Addison's and exercise, getting started

Disclaimer:  This entire post is OPINION and not based on studies or anything other than personal experience and observation.  Do not start an exercise program without the permission of your physician.

I seem to be getting a lot of questions lately about getting started with exercising when one has Addison's.  (Thanks R and MDJunction friends!! and B).  My answer to how to get started is not usually well received!  Most people want to jump right back in to where they were at their peak physical form prior to diagnosis.  My opinion is, that's a terrible idea!  You're setting yourself up for injury and despising exercise. 

FYI, I do not consider myself an expert on exercise by any means.  I DO have experience with Addison's and exercise.

As I'm thinking about this, it's going to be a long one.  As usual, I'll put bold subheadings so you can skip stuff you don't want to read.

DIAGNOSED OR NOT?

• Are you diagnosed?  If no and you think you have Addison's, don't freaking exercise.  Your glycogen stores are depleted and you're prone to hypoglycemia, low blood pressure and you will lower your immunity.  One of the hallmarks of Addison's is fatigue that's worsened by exercise.
• Are you diagnosed?  If yes, are you stable?  Do you feel well for most of a day?  A week?  If you can't answer yes to those questions, do you feel better with a short bout of exercise?  Get clearance from your doctor to exercise.  If you don't feel well for most of a day, 
• Have you had your thyroid properly evaluated?  Pernicious anemia?  Iron deficiency anemia?  Parathyroid?  Diabetes?  Celiac?  Lupus?  Etc.
• Do you replace deficient hormones like testosterone (yes ladies, that means you!), DHEA, progesterone, estrogen, sodium/potassium balanced with florinef?
• OK, so you're diagnosed, stable and you have your doctor's permission to start exercising!  Yahoo!

DIAGNOSED, STABLE, DR'S PERMISSION AND RARING TO GO!!!!!!

• Set a goal.  Research it, Evaluate it, write it down, announce it.  Know what it involves.  For example, want to go windsurfing in Mexico for a week.  Do you know how to swim?  What time of year is best to do this?  So, you need swimming lessons, money, plane tickets and you'll need to rent gear.  When's the next round of swimming lessons offered?
• Evaluate your current condition.  BE REALISTIC.  Can't walk to the mail box?  Recently suffered from a huge crisis?  Feel ok?  IT DOESN'T MATTER, START SLOW.  Here's where you're going to start hating my advice.
• Create a REALISTIC time line.  Jumping in full bore after a period of longer than three weeks of inactivity is, well, plain old dumb.  You are risking getting very sore (UNNECESSARY IN MY OPINION!!!)  and risking injury (ALSO UNNECESSARY).  Consider this, if you haven't done much for months and then you start slowly increasing exercise and intensity, you're doing much more than you've done for months.  Getting sore is not necessary in my opinion.  How can it be beneficial to do too much and get sore and not be able to do anything for days?  Doesn't it seem more reasonable to do a little bit every day?
• SLOW DOWN.  Do less than you think you ought to and more often than you think you should.  For example, do you want to run a marathon?  Haven't run at all for months or years?  Start out walking every day.  Make your walking intentional, not like walking from your car to the mall and back. Current government guidelines.  
• MAKE A PLAN  Find a good exercise plan for the activity you want to achieve.  Do you fit the minimum requirements.  Let's say no.  Let's say it's a marathon training program and the minimum requirement is a 15 mile training week prior to starting the program.   You can easily get there slowly!!
• WALK, WALK, WALK  I'm a huge proponent of WALKING.  There's no shame to walking and it's GREAT exercise.  It's aerobic (if you're doing it right) and can be challenging.  Let's say you haven't been exercising at all and one mile is a reasonable distance for you.  
• Plan to walk a mile a day for a week.
• The next week, walk a mile a day but faster.
• The third week, walk alternately a mile a day and two miles a day.
• The forth week, walk two miles a day.
• Week 5, you'll be way ahead of what you were doing a month ago!!!  You can start Hal Higdon's 18 week novice marathon training program as a power walker!!
• Week 6, run one minute and walk four minutes.  Slowly, slowly increase the amount of running you do over weeks and months.
• MEDS
• I increase my hydrocortisone 5 mg for the first three exercises sessions of something I'm out of practice or have never done.
• For long runs, I increase my hydrocortisone 1 mg for every mile.  For example, I would increase hydrocortsione by 5 mg for a 5 mile run.  Eventually, you may not need to increase for some runs.  You'll have to determine for yourself if it's necessary.
• I used to increase my florinef.  Now, I do not.  With the increase of hydrocortisone, you get more mineralocorticoid properties of florinef.  
• I use SaltStick when it's hot.  Admittedly, I don't have much experience with heat as it rarely gets warm enough to wear short sleeves here in Teton Valley.  This spring when I was running in Morocco, I took 2 SaltStick with my morning meds, 2 SaltStick prior to exercise and 2 SaltStick every hour I was running, 2 SaltStick or a high sodium dinner.  It worked well.
• Hydrate.  Yep, drink water but not  too much.  Pee once an hour.  
• Weight lifting and alternate exercises
• I currently love the twohundredsquats.com programs for squat, situps, pushups and dips.  It's very reasonable and slowly but surely increases reps.  No weights needed.  The goal is set for you so you don't have to research.
• Use good form if you decide to lift weights.  START SLOWLY so you don't damage ligaments and tendons.  My opinion is the same for men as women.  Start slow and light, really.  Get a trainer if you really want to lift and don't know GOOD FORM.  
• Yoga, I started doing Anusara yoga last fall and I think it's the greatest exercise EVER.

Crap, this is too long.  I doubt anyone even read this far down.  Use common sense!  Do less at the start of your exercise program!  Get a doctor's permission before you begin!

Please ask me questions in the comments section.  I probably didn't make sense in the above babble.  Remember, this is entirely based on opinion and experience, not fact.  Also, remember, I stink at running.  I'm a back of the pack "runner", mountain biker and pretty much any other physical activity.  I like lots of sports that I'm not good at and I do them regardless of how bad I am at them because I enjoy exercise despite my physical inability to do any of them well.