Making physical activity business as usual: Learnings from across the Atlantic
There is strong evidence that physical activity is highly beneficial for people living with and beyond cancer. Research has shown it can reduce side effects and improve quality of life at all stages of cancer treatment. There is also evidence physical activity can reduce reoccurrence and improve survival rates in some cancers. Despite the evidence, physical activity is not routinely available as part of cancer care in the UK.
In February 2020, I was awarded a Churchill Fellowship to explore how we can make physical activity ‘business as usual’ within cancer care. The Fellowship was an experience of a lifetime, allowing me to travel to the USA and Canada to learn from world leading experts and visit innovative exercise oncology services.
Before travelling, I hypothesised that the USA’s and UK’s differing healthcare models would influence the availability of funding and thus the culture of embedding physical activity into clinical care. However, I learnt that how programmes are funded had very little impact on their success, and the extent to which physical activity was normalised by the design of clinical environments and processes was far more influential.
Design features can significantly affect people’s perceptions and behaviours. Health professionals are more likely to talk about physical activity and refer patients to support programmes, if it feels like a normal part of their work. Equally, patients will be more receptive to the conversation and adhere to the physical activity support if it feels like a normal part of their cancer treatment.
In some exemplar programmes in the USA, exercise facilities have been strategically placed next to a hospital reception and in close proximity to chemotherapy wards. This intentional design allows for a powerful message to be conveyed to all those who enter the hospital - that in the midst of cancer treatment, it is possible and encouraged to stay physically active. By being visible and easily accessible during treatment, the facilities also serve as regular prompts for both patients and clinicians to incorporate physical activity into their routine. This reduces stigma and creates the perception that exercise is an essential part of cancer care.
In contrast, many exercise programmes in the UK are delivered in community gyms without any visible connection to healthcare. This separation leads to the misconception that exercise is optional or only for those who are interested. Although there are advantages to offering physical activity support outside of hospital settings and closer to people’s homes, when a visual prompt for physical activity is provided within a clinical environment, it increases the likelihood that individuals will utilise these opportunities, even if they are not located within that facility.
Successful programmes recognise that the needs of people living with cancer can vary greatly and offer a range of options, including clinical exercise interventions, self-management advice, and community signposting. They also acknowledge that the success of any programme relies on uptake and adherence by patients. Thus, it is crucial that the importance of physical activity is emphasised throughout the design of the clinical pathway to enable more people to access various forms of support.
Although funding is essential to deliver programmes, the most successful interventions had sustained the programme for several decades without funding from healthcare systems. In these examples, the healthcare systems had still committed to the programme by providing space within a hospital. As healthcare space is a premium commodity, this provision creates the perception that physical activity is prioritised by the organisation, further re-enforcing its importance. In contrast, if a health organisation supports a programme purely through funding, the support is unlikely to create a normalising effect, as clinicians and patients aren’t usually aware of how the programmes are funded.
As we continue to advocate for physical activity to become part of standard care, the importance of making physical activity look and feel part of normal cancer treatment cannot be forgotten. Building new hospitals to accommodate exercise facilities is not feasible everywhere, nevertheless, there are simple and cost-effective design modifications that everyone working in cancer care could implement. For millions of people living with and beyond cancer, the benefits of physical activity could be truly life changing, and in some cases, lifesaving.
Whether you are a clinician, exercise professional, or researcher working with cancer patients, ask yourself, how can we work together to create a culture where physical activity is ‘business as usual’?
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To get in contact visit Beth’s LinkedIn Beth Brown - Operations Manager - National Centre for Sport & Exercise Medicine - Sheffield Teaching Hospitals NHS Foundation Trust | LinkedIn
Beth has over 10 years experience developing physical activity interventions. In her current role as Operations Manager at the National Centre for Sport & Exercise Medicine Sheffield, she oversees a model that transforms how physical activity is integrated into the NHS. In 2020, Beth was awarded a Churchill Fellowship to learn about the latest innovations in exercise oncology.