056 Cancer Prehab - what it is and why it is important with Adrian Fautly

In this week's episode I am joined by Adrian Fautly, a cancer exercise specialist within the NHS and a trainer for CanRehab, the foremost cancer and exercise training organisation in the UK and overseas.

Hear us talk about:

• what is prehab
• the benefits of prehab
• what happens in a prehab setting

Join us as we discuss how beneficial and important prehab is for cancer patients.

About Adrian:
Adrian Fautly is a Cancer Exercise Specialist who has worked at a leading NHS cancer hospital in London for the last 6 years. He works with all different cancer types and with people at various stages of their treatment pathways from prehab to rehab.  Adrian’s role involves supporting the hospital's physiotherapy prehabilitation service in getting eligible surgical patients physically fitter and more prepared for major cancer surgery. 

Adrian is one of the teaching team for CanRehab, the foremost cancer and exercise training organisation in the UK and overseas and he has a keen interest in research into prehabilitation.  

During this episode, Adrian will discuss what prehabilitation entails and the benefits associated with these programs.

If you want to get in touch with Adrian, contact me at admin@sarahbolitho.com.

For more information on Can Rehab training contact info@canrehab.com 

About Sarah Bolitho:
Sarah Bolitho helps fitness and health professionals develop their careers and grow their businesses by providing specialist training in teaching, assessing, and internal quality assurance, together with qualifications in exercise referral and disability.   

With over 30 years in the health-related fitness and physical activity fields, Sarah has a wealth of experience and knowledge.  She has worked in most roles in the industry from group exercise to personal training but specialised in working with specialist populations.  For over 25 years Sarah has trained fitness and health professionals to work with clients with long-term conditions, mental health issues, disabilities, older adults and pre/post-natal women.  She has a post-graduate diploma in exercise and health behaviour and extensive training in supporting behaviour change.  She has worked with awarding organisations to develop qualifications and training and with accreditation bodies to endorse high-quality non-regulated training. 

For more about the training and support Sarah offers, visit www.sarahbolitho.com or contact her at admin@sarahbolitho.com.

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Transcript

Sarah (00:01.25)

Hello and welcome to this episode of Creating Active Lives with me, Sarah Blyther and my guest this week, Adrian Fautly. I'm really pleased to have Adrian on because we work together on the Level 4 Cancer Course, so we know each other quite well. Adrian's a cancer exercise specialist and has been working at a leading NHS cancer hospital in London for the last six years. He works across all different types of cancer and with people at various stages of their treatment pathways, everything from sort of pre-hab to rehab and we're going to talk more about what all that is. His main role involves supporting the hospital's physiotherapy prehabilitation service in getting eligible surgical patients physically fitter and more prepared for major cancer surgery. And we're going to talk a little bit about what pre-hab is. But Adrian, do you want to just say hello and introduce yourself?

Adrian (00:53.548)

Yeah, so thanks very much for having me on Sarah. So yes, my name is Adrian. And as Sarah said, I work in the NHS in like a physio team at cancer hospital. And part of my role is prehab. But I work both sides in both rehabilitation and, and prehab and basically work with patients at the hospital every single day. So I'm not really in too many meetings or doing too much managerial stuff, but I'm very much sort of on the on front line, I guess. So seeing people one to one and in groups and actually sort really supporting the service and trying to optimize people for surgery.

Sarah (01:35.814)

And it's, I mean, you are exactly the sort of person we, you know, those of us that are in the sort of clinical exercise field, we want to get more people like you in clinical exercise because it is so important for many reasons. But we're talking about pre -hab now, I'm guessing the majority of people out there will know what rehabilitation is and rehab and things like that. But pre -hab is quite a new term, I think, for the general public. A lot of us who've been working within fitness and things like that especially in clinical settings are familiar with it. But for people out there who are going, what's prehab then? What is prehab?

Adrian (02:12.398)

Well, I think traditionally we think of prehab as essentially optimizing our body for major surgery. And I think that's very much how prehab has sat for quite a while. And essentially that is a big part of prehab. It's often we associate it with surgery. But nowadays we're sort of thinking as prehab can be before anything, particularly anything sort of significant, which is usually surgery. And in my role, it's before major cancer surgery, which would be like between sort of five to 10 hour operations. But I guess you could think about pre-hab before starting something like radiotherapy or another form of treatment. And we always think of it as exercise, but it could be nutritional optimization. It could be psychological optimization. And essentially it's a continuum to rehab.

I guess the best way of thinking of prehab is, you know, if I was to, you're essentially building up to a major event. So, you know, if I'm about to do like a marathon, you know, I can either do my preparation for that marathon, I can go for lots of training runs, and then I know I'm probably going to do better in that marathon or at least be able to complete it. Whereas actually, if I've done absolutely no preparation for this quite major event I'm building for, then actually the chances of something wrong happening or things just not going so well, you can imagine a considerably higher. Okay, and that's really where, that's how I'd like to almost see it, almost say that again. So that's really where I would sort of say, like that's where prehab fits. Essentially, it is optimizing yourself before something quite major. If you break down the word prehab, essentially, it's preparation for rehab. So, think about what's going to happen afterwards and see if you can start doing it before so that, yes, we might be able to change the physiology and actually reduce someone's risk of negative things happening, but actually it will really sort of help them to engage in that rehab process afterwards.

Sarah (04:27.846)

I mean, I was actually going to talk, liken it to a marathon as well. It is, the majority of us would not decide to do a marathon and not train, not do the pre -training, the preparation. And that's what it is. You know, operations or treatments and things like that are major events for people. And they do take a lot of, they put a lot of pressure on the body. They take their toll. So the better condition you're in beforehand, the better, you know, if you run, if I went out tomorrow and ran a marathon I'd pull every single muscle going, I'd injure myself because I'm just not ready for it, whereas if I prepared for it, I'd have a much better shot at finishing it really. So I think this is...

Adrian (05:09.166)

Yeah, and you almost have to, absolutely. And you almost have to think like, people who maybe haven't done any preparation, who are potentially younger and don't have any other medical conditions, they might be able to go into a marathon and still be fine. They might still struggle and still be fine. But actually, as we get older, if you've got more conditions, then actually the risk of something happening is much higher. And you've almost got to think of like major surgery as the same kind of thing.

Typically, if you're older and or if you've got lots of other medical conditions, things are more likely to not go so well. So that's really where training, whatever form of training that entails, whether that's nutritional or whether that is fitness training or building up psychothoracic resilience, it's going to help at any level. And even if that's to optimize like a comorbidity, so if someone's got heart disease or if they've got diabetes before going for an operation. If you can optimise either of these, that's essentially going to reduce your risk of a delayed recovery or complications afterwards.

Sarah (06:19.59)

And that's it, isn't it? It really is preparing for a major event in your life and getting yourself in the best possible condition in the best time. I mean, ideally, in an ideal world, we'd all be keeping ourselves fit, healthy, optimally nourished and all that sort of thing throughout our lifespan. But that's not the case for a lot of people, is it? And it's something that I think we're going to be offered a lot more before any kind of medical intervention might well be, look you need to do that and we know a lot of people who are up for knee replacements or shoulder replacements, hip replacements are told that they need to get their weight down before they have the operation so it's all about optimizing it. So who's it for? We've kind of touched on it but who's prehab for?

Adrian (07:09.41)

Prehab could be for anyone. Now it's usually before, well, essentially it is anyone who is about to go for something quite major. If it's, again, in my field, it is basically optimizing before some form of treatment. Now that treatment is often surgery, but I've also seen people who have been under that umbrella of prehab going for radiotherapy or about to start like immunotherapies or chemotherapy. So it's really for anyone who's about to have something quite sort of major happening in their life. And so really, it's about preparation. It's how can you prepare yourself for what's about to happen. So really, yeah, prehab is for anyone. I think the best way to think about it is you know, if you are already engaging in exercise, if you are already living quite a healthy life, that is essentially in a sense, your form of prehabilitation for if anything was to happen. For example, if I was suddenly had to go for major abdominal surgery, or going for like a 10 hour operation, I know because I already do quite a lot of running, and I would like to think my fitness is already pretty good, that actually I've already addressed that initial concern, what the anaesthetist would say for that compared to someone who hasn't done any form of exercise in their life or is actually living quite an unhealthy life so far. So, yeah, essentially it's prehab is for anyone, but specifically, you will be given something to work towards or having to sort of build towards in terms of going into some form of rehab program.

Sarah (09:04.806)

And this is something that I think surprises quite a lot of people. I know when we talk about this on the course, it does surprise people that, you know, people think of preparing for something like this as being a longer term thing, several weeks and that, but actually it could be as short as a week just to do something, can't it? It's not always, oh, let's get you fit over a couple of months and then we'll do the operation. It's often a much shorter timeframe, isn't it?

Adrian (09:31.47)

Yeah, absolutely. I mean, some people might be given a diagnosis and say we have to operate in two weeks, in which case, you know, that's where, you know, that optimization has to be done in a really short space of time. But it can be done. And there are specific protocols out there, which say actually, if you engage in X number of sessions a week, then we can we know that we can actually make these physiological improvements or still optimize you so that your risk of any complications or delayed recovery afterwards is going to be much less. So yes, ideally, you would have as much time as you possibly can before to actually do some form of intervention. But there have definitely been benefits seen within sort of two weeks. So even if you think, oh, I've run out of time, I've only got two or three weeks before I have to have this done, it's the best thing to do is start straight away.

and don't delay and don't think that you can't make differences because even if it's a case of you are preparing yourself psychologically for that recovery afterwards and almost building muscle memory or actually just getting into a habit of what you're going to have to eventually adapt to, then that is all really, really beneficial. What we find at our hospital is those who, even if they've only undergone like a week of prehab or two weeks of prehab, even if there's been no sort of significant changes in their physiology, they are much more willing to engage in rehab straight afterwards. And generally their recoveries are a lot better because they almost know what to expect and they know that there's going to be work the other side of it. So I think it really might, it very much is just trying to build that confidence and build up sort of that, I guess, resilience to know that actually this is the start of your rehab already.

Sarah (11:30.15)

Hopefully it's something that they think, actually, do you know what? This isn't too bad. I quite enjoy this. And we know how important being physically active is in recovery. We know that the more people can gradually build up, I'm not saying have an op, go and run. I mean, it's a very tailored gradual approach to becoming more active. But if you've kind of had that support, you've had that psychological boost of thinking, oh, actually, I can do this. Mmuch like you say, you're much more likely to get into it afterwards and sort of start doing something straight away. And I think for a lot of people, if they haven't been active, they're just worried about how it's going to feel, what they're going to have to do. So having a little insight, even if it is just for a couple of weeks, gives them that kind of, you know what, I think I probably can do this. This is OK. And that's that anyone who knows me knows that that's a huge part of everything that I believe in is, you know, let's make it fun. Let's make it enjoyable. But let's make it something the person can do. They go away thinking, oh, I can do this, not, whoops, too hard. So what are the benefits? What is better? Let's start with the individual. What are the benefits for somebody in being offered and taking up prehab? Because I'm guessing not everybody has to. They're not forced to, but they're strongly recommended.

Adrian (12:47.79)

Yeah, no, absolutely. And I guess some of these are that the evidence based benefits for prehab is and again, this is more sort of surgically is one it's meant it's supposedly meant to reduce the risk of postoperative complications. Okay. So sort of like respiratory complications afterwards, which will essentially keep you in hospital for longer. So again, a second one is that it's going to reduce the number of days you've spent in hospital and essentially your length of recovery. And I guess the third one is you can essentially get back onto your feet a lot quicker. You can get out of hospital, you can essentially go back to a better quality of life much sooner. And that could be a difference of, you know, that could be a difference of six months, depending on how well the operation goes.

Yeah, so they're probably the key ones in that it reduces your length of stay in hospital, it gets you back to independence, or level of independence quicker, and reducing your risk of initial sort of post -operative complications. And again, that's obviously dependent on what someone is having done. But also, you know, we can also reduce, you know, if we're, if we are, reducing the amount of time someone is having to stay in hospital or reducing amount of treatment they need to have. That also comes with a cost as well. So actually that's hopefully reducing the cost to the NHS or to the person if they are paying privately as well. So there is sort of financial benefit to this as well.

Sarah (14:27.59)

I was going to say what are the benefits specifically for the NHS, but cost is definitely one of them, isn't it? Because obviously if people have shorter hospital stays, it means you can get the next person in more quickly, perhaps. And, you know, and anybody out there who reads the news will know that, you know, waiting times aren't great at the moment, but the fitter people are, the shorter they're in hospital, it means we can reduce them that way as well as improving recovery and quality of life as well.

Adrian (14:56.942)

Yeah, yeah, absolutely.

Sarah (14:58.214)

Yeah. So we've talked about what it is and whether people will be offered and things like that. What do you actually do with somebody in a prehab session? Suppose they come along, they've been told they've got to do some prehab, they need to improve that or optimize their fitness as much as possible before the operation. What sort of things do you do?

Adrian (15:19.598)

So at my place, or what I would do is essentially do like an initial assessment with someone, I might do a bit of benchmarking. So very much my role in prehab is to improve someone's fitness or to improve someone's strength or flexibility, depending on what type of thing they are going for. But the first thing I'll do is do initial assessment. And I will essentially benchmark and do some outcome measures. So I might do a fitness test. Okay, to say actually, right now your fitness is this, and it's either good or it's low or actually it's okay, but we want to try and get it to this level. Or we might look at someone's strength to say, actually, your muscles quite weak at the moment, we really need to optimize that if you're about to go for this, this this event. We obviously have to screen as well. So often, it's not quite as simple as, oh, you come in, we've done a few assessments, and then let's go.

People often will come with other comorbidities. So we have to think about, has this person got heart failure? Have they got diabetes, COPD? All of these things which might add a few barriers into what we can actually do with them. Are they on other medication? Do they have really bad arthritis and we can't do certain things with them? So then we're having to think about what are the alternatives? What's the most logistically feasible thing we can do. Do they live quite close to us or do we have to do things virtually or do we have to do it over the phone or give them a home program? Again, once we've sort of established all of that, we then essentially will do some form of intervention. Now, usually that would be like a face -to -face intervention where we would get someone to come in and we would do very sort of structured exercise sessions to essentially build up what we think is going to be really important for them for afterwards or for their anesthetic assessment. So often for us, it's the case of optimizing their cardio respiratory fitness. So we'll do a lot of things like cycling, walking, essentially anything which is getting their heart rate up to sort of build their fitness levels if that's something which we think is quite low at the moment. However, if we are, you know, if you were to work with someone who's about to go for, say, knee surgery or shoulder surgery, then it might be a case of actually

Adrian (17:44.238)

your intervention should be more focused on building muscle strength or building flexibility prior to how that goes. We try and see people quite frequently because we know that actually frequency is a really key part in terms of exercise prescription as well as intensity and duration. So we try and see people quite frequently and if we can't do that, then we try and give them really specific things to do throughout the week in terms of targets at home, or follow this program or flow this, we should be getting to this sort of level when you're exercising. And then essentially, once we've done a few weeks of that, then we will do like a retest. And we'll sort of give them some targets of, okay, now you're coming back in, and we're going to repeat some of these tests and see how much things have changed. And essentially, that is what our prehab intervention looks like. But people will often get like anemia screening as well. So they will check their bloods to see actually if they're quite anemic or they also see the dietician to make sure they're nutritionally optimized. And they might also be under sort of a psychological support team as well, so that we're doing sort of a multi pronged approach to really optimize someone.

Sarah (18:58.118)

Because it must be, I mean, you work specifically within a cancer hospital. People have just received what is probably a devastating diagnosis. Do you find that they're skeptical about what pre -health can do for them or are they kind of happy to go along? Do they find it's a distraction? Too many questions there, I know, but.

Adrian (19:20.91)

Yeah, no, no, no, it's it varies. That's that's the thing. It varies. And you do definitely get people come in who are very skeptical. And they're very much like, well, I don't need this. It's just an operation. I will make that natural recovery. And I think that is so true for certain things. But I don't think they necessarily get the fact that they're that not every operation is the same. And that what they're going for is going to have a much bigger physiological impact on them.

And so sometimes it's very much education is a big part of our intervention as well of explaining, OK, well, this is why we're doing it. We really need to try and help with your recovery afterwards. And what are the other parts to your question?

Sarah (20:06.818)

I was going to say, do some people find actually, yeah, I'll do this because it'll distract me from what's going on. It means I'm not sitting at home brooding.

Adrian (20:12.428)

Yeah, I mean, some people find it really beneficial, actually, like they come in and they're really skeptical. But then actually, once you do one or two sessions with them, you can really get them on board. People really get on board once they start to see benefit. And sometimes that is that's almost what you have to say to someone is that when we start this, you're probably not going to enjoy it. And it's going to be quite hard. But once you starpt to do a few sessions, and then you start to feel a little bit better, which won't take very long. eople will often then start to engage a lot more. And then amazingly, they'd actually want to come back afterwards. So once they've even had whatever they're having, or after their surgery six months later, some of the a lot of these people just want to come back and they because they know that actually that's benefited them and how well they felt from doing it. That can it can be a real sort of, I guess, a teachable moment and a bit of a sort of a life changing thing of actually maybe this exercise or this life of being actually actually isn't so bad and actually this is really what I need to do to continue to do the things that you know I would like to do.

Sarah (21:27.494)

I think what a lot of people don't realise is physical activity. One is being physically active reduces your risk of developing cancer in the first place. That's not to say if you're active, you won't get it. I mean, you can do everything kind of right according to what they say and develop cancer. You can not bother with anything and avoid it. There's no hard and fast rules, say this or that. But A, being physically active generally reduces your risk of developing cancer. But also we know that being physically active after a diagnosis, after treatment, reduces your risk of cancer coming back. And it can be, you know, 20, 30, 40%, depending on the type of cancer. And I think most people would think, do you know what, I'll take those odds. If this is going to give me a reduced risk of it happening again, I'll do it. Is that something in your experience people are aware of the benefits of physical activity, either in reducing risk originally or in reducing risk of recurrence?

Adrian (22:27.566)

Some people are. And it's the same with it with with a lot of with a lot of things that some people have really switched on with the research and they know those stats and they're like, I've read this. So I'm really want to come and see you and I really want to engage in this. Because it's meant to reduce my risk of this and that's and that's great. And actually someone like it's so easy to work with. But a lot of people don't and I think the vast majority of people don't don't know that. And I think, exercise and physical activity, particularly after a cancer diagnosis, for a lot of people is probably not the, that's not the priority is probably caught for some people is probably right at the bottom of the list of priorities. And so sometimes we sometimes be the first people to actually talk about these things that actually, you know, being physically active and doing exercise will actually probably really help you with your treatments. And it's actually one of those very few things which you can now control. You know, you can't control what drugs you'll be given necessarily. Someone else will be in control of your surgery. Other people will be monitoring all these other things about you. But actually, one of the things you can do is actually keep yourself fit, keep yourself active. That will probably help you to deal with a lot of your treatment side effects. And if you are going for major surgery, then it's going to put you in a much better place on the other side of it.

Sarah (23:55.878)

That's it, isn't it? And I was talking to somebody on the podcast recently and he'd had prostate cancer and he was saying that he genuinely believes he'd be in a much worse state if he wasn't already physically active and healthy. But also he did, he was he was very active, very healthy beforehand. He did the prehab just to sort of give himself a boost and he's kept going and he's a real shining light now and he recommends physical activity to everybody and he talks to people about it. But there are so many people out there who don't have opportunity to access prehab. It's not always available, is it, for some people? And I think this is where it's so important that people can access advice and support wherever. And we know organisations like Macmillan and Prostate Cancer UK do an amazing job of recommending activity but it's being able to actually talk to somebody like you who can break it down into what matters to that person and explain things in layman's terms. And I don't mean that, you know, patronizingly, but in a non -medical way, it's look, this is what it's going to be. You'll be in hospital for a shorter time. Your recovery will be better, it'll be quicker. Obviously we can't guarantee those things, but generally this is the case.

Sarah (25:18.852)

Do you think that's why it's so important that people like you are there on the wards in the hospitals to be able to support people in a way that the medical teams, and it's not their job, can I just say medical teams, that is not their job, but someone like you, that's your role. And it means that they've got somebody they can talk to and who can dispel some of their fears.

Adrian (25:41.454)

Yeah,  absolutely. I think, yeah, there's definitely quite a lot of people out there. Again, it's more of a case of, well, I guess we work with a few different types of people. You get those who really need that support, who really don't know where to start and just need that guidance of, okay, you know, how do I even get started with this? What do I do? And that's where we can really, you know, try and help people. You know, we can give people that starting point.

They don't even have to think. I think the big thing is that they can come to us and they don't really have to think about it. They can come to us and we will give them really specific things to say, let's do this or let's try this. And then they come and do it. And then actually that's and then they just go by what they're how they sort of felt in that session. And if they felt good, they're more likely to keep coming and keep doing it again. And I guess what we know is probably how to pitch it to someone.

So we know that when they come to us, we're not going to try and make it absolutely horrible for someone because actually we know that they're going to then use that as a really negative experience. They're never going to come back to us. We don't always get it right, but...

Sarah (26:37.562)

It's not a question is it of you know right you need to get fit to get on that treadmill and run now for the next two weeks it won't be right come with me we're going running or anything it's what's appropriate for that person at that time start where they are you know is a big thing isn't it it's it's

Adrian (26:55.648)

And I - and I think it's so easy, isn't it? Just to say, you know, go and do this or go and do that or go and do that. But really what we have to do is, you know, people, particularly people I see, they've got so many other things going on. And we really have to fax that in and acknowledge it. So actually, that's where the benefit of, you know, going to see your physiotherapy team, or going to see someone like myself can, that's maybe where we can just add a bit more or value.

But also you'll get the people who really know and they're people who have been so active like their whole lives. But even people like this need a little bit of direction because they might be doing things which are not necessarily enough or they might be doing things which are a little bit wrong or they might be doing loads of resistance training. But really what they want to do for this operation is actually they need to really sort of work on their cardio.

So that's where we can just give someone like just a few sort of pointers in the right direction as well and tell people actually they might be overdoing it or are you doing enough or are you doing too much? So we can just give people a bit more sort of tailoring if they are sort of the other side of the spectrum.

Sarah (28:17.382)

And it's not about giving up what they enjoy doing, it's about saying, right, just for the next couple of weeks, this is what we need to prioritise. You can go back to what you love doing later, but let's just prioritise this for a couple of weeks. Do you give advice on things that they can do in their everyday life that will help to supplement what they do with you?

Adrian (28:35.256)

Yeah, absolutely. Well, we do give out sort of home programs. I think one of the key messages we say, or I guess some of the two sort of key messages I probably say in terms of exercise and activity is that sitting down for long periods of time is actually probably one of the worst things you can do. And again, there's now a lot more sort of evidence saying that sitting is actually really, really bad if you're doing it for long periods of time without moving.

So actually just breaking up long periods of inactivity. Even if it's just getting up, moving around for five minutes or just stretching the legs for a couple of minutes. Even basic things like that is really good. And the second bit of advice is getting out of breath is a good thing and try not to perceive it as a threat or a negative. Almost perceive getting a bit out of breath or sustain breathlessness through movement.

And that is what essentially is building your fitness. And that is essentially your body responding to stress. Don't get to the point where you are absolutely struggling for air, but to the point where getting a bit out of breath, a bit hot and sweaty, a little bit uncomfortable, that is essentially making your body stronger. So it's just trying to get people familiar with a feeling of what's actually going to benefit them and what's too much and actually what's not enough.

Sarah (29:38.438)

Yeah, and I always say, you know, I always talk about exercising to tolerance, but it's that point where, do you know what? This is just getting a little bit uncomfortable. I can do a bit more, but not a lot more. And I think it's that, isn't it? It's not where this is really awful, I can't do anymore, or this is really easy, I could keep going forever. It's, you know, I can keep going, but not for long. You always want to just overload yourself slightly, but it should still feel okay. And like you say, you should be a bit breathless rather than gasping for breath. You know, your heart should be working a bit harder rather than pounding. But you build up to it gradually. You know, you say, right, okay, today we're just going to do this, which is a bit harder. And then then we'll do something that's a little bit harder. And that's the important thing, isn't it, of working with someone like you is that you can progress them gradually from where they are to where they need to be rather than, right, we haven't got much time. Let's just run. And as I say, I think that's what a lot of people are nervous about. They may have had very negative experiences at school. And I know a lot of people, it might have been 50 years, 60 years since they were at school, but it sticks in your mind, those vaults. But also they may have gone to the gym and been given incorrect advice or bad advice or no advice. They may have gone to exercise classes and pulled a muscle. And so in their minds, it's like, it's not for me. They don't necessarily think I had an instructor who didn't know how to look after me. Do they? They never think that.

Adrian (31:08.054)

Yeah.

Sarah (31:28.23)

It's very much, it's not for me. I couldn't do it rather than if I'd had an instructor who showed me what to do, I would, I'd be really, really, you know, into it by now. And I think that's where you come in, isn't it?

Adrian (31:28.556)

Yeah. I guess the, what we both know is actually the biggest source of self -efficacy or self -confidence is previous experience. So if your previous experience is really good, really positive, then you're gonna, you know, you'll be, you'll be absolutely fine. And you'll be willing to engage in all of this and you'll know what the benefits are. Whereas actually if your previous experience, and even if it's back at school 50 years ago, was negative. Again, that's very much going to influence your confidence to be active or engage in this type of program or be fit or to do exercise.

Sarah (32:20.358)

Do you find that people, and this is something I do come across, but do you find that quite often age is a bit of a barrier in that people think they're too old to start now, they're too old to get fit now, they're too old for exercise?

Adrian (32:32.942)

Yeah, definitely. And I think it's, again, that's so historical, isn't it? I think it's always, I guess if you go back, again, I don't know how many years, but because the advice used to be, rest is best, and don't move, then...

Maybe some people just keep adopting that, but yeah, age is tricky. I definitely come across quite a lot of people who say, oh, you know, I am, you do realize that I am 80 years old. And I guess I could totally get it when they say, well, you're only in your 20s. So you don't understand what it's like, you know, I've worked hard my whole life and all of this, and I do get there, but actually what we do know is that being more active as we get older is so much more important than necessarily being in your 20s and doing it. Because we're very much sort of having to counteract the effects of aging, which unfortunately is usually not great for our bodies, and we want to slow it down as much as possible.

Sarah (33:35.27)

That's it, physiologically ageing is a bit of a, a bit of a, um, bit of a blow, but being physically inactive just worsens everything. Um, and, and, you know, for a lot of people when they retire, if they're retiring sort of in the mid-sixties, potentially they've got another 25 years at least. You want to be able to live that as healthy as possible. And this is where even with a diagnosis of something like cancer and having to have surgery, just those few weeks of prehab and then moving into rehab afterwards can really make the difference between a good recovery and I suppose a basic recovery, can't it?

Adrian (34:23.278)

Yeah, and it's about trying to live as live as best as you can for as long as you can. That's very much what prehab is about. I think it's it's making sure that you know, you can still get back to a good quality of life and still enjoy your life to the point where you can do most of the things which you still want to be able to do for as long as you possibly can. That's really the whole basis of this and to not leave you completely disabled knowing that you can't do a lot of the things that you enjoy.

Sarah (34:27.258)

And I think that is an absolutely perfect place to finish actually is, you know, prehab isn't about preparing for an operation. It's about preparing for the rest of your life, really. And let's let's let's do it. Yeah, yeah, let's do it. Adrian, thank you so much for coming in. Anybody who's listening wants to get in touch with Adrian, do get in touch with me. And if you want to know more about the CanRehab cancer exercise courses I'll put a link in as well because you can if you are an instructor and you want to know more then you can you'll see both of us on that course so thank you so much for coming in it's interesting I think hopefully a lot of people will realize that prehab isn't about exhausting yourself for surgery it's about getting yourself fit for surgery or treatment so thank you.

Adrian (35:36.014)

Yeah, absolutely. So thanks very much for having me on. I appreciate it.

Sarah (35:40.678)

You've been listening to me, Sarah Bolitho and my guest Adrian Fautly on Creating Active Lives this week. Don't forget to give us some likes and subscribe and we will see you very, very soon.