Latest / Rad Chat / E214: Anne-Marie Ball - Exercise and Oncology
Transcript
- Jo McNamara Rad Chat Host (00:00) Hello everyone and welcome to Rad Chat, founded by me, Jo McNamara. Naman Julka-Anderson (00:04) And me, Naman Julka-Anderson. Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their expertise in therapeutic radiography and oncology. Unlike traditional academic resources, we blend real-world experience, expert insights, best practice, and patient perspectives. Jo McNamara Rad Chat Host (00:21) We make advanced knowledge engaging and accessible, supporting continuous learning and professional development without compromising patient care or your personal time by providing insights into both technical skills and career development, helping you to progress confidently in your field and shape your professional future. Naman Julka-Anderson (00:38) Just to let you know, our episodes may contain sensitive and difficult topics that you might find distressing or triggering. Please consider checking out another episode. Jo McNamara (00:47) So this episode is part of the Living With and Beyond Cancer series, where we're going to be hearing from our amazing guest, Anne-Marie Ball, for talking about the benefits of exercise for people going through cancer treatment and her own experience. So welcome Anne-Marie, thanks for coming on Rad Chat. Anne-Marie Ball (01:03) Thank you so much for having me, I'm very happy to be here. Jo McNamara (01:06) We're so excited to have you on and for anyone who is feeling tired they will be energised just by Anne-Marie's passion, enthusiasm, know the tone of your voice. They'll leave the podcast episode feeling invigorated I have no doubt. Anne-Marie Ball (01:24) I do hope so. That'd be fabulous, wouldn't it? That'd be an extra bonus. Jo McNamara (01:29) So Anne-Marie for anyone who doesn't know you tell us a little bit about yourself and what you currently do in your day job. Anne-Marie Ball (01:35) I will tell you all of those things. So my name is Anne-Louise Ball and my background is in exercise. So I've worked in the fitness industry for a very, very long time. And then probably around about 10 years ago, I diversified slightly and started working with clinical populations. And from that, I've sort of nurtured a passion. I really enjoy working with cancer patients, cardiac patients. And then quite recently I became a cancer patient myself and that's just really reinforced that passion and having the knowledge to deliver sessions that are appropriate for these populations, it's just so important. And ultimately I'd like to think at some point it's gonna be a part of the treatment pathway, it needs to be, but it seems to be a long way off, but that's something else that I'm currently working on. So my background is in exercise oncology and I'm currently working on a PhD study and I can't talk about that too much but what I will say is that we're working with breast cancer populations and it has something to do with exercise and it has something to do with returning to the workplace. So a few little clues there but the studies we... Naman Julka-Anderson (02:51) Such a tease. Anne-Marie Ball (02:52) I know. The study is really in its infancy so I can't really divulge too much information at this time but I'm super excited to share it with you at a later date. When we're a little bit more ahead, when we're in the middle of the trial then I'll certainly come back and tell you all about it because it's very exciting and it could really ultimately make a difference to lots of women that are going through the treatment pathway. People get to the end and then they just think what do I do now? Naman Julka-Anderson (03:22) Can I ask Anne-Marie, before we ask you about your experience, what's your favourite exercise in the gym? Or outside? Anne-Marie Ball (03:27) Oh, impossible to say. So many. I love compound exercises. So give me something like a deadlift and an upright row combo, kettlebell, dumbbells, whatever. I love strength training. But equally, I love a bit of HIIT training. So like a bit of cardio, like a bit of spinning. So all of those things. And we should all be doing a combination. You know, to achieve the best outcomes, we need to be doing combinations of strength and the cardio training. the evidence is all there, it all points to that. yeah, I love it all. All exercise is good for me. Hiking up a mountain, get the endorphins going, the happy hormones. That's why I'm smiling all the time, it's all the exercise. I really do believe that. Naman Julka-Anderson (04:13) You're actually on an exercise bike right now, aren't you? Anne-Marie Ball (04:15) Do you know what's downstairs? I was on it this morning but I'm not on it now. That would be quite strange, wouldn't it? Naman Julka-Anderson (04:22) You'd say strange but actually we've had meetings with Jo being on a peloton. Yeah, Anne-Marie Ball (04:27) Really? Naman Julka-Anderson (04:28) happens a lot. Anne-Marie Ball (04:29) I love that so much. So I don't know whether you've heard about the research, so I'm diversifying a little bit again now, but we're still on the subject of exercise oncology. So I don't know whether you've heard about the research where they've had people receiving chemotherapy while they've been cycling. And I just love this so much to try and improve the efficacy of the drug. I mean, what a fabulous concept. So I don't really know what the outcomes of that are. Jo McNamara (04:57) I going to say when I teach the radiobiology and how our cells respond to cancer treatments I always think there must be positivity in oxygenating those cells. It all points to that from a biological perspective so yeah I'm really really interested and I know we've had guests on before who had private treatment and they specifically requested can I be on a rower whilst I have my chemotherapy regime? How amazing to be able to do that. Anne-Marie Ball (05:32) Absolutely fabulous and it must make you feel better while you're receiving the treatment as well. Release the happy hormones, you know that you're doing something positive for your body. So it's a win-win really, isn't it? It's going to distract you from what's actually going on. I think it's fabulous. I love that concept so much. So I really hope that when the evidence comes out, when the publications come out, that it actually is reinforcing the fact that it works. I've actually worked with patients in the past that have been going to receive treatment and I've trained them remotely in the morning for the same purpose, to try and increase blood flow, get the endorphins flowing so it improves your mood, you arrive at the unit, you feel in a better place and you're ready for the treatment. I had a client that I was working with a couple of years ago and she regularly used to train with me first thing in the morning and then she'd go and receive a treatment. And she said, Anne Marie, I just feel better. by the fact that we've had an hour together, I know I've done something positive, and then I know that I'm doing something else, I've got to do it, but in my mind it's improving the effectiveness of the drug, and if in my head I feel like that, maybe it is. And that's a really lovely way to think, isn't it? We're manifesting it. Jo McNamara (06:49) I would expect that even if you weren't exercising, spending an hour with you before treatment would have the same effect. Anne-Marie Ball (06:59) I love that so much, thank you. I try my best. Positivity, it goes a long way. Naman Julka-Anderson (07:07) And Marie, you talked about your own experience of cancer. Would you feel comfortable just telling us a bit more about that, please? Anne-Marie Ball (07:12) Yeah, absolutely. I'm very happy to talk about that because there's another message in that I found my lump myself because I check regularly. Having worked with breast cancer patients for a long time in rehab and prehab, I've just made it a part of my routine and literally it was, I can tell you the day, was in November 2024 and I was doing my check and I found a lump and I thought, what the heck? I think you kind of just get a bit of a feeling, don't you? Just think, okay, that's not right. That wasn't there last month, so where's that come from? So I had it checked and it did turn out to be, I was very lucky because I found it very early. I was stage one, said my prognosis is really good. My treatment pathway was very straightforward. was literally, I ended up having two surgeries because I didn't have clear margins the first time. So it was literally surgery radiotherapy but I am on aromatase inhibitors now and they are not fun I have to say and that actually ties in with the study that I'm doing at the moment. I really love the whole essence of our study because a lot of the ladies that we're working with are being treated with aromatase inhibitors and they really change the landscape. The long-term effects of being on these drugs they're huge. really quite detrimental to quality of life, physical function, cognitive function. So again, exercise really helps all of those things. And I've lived this now, I know that this actually happens. So even if you wake up and you haven't really had a very good sleep, get up in the morning and you feel a bit rubbish, your joints are a bit achy, it's one of the side effects of the aromatase inhibitors. By the time you've done 45 minutes to an hour's exercise, you feel like a different person. So I know that it really works. So to be able to share this with the women that we're working with on the study is absolutely fabulous and I know it's going to benefit them. That's the best thing I've experienced at first hand. Jo McNamara (09:19) And Marie, for anyone listening who maybe isn't quite aware, what side effects specifically have you or that you've seen other patients experience? Anne-Marie Ball (09:28) So as a result of taking aromatase inhibitors or tamoxifen drugs or as a result of the treatment or all of it, all of those things. All Jo McNamara (09:37) All of it. Yeah. Anne-Marie Ball (09:39) of those things, there is a myriad of side effects. It goes on and on and on. So I was extremely fortunate that I had surgery. didn't have to have chemotherapy. But I did have radiotherapy and as you will know, it makes you really tired. And the surprising thing for me was how far After I'd finished treatment, I was still extremely fatigued. So probably a month later and I still had the brain fog and all of those things that are associated with radiotherapy, but the fatigue was probably the biggest issue. The aromatase inhibitors do exactly the same thing, the tamoxifen. So if you are diagnosed with a hormone receptor positive cancer, which 90 % of cancers are, breast cancers, will likely be prescribed one of these drugs and the long-term effects. Some people are on them five, ten years. So you're living with these effects for a really, really long time. But I can say from experience that the fatigue is improved by exercise, the insomnia and the sleep disturbances, they can be helped by exercise, particularly if you're exercising later in the day or you go out for an evening walk, that really helps makes you feel a bit sleepy, makes you feel relaxed, so it can help you sleep better. The anxiety, the anxiety about recurrence is huge. I don't think I speak to anybody that's been diagnosed with cancer that doesn't experience that on a regular basis, you know, when you're self-checking, whether you've had breast cancer or any kind of breast, or any kind of cancer. When you're being checked, having your scans, scanxiety, all of those things, they've all helped by exercise. All of those things. So I'm a huge advocate, as you can tell, it's so important and we should all be doing it. Unfortunately, at the moment, as you'll know, exercise either prehab or rehabilitation, it's not an integral part of the treatment pathway. But once I finish my PhD, my next thing that I would really like to do is advocate for that. This part of the study, we're trying to push in that direction. We would ultimately love it. If this was absorbed into the NHS and it was a part of the referral pathway, you get to the end of your radiotherapy and then it's okay, so next steps, here's your referral, here's your signposting to these services, whether it's a home-based exercise programme or it's a community programme, peer support, clinician support, community support, it's all really, really important to motivate the patients to do that. So it's really important that we get that message out there. And I feel as if it's trickling through, I see an awful lot now in social media, different outlets where people are talking about exercise oncology a lot. And I do feel in the UK that it's just starting to ramp up. There are some services that are being started, but it's very patchy across the UK and these services need to be available to everybody. So that's really my long-term goal. When I've finished my PhD, if it doesn't happen during the PhD, I'm going to be pushing on doing that and just trying to firstly educate clinicians. We can talk about this in a minute actually. So to educate the clinicians so that they feel comfortable with signposting and advising the patients in what they can do. I think that's just so important. Jo McNamara (13:15) I'm with you Anne-Marie. If you don't get it done through your PhD we'll join forces and yes count me in, count me in. Anne-Marie Ball (13:20) Amazing. Jo, I'm there. 100%. I'm so there. Jo McNamara (13:25) Naman will get dragged along whether he wants to or not. Naman Julka-Anderson (13:28) I'm always part of this. I prescribe exercise Anne-Marie Ball (13:28) I love this. Naman Julka-Anderson (13:30) to my patients if I can. It doesn't always go Anne-Marie Ball (13:32) I love that. Naman Julka-Anderson (13:33) down very well because they think, it's not drug. It's like, well in some ways it is because it is increasing blood flow. It's doing lots of different bits and pieces like you just explained but yeah. Anne-Marie Ball (13:42) all those things and you know that whole saying that gets bandied around, exercise is the most underutilised form of antidepressant and it is absolutely true. I've never run a session with anybody that's turned up and they've said, I'm so tired today, I really don't feel like it. Nobody ever gets to the end of the session and goes, I really wish I hadn't done that. You always feel Jo McNamara (14:05) Yeah. Anne-Marie Ball (14:06) better at the end of an exercise session, always. So it's always worth doing, even if it's 20 minutes, even if it's 10 minutes, just doing something that raises the heart rate, gets the endorphins flowing. It's something that's positive for your body and you're taking time out for you. It's just so invaluable. Jo McNamara (14:24) And I also think, isn't it amazing that we're having this discussion on National Social Prescribing Day? I think, I think, Anne-Marie Ball (14:31) I know, it really is! Jo McNamara (14:33) yeah, it is, it's kind of jinxed it because we've had to delay recording this episode for such a long period of time because I broke my leg for anyone listening who didn't know. And yeah, National Prescribing Day. So come on, Anne-Marie, how can we start to actually implement prehabilitation and rehabilitation. What is it that you think needs to happen? Is it just talking to clinicians and getting them to prescribe? Is it funding or is it thinking about third sector parties and how we can maybe link in with those? Anne-Marie Ball (15:15) It's all of the above. It's all of those things. I think it's really important. There's a lot of evidence out there. I've done quite a lot of studies around this that indicate that patients will exercise if they are advised to exercise by a clinician. And the evidence actually is outstanding. And I think that the statistics just off the top of my head in one of the studies that I was appraising, it was something like 87 % of patients said that they would exercise regularly for a prescribed period of time if a clinician told them that it was beneficial and it would help their long-term outcomes. So first of all, that's really important. Now I know that a lot of clinicians or not on board with prescribing exercise because some people are still of the mindset that rest is best and we know better now and the evidence is telling us that actually it's beneficial for us to exercise. Jumping ahead, I think that clinician education is essential in making that happen. I would love to do that. And before I started my PhD, I'd finished my masters in cancer care. And I was actually thinking at that stage, this is going to be my next step. So when I had my radiotherapy, I was talking to the girls in the department who were absolutely gorgeous. They really looked after me and I was telling them what I did and I'd just finished my master's degree and I specialised in exercise oncology. And they were saying, that's amazing. That's so interesting. And they said, so I was talking to them, I was having my treatment and they said, we would love it if you would come in and do a session for us. We would love to know more about this. I said, I would love to tell you more about this because it's so important. You need to know about this stuff. And then when people ask us all the time what we should do, where can we go? Do you know where we can go to do some exercise? When is it safe for me to start running again? When can I go back to the gym? You know, when will my arm be healed or when will my breast be healed? When will it be safe? And they said, we feel terrible because we really don't know and they don't have the confidence. And I've also read some research and I'm sure you guys are familiar with this. And it was something like 37 % of clinicians only felt confident they could give safe, effective guidance regarding exercise and next steps. It's a really, it's a small number. So really that needs to be addressed, doesn't it? So if I hadn't started the PhD and I have to say it's my dream job and I... absolutely love it. It's like my best dream come true really is and that was going to be my next thing. I was already planning how I was going to have some posters made to go in the changing rooms in the radiotherapy units and I was thinking all of these things it would be amazing and all the people that finishing their treatment they've then just got a little bit of comfort in knowing that it is safe to exercise. They don't have to wait for a really long time you know swimming not initially, but you can certainly get out there and you can power walk and you could do couch to 5k if you feel that you're able to do that. You can lift weights as long as they're light and you're building up and it's progressive and all the rest of it. All those things are safe to do, but without the guidance people just don't because they're too frightened and I absolutely understand that. Naman Julka-Anderson (18:43) It's interesting though, I'd wonder with those kind of studies which clinician groups or professional groups felt more confident to talk about it. And also I've worked with or have worked with radiographers or nurses or oncologists who exercise themselves but don't feel confident to talk to their patients about it. Which I always find is a bit of a disconnect because if you can get on a treadmill, know how to not fall off, run until you're not going to pass out, you can tell a patient to walk on a treadmill. You can't have them to walk outside. Like these are all very, I would argue, simple things. I think we're not trying to tell people to go and do marathons and Ironmans, but there are people who do that as well. There's a lady called Sally Orange at MBE who's finished treatment Anne-Marie Ball (19:24) Yes, I know, Naman Julka-Anderson (19:25) and she ran to most of her treatments. And I think she might be in Tenerife. She's always in Tenerife, but she did another half marathon and all sorts of stuff. But that doesn't mean that has to be your thing. And I think... Sometimes patients want to walk a 5k before they can run it or whatever, like it's completely up to you. Anne-Marie Ball (19:44) But it's just having that confidence to know what you can do. And I do understand to a degree name, and so it's very different being able to say, I know what's safe for me to exercise, but there are so many contraindications associated with cancer treatment that you do have to be very careful with what you're prescribing to make sure it's safe and it's appropriate for whatever surgery they've had, whatever treatment they've received. There's a fine line really, so I do understand it, but do you know what? It'd be really simple to make some very basic posters to say, it's safe to do this, it's safe to do that, you know, this is where you can access other services. I live in Chester and there isn't very much available around here. We don't have any prehab or rehab services. Sadly, I'd love to change that. However, you know, that's the other issue. So thinking about third party services, if you haven't got anywhere to sign both the patients to, what do you do? Short of prescribing a home-based programme, which sounds like a really good idea to me, a home-based exercise programme could be the way forward. If you had somebody literally exercising in real time with you effectively, making you a video, explaining the exercises, going through technique, all of those things, that'd be a really nice thing to be able to do. And if you could give those skills to somebody and give that knowledge to somebody at the end of the treatment process, I just think it would be fabulous in promoting long-term health-related outcomes, mental health, all of those things that are really, really important for getting people back on their feet again. So that's... Jo McNamara (21:28) I think we also underestimate, don't we, how actually going through something like cancer can positively impact someone's health and quality of life overall. So I'm not saying that that's the case for everyone and I absolutely know that it is very specific to potentially the diagnosis that people have. We've definitely had patients who've come on Rad Chat that have commented on the fact that their life is better now as a result of having had cancer because they have made positive changes or it's made them think about what's important in their life that maybe they hadn't thought about before. But I definitely think, especially when we look at kind of males going through prostate cancer and the timeframe that potentially they have before they start radiotherapy there is a real window there that we can positively impact a patient's feasibility of reducing their cardiac health. We know that prostate cancer patients might survive their cancer, but cardiovascular disease is something that potentially they may get later on in life. And so by having... potentially a prehabilitation rehabilitation programme. How amazing to be able to, support them going through their cancer treatments, but also reduce the likelihood of them dying of cardiovascular disease later on in life. Anne-Marie Ball (23:01) Yeah, absolutely. know, prehab services actually are just as important. And you're absolutely right, Jo, for those cancers where their treatment's going to be delayed for a period of time, there is a really invaluable window there where they could be actually increasing their fitness levels, increasing their flexibility, their balance, their mobility, all of those things that might suffer during treatment. So there is a window there and it just doesn't seem to be important enough for this to be prescribed routinely and you're so right because there might be other issues down the line like cardiovascular disease and that would really benefit them in the long term wouldn't it? I think a lot of people when they get diagnosed with cancer you're absolutely right Jo, some people do run with it and they just go right this has been a real wake-up call and I'm gonna change my lifestyle I'm gonna exercise regularly I'm actually working with some really fabulous ladies on the study that I'm working on at the moment and they've done exactly that. So they weren't really exercising very much prior to diagnosis, but then post diagnosis, they're in the gym, they're strength training, they're walking, they're hiking up mountains. And people are saying to me when I'm talking to them, I barely did anything before. I used to go for a walk with my friends and that kind of walking, are you really getting any cardiovascular benefits? Because you go for a little lamb around the lanes and you have a chat. It's not the same. So I think you're absolutely right. A lot of people see it as an opportunity. It's all about promoting longevity, isn't it? How long do we want to be here? Conversely, I do know other people that really go down the rabbit hole with cancer diagnosis and they just go, I can't, I've got cancer. Now I'm on cancer treatment, I can't possibly do that. My argument is always, yes you can and you will feel better for it but you have to pick the times when you do it. So if you are fatigued, just go for a walk around the block, go and get some fresh air. You don't have to be doing really long sessions every day and if you don't feel like it, just going outside in nature, have some fresh air, go for a 15-20 minute walk, you do feel better for it at the end. And then also on other days where you've got more energy do some strength training. The strength training is so important. So as we know, the ACSM, they're prescribing now 150 to 300 minutes of moderate intensity exercise for cancer patients. So that's been amended, so up to 300 minutes. And that sounds like a lot, but if you're going out and you're walking at a moderate pace, you could be achieving that over the course of a week you know, maybe not initially, but it's something to build up to. It's a goal and we all need a goal. It's good to have something to look forward to. Two strength training sessions a week are recommended. So again, really important to be getting the strength training in and balance exercises. We're now really recognising the value of balance exercises because obviously as we get older, our balance declines. So if we're really working on that, we're trying to promote the neural pathways where we can stand on one leg for 30 seconds and then we can go, okay, I did that for a minute today. And, you know, it's something to aim for. And I love that. I have a lady who is 73 that I work with and she stands on one leg while she cleans her teeth in the evenings. I have to get her to listen to this podcast because she'll be delighted that I've just mentioned her, not by name. But so she does that every evening when she brushes her teeth, she stands on one leg. The age of 73 and I just love that positive mindset. She knows that she's doing something that's going to help her in the long term and she's amazing. Jo McNamara (26:58) Anne-Marie can I ask about health inequalities? Because I'm really keen what your experience has been. Do you have a specific demographic of patient that... you see a lot utilising maybe exercise in this way because I know from personal experience in helping people setting up rehabilitation and rehabilitation services they really struggle to engage with specific demographics of patients or different communities and I don't know what your experience has been but how can we help and support people who potentially know, sport or activity has never been part of their life and how do we engage them and reassure them that it's safe but also this is something that they can get involved in. Anne-Marie Ball (27:48) So I think again, it comes down to having potentially an exercise professional that's qualified in cancer rehab, cancer prehab whatever it is, whichever end of the treatment spectrum that they're receiving their prescribed exercise. And I think that that really empowers people, that makes them feel that they can trust the person that's prescribing the exercise. And anybody that is a qualified cancer exercise specialist, will obviously appreciate that if you've got somebody that's never been into a gym, doesn't do any physical activity whatsoever, they're literally just doing daily activities, they're moving around the house, they might be mowing the lawn, but they do nothing beyond that. We know that you have to start off really slowly to promote motivation, so to promote motivation and adherence as well, because if you give a programme that's... overly reaching or it's going to be too complex or it's too challenging, the patient won't do it. They won't engage with that. So it's just giving them activities that they can do that won't overstretch them and that they feel it's achievable. That's really important. But going back to home-based activities, I do think that's one of the things that's really well received. I worked on another study which was the Action Feasibility Study in head and neck cancer patients and it was all home based and we prescribed home based exercise programmes and they were all going through radiotherapy, they were all on treatments so we did an eight week programme whilst they were receiving radiotherapy and they all did it. All it did to the program, all of my patients did anyway. So I would check in with them once a week and we went through what they were able to do and we would talk about the side effects of their treatment. And as you know, they can be really debilitating. know, the dysphasia kicks in and then some of them were on the brink of malnutrition. So it's really challenging to exercise. But if you've got somebody that's encouraging you, motivating you, but also amending your programme accordingly. on week, so around about week four, I knew after a while on the trial, that patients started to degenerate slightly. So the fatigue really kicked in and they were nutritionally compromised. The dysphagia was really quite difficult. They were struggling really to speak and to swallow at that stage. And it just got progressively worse for the next four weeks. The debilitating side effects of the radiotherapy. So moving was a challenge, but that was one of the things that we were trying to encourage them to maintain the mobility in their neck, back, shoulder area. Because of course, when something feels uncomfortable, your natural inclination is don't move it, you keep it still. But it was essential that they did continue to move it as long as everything was well lubricated and mobilised, we wanted them to be able to turn their head because it's that old saying, if you don't use it, you lose it. So it was really important in this population and the home-based exercise worked really well. So I think going back to your question, that was a really long answer. I think that it's important that people are given really simple options such as even if it's a worksheet, and it's printed out exercises. I've done this with patients in the past and I'll just say, so that's exercise one, number two, number three, number four. There's only four exercises and you're going to repeat it twice. So as long as you're targeting the main muscle groups, so we're strengthening the lower body, we're strengthening the upper body, they're simple exercises. People won't get confused. They won't think, heck, I can't remember how to do this. It's achievable. It won't take them a long time to do it. They don't have to go anywhere to do it. All of those things are really important to promote motivation and adherence. Naman Julka-Anderson (32:06) I'm just going to talk about prehab, I guess, that is in the cancer plan. It's something we've talked about for decades. A Anne-Marie Ball (32:14) yeah. Naman Julka-Anderson (32:15) really good resource is the Macmillan Prehab Guidance, which was updated. So 2025, if you look it up. But it's got that amazing graph, obviously, which shows you what happens if you do prehab and rehab and if you don't. And it's exactly as you said, it's that baseline period of if you can get yourself up to a really good fitness if you want to call it that or a standard when the side effects hit you you're not dropping as low as you would without it and actually then the recovery is better but also you hopefully would feel a bit more empowered and I'm setting up a late effects clinic and one of the first things I said is I want to set up prehab and quite a few people said what it's got nothing to do with late effects like you can't have rehab without prehab. Anne-Marie Ball (32:55) No. Naman Julka-Anderson (32:56) You can't rehab someone to that low point back up. It's really difficult. And actually, if you can get them to that level to start with and also the universal offer for prehab, in my opinion, and I'm sorry if people don't like hearing this, but it's so easy to talk about. It's exactly as we said, it's the basic advice around how to look after your mental health, exercise, nutrition, all these things we talk to our patients about anyway. So actually that is prehab and there's obviously the different levels, the universal targeted specialist, but it is really I don't know, maybe I'm making it sound too easy, but I feel like it's really easy. And actually as a quality improvement project for everyone, you can go on Google. Lots of departments have made pre-hab booklets for their patients decades ago. Just copy it, change the words a bit, change the logos, like you can use it. I just, yeah. Jo McNamara (33:44) Or what you could do is get in contact with me and find out about an amazing MSc course specifically designed for prehabilitation and rehabilitation. Anne-Marie Ball (33:54) for even better. Do that. was just, Jo McNamara (33:58) What a plug! Anne-Marie Ball (34:00) that was really good wasn't Naman Julka-Anderson (34:00) You're welcome, Jo, I'll teach you how. Anne-Marie Ball (34:01) it? Slide that in. I was just about to say though actually, it would save the NHS by implementing these pre-hab programs. It would save the NHS, hundreds of thousands. I mean I don't exactly know how much. Millions, millions. I'm low balling it. Jo McNamara (34:15) Yeah, it is millions. Yeah. Do you know Naman Julka-Anderson (34:16) Millions, Anne-Marie. You're way lowball there. Millions. Jo McNamara (34:20) what is frustrating though is having worked with a lot of healthcare professionals from wide multidisciplinary teams who set up rehab and rehab services is the fact that as part of their business case, they are often asked about... the impact on their services in relation to bed stays. And it's Anne-Marie Ball (34:45) Yes. Jo McNamara (34:45) my biggest bugbear because that isn't necessarily something that is going to be affected by prehabilitation and rehabilitation. But what will be is the fact that if you don't, you know, exercise your shoulder whilst you're going through hormone treatment after radiotherapy, after surgery for breast cancer, and then you get frozen shoulder and you have to then... essentially have months Anne-Marie Ball (35:11) video. Jo McNamara (35:12) worth of physio, you're costing the NHS money. So it's really, really, you know, it's just annoying that business Anne-Marie Ball (35:19) It's sure sighted! I know! Jo McNamara (35:22) cases are so strict in the kind of criteria that they use to measure how impactful something like pre-hab and rehab would be. But Macmillan have put a lot Anne-Marie Ball (35:31) It's ridiculous really. Jo McNamara (35:33) of work into it. there are some amazing resources there. So again, it's not reinventing the wheel, is it? It's about going out there and seeing what's available. Anne-Marie Ball (35:44) I know there is some evidence around length of stay as well about pre-hab reducing length of stay. So, you know, from that perspective alone, the hospitals are all overcrowded. So implement a pre-hab program and then we'd get more patients in, reduce the waiting times, all of those things. It's another knock on effect, isn't it? Aside of saving money. So you're so right. It's all really, really important. Jo McNamara (36:17) Amazing. Well we could talk all night with you Anne-Marie Anne-Marie Ball (36:19) I always say code. Jo McNamara (36:21) but we have come to the end of the podcast episode and the thing that we always end with is top tips. So have you got any top tips for the listeners? Anne-Marie Ball (36:31) that's a really difficult one. it depends who, well, you know what, I know loads of people that watch these podcasts, listen to these podcasts. So we've probably got a really wide demographic, but I would definitely say to anybody that's training as a radiographer, so I'm actually doing some work at University of Liverpool next month, plug that, working with the radiographer learners and I did some training with them last year as well firstly as patient user, then also giving them a little lecture on the value of prehab and rehab. They absolutely loved it last year. And I think that if they can be exposed, you're already doing this, but if they can be exposed to some sort of education around prehab and rehab, it's invaluable. It's empowering them with the knowledge, but also they can help the patients. And I think for a lot of patients when they get to the end of radiotherapy, they're really lost and they really don't know what their next steps are. They leave that unit and they're just left on their own and they don't know what to do. So wouldn't it be fabulous if they could leave and they've got a little booklet or they've had a chat with somebody and they said, okay, so I don't know if exercise physical activity is your thing, but this could be really beneficial for you. So I think for any radiographer learners, that would definitely be something that would be invaluable. I was very fortunate I could rehab myself but most women that I come into contact with, most people that are coming, they don't know and they feel really nervous and they lack confidence. To any patients that are listening to this and thinking I don't know what to do, start small and build up, it's really good to have a goal. There are loads of resources online and you are at absolutely right. Macmillan are fabulous and they've got lots of information. So there are all sorts of resources online. Obviously look at something credible because there's a lot of rubbish out there as well. But there is quite a lot of stuff that you can follow. But it's empowering. It's just all about promoting your long term health and outcomes and mental health. It's so important. Exercise is fabulous for that. Jo McNamara (38:44) No thank you so much you've been incredible. Anne-Marie Ball (38:47) it's my pleasure. Thank you so much. It's been great seeing you both. I've absolutely loved it. And I will come back Jo McNamara (38:52) No. Anne-Marie Ball (38:52) when my study is underway. I'll definitely come back and tell you about it. I'm going to. I'm super excited about this. It's going to be amazing. It's going to be life changing. Jo McNamara (38:56) yeah, yeah. I think she's done this Naman Julka-Anderson (38:54) You have to, you've teased us all the way through. Jo McNamara (39:02) on purpose. think this she... Naman Julka-Anderson (39:03) You know when people are like, I've got the answer for you, buy my book. That was it. Read my thesis. Anne-Marie Ball (39:07) I know. You know what? Jo McNamara (39:07) Ha! Yeah Anne-Marie Ball (39:11) It's always been on my tick list. I want to write a book. So this could be it, couldn't it? I'm going to settle for... Jo McNamara (39:15) There you go. Naman Julka-Anderson (39:16) You are writing a book, a thesis is a book. Anne-Marie Ball (39:19) Do you know what? I said to my supervisor, I'm sure she'll listen to this. I said, how long is my thesis going to be? And she went up to 100,000 words. I went, okay, that's fine. Just Jo McNamara (39:29) Yeah. Yeah. Anne-Marie Ball (39:30) 100,000 words. But you know what? I can see how it's going to happen. The materials building up. and I will have written a book about City Right. It's a long-term goal. Thank you so much. Jo McNamara (39:40) pleasure. Well a huge thank you again to our guest Anne-Marie Ball for talking about the benefits of exercise for people going through cancer treatment and sharing very openly her own experience of cancer. Thank you for listening to Rad Chat with myself Jo McNamara and Naman Julka-Anderson. Jo McNamara Rad Chat Host (39:55) So what do you do now? Well you can use this episode as part of our free continual professional development accredited content which offers flexible learning that fits your busy schedule. Just check out the show notes for the reflective questions, links to literature and resources and link to the completed form to receive your accredited certificate. Naman Julka-Anderson (40:14) Stay up to date with the latest radiotherapy and oncology advancements by liking and following us on social media and hitting subscribe wherever you get your podcasts. Jo McNamara Rad Chat Host (40:24) Please do join our supportive community designed by professionals who understand the unique challenges of working within radiotherapy and oncology. Follow us across all of our social media channels and make sure to check out our website www.radchat.co.uk. Together we're actively working to improve our profession and make a lasting positive impact on cancer care. Naman Julka-Anderson (40:47) It goes without saying that we can't achieve this alone. It takes all of us working together to create real change. That's why we value every voice and every contribution. We ask that you listen and learn and spread the word, share your story with us and connect with us. Jo McNamara Rad Chat Host (41:02) And if you have liked this content, why not buy us a coffee? Go to our website and drop us some love. Thank you all for listening and take care.