Russell Winwood was an active and fit 45-year-old when he was diagnosed with stage 4 chronic obstructive pulmonary disease, or COPD. But just eight months after that fateful visit to the doctor’s office in 2011, he completed his first Ironman event.

Despite having 22 to 30 percent lung capacity, and having suffered a stroke almost 10 years prior, Winwood refused to let the diagnosis stop him from doing what he loves. The Australian fitness enthusiast has finished a handful of marathons and triathlons since, including the New York City Marathon.

On November 1, 2015, he joined 55,000 others on a 26.2-mile jaunt across the Big Apple. While he certainly wasn’t alone, Winwood became the first person with stage 4 COPD to do so. Russell finished the race and raised $10,000 for the American Lung Association.

We caught up with Winwood days before the race to talk about his training, goals, and what it’s like to be into fitness when you have end-stage COPD.

Challenging normal ideas about what a stage 4 COPD patient can do. A lot of people are skeptical of how I can do what I do, as people with my stage of disease don’t do Ironman events or run marathons. But the truth is that a healthy lifestyle that includes plenty of exercise will give you a better quality of life.

Australian Ironman at Port Macquarie was my first event after my diagnosis. I had already entered the event five months before I was diagnosed. It had been a dream to complete one of these races, which entails a 2.4-mile swim, 112-mile cycle, and ends with a marathon. My respiratory specialist told me I wouldn’t finish it, but that made me more determined to complete the event.

That race was the most challenging, for a couple of reasons. Firstly, I had to train differently: slow, long, low-intensity training sessions with a focus on gradually building my exercise capacity. Secondly, the time I had to train before the race was limited, so I always knew I would be competing underprepared. It was very satisfying finishing the race 10 minutes before the cutoff, but it was very hard on me physically and emotionally due to the lack of preparation.

My son was responsible for me starting cycling, which evolved into triathlons. He was an avid cyclist who did the occasional triathlon. My wife, Leanne, loves being active and due to the time commitment of these events decided to do them with me, so we [could spend] more time together. Our friends call her “the enabler”! Some of my friends and family have taken to triathlons and marathons after coming to watch me race.

Bringing awareness to COPD, asthma, and other respiratory diseases is the main reason I’m competing in the NYC Marathon. So much more needs to be done to help people with these diseases live a better quality of life, as well as educate people on how to prevent developing a respiratory disease. My secondary goal is to run, not walk, a marathon in under six hours. This has never been done by someone with my stage of COPD.

To do this race poses challenges that I haven’t dealt with before, especially running in an environment that is cold and has pollution. While I have been training in the cold so my body can adapt, it’s hard to train for pollution. Other important factors to consider are heart rate, blood pressure, and oxygen levels. I regularly monitor all of these during training. Recovery time between training sessions is important, as endurance training can play havoc with your immune system.

As a COPD patient, I’m very conscious about keeping my immune system strong so I don’t become sick. Race week is all about rest and freshening up your muscles before race day. Rest after these events is important for the same reason. It takes a lot out of you, and it’s important to not only look after your body, but to listen to it.

My medical team has gone from the teachers to the students. Because COPD patients don’t do what I do, it’s been a learning experience for all of us. But exercise for people with respiratory disease is very feasible and very necessary if they want a better quality of life. It’s all about building your exercise capacity gradually and consistently.

Training has been very different to previous events. This time, my coach, Doug Belford, has implemented high-intensity training sessions into my program, which has pushed me harder than ever. It’s been very different to Ironman training, and the results will be found out on November 1st.

I’d love to run under six hours and set a goal time of five hours, 45 minutes. All going well, I’m confident I’ll be close to this time.

You’re making a documentary about running the New York City Marathon. What made you decide to make it?

Coach Doug come up with the idea of filming a documentary about this journey. Given that what I’m trying to achieve will be a world first for someone with my condition, we thought people may be interested. The message we want people to take away from the film is what is possible for patients with respiratory disease, and hopefully to motivate them to be active.

Watch Russell’s message for World COPD Day below:

You can read more about Russell Winwood on his website, COPD Athlete, or catch up with him on Twitter @russwinn66.