Ms Susan Moug's keynote speech 'The Promotion of Physical Activity - Everyone's Responsibility' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.

1. The promotion of physical activity-
everyone's responsibility
View from a colorectal surgeon
Susan Moug

2. 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

3. Where is the physical activity bit?

4. 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?

5. 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.

6. 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.

7. 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’

8. 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.

9. 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.

10. 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’

11. 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

12. 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

13. 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.

14. 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

15. 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?