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Broken Heart Syndrome, Heart Disease and HIIT Everything you need to know

With Valentine’s Day just around the corner, the topic of this month is the heart!

Bridging the gap between literal and metaphorical, did you know that Broken Heart Syndrome is a real physical condition!? 💔

It is also known as Takotsubo (Tah-kah-tsu-bo) Cardiomyopathy or Stress Cardiomyopathy. It involves sudden but temporary weakening of the heart muscle and is triggered by emotional or physical stress, including: the death of a loved one, a relationship break-up, illness, and surgery. Fortunately, the condition usually reverses itself in a few days or weeks.

Heart Disease

Heart Disease can include:

  • Cardiovascular Disease, often blockages in the blood vessels leading to lack of blood and oxygen to the muscles (including heart muscle), Coronary Heart Disease, Stroke, cardiomyopathy, heart attacks.
  • Arrhythmias
  • Valvular Heart Disease
  • Heart Failure

!Cardiovascular Disease is the leading single cause of Death in Australia!

In 2017, Heart Disease was responsible for a death in Australia every 28 minutes

Specialised Health vs The Heart

Specialised Health strives to provide superior Exercise Physiology services, delivering the best care to customers, claimants and their rehab team. You wouldn’t usually consider heart health for a knee injury suffered in the workplace, or even whiplash after a car accident. However, as Exercise Physiologists, conditioning people back to work and life through physical activity, we need to be aware of any pre-existing conditions or risk factors (such as cardiovascular disease!). Plus, increased fitness has been associated with: decreased pain tolerance and improved mood symptoms (side effects we often see from disruptive injuries).

We are also referred customers under Income Protection, specifically with cardiac conditions. With the heart being so imperative to keeping us alive, when something goes wrong it can be quite scary. So, other than the obvious improvements in physical fitness the main feedback we get back from our claimants is about the relief and gratification they experience with the increased confidence they have in returning to their normal activities after our program. (And that’s why we do what we do!)

In addition to aerobic fitness and cardiovascular health we are learning more and more about the relationship between the heart and the nervous system through Heart Rate Variability. Make sure you’re keeping an eye on the Specialised Health spaces online to keep up to date with our new initiatives.

Now, the question that everyone wants to ask… What’s all this business with HIIT?

HIIT (High Intensity Interval Training), has been around for decades however has increased in popularity lately, assumedly due to it being “time-efficient,” fitting in with our busy lives and desire for quick results. Physiological adaptations (cardiovascular, metabolism, blood profile, oxygen utilisation) occur, with ½- ⅓ of the time commitment compared to lower intensity, continuous exercise.

HITT is an exercise protocol that includes:

  • 30 seconds – several minutes of high intensity exercise (approx 85% Max Heart Rate)
  • Rest for 1-5 minutes of either no or low intensity
  • Repeated 4-6 times


Due to the higher intensity and potential of insufficient rest periods, there is a higher injury risk with HIIT, especially if you are new to exercise. It is not safe for everyone, particularly those with hypertension / high blood pressure. (This website provides some good recommendations to decrease injury risk:

Always check with your doctor before starting a new exercise program, particularly if you have any health conditions or haven’t exercised for a while.

Any exercise is better than no exercise!

Depending on what condition you are in physically and behaviourally, it may be worth starting at lower intensities and building your habit and confidence in exercise.

I don’t always agree with “articles” I find online, but this one I like! 5 Common Myths about HIIT. All that said, research clearly supports the effectiveness and superiority of HIIT! – Just be smart about it!

Fun Facts About the Heart

  • The first heart beat sound we hear is the closure of the AV valve (which happens after atrial contraction)
  • The second heart beat sound we hear is the closure of the Semilunar valves (valves between the ventricles and arteries).
  • The average heart weighs between 200-400 grams
  • By the end of the average life, the heart has beaten more than 350 billion times
  • At rest, 15-20% of blood goes to skeletal muscle; during exercise, this amount increases to 80-85%.
  • Variety of colours in your diet provides variety in nutrients. Foods containing cocoa improve blood vessel health (endothelial function) and blood pressure! (That’s associated with very high dark chocolate, and excess is not recommended!)
  • Exercise has been shown to be more important than smoking cessation! I.e. A fit smoker is healthier than a sedentary individual (Though an active non-smoker likely has the best future obviously…!!)

Find tips to manage or decrease risk of heart disease here.

Recognise a Heart Attack here

Support to decrease risk:

  • Find some great recipes here
  • Find an app to help you quit smoking here

Yours in Health,
Biara Webster

Exercise Physiologist






  • Australian Bureau of Statistics 2018, Causes of Death 2017, ABS cat. no. 3303.0,September’s%20leading%20caues%20of%20death,%202017~2
  • Aerobic Exercise Improve Pain Perception and Mood? A Review of the Evidence Related to Healthy and Chronic Pain Subjects Hoffman, M.D. & Hoffman, D.R. Curr Pain Headache Rep (2007) 11: 93.
  • Exercise and the Cardiovascular System Clinical Science and Cardiovascular Outcomes Circ Res. 2015;117:207-219. DOI: 10.1161/CIRCRESAHA.117.305205)
  • Cocoa Intake, Blood Pressure and Cardiovascular Mortality Arch Intern Med. 2006;166(4):411-417. doi:10.1001/archinte.166.4.411

What’s Your Sleep Score??

“Sleep Hygiene” seems to be the new kid on the block when talking holistic health. We did some digging around Health and Medical Research Journals to find out more and here’s what we found….

“But I feel fine, why is Sleep Hygiene and Sleep important to health?”

Poor quality of sleep is associated with impairments in motivation, emotion, and cognitive functioning as well as increased risk for serious medical conditions such as lowered immune system, diabetes, cardiovascular disease and cancer.

Sleep is the best time for your body to recover. Growth Hormone spikes when you’re asleep and so do the hormones Prolactin and Melatonin which are potent (and natural and free!) antioxidants. Plus, sleeping allows the brain a chance to get rid of metabolic waste accumulated around the brain (That’s right! Like any metabolic reaction inside the body there are by-products).

Still feel fine? Maybe you could feel even better, and you don’t even know it yet!

How is your Sleep Hygiene? Take the Quiz below!
Scoring: Yes = 0 No = 1

Question Score
1. Stimulants
Do you drink caffeinated beverages within 7 hours of bed-time? Do you smoke or Vape? Are you frequently exposed to Second-Hand Smoke?

2. Alcohol
Do you drink alcohol within 6 hours before bed-time?

3. Granny Naps
Do you nap throughout the day?

4. Irregular bedtime or waking time
Do you go to bed or wake up at different times each day?

5. Wind-down routine
Do you go to bed emotionally or intellectually stimulated?

6. Exercise
Do you get less than 30 minutes of exercise a day,5 days per week?

7. Nutrition
Do you think your diet could be substantially better? (to include a balanced diet of some fruit, plenty of vegetables, sufficient protein and some grains)

8. Stress
Are you stressed throughout the day, even before bed-time?

9. Noise Pollution
Do you hear a lot of noise from your bedroom (traffic, hum of fridge)?

10. Light Pollution
Is there light in your room (from electronics, or street lights)? Are you exposed to a lot of artificial light within 2 hours before bed-time (from screens and light bulbs)?

How did you score?
10/10 is a perfect score! Not much more you can do to improve your Sleep Hygiene.

If you scored 10/10 yet still experience poor sleep or are frequently tired you may need to speak to your GP or another health professional.

Result Interpretation*
*Completely Invented by me
10 – Sleep ninja! (Pro!)
7-9 – Sleep Student (Learning Mastery, keep it up!)
4-6 – Agnostic Sleeper (Yet to trust in the power of sleep)
0-3 – Sleep Squirrel (Sleep is for the dead?)

Want to score higher next time you review your Sleep Score?! Here’s how:

1. Stimulants
Research shows stimulants such as caffeine and nicotine significantly impact our sleep quality. This is because they are stimulants; they act on neurotransmitters (brain chemicals) in the brain to keep us alert.

Caffeine levels peaks after 30 minutes of consumption, so definitely no caffeine to be used as a night cap! The research states the half-life to be 3-7 hours, depending on the individual. Which means the amount circulating in your blood stream is still half the amount of its peak level.

Quitting coffee can result in withdrawal symptoms, so do take care. It should take 3-4 days to pass however if you are concerned, always see your GP.

Disclaimer! There’s actually been an adenosine (neurotransmitter) receptor gene associated with caffeine sensitivity… apparently there are people who exist that are caffeine-insensitive! (I am not one of them!). However, the best way to determine your level of sensitivity is to go without caffeine for a week or two, and then bring it back to monitor your alertness and sleep quality, so give yourself an extra point in a few weeks if you determine yourself to be a caffeine-mutant.

Nicotine is also a stimulant and we couldn’t find any specific information indicating it’s ok at any time of day (compared to caffeine). Even second-hand smoke influences sleep quality. All types of nicotine consumption were associated with poorer sleep; however, cigarettes were the worst due to all the other chemicals they contain as well.

Quitting nicotine in order to improve your sleep quality (and probably lung health) is a good idea. However, you should do this under the supervision of your GP, if you go cold turkey, withdrawal symptoms can actually worsen sleep for a few weeks.

2. Alcohol
Alcohol may help us to get to sleep, however research using EEG (electrocorticography) has shown it actually worsens our sleep quality, also acting on a variety of neurotransmitters. It is recommended to cease alcohol consumption 1 hour before going to bed, some research suggests 6 hours.
– Yes the quiz was misleading… Innocently trying to spike your curiosity!…

…So if you want an extra point for consuming alcohol more than 1 hour before bed, the point is all yours. No binge drinking! The health guidelines stipulate 1-2 alcoholic drinks per day, with at least one day without.

3. Granny Naps
Taking naps throughout the day has been shown to decrease sleep quality throughout the night. Napping can assist clarity if you’re just feeling too tired however your nap should be limited to 30 minutes.

4. Irregular bedtime or waking time
Keeping to a regular bed time or waking time makes it easier for our body to maintain a regular circadian rhythm.

Research indicated that a regular waking-time was more important, so if you have to pick one, pick what time you’re going to wake up and stick to it. Genetics does effect sleep-timing (Chronotype). Find what’s best for you.

5. Wind-down routine
If you go to bed emotionally or intellectually stimulated… you are stimulated! For example, watching scary t.v., working or being involved in conflict. This is not an ideal state for relaxation or rest!

Tips for wind-down routine:
– Try meditation or mindfulness
– Stretch
– Bathe or shower (this actually helps your body find a good temperature for sleeping as well)
– Non-caffeinated tea
– Read something that isn’t too stimulating

6. Exercise
The recommended exercise levels for general health is: at least, 30 minutes of moderate aerobic exercise, 5 times per week and 2-3 strength training sessions.

Exercise 4-8 hours before bedtime can help sleep quality because of the effect on the body temperature as well as neurotransmitters and hormones, as well as decreasing stress! 1 hour of exercise (any type) was shown to have the best results.

The more muscle mass you have the more sleep neurotransmitters you have in your blood stream. Do you even lift bro?

Some people may be susceptible to increased stimulation if they exercise too close to bed-time.

Have injuries, illnesses, or just not sure where to start? See an Accredited Exercise Physiologist (I know some good ones 😉)

7. Nutrition
A well-balanced diet increases the production of melatonin (our sleeping hormone). This is because EVERYTHING in our body is synthesized from the ingredients we feed it.

Being over-weight is also correlated with less Melatonin. And so is restricting your calorie intake! Confusing huh! It’s a fine balance. Work with your Dietician or Nutritionist for best results.

8. Stress
Stress is a stimulant! It increases your sympathetic nervous symptom actions including heart rate and blood pressure among other things.

Tips for Stress and Sleep:
– Meditation or mindfulness
– Diary
– Exercise
– Nutrition
– Enjoyable social activities

If you feel very overwhelmed, or if you’re friends/family/co-workers are worried about you, speak to your GP and/or find a Psychologist.

9. Noise Pollution
Noises such as outside traffic, annoying neighbors or even the hum of fridge can decrease sleep quality. This is because our brain is switched on and ready to look out for danger.

– Ear plugs
– Sound proofing
– DON’T: get into a fight with your neighbour, but maybe you can ask them nicely to be quieter during normal sleeping hours.

10. Light Pollution
Blue light from computer screens, tablets and phone as well as LED or Fluorescent light bulbs decrease our Melatonin (Sleeping-hormone). Even artificial light from outside or inside the bed-room can affect us. The darker the better!

Speaking of light, Vitamin D deficiency is associated with poor sleep as well, so make sure you’re getting some sun shine into your day (10-15 minutes for average Caucasian skin, less if you’re from Ye Olde’ England and more for darker skin), just don’t get burnt!

– Download a blue light blocker on to your device, use 1-2 hours before bed time
– Find some blue light blocker glasses (red lenses), use 1-2 hours before bed time. I have some.
They’re stylish.
Ok… I get teased…
But maybe if we all do it we can head a new fashion?
– Dim the lights
– Get romantic and use candle light. *Caution, candles include live flames, use safely.
– Use incandescent and halogen light bulbs
– Effective blinds and curtains in the bedroom

– Eye mask

– Get some sunshine in to brighten your day

11. Other cool facts
– Find a comfortable temperature in bed. You may need to play around with bed covers, pyjama materials, air flow etc.
– Have a comfortable mattress/pillow.

I think I’ve covered everything. If you got to bottom of this without falling asleep, well done! If you have any other tips or questions let us know!!

Happy Sleeping! 😴



Biara Webster
Accredited Exercise Physiologist, Specialised Health



Irish et al., The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence, Sleep Med Rev. 2015 August ; 22: 23–36. doi:10.1016/j.smrv.2014.10.001

The effects of programmed air temperature changes on sleep quality and energy saving in bedroom , DOI: 10.1016/j.enbuild.2016.08.001

Katri Peuhkuri*,Dietary factors and fluctuating levels of Melatonin, Institute of Biomedicine, Pharmacology, Medical Nutrition Physiology, University of Helsinki, Helsinki, Finland

Edward J. Stepanski and James K. Wyatt (2003) Use of sleep hygiene in the treatment of insomnia, Sleep Medicine Reviews, Vol. 7, No. 3, pp 215±225, 2003

Chennaoui (2015), Sleep and exercise: A reciprocal issue?, Sleep Medicine Reviews 20 (2015) 59e72

Vollmer and Randler (2015) Sleep duration and chronotype in adults in Côte d’Ivoire: influence of gender, religion and age Journal of Psychology in Africa · August 2015

WHO technical meeting on sleep and health (2004)

Blue light from light-emitting diodes elicits a dose-dependent suppression ofmelatonin in humans, Appl Physiol 110: 619– 626, 2011.

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: 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.


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!


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.



  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.


  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. Retrieved 23 November 2017, from

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.

  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.


  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 

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1. Australian Government. (2017). October, Australia’s Breast Cancer Awareness MonthCancer Australia. Retrieved 23 October 2017, from

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

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.

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