Exercise for Chronic ConditionsFEATURE ARTICLE

Lou James (MNZM), Founder and CEO Pinc & Steel International

I was passionate about becoming a Physiotherapist from the age of 15. I was seriously into sports and represented New Zealand at the Triathlon World Champs for the first time when I was 17. I really wanted to work with athletes to help them rehabilitate and become active again after injury. I started my own Physiotherapy & Pilates studio in Ponsonby when I was 25. However, it wasn't until I started helping people facing cancer that I really felt I was making the valuable difference to people's lives that had originally inspired me to become a Physiotherapist.

Now in my forties I continue to be hugely motivated to help people affected by cancer and to teach other Physiotherapists how to use their skills to make a difference too. I founded Pinc & Steel International in 2008 and now our cancer rehabilitation education programs are being accessed by Physiotherapist’s in 11 countries. One of the most rewarding aspects of my work is hearing from the Physios we train about how our programs have sparked their passion for working in this rewarding field.

The burden of cancer in our communities is enormous and for many, cancer is a chronic illness, with echoes that last long after treatment ends. It is exciting to see the advances in research over the past decade, particularly supporting the use of exercise training for this patient population. Emerging literature has addressed the effects of exercise-based rehabilitation programs along the continuum of the disease and this has rapidly progressed the role of physiotherapy in cancer.

Photo credit: Lou James (PINC & STEEL Founder) running with breast cancer survivor Judith Ansell.

The primary focus of oncology medical professionals is to eliminate or control disease by suppressing cancer cell growth (chemo, radiation, targeted therapies or directly removing the tumour (surgery). These treatments are increasingly successful but they also damage ‘normal’ tissue. While oncology specialists seek the best possible outcomes, i.e. the absence of any residual cancer –this does not mean genuine, meaningful recovery is complete. The Cancer Rehab Physiotherapists’ focus is on supporting the whole patient, not just addressing their cancer.

Physical activity and exercise are vital components targeting three main aspects of the cancer continuum: prevention, morbidity and mortality. Exercise rehab in cancer care is a growing area of practice and has the potential to:

1. HELP PREVENT UNNECESSARY DISABILITY - The number of people living longer and surviving cancer is growing, however these people may be living with long-term side effects of the disease and treatment (both physical and emotional), which make them feel they haven’t ‘beaten’ cancer at all. Side effects may be visible during or very soon after treatment, or they may take months and years to be seen. Many of these side effects can significantly affect quality of life. Exercise prescription tailored to the individual can help minimise the risk of short and long-term side effects and help prevent unnecessary disability.

2. RESTORE MOVEMENT AND FUNCTION -

Cancer rehabilitation physiotherapists are experts in restoring movement and function to people affected by cancer. However, it doesn't stop there. There is also strong evidence supporting exercise rehabiliation not only helping people physically but also emotionally, vocationally and socially.

3. HELP MANAGE FATIGUE, DURING AND

AFTER TREATMENT - There is an abundance of evidence that regular moderate exercise can decrease feelings of tiredness, lack of energy and fatigue. During cancer treatment it is often possible to continue exercising if it is carefully prescribed by a Cancer Rehab Physiotherapist.

4. ASSIST THE PSYCHOLOGICAL RECOVERY -

There is an emotional toll that cancer survivors face in addition to the physical one. A cancer diagnosis can cause depression, anger, anxiety, fear and stress. Exercise rehabilitation, reassurance and education can help improve psychological recovery.

5. PREVENT FURTHER DEGENERATION OF

HEALTH - If symptoms are not managed throughout treatment there is a greater risk a patient will have problems coping. The combined burden from treatments and lack of physical activity can cause de-conditioning, which can further exacerbate fatigue and lead to a longer road to recovery. Cancer Rehab Physiotherapists can help patients overcome the significant physical and functional impairments suffered after cancer surgery and treatments that act as major barriers to resuming physical activity.

6. REDUCE AND DECELERATE THE IMPACT OF

A RANGE OF SYMPTOMS - There is evidence that exercise can help in symptom control, reduction of treatment toxicity and ability to improve the tolerance of and recovery from intensive cancer treatment regimens. Exercise rehabilitation can help patients: • maintain their independence; • increase their strength, range of motion, functional status, and physical activity levels; • manage their fatigue, and pain; • restore bowel and bladder function, and • help people return to work, sport and activities they love.

CONTINUED ON NEXT PAGE >> The thought of exercise can be overwhelming to people affected cancer, but a well-designed exercise program may help them feel better physically and mentally, and it may also decrease the risk of further disease. Recent insights are beginning to illustrate the progression and plausibly extending overall survival, largely through preclinical studies or epidemiological associations. Exercise is a dose-dependent mechanical stimulant (with evidence of dose-response) that can be safely prescribed to patients with advanced cancer and sclerotic metastases. Patients are at increased risk of osteoporosis, cardio-vascular disease, diabetes, functional decline and cancer recurrence. My work with this population, as well as published research, confirms that exercise helps to mitigate the side effects of cancer treatment and surgery.

Cancer Rehabilitation is very rewarding work for physiotherapists to be involved in and you can truly make a big difference to peoples’ lives.

Cancer patients endure a huge amount and their journey is long and uncertain. I have been privileged to meet many inspiring people thorough my work and observe their strength and uncommon wisdom. It is not simply that they see the big picture, if you spend long enough with them they help you see it too.

To find out more about Cancer Rehabilitation Education for Physiotherapists visit www.pincandsteelphysios.com

Lou James (MNZM) has dedicated the last 15 years to helping improve the lives of people affected by cancer in New Zealand and overseas. Lou graduated with a Bachelor of Health Science in Physiotherapy from AUT in 1997. She is responsible for the introduction of the PINC & STEEL, Next Steps and PaddleOn Cancer Rehabilitation Programmes, which focus on the physical and mental wellbeing of people affected by cancer. The programmes are now available in 11 counties and have supported thousands of people. In New Zealand the programmes are supported by a number of charities including Breast Cancer Foundation New Zealand, CanTeen, The Bowel Cancer Foundation Trust, Look Good Feel Better, Leukemia & Blood Cancer NZ and the Prostate Foundation.

In 2006, Lou founded the PINC & STEEL cancer rehabilitation Trust to help make rehabilitation more accessible and affordable for New Zealanders. Lou has been recognised for her pioneering work in this field, most recently being appointed a Member of the New Zealand Order of Merit in the 2017 Queens New Years Honours List for services to people with cancer.

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