T Nation

Loaded Topic of Heavy Lifting and Cystic Fibrosis

I’m going to throw this in the rehab section because I don’t really know where else to put it.

For a quick background, I’m making this thread for a friend/lifting partner who has Cystic Fibrosis (in short, a lung disease that causes massive mucus build up in the lungs, and also a very bad inability to process vital nutrients) and need a few ideas for lifting alternatives, and general helpful insight.

Obviously the nutrient issue is pretty cut and dry, his docs have told him he just needs to eat constantly, and has medication to help process said nutrients, otherwise he was just shit on by genetics.

Some basic details:

He’s like 130lbs (or so he says, I’m willing to bet closer to 120)
Eats like a pig
Minor back injury, basically only prevents deadlift
Anything too taxing causes caughing fits

And he really fucking wants to get strong(er), he’s dedicated, he stretches everyday, and we haven’t missed a planned lift together since he started up with me about 5 months ago.

He’s definitely gained some visible mass, but not what I’d call “newbie gains”

So my immediate questions are: (also open to any off the wall suggestions not related to this info)

Hard gainer diet? Something easy and affordable (he’s on disability, so money is a very real limiting factor)

Alternatives to deadlift and squat (I have a few squat alternatives, but more is welcome; and deadlift upsets his back, as well as being too taxing on his lungs)

Expanding breathing capacity? I don’t even know if this is a possibility, I never smoked, and have really healthy lungs so I don’t have any knowledge


Our routine is a chest/tri, back/bi, leg/shoulder split, with abs sprinkled in 4 or five days a week. 2 days on, 1 day off schedules. (I like to always be prepared for curveballs that would make me miss a day, we schedule 4 unmissable days, and the rest we do if we can)

His docs recommended a lot of excersise, and promoted heavy (er) lifting as a good idea.

Thanks for any advice!

Physio student here (not qualified tho so have someone follow up with a medically professional)

It’s great to hear you are helping him out. CF does indeed benefit from exercise including both resistance and cardiovascular. Hell it’s crucial to improve quality of life in CF. Resistance exercise make everything more efficient and that strength and fitness will reduce the workload on his systems as well put him at a higher level should an exacerbation of his cystic fibrosis temporarily reduce his fitness. There’s a host of other health benefits too not just for CF.

Does he work with a physical therapist or physiotherapist who has prescribed an airway clearance routine consisting of some exercises? It could be beneficial to perform airway clearance techniques before exercise so his lungs are as clear as possible allowing him to perform to his best capacity. Same goes with the timing of some medications he may use such as various bronchodilators or corticosteroids. Have him discuss this with his physio or doctor as timing, frequency and or modality have all likely been medically prescribed and shouldn’t be altered without consultation.

In session rest, not just rest times but rest for his breathing and all its associated systems and functions should be priority both for safety and performance. Once again a medical professional e.g. physiotherapist can give specifics but positioning can help greatly his shortness of breath e.g. sitting down (no shame in it if the work is being done during sets) or leaning on a rack. Longer rest times are probably required and training should be based on that e.g. (high reps low rest intervals, SUPAsets and dropsets will probably be poorly tolerated)

Diet wise I’m not a dietician but do know that in CF issues with pancreas function and its production of digestive enzymes messes with digestion and absorption of nutrients. I understand fat content of food is related to how poorly it’s processed and whether or not enzyme replacement medication is taken with it. Foods containing mostly carb are ok to go I believe so taking advantage of the body’s use of carbs to fuel high intensity activity with pre, intra and post workout carbs will be advantageous. Double check with his doc tho.

In terms of gains and I can see being in a caloric surplus would be harder for your friend. Like the doc said: Eat loads co he’ll need all he can get.

As much as I love barbell work, a case could be made for some machine exercises. For example on a machine/plate loaded chest press you can bail at anytime, letting the weight drop freely without fear of injury. If your friend is feeling breathless he can simply stop whenever or push on at the cost of worse breathing and a longer rest. Under a barbell squat however he either has to gauge how his breathing is doing and end the set according or if he pushes it risk injury and damage failing/bailing from a squat. Similarly coughing fits during a set should be considered.

Do you also do cardiovascular or endurance exercise with him or is that done seperately? While his lung function probably won’t improve long term his fitness can like anyone else’s allowing him to best use his “breathing capacity” and lift harder/longer (because priorities lol)

Don’t underestimate his ability to make gains even with CF. Good luck to you both

Phenomenal response, thank you!

To be honest, he’s terrible at making healthy life choices, he only sees his doc in Chapel Hill whenever his lungs capacity greatly drops (which hasn’t happened since we started lifting, which is great). Other than that, he doesn’t go to any other medical professional. I managed to get him off sugar, and cut back his drinking to an average of once a week or less (he had a small problem) other than that, his healthy choices kind of stop there.

He has a nebulizer he’s (supposed) to use once a day, that helps clear his airways, so I guess that would be similar to a breathing exercise for him. As far as medication goes, he only uses that, an abuterol inhaler, and takes creon for processing his foods

As for his rest, I’m always the guy that bitches when partners sit in a workout unless they’re just tapped out, but always let him sit whenever he needs to, it makes the difference between a 2 minute rest, and him possibly having to call the workout and go back inside. (Also should be noted we workout in my garage, which influences some of my responses) personally I’m trying to work on his posture and have him sit upright, cause I’m sure that’d go miles by itself.

Food: at this point I’m just trying to make sure he hits a surplus of calories, I’m not too concerned with how clean he’s eating. Probably the only time I ever heard a doctor say “you’re just as well off eating McDonald’s everyday so you can gain some weight” when he got diagnosed. He is Italian, and he likes his pasta, so I’ll definitely start steering him hard towards that. The pre/intra/post will be something I focus on when I can get him to eat more, he eats a lot, it’s just not enough.

Machines are going to be difficult, we lift in my garage and have the following:

Bench/squat rack combo
Olympic bar
Various plates up to about 345lbs total
Dumbbells 15, 20, 25, 30, 50
A few resistance bands, I’ve been buying various kinds every paycheck or so

So we’re actually quite limited, great for what I’m pursuing, not everything he would need

We lift almost the same as far as excersises go, he has to occasionally adjust his lifts for his breathing and back, and we’re about to start conditioning soon, I was working an extremely physical job for the last 5 months, and he had no interest in exerting himself like that. But hopefully that’ll start soon, and I can start him up.

Thanks for the response again, man

Hmm. Would think that he’d have more support from healthcare professionals but perhaps it’s early goings and he is managing his condition well at the moment.

It’ll be if an exacerbation is real bad or his condition deteriorates markedly or a hospitalisation occurs that he’ll get all this “extra” support. IMO prevention or at least preparation for an exacerbation is essential.

Don’t know how the healthcare system or health insurance works wherever you are at but I think it’d be worthwhile to ask the doc for a referral to a physio or Cardiorespiratory therapist.

Failing that a quick Google search can come up with many handy resources even those aimed towards other diseases as the problem of impaired airway clearance is shared.

As stupid as it sounds getting medical advice off the internet and apply it, in this case I think little to no harm could be done, even in the absence of professional guidance, for some possible benefit. Some topics may be worth a search: e.g Airway Clearance Techniques and Positions to Relieve Shortness of Breath or Breathing Control Techniques. The experiences of people living with CF at a stage where daily airway clearance techniques and exercises are no longer an optional extra but crucial to maintaining quality of life and respiratory function are also invaluable.

Diet wise it seems the only thing needed is more. There’s people with normal digestive function who complain or being hard gainers never mind in CF. I can empathise with eating being tedious but something can worked for me is drinking a lot of calories.

Does your friend have Cystic Fibrosis Related Diabetes? If not drinking calories is easier and faster. Anyone can smash down a can of Coke or glass of juice after a meal or as a snack. 10 seconds 100+ cal couple of times a day adds up.

As important as good posture is to long term musculoskeletal function you have to be aware of what’s important short term. Think of the postures one assumes say after a 400m sprint. You likely won’t see many standing up tall unless they won instead the tendency will be to find a resting position. For many this will be standing hunched over with hands on their knees. This “poor” posture is helpful in facilitating diaphragmatic breathing and use of accessory muscles of breathing. Point is don’t force “good” posture when resting, let the body use its resting positions. Enforce when lifting for safety and performance.

As far as actually lifting goes you got to work with what you have. Get a little creative with exercises e.g seal rows or bench/chest supported rows. What you have is more than enough.

Squat Rack Safeties should be set properly because a lazy set up may mean the difference between serious injury and a minor bruise. Close effective spotting from you will also be crucial in making sure that whatever happens he will be safe and that he knows it thus giving him full confidence to push himself if he so desires.

Think about rep schemes too. A triple at 80% or some other lower RPE work will be unlikely to gas you like a set of 10 at 12RM. Gains are also similar between 3 sets of 10reps and 10 sets of 3reps with intensity adjusted accordingly. So lower-moderate reps will probably give the best results.

Frequency can also be manipulated to cater for preference or necessity. Lazy mf who wants to work out thrice a week max? Full Body 3x per week. Working most days? Same deal. Push Pull, Upper Lower etc. all work well. Most important thing is to have something y’all will stick to. Best exercise program in the world is worth nothing if you don’t stick to it.