I’m currently reading a book called “The Slight Edge,” by Jeff Olson. The basic message is that significant change is made quite easily if taken one small and consistent step at a time. As a wellness coach, I have read quite a bit about change psychology, and the directness and simplicity of this author’s approach is very appealing to me. I’ve decided to take it on a test drive, and am trying to revive my blog with this approach. When I first started blogging, I loved doing it and felt like it was an awesome way to get my message(s) out about living well despite having ongoing and serious health concerns. Then, life got in the way, and blogging took a back seat to just about everything else that I could think of. Enter the Slight Edge. I will be posting more.
It seems to me that life is somewhat unfair in that good habits seem to require effort to develop, while bad habits form quite easily simply by being unconscious about choices we make. The Slight Edge basically refutes this, by making the very obvious point that over time, simply taking one small action each day will compound into huge and lasting change. On the other hand, not taking that one action will also compound. Unfortunately, compounding in this negative sense can be disastrous.
A very clear example for the cystic fibrosis peeps out there is doing your daily aerosol treatments. These are very easy to do (note that I didn’t say “convenient” or “pleasant”). Seriously…you just sit and inhale stuff. It’s not like you aren’t going to inhale anyway! And sitting in a chair holding a nebulizer is not exactly manual labor. So it’s easy to do treatments.
But it is also very easy to blow them off. There are a myriad of things that, in the moment, seem way more important than that hypertonic saline, right? Sleeping in, stopping for coffee before work, playing with your cat, browsing favorite websites, cleaning your closets, plucking your eyebrows…you name it. Who wants to sit and cough?
But now imagine what happens if that decision to blow off your treatments is compounded, day after day. Then compare that image to what it looks like if you make that simple decision to do the treatments every day. Stretch your imagination out to a month or two (here is where I wish you were a pathologist, because my mental image is a slide of healthy, pristine lung tissue vs. nastiness on a slide). Two very, very different images as a result of two sides of a decisional coin, compounded over time.
Of course, this relates to just about any area of life…not just medical treatments. Decisions about fitness habits, what you eat or drink, how you relate to people, how you work, and how you deal with stress all compound over time this way. On a day-to-day basis, it doesn’t matter in a huge way whether you take your daily walk or sit for your meditation. Not doing them ONE day is easy, and it won’t make a dent in your overall fitness or stress level. Alternately, actually doing these things probably aren’t going to matter a huge amount on that particular day. But compound these decisions over time and see what happens.
What one life-enhancing thing, something that is both very easy to do but also very easy to blow off, can you to do, today and every day? Gotta go do my saline now.
It’s kinda crazy that it took four steps to get to “movement preparation,” but this is just what active stretching is called.
Remember back in the days when you would hold static stretches before you exercised? I still see people doing this…going straight from the locker room to the stretching mat and doing seated forward bends and holding calf and quad stretches before going to the elliptical machine or treadmill. We know better now. First, it’s not good to stretch cold muscles. If you must do static stretches, it’s much better to do five minutes of jumping rope or fast walking first, as the increased blood flow to the muscles helps to warm them up and may increase their elasticity. It also turns out that stretching a muscle statically (holding the stretch for 20-30 seconds) may actually decrease its ability to perform strength and power moves. So if you are intending to lift weights, it will benefit you to find better ways to stretch prior to your workout, and do the static stretches at the end.
A better way to stretch cold muscles and get them ready to work is to stretch them actively. This simply means to stretch your muscles while they are in the act of moving. This is a dynamic process. Nothing is held for time. You simply wake your muscles up by asking them to move into stretched positions. A great example of this is the “inchworm,” one of my favorites. Here is a great example of this. Notice that the hamstrings and calves get a great stretch as they are working.
Another great exercise for the upper body targets the front of the shoulders and the upper back. This is much harder than it looks, especially when you keep your butt, upper back, head, forearms, and wrists touching the wall the entire time. Check it out here:
Walking lunges are a great way to warm up for running or lower body weight lifting. To increase the stretch in the hip flexors, add a twist in the direction of the forward lunging leg. Check this out here:
These are some of my favorite movement preparation exercises. I will also do a few sets (if I am lifting weights) or a few minutes (if I am doing cardio) at a much lighter intensity level than what I do normally as more movement prep. After all, the best way to prepare to do something is to do it…with a very light load. This tells both your muscles and your brain to get ready for what is to come.
After you have read “The Perfect Workout,” you will have a basic understanding of the eight steps, in the right order, to use as the backbone of your workout. Step One (discussed here) of your workout, involves rolling out soft tissue knots and tight areas with the foam roller, or a small ball (or pair of balls).
Now it is time to move on to Step Two, which is all about improving mobility. Mobility is becoming one of my favorite subjects lately, and I have been working diligently to improve my own. It is not a complex subject; mobility is simply the ability to move. As it relates to exercise, mobility is about the ability of every joint in your body to move through its natural range of motion. Now, there are many, many joints in your body…somewhere between the mid 200’s to mid 300’s (the definition of “joint” is a bit fuzzy). Most of those don’t need a lot of your attention. But before you stress your body with exercise, it is good to circulate a bit of synovial fluid (the stuff that lubricates joints) and wake up the millions of mechanoreceptors that live around your major joints…especially the ones you plan on taxing during your workout.
I have many tight and not so smoothly moving areas that I like to focus on, but the one area I’d like to talk about at length here, because I am certain that we all share this issue, is the thoracic spine.
Think about your posture. Adults with CF very commonly have poor posture, and most of us with poor posture know that it is a problem. The causes of the problem are many. First, we are getting older, and with age comes increasing reinforcement of poor movement patterns. The body adapts perfectly to what is asked of it. If you start slumping your shoulders when you sit at the computer, or drive, or breathe, the body decides this is the position it is to always assume. Second, with age comes bone loss (especially in CF), which can lead to osteoporosis and subsequent hunching of the upper spine (technically called kyphosis). Finally, as breathing mechanics change with increasing lung disease, there is consequential structural alteration of the thoracic cavity that worsens kyphosis.
Why is this? Because the body tries to offset or balance the increased hunching (kyphosis) of the thoracic spine with an over-pronounced swayback of the lumbar spine, also known as lordosis. This leads to pelvic and hip problems, and the result is a mess. Sounds bad, right? It is, and the worst part is that all of this leads to a very common problem in adults with CF, back pain. The picture below illustrates this problem.
The thoracic spine is actually supposed to be very flexible. It is supposed to flex, to extend and to rotate. In contrast, the lumbar spine is designed more for stability and less for flexibility. Sadly, most people have this backwards, and tend to use the lumbar spine more than the thoracic and hips for bending and rotating. This often leads to pain, and commonly to injury. Because the thoracic spine in CF tends to be even more “frozen” in place because of the above-mentioned issues, pain is extremely common.
But wait, there’s more. Pain is bad enough, but what is worse is that the combination of poor posture and pain leads to inhibited airway clearance, less expansion of lung tissue and deteriorating lung function. Stiff and unmoving thoracic vertebrae also increase the work of breathing (isn’t it hard enough?). None of this is good. Not good at all.
But here is the good news: Some of the postural problems in CF can be corrected. Those having to do with muscle and soft tissue tightness are reversible! Stiff joints can be mobilized with specific exercises and soft tissues can be stretched to allow for normal alignment and movement.
This is why at least 10 minutes of your workout should be spent waking up and moving your thoracic spine. If you are like me, you literally need to teach your brain exactly where this part of your back is, and how to move it because of something called sensory-motor amnesia. This is exactly what it sounds like: When you don’t move a body part much, the brain 1) forgets where it is, and 2) forgets how to move it.
I’m Convinced. What Should I Do?
First, take a breath and don’t panic. Then, check with your doctor and make sure these are safe for you, especially if you have osteoporosis. Next, to get a rough assessment of the amount of kyphosis in your upper spine, do this test.
Lie down on your back with your feet on the floor, knees bent to about 90 degrees. Now press your low back into the ground and keep it there as you do the following: bring your arms up and over your head, keeping them straight with your biceps muscles close to your ears. Don’t move into pain, but see if you can bring your wrists and back of hands to the ground above your head. If you have normal thoracic mobility, this is a breeze. If you can’t, you are like me and have some pretty stiff and sticky thoracic vertebrae. The following exercises are for you. If you can, and want to keep it this way, the following exercises are for you.
1)Spend quality time with your double tennis ball contraption (link) every day…before your workout as I discussed in the previous article, and also throughout the day, especially if you sit at a desk a lot. If you are bigger and have more muscle mass, you might graduate to double lacrosse balls. This is not in my future.
2) Roll your upper back with a foam roller. As you do this, bring your hands behind your head and keep your elbows close together (this gets your shoulder blades out of the way). Slowly roll up and down the spine, stopping at the neck above, and the lowest rib below. Try to “curl” yourself around the roll by aiming the top of your head to the ground. If you have tight spots that are slightly uncomfortable, spend some time there.
3) Get on hands and knees and push your butt slightly back toward your heels. Now take one hand (for example, the right) and place it behind your head by bending your elbow. Now, keeping your butt back, rotate your spine by reaching the right (bent) elbow toward your left knee. Come back up and do this several times, slowly. Repeat on the other side.
4) Stay on hands and knees, but this time sit all the way back onto your heels. Take right hand again behind your head, and now rotate it up, toward the ceiling, trying to open your chest to the ceiling as well. Don’t move your butt–this is keeping the lumbar from moving, thus isolating the upper back. Repeat on the other side.
The sensory-motor amnesia problem is a bit more complicated, but can also be remedied with some drills taken from a system called Z-health. I am currently immersed in learning Z-health and will write more about it in future posts, but these are some basic exercises that will begin waking up and mobilizing the spine. Try them and then retest with the “raising the hands over the head” exercise. My bet is that it will improve. I don’t start my workout until I can do this without discomfort (but it has taken awhile to get there). Start slowly, but be persistent and patient. Your spine and lungs (and posture) will thank you.
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!
What is a “boot camp” and how can it help me?
A traditional “boot camp” is an intense training program for military recruits. Fitness professionals everywhere have stolen this idea. Now you can easily find an early morning community “boot camp” style exercise class at your local community college or gym. They are basic, nothing fancy, no frills sessions complete with old-fashioned calisthenics, running, jumping, climbing, grunting and sweating. New friendships are forged each session as groups of people meet at ridiculous o’clock in the morning in ungodly weather with the mutual goal of becoming fit.
It occurred to me during a recent exacerbation of my cystic fibrosis that the concept of a “boot camp” could be extremely beneficial to people dealing with the ups and downs of living with chronic disease. In this series of posts, I discuss how a focused period of intense attention to health and lifestyle improvements can assist in “coming back” from a CF setback, but the idea can really be applied to any ongoing health problem characterized by exacerbations and remissions.
In the first rendition of this chapter, I had come up with a three week plan following a course of home intravenous antibiotics which I needed for a basic “tune up” following a series of upper respiratory infections. I felt less than energetic, and was coughing more than usual, but certainly was not so ill that I couldn’t set exercise and nutrition goals with full confidence that I could achieve them.
Then, as fate would have it, the program AND the book got put on indefinite hold as I became extremely sick, hospitalized with acute pneumonia and needed another full four week course of treatment. I lost seven percent of my bodyweight, probably all from muscle mass since I didn’t have much body fat to start with. Suddenly, it was “exercise” to get up from the chair and walk down the hall to the bathroom.
My confidence was shaken, but the end result was a slightly different perspective, one that is more in line with the majority of adults with CF. The “boot camp” plan that follows is one based on the very real fact that when you are coming back from getting knocked down, there are two important principles to follow. First, you must have compassion for yourself and for what your body is dealing with. Second, you must be patient and persistent. And never give up.
As a wellness coach, I have helped many people come up with “wellness visions” and design strategies to achieve them. I work mostly with people with serious health problems, and it is essential for me to remind people to have big goals, but to go slowly and carefully toward them. This is what I have tried to do with the CF Wellness Boot Camp.
The intention is that you will do this after treatment for an exacerbation. This is because I know you feel better and stronger than you did a few weeks ago. I know your lungs are as clear as they can be, and your energy level is optimal. Now is the time to act. If there is ever a time to get healthy in ALL areas of your life, it is now. USE the benefits that modern medicine has provided through that IV tubing, and SUFFUSE the rest of your life with wellness. Now, if you aren’t coming off of IV’s, that is no reason not to do this boot camp. This program is designed for anyone who wants to achieve optimal wellness, regardless of where he or she is starting.
So dust off your Vest, find your flutter, and recommit to hypertonic saline. You are about to learn a new response to this thing called Cystic Fibrosis. It may knock you down again, but you’ll get up again, and again, and again as you refine your own personal “boot camp” to meet your needs.
Overview of Program
This program is designed for people with cystic fibrosis. It is especially useful if you are recovering from an exacerbation. This is intentional. I know from personal experience that following a “tune up,” people feel the best, and are most interested and motivated to do what it takes to KEEP feeling good. With memories of the hospital fresh in their minds, they are also more likely to take on new practices that may help keep them out of the hospital for a longer period of time.
It is said that three weeks is the minimum time it takes to establish a new habit. From Day 1, you will be asked to make small step improvements in the areas of exercise, nutrition, rest, and stress management. Hopefully, by the end of the 21 days, these practices will be on “autopilot” just as brushing your teeth twice a day is something you simply do. You don’t need to get psyched or motivated to brush…it just happens.
In addition, during the 21 days you will explore other practices that you will hopefully find enjoyable. Not only are many of them fun, but they are also good for your health. You may also want to incorporate some of these into your daily regimen.
Think of this three week period as an intense “time-out,” with the goal to focus completely on your well-being, and how you can learn to extend the “post-antibiotic” high as long as possible.
There will be specific activities to do each day (created by you), as well as daily introspection exercises, either by journaling or with online activities designed to teach you something about yourself.
One of your first journaling activities will be to create a “well-being” tracking sheet. Here, you will list 5-10 things YOU KNOW would be beneficial to you health to do on a daily basis. After a careful consideration of what your body needs and what your goals are, you will consider seriously what areas of your life could use some tweaking. It may be adding more (or, some) exercise to your days. It may be getting more rest. It may be reconnecting with friends.
I will ask you to envision exactly what you want your life to look and feel like one year from Day One of the program. This will be an exercise in imagery. You will imagine you as your best self, and paint that picture in words in your journal. Then, you will set some long-term goals that will enable that vision to manifest. These goals will be behavioral…they will describe what you are doing, regularly, 1 year from Day 1, in the areas of exercise, nutrition, stress management, sleep, disease management, and social connection.
Let’s say that in your vision you are climbing Half Dome with ease. Behavioral goals to support that vision might include building up to this level of fitness and stamina by doing aerobic exercise for 30 minutes, 3 times a week at an intensity of 75% of your maximum.
Or maybe your vision is that you are 10 lbs of pure muscle heavier than you are now. A behavioral goal in line with that vision may be that you are lifting weights 3 times a week for 30 minutes and eating protein with meals six times a day.
You will create S.M.A.R.T. (Specific, Measurable, Actionable, Realistic and Time Bound) goals that are relatively long term (12 months), and then create your list of five to ten things that put you on the direct path to those goals. By the end of 3 weeks of doing these things, you will be well on your way to achieving your vision. You will also know in your bones that you are capable of making a difference regarding your health, because as you begin to achieve your behavioral goals, you will begin to see real results in the way you feel and look.
The beauty of the Boot Camp program is that it can be used over and over again. The reality of Cystic Fibrosis is that this is exactly what we need. We get sick, over and over again. When we do, instead of thinking, “Arrrg, I have to start all over again!” we can think, “Oh boy, I get to do Boot Camp again!” Each time can be tailored even more specifically to you and your body as you learn what works best.
Tomorrow’s post will focus on preparation for the following three week program. For now, try thinking about what areas of your life could use some mild tweaking. Your body knows, and so do you.