This podcast contains the personal stories, opinions and experiences of its speakers, rather

than those of Breast Cancer Now. Welcome to the Breast Cancer Now podcast, providing support and

information to anyone affected by breast cancer. I'm Laura Price and I'm the host of the Breast

Cancer Now podcast. I'm a food writer and author and I live with secondary breast cancer. Today's

episode, we are talking to Dr. Sam Orange, a clinical exercise physiologist and deputy

director of research in the School of Biomedical, Nutritional and Sports Sciences at Newcastle

University, who wants to improve women's access to diet and physical activity support after their

breast cancer treatment. More women are living with and beyond breast cancer than ever before,

with survival rates doubling in the last 40 years. It's widely known that exercise and a healthy

lifestyle can improve outcomes and survival, but there are various barriers that prevent patients

from getting the support they need, including limited resources on the NHS. In a project funded

by Breast Cancer Now, Dr. Sam Orange is helping healthcare professionals to refer women to

community support services, while developing a training package so that those services can

specifically support women who have gone through breast cancer treatment. Sam, welcome to the

Breast Cancer Now podcast. Thank you very much for having me on. Oh, you're welcome. It's a pleasure

to have you. So, Sam, we know that more women are surviving or living with breast cancer than ever

before, which is obviously fantastic news. But we also know that one in three of those women will

experience persistent tiredness or fatigue and almost half will experience depression and

anxiety. And I'm sure lots of our listeners are nodding their heads right now. Before we talk

about your work, could you explain how exercise and a healthy lifestyle can help with those

symptoms of low mood and tiredness? Yeah, absolutely. Thanks, Laura. Simply put, being

physically active is one of, if not the best thing that people can do for low mood and feeling

fatigued and tired for a long time after breast cancer and cancer treatment. And you really

shouldn't just take my word from it, but that's supported by some strong evidence. So there was a

review, a large review put together a few years ago that pulled together all the evidence in this

area. And it looked at the effects of exercise, the effects of psychological interventions, such as

things like cognitive behavioral therapy, and drugs as well. So the effect of drugs on

cancer-related fatigue. And what that larger review found was that actually, drugs had no

positive impact on cancer-related fatigue, but both exercise and psychological interventions,

again, like cognitive behavioral therapy, both helped alleviate cancer-related fatigue. And

out of the two, exercise was actually slightly better. So the evidence does suggest that

exercise is particularly beneficial for cancer-related fatigue. We don't really know why

yet. There are some mechanisms, plausible mechanisms that have been proposed. So exercise

can help with things like inflammation, improving the activity of the immune system. It

can help with things like energy metabolism and improving fitness and reducing muscle wasting.

And all those factors might play a role in how exercise can help with fatigue. But the evidence

is pretty clear. And it can sometimes sound quite counter-intuitive and counter to the fact that we

should, physical activities, recommended to improve tiredness when typically physical

activities are the last thing on people's minds when they are feeling tired. But the evidence is,

again, is really strong in support of that. And in regards to low mood too, so the National Institute

for Health and Care Excellence, or NICE, which listeners may have heard of, and they're

essentially the NHS watchdog, they make recommendations to the NHS based on

cost-effectiveness of different treatments. So they recommend what the NHS should be prescribing

to patients across a range of conditions, including cancer. And for mild to moderate

depression, or less severe depression, it's sometimes called exercise is one of the

first-line treatment options for mild to moderate depression. And that's on the basis of

the strength of evidence supporting being physically active and taking part in exercise to

help alleviate some symptoms of low mood and depression and anxiety. And that evidence is

specific to people with cancer as well. There have been lots of large reviews that have looked at the

evidence between exercise and symptoms of anxiety and depression, which are often common in

people who are diagnosed and have treatment for cancer. And again, similar to fatigue exercise is

one of the best things that people can do for that follow mood. I'm just going to jump in and preempt

what some of our listeners might be thinking, which is if I'm so exhausted, I can barely get off

the sofa. How do you expect me to muster the energy to go to the gym or go for a run? That's a really

important and legitimate point. And I understand that that would be, as you say, a first response to

many people experiencing tiredness and fatigue. But there are a couple of really important points

here. The first one is that physical activity comes in so many different forms. And it's

probably a good point here to define or look at the difference between physical activity and

exercise. So physical activity is actually any bodily movement that requires energy

expenditure. Exercise is a subcomponent of physical activity that is purposefully

undertaken to improve health or fitness. So for instance, going to the gym or going for a longer

run. So physical activity encompasses so much more than just going to the gym and lifting

weights. And it's really important to remember that anything is better than nothing. So any

movement, any amount and any type is beneficial. And more of that is better. And so I tend to see

physical activity as a continuum. So or a staircase, if you will. So simply just reducing

being sat down. So standing up regular intervals or walking around the living room, for example, is

beneficial. It doesn't sound like much, but versus compared to just sitting down, that's

beneficial. And then you can go right across the other end of the continuum when we have more

structured planned exercise such as lifting weights in the gym or going out for a job. And that

brings us to my second important point. And I think it's important to raise that it's important to be

kind to ourselves. Right. And fatigue will often come in ebbs and flows. So on some days and some

times after a cancer diagnosis, and during and after treatment, it's very likely that during

some days and times that people will feel exhausted and really, really fatigued and tired.

There are other days and times potentially where people feel a little bit better and a little bit

better symptom wise and have a little bit more energy. And we can use that to accommodate how much

physical activity we do. So on days where fatigue is really high and we simply feel exhausted, let's

be kind to ourselves. And it might be on those days that actually doing a little bit of activity

around resting. So for instance, washing up, getting up from the sofa at some intervals,

walking to the corner shops to grab some milk, for instance, is actually all going to be beneficial.

So that's important to remember that that is beneficial. And then on days and times where we

feel a little bit better, we could then potentially consider taking part in some more

structured exercise. So that might be, going out for a 10 minute walk. For some people, that might be

going to the gym. And if it's, I think we're all guilty of thinking of exercise, and then we're

picturing this weightlifter in a gym or picturing someone wearing not so many clothes going out for a

run, for instance. And we don't tend to associate ourselves with that person or that activity. But

physical activity for one person can be so different to physical activity for another

person. And so for some people, on days and times when they're feeling better, it might be that they

want to go to the gym or go out for a run. Other people activity might look different. That might be

going for a walk with a friend or a relative or a dog, for instance. It also might be, I often think,

like, think back to what you used to like when you were little or when you're at school, because for

some people, they might have played, I don't know, tennis or rounders or something like a team sport.

When they were little and they don't feel like they now have that access anymore, that they're older,

but maybe there are ways to get back into sports that people loved as well. Yeah, you make a great

point. And I think it's important when people are interested in increasing their physical

activity. That's not always easy. It actually can be very challenging. And it's important to

remember that physical activity, again, comes in many forms and take actually some time to reflect

what does being regularly physical active mean to me? What does that look like to me? Sometimes

that's what do I enjoy? So what do I enjoy doing? A lot of people come back and say they don't enjoy

being physical active, which is fine. But it might be what is accessible to me. What is feasible to fit

in? Who else can I be physically active with? So I think you're right. It's important to take some

time and think about what does physical activity look like for me. And there are many options to

that. And sometimes I mean, I'm very physically active, but there are times when I just am

absolutely exhausted. It might be because of my symptoms, it might just be because I'm working

hard or whatever. And I don't feel like going to, going for a swim or going to my spinning class, for

example. And on some occasions, I stay at home, but on other occasions, I go and I come out feeling more

energetic and feeling a bit better. Is that a thing? Is that psychological? Or is there a thing

that happens that actually means that exercise makes us feel less tired? Yeah, absolutely. That

is certainly a thing. And injuries aside, I don't know anyone who's ever felt tired and then gone to

be physically active or exercise who's then regretted it and thought, actually, I feel more

tired now or feel worse. Almost every time the person will say, I'm glad I did that. And of course,

that's not to say that that's an easy thing to do to get up and go and, you know, and when you're feeling

tired to go and exercise or go physically active, that's of course very challenging. The person

like you said in your experience feels more energetic afterwards. And I share those

experiences as well. We're not exactly sure why that is. There's a common theory about endorphins

being released, which certainly has some legitimacy to that. And there are also a lot of

other theories as well. So as well as endorphins, our muscles actually, when we are active, they act

as endocrine organs. So the don't muscles don't just help our bodies move. But when we contract

them, when we're active, particularly at a certain level of effort, they actually produce

small proteins, thousands of them in fact, into the circulation. And it's thought that those

different proteins and small molecules might be able to have a beneficial impact on our health. And

one of those things is fatigue. And that's really, I think reassuring in a nice message that actually

every time we are active, even that just one brisk walk or one spinning session to use your example,

that's contributing to us feeling better and being healthier. I think that's a nice message to

take with. Yeah, definitely. And just before we talk about your research, can I ask you the fatigue

that we experienced through cancer, having cancer treatment is not, it's a tiredness that is

not alleviated with rest, basically. Yeah, absolutely. It's not really, it's not

proportional or related to previous activity. And it's not alleviated by sleep or rest, for

instance. That's brilliant. Because I think for a lot of cancer patients, me included, sometimes

someone will say, I'm so tired. And I will think, I wish I had a way to explain how tired I am that isn't,

it isn't just because I've been working hard or whatever it's, I woke up after a 10 hours, 10 hours

sleep, and I could sleep all day and all week, because my body is just completely done in, but

it's hard sometimes to explain that to someone who doesn't have cancer. So absolutely, I completely

appreciate that. With other conditions, for instance, if you have an injury, a physical

injury, it's quite easy for people to contemplate that and understand that, it's easy for them to see

that. But I understand trying to articulate long lasting tiredness that is so real and so genuine

and has such a large impact, trying to articulate that and have people understand the implications

of that would be very, very challenging. Yeah. Okay, thank you. Well, let's talk a little bit

about the research project that you're doing with funding from Breast Cancer Now. Can you tell us

what sparked that project and what's the end goal and how does it work? So this research, as you said,

is funded by Breast Cancer Now. Research funding is incredibly difficult to come by. So what

happens is, as researchers, we put together, we have an idea, we put together a research funding

application, usually in collaboration with people who have experienced that condition. For

instance, women who've had Breast Cancer and doctors and nurses who treat that as well. It

usually takes around 12 months to put a proposal together because it's very competitive. You need

to find a funder that where their priorities and values align with your research priorities and

values of the project. So for example, this project that we have funded, I'll talk about in a

moment, we couldn't go to Cancer Research UK for that funding because their remit does not cover

cancer survivorship. Their priority is preventing cancer rather than health and

well-being in cancer survivorship. It typically then, once submitted, it takes about six months,

usually sometimes longer. And then the acceptance rate, the funding rate, is around 15%.

So eight or nine out of 10 applications that you submit will be rejected after 18 to 20 months of

putting that together and waiting for the decision. I just think it's worth raising that to

listeners that, of course, there was many research projects that we would like to run, but

they are very challenging and time-consuming to put together. And so it isn't just as simple as,

I've got an idea, let's get some money and let's do this. I think that's probably worth raising at

this point. Of course, yeah. And just to interject, I think that so many people listening

probably will have done some fundraising for Breast Cancer Now or for another charity over the

years, whether it's a coffee morning or a sponsored walk or whatever. And it's just really

interesting to know what that money goes into and all the work that goes behind the scenes and how

well-considered the use of that money is. So it's really, hopefully, really reassuring to people

to know that. Yes, absolutely. And this research just, none of this could happen without the

generosity of people fundraising for charities like Breast Cancer Now. And you're absolutely

right. The low acceptance rate of proposals is there for a good reason, because this money is

important and we need to, or charities like Breast Cancer now, need to put that money and fund the best

research possible. On that note, tell us about your work. Yeah, that was a good segue, wasn't it?

The best research possible into our research project, of course, and bias. So our project is

called Expanding Intercommunities to Improve Lifestyle Support for Women After Breast Cancer,

and we've shortened that as Purex. And the aim of the project, as you said, at the start is to

improve, is simply to improve women's access to physical activity and diet support after

finishing breast cancer treatment. And we want to do that in two ways. First one is to develop a new

referral pathway that will enable healthcare professionals to simply and quickly refer women

into physical activity and diet support services that are based in the community. And the second one

is to then train existing community service providers, so for example, local community

centres and charities to adapt their existing healthy lifestyle programmes, for example,

exercise services specifically for women with breast cancer. And I can't really articulate how

excited I am for this project. I genuinely think it has a real potential for impact. Of course, I'm

biased as well, being a lead investigator on this. And I thought about this for a long time before

talking about research funding, before we decided to ask Breast Cancer now and submit our

proposal to Breast Cancer now, because I believe our values aligned really well with Breast Cancer

now priorities. And what this came from was, I felt it was a chance to essentially connect the dots. So

there are lots of exercise services out there in the community already. I'm sure all the listeners

can think about exercise services in their own local community, exercise classes for the

general population, exercise classes for people who are at high risk of falls or risk of diabetes or

have had a heart condition. And so there are those classes and services in the community already.

And we know there is good evidence, as I talked about, about how physical activity can support

women who've had breast cancer and finished treatment to improve things like fatigue and

symptoms of depression and anxiety and improve mood. And so my line of thought was, well, can we

utilize and harness this infrastructure that's out there already, this existing community

infrastructure, and use that to support women after breast cancer treatment to be physically

active? And that's exactly what we're trying to do. We're coming up with a referral pathway that

again allows healthcare professionals to make that referral into community services. And then

we're developing this training package to then train these existing community service

providers how to adapt the existing portfolio of exercise services for women with breast cancer.

So it may look as simple as a one day consultation where we might work with an exercise provider and

say, okay, this is what you offer currently. This is what the exercise and nutritional needs are for

women who've had breast cancer and breast cancer treatment. And so therefore, these are the tweaks

and that you can make to your existing services and how you can adapt those. And then that service will

be certified or qualified to then deliver the exercise and nutritional services to women with

breast cancer. And we have a quite a clear vision for this project. I always think it's so important

to have what you think the end goal is here and what you're working towards. And what I think this

might look like is that with comprehensive input from people affected by breast cancer, for women

who've had breast cancer, but also from exercise professionals, physiotherapists, dietitians,

oncologists, specialist nurses, etc. We're developing this training package. And so we want

to train community service providers across the country. We think this will hopefully be scalable

in the longer term, who are then certified to provide exercise services to women with breast

cancer. Then what we think this will look like is healthcare professionals have a list of

certified community service providers that they're able to refer women to. And then during

routine follow-up care for women after they've had their primary treatment for breast cancer,

women are then offered a referral to these community physical activity and diet services as

a routine part of their follow-up care. And that gives women the option therefore to have support

after finishing treatment for primary breast cancer to be physically active as part of the

community alongside other women who've gone through a similar thing and can share similar

experiences. And is it, are you only working with women because you talked about after treatment,

but what about women who are still having treatment because they have secondary breast

cancer? Are they included in your study? So this specific project is for women with primary breast

cancer who've had uncompleted treatment for that cancer. This is not to say that physical activity

isn't beneficial in the secondary cancer setting because evidence would suggest that it is.

Typically when you acquire funding, you have to focus on a specific population. And there are of

course major differences between in treatments and things between primary and secondary breast

cancer. So for this project, we have focus on primary breast cancer, but we are very aware of

sometimes the imbalance between research opportunities for people with primary versus

secondary breast cancer. And that's something we feel strongly about and are looking to address in

the future. One of my key aims in the near and long future is to develop a support program for women

with secondary cancer. And what got you into this? Do you have any personal connection with breast

cancer? I don't have any personal connection with breast cancer, fortunately, not at this moment in

time. What got me into this lore is probably a larger backstory I'm very happy to share if you'll

indulge me for a couple of minutes. Fantastic. So I'm very fortunate not to have any personal

connection with breast cancer. My background is I was a professional rugby league player. And

that's all I ever wanted to do. I've been five years old, I've not been facetious there. I dreamed of

being a rugby league player. And I signed my first professional contract when I was 16 and as I said,

played professionally. And I had several between the ages of 17 and 21, I had several season ending

injuries. So I was in a quite a large car crash where I lost my memory in the hospital for a while in Broca

vertebrae. I had three knee reconstructions, a shoulder reconstruction. And essentially, I

spent the vast majority of then those four or five years trying to cement my professional sports

career on the sidelines. I then decided because of the toll that I take in both physically and

mentally, if I'm completely honest, through injury, I decided to stop playing after my latest

injury when I was 21, which would have taken another 12 months to have surgery and recover

from. I remember always telling my manager at the time and then went into the changing rooms and just

wept and wept. I was really, really, you know, gutted to be stopping playing and I felt very lost

at the time really lost my identity because I was a rugby player and that's how people knew me. And I

really reflected and I thought, okay, what am I going to do now? And I'd gone to university on the

side in York and really enjoyed it was where I'm from and really enjoyed it. And I thought, okay,

how can I best use the skills and experience that I feel I've gained through a short but real, you

know, professional sports career? And how can I apply that to the greatest need? You know, where

can I apply it where there would be the most benefit and impact? For me, that wasn't working in sports.

I didn't feel like I would have as much a meaningful impact. And for me, there was, when I reflected on

that, there was a really unmet need in people with cancer, including women with breast cancer, in

terms of there was a mismatch between what the evidence was saying and actually what support

that people with cancer are actually being offered. And then from then onwards, I have

dedicated the past 10 years to try my best to address that. And I'm very ambitious and driven,

and I will continue to address that until there is no longer that particular unmet need. Wow, thank

you so much for sharing that, Sam. It's an amazing story. And I can only begin to imagine how

heartbreaking and crushing that must have been to just have lost your dream career so early on

through injury. It's just heartbreaking. But yeah, well done, you for turning it into something

so positive for other people. It's a massive success story, I would say. Have you managed to get

back into exercise now? Are you physically fit now? I am physically fit. Yes. I'm feeling really

good, actually, as I said, almost a short lifetime of injuries. And I'm feeling really good at

exercises. It's not one size fits all. And I avoid particular exercises because they don't work for

me. And so now I lift weights. I've always enjoyed enjoying lift weights. And I think that's

probably born from, and it was, but it's spending so much time in the the physical room that I sort of

trying to get back fit and strong to play on the field. That's all I fell in love with, with the gym

really, and I cycle as well to try and keep fit. So I both cycle as much as I can to the shops and to

friends house and things like that. But I also do some structured purposeful cycling as well to try

and improve my fitness. I'll share a little experience of mine as well, which is slightly

related to yours, which is a year ago I had secondary breast cancer in my sternum bone. And I

had an operation to remove my entire sternum bone. And it was a huge recovery period in which I'm a

swimmer. And I wasn't both before the operation when the pain was so bad in my bones, that it was

affecting my swimming. Then it got better with drugs. And then I had the operation and then I

couldn't exercise at all for at least a month. And for me, obviously physically, there were major,

you know, difficulties. But mentally, that was the worst period probably in my life, because I

couldn't do the two things that make me feel good, which are working and exercising. And I was

sitting at home, depending on others, to do things for me. And I couldn't cook either because I

couldn't pick up a pot or a chopper carrot. I'm now fortunately much better after that operation,

but I'm having another operation this week, which will put me out. I won't be able to swim or cycle for a

few weeks. And I also have a recurring groin strain injury, which seems to be that no matter what I do,

every softening just keeps coming back. And then I can't swim or do things for a week or so. So I just

wanted to ask you about what we can do mental health wise when we can't exercise. And I know that's a

really hard question. Yeah, that's a really interesting question. And I haven't figured that

out yet either, Laura. And it's physical activity, I guess, just drawn on my experiences

for a second as well, is that I genuinely feel privileged every day that I have a body that moves,

I am able to move. In the way that I work on a fifth floor in a building, I have not used the lift yet,

because I've got a body that can, I'm privileged that I have a body that can walk up those stairs. And

physical activity just so much for me, mentally as well, I tend to be physical active little and often

because I get even 15 minutes of physical activity brings that benefits. And if I can have that every

day, then I try my best to. So, and I thought a lot about this from the injuries that I have had. And so

there's nothing that either comes to mind or is in my scope of expertise, I think, to suggest the

thing that I would suggest considering is remembering again, that I keep banging this drum,

but that you don't have to go to the gym and do 45 minutes of intense spinning classes to be

physically active. So what might whilst you're injured, whilst you're post surgery, for

instance, actually what you're you need to we need to change gears in those contexts. And so what

might be fit, what might mean or be represent physical activity in those contexts might be just

walking around around the block around the street and back. And that will you probably be surprised

at how much benefit that actually brings just been able to just been able to do that. And I think it is

just around shifting gears at that time, which means okay, my body won't allow me to do what I used

to be able to do or what I want to do at this moment in time, but focusing on what you can do. And I think

that sort of and bodies of positive mindset as well, which has its own independent benefits. Not

everyone loves exercise, not everyone is motivated to exercise. And you know what, that's

absolutely fine. So in that context, what I'd always suggest is is almost trying to disguise

physical activity as something else. So I'll use my, my own mom as an example, I'm sure she she won't

mind. She's my mom has never been someone who's been overly physically active. But what she used

to do with a friend and she this lasted for for many years is most evenings, particularly in the

spring, autumn and summer is go for a walk with with her closest friend, who's now moved away, but

during the many years she was here. And again, I'm one never someone who's ever stepped foot in a gym

and would not be consciously physically active. But she walked a reasonable distance every night

after work, because it was catching up with her dearest friend. And I think that's just one

example of how we're able to be physically active. But it's not something we're, it's not our primary

goal of that activity, but it is a side consequence of that. And I think there's something a lot to be

said about that that again, it doesn't just have to be going out for this run to get fitter. It might be

an activity that's catching up with friends or something similar, but you're also being

physically active. Absolutely agree, yes. And it also made me think of who you mentioned just before

our recording, which is Jeffrey, the dog who I believe is in the room with you. And obviously

walking a dog can be a great way of disguising your own exercise, because you got to walk that dog.

Absolutely. And just on that, Laura, that's absolutely my experience as well. And there's

certainly, I think, days without, without having Jeffrey, the dog, that I would probably struggle

leaving the house with long hours at work and working from home sometimes as I'm at home here.

And the dog certainly does, I have to be out. And I'd probably give it 25 minutes, Laura, and he's

probably jumping on laps and I need to, I need to take him out. So I will watch out for that. So going

back to your study, often we think of a researcher in a white coat, in a lab, working on their own, but

your study involves working with real breast cancer patients. What's the, what's the process

like with, with those patients? What kind of involvement do you have? How do you find them? And

what information are you getting from them? Yeah, great question. It's absolutely, you know,

incredibly important to work with women who've experienced breast cancer when developing a

support program for women who've had breast cancer. That sounds, of course, so obvious when

you say it out loud, but there's been so many instances in the past where researchers like me

have developed support programs for, for instance, for people with cancer and not spoken to

people with cancer. And then we then have no idea whether it's acceptable to them, whether people

are going to enjoy and take part in that support program. And so we're really taking a

comprehensive approach to make sure that everything we do, this full support program is

very much grounded in the views and the needs of people who've experienced breast cancer. So we

have what we call a patient and public involvement or PPI group that are following the entire process

throughout the whole three years. We've got two patient leads who are essentially sharing and

managing our patient and public involvement group. And they're working with another eight

fantastic women, so 10 in total, who are working with our research team. And they will be, they're

actively involved in making decisions and shaping the direction of the project. And so they

are just, as if not more important than any of us researchers who are developing this support

program. And that group will, again, work with us throughout the duration of the project. We then

conduct in the first instance, so actually starting next week is holding some focus groups

with other women who've had experience with breast cancer to really better understand their

experiences and views of physical activity and diet support after their breast cancer diagnosis

and after finishing treatment. We're also doing or holding focus groups with other, what I'd call

stakeholders as well. So exercise professionals, dietitians with expertise in

cancer oncologists, nurses, primary care professionals to have their input as well about

their barriers and facilities of providing this support within the follow up pathway and exactly

what is the support that they think would be best to offer in this context. We're then holding some

workshops where based on what we've learned from the focus groups, we'll essentially say, this is

what we think the support program will look like based on everything we've learned. What do you

think of it? We think we'll do that a couple of times and then get to an end product if you like where we

can say, okay, we think this referral process and this training package, how we will train

community service providers is, we think this is feasible and acceptable to both women and also

other stakeholders like oncologists and healthcare professionals. Then what we'll do is

actually run the trial with around 40 women who will be referred by their healthcare

professional into a community exercise and diet program that's delivered by a health works

charity who've received our training package and we'll further then we'll be conducting some

interviews with some of those women in the healthcare professionals to understand again

exactly how the referral process was implemented in standard care, what the barriers and

facilitators were to carrying out that referral process, whether women turned up to the exercise

program, whether they enjoyed it. So very much the person's voice who's had experience of breast

cancer is so central to this project and it just would not go ahead without it. So in terms of

timelines, when are you hoping to complete the project and how will our listeners be able to

access those better services? Great question. Unfortunately, these things do take some time. So

our project started in October 2023 and it's due to last three years, so finish in September 2026. So

what we're looking to get out of the end of that project, we're hoping to have a program that

encompasses a referral pathway and a training package that we've tested and is feasible and

acceptable to women who've had breast cancer. Our intentions after that is to work out a way to roll

that out and implement that. So that will probably take a little bit of work of what we call

implementation science about how we are going to not just work with a small charity and a couple of

NHS trusts in the Northeast, but how we can roll this out nationwide. That might take a couple of

years by the time we have acquired funding and been able to complete that work. What I would say

between five to six years, my vision for this project is to have these services embedded, this

referral to these services embedded within standard care as part of routine follow-up for

women with breast cancer. Okay, well obviously that doesn't mean that people who have had breast

cancer treatment should wait five to six years to start exercising. They should start today,

right? Are there particular exercises or particular physical activities that are

especially beneficial for people who've had breast cancer? So a couple of important points I

always like to raise and I physical activity is beneficial. So any type, any amount of physical

activity done at any intensity, so it all beneficial. But more is better. In terms of the

type of physical activity, again there are various different types. We usually split these

into four different domains. One is physical activity done as part of household chores in the

household domain. So for instance, you know washing up, gardening, etc. Physical activity

done as transport, so walking to work or cycling. Physical activity done as part of work. So that

could compass any working behind a bar, for instance, and being physically active during

that. Or physical activity as part of leisure time. And that's essentially exercise is what

we're referring to there. Now on the caveat that all physical activity is beneficial. So done as

part of home, done as part of transport, as work, or during leisure time, all is beneficial. But there

is, I believe there's something particularly special about physical activity done as part of

leisure time or planned structured exercise. Usually it is split into two different types and

that's aerobic exercise and resistance exercise. So aerobic exercise might be going for a

brisk walk, for instance, usually done at a moderate intensity or above, which essentially

just means you're starting to get breathless. And resistance exercise, which I know Laurie are

particularly interested in. And that's what is sometimes referred as muscle strengthening

exercises. So lifting weights, but it doesn't always have to be lifting weights. So it could be

lifting household objects, for instance, or things like using resistance bands, which

typically can be quite helpful around the home. When you said then that I am particularly

interested in resistance, so this is actually something and I know a lot of people will relate to

this. I had a big operation last year, I'm in my early 40s now, and have experienced all the

menopausal symptoms, having had nearly 12 years of cancer treatment and now with secondary breast

cancer. And so for me, muscle maintenance and muscle strengthening is, I am told, more

important than anything else. And I'm also getting a lot of injuries now, a lot of recurring

injuries. Where would you suggest people start in terms of strengthening and weightlifting, which

as you mentioned earlier can seem like a really scary daunting task for someone who's never done

it? Resistance exercise, as you said, it is the best type of exercise for muscle mass, muscle

strength and bone health. And I think it's important again to remember that there are no

particular exercises that you must do. And I think we can all fall into this trap. I know I have, for

example, that's not true. And one resistance exercise might look to another despite having

similar benefits. And sometimes that's around trial and error, finding the right type of

resistance exercise that works for you and avoids, you said, you had some injuries and some

pain. And it's about working around those, it's about avoiding pain. And sometimes again, it can

take trial and error to find the right exercise that avoids pain. Low impact exercise can be

beneficial. So you might avoid jumping, for instance. And there's a lot to be said about

starting slowly and building up gradually. Again, I think we can all think okay, we've

probably all been guilty of thinking, okay, I'm going to start exercising, I need to go to the gym

for an hour and do this many exercises for this to be beneficial. And it all comes from some of the myths

around no pain and no gain and all that rubbish, which is rubbish. And so I think there's a lot to be

said for starting slow and gradually building up. And also having a thorough warm up as well will be

beneficial around pain. Getting started with resistance exercise can be very daunting and

quite challenging. There are lots of things that people can do around the home. So in the home that

that count as resistance exercise, so a very simple one sat on in your chair or sat on your sofa,

standing up, sitting back down again, standing up, sitting back down again, you've just

performed two body weight squats. Surprisingly hard as well, surprisingly challenging to see how

many of those you can do in one minute was a test that I had from my physio. Yes, absolutely. And they are

very difficult. And and so there are ways to make those easier, for instance, if that's not

comfortable for you at the moment, there are ways that you can, for instance, put cushions

underneath your bum when you sit down to make the distance that you're standing up a little bit

less. There are also ways to make it harder, actually, if they are become over time quite easy

for people. For instance, you could hold some books in your hand as you stand up to add some

resistance. For other people, people might be interested in going to a gym. So it's absolutely

and again, it's just what works for you resistance exercise is important. It can be done at home with

simple objects around the house, for example, having some cans of soup and lifting them above

your head. For example, for some people may want to go to a gym and that's fine as well. I would always

suggest if people haven't gone to a gym previously and it's something they are looking to start is to

proactively seek out support for that. That might simply be just going with a friend a couple of

times. In the first instance, to build up some confidence around the exercises and the

machines. And again, we've probably all experienced this that we walk in, for those who

have gone to a gym, you walk into a gym, and you think, man, this is this is quite daunting. I have

really no idea how to use this equipment and things. So going with someone who a friend or

someone you know, or even someone a gym instructor who was able to induct you into the gym is really

beneficial. There are lots of different classes out there at the moment, unfortunately, not

cancer specific, which we hope to change throughout projects, but other community

classes that people might consider going to as well, which are usually circuit based or involve

some resistance exercise, but have an instructor there and different people there who are able to

help. I would also say services are completely different around the country. But I would say if

anyone is currently being treated at a hospital, do ask your oncologist or if you're given a breast

cancer nurse, do ask them if there is a physio or if there are any exercise support services that they

have, because from my experience, those aren't necessarily given to you on a plate. But if you ask,

you often find that there is a service and I've just had six amazing gym sessions over a six week course

with the with my hospital physio, which was completely free and was absolutely life changing

because it just gave me the confidence to use weights. And I actually, as you said, I started off

with those 400 gram tins of beans at home. And so it can be free. And it can be much easier than you might

think. And also, if somebody is a member of a gym already, often gyms give a free maybe half hour

session that's included like an induction, you don't necessarily have to pay a personal trainer

to get started. So there are always ways to get started. Yeah, absolutely. You make an

absolutely fantastic point that asking that question of with your healthcare provider is a

really good place to start. And I'm a really big believer that for those of us who are able bodied,

we can be physical active. It's an exercise is frozen. I again, we have these connotations of

what exercise looks like. And we think, okay, that's that's not for me. That's not who I am. I'm

not a gym person. But you don't have to be to be to be physical active. And there's a lot to be said about

around building confidence around the ability to exercise that can then help propagate and sustain

exercise in the future. Yeah. And possibly even through breast cancer now, people can just be

connected with another patient who then might you might start something with because obviously a

lot of people do lack that confidence to just get started on their own. I know you're not a

nutritionist. But I wonder if you do have any small tips on diet to supplement to supplement a healthy

exercise routine. We know that alcohol and smoking is bad. But are there any particularly

good foods that you can recommend or any particular diet changes? Yeah, absolutely. And

that's something else that it's probably worth clarifying that this difference between a

dietitian and a nutritionist. So I would consider myself as a nutritionist to have the nutrition

qualifications to support that. But what I'm not is a is a dietitian and dietitians, they assess,

they treat and diagnose dietary nutritional problems. And they're able to recommend specific

diets, for instance, as a nutritionist, I can provide general health eating guidance. And I

think that's an important distinction to make. And I'm a big believer in staying in my own lane. I

have some, it may surprise, I have some expertise in some areas, but I'm the first one to say, hang on,

I'm no expert in this area. Let's have a chat with a colleague who is so health in terms of health

eating for women who've had breast cancer. Currently, the best available evidence suggests

following a healthy diet pattern that's very similar to what people have probably heard before

for other health, for general health purposes. And that encompasses things like following a diet

plan that helps maintain a healthy weight. Some other components of a healthy diet include

following eating a diet that's rich in whole grains, including fruits and vegetables,

avoiding sugary drinks and limiting things like fast and processed foods. And as you've just

mentioned, limiting alcohol intake and not smoking. So there's no specific foods or that are

that people should or shouldn't eat after breast cancer and is streaming or at least the moment the

current evidence doesn't suggest that. But following those healthy eating principles will

be helpful to living well after breast cancer. Sam, I would like to ask you the question we ask all

our guests on this podcast, which is, what is the one thing you'd like to see change in the coming

years in terms of breast cancer, diagnosis, treatment and beyond? Great question. I would

like to see physical activity and support and referral to be routinely offered as part of

standard follow-up care for women who've had breast cancer and breast cancer treatment. We

hope, I hope that our projects called Purex can provide a feasible and acceptable and scalable

model to be able to do that. Fantastic. And is there anything else you'd like to share with us? I guess I

would like to finish on just a couple of takeaway key points. And that is, and I've said this a few

times, that remember that being physically active is for most of us, if not all of us, doing any

physical activity is beneficial, any amount in any type and doing more is better. It can bring a

whole host of benefits. The strongest evidence is for improving things like fatigue, low mood and

there is emerging evidence now that physical activity after breast cancer treatment can help

stop or reduce the risk of breast cancer coming back in the future. It doesn't completely

eliminate the risk, but it does provide a small risk reduction. And I was actually just talking to

one of our patient leads, Kelly Ross, about this and how this is put across to the public and people

who have had breast cancer to avoid any feelings of guilt. So after having breast cancer and having

treatment and being a remission of breast cancer, being physically active after that can reduce the

risk of breast cancer coming back by a reasonably small amount. So it can help. That does not mean if

you're, even if you're highly physical active, you're always going to the gym, you're always

going on runs that breast cancer won't come back. That it does, that's not what it means. What it

means is compared to if you weren't physical active at all, being regularly physical active,

the risk of breast cancer coming back is lower. So and that's, I think, a really important message

because when we speak to women who've had breast cancer, reducing the risk of that cancer coming

back is very much understandably so on the forefront of people's worries and their minds. So

physical activity can help with that. It may help with things like, again, immune system activity,

things like inflammation and things like insulin resistance as well. So we don't have the exact

reasons why yet, but there are lots of proposed mechanisms that do have some legitimacy to them.

Yes. I just wanted to say if your breast cancer comes back and you haven't exercised, it doesn't

mean that it's your fault. Similarly, because there are so many different factors that

contribute to getting breast cancer in the first place and breast cancer recurrence, ranging from

lifestyle to environment to genetics to so much more. So it's never your fault. I think is the

message that we want to get across on this podcast, which you've said about various things as well.

Yeah, absolutely. Thanks for picking up Laura. And that's such an important message. And again,

that was something I was speaking to a patient lead about that both those sides, as you say, if you're

not physical active and the breast cancer comes back, that is absolutely not your fault. And the

other side as well, if you are very physical active, you can still get breast cancer. So you're

right, those are really important messages to put across. Where can people find out more about your

work? So they can go on the Breast Cancer Now website, which will be posting updates on our

project. And the other way is via my staff page on Newcastle University's website. So if people are

interested, if they Google Sam Orange, Newcastle University, that's probably the first thing

they'll come up. And you can see different projects that I'm working on and papers that I've

published on that website. We will put all those links in the show notes as well. So you don't have to

do any Googling. And the same with healthy eating tips. There's there's lots of those on the breast

cancer now website as well. So we'll put all those links in the show notes. Well, thank you so much for

joining us. I wish you all the best for your research and your work. And I really hope we will

see some brilliant results on the Breast Cancer Now website in the future. Dr Sam Orange, thank you

so much for joining us. Thank you very much. If you enjoyed this episode of the breast cancer now

podcast, make sure to subscribe on Apple Podcasts, Spotify, or wherever you get your

podcasts. Please also leave us a rating or review on Apple podcasts and perhaps recommend it to

someone you think would find it helpful. The more people we can reach, the more we can get Breast

Cancer Now's vital resources to those who need them. You can find support and information on our

website, breastcancernow.org, and you can follow Breast Cancer Now on social media at Breast

Cancer Now. All the links mentioned in this episode are listed in the show notes in your

534 00:58:25,990 --> podcast app. Thank you for listening to the Breast Cancer Now podcast.