Intro: Hello and welcome to the Movement Prescription Podcast.

Intro: Today we've got an episode about moving through cancer.

I'm Callum, Intro: I'm your host, and I've got two guests.

Intro: Firstly, Kat Fraser-Harris.

Kat is a practicing physio just outside of Edinburgh Intro: and she's recently been documenting her journey, Intro: having been diagnosed with sarcoma and as a physical activity enthusiast, Intro: has been showing how she's been moving through her treatment to try and support and inspire others.

Intro: And we've also got Lucy Gossage.

Lucy is a practicing consultant oncologist Intro: with a PhD in renal cancer and was formerly a professional triathlete, Intro: a 14-time Ironman champion, Intro: and now a pretty handy ultra runner.

Intro: The conversation is fairly wide-ranging it's powerful and emotive as Kat shares Intro: her journey and there's loads of practical and helpful tips within there as Intro: they both talk about their experiences as practitioners I really hope you enjoy Intro: and please do share your thoughts.

Callum: Kat I wonder if I can start by asking you a question.

Cat: Yeah really.

Callum: Just wondering if you might be able to share a bit about your journey with sarcoma Callum: and how you've been documenting your physical activity through your treatment.

Cat: Yep uh last july after a run actually very fittingly with movement um i noticed Cat: a lump just below my knee immediately and uh it was a bit odd but being a physio Cat: i tried to physio my way out of it to figure out what it was, Cat: asked a few of my healthcare professional friends, GPs and things, Cat: and then by September decided I should probably go to the GP to double check Cat: it because I couldn't figure out what it was.

Cat: Went to GP, got referred down the sarcoma pathway, had an MRI two days before Cat: I ran the marathon, and then that came back as maybe a hemangioma, nothing to worry about.

Cat: Got referred for an ultrasound guided biopsy, went for that, Cat: and didn't get a biopsy because the radiologist said it definitely looks like Cat: a lipoma, but because it's sitting right on top of your hamstring tendon, Cat: let's get it out non-urgently.

Cat: Luckily, didn't have to wait that long, got it out in December.

Cat: And then a month later, got my biopsy results back.

Cat: And it was a mixoid liposarcoma.

Cat: Yeah, so that was a bit of a shock to everybody.

I think nobody suspected it was that.

Cat: And then since then, I've had 25 sessions of radiotherapy.

Cat: And then I had a month's rest.

And then I had surgery to remove more tissue Cat: below my knee, including quite a lot of my medial muscular support for my knee, Cat: tendons, nerve, and then relocated my medial head of gastrop to fill the hole Cat: and the skin graft on top.

Cat: So that's a little summary of my cancer bit.

Cat: Early on in my journey, I went to a talk at Maggie's at the Western General, Cat: which was mainly run by Professor Anna Campbell, who's done loads of research Cat: into movement and cancer.

Cat: And it was really interesting and just confirmed what I already think in that Cat: movement is amazing and good for everything.

Cat: There was really compelling evidence that it's really positive to do, Cat: reduce your risk of recurrence, reduce your side effects, everything like that with treatment.

Cat: So that just confirmed to me that I should keep moving.

Cat: My brain went into overdrive as a physio.

I was thinking, when shall I move?

Cat: What type of movement shall I do?

So those questions, most of them weren't really Cat: answered by my medical team.

They said, just move.

Cat: And what I wanted to do is start to document my journey and kind of encourage Cat: other people to move because as a physio movement is so positive anyway, Cat: but if it can have such big effects on your kind of cancer journey and symptoms Cat: and reduce the risk of getting it back, Cat: why wouldn't you move and why wouldn't I want to get people moving?

Cat: So hopefully as an inspiration for people.

Cat: And when you have a diagnosis, I don't know, I initially looked for blame.

Cat: I was like, what have I done wrong?

what have I eaten wrong Cat: I don't smoke I don't drink very much I exercise I Cat: ran two marathons last year and so just showing that it doesn't discriminate Cat: but you can continue to move as a as a positive to help you through yeah so Cat: kind of why I am exercising and how it can help that's how I'm documenting it on Instagram.

Callum: Thanks Kat it's uh it's super inspirational you can you tell our listeners what Callum: your Instagram handle is?

Cat: Yeah, it's moving through cancer.

Callum: Perfect.

Yeah, give Kat a follow.

It's really amazing.

Callum: It must be quite a vulnerable experience as well, sharing these things, Callum: but you're doing an amazing job.

Cat: Yeah, there's certain bits, but I think because I've always moved through my Cat: life, everyone says it's inspirational, but it just feels normal to me.

Cat: And it's a way to kind of hold on to normality in a situation where you don't Cat: have control over some quite big things happening in your life.

Callum: One of the things you mentioned was was being told just Callum: to move and and kind of a lack of clarity around that and hopefully we can we Callum: can kind of unpick that a bit more as we go on but and that's been something Callum: that resonates with me is kind of a lack of possibly another side of the fence Callum: a lack of comfort in in knowing what to say for certain conditions and and and Callum: that was the original inspiration for this podcast really was to try and address that, Callum: Lucy, just kind of over to you briefly, Callum: could you tell us a bit about how you got involved in Move Against Cancer and Callum: how your athletic background has influenced what you do?

Callum: For those that are listening, for context, Lucy is appropriately dressed.

Callum: She's in sunglasses and a vest having just been to the gym.

Callum: So I feel inadequate.

I'm in a jumper.

Lucy: Yeah, so I'm an oncologist.

And I did have quite a lot of time out actually Lucy: as a professional triathlete, kind of during my registrar training.

Lucy: And I guess whilst I was kind of away, I became aware that there was quite a Lucy: lot of evidence accumulating that exercise was a positive thing for people living with an after cancer.

Lucy: And I remember it really clearly.

It was probably 2017, I think.

Lucy: I was still a registrar and I went to see a young patient on the ward.

Lucy: He was probably 21, 22.

I hadn't treated him I Lucy: just he just needed a prescription we got chatting and he'd Lucy: had a really rare brain tumor um a germ cell Lucy: tumor testicular tumor in his brain and he'd Lucy: theoretically been cured of the cancer um but Lucy: in the process he'd put on several stone in weight he'd Lucy: lost most of his friends he'd lost his job and he was spending Lucy: all day asleep and all night awake playing computer games Lucy: and I just I remember so clearly walking away from Lucy: the ward and I'd had all this time out thinking what are Lucy: we what are we doing if if our cure is you Lucy: know cure rates for people with cancer are so much better yet Lucy: this is the life that they're left with um and Lucy: I'd always loved park run and I just thought Lucy: I wonder whether we could get a group of young people who'd have their who've Lucy: had their cancer treatment um together to build up to doing a park run in three Lucy: months time and um kind of you know and I guess I had a friend who'd been depressed Lucy: I'd see no exercises help them so those were kind of the cogs that were churning and.

Lucy: Tested this idea in the hospital everyone was like no way Lucy just because Lucy: you love running people with cancer aren't going to want to be told to run, Lucy: And I just thought, you know what, I do believe there's something in this.

Lucy: So I looked elsewhere and I came across Gemma Hillia-Moses, who is an amazing Lucy: person.

She had had cancer when she was 25.

Lucy: She was a runner and she had just founded Move Charity with the goal of providing Lucy: other young people with the support to be active, which she didn't get through her cancer treatment.

Lucy: So I got in touch with Gemma.

We had a coffee.

We started talking.

Lucy: We realized we both shared the same vision.

and Gemma didn't say no the Park Lucy: Run idea is nonsense she said well let's just give it a go.

Lucy: So that's that led to the founding of Lucy: 5K UA Move Against Cancer which is now one Lucy: arm of Move Against Cancer charity so it's Lucy: a really simple idea we have over 105 Lucy: groups I think now across the UK and Ireland we meet Lucy: at Park Run on the last Saturday of every month Lucy: each group's led by a volunteer ambassador who's been Lucy: impacted by cancer in some way and people walk jog Lucy: run cheer volunteer and have a catch-up and Lucy: a coffee over um a catch-up and Lucy: a chat over a coffee so it's an active support group with a Lucy: difference um and this is all part of Lucy: move against cancer charity which is a small but mighty charity Lucy: is how i describe it um and our aim is Lucy: to support inspire and empower people living with Lucy: and after cancer to be active um because we believe Lucy: that movement matters but actually the evidence now also Lucy: shows that movement matters and I feel very passionately as Lucy: a doctor that the evidence is enough Lucy: now that um every person who Lucy: is who receives a cancer diagnosis should be Lucy: told that exercise is one of the things that they can do to help Lucy: themselves um and at the moment that's not really happening Lucy: um yeah that was kind of kind of how I got involved to move against cancer um Lucy: spent a huge amount of time kind of from 2018 to 2022 spending two days a week Lucy: helping to grow it but we've now got um yeah i'm now much more in the background Lucy: um and yeah it's doing doing some amazing stuff.

Callum: Oh cool yeah it's really incredible and Callum: and uh yeah we'll put some show notes with Callum: a link to move against cancer in in the podcast uh Callum: lucy you mentioned about the accumulating evidence Callum: uh one of the things that certainly Callum: prompted this podcast was there was a really interesting paper Callum: that was released uh about colorectal cancer and the role of exercise and and Callum: uh it was all over the news and it is great that it's getting quite wide exposure Callum: uh but i was wondering if you could explain some of the science behind how physical Callum: activity and movement benefit people living with cancer.

Lucy: So i think the reality is we don't really understand how it helps but we know Lucy: that it does help um and there are there are lots of different theories um.

Lucy: I was really excited by that study.

So I've done loads of conference talks over Lucy: the last kind of eight years.

And I've always said, this is what we know.

Lucy: And I think if I do this talk in 10 years time, we'll have high quality data Lucy: from phase three, big randomized trials that prove that exercise improved survival.

Lucy: And then finally, we've got this study which proves just that.

Lucy: So until recently, we've known for sure that exercise is the best treatment for cancer fatigue, Lucy: which is a massive thing for so many people, not just during their cancer treatment, Lucy: but after their cancer treatment and for people living with cancer.

Lucy: We've known that it improves mood, reduces depression, anxiety.

Lucy: We've known it makes people feel better.

We know that it improves health-related Lucy: quality of life.

So those were all proven.

Lucy: But there was also a lot of accumulating evidence, though not really definitive Lucy: proof, that it likely improved how well cancer treatments worked, Lucy: reduced side effects from cancer treatment, Lucy: definitely reduced the long-term consequences of cancer treatment, Lucy: particularly for people living with cancer that's probably not curable.

Lucy: But there's a huge proportion of people who are living very, Lucy: very many years with really good quality of life having ongoing cancer treatment.

Lucy: So we know exercise mitigates a lot of the toxicities from that, Lucy: particularly cardiovascular and metabolic.

Lucy: And what's been amazing over the last few months This is a publication of the Lucy: Challenge trial, which was a big trial of nearly 900 people who'd had treatment for bowel cancer.

Lucy: So they'd had surgery and then chemotherapy and they were randomized either Lucy: to get generic advice around exercise or to get specialized support to be active Lucy: for the three years after their cancer.

Lucy: Treatment and it showed that the Lucy: risks of recurrence in the group that were randomized to Lucy: the supervised exercise was significantly lower Lucy: than the group that were just given generic advice so it's the Lucy: first definitive proof we have that exercise Lucy: interventions reduce the risk of recurrence so for Lucy: me for someone who's lived and breathed this for the Lucy: last kind of eight years or whatever to finally Lucy: have the proof and be able to say to other healthcare Lucy: professionals look there's a study yes it's just in bowel cancer Lucy: but there's no reason why that shouldn't be replicated for other cancers surely Lucy: this has to change the conversations that you have with your patients um Lucy: is really powerful and it was great it was all over mainstream Lucy: news um it does seem to fizzled out Lucy: and i think my worry is that with the the challenges Lucy: with funding etc in the nhs it's not going to translate into Lucy: the big changes that it should do because actually if you've got a Lucy: study that proves that the benefits of exercise are Lucy: as good as the benefits of chemotherapy that should be Lucy: funded um and anyone who says um people Lucy: with cancer won't want to be told to exercise i would turn Lucy: that on its head and say people with cancer turn up to Lucy: get chemotherapy once a week that makes them lose their hair that.

Lucy: Makes them feel sick that has potentially lifelong consequences on Lucy: fertility on cardiovascular health to so many people with cancer exercising Lucy: would be and it should never be an alternative to chemotherapy it should be Lucy: an add-on so i'm very clear it's not an alternative but um I think a very significant Lucy: proportion of people with cancer would want to be told that exercise was something Lucy: they can do to help themselves, Lucy: plus we know it makes people feel better but it's easy Lucy: to say that and we need to work out you know and it's easy for people like me Lucy: and cats who love exercise it's a massive part of our lives I know for people Lucy: for whom exercise hasn't been part of their life it's a really big thing and Lucy: it's a challenge and that's why the study I guess showed that you need supervision Lucy: and you need structured support and guidance.

It's not just enough to give someone a leaflet.

Lucy: Yeah, it's really exciting.

Callum: Yeah, it's cool.

And that reframing is really interesting of how we kind of Callum: repackage physical activity within cancer.

Callum: Yeah, hopefully there's loads to come and we can continue to use that, Callum: kind of capture the public imagination about the role of physical activity.

Callum: But you're right, it's maybe disappointing that messaging was quite short term.

Callum: So, Kat, Lucy mentioned a few of the many challenges, not least the fatigue with cancer.

Callum: What have been your personal challenges and motivators to date so far?

Callum: And I suspect there'll be new ones to come as well.

Cat: Well, fatigue was top of my list.

So for me, it was initially when I had my Cat: diagnosis, I didn't sleep very well.

I woke up pretty early every morning.

Cat: So I was generally quite tired.

I run quite tired anyway.

I think I run on full Cat: pelt all the time.

So I am quite tired.

Cat: But also side effects of radiotherapy and just the emotional fatigue as well Cat: of a diagnosis and kind of a change in your life and plus I'm a mum of two small Cat: kids so I have that fatigue as well.

So a few different fatigues not all cancer related.

Cat: Time as well for me I'm self-employed so Cat: I kept working throughout all Cat: my radiotherapy and in between Cat: radiotherapy and surgery and then went back to clinic Cat: three weeks after my surgery which was maybe a Cat: bit soon but yeah so time the Cat: hospital was an hour away and there were horrendous roadworks Cat: for most of my radiotherapy so it just took Cat: a big chunk out of your day and a long time in the car um Cat: yeah and again two small kids and still doing school Cat: drop off pickup everything like that so time got in the Cat: way that was a challenge and then more latterly Cat: physical challenges so post-surgery I've Cat: had quite extensive surgery to my leg I can't move how Cat: I used to move I still can't walk fully properly and like Cat: my muscle strength is different so those physical Cat: challenges as well are there and I can't Cat: do I normally run play tennis walk the dog it goes swimming so everything like Cat: that I wasn't able to do for a while so that was a big challenge in terms of Cat: trying to keep moving but the motivators I had were as Lucy said about all the Cat: evidence if that evidence is there why wouldn't I be exercising?

Cat: For me, it's an absolute no-brainer.

If it's going to help reduce my recurrence, Cat: if it's going to help with my fatigue and everything like that, then.

Cat: There's not really any other option other than to move.

Also, Cat: if I see other people doing it as well, I'm like, well, they're actually in Cat: a similar situation to me and they're moving too.

Cat: So why can't I?

I should move as well.

Cat: And knowing, as Lucy said, we both love exercise.

Cat: I know if I'm feeling a bit tired and get up and move, I will feel less tired.

Cat: So in normal life, before cancer and things Cat: anyway I'd move to help with fatigue and so Cat: again knowing that it would make me feel better helped Cat: and also role modeling for my kids as well I think that's a big part of exercise Cat: for me anyway it's normal for them to see me and my husband going out for a Cat: tennis match or cricket match or something and they're like okay have fun and Cat: so knowing that actually you can And kind of if you have these challenges, Cat: you can treat them with exercise.

Cat: I think exercise is very much my drug.

So that's the motivator for me.

Cat: I know it helps.

I know it helps pre-cancer.

Cat: And the evidence is there that it helps during and after as well.

Cat: And even though now I'm restricted to going on a bike, which is fun still, Cat: and doing my rehab, I still feel better after I've done those.

Cat: So, yeah, it's a no-brainer just to keep moving.

and that's the motivator there because.

Lucy: Can I just jump in on what you said if you Lucy: know exercise is your drug um and it is a cliche but Lucy: actually if you had a pill that did everything that Lucy: exercise did in one package that you could take once a Lucy: day you would at the cost that exercise costs Lucy: you would give it to every single person probably every Lucy: single person in the world but um certainly every single person Lucy: with a cancer diagnosis so it is a cliche but if exercise was a drug and that Lucy: study uh the challenge trial had been a study of a drug it would be fast track Lucy: through nice the the drug approval process for fast track approval um which Lucy: is why i feel so passionately that it has to trigger changes in the health care system so it's the fact.

Cat: That you i would go into radiotherapy waiting room in Cat: my shorts having gone for a run with my friends who've Cat: taken me there because uh again i just Cat: wanted to keep moving and most people were sitting Cat: there looking exhausted like obviously Cat: a big range of people but nobody else was Cat: doing that and I'm like come Cat: on guys you need to move even if it's just simple things but the evidence is Cat: there all across the board for loads of different conditions not just cancer Cat: like as a physio we treat osteoarthritis all these things but people would rather Cat: take a drug to try and treat symptoms when actually movement can reverse lots of other things too.

Lucy: And I think there is a barrier that, sadly, there's still a hierarchy in the Lucy: NHS and a lot of patients need to hear it from their consultant before they'll believe it.

Lucy: So whilst it's really sad, I think the conversations have to start with the consultants.

Lucy: And there is still a perception, it is changing, but there's still a perception Lucy: that the best thing you can do if you've got cancer is rest.

Lucy: And I think one of the most important things to do, particularly for less fit Lucy: patients who've been given a cancer diagnosis, is at the very least dispel the Lucy: myth that rest is best because it's not.

Lucy: So if all you're going to do is give people permission to move, Lucy: that's better than just ignoring it because so many people otherwise, Lucy: particularly the loved ones or the person who's got a cancer diagnosis, Lucy: will assume that cancer means that you need to rest.

And actually the evidence Lucy: is a completely opposite.

Cat: Yeah.

And I spoke to one of my, well, I spoke to the radiotherapists every day Cat: I was there, but I'd always have a question to ask them and I was asking them Cat: about what's the evidence for exercise.

Cat: Should I exercise before my treatment, after my treatment?

Cat: And one of them had been there for a while and she said it used to be that we Cat: tell all our patients to go home and rest for the rest of the day.

Cat: Yeah.

But now it is changing and it's getting there.

Cat: And it's just like physio for back pain.

we used to tell people to to rest and Cat: now it's all about moving.

Lucy: So there's an interesting um there Lucy: was an interesting animal study where if they put mice on a Lucy: treadmill basically they gave my made mice exercise Lucy: before the radiotherapy the responses to the radiotherapy were Lucy: better and there's this theory that exercise you know Lucy: just a short burst just before your radiotherapy opens up all the blood vessels Lucy: so it means that the rate the impact of the radiotherapy can be more powerful Lucy: so that's not definitive proof but um there is kind of some evidence that actually Lucy: exercising just before you're ready to open might be a positive thing but certainly Lucy: it's very unlikely to do to do you harm if you feel well enough to do it.

Callum: You mentioned role modeling cat but Callum: uh to the kids but you're also super cool you're role modeling to Callum: to other patients as well and and and setting Callum: kind of setting an inspiration an example uh you mentioned social support and Callum: i think that ties in closely to what lucy mentioned earlier around uh 5k your Callum: way how have you found or have you managed and found much social support for moving in your cancer?

Callum: And then maybe once you've answered that, Lucy, you can tell us a bit more about Callum: how you've kind of managed to integrate that within 5k your way and move against cancer.

Cat: Yeah, well, I've always found having sort of support around you really important.

Cat: And I've, over the last few years, swapped to being much more of a social runner.

Cat: And I prefer running with my friends rather than on my own.

Cat: I think the trouble with being up in Scotland is everything is a wee bit smaller.

Cat: And the 5k your way were at the talk I went to at Maggie's.

Cat: But they're only based at two park runs in Scotland.

Cat: Um so it's a bit more tricky Cat: at the moment at the moment yeah it's a Cat: bit more tricky to access that um but Cat: I found like the support of my friends Cat: who I exercise with anyway that was Cat: amazing and it changes exercise because you're doing Cat: it for a social thing but you're also you Cat: can offload to them you're running with them and the chats that you have Cat: when you're running get quite deep and it Cat: makes you feel better it's really that more mental Cat: side of things that you feel better physically after doing Cat: exercise but if you've had a really good talk with somebody Cat: as well and it it really Cat: helps the kind of mental side too and I've Cat: connected with quite a lot of people now through my social media with Cat: cycling because I'm doing Chris Hoy's Tour Cat: de Four cycle in September and that's Cat: been really good and it's been really inspirational for me too Cat: seeing because having that community there to connect with even though it's Cat: virtually seeing people going through lots of horrible things but moving and Cat: enjoying it and things and then it gives you even more motivation as a cancer Cat: patient to get out and move.

Callum: Kat I was going to ask you briefly, if you could tell us a little bit more about Tour de Hoi.

Cat: Tour de Four.

Callum: Tour de Four, sorry, Tour de Four.

It's Chris Hoyt, I'm getting all confused.

Cat: It's a cycling event, so there's, I'm doing the second longest route, Cat: so there's a 50-something mile cycle, Cat: a 30-something mile cycle, and then there's a one-kilometer loop you can do Cat: as many times as you want, and then there's also static bikes and other things Cat: for people who aren't able to cycle.

Cat: And it's organized by Chris Hoyt, who obviously had his stage four cancer diagnosis.

Cat: To raise awareness of stage four cancer.

But I think part of the main message Cat: is that stage four cancer diagnosis doesn't mean stop.

Cat: Like that is the end.

You can't do anything.

I think it's trying to show that Cat: people, you can keep moving and the positivity of exercise.

Cat: Yeah, so it's been really good for me as well because I think, Cat: like I said before, I haven't been able to walk very far or run, Cat: but I can get on a bike.

so I'm now going whole hog on a bike.

Cat: I started on my turbo and now going out but it also brings in the community Cat: side because four of my friends have signed up so we've been able to go out and cycle together.

Cat: Yeah, but I'm quite looking forward to it.

It looks like a really good event.

Callum: And community is such a core part of sustainable interventions and Lucy, Callum: kind of move against cancer in 5k your way, that definitely integrates community.

Callum: And you mentioned earlier about going for coffee and chatting.

Callum: Is that been an intentional thing or is that something that's kind of grown Callum: organically, that community?

Lucy: Um, I guess a bit of both really.

I mean, the, the Nottingham group, Lucy: which is where we started it back in 2018.

So it got seven years, seven years now.

Lucy: And we've got people who came to the first one who still come and their cancer Lucy: for them is, you know, is in the past.

Lucy: We've got people who've been living with stage four cancer since 2018.

Lucy: We've had people that have, that, you know, sadly died, but, Lucy: um, we've got people that have become lifelong friends through that community.

Lucy: And um it's like any any active intervention Lucy: sport is a real leveler and our Lucy: can we've got they call themselves the knotty and grannies and Lucy: then they're in their 70s and 80s and they're absolutely Lucy: crazy and they walk a little bit Lucy: sometimes they walk the whole thing um and we've Lucy: we've actually just recently got um some two Lucy: young guys in their 20s who've just finished their cancer treatment for Lucy: whom actually walking 5k is a Lucy: massive thing like it's not something they could ever imagine Lucy: doing just three months ago um and Lucy: it's yeah it's it's incredible I I think Lucy: each time I go because I I'm not I don't really need to be there anymore it Lucy: runs without me but I go and I just come away full of um can't even articulate Lucy: it just the magic of of community and I think everyone that has got the guts to turn up at a new group.

Lucy: Aimed at people impacted by cancer are all Lucy: people who are looking for silver linings and that's part of Lucy: the magic of this community that everyone there has faced Lucy: adversity yet has found ways and Lucy: is looking actively looking for ways to overcome that.

Lucy: Adversity and um some of the friendships and Lucy: the you know it's it's just really magical um Lucy: and seeing the grannies support the Lucy: 20 year olds from completely different backgrounds is Lucy: yeah it's it's hard to describe just how Lucy: special it is um but I think one of Lucy: the powers of kind of group supports is that actually the Lucy: friendships form and then like any sports group Lucy: people that are then go out and be active away Lucy: from the group so you don't need to stay part of whichever sports group Lucy: it is it might just you might just dip in a couple of times Lucy: and then it gives you the confidence to go and go and be Lucy: active on your own um so yeah and and it's Lucy: not obviously I see the Nottingham group but watching groups around Lucy: the country who've been going for some time and seeing Lucy: their camaraderie and their friendships is um yeah Lucy: is really special so yes of course it's it is about Lucy: the exercise but it's just as much about Lucy: the the friendships and the camaraderie and I think people that Lucy: are part of the group say would say something along the lines of it's it's just Lucy: being nice being around people who get it um I think that's what those two 20 Lucy: year olds said to me that they'd told me in clinic they wanted to meet other Lucy: people who had been through similar and that was a way that they could um and Lucy: the grannies would probably say exactly the same I.

Cat: Think just touching on that it's so true it's like with lots of experience and Cat: in life you can't fully understand it if you haven't been through it so everyone Cat: all the people that you love and things are trying to support you But unless Cat: they've been through something, Cat: they don't 100% know the extra bits of it, how you're feeling and stuff.

Cat: Whereas connecting with people who are in a similar situation is really reassuring and, Cat: it's really positive.

Lucy: And I think it's also really nice for the family Lucy: so it's a Debs who now runs the Nottingham group quite incredible Lucy: lady um but she came down when she Lucy: was going through her chemotherapy and she brought her whole family with Lucy: her and she said it's something that that we can all do together Lucy: and be part of that and we've got people who's Lucy: you know whose partners have have died from cancer who Lucy: still come down because of that community so it is Lucy: a yeah it's something the family can get involved with Lucy: and we've got the daughter but one of the ladies that's been coming since Lucy: the start the daughter's a teenager she was a Lucy: little girl back at the start um but yeah Lucy: I just I just think um physical activity Lucy: groups whether they're for people with cancer or Lucy: just you know for anybody do um Lucy: accelerate friendships to some extent and for people who who understand cancer Lucy: for whatever reason it's just a safe space for them to kind of talk and share Lucy: but not have those awkward silences that you're getting a sitting having a crappy Lucy: cup of tea in a in a support group and.

Callum: A lot of that speaks into the kind of the mental resilience and Callum: also the yeah I think community a lot of the communication Callum: that I find I'm giving or or inclined to give Callum: is around the physical benefits of physical activity I'm Callum: not sure how how well that that sits how Callum: well it kind of lands I think if we were to or I Callum: try now and emphasize more of the short-term benefits and and I I hope that Callum: it offers a bit more encouragement and and possibly a kind of more longevity Callum: in outcome by emphasizing the kind of short-term community and and well-being aspects of moving.

Lucy: But it is I think it is it's scary Lucy: like even for someone like me with all my sporting background I Lucy: would be nervous about turning up at a running group and i'd Lucy: have the same fears am i quick enough i'm like all those Lucy: stuff so for someone who's never had any Lucy: experience of exercise to turn Lucy: up at a group that's aimed at exercises is really Lucy: like i just think it's so brave those people that turn up Lucy: on their own and we've got um a charity that Lucy: does group exercise classes in nottingham and and again Lucy: you see the same that you get with 5k you wear these friendships that are Lucy: formed from from doing these circuits in the gym um Lucy: but yeah how you have the conversation to Lucy: to give people enough confidence to Lucy: actually turn up is is really challenging and I Lucy: guess that goes a little bit about the messaging that goes along Lucy: with you know exercise interventions and exercise Lucy: the word exercise can be quite off-putting for Lucy: a lot of people whereas movement might be a little bit Lucy: less off-putting I think my background um it still Lucy: is a big barrier for me because people assume you know like they did eight years Lucy: ago just because you love running not everyone with cancer is and they assume Lucy: oh it's going to be a running race and um yeah exercise can is very different Lucy: to different people um but one of the things we were saying when you were offline was um.

Lucy: I think everyone who does find the courage to join a support group or an exercise Lucy: group is the kind of person who's looking for a silver lining.

Lucy: And that's why those communities are so special.

But the challenge is, Lucy: how do we get the people who aren't kind of classically silver lining hunters, Lucy: how do we get them to find those support networks as well?

Cat: I think there's also a bit of a stigma around exercise, like you were saying, it's scary.

Cat: And people are like, oh, I'm going to do a park run, I Cat: probably should make sure I can run a bit but Cat: and that's the study that came out recently what I Cat: liked about it as well is it's like no you don't have to go and Cat: do a HIIT workout or run a marathon or run you can Cat: walk you can so like you say it's movement rather Cat: than exercise so selling that sort of thing if or sport Cat: because that can put people off they're like Cat: I don't do sport I can't hit a ball I can't run I can't do Cat: that so I can't do it I won't do it whereas if you can be like you just need Cat: to walk to the end as a rodent back that's a start it needs to be little like Cat: bits at a time and small goals and not to scare people off because everybody Cat: can walk if you've walked into an appointment you can walk a short distance yeah.

Lucy: And a 45 minute brisk walk which is um kind of the intervention that a lot of Lucy: people in the study were doing that is still a massive challenge for a lot of Lucy: people who've never exercised but you don't need to start with a.

Cat: 45 minute walk you.

Lucy: Can start with a two minute walk and back and then you know you can build it Lucy: really gradually but people need that support and um yeah I think that's what Lucy: the study showed they need the support to to do that.

Callum: From uh for for health professionals listening and and and kind of coming back Callum: to what you said earlier Kat about people not really knowing what to say and Callum: what advice to give with both of your experiences what what what could we say Callum: what what would be good things to say and and you know maybe from a personal Callum: perspective, Kat, what would you have liked to have heard.

Cat: I probably would have quite liked to have heard a lot more.

I think I'm quite Cat: different, though, probably compared to a lot of the lay population, like Lucy was saying.

Cat: I'm not a professional athlete like Lucy was, but my level of exercising before Cat: my cancer diagnosis was quite a lot.

Cat: So I wanted to know, like, can I continue?

Is it safe to do so?

Cat: But also I wanted to know about timing of exercise like we were saying with Cat: radiotherapy treatment when should I exercise around my treatment to get the Cat: best effectiveness out of treatment.

Cat: But I think a lay person who doesn't exercise would probably have quite different Cat: questions to me and want to know different things I think knowing the evidence Cat: would be really useful just simple things like the list that Lucy did about Cat: how it can reduce fatigue, Cat: reduce anxiety, depression all those things and Cat: the strength of the evidence as well because there's a lot of good strong evidence Cat: out there um I think that and maybe I think signposting as well would be really Cat: good because there are lots of community groups I had no signposting with my Cat: diagnosis but I found quite a lot myself especially as a younger person with Cat: social media there's charities for people in their Cat: 20s, 30s, 40s with cancer that provide free 12-week programs with a cancer exercise specialist.

Cat: So there's actually quite a lot out there, but it's about signposting people Cat: to the right things for them, if that makes sense.

Cat: Because I did so much digging myself because I think my way of dealing with Cat: my diagnosis was what can I control?

Cat: I can control what goes into my body and how I move.

So I looked into nutrition Cat: and things, but also looked into the timing of exercise, what type of exercise.

Cat: And I'm lucky as a physio that I knew I was going to be having surgery to remove Cat: certain bits of my anatomy and knew what those muscles do and what I could do as prehab myself.

Cat: But I think it's a bit of a postcode lottery as well in terms of physio with Cat: cancer because I know where we are, there's no physios as part of the sarcoma team.

Cat: Lucy and I were chatting about this and it has quite a big impact on you physically Cat: dependent on where the sakuma is.

Cat: And if you're not given the advice on how to move afterwards or how to get back Cat: to moving, you're not going to move.

Cat: And then you're missing out on all the benefits of exercise.

Callum: A lot of that, it feels like you kind of needed more time and space, Callum: which is a challenge in the NHS, isn't it?

Callum: A perpetual one, but yeah.

Callum: But a lot of what you say, it kind of makes a lot of sense, doesn't it?

Callum: I'm sorry your experience is what it was.

Cat: Well, I'm lucky though.

I think I've said, well, I'm unlucky in one way, Cat: but I'm lucky there's a lot of, I think I'm definitely a silver lining person.

Cat: There's a lot of glitter on my situation.

in that I have that knowledge.

Cat: I've got physio friends.

I've got Cat: doctor friends.

I've got a really good community to support me through.

Cat: And I'm very much of the belief that knowledge is power.

So my kind of coping Cat: mechanism is to start reading into things.

Cat: What's the evidence?

What can I do to help myself?

Cat: Whereas I think a lot more people are quite passive and they'd be in the same Cat: situation and be less active than they were before, which might not have been Cat: very active in the first place.

Callum: How about you, Lucy?

Any thoughts on what health professionals can do to support Callum: people with cancer to move more?

Lucy: I mean, I think, number one, just bring it up in a consultation.

Lucy: And I think what I've listened, what I've heard from what Kat's just said is Lucy: she wanted to know what she can do.

Lucy: And I think in my experience, most people with cancer want to know what they can do.

Lucy: And exercise is something that everyone with Lucy: cancer can do and I think yeah bringing Lucy: that up in conversation as part of your your.

Lucy: Your consultation is is really important and it's Lucy: also actually a really positive thing to do because I'm you know as an Lucy: oncologist I prescribe drugs and the first Lucy: time I meet a patient once I've chatted with them Lucy: find out what you know what matters to them what the Lucy: symptoms are etc we talk about the treatments and Lucy: then I go through a long list of side effects and it's really Lucy: scary and it's quite it's a horrible way to send end Lucy: a consultation assignment consent form with these side effects but Lucy: you can then follow up with something that's actually quite positive that Lucy: will undoubtedly make people feel better and so Lucy: as a healthcare professional you do need Lucy: to to kind of I guess think about how you're Lucy: going to bring it up moving medicine's got some it's a Lucy: website it's got some great kind of conversation like the two minute Lucy: conversation the five minute conversations it's got some great suggestions Lucy: about how you can bring that up but it is a really positive Lucy: thing that that you can do that can you know Lucy: will help give patients back some sense of control um Lucy: but also end the consultation on a slightly positive note Lucy: um and I guess I'd also encourage people to remember that so many people with Lucy: cancer assume that they need to rest and actually giving them permission to Lucy: go outside and and move is a really positive thing that will take off a lot Lucy: of anxiety and weight off their mind um and and probably change their perceptions.

Lucy: Yeah, so I think understand the evidence and bring it up in conversation is Lucy: probably the two things.

Lucy: And I certainly, I think the challenge for our show is that we owe it to patients.

Lucy: Like it proves we have to have those conversations with everyone who's been Lucy: given a cancer diagnosis.

Cat: I think you make a really good point because I think in my initial consultation, Cat: I brought it up at the end rather than it being brought up to me.

Cat: So you you as an Cat: oncologist have the have you obviously are very Cat: interested in the exercise side of things as well but my Cat: oncologist was like yes of course you need to move and like Cat: oh I had someone in here the other day who has been having Cat: radiotherapy on their knee and hasn't moved it for six weeks I'm like Cat: okay but it needs to be job I asked Cat: yeah and but uh yeah Cat: so it is about bringing it up and like you said well we Cat: said before about the cliche of exercise as a drug you're talking Cat: about chemotherapy which is obviously a drug and a treatment which people need Cat: to have but exercise should have as much importance in a consultation because Cat: of the evidence that's that's there as well as an add-on to the treatment that Cat: you're having so I think it's.

Lucy: But then I come I guess coming along with that it's nice then for healthcare Lucy: professionals to have somewhere to signpost patients to because they're not Lucy: going to have the expertise to tell all the time to go through a structured exercise program.

Cat: No there are charities.

Lucy: Out there so having a you know a list of places that you can signpost to I think Lucy: I think that I think healthcare professionals will say that makes it easier Lucy: to have a conversation as well because you can have the conversation and then Lucy: pass part you know point the person into a into the right direction oh and by Lucy: the way it's great to exercise off you go.

Cat: Exactly you have to have the resources to Cat: back it up yeah but even like I know Cat: when I was still working in the NHS we loved leaflet and it was a really good Cat: way to tell people how many things they could do for their arthritis or something Cat: and exercise is one of them and you have all the resources on the back so it's Cat: just simple communication and to provide the people with the places to look.

Callum: The other thing you both are are amazing at Callum: is is the power of advocacy i think when you're you're passionate Callum: about something and you represent it and one of Callum: the things that i think healthcare professionals as a Callum: population are often really active particularly doctors i think sometimes Callum: some uh sometimes we don't Callum: represent that very well and i've become conscious about trying to Callum: to leave kind of not very subtle signs around Callum: my consulting room so that people know it's a priority in in Callum: in my life and and yeah Callum: whether we can we can encourage colleagues to do something similar I I Callum: don't know but uh but yeah I'm sure you guys do that and and certainly and yeah Callum: well you are doing that so which is bro just to finish it would be really interesting Callum: just if you guys had any final thoughts or or reflections or or just you know Callum: something that you wanted the listener to, Callum: to take away from from from this i i kind of putting you both on the spot i'm Callum: gonna fill time just briefly and then and then hand over lucy yeah perfect no.

Lucy: I guess this is for a healthcare professional um so one of my in the early days Lucy: of 5k away there was um an incredible lady called sue and she's died now but Lucy: she was 70 or 71 i think and she'd been diagnosed with bowel cancer that had Lucy: spread her liver.

She had never run in her life.

Lucy: And when she was in hospital having a bowel cancer surgery, she saw the flyer Lucy: for 5k your way and she joked to her family.

Lucy: She said, when I get out of here, I'm going to do that.

And her family like, Lucy: you don't run.

She's 70 or 71.

Lucy: Anyway, she got out of hospital.

She could hardly walk to the toilet.

Lucy: She came to 5k.

She walked a Lucy: bit of it and she came back and she came back and she built up to running.

Lucy: And eventually she set the target of if I break 35 minutes, I'm going to get Lucy: in the river naked.

And she got in the river naked.

Lucy: But I've got this amazing video of her saying, when people ask me how I am, Lucy: I don't talk about the bad stuff.

I tell them I've started running.

Lucy: And she's a lady that you would never assume would want to be told to exercise.

She's 70.

Lucy: She's just been diagnosed with stage four cancer.

Lucy: She's exercise was not part of her life.

Yet actually what it turned into was Lucy: her crutch during the years that she was living with cancer.

Lucy: And for me, that's kind of whenever I've struggled with the charity and growing Lucy: a charity, it's a lot of work and it's stressful at times.

Lucy: I very often come back to Sue and there are so many Sue's out there who could Lucy: get so much joy and medical benefits if they just were given the information Lucy: about benefits of exercise.

Lucy: So that's my little anecdote that I'll end on.

Callum: Thanks Lucy.

How about you Kat?

Cat: I think kind of following on from what Lucy's just said, a lot of it, Cat: I'm a big believer in knowledge is power.

Cat: So if you can equip people with Cat: the knowledge that doing something can help Cat: them again going back to signposting and Cat: things then it gives them the power Cat: to try it that makes sense it's again like i think permission has been mentioned Cat: a lot it's that permission you are allowed to move you're not going to harm Cat: yourself moving doesn't mean running a marathon moving doesn't mean doing something Cat: really extreme it can be walking it can be anything and so it's that permission Cat: to do it but also arming people with the knowledge, Cat: that they can do it and should do it.

Callum: Permission and empowerment, good note to end on.

Thanks, guys.

Intro: Hi, it's Callum.

I really hope you enjoyed the episode.

Intro: We are so grateful to the British Society of Lifestyle Medicine for their support Intro: in producing these podcasts.

Intro: And we wholeheartedly share their vision of transforming healthcare and levelling Intro: health inequalities through lifestyle medicine.

Intro: If you want to find out more, please head to bslm.org.uk.

Intro: Although catering for healthcare professionals, this podcast is for everyone.

Intro: If you enjoyed it, please share it.

And we love hearing from you.

Intro: So do reach out.

Thanks for listening.