Episode 7
Moving Through Cancer with Lucy Gossage and Cat Fraser-Harris
In this inspiring episode of The Movement Prescription, join Callum as he explores the power of movement in cancer with guests Cat Fraser-Harris and Lucy Gossage. Cat shares her personal journey with sarcoma and how documenting her physical activity has become part of her journey. Lucy, an oncologist and former professional triathlete, shares insights on the impact of exercise for those living with and beyond cancer. Together, they explore the challenges, motivators, and the benefits of staying active. Tune in to learn how movement can be a powerful ally in the cancer journey.
Produced with support from the British Society of Lifestyle Medicine.
Find us at https://themovementprescription.co.uk/ and join the conversation!
Transcript
Intro: Hello and welcome to the Movement Prescription Podcast.
Speaker:Intro: Today we've got an episode about moving through cancer. I'm Callum,
Speaker:Intro: I'm your host, and I've got two guests.
Speaker:Intro: Firstly, Kat Fraser-Harris. Kat is a practicing physio just outside of Edinburgh
Speaker:Intro: and she's recently been documenting her journey,
Speaker:Intro: having been diagnosed with sarcoma and as a physical activity enthusiast,
Speaker:Intro: has been showing how she's been moving through her treatment to try and support and inspire others.
Speaker:Intro: And we've also got Lucy Gossage. Lucy is a practicing consultant oncologist
Speaker:Intro: with a PhD in renal cancer and was formerly a professional triathlete,
Speaker:Intro: a 14-time Ironman champion,
Speaker:Intro: and now a pretty handy ultra runner.
Speaker:Intro: The conversation is fairly wide-ranging it's powerful and emotive as Kat shares
Speaker:Intro: her journey and there's loads of practical and helpful tips within there as
Speaker:Intro: they both talk about their experiences as practitioners I really hope you enjoy
Speaker:Intro: and please do share your thoughts.
Speaker:Callum: Kat I wonder if I can start by asking you a question.
Speaker:Cat: Yeah really.
Speaker:Callum: Just wondering if you might be able to share a bit about your journey with sarcoma
Speaker:Callum: and how you've been documenting your physical activity through your treatment.
Speaker:Cat: Yep uh last july after a run actually very fittingly with movement um i noticed
Speaker:Cat: a lump just below my knee immediately and uh it was a bit odd but being a physio
Speaker:Cat: i tried to physio my way out of it to figure out what it was,
Speaker:Cat: asked a few of my healthcare professional friends, GPs and things,
Speaker:Cat: and then by September decided I should probably go to the GP to double check
Speaker:Cat: it because I couldn't figure out what it was.
Speaker:Cat: Went to GP, got referred down the sarcoma pathway, had an MRI two days before
Speaker:Cat: I ran the marathon, and then that came back as maybe a hemangioma, nothing to worry about.
Speaker:Cat: Got referred for an ultrasound guided biopsy, went for that,
Speaker:Cat: and didn't get a biopsy because the radiologist said it definitely looks like
Speaker:Cat: a lipoma, but because it's sitting right on top of your hamstring tendon,
Speaker:Cat: let's get it out non-urgently.
Speaker:Cat: Luckily, didn't have to wait that long, got it out in December.
Speaker:Cat: And then a month later, got my biopsy results back.
Speaker:Cat: And it was a mixoid liposarcoma.
Speaker:Cat: Yeah, so that was a bit of a shock to everybody. I think nobody suspected it was that.
Speaker:Cat: And then since then, I've had 25 sessions of radiotherapy.
Speaker:Cat: And then I had a month's rest. And then I had surgery to remove more tissue
Speaker:Cat: below my knee, including quite a lot of my medial muscular support for my knee,
Speaker:Cat: tendons, nerve, and then relocated my medial head of gastrop to fill the hole
Speaker:Cat: and the skin graft on top.
Speaker:Cat: So that's a little summary of my cancer bit.
Speaker:Cat: Early on in my journey, I went to a talk at Maggie's at the Western General,
Speaker:Cat: which was mainly run by Professor Anna Campbell, who's done loads of research
Speaker:Cat: into movement and cancer.
Speaker:Cat: And it was really interesting and just confirmed what I already think in that
Speaker:Cat: movement is amazing and good for everything.
Speaker:Cat: There was really compelling evidence that it's really positive to do,
Speaker:Cat: reduce your risk of recurrence, reduce your side effects, everything like that with treatment.
Speaker:Cat: So that just confirmed to me that I should keep moving.
Speaker:Cat: My brain went into overdrive as a physio. I was thinking, when shall I move?
Speaker:Cat: What type of movement shall I do? So those questions, most of them weren't really
Speaker:Cat: answered by my medical team. They said, just move.
Speaker:Cat: And what I wanted to do is start to document my journey and kind of encourage
Speaker:Cat: other people to move because as a physio movement is so positive anyway,
Speaker:Cat: but if it can have such big effects on your kind of cancer journey and symptoms
Speaker:Cat: and reduce the risk of getting it back,
Speaker:Cat: why wouldn't you move and why wouldn't I want to get people moving?
Speaker:Cat: So hopefully as an inspiration for people.
Speaker:Cat: And when you have a diagnosis, I don't know, I initially looked for blame.
Speaker:Cat: I was like, what have I done wrong? what have I eaten wrong
Speaker:Cat: I don't smoke I don't drink very much I exercise I
Speaker:Cat: ran two marathons last year and so just showing that it doesn't discriminate
Speaker:Cat: but you can continue to move as a as a positive to help you through yeah so
Speaker:Cat: kind of why I am exercising and how it can help that's how I'm documenting it on Instagram.
Speaker:Callum: Thanks Kat it's uh it's super inspirational you can you tell our listeners what
Speaker:Callum: your Instagram handle is?
Speaker:Cat: Yeah, it's moving through cancer.
Speaker:Callum: Perfect. Yeah, give Kat a follow. It's really amazing.
Speaker:Callum: It must be quite a vulnerable experience as well, sharing these things,
Speaker:Callum: but you're doing an amazing job.
Speaker:Cat: Yeah, there's certain bits, but I think because I've always moved through my
Speaker:Cat: life, everyone says it's inspirational, but it just feels normal to me.
Speaker:Cat: And it's a way to kind of hold on to normality in a situation where you don't
Speaker:Cat: have control over some quite big things happening in your life.
Speaker:Callum: One of the things you mentioned was was being told just
Speaker:Callum: to move and and kind of a lack of clarity around that and hopefully we can we
Speaker:Callum: can kind of unpick that a bit more as we go on but and that's been something
Speaker:Callum: that resonates with me is kind of a lack of possibly another side of the fence
Speaker:Callum: a lack of comfort in in knowing what to say for certain conditions and and and
Speaker:Callum: that was the original inspiration for this podcast really was to try and address that,
Speaker:Callum: Lucy, just kind of over to you briefly,
Speaker:Callum: could you tell us a bit about how you got involved in Move Against Cancer and
Speaker:Callum: how your athletic background has influenced what you do?
Speaker:Callum: For those that are listening, for context, Lucy is appropriately dressed.
Speaker:Callum: She's in sunglasses and a vest having just been to the gym.
Speaker:Callum: So I feel inadequate. I'm in a jumper.
Speaker:Lucy: Yeah, so I'm an oncologist. And I did have quite a lot of time out actually
Speaker:Lucy: as a professional triathlete, kind of during my registrar training.
Speaker:Lucy: And I guess whilst I was kind of away, I became aware that there was quite a
Speaker:Lucy: lot of evidence accumulating that exercise was a positive thing for people living with an after cancer.
Speaker:Lucy: And I remember it really clearly. It was probably 2017, I think.
Speaker:Lucy: I was still a registrar and I went to see a young patient on the ward.
Speaker:Lucy: He was probably 21, 22. I hadn't treated him I
Speaker:Lucy: just he just needed a prescription we got chatting and he'd
Speaker:Lucy: had a really rare brain tumor um a germ cell
Speaker:Lucy: tumor testicular tumor in his brain and he'd
Speaker:Lucy: theoretically been cured of the cancer um but
Speaker:Lucy: in the process he'd put on several stone in weight he'd
Speaker:Lucy: lost most of his friends he'd lost his job and he was spending
Speaker:Lucy: all day asleep and all night awake playing computer games
Speaker:Lucy: and I just I remember so clearly walking away from
Speaker:Lucy: the ward and I'd had all this time out thinking what are
Speaker:Lucy: we what are we doing if if our cure is you
Speaker:Lucy: know cure rates for people with cancer are so much better yet
Speaker:Lucy: this is the life that they're left with um and
Speaker:Lucy: I'd always loved park run and I just thought
Speaker:Lucy: I wonder whether we could get a group of young people who'd have their who've
Speaker:Lucy: had their cancer treatment um together to build up to doing a park run in three
Speaker:Lucy: months time and um kind of you know and I guess I had a friend who'd been depressed
Speaker:Lucy: I'd see no exercises help them so those were kind of the cogs that were churning and.
Speaker:Lucy: Tested this idea in the hospital everyone was like no way Lucy just because
Speaker:Lucy: you love running people with cancer aren't going to want to be told to run,
Speaker:Lucy: And I just thought, you know what, I do believe there's something in this.
Speaker:Lucy: So I looked elsewhere and I came across Gemma Hillia-Moses, who is an amazing
Speaker:Lucy: person. She had had cancer when she was 25.
Speaker:Lucy: She was a runner and she had just founded Move Charity with the goal of providing
Speaker:Lucy: other young people with the support to be active, which she didn't get through her cancer treatment.
Speaker:Lucy: So I got in touch with Gemma. We had a coffee. We started talking.
Speaker:Lucy: We realized we both shared the same vision. and Gemma didn't say no the Park
Speaker:Lucy: Run idea is nonsense she said well let's just give it a go.
Speaker:Lucy: So that's that led to the founding of
Speaker:Lucy: 5K UA Move Against Cancer which is now one
Speaker:Lucy: arm of Move Against Cancer charity so it's
Speaker:Lucy: a really simple idea we have over 105
Speaker:Lucy: groups I think now across the UK and Ireland we meet
Speaker:Lucy: at Park Run on the last Saturday of every month
Speaker:Lucy: each group's led by a volunteer ambassador who's been
Speaker:Lucy: impacted by cancer in some way and people walk jog
Speaker:Lucy: run cheer volunteer and have a catch-up and
Speaker:Lucy: a coffee over um a catch-up and
Speaker:Lucy: a chat over a coffee so it's an active support group with a
Speaker:Lucy: difference um and this is all part of
Speaker:Lucy: move against cancer charity which is a small but mighty charity
Speaker:Lucy: is how i describe it um and our aim is
Speaker:Lucy: to support inspire and empower people living with
Speaker:Lucy: and after cancer to be active um because we believe
Speaker:Lucy: that movement matters but actually the evidence now also
Speaker:Lucy: shows that movement matters and I feel very passionately as
Speaker:Lucy: a doctor that the evidence is enough
Speaker:Lucy: now that um every person who
Speaker:Lucy: is who receives a cancer diagnosis should be
Speaker:Lucy: told that exercise is one of the things that they can do to help
Speaker:Lucy: themselves um and at the moment that's not really happening
Speaker:Lucy: um yeah that was kind of kind of how I got involved to move against cancer um
Speaker:Lucy: spent a huge amount of time kind of from 2018 to 2022 spending two days a week
Speaker:Lucy: helping to grow it but we've now got um yeah i'm now much more in the background
Speaker:Lucy: um and yeah it's doing doing some amazing stuff.
Speaker:Callum: Oh cool yeah it's really incredible and
Speaker:Callum: and uh yeah we'll put some show notes with
Speaker:Callum: a link to move against cancer in in the podcast uh
Speaker:Callum: lucy you mentioned about the accumulating evidence
Speaker:Callum: uh one of the things that certainly
Speaker:Callum: prompted this podcast was there was a really interesting paper
Speaker:Callum: that was released uh about colorectal cancer and the role of exercise and and
Speaker:Callum: uh it was all over the news and it is great that it's getting quite wide exposure
Speaker:Callum: uh but i was wondering if you could explain some of the science behind how physical
Speaker:Callum: activity and movement benefit people living with cancer.
Speaker:Lucy: So i think the reality is we don't really understand how it helps but we know
Speaker:Lucy: that it does help um and there are there are lots of different theories um.
Speaker:Lucy: I was really excited by that study. So I've done loads of conference talks over
Speaker:Lucy: the last kind of eight years. And I've always said, this is what we know.
Speaker:Lucy: And I think if I do this talk in 10 years time, we'll have high quality data
Speaker:Lucy: from phase three, big randomized trials that prove that exercise improved survival.
Speaker:Lucy: And then finally, we've got this study which proves just that.
Speaker:Lucy: So until recently, we've known for sure that exercise is the best treatment for cancer fatigue,
Speaker:Lucy: which is a massive thing for so many people, not just during their cancer treatment,
Speaker:Lucy: but after their cancer treatment and for people living with cancer.
Speaker:Lucy: We've known that it improves mood, reduces depression, anxiety.
Speaker:Lucy: We've known it makes people feel better. We know that it improves health-related
Speaker:Lucy: quality of life. So those were all proven.
Speaker:Lucy: But there was also a lot of accumulating evidence, though not really definitive
Speaker:Lucy: proof, that it likely improved how well cancer treatments worked,
Speaker:Lucy: reduced side effects from cancer treatment,
Speaker:Lucy: definitely reduced the long-term consequences of cancer treatment,
Speaker:Lucy: particularly for people living with cancer that's probably not curable.
Speaker:Lucy: But there's a huge proportion of people who are living very,
Speaker:Lucy: very many years with really good quality of life having ongoing cancer treatment.
Speaker:Lucy: So we know exercise mitigates a lot of the toxicities from that,
Speaker:Lucy: particularly cardiovascular and metabolic.
Speaker:Lucy: And what's been amazing over the last few months This is a publication of the
Speaker:Lucy: Challenge trial, which was a big trial of nearly 900 people who'd had treatment for bowel cancer.
Speaker:Lucy: So they'd had surgery and then chemotherapy and they were randomized either
Speaker:Lucy: to get generic advice around exercise or to get specialized support to be active
Speaker:Lucy: for the three years after their cancer.
Speaker:Lucy: Treatment and it showed that the
Speaker:Lucy: risks of recurrence in the group that were randomized to
Speaker:Lucy: the supervised exercise was significantly lower
Speaker:Lucy: than the group that were just given generic advice so it's the
Speaker:Lucy: first definitive proof we have that exercise
Speaker:Lucy: interventions reduce the risk of recurrence so for
Speaker:Lucy: me for someone who's lived and breathed this for the
Speaker:Lucy: last kind of eight years or whatever to finally
Speaker:Lucy: have the proof and be able to say to other healthcare
Speaker:Lucy: professionals look there's a study yes it's just in bowel cancer
Speaker:Lucy: but there's no reason why that shouldn't be replicated for other cancers surely
Speaker:Lucy: this has to change the conversations that you have with your patients um
Speaker:Lucy: is really powerful and it was great it was all over mainstream
Speaker:Lucy: news um it does seem to fizzled out
Speaker:Lucy: and i think my worry is that with the the challenges
Speaker:Lucy: with funding etc in the nhs it's not going to translate into
Speaker:Lucy: the big changes that it should do because actually if you've got a
Speaker:Lucy: study that proves that the benefits of exercise are
Speaker:Lucy: as good as the benefits of chemotherapy that should be
Speaker:Lucy: funded um and anyone who says um people
Speaker:Lucy: with cancer won't want to be told to exercise i would turn
Speaker:Lucy: that on its head and say people with cancer turn up to
Speaker:Lucy: get chemotherapy once a week that makes them lose their hair that.
Speaker:Lucy: Makes them feel sick that has potentially lifelong consequences on
Speaker:Lucy: fertility on cardiovascular health to so many people with cancer exercising
Speaker:Lucy: would be and it should never be an alternative to chemotherapy it should be
Speaker:Lucy: an add-on so i'm very clear it's not an alternative but um I think a very significant
Speaker:Lucy: proportion of people with cancer would want to be told that exercise was something
Speaker:Lucy: they can do to help themselves,
Speaker:Lucy: plus we know it makes people feel better but it's easy
Speaker:Lucy: to say that and we need to work out you know and it's easy for people like me
Speaker:Lucy: and cats who love exercise it's a massive part of our lives I know for people
Speaker:Lucy: for whom exercise hasn't been part of their life it's a really big thing and
Speaker:Lucy: it's a challenge and that's why the study I guess showed that you need supervision
Speaker:Lucy: and you need structured support and guidance. It's not just enough to give someone a leaflet.
Speaker:Lucy: Yeah, it's really exciting.
Speaker:Callum: Yeah, it's cool. And that reframing is really interesting of how we kind of
Speaker:Callum: repackage physical activity within cancer.
Speaker:Callum: Yeah, hopefully there's loads to come and we can continue to use that,
Speaker:Callum: kind of capture the public imagination about the role of physical activity.
Speaker:Callum: But you're right, it's maybe disappointing that messaging was quite short term.
Speaker:Callum: So, Kat, Lucy mentioned a few of the many challenges, not least the fatigue with cancer.
Speaker:Callum: What have been your personal challenges and motivators to date so far?
Speaker:Callum: And I suspect there'll be new ones to come as well.
Speaker:Cat: Well, fatigue was top of my list. So for me, it was initially when I had my
Speaker:Cat: diagnosis, I didn't sleep very well. I woke up pretty early every morning.
Speaker:Cat: So I was generally quite tired. I run quite tired anyway. I think I run on full
Speaker:Cat: pelt all the time. So I am quite tired.
Speaker:Cat: But also side effects of radiotherapy and just the emotional fatigue as well
Speaker:Cat: of a diagnosis and kind of a change in your life and plus I'm a mum of two small
Speaker:Cat: kids so I have that fatigue as well. So a few different fatigues not all cancer related.
Speaker:Cat: Time as well for me I'm self-employed so
Speaker:Cat: I kept working throughout all
Speaker:Cat: my radiotherapy and in between
Speaker:Cat: radiotherapy and surgery and then went back to clinic
Speaker:Cat: three weeks after my surgery which was maybe a
Speaker:Cat: bit soon but yeah so time the
Speaker:Cat: hospital was an hour away and there were horrendous roadworks
Speaker:Cat: for most of my radiotherapy so it just took
Speaker:Cat: a big chunk out of your day and a long time in the car um
Speaker:Cat: yeah and again two small kids and still doing school
Speaker:Cat: drop off pickup everything like that so time got in the
Speaker:Cat: way that was a challenge and then more latterly
Speaker:Cat: physical challenges so post-surgery I've
Speaker:Cat: had quite extensive surgery to my leg I can't move how
Speaker:Cat: I used to move I still can't walk fully properly and like
Speaker:Cat: my muscle strength is different so those physical
Speaker:Cat: challenges as well are there and I can't
Speaker:Cat: do I normally run play tennis walk the dog it goes swimming so everything like
Speaker:Cat: that I wasn't able to do for a while so that was a big challenge in terms of
Speaker:Cat: trying to keep moving but the motivators I had were as Lucy said about all the
Speaker:Cat: evidence if that evidence is there why wouldn't I be exercising?
Speaker:Cat: For me, it's an absolute no-brainer. If it's going to help reduce my recurrence,
Speaker:Cat: if it's going to help with my fatigue and everything like that, then.
Speaker:Cat: There's not really any other option other than to move. Also,
Speaker:Cat: if I see other people doing it as well, I'm like, well, they're actually in
Speaker:Cat: a similar situation to me and they're moving too.
Speaker:Cat: So why can't I? I should move as well.
Speaker:Cat: And knowing, as Lucy said, we both love exercise.
Speaker:Cat: I know if I'm feeling a bit tired and get up and move, I will feel less tired.
Speaker:Cat: So in normal life, before cancer and things
Speaker:Cat: anyway I'd move to help with fatigue and so
Speaker:Cat: again knowing that it would make me feel better helped
Speaker:Cat: and also role modeling for my kids as well I think that's a big part of exercise
Speaker:Cat: for me anyway it's normal for them to see me and my husband going out for a
Speaker:Cat: tennis match or cricket match or something and they're like okay have fun and
Speaker:Cat: so knowing that actually you can And kind of if you have these challenges,
Speaker:Cat: you can treat them with exercise.
Speaker:Cat: I think exercise is very much my drug. So that's the motivator for me.
Speaker:Cat: I know it helps. I know it helps pre-cancer.
Speaker:Cat: And the evidence is there that it helps during and after as well.
Speaker:Cat: And even though now I'm restricted to going on a bike, which is fun still,
Speaker:Cat: and doing my rehab, I still feel better after I've done those.
Speaker:Cat: So, yeah, it's a no-brainer just to keep moving. and that's the motivator there because.
Speaker:Lucy: Can I just jump in on what you said if you
Speaker:Lucy: know exercise is your drug um and it is a cliche but
Speaker:Lucy: actually if you had a pill that did everything that
Speaker:Lucy: exercise did in one package that you could take once a
Speaker:Lucy: day you would at the cost that exercise costs
Speaker:Lucy: you would give it to every single person probably every
Speaker:Lucy: single person in the world but um certainly every single person
Speaker:Lucy: with a cancer diagnosis so it is a cliche but if exercise was a drug and that
Speaker:Lucy: study uh the challenge trial had been a study of a drug it would be fast track
Speaker:Lucy: through nice the the drug approval process for fast track approval um which
Speaker:Lucy: is why i feel so passionately that it has to trigger changes in the health care system so it's the fact.
Speaker:Cat: That you i would go into radiotherapy waiting room in
Speaker:Cat: my shorts having gone for a run with my friends who've
Speaker:Cat: taken me there because uh again i just
Speaker:Cat: wanted to keep moving and most people were sitting
Speaker:Cat: there looking exhausted like obviously
Speaker:Cat: a big range of people but nobody else was
Speaker:Cat: doing that and I'm like come
Speaker:Cat: on guys you need to move even if it's just simple things but the evidence is
Speaker:Cat: there all across the board for loads of different conditions not just cancer
Speaker:Cat: like as a physio we treat osteoarthritis all these things but people would rather
Speaker:Cat: take a drug to try and treat symptoms when actually movement can reverse lots of other things too.
Speaker:Lucy: And I think there is a barrier that, sadly, there's still a hierarchy in the
Speaker:Lucy: NHS and a lot of patients need to hear it from their consultant before they'll believe it.
Speaker:Lucy: So whilst it's really sad, I think the conversations have to start with the consultants.
Speaker:Lucy: And there is still a perception, it is changing, but there's still a perception
Speaker:Lucy: that the best thing you can do if you've got cancer is rest.
Speaker:Lucy: And I think one of the most important things to do, particularly for less fit
Speaker:Lucy: patients who've been given a cancer diagnosis, is at the very least dispel the
Speaker:Lucy: myth that rest is best because it's not.
Speaker:Lucy: So if all you're going to do is give people permission to move,
Speaker:Lucy: that's better than just ignoring it because so many people otherwise,
Speaker:Lucy: particularly the loved ones or the person who's got a cancer diagnosis,
Speaker:Lucy: will assume that cancer means that you need to rest. And actually the evidence
Speaker:Lucy: is a completely opposite.
Speaker:Cat: Yeah. And I spoke to one of my, well, I spoke to the radiotherapists every day
Speaker:Cat: I was there, but I'd always have a question to ask them and I was asking them
Speaker:Cat: about what's the evidence for exercise.
Speaker:Cat: Should I exercise before my treatment, after my treatment?
Speaker:Cat: And one of them had been there for a while and she said it used to be that we
Speaker:Cat: tell all our patients to go home and rest for the rest of the day.
Speaker:Cat: Yeah. But now it is changing and it's getting there.
Speaker:Cat: And it's just like physio for back pain. we used to tell people to to rest and
Speaker:Cat: now it's all about moving.
Speaker:Lucy: So there's an interesting um there
Speaker:Lucy: was an interesting animal study where if they put mice on a
Speaker:Lucy: treadmill basically they gave my made mice exercise
Speaker:Lucy: before the radiotherapy the responses to the radiotherapy were
Speaker:Lucy: better and there's this theory that exercise you know
Speaker:Lucy: just a short burst just before your radiotherapy opens up all the blood vessels
Speaker:Lucy: so it means that the rate the impact of the radiotherapy can be more powerful
Speaker:Lucy: so that's not definitive proof but um there is kind of some evidence that actually
Speaker:Lucy: exercising just before you're ready to open might be a positive thing but certainly
Speaker:Lucy: it's very unlikely to do to do you harm if you feel well enough to do it.
Speaker:Callum: You mentioned role modeling cat but
Speaker:Callum: uh to the kids but you're also super cool you're role modeling to
Speaker:Callum: to other patients as well and and and setting
Speaker:Callum: kind of setting an inspiration an example uh you mentioned social support and
Speaker:Callum: i think that ties in closely to what lucy mentioned earlier around uh 5k your
Speaker:Callum: way how have you found or have you managed and found much social support for moving in your cancer?
Speaker:Callum: And then maybe once you've answered that, Lucy, you can tell us a bit more about
Speaker:Callum: how you've kind of managed to integrate that within 5k your way and move against cancer.
Speaker:Cat: Yeah, well, I've always found having sort of support around you really important.
Speaker:Cat: And I've, over the last few years, swapped to being much more of a social runner.
Speaker:Cat: And I prefer running with my friends rather than on my own.
Speaker:Cat: I think the trouble with being up in Scotland is everything is a wee bit smaller.
Speaker:Cat: And the 5k your way were at the talk I went to at Maggie's.
Speaker:Cat: But they're only based at two park runs in Scotland.
Speaker:Cat: Um so it's a bit more tricky
Speaker:Cat: at the moment at the moment yeah it's a
Speaker:Cat: bit more tricky to access that um but
Speaker:Cat: I found like the support of my friends
Speaker:Cat: who I exercise with anyway that was
Speaker:Cat: amazing and it changes exercise because you're doing
Speaker:Cat: it for a social thing but you're also you
Speaker:Cat: can offload to them you're running with them and the chats that you have
Speaker:Cat: when you're running get quite deep and it
Speaker:Cat: makes you feel better it's really that more mental
Speaker:Cat: side of things that you feel better physically after doing
Speaker:Cat: exercise but if you've had a really good talk with somebody
Speaker:Cat: as well and it it really
Speaker:Cat: helps the kind of mental side too and I've
Speaker:Cat: connected with quite a lot of people now through my social media with
Speaker:Cat: cycling because I'm doing Chris Hoy's Tour
Speaker:Cat: de Four cycle in September and that's
Speaker:Cat: been really good and it's been really inspirational for me too
Speaker:Cat: seeing because having that community there to connect with even though it's
Speaker:Cat: virtually seeing people going through lots of horrible things but moving and
Speaker:Cat: enjoying it and things and then it gives you even more motivation as a cancer
Speaker:Cat: patient to get out and move.
Speaker:Callum: Kat I was going to ask you briefly, if you could tell us a little bit more about Tour de Hoi.
Speaker:Cat: Tour de Four.
Speaker:Callum: Tour de Four, sorry, Tour de Four. It's Chris Hoyt, I'm getting all confused.
Speaker:Cat: It's a cycling event, so there's, I'm doing the second longest route,
Speaker:Cat: so there's a 50-something mile cycle,
Speaker:Cat: a 30-something mile cycle, and then there's a one-kilometer loop you can do
Speaker:Cat: as many times as you want, and then there's also static bikes and other things
Speaker:Cat: for people who aren't able to cycle.
Speaker:Cat: And it's organized by Chris Hoyt, who obviously had his stage four cancer diagnosis.
Speaker:Cat: To raise awareness of stage four cancer. But I think part of the main message
Speaker:Cat: is that stage four cancer diagnosis doesn't mean stop.
Speaker:Cat: Like that is the end. You can't do anything. I think it's trying to show that
Speaker:Cat: people, you can keep moving and the positivity of exercise.
Speaker:Cat: Yeah, so it's been really good for me as well because I think,
Speaker:Cat: like I said before, I haven't been able to walk very far or run,
Speaker:Cat: but I can get on a bike. so I'm now going whole hog on a bike.
Speaker:Cat: I started on my turbo and now going out but it also brings in the community
Speaker:Cat: side because four of my friends have signed up so we've been able to go out and cycle together.
Speaker:Cat: Yeah, but I'm quite looking forward to it. It looks like a really good event.
Speaker:Callum: And community is such a core part of sustainable interventions and Lucy,
Speaker:Callum: kind of move against cancer in 5k your way, that definitely integrates community.
Speaker:Callum: And you mentioned earlier about going for coffee and chatting.
Speaker:Callum: Is that been an intentional thing or is that something that's kind of grown
Speaker:Callum: organically, that community?
Speaker:Lucy: Um, I guess a bit of both really. I mean, the, the Nottingham group,
Speaker:Lucy: which is where we started it back in 2018. So it got seven years, seven years now.
Speaker:Lucy: And we've got people who came to the first one who still come and their cancer
Speaker:Lucy: for them is, you know, is in the past.
Speaker:Lucy: We've got people who've been living with stage four cancer since 2018.
Speaker:Lucy: We've had people that have, that, you know, sadly died, but,
Speaker:Lucy: um, we've got people that have become lifelong friends through that community.
Speaker:Lucy: And um it's like any any active intervention
Speaker:Lucy: sport is a real leveler and our
Speaker:Lucy: can we've got they call themselves the knotty and grannies and
Speaker:Lucy: then they're in their 70s and 80s and they're absolutely
Speaker:Lucy: crazy and they walk a little bit
Speaker:Lucy: sometimes they walk the whole thing um and we've
Speaker:Lucy: we've actually just recently got um some two
Speaker:Lucy: young guys in their 20s who've just finished their cancer treatment for
Speaker:Lucy: whom actually walking 5k is a
Speaker:Lucy: massive thing like it's not something they could ever imagine
Speaker:Lucy: doing just three months ago um and
Speaker:Lucy: it's yeah it's it's incredible I I think
Speaker:Lucy: each time I go because I I'm not I don't really need to be there anymore it
Speaker:Lucy: runs without me but I go and I just come away full of um can't even articulate
Speaker:Lucy: it just the magic of of community and I think everyone that has got the guts to turn up at a new group.
Speaker:Lucy: Aimed at people impacted by cancer are all
Speaker:Lucy: people who are looking for silver linings and that's part of
Speaker:Lucy: the magic of this community that everyone there has faced
Speaker:Lucy: adversity yet has found ways and
Speaker:Lucy: is looking actively looking for ways to overcome that.
Speaker:Lucy: Adversity and um some of the friendships and
Speaker:Lucy: the you know it's it's just really magical um
Speaker:Lucy: and seeing the grannies support the
Speaker:Lucy: 20 year olds from completely different backgrounds is
Speaker:Lucy: yeah it's it's hard to describe just how
Speaker:Lucy: special it is um but I think one of
Speaker:Lucy: the powers of kind of group supports is that actually the
Speaker:Lucy: friendships form and then like any sports group
Speaker:Lucy: people that are then go out and be active away
Speaker:Lucy: from the group so you don't need to stay part of whichever sports group
Speaker:Lucy: it is it might just you might just dip in a couple of times
Speaker:Lucy: and then it gives you the confidence to go and go and be
Speaker:Lucy: active on your own um so yeah and and it's
Speaker:Lucy: not obviously I see the Nottingham group but watching groups around
Speaker:Lucy: the country who've been going for some time and seeing
Speaker:Lucy: their camaraderie and their friendships is um yeah
Speaker:Lucy: is really special so yes of course it's it is about
Speaker:Lucy: the exercise but it's just as much about
Speaker:Lucy: the the friendships and the camaraderie and I think people that
Speaker:Lucy: are part of the group say would say something along the lines of it's it's just
Speaker:Lucy: being nice being around people who get it um I think that's what those two 20
Speaker:Lucy: year olds said to me that they'd told me in clinic they wanted to meet other
Speaker:Lucy: people who had been through similar and that was a way that they could um and
Speaker:Lucy: the grannies would probably say exactly the same I.
Speaker:Cat: Think just touching on that it's so true it's like with lots of experience and
Speaker:Cat: in life you can't fully understand it if you haven't been through it so everyone
Speaker:Cat: all the people that you love and things are trying to support you But unless
Speaker:Cat: they've been through something,
Speaker:Cat: they don't 100% know the extra bits of it, how you're feeling and stuff.
Speaker:Cat: Whereas connecting with people who are in a similar situation is really reassuring and,
Speaker:Cat: it's really positive.
Speaker:Lucy: And I think it's also really nice for the family
Speaker:Lucy: so it's a Debs who now runs the Nottingham group quite incredible
Speaker:Lucy: lady um but she came down when she
Speaker:Lucy: was going through her chemotherapy and she brought her whole family with
Speaker:Lucy: her and she said it's something that that we can all do together
Speaker:Lucy: and be part of that and we've got people who's
Speaker:Lucy: you know whose partners have have died from cancer who
Speaker:Lucy: still come down because of that community so it is
Speaker:Lucy: a yeah it's something the family can get involved with
Speaker:Lucy: and we've got the daughter but one of the ladies that's been coming since
Speaker:Lucy: the start the daughter's a teenager she was a
Speaker:Lucy: little girl back at the start um but yeah
Speaker:Lucy: I just I just think um physical activity
Speaker:Lucy: groups whether they're for people with cancer or
Speaker:Lucy: just you know for anybody do um
Speaker:Lucy: accelerate friendships to some extent and for people who who understand cancer
Speaker:Lucy: for whatever reason it's just a safe space for them to kind of talk and share
Speaker:Lucy: but not have those awkward silences that you're getting a sitting having a crappy
Speaker:Lucy: cup of tea in a in a support group and.
Speaker:Callum: A lot of that speaks into the kind of the mental resilience and
Speaker:Callum: also the yeah I think community a lot of the communication
Speaker:Callum: that I find I'm giving or or inclined to give
Speaker:Callum: is around the physical benefits of physical activity I'm
Speaker:Callum: not sure how how well that that sits how
Speaker:Callum: well it kind of lands I think if we were to or I
Speaker:Callum: try now and emphasize more of the short-term benefits and and I I hope that
Speaker:Callum: it offers a bit more encouragement and and possibly a kind of more longevity
Speaker:Callum: in outcome by emphasizing the kind of short-term community and and well-being aspects of moving.
Speaker:Lucy: But it is I think it is it's scary
Speaker:Lucy: like even for someone like me with all my sporting background I
Speaker:Lucy: would be nervous about turning up at a running group and i'd
Speaker:Lucy: have the same fears am i quick enough i'm like all those
Speaker:Lucy: stuff so for someone who's never had any
Speaker:Lucy: experience of exercise to turn
Speaker:Lucy: up at a group that's aimed at exercises is really
Speaker:Lucy: like i just think it's so brave those people that turn up
Speaker:Lucy: on their own and we've got um a charity that
Speaker:Lucy: does group exercise classes in nottingham and and again
Speaker:Lucy: you see the same that you get with 5k you wear these friendships that are
Speaker:Lucy: formed from from doing these circuits in the gym um
Speaker:Lucy: but yeah how you have the conversation to
Speaker:Lucy: to give people enough confidence to
Speaker:Lucy: actually turn up is is really challenging and I
Speaker:Lucy: guess that goes a little bit about the messaging that goes along
Speaker:Lucy: with you know exercise interventions and exercise
Speaker:Lucy: the word exercise can be quite off-putting for
Speaker:Lucy: a lot of people whereas movement might be a little bit
Speaker:Lucy: less off-putting I think my background um it still
Speaker:Lucy: is a big barrier for me because people assume you know like they did eight years
Speaker:Lucy: ago just because you love running not everyone with cancer is and they assume
Speaker:Lucy: oh it's going to be a running race and um yeah exercise can is very different
Speaker:Lucy: to different people um but one of the things we were saying when you were offline was um.
Speaker:Lucy: I think everyone who does find the courage to join a support group or an exercise
Speaker:Lucy: group is the kind of person who's looking for a silver lining.
Speaker:Lucy: And that's why those communities are so special. But the challenge is,
Speaker:Lucy: how do we get the people who aren't kind of classically silver lining hunters,
Speaker:Lucy: how do we get them to find those support networks as well?
Speaker:Cat: I think there's also a bit of a stigma around exercise, like you were saying, it's scary.
Speaker:Cat: And people are like, oh, I'm going to do a park run, I
Speaker:Cat: probably should make sure I can run a bit but
Speaker:Cat: and that's the study that came out recently what I
Speaker:Cat: liked about it as well is it's like no you don't have to go and
Speaker:Cat: do a HIIT workout or run a marathon or run you can
Speaker:Cat: walk you can so like you say it's movement rather
Speaker:Cat: than exercise so selling that sort of thing if or sport
Speaker:Cat: because that can put people off they're like
Speaker:Cat: I don't do sport I can't hit a ball I can't run I can't do
Speaker:Cat: that so I can't do it I won't do it whereas if you can be like you just need
Speaker:Cat: to walk to the end as a rodent back that's a start it needs to be little like
Speaker:Cat: bits at a time and small goals and not to scare people off because everybody
Speaker:Cat: can walk if you've walked into an appointment you can walk a short distance yeah.
Speaker:Lucy: And a 45 minute brisk walk which is um kind of the intervention that a lot of
Speaker:Lucy: people in the study were doing that is still a massive challenge for a lot of
Speaker:Lucy: people who've never exercised but you don't need to start with a.
Speaker:Cat: 45 minute walk you.
Speaker:Lucy: Can start with a two minute walk and back and then you know you can build it
Speaker:Lucy: really gradually but people need that support and um yeah I think that's what
Speaker:Lucy: the study showed they need the support to to do that.
Speaker:Callum: From uh for for health professionals listening and and and kind of coming back
Speaker:Callum: to what you said earlier Kat about people not really knowing what to say and
Speaker:Callum: what advice to give with both of your experiences what what what could we say
Speaker:Callum: what what would be good things to say and and you know maybe from a personal
Speaker:Callum: perspective, Kat, what would you have liked to have heard.
Speaker:Cat: I probably would have quite liked to have heard a lot more. I think I'm quite
Speaker:Cat: different, though, probably compared to a lot of the lay population, like Lucy was saying.
Speaker:Cat: I'm not a professional athlete like Lucy was, but my level of exercising before
Speaker:Cat: my cancer diagnosis was quite a lot.
Speaker:Cat: So I wanted to know, like, can I continue? Is it safe to do so?
Speaker:Cat: But also I wanted to know about timing of exercise like we were saying with
Speaker:Cat: radiotherapy treatment when should I exercise around my treatment to get the
Speaker:Cat: best effectiveness out of treatment.
Speaker:Cat: But I think a lay person who doesn't exercise would probably have quite different
Speaker:Cat: questions to me and want to know different things I think knowing the evidence
Speaker:Cat: would be really useful just simple things like the list that Lucy did about
Speaker:Cat: how it can reduce fatigue,
Speaker:Cat: reduce anxiety, depression all those things and
Speaker:Cat: the strength of the evidence as well because there's a lot of good strong evidence
Speaker:Cat: out there um I think that and maybe I think signposting as well would be really
Speaker:Cat: good because there are lots of community groups I had no signposting with my
Speaker:Cat: diagnosis but I found quite a lot myself especially as a younger person with
Speaker:Cat: social media there's charities for people in their
Speaker:Cat: 20s, 30s, 40s with cancer that provide free 12-week programs with a cancer exercise specialist.
Speaker:Cat: So there's actually quite a lot out there, but it's about signposting people
Speaker:Cat: to the right things for them, if that makes sense.
Speaker:Cat: Because I did so much digging myself because I think my way of dealing with
Speaker:Cat: my diagnosis was what can I control?
Speaker:Cat: I can control what goes into my body and how I move. So I looked into nutrition
Speaker:Cat: and things, but also looked into the timing of exercise, what type of exercise.
Speaker:Cat: And I'm lucky as a physio that I knew I was going to be having surgery to remove
Speaker:Cat: certain bits of my anatomy and knew what those muscles do and what I could do as prehab myself.
Speaker:Cat: But I think it's a bit of a postcode lottery as well in terms of physio with
Speaker:Cat: cancer because I know where we are, there's no physios as part of the sarcoma team.
Speaker:Cat: Lucy and I were chatting about this and it has quite a big impact on you physically
Speaker:Cat: dependent on where the sakuma is.
Speaker:Cat: And if you're not given the advice on how to move afterwards or how to get back
Speaker:Cat: to moving, you're not going to move.
Speaker:Cat: And then you're missing out on all the benefits of exercise.
Speaker:Callum: A lot of that, it feels like you kind of needed more time and space,
Speaker:Callum: which is a challenge in the NHS, isn't it?
Speaker:Callum: A perpetual one, but yeah.
Speaker:Callum: But a lot of what you say, it kind of makes a lot of sense, doesn't it?
Speaker:Callum: I'm sorry your experience is what it was.
Speaker:Cat: Well, I'm lucky though. I think I've said, well, I'm unlucky in one way,
Speaker:Cat: but I'm lucky there's a lot of, I think I'm definitely a silver lining person.
Speaker:Cat: There's a lot of glitter on my situation. in that I have that knowledge.
Speaker:Cat: I've got physio friends. I've got
Speaker:Cat: doctor friends. I've got a really good community to support me through.
Speaker:Cat: And I'm very much of the belief that knowledge is power. So my kind of coping
Speaker:Cat: mechanism is to start reading into things.
Speaker:Cat: What's the evidence? What can I do to help myself?
Speaker:Cat: Whereas I think a lot more people are quite passive and they'd be in the same
Speaker:Cat: situation and be less active than they were before, which might not have been
Speaker:Cat: very active in the first place.
Speaker:Callum: How about you, Lucy? Any thoughts on what health professionals can do to support
Speaker:Callum: people with cancer to move more?
Speaker:Lucy: I mean, I think, number one, just bring it up in a consultation.
Speaker:Lucy: And I think what I've listened, what I've heard from what Kat's just said is
Speaker:Lucy: she wanted to know what she can do.
Speaker:Lucy: And I think in my experience, most people with cancer want to know what they can do.
Speaker:Lucy: And exercise is something that everyone with
Speaker:Lucy: cancer can do and I think yeah bringing
Speaker:Lucy: that up in conversation as part of your your.
Speaker:Lucy: Your consultation is is really important and it's
Speaker:Lucy: also actually a really positive thing to do because I'm you know as an
Speaker:Lucy: oncologist I prescribe drugs and the first
Speaker:Lucy: time I meet a patient once I've chatted with them
Speaker:Lucy: find out what you know what matters to them what the
Speaker:Lucy: symptoms are etc we talk about the treatments and
Speaker:Lucy: then I go through a long list of side effects and it's really
Speaker:Lucy: scary and it's quite it's a horrible way to send end
Speaker:Lucy: a consultation assignment consent form with these side effects but
Speaker:Lucy: you can then follow up with something that's actually quite positive that
Speaker:Lucy: will undoubtedly make people feel better and so
Speaker:Lucy: as a healthcare professional you do need
Speaker:Lucy: to to kind of I guess think about how you're
Speaker:Lucy: going to bring it up moving medicine's got some it's a
Speaker:Lucy: website it's got some great kind of conversation like the two minute
Speaker:Lucy: conversation the five minute conversations it's got some great suggestions
Speaker:Lucy: about how you can bring that up but it is a really positive
Speaker:Lucy: thing that that you can do that can you know
Speaker:Lucy: will help give patients back some sense of control um
Speaker:Lucy: but also end the consultation on a slightly positive note
Speaker:Lucy: um and I guess I'd also encourage people to remember that so many people with
Speaker:Lucy: cancer assume that they need to rest and actually giving them permission to
Speaker:Lucy: go outside and and move is a really positive thing that will take off a lot
Speaker:Lucy: of anxiety and weight off their mind um and and probably change their perceptions.
Speaker:Lucy: Yeah, so I think understand the evidence and bring it up in conversation is
Speaker:Lucy: probably the two things.
Speaker:Lucy: And I certainly, I think the challenge for our show is that we owe it to patients.
Speaker:Lucy: Like it proves we have to have those conversations with everyone who's been
Speaker:Lucy: given a cancer diagnosis.
Speaker:Cat: I think you make a really good point because I think in my initial consultation,
Speaker:Cat: I brought it up at the end rather than it being brought up to me.
Speaker:Cat: So you you as an
Speaker:Cat: oncologist have the have you obviously are very
Speaker:Cat: interested in the exercise side of things as well but my
Speaker:Cat: oncologist was like yes of course you need to move and like
Speaker:Cat: oh I had someone in here the other day who has been having
Speaker:Cat: radiotherapy on their knee and hasn't moved it for six weeks I'm like
Speaker:Cat: okay but it needs to be job I asked
Speaker:Cat: yeah and but uh yeah
Speaker:Cat: so it is about bringing it up and like you said well we
Speaker:Cat: said before about the cliche of exercise as a drug you're talking
Speaker:Cat: about chemotherapy which is obviously a drug and a treatment which people need
Speaker:Cat: to have but exercise should have as much importance in a consultation because
Speaker:Cat: of the evidence that's that's there as well as an add-on to the treatment that
Speaker:Cat: you're having so I think it's.
Speaker:Lucy: But then I come I guess coming along with that it's nice then for healthcare
Speaker:Lucy: professionals to have somewhere to signpost patients to because they're not
Speaker:Lucy: going to have the expertise to tell all the time to go through a structured exercise program.
Speaker:Cat: No there are charities.
Speaker:Lucy: Out there so having a you know a list of places that you can signpost to I think
Speaker:Lucy: I think that I think healthcare professionals will say that makes it easier
Speaker:Lucy: to have a conversation as well because you can have the conversation and then
Speaker:Lucy: pass part you know point the person into a into the right direction oh and by
Speaker:Lucy: the way it's great to exercise off you go.
Speaker:Cat: Exactly you have to have the resources to
Speaker:Cat: back it up yeah but even like I know
Speaker:Cat: when I was still working in the NHS we loved leaflet and it was a really good
Speaker:Cat: way to tell people how many things they could do for their arthritis or something
Speaker:Cat: and exercise is one of them and you have all the resources on the back so it's
Speaker:Cat: just simple communication and to provide the people with the places to look.
Speaker:Callum: The other thing you both are are amazing at
Speaker:Callum: is is the power of advocacy i think when you're you're passionate
Speaker:Callum: about something and you represent it and one of
Speaker:Callum: the things that i think healthcare professionals as a
Speaker:Callum: population are often really active particularly doctors i think sometimes
Speaker:Callum: some uh sometimes we don't
Speaker:Callum: represent that very well and i've become conscious about trying to
Speaker:Callum: to leave kind of not very subtle signs around
Speaker:Callum: my consulting room so that people know it's a priority in in
Speaker:Callum: in my life and and yeah
Speaker:Callum: whether we can we can encourage colleagues to do something similar I I
Speaker:Callum: don't know but uh but yeah I'm sure you guys do that and and certainly and yeah
Speaker:Callum: well you are doing that so which is bro just to finish it would be really interesting
Speaker:Callum: just if you guys had any final thoughts or or reflections or or just you know
Speaker:Callum: something that you wanted the listener to,
Speaker:Callum: to take away from from from this i i kind of putting you both on the spot i'm
Speaker:Callum: gonna fill time just briefly and then and then hand over lucy yeah perfect no.
Speaker:Lucy: I guess this is for a healthcare professional um so one of my in the early days
Speaker:Lucy: of 5k away there was um an incredible lady called sue and she's died now but
Speaker:Lucy: she was 70 or 71 i think and she'd been diagnosed with bowel cancer that had
Speaker:Lucy: spread her liver. She had never run in her life.
Speaker:Lucy: And when she was in hospital having a bowel cancer surgery, she saw the flyer
Speaker:Lucy: for 5k your way and she joked to her family.
Speaker:Lucy: She said, when I get out of here, I'm going to do that. And her family like,
Speaker:Lucy: you don't run. She's 70 or 71.
Speaker:Lucy: Anyway, she got out of hospital. She could hardly walk to the toilet.
Speaker:Lucy: She came to 5k. She walked a
Speaker:Lucy: bit of it and she came back and she came back and she built up to running.
Speaker:Lucy: And eventually she set the target of if I break 35 minutes, I'm going to get
Speaker:Lucy: in the river naked. And she got in the river naked.
Speaker:Lucy: But I've got this amazing video of her saying, when people ask me how I am,
Speaker:Lucy: I don't talk about the bad stuff. I tell them I've started running.
Speaker:Lucy: And she's a lady that you would never assume would want to be told to exercise. She's 70.
Speaker:Lucy: She's just been diagnosed with stage four cancer.
Speaker:Lucy: She's exercise was not part of her life. Yet actually what it turned into was
Speaker:Lucy: her crutch during the years that she was living with cancer.
Speaker:Lucy: And for me, that's kind of whenever I've struggled with the charity and growing
Speaker:Lucy: a charity, it's a lot of work and it's stressful at times.
Speaker:Lucy: I very often come back to Sue and there are so many Sue's out there who could
Speaker:Lucy: get so much joy and medical benefits if they just were given the information
Speaker:Lucy: about benefits of exercise.
Speaker:Lucy: So that's my little anecdote that I'll end on.
Speaker:Callum: Thanks Lucy. How about you Kat?
Speaker:Cat: I think kind of following on from what Lucy's just said, a lot of it,
Speaker:Cat: I'm a big believer in knowledge is power.
Speaker:Cat: So if you can equip people with
Speaker:Cat: the knowledge that doing something can help
Speaker:Cat: them again going back to signposting and
Speaker:Cat: things then it gives them the power
Speaker:Cat: to try it that makes sense it's again like i think permission has been mentioned
Speaker:Cat: a lot it's that permission you are allowed to move you're not going to harm
Speaker:Cat: yourself moving doesn't mean running a marathon moving doesn't mean doing something
Speaker:Cat: really extreme it can be walking it can be anything and so it's that permission
Speaker:Cat: to do it but also arming people with the knowledge,
Speaker:Cat: that they can do it and should do it.
Speaker:Callum: Permission and empowerment, good note to end on. Thanks, guys.
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