Today it is just under 3 weeks since I left hospital and I walked over 80 minutes up and over Parliament Hill and on to
Kenwood. Am I doing too much exercise? According to the standard instructions I was given in the hospital I am, but I don't think so; I felt fine during and
after the exercise and my greatest fear is losing all my muscle mass by
doing too little. I have decided to take the advice of one of the hospital physios who was also a
runner. He said that so long as I listen to my body I could do as much
as I felt comfortable with. No running of course for at least 6 weeks,
until my sternum has healed.
The standard instructions
clearly assume patients are overweight, unused to
exercise, old or very unfit. Starting at just 5 minutes exercise a day in week one (after leaving hospital), exercise increases by 5
minutes a week. Effort is measured on the "Borg" breathing scale. I should keep my breathing in the scale range 2- 4 which means from light to moderate-severe (the scale is 1-10 with 10 being extremely severe). Unfortunately no one has explained what "moderate-severe" feels like and in any event if I only exercise according to the instructions I would never reach these levels anyway. So on the basis that the scale is somewhat subjective, using terms like moderate and severe begs the question "severe for whom?") I have interpreted the scale, based on my experience running, as follows:
The TOB-interpreted Borg scale
1. No exertion (resting)
2 Slight effort - no noticeable increase in breathing
3 Slight effort - steady breathing, increased effort apparent at rest.
4 Moderate effort - steady breathing 3 paces in/3 paces out
5 Moderate/Severe - Steady Breathing 3 paces in / 2 paces out
6
7 Severe - 2 paces in / 2 paces out
8
9 very Severe - faster than 2 in/ one out
10 Uncontrolled breathing (gasping). Probably standing still (ie: cannot continue exercising)
Borg is not enough
Just relying on the "Borg" breathing scale to assess my effort does not
seem to work mainly because there are too few hills long enough to push me much past level 3. So I am taking a leaf out
of the runner's approach. Running coaches talk of 4 different types of training (eg: see @letsgetrunning's guide "going through the gears" ), which encompass long slow runs for endurance (aerobic training), faster sessions to strengthen the heart and develop aerobic capacity, and speed sessions or intervals to train anaerobically. I have adopted a similar approach in my
exercise plan with three main elements, monitoring pulse as well as breathing.
1. endurance:
Long flat/gentle hill walks typically at a high pace (6 kph) get my breathing to Borg level 2-3 and pulse in the range 90-110.
2. Threshold / cardio / aerobic capacity:
Moderate hills (average grade 4/5, probably only 3-5%, but can be steeper sections) at a high pace (5kph). Breathing Borg 3-5, pulse can reach into 120-140 range on steeper sections. It is difficult to find hills that are of a consistent gradient and sufficient length to count, so usually shorter ones are interspersed with downhill or flat sections.
3. Anaerobic:
Fast stair repeats (2 story repeats * 6- 10, walking down for partial recovery). Borg 4-6 and pulse 120-140.
My programme will include a couple of each of these each week. I am thinking of adding a stationary cycle (which does mean reinstating my gym membership) as an alternative threshold session. The advantage of this is that I can sustain a desired level for a longer period which walking cannot do as there are no hills in London big enough.
I have no idea if I am doing too much, but if I monitor outputs and still feel good at the end I hope that I am at least doing no harm and will be in a better place to start training more quickly when I can get back to running. Lets hope so!
NB: this programme is for me, and is not a recommendation for anyone else. You should do what is right for you, given your underlying fitness, medical condition and the advice that you have reeived from professionals.
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