A conversation with Zoe Merchant, AHP Clinical Lead for the Prehab4Cancer Programme and Jack Murphy, Prehab4Cancer Programme Manager for GM Active.
Podcast transcript
Introduction
You are listening to the Four Ways Forward podcast. A podcast exploring how physical activity can help people live healthier, longer and more independent lives. You may be using physical activity to improve your mental health, improving your joint health, skin health. This is a podcast where we hear from health experts on the importance of movement for our health and the health of the NHS.
“I too want to feel the benefits of that. I would like my mental wellbeing to be better and be part of a community and do something with people that are like minded.” A podcast on how we can empower health and care professionals. “Just taking a physical activity history can be a game changing moment. In a consultation, a podcast discussing exercise in all its forms.”
Zoe Merchant, AHP Clinical Lead for the rehab for Cancer Programme:
Hi everyone, I’m Zoe Merchant. I am the AHP Clinical Lead for the rehab for cancer programme in Greater Manchester. I’m an occupational therapist by background. I also manage the lung cancer screening program in Greater Manchester. And I’m joined by Jack over to Jack.
Jack Murphy, Prehab4Cancer Programme Manager for GM Active
Hi, Zoe. It’s always lovely to see you. Yeah. Hi, everybody. I’m Jack. I’m a cancer programme manager, so I’m responsible for the day-to-day delivery of the prehab cancer service across Greater Manchester.
Zoe:
Great, Jack. Right. So you all listening to the final episode in a series from NHS England and NHS horizons exploring the benefits of physical activity and exercise and the Four Ways Forward initiative. This episode is a little different to the rest because we get to specifically talk about exercise and cancer.
So we’ll do a deep dive into what’s a very serious subject. I’m really keen to ask Jack about how he got into exercise. So, Jack, tell us how you got into the role that you’re in, if you recall. So the first time that we met.
Jack:
I think we discussed this very topic when we first met. And I did come to tears at the time. So hopefully that won’t happen again. Exercise has always been very important to me. Sadly, I lost my dad at a very young age to cancer, and he had a very rare form of spindle cell sarcoma. And he was very fit and active himself.
I suppose I used exercise as a bit of an anchor for my mental health. It was something positive to focus on during that time. So, yeah, I suppose it was for my own wellbeing. But out of that, it’s evolved into a deep passion because of my understanding of the benefits of exercise.
And that’s obviously driven by a personal experience from losing a loved one family member to cancer and the benefits that exercise can have in relation to a cancer diagnosis. So as far as I’m the perfect position, in relation to my career and to support people with exercise in relation to a cancer diagnosis. And what about yourself?
Zoe:
So actually, as it happens, I’m about to run the Amsterdam Marathon on Sunday. So I’m very focused on exercise right now. But for me, I’m an occupational therapist by background. The, the main tenant to occupational therapy is about using occupation, meaningful activity, for improvement and quality of life and about it’s about, you know, it’s therapy essentially.
I’ve always been, someone who really believes in that and been involved in lots of different things. But, when I got into doing rehab around the same time I’d had I had young children, and I started to get into running, and I realised for me, you know, this was a really good way in terms of how I manage my mental health if I’m running, what I find is that I just feel a lot more stable.
I have less anxiety, you know, my mood is positive. It helps for me that I run with a, like, a community running club. Shot out to Gatley Runners! So, you know, our every day, every morning, 6:30 a.m., I meet somebody at a local spot, and we go for a run together. And so for me, exercise has been a massive boost in terms of mental health and in terms of enabling me to do everything I do in my day, including work and managing family life, etc.
And it’s been hugely important to me.
Jack:
So yes, it’s having that accountability to another person or an organisation or a group of service can really help with motivation in relation to exercise and physical activity.
And just being able to show up for another person can be really, powerful and I just want to touch on physical activity in exercise, because those two words are used interchangeably quite often. And exercise is a very scary word to some people. I’ve personally supported well over a thousand people now that have turned up for an assessment at our service, and majority of people are put off by the idea of exercise, because it’s often portrayed to us in a way in which we need to sweat profusely and, high intensity and what have you just touched on the difference between that physical activity and exercise, which one is it?
Zoe:
So I actually feel quite strongly about this. I know it might seem like it’s semantics, but I think the difficulty is, that if you say to somebody that you can just do a little bit of physical activity, I appreciate that that feels potentially sometimes, an easier concept to somebody and a bit less scary than the word exercise.
But when we’re talking about rehabilitation and cancer, this isn’t just a nice thing to do. You know, go for a walk and that’ll really help. There’s actually a lot of scientific reasons as to why we’re asking people to do pre-rehabilitation. Well, I mean, speaking of marathons, what we often say is, if you’re going into a marathon, you won’t do that without doing some training beforehand.
A lot of the cancer treatments that we offer patients, whether that’s having a surgery, you know, an operation, whether it’s having chemotherapy, radiotherapy, immunotherapy, we’re asking a lot of the patient when we do these treatments, we’re asking a lot of their bodies. And so sadly to prepare physically and mentally and nutritionally and psychologically for that, just doing a little bit of physical activity isn’t necessarily going to bring about the changes that doing exercise would do.
The way I see it is physical activity may be walking down to the shops every day, or it might be just going up and down the stairs a couple of times a day. That’s, physical activity. For some people that’s a lot. And that could feel, enough to embrace what’s happening with their bodies.
But actually, for most people going through, a cancer diagnosis and being offered surgery and other things in order to gain the most benefit, we really need them to be engaging in exercise. So we really need to have a proper assessment, and we need to be understanding what it is that they should be doing. And you can speak about this much better than I can.
Jack:
You said exactly how and how I would frame it. So, and I often have this conversation with patients about the understanding of the difference between physical activity and exercise. Yeah, going to the shops for a walk is okay. Please don’t stop doing that. Well. So physical activities, movement or exercise is structured movement with an intent and a purpose.
So when you’re given a cancer diagnosis, it’s really important that we introduce a little bit of a challenge in the body so that we can help to build additional fitness. So if it’s cardiorespiratory fitness for example we need to place some structure around building aerobic capacity to help improve the physical function of the body.
Zoe:
And I think what’s interesting is that depending on which health care professionals you speak to, you’ll get a very different view about how people feel about this topic.
Some people think it’s not fair for us to use the word exercise and that we should be sticking to physical activity because it’s more palatable to people. And I know, and it’s hard, you know, especially for the health care professionals or other people involved who work with people who’ve had a cancer diagnosis. There’s lots of patients we can think of or people we can think of, who the thought of asking them to do exercise feels insurmountable or like not something that you should be doing. But actually, I think we need to be clear going forwards that really, you should think about exercise the same way you think about giving somebody a medication. So the same way you think about giving chemotherapy. And yes, it is a scary word. And for some people it is going to be.
Well I’m not sure I can do that. I don’t I don’t want to do that. But it’s all of our job to be breaking that down and to be supporting people and to be helping them to understand that we’re not going to ask them to go out or run a marathon when they’ve never even put some running trainers on.
That is not what this is about. Well, we’re going to be doing is we’re going to be working with every individual person. I’m going to be understanding what they’re capable of doing, and we’re going to just be asking them to push themselves enough that it’s something that they can do, but also they’re going to get the absolute best benefits when they go through their cancer treatment and they go through the pathways that they’re going through, rather than focusing too much on the word physical activity versus exercise.
I think it’s about how you’re working with individuals, and patient-centred care.
Jack:
That’s exactly it Zoe, it’s all about patient-centred care, understanding the psychological impacts that a cancer diagnosis can have on an individual. And then on top of that, you’re asking them to do exercise and the stereotypes that exist around exercise. It’s really scary. So physical activity can be a bit easier to digest. It can be a gentle nudge through the front door of exercise. And I suppose that’s really where our service and prehab for cancer and you and Professor John, were fundamental in the design and set up and implementation of the pre-op for cancer service. Can you tell us how that came about?
Zoe:
So, people might be aware, but there’s another program that’s called Eros. And we’ve we referred to our imaginary professor Jamil. He’s a consultant anaesthetist. So he was very much involved in what was called the year programme originally.
And I think what he realised, certainly where we work in Greater Manchester, there’s lots of people out there where if you say to them before you have this surgery or before you have chemo, before you have, you know, radiotherapy, you need to be doing lots of exercise. They haven’t got the foggiest of where to start, not least if they’ve just been told they’ve got cancer.
You know, it’s one thing to ask somebody to do something in the best of times. If you then asking somebody when they’ve just had that devastating news and they’re on the floor to suddenly go and do something that they don’t have any confidence to do, you know, that’s not enough. And that’s not good enough. And so there was a kind of recognition that really we need to be, in a position where we’ve got that support embedded into the NHS and so, we decided in Greater Manchester that we would get this programme up and running, and prehabilitation, is not just about exercise. But it’s also it’s, it’s what’s called multimodal. Partly it’s about how you prepare people physically. Part of it’s about nutritionally what people are eating, what’s going on from nutrition perspective. And then the final bit is the psychological bit. And so essentially, Professor John Moore was able to secure some money for something across Greater Manchester, with all the different leisure organisations and all come under the banner of Greater Manchester Active, which is what we’ve got on our shirts.
And it was about how can we, take patients who were being diagnosed with cancer in the run up to them having their, surgery or other treatments? How can we deliver a programme for them? That means that they’re going to be as physically and mentally and nutritionally prepared as they can possibly be to get the best outcomes when they go through that treatment. And there was already some evidence available about this in the literature, some research done, some indication, but it was very much in its infancy. What we did was over the first couple of years, put a team of people together who were all experience and exercise qualifications and exercise, used to work with people with lots of different health conditions.
And then we got this programme up and running, all the hospitals in Greater Manchester, which were ten different hospitals, could all refer in. And we picked out some specific cancers that we knew this was going to work best for. So people with lung cancer, people of colorectal cancer, people with upper gastrointestinal, cancer, and that was in 2019, we started, and we’ve been going ever since.
And I suppose the final word I will say is that when you tell people about this, it seems very common sense. And I think we’ve had so much support from all sorts of different healthcare professionals – surgeons, oncologists, nurses, allied health professionals, physios, dieticians. We’ve had a lot of academic support in how we do this and how we designed it.
Because this is something that you can absolutely get on board with. And I mean, I think it’d be great to hear from you about what it means on the ground and just the what the impact is for patients who go through the programme.
Jack:
Yeah, I think that’s the importance of the people for cancer service and the impact it has on the individuals that we support day to day is massive.
I had the privilege of supporting over a thousand personally supporting over a thousand patients through the service. Now we’ve had over 10,000 referrals to date, and to a 75% of patients that get referred into the service. Do take us up at that point, because I suppose a cancer diagnosis and going back to what we discussed earlier, it can be a real teachable moment.
It can be that moment in which a person can take control back and do something positive, really empower them to take that control back from the cancer diagnosis. I met a gentleman in Salford on Wednesday, and within three weeks it increased his six-minute walk to us by 98m. It increased his sit to stand test, score by four for repetitions.
So are just signs that within a three-week period you can get fitter, which can reduce your risk of post-operative complications, get home after surgery much quicker. And but for the patients themselves, they can get back to the families that their lives much earlier and can really help to enhance their recovery.
Zoe:
We all do it, but let’s do a bit of jargon busting. So what’s a six when it will test that?
Jack:
A good question, yeah, I’ve just kind of fluffed over that as if everyone knew a six minute. Well, it says so six-minute walks us because we don’t have when we’re working in the community, in the public leisure facilities, we don’t have the privilege of using sophisticated equipment. So, two cones ten meters apart walk as much distance as you can within the six minutes.
And it can be a really good indication of, a person’s fitness. So of course, low fitness scores would indicate that that person is potentially higher risk for surgery. So what we’ve got to do is improve six minute what’s our scores as much as possible for that person demonstrating that we’re getting them fitter. And as a result of that, reducing, any post-operative complications and supporting early recovery.
Zoe:
That’s the cardiovascular aspect, what’s the other bit that’s really important? So the set to stand.
Jack:
Yeah the sets to stand. So yeah the increase in four repetitions I also dropped in and some do it from a seated position requires strength in our muscles. And some of the people that come through the service can’t do that. They struggle to stand unaided after working with them for a few weeks.
That that ability returns because it’s a loss of strength. And as we age, unfortunately, we do get that gradual reduction in the size and strength. But it pleased to say that age isn’t the determining factor in that it’s often physical inactivity. So we know that if a person has any prolonged physical inactivity, then you will get a deconditioning effect on the body so they will get weakened, less fit as a result of that and just bring in the psychological impact to the cancer diagnosis back in, rest is not best. And it used to be, it used to be prescribed to people that are impacted by cancer and as well family, friends. We think we’re doing well for the person that we support with a morning tea and with them wrapped up on the sofa.
That’s often the worst thing that we could do because we will get that deconditioned effects. If you couple that with impactful cancer treatment, injected with chemicals and zapped with radiation, it can only accelerate that deconditioning effect. So it’s really important that we get moving. We bring in some movement that suits the patient.
Zoe:
One of the things I was going to add in with all of that is that when we’re thinking about the rationale for rehabilitation and the science behind it, something that’s really important for people going into, any kind of cancer treatment is about muscle.
You know how strong someone is. This is a word I’m going to use called sarcopenia. So some people are know what that means. Some people won’t. But what sarcopenia means is muscle wastage. And obviously this is something that’s quite common as people get older. It is common with certain health conditions as well. If it’s left untreated, then actually what it can turn into is what’s called Cachexia. That’s where your systems are really breaking down. And interestingly, you know, when it comes to sarcopenia, when it comes to doing strength training, it’s not just for people who’ve got a cancer diagnosis. The chief medical officers guideline is about, exercise. It states in there that so anyone over the age of 65, regardless of whether you’re healthy or whether you’ve got any kind of health condition, you should be doing at least two times a week sessions of strength training.
I mean, I’m 43 but even I do strength training every week because I know my muscles are slightly going down, the pain as I become perimenopausal and other things. But it’s important when the cancer pathways for people who’ve been diagnosed with cancer, because actually what the research tells us is that if you’ve got sarcopenia, so if your muscles are wasting and you go into surgery, you’re not going to do as well as somebody who doesn’t.
And so there’s really clear evidence that shows that people going through surgery. The outcomes from this area was that more likely to have perioperative complications that what that means? Again, still a bit of a jargon busting is that after the surgery, they’ll have complications. That means that they’re in hospital for longer and they’re not doing as well.
And actually half the time with cancer surgery, it’s not necessarily the cancer. That is the thing that we’re really focused on. Just putting somebody through surgery is it’s a big deal. You know, a lot of surgeons or a lot of anaesthetists. Professor John Moore, they’ll tell you is that actually if somebody goes for a major operation, it’s probably going to be the biggest onslaught their body has in their entire life.
So a lot of the work we’re doing, it’s not just aimed at people have cancer, it’s aimed at anyone going for major operations. And it is about understanding that you’re more likely to be alive one year down the road, or you’re more likely to not have those kinds of complications that can make people unwell, if you’re going into that procedure as fit and as strong as possible.
Jack:
I think what I hear you saying, there’s always that we could actually be doing more harm by not prescribing exercise to somebody that’s been impacted by cancer or that is a in surgery.
So I, I feel like I still feel like banging my head off the wall sometimes. The exercise and physical activity that we’re still having this conversation that isn’t just standard care because it should be. I mean, the evidence is massively overwhelming. Now, just as you mentioned, the guidelines 150 minutes of moderate intensity exercise a week, including the two sessions of strength training to support activities of daily living.
So if you have a surgery and you’re not strong to begin with, it’s going to be a lot more difficult to get up and out of bed after the operation. So I suppose you pulled in a plus before or enhanced recovery after surgery, and it’s building it all together. It’s bringing all together that the very first moment that you receive that cancer diagnosis, your recovery from that starts from that point.
If you want to curative in some pathway, of course. Exercise can improve, so reduce the incidence, progression and metastases as cancer as well. And it can also improve the efficacy of treatment. So if you are undergoing chemotherapy treatment radiotherapy exercise has been proven to improve the efficacy of that due to the machines that are released, your own muscle strength working and high intensity interval training as well.
Zoe:
We’re aware of how people might feel being asked to do exercise. So what did the conversation’s another controversial conversation that comes up with healthcare professionals is it fair to ask a cancer patient to do this when they’ve just been told they’ve got cancer? So often we talk about, the burden that we might put on somebody who’s just had that diagnosis.
And it’s not just the person themself; it’s everyone. He’s around them, it’s their family members. It’s, you know, it’s their parents, it’s their children. It’s people that care for them. And I suppose one of the things I wanted to highlight was that when we’ve designed, we have the cancer programme, but across the boards, it’s not just us because there’s other rehabilitation services in the UK and, and elsewhere in the world.
We’ve had lots of people who’ve been diagnosed cancer involved from the start. So actually, helping us to design it helping is to, think, what’s the right way of going about this? You know, we did a brilliant focus group when we first started. We said to patients, what do you think about this? Like, is this something that’s palatable or not?
And I think what I took away from that is that people really did say that it’s absolutely the right thing to be doing. They want to be able to take control. You know, people told us that sometimes when you get told you got cancer, you feel like you’re on a conveyor belt. You go into hospital, you have surgery, you come home, you’re at home, you kind of just got to get on with your life again.
And that you kind of being done to all the time. You’re having tests and you’re having surgery done, you’re having chemotherapy done, and that you don’t have any control over what’s going on. And so, for me, you know, whenever I think about how amazing, this, this programme is, that’s often what comes up. And actually, I want to tell you this, Jack. So I was at a conference in Wales on Wednesday, which was all about rehabilitation and in Wales, and there was a woman there, and she told me that her best friend had come to prehab for cancer during Covid.
And she told me, and she had tears in her eyes, which makes me feel emotional. But she told me that it was one of the best things that happened to that person during the time that she had her cancer.
This lady was doing sit to stands in her very final moment. She was a lovely person to work with and very inspirational. It’s really heart-warming to hear the stories and the feedback that we get from many people that we’ve supported through the service. Again, you can’t even put into words to the impacts that we have. And yeah, many, many people that I feel inspired by that we’ve worked with every, every single day.
Yeah. I think for me it’s like we can talk about the numbers. And obviously for us, we’re really proud that we’ve had 10,000 people referred, that we’ve had this many people attend the service. But I think all of us involved, you know, there’s individual stories to be, to be pulled aside in a meeting and to be told, you know, this meant so much to this person and her family and her friends that she had this and that she was doing this, and it wasn’t us doing it to her. This was something that she was doing. She was taking control of, you know, sadly, that patient ultimately, she didn’t survive the cancer. And I think we, you know, we need to be clear sometimes that sadly, regardless of all the different treatments available, regardless of all the different interventions we might do, it’s not always a positive outcome for people.
But what’s amazing to hear that despite that, the fact that somebody come along to the programme and engaged in the program and been able to go through what was awful and none of us could ever wish it on anyone and be positive about it. You know that to me, it’s those individual patient stories that make me so enthusiastic about what we’re doing.
Yeah. I couldn’t agree more of it. It’s it’s very much that the people that we support are really, really powerful stuff. And we don’t always experience a positive outcome. We’re working with people that have been given a cancer diagnosis. And but it’s also the quality of that person’s life. So staying strong and fit for as long as possible so that they can still do the things that they want to do to enjoy however long it is that they may have left.
And if it’s the same person that, I think that you speaking about. So this person was able to get back to, to Ireland to see her family and, and were still able to be, to be fit and strong, to go for walks and hikes that she liked to do.
Jack:
So I do think we should talk about what you actually do with people because again, I think right now someone’s going to think, oh, this all sounds great, but do they, you know, it’s somebody in the gym like, you know, having to do like, all sorts of crazy things on a bike and, you know, like that’s their, their the stereotypes of exercise that
you mentioned, there’s oh, burpees and sweating profusely. I could not do anything. I’m just sick. And I just have not figured out how to do a burpee. Full disclosure.
Zoe:
Anyway, so if Mrs. Jones came along to Jack, you know, let’s take, I don’t know, somebody in her mid 60s has an exercise for many years. Sadly, he’s just been given a diagnosis of cancer.
Has agreed to come along to the gym. The local leisure centre is feeling pretty anxious about what she’s going to get asked to do. Turned up in a kind of jogging bottoms and some trainers. What kind of things would you be asking Mrs. Jones today?
Jack:
That takes a lot of courage. What you just explained. There’s a way for that person to do that, to turn up at the leisure centres, in the jogging bottoms are ready to engage in the service.
Yeah. Our responsibility is that person, obviously, to help support them, to get as fit as possible. So exercise of course, is our main responsibility, our priority. But you mentioned before it’s multimodal. So we carry out an assessment which is a fancy way of saying get to know the person, help to understand what they need from us as a support us as a service.
And I suppose as a community, as with the prehab cancer service. We bring people together in group, group exercise group sessions, whether that’s in the gym or away from the gym, in a studio, or it gives people that opportunity to share lived experience. Believe it or not, that’s not often an experience that they get just to speak to somebody else that’s been diagnosed with cancer and to share that experience.
And that’s where you get all the psychosocial benefits of group-based exercise as well, which can help to relieve anxiety, depression. So you’re getting all the mental wellbeing benefits of exercise as well. And but I suppose we deliver exercise to people. So that’s what we do. So it might be cycling, walking but it would be very specifically tailored to that individual.
I suppose a standardised way approach to exercise is through high-intensity interval training.
Zoe
So otherwise known as HIT Yeah.
Jack
Yeah. We manage the volumes and progressions to suit that a patient. So a lady that I was working with a few months, six months ago, 88 years of age, she came into the gym and the assessment, it got her on the exercise bike.
And yes, we were doing high intensity interval training with this, with this person. But of course, it would say to her ability levels, she had colorectal surgery and she made a fantastic recovery. She’s now back swimming, three times a week. She comes into the gym once or twice a week during our supervised gym sessions, during our recovery.
So yeah, it might almost scare people to hear that an 88-year-old, has been on an exercise bike in the gym, and she’s doing high intensity interval training. But the positive benefits that person can have are massive.
Zoe:
So, take that person you just described. So obviously that’s the cardiovascular that you’ll have done, but what about the strength stuff. So what would you you’ve got her to do in terms of the strength exercises she would have had to have done?
Jack:
Yeah. So we’re looking at some functional movements to help build strength in the major muscle groups. So again, you’re looking at you set the standard.
So you might do a weighted set to some to increase the amount of force that the muscles have to produce to increase strength. So yes, exercises that can support activities of daily living. Well, again, specific to that person. So if there’s any musculoskeletal conditions and any pain for example, any hip pain, then we might want to tailor the exercise selection to suit.
And when you do set foot in the gym, it looks like a room full of instruments of torture. But once you get on and you get using the equipment, you can you soon see that the very easy and comfortable to use. So it’s kind of breaking down those barriers to access and using the, using the facilities.
Zoe:
Another aim that we have with what we’re doing is about lifelong behaviour change. So it’s about people continuing to do exercise. Yes we did. We didn’t want people to have to come to a gym in a hospital. What is like one bike. And again, it’s in this horrible place which they’re associating with the fact that they’ve been told that they’ve got cancer.
Instead, we wanted it to be that near where they live. They would wander along to their leisure centre. They’d see their neighbour in there, they might see somebody that they know, you know, it’s an environment that is not to do with cancer. It’s not to do with hospitals. It’s a very normal environment. And to anyone else in the gym that does somebody else in the gym doing some exercise, which again, I know can be scary.
But actually, again, it’s, you know, 2 or 3 times a week, free gym membership, people coming along, able to access whatever else is going on in the leisure centre. And I think that in itself is really important. Because this is about how we, make people feel that, really, it’s, again, something really positive that they’re, that they’re engaging in, they’re doing.
And like, we know, not everyone, is ready for coming back afterwards, but actually the majority of people want to continue doing exercise, talk to us about kind of the exercise and a physical activity. We might someone might do afterwards when they’re kind of in that recovery phase, after they’ve had the treatment.
Jack:
Yeah. A really important point. So obviously the prehabilitation phase, that small window of time that we’ve got to work with a person, to support a person to get as fit and as strong as possible for their surgery or treatment. 3 to 4 weeks typically. So it does need to be a bit more intense for the recovery and the rehab element.
That can be a little bit more relaxed, it can be more person centred, and the rehab is more tailored to, what they enjoy doing, what their likes and interests are. Well, I’m, I always think is great is that somebody might go on to do like line dancing or someone might go on to do like Zumba or like, you know, for example.
And so a lot of what we’re trying to do is once people have, you know, leaving the service and leaving the program, it’s like, what do you want to be doing? For me, it’s always trying to let people know that we deliberately do a very specific exercise programme before, as part of the prehab portion, and actually during as well.
Zoe:
So the definition of prehabilitation has just been updated recently. And if you’re having, chemotherapy and radiotherapy, you would be doing your rehabilitation during at the same time.
Jack:
Yeah. That’s a really important stage in the pathway for people as well as all the support that we offer into them, because we know how impactful chemotherapy treatment is.
And the impact that that can have on the body. So we want to reduce any deconditioning effects on the body during that time. We fully encourage people to stay as active as possible and still come to attend leisure centres so we can support them during chemotherapy treatment. Yeah, of course we would adapt our exercise prescriptions, support that that patient based on their based on their needs on any given, any given day.
But yeah, we fully encourage people to stay active during chemotherapy treatment and all of the evidence supports. And so, what’s the call to action? How do we get the message across to other health care professionals, to integrate physical activity and exercise as standard into care pathways?
Zoe:
So this a there’s a few things that I’d want to say in response to that. So, I didn’t mention it before, but I’m part of the national group, that have written the NI guidelines. So, people might already have heard of the Macmillan Rehab guidance that was released in 2019, of which there’s a lovely picture of Jack in that document.
If anyone wants to go and find it, he looks a bit younger. Okay. Looking very different. But that was from 2019 and we’ve just gone through a huge process, led by Macmillan and the Royal College of Anaesthetists, the British Dietetic Association, the World Health Organisation, and we’ve done a two year systematic review of looking at all the evidence that exists for rehabilitation and an updated the guidelines, which, if anyone wants to find it, look on the Macmillan website, which is where it will be hosted.
So for starters, I would really recommend that healthcare professionals go and find that document because, what we’ve done is we’ve taken all the research and all the evidence, we’ve, you know, agreed guidelines of how you deliver rehabilitation, what you need to be thinking about, what is the best evidence around it, which, who, who in the workforce should be involved.
You know, exercise professionals, allied health professionals, psychologists, cancer nurse specialists, all the different people who are involved. So I would really recommend people go and have a look at that document. The bit of it I was involved in most was the health economics. So often, you know, the science of rehabilitation I think is quite easy to understand.
And I think hopefully we’ve covered that off. But what we know, and certainly locally in terms of the evaluation we’ve done of private cancer, we’ve shown that actually, if you compare people who do prehab to people who’ve had the same kind of cancer, same kind of treatment, the same kind of people and haven’t done rehab, it costs more money.
And in in the healthcare delivery to do that. So actually we’ve shown that, it’s roughly three times more expensive for the patients who’ve not done prehab to those that have sort of essentially pre rehab is delivering a free times return on investment is fancy terminology. So we did an evaluation when you know two three years into the service.
And then we’ve done it again just recently. We’re showing that for some patients absolutely they get out of hospital quicker. They don’t have as many days in hospital which is obviously costly. They have less readmissions to hospital, less admissions into A&E. The really amazing thing that we’ve been able to see is that actually people who do prehab compared to people that don’t, if you compare whether people are alive at one year or five years, which we’ve been able to date because we’ve been running the service for that long, there’s a better survival for people who do prehab.
And if you compare this to drugs, you know, it would be the most prescribed joke in the world to be able to show that we can actually have that benefit. But we’ve also looked at other evaluations, that of other services elsewhere that have been conducted independently. So, for example, in Sheffield, Leeds does the Active Together service. Across the country there’s lots of different rehab services. And actually what’s really reassuring is they’re all finding this. There’s a health economic benefit from doing prehabilitation. And actually there again is this improvement in survival. To me it’s a no brainer isn’t it.
Jack:
it’s astonishing isn’t it. The findings that we’ve been able to demonstrate and yeah, literally saving lives through the delivery of rehabilitation and recovery programs. And it’s great that so many other fantastic rehabilitation services are popping up nationally now as well. It’s really that why do you get out of bed in the morning.
Well doing it to save people’s lives that are impacted by cancer is massive. Yeah. And I think as again, just a bit of feedback that we get from patients’ day to day so that that that voice, the health care professional is really trusted to patients. Patients trust that nurses, their doctors, their consultants. So be an advocate for exercise and physical activity.
Really encourage and get advocate for patients to engage with exercise and physical activity. Because of all the reasons that we’ve discussed today and the benefits that it can have to that person, I’m conscious that obviously, you know, we’re banging on about this brilliant service we have in Greater Manchester. And so you know, if we had to kind of tell people listening from other parts of the country, about how to think about this, how to do more, you know, we’ve got a website, we’re WW, DWP rehab 4 cancer.co.uk
If you search Macmillan Rehabilitation, there’s lots of information; NHS England. We’ve got psi UK, another charity. We’ve been involved in creating some videos. We’ve got lots of videos available on YouTube. Again, if you search for prehab for cancer on YouTube.
Zoe:
So we understand that, not everyone’s in a lucky position that they’ve got a rehab service.
They can refer a patient into. So the lovely Jack, you can see him doing videos of various different levels of strength and cardiovascular exercise, which people like my mother-in-law, he lives down in Dorset. She does tai chi with Rob, which is one of the prehab for cancer videos every. I think she does every other day. She constantly tells me when which about going to make another tai chi video.
I mean thinking about it. There’s also the, you know, movement is medicine. Website, which again, that’s got all the different health care conditions. So for any health care professional who’s thinking, right, well, how do I speak to my patients about, getting them to do some exercise of physical activity? It’s got really helpful instructions and videos that are one minutes, five minutes and ten minutes that can talk to you about if you’ve got one minute or you’ve got five minutes with a patient and you want to talk to them about exercise, this is some advice of what you can do.
You know, it’s great. We have got loads of different resources available to us haven’t we. But equally, I think our goal is to make sure that there’s more comprehensive pre-publication services available across the country. And actually, people will be pleased to hear that from a cancer perspective, in the NHS cancer plan and in the 10- year plan that’s come out recently, you know, exercise is part of that.
You know, prehabilitation is certainly part of the cancer plan. This is starting to be something that’s not just a nice thing to do that some people are doing is starting to be absolutely embedded across all the strategy and all the policies and the planning guidance that health care professionals and managers have when it comes to thinking about what they should be doing.
Well, look, thank you so much for joining me, Jack. You know, I’m I like the work you do and what the team does have so much pride in being able to work with you all. And thank you to everybody who’s listened. Hopefully we’ve inspired you to maybe just go and do some exercise yourself. Perhaps actually think about how you’re going to encourage the people that you work your patients.
You know, if you’re a health care professional or if you’re a NHS manager, how you’re going to think about making sure that exercise is part of the work that you’re doing. Remember, there’s a total of four podcast episodes in this series exploring the full ways forward. Please data and to all the exercise if you haven’t already. And I think that’s everything, for now.
So thank you very much for listening. Thanks, everyone.
Jack:
Thanks, bye.
Thank you for listening to the Four Ways Forward podcast produced by NHS horizons for NHS England. You can listen to all episodes in the series by visiting England dot NHS stuck and searching the words for ways forward.
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