Episode 3
Bridging Fitness and Medicine: The Role of Clinical Exercise with Rob Bird
In this episode of The Movement Prescription Podcast, hosts Suzy and Callum sit down with clinical exercise specialist Rob Bird to explore the critical role of exercise in healthcare. Rob shares his journey from the traditional fitness industry to clinical exercise, highlighting the importance of tailored movement for individuals with chronic conditions. They discuss the barriers many face when engaging in physical activity, the need for healthcare professionals to guide patients effectively, and how behavioral change principles can enhance adherence to exercise. Rob also breaks down key assessment strategies, the evolution of functional movement, and why the people who need exercise the most are often the least likely to access it.
Whether you’re a healthcare provider or simply interested in the science of movement, this episode provides valuable insights into making exercise a powerful tool for long-term health and well-being.
Produced with support from the British Society of Lifestyle Medicine.
Find us at https://themovementprescription.co.uk/ and join the conversation!
Transcript
Suzy: Welcome to this episode of the Movement Prescription Podcast,
Speaker:Suzy: supported by the British Society of Lifestyle Medicine.
Speaker:Suzy: Join Callum and I in conversation with Rob Bird, who is a clinical physical
Speaker:Suzy: activity specialist and exercise consultant.
Speaker:Suzy: Learn what this actually means and how he got here from his frustrations with
Speaker:Suzy: the fitness industry in the 1990s through various qualifications and certifications.
Speaker:Suzy: Learn from his pearls of wisdoms about how exercise is the cornerstone of health.
Speaker:Suzy: And remember that the physician message is really one of the most important
Speaker:Suzy: tools that we have. I hope you enjoy it.
Speaker:Suzy: Rob, it's an absolute pleasure to have you here today.
Speaker:Suzy: And we're really looking forward to learning from all your experience and wisdom
Speaker:Suzy: in all things physical activity.
Speaker:Suzy: And so we were just chatting before we came on the podcast. And I understand
Speaker:Suzy: you're a clinical exercise consultant. Could you tell us what does that mean?
Speaker:Rob: Interesting question. Yeah. Hi, guys. Thanks for having me on.
Speaker:Rob: What's the clinical exercise consultant?
Speaker:Rob: Well, I guess we are a group of people who have a clinical understanding of
Speaker:Rob: physiology and how exercise integrates with that.
Speaker:Rob: So from that perspective, we're very different in many ways to normal exercise
Speaker:Rob: instructors because we have a clinical background. So that gives us an insight
Speaker:Rob: into clinical conditions, pharmacology, and how exercise kind of integrates with that.
Speaker:Suzy: So could you tell us then just a little bit about your journey and how you came
Speaker:Suzy: to that point, Rob? I would love to hear a bit more about how you got there.
Speaker:Rob: Well, I started in the exercise industry in the mid-90s and realized very quickly
Speaker:Rob: that gyms were full of people who were fit already and didn't really need to be in that environment.
Speaker:Rob: Are the people who are really going to get a benefit from physical activity,
Speaker:Rob: bearing in mind that ACSM were always quoted on all of the courses I did.
Speaker:Rob: The people who were going to get the benefit weren't actually coming through the door.
Speaker:Rob: You know, we know that exercise has a massive impact on many clinical conditions,
Speaker:Rob: yet most of the people in the gym didn't fall into that remit.
Speaker:Rob: They were people who were fit, people who were training for events,
Speaker:Rob: people who were training to go on holiday.
Speaker:Rob: And we were kind of missing the point, really. So I went off and did some stuff
Speaker:Rob: in the US with the American College of Sports Medicine and learned a little
Speaker:Rob: bit more about clinical exercise.
Speaker:Rob: I came back to the UK and did a master's degree in 2007 in exercise and behavioral medicine.
Speaker:Rob: And then in 2011, did some stuff around preventive cardiology with Professor
Speaker:Rob: David Wood at Imperial College and kind of evolved my business from there, really.
Speaker:Rob: We know that, as I say, exercise is incredibly beneficial for people with clinical
Speaker:Rob: conditions, and I've developed a business around that.
Speaker:Callum: Robert, it's really interesting. You started in the 90s. There's a lot of lycra
Speaker:Callum: and spandex, but also the other thing which is really interesting about the
Speaker:Callum: 90s is we were quite reductionist in the way that we viewed the body.
Speaker:Callum: The things in the gym were often cable machines and you worked on a single muscle group at a time.
Speaker:Callum: It must be really interesting to see how the fitness injuries evolved.
Speaker:Callum: I can see how it would be very easy to be disillusioned by it and no doubt you're ahead of your time.
Speaker:Callum: And now we have things like CrossFit, which are great because they integrate full body movement.
Speaker:Callum: But at the same time, it's quite exclusive and still has those challenges that
Speaker:Callum: you talked about, which is that actually it only appeals to a certain group
Speaker:Callum: of people who are probably going to be active anyway.
Speaker:Rob: Yeah, I think you're right. I mean, the fitness industry evolves over the years
Speaker:Rob: and with January coming around, I suspect we'll have another new evolution,
Speaker:Rob: which won't really be one at all.
Speaker:Rob: The reality is that the client-based ideal always.
Speaker:Rob: Yes, of course, we talk about functional movement now, and we didn't back in the 90s, perhaps.
Speaker:Rob: But I often wonder what functional movement actually is. Function is different
Speaker:Rob: for everybody, isn't it?
Speaker:Rob: And the client base I have, function means different things to different people.
Speaker:Rob: You have a stroke survivor, function is very different to someone who wants to run a 10K.
Speaker:Rob: So I think the word functional is good. I think sometimes it's misused,
Speaker:Rob: and it kind of crosses over perhaps in not a very good way
Speaker:Rob: because the functional fitness sections in modern gyms now are battle ropes
Speaker:Rob: and all these kind of things you'll see but I'm not necessarily sure that's
Speaker:Rob: relevant to my population group so yeah you're right the 90s was very different
Speaker:Rob: now we're very different but I think we all end up in the same place.
Speaker:Suzy: Rob I'm interested what is your client group what would you say your average
Speaker:Suzy: patient is like sort of demographically?
Speaker:Rob: Well, demographically, I would say most of my patients are 45 plus.
Speaker:Rob: I would say the vast majority of my patients are 60 plus.
Speaker:Rob: And they're coming to me, they're self-referred, actually. We don't have a referral
Speaker:Rob: pathway, at least for the NHS in my local area.
Speaker:Rob: They come to me on the back of a diagnosis or an abnormal blood test or an event.
Speaker:Rob: So you may have someone who comes here who's been told they've got metabolic
Speaker:Rob: syndrome, for example, and they might not want to go on insulin.
Speaker:Rob: They might be diabetic, they want to go on insulin.
Speaker:Rob: There are people here who have had strokes, cardiac rehabilitation,
Speaker:Rob: those kind of things, cancer survivors.
Speaker:Rob: So it's quite a unique group of people, really. And these are the people that
Speaker:Rob: probably wouldn't go into a mainstream facility anyway, whether that's through
Speaker:Rob: fear or they perhaps wouldn't be served for.
Speaker:Suzy: And I guess what's really interesting is that you've got a self-selecting group there.
Speaker:Suzy: Yes, they are diverse, but they are already quite a long way around that cycle
Speaker:Suzy: of change. And you mentioned there that there isn't an NHS referral pathway.
Speaker:Suzy: And obviously, you know, someone like me, a GP working on the frontline in a
Speaker:Suzy: very deprived demographic, you
Speaker:Suzy: know, the hardest part for me is getting patients across the threshold.
Speaker:Suzy: But I suspect you've got a lot of lessons and probably a lot of advice for how
Speaker:Suzy: do we get people to a facility like yours?
Speaker:Rob: Well, I guess the question is, and I'm guessing the areas you guys are working
Speaker:Rob: with is the same, is we don't yet have an established referral pathway.
Speaker:Rob: There is no template for referral.
Speaker:Rob: And so for you guys, I guess the question is, how do you actually identify which
Speaker:Rob: exercise professional to refer to? And that's difficult.
Speaker:Rob: There's work in the background by an organization called ZIMSBUT,
Speaker:Rob: who are the Chartered Institute, and they are working with Level 2 and Level
Speaker:Rob: 3 instructors and Level 4 instructors.
Speaker:Rob: But that's going to be a piece of work that's going to take some time.
Speaker:Rob: So there is also Clinical Exercise UK now, which is an organisation I'm very interested in.
Speaker:Rob: And they are certifying clinical exercise specialists, people who have degrees in the field.
Speaker:Rob: So from a medical perspective, I suspect they would be the people you're better
Speaker:Rob: referring to if we could at some point get a referral pathway,
Speaker:Rob: which, as we know, is not necessarily there yet. most of my referrals are self-referred
Speaker:Rob: off to the private sector.
Speaker:Callum: A couple of questions just on the back of that the first is
Speaker:Callum: your self-referral still requires people to hear about it
Speaker:Callum: and so how are they hearing about it how how are
Speaker:Callum: they saying they're coming to you and and the second is
Speaker:Callum: slightly slightly independent of that but you
Speaker:Callum: mentioned simspa and the different pathways for
Speaker:Callum: certifying as a as an exercise specialist
Speaker:Callum: that i think it's a really murky water and quite hard to unpick you
Speaker:Callum: say you're you're either listening to this podcast because you you want to engage
Speaker:Callum: in that or you want to do some more exercise how do you go and find someone
Speaker:Callum: that is appropriately trained for you that might have chronic conditions so
Speaker:Callum: sorry two parts or two different questions well.
Speaker:Rob: First of all the referral pathway people find me by word of mouth I mean my
Speaker:Rob: my business established I've been doing this for nearly 30 years so a lot of
Speaker:Rob: clients that work with me are passing on the information about their successes
Speaker:Rob: and that's kind of how they find me.
Speaker:Rob: It's unfortunate that there are not many more people engaging with me.
Speaker:Rob: I have a busy practice for sure but there are probably many people out there
Speaker:Rob: who are missing out because there is no established pathway.
Speaker:Rob: So in answer to your question most of my stuff is word of mouth and as I say
Speaker:Rob: that's something that needs to be addressed and I'm hoping Zimspot or someone
Speaker:Rob: similar will do that at some point.
Speaker:Rob: I know some GPs have GP referral pathways into local fitness centres,
Speaker:Rob: but that links into your second question, really.
Speaker:Rob: Some of the people in fitness centres are going on basic courses.
Speaker:Rob: There are some level four courses, and just so you know, a level four courses
Speaker:Rob: class is something that has a medical content.
Speaker:Rob: And depending on how you risk stratify your patient, and some of those instructors may be appropriate.
Speaker:Rob: So a GP referral pathway into a mainstream gym may be a way for you to think
Speaker:Rob: about it and Zinspa do charter level three and level four instructors I believe.
Speaker:Callum: Rob, can you just, for me, I have no idea, but also hopefully for listeners,
Speaker:Callum: what is a level, what does it take to be a level three, a level two,
Speaker:Callum: a level three, a level four, if that makes sense?
Speaker:Rob: Level 2 are very short courses and are basic for sure.
Speaker:Rob: Level 3 are a step above that and they'll be multiple weekends in duration or
Speaker:Rob: a couple of weeks perhaps.
Speaker:Rob: And they'll cover physiology and basic exercise prescription in a bit more depth.
Speaker:Rob: By the time you get to level 4, they're talking about specific clinical conditions,
Speaker:Rob: cardiac rehabilitation, cancer, those kind of things.
Speaker:Rob: And some of the content of those courses, I've done a lot of those courses over
Speaker:Rob: the years are really good and they open the door for more information for the
Speaker:Rob: instructor but they have quite a strict risk stratification criteria which means
Speaker:Rob: a lot of the complicated cases probably wouldn't be referred to those people
Speaker:Rob: either and that's where the clinical exercise stuff comes in.
Speaker:Rob: We're taking on clients that nobody else would take because we have an understanding
Speaker:Rob: of complex pharmacology and comorbidities and those kind of things.
Speaker:Suzy: That brings me really nicely onto a question that I've often heard because I'm
Speaker:Suzy: not clinically trained to, you know, when it says to patients,
Speaker:Suzy: ask your GP before embarking on a new physical activity regime.
Speaker:Suzy: I haven't had the training for that. We are quick learners. So what do we need to know?
Speaker:Rob: Oh, that's an interesting question. I mean, depending on,
Speaker:Rob: there's a whole, we know that exercise is good for us right we know that and
Speaker:Rob: we know that everyone should be probably more active or at least most people
Speaker:Rob: should i guess it's difficult for you guys because you don't have very long
Speaker:Rob: in your consultations to actually unpick this stuff for me it's really much
Speaker:Rob: really much easier because i have time with clients to get to know them what makes them tick um,
Speaker:Rob: what you need to know specific conditions have specific criteria around exercise
Speaker:Rob: prescription and what you do and there is there is some good resources that
Speaker:Rob: i can definitely direct you towards one that I would recommend every GP to have in their surgery.
Speaker:Rob: And as much as we've got multiple guidelines online, the ACSM,
Speaker:Rob: the American College of Sports Medicine, have kind of been pioneers in this stuff.
Speaker:Rob: And they have a small book, Guidelines for Exercise Testing and Prescription, now in its 11th edition.
Speaker:Rob: And if we could get GPs to have that in their practice, you can turn a page
Speaker:Rob: and have a summary of clinical conditions and considerations.
Speaker:Rob: And I think that would be a really useful resource for all of you actually.
Speaker:Suzy: I've not heard of that one. I'm going to put that on my Christmas list.
Speaker:Suzy: Callum?
Speaker:Callum: I've read it, Rob. I agree. I really enjoyed it. I actually did it.
Speaker:Callum: I didn't know about it, but I did the Diploma of Exercise Medicine,
Speaker:Callum: which is the Faculty of Sport and Exercise Medicine.
Speaker:Callum: The first run was last year or 2024.
Speaker:Callum: And that was the core reading. And it's quite nice. It's only about 120 pages or so long.
Speaker:Callum: It's very concise. You can pick it up, put it down. But yeah,
Speaker:Callum: thanks for recommending it.
Speaker:Rob: And it's like a resource manual. It's clear,
Speaker:Rob: it's concise and summarizes so for you guys you could turn a page you could
Speaker:Rob: look at a specific condition and it will give you a list of contraindications
Speaker:Rob: things to consider so and a conversation from a physician we've got lots of
Speaker:Rob: evidence for this really carries a lot of weight,
Speaker:Rob: it's all very well for somebody like me telling people maybe they should do
Speaker:Rob: x y and z but if it comes from their doctor we've it seems to carry a lot more
Speaker:Rob: weight which i completely get quite So we want to make sure you're giving them
Speaker:Rob: the right information before they leave your surgery.
Speaker:Suzy: And that's really good advice there. And I'm looking forward to having a resource on my table.
Speaker:Suzy: Just for people who like online resources, is there an online version?
Speaker:Rob: Um you can look at the acsm website and there's quite a lot of exercises medicine
Speaker:Rob: resources on there and you don't have to be a member of the acsm to access some of that stuff,
Speaker:Rob: and the reason i mention the acsm is because they've been around forever they've
Speaker:Rob: written all the guidelines for all of the trading companies if you go on a level
Speaker:Rob: three course they will quote acsm guidance so it's it's it's always been there.
Speaker:Suzy: So give me a little crash course then because i know from from um you know a
Speaker:Suzy: lot of colleagues that they'll be really worried particularly about patients
Speaker:Suzy: with breathlessness, patients with asthma, with COPD, for example,
Speaker:Suzy: and especially ones with exercise-induced symptoms.
Speaker:Suzy: So, you know, what would your advice be to it? What would you wish that GPs
Speaker:Suzy: knew about that? How can you give us confidence?
Speaker:Rob: Well, there's a whole lot of guidelines around asthma and COPD,
Speaker:Rob: as you can imagine, and the ACSM guidelines will lead you nicely down a nice summary for that.
Speaker:Rob: But it's patient assessment.
Speaker:Rob: For me, referring to the right person is really important, Somebody who understands
Speaker:Rob: the condition, understands the pharmacology, how it affects their exercise capacity,
Speaker:Rob: how it affects your ability to monitor their intensity, those kind of things.
Speaker:Rob: So if someone has asthma, for example, and they're regularly using an inhaler
Speaker:Rob: before they exercise, then monitoring their heart rate is probably completely
Speaker:Rob: pointless because it's going to elevate their heart rate, at least in the short term.
Speaker:Rob: So we have things like perceived exertion scales that we would use to give people
Speaker:Rob: a guideline of how to exercise and what to expect.
Speaker:Rob: And again, the Borg scale is something you may well be familiar with.
Speaker:Rob: It's certainly used in cardiac rehab and COPT rehabilitation,
Speaker:Rob: something that you could just direct the patient to, to safely monitor their exercise capacity,
Speaker:Rob: which is I use it a lot for sure, because you quite often find that people coming
Speaker:Rob: not just on one drug either,
Speaker:Rob: There are multiple drugs and that can do all sorts of things to heart rates
Speaker:Rob: and responses and autostatic issues and all of those things that a patient,
Speaker:Rob: if they're not aware of, will be absolutely terrified of.
Speaker:Suzy: And I think also, you know, you brought a paper along to one of the meetings
Speaker:Suzy: that we've been in together about the effect of antihypertensives on your body's
Speaker:Suzy: response in exercise. Tell us a bit more about that.
Speaker:Rob: You know, that's a classic example, actually. We have lots of people who come
Speaker:Rob: to the door here on pharmacology for high blood pressure, two or three,
Speaker:Rob: maybe four different meds.
Speaker:Rob: And once they start bringing exercise into the mix and they get that post-exercise
Speaker:Rob: hypertensive effect, which is a massively marked effect actually,
Speaker:Rob: which is why exercise is so effective for reduction of blood pressure over time.
Speaker:Rob: And they find that suddenly their medication is too aggressive and they start
Speaker:Rob: experiencing autostatic responses and dizziness when they stand and things that
Speaker:Rob: terrify them, quite frankly.
Speaker:Rob: And if they're not aware of those potential interactions, it can put them off activity.
Speaker:Rob: And they'll say, well, I started exercising and suddenly I got dizzy.
Speaker:Rob: And that terrifies me. So we need to let them know about all this potential interaction.
Speaker:Suzy: Terrifies me too.
Speaker:Callum: Robert, I think that's a really interesting point that I just wanted to pick up on.
Speaker:Callum: Because I think we often have one opportunity with people.
Speaker:Callum: They may come, they're kind of contemplating taking up physical activity and
Speaker:Callum: we need to get it right. or if we don't get it right, it might put them off for a long time.
Speaker:Callum: And obviously competence is a big part of that. But when someone comes to you,
Speaker:Callum: they turn up at your door.
Speaker:Callum: What are the first things that you do in your practice just to make people feel
Speaker:Callum: comfortable and to kind of break down those barriers that people might or the
Speaker:Callum: cross that they might carry as they arrive at your door?
Speaker:Rob: Well, as I said before, I have the luxury of having time.
Speaker:Rob: So I can sit them down and do an in-depth history about their experiences of
Speaker:Rob: activity, what they like, any diagnosis they have, what medication they're on,
Speaker:Rob: previous experiences about being in an environment like this,
Speaker:Rob: for example, exploring barriers around all the lifestyle medicine protocols, really, how we sleep.
Speaker:Rob: Do they have a social outlet? Do they like to exercise in a group?
Speaker:Rob: And once we've unraveled all that stuff and we've knocked down some of those barriers,
Speaker:Rob: then we start looking at how their medication and
Speaker:Rob: their comorbidities and their orthopedic issues
Speaker:Rob: might interact with the decisions they're making about activity if
Speaker:Rob: someone wants to run a marathon and they've got arthritic knees and
Speaker:Rob: they're on three or four um different medications for
Speaker:Rob: different things it's not going to be an approach at starting point
Speaker:Rob: at least and you'd be surprised how many people have that perception
Speaker:Rob: that they're going to go from doing nothing to doing
Speaker:Rob: something really intense very quickly and there's a huge bit
Speaker:Rob: between that top end and where they
Speaker:Rob: start and part of my job is to advise them
Speaker:Rob: and very commonly what i do here is i meet people who are exercising at the
Speaker:Rob: wrong level and having problems so we end up scaling them back a bit and giving
Speaker:Rob: them something more focus that in itself builds confidence and once they've
Speaker:Rob: got the confidence you'd be amazed what they can achieve they certainly are it's.
Speaker:Suzy: So often you know doing the simple things well isn't it rob you know what i'm
Speaker:Suzy: hearing from what you're saying there is is you know start low go slow and if
Speaker:Suzy: you're going too fast and then just just cut it back a bit um and.
Speaker:Rob: Just being.
Speaker:Suzy: Generally sensible um isn't it.
Speaker:Callum: Rob gonna put you on the spot if you've got
Speaker:Callum: very short you know if if if like suzy and i you you've got very short time
Speaker:Callum: with with someone what are the real tips that we can do in that time to to kind
Speaker:Callum: of keep people motivated and possibly move them through that that cycle of change.
Speaker:Rob: Well, I guess we know that this is all about behaviour change.
Speaker:Rob: So I'm guessing the first question is, what have you done previously? What do you like?
Speaker:Rob: And then I guess you can kind of integrate that with the information you have
Speaker:Rob: in front of you with regards to their clinical diagnosis potentially and what medication they're on.
Speaker:Rob: And then you can pick up your ACSM manual and look at what it's guiding you towards.
Speaker:Rob: Because believe me, this is a really comprehensive piece of literature.
Speaker:Rob: So if you have someone who's on multiple pharmacology for high blood pressure
Speaker:Rob: and has arthritic knees and wants to go and do some exercise because I know
Speaker:Rob: it's good for them, then for you, it's about what have you done previously?
Speaker:Rob: What are you looking to do in the future?
Speaker:Rob: And how, you know, you might want to be aware of this, this and this as you start.
Speaker:Rob: Can you get all that into a seven-minute consultation with us,
Speaker:Rob: I guess, is the question.
Speaker:Suzy: I'm a firm believer in seed planting as well, even if it's not going to work
Speaker:Suzy: on consultation number one.
Speaker:Suzy: Hopefully, if you've got a team around you that's going to bring up the same
Speaker:Suzy: conversation again, how many times is it you need to be introduced to an idea
Speaker:Suzy: or a new food before you'll accept it?
Speaker:Suzy: I think we just need to be doing this constantly low-level, encouraging people
Speaker:Suzy: to see what's possible, I think.
Speaker:Suzy: But what you say about word of mouth as well is really important,
Speaker:Suzy: isn't it? It's, you know, folk like me, it's being inspired by other people
Speaker:Suzy: who are doing what they're doing and learning from them.
Speaker:Suzy: We spoke a minute ago about things that strike fear into our hearts as GPs.
Speaker:Suzy: And one of the other ones, Rob, I want your reassurance. What about patients with angina?
Speaker:Suzy: What do you do with these patients who have a background cardiac condition?
Speaker:Rob: Well, the utopia for anyone with a cardiac condition is proper assessment.
Speaker:Rob: And unfortunately, we don't often get that. So I'll have someone turning up
Speaker:Rob: here who has been diagnosed with angina and been put on medication to manage
Speaker:Rob: it and has been told to get fit, and they've kind of been left at that point.
Speaker:Rob: What I'll do is I'll assess them, have a conversation with them,
Speaker:Rob: reassure them that exercise is a really good idea because it is.
Speaker:Rob: We've got lots of evidence for that.
Speaker:Rob: And then we'll bring them in, and I'll have to do some kind of, you know,
Speaker:Rob: a field assessment of some description, which will be probably something as
Speaker:Rob: simple as getting to do a mode of activity that they're comfortable with and
Speaker:Rob: a talk test or using a ball scale just to kind of see where they're at.
Speaker:Rob: I think the most important thing is reassurance and showing that they can be
Speaker:Rob: safe and teaching them how to monitor themselves safely.
Speaker:Rob: In any cardiac rehab program, that would be something that they would spend
Speaker:Rob: weeks doing, for example.
Speaker:Callum: I'm probably going to take a bit of a sidestep here, but one of the things seeing
Speaker:Callum: a lot at the moment is people coming in asking about Wigovi and Nanjaro and
Speaker:Callum: the medication that are being marketed as these wonder drugs.
Speaker:Callum: It actually presents a lot of challenges, no doubt,
Speaker:Callum: but I think it also presents an opportunity because people are
Speaker:Callum: suddenly aware or being made aware of the impact
Speaker:Callum: of obesity on health and the need to to manage
Speaker:Callum: that and so i kind of wanted to segue
Speaker:Callum: into into metabolic health possibly and how you
Speaker:Callum: manage people with metabolic health and i think that the
Speaker:Callum: people or or as the pathways for
Speaker:Callum: the prescription of of of manjaro wagovi are established there's opportunity
Speaker:Callum: in there and i think we we need to be mindful of having these conversations
Speaker:Callum: so yeah just uh what what do you do uh to encourage people with diabetes metabolic
Speaker:Callum: syndrome to to be more active.
Speaker:Rob: Well those prevalent conditions i see certainly
Speaker:Rob: in the last couple of years been exactly those things metabolic issues
Speaker:Rob: sure metabolic syndrome diagnosing people in the 30s and 40s who are clinically
Speaker:Rob: heavily overweight and because i work alongside the private sector i am seeing
Speaker:Rob: a lot of prescription of the drugs you've just mentioned so when there's no
Speaker:Rob: question that exercise should be a cornerstone of diabetes therapy.
Speaker:Rob: Absolutely no question. We've got so much evidence for that.
Speaker:Rob: You know, if we can tell people that if they can get a little bit more lean
Speaker:Rob: body mass, for example, they're going to dispose of this excess glucose in their system.
Speaker:Rob: We can tell them that being physically more active doing so,
Speaker:Rob: even something as simple as going for a walk, if they're really sedentary,
Speaker:Rob: they're going to see quite significant changes quite quickly.
Speaker:Rob: We've got a lot of evidence for that. and if you link that
Speaker:Rob: to the prescription of things like manjaro and
Speaker:Rob: semiglotide and things like that there's also the issue around
Speaker:Rob: preservation of lean body mass because we've got
Speaker:Rob: quite a lot of evidence that those drugs not only obviously
Speaker:Rob: affect weight with regards to body
Speaker:Rob: fat but they also attack lean body mass as well muscle mass
Speaker:Rob: and in my work in in with these patients our ultimate goal while they're on
Speaker:Rob: this uh journey of semiglotide or whatever they're taking is to ensure that
Speaker:Rob: they come out of that process with preservation and then the ability to dispose
Speaker:Rob: of glucose going forward.
Speaker:Suzy: How many people do you think are actually aware that their lean body mass is
Speaker:Suzy: being affected by these medications? Do you think that message is out there?
Speaker:Rob: I'm not sure it is. I think it's growing. If you look at, I mean,
Speaker:Rob: I'm not on social media personally, but I get given a lot of things by my clients that they've read.
Speaker:Rob: And I think the message is starting to change.
Speaker:Rob: Unfortunately, as well, and you'll probably see some of this yourself,
Speaker:Rob: there are plenty of people who can afford to buy these drugs on the black market
Speaker:Rob: who don't necessarily need them.
Speaker:Rob: And they are having real issues. I'm seeing that here.
Speaker:Rob: They're having real issues around loss of function and lean body mass in their 30s.
Speaker:Rob: They're taking drugs they don't need because they want to lose weight for a holiday, for example.
Speaker:Rob: I'm sure you've met people like this yourselves. They don't really have a metabolic
Speaker:Rob: issue that would warrant that prescription.
Speaker:Rob: And that's definitely a message we can give to those people with
Speaker:Rob: regards to the metabolic patients i guess that's something that you
Speaker:Rob: guys could be saying if you're coming across these
Speaker:Rob: prescriptions the importance of maintaining good function good lean body mass
Speaker:Rob: while they're on the journey i think most prescription journeys are 12 to 18
Speaker:Rob: months aren't they and that's uh if you're losing lean body mass over that time
Speaker:Rob: by the time you end that process you could have lost a significant amount of
Speaker:Rob: muscle and actually function as well i.
Speaker:Callum: Think it's a really interesting point rob that we need
Speaker:Callum: to be doing these i think there's there are
Speaker:Callum: appropriate prescriptions of these drugs and people that need them and and
Speaker:Callum: i'm definitely seeing people up here in scotland who
Speaker:Callum: are buying it online because they they they want to lose weight and and it's
Speaker:Callum: not available but i think it needs to be done in conjunction with lifestyle
Speaker:Callum: changes because otherwise it will end up in a kind of either a dependency or a yo-yo effect.
Speaker:Callum: And so, yeah, I think that's a really important point. And I suppose it interlinks
Speaker:Callum: with that lean muscle mass as well or lean body mass.
Speaker:Rob: Well, it's back to that behavioural aspect, isn't it? I mean,
Speaker:Rob: the reality is if people have prescribed these drugs because they have a clinical
Speaker:Rob: need and they're not addressing how they got there in the first place,
Speaker:Rob: potentially when they're coming off the medication, they're going to end up in the same spot.
Speaker:Rob: I mean, there's a lot of evidence to say that the weight regain after coming
Speaker:Rob: off these medications is quite significant.
Speaker:Rob: And actually some people that I've seen here actually or we're starting to see
Speaker:Rob: it, that they're not necessarily addressing the behavioural aspects,
Speaker:Rob: of how they got what they got, And they are about to go back on the journey
Speaker:Rob: of eating the wrong foods, not necessarily addressing the lifestyle issues.
Speaker:Rob: And when the medication stops, they have two choices.
Speaker:Rob: They regain the weight or they stay on the meds. And I'm not sure there's a
Speaker:Rob: huge amount of evidence for long-term use of those medications.
Speaker:Rob: I'm not sure. You might better talk about that.
Speaker:Suzy: Definitely a political hot potato. and in my diabetes role we were just talking
Speaker:Suzy: about this yesterday and you know the emerging,
Speaker:Suzy: problems with with the combination of obesity
Speaker:Suzy: and malnutrition I think is one that worries me
Speaker:Suzy: but I guess that takes us slightly off the the discussion about physical activity
Speaker:Suzy: um but definitely more to come I think on that topic and it will be interesting
Speaker:Suzy: to see how that that evolves but really important that we know about this because
Speaker:Suzy: I don't think that knowledge is widespread about the loss of lean muscle mass
Speaker:Suzy: with a lot of these um these medications um and.
Speaker:Rob: It's certainly something think that um we are very focused on
Speaker:Rob: if we're confronted with someone who's on this drug regimen
Speaker:Rob: then we are very much focused on that and it
Speaker:Rob: seems they seem to buy into that quite quite well actually i mean most of the
Speaker:Rob: people are quite interested to know as you rightly point out and they weren't
Speaker:Rob: necessarily told that although i because i work in the private sector the guys
Speaker:Rob: i work alongside are lifestyle medics so they're able to give that information
Speaker:Rob: when they're prescribing which obviously you guys may or may not be able to do.
Speaker:Suzy: Can you clear something up for me i have read various things um you know i'm
Speaker:Suzy: not an expert in in managing the metabolic syndrome or obesity but you know
Speaker:Suzy: people say well actually physical activity is not going to get you slimmer you're
Speaker:Suzy: probably going to gain weight if you do exercise because because it affects
Speaker:Suzy: how hungry you are what would you say to that.
Speaker:Rob: Well there's absolutely no question that when we've got lots of evidence to
Speaker:Rob: suggest that people if you're using exercise purely for weight loss then obviously
Speaker:Rob: i I think you're barking up the wrong tree.
Speaker:Rob: We've got lots of evidence to say it has lots and lots of benefits with regards
Speaker:Rob: to how you manage your metabolic health, how you process glucose.
Speaker:Rob: But just from a weight loss intervention, there's a subtle weight loss intervention,
Speaker:Rob: there's not a huge amount of evidence that exercise on its own,
Speaker:Rob: at least, will have a massive impact.
Speaker:Rob: In conjunction with dietary changes and other things, then we get some really good outcomes.
Speaker:Rob: But the message I always say to my clients is, ultimately, exercise is going
Speaker:Rob: to do lots of things for you. It's going to help you manage your blood glucose
Speaker:Rob: much better, et cetera, et cetera.
Speaker:Rob: But if you're doing this purely to lose weight, then we probably have to have
Speaker:Rob: another conversation around nutrition as well.
Speaker:Callum: I think the other point there is there's pretty good evidence to show that it's
Speaker:Callum: helpful for maintaining weight loss once you have lost it.
Speaker:Callum: And so it's a fairly integral part of the approach to sustain weight loss.
Speaker:Rob: Absolutely. And I wouldn't argue with that. And again, it goes back to that
Speaker:Rob: conversation about if you can get everyone engaged in this process,
Speaker:Rob: then all of these things have their role.
Speaker:Rob: Physical activity has so many benefits.
Speaker:Rob: But when people get on the scales and they don't necessarily see a weight loss
Speaker:Rob: because their lean body mass is going up again an education and a conversation
Speaker:Rob: around that is really important.
Speaker:Suzy: I think my narrative on on this has changed dramatically
Speaker:Suzy: over the years and i i now actually tell people just do you know what just move
Speaker:Suzy: the scales i don't know why we do a bmi what you need is the trousers of truth
Speaker:Suzy: in your life so we've all have a pair of those trousers that will let us know
Speaker:Suzy: where we are in on our journey and how we feel and and how you know because
Speaker:Suzy: all of the pillars of health are interrelated.
Speaker:Suzy: I know if I haven't had my physical activity for the day, I'm not going to sleep
Speaker:Suzy: particularly well. And then I'm going to be stressed and grumpy.
Speaker:Suzy: And then my relationships might suffer as a result.
Speaker:Suzy: And then I'll probably drink too much coffee. I'm thinking about sort of substances.
Speaker:Suzy: And that was the one that sprung to mind and things that are harmful for us.
Speaker:Suzy: So there's so much here, Rob. I
Speaker:Suzy: could talk to you all day and we could learn so much more
Speaker:Suzy: from you but um i think you've given us some real pearls of
Speaker:Suzy: wisdom today um and i'm going to do a little bit of a take-home message
Speaker:Suzy: thing and i'm going to go first and then i'm going to come to callum and then rob you're going
Speaker:Suzy: to give us the take-home nuggets for um
Speaker:Suzy: for people in primary care to to you know because this is what we're about in
Speaker:Suzy: the movement prescription podcast it's about trying to encourage our colleagues
Speaker:Suzy: to do this better because we know that it works so take-home message for me
Speaker:Suzy: is that i'm going to have to get um revise the borg scale because i think that
Speaker:Suzy: sounds like a really important thing just to be able to refer to.
Speaker:Suzy: And I'm going to get myself a new book, another book. I am a bibliophile.
Speaker:Suzy: I have more books than I can ever read, but it sounds like a really important
Speaker:Suzy: reference to have actually on hand.
Speaker:Suzy: So those are my two take-home messages for today. How about you, Callum?
Speaker:Callum: The Faculty of Sport and Exercise Medicine statement on risk,
Speaker:Callum: which says there's almost no, there are some, but there's almost no circumstances
Speaker:Callum: in which the risks outweigh the benefits is really important.
Speaker:Callum: And so kind of possibly reframing the whole worry about liability and saying,
Speaker:Callum: well, are you causing harm by not promoting physical activity to your patients?
Speaker:Rob: Oh, and my one, from the perspective of the pearls of wisdom you mentioned,
Speaker:Rob: I guess the question is, guys, we know that exercise is a cornerstone of everything
Speaker:Rob: from regards to therapy for clinical conditions.
Speaker:Rob: And I have had so many case studies here that kind of prove that.
Speaker:Rob: From your perspective, your message in your surgery in that timeframe you have
Speaker:Rob: is going to be, in many cases, the
Speaker:Rob: difference between someone adhering to something or at least starting it.
Speaker:Rob: You know, that physician message, endorsing something is everything.
Speaker:Rob: So tell them it's important, maybe warn them about some certain bits and pieces
Speaker:Rob: to be aware of, or at least advise them.
Speaker:Rob: And then if you get the opportunity, follow them up.
Speaker:Suzy: Brilliant, Rob. Thank you. It's been an absolute pleasure to have you here.
Speaker:Suzy: I will be doing brief interventions, giving people the confidence that you talk about there.
Speaker:Suzy: Thank you so much. And take care of yourself.
Speaker:Callum: Thanks, Rob.
Speaker:Rob: Okay, great to see you guys. See you soon. Take care. Bye-bye.
Speaker:Callum: Hi, it's Callum. I really hope you enjoyed the episode.
Speaker:Callum: We are so grateful to the British Society of Lifestyle Medicine for their support
Speaker:Callum: in producing these podcasts.
Speaker:Callum: And we wholeheartedly share their vision of transforming healthcare and levelling
Speaker:Callum: health inequalities through lifestyle medicine.
Speaker:Callum: If you want to find out more, please head to bslm.org.uk.
Speaker:Callum: Although catering for healthcare professionals, this podcast is for everyone.
Speaker:Callum: If you enjoyed it, please share it. And we love hearing from you.
Speaker:Callum: So do reach out. Thanks for listening.
