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The Promotion of Physical Activity - Everyone's Responsibility | Susan Moag

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Ms Susan Moug's keynote speech 'The Promotion of Physical Activity - Everyone's Responsibility' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.

Published in: Government & Nonprofit
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The Promotion of Physical Activity - Everyone's Responsibility | Susan Moag

  1. 1. The promotion of physical activity- everyone's responsibility View from a colorectal surgeon Susan Moug
  2. 2. What does a colorectal surgical team have to do with physical activity? Referrals of patients with bowel symptoms Take a history and examine Arrange/perform investigations Diagnose colon and rectal cancer Plan treatments Liaise with anaesthetists, oncologists, nurse specialists Follow up for 5 years
  3. 3. Where is the physical activity bit?
  4. 4. The colorectal surgical team in RAH  Estimate each specialist’s minimum patient contact time  Ask them 2 main questions – 1) Do you ask about exercise or physical activity If yes – what do you ask? If no – why not? 2) Do you ask about co-morbidities/smoking/alcohol? If there were issues would you act upon them?
  5. 5. The Surgeon Total contact time >1 hour 1) Physical activity – YES. ‘how far can they walk without getting breathless’ ‘I haven’t before’ ‘would it change anything?’ 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes.
  6. 6. The Colorectal Cancer Nurse Specialist Total contact time > 1 hour 1) Physical activity – no. ‘is physical activity important’ ‘what activity would I recommend, I have no experience’ 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes.
  7. 7. The Oncologist Total contact time > 1 hour 1) Physical activity – YES. ‘can you climb two flights of stairs’ 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes. ‘could delay/ interfere with planned chemo/radiotherapy’
  8. 8. The Anaesthetist (pre-assessment nurse) Total contact time >1 hour 1) Physical activity - yes. can you climb 2 flights of stairs? 3 self-reporting questions don’t make any recommendations 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes.
  9. 9. The Stoma Nurse Total contact time >1 hour 1) Physical activity - no. ‘ask about arthritis’ 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes.
  10. 10. The ERAS Nurse Total contact time > 1 hour 1) Physical activity - no. 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes. ‘I sometimes wonder if the ERAS regime is the most exercise some patients have done in years’
  11. 11. Summary Lots of contact time with patients that have colorectal cancer See patients pre-peri- and post-operative Different specialists see patients at different times Colorectal team is perfectly positioned to perform exercise intervention in patients with colon and rectal cancer However…….. Only ask approx 50% When we do ask it’s non-specific and we do not change anything Contrasts with other lifestyle factors that we all ask and all act upon
  12. 12. Is this just us? Dayna Alexander: BMedSci (Public Health) record of physical activity from Pre-Assessment Clinics reviewed 2011-2013 n=527 curative surgery for colorectal cancer To date, assessed 377 n= 247 no record of physical activity n=130 with activity recorded n=4 could not climb the stairs n=9 could climb the stairs with stopping n=117 could climb the stairs without stopping
  13. 13. What’s next? The Feasibility of Performing a walking programme in patients with rectal cancer undergoing chemo-radiotherapy (The REx Trial). 80 patients diagnosed with rectal cancer Primary intervention is neo-adjuvant chemo-radiotherapy randomise to two groups one control one walking intervention/ prehabilitation all sites in GGC, over 2 years.
  14. 14. Rectal cancer diagnosis and discussion at MDT Intervention 1 (15-17 weeks) OPC Surgery Neo- adjuvant therapy Introduced to REx Recruitment and randomisation to REx Peri-operative period Baseline Test 1 Post Exercise Test 2 The Feasibility of Performing a Walking Intervention in Patients with Rectal Cancer: The REx study. 5 weeks of therapy 10-12 weeks recovery
  15. 15. The Future? All patients with colorectal cancer undergo pre-operative lifestyle counseling All specialists see it as their responsibility Programmes developed to modify physical activity ?prehab Nurse Specialist Will there be enough evidence for pre-habilitation to alter timing of first treatment/surgery?

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