Getting Back to Barbell Squats

We moved halfway across the country in December, and, as part of the effort to lighten our move as much as possible, we got rid of as much stuff as we could.  Because we would be living in an apartment for the better part of our first year in Arizona, I knew I had to part with all of my strength training equipment, save for my PowerBlock dumbbells and adjustable utility bench.  When it came to training legs, for nine months I got by on dumbbell squats and split squats, as well as lunges.  The multi station gym in the apartment complex fitness center did feature a leg developer station, and that added some variety to my workout routine.

As soon as we knew we were moving into a house, I started searching for a squat rack to put in the garage.  Space was my primary concern and cost was a close second.  When I came across a brand-new, still-in-the-box Gold's Gym XRS 20 squat rack at a liquidation store for under $45, I grabbed it.  We didn't know if it would fit, but we figured we could sell it for at least what we paid for it if it didn't.  Turned out that if fit perfectly.  We can still park two cars in the garage; I just have to back mine out a few feet when using the rack.

With a rack now in my possession, my attention turned to securing a barbell and weights.  I searched Craigslist multiple times a day before I found a 170-pound set of Olympic plates.  A couple of weeks later I found a 45-pound CAP barbell (actual weight: 43 pounds) offered for sale by the same individual from whom I'd bought the weights. Including 12 square feet of gym floor puzzle mat which was also purchased from the liquidation store, for a total investment of $200 I was back in business.

Depending on if I decide to include barbell deadlifts in my routine on a regular basis, I may need to acquire additional weight.  But for the time being, especially considering my age and transplant recipient status, I am happy with what I have.  I'm not a heavy lifter anyway and therefore plan on advancing very deliberately with the barbell squats.  With dumbbell squats, the maximum weight I could hoist onto my shoulders was 110 pounds - 55 pounds per hand.  So in week one I went with the same weight I used when performing dumbbell squats.  I increased the weight 5 pounds for week two and plan on advancing in 5-pound increments going forward until I reach my physical limitations.  The video below is me performing my fourth and final set of squats at 115 pounds.

Pondering Push-Ups

Saturday morning I woke up and performed 100 push-ups, after my coffee, of course, in five sets of roughly 20 repetitions. I'm not sure why I did this. Maybe it was because all the lifting I'd done the previous day at work had infected my psyche, leaving my subconscious to believe that I needed to balance myself out with some push movements. Perhaps I was just taking full advantage of a little down time to jump-start the day in a decidedly healthy manner, as any weekend fitness blogger would, while also setting a positive example for my family. Or maybe this early morning burst of energy was more preemptive in nature, an innocent way of looking preoccupied so that I wouldn't be tasked with taking out the trash or wiping down the table before breakfast. Whatever the root cause, the fact of the matter is that push-ups have been on my mind this week, and I wanted to share with you now some of what I learned while researching this time-honored, closed chain compound exercise.

That's the first thing I learned: that because the body is in contact with the floor and more than one joint is involved at the same time, the push-up is considered a closed chain compound movement. Trivial, I know, but knowledge which could come in handy if you ever find yourself on Jeopardy. There are many varieties of the push-up, which I won't get into here, designed to place stress on different muscle groups and/or increase the difficulty of the movement. For example, I use push-up stands to increase the depth of the push-up, which makes the exercise more demanding.

Push-ups require moving about 66% of bodyweight. There are ways to cheat this, thereby defeating the sole purpose of performing push-ups, while at the same time safely maintaining a strong ego. Perhaps the most common way of cutting corners in the push-up is to simply avoid the bottom portion of the movement, or the most difficult part, by performing only partial reps. Allowing one's hips to sag fools an individual into thinking he is performing full range reps, as the hips will touch the ground before the chest. This also reduces the amount of bodyweight being lifted, obviously making the exercise much easier.

Hand position can also make a difference in the level of difficulty. High and wide hand placement makes for an easier push-up because it is easier to produce force from this position. Keeping the hands closer together with elbows tucked requires greater muscle activation in the pectoral muscles and triceps.

Former football great Herschel Walker set a record at the University of Georgia with a 375-pound bench press. Quite impressing, particularly given that he did not lift weights. Instead, Herschel relied on push-ups, performing up to 1,500 on a daily basis. Now, I can't perform this many push-ups in a day, nor would I want to even if I could. But because push-ups do build strength and muscle endurance, they should be included as part of an ongoing conditioning program. Most people will not build mass the way Mr. Walker did, but there are better, more efficient methods of accomplishing this (progressive overload bench press, for example) if this is your goal.

Like I said, push-ups are a great compliment to any strength routine. They can be used at the end of a session to really "finish off" the pecs and triceps, without fear of a loaded barbell crashing down upon you as you reach muscle failure. I recently began sandwiching my push-ups around the other exercises in my Tuesday night routine. Once a week, I will do two of sets of 20 at the onset of the workout and three sets of 20 at the conclusion for a 100 rep total. Before, I was performing sets in a contiguous fashion, satisfied with completing four sets for an 80 rep total. My new practice has increased my push-up total by 25% in the same amount of total workout time.

I'm not setting the world on fire, but this does represent progress for me. Achieve enough progress over time and the end result is success. And as transplant recipients, we all have a vested interest in achieving health success.


Sources accessed in composing this post:
http://www.livestrong.com/article/301242-5-facts-about-push-ups/
http://www.livestrong.com/article/294134-the-purpose-of-push-up-stands/
https://www.t-nation.com/free_online_article/most_recent/the_best_damn_pushups_article_period
http://hubpages.com/hub/The-Herschel-Walker-Workout-Pushups-for-Muscle-Mass
http://en.wikipedia.org/wiki/Herschel_Walker

Dumbbell Power Clean and Press

Here's an exercise seemingly tailored-made for kidney transplant recipients, or nearly anyone else for that matter. This compound movement is praised for both its strength-building and endurance-enhancing qualities. And rightfully so, as this exercise works practically all muscles in the body while taxing the cardiorespiratory system as good as, or better than, any set of squats or deadlifts can.

I won't go into all the reasons renal transplant recipients - particularly those taking prednisone - should be regularly exercising (click on heart health in the list of labels in the right-hand margin for posts relating to this topic), but a quick recap of some of the most important points is worthwhile:

• We are 4-6 times more likely to die from cardiovascular disease than the general public
• Studies show patients have greater fat mass 1-year post-transplant than study control groups
• We remain low in peak oxygen uptake compared to sedentary normal controls and have a lower exercise capacity
• From the beginning, prednisone causes a breakdown of muscle (catabolism). This is most striking in the quadriceps, glutes, and shoulder girdle. Many on long-term corticosteroids develop very thin arms and legs. At the same time, prednisone has been called "pro-obesity."
• Prednisone is associated with osteopenia, a weakening of the bones, and osteoporosis, a disease which can cause spontaneous bone fractures.

The National Institutes of Health has stated that "aerobic exercise is necessary to reduce the risks for cardiovascular disease, minimize osteoporosis, and facilitate weight loss, whereas strength-based exercise is necessary to minimize sarcopenia," a degenerative loss of skeletal muscle mass and strength associated with age (and prednisone).

So, according to the National Institutes of Health, incorporating both aerobic- and strength-based exercises into our routines can act as a counterbalance to many of the physiological challenges working against us as transplant recipients. The dumbbell power clean and press, though not usually performed as an aerobic exercise, certainly works the anaerobic system, which is crucial to enhancing muscular strength and muscular endurance while also combating the deterioration of lean muscle mass.

Bill Starr, one of the NFL's first strength and conditioning coaches, once wrote that cleaning and pressing dumbbells is an excellent way to build size and strength in the shoulders (see the 4th bullet point above) that no other upper-body exercise can match. Even if you're not looking for size or strength gains, Starr notes, cleaning and pressing dumbbells makes a fine addition to any conditioning program. "You don't need heavy weights," says Starr. "If you only have light dumbbells, just run up the reps. You can clean the dumbbells and press them 30 or 40 times, or you can turn this simple exercise into an excellent cardio [aerobic] workout. Clean the weights, press them overhead, set them back on the floor and repeat: clean, press, clean, press. Do that for 20 or more consecutive reps, and I guarantee that you'll be blowing at the end even if you only use 15-pound dumbbells."

Of course the clean and press can also be performed with a barbell, but the dumbbell version has some distinct advantages. First, there is the simple fact that dumbbells require less space and are generally safer to train with, particularly when training alone. Because dumbbells require equal work from both arms, any strength imbalances can be more easily identified. As dumbbells are more unwieldy to handle than a barbell, more stabilizer muscles are recruited by the body to perform the movement. And in the clean and press, dumbbells have to be pulled higher than a bar because it's so much harder to dip under them as you would a bar prior to the pressing motion. This means the deltoids have to work a little harder than they do in a barbell clean and press.

In either option, barbell or dumbbell, the entire body receives a vigorous workout. Legs, hips, glutes, back and abs are all involved, and not in just a supportive role. The power clean and press is a very demanding exercise which will produce great results. Use it how you want - for strength or cardio, or both. Currently, I perform three sets in the 8-10 rep range with 35-pound dumbbells. In the demonstration video below, I performed 5 reps and was already breathing heavy.

DIY Low Pulley Cable Row

Over the last couple of weeks I've been working on an idea for a low cable row pulley system that I can incorporate into my home-based workout routines. Because I train with weights in the living room, all of my equipment must have a small footprint and be assembled and disassembled both quickly and easily. I looked into the resistance bands with the door anchors - and some of those I really like - but I just don't have a good place to use them. One day, after finishing a squat workout, I took a good look at my portable squat stands and wondered how they could provide the support for a pulley system.

An Internet search turned up some good sources, one of which provided detailed instructions on a simple but heavy-duty DIY loading pin made largely from plumbing supplies. I then found a video featuring a homemade high cable pulley attached to a pull-up bar and another attached to a homemade power rack. I thought a little more about my squat stands and, using the DIY tips discovered online, came up with an idea which I thought might work for me. I'm not an engineer so I'm unsure about maximum loads, beyond those limits listed on various pieces of equipment. This contraption is just something I've done for myself, and I thought I'd share it here. In the video below, I go into some detail describing my homemade system for performing low cable rows.

DIY Dip Station

Exercise equipment is expensive. And so is square footage. For this reason, I frequently exercise in the living room and search for creative and affordable options when it comes to meeting my equipment needs. Fortunately, the Internet is packed full of valuable ideas for do-it-yourself exercise enthusiasts on a budget. This is where I found the instructions for my homemade dip station.

For years I have wanted to integrate dips into my exercise regimen, but could never figure out a good way to accomplish this. My equipment must be portable and, preferably, collapsible so it can all quickly be put back in the corner when I'm finished. That way, I earn my gold star for the day and get to stay up a half-hour late on Saturday! But because dip stations are typically fixed and heavy, I had just about given up on being able to perform this excellent upper body exercise at home. Coincidentally, that's about the same time I came across a blog called Homemade Strength. Carl is the author of this blog, which features numerous projects that the average DIY guy or gal can complete fairly easily. For a detailed description of the dip stands featured in this post, click through to http://homemadestrength.blogspot.com/2011/06/dip-stands.html.

Since there already exists a complete how-to guide on these stands, I'll forgo the finer points of construction and stick with a summarization. Importantly, this pair of dip stands required me to buy nothing. Everything I used for this project was scrap. Even the collapsible metal sawhorses, upon which the stands are positioned, were purchased years ago for use as safety rails when performing barbell squats.

Following Carl's instructions, I started by cutting two foot-long sections of metal pipe. I then took a 2x4 and cut this board into (8) five-inch pieces. Using a hole saw, I cut holes through four of these five-inch pieces into which the pipe ends could slide. So, half of my 2x4x5's have holes through them and half don't. The 2x4x5's without holes are secured to the outside of the 2x4x5's with holes and the pipe rests in the middle, with the ends of the pipes secured inside the holes.

Dip Stands beginning to take shape

 

Both pipes are secured into the wood on one side by a bolt which runs through the top of the 2x4 with the hole cut. This bolt first goes into the wood from above and travels completely through the metal pipe before finally entering the wood underneath, preventing the pipe from moving. The process for this is described in great detail at the link provided above. Though it sounded a little daunting, it was really pretty easy.

 

This secured one side of each stand, and now it was time to secure the opposite sides. This was accomplished by attaching a plywood base to the bottom of both sides of the stands.

 

One solid dip stand, upside down

 

The dip stands complete, I needed only to secure them to the sawhorses. Because I use these sawhorses for squats and because I exercise in the living room, I have to be able to assemble and disassemble this station quickly. The sawhorses come with holes already pre-drilled, so I was able to simply drill holes through the plywood base that lined up with the existing ones. To secure his stands to his sawhorses, Carl at the Homemade Strength blog just fits a hex wrench through the plywood base and metal frame. Though this is a terrific idea, I had no extra hex wrenches laying around so I used what I did have - nuts and bolts. Finger tight is plenty enough, so it is a pretty quick process putting up and taking down these stands.

 

Two small bolts secure each stand to the metal frame

 

The project was now complete, unless I wanted to go the extra mile and paint or stain the stands. I quickly opted out of this option, preferring instead to take the pair straight to the proving grounds for a quick test drive. And, as advertised, the stands worked perfectly. My thanks to Carl at http://homemadestrength.blogspot.com/ for taking the time to share this and many other projects with those of us out in cyberspace. I'm finally able to introduce dips into my strength program, and it didn't cost me a dime.

 

The finished product

 

Test drive proved the design was a success



   





What Does a Weightlifting Routine for a Transplant Patient Look Like?

The answer: like any non-transplant patient's weightlifting routine. Every situation is unique and transplant recipients should always check with their medical providers first, but I have yet to discover any weight-bearing exercises which are off-limits due to my having had organ transplant surgery.

Of course there is a plethora of information out there regarding exercises and exercise programs and what's appropriate/inappropriate, depending on the individual's goals and his/her age, weight, health, etc. I'll gladly leave that discussion to the experts (and to all the discussion forum posters). But I have found little in the way of resistance training guidance geared toward kidney transplant recipients, other than that it is something important we need to do, particularly those of us currently taking Prednisone.

For this reason I thought I'd share my current program here, which is an adaptation of Wendler's 5/3/1 program. For those unfamiliar with Wendler's 5/3/1, it is a routine built on progressive overload that follows a repeating four-week cycle, known as a mesocycle. Not your typical run-of-the mill bodybuilding split routine, Wendler's is built for strength gains, focusing on big compound movements. Volume and intensity varies week to week, with the idea being that your one-rep max increases every four weeks. The great thing is that the lifter's one-rep max goes up without ever actually performing a one-rep max, something which is largely inadvisable and unnecessarily risky for everybody but competitive power lifters.

Genetics and age, of course, play a factor so the weight gains don't come automatically every four weeks. And at some point, they won't come at all. But the important thing is to keep putting our muscles through the paces because the corticosteroids we're taking are working very much against them. The pills don't take a break and neither should we.

Specific information on the 5/3/1 program is easy to find on the Internet, and you can follow it verbatim or amend it to your individual taste. I'm on my 5th mesocycle and am still enjoying it (as much as it's possible to really enjoy physically demanding work!). The nice part about my adaptation of the program is that I can accomplish a lot in a relatively short amount of time. Compare my version of Wendler's to an ordinary bodybuilding routine, and you'll see just how much time you can free up during the week without sacrificing results.

So what does a weightlifting routine for a transplant patient look like? Well, for this transplant patient two weeks worth of work-outs look like this:

Saturday
Box Squats 3 sets x 5 reps
Squats (50% of 1RM) 5x10
Dumbbell chest press 3x5
Incline bench dumbbell fly 3x10
Pull-ups 4 sets of as many as I can perform

Tuesday
Reverse Lunge w/dumbbells or Bulgarian Lunge
EZ-bar rows
Push-ups 4 sets of 20 or so

Thursday
Deadlift 3x5
Deadlift (50% - 60% of 1RM) 5x8
Dumbbell shoulder press 3x5
Dumbbell shoulder press (50% - 60% of 1RM) 5x10

Sunday
Box Squats 3x3
Squats (50%) 5x10
Dumbbell chest press 3x3
Flat bench dumbbell fly 3x10
Pull ups 4 sets of as many as I can perform

Wednesday
Deadlift 3x3
Deadlift (50 - 60%) 5x8
Dumbbell shoulder press 3x3
Dumbbell shoulder press (50 - 60%) 5x10
Dumbbell pullovers 3x10

On Saturday the two-week cycle will repeat itself, only with a different intensity and repetition scheme, as these next two weeks will represent weeks three and four of the four-week mesocycle. And so there it is, a complete weight lifting regimen currently implemented by at least one kidney transplant recipient.

Getting Small with PowerBlocks: DIY Microloading for Big Results

Resistance training is an important part of a healthy lifestyle. The flexibility of old-school free weight exercises, with their natural transferability to real-world movements and increased recruitment of stabilizer muscles when compared against modern machine exercises, offers a superior workout for most fitness enthusiasts. With just a pair of dumbbells, an individual has all the tools to complete an effective full-body workout.

One drawback to dumbbells is that they are often sold in increments of 5 pounds. In order to make consistent gains utilizing progressive overload techniques, this frequently means moving up a total of 10 pounds for many exercises. For an average-build, middle-aged guy like me, this can be quite challenging, not to mention downright discouraging. My selectorized PowerBlock Sport 9.0 dumbbells help combat this by offering incremental increases of 2.5 pounds between some of the weight settings. For example, you can move from 15 to 17.5 to 20 pounds. You can do the same starting with 25 and advance to 27.5 and 30. But there is no 22.5-pound option, nor are there selections for 32.5-lb, 42.5-lb, 52.5-lb, etc. As a result, my experience has been that I tend to stall at 40, 50, 60, or 70 pounds, depending on which exercise I'm performing.

Hard to see here, but some weight increments are 2.5 lbs, others are 5 lbs

There are products on the market designed to overcome this inherent shortcoming of dumbbells. The two products I've seen use magnets to attach additional weight to the ends of dumbbells. These options are both expensive, though not quite as expensive as buying your own rare earth magnets, some Loctite or J.B. Weld, and four 1.25-pound weight plates (two plates on either end of both dumbbells for a total of 2.5 pounds per hand). To get four 1.25-pound plates with integrated magnets, I found, would set me back $50 on Amazon. This was not a viable option, so I opted for Plan B, which set me back about $6.50 at Wal-Mart.

 2 strips of Velcro stuck back-to-back makes a great strap

I needed only some fastening tape (commonly referred to as Velcro) for this simple project. I cut two eleven-inch pieces and stuck them together sticky side-to-sticky side, creating a quick and easy strap when the Velcro is folded back onto itself. I made four of these, two per dumbbell, with the idea being to hold a 2.5-pound barbell plate to the bottom of each PowerBlock.

Weight plate attached to the adder weight housing of the PowerBlock

The 2.5-pound plate does not fit perfectly along the bottom of the PowerBlock. The plate is a little too large to fit between the bottom lips of the handle core and flush against the two tubes housing the adder weights. However, I have found that if I place the weight above the lip nearest my pinkie finger, I experience no problems with plate movement throughout the duration of the exercise.

   Two straps securely hold the weight

Two Stage II PowerBlock Sport 9.0 dumbbells provide the equivalent of 56 individual dumbbells, ranging between 2.5 and 90 pounds. Factoring in my do-it-yourself microloading method increases this equivalency to 74 individual dumbbells and ups the range to 92.5 pounds, which is more than enough weight for me. 

These smaller increments make it easier to advance when you hit a brick wall. My personal sticking point recently has been with making the leap from 40-pound dumbbells to 45-pounders on the shoulder press. So today I strapped on the 2.5-pounders and created a pair of 42.5-pound dumbbells. As it turned out, my wife just happened to be standing by with a stool and a camera to capture me experimenting with my design. What great luck! But the camera batteries were dead. Now that's more like the luck I'm accustomed to. I wanted the picture to *prove* my design worked. Finally, by about the 3rd set, and after thoroughly trashing the Rayovac brand, Tara got the picture I needed to complete this post.

Pressing up the crude, but effective, 42.5-lb DIY PowerBlocks

     



       

Of Snake Plissken, Coffee, and Squats

Glucocorticoids [such as prednisone] cause proximal muscle weakness and atrophy. Ultrastructural abnormalities in skeletal muscle include reduced myofibrillar mass, mitochondrial volume, and decreased capillary number. Lower extremities typically are the first affected, demonstrating the first signs of weakness during climbing stairs and rising from chairs. Quadriceps strength is markedly reduced in both kidney and heart transplant recipients and reported to be 80% and 69% of untrained sedentary control subjects.

The above is an excerpt from a study published in Kidney International in 2003, which can be found here. I remembered having read this when, after taking a week off from weight training while camping, I returned home and resumed with my regular weightlifting regimen. The first day back I was to do squats. I felt weak on my first warm-up set, and after the second warm-up set, I knew I would have to reduce the weights on my working sets. I dropped down 15 pounds, and it was all I could do to complete the sets. My legs were SORE for the next 3 days. I mean, it was as if I had caught 9 innings for both teams in a knuckleballer duel. If you're a transplant recipient and you work nothing else, work those legs. Hard.

***

What is Snake Plissken doing inside this New York City Chock Full o'Nuts? With less than 24 hours before his potential demise, he needs a leg up on his competition. Sure, that automatic rifle he wields helps level the playing field, but a cup of joe might provide him with the kind of advantage he really seeks. According to the New York Times, in studies going back to 1978, researchers have consistently concluded that caffeine improves athletic performance. This has been shown to be true with sprinters, marathon runners, cyclists, rowers, swimmers, and tennis players. Dr. Mark Tarnopolsky of McMaster University in Canada says it is "unequivocal that caffeine improves performance." Following is an excerpt from the March 25, 2009 Times article:

Caffeine increases the power output of muscles by releasing calcium that is stored in the muscle. The effect can enable athletes to keep going longer or to go faster in the same length of time. Caffeine also affects the brain's sensation of exhaustion, that feeling that it's time to stop, you can't go on any more. That may be one way it improves endurance, Dr. Tarnopolsky said.

Just a little caffeine goes a long way. A 176-pound man needs only 4 ounces of coffee, or about two 12-ounce cans of coke to reap the full caffeine effect, according to Louise M. Burke, the head of sports nutrition department of the Australian Institute of Sport in Canberra. And Terry Graham, chairman of the Department of Human Health and Nutritional Sciences of the University of Guelph in Canada, found that at 9 milligrams per kilogram, athletes actually did worse.

As far as the adverse effects of caffeine, which are frequently repeated in the media, Dr. Tarnopolsky notes, "Athletes do not get dehydrated from caffeine, contrary to popular myth." And he says that though caffeine does increase the heart rate and blood pressure in people who are not regular users, "after three or four days, that potentially negative effect is gone." Dr. Tarnopolsky, an elite triathlete, ski orienteer and trail runner who has competed nationally and internationally, adds that even if you are a regular coffee drinker, if you have a cup of coffee before a workout or a race, you will do better.

Plissken never did get that performance-enhancing cup of coffee in what was, at the time, a futuristic version of 1997 Manhattan. He even lost his rifle not long after his hasty exit from the store. But, as it turned out, he made out pretty good. In fact, his competition was blown away. Literally.

~ Finding Chock Full o'Nuts coffee on the shelf recently at Food Lion assisted in the development of this post

   

Hitting the Trails for a Really Intense Leg and Back Workout

For many people, myself included, leg training is not one of the more enjoyable features of a strength and conditioning program. It can be excrutiatingly hard; it gets our hearts pounding to the point that we almost feel as if we're about to go horizontal and stay that way; and, after it's over, we're forced to return to our daily obligations in long pants - just to spite our vanity, I believe. Any muscle mass gained by subjecting ourselves to repeated sets of agonizing squats, lunges, and stiff-legged deadlifts remains a closely guarded secret underneath our Dickies and Levis. It is true, however, that if you dare to fly the suspicious skies here in America you could presumably dazzle the occasional TSA passenger screener.

So what's the payoff? After all, we're not football players or aspiring Olympic swimmers, and I for one won't be entering any bodybuilding contests in the near, distant, or intermediate future. The reward, of course, is having the physical strength and stamina necessary to continue pursuing those activities we currently enjoy later into our lives. Take this weekend, for instance, when I plan to take a really long walk. I have a couple of options as to where I might go:

                                                                           Option A

Option B

Which would you choose? Not much of a decision, is it? Option B is by far the more demanding of the two, particularly if you want to make a weekend of it. Loading everything you need for two days on your back and stomping around the woods, in and out of the gulfs and on and off the ridges, is both an exhilarating and exhausting work out. Option A is great for rainy days and Mondays - and not much else, in my opinion. So I will spend this weekend in the South Cumberland State Recreation Area, where the above photograph was made. Hopefully, all of my strength training, which has provided little superficial satisfaction, will now pay meaningful dividends in the form of a more enjoyable hike, one where I can focus my attention on the beauty encompassing me instead of on the pain and fatigue devouring me.

Strength Training? Yes we can!

As we grow older it becomes vital that we incorporate strength training into our exercise regimen in order to ward off the debilitating effects of sarcopenia, an age-related loss of muscle mass, strength and functionality. This is especially true for those of us taking immunosuppressants, as osteoporosis and sarcopenia are conditions for which we are already at an elevated risk of developing. As author and well-known trainer Will Brink explains, "Muscles generate the mechanical stress required to keep our bones healthy; when muscle activity is reduced it exacerbates the osteoporosis problem and a vicious circle is established, which accelerates the decline in health and functionality."

Where's a good place to start with strength training? Well, naturally we'll get the biggest bang for our buck by working our largest muscles, which are found in our lower regions. In training our legs, we burn more calories and jump-start our metabolism, as our hearts work hard to supply our glutes, thighs, hamstrings, calves, and lower back with fresh, oxygen-rich blood. According to former Navy SEAL Stew Smith at military.com, we burn at least 200% more calories by adding squats and lunges to our walks or jogs.

Good examples of squats and lunges are all over the Internet. My personal favorite squatting exhibition is found in the video link below. Here, kidney transplant recipient Luke Edwards is seen perfoming box squats, Westside Barbell-style. It goes without saying that I do not begin to approach Mr. Edwards' level of strength or ever imagine myself lifting that kind of weight. However, I do find his performance to be quite inspiring. I would say that, in Mr. Edwards case, the answer to the question of strength training is: Mission Accomplished!

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The Importance of Exercise in Post-Transplant Kidney Patients

Everyone knows the vital role physical fitness plays in a healthy lifestyle. What the blogosphere doesn't need are more average joes like me either parroting well-known truths or adding to the endless stream of dubious claims circulating around countless gyms and Internet forums, myths commonly referred to as broscience. I vow to do my best to avoid this by presenting in this post what is hopefully enlightening and scientifically-backed information.

Four years ago this month I underwent renal transplant surgery, the kidney an unsolicited gift of life from my selfless and all-too-generous wife. While the post-transplantation care I have received from my doctors and nurses has been exceptional, their perspective is reactive and medicinal-centric, not necessarily preventive and holistic. Prescription pad in hand, they stand ready to intervene if my cholesterol gets too high or if my bones become too weak. And I thank God for their vigilence and intimate knowledge of medicine and the human body. But what to do in the meantime, while my cholesterol levels are normal and my bones relatively strong? Outside of the standard watch-your-weight-and-be-sure-to-eat-your-Wheaties pep talk, I never really had a deep conversation with my medical providers about what I could or should do to keep from slowly degenerating. As I soon discovered in my own research that as a transplant patient I am more susceptible to chronic conditions such as cardiovascular disease and osteoporosis, I began to wonder how many other transplant patients remain in the dark concerning the long-term ramifications of immunosuppresants and the actions necessary to mitigate their negative effects.

A March 3, 2011 American Society of Nephrology news release stating that kidney transplant patients are 4-6 times more likely to die from cardiovascular disease (CVD) than people in the general population was a real eye opener for me. I had never heard anything like that from my transplant team. I continued my research. Besides weight gain, I learned that prednisone (a corticosteroid I will be taking for life) is associated with osteopenia, or weakening of the bones, and osteoporosis, a serious disease that can cause spontaneous fractures. Worse yet, according to a 1998 University of Florida study, the usual treatment for osteoporosis, oral calcium supplements and hormone replacement therapy, does not work with transplant patients because the anti-rejection steroids we take are too powerful. Randy Braith, a UF associate professor of cardiology and physiology involved in the study, went on to report that almost 100% of heart transplant recipients develop osteopenia and half of these will develop osteoporosis.

So what's a transplant recipient to do? Our solutions don't always come in the form of miracle pills. Our best bet is to exercise. A National Institutes of Health artcle notes that "aerobic exercise is necessary to reduce the risks for CVD, minimize osteoporosis, and facilitate weight loss, whereas strength-based exercise is necessary to minimize sarcopenia," a degenerative loss of skeletal muscle mass and strength associated with age (and prednisone). Providing a bit of reassurance to the leery (and at the same time debunking the excuses of the sedentary crowd), the article goes on to state that "there are no documented adverse consequences attributed to physical activity in kidney transplant patients."

Because few medications can stop bone loss and even fewer effectively stimulate new bone growth, lifting weights is absolutely essential for those of us on prednisone. The 1998 UF study cited above showed that weight-lifting exercises can counteract rapid bone loss in patients after an organ transplant. And the rapidity of bone loss in transplant patients can be quite staggering. Mr. Braith reported that bone density in heart transplant patients after surgery showed up to 25% loss during the first two months alone. However, the good news is that those patients who began weight training two months after transplant surgery were able to recover and maintain bone density to the same level it was before the operation. That's right, bone loss and osteoporosis caused by prednisone is not only preventable, it is also reversible through weight-lifting exercises!

So, the takeaway for all of transplant recipients is to get active and stay active. We need to do cardio and we need to pump iron. We reap all the benefits of exercise that the general population does and more. We have more to lose, and thus more to gain. Have fun and be fit and, of course, check with your transplant team before engaging in any type of exercise regimen.