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Building Body Awareness to meet the challenges of cancer treatment

Kirsty Rowlinson-Groves

Kirsty Rowlinson-Groves, an exercise specialist who supports men with prostate cancer in preparing for and recovering from treatment, joins OnFocus to how men can benefit from programmes like the one she runs in Manchester called Prehab4Cancer. This is an exercise, nutrition and wellbeing scheme run through the NHS in Greater Manchester, and has won numerous awards for its dedication, commitment and innovative approach to cancer patients across the region.

 

Clare Delmar

Hello and welcome to On Focus brought to you by The Focal Therapy Clinic, where we connect you with issues facing men diagnosed with prostate cancer that are little known, less understood, often avoided or even ignored. Prostate cancer is now the most commonly diagnosed cancer amongst men in the UK, and with this sombre fact comes a multitude of challenges and opportunities. I’m Clare Delmar. Joining me today is Kirsty Rowlinson-Groves, an exercise specialist who supports men with prostate cancer in preparing for and recovering from treatment. She’s a programme manager at Prehab4Cancer, an exercise, nutrition and wellbeing scheme run through the NHS in Greater Manchester. She’s here to speak with me today about the impact programmes like hers have on men living with prostate cancer. Kirsty, thanks so much for joining me today. It’s really great to have you.

Kirsty Rowlinson-Groves

Oh, no problem. It’s really good to be here. Thank you.

Clare Delmar

I’m really excited to learn more about what you do, because I can see from the website that Prehab4Cancer has won all kinds of awards and just seems to be a really fantastic programme that a lot of clients that go through it are just really excited about. So I’m delighted that you’re here. And let’s just dive right in. And one of the top questions I have is about the way you work with cancer patients. And I’m really interested if you can tell us specifically what is the difference between prehab and rehab.

Kirsty Rowlinson-Groves

Yes. So everybody knows the word rehab. It’s quite common state of affairs in a lot of walks of life. And prefab is sort of its new cousin that has come along. So we work with newly diagnosed cancer patients in Greater Manchester, just on three tumour groups at the moment but we are looking to expand. And the prehab is basically the preparation for the physiological but also the psychological challenges of cancer treatments and/or surgeries that people face when they are diagnosed. So the prehab is sort of like preparation and we always use the analogy of you wouldn’t run a marathon without any training and we think of the impact of cancer treatments and surgeries, the physiological impacts on a body can be akin to something as big as a marathon sort of thing. So it’s all about the optimisation of the body to go through that treatment or surgery. The three things that we focus on in our programme is nutrition, exercise and wellbeing. But there’s also things like medical optimisation. So making sure that blood pressure and iron levels are correct, there’s pharmacological optimisation and there’s also like smoking and alcohol cessation and support for that sort of optimisation. And then, like I said, the rehab is what comes after the treatments and the surgery. So it’s getting people back to their pre diagnosis fitness or even higher than that, and getting people back to work, getting people back to just coping with their everyday life, which sometimes can be a bit of a challenge, especially in active treatment and directly straight after surgery.

Clare Delmar

Indeed. And as we’ve spoken about before, prostate cancer presents particular challenges around sexual health or urinary incontinence and mental health, which I know you mentioned a few minutes ago. How has your programme helped men with these particular challenges?

Kirsty Rowlinson-Groves

In one of my previous roles in a rehab programme the particular challenge of urinary continence and mental health came up a lot with the gentleman that came through our prostate referral pathway. For the exercise point of view, obviously we all know that exercise, like the exercise high, so it releases those happy hormones. So people getting a buzz from that and feeling better because of that sort of reaction that exercise can do in rehab, but also from the wellbeing. They got the chance to have some peer support. So there were groups where they could all exercise together. They could talk, they could chat, they could compare notes on their treatments and their side effects and just get a bit of peer support that way and just talk to other men going through the same thing and talk about how they were feeling. And then also it gives people confidence and confidence in their own bodies. When you are set a challenge, an exercise challenge and then you notice that your body can do it, it really improves somebody’s wellbeing to achieve goals that way. And then we also look from the exercise perspective on how we can help with side effects of treatment. So we know deep core control and pelvic floor exercises can help with some sexual health and some urinary incontinence issues. So we build them into the programme as well. So we look at the side effects and we try and pick the exercises that we know are going to try to help with those side effects. But also, I think just openly discussing on that prostate pathway from the rehab programme. Just recognise that yes there are side effects. Other people are going through it. And we can try to help by putting in certain things like, say, the deep core control or the pelvic floor exercises, the breathing exercises. So. So, yeah, I’d say that this probably how we helped most.

Clare Delmar

No, it sounds fantastic and I completely take your point about just even vocalising these things. And if that’s done through a medium like exercise or core strengthening programmes, that’s absolutely fantastic. I guess one of the questions I would have is how personalised are these programmes?

Kirsty Rowlinson-Groves

In the current programme and in the past, every patient gets a full make up, so a full make up of assessments, and from that we then design the best tailored exercise programme for the individual. So it’s not a one size fits all by any means.

Clare Delmar

OK

Kirsty Rowlinson-Groves

At the moment in remote delivery like we are at the moment due to covid restrictions, we design a tailored home exercise programme every patient gets and then patients can also be categorised into levels, so level one, level two level three, and then they’re directed to the exercise classes that most suit that level. So they can still get that peer support because they’re going onto online exercise classes. They all still get a tailored home exercise pack, which looks at functional capacity, their aerobics fitness, as well as the strength and their core.

Clare Delmar

OK, and something else that I always find interesting with programmes that help men open up about how they’re feeling. And as you say, their wellbeing, is exactly the role of their partners, because we often find that it’s the partners of our patients that play a critical role in their other halves’ health and care. And this is often around motivation and et cetera, et cetera. Have you seen this? And if so, how have you addressed it?

Kirsty Rowlinson-Groves

Yeah. So in previous roles we see this a lot and we see it currently. I’ve also been the partner of a cancer patient, so I have really good knowledge of how that partner becomes the care navigator, the administrator. They keep track of every single piece of paper and every single appointment. So we know that it’s a real valued resource that we can tap into. If we can get the partner involved and get them motivating the patient and encouraging the patient, we know that the patient is more likely going to enjoy it because we sometimes get partners involved as in they do the exercise as well. If we bring them into the gym, they get the free gym membership just as the person affected with cancer does. They really both enjoy it and both do it. And also it gives that little bit of wellbeing to the carer as well, because I think sometimes they’re overlooked. So they’re expected to do the care navigation, the administration. So it also gives it gives the carer or partner that role of, oh, it’s something I can do as well for me. And they and they can get the benefit. So it’s definitely an untapped resource that we unashamedly tap into.

Clare Delmar

Have you ever see partners being competitive?

Kirsty Rowlinson-Groves
Yes, yes, we see that a lot, especially in the gym. If they were side by side on a bike or a treadmill or rowing machine there is definitely some competition there. If the person responds well to that, then we encourage it for sure. We have come up against the other side of that coin, though, where the partners or carers are a bit overprotective and want to wrap their significant other up in cotton wool a little bit. And the thought of exercise, especially if somebody is going through active treatment, can be very, very scary for a partner or a carer. They’re the ones that see behind closed door how much that treatment is affecting that person. And so sometimes we have to do a lot of education with the partners and carers about the benefits and why it’s so important.

Clare Delmar

OK, and which leads me to another question, which is about personal control, particularly in a man with with prostate cancer, because diagnosis often brings with it a loss of control. And that could be devastating for anybody and particularly for men. We see that anyway. So I’m wondering how your programmes bring back that sense of personal control through exercise and through the wellbeing and nutrition workshops?

Kirsty Rowlinson-Groves

We always hear of experiences of it’s a bit of a whirlwind. You’re getting called for appointment after appointment and everybody wants blood and everybody wants to take a scan. And it’s a bit like being on a conveyor belt and everybody’s prodding and poking and getting their own bit of that person. As an exercise specialist, whenever I’ve met any cancer patient, it’s always I feel my job to put a stop on all that and ask them, do they understand why exercise has been suggested for one. In that whirlwind of information that gets given out, they get sent everywhere so they might not even remember the exercise was offered. And in that conversation, we then speak about what it is that they want. If they rate their health three out of ten, how how can we increase it? How can we put that up? And it’s usually things really simple, like they just want to be able to climb up the stairs a bit easier or they don’t want to get out of breath when they’re running down the stairs or something like that. So, we give control by setting their goals and then we put what they want first. Yes, we always have one eye on making sure we’re doing our best to improve the outcomes. Well, it’s very much based around what their aim is and what their goal is. And then that gives them that control is something that they can do for themselves. And it’s only themselves that can do this. We can’t give them a treatment which is going to make them fit unfortunately. We can’t give them a surgery which is going to improve their fitness, really. But they can do it for themselves. They’re the ones that have to wake up in the morning and think, right, when am I going to fit my exercise in? So I think that’s how they take control as well, because there’s nobody else who can do this type of intervention apart from them.

Clare Delmar

Yeah, indeed. So given your experience working with with men living with prostate cancer, are there any obvious gaps in their care that you’ve seen or you currently see? And what advice would you have for men at both diagnosis and pre and post treatment?

Kirsty Rowlinson-Groves

So I think the obvious gap in the care, I think, is the mental wellbeing side. Unfortunately, I think it’s a gap in most cancer care. And just because of the way the services are stretched and I think with the prostate cancer pathways I’ve worked in in the past, I think because men tend to not be openly asking for it, it can take a while to get that referral through. So I think that’s probably where I see the biggest gap. And then I’d also say that the conversations around sexual health as well don’t happen as easily or as quickly as they possibly should. Again, I think it’s down to the patient or the carer because it usually falls on the carer and partner’s shoulders to go and educate themselves about that side of the side effects of the treatments and ask for more information rather than it being readily available.

And do they come to you for that? Are you are able to provide that or at least help them navigate a source?

Kirsty Rowlinson-Groves
Yes, when we had the prostate referral pathway in my rehab programme, we were set up really closely with the local hospital. So if a partner or a carer or even the gentleman themselves said anything, then we could refer on to the correct services. We also had a fantastic link with a local prostate cancer support group. A talking therapies group, who we used to signpost a lot of men to, who didn’t openly discuss things, but seeing that they wanted to but didn’t feel safe in the setting that we were in. So we would encourage them to go there as well. So we were able to signpost them into the correct services, or into the more gentle community based stuff like talking groups and walking groups for men.

Clare Delmar

Fantastic. I mean, it’s so inspiring to talk to you about such a positive signposting and positive messages and positive programmes for these cancer patients. It’s very refreshing and I wish you all the best in continuing to give men and their partners the benefits of your expertise and your enthusiasm. Thank you so much.

Kirsty Rowlinson-Groves

Oh, well, thank you very much for having me.

Clare Delmar

It’s been a real pleasure. Further information on support programmes like Kirsty’s and like Prehab4Cancer is available on our website, along with a transcript of this interview and additional information and interviews, stories about living with prostate cancer. Please visit www.thefocaltherapyclinic.co.uk and follow us on Twitter and Facebook at The Focal Therapy Clinic. Thanks for listening and from me, Clare Delmar, see you next time.

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