Strategy for Chronic Pain Management

Strategy for Chronic Pain Management

Recently the government released a document on a nationwide strategy on pain management. Pain (especially chronic) is prevalent, yet misunderstood. There’re many current flaws leading sufferers to be neglected, ultimately leading to non empirical options such as opioid use. In regards to Opioid use, we now have strong evidence that it leads to poor outcomes. The national strategic plan is a thirty-two page document. So I will iNform you on the relevant key points from an exercise physiology perspective. 

Key point one: 

Chronic pain from a medical perspective was not classed on its own as a specific condition. When seeking a team care arrangement (TCA) from a general practitioner (GP) you would have to have an accompanying comorbid condition to be eligible, which is a sadistic oxymoron. A comorbid condition such as type two diabetes mellitus for example. Secondly, living with chronic pain is terribly difficult without the appropriate resources and social support. Along with access to evidence based care which is lacking in some states in Australia. The aforementioned strategy is advising to include chronic pain as a specific medical condition. With eligibility to access a TCA which is fantastic news! And which brings me to my second key point.

Key point two: 

Team care arrangements (TCA) are medical resources for certain populations whom are eligible for five appointments with an allied health practitioner through the Medicare benefits scheme (MBS). The premise of the five appointments is to access support and guidance to manage and optimistically ameliorate one’s chronic condition. Now, allied health professionals have been stern over the years that five rebatable appointments are well below par to make any inroads and psychophysiological change. It was only recently due to the COVID-19 pandemic that a mental health care plan was extended from ten appointments to twenty via the MBS. And most would argue that twenty appointments with a psychologist for a complex psychological issue is only minor at best, however is a good start. It is proposed that ten appointments will be issued with the aforementioned strategic plan which again is progression albeit insignificant to guide and implement real change.

Don’t get me wrong, I’m an optimist. When you’re in the field of chronic pain you see suffering, you empathise deeply and you require more time and resources to help. 

To gain access to the national strategic plan for pain management. Readers can access via the page. 

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Understanding Osteoporosis: Why Exercise is Important

Understanding Osteoporosis: Why Exercise is Important

Osteoporosis is a progressive metabolic bone disease characterised by the loss of bone mineral density (BMD) and compromised bone strength. Osteopenia is considered a halfway point to osteoporosis; the bone density is lower than normal and treating it may slow the progressive bone loss that leads to osteoporosis.


Understanding exercise and bone health begins with understanding how bones are made.

We repeatedly place demands on our bones and these demands cause our bones to constantly re-modelling themselves. Bone re-modelling occurs in two phases. First, special bone cells called osteoclasts break down bone. Then, other bone cells called osteoblasts create new bone. Osteoclasts and osteoblasts can coordinate well for most of your life. Eventually, this coordination can break down, and the osteoclasts begin to remove more bone than the osteoblasts can create leading to osteoporosis.


Why is exercise important for Osteoporosis?

Exercise is a highly modifiable contributor to bone health (osteogenic). Physical activity generates external (ground reaction and inertial) and internal (skeletal muscle) forces on the skeleton. These forces cause very small amounts of deformation in the bone tissue, resulting in mechanical strain. This mechanical strain is sensed by cells (osteocytes) that reside in bone. When unusual strains are sensed, osteocytes initiate an adaptive response that produces new bone tissue (osteoblasts). The more vigorous the strain, the greater the response.

For a given external force, weak bones deform more, resulting in relatively large tissue strains, whereas strong bones experience low strains. This elicits a more robust biological, bone building response in the weaker bone that eventually results in stronger bone.


What types of exercises help?

Types of exercises that ARE osteogenic:

  • Resistance training
  • Jumping, landing, hopping, Running, jogging, very brisk walking
  • Netball, basketball, soccer
  • Dancing, impact aerobics

Types of exercise that are NOT osteogenic:

  • Swimming
  • Leisure walking
  • Cycling
  • Yoga, tai chi
  • Lawn bowls


Structured osteogenic exercises: Where to start?
  1. Wholistic strength training
    • Goal/s: Improve bone strength and ensure injury prevention.
    • Frequency: 2 week Prescription: 2-3 sets of 5-8 repetitions (~8 exercises).
    • Target major muscle groups attached to the hip and spine.
    • Intensity: 8/10 (hard but not maximal)
  1. Impact exercise
    • Goal: To induce relatively high bone strains (rapidly).
    • Frequency: 4-7 days per week
    • Prescription: Aim to work up to 50 repetitions over time (5 sets of 10 repetitions with 1–2 min rest between sets).
    • Vertical and multidirectional jumping, bounding, hopping, skipping and bench stepping.
  1. Balance training
    • Goal: Reduce the risk of falls, which can lead to fractures.
    • Frequency: Up to 4 days per week.
    • Can be built into a strength program.
    • Prescription: <10 seconds per exercise, challenging, a variety of exercises


Tips and tricks:

Begin loading your bones slowly.

  • Whilst impact training is encouraged, it is important you have the strength and stability to complete those movements without increasing the risk of injuring yourself. For example, you would never take up sprinting before jogging. Strength training is a good place to start.

Form is more important than anything

  • Training with good technique (both strength training and impact exercise) is essential to reduce your risk of injury. Getting support and guidance from a trained individual is useful.

Introduce impact exercises into your daily life.

  • Because you only need to do 10 impacts at a time, there is no reason why you can’t do them sporadically throughout your day.

Resistance and impact training should not be painful

  • You may need to reduce or eliminate high ground reaction forces if you have joint or muscular pain (such as arthritis or lower back pain). You can slowly build intensity up over time. Managing your osteogenic exercise program can be challenging.


If you would like support, guidance or more information please call, email or visit the iNform Health website.


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The science behind why exercise is beneficial for individuals with cancer

The science behind why exercise is beneficial for individuals with cancer

Exercise as a cancer therapy

Over the past few years, exercise has emerged as a potential therapy (in conjunction with other standard treatments) to help delay cancer progression, reduce recurrence risk, and improve overall survival. Did you know that physical activity has been linked to between 30-60% risk reduction in cancer-specific mortality?


The mechanisms for the beneficial effect of exercise on cancer is complex and multifaceted. Here are a few ways exercise can work (in no particular order):


1. Improved immune system function

A good immune system is necessary to slow cancer growth. In fact, there is a whole type of treatment which aims to increase fight from your immune system called immunotherapy. Excitingly, aerobic exercise has been shown to increase the production of immune cells (i.e. natural killer cells), and infiltrate these cells into tumours. Natural killer cells can produce an approximate 60% reduction in tumour incidence. These immune cells are mobilised within minutes of your exercise starting, and maximal mobilisation of these immune cells is achieved after 30 minutes of exercise. This essentially means you need to have small doses often to get the best effects. Exercise once per week may not cut it. Exercise may also positively affect immune cell activity through muscle contraction-induced release of beneficial immune cells.


2. Increased blood flow to a tumour

The region surrounding a tumour is typically low in oxygen (hypoxic) because the body is not able to deliver enough oxygen amidst the disorganised and poorly working vessel structure of a tumour. During exercise, blood flow increases all over our body, including around any tumours. If we keep exercising, we can improve how arteries, capillaries and veins work within and around the tumour. All of which increases the delivery of our body’s own cancer killer immune cells and therapeutic agents such as chemotherapy drugs, making treatments more effective.


3. Regulating the way our genes express to help fight cancer

Epigenetics is a big word for changes in the way our genes express in the body without actually changing our DNA sequence (all of the those A, C, T, G’s that we learnt in science classes). Epigenetic alterations are necessary for cancer cells to grow and divide; however, on the other hand, exercise can modify the way our genes express and regulate and reduce the growth of cancer cells. This is a fairly new discovery, and more research is needed to understand what types of exercise are more effective for different, ages, races and cancer types. Exciting none the less.


4. Inflammation reduction

Chronic inflammation is widely recognised to encourage tumour growth in several ways: (1) Suppresses programmed cell death (apoptosis). (2) Promote cell growth (proliferation). (3) Improve the ability to spread to nearby tissues as well as distant organs (metastasis). Exercise can play a large role in reducing inflammation via several processes.  Getting active can reduce pro-inflammatory markers (the bad ones) and increase the number of myokines (small secreted proteins that can reduce inflammation). All of which can prevent the growth of tumours.

Final thoughts

It must be noted that research is still evolving in this area. The effects of exercise on different cancer types still needs more time and research funds. We cannot definitely say exercise will have a significantly positive effect on every cancer and will not cure your cancer in isolation. However, it is clear that being active has so many benefits for cancer patients.

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If you would like to read more:

Exercise protects from cancer through regulation of immune function and inflammation (2017)

Mechanisms of Exercise in Cancer Prevention, Treatment, and Survivorship (2020)

The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management (2019)




Finding Your Root Cause of PCOS

Finding Your Root Cause of PCOS

So you’ve been diagnosed with Polycystic Ovary Syndrome (PCOS).

You might be sitting there wondering where to go from here? You FINALLY have an explanation for why you’ve been experiencing all those symptoms; hooray! This is good news (even if it doesn’t feel like it) because NOW you can do something about it.


Root cause of PCOS

Managing PCOS enables you to take back control of your life and it starts by finding the root cause driving your symptoms.

PCOS occurs when there is an imbalance of hormones in the body (this is what causes all those annoying symptoms you’ve been experiencing). So it makes sense the aim of managing your PCOS should be to determine what’s causing this imbalance and work towards re-balancing your hormones. 



Insulin Resistance & PCOS

This is the most common type of PCOS. Insulin resistance occurs when the body stops responding to insulin, and both sugar and insulin levels in the blood start to rise. High levels of insulin can stimulate androgen production, thus disturbing the normal balance of hormones.

A blood sugar test from your GP can determine whether you have insulin resistance. If insulin resistance is driving your PCOS it’s particularly important to adopt a healthy and nourishing diet, and exercise regularly to manage and improve your blood sugar levels.


Healthy food for PCOS


Inflammation & PCOS

Inflammation can be present in all types of PCOS. Things such as; stress, food sensitivities, poor gut health can lead to long term inflammation in the body. Long term inflammation can disrupt the body’s normal hormone levels and wreak havoc on both your physical and mental health.

Symptoms of inflammation are things like; fatigue, anxiety, IBS like symptoms, or joint pain (to name a few). If inflammation is the driver of your PCOS: determine your underlying source and start including positive lifestyle behaviours to support your body and manage your symptoms.


Movement for PCOS


Adrenal & PCOS

If you don’t fit the insulin resistant or inflammatory type PCOS you may be one of the few women who have an adrenal form of PCOS. This occurs when the ovaries function as normal but the adrenal glands produce androgens in response to “stress” which can then result in an imbalance of hormone.

A blood hormone test (testing for DHEA/DHEA-S) from your GP would help determine whether adrenal glands are functioning as normal. If your stress response system is driving your PCOS, learning to manage your stress and support your nervous system is vital!


Mindfullness for PCOS


Knowing your root cause can be a game changer when it comes to better managing your PCOS. Now you can work towards re-balancing your hormones, improving your symptoms, and get back to feeling better day to day! 


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Take Control of Your PCOS! How Exercise Can Help

Take Control of Your PCOS! How Exercise Can Help

PCOS can make you feel like you’re going insane! 

Some days are good, some are bad, and then there’s the days you just feel plain awful. It seems like nobody understands how you feel or what you’re going through, heck sometimes you don’t understand what’s going on and life feels out of control. Trust me when I say you’re not alone and trust me when I say there IS something you can do to take back control of your life!


What is PCOS?

Polycystic Ovary Syndrome (or PCOS) occurs when there is an chronic imbalance of hormones in the body. This can cause havoc on the body and possible symptoms are; fatigue, bloating, hair loss or unwanted hair growth, acne, and weight gain.


What YOU can do about your PCOS?

So you may have been told to “lose 5-10% of your body weight” or “take these medications”, or if you have lean PCOS the classic “there’s nothing we can do, so just come back when you’re trying to get pregnant and we’ll help”. But let me tell you… there IS something YOU can do to help get your life back!


Now I’m not talking about going out and flogging yourself at the gym or running until you vomit. I’m talking about the kind of exercise to get your body moving, make you feel better, and improve your PCOS symptoms.


How will exercise help my PCOS?

Exercise can help you manage your PCOS in a number of ways such as;

  • Help to balance your hormones,
  • Reduce symptoms such as;
      • Bloating
      • Fatigue
      • Low moods, anxiety, and/or depression
      • Stress
  • Help regulate your periods and hence increase chance of pregnancy,
  • Manage your weight either by;
      • Reducing body weight by 5-10% (which helps improve symptoms and increase chance of pregnancy), or
      • Improve body composition by increasing muscle mass and maintaining a healthy level of fat (very important for ovulation!)

Along with a healthy diet, plenty of sleep, reducing stress, and learning to understand your cycle you can also improve acne, hair loss, unwanted hair, and improve overall well-being, and give you back some control in managing your PCOS.



Exercising for PCOS

So now you know why exercise is good for PCOS, but how should you add it into your life? Here is a bit of a guide…..

  • Aim for 30 minutes most days of the week of moderate aerobic exercise 

This is important for reducing inflammation in the body, and improving symptoms.

  • Add 2-3 strength training days into your week

This is important for improving body composition, increasing metabolic rate for weight loss, and supporting the body through pregnancy.

  • Find a form of exercise that you enjoy

This will make it much easier to stick with and reach your health goals, whether that’s gym exercises, pilates, group classes, running, swimming, aqua aerobics, cycling, dancing, hiking, there’s many ways to exercise so think big! 

  • And most importantly listen to your body!

Move in a way that will leave you feeling good, this may change how you exercise day to day, but it is important for long term recovery of your body.


There you have it, how you can take your health into your own hands and manage your PCOS. If you would like some more information or help in managing your PCOS contact one of our Exercise Physiologists and we will help you through your journey to better health.

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Should I Workout When I’m Sick?

Should I Workout When I’m Sick?

Should I workout when I’m sick?

You would be amazed how often I hear this question. At least once a week I will get a message from a client who are feeling a little under the weather. Saying that they are unsure if they should come in and train, or not.

And — like most things in the health industry — it depends.


Should I workout when I’m sick?

I get it.

You have finally gotten into a solid training routine. Finally gotten in a couple consistent weeks of exercise. Your feeling good, seeing progress, and making change.

And boom — disaster strikes.

A head cold, a runny nose, or even a mild cough.

But are these enough to stop you from working out, or should you just push through?


The “above the neck” rule

When it comes to working out when sick, I tend to stick with what is known as the “above the neck” rule.

This rule simply suggests that if you are strictly experiencing symptoms above your neck, then you are probably fine to exercise. This means that if you have a head cold, a stuffy nose, or a mild earache, you are good to go.

However, if your symptoms extend below the neck (think a chest cough, fever, vomiting, or diarrhoea) then you might want to give it a miss.



How do I know for sure?

Now, while the above the neck rule does provide a simple way of telling whether you should workout or not, it isn’t always 100% accurate.

See, when you are sick, your body is working overtime to get better. It needs extra energy to support your immune system, and often extra rest as well. With this in mind, it is important to remember that exercise places your body under more stress that it needs to recover from.

This can obviously impair your ability to heal.

As a result, even if all your symptoms are above the neck, there are still times when you might want to avoid exercise. These include:

If you fall into one of these categories, give your session a skip and get some rest.



But what about my gains?

But what about my gains?

One of the most common reasons people want to keep training (even when they are sick) is because they don’t want to lose their fitness.

And I get it.

I mean, you have spent all this time training diligently, and now its all going down the toilet — right?

Well, not quite. See, you will be happy to know that it actually takes a decent amount of time to lose fitness.

In fact, if you stop exercising completely, you wont start losing strength or muscle mass until around your third week without exercise. Similarly, it is unlikely you will see any loss of endurance or aerobic fitness until after your second week without exercise.

Note here that I said if you “stop exercising completely”.

Positively, if you can even get in one training session per week, your loss  of strength and fitness will be attenuated significantly. This means that if you have a day where you are feeling good, you can sneak in a light session to avoid any losses of fitness occurring.

In short, you have nothing to worry about!


Take Home Message

Should I workout when I’m sick? Well, I think we have answered that question pretty comprehensively.

In my mind, adhering to the above the neck rule is a great place to start. However, if you are simply not feeling up to it, or exercise makes your symptoms worse, then you should probably give it a miss for now.

And no, you don’t need to worry about losing all your gains, because that wont start to happen until week 3 without exercise — so make sure you take some time to recover if you need it!

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