestion capacity, will help. Bon appétit.
*Ask your CF nutritionist if this amount of protein is safe for you.
** Don’t break the rule about not eating junk food. You are what you eat. So eat real, whole, healthy food.
One of the drawbacks to not digesting nutrients very well is that people with CF are often small. Male or female, we tend to run on the petite side if we are pancreatic insufficient. With earlier diagnosis and better enzyme replacement therapy, this is slowly improving, of course. But for those of us who are already full grown, it can be a constant struggle to keep weight on. Not only do we want to maintain weight, it is often encouraged to have a few extra (I said, “a few”) pounds on board to stay strong and resilient to lung infections.
I don’t know about you, but when I need to gain weight—which is pretty much always—I would rather put on lean muscle tissue than fat. This is not just an aesthetic issue, either. The amount of lean body mass (LBM) you have (this includes everything but fat and water) correlates with disease severity. The less LBM a CF patient has, the more severe their disease tends to be. Additionally, LBM decreases with age, so as we get older it becomes more and more important to try to increase muscle mass.
So, what does it take to gain muscle? Three things, well…maybe four. If you are pancreatic sufficient, it takes doing three things, regularly. If not, it takes four (the fourth being, obviously, sufficient supplementation with pancreatic enzymes). This post is all about thing number one: Resistance Training.
First, you have to lift weights. Muscle tissue does not grow unless you impose a stress to it that it cannot handle. When you do that, the muscle adapts by healing and coming back bigger and stronger. In my opinion you should lift weights at least three times per week if you are serious about gaining muscle mass, and it is everyone’s opinion that you must lift heavy weights (for you). So ladies, forget about the purple Barbie weights. Soup cans will not work for long. Sure, you may have to start there, but within a couple of weeks, you will be strong enough that you will have to put some energy into finding heavier resistance. I realize most people are not training program junkies like me, and that you might not have a clue what to do with those heavy weights. One great resource is The New Rules of Lifting for Life, by Lou Schuler and Alwyn Cosgrove. You can probably find about a million training programs online, but the reason that I like this one is that it is scalable…you get to decide what level you begin at in each of the basic movements, and progress from that point. So, brand new lifters or old pros have something to gain from this book. I am also working on my own CF-specific training program, which will hopefully be available in a couple of months. Don’t wait for me though…get started now.
So, in summary, if you want or need to gain weight, do it in style—by adding muscle. There are three keys to doing this. First, find a weight lifting program that works for you, and commit to it for at least three months. If you do this, in addition to the two remaining steps outlined in the following posts, you will increase your lean body mass, and with it, your chances for a longer and healthier life. When you see the progress that you have made in the three months, I’m betting that you will be hooked for life.
I have a tad bit of trepidation writing this post. The last thing I want to do is tell people with CF to take it easy when it comes to exercise, but this is indeed what I am about to do. It may be a controversial topic…and that’s ok.
Despite being a nerd who never did anything but read as a young girl, the last thirty-eight years of my life have been marked by a pronounced exercise addiction. As such, both good and not-so-good things have occurred. The good is clear: Somehow, I’ve beaten back the CF monster time and time again, and I honestly believe that my fitness level has been a huge contributor to this bit of good fortune. It’s been known since the early days of CF research that fitness level corresponds very well with survival in CF (Nixon, 1992). I certainly didn’t know anything about this at the time I started running in order to be the skinniest girl in my high school class (thank God I didn’t win that competition), but the consequent addiction to fitness has certainly paid off. The need to be skinny turned into the need to be in control (thank you weight-lifting), which morphed into the need to combat stress (thank you medical school), which then turned into the need to get out of the house (thank you two toddlers). It wasn’t until my CF began to really let it’s presence be known to me in more serious ways that exercise became my need to (literally) run away from reality.
It was only when out for a run, or when strutting around in the gym looking (and actually being) strong that I forgot about those pesky malfunctioning genes that took my sister and brother’s lives, and would likely take mine. Taking on fitness challenges and training for them was a way to beat CF, and forget about it at the same time. This is how I coped, and it worked really well.
Until it didn’t. The wake up call for me was last spring, when I lost my mind and decided to train for, and pass the RKC. You can read about that little escapade here. So, at 50, I proved that I could train myself so hard that I could end up in the hospital with pneumonia. Sure, it was a great experience (the RKC, not the pneumonia…that sucked), it was very good for my ego, and I think I even surprised a few people, but was it really worth the blow to my immune system, the chronically elevated cortisol levels, and the resulting scars in my lung tissue which are permanent?
Here is my point. If you have CF, exercise. Heck, if you don’t have CF exercise. That is what our bodies need…what we are made to do. Everyone is healthier when they move frequently. But overdoing it is not a good idea. Over-training is a serious stressor to the body. It causes hormonal chaos, as the body thinks the stress is never going to stop and keeps on pumping out cortisol like crazy. Cortisol is the body’s version of a drug we commonly have to take to dampen inflammation in the lungs, prednisone. Remember the last time you had to take prednisone? The shaky feeling? The mood swings? The elevated blood sugar? The yeast infections? Elevated cortisol over a long period can lead to these things and worse . It not only turns down the inflammatory response in the lungs, but it also turns down the immune response to infections, resulting in….trips to the hospital with pneumonia.
So what is a cyster (or fibro) to do? Moderate. It is the best course of action. Here is how I do it now (at age 51). I walk every day, at least 30 minutes, usually more like 60 minutes. This is at a moderate pace, and is usually a pretty low key event. My heart rate is never more than 50-60% of my maximum (although this is a guess since I never take it). There is a little bit of an upper body workout component as I am always accompanied by two dogs, one of which almost outweighs me, is horribly leash-trained, and constantly looking for squirrels.
Three days a week, I pick things up and put them back down (weight lifting). This consists of a heavy day, a medium day, and a light day each week. The “heavy” day means heavy (for me) weights, which means fewer reps. This day usually consists of deadlifts and bench presses, with some ab work thrown in for good measure. The “medium” day means not heavy, but not too light weights. It’s a Goldilocks day. The exercises are usually squats, military presses and rows, and the rep range is 8-10. I may “play” with kettlebell exercises this day–but nothing hard. The “light” day is just that–light. I go back to deadlifts, but just practice form, and work on my pull ups. This is the day I will “practice” my kettlebell favorites, like the Turkish Get Up or the snatch. Again, the focus is on practicing and playing. Currently, my weight workouts are limited to 45 minutes. I’m trying to get them down to 30 minutes, but this is tough for me, because I always think of “just one more thing” I want to do.
I can hear you now. “What about cardio?” I know, I know. Running has saved me from the CF beast. I can’t give it up…the beast might get me.
I’ve been experimenting with limiting my “run” days to two a week at the most. And they are not runs anymore. They are interval workouts, where I either run fast (I would say sprint, but that’s sort of stretching it) for short periods (15-30 seconds) and walk to recover, repeating for as long as it feels right, OR I walk uphill fast wearing a 20 lb weighted vest, and then slow way down (and decrease the incline) to recover, again repeating the work:rest intervals for as long as seems right. Because interval training is hard, these are short workouts; 20 minutes maximum.
So, let’s think about this: walks daily…at such an easy pace they don’t really count. Weight lifting 3/week at 30 minutes (that’s the goal anyway). Interval training 2/week at 20 minutes. Not much time, right? Now trust me, in order to get the work done, and make it worth your time, those short workouts have to be pretty fast pace and intense (except the easy weight lifting day…don’t even consider “intense”). This is what I’ve been doing this year. And guess what? I’m going on seven months with no infections and no IV’s. My weight is up. My mood is up. My numbers are up. Life is good. Compared to the times in the past when I’ve been working out like crazy, one to two hours-a-day, this is a much more sane, and healthy (I think) approach to fitness.
Here’s my final point: This isn’t a lot of time. So the next time you try to convince yourself that you don’t have time to exercise because you are so overwhelmed by the CF regimen, ask yourself if you have 20-30 minutes. That’s not even a sit-com!
Lastly, an important caveat: If you are just starting to exercise, or just coming back to exercise after being sick, start with the daily walks. Get those down first, building up an aerobic base. Next, add the lifting. When you feel strong again, start in with the intervals. At first, intervals may look like this: 30 sec walk fast, 1:00 walk normally. Then maybe build up to a jog for the work intervals…then a run…then a sprint….then a sprint uphill (ok so maybe this won’t happen until the Magic Pills are approved). Go VERTEX!
It has been a very long time since I have written a word on this blog. I don’t know why. Sometimes, I just don’t have much to say. But now I do. Life is good. I am healthy and fit (for me), and I want to talk about why this might be true.
In brief, I have quit trying to kill myself with intensely hard workouts, day after day. You would think after living with cystic fibrosis for 51+ years, I might have embraced the wisdom of this before now, but alas…
What has caused this epiphany, you ask? After attending a four day Z Health course last month, I’ve begun to re-train my nervous system as part of my overall exercise program. By necessity, this means I am being nicer to myself. I’ve learned that my brain doesn’t like to be whipped into an endorphin frenzy every single day…and neither does my body. Oddly, I’m 1) in better shape than I’ve been in years, and 2) not injured.
“OMG,” I can hear you now. “First, I have to take a million medications, AND I have to do hours and hours of daily treatments, AND I have to wear a vibrating vest for an hour a day, AND I need to go outside and walk or lift weights every day, AND I need to get 8-9 hours of sleep, AND I need to eat 5-6 times a day (add more pills), AND I need to work, AND I need to raise kids and be a spouse or partner and dog mom, AND I have to fit in a few home (best case scenario) IV sessions each year, and NOW I HAVE TO RE-TRAIN MY NERVOUS SYSTEM, TOO???”
Only if you want to minimize pain and injury and maximize your movement excellence. I’ll write more about Z and what it is doing for me in subsequent posts. Oh, and just a side note: if you move well and without pain, you move more. When you move more, you increase your fitness. And when you have CF, it’s not fitness, it’s life.