Creating a Fitness Plan
So, how do you develop a fitness plan you can enjoy and stick with? Think about your interests and abilities, then work with your cystic fibrosis care team to plan a fitness program around what you like to do and what fits your lifestyle.
Make it sustainable. These three key steps will help you develop a fitness plan you'll keep doing:
- Select a variety of activities that you know you will enjoy.
- Find a social setting in which to participate with your partner or friends.
- Talk with a person who knows CF and exercise to help develop a plan that is right for you.
Working With Your CF Physical Therapist
Not all CF care teams include a physical therapist. If yours does, then he or she is trained to design an exercise or physical activity program to fit into your daily routine. If your CF team does not include a physical therapist, ask them to help you find one.
Your physical therapist will work with you to design an exercise or fitness program that is based on your age, health status, and include sports or other physical activities that you enjoy doing to help you maintain lung function and a generally good physical fitness level.
“My physical therapist challenged me, and when I experienced what oxygen was able to help me accomplish, I immediately began to see it as a tool for my benefit as opposed to something that should define my limitations. A switch was flipped in my mind and that sudden realization — that increasing my oxygen usage could help discover my true physical potential — was a euphoric sensation.” Brian Armstrong, adult with CF, from the CF Community Blog
You can also work with your CF physical therapist on ways to maintain a good posture and build or regain muscle strength and endurance through various techniques to improve your mobility and lung function. They can also help you address embarrassing issues such as urinary incontinence (UI). In some CF care centers, the physical therapist will also help you learn airway clearance techniques (ACTs), which should be done in addition to your fitness program.
At a glance, your CF physical therapist:
- Works with you to design a fitness program for your daily routine.
- Can help you find ways to maintain good posture, manage pain, treat UI, and build or regain muscle strength and endurance.
- May also help you learn ACTs.
Get Cleared for Exercise
Adults with existing medical conditions like CF should talk to their health care provider before starting an exercise program. You may be asked to do some tests first, depending on your level of activity and health. A regular exercise test can help you find out the strength of your lungs, heart, and muscles.
A physical therapist or other member of your care team can help you figure out your fitness level by testing your current physical fitness. Usually, it's smart to measure both aerobic fitness (cardiovascular) and muscular fitness (muscular strength).
Fitness testing may be done using simple tests like walking certain distances and doing calisthenics (a form of rhythmic exercise that can be done without equipment). Testing may be done in a laboratory with special exercise equipment. These tests help:
- Find your baseline exercise ability, which you will aim to improve or maintain.
- Find the right exercise intensity for you and your goals.
- Measure your progress. At different stages of your program, you can repeat the test to see how far you've come.
- Show if your oxygen levels decrease during exercise and, if so, at what exercise level. Testing can also give you and your care team information about your CF lung disease -- much like pulmonary function, nutritional status, and other clinical tests do.
Goal setting is one of the keys to success in changing your habits. The clearer and more realistic your goals, the more likely you are to achieve them. There are two major types of goals:
- Product goals are the overall objectives of your exercise program
- Process goals are the in-between steps required to get there
- Your overall goal, or product goal, may be to move from an inactive lifestyle to doing regular physical activities at levels recommended for health. To reach this long-term goal, your care team may set a series of process goals.
These may include beginning with two 10-minute brisk walks on five days per week for two weeks; then doing three 10-minute walks, five days per week in the next two weeks; and moving on to a 30-minute walk, three days per week, plus a 10-minute jog, one day per week during the next two weeks, and so on.
The point is, rather than simply saying, "I plan on exercising more every two weeks," you set a specific goal of exercises with specified intensities, duration, and frequency.
You can also plan for a realistic time schedule, such as 30 minutes every Monday, Wednesday, and Friday, that can be monitored and modified as needed. Even if you don't fully reach your overall process goal, the exercise program can still result in meaningful changes in your health.
Track Your Progress
A critical part of the exercise program is keeping records of your daily exercise. This will help you know if you are meeting both process and product goals. Keeping records will be helpful to measure your progress.
One approach is to keep an exercise diary in a notebook or on the computer. Step counters, or pedometers, are easy-to-use monitoring devices. They are usually portable and can be worn on your belt to record the number of steps that you take throughout the day. On many devices, the step count is displayed on a digital screen so you always have feedback on how much you're walking. Another option is to add a fitness app to your smartphone.
Your aerobic exercise program can include a target number of daily steps, often set at 10,000 steps per day, which may help motivate you to reach your exercise goals. If you are currently inactive, set your steps per day goal lower and gradually increase it to 10,000 (or higher) as you become more active.
Find Your Exercise Prescription
The physical therapist, exercise physiologist, or physician on your care team can help you determine the right energy expenditure or “exercise dose” for your individual exercise program.
Your care team can help you develop an exercise program tailored for your level of fitness, your exercise and health goals, and the equipment available. To reach your desired exercise dose, the type, intensity, duration, and frequency of exercise will be considered.
- The type of exercise should be dynamic and use many major muscle groups, such as walking, jogging, swimming, or dancing. Keep in mind that if you do activities you enjoy, chances are you'll be more likely to keep doing regular exercise which studies have shown to be more important than the exact type of exercise.
- The intensity should be at least moderate. A simple way to monitor intensity is the talk test. For moderate intensity, you should be able to have a conversation comfortably while doing an activity that's increasing your heart rate and breathing rate, and maybe even making you sweat a little. Vigorous intensity results in sweating, large increases in heart rate and breathing, and not being able to carry on a conversation during the activity.
- The duration and frequency will depend on two factors: your initial fitness level and the amount of exercise dose that you want to achieve. The total amount of energy expenditure is a function of the intensity, duration and frequency of activity. Exercise dose can be increased by exercising at a higher intensity while keeping duration and frequency constant; or by exercising for longer durations or at more frequent intervals while keeping the intensity constant.
Resistance exercise, consists of the type, number of repetitions and sets, and intensity of muscle-strengthening activities.
- The type of activity generally involves free weights, weight machines, rubber exercise bands, or calisthenic (your own body weight) exercises that use multiple large muscle groups. Activities can include bench presses, leg presses, pushups, and lunges.
- The repetitions are the number of times you can do a resistance exercise at a given intensity.
- The intensity is the amount of resistance (the amount of weight) that you exercise against. For free weights and weight machines, this generally is the amount of weight you can lift for a specified number of repetitions. Resistance exercise intensity can be found by doing a resistance exercise fitness test with the help of your care team. Your body weight may serve as the resistance when completing calisthenic exercises like pushups, pullups, situps, and lunges.
- The sets are the total number of times you complete repetitions of a given lift, such as doing two sets of eight repetitions each.
- Resistance training should be done two to three times per week and include upper body, lower body, and trunk exercises.
What About Stretching?
As part of your cooling-down period after exercise, think about doing some gentle stretches. Not only will these stretches help you wind down after exercise, they may improve your flexibility. This slideshow from the Mayo Clinic explores some of the more important stretches to include in your routine.
It is also important to include stretches for your upper body. Good flexibility in your shoulders and trunk will help to improve your posture, prevent pain, and make it easier to breathe deeply.
Yoga is a great way to stretch and increase flexibility as well as:
- Increase muscle strength and tone.
- Improve balance.
- Improve breathing and energy.
- Prevent pain and injury.
- Increase fitness level.
You can do yoga at a studio or at home with a video. Contact firstname.lastname@example.org to get your own copy of the DVD, “Yoga for CF.”
Keep Exercise Safe
Regular exercise is a good health habit. But you should talk with your doctor or physical therapist about any risks that may result.
The most common risk during exercise is musculoskeletal injuries, such as sprained ligaments, strained muscles, and overuse injuries. Injury risk is higher in those with a history of previous musculoskeletal injury and is associated with exercise intensity.
The risk of exercise-related cardiovascular complications (for example, heart attack) is quite low. Cardiac events during exercise are most likely to occur in people with existing cardiovascular disease and in those who are inactive and out of shape.
The risks of exercise can be reduced through sensible habits that include warming up before and cooling down after exercise. Slowly increasing your exercise amount and the intensity toward your goal is also recommended. You don't want to start walking three miles (your goal) when you haven't even walked four blocks regularly.
Pay attention to sensations or responses during exercise that may be a sign of injury. Talk to your doctor or physical therapist before exercising if you have:
- Cor pulmonale (failure on the right side of the heart) or pulmonary hypertension
- Symptomatic heart disease
- Cystic fibrosis-related diabetes (CFRD)
Modify your exercise program when you have:
- An exacerbation or acute respiratory infection
- A musculoskeletal injury or condition that limits mobility
Dehydration is a real concern for active people living with CF because they can lose more salt (sodium and chloride) when they sweat than those who don't have CF. This is especially important if you're playing sports or exercising outside when it is hot and humid.
Preventing dehydration is key. Start drinking more fluids before, during, and after exercising to help you maintain or replace electrolytes (chemical salts such as sodium, chloride, potassium, and bicarbonate that help your cells work). Many sports drinks can be good sources of electrolytes and you may want to increase your salt intake by eating salty snacks. You should also try to avoid drinks with caffeine, which can increase fluid loss.
You can prevent becoming dehydrated by:
- Drinking plenty of fluids throughout the day, even if you are not thirsty
- Eating salty snacks such as potato chips, crackers, pretzels, cheese, or nuts
Repeating the physical fitness testing you did with your care team before starting your exercise program will give you important information on how exercise is helping your body. This information is useful for modifying the exercise prescription during the program and for evaluating the overall success of the exercise program. It may help you and your health care provider decide whether to begin new CF therapies or modify your current therapies.
What Else Can You Do?
Get the most out of your exercise program by paying close attention to your diet. Eat a balanced diet that has enough calories to meet your energy needs.
Seek ways to engage with others as part of your exercise program. Join a hiking club, fundraising walks, and organized runs.
Reduce your inactive time -- sitting at the computer, playing video games, watching TV -- and replace that time with more active pursuits.
Take “active breaks” from your sitting: You should stand up and move for one to two minutes every 20 minutes. Set an alarm to remind you while at your desk or stand up during every commercial break while watching TV.
Remember, the severity of your lung disease and certain medications may change how your heart rate responds to exercise. You should always talk to your doctor or physical therapist to be sure you are monitoring your exercise intensity correctly.
Gym memberships, yoga classes, and sports teams can be expensive. If the cost of your or your child’s favorite activity is keeping you from being active, talk with your CF team to learn about grants and scholarships you may be eligible for.
Want to Challenge Yourself Even More?
If you are thinking of doing a competitive sport, keep these things in mind:
- Find an environment where you will get positive feedback. This means that the activities are supervised or refereed properly and that the competition does not pose special risks.
- Avoid competitive environments that put pressure on you to continue activity when your lungs or body might be telling you to stop. Winning is OK, but not at all costs.
- Many adults with CF are able to participate in strenuous sporting events, including running marathons. Talk about these activities with your health care team before starting.