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Exercise & Movement in the Management of Disease with Dr. Damian Kristof and Ben Southam

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Exercise & Movement in the Management of Disease with Dr. Damian Kristof and Ben Southam

With high rates of chronic disease, mental health and less physical activity exacerbated by COVID lockdowns, exercise physiology is the focus of our latest podcast. Accredited exercise physiologist, Ben Southam and Dr. Damian Kristof discuss opportunities to include exercise physiology in a collaborative care model for our patients. 

Ben and Damian bust the perception that exercise physiologists are all about squats and lunges, and discuss the complimentary nature of exercise physiology, how each consultation is tailored to meet the clients needs and the differences between a physical activity prescription and an exercise prescription.  

Ben and Damian discuss the supportive role of exercise physiology in helping to lower risk factors for disease in addition to the increasing demand for exercise physiologists to provide long term support for both rehabilitation and performance enhancing movement. Ben also provides us with timely insights on the safest way to return to exercise following a COVID diagnosis.  

Covered in this episode

[00:39] Welcoming Ben Southam
[01:40] Differentiating exercise physiology from exercise science and personal trainers
[06:16] How exercise physiology helps with chronic disease
[09:14] adapting treatment to the client
[12:38] What happens in an exercise physiology consultation
[16:05] Building a referral network and co-management of patients
[19:57] How physical activity prescriptions work
[25:12] Addressing COVID with physical activity
[28:59] Practitioner access to NDIS
[32:54] Exercise plans for mental health
[35:55] Thanking Ben and closing remarks

Key takeaways 

  • Exercise physiologists can work alongside other modalities to support rehabilitation and disease prevention and treatment using evidence-based techniques. 
  • Exercise physiologists are covered by Medicare, WorkCover, NDIS and TAC and are regulated by the ESSA.
  • Increased rates of chronic disease, poor mental health and a reduction in movement associated with COVID-19 lockdowns in Australia has led to an increased demand in exercise physiologist support. 
  • To support clients to reach their movement potential and promote compliance, exercise physiologists tailor their exercise and physical activity prescription to the needs and capacity of each individual client. 
  • There is no required level of exercise or fitness experience to see an exercise physiologist. 
  • People who are recovering from COVID are advised to slowly increase the intensity of their movement overtime to minimise the risk of delaying recovery. 

Resources discussed

Ben Southam
Pace Health Management
Exercise Physiology - exerciseismedicine.com.au
 Exercise & Sports Science Australia (ESSA) | Fact Sheets
Returning to Exercise Post Coronavirus (COVID-19) by Chloe Louise Dunne for
PACE Health Management 2022


Damian: This is FX Medicine bringing you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Dr. Damian Kristof, a Melbourne based chiropractor and naturopath and joining us today is Ben Southam. He's an accredited exercise physiologist and director at Pace Health Management in Victoria. Drawn to exercise physiology via his love of the human body at school, Ben attended Deakin University and completed his undergraduate in Exercise science, followed by a Master's of Exercise Physiology. 

Ben enjoys the diversity of conditions he gets to work with on a daily basis, supporting his team in their professional endeavours and the amazing people he gets to meet. In his spare time, you'll find Ben keeping active running in the paths of Bayside, playing a round of golf, I got to tell you, drinking a coffee, and also enjoying baby chinos with his daughter. 

Ben, thank you so much for joining me today. It's a pleasure to have you on our podcast.

Ben: No worries at all, Damian. Thank you for having me and giving me the opportunity to talk a little bit about exercise physiology.

Damian: Ben, you know, I've known you for, it feels like an eternity now, 10 years or so I think it would be since you've come into Sandringham. And I've always been fascinated because for a long time, you had personal trainers kind of paving a way. And then there's exercise scientists coming into the space, and there's exercise physiologists in the space, and there's physiotherapists in the space. And I've never really known the difference between each of them, except for maybe there's some extra education. But could you shed some light on the difference between say EP and Exercise Science or, you know, personal training, for example, just so that people who are listening, our other practitioners who are listening could maybe get a sense of how highly skilled you guys actually are.

Ben: Yeah, sure. Look, it's probably one of the number one questions we get on a daily basis, is what's the difference between us and physios, and us and personal trainers? To just explain it, I suppose is an exercise scientist is someone who's done a three-year undergraduate course in Exercise Science, which exercise physiologists have also done. 

So what that enables those people to do is they can go out and treat people who are apparently healthy. And they really work in the space of preventing chronic diseases and helping people to maintain health and well-being. From their three year undergraduate, to become an exercise physiologist, you do a further 18 months as a Master's of Exercise Physiology. And this really gives you the tools and skills to deal with people who have chronic diseases and, I suppose, is a much more evidence-based approach to managing these conditions, for example, diabetes, heart disease, stroke, mental health, and so forth. So, as an exercise physiologist, I'm also an exercise scientist. And in our clinics, we do have exercise scientists working with our apparently healthy clientele, and then our exercise physiologists then deal with more chronic health and chronic pain areas. 

In regards to physios and exercise physiologists, we work really closely with physios and chiropractors and osteos, but as exercise physiologists, we don't do any hands-on treatment. And we don't really work in the acute injury or the acute space. So, to give an example I usually give is, if someone, say, has done, you know, an ACL tear, usually they'll seek physiotherapy treatment for the acute phase, pre and post the surgery, or if they're not going to do surgery for a post-injury. And then after that acute phase is done, that's where exercise physiology can then step in and sort of go that more long-term approach with rehabilitation, and then moving towards that performance as well.

So I hope that just outlines a little bit of the differences between those three subgroups.

Damian: Yeah.

Ben: In regards to personal training, I suppose the main difference we have is, as exercise physiologists, we have provider numbers as well, so we can work with Medicare, WorkCover, TAC. And we also have a governing body called ESSA, which then ensures that there's rules and regulations we have to work within and standards, which is I suppose slightly different to the personal training scope.

Damian: Yeah, well-said, Ben, and thanks so much for being so clear on that because I think there's been certainly a misunderstanding of where, potentially, EP fits into. I'm going to shorten exercise physiology to EP if that's okay for everybody else.

Ben: Yeah.

Damian: It sounds okay, to me. But I'm just going to assume that you agree that EP is okay to call it. We're going to call it exercise physiology, EP. You know, it's such a great…it’s a pearl for me to understand that you guys have done a three-year undergraduate Exercise Science qualification, then you've gone on to do a Master's program, and that's the reason why you're able to manage these chronic disease issues. 

And obviously, in naturopathy and the natural medicine space and integrative general practice and herbal medicine, nutrition, dietetics, chiropractic, you know, all of these professions, we all deal with people that are in either the mode or mindset of prevention of disease or in the management of chronic disease. And so, to know where you guys slot into that, I think it's, you know, super important. So thanks for clarifying all that for me, Ben, and for everybody else too. That's fantastic. 

Ben, the field that you're in is definitely emerging, it's growing at a rate of knots. And there appears now to be, I suppose a greater need for the work that you do, more so than ever before. We've got diabetes spiralling out of control, we've got obesity rates, it's now more common to be overweight or obese than to be of normal weight, which I find absolutely mind-blowing, particularly here in Australia. Cancer is a chronic disease, heart disease is a chronic disease, there's so much. What are you guys seeing in your practices? And what does your research give us hope towards what you're able to help out with?

Ben: Yeah, I mean, you chuck all the COVID stuff on top of that and, yeah, it's a bit worrying at the moment. Look, to be honest, most recently, we are seeing a lot of mental health...

Damian: It's rough.

Ben: ...which does have a correlation regarding COVID-19 and the isolation requirements and the lock-downs that have been going on as well. So you're seeing a lot of people with mental health. And now that we're sort of emerging out of, hopefully, that space, I'm predicting, and we're seeing a lot more, I suppose chronic health plans being referred to us. So potentially people who may have slipped through the cracks during those lock-downs, where they may not have seen their GP as often and haven't had their regular health checks, now, it's sort of to do that catch-up model where, you know, a lot more type-2 diabetics coming through, heart disease, as I mentioned, mental health, so a lot of depression and anxiety out there. So, you know, that's sort of what we're seeing in clinic.

And I suppose, from the research point of view, we see so many different diverse conditions every day in our clinic. And the research is so diverse that's sort of covering all different topics that we're seeing in clinics. So one website, I will advise that a lot of listeners have a look at is what's called exerciseismedicine.com.au, and that's actually a website that's developed by our governing body Exercise & Sports Science Australia. And on there, they have a fact sheet page, which is available to everyone. And basically what it is, is it's just a constantly up-kept factsheet for distribution and for health professionals to read through, that shows them what the most up-to-date research is on exercise prescription for different conditions. 

So, there's fibromyalgia on there, there's mental health, there's as type-2 diabetes, you know, anything that's within that EP scope is up on that website as well.

Damian: Yeah. Oh, wow. That's fantastic. So it's exerciseismedicine.com.au. So go and check that out, everyone. And we'll give that link in the show notes as well so that everyone can get access to that. I think that's a really important and certainly helpful resource. Thanks, Ben. That's great. 

I think there's a couple of levels when we consider evidence, and I think almost every health profession sits in this same space, is that there's a tendency to desire the gold standard of research in the clinical trial, the double-blind, placebo-controlled trials. But how often do you see someone or two people with exactly the same complications of type-2 diabetes? And then how often would you see somebody with exactly the same complications associated with an ACL tear?

My question is then to you, Ben, do you find that sometimes it's difficult to get that robust evidence because of the difference in the way in which people might present their ability to do certain exercises? And then should we be considering and consider it more so of the practitioner and patient interaction component of evidence-based medicine in this particular regard? I'd love your thoughts on mate.

Ben: Yeah, definitely. Look, everything that we're doing in the clinic is geared towards evidence-based research. But you do need to obviously treat the person that's in front of you. You would probably prescribe, the gold standard, best research-based approach, but if that person doesn't understand or is not capable of doing that, you got to try and work with that individual to steer them towards the best outcome that they can get. There's a lot of health behaviour change we need to conduct during our assessments in our treatment to try and get people understanding why things are important. But you've also got to understand what that person likes, and what's going to be the most important thing for them to do to then do long-term, and then become self-managed as well.

Now, if someone doesn't love running, you're not going to give them running, or if they have a real aversion to squats, you might have to change and then give them something different, that they will enjoy, that they'll do long-term. So yeah, it's a very, as you would know, Damian, with your work as well, that very much goes part in part with trying to work the best, I suppose, exercise prescription in with that individual as well, and trying to work with all different comorbidities, and also, you know, preferences there.

So it's a bit of a fine balance to get that end result, which is, for us, it's all about trying to get them empowered and self-managing their chronic health condition, because a lot of the time it's not going anywhere, it's going to be there for the next 10, 20, 30, 40 years, you just got to try and enable them to get that self-management and that long-term outcome.

Damian: Wow, there's a few amazing points in there. And I think one of the things you raised there, Ben, is that these people who are in chronic disease, for many of them, it's going to be about managing this chronic disease, it's not necessarily going to be about cure. Some of them will get there, some of them will be able to adjust their full lifestyle through different types of prescriptions, whether it be pharmaceutical prescriptions, herbal medicine, nutritional prescriptions, exercise prescriptions. They'll be able to manage that chronic disease, and maybe move themselves out of that chronic disease, which would be unreal. 

And I can see that happening for heart disease and probably relatively easily and also type 2 diabetes. But for other long-term diseases, it could be a bit more complicated. But I love that personalised approach, and that readiness to change model that you alluded to there, Ben, as well. And that readiness to change piece, I think is great. 

And I'd love it if you could maybe just step us through maybe what a consultation might look like, your initial consultation. Because in my mind when I walk past your practice, I'll see this nice little beautifully presented boutique gym space where people can feel comfortable, but I just don't know what it is. It's like this mystery box. People walk in there looking happy and they walk out looking even happier. So can you take us through what a consultation might look like with these people?

Ben: Yeah, Damian. That's great to hear. And we do that with a purpose because a lot of people that we see may be a little bit intimidated or might not enjoy that sort of gym mentality. And people that come into our clinic are people that may have never touched gym equipment before, or they've never experienced structured exercise. One might be a 94-year-old lady who doesn't really want to walk into a really loud gym. So we try to make our clinics very approachable and there a more like a family feel when people come in. 

But the way we treat has changed so much from when I graduated to now. When I first left uni, I used to address my initials very very structured, and I was spending half an hour of planning and get all my questions ready, and try and really evaluate why this person is coming in.

Whereas nowadays, to be honest, when someone comes in for their initial consultation, normally the one question I ask is, "Tell me a little bit about yourself and why you're here?" And I sort of try and talk less, and let clients talk more to try and get a deeper understanding on what's actually happening, what they're looking to get out of it, and how we're going to get from A to B. And then I'll try and steer around that and try to develop a really nice action plan so that they can understand the requirements of what they need to do to get to their goals, both from us and from them.

And then we work around the programming around that and try to set up some specific goals and structures around helping them do that. We're really there as a bit of a support person for them and a bit of a supporting coach and try to keep them on track and educate them and really delve into their why about why they want to do that change. And then we try and really put the onus on the client to action that and to get good results. 
So that's a very quick as far as in terms of the initial. Obviously, we do a lot of objective measures. We do all the blood pressure, heart rate. We'll do objective measures in regard to muscle mass testing, if that's part of their outline, we'll do some cardiovascular testing so that we've got really nice, clear objective measures from the start. And then we'll usually implement this throughout their treatment plan as well, just to assess progress.

Damian: Yeah, nice. So the progress is always managed, it's always monitored. You're looking at, I suppose, a set of outcome measures, whether it be, as you said, muscle mass shift and change, and that's difficult to achieve. It could be weight loss, maybe. Is that something that you guys might consider as well?

Ben: Yeah, we do. Look, to be honest, I don't ever weigh, anyone. I've gone way away from the scale these days.

Damian: Sure.

Ben: We do waist circumference measurements. But I'm more like to develop the NHK people on more the benefits of strength training, and more the habits, and the routine, behind that or, because it's more about the process, apart from the result, if that makes sense. So it's, I really want to try and drive into them the process to get from A to B, rather than just focusing too much on B. If that makes sense.

Damian: Yeah. And I love that. And the reason why I asked that question, it's a bit leading, I didn't even know, I didn't tell you I was going to ask that question. Sorry.

Ben: No, it's okay.

Damian: But the reason why I snuck that one in there was because there's people listening to this podcast right now and trying to make sure that you're not competition. And the reason why I say that, is because in the health space, there's a lot of people that are in private practice and they see a patient as someone that becomes “there’s," becomes a property of as opposed to a patient being someone who's seeking the care of multiple practitioners to help them be healthy, they need support, they need help. Where I see you guys dovetailing is that it's a supportive co-managed approach where people can get exercise prescription to assist them in, whether it'll be the nutrition model, or the pharmaceutical model, or an integrative model of care, and you dovetail into that.

And there's another level there, which I love to talk about, which is a third-party endorsement. So a third-party endorsement for me, Ben, is that there's an endorsement of your ability and in reverse. So for example, if I've got a patient that I'm sending down to you, I'm going to say, "Ben's a great practitioner. He works unbelievably well in the exercise physiology space. He'll be able to prescribe exercises for you, monitor your progress, monitor your condition, and make sure that you're moving in the right direction."

And then the flip to that would be that Ben would say, "Oh, great that you've come up here, Damian's a great chiropractor," I hope you say, "Damian's a great chiropractor. And he's able to manage the components of your care that I don't manage." And that little piece, that little discussion there helps the patient see the space between the practitioners. There is always going to be some degree of overlap, there will be some degree of agreement on a course of care, or progress of care, or a program of care, but the endorsement of each other strengthens the resolve of the patient to get a better result.

And I love that we do that. But the reason that I'm saying this for the people listening to this is that that's how you can build that little third-party endorsement, that promotion of your care that you provide through another practitioner. And you've got that space to be able to do that, Ben, which I love. 

And I wonder too, Ben, then with your patients, when patients come to you and say, "I'm following this nutrition plan from my nutritionist or my naturopath," what's the conversation that you might have with them about that nutrition plan, in conjunction with your exercise plan?

Ben: Good question. From the nutrition side, our studies are very limited in that. So to be honest, I would probably leave all that to the treating clinician who's dealing with all that nutrition side of things. From our perspective, we would perhaps just liaise with that clinician on what they're going to be doing with us so that clinician then has an understanding of the requirements that they might need to change. So for example, if the client is going to move into a heavy 8 to 12 weeks strengthening phase to try and really increase muscle mass and muscle strength, that requires different demands from a nutrition side.

So just be more, as you’re mentioning throughout, just that liaison between us and the other clinician trying to let them understand what we're doing, they can educate us on what they want us to reinforce as well. So that client then has the best outcome. So more just working closely with different professionals that have different expertise than us and trying to get that end goal is the best outcome for everyone, to be honest.

Damian: That should give everyone listening to this great confidence to know that you can include EP in your care plans for your patients and you feel very safe and secure that there's not going to be conflicting advice given there. So it's all about swimming in your lane and making sure that you're working together at the same time. I think is really important.

Could we just jump to physical activity prescription, if you don't mind, Ben? I just want to understand, how do you do it? What's the language that you might use with your patients, with your clients that come in? You know, what are you saying to them in terms of, you know, what is a good prescription? And how would you progress with that? Is that...do you progress with that just based on your outcome measures? Or does the patient say, "Oh, Ben, look, I think this is a little bit too easy, can you step it up a little bit?" And do you need to rein them back in? How does that prescription go?

Ben: Yeah, it's a bit of both, to be honest. There's two different types of prescription. There's the physical activity prescription, and then there's exercise prescription.

Damian: That's right.

Ben: So say, let’s use an example of a diabetic who's come in. Physical activity is basically anything that gets your body moving a little bit and perform some energy expenditure, it's usually non-structured. So it's things like taking the stairs, rather than the lift, parking further away from the station and walking that extra 10 minutes and things of that nature, whereas exercise prescription is much more structured and managed, I suppose. 
So physical activity prescription, we use, perhaps a lot at the start. So if someone's done nothing, and is really new to our area, and they're maybe a little bit nervous and overwhelmed about coming into see us. Now, some strategies we might use just to start to improve their exercise capacity might be, "Hey, Bob, this Saturday I want you to go out with your kids and just walk around the oval and have a bit of a kick with them, just get the body moving a little bit more than you are at the moment." Trying to increase just in general how much they're moving throughout their week, so that their body starts to get used to that extra loading.

It's also been a nice way to start with those people because it's less daunting, it's a bit less structured, so there's more flexibility in it. And to be this more sneaky way to get them moving a little bit more. And then from there, we'd move towards the exercise prescription, which is where all that evidence-based aspect is. 

As a start we definitely go lower load and a bit higher reps, just because you're seeing someone who's very new to this strength or cardiovascular fitness, you don't want to firstly, A, scare them away and make them really sore and look really negatively on exercise, which I think a lot of people do see exercise as a punishment or something they have to work really hard. Whereas, realistically, consistency will always outperform intensity.

Damian: Nice.

Ben: So, just trying to instil that within their life. And look, I never ever put finish lines on anyone as well. I always like to just sit down with them and go, "Look, you tell you when you feel like you're at a stage where you don't want to progress anymore, but we can just keep progressing and keep pushing you, and sort of keep improving your exercise capacity to a level where you're happy. And then from there, then we can go into the maintenance phase."

Damian: I kind of love that. I really love that because there's some degree of direction there from both the patient as well as the practitioner. And I was interested because one of my questions was going to be was, when is it ok to pull up and say, "This is just me."? 

So let's say, for example, someone's being given an exercise program from you guys, as well as their movement prescription. When is it okay for the patient just to say, "Ben, this is as good as I want to get." Do you ever say, "Oh, come on, Damian, you can get better than that." Or, if I've ever gone to...and when I say, "If I've ever," I did, I used to go F45 all the time. If ever I felt like that was enough, I'd get screamed at, you know, like, "Get moving. Give me 20." That kind of thing. Obviously, that's not what EP is. But do you use techniques to keep people going and push themselves further? Do you feel that sometimes people don't really know their true potential?

Ben: Yeah, it's a hard question, that one. Look...

Damian: Sorry about that, Ben.

Ben: It depends on a number of things. If they're coming in under a chronic health plan and their blood lipids are not where they should be, their glucose is uncontrolled, and things of that nature, then yeah, we definitely use motivational interviewing techniques. We definitely try and educate them further on why they need to do more, or how they can improve their health picture. But say you got someone who’s just a weekend warrior who's running their 10Ks every Saturday, they're feeling really good, they're doing their two strength sessions a week that you've given them, they don't really want to push any further and they're sort of happy with their current capacity, then that's, that's happy day. That's sort of hitting A to B and getting to your end result.

So from there, we'll just give them some simple strategies around how they should be maintaining what they've got. And then after that, it can be a little bit about trying to just keep the variety up so that they stay engaged in the program and stay at their current level. So, as everyone knows, everyone likes variety, and variety is the spice of life. So you've just got to use different strategies just to try and maintain their exercise capacity.

Damian: Yeah, I love that. I love that. It's, again, measured, and metered, and monitored, and kind, which I think is really nice kindness, it's a ripper. 

Now, you touched on COVID earlier on. And obviously, there's very little evidence around what it is that we can do for COVID because it's emerging, it's only a couple of years old. So we are seeing a lot of people coming in with long COVID symptoms, and complications associated with COVID, whether it be respiratory tract, or muscles, or overall fatigue within the body. How are you guys addressing that? And have you noticed that there's an approach to, I suppose, getting back into exercise after COVID that seems to work better across the board? Or again, obviously, there's individualities for each and every single person, but how are you guys approaching this post-COVID time?

Ben: Yeah, look, there's definitely just more up-to-date research coming through as this pandemic continues. And, and we've actually had one of our students who have come through our clinic recently, do a full evaluation for us and have a look at the research around, "Hey, should we reintegrate back into exercise post-COVID?" So I'm happy to share that with you as well if you'd like to put that in the show notes for clinicians to look through.

Damian: That would be great.

Ben: But, you know, I am someone who recently also had COVID, courtesy of my daughter, and I was asymptomatic, I can very much advocate for a slow and progressive return back to exercise. I was a bit brazen in my approach, and sort of one week post, tried to go out for a nice 8 to 10k run, and definitely felt the effects of having those symptoms, I felt the effects and having COVID.

What's sort of being suggested at the moment is really a five-week build post symptoms. So they're sort of saying, after your symptoms have subsided, for one week, we sort of look at a sort of five-stage rebuild.
So looking at, firstly, just doing some really gentle breathing, stretching, balance exercise in the first phase, and then slowly progressing towards lighter duties such as yoga, some lighter yoga, walking, some light strengthening work. And then as the phases go on, you're slowly returning back to what you were doing pre-COVID.

There's some guidelines around when you shouldn't continue to progress, if symptoms are returning or if your fatigue is getting worse. And there's a bit of a diagram I can share with you about this, but there's different things that can sort of educate you on when you should just stay in your current phase before progressing. 

But I'd probably just stress, for everyone here listening, to really respect, if you've had COVID, just respect the progress afterwards. So just not trying to be the hero in the first sort of three to five weeks, just really trying to listen to your body. Listen to how you're pulling up, analysing your fatigue levels, your sleep quality, and your stress management, as well. And just giving your body time to get back to where it was because you will, you just don't want to prolong the effect of what you've just gone through.

Damian: Yeah, yeah, great point. Great point. And obviously, everyone's gonna be different. I've had this tickly cough thing for...I don't know, it must be six weeks now, it just doesn't want to go. It seems to get worse in the evening. So, fortunately, I exercise most of the time in the morning. But this tickly cough thing, which is a post-viral thing. It's very common with all kinds of viruses, it can persist for a long time. That's as bad as mine gets. But some people have got this extreme fatigue and some people still have joint ache and body ache. And so I think it's really important just to go easy. And regardless of what your health philosophy is, or what your views are on how this infection is playing out, I think it's really important to just kind of manage the expectations of your patient, because they may be keen to get into it sooner than what they should be. But you've got to be sensible in the way in which you're prescribing movement to these people, for sure.

Ben: Yeah, definitely.

Damian: Ben, there's a great space these days, NDIS. And I know a lot of people work in that space, you and I have got patients that we share in that space. And the reason why I wanted to just quickly talk about this is because not all practitioners have access to NDIS. And it's a fascinating little space, that's been set up by the government, and I think it's really great and the patients who can access NDIS, and then access practitioners within NDIS tend to be very, very happy and very, very satisfied. In that space, do you find that there's a willingness to participate? Or do you feel that sometimes people, like in other spaces, you feel that sometimes people will just expect you to do all of the work, and they're not going to do the work?

I don't want to say here that there's a group or a subset of people that don't want to work, but I'm always interested to find out whether or not something's working. So, I'd love to know whether or not you've got some ideas around how NDIS could work better, or whether or not you think it's working really well, as it is?

Ben: Yeah, the NDIS is massive. It’s probably doubled our businesses since we came in.

Damian: Yeah.

Ben: And it's just absolutely fantastic for people who are under the NDIS to have that level of support and the questions available to them to help manage their conditions. So it's a great thing that's come in for people who are under it to access, health professionals that they need and to give them the support that they need. 

Looking at our clinics, we see, as with all our clients, there are quite a diverse range of people under the NDIS, from mental health to Down syndrome to autism, and within that there's different scopes and different levels, as well. Each perform their own challenges, some highly motivated and come in and they get really good results. And then you're notified with other clients, if they're really struggling with mental health or schizophrenia, or they have some other comorbidities that really affects their motivational levels, that can be difficult to try and work with them to improve.

But I think the underlying aspect is they've got that support, and they've got that available to them to hopefully, improve their long-term picture. And it's a lot more than they used to have, which is great. I suppose, overall, from the overall picture of the NDIS, I think it's just fantastic.

Damian: It's so good. I'm wrapped that you said that Ben, because there'll be people listening to this podcast that will have people with mental health challenges, who may not have exhausted all of their opportunities, all of the support that's available to them. And again, this goes back to a multi-modal approach to their care. 

So let's say, for example, a nutritionist or a naturopath has a patient under care who's certainly suffering with mental health issues, they may not have actually spoken with their GP, necessarily about that for fear of a prescription they may not want to go on to, or for another reason, maybe there's some embarrassment or whatever else, or maybe their main trust goes with another practitioner.

But the encouragement of the practitioner for the patient to speak to their GP, their primary health care provider to enrol them in accessing NDIS and other types of support, I think, is really important and it takes for some people the financial burden or lessens the financial burden for a lot of people to access this kind of care. 

So, if you're there listening to this, and you're thinking about Mrs. Blogs and you're thinking, "Oh, my gosh, maybe I should or could recommend that she goes back to a GP to have some question time and some consultation about how they can get support,” feel safe in knowing that it's a really great place to go. And of course, that's what you're looking at there, Ben.

Ben, with the mental health issue. There's challenges there, right? You know, there's a lot of mental health, the last couple of years has presented a lot of mental health challenge for a lot of people, whether it be anxiety or depression to even just feeling full-on, lacking motivation. What's the approach with exercise? There used to be a commentary, and I used to say this a lot in my presentations, is that if you walked for 30 minutes a day, it would decrease the impact of cortisol in your system by about 50%. What's the discussion these days around exercise and movement and mental health?

Ben: Well, firstly it's about enjoyment and trying to work with them about what they enjoy doing and trying to work around and improve that area. The more I do this as well, sometimes all of our consultations might not be even regarding exercise, especially people with chronic pain, and looking at the biopsychosocial approach to helping with chronic pain.

There's breathing techniques, there's addressing sleep quality, there’s stress management. For example, the other day, I had a lady in the clinic who was going through some chronic pain flare-ups, and she came in and her homework for the week that I gave her was just to go and put on a really nice podcast that she wants to listen to, maybe even this one. And just to go for a 20-minute walk, listen to a podcast, just to try and change her mind a little bit, have her think about something else in the day as opposed to what she was currently doing.

So, exercise prescription can work in that way as well. It might be go and talk to a friend and try and meet up every Sunday for a 20-minute walk so you get that socialisation to it. On the flip side, that also makes that person have to call that friend if they're going to cancel. So it sort of helps them to keep compliant with their exercise program.

And realistically, what I tell them is if you can try to commit to, say, two to three weeks of this stuff where you're putting in simple strategies around things that you enjoy with people you like, with music or podcasts you like to listen to, maybe go to an awesome cafe that you'd love to go to where they've got the best coffee, and you can just try and plan in your week to walk to. After two or three weeks, hopefully, they start to feel the benefits of that exercise, or the increased movement through endorphin relief and decrease in cortisol, and their mental health, maybe hopefully improving, and that starts to then get that habit and that compliance going. And then they start to realise, the benefits of it all.

Sometimes less is more and you just need to start really small and, and try and keep it really realistic for them. And then after they sort of get the hook and they start to enjoy it, that's where you can start to get a bit more exciting and build it up. But everyone's different. There's always different approaches. Never underestimate the power of just listening and talking with your clients. It doesn't always have to be coming in the clinic and working really hard. Sometimes it might be just a sit-down chat and a bit of a brainstorm and a bit of an action plan session where they just need to feel a bit more control of what they're doing and see what they want to get out of it.

Damian: That's so good, Ben. So good. There's been so many pearls today. And I think for a lot of people listening to this you will have got the EP can fit into your healthcare plans or your management plans. You can see that the individualised approach is so important, that measurement’s absolutely crucial. That the application of EP and any therapy in combination with other types of practitioners and other types of treatment in care plans is so important for the practitioners' and patients' journey. Ben, thanks so much for joining us today.

Ben: No worries. Thanks for having me. And any chance I get to talk about exercise physiology and increase that awareness around what we do and how we do it, I think it's invaluable for everyone and all clinicians. So thank you very much for having me.

Damian: Now to get more information on Ben head to pacehm.com.au, and on Exercise Physiology and go to exerciseismedicine.com.au

Thanks, everyone, for listening today. Don't forget that you can find all of the show notes from today and all the other podcasts that we've done, transcripts, and all other resources on the FX Medicine website. I'm Dr. Damian Kristof and thanks for joining us.

About Ben Southam

Ben is an accredited exercise physiologist and Director at Pace Health Management in Victoria. Drawn to exercise physiology by his love of the human body at school, Ben attended Deakin University and completed his Undergraduate in Exercise Science followed by a Masters of exercise physiology. Ben enjoys the diversity of conditions he gets to work with on a daily basis, supporting his team in their professional endeavours and the amazing people he gets to meet.  In his spare time you will find Ben keeping active running the paths of Bayside, playing a round of golf and enjoying babychino's with his daughter.  

PACE Health Management is located throughout south east victoria with 28 exercise physiologists, 3 dietitians and occupational therapy.


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