1 00:00:00,000 --> 00:00:05,160 This podcast contains the personal stories, opinions and experiences of its speakers, rather 2 00:00:05,160 --> 00:00:11,500 than those of Breast Cancer Now. Welcome to the Breast Cancer Now podcast, providing support and 3 00:00:11,500 --> 00:00:17,440 information to anyone affected by breast cancer. I'm Laura Price and I'm the host of the Breast 4 00:00:17,440 --> 00:00:24,540 Cancer Now podcast. I'm a food writer and author and I live with secondary breast cancer. Today's 5 00:00:24,540 --> 00:00:30,060 episode, we are talking to Dr. Sam Orange, a clinical exercise physiologist and deputy 6 00:00:30,060 --> 00:00:35,880 director of research in the School of Biomedical, Nutritional and Sports Sciences at Newcastle 7 00:00:35,880 --> 00:00:41,300 University, who wants to improve women's access to diet and physical activity support after their 8 00:00:41,300 --> 00:00:47,240 breast cancer treatment. More women are living with and beyond breast cancer than ever before, 9 00:00:47,240 --> 00:00:52,860 with survival rates doubling in the last 40 years. It's widely known that exercise and a healthy 10 00:00:52,860 --> 00:00:57,880 lifestyle can improve outcomes and survival, but there are various barriers that prevent patients 11 00:00:57,880 --> 00:01:04,000 from getting the support they need, including limited resources on the NHS. In a project funded 12 00:01:04,000 --> 00:01:09,160 by Breast Cancer Now, Dr. Sam Orange is helping healthcare professionals to refer women to 13 00:01:09,160 --> 00:01:14,160 community support services, while developing a training package so that those services can 14 00:01:14,160 --> 00:01:19,300 specifically support women who have gone through breast cancer treatment. Sam, welcome to the 15 00:01:19,300 --> 00:01:24,340 Breast Cancer Now podcast. Thank you very much for having me on. Oh, you're welcome. It's a pleasure 16 00:01:24,340 --> 00:01:29,300 to have you. So, Sam, we know that more women are surviving or living with breast cancer than ever 17 00:01:29,300 --> 00:01:34,340 before, which is obviously fantastic news. But we also know that one in three of those women will 18 00:01:34,340 --> 00:01:39,180 experience persistent tiredness or fatigue and almost half will experience depression and 19 00:01:39,180 --> 00:01:44,020 anxiety. And I'm sure lots of our listeners are nodding their heads right now. Before we talk 20 00:01:44,020 --> 00:01:48,980 about your work, could you explain how exercise and a healthy lifestyle can help with those 21 00:01:48,980 --> 00:01:57,280 symptoms of low mood and tiredness? Yeah, absolutely. Thanks, Laura. Simply put, being 22 00:01:57,280 --> 00:02:05,000 physically active is one of, if not the best thing that people can do for low mood and feeling 23 00:02:05,000 --> 00:02:12,460 fatigued and tired for a long time after breast cancer and cancer treatment. And you really 24 00:02:12,460 --> 00:02:18,620 shouldn't just take my word from it, but that's supported by some strong evidence. So there was a 25 00:02:18,620 --> 00:02:25,900 review, a large review put together a few years ago that pulled together all the evidence in this 26 00:02:25,900 --> 00:02:34,180 area. And it looked at the effects of exercise, the effects of psychological interventions, such as 27 00:02:34,180 --> 00:02:40,340 things like cognitive behavioral therapy, and drugs as well. So the effect of drugs on 28 00:02:40,340 --> 00:02:46,720 cancer-related fatigue. And what that larger review found was that actually, drugs had no 29 00:02:46,720 --> 00:02:52,900 positive impact on cancer-related fatigue, but both exercise and psychological interventions, 30 00:02:52,900 --> 00:02:59,120 again, like cognitive behavioral therapy, both helped alleviate cancer-related fatigue. And 31 00:02:59,120 --> 00:03:05,440 out of the two, exercise was actually slightly better. So the evidence does suggest that 32 00:03:05,440 --> 00:03:12,280 exercise is particularly beneficial for cancer-related fatigue. We don't really know why 33 00:03:12,280 --> 00:03:19,140 yet. There are some mechanisms, plausible mechanisms that have been proposed. So exercise 34 00:03:19,140 --> 00:03:25,840 can help with things like inflammation, improving the activity of the immune system. It 35 00:03:25,840 --> 00:03:32,040 can help with things like energy metabolism and improving fitness and reducing muscle wasting. 36 00:03:32,040 --> 00:03:37,660 And all those factors might play a role in how exercise can help with fatigue. But the evidence 37 00:03:37,660 --> 00:03:45,420 is pretty clear. And it can sometimes sound quite counter-intuitive and counter to the fact that we 38 00:03:45,420 --> 00:03:53,240 should, physical activities, recommended to improve tiredness when typically physical 39 00:03:53,240 --> 00:03:58,860 activities are the last thing on people's minds when they are feeling tired. But the evidence is, 40 00:03:58,860 --> 00:04:06,620 again, is really strong in support of that. And in regards to low mood too, so the National Institute 41 00:04:06,620 --> 00:04:13,280 for Health and Care Excellence, or NICE, which listeners may have heard of, and they're 42 00:04:13,280 --> 00:04:19,300 essentially the NHS watchdog, they make recommendations to the NHS based on 43 00:04:19,300 --> 00:04:25,480 cost-effectiveness of different treatments. So they recommend what the NHS should be prescribing 44 00:04:25,480 --> 00:04:33,660 to patients across a range of conditions, including cancer. And for mild to moderate 45 00:04:33,660 --> 00:04:41,700 depression, or less severe depression, it's sometimes called exercise is one of the 46 00:04:41,700 --> 00:04:47,300 first-line treatment options for mild to moderate depression. And that's on the basis of 47 00:04:47,300 --> 00:04:52,600 the strength of evidence supporting being physically active and taking part in exercise to 48 00:04:52,600 --> 00:05:00,540 help alleviate some symptoms of low mood and depression and anxiety. And that evidence is 49 00:05:00,540 --> 00:05:07,500 specific to people with cancer as well. There have been lots of large reviews that have looked at the 50 00:05:07,500 --> 00:05:12,920 evidence between exercise and symptoms of anxiety and depression, which are often common in 51 00:05:12,920 --> 00:05:19,320 people who are diagnosed and have treatment for cancer. And again, similar to fatigue exercise is 52 00:05:19,320 --> 00:05:25,740 one of the best things that people can do for that follow mood. I'm just going to jump in and preempt 53 00:05:25,740 --> 00:05:30,300 what some of our listeners might be thinking, which is if I'm so exhausted, I can barely get off 54 00:05:30,300 --> 00:05:36,960 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 55 00:05:36,960 --> 00:05:45,400 important and legitimate point. And I understand that that would be, as you say, a first response to 56 00:05:45,400 --> 00:05:50,960 many people experiencing tiredness and fatigue. But there are a couple of really important points 57 00:05:50,960 --> 00:05:59,120 here. The first one is that physical activity comes in so many different forms. And it's 58 00:05:59,120 --> 00:06:06,140 probably a good point here to define or look at the difference between physical activity and 59 00:06:06,140 --> 00:06:11,960 exercise. So physical activity is actually any bodily movement that requires energy 60 00:06:11,960 --> 00:06:19,780 expenditure. Exercise is a subcomponent of physical activity that is purposefully 61 00:06:19,780 --> 00:06:26,160 undertaken to improve health or fitness. So for instance, going to the gym or going for a longer 62 00:06:26,160 --> 00:06:32,580 run. So physical activity encompasses so much more than just going to the gym and lifting 63 00:06:32,580 --> 00:06:38,720 weights. And it's really important to remember that anything is better than nothing. So any 64 00:06:38,720 --> 00:06:46,460 movement, any amount and any type is beneficial. And more of that is better. And so I tend to see 65 00:06:46,460 --> 00:06:54,840 physical activity as a continuum. So or a staircase, if you will. So simply just reducing 66 00:06:54,840 --> 00:07:03,780 being sat down. So standing up regular intervals or walking around the living room, for example, is 67 00:07:03,780 --> 00:07:10,600 beneficial. It doesn't sound like much, but versus compared to just sitting down, that's 68 00:07:10,600 --> 00:07:15,500 beneficial. And then you can go right across the other end of the continuum when we have more 69 00:07:15,500 --> 00:07:23,380 structured planned exercise such as lifting weights in the gym or going out for a job. And that 70 00:07:23,380 --> 00:07:31,340 brings us to my second important point. And I think it's important to raise that it's important to be 71 00:07:31,340 --> 00:07:40,700 kind to ourselves. Right. And fatigue will often come in ebbs and flows. So on some days and some 72 00:07:40,700 --> 00:07:48,480 times after a cancer diagnosis, and during and after treatment, it's very likely that during 73 00:07:48,480 --> 00:07:55,020 some days and times that people will feel exhausted and really, really fatigued and tired. 74 00:07:55,020 --> 00:08:01,140 There are other days and times potentially where people feel a little bit better and a little bit 75 00:08:01,140 --> 00:08:09,800 better symptom wise and have a little bit more energy. And we can use that to accommodate how much 76 00:08:09,800 --> 00:08:18,640 physical activity we do. So on days where fatigue is really high and we simply feel exhausted, let's 77 00:08:18,640 --> 00:08:24,280 be kind to ourselves. And it might be on those days that actually doing a little bit of activity 78 00:08:24,280 --> 00:08:32,240 around resting. So for instance, washing up, getting up from the sofa at some intervals, 79 00:08:32,240 --> 00:08:37,940 walking to the corner shops to grab some milk, for instance, is actually all going to be beneficial. 80 00:08:37,940 --> 00:08:43,200 So that's important to remember that that is beneficial. And then on days and times where we 81 00:08:43,200 --> 00:08:48,640 feel a little bit better, we could then potentially consider taking part in some more 82 00:08:48,640 --> 00:08:55,880 structured exercise. So that might be, going out for a 10 minute walk. For some people, that might be 83 00:08:55,880 --> 00:09:02,060 going to the gym. And if it's, I think we're all guilty of thinking of exercise, and then we're 84 00:09:02,060 --> 00:09:10,120 picturing this weightlifter in a gym or picturing someone wearing not so many clothes going out for a 85 00:09:10,120 --> 00:09:16,520 run, for instance. And we don't tend to associate ourselves with that person or that activity. But 86 00:09:16,520 --> 00:09:20,880 physical activity for one person can be so different to physical activity for another 87 00:09:20,880 --> 00:09:26,720 person. And so for some people, on days and times when they're feeling better, it might be that they 88 00:09:26,720 --> 00:09:32,500 want to go to the gym or go out for a run. Other people activity might look different. That might be 89 00:09:32,500 --> 00:09:39,320 going for a walk with a friend or a relative or a dog, for instance. It also might be, I often think, 90 00:09:39,320 --> 00:09:43,640 like, think back to what you used to like when you were little or when you're at school, because for 91 00:09:43,640 --> 00:09:50,120 some people, they might have played, I don't know, tennis or rounders or something like a team sport. 92 00:09:50,120 --> 00:09:55,020 When they were little and they don't feel like they now have that access anymore, that they're older, 93 00:09:55,020 --> 00:10:00,760 but maybe there are ways to get back into sports that people loved as well. Yeah, you make a great 94 00:10:00,760 --> 00:10:07,300 point. And I think it's important when people are interested in increasing their physical 95 00:10:07,300 --> 00:10:13,580 activity. That's not always easy. It actually can be very challenging. And it's important to 96 00:10:13,580 --> 00:10:20,120 remember that physical activity, again, comes in many forms and take actually some time to reflect 97 00:10:20,120 --> 00:10:26,800 what does being regularly physical active mean to me? What does that look like to me? Sometimes 98 00:10:26,800 --> 00:10:31,680 that's what do I enjoy? So what do I enjoy doing? A lot of people come back and say they don't enjoy 99 00:10:31,680 --> 00:10:40,720 being physical active, which is fine. But it might be what is accessible to me. What is feasible to fit 100 00:10:40,720 --> 00:10:47,360 in? Who else can I be physically active with? So I think you're right. It's important to take some 101 00:10:47,360 --> 00:10:51,460 time and think about what does physical activity look like for me. And there are many options to 102 00:10:51,460 --> 00:10:57,220 that. And sometimes I mean, I'm very physically active, but there are times when I just am 103 00:10:57,220 --> 00:11:01,480 absolutely exhausted. It might be because of my symptoms, it might just be because I'm working 104 00:11:01,480 --> 00:11:09,580 hard or whatever. And I don't feel like going to, going for a swim or going to my spinning class, for 105 00:11:09,580 --> 00:11:16,740 example. And on some occasions, I stay at home, but on other occasions, I go and I come out feeling more 106 00:11:16,740 --> 00:11:21,860 energetic and feeling a bit better. Is that a thing? Is that psychological? Or is there a thing 107 00:11:21,860 --> 00:11:28,840 that happens that actually means that exercise makes us feel less tired? Yeah, absolutely. That 108 00:11:28,840 --> 00:11:35,800 is certainly a thing. And injuries aside, I don't know anyone who's ever felt tired and then gone to 109 00:11:35,800 --> 00:11:40,260 be physically active or exercise who's then regretted it and thought, actually, I feel more 110 00:11:40,260 --> 00:11:47,440 tired now or feel worse. Almost every time the person will say, I'm glad I did that. And of course, 111 00:11:47,440 --> 00:11:52,800 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 112 00:11:52,800 --> 00:11:57,240 tired to go and exercise or go physically active, that's of course very challenging. The person 113 00:11:57,240 --> 00:12:01,200 like you said in your experience feels more energetic afterwards. And I share those 114 00:12:01,200 --> 00:12:08,340 experiences as well. We're not exactly sure why that is. There's a common theory about endorphins 115 00:12:08,340 --> 00:12:16,960 being released, which certainly has some legitimacy to that. And there are also a lot of 116 00:12:16,960 --> 00:12:22,920 other theories as well. So as well as endorphins, our muscles actually, when we are active, they act 117 00:12:22,920 --> 00:12:29,700 as endocrine organs. So the don't muscles don't just help our bodies move. But when we contract 118 00:12:29,700 --> 00:12:34,980 them, when we're active, particularly at a certain level of effort, they actually produce 119 00:12:34,980 --> 00:12:41,840 small proteins, thousands of them in fact, into the circulation. And it's thought that those 120 00:12:41,840 --> 00:12:48,740 different proteins and small molecules might be able to have a beneficial impact on our health. And 121 00:12:48,740 --> 00:12:54,880 one of those things is fatigue. And that's really, I think reassuring in a nice message that actually 122 00:12:54,880 --> 00:13:03,740 every time we are active, even that just one brisk walk or one spinning session to use your example, 123 00:13:03,740 --> 00:13:08,500 that's contributing to us feeling better and being healthier. I think that's a nice message to 124 00:13:08,500 --> 00:13:13,360 take with. Yeah, definitely. And just before we talk about your research, can I ask you the fatigue 125 00:13:13,360 --> 00:13:20,220 that we experienced through cancer, having cancer treatment is not, it's a tiredness that is 126 00:13:20,220 --> 00:13:24,280 not alleviated with rest, basically. Yeah, absolutely. It's not really, it's not 127 00:13:24,280 --> 00:13:29,300 proportional or related to previous activity. And it's not alleviated by sleep or rest, for 128 00:13:29,300 --> 00:13:35,140 instance. That's brilliant. Because I think for a lot of cancer patients, me included, sometimes 129 00:13:35,140 --> 00:13:43,600 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, 130 00:13:43,600 --> 00:13:49,320 it isn't just because I've been working hard or whatever it's, I woke up after a 10 hours, 10 hours 131 00:13:49,320 --> 00:13:54,880 sleep, and I could sleep all day and all week, because my body is just completely done in, but 132 00:13:54,880 --> 00:14:01,560 it's hard sometimes to explain that to someone who doesn't have cancer. So absolutely, I completely 133 00:14:01,560 --> 00:14:10,280 appreciate that. With other conditions, for instance, if you have an injury, a physical 134 00:14:10,280 --> 00:14:15,980 injury, it's quite easy for people to contemplate that and understand that, it's easy for them to see 135 00:14:15,980 --> 00:14:23,240 that. But I understand trying to articulate long lasting tiredness that is so real and so genuine 136 00:14:23,240 --> 00:14:30,520 and has such a large impact, trying to articulate that and have people understand the implications 137 00:14:30,520 --> 00:14:35,380 of that would be very, very challenging. Yeah. Okay, thank you. Well, let's talk a little bit 138 00:14:35,380 --> 00:14:39,960 about the research project that you're doing with funding from Breast Cancer Now. Can you tell us 139 00:14:39,960 --> 00:14:47,580 what sparked that project and what's the end goal and how does it work? So this research, as you said, 140 00:14:47,580 --> 00:14:54,480 is funded by Breast Cancer Now. Research funding is incredibly difficult to come by. So what 141 00:14:54,480 --> 00:15:00,840 happens is, as researchers, we put together, we have an idea, we put together a research funding 142 00:15:00,840 --> 00:15:06,380 application, usually in collaboration with people who have experienced that condition. For 143 00:15:06,380 --> 00:15:13,140 instance, women who've had Breast Cancer and doctors and nurses who treat that as well. It 144 00:15:13,140 --> 00:15:19,720 usually takes around 12 months to put a proposal together because it's very competitive. You need 145 00:15:19,720 --> 00:15:27,980 to find a funder that where their priorities and values align with your research priorities and 146 00:15:27,980 --> 00:15:33,560 values of the project. So for example, this project that we have funded, I'll talk about in a 147 00:15:33,560 --> 00:15:41,460 moment, we couldn't go to Cancer Research UK for that funding because their remit does not cover 148 00:15:41,460 --> 00:15:48,000 cancer survivorship. Their priority is preventing cancer rather than health and 149 00:15:48,000 --> 00:15:54,860 well-being in cancer survivorship. It typically then, once submitted, it takes about six months, 150 00:15:54,860 --> 00:15:59,920 usually sometimes longer. And then the acceptance rate, the funding rate, is around 15%. 151 00:15:59,920 --> 00:16:07,860 So eight or nine out of 10 applications that you submit will be rejected after 18 to 20 months of 152 00:16:07,860 --> 00:16:12,920 putting that together and waiting for the decision. I just think it's worth raising that to 153 00:16:12,920 --> 00:16:20,620 listeners that, of course, there was many research projects that we would like to run, but 154 00:16:20,620 --> 00:16:27,320 they are very challenging and time-consuming to put together. And so it isn't just as simple as, 155 00:16:27,320 --> 00:16:31,580 I've got an idea, let's get some money and let's do this. I think that's probably worth raising at 156 00:16:31,580 --> 00:16:37,900 this point. Of course, yeah. And just to interject, I think that so many people listening 157 00:16:37,900 --> 00:16:41,900 probably will have done some fundraising for Breast Cancer Now or for another charity over the 158 00:16:41,900 --> 00:16:47,820 years, whether it's a coffee morning or a sponsored walk or whatever. And it's just really 159 00:16:47,820 --> 00:16:52,860 interesting to know what that money goes into and all the work that goes behind the scenes and how 160 00:16:52,860 --> 00:17:00,900 well-considered the use of that money is. So it's really, hopefully, really reassuring to people 161 00:17:00,900 --> 00:17:08,800 to know that. Yes, absolutely. And this research just, none of this could happen without the 162 00:17:08,800 --> 00:17:14,460 generosity of people fundraising for charities like Breast Cancer Now. And you're absolutely 163 00:17:14,460 --> 00:17:21,260 right. The low acceptance rate of proposals is there for a good reason, because this money is 164 00:17:21,260 --> 00:17:27,579 important and we need to, or charities like Breast Cancer now, need to put that money and fund the best 165 00:17:27,579 --> 00:17:34,700 research possible. On that note, tell us about your work. Yeah, that was a good segue, wasn't it? 166 00:17:34,700 --> 00:17:40,980 The best research possible into our research project, of course, and bias. So our project is 167 00:17:40,980 --> 00:17:46,700 called Expanding Intercommunities to Improve Lifestyle Support for Women After Breast Cancer, 168 00:17:46,700 --> 00:17:54,960 and we've shortened that as Purex. And the aim of the project, as you said, at the start is to 169 00:17:54,960 --> 00:18:00,940 improve, is simply to improve women's access to physical activity and diet support after 170 00:18:00,940 --> 00:18:10,240 finishing breast cancer treatment. And we want to do that in two ways. First one is to develop a new 171 00:18:10,240 --> 00:18:17,120 referral pathway that will enable healthcare professionals to simply and quickly refer women 172 00:18:17,120 --> 00:18:23,660 into physical activity and diet support services that are based in the community. And the second one 173 00:18:23,660 --> 00:18:30,060 is to then train existing community service providers, so for example, local community 174 00:18:30,060 --> 00:18:36,840 centres and charities to adapt their existing healthy lifestyle programmes, for example, 175 00:18:36,840 --> 00:18:44,100 exercise services specifically for women with breast cancer. And I can't really articulate how 176 00:18:44,100 --> 00:18:52,180 excited I am for this project. I genuinely think it has a real potential for impact. Of course, I'm 177 00:18:52,180 --> 00:18:58,920 biased as well, being a lead investigator on this. And I thought about this for a long time before 178 00:18:58,920 --> 00:19:05,040 talking about research funding, before we decided to ask Breast Cancer now and submit our 179 00:19:05,040 --> 00:19:10,240 proposal to Breast Cancer now, because I believe our values aligned really well with Breast Cancer 180 00:19:10,240 --> 00:19:17,740 now priorities. And what this came from was, I felt it was a chance to essentially connect the dots. So 181 00:19:17,740 --> 00:19:24,360 there are lots of exercise services out there in the community already. I'm sure all the listeners 182 00:19:24,360 --> 00:19:29,820 can think about exercise services in their own local community, exercise classes for the 183 00:19:29,820 --> 00:19:37,440 general population, exercise classes for people who are at high risk of falls or risk of diabetes or 184 00:19:37,440 --> 00:19:45,220 have had a heart condition. And so there are those classes and services in the community already. 185 00:19:45,220 --> 00:19:51,760 And we know there is good evidence, as I talked about, about how physical activity can support 186 00:19:51,760 --> 00:19:59,320 women who've had breast cancer and finished treatment to improve things like fatigue and 187 00:19:59,320 --> 00:20:08,000 symptoms of depression and anxiety and improve mood. And so my line of thought was, well, can we 188 00:20:08,000 --> 00:20:12,920 utilize and harness this infrastructure that's out there already, this existing community 189 00:20:12,920 --> 00:20:19,420 infrastructure, and use that to support women after breast cancer treatment to be physically 190 00:20:19,420 --> 00:20:26,060 active? And that's exactly what we're trying to do. We're coming up with a referral pathway that 191 00:20:26,060 --> 00:20:31,220 again allows healthcare professionals to make that referral into community services. And then 192 00:20:31,220 --> 00:20:36,240 we're developing this training package to then train these existing community service 193 00:20:36,240 --> 00:20:45,440 providers how to adapt the existing portfolio of exercise services for women with breast cancer. 194 00:20:45,440 --> 00:20:53,780 So it may look as simple as a one day consultation where we might work with an exercise provider and 195 00:20:53,780 --> 00:21:00,820 say, okay, this is what you offer currently. This is what the exercise and nutritional needs are for 196 00:21:00,820 --> 00:21:05,780 women who've had breast cancer and breast cancer treatment. And so therefore, these are the tweaks 197 00:21:05,780 --> 00:21:13,680 and that you can make to your existing services and how you can adapt those. And then that service will 198 00:21:13,680 --> 00:21:19,680 be certified or qualified to then deliver the exercise and nutritional services to women with 199 00:21:19,680 --> 00:21:26,380 breast cancer. And we have a quite a clear vision for this project. I always think it's so important 200 00:21:26,380 --> 00:21:31,760 to have what you think the end goal is here and what you're working towards. And what I think this 201 00:21:31,760 --> 00:21:39,740 might look like is that with comprehensive input from people affected by breast cancer, for women 202 00:21:39,740 --> 00:21:44,760 who've had breast cancer, but also from exercise professionals, physiotherapists, dietitians, 203 00:21:44,760 --> 00:21:51,280 oncologists, specialist nurses, etc. We're developing this training package. And so we want 204 00:21:51,280 --> 00:21:56,300 to train community service providers across the country. We think this will hopefully be scalable 205 00:21:56,300 --> 00:22:02,900 in the longer term, who are then certified to provide exercise services to women with breast 206 00:22:02,900 --> 00:22:09,080 cancer. Then what we think this will look like is healthcare professionals have a list of 207 00:22:09,080 --> 00:22:16,920 certified community service providers that they're able to refer women to. And then during 208 00:22:16,920 --> 00:22:23,240 routine follow-up care for women after they've had their primary treatment for breast cancer, 209 00:22:23,240 --> 00:22:29,000 women are then offered a referral to these community physical activity and diet services as 210 00:22:29,000 --> 00:22:37,360 a routine part of their follow-up care. And that gives women the option therefore to have support 211 00:22:37,360 --> 00:22:43,080 after finishing treatment for primary breast cancer to be physically active as part of the 212 00:22:43,080 --> 00:22:47,820 community alongside other women who've gone through a similar thing and can share similar 213 00:22:47,820 --> 00:22:53,260 experiences. And is it, are you only working with women because you talked about after treatment, 214 00:22:53,260 --> 00:22:56,620 but what about women who are still having treatment because they have secondary breast 215 00:22:56,620 --> 00:23:03,680 cancer? Are they included in your study? So this specific project is for women with primary breast 216 00:23:03,680 --> 00:23:09,220 cancer who've had uncompleted treatment for that cancer. This is not to say that physical activity 217 00:23:09,220 --> 00:23:15,260 isn't beneficial in the secondary cancer setting because evidence would suggest that it is. 218 00:23:15,260 --> 00:23:23,540 Typically when you acquire funding, you have to focus on a specific population. And there are of 219 00:23:23,540 --> 00:23:28,000 course major differences between in treatments and things between primary and secondary breast 220 00:23:28,000 --> 00:23:34,580 cancer. So for this project, we have focus on primary breast cancer, but we are very aware of 221 00:23:34,580 --> 00:23:41,600 sometimes the imbalance between research opportunities for people with primary versus 222 00:23:41,600 --> 00:23:46,960 secondary breast cancer. And that's something we feel strongly about and are looking to address in 223 00:23:46,960 --> 00:23:58,220 the future. One of my key aims in the near and long future is to develop a support program for women 224 00:23:58,220 --> 00:24:03,800 with secondary cancer. And what got you into this? Do you have any personal connection with breast 225 00:24:03,800 --> 00:24:12,340 cancer? I don't have any personal connection with breast cancer, fortunately, not at this moment in 226 00:24:12,340 --> 00:24:19,980 time. What got me into this lore is probably a larger backstory I'm very happy to share if you'll 227 00:24:19,980 --> 00:24:26,040 indulge me for a couple of minutes. Fantastic. So I'm very fortunate not to have any personal 228 00:24:26,040 --> 00:24:33,760 connection with breast cancer. My background is I was a professional rugby league player. And 229 00:24:33,760 --> 00:24:40,260 that's all I ever wanted to do. I've been five years old, I've not been facetious there. I dreamed of 230 00:24:40,260 --> 00:24:46,380 being a rugby league player. And I signed my first professional contract when I was 16 and as I said, 231 00:24:46,380 --> 00:24:55,120 played professionally. And I had several between the ages of 17 and 21, I had several season ending 232 00:24:55,120 --> 00:25:00,740 injuries. So I was in a quite a large car crash where I lost my memory in the hospital for a while in Broca 233 00:25:00,740 --> 00:25:07,280 vertebrae. I had three knee reconstructions, a shoulder reconstruction. And essentially, I 234 00:25:07,280 --> 00:25:14,260 spent the vast majority of then those four or five years trying to cement my professional sports 235 00:25:14,260 --> 00:25:22,480 career on the sidelines. I then decided because of the toll that I take in both physically and 236 00:25:22,480 --> 00:25:28,240 mentally, if I'm completely honest, through injury, I decided to stop playing after my latest 237 00:25:28,240 --> 00:25:33,220 injury when I was 21, which would have taken another 12 months to have surgery and recover 238 00:25:33,220 --> 00:25:39,820 from. I remember always telling my manager at the time and then went into the changing rooms and just 239 00:25:39,820 --> 00:25:44,280 wept and wept. I was really, really, you know, gutted to be stopping playing and I felt very lost 240 00:25:44,280 --> 00:25:50,800 at the time really lost my identity because I was a rugby player and that's how people knew me. And I 241 00:25:50,800 --> 00:25:58,080 really reflected and I thought, okay, what am I going to do now? And I'd gone to university on the 242 00:25:58,080 --> 00:26:04,380 side in York and really enjoyed it was where I'm from and really enjoyed it. And I thought, okay, 243 00:26:04,380 --> 00:26:13,160 how can I best use the skills and experience that I feel I've gained through a short but real, you 244 00:26:13,160 --> 00:26:18,900 know, professional sports career? And how can I apply that to the greatest need? You know, where 245 00:26:18,900 --> 00:26:26,000 can I apply it where there would be the most benefit and impact? For me, that wasn't working in sports. 246 00:26:26,000 --> 00:26:31,780 I didn't feel like I would have as much a meaningful impact. And for me, there was, when I reflected on 247 00:26:31,780 --> 00:26:39,260 that, there was a really unmet need in people with cancer, including women with breast cancer, in 248 00:26:39,260 --> 00:26:44,120 terms of there was a mismatch between what the evidence was saying and actually what support 249 00:26:44,120 --> 00:26:50,740 that people with cancer are actually being offered. And then from then onwards, I have 250 00:26:50,740 --> 00:26:58,600 dedicated the past 10 years to try my best to address that. And I'm very ambitious and driven, 251 00:26:58,600 --> 00:27:06,020 and I will continue to address that until there is no longer that particular unmet need. Wow, thank 252 00:27:06,020 --> 00:27:13,120 you so much for sharing that, Sam. It's an amazing story. And I can only begin to imagine how 253 00:27:13,120 --> 00:27:19,980 heartbreaking and crushing that must have been to just have lost your dream career so early on 254 00:27:19,980 --> 00:27:26,580 through injury. It's just heartbreaking. But yeah, well done, you for turning it into something 255 00:27:26,580 --> 00:27:32,260 so positive for other people. It's a massive success story, I would say. Have you managed to get 256 00:27:32,260 --> 00:27:42,110 back into exercise now? Are you physically fit now? I am physically fit. Yes. I'm feeling really 257 00:27:42,110 --> 00:27:50,370 good, actually, as I said, almost a short lifetime of injuries. And I'm feeling really good at 258 00:27:50,370 --> 00:27:57,670 exercises. It's not one size fits all. And I avoid particular exercises because they don't work for 259 00:27:57,670 --> 00:28:04,730 me. And so now I lift weights. I've always enjoyed enjoying lift weights. And I think that's 260 00:28:04,730 --> 00:28:11,030 probably born from, and it was, but it's spending so much time in the the physical room that I sort of 261 00:28:11,030 --> 00:28:17,290 trying to get back fit and strong to play on the field. That's all I fell in love with, with the gym 262 00:28:17,290 --> 00:28:25,330 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 263 00:28:25,330 --> 00:28:33,050 friends house and things like that. But I also do some structured purposeful cycling as well to try 264 00:28:33,050 --> 00:28:37,790 and improve my fitness. I'll share a little experience of mine as well, which is slightly 265 00:28:37,790 --> 00:28:45,450 related to yours, which is a year ago I had secondary breast cancer in my sternum bone. And I 266 00:28:45,450 --> 00:28:52,830 had an operation to remove my entire sternum bone. And it was a huge recovery period in which I'm a 267 00:28:52,830 --> 00:28:59,470 swimmer. And I wasn't both before the operation when the pain was so bad in my bones, that it was 268 00:28:59,470 --> 00:29:04,030 affecting my swimming. Then it got better with drugs. And then I had the operation and then I 269 00:29:04,030 --> 00:29:11,330 couldn't exercise at all for at least a month. And for me, obviously physically, there were major, 270 00:29:11,330 --> 00:29:18,270 you know, difficulties. But mentally, that was the worst period probably in my life, because I 271 00:29:18,270 --> 00:29:25,390 couldn't do the two things that make me feel good, which are working and exercising. And I was 272 00:29:25,390 --> 00:29:30,930 sitting at home, depending on others, to do things for me. And I couldn't cook either because I 273 00:29:30,930 --> 00:29:38,250 couldn't pick up a pot or a chopper carrot. I'm now fortunately much better after that operation, 274 00:29:38,250 --> 00:29:43,210 but I'm having another operation this week, which will put me out. I won't be able to swim or cycle for a 275 00:29:43,210 --> 00:29:51,050 few weeks. And I also have a recurring groin strain injury, which seems to be that no matter what I do, 276 00:29:51,050 --> 00:29:57,890 every softening just keeps coming back. And then I can't swim or do things for a week or so. So I just 277 00:29:57,890 --> 00:30:06,530 wanted to ask you about what we can do mental health wise when we can't exercise. And I know that's a 278 00:30:06,530 --> 00:30:13,090 really hard question. Yeah, that's a really interesting question. And I haven't figured that 279 00:30:13,090 --> 00:30:20,350 out yet either, Laura. And it's physical activity, I guess, just drawn on my experiences 280 00:30:20,350 --> 00:30:29,470 for a second as well, is that I genuinely feel privileged every day that I have a body that moves, 281 00:30:29,470 --> 00:30:37,730 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, 282 00:30:37,730 --> 00:30:44,850 because I've got a body that can, I'm privileged that I have a body that can walk up those stairs. And 283 00:30:44,850 --> 00:30:52,650 physical activity just so much for me, mentally as well, I tend to be physical active little and often 284 00:30:52,650 --> 00:30:58,470 because I get even 15 minutes of physical activity brings that benefits. And if I can have that every 285 00:30:58,470 --> 00:31:09,790 day, then I try my best to. So, and I thought a lot about this from the injuries that I have had. And so 286 00:31:09,790 --> 00:31:18,450 there's nothing that either comes to mind or is in my scope of expertise, I think, to suggest the 287 00:31:18,450 --> 00:31:26,450 thing that I would suggest considering is remembering again, that I keep banging this drum, 288 00:31:26,450 --> 00:31:32,390 but that you don't have to go to the gym and do 45 minutes of intense spinning classes to be 289 00:31:32,390 --> 00:31:38,370 physically active. So what might whilst you're injured, whilst you're post surgery, for 290 00:31:38,370 --> 00:31:46,790 instance, actually what you're you need to we need to change gears in those contexts. And so what 291 00:31:46,790 --> 00:31:54,750 might be fit, what might mean or be represent physical activity in those contexts might be just 292 00:31:54,750 --> 00:32:00,370 walking around around the block around the street and back. And that will you probably be surprised 293 00:32:00,370 --> 00:32:06,190 at how much benefit that actually brings just been able to just been able to do that. And I think it is 294 00:32:06,190 --> 00:32:14,870 just around shifting gears at that time, which means okay, my body won't allow me to do what I used 295 00:32:14,870 --> 00:32:20,530 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 296 00:32:20,530 --> 00:32:26,910 that sort of and bodies of positive mindset as well, which has its own independent benefits. Not 297 00:32:26,910 --> 00:32:32,570 everyone loves exercise, not everyone is motivated to exercise. And you know what, that's 298 00:32:32,570 --> 00:32:40,170 absolutely fine. So in that context, what I'd always suggest is is almost trying to disguise 299 00:32:40,170 --> 00:32:48,930 physical activity as something else. So I'll use my, my own mom as an example, I'm sure she she won't 300 00:32:48,930 --> 00:32:57,770 mind. She's my mom has never been someone who's been overly physically active. But what she used 301 00:32:57,770 --> 00:33:04,570 to do with a friend and she this lasted for for many years is most evenings, particularly in the 302 00:33:04,570 --> 00:33:12,390 spring, autumn and summer is go for a walk with with her closest friend, who's now moved away, but 303 00:33:12,390 --> 00:33:19,190 during the many years she was here. And again, I'm one never someone who's ever stepped foot in a gym 304 00:33:19,190 --> 00:33:28,010 and would not be consciously physically active. But she walked a reasonable distance every night 305 00:33:28,010 --> 00:33:33,430 after work, because it was catching up with her dearest friend. And I think that's just one 306 00:33:33,430 --> 00:33:42,230 example of how we're able to be physically active. But it's not something we're, it's not our primary 307 00:33:42,230 --> 00:33:49,430 goal of that activity, but it is a side consequence of that. And I think there's something a lot to be 308 00:33:49,430 --> 00:33:55,810 said about that that again, it doesn't just have to be going out for this run to get fitter. It might be 309 00:33:55,810 --> 00:34:00,290 an activity that's catching up with friends or something similar, but you're also being 310 00:34:00,290 --> 00:34:07,750 physically active. Absolutely agree, yes. And it also made me think of who you mentioned just before 311 00:34:07,750 --> 00:34:11,969 our recording, which is Jeffrey, the dog who I believe is in the room with you. And obviously 312 00:34:11,969 --> 00:34:19,370 walking a dog can be a great way of disguising your own exercise, because you got to walk that dog. 313 00:34:19,370 --> 00:34:24,810 Absolutely. And just on that, Laura, that's absolutely my experience as well. And there's 314 00:34:24,810 --> 00:34:32,909 certainly, I think, days without, without having Jeffrey, the dog, that I would probably struggle 315 00:34:32,909 --> 00:34:39,650 leaving the house with long hours at work and working from home sometimes as I'm at home here. 316 00:34:39,650 --> 00:34:45,830 And the dog certainly does, I have to be out. And I'd probably give it 25 minutes, Laura, and he's 317 00:34:45,830 --> 00:34:50,710 probably jumping on laps and I need to, I need to take him out. So I will watch out for that. So going 318 00:34:50,710 --> 00:34:58,090 back to your study, often we think of a researcher in a white coat, in a lab, working on their own, but 319 00:34:58,090 --> 00:35:04,090 your study involves working with real breast cancer patients. What's the, what's the process 320 00:35:04,090 --> 00:35:09,110 like with, with those patients? What kind of involvement do you have? How do you find them? And 321 00:35:09,110 --> 00:35:15,910 what information are you getting from them? Yeah, great question. It's absolutely, you know, 322 00:35:15,910 --> 00:35:22,930 incredibly important to work with women who've experienced breast cancer when developing a 323 00:35:22,930 --> 00:35:30,110 support program for women who've had breast cancer. That sounds, of course, so obvious when 324 00:35:30,110 --> 00:35:37,390 you say it out loud, but there's been so many instances in the past where researchers like me 325 00:35:37,390 --> 00:35:42,650 have developed support programs for, for instance, for people with cancer and not spoken to 326 00:35:42,650 --> 00:35:48,210 people with cancer. And then we then have no idea whether it's acceptable to them, whether people 327 00:35:48,210 --> 00:35:55,590 are going to enjoy and take part in that support program. And so we're really taking a 328 00:35:55,590 --> 00:36:00,870 comprehensive approach to make sure that everything we do, this full support program is 329 00:36:00,870 --> 00:36:06,010 very much grounded in the views and the needs of people who've experienced breast cancer. So we 330 00:36:06,010 --> 00:36:15,230 have what we call a patient and public involvement or PPI group that are following the entire process 331 00:36:15,230 --> 00:36:23,870 throughout the whole three years. We've got two patient leads who are essentially sharing and 332 00:36:23,870 --> 00:36:31,010 managing our patient and public involvement group. And they're working with another eight 333 00:36:31,010 --> 00:36:39,510 fantastic women, so 10 in total, who are working with our research team. And they will be, they're 334 00:36:39,510 --> 00:36:45,430 actively involved in making decisions and shaping the direction of the project. And so they 335 00:36:45,430 --> 00:36:51,310 are just, as if not more important than any of us researchers who are developing this support 336 00:36:51,310 --> 00:36:57,070 program. And that group will, again, work with us throughout the duration of the project. We then 337 00:36:57,070 --> 00:37:02,590 conduct in the first instance, so actually starting next week is holding some focus groups 338 00:37:02,590 --> 00:37:09,850 with other women who've had experience with breast cancer to really better understand their 339 00:37:09,850 --> 00:37:16,510 experiences and views of physical activity and diet support after their breast cancer diagnosis 340 00:37:16,510 --> 00:37:22,570 and after finishing treatment. We're also doing or holding focus groups with other, what I'd call 341 00:37:22,570 --> 00:37:29,410 stakeholders as well. So exercise professionals, dietitians with expertise in 342 00:37:29,410 --> 00:37:35,630 cancer oncologists, nurses, primary care professionals to have their input as well about 343 00:37:35,630 --> 00:37:42,470 their barriers and facilities of providing this support within the follow up pathway and exactly 344 00:37:42,470 --> 00:37:49,510 what is the support that they think would be best to offer in this context. We're then holding some 345 00:37:49,510 --> 00:37:58,250 workshops where based on what we've learned from the focus groups, we'll essentially say, this is 346 00:37:58,250 --> 00:38:03,170 what we think the support program will look like based on everything we've learned. What do you 347 00:38:03,170 --> 00:38:11,330 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 348 00:38:11,330 --> 00:38:17,130 can say, okay, we think this referral process and this training package, how we will train 349 00:38:17,130 --> 00:38:23,650 community service providers is, we think this is feasible and acceptable to both women and also 350 00:38:23,650 --> 00:38:30,510 other stakeholders like oncologists and healthcare professionals. Then what we'll do is 351 00:38:30,510 --> 00:38:36,210 actually run the trial with around 40 women who will be referred by their healthcare 352 00:38:36,210 --> 00:38:43,370 professional into a community exercise and diet program that's delivered by a health works 353 00:38:43,370 --> 00:38:49,050 charity who've received our training package and we'll further then we'll be conducting some 354 00:38:49,050 --> 00:38:53,230 interviews with some of those women in the healthcare professionals to understand again 355 00:38:53,230 --> 00:38:59,930 exactly how the referral process was implemented in standard care, what the barriers and 356 00:38:59,930 --> 00:39:07,110 facilitators were to carrying out that referral process, whether women turned up to the exercise 357 00:39:07,110 --> 00:39:13,590 program, whether they enjoyed it. So very much the person's voice who's had experience of breast 358 00:39:13,590 --> 00:39:20,530 cancer is so central to this project and it just would not go ahead without it. So in terms of 359 00:39:20,530 --> 00:39:25,950 timelines, when are you hoping to complete the project and how will our listeners be able to 360 00:39:25,950 --> 00:39:35,230 access those better services? Great question. Unfortunately, these things do take some time. So 361 00:39:35,230 --> 00:39:44,430 our project started in October 2023 and it's due to last three years, so finish in September 2026. So 362 00:39:44,430 --> 00:39:51,890 what we're looking to get out of the end of that project, we're hoping to have a program that 363 00:39:51,890 --> 00:39:58,350 encompasses a referral pathway and a training package that we've tested and is feasible and 364 00:39:58,350 --> 00:40:07,130 acceptable to women who've had breast cancer. Our intentions after that is to work out a way to roll 365 00:40:07,130 --> 00:40:13,810 that out and implement that. So that will probably take a little bit of work of what we call 366 00:40:13,810 --> 00:40:20,410 implementation science about how we are going to not just work with a small charity and a couple of 367 00:40:20,410 --> 00:40:26,770 NHS trusts in the Northeast, but how we can roll this out nationwide. That might take a couple of 368 00:40:26,770 --> 00:40:32,710 years by the time we have acquired funding and been able to complete that work. What I would say 369 00:40:32,710 --> 00:40:40,130 between five to six years, my vision for this project is to have these services embedded, this 370 00:40:40,130 --> 00:40:46,630 referral to these services embedded within standard care as part of routine follow-up for 371 00:40:46,630 --> 00:40:53,130 women with breast cancer. Okay, well obviously that doesn't mean that people who have had breast 372 00:40:53,130 --> 00:40:57,190 cancer treatment should wait five to six years to start exercising. They should start today, 373 00:40:57,190 --> 00:41:02,770 right? Are there particular exercises or particular physical activities that are 374 00:41:02,770 --> 00:41:09,550 especially beneficial for people who've had breast cancer? So a couple of important points I 375 00:41:09,550 --> 00:41:19,910 always like to raise and I physical activity is beneficial. So any type, any amount of physical 376 00:41:19,910 --> 00:41:27,510 activity done at any intensity, so it all beneficial. But more is better. In terms of the 377 00:41:27,510 --> 00:41:33,570 type of physical activity, again there are various different types. We usually split these 378 00:41:33,570 --> 00:41:41,470 into four different domains. One is physical activity done as part of household chores in the 379 00:41:41,470 --> 00:41:47,710 household domain. So for instance, you know washing up, gardening, etc. Physical activity 380 00:41:47,710 --> 00:41:58,810 done as transport, so walking to work or cycling. Physical activity done as part of work. So that 381 00:41:58,810 --> 00:42:03,310 could compass any working behind a bar, for instance, and being physically active during 382 00:42:03,310 --> 00:42:09,350 that. Or physical activity as part of leisure time. And that's essentially exercise is what 383 00:42:09,350 --> 00:42:15,130 we're referring to there. Now on the caveat that all physical activity is beneficial. So done as 384 00:42:15,130 --> 00:42:22,790 part of home, done as part of transport, as work, or during leisure time, all is beneficial. But there 385 00:42:22,790 --> 00:42:29,030 is, I believe there's something particularly special about physical activity done as part of 386 00:42:29,030 --> 00:42:36,710 leisure time or planned structured exercise. Usually it is split into two different types and 387 00:42:36,710 --> 00:42:43,910 that's aerobic exercise and resistance exercise. So aerobic exercise might be going for a 388 00:42:43,910 --> 00:42:48,450 brisk walk, for instance, usually done at a moderate intensity or above, which essentially 389 00:42:48,450 --> 00:42:56,070 just means you're starting to get breathless. And resistance exercise, which I know Laurie are 390 00:42:56,070 --> 00:43:02,290 particularly interested in. And that's what is sometimes referred as muscle strengthening 391 00:43:02,290 --> 00:43:06,850 exercises. So lifting weights, but it doesn't always have to be lifting weights. So it could be 392 00:43:06,850 --> 00:43:12,170 lifting household objects, for instance, or things like using resistance bands, which 393 00:43:12,170 --> 00:43:17,370 typically can be quite helpful around the home. When you said then that I am particularly 394 00:43:17,370 --> 00:43:22,590 interested in resistance, so this is actually something and I know a lot of people will relate to 395 00:43:22,590 --> 00:43:28,910 this. I had a big operation last year, I'm in my early 40s now, and have experienced all the 396 00:43:28,910 --> 00:43:35,330 menopausal symptoms, having had nearly 12 years of cancer treatment and now with secondary breast 397 00:43:35,330 --> 00:43:45,130 cancer. And so for me, muscle maintenance and muscle strengthening is, I am told, more 398 00:43:45,130 --> 00:43:50,130 important than anything else. And I'm also getting a lot of injuries now, a lot of recurring 399 00:43:50,130 --> 00:43:59,210 injuries. Where would you suggest people start in terms of strengthening and weightlifting, which 400 00:43:59,210 --> 00:44:03,310 as you mentioned earlier can seem like a really scary daunting task for someone who's never done 401 00:44:03,310 --> 00:44:11,030 it? Resistance exercise, as you said, it is the best type of exercise for muscle mass, muscle 402 00:44:11,030 --> 00:44:17,470 strength and bone health. And I think it's important again to remember that there are no 403 00:44:17,470 --> 00:44:23,570 particular exercises that you must do. And I think we can all fall into this trap. I know I have, for 404 00:44:23,570 --> 00:44:32,510 example, that's not true. And one resistance exercise might look to another despite having 405 00:44:32,510 --> 00:44:37,730 similar benefits. And sometimes that's around trial and error, finding the right type of 406 00:44:37,730 --> 00:44:45,310 resistance exercise that works for you and avoids, you said, you had some injuries and some 407 00:44:45,310 --> 00:44:50,930 pain. And it's about working around those, it's about avoiding pain. And sometimes again, it can 408 00:44:50,930 --> 00:44:59,530 take trial and error to find the right exercise that avoids pain. Low impact exercise can be 409 00:44:59,530 --> 00:45:10,010 beneficial. So you might avoid jumping, for instance. And there's a lot to be said about 410 00:45:10,010 --> 00:45:16,350 starting slowly and building up gradually. Again, I think we can all think okay, we've 411 00:45:16,350 --> 00:45:20,930 probably all been guilty of thinking, okay, I'm going to start exercising, I need to go to the gym 412 00:45:20,930 --> 00:45:27,330 for an hour and do this many exercises for this to be beneficial. And it all comes from some of the myths 413 00:45:27,330 --> 00:45:35,190 around no pain and no gain and all that rubbish, which is rubbish. And so I think there's a lot to be 414 00:45:35,190 --> 00:45:41,870 said for starting slow and gradually building up. And also having a thorough warm up as well will be 415 00:45:41,870 --> 00:45:50,770 beneficial around pain. Getting started with resistance exercise can be very daunting and 416 00:45:50,770 --> 00:45:58,110 quite challenging. There are lots of things that people can do around the home. So in the home that 417 00:45:58,110 --> 00:46:06,370 that count as resistance exercise, so a very simple one sat on in your chair or sat on your sofa, 418 00:46:06,370 --> 00:46:12,030 standing up, sitting back down again, standing up, sitting back down again, you've just 419 00:46:12,030 --> 00:46:19,050 performed two body weight squats. Surprisingly hard as well, surprisingly challenging to see how 420 00:46:19,050 --> 00:46:25,190 many of those you can do in one minute was a test that I had from my physio. Yes, absolutely. And they are 421 00:46:25,190 --> 00:46:31,630 very difficult. And and so there are ways to make those easier, for instance, if that's not 422 00:46:31,630 --> 00:46:36,030 comfortable for you at the moment, there are ways that you can, for instance, put cushions 423 00:46:36,030 --> 00:46:40,310 underneath your bum when you sit down to make the distance that you're standing up a little bit 424 00:46:40,310 --> 00:46:46,390 less. There are also ways to make it harder, actually, if they are become over time quite easy 425 00:46:46,390 --> 00:46:51,090 for people. For instance, you could hold some books in your hand as you stand up to add some 426 00:46:51,090 --> 00:46:57,770 resistance. For other people, people might be interested in going to a gym. So it's absolutely 427 00:46:57,770 --> 00:47:02,690 and again, it's just what works for you resistance exercise is important. It can be done at home with 428 00:47:02,690 --> 00:47:08,570 simple objects around the house, for example, having some cans of soup and lifting them above 429 00:47:08,570 --> 00:47:16,330 your head. For example, for some people may want to go to a gym and that's fine as well. I would always 430 00:47:16,330 --> 00:47:22,250 suggest if people haven't gone to a gym previously and it's something they are looking to start is to 431 00:47:22,250 --> 00:47:26,990 proactively seek out support for that. That might simply be just going with a friend a couple of 432 00:47:26,990 --> 00:47:34,370 times. In the first instance, to build up some confidence around the exercises and the 433 00:47:34,370 --> 00:47:39,110 machines. And again, we've probably all experienced this that we walk in, for those who 434 00:47:39,110 --> 00:47:44,250 have gone to a gym, you walk into a gym, and you think, man, this is this is quite daunting. I have 435 00:47:44,250 --> 00:47:49,090 really no idea how to use this equipment and things. So going with someone who a friend or 436 00:47:49,090 --> 00:47:55,450 someone you know, or even someone a gym instructor who was able to induct you into the gym is really 437 00:47:55,450 --> 00:48:03,030 beneficial. There are lots of different classes out there at the moment, unfortunately, not 438 00:48:03,030 --> 00:48:07,890 cancer specific, which we hope to change throughout projects, but other community 439 00:48:07,890 --> 00:48:15,730 classes that people might consider going to as well, which are usually circuit based or involve 440 00:48:15,730 --> 00:48:20,150 some resistance exercise, but have an instructor there and different people there who are able to 441 00:48:20,150 --> 00:48:26,390 help. I would also say services are completely different around the country. But I would say if 442 00:48:26,390 --> 00:48:37,530 anyone is currently being treated at a hospital, do ask your oncologist or if you're given a breast 443 00:48:37,530 --> 00:48:44,470 cancer nurse, do ask them if there is a physio or if there are any exercise support services that they 444 00:48:44,470 --> 00:48:51,350 have, because from my experience, those aren't necessarily given to you on a plate. But if you ask, 445 00:48:51,350 --> 00:48:59,590 you often find that there is a service and I've just had six amazing gym sessions over a six week course 446 00:48:59,590 --> 00:49:04,990 with the with my hospital physio, which was completely free and was absolutely life changing 447 00:49:04,990 --> 00:49:10,750 because it just gave me the confidence to use weights. And I actually, as you said, I started off 448 00:49:10,750 --> 00:49:18,630 with those 400 gram tins of beans at home. And so it can be free. And it can be much easier than you might 449 00:49:18,630 --> 00:49:26,490 think. And also, if somebody is a member of a gym already, often gyms give a free maybe half hour 450 00:49:26,490 --> 00:49:31,730 session that's included like an induction, you don't necessarily have to pay a personal trainer 451 00:49:31,730 --> 00:49:38,490 to get started. So there are always ways to get started. Yeah, absolutely. You make an 452 00:49:38,490 --> 00:49:45,890 absolutely fantastic point that asking that question of with your healthcare provider is a 453 00:49:45,890 --> 00:49:54,610 really good place to start. And I'm a really big believer that for those of us who are able bodied, 454 00:49:54,610 --> 00:50:02,950 we can be physical active. It's an exercise is frozen. I again, we have these connotations of 455 00:50:02,950 --> 00:50:07,330 what exercise looks like. And we think, okay, that's that's not for me. That's not who I am. I'm 456 00:50:07,330 --> 00:50:13,490 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 457 00:50:13,490 --> 00:50:22,710 around building confidence around the ability to exercise that can then help propagate and sustain 458 00:50:22,710 --> 00:50:29,170 exercise in the future. Yeah. And possibly even through breast cancer now, people can just be 459 00:50:29,170 --> 00:50:34,530 connected with another patient who then might you might start something with because obviously a 460 00:50:34,530 --> 00:50:39,030 lot of people do lack that confidence to just get started on their own. I know you're not a 461 00:50:39,030 --> 00:50:46,370 nutritionist. But I wonder if you do have any small tips on diet to supplement to supplement a healthy 462 00:50:46,370 --> 00:50:53,590 exercise routine. We know that alcohol and smoking is bad. But are there any particularly 463 00:50:53,590 --> 00:51:00,310 good foods that you can recommend or any particular diet changes? Yeah, absolutely. And 464 00:51:00,310 --> 00:51:05,310 that's something else that it's probably worth clarifying that this difference between a 465 00:51:05,310 --> 00:51:12,370 dietitian and a nutritionist. So I would consider myself as a nutritionist to have the nutrition 466 00:51:12,370 --> 00:51:20,170 qualifications to support that. But what I'm not is a is a dietitian and dietitians, they assess, 467 00:51:20,170 --> 00:51:26,370 they treat and diagnose dietary nutritional problems. And they're able to recommend specific 468 00:51:26,370 --> 00:51:34,130 diets, for instance, as a nutritionist, I can provide general health eating guidance. And I 469 00:51:34,130 --> 00:51:40,080 think that's an important distinction to make. And I'm a big believer in staying in my own lane. I 470 00:51:40,080 --> 00:51:46,790 have some, it may surprise, I have some expertise in some areas, but I'm the first one to say, hang on, 471 00:51:46,790 --> 00:51:53,090 I'm no expert in this area. Let's have a chat with a colleague who is so health in terms of health 472 00:51:53,090 --> 00:51:59,690 eating for women who've had breast cancer. Currently, the best available evidence suggests 473 00:51:59,690 --> 00:52:05,190 following a healthy diet pattern that's very similar to what people have probably heard before 474 00:52:05,190 --> 00:52:12,310 for other health, for general health purposes. And that encompasses things like following a diet 475 00:52:12,310 --> 00:52:18,990 plan that helps maintain a healthy weight. Some other components of a healthy diet include 476 00:52:18,990 --> 00:52:25,290 following eating a diet that's rich in whole grains, including fruits and vegetables, 477 00:52:25,290 --> 00:52:31,190 avoiding sugary drinks and limiting things like fast and processed foods. And as you've just 478 00:52:31,190 --> 00:52:40,550 mentioned, limiting alcohol intake and not smoking. So there's no specific foods or that are 479 00:52:40,550 --> 00:52:47,670 that people should or shouldn't eat after breast cancer and is streaming or at least the moment the 480 00:52:47,670 --> 00:52:54,430 current evidence doesn't suggest that. But following those healthy eating principles will 481 00:52:54,430 --> 00:53:00,650 be helpful to living well after breast cancer. Sam, I would like to ask you the question we ask all 482 00:53:00,650 --> 00:53:05,250 our guests on this podcast, which is, what is the one thing you'd like to see change in the coming 483 00:53:05,250 --> 00:53:12,470 years in terms of breast cancer, diagnosis, treatment and beyond? Great question. I would 484 00:53:12,470 --> 00:53:19,330 like to see physical activity and support and referral to be routinely offered as part of 485 00:53:19,330 --> 00:53:25,810 standard follow-up care for women who've had breast cancer and breast cancer treatment. We 486 00:53:25,810 --> 00:53:32,750 hope, I hope that our projects called Purex can provide a feasible and acceptable and scalable 487 00:53:32,750 --> 00:53:40,270 model to be able to do that. Fantastic. And is there anything else you'd like to share with us? I guess I 488 00:53:40,270 --> 00:53:46,270 would like to finish on just a couple of takeaway key points. And that is, and I've said this a few 489 00:53:46,270 --> 00:53:56,270 times, that remember that being physically active is for most of us, if not all of us, doing any 490 00:53:56,270 --> 00:54:03,390 physical activity is beneficial, any amount in any type and doing more is better. It can bring a 491 00:54:03,390 --> 00:54:11,730 whole host of benefits. The strongest evidence is for improving things like fatigue, low mood and 492 00:54:11,730 --> 00:54:16,290 there is emerging evidence now that physical activity after breast cancer treatment can help 493 00:54:16,290 --> 00:54:26,050 stop or reduce the risk of breast cancer coming back in the future. It doesn't completely 494 00:54:26,050 --> 00:54:32,490 eliminate the risk, but it does provide a small risk reduction. And I was actually just talking to 495 00:54:32,490 --> 00:54:39,430 one of our patient leads, Kelly Ross, about this and how this is put across to the public and people 496 00:54:39,430 --> 00:54:47,810 who have had breast cancer to avoid any feelings of guilt. So after having breast cancer and having 497 00:54:47,810 --> 00:54:53,830 treatment and being a remission of breast cancer, being physically active after that can reduce the 498 00:54:53,830 --> 00:55:01,710 risk of breast cancer coming back by a reasonably small amount. So it can help. That does not mean if 499 00:55:01,710 --> 00:55:06,790 you're, even if you're highly physical active, you're always going to the gym, you're always 500 00:55:06,790 --> 00:55:12,690 going on runs that breast cancer won't come back. That it does, that's not what it means. What it 501 00:55:12,690 --> 00:55:20,270 means is compared to if you weren't physical active at all, being regularly physical active, 502 00:55:20,270 --> 00:55:28,090 the risk of breast cancer coming back is lower. So and that's, I think, a really important message 503 00:55:28,090 --> 00:55:34,910 because when we speak to women who've had breast cancer, reducing the risk of that cancer coming 504 00:55:34,910 --> 00:55:41,370 back is very much understandably so on the forefront of people's worries and their minds. So 505 00:55:41,370 --> 00:55:48,370 physical activity can help with that. It may help with things like, again, immune system activity, 506 00:55:48,370 --> 00:55:54,050 things like inflammation and things like insulin resistance as well. So we don't have the exact 507 00:55:54,050 --> 00:56:00,450 reasons why yet, but there are lots of proposed mechanisms that do have some legitimacy to them. 508 00:56:00,450 --> 00:56:07,590 Yes. I just wanted to say if your breast cancer comes back and you haven't exercised, it doesn't 509 00:56:07,590 --> 00:56:11,130 mean that it's your fault. Similarly, because there are so many different factors that 510 00:56:11,130 --> 00:56:16,790 contribute to getting breast cancer in the first place and breast cancer recurrence, ranging from 511 00:56:16,790 --> 00:56:23,110 lifestyle to environment to genetics to so much more. So it's never your fault. I think is the 512 00:56:23,110 --> 00:56:28,630 message that we want to get across on this podcast, which you've said about various things as well. 513 00:56:28,630 --> 00:56:34,270 Yeah, absolutely. Thanks for picking up Laura. And that's such an important message. And again, 514 00:56:34,270 --> 00:56:40,750 that was something I was speaking to a patient lead about that both those sides, as you say, if you're 515 00:56:40,750 --> 00:56:45,370 not physical active and the breast cancer comes back, that is absolutely not your fault. And the 516 00:56:45,370 --> 00:56:51,290 other side as well, if you are very physical active, you can still get breast cancer. So you're 517 00:56:51,290 --> 00:56:56,430 right, those are really important messages to put across. Where can people find out more about your 518 00:56:56,430 --> 00:57:04,090 work? So they can go on the Breast Cancer Now website, which will be posting updates on our 519 00:57:04,090 --> 00:57:11,030 project. And the other way is via my staff page on Newcastle University's website. So if people are 520 00:57:11,030 --> 00:57:17,610 interested, if they Google Sam Orange, Newcastle University, that's probably the first thing 521 00:57:17,610 --> 00:57:23,470 they'll come up. And you can see different projects that I'm working on and papers that I've 522 00:57:23,470 --> 00:57:27,730 published on that website. We will put all those links in the show notes as well. So you don't have to 523 00:57:27,730 --> 00:57:32,850 do any Googling. And the same with healthy eating tips. There's there's lots of those on the breast 524 00:57:32,850 --> 00:57:37,770 cancer now website as well. So we'll put all those links in the show notes. Well, thank you so much for 525 00:57:37,770 --> 00:57:44,310 joining us. I wish you all the best for your research and your work. And I really hope we will 526 00:57:44,310 --> 00:57:49,530 see some brilliant results on the Breast Cancer Now website in the future. Dr Sam Orange, thank you 527 00:57:49,530 --> 00:57:54,870 so much for joining us. Thank you very much. If you enjoyed this episode of the breast cancer now 528 00:57:54,870 --> 00:57:59,530 podcast, make sure to subscribe on Apple Podcasts, Spotify, or wherever you get your 529 00:57:59,530 --> 00:58:05,170 podcasts. Please also leave us a rating or review on Apple podcasts and perhaps recommend it to 530 00:58:05,170 --> 00:58:10,030 someone you think would find it helpful. The more people we can reach, the more we can get Breast 531 00:58:10,030 --> 00:58:15,350 Cancer Now's vital resources to those who need them. You can find support and information on our 532 00:58:15,350 --> 00:58:21,330 website, breastcancernow.org, and you can follow Breast Cancer Now on social media at Breast 533 00:58:21,330 --> 00:58:25,990 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.