WA News News & Reports Key Message? Keep Moving!
Key Message? Keep Moving!
Written by Peter McClelland
Monday, 02 October 2017

 


29092017-Exercise-Equipment--Oct 17Clinical research is firmly backing the benefits of exercise in a number of contexts both physiologically and psychologically. It’s important to keep moving and the endorphins are an added bonus.

Medical Forum spoke with several practitioners and academics about their work in the area.

Exercise physiologist Marianne Garvey is working with cancer patients to keep their muscles and spirits toned.

“There’s no doubt that a well-supervised exercise program can result in real benefits for cancer patients. We’ve done pilot trials on pancreatic, head and neck cancers and an extensive cancer survivor study that confirms just that,” she said.

“And we’ve seen positive spin-offs such as reduced fatigue and a lessening impact relating to treatment toxicity. I had one interesting comment from a radiologist who said she could usually tell the patients who were on the exercise program. They were then ones who were invariably positive throughout their treatment.”

“We do have patients who come in here and, initially, can barely get out of their chair. And, sadly, there are some who can’t continue with the program due to the progression of their disease. Nonetheless, we have many people who are so excited about the exercise program that we have to wait for their blood pressure to settle down before they can get onto the machines.”

Some doctors uncertain

Most doctors are highly supportive but some have reservations, says Marianne, who works at GenesisCare’s Wembley clinic.

“There are a few GPs, particularly the older ones, who remain a little sceptical and some have actually refused permission for the patient to participate in the program. I guess they have a vision of a challenging gym environment with lots of shiny machines, but it’s not like that at all.”

“We have an individually tailored program underpinned by a thorough clinical assessment from a medical specialist. We have to remember that some of the people who walk in the door have never seen the inside of a gym in their entire lives. And, of course, all this can be pretty overwhelming for anyone dealing with a cancer diagnosis and that needs to be taken into account.”
Is there an emotional impact on health professionals working with cancer patients?

“There are some cases that are quite upsetting. I had one couple, a man and his wife, who had both been diagnosed with cancer and their children were about the same age as mine. It was all a bit close to home and I did get a bit teary after they’d gone.”

“But most of the time the exercise clinic is a pretty happy, upbeat place with plenty of banter and repartee. I had one patient, a retired doctor, who loved life and a glass or two of red wine and he embraced the program with gusto.”

“It’s so important to keep moving, particularly after a diagnosis such as this. And when it comes to fall prevention it’s all about glutes, glutes, glutes!”
Medical Forum also spoke with researchers Dr Rob Stanton and Dr Amanda Rebar, from Central Queensland University, Rockhampton. Their team’s focus is on the application of more finely tailored exercise programs for mental health disorders such as anxiety and depression.

Finding the limits29092017-Stanton-Rob-Dr--Sep 17Dr Rob Stanton

“The benefit of aerobic exercise is well established, there’s a lot to be said for raising the heart rate and generating pleasurable responses linked with the production of endorphins. Nonetheless, it’s well acknowledged that if you raise the intensity of the program beyond a certain point some people will inevitably feel worse,” he said.

“And, when you’re dealing with comorbidity such as anxiety and depression, it becomes quite complex if you’re trying to develop a program that takes into account the full suite of symptoms.”

“We need to understand this comorbidity to ensure that we respond in the best way to people suffering from linked disorders. We’re not trying to replace other therapies, just work alongside them to best help these patients.”
As Rob suggests, it’s absolutely crucial that the ‘consumer’ is an integral part of the process.

“One of the keys to success is to make sure that patients are involved in the design, implementation and evaluation of these programs. People’s symptoms can vary significantly from week to week, particularly with anxiety and depression.”

“We need to listen to them closely to ascertain just what makes them feel better.”

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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