The promotion of physical activity-

everyone's responsibility

View from a colorectal surgeon

Susan Moug

What does a colorectal surgical team have to do with physical activity?

Referrals of patients with bowel symptoms Take a history and examine Arrange/perform investigations Diagnose colon and rectal cancer Plan treatments Liaise with anaesthetists, oncologists, nurse specialists Follow up for 5 years

Where is the physical activity bit?

The colorectal surgical team in RAH

Estimate each specialist’s minimum patient contact time Ask them 2 main questions –

1) Do you ask about exercise or physical activity If yes – what do you ask? If no – why not? 2) Do you ask about co-morbidities/smoking/alcohol? If there were issues would you act upon them?

The Surgeon

Total contact time >1 hour

1) Physical activity – YES. ‘how far can they walk without getting breathless’ ‘I haven’t before’ ‘would it change anything?’ 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes.

The Colorectal Cancer Nurse Specialist

Total contact time > 1 hour 1) Physical activity – no. ‘is physical activity important’ ‘what activity would I recommend, I have no experience’

2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes.

The Oncologist

Total contact time > 1 hour 1) Physical activity – YES. ‘can you climb two flights of stairs’ 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes. ‘could delay/ interfere with planned chemo/ radiotherapy’

The Anaesthetist (pre-assessment nurse)

Total contact time >1 hour 1) Physical activity - yes. can you climb 2 flights of stairs? 3 self-reporting questions don’t make any recommendations 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes.

The Stoma Nurse

Total contact time >1 hour 1) Physical activity - no. ‘ask about arthritis’ 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes.

The ERAS Nurse

Total contact time > 1 hour 1) Physical activity - no. 2) Co-morbidities/smoking/alcohol – yes. would you act upon issues –yes. ‘I sometimes wonder if the ERAS regime is the most exercise some patients have done in years’

Summary

Lots of contact time with patients that have colorectal cancer See patients pre-peri- and post-operative Different specialists see patients at different times

Colorectal team is perfectly positioned to perform exercise intervention in patients with colon and rectal cancer

However…….. Only ask approx 50% When we do ask it’s non-specific and we do not change anything Contrasts with other lifestyle factors that we all ask and all act upon

Is this just us?

Dayna Alexander: BMedSci (Public Health) record of physical activity from Pre-Assessment Clinics reviewed 2011-2013 n=527 curative surgery for colorectal cancer To date, assessed 377 n= 247 no record of physical activity n=130 with activity recorded n=4 could not climb the stairs n=9 could climb the stairs with stopping n=117 could climb the stairs without stopping

What’s next?

The Feasibility of Performing a walking programme in patients with rectal cancer undergoing chemo-radiotherapy (The REx Trial). 80 patients diagnosed with rectal cancer Primary intervention is neo-adjuvant chemo-radiotherapy randomise to two groups one control one walking intervention/ prehabilitation all sites in GGC, over 2 years.

Rectal cancer diagnosis and discussion at

MDT

Intervention 1 (15-17 weeks)

OPC Surgery Neo-

adjuvant therapy

Introduced to REx

Recruitment and

randomisation to REx

Peri-operative period

Baseline Test 1

Post Exercise Test 2

The Feasibility of Performing a Walking Intervention in Patients with Rectal Cancer: The REx study.

5 weeks of therapy

10-12 weeks recovery

The Future?

All patients with colorectal cancer undergo pre-operative lifestyle counseling All specialists see it as their responsibility Programmes developed to modify physical activity ?prehab Nurse Specialist Will there be enough evidence for pre-habilitation to alter timing of first treatment/surgery?