Strength Training – Getting Started! (Part I)

This will be a series of articles! Too much information to cover in one.

Don’t worry, I am not trying to turn you all into Olympic Weight Lifters. I am definitely not an Olympic weight lifter, by any means! More and more studies are confirming that strength training is beneficial. And, believe it or not surprisingly good for people in their 90s. Both my general practitioner and my rheumatologist wholeheartedly support my efforts. To quote my general practitioner, “Strength training is so important”.

CAVEAT: This article assumes you have medical clearance to exercise. If you do not, please get clearance from your doctor. This article focuses on musculoskeletal chronic conditions but the underlying logic can be applied to many conditions.

I will admit to being biased. My fitness regime has always included weight lifting. That is not including lifting bales of hay and sheep on the farm! When I first became unwell, I had to take a break, but when I slowly started back, I wasn’t starting from scratch. I knew how to lift weights from past experience and I did a Fitness Coaching course specifically to learn more so I could keep myself as close to “healthy” as I could.

Practical experience taught me more aspects specific to having chronic conditions, musculoskeletal conditions in particular. When I did my qualifications, the course didn’t cover much about chronically ill clients. We did learn a bit about diabetic and asthmatic clients, but that was about it. From talking to other trainers who have qualified more recently than I, not a lot has changed in that respect. So bear in mind my advice in this article is based on my practical experience, building on what I learnt on the course. Think of your medical specialists – your rheumatologist did not graduate from medical school as a rheumatologist: a lot more study and experience and training was required. Personal trainers/fitness coaches are really no different. After they’ve completed their basic training they may go on to specialise in different aspects of training. Many will have such information about themselves publicly available on a web page. They may be like me, have medical conditions themselves and therefore have lived experience. They may have a family member or friend with a medical condition or just simply have an interest in the field and have undertaken additional training. Be prepared to interview your prospective trainers to ensure they have the appropriate experience to guide you. I will suggest some questions in Part II.

In my recent article, Accept the Project, I talked about the challenges we face when we initially find out we are now different. Generally our doctors will tell us to “get exercise” or “keep exercising” but it is not their role to give us specific instructions. As a result, many people will try to do what they did before. THAT IS NOT GOING TO WORK (unless you are extremely lucky). If you try to do that, the most likely outcome is you will end up in the Boom/Bust Cycle or, even worse, you may injure yourself.

My advice is start as if you’ve never picked up a dumbbell in your life before. If you have a history of weight training and are confident your technique is good, maybe you don’t need to consult a trainer. For complete novices, definitely consult a trainer. If you’ve had a considerable time away from lifting, I recommend consulting a trainer to ensure your technique is still correct. Technique (how you lift) is critical for healthy people, even more important for us.

Let me illustrate. If I am not in the perfect position when doing the shoulder press, my right shoulder will click. It doesn’t hurt, but I can feel it and hear it. It may not hurt now, but if I did that often enough, I’d very likely end up with an inflamed shoulder. My guess is my underlying conditions result in me not holding my shoulders in the correct position all the time, so I have to correct my posture before continuing with the set. But if we have no idea what correct technique for an exercise is, we could be doing it in a way that may exacerbate our situation rather than help us. I got caught the other day. I switched from tricep pushdowns to tricep kickbacks because my wrists didn’t like the pushdowns. One of the trainers pointed out my back was not in the correct position. Sometimes even when we KNOW how we should do something, because we can’t see ourselves, we don’t realise our technique needs correcting.

This next bit will be harder for some of us than for others. Sorry in advance! I used to do mostly free weights, not the machines. After I developed my condition(s), I realised quite quickly it is much safer to use the machines. Do I like using the machines instead of free weights? No. But I also know I need to be safe. Think of the chest press. If I am lying on a bench with a dumbbell in each hand and my body suddenly says, “No, sorry, not today” for whatever reason, I could lose control of those dumbbells and hurt myself in the process. On the chest press machine, at least the machine I use, I can transfer the load from my arms/hands to my feet very quickly (remember, I have bionic legs, so they cope!). In the picture below the foot rest can be seen. This moves as the handles move. Applying pressure to the footrest takes the load from the handles.

A chest press machine at the gym
Chest Press Machine

This way my chances of hurting myself are virtually zero. The machines can also be easier to adjust. Although we do aim to increase the weights over time just like any healthy person does, there will be days when for some unknown reason the body is just a bit “off”. I’ll put the pin in the plate I lifted two days prior and won’t be able to budge it. Very quick and easy to shift the pin to a lower weight without having to return dumbbells to the rack and get lighter ones. Usually dropping back by one plate is enough and I can keep going.

Having got those preparation aspects out of the way, what weights and exercises should you start with? You know what my answer is before I even type it, don’t you? IT DEPENDS! On so many things. Below is an example of what I am currently doing. This will be way too much for some people and others will scoff at my (to them) meagre weights. Yes, this is also an issue for those with a past history of lifting. I used to leg press over 200 kgs. My personal best since developing chronic conditions is 160 kg. At the moment I am sitting on 125 kg. If you are a competitive person it can be VERY, VERY hard to accept you are very unlikely to lift your previous weights again. My bicep curls are currently 12 kg – 2 x 6 kg dumbbells. Nothing wrong with my biceps, but prior to my recent new diagnosis my wrists couldn’t cope with anything heavier than about 4 kg. In my forties I was using much heavier weights. This is something we have to accept. We are now different, we have to have different goals.

THIS IS NOT WHERE YOU START! I’m merely illustrating what is possible over time.

The above shows two days. I go to the gym three days a week: Thursday, Saturday and Monday. The Thursday and Monday are fairly similar, but the Saturday is a lighter day and I do different exercises than the other two days. At the moment: I can change things around at any time.

Why are some sets only 8 reps and other 12? Usually 8 will indicate I’ve just increased the weight, 12 will indicate I am about to increase the weight. On the other hand, a 12 may indicate I have dropped a weight because that body part is not as happy as usual and I’m waiting for it to settle, so I’ve dropped the weight and increased the reps.

No, there isn’t a lot of core in that list. A lot of core exercises are on the floor and those I do at home. I also have a swiss ball at home. I don’t usually do squats at the gym, but that particular day I was short on total time so threw a set in to reach my time target.

In Part II of this series I discuss how you determine where to start on this journey. What questions might you ask a prospective trainer? What might be a good program? How many times a week? What kilograms might you start with?

Further Reading:

Not everything in the articles below is applicable to those with chronic conditions, but clearly the benefits of strength training are being recognised.

The ninetysomethings who revolutionized how we think about strength training – The Guardian
From strength training in your 20s to yoga in your 80s: how to reach peak fitness at any age – The Guardian
‘Never think you’re too old’: meet the world’s fastest 75-year-old woman – The Guardian

Robyn Dunphy1 Comment

Getting Back Into It!

I’d put off writing about my IMPROVEMENTS until I was reasonably sure I was staying on track! I’ve reached the point I’m reasonably sure! If you are catching up, please read A New Diagnosis: and Other New Stuff to understand recent events.

One thing I have learnt is often when we are in the midst of an absolute crap time, we don’t realise just how bad it was until we are out the other side. To give you an example, last week I started swimming again. Given how bad my shoulders had been, there had been no swimming for quite some time. I didn’t realise how long: when I looked back in my Garmin records, I had swum twice in 2023 and not at all in 2024. Had you asked me, I would not have thought it was that long. Lifting weights wasn’t quite as bad, but almost. I’d lived most of those two years, off and on, taking prednisolone and Celebrex. Earlier this year I had two rounds of steroid shots in each shoulder. Of course, during that time I’d also had my second knee replaced and an ankle fused.

The biggest problem had been the inflammatory stuff though, not the surgeries. At one point I had sore shoulders, fingers, wrists, elbows, the unoperated ankle and my neck and TMJ played up as well from time to time. Even my knees were painful at times – after all, after knees are relaced, the original muscles, tendons and ligaments are still there for any inflammatory disease to attack. My blood pressure (BP) was also up.

I am being VERY CAREFUL! Once I realised how much I hadn’t done, I knew I had to be slow and steady. Follow your own advice, Robyn! I had kept walking though. In fact August 2024 was my best walking month ever (well, since I started recording steps) and that only happened because a friend on BlueSky challenged me. But the upper body was a nightmare.

Personal Step records per Garmin. Most steps in a Month: 317,557 31/8/2024

To put some dates around this, my first injection of my new medication was on October 16. A few weeks of loading (weekly) injections, then fortnightly. Yesterday was the eight week mark. I’d said I wasn’t going to be sure about progress until about the middle of December as when I first started I had the previous medication still in my system (presumably it was doing something, even if not much) and was on loading doses of the new medication. By now the old med will be washed out of my system and I’m on the standard injection regime, fortnightly.

One BIG plus? NO Celebrex! YAY! Looking back on my symptom diary, I assessed myself as feeling 15% better the morning after the first injection. I’d noted specifically that elbows and fingers were not as bad. Since then, constant improvement. I have not taken any major pain medication either. The odd Panadol Osteo for my back, which is not surprising given I hadn’t been able to keep up my posterior chain strength for the osteoarthritis.

I did a couple of very tentative gym visits in November to see how my body would react, than on December 1 I started back with a strategy.

Before you look at these numbers please bear in mind for some readers (e.g. healthy young weightlifters) these numbers will look terrible. To a chronically ill person of probably any age, these numbers may look like a bridge too far. And there will be people to whom the numbers look achievable or where they are at or they are already above. To those starting out, DO NOT rush in where angels fear to tread. Seek professional guidance if you can. Read my Pacing articles. Remember, I’m qualified to guide myself AND I’ve had 10 years practice at reading my body. Just because I’m doing something doesn’t mean you should – but it doesn’t mean you should not either. It isn’t really the numbers themselves that are important here – it is the fact I am improving! That’s the important bit.

Yes, to me the kgs look awful! But this is what (re)starting from scratch looks like, so I’m being transparent!

At the moment I am lifting weights every third day. By December 10 I had improved a few things! I did get pec dec on the other two days, just, of course, not the day I’m using here. I’m halfway back to my PB leg press of 160 kg. That is my PB since I’ve been chronically ill, not PB ever. I prefer to only compare within my health status – comparing to a healthy me is unfair and somewhat demoralising, so best not to do it.

I also got back in the pool. Given my shoulders had been SO BAD earlier in the year I am being very careful. I did 10 laps of the 25 metre pool, so 250 metres. The hardest part I found was my breathing! So long without swimming and I was struggling. Breathing during breast stroke was OK, but breathing during front crawl (commonly called freestyle) was a challenge. Today I swam again and my breathing was better. I’d like to swim more often, but lane availability is scarce, sadly. Am looking into how I can schedule more swimming without getting to the pool at 5:45 am – that is NOT a good time for people like me due to morning stiffness. The 50 metre pool has more availability, but until my breathing improves I don’t want to risk it. Very embarrassing to have to stop halfway down the pool.

In summary, I am very happy! My fingers are still a bit bothersome, but manageable. The wrists need strengthening – I could do heavier bicep curls, for example, as the biceps are fine – but the wrists get grumpy if I up the weight too much at the moment. There is improvement though and that is what counts. I’m not trying to head for the Olympics, just maintain and improve mobility and strength. My BP is back to normal, I’ve lost weight and my brain aneurysm has shrunk – a few very nice added benefits!

Robyn Dunphy1 Comment

A New Diagnosis: and Other New Stuff

My chronic Illness life has been a a bit hectic of late. Several changes. I was going to title this “New Stuff Coming Out of My Ears”, but thought readers might think I actually did have stuff coming out of my ears – I can assure I don’t. Not yet anyway!

I honestly didn’t quite know how to write about it all. I want to help other patients understand what may happen during their journeys and yet I wasn’t quite sure what was happening to me! So I kept quiet for a while until I could wrap my own head around the whole situation. Plus I wanted to be able to have a positive outcome to talk about. My main message to other patients is do not be afraid to ask the hard questions of your medical team if necessary. Some conditions/diseases are clear, others not so much. Medicine is not an exact science. My thyroid diagnosis was always clear: bloods and imagining are well established. Other conditions are not so easy to be accurate about, especially perhaps in the early days of the condition.

As some readers will know, earlier this year I moved to a different rheumatologist. We will call her Dr IV (Dr Four). I don’t exactly remember why now, but one of the things Dr IV did was send me for a brain MRI. That came back showing while the brain was actually pretty darn good, thank you very much, there is a small brain aneurysm. By small I mean somewhere between 4.5 and 5 mm, depending on who is measuring it, it seems. I am assured we don’t worry unless it is 7 mm. Now, to a doctor dealing with these things, 2.5 mm might seem like the size of the Grand Canyon. To the patient 2.5 mm is a pretty small difference! However, I’ll take the neurosurgeon’s word for it! The medical advice is to monitor. He did send me off for a CT scan as well, but at the time of writing I do not have the results – it was being done more as a baseline for future comparisons. This was, yes, a bit of a shock! (See update 1 below)

Around the same time I was referred by my previous sleep specialist to a colleague of his. Now this was interesting. His colleague, let’s call her Dr S2 (for Sleep Specialist Two), read my sleep study results from two years ago rather differently and recommended a CPAP machine. So this was a whole new adventure too. I will write about the CPAP experience in a later article.

After the above issues, and already on my THIRD PsA medication for the year, I asked both my GP and Dr IV, “Do we have the right diagnosis?”. My GP said, “Fair question!’. Dr IV kinda went “Hmmm” and wrote out a pathology request including tests I had not had for years.

Those tests came back as a bit of a shock! I have rheumatoid arthritis (RA) – the tests were pretty conclusive and my Rheumatoid Factor (RF) was, shall we just say, quite high. There was another test as well that when considered together with the RF is about as conclusive as you can get. My medication was changed that day. So medication number four for 2024.

By now my head was spinning a bit. Brain aneurysm, CPAP machine and a new arthritis diagnosis all in the space of a few weeks. Actually, it is an old diagnosis revisited, as I was first diagnosed with RA in 2014. Then in late 2018 that was changed to PsA. Now in 2024 I’m back to RA.

Or – do I actually have both? Dr IV and I are keeping an open mind on that question. Well, Dr IV more than me – after all she makes the call, not me! Let’s just say I would not be surprised to have both. It is considered rare, but not unknown.

Having both would also explain, I suspect, why I was getting worse – the PsA may have been being relatively well controlled, but in the background the RA was ramping up. I want to be VERY clear – that is MY thought at this time, it has not been suggested to me by my doctors, who are still investigating.

Since all of that, Dr IV has also ordered more blood tests, some of which are new to me. I do not know what the outcome of those will be, I had them done on Friday. (See update 2 below)

How did I feel during all of this? My emotions included anger, fear, relief, gratitude: each of which would come and go. Gratitude Dr IV was going all out to get to the bottom of the problem. Anger that the increase in RF hadn’t been picked up before, fear re the brain aneurysm before I knew the size, less fear (but a little) re the high RF which can be related to many things, not just arthritis. Relief there was an explanation for why I was so sore everywhere! At the time of the new/(additional) diagnosis, I had painful arm muscles, shoulders, wrists, elbows, neck, fingers. Even my wonderful replaced knees were sore. Worth noting when knees are replaced, the muscles, ligaments, tendons etc remain and they can still get inflamed by inflammatory conditions. It was comforting that during this time I coincidentally also had my twelve month final post-operative check with my knee surgeon and both knees looked perfect from a mechanical perspective on x-ray. So the knee pain had to be inflammation related.

As most of us know, some of these medications can take months to work. I was really surprised with my new medication this time. I’m not perfect yet (probably never will be), but I’m so much better than I was on the day I took the first injection! I am off Celebrex totally and only on 7.5 mg of prednisolone per day. Hope to get off that entirely, of course. My blood pressure has improved too (Celebrex may increase some people’s blood pressure and I may be one of those people).

Today for the first time in ages I walked 3 km in one hit. I always walk 4 km a day, but lately 2 km has been my maximum distance in any single walk. Not only that, I did it at a pace of 11:51 minutes per km. I was very happy with that!

Thankfully, irrespective of whether I have RA, PsA or both, Movement As Medicine still applies. I don’t have to change my regime. In fact, Dr IV said to me she sees my dedication to Movement As Medicine as being what has got me through the years so far. That also made me happy.

This story isn’t over yet. There are more tests to come back, I still need to follow-up with the neurosurgeon for my own peace of mind and there is still the question of do I have both RA & PsA. The medication I am currently on treats both, which is comforting.

I have no sore bits anywhere. The capometacarpal joint areas of the index fingers are still both swollen, as are the areas around the ulnocarpal joints in both wrists. Dr IV tells me it can take a while for the swelling to go down. The heat of those swellings has gone. I am still limited with some finger mobility, but I’m working on the fingers and there are improvements. The top photo is my left hand today (can’t cross fingers), this photo is my right hand today (can cross fingers).

The video was captured last month. You can see on the left hand I can touch all my fingers to my thumb. On the right hand, not yet.

The best thing? No pain medications so I can hit the weights again (have done a few sessions already) and get those weights back up! Will I get back to 160 kg on the leg press? I don’t know, but I’m going to try!

Updates November 13, 2024

  1. I rang my neurosurgeon yesterday, just for peace of mind, for the CT results. That is when I discovered I forgot to tell his PA when I had the CT done. Where I had it done, they don’t send the results automatically. I burst into tears on the phone out of frustration at myself and embarrassment. The memory AGAIN. In fact, during that call, I could not even remember having the CT done, but I knew I had. I checked my calendar for the appointment and just after I found it, I REMEMBERED! It was in one of the rear buildings and I’d been trying to remember going to the main building. Nothing urgent about the results, but I will see neurosurgeon later this month to go through both the results and the plan for the future.
  2. I received a message yesterday that the blood tests done on Friday are not concerning, so THAT is a major relief!

Robyn Dunphy7 Comments
leg press

Are Strong Pain Meds and Exercise a Good Combination?

Rule number 1 – discuss your specific situation with your doctor if in any doubt. Having said that, my experience is no, usually not a good combination.

Now, obviously I am not talking about trying to lift weights on pain meds after surgery! Just listen to your rehab physiotherapist!

What I am talking about is when patients are in situations like mine. We have a chronic illness, in my case psoriatic arthritis, and one of several things happen (or more than one happen together).

The most obvious examples are:

  • The condition flares
  • The primary treatment medication stops working for the patient
  • The patient is waiting for a new medication to start working.

At times like this the patient may have no option but to resort to a stronger pain medication than Panadol Osteo or similar.

Side note! If you are a friend, family member or colleague of a patient reading this, please be aware changing medications is not a simple thing with many of these diseases. A new medication can take anywhere from two weeks to six months to reach full effectiveness, with hopefully incremental improvements along the way. The medications are also NOT a cure. Not all medications work for all patients: I’m a prime example, my newest medication is medication number 11 in the 10 years I’ve been managing my disease. Medical science may develop cures in time, but we are not there yet.

My usual routine is I lift weights, walk and swim. If I am on strong pain meds, I do not lift weights. If the shoulders are involved, I do not swim either.

In order to exercise safely you need to be able to listen to your body. Perfectly healthy people lifting weights need to listen to their body: it is even more important for those of us with an illness we are managing to be able to listen to our bodies. Some time ago I wrote Changing Your Exercises for Safety where I looked at some adjustments we can make to exercise safely. I didn’t discuss pain medications as back then I really wasn’t using any of the “big stuff”. In 2023 I wrote about changing medications and what you can expect – it isn’t always easy!

If I am on strong pain meds, I can’t read my body as well as I need to be able to, to protect myself from inadvertently injuring myself or making my situation worse. I can’t necessarily tell if I should drop (reduce) the weight I’m lifting because it is possible the pain meds are blocking any discomfort I am causing myself.

Yes, not going to the gym may cause other issues. At the moment my lower back is a bit grumpy because I have been not willing to risk doing the extensive range of posterior chain exercises I usually do which keep my back in a pain-free state. But I’ve been on pain meds, off and on, for much of this year. I’ve just started my third treatment medication for this year and have been able to stop the strong meds.

I returned to the gym yesterday. I was VERY careful. Lifted very low (for me) weights to see how my body responded. No trying to do 160 kg on the leg press, I assure you. I did 45 kg. So embarrassing. I found the leg extension a real challenge, so was very careful. Despite how much walking I do, clearly my quads have taken a little holiday.

The quads are a good muscle to compare with others from yesterday. They seemed so weak that I don’t think I’d have physically been able to do myself any damage even if I was on pain meds – the strength just wasn’t there. However, the chest press was a different story: I had the strength to lift more than I did, but doing so hurt my shoulders and I could feel that, so dropped the weight back. On pain meds I probably would not have been able to feel that warning. I may have overly stressed my shoulders which are in recovery mode at the moment. I will say my shoulders feel better today than they have for months. I had steroid injections in them a few months ago – they were bad. But I need to go slow and steady to build up my strength again. And give the new medication a chance to work.

Why have I not been swimming? Same thing: reading my body. On strong pain meds I would not be able to tell if I was aggravating my shoulders or not. I will try swimming this week and see how the shoulders react, but I will be very careful.

Each disease is different. Each patient is different: patients will be on different pain meds and even if on the same pain med they may be on different doses or strengths. This isn’t a one size fits all situation.

If I know beyond doubt it is only my upper body flaring, for example, I’ll still do lower body exercises and vice versa. But it takes experience to be able to determine these things. I’ve clocked up 10 years this year and every year brings something different to learn as a patient.

Movement IS Medicine – but we need to be very careful when our disease is running riot and we are having to resort to strong pain medication.

Robyn Dunphy1 Comment

Tough, But Worth It!

Yes, I’ve been very quiet. VERY quiet. I know, I’m sorry. Recovery from my November surgery took quite a lot of effort. On top of that, the mobility restrictions meant my psoriatic arthritis decided to complain, so I was fighting on two battle fronts.

My ankle surgery took place on November 28, 2023. My first completely pain/discomfort free walk was March 22, 2024. 16 weeks and 2 days.

I’m not repeating the details previously documented, so if you are catching up, read the surgery article linked above first! The moon boot was better than the cast and knee scooter for sure. I could shower without “bagging” my leg in plastic bags! I didn’t have to sleep in the moon boot! I was no longer doing three-point turns in my small apartment or constantly reversing in and out of spaces. I could drive! I was no longer so totally dependent on other people, I had a modicum of freedom.

I was allowed to go to the gym to do upper body work. ONLY upper body work, but at least it was something! The gym staff looked at me a little askance, but let me in.

I was to gradually increase the percentage of weight on that leg each week and could try proper shoes at week four of moon boot life. I will admit I snuck into shoes a couple of days early because the moon boot meant my legs weren’t the same length and my right piriformis muscle was not overly impressed with that situation. I was VERY careful though.

At my 12 week post-op my surgeon was very happy with how everything had knitted and I was finally allowed to go to the physiotherapist. It is amazing how weak your calf and ankle muscles can become after 12 weeks of no use. Surprisingly, this physiotherapist wasn’t as bossy as the knee physiotherapists: exercises every second day instead of every day.

On February 14 I started short walks – between 500 and 800 metres depending on how the ankle was feeling. I managed my first 1 km walk on February 20 and have slowly built up from there. March 21 I walked 2 km in one hit! I should add I was doing multiple walks a day by this stage, with the physio’s permission.

While the ankle/foot wasn’t really painful, it wasn’t 100% comfortable either until March 22. That was the day I felt free!

Funny conversation with surgeon at the 12 week post-op.

Me: “So I have no restrictions now?”
Surgeon: “No, you’re fine!”
M: “So I can do the leg press?”
S: “Sure!”
M: “So what weight can I start at?” (Thinking to myself 50 kgs seemed reasonable to start)
S: “Oh, just the plate, no weights!”
M: Thinking – that sounds like a restriction to me!

It always pays to clarify. I think maybe he didn’t consider his nearly 70 year-old patient was going to be doing things like the leg press. Have I got news for him!

I have interesting rehabilitation exercises, such as standing on one leg for 30 seconds and calf raises on one leg. Now, to be honest, I still cannot do the one-legged calf raise, but I’m getting there with a little help from the other leg. A little less help each day. Hoping I can do the single leg calf raise by my next physio visit!

So yes, it was well worth it, but man alive, am I glad I only have two ankles. I’ve learnt a lot of this experience and will plan the next one with the knowledge I now have about how VERY different this is from knee replacement surgery.

Of course not every ankle surgery will be exactly the same as mine. Other patients may spend less time in a cast for example. Or more time in a moon boot. It definitely isn’t as easy as knee replacement though.

Due to the lack of exercise during those weeks of recovery, my back is not happy. It is getting happier now I am back to a more normal routine, but some days have been quite tough. Moving is not as bad, most of the time, as being stationary, luckily. My back has been under control for some years, due to the work I keep doing on my posterior chain to support it, but at my age we decondition faster than in our twenties – I’m having to build up that strength again. The shoulders and wrists didn’t like the crutches either – the psoriatic arthritis complained. Both wrists and shoulders are now improving with increased exercise and no irritation from the load of crutches.

One thing I wasn’t happy about was once I could walk 1 km, I discovered I’d lost another point on my VO2 Max reading. I was devastated. While I don’t do high intensity exercise and therefore don’t expect a high VO2 Max reading, I do want something healthier than “poor”! Thankfully, I’ve worked hard enough this week (shown below) and last week to recover that measly one point. The lost of the one point had worried me because it was the continuation of a downward trend that started early 2023 and so desperately want to turn it around and get back to where I was.

Steps per day March 19 - 25
Formal measured walks per day March 19 - 25

So that’s it for this ankle. When the next one will be done is debatable. Naturally the surgeon looks at risk mitigation from the perspective of the risks of surgery. I’m looking at it from the recovery perspective. It doesn’t matter how brilliant his surgery is if I am not well enough to manage the recovery properly and at this point in time I’m still not sure we will get my psoriatic arthritis under control. I needed my wrists, shoulders, piriformis and back to be better behaved. I managed, but it was tough.

Onwards and upwards! I need another 3,700 steps today to hit my daily goal, so off I go!

Robyn Dunphy3 Comments
chronic conditions care courage consistency coaching

Care, Consistency, Courage and Coaching

Chronic Conditions

Care, consistency, courage and coaching are my “4 Cs” of chronic condition management.

Care

There are different types of care. Top of the list is great medical care. You must have a good relationship with your primary care provider (general practitioner, GP). I’m not suggesting you be family friends who go out for dinner (that could be difficult) but you should feel comfortable that your GP “gets” you and that you trust their level of care. This is the medical professional on your team that herds the cats (your specialists) and keeps the information flowing, in a sense the gate-keeper.

Self-care is extremely important. Self-care isn’t all bubble baths and scented candles, although those are nice. Self-care includes doing the things you MUST do to maximise your health, minimise your pain. Making the time to do stretches, walk, swim, lift weights, sleep, eat well: “doing the hard yards” as my father would say. Yes, the other sort of self-care, the time-out, rest, relax: also very important.

Mental health care is extremely important. As I have written about that in “We Need Mental Health as well as Physical Health, I won’t say more here. Reducing stress is part of mental health care.

Being careful is also a form of care. One example I have written about before is changing exercises where necessary. My own example is I no longer do dumbbell chest press because getting off the bench irritates my spine.

Being careful with our body weight is important – for many, weight gain can mean increased pain levels.

breakfast
Breakfast

Consistency

Consistency is paramount. When we were healthy, our bodies could recover from a week or two of no exercise, a night on the booze or day of crap food. Sure, we may have suffered a hangover or the scales may have jumped a kilogram, but we easily recovered from the damage.

Once we have a chronic condition/illness/disease not only are our bodies not as resilient, we are likely on medications that, while doing very good things for us, may also compromise other aspects of our “internal workings”. My own example is my rheumatoid arthritis (RA) medication suppresses my immune system – logical when you think about it, of course, given RA is an autoimmune condition, my own immune system attacking me. This means I have to be super careful not to catch bugs/viruses, as I recently did. I ended up in ED with what felt like a ping-pong ball in my throat.

Exercise, such as stretching and resistance training, will stop your body deconditioning and greatly assist with pain management. However, the gains we make can be lost VERY quickly once our bodies are unwell. Consistency is vital to ensure we maintain our gains and keep building on our achievements. I have discussed exercise in more detail in Doctors and Exercise, so please click that link for a more comprehensive presentation about the importance of exercise.

de-conditioning

During a consultation with my endocrinologist he asked, “Do you take your meds?” Frankly, I was shocked – what a strange thing to ask, I thought, of course I take my medications! He asked because my thyroid was misbehaving again and my blood tests were not within the reference range – again. Clearly some patients don’t take their medications as prescribed.

Most medications for chronic conditions require consistency to be effective. If you feel the dose or the medication isn’t working as it should, TALK TO THE SPECIALIST before changing anything. You may do more harm than good. If the problem is remembering, set alarms in your phone. Some medications can take three or more months to reach the required level of effectiveness.

Be consistent. With medications, exercise, diet, rest, sleep, hydration.

consistent exercise
Consistent daily steps

Even if you have to dance to get there!

Courage

Yes, courage. It takes courage to start AND to keep up the fight. “The cave you fear to enter holds the treasure you seek”. The treasure is maintaining quality of life for as long as possible. For some, the cave is MOVEMENT! It can be hard to think about movement when we are in pain. Or we feel we can’t “keep up” in the gym. Today is my swimming day. The predicted high is 13 Celsius. Do I REALLY want to get into my bathers and hit the pool, or would I prefer chocolate cake and a nip of Bailey’s Irish Cream? Consistency! Courage! Just do it!

leg press

The benefits are worth it. I have avoided a knee replacement and radiofrequency denervation of the lumber spine. Yes, I MAY need both some time in the future (distant future, I hope) but for the moment, I’m good. I’m on no pain medications.

Four years ago I started with four x 5 minute walks a day.

Now a gym session looks like this:

  • 4 sets leg press
  • 3 sets chest press
  • 3 sets shoulder press
  • 1 set body weight squats
  • 3 sets Smith Machine squats
  • 3 sets tricep extensions
  • 3 sets bicep curls
  • 3 sets lat pulldowns
  • 3 sets leg extensions
  • 3 sets pec dec
  • 8 minutes on the rowing machine

I got VERY annoyed recently when I lost muscle strength and had to drop my leg press weight down from 160 kgs. While we still don’t have a medical explanation, I am building back up again, so perhaps it was just a temporary glitch. We have temporary glitches.

I didn’t get to where I am now without care, consistency and courage.

Coaching

Professional athletes all have coaches. They have goals. WE also have goals (hopefully SMART goals)!

Perhaps we need to look at ourselves as endurance QOLs –  Quality of Life is the goal we strive for, not necessarily running 3,100 kilometres in 45 days! Our mental challenge can be just as extreme, even if our physical achievements are not. 8 Steps to Retain/Regain Quality of Life

People are all different, conditions vary greatly. Even so, the sooner you start managing your condition instead of your condition managing you, the better your chances of retaining your quality of life for as long as possible.

Sometimes all that is needed is help to get started. Sometimes a patient may prefer longer term support and encouragement.

Coaching helps the chronic condition patient take control. There is a fifth “C” – Control!

Too often patients feel they are “OK for the moment, I’ll worry about all this later” (when my job is not so stressful/the kids are older/the house is paid off). My advice is don’t wait. Start now to protect your future.

Contact me for a confidential chat as a starting point.

Note this article is intended for chronic condition patients who have a medical clearance or medical advice to exercise. This can be at any level from beginner.

Robyn Dunphy4 Comments