Jo McNamara Rad Chat Host (00:00)
Hello everyone and welcome to Rad Chat, founded by me, Jo McNamara.

Naman Julka-Anderson (00:04)
And me, Naman Julka-Anderson. Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their expertise in therapeutic radiography and oncology. Unlike traditional academic resources, we blend real-world experience, expert insights, best practice, and patient perspectives.

Jo McNamara Rad Chat Host (00:21)
We make advanced knowledge engaging and accessible, supporting continuous learning and professional development without compromising patient care or your personal time by providing insights into both technical skills and career development, helping you to progress confidently in your field and shape your professional future.

Naman Julka-Anderson (00:38)
Just to let you know, our episodes may contain sensitive and difficult topics that you might find distressing or triggering. Please consider checking out another episode.

Jo McNamara (00:49)
So this is episode 207, which is part of the Living With and Beyond Cancer series, where we're going to be hearing from our guest, Emily Spillman and her role as a physical activity lead at Penny Brohn UK. So hi, Emily, welcome to Rad Chat.

Emily Spillman (01:03)
Hi everyone, thank you so much for having me. This is very, very exciting.

Jo McNamara (01:06)
An absolute pleasure. We've been very excited to have you on and from a personal perspective talking about prehab and rehab I'm very excited. So Emily for anyone listening who doesn't know you or hasn't heard of you before can you give us a bit of a kind of introduction to yourself and a little bit about your career today?

Emily Spillman (01:26)
Yeah, for anyone that does know me, they will know that I wear many hats and spin many plates. But I suppose my current roles at the moment, I am the physical activity lead at Penny Brohn UK, which is a cancer charity, which we'll talk a bit more about in a moment. And then alongside that, I'm a nurse as well as a personal trainer.

So that's my kind of hybrid roles, I would say. They're kind of almost like two things together now. And when I qualified, God, which was 2012, I actually started my career at the Bristol Hematology and Oncology Centre as a chemotherapy nurse and worked there for a few years, sort of working my way up the ranks of working within haematology and oncology

working day units as well, which gave me quite a breadth. And then I had my first child and then I thought, I'll have a challenge and go to A&E Soon realised that, yeah, that's a very different ball game to cancer nursing. So swiftly moved into the community and did, yeah, community nursing, which I loved and going out to people's homes, doing end of life care as well, which I really was a huge passion of mine

as well as like wound healing and stuff like that. And then, and it was then that I really started to...

I suppose put the pieces together a little bit in terms of the work that we were doing as nurses and often very task-orientated and you probably see this in the NHS a bit, but not necessarily everyone putting all the pieces together and working together to support someone. And that is across kind of, again, wound healing as well. I remember, you know, supporting someone and we're not, we were just all fighting over what wound dressing to put on this person and not necessarily all of the other stuff that's going to help that person heal.

And again, even in diabetes care, and I was starting to sort of use a lot of my...

little bit of knowledge that I was gaining through my training as a personal trainer because I sort of did that alongside my community nursing and I thought well if I can use that knowledge and see if I can support people in a more holistic way and yeah that kind of then enabled me to start doing some community exercise classes with like an older ladies group in my local community centre and then good old Covid happened two weeks later so I was

was really back into like fighting fires in the NHS and yeah, sort of getting through the pandemic. But ultimately after that happened, I was introduced to a physio at GenesisCare, which is a private cancer company or, you know, delivering radiotherapy and chemotherapy. And they provide a 12-week exercise program. And I thought actually that brings my two worlds together really nicely. So I

took

the role there as their personal trainer and the lovely Sarah there who I miss dearly was just amazing allowing me to really shape the service and we did lots of we sort of launched our online program there and that

yeah, it was really like my baby at the time. And then it was really successful. And we were able to then reach more people who ordinarily would come for their radiotherapy, but then weren't able to then get to the centre to do the exercise programme. So that was really great. And then I unexpectedly and me and my husband were a bit irresponsible and had ⁓ a second child that wasn't in the plan

actually during that time it was great, you know, would not change it for the world but I was then, GenesisCare have a partnership with Penny Brohn UK anyway and I knew about the charity and supported it and loved everything that it did but they asked me to be the Physical Activity Lead because it was a role that had been empty for a little while and I've been there for yeah nearly two years.

So yeah, that's, that is essentially me in terms of career. Well, I say that I was doing a bit of part-time work as well in the bladder and bowel service, which then as again, that many hurts many spinning of plates. But actually during the pandemic and after the pandemic and I was working part-time at GenesisCare, I started working within the bladder and bowel service and that opened my eyes fully

just to kind of what people were dealing with and I just fell in love with it and it again really supported a lot of the work that I was doing with people who were struggling with symptoms after their cancer treatment.

And I got to learn about doing pelvic floor assessments, so doing internals. And yeah, and that just sent me down a real rabbit hole of learning about women's health, particularly. And that is a huge passion of mine and something that I now do in my own business. I'm running that alongside all the other plates and hats that I do. And really, I think for me as a personal trainer now, I am really passionate about making it accessible, but also

obviously exploring the in-benefits, which we'll talk about in a second, but in a really accessible, down-to-earth way, which I think people will start to notice as we go through this podcast. I am.

Jo McNamara (06:13)
So you're a busy lady, Emily.

I think one thing you have highlighted though, really succinctly actually, is the fact that having a portfolio career allows you to look at things not just in that kind of two-dimensional viewpoint and almost with your blinkers on. I know Naman and I have said this loads, but you know the work we do with Rad Chat and stuff really allows you to get that holistic approach to supporting people going through cancer because of the fact you're learning lots

Emily Spillman (06:41)
Yeah.

Jo McNamara (06:45)
in each of these different roles but you do then bring that knowledge into other things that you would never have ordinarily brought them into. What's been the most transformational thing do you think from your learning in your different roles that you think has had the biggest impact on patients?

Emily Spillman (07:01)
I think for me, it is really seeing the barriers that are really impacting people's ability to exercise. And I think particularly through my education in pelvic health

about that mind body connection and not being able to separate those two and how that can, yeah, I suppose impact our physical self when, you know, our mental health is affected, but also in terms of our nervous system and how that impacts our ability to make decisions and to, you know, ideally we want to be able to do health promoting activities, but for a lot of us, like we are

often in a bit of a fight or flight, we don't have the education or the agency to do all the things that often, I think for a lot of healthcare professionals, we just think, okay, we'll just tell that person to exercise more, but not really understanding the kind of social determinants, but equally just the everyday barriers that I think a lot of us are facing. And we only have to look at the news at the moment and it is a very hectic world that we are living in at the moment. And I think for

my work in my own practice, in my personal training but also speaking to women particularly, I do work with men occasionally

but they are, they are exhausted. They're, you know, we are, all of us are really spinning a lot of hats and plates. So don't think I am an exceptional, you know, I'm not out of the exception here. And, and I think, you know, when we deliver certain messaging around it, exercise in particular, and you've got to think about the fitness industry as a whole, diet culture, you know, the beauty industry.

Naman Julka-Anderson (08:39)
not forget hyrox.

I feel like you can't talk about exercise and not talk about hyrox at the moment.

Emily Spillman (08:44)
Absolutely, but it is super high intense and for the majority of people it's not an accessible form of exercise but it can be an amazing form of exercise and community but it's just for different people but I think sometimes we glorify a type of exercise and then it just makes everyone else feel like I'm not doing enough and I think we're all feeling like we're failing at something and I think

for me, I think acknowledging people's barriers to exercise I think is a really important thing that for us as healthcare professionals, we need to understand. And I remember recently having some medical students from Bristol University in and we were talking and I got them sort of between us like, note down what barriers do you face with exercise? And they did have quite a few. know, time is a huge factor,

finding spaces that people feel that they belong and they can feel comfortable in their bodies are quite rare for a lot of people. Money as well. And then you apply having a cancer diagnosis and all of the treatment that's coming up. But even some of the language as well that we often say around exercise can be like a massive shut the door on exercise for a lot of people. And then they're just too scared to do

that to do any form of movement to be quite honest. You know I've worked with quite a few people now that

I think often they're just like, I've just been told not to do something or it might be that I can't do any repetitive movement or I can't, you know, I think there's so many counts and we don't then follow it up with what can that person do? And that can then be like a huge facilitator for exercise. Because one, it's come from a healthcare professional or it's come from a professional, which is a massive thumbs up. But at the same time, we can use our language to be protective. think ultimately we want to do no

harm and I completely get that but I think someone being sedentary and not doing anything at all is more harmful for that person than potentially the know the the risk of exercise to the individual which is very low for the majority of people.

But yeah, it's definitely made me more holistic having different hats and thinking about those different elements of someone's life. And I think being compassionate to oneself when we are navigating changes in our activity or changes to our...

our emotion, you know, how we're feeling, the fear of treatment, the fear of hurting ourselves. you know, so I get people who are super active and then stop because I'm like, God, I just don't want to hurt myself. And, and they can then often then carry that on

through their treatment and beyond. So my job is very much around taking a step back and acknowledging and validating people's barriers, but then giving them some solutions to support them to even just do a little bit of movement. I think is a huge bonus, I think, for a lot of the community that we're supporting within the NHS and the private sector and charity sector as well.

Jo McNamara (11:40)
I was really naïve about some of the challenges and barriers because quite often when I speak to people about doing exercise, I always thought, well, cost and time are going to be the ones that come up really frequently. But actually, a lot of people said, well, I don't own any trainers. I have no kind of clothes that would be suitable for me to go and participate in a sport. And I had never, ever thought that

someone wouldn't have a pair of trainers. But it's that kind of insightfulness that I think is so important that you do ask what those barriers are so that you can help find solutions rather than just have this, you know, sense of, well, anyone can do exercise. You know, yes, they can, but sometimes there are real challenges that stop people from doing that.

Emily Spillman (12:26)
Yeah, and I would say that for those people who, you know, I wear quite a lot of kit from Tesco. I literally have stuff from, you know, go outdoors. Like it doesn't have to be Sweaty Betty and Lululemon. Sorry, there are other brands available. But it can be, I think, you know, social media and everything else can make it a little bit of an aesthetic

ultimately I've worked out in my pajamas and barefoot as well. Obviously going out and doing a sport, you know, I think it's very different, know, having appropriate footwear is important. But yeah, but for a lot of people that can be reality. But I think there's obviously sturdy shoes. I don't think we need to get too hung up on, you know, having the latest

you know, brand of trainer. But as long as they're good, sturdy shoes that can help you get out for a walk, I think is a good form of exercise too. So yeah, but I think it's our perception of what

exercising should look like and it should look a certain brand or a certain way and actually you know movement can be hiking up a hill with a baggy t-shirt and some you know some trousers and some sturdy shoes or a pair of wellington boots and yeah so again with I suppose

yeah, the equipment required. There is definitely lots of things that we can do that doesn't require equipment or big memberships or, you know, big commitment, I think, as well to certain types of exercise.

Naman Julka-Anderson (13:59)
Emily, just thinking back to your education, kind of doing nursing, how has your perception of exercise, physical activity changed since then? And did you have any of that in your education?

Emily Spillman (14:08)
Yeah, it's changed a lot. remember being in just the lunch break room on most wards and

our perception of exercise was that it had to be hard or go home. had to, like, we had to do it unfed. You know, our perception of diet, like diet culture was rife within the nursing rooms. And I, we are not educated very well on, I think

the realities of the majority of people in society when it comes to our perceptions of exercise and nutrition. I would say it was quite, I had quite a poor relationship with exercise and nutrition prior to training and then educate myself better in different, particularly in the women's health sphere. It was all about exercising for weight loss, never about exercising just for general wellbeing. Yes, the byproduct of exercising made me feel better

but that was not my goal. My goal was to be thinner, essentially, and so my relationship with exercise has changed

immensely through, I think, just understanding the benefits aside from weight loss, you know, in terms of supporting our mental health, but ultimately like our immune system. you know, I speak about this a lot at Penny Brohn in terms of, you know, just by contracting our muscles, that can produce immune cells that can reduce inflammation and it's an anti-inflammatory properties that can really help

create like an anti-cancer environment in our bodies essentially and to mobilise our immune system to be more effective. And that's the same for any inflammatory disease. Exercise can be really helpful for managing joint pain, osteoarthritis, but often our societal...

expectations of exercise is that we have to be gentle, we have to rest and we have to, you know, ⁓ not injure ourselves when we have these conditions, when ultimately the movement and physical activity and structured exercise all have its place in helping us to reduce the inflammation and then that effect that has on our bodies and

because of that anti-inflammatory effect, can really help with things like fatigue. We know that fatigue is a huge, probably the number one side effect of treatment with cancer.

And it is a really hard one to navigate because a lot of the time movement does not feel like the first thing to do when you're feeling fatigued. And, and, and it's definitely dose, you know, the amount of exercise is important too. And we know that by moderate intensity exercise sort of yields the best sort of effects when it comes to fatigue. But, but there's, not, that's not saying that low level, lower intensity exercise isn't valid because we know that things like yoga, Tai Chi, Pilates, you know,

they kind of have like a really nice psychological effect as well, which again, psychological stress can increase inflammation. So if we can reduce psychological stress, that can also help with those sort of anti-inflammatory properties too. So that's why I would say, yeah, it's definitely evolved to being a bit more...

what is movement going to give me that is aside from the aesthetics. And I think that's definitely improved my body image in terms of, yeah, like my, you know, my body is not my business card when it comes to being a PT. at the same time, I use movement in a definitely more positive way. And it doesn't take up all of my, what's the word I'm looking for? Like I'm not preoccupied.

with like have I done enough movement, have I done enough steps, have I you know have I done my 150 minutes of physical activity and two straight training sessions, have I yeah and there's that's you know I'm friends with a lot of PT's who are on Instagram and it is a real...

Naman Julka-Anderson (17:42)
have you videoed it for Instagram as well.

Emily Spillman (17:50)
like none of us really like doing it and I've kind of stopped now. I did do it in my pajamas so you know there is me exercising in my pajamas on the internet so you know I am practicing what I preach.

Naman Julka-Anderson (18:03)
I think that's a bit of

a worry for maybe some of the younger generations of healthcare professionals but also our patients coming through where the perception of your body, you know, an app can make you look completely different. There's obviously different types of injections now, almost like a quick way to lose weight but actually the healthy side as you talked about, I don't know, it's a bit of a minefield anyway with when it comes to cancer and all the different interactions with drugs and chemotherapy, etc. But it is a bit of a worry I think for me just

what the next few decades is going to show around exercise and physical activity.

Emily Spillman (18:33)
I get where you're going, Naman, but I also think it's always been around because I've been supporting women in their 80s, you know, sometimes dying who are just like, ⁓ I've never looked so thin. And like, it's just, I feel like there is just this culture that we have of like, that's the like the most important thing. And I think it's different. I think it's just changed and evolved. It's always been there

but I think it's changed and evolved as we've, through the generations and yeah, I think, you know, the aesthetic of exercise is definitely like...

you know, on my feed. And it is very difficult for me as a PT who wears size 14, 16, you know, fitness clothes to have that representation. And I can still, we know that, that, you know, in terms of our health is not something that we can see, you know, and you only have to, you know, and I see this so much in the cancer community as well, because I feel so sorry for people, because, you know, the first thing people go, oh, you look great. And you've lost weight because

of your cancer treatment and it's like you know it's it's like when are we gonna yeah we need to get better at understanding that health is more than a look if that makes sense and and and the benefits of exercise are something that we don't always see we don't get that instant gratification but we know just from like one bout of exercise we get that anti-inflammatory effect essentially and the benefit that that brings so I always say like the magic is happening on the inside I know it's not

showing you or yielding you the kind of stuff that we sort of see those outcome measures that we see on the outside. you know, and I think in terms of confidence, you know, I've seen from my work, I have a gym here at my home and I work with like three women at a time. And I remember like one lady really struggling with a lot of fatigue and, you know, my migraines, like hormonal because of like her treatment.

And she was like, ⁓ I really need to do more than just like one a week. And I said, yeah, but what are you doing right now? She's like, nothing. I was like, okay.

Let's just do one a week. Let's just get one strength session in a week and do that with me. I can give you some confidence and, you know, some support with that. And she's been doing that consistently for over a year now. So, you know, and now she's like, yeah, I can start adding some more things. And she started to feel better. She's managing some of those side effects a better. But the sad thing is, is that, you know, going to her GP and I'm not anti-GPs at all. So any GP is listening to this. But just maybe hear this.

But she went and the GP and she said, you know, I've been doing this like consistently. This was about six months in and, you know, and she's, ⁓ you know, what are you doing? And, you know, she said, I've been going once a week and it's really great. She said, yeah, but we ideally need to get to like two times a week. And rather than praising her for being consistent with that, it was just like straight into like, you need to be doing two times a week. And I understand that the guidelines are there, but they are just guidelines and we have to meet the person that we've got in that clinic where they're at because to her,

that completely shattered like all of the hard work that she's done in terms of having a consistent something for her that she had never done her whole life. you know, just because someone's, you know, has cancer or, you know, or have a long-term health condition, they might have had no activity prior to that health condition. It's only now that they have their health condition that they're thinking about, you know, integrating things. But for them, they might have families, they've, you know,

got lots of juggling, lots of plates. And so a consistent once a week, that's a well structured exercise routine can be really okay. So I think we've got this perfectionist mentality and as a recovering perfectionist, I understand. But it's, we just got to kind of let go of what we the ideal because, you know, we've got lots of lots of research and I will actually share with you and

the ACSM. But they basically put out all of the different like health related outcomes for cancer and like how much exercise and what types of exercise or whether that's like aerobic exercise or like cardiovascular exercise or resistance only or a combination of the two. And then just giving like, like how many sets and reps is, you know, suit like, like supportive of like, how it's related fatigue. And it's just a really helpful guide as well for things like bone

health as well which I know is another big thing for a lot of people when they're navigating particularly in recovery after their treatment but also things for like lymphoedema as well and how supportive resistance training is for lymphoedema so all these concerns that often people have I think this is yeah a nice thing so I'll share that with you guys and to share with your audience it's just a nice it's visual as well I'm a visual learner so I like things to be yeah nice and visual and easy.

Naman Julka-Anderson (23:19)
You talked about Penny Brohn. Do you to tell us a bit more about that please?

Emily Spillman (23:22)
Yeah, so Penny Brohn is a cancer charity based in Pill in Bristol. They have an amazing, lovely, stately home there, which they've put extensions on over the years as well. And we provide holistic cancer support, looking at the kind of toolbox of support that we can give people navigating cancer as a way

to support their treatment because Penny Brohn who founded the charity, you know, always saw that the NHS or typical Western medicine was really great at treating cancer, but not so great at the kind of wraparound support, supportive care that would help her to feel well. And we've got like a lovely quote that we often use where one of our users said that the NHS sort of

saved my life but Penny Brohn showed me how to live it and I think that's like a really nice

Yeah, a really nice way to showcase kind of what we do there. And we are a small but mighty team there. But we've we've I'm the physical activity, but we've got a nutritional lead. And it's our lovely Kim. We've got a clinical lead now. He's the lovely Claire, who has worked in as a specialist cancer nurse. And a lot of us have all got kind of like hybrid roles

but we've maybe got sort of our clinical experience and then we trained in another area and we provide in-person services as well as online services. Online services definitely came a lot more after the pandemic and they've been a real lifeline for a lot of people to access stuff when they can't get out and about or they've got their risk of infection high at that point in their lives.

And we...

provide this toolbox of online sessions. So things like exercise classes. So I do a live one called Strength and Stamina. We've also got yoga instructors from physios to Tai Chi and Qigong. And then as well as like mindfulness practices or clinical hypnotherapy or like breath work as well. So like breathing through anxiety is like a really popular class as well. And then nutrition as well. like nutrition know-how and just

kind of like helping people with the basics, think is probably our good, is a good standpoint for us as a charity. Because I think it can be really overwhelming.

There's lots of noise in the cancer spirit online. And, and I think it can feel really overwhelming for a of people. And I think for a lot of people, they want to throw the kitchen sink at cancer, which I completely get. But I think we, we have a really nice toolbox that just helps people understand the basics, understands what's going on for them. And we have these kind of standalone sessions that people can dip in and out, whatever they want to do. We do in-person services where we do like, we've got these

relax and restore retreats, is just really just restorative, mainly for people who just need a bit of time out from cancer as such and just, you know, recover recuperate and it's really slow and really nice. And then we've got our

of well-being, these we call our well-being days but they're now kind of like our cancer support days so we've got some upcoming ones that are focused primarily on things like fatigue, sort of ⁓ managing anxiety so mind matters and then managing menopausal symptoms as well so we get you know practitioners and doctors in as well. We recently did one with

Dani Binnington through menopause and cancer, which was an amazing day as well. So yeah, so just thinking about the symptoms, I think that people are really struggling with, and I think that really helps to people to understand what the different pillars within that symptom that we can support with. And I think as a charity, we are starting to be more recognized as this kind of...

just a good package really in terms of supporting people through their treatment alongside that. we've done, we've now been running another service called Treatment Support Programme for a number of years now. And that's been really popular and really helpful, you know, looking at physical activity, nutrition, complementary therapies and sort of supporting mental health and anxiety. And that's again, focusing on those symptoms during treatment. And then my main job within my

15 hours a week at Penny Brohn at the moment has been...

setting up prehabilitation. But because we are a cancer charity, we aren't a clinical service as such, so we kind of renamed it Preparing for Treatment Program ⁓ as opposed to prehabilitation, which I would say was kind more in the scope of the hospitals. And that is really us trying to help people navigate that time, which is very overwhelming for lot of people

often the focus is just getting to appointments and dealing with what's happened but we know that when people start early and can start to think about movement, optimising their nutrition as well as helping them to navigate the of the resilience that's required to get free treatment as well

mentally and physically. We can utilise a lot of the services that we already have running at Penny Brohn on a weekly basis. These aren't just things that happen every so often. We're running these on a weekly basis. They're really regular. And so we created some on-demand resources to support people with thinking about all the different hats that all of us in the team have, but just really focusing on the things that are important. So thinking about just some strength training

either in a chair or standing, getting that done, if that's important and is required for you. If you're already meeting, you you're doing, you're active and you can still maintain that, we just might need to give you bit of guidance and reassurance that you're doing it fine and that's okay. So you don't need to add more.

And, ⁓ but then if we highlight that you need a bit more support from a nutrition perspective, then we can either book you in with our, with Kim, who can do like a one-to-one with certain people. But ultimately if we screen that person and they need more than what we can do as a charity, then we can help navigate them back into the NHS to go, actually you need to be seen by the dietetics team to really support you prior to your treatment. So we can basically optimize them as much as we possibly can with a slightly lighter touch that

I think a lot of prehabilitation programs have done in the past but because we are in this very much landscape of minimal funding and there's not a huge amount of funding and unfortunately a lot of prehabilitation programs have stopped and there are still lots running but ultimately we were trying to figure out a way that we could, with the capacity that we have as a charity, to be a bit more than a leaflet

and a bit more than a webpage but support people with a bit more hand holding.

And so our pilot is just finished. And so we're just kind of collecting some feedback and putting it through our client voice again and making sure that we can, yeah, there's definitely things we've learned from the pilot that we definitely want to change and do differently moving forward. But that's what pilots are for. but yeah, but it's been really exciting to be able to create stuff like that ⁓

you know, as a, I think as a nurse and a, as a, you know, as an exercise specialist, um, I think it's just nice that it's the drum is being a sort of beaten by other healthcare professionals as opposed to just physios. And, we've utilised physios within our team as well, um, to do that. But yeah, it's definitely something I'm very proud of and really excited to, develop further. And then hopefully as part of our pathway at Penny Brohn and ultimately it will help save

the NHS dots of money and improve people's quality of life which you know if anyone's in commissioning please email me.

Jo McNamara (30:46)
I love the plug, I love the plug. Emily, how

can people access these? Is it just for people in the area of pill or can anyone nationally access it?

Emily Spillman (30:56)
Yeah, so we are actually a national charity. We are Bristol's best kept secret, but we are trying to improve that by being on amazing podcasts like this. So yeah, so we are a national charity. So we support anyone in the UK with any type of cancer at any stage.

We do stuff in person. So like I said, those kind of more longer stays and we can stay overnight as well. So we have a residential element at place at the centre. So you can stay over. But a lot of the services that we provide that I've spoken about are online as well. So they can be accessed by people all over the UK. So my strength and stamina class is people local, but then I've got, you know, people up in Scotland who access the services.

And we've got an amazing client support team as well who are lush. They are like the glue that keeps us all together. And yeah, they're just a great...

just a great team to speak to as your kind of first entry point. But if you feel a bit overwhelmed by any of our services, or it just feels a bit too much, we do have the lovely Steph too, who's our personal planner. So she can book in a slot with certain people if they're really struggling to navigate it, to maybe look at their kind of, I suppose their main concerns really, and then thinking, what are the services that might do that? And I think that's important for all of us to, you from a holistic lens, we can, it's great having this holistic toolbox, but ultimately,

it's quite overwhelming even for me to think about all the different things that I could do as an individual to improve my health.

And, you know, we can look at all the different spheres, but ultimately we have to prioritise what is the most important. And ultimately as individuals, we're only going to have capacity really to focus on maybe one or two of those things. And particularly when you're navigating cancer, that, that capacity gets even less. so yeah, it's great to have the toolbox, but just remember that you don't have to use every single tool at the same time. It might be that you just have to focus on a couple to, to kind of, yeah, sort of build what you need to

for that moment in time, park the rest of it and then think about that as well. So that's just a good tip for people who maybe go to the website and think, my god, there's just so much that I could do. But just remember what do you need it for right now? What could be support with your health right now? What do you need to learn more about to help you understand things? And yeah, so that can be really helpful too.

Naman Julka-Anderson (33:16)
Emily, we're nearly out of time. I just wanted to ask, what's your biggest success story with a patient? Just for anyone listening.

Emily Spillman (33:21)
A lady that I had, who was really struggling with incontinence after her treatment and just trying to rebuild afterwards and no one really mentioned about the menopause and wasn't really sure about that either, which I, and I think she was a younger woman as well. And I think just being able

able

to signpost back to, you know, to help her navigate, like, you know, the conversation she should she should be having with her team but, know, this was stopping her from being able to be active, like incontinence and, um, all of those things are a real barrier to, to, exercise, that, that can really impact someone's self-confidence. It impacts like incontinence and affects so much of our lives. I think that's why I'm so passionate about pelvic health to a degree, cause it's almost

like the foundation to our bodies to a degree, well it is matter of fact, it was, she couldn't go out with her friends, couldn't, yeah, she couldn't like pick her kids up, it was like getting to the point where it was really impacting her life. And just through having conversations with her oncologist and her GP, know, sort of supporting her pelvic health

really helped to, because she was struggling with, you know, things like vaginal dryness and things like that, which was really impacting her pelvic floor as well. And just by having those conversations, getting prescriptions to support that element of her health, then doing some exercise that was a good level for her, which then was able to fit in with her life with young children.

And then, and she was keen to get back to playing netball, which again requires a lot of jumping, which for someone who's leaking is like a big, like, I'm never going to be able to do that ever again. And I think, you know, and I was like, right, I can't promise you anything, but we're going to give it a good go. And, and, and just purely from doing all the little conversations, like getting the prescriptions of the GP.

And then doing some gradual exercise, doing some pelvic floor muscle training, which again, again, hadn't had been mentioned prior to her treatment, but wasn't a big focus because, you know, breast cancer and everything else is sort of primarily focusing on the upper part of their body. But, you know, when you have to go through hormone deprivation treatment, again, that will affect your pelvic floor. So, and again, a lot of the, I suppose the, the conversations

always on sexual health and and sort of and not necessarily on continence so I think screening should be a little bit better for incontinence issues for anyone going through yeah like you guys with pelvic radiation and everything else

but just from doing that and getting like regular exercise, but even just once a week was really helpful. And then just adding in some bouncing exercises over time. And eventually we got her to like play netball again, yeah, was yeah, just nice. Because I think again, there's just so much.

I can't and you know, I've had clients again who were just like, I don't think I can do that. And I'm like, yes, we can. We can, we can definitely do something. And I think that's the, my overarching message is like something is better than nothing. And, and, and obviously I know it is a huge privilege working with, you know, having a

an exercise specialist to help you along the way. My dream would be that anyone that goes through any health condition has support, even if it's just a little bit of support

with exercise to just be a bit more positive and to know that there's lots of things that they can do. Even if you are restricted to a mobility scooter, there are definitely things that can be done. yeah, overarchingly, I just want to know that there is always something people can do. It's just finding what makes you tick, but also what you feel safe doing is important too. So yeah, so that's probably...

lots of messages there in one go sorry

Jo McNamara (37:09)
Amazing. No, absolutely

and really highlights how

having that support and motivation is critical for patients being able to kind of be autonomous in going, actually, yeah, I can do this and it's something I can do for myself. And isn't cancer related? Like, yes, you might be doing it because of the side effects that you're experiencing, but isn't it great to do something for yourself that isn't just, you know, focused around cancer and the cancer treatment. And what you said resonated with me because being in a wheelchair for a number of

Emily Spillman (37:26)
Yeah.

Jo McNamara (37:40)
weeks now I attempted to do some yoga in a wheelchair and do you know what it made me feel so much better just because I was moving because I've been so sedentary I was like you know what it's great to just be able to do something and move my body and you do realise how actually not doing what you usually do the reversibility is immense ⁓ and you know your muscles do start to

Emily Spillman (37:49)
Yeah.

Yeah.

Jo McNamara (38:04)
go as soon as you stop doing your usual activity and movement, so really important.

So Emily, at the end of all our podcast episodes, we always ask for top tips. So do you have any top tips for the audience?

Emily Spillman (38:23)
I would say is essentially do what you can, in terms of when you're feeling overwhelmed by like what you should be doing. I feel like the word should should just go out the window and just be sort of booted out. because I think ultimately, we, we first need to like, kind of look at like what we're already doing. Because for a lot of us, we might already be doing quite a bit already. and that's ticking the box in terms

of like the minutes that we're doing each week in terms of physical activity and movement that we're doing and just in our everyday lives. So just taking a good check of that before you start sort of feeling bad that you're not doing enough, if that makes sense. And then just start adding in things like walking if you're able to, or doing like the gentle movements. So if you're someone who is limited in your mobility, I particularly with like when you're struggling with fatigue is,

take notice of like what movement provides you, like how it makes you feel. Because when you notice how it makes you feel afterwards, that feeling is what's to anchor. Anchor yourself to that feeling because that will help you to know what your body needs when you are feeling rubbish. And so, know, I'll often like you did that nice bit of chair yoga. I just do like just some joint mobilisations literally from, I'm quite a methodical person. So I quite like just sort of doing my wrists then going to my shoulders

and then getting a bit of rotation, getting down into my hips, down into my knees. And just doing that for a couple of minutes, I already just feel a little bit warmer and I feel a little bit like I'm primed. I've primed my body. I've got all of my, you know, I've lubricated, I've got my WD-40 and all my joints sort of working. That can in itself just lift that kind of cloud that can sometimes be a bit like heavy and dark over us sometimes when it, in terms of facilitating movement. So doing a little bit

movement that seems like it's not, it seems pointless to some people when I do that. But just do it and just notice how it makes you feel. Because it might then be a facilitator for more movement. So, and that's my biggest tip whenever I'm working with anyone is like, if you're feeling super rubbish, don't think about the goal of getting like one big workout done. Like take it back, like have the intention of going, right, my intention is to move today, but I'm just going to bring it back to.

I'm just going to do what I can do right now. And if that then enables me to do more, ideal, if not, tomorrow's another day. So, yeah, so that's kind of, yeah, probably my biggest tip when it comes to movement and managing side effects is just do a little bit, see how you feel, and then do more if you're able, if not, tomorrow's another day.

Jo McNamara (40:51)
Amazing, a huge thank you to our guest Emily Spillman for talking about her role as a physical activity lead at Penny Brohn UK. Thank you for listening to Rad Chat with myself, Jo McNamara and Naman Julka-Anderson. Our next guest feature will be Dr Matt Morgan as part of our education and workforce development series about his role as a consultant in intensive care and his experience of witnessing near-death experiences. Thank you very much.

Jo McNamara Rad Chat Host (41:15)
So what do you do now? Well you can use this episode as part of our free continual professional development accredited content which offers flexible learning that fits your busy schedule. Just check out the show notes for the reflective questions, links to literature and resources and link to the completed form to receive your accredited certificate.

Naman Julka-Anderson (41:35)
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Jo McNamara Rad Chat Host (41:45)
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Naman Julka-Anderson (42:08)
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Jo McNamara Rad Chat Host (42:23)
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