A patient’s perspective: Exercise prescription for a cancer patient

Good morning, Mr. Kenna, and thanks for agreeing to come and speak to us here. You’re welcome. Good morning to you. If you don’t mind, I’ll ask you a few questions about an exercise rehabilitation programme you were involved in, which is here in the clinical research facility. But first, I might just recap briefly, with your permission, on your medical history and how you ended up taking part in the research with us? So Mr. Kenna, you were diagnosed with esophageal cancer and underwent treatment for this illness, which included surgery. Correct. And to aid your recovery, you took part in an exercise rehabilitation programme, here in St. James’s Hospital in the clinical research facility. Yes. So, that was 12 weeks long?

It was, yes. We have we used this room, where we are now. We had various machines. There’s the bicycles, and the treadmills, weights, walking. And then we also had a nutritionist who was here, which was great. I was able to meet once or twice, during the period of time, to discuss the diet. Excellent. So there was an education component to nutrition as well. Absolutely, yeah. It was fantastic. And how many people would have been in a class with you, at one time? There were 12 in total on the programme, and so we were split into groups of six and we did shift work.

So we started– I think my normal time was quarter to one, and then we do a session. And then at 2 o’clock, then we have a meeting, every week or every two weeks it was at the time. There’d be different presenters and different individuals talking to us about the various effects of our illness, the effects of the way forward from there. It was brilliant. And then our group would go home and the other group would come in and do their exercise. So, we worked out very well. So, about an hour engaging in exercise? It was about an hour and half in total, about an hour for exercise, yeah. And how did you monitor how much exercise you were doing?

I believe you wore heart rate monitors? We did. The very first time I came, and I have the photograph to prove it, I looked like somebody who was about to climb Mount Everest in a gas, with the oxygen masks on, all these things. They took a baseline at that point so they could see how unfit I was, and then we worked from there up. So the heart monitor was on each time I was here, for the duration of the thing. And I had to build it up over that twelve week period. It was actually tracked. It was tracked? Yeah. Individual to you? So I could see the progress.

So I was getting more and more fit and less and less tired as I went on. Brilliant. And tell me, how did you feel about the idea of exercising, after the diagnosis of cancer and having gone through your treatment? Had you any concerns? It was vitally important that I kept it going. I was very active before I got ill. I was a regular at tag rugby. And then I went through chemo, prior to the operation, I couldn’t play anything or do anything with chemo because I had a belt with a bottle on me. So I wasn’t able do anything. As soon as that came off after 12 weeks, I was back playing tag rugby.

Well, you’ve kind of answered some of my question. But I guess, what effect if any, did the exercise rehabilitation programme after surgery have on your health and your quality of life? Well, it was a little while after the surgery that I came in here. I had been working, but again, it was hit and miss. After surgery, for at least a year, my energy levels were on the floor. I found it very difficult to do anything at all, very tired. Of course, I went back on chemo after the operation as well. So by the time I came to do this course, I was ready in my head to try to get fit. And it made a huge difference.

And after, I think it was 12 weeks in total, that’s like a three month period. At the end of it, I felt that you know I could run out there and run a marathon. I felt great. Brilliant, brilliant. So it helped your energy levels then? It definitely helped, yeah. Made a big difference. Did you find it hard to exercise? You mentioned at the beginning you had supplemental oxygen. Yeah. Getting back into exercise after such a big operation and then more chemo, just the fatigue that came with it, the mental kind of– the negative thoughts that go through your head. You know, I’m too tired to go and do this, or I should go walking. My partner was great.

She was sort of kicking me out. Come on, come with me. And she’s an avid walker, and I couldn’t keep up with her. But I do a little bit. I’d stop and I’d go and read the paper, have a cup of coffee while she did the rest and that helped me. But by the time I got in here, you know, I think I was ready, at that point, to do more aggressive, almost like training kind of exercise. And what did you enjoy about the exercise? Well, I think just getting back into it. This was great. It helped me to get back into it because I was, as I say, I was sort of making excuses.

So this got me back into it. And after the first two or three weeks– I travelled a fair distance to get here, once a week for the first four weeks, and then it was broken down. But after the first couple of weeks, I was actually enjoying coming because I knew I was getting benefit from it. Yeah. And tell me, what did you feel when you were exercising? So, you know, there was obviously anticipation and maybe some difficulties getting motivated. But when you were actually on the treadmills and on the bike, how did that feel for you? Initially, I felt quite tired. I mean, I’d be looking at my watch, another 15 minutes to go, and going, oh.

So that was the first couple of weeks because I wasn’t used to it. But after getting over that, then I was able to push myself a bit. Very good. Would you have been sweating, and heart rate up? Oh yeah. Oh, definitely. Yeah. We have the training gear shorts, and everybody here who was doing it was kitted out accordingly because you are really pushing it. Especially in the middle, and then it got tougher, obviously, as you go on because you were asked to push it and get your heart rate up higher and higher and higher each time. And so certainly by the second, or the third or fourth weeks, we were really flat out.

By that stage, I was able to handle it. Well, listen. It’s so important for us, as health care professionals, to get a patients perspective and understand your point of view, and how it feels for you going through this. So, would you have any advice or anything you’d like to say to health care professionals, who might be thinking about using exercise prescription for a treatment with people who have chronic disease? Well, I would suggest that, obviously supervised or with care, as soon as you possibly can advise or help your patients to start exercising. Like, I remember being here in this hospital, and it was a week after the operation.

And the physios came, and there was all tubes out of me and bags for this and bags for that. And the physiotherapist student came to me and said, come on, come for a walk. And they took me out on the corridor, and they walked me down to the coffee shop and then back again. And I tell you what, that made me feel normal again. It made me feel, well I could do that, after what I’ve been through and still hooked up to these things. So it felt great. You know, in my own head it was just a positive thing. So that it started for me, I was able keep it going after that. Yeah, keep you going.

So it is really important. Well, that’s really helpful, you know. So start and keep going. Keep going. Start as you mean to go on, yeah. Listen, thanks so much. Pleasure. For coming in and speaking with us here. We really appreciate it and it’s important for us to understand the patients point of view. Well I hope it does help.