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
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.
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.
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!
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.
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?
After living 50 years as a fitness nerd, I have a few ideas about what constitutes a perfect workout for me. Of course, this all depends on which “me” shows up to exercise that day. Is it the “feeling great” me, the “getting back up on my horse after a round of IV’s” me, or the “not exactly sick, but not feeling at my peak” me? The right workout for each situation will be vastly different, but the basic constituents of the hour or so at the gym are the same.
Is there a “perfect workout” for you? Yes, but I guarantee it is unique to you, and unique to you on this particular day. From the 10,000 ft point of view, the “perfect workout” is the one that you will do, consistently, and if not enjoy, at least not abhor. It should leave you feeling tired in a good way, so that you know you did some work, but not so exhausted that you dread the next encounter with your inner athlete. And if you live with CF or some other chronic illness that waxes and wanes, the perfect workout is a moving target. Some days, 20 minutes on the elliptical is the right amount, while other days, 5 minutes on the stationary bike is what your body needs. On really awesome days, a 5-mile hike in the woods fits the bill perfectly.
But whatever state your body is in, the components of each workout should be the same, modified to suit your body, with its particular issues. Each component is important, and the order that you complete each component matters. I’m going to run briefly through each, and offer some suggestions for specific exercises that work for me and might also benefit you.
The order is as follows:
soft tissue work
corrective exercises or “pre-hab”
movement preparation or active stretching
cardio or “metabolic conditioning”
Yes, I put nutrition in there at the end, because at least for me, it is vitally important to feed my muscles nutritious food including both carbs and protein very soon after exercise. Experts say a ratio of 4:1 carbohydrate to protein is what you should shoot for. You can do this very easily by drinking some chocolate milk, or eating a peanut butter sandwich. It doesn’t have to be complicated, but it does have to happen.
So, let’s go through the actual workout.
This consists of a:bout 10 minutes of foam rolling or using a tennis or lacrosse ball in areas of muscle and connective tissue that is excessively tight. You know an area needs to be rolled when it is uncomfortable to do so. If you don’t feel discomfort, you are good to go on to the next spot. I generally start with a ball to my feet (ouch), and then go to the foam roller for calves, hamstrings and glutes. I then flip over and do my quadriceps. Then I take out the magic “peanut,” my extremely complicated and expensive device that I now absolutely cannot live without. With this, all my tension dissipates from my back, as it remembers how to extend after my day of sitting, coughing, and typing. That’s it!
As I said, I’m fifty. I have accumulated a lot of tight areas. You may not need this much, or you may need more. Only you will know, by trial and error.
This is also not complicated and we are talking about joints here. Having good mobility simply means that you are able to take each joint through its natural range of motion. Each joint is different, of course. The knee joint shouldn’t be able to traverse a circle, while the ankle joint should (ha…tell that to my ankles!). Take a survey of your body. You will be able to tell which joints are tight. Work on those. Also, do some range of motion in the joints that you intend to use in your workout.
These are also referred to as “pre-hab” exercises, presumably because if you do them, you won’t ultimately require “rehab” exercises. Simply put, the idea is to strengthen weak areas that contribute to unhealthy movement patterns or poor posture. In my case, and likely in the case of anyone with CF, this is primarily my thoracic spine. Lung disease and chronic coughing cause the biomechanics of the chest wall to get messed up (to use a technical term). The result is the “hunched” back and rounded forward shoulders we commonly see in each other. Corrective work for this focuses on opening the anterior chest and shoulders with active stretching, and strengthening the muscles of the back that pull the shoulder blades back and down.
Movement Preparation (AKA active stretching):
This is the “warm up” part of the workout. The goal for this portion of time is to actively work the areas of your body that you are about to engage. You slowly start asking more of the heart and lungs as you begin using large muscle groups in a similar way to what you are about to ask of them. For example, if this is a leg workout day, you might begin with some lunges, or body squats and add in some walking hamstring stretches. If you are going to focus on bench pressing, simply pressing a very light weight for a few sets of 5-8 would be a great warm up. If you are going for a walk or jog, beginning to do that exercise at a slow rate for a few minutes is the way to go. It all depends on what you plan to focus on that day.
Strength Training or Cardio (metabolic conditioning):
I put these in the same category because I would suggest focusing on one or the other during a workout. You can do this by alternating lifting days with cardio days. Alternately, you can do both at the same time by doing weight training in a circuit fashion, with little rest between exercises. My favorite way of doing this these days is with kettlebells, which I will discuss in another article.
The main thing to remember here is to start small and slowly progress as your body adapts to the challenge. If you want to be able to run a 10K, that is awesome, and you can do it! But start with walking/jogging intervals which feel like work, but also feel good! There is no better way to sabotage yourself than to rush your body faster than it can go. How will you know if you are? You won’t want to keep doing it. When you start dreading your daily jog, you know you are pushing too hard. As you very slowly start adding time to your workout, or lesson the periods of rest (if you are doing intervals), you get stronger and stronger.
Ah…this is what you’ve been waiting for. The end of the workout! You’ve done your last set, or run your last interval. You want to grab your stuff and go fall on your couch. But wait! There’s more…
This is the time to do just a little bit of flexibility training. Your muscles are warm and pliable…a perfect set up for some passive stretching. Passive stretching just means holding a muscle in the stretched state for about 20-30 seconds. This is what we normally think of as stretching. Spend just 5 minutes stretching those areas on your body that tend to be tight. You don’t need to go through a whole yoga series here. You know what you need. I almost always need low back and hamstring stretches at this point. I also find that this is the perfect time to lay across the foam roller lengthwise (so it is under my spine from my head to my butt) and open my arms to the side and let gravity open my chest. Some deep, meditative breathing in this position is the perfect way to conclude the workout.
And before you hit the couch, don’t forget to eat!
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!
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.
I’ve never been very good at keeping New Year’s Resolutions, and I have a feeling I am not alone in this regard. Many a January first has gone by with me having the best of intentions. I will eat more fruits and vegetables…I will gain 10 lbs of muscle…I will play the piano every day…I will be better about calling my family…I will stop yelling at my kids, and, a favorite and recurrent theme, I will begin a daily meditation practice and stick with it.
Though I have often done well for a few weeks, I didn’t often have great success. I know why, of course. As any good wellness coach knows, lasting change comes only when proper motivation, preparation and support has been put in place. If I look at the things I have accomplished in life, they have all been because I have been motivated by fear of failure (i.e. academics), or a true passion for and interest in doing something (i.e. fitness goals). Just FYI: passion and interest and much better motivators than fear.
This year, I have decided that I’m going to try a new tactic. Instead of declaring, “From this day forward, I will (fill in the blank),” I’m going to work backwards. Somebody smarter than I am once said, “Start with the end in mind.” So here is the plan:
Decide what will be the state of your life (the goal) as of December 31, 2009. Ask yourself “why” this is important. Then ask “why” the answer to “why this is important,” and so on, until the real reason you want this is clear. You’ll know it is the real reason when you have no more answers to “why.”
For instance, I want to have a daily meditation practice of 1 hour/ day, and be well into Holosync Awakening Level 3 (currently in level 1) by the end of the year. Each level of the Awakening Series is about 6 months long. I have had success with this program before, and I really want to get back into it. I’ll write another time about it. For now, I want to be doing my meditation every morning at 5:30 am, followed by 30 minutes of yoga before the kids wake up and chaos ensues. If I had set this all up as my New Year’s Resolution, to start at 100% full throttle on Jan 1, I would have quit already.
First, the why’s. Just for brevity, the following includes short answers as they occur to me with each subsequent “why.” Why do I want to meditate every day? It’s good for me. Why? Relaxation and stress relief are important. Why? Life with CF is stressful and I need to deal with it. Why? Because eventually I will be pretty sick, and I want to be able to find a sense of peace and calm within me when that happens. Why? Because I want to die the way I try to live, with courage and a sense of humor.
When your motivators are clear, break the final goal (what you will be doing in one year) into 12 smaller “chunks.” Then, break the first chunk into 30 very small pieces. Do one piece/day for January. Do the same for the rest of the “chunks” and the rest of the months. Easy, right?
With regard to my meditation goal, the one-hour per day is intense, but it isn’t the biggest obstacle. I’ve been able to sit for 30 minutes daily for a few weeks now, and it seems to be getting easier. It’s the 5:30 am part that is killer. However, I know myself pretty well after these 49 years, and I simply won’t do it if I put it off until later into the day. Life just always seems to get in the way when this happens. I need to establish a morning practice…and it has to be that early because of those wonderful kids of mine…they need to be asleep. Now, 5:30 am is easily 90 minutes earlier than I now wake up. That is way too much to tackle at once. I made the mistake just this morning of forgetting the “small bite” piece. “I can do 6:00,” I thought…”no problem. I’ll start slow…just one day a week.”
I ended up hitting the snooze exactly 6 times, and got up at the usual 7:00 am.
Recently, I discovered a great blog, Zen Habits, where I read a post entitled, “10 Benefits of Rising Early, and How to Do It.” ( Link ) It made great sense to me, especially after my experience this morning.
“ Don’t make drastic changes. Start slowly, by waking just 15-30 minutes earlier than usual. Get used to this for a few days. Then cut back another 15 minutes. Do this gradually until you get to your goal time.”
Now there is a concept. I can certainly wake up 15 minutes early! Of course, that doesn’t give me much extra time…but, it’s certainly a step in the right direction. If I can wake 15 minutes earlier each week, I’ll be up by 6:00 at the end of January, and hit my goal of 5:30 by mid-February.
So here is how this one particular goal comes to pass:
Jan: Work on waking up by 6 am by end of month. Spend extra time in morning enjoying coffee, alone time, yoga…things I like. Continue with 1 hr Holosync ( Level 1) in early am (after kids are in school). Concurrently adjust bedtime to 10 pm (from 11 pm).
Febr: By end of month, established routine of being in bed by 9:30 pm, up at 5:30 am (gulp). Continue Level 1. By Mid- February, begin early am meditation.
March—May: finish Level 1
June—Nov: Level II
Dec—Begin Level III
Now when I look forward to tomorrow, I don’t say OMG I have to get up at an ungodly hour and do an entire HOUR of meditation and THEN yoga! I simply have to get up at 6:45 and reward myself with a cup of hot Joe. If every resolution is set with the end in mind, a good reason “why,” and small steps to get there, I think RQ (resolution quotient—I just made that up) would be much closer to 1.