Running for airway clearance with cystic fibrosis

I’ve never been much of a runner. I’ve tried at various points in my life.

The reason I keep trying is because I know that it’s really good for my lungs. Living with cystic fibrosis, I have to put a lot of time and effort into keeping my lungs clear and healthy, and one of the things that gives me the biggest bang for my buck when it comes to airway clearance is running. Well, jogging, in my case...

A brief history of my running experiences and experiments

My running history looks something like this:

When I was in sixth form college, after hating cross-country in P.E. class and never being very sporty, my parents got a treadmill. I have no idea what triggered me to use it. But I recall (potentially inaccurately) using it a couple of times a week to jog for around 20 minutes.

I tried to do the NHS couch to 5k programme from the NHS website while living in London. This led to me researching air pollution masks.

The couch to 5k prepped me (if only a little) to complete a charity 5k with work mates. It was horrible. Someone ran in front of me and coaxed me along with wine gums. True story.

I completed the couch to 5k programme again. On the app this time. I did it. But it still sucked. It never seemed to get any easier.

Throughout all this, I intermittently did treadmill sprints at the gym over the course of years.

Sometimes, even during treadmill sprints, I’d find it hard to control my breathing. My breath was erratic. My neck and shoulders got tight. It felt disproportionately difficult for me to run. For someone who is generally active, fit and healthy, my heart rate, while running, did not reflect this.

I visited a fantastic sports therapist and osteopath to try and understand why I was having issues with tension in my neck and chest during running. Lots of work was done in clinics and at home that definitely improved my wellbeing... but not my running.

Eventually, I went to The Running School for a proper assessment of my running technique. I learnt a lot. And I really, really enjoyed my sessions. The team there was supportive and knowledgeable. The best in their field. My running technique became better. I was picking up my feet more, getting a more efficient stride... but it still never got easier. I still couldn’t maintain pace. I still couldn’t do anything beyond short intervals.

Then, last year, I started regularly walking in the park with my human. He usually jogs in that park. But he walked with me. I didn’t want him to miss out on doing something that he loved and that benefited his wellbeing. Plus, he really inspired me. I spoke to him about it. I regurgitated my history of running. I admitted how good it was for my lungs, but that I just struggled and I hated that feeling. With his support though, I gave it a go again. I started jogging in the park with my human. Just 30 seconds at a time, and a minute or so walking to recover. I started to love this because it felt doable. I couldn’t sustain any running for more than about 45 seconds though, and so it felt hard to feel like I was making progress because I’d eventually always hit this wall.

And then, it all changed and within a couple of weeks, I could jog for more than 20 minutes and saw huge benefits to my airway clearance because of it.

How I became able to jog

People kept telling me to slow down. I was resistant. I felt like I was already going so slow during my 30 second intervals compared to other people. Plus, when I was running at that pace and for that duration, I felt so good. Like I was capable. And flying.

But finally, I fought my unwillingness to slow down. I very quickly started to be able to jog again... slowly. Very slowly. I very quickly was able to jog for 2.5 minutes. Then 3. Then 6. Then 11. Then 20. 22. 25 minutes.

That’s really all there was to it.

I went slower than usual. And then slower than that. And then slower than what felt slow. And then slower again.

I used a treadmill to help pace myself and to resist the urge to speed up.

Honestly, I probably could walk faster than I jog. But that’s not the point. That’s maybe what I was always missing. It’s an entirely different motion with benefits in all different places.

Jogging for airway clearance

Here’s how I think of jogging for airway clearance with cystic fibrosis....

Imagine you have a jar of jam, sauce, chocolate spread... whatever it is. You’ve finished it. All but a few bits that you want to wash away so that you can reuse or recycle the jar (consider that a little nudge to live more sustainably if you don’t already…).

If you hold that almost empty jar with those few bits stuck to the sides and shake it, it does pretty much nothing, right?

Add some water and washing up liquid though…Even just enough to cover the bottom of the jar. Now put the lid on and shake it. What happens?

Stuff starts to unstick.

About to publish a blog post on running/jogging for airway clearance with #cysticfibrosis - really looking forward to sharing my experience 🙂

In the meantime, any guesses what I used this jar in an analogy for? 🤔🧠 pic.twitter.com/5xfsJpRPW8

— Natalie Goodchild (@_nataliejohanna) August 12, 2020

If you hadn’t already caught on to the analogy... the jar is your lungs the sticky leftovers are the thick mucus that sticks in CF lungs, the water and detergent are nebulised solutions, like hypertonic saline or pulmozyme (DNAse) and the shaking is exercise - jogging specifically. That forceful up and down movement. It may not be a clinically robust analogy but this is how it feels when I do my nebulisers, followed a little later by a jog. Maybe bouncing on a trampoline or doing star jumps would have a similar effect. Maybe I’ll start to experiment sometime soon.

Jogging is so effective for me because of the combination of several factors. Here are the main two: The increased tidal volume as a result of deeper breathing and faster breathing rate. The impact of hitting the ground or treadmill, which sends vibrations to loosen secretions. That ‘shaking’ that works so well with a jam jar. In a way, this is what people who use the vest are doing, though potentially more gently and passively.

No other exercise has quite the same effect. Nothing else mimics jogging to the same extent. So while I like to mix up my workouts (and weight training and dance are really where my heart lies), this explains why I’ve come back to running and jogging time and time again, even when it felt like it really, really sucked.

Jogging helps my sinuses, too!

I also find that jogging helps my sinuses as well as my lungs. Sinus clearance is a thing too!

Often after a jog, especially a longer one, I will feel discomfort in my sinuses and, rather than letting it put me off, I jump off the treadmill and do a sinus rinse (or three… seriously…) right away. It’s so satisfying and really works!

I think that what does it for me is the action of nasal breathing at a higher tidal volume. What this means is that I breathe in through my nose every breath when I run (nasal breathing) and at a higher rate than usual (I’m breathing stronger and faster).

But it’s still not easy...

One important thing to remember is that every day is different.

Today I jogged for 25 minutes without stopping. Which I’m pretty sure is a record for me. At least, it’s a record as far back as I remember. For sure I haven’t done that for a few years. And I’ve definitely never done it with ease.

But equally, the other day, I had to rest after 6 minutes.

I know that there are things that affect me. Especially during the COVID-19 lockdown, when I’ve been running at home on the treadmill, I notice that some things that affect my ability to jog for longer are things like temperature (the treadmill is in a conservatory, so it can get pretty hot on sunny days!), time of the month and even my mindset. There’s also allergies to contend with right now.

Tension in my neck and shoulders can be a limiting factor for me too. So I try to remain mindful of posture and do some stretches to mitigate this.

But the most important thing here - and the whole point of this article - is that you know… however long you jog for, it’s better than nothing. I started at 30 seconds. And even that was still good for my airway clearance. Something is always better than nothing. And jogging is always going to help your airway clearance more than not jogging.

How I optimise my jogging for healthier lungs

A quick summary:

• Bronchodilator inhaler, like ventolin (the blue one)
• Nebuliser, such as DNAse
• Mobilise - some neck, back, chest and shoulder stretches are useful
• Jog for as long as I am able on any given day
• Hypertonic saline nebuliser
• Lay down to relax chest, back and neck muscles
• Airway clearance breathing exercises

While I love to optimise, and this is the process that I advocate, I know that it can be mentally demanding to always have to plan to do things in a set order. So, if the urge hits you to jog a bit and you think it might disappear by the time that you’ve done nebuliser, stretched a little, or whatever else… just do it.

I’ve learned that as much as I love this routine and as much as I love to optimise my health, sometimes, I just need to trust my gut and do what will make me happiest in the moment.