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Over 500,000 Australians have this condition and don’t know it yet…

Early Detection of Diabetes – National Diabetes Week
8th – 14th July 2018

The Background

Did you know that half a million Australians could have type 2 diabetes, but don’t know it yet?

Did you know that 600 people present to hospital emergency rooms each year feeling unwell, and discover that it’s due to undiagnosed type 1 diabetes?

This July, Diabetes Australia aims to reduce these figures and the impact they have on the healthcare system (not to mention the individual). National Diabetes Week is all about raising awareness around early warning signs and ongoing management of these conditions.

Insulin lets the glucose in

Every time you consume food which contains carbohydrates (basically all the yum stuff!), the body breaks it down into glucose and tries to put it away as a fuel source – namely in the muscles for exercise, the brain for thinking, and the liver for longer term storage.

If you imagine that all of these locations have a locked door, you could consider insulin to be the key. Once unlocked, insulin is able to move the glucose out of the blood and into the cells.

In type 1 diabetes, not enough keys are being produced, and glucose levels start to rise. This is an autoimmune condition, and is often, but not always, diagnosed in childhood.

In type 2 diabetes, the keys are ready to go, but it’s as though someone has changed the locks. This is an unhelpful adaption to an unhealthy lifestyle, and is more likely to be diagnosed in adulthood.

Hyperglycaemia: too much of a good thing

Glucose, preferably broken down from complex carbohydrates (although particularly delicious in desserts), is an important fuel source for day to day functioning. In a healthy individual, it can be rapidly broken down for use in moderate and high intensity exercise, provides power to the brain, and lives in the muscles and the liver for later use.

In the case of diabetes, glucose levels in the bloodstream creep up over time and start to damage the small blood vessels and nerves throughout the body. The retina of the eye, kidneys, heart and peripheral nerves of the hands and feet are particularly susceptible to this damage, which is highly preventable if detected and managed early.

Know the 4 Ts for Type 1 Diabetes

When it comes to diagnosing type 1 diabetes, there are four predominant early warning signs:

1. Thirst – are you overly thirsty and feel unable to quench that thirst?
2. Toilet – are you frequently urinating?
3. Tired – are your energy levels low?
4. Thinner – have you recently lost weight?

Undiagnosed type 1 diabetes can be potentially fatal due to the fluctuations of blood glucose in the body – if in doubt, contact your GP.

Calculate your risk for Type 2 Diabetes

The Australian Type 2 Diabetes Risk Asssesment Tool (found here: https://www.diabetesaustralia.com.au/risk-calculator) is a fast way to know your risk.

You’ll notice that while some of the risk factors are non-modifiable (age, gender, race, family history); many of them can be changed (fruit and vegetable intake, waist circumference, physical activity levels).

What can be done?

Well prescribed exercise is an underutilised and highly beneficial tool in the management of both type 1 and 2 diabetes, and is especially powerful in the prevention of type 2 diabetes.

Be sure to read the second instalment of this Specialised Health article to find out what simple actions you can take to drastically reduce your risk.

Boosting Physical Activity, The How-to and Why-to Guide

From Specialised Health’s Exercise Physiologist, Jennifer Smallridge

In our previous newsletter (click here to go back and check it out), we gave a comprehensive background on Physical Inactivity Awareness Month and the widespread epidemic of insufficient movement in Australia. In this update, we relate this back to the Insurance industry and explain how increasing physical activity can have a positive flow on effect to other areas  of health, how exercise physiologists facilitate this behaviour change and how case management strategies can be improved as a result.

Determining the drivers for change

Knowledge around the benefits of exercise is the tip of the iceberg when it comes to making sustainable behaviour change. Exercise physiologists are specifically trained in behavioural psychology strategies, such as motivational interviewing, to elicit desired outcomes, particularly in a previously ‘unmotivated’ individual.

Whilst obtaining a subjective history, Exercise Physiologists are constantly assessing for cues that may give us a hint about which stage of change this person might be in. Are they completely inactive and unaware of how to exercise for their condition, or do they occasionally walk the dog? Are they voicing or alluding to any barriers, real or perceived? What about the enablers – do they have positive social support in their life? When you make a referral to exercise physiology, you can rest assured that these factors are being taken into consideration when devising an effective conditioning program.

An Exercise Physiologist’s toolkit

Rather than a simple ‘set and forget’ work conditioning program, exercise physiologists use a variety of evidence-based strategies to increase adherence and maximise results. These may include, but are not limited to:

  • Subjective self-report diaries of exercise, mood, sleep, nutrition, energy levels
  • Objective measures such as pedometers and activity trackers
  • Access to suitable equipment within the home setting, or appropriate facilities through a gym membership
  • Devices such as the iThlete to track nervous system recovery, particularly in the fatigue cohort
  • Online integrated systems such as Physitrack which provide videos of prescribed exercises and enable practitioner-customer communication

More than movement

Engaging in supervised physical activity on a regular basis can bring about more than lifting capacity or cardiovascular fitness. Some of the ‘behind-the-scenes’ benefits of service provision include the following:

  • Appointment-keeping

If an individual has been off work for a while and checks in with their GP or specialist sporadically; exercise physiology appointments can serve as a useful re-integration into activity scheduling and responsibility. The time of day that the appointment occurs can also provide a good gauge of function; particularly if sessions have moved from late in the day to early morning appointments.

  • Self-efficacy

Self-efficacy is defined as one’s belief in their ability to complete a task successfully, even in the face of barriers. Work conditioning programs are one of many ways of boosting self-efficacy, by being set a task (regular, targeted exercise) to complete when there may be acknowledged obstacles (fatigue, pain, low motivation). Anecdotally, this factor has been known to improve engagement in other areas of life; from good nutrition, to sleep hygiene, to job seeking. There are validated measures around exercise self-efficacy available which capture this information and can also prove helpful when assessing program impact.

  • Constant communication

Through formal reports and more informal updating, exercise physiologists can provide information that may not have been previously known, particularly if there has been communication issues in the past. Each health professional adds another ‘set of eyes’ to gather data pertaining to the presentation, capacity, and overall wellbeing of the patient. We are in a unique position to be able to see people in the home, gym or work environment actually performing their required tasks, which allows the customer to build confidence in their own abilities and also allows others such as the GP, Rehab Provider and Insurer to strategise accordingly and potentially offer services to the client which are more aligned with their goals, abilities and beliefs.

The take home message:

The National Physical Guidelines recommend 150 minutes of moderate-intensity physical activity per week for good health, and it is the goal of any intervention to reach this target in a way that meets specific customer needs. Exercise physiologists possess not only the knowledge but the how-to when it comes to promoting long term change.

References:

Mirotznik, J., Ginzler, E., Zagon, G. and Baptiste, A., 1998. Using the health belief model to explain clinic appointment-keeping for the management of a chronic disease condition. Journal of community health23(3), pp.195-210.

Marcus, B.H., Selby, V.C., Niaura, R.S. and Rossi, J.S., 1992. Self-efficacy and the stages of exercise behavior change. Research quarterly for exercise and sport63(1), pp.60-66.

 

 

 

 

 

Do you know what the 4th biggest (but preventable) cause of death is in Australia??

From Specialised Health’s Exercise Physiologist, Ms Jennifer Smallridge

Physical Inactivity Awareness Month, March 2018

Did you know that being physically inactive is the 4th leading cause of death due to preventable diseases1? Exercise and Sport Science Australia (ESSA) is the national body for the field of exercise physiology, and they are dedicated to raising awareness around physical inactivity for the month of March.

As a society we have become skilled at identifying hazardous behaviours such as smoking, excess alcohol and sun exposure, eating too many fatty foods; however physical inactivity as an independent variable is often overlooked when it comes to the prevention and management of chronic disease.

Determining inactivity

So what actually constitutes someone as being ‘inactive’? The National Physical Activity Guidelines stipulate that if you have completed 150 minutes of physical activity in the last week, you are sufficiently active. That’s 2.5 hours, or 5 x 30 minutes, or 15 x 10 minute bursts, out of approximately 117 waking hours – less than 2% of your week!

Keeping the above 7-day recall question in front of mind can also form a ‘quick screen’ for determining current health behaviours and subsequent risk of chronic disease for customers.

Why movement matters

It may not sound like much, but research1 has found that if all Australians did an extra 15 minutes of brisk walking on at least five days each week, the disease burden due to physical inactivity would be reduced by approximately 13%. If this was upped to 30 minutes of walking, the burden could be reduced by 26%. Imagine what would be possible everyone utilised active transport or parked their car a bit further away?

Of particular interest are the seven diseases most closely linked to being inactive, in descending order:
1. Type 2 diabetes
2. Bowel cancer
3. Uterine cancer
4. Dementia
5. Breast cancer
6. Coronary heart disease
7. Stroke

All of the above diseases contribute significantly to health expenditure and burden of disease in Australia, not to mention the impact they have on the quality of life of individuals and their families.

In addition to the above disease states, inactive individuals are also…
⁃ 150% more likely to develop depression
⁃ 23% more likely to develop hypertension
⁃ 82% more likely to develop Alzheimer’s
⁃ 52% more likely to report low levels of happiness.

Those figures alone should make us want to move more!

Are some people predisposed to being more active?

Whilst 55.5% of Australians reported being sufficiently active in the 2014-15 National Health Survey1, we know that more and more people are suffering from conditions that can be linked to a lack of exercise. The decision to participate in physical activity is complex interplay between a number of individual, social and environmental factors.

Analysis of the National Health Survey discovered that the following correlates can determine physical activity participation:
– Socioeconomic disadvantage: Adults in the highest socioeconomic category were 1.5 times more likely to have met the guidelines than those in the lowest
– Health status: Adults who described their health as “excellent” were over twice as likely to have done sufficient physical activity compared with people with “poor” self-assessed health. It makes you wonder which came first – the excellent health, or the decision to exercise? They are inextricably linked.
– Body mass index (BMI): The underweight/normal weight population were 1.4 times more likely to have done sufficient physical activity compared with the obese population.
– Smoking status: ex–smokers and people who never smoked were 1.2 times more likely to have done sufficient physical activity compared with current smokers.

What can be done about physical inactivity?

Exercise Physiologists are exceptionally placed to address this growing problem at an individual, environmental and policy level. Tune into our next Specialised Health update to see what strategies can be utilised to increase physical activity. You might even try some yourself!

References:

1. Australian Institute of Health and Welfare 2017. Impact of physical inactivity as a risk factor for chronic conditions, Australian Burden of Disease Study. Australian Burden of Disease Study series No15. AIHW.

Bowel Cancer Part 2 – The Latest Research and Strategies for Case Managers

From Specialised Health’s Exercise Physiologist, Ms Jennifer Smallridge:

In our previous email, we gave a comprehensive background of bowel and colorectal cancer, in light of the Decembeard initiative by Bowel Cancer Australia. In this update, you will find out why a multidisciplinary approach to bowel cancer works, and how best to provide support from a case management perspective.

Cancer survivorship essentials

The Department of Health and Human Services3 has compiled an optimal care pathway for people with colorectal cancer, and has identified four crucial components of survivorship care:

  • The prevention of recurrent and new cancers
  • Surveillance for cancer spread, screening for medical and psychosocial factors
  • Management of symptoms, distress and practical issues
  • Coordination of care between all providers to ensure the individual’s needs are being met.

Case management and appropriate referrals to allied health support can be particularly effective in managing the latter two stages of the pathway, and should not be underestimated in making the much-needed transition from treatment to remission, and ultimately returning to normal life.

Looking at the whole picture

Bowel cancer survivors may particularly need assistance with and consideration of the following:

  • malnutrition post-treatment due to ongoing treatment side effects (such as weight loss or reduced food intake)
  • altered bowel function and incontinence
  • stoma management
  • decline in mobility and functional status as a result of treatment
  • cognitive changes (altered memory, attention and concentration)
  • emotional distress, fear of disease recurrence, body image issues
  • a need for increased community support

The role of resistant starch

As nutrition is such a significant risk factor for bowel cancer in the first place, it can also assist or detract from appropriate recovery. Recent research2 has looked closely at the role of resistant starches in not only cancer, but type 2 diabetes and obesity. Resistant starch refers to the components of our dietary carbohydrates which pass through the digestive tract unchanged. It helps to feed the good bacteria in the intestine, and prevents the build-up of polyamines (cancer promoting chemicals) in the bowel2.

Resistant starch can be increased in the diet through consumption of the following foods:

  • Slightly green bananas
  • Potatoes and rice that has been cooked, and then cooled (eg: in salads)
  • Wholegrains
  • Seeds and beans such as chickpeas and lentils

Exercising beyond bowel cancer

The links between exercise and quality of life in cancer survivors has been extensively studied, however of interest to a particular group of researchers4 was the finding that as cardiovascular fitness went up, anxiety decreased and functional capacity increased.

Individuals who were previously active but failed to recommence exercise after cancer experienced the lowest quality of life in the following four years4, emphasising that exercise is helpful beyond just the physical benefits for this population group.

From a behaviour change perspective, exercise adherence is found to be highest5 when perceived behavioural control is also high (for example, when individuals feel confident in overcoming barriers and identifying enablers). This research further highlights the need for additional health behaviour support during this challenging time, something exercise physiologists are extensively trained in.

The most frequently reported6 barriers to exercise by bowel cancer survivors include:

  • Lack of time
  • Treatment side effects
  • Fatigue
  • Nausea/gastrointestinal upset
  • Surgical complications

Engaging in a well thought out work conditioning program is therefore a viable option and empowers the individual to make behaviour change to support their recovery.

The take home message:

The life insurance sector is well placed to support an individual across all stages of bowel cancer care, bridging the gap between initial diagnosis/treatment, to successfully returning to work and activities of daily living.

Making the right referrals at the right time supports the multidisciplinary recommendations of the research in this field and also facilitates the individual to move towards self-determination.

Resources:

https://www.bowelcanceraustralia.org

http://www.cancer.org.au/about-cancer/types-of-cancer/bowel-cancer/

References:

  1. Higgins, J. A., & Brown, I. L. (2013). Resistant starch: a promising dietary agent for the prevention/treatment of inflammatory bowel disease and bowel cancer. Current opinion in gastroenterology29(2), 190-194.
  2. Gamet L, et al., (1992). Effects of short-chain fatty acids on growth and differentiation of the human colon-cancer cell line HT29. International Journal of Cancer, 52:2; 286-289.
  3. Department of Health & Human Services, (2015). Optimal Care Pathway for People with Colorectal Cancer, Victoria State Government.
  4. Courneya, K. S., Friedenreich, C. M., Quinney, H. A., Fields, A. L. A., Jones, L. W., & Fairey, A. S. (2003). A randomized trial of exercise and quality of life in colorectal cancer survivors. European journal of cancer care12(4), 347-357.
  5. Courneya, K. S., & Friedenreich, C. M. (1997). Determinants of exercise during colorectal cancer treatment: an application of the theory of planned behavior. In Oncology nursing forum(Vol. 24, No. 10, pp. 1715-1723).
  6. Courneya, K. S., Friedenreich, C. M., Quinney, H. A., Fields, A. L., Jones, L. W., Vallance, J. K., & Fairey, A. S. (2005). A longitudinal study of exercise barriers in colorectal cancer survivors participating in a randomized controlled trial. Annals of Behavioral Medicine29(2), 147-153.

 

Bowel Cancer – What You Need to Know about Prevention and Treatment

“DecemBeard” – Raising Awareness for Bowel Cancer Australia

1st – 31st December 2017

From Specialised Health’s Exercise Physiologist, Jennifer Smallridge:

Aside from Santa Claus, you might be seeing a few more beards around in December, thanks to Bowel Cancer Australia’s “DecemBeard” campaign. For the fifth year running, DecemBeard encourages men to grow their facial hair to raise awareness and much needed funds for bowel cancer.

At Specialised Health, our Exercise Physiologists are frequently working with many types of cancer, and bowel cancer is no exception. Exercise can help along all stages of the journey, particularly to reduce cancer-related fatigue and subsequent comorbities which may develop.

Bowel cancer is Australia’s second most common cancer1, and becomes more prevalent in people over the age of 50. You may also know it as colorectal cancer, and it is usually preceded by the presence of polyps, which can become invasive if undetected.

Early detection is crucial

In recent years, the National Bowel Cancer Screening Program has offered a non-invasive test to be completed in the home free of charge for those over 50. Participation in this program is reported to be around 39%, and it is proposed2 that achieving the targeted uptake of 40% will prevent 92,200 cancer cases until 2040.

The need to screen for this bowel cancer is largely due to the rapid rise in cases, as well as the fact that if detected early, bowel cancer is highly treatable. It can present with no symptoms, however any changes in bowel habits, including the presence of blood, is encouraged to be discussed with a GP.

Prevention is the cure

 Bowel cancer is one of the most preventable cancers, and the Cancer Council3 recommends the following for effective protection:

  • Undertaking the free screening available, every two years, after the age of 50
  • Completing 30-60 minutes of exercise per day
  • Maintaining a healthy body weight
  • Eating a well-balanced diet, high in fruits and vegetables
  • Eating naturally high-fibre foods
  • Avoiding processed and burnt meat, and limiting red meat intake to 3-4 times per week
  • Limiting alcohol, and quitting smoking

It is important to note that most people who develop bowel cancer have no family history of the disease, however a first-degree relative with bowel cancer can increase risk.

Common treatment pathways

The main treatment for early bowel cancer is surgery, removing the cancer and surrounding tissue and rejoining the bowel to restore normal function. In less than 5% of cases, this may result in a permanent colostomy to allow removal of body waste via the abdominal wall. Bowel surgery is a major operation, requiring a recovery period of four to six weeks. If the cancer is detected early, it is less likely that adjuvant therapies such as radiation and chemotherapy need to be utilised.

Life after bowel cancer

Social connection and peer support is crucial after any cancer diagnosis, and Bowel Cancer Australia have established a peer-to-peer network to connect cancer survivors with each other. Many people report a fear of “having the cancer grow back”, and as such a multi-disciplinary approach including follow up appointments and lifestyle support proves to be the best practice in managing the mind and body.

The five-year survivorship rate after a diagnosis of bowel cancer is 69%, and many individuals successfully return to the workforce and the activities that they enjoy.

If you are currently working with a customer who has been diagnosed with bowel cancer, be sure to read our next instalment in the Specialised Health newsletter regarding the most up-to-date research and evidence based recommendations for engaging assistance.

Resources:

https://www.bowelcanceraustralia.org

http://www.cancer.org.au/about-cancer/types-of-cancer/bowel-cancer/

References:
  1. Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.
  2. Kuipers, E.J & Lansdorp-Vogelaar, I. (2017). Colorectal cancer screening in Australia. The Lancet Public Health, 2(7), e304-e305.
  3. Cancer Australia (2017). Bowel cancer fact sheet. Cancer.org.au. Retrieved 23 November 2017, from http://www.cancer.org.au/about-cancer/early-detection/early-detection-factsheets/bowel-cancer.html

Perinatal Anxiety and Depression – Eating and exercising your way back to health

In our previous article, we gave a comprehensive background of perinatal depression and anxiety with a particular focus on postnatal depression (PND), in light of Perinatal Depression and Anxiety Awareness Week from November 12th to 18th. In this update, you will find out why a multidisciplinary approach to PND works, and how best to provide support from a case management perspective.

The food-mood link

The majority of research looking deeper at PND suggests an interplay between hormones, neurotransmitters and environmental factors. When looking at what can be done from a dietary point of view, one study1 identified the following nutrients as important when considering food and mood during this time:

  • Folate, vitamin B6, vitamin B12: for their known role in the biochemical processes around mood regulating hormones such as serotonin, noradrenaline and dopamine
  • Vitamin D: responsible for boosting mood, particularly if sunlight exposure is inadequate
  • Zinc: low zinc status is related to depression in the general population
  • Omega-3 fatty acids: particularly important for postnatal depression; omega-3 levels have been found to be lower in women who develop PND than those who do not

The take home message: enquiring about diet is always valid when dealing with mental health conditions, particularly PND, and provide a quick snapshot regarding the overall state of health of a customer

A well-balanced diet ensures a constant supply of these mood regulating nutrients for not only the mother but the baby, and can simultaneously help to keep other health conditions at bay.

New mothers can feel time-poor and might be focusing on their child’s nutrition rather than their own, but as seen above, neglecting key nutrients results in disrupted mental health in the long term.

The role of exercise

The antidepressant effect of exercise has been established across general and clinical populations, and PND is no exception to this. It is worth mentioning that actual antidepressants have some clinical benefit in one small trial, but there is generally reluctance to take a pharmacological option during pregnancy and breastfeeding.

On the other hand, exercise such as regular walking has minimal side effects and can be empowering for a new mother (i.e: they can self-administer the ‘treatment’). A review2 of exercise in managing PND acknowledges that physical activity improves physical and psychological health in the mother simultaneously, and therefore has a positive flow on effect to her children’s health.

The barriers to engaging in exercise after childbirth must be considered, including changes in body weight and fitness, lack of time, low energy and self-efficacy due to PND. Fortunately, an exercise physiologist can use motivational interviewing techniques to work with customers to overcome recognised barriers and bring awareness to other lifestyle factors which may be conducive to wellbeing.

The take home message: while most people know that exercise is good for them, we cannot underestimate the perceived barriers to being active, particularly in the postnatal period.

In summary – pregnancy is an exciting time for many families, however it is also a vulnerable time for the onset of mental health conditions. With the right care in place, the experience of perinatal depression and anxiety doesn’t need to be isolating or overwhelming

Good food, good movement, good social supports and good psychological input can be engaged in a way that mum, dad and baby will all benefit from.

References:
  1. Leung, B. M., & Kaplan, B. J. (2009). Perinatal depression: prevalence, risks, and the nutrition link—a review of the literature. Journal of the American Dietetic Association, 109(9), 1566-1575.
  2. Daley, A. J., Psychol, C., MacArthur, C., & Winter, H. (2007). The role of exercise in treating postpartum depression: a review of the literature. Journal of Midwifery & Women’s Health52(1), 56-62.

Perinatal Depression and Anxiety

Perinatal Depression and Anxiety Awareness Week

12th – 18th November 2017

By Jennifer Smallridge, Accredited Exercise Physiologist

 

At Specialised Health, our Exercise Physiologists are frequently working with customers with a diagnosed mental illness such as depression, anxiety, PTSD or bipolar disorder. One less frequently encountered condition in the Life Insurance space is Perinatal Depression. In light of it being Perinatal Depression and Anxiety Awareness Week, we wanted to shine a light on this illness and provide some information about the profound effect it can have.

Over 100,000 Australian families are affected by perinatal anxiety and depression each year. PANDA – or Perinatal Anxiety and Depression Australia – exists to promote vital information and support mental health in the antenatal (during pregnancy) and postnatal (after pregnancy) periods.

Due to rapid changes in hormone levels, it is not uncommon for mothers to feel teary and overwhelmed in the three to five days after the birth of her child – up to 80% of women experience the phenomenon known as the ‘baby blues’ immediately after childbirth. The good news is, aided by reassurance and support, these symptoms generally do fade after a few days without treatment.

Signs and symptoms

Postnatal depression (PND) is characterised by a significant period of depression that comes on within the first 12 months of having a baby, and usually strikes within the first few weeks or months. It is most common after a woman’s first pregnancy, and although the severity can vary, symptoms include:

  • Feelings of low self esteem
  • Lack of confidence
  • Feelings of inadequacy and guilt
  • Feeling unable to cope
  • Difficulty sleeping, or sleeping too much

It is important to mention that around 3% of fathers also experience PND, and organisations such as PANDA can assist with both maternal and paternal changes in mental health.

Risk factors

 A large scale review1 of the literature has revealed some recurring risk factors for PND, listed below in order of their impact:

  • Depression and anxiety during pregnancy, which is then exacerbated after pregnancy
  • A personal history of depression
  • Perceived life stress
  • Lack of social support
  • Marital dissatisfaction
  • Low socio-economic status
  • A difficult or traumatic birth experience

 From the mother’s perspective

One study2 which looked into women’s beliefs and attitudes around treatment for PND revealed that the preferred treatment choice for most women was individual psychotherapy sessions. Interestingly, although the value of social support for this population is well established, the women surveyed did not perceive group psychotherapy to be a desired option – this may be as a result of concurrent anxiety or simply having too many scheduled appointments during this important time.

Much of the difficulty in managing PND is related to the stigma associated with asking for help, as it is socially accepted that having a baby is considered to be a joyous and positive life event. This attitude can further isolate a mother who is feeling depressed. A frequent barrier cited by PND sufferers to seeking help was around fear of being labelled a “bad mother”.

What can be done?

Research supports stigma reduction around this serious condition by shining a light on the subject – brochures and posters in waiting rooms, open conversations with obstetricians and GPs with clear referral pathways, routine screening, as well as the sharing of stories through groups, forums and ambassadors in the media.

Remember that the human brain is hard-wired for connection, and so a new mother feeling isolated and overwhelmed by her sadness requires strong social supports to counter this. The quote “it takes a village to raise a child” still rings true, and mothers who are striving to “do it all” may actually end up more susceptible to mental health issues.

If you are currently working with a customer who is suffering from PND, be sure to read our next instalment in the Specialised Health newsletter regarding the most up-to-date research and evidence based recommendations for engaging help for someone with PND.

References:

  1. Norhayati, M. N., Hazlina, N. N., Asrenee, A. R., & Emilin, W. W. (2015). Magnitude and risk factors for postpartum symptoms: a literature review. Journal of affective Disorders175, 34-52.
  2. Goodman, J. H. (2009). Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth36(1), 60-69.

What role is exercise playing in breast cancer prevention and survivorship? The science behind the movement

From Specialised Health’s Exercise Physiologist Jennifer Smallridge:

October is Breast Cancer Awareness Month 
Aside from non-melanoma skin cancer, breast cancer is the most common cancer among Australian women – the chances are that you’ve been involved in a case with a breast cancer survivor. Fortunately, 89 out of 100 women1 diagnosed with invasive breast cancer survive five or more years beyond diagnosis, but the impact of the treatment and recovery process often remains.

The relationship between exercise and breast cancer prevention and survivorship have been well researched, but here is a snapshot of the most up-to-date evidence in the field.

1. Exercise boosts mental processing speed.
With or without chemotherapy, many breast cancer survivors report a decline in brain function which affects memory, thinking and concentration. A 2017 study2 from the San Diego School of Medicine found that incorporating 12 weeks of regular exercise showed more than double the improvements in cognitive processing speed than that of the control group.

2. Exercise alters tumour gene expression.
Emerging research3 presented at the San Antonio Breast Cancer Symposium in 2016 have confirmed what has been found in animal studies for years – exercise in humans changes the genetic makeup of tumour cells. Study participants in the exercise intervention showed upregulation in cytokine gene expression (responsible for cell death), and downregulation of RNA transport and DNA replication (responsible for tumour growth).

3. Exercise prevents the risk of cardiovascular disease in this population.
For women with non-metastatic breast cancer, cardiovascular disease is the leading cause of death. 2016 research4 from the Journal of Clinical Oncology has found that regular exercise results in a substantial reduction in the incidence of cardiovascular events, coronary artery disease and heart failure.

4. Exercise is vital during chemotherapy.
Being physically active during chemotherapy for early-stage breast cancer improves fitness, quality of life, chemotherapy completion rate, and disease-free survival5. The dose-response relationship for this important stage of treatment appears to be the more exercise the better, with one trial5 finding that outcomes were optimised with 3 x 60 minute sessions per week. 2016 research5 also highlighted the need for motivation from healthcare professionals at this time, resulting in higher compliance and increased satisfaction around the exercise program.

While ongoing research breakthroughs continue to explain the causes behind these anti-cancer mechanisms, the main thing is that women feel supported and encouraged to remain physically active during and beyond a breast cancer diagnosis.

Exercise is an essential part of managing breast cancer but employing the most effective strategies to encourage patients to move and maintain activity is perhaps the most important step.

Motivational interviewing, wellness coaching and cognitive behavioural therapy are all techniques that skilled professionals are able to employ to help with overcoming the many barriers that women experience to being active and often a joint approach between physical and psychological-based professionals is the best way to get the ball rolling.

If you have a customer with breast cancer who is reporting concerns with fatigue, energy levels, cognition, sleep disturbance or just a general lack of conditioning, consider recommending a physical conditioning program as, like we’ve seen, the results can be amazing!

More info:
McGrath Foundation

Breast Cancer Network Australia

Pink Hope 

Make sure to hit “Like” and follow our Facebook page here to get some more insights into what an Exercise Physiologist is and what we do

AND of course if you’d like to make a referral for Exercise Physiology services go ahead and click here

References:
1. Australian Government. (2017). October, Australia’s Breast Cancer Awareness MonthCancer Australia. Retrieved 23 October 2017, from https://canceraustralia.gov.au/healthy-living/campaigns-events/breast-cancer-awareness-month

2. Galindo, Y. (2017). Brain Powered: Increased Physical Activity Among Breast Cancer Survivors Boosts CognitionUC San Diego News Center. Retrieved 23 October 2017, from http://ucsdnews.ucsd.edu/pressrelease/brain_powered_increased_physical_activity

3. Ligibel, J. A., Irwin, M., Dillon, D., Barry, W., Giobbie-Hurder, A., Frank, E., … & Brown, M. (2017). Abstract S5-05: Impact of pre-operative exercise on breast cancer gene expression.

4. Jones, L. W., Habel, L. A., Weltzien, E., Castillo, A., Gupta, D., Kroenke, C. H., … & Yu, A. (2016). Exercise and risk of cardiovascular events in women with nonmetastatic breast cancer. Journal of Clinical Oncology34(23), 2743-2749.

5. Courneya, K. S., Segal, R. J., Vallerand, J. R., Forbes, C. C., Crawford, J. J., Dolan, L. B., … & McKenzie, D. C. (2016). Motivation for Different Types and Doses of Exercise During Breast Cancer Chemotherapy: a Randomized Controlled Trial. Annals of Behavioral Medicine50(4), 554-563.

How creative thinking and merging technology with rehabilitation can deliver amazing outcomes previously not possible

We recommend clicking settings at the bottom of the video above and turning on subtitles.

A few months ago I penned an article on Linkedin which you can see here titled “The Future for Rehabilitation?”. In it i explained Paul’s situation. Paul was a Cattle Farmer living in outback Victoria who had torn his supraspinatus tendon lifting a fencepost and for whom, at the time of writing the article, we had just commenced his  video-based rehabilitation / strengthening program.

At the end of the article I made the statement “We can’t wait to see how his case unfolds.”

Well here we are at the end of the process and we couldn’t be happier with the result!

Check out the video above to hear all about what unfolded in Paul’s words.

I also alluded in the article to the forward thinking staff at BT Financial whom we were working with and whom had engaged us initially to provide the program for Paul.

Enter the brilliant Occupational Therapist, Liz McClean, who initially suggested using a video-based exercise program and encouraged us to explore providing this for Paul. I asked Liz to provide her perspective of Paul’s case and how it unfolded.

From Liz:

“As an Occupational Therapist, finding solutions to facilitate ongoing recovery progression and independence in activities is the key focus of intervention. This can become significantly more challenging when faced with additional barriers where an individual lives in a remote rural location without access to appropriate rehabilitation. When I first reviewed Paul’s claim, I quickly realised that some creative problem solving would be required. It was clear that Paul needed additional support to increase shoulder strength and activity tolerances, if he had any chance of returning to his farming duties. The idea of providing specialised and client centred exercise physiology via Skype or video linking was considered, and after speaking with Brad Domek, we all realised it could be achieved!

The results were absolutely amazing, and I was thrilled to see Paul making gradual progress with each update from Brad. Prior to this assistance, Paul had been advised he needed to avoid many of his farming duties, and continue with light work only. Does light farming work really exist? Brad did an amazing job with Paul, and was able to ensure the exercise program was specific to Paul’s needs and occupational goals.  At the conclusion of the program, Paul had achieved a significant improvement in shoulder movement and strength. He had been able to return to many of his farming duties, which was an incredible result for Paul.

The success of this program proves that barriers can be overcome. Technology can assist in ensuring that all customers have access to appropriate rehabilitation and skilled clinicians, despite their location around Australia – and every customer deserves the best care to ensure a positive outcome.”

Note: Liz McLean has since moved on from BT Financial and is providing her Occupational Therapy services throughout Sydney with a specific focus on applying her specialist skills in the Life Insurance sector. Liz can be reached on 0409 904 959 or liz@emrecovery.com.au

We think that Paul has such an inspiring story and if you agree we’d love you to share it with your customers / clients / workers who may be facing similar battles to those Paul had to overcome. If they can gain some confidence from seeing others who’ve been down the same road and have come out the other side we feel like it’s worth the share.

We’ll be sharing Paul’s story on our FB page which you can link to here and we’d love you to jump over and share it there too. Again, the more we can inspire others to take action the more we’ll see brilliant outcomes like this coming through.

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Low back pain can affect your life in unexpected ways (luckily, we have some exercises to help)

For better viewing and to not disturb anybody we recommend you turn on subtitles for this video, click on settings at the bottom of the video above.

For obvious reasons, low back pain is tough to deal with. But what many people don’t realize is that, beyond the hurting, low back pain also affects many of your day-to-day movements. This ends up creating a vicious cycle: your back hurts, so you alter some of your day-to-day movements without realizing it. And usually, the way you alter these movements actually ends up exacerbating your back pain even more, thus putting you into a cycle of pain that can be difficult to break free from.

In this week’s video and article, our EP Paul Macgugan will cover some of these problematic day-to-day movements, show how these movements should and shouldn’t look, and go through the top two exercises he uses to put his patients on the path to rehabilitation.

3 unexpected daily movements low back pain affects:

(Be sure to watch the video above to get a demonstration of what all these movements looks like)

1. Walking

Yes, low back pain can change the way you walk! What usually happens is this: when someone has a back injury or general back pain, they end up with very tight hips. This in turn causes their feet to turn out at an irregular angle so they walk with an altered gait and with this comes changes to their natural muscle activation, causing ongoing imbalances and further impact to the lower back.

2. Sitting down and standing up

When people suffer from back issues, a basic action like sitting or standing can make things much worse if they aren’t careful.

Often, when people with low back pain move from a sitting to a standing position, they have the tendency to first lean forward and round their back. Then, they put their all their weight on their toes and fold up in a way that puts a lot of compression (and extra stress) on their lumbar spine. Naturally, this only makes the pain worse.

To avoid this, every time you move to sit or stand, make sure you focus on putting your hips back and down. Keep your weight on your heels and try to keep your spine straight instead of rounded as you go up or down.

3. Squat lifting and picking things up

People with back pain rarely end up getting their squat form right.

When Paul teaches squat lifts (or the same movement you use to pick things up), this is what he tells his patients first: when you move into a squat or lift, focus on putting your hips back and down with your feet turned slightly outward. Done right, you should have a nice, straight back and be putting most of your weight on your heels.

Something else to keep in mind is that your knees shouldn’t go over the balls of your feet. If they do, you risk hurting your knees. One way to know if you are in the right squat position is to see if you can wiggle your toes. This lets you get a smooth, easy lift up from the ground as you move to a standing position.


Two exercises to help you go through these daily movements without making your back worse:

One way to make sure you are doing the day-to-day movements correctly is simply to be aware of what the right and wrong form for each movement looks like. Then, try to correct your form as much as you can. But for someone who has back pain, this is easier said than done!

So, it’s also worth strengthening the muscles used in the motions above so you can do them more comfortably in a way that doesn’t make your back worse. On that note, here are two exercises from our physiology program that’ll help you with this strengthening (be sure to watch the video at the top to see exactly how they’re done):

1. Glute Bridge

The glute bridge begins with you lying down with your back on the floor. Then, keeping your back nice and flat on the ground, lift your hips up off the ground. With the glute bridge, it’s important to make sure you get your pelvis at just the right angle so your back remains on the ground. Also be sure to keep the weight on your heels.

Then, you lift up as high as you can go, hold for two seconds, and ease down slowly. As you come down, once again make sure your back stays flat on the ground the entire way.

2. Single Legged Glute Bridge

The next exercise begins the same as the first with a slight variation. Once you’ve lifted up your hips with your back flat on the ground, keep one knee bent as is and straighten out your second leg. This gives you a little more resistance in your glutes and hamstrings. Plus, it activates the external rotators of your hip.

Back pain is a difficult enough problem to deal with on its own….don’t let yourself make it any worse by doing your day-to-day movements incorrectly! If you help yourself get these movements right with a few strength exercises, you’ll be surprised by the difference you feel not only in your back , but in your normal life.

Sign up to our email list here to get more helpful info about Exercise Physiology delivered straight to your inbox. No spam and no selling!! Just useful info to help you understand more about what Exercise Physiology is and how it can help.

AND, make sure you “Like” our Facebook page here for more insights into how we’re using Exercise Physiology to improve outcomes for all of our customers

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