Episode 3
Reframing the Perioperative Period: Movement as Standard Surgical Care
What if we stopped viewing surgery as something that passively happens to patients, and instead treated it as an event they can actively train for? In this episode, Dr. Hussain Al-Zubaidi sits down with Professor Scarlett McNally, an orthopedic surgeon and national clinical leader, to explore the profound power of movement in the perioperative period. Scarlett breaks down the compelling data behind "fitter in, faster out," explaining how prehabilitation can slash surgical complications by up to 50% and turn lengthy hospital stays into day-case recoveries.
Scarlett also opens up about her extraordinary personal health battle with myeloma and heart failure, sharing how she used an electric bike to build the physical resilience needed to survive a life-saving stem cell transplant. From navigating "teachable moments" on the waiting list to the necessity of human-driven "surgery schools," this conversation is a masterclass in why movement must become standard surgical care rather than the exception.
Key Takeaways:
- Why moving a patient from zero activity to just 30 minutes a week triggers the steepest drop in surgical risk.
- How building strength beforehand provides a vital protein and antibody store for post-op wound healing.
- Why every member of the healthcare team needs to give patients "permission to move."
Resources Mentioned:
- Centre for Perioperative Care (CPOC): cpoc.org.uk
- Moving Medicine (Consultation Guides): movingmedicine.ac.uk
- British Society of Lifestyle Medicine: bslm.org.uk
Produced with support from the British Society of Lifestyle Medicine.
Find us at https://themovementprescription.co.uk/ and join the conversation!
Transcript
Hussain: Welcome to the Movement Prescription Podcast from the British Society of Lifestyle
Speaker:Hussain: Medicine, the show where we explore how physical activity can be used as a powerful,
Speaker:Hussain: practical tool in everyday healthcare.
Speaker:Hussain: I'm your host, Dr. St. Alzebedi, and in this episode, we focus on a path of
Speaker:Hussain: healthcare where we don't always talk about movement enough,
Speaker:Hussain: the perioperative period.
Speaker:Hussain: Surgery is often seen as something that happens to patients,
Speaker:Hussain: but what if we've reframed it as something patients can actively prepare for,
Speaker:Hussain: and recover from, with physical activity as a core part of treatment, not an afterthought?
Speaker:Hussain: I am delighted to be joined by my friend, Professor Scarlett McNally,
Speaker:Hussain: orthopedic surgeon, national clinical leader, and a long-standing advocate for
Speaker:Hussain: making physical activity routine across healthcare systems.
Speaker:Hussain: Scarlett has been instrumental in championing prehabilitation,
Speaker:Hussain: early mobilization, and the idea that movement is not simply safe around surgery.
Speaker:Hussain: It's often one of the most effective interventions we have.
Speaker:Hussain: In this episode, we explore the evidence behind preoperative activity,
Speaker:Hussain: how much movement really makes a difference,
Speaker:Hussain: practical behavior change strategies, and what needs to shift at a system level
Speaker:Hussain: so that movement as medicine becomes standard surgical care rather than the exception.
Speaker:Hussain: If you work in primary care, surgery, rehabilitation, or community health,
Speaker:Hussain: or from the physical activity sector, this one's for you.
Speaker:Hussain: Hello, Scarlett. Great to have you on the Movement Prescription Podcast. How are you?
Speaker:Scarlett: Very well, thank you. Yes.
Speaker:Hussain: Really appreciate you giving up the time. And we had such a myriad of speakers
Speaker:Hussain: and professionals come onto this podcast from different realms.
Speaker:Hussain: But I was really excited to get you on because every time I see you talk and
Speaker:Hussain: I see you present, there's always so much energy and everyone that knows you
Speaker:Hussain: just loves the passion that you have.
Speaker:Hussain: So I'd love to find out where has this passion come from? Why does physical
Speaker:Hussain: activity mean this to you?
Speaker:Scarlett: Well, so I'm a surgeon, and I've been a doctor for 35 years.
Speaker:Scarlett: And I was on the Council of the Royal College of Surgeons of England representing
Speaker:Scarlett: that college at the Academy of Medical Royal Colleges about health inequalities.
Speaker:Scarlett: And at the time, this is like 2014, we realized that there are huge differences
Speaker:Scarlett: in health across different types of populations.
Speaker:Scarlett: So we were collecting numbers, but there wasn't anything obvious to do about it.
Speaker:Scarlett: And at the time, people knew about smoking and nutrition and so forth,
Speaker:Scarlett: but there wasn't much about exercise.
Speaker:Scarlett: So anyway, what we did was collated all the evidence about if you do some exercise,
Speaker:Scarlett: does it reduce your risk of certain conditions.
Speaker:Scarlett: And basically, yes, it does. And there's 200 references in the report that I
Speaker:Scarlett: ended up leading that show that if you do exercise, it reduces your risk of,
Speaker:Scarlett: dementia 30%, diabetes 40%, depression 30%.
Speaker:Scarlett: And does it treat those conditions? Yes, it does.
Speaker:Scarlett: And you're less likely to break your hip. It's all that stuff.
Speaker:Scarlett: So Exercise the Miracle Cure, Zana, came out in 2015.
Speaker:Scarlett: And it was dumbing down that information, as it were, so that people can read it.
Speaker:Scarlett: And it wasn't anything that other people hadn't been saying,
Speaker:Scarlett: but it just felt so important to get that out there as a way of improving people's health.
Speaker:Scarlett: And it's just rocketed from there.
Speaker:Hussain: And from your experience as a surgeon, is sort of increasing your physical activity,
Speaker:Hussain: improving your fitness.
Speaker:Hussain: Is that something that most patients want to either get as an outcome post-operation
Speaker:Hussain: or as something to prepare themselves for the operation? What's kind of been
Speaker:Hussain: your insights from the patients that you've managed?
Speaker:Scarlett: So most patients don't know about this.
Speaker:Scarlett: And the public and a lot of NHS staff still think about rest as being the way forward.
Speaker:Scarlett: And particularly, I'm an orthopedic surgeon, people particularly think,
Speaker:Scarlett: oh, I shouldn't be doing something because I'll make it worse.
Speaker:Scarlett: Or I've got a condition caused by wear and tear, I shouldn't be doing anything
Speaker:Scarlett: that, you know, makes it worse.
Speaker:Scarlett: Whereas actually, We don't know what causes pain and there are now new resources
Speaker:Scarlett: showing what people can do when they have,
Speaker:Scarlett: an orthopaedic problem to keep them active. It just changes what you do.
Speaker:Scarlett: It shouldn't change the fact that you should do something.
Speaker:Hussain: And when people talk about the perioperative period, what does that actually
Speaker:Hussain: include? Like what are the timeframes that we're talking about?
Speaker:Scarlett: So the perioperative phase is everything from the moment an operation is contemplated,
Speaker:Scarlett: until full recovery at home, not just in the recovery ward.
Speaker:Scarlett: And that would include people who are considering an operation but then don't have it.
Speaker:Scarlett: So because some people get better or change their mind or other things intervene
Speaker:Scarlett: and actually exercise does reduce people's need for knee replacement for example um,
Speaker:Scarlett: but basically it's the entire phase so it's preparation for surgery the operation,
Speaker:Scarlett: phase itself and the recovery and then the rehabilitation and getting better
Speaker:Scarlett: afterwards so it's it's all of it.
Speaker:Hussain: Yeah and In lifestyle medicine, we often talk about inspirational moments,
Speaker:Hussain: you know, key moments where there can sometimes be weakening in the walls to
Speaker:Hussain: allow behavior change to be maybe a bit more likely to achieve,
Speaker:Hussain: whether it's a new diagnosis or a change in circumstances.
Speaker:Hussain: Would you say the perioperative period is that potential moment or would you
Speaker:Hussain: say it's challenging time to instigate lifestyle changes?
Speaker:Scarlett: I think absolutely is, we call it a teachable moment.
Speaker:Scarlett: So for a number of people you carry on living your life and you don't change something unless,
Speaker:Scarlett: you have to you know you adjust when the kids move to secondary school or something,
Speaker:Scarlett: but you don't otherwise make big changes in your life and this is for many people
Speaker:Scarlett: getting a diagnosis um or,
Speaker:Scarlett: about to have an operation is a big wake-up call um because otherwise it's lives
Speaker:Scarlett: are so busy and it's very difficult to change.
Speaker:Hussain: Fair enough and let's say we do have someone that wants to or is motivated to
Speaker:Hussain: make those change what would you say are the biggest modifiable factors influencing
Speaker:Hussain: surgical outcomes today.
Speaker:Scarlett: So, actually, there are seven. So, there is a website, cpoc.org.uk,
Speaker:Scarlett: Centre for Periocative Care, cpoc.org.uk.
Speaker:Scarlett: And I was deputy director there for six years, I've just finished.
Speaker:Scarlett: And it's hosted at the Royal College of Anesthetists. And we have seven pages
Speaker:Scarlett: on the things people can do if they're preparing for an operation.
Speaker:Scarlett: Um so stopping smoking is the big one it halves the risk complications um exercise um,
Speaker:Scarlett: reduces complications around 50 percent um nutrition's around 40 percent there's not so many uh,
Speaker:Scarlett: studies on that um and then practical preparation not just for the operation
Speaker:Scarlett: but for the time afterwards so that you feel empowered you're ready and you're
Speaker:Scarlett: far more likely to be a day case if you if you do all of this.
Speaker:Scarlett: And then psychological preparation, so that you're getting some sleep,
Speaker:Scarlett: you're ready for it, you feel empowered.
Speaker:Scarlett: All of these things matter and do make a difference. The evidence hasn't been
Speaker:Scarlett: collected, I'm going to say.
Speaker:Scarlett: And then getting the kind of the medical things sorted,
Speaker:Scarlett: which doesn't have to necessarily be the doctor doing that,
Speaker:Scarlett: but about a quarter of people who come to preoperative assessment can't go straight
Speaker:Scarlett: forward because they have a medical problem, such as anemia,
Speaker:Scarlett: diabetes, hypertension, and so forth.
Speaker:Scarlett: And about a quarter of the cancellations on the day are because of a medical condition.
Speaker:Scarlett: So all of that better management and actually exercise is a huge influence on
Speaker:Scarlett: that better management.
Speaker:Hussain: And how strong would you say these interventions are if we compared them to,
Speaker:Hussain: you know, whether they'll be medical or further other investigations that you
Speaker:Hussain: may want to do during that period? Like, are they comparable in terms of the benefits?
Speaker:Scarlett: So I'm a surgeon and I'm going to say this is better than the medical stuff,
Speaker:Scarlett: because this this makes a difference to everybody,
Speaker:Scarlett: because particularly with the
Speaker:Scarlett: exercise it isn't just being a bit fitter to get through the anesthetic,
Speaker:Scarlett: it also um you get the endorphins so you you're used you can manage pain it
Speaker:Scarlett: helps in pain management you feel very you feel empowered you feel you'll have things under control,
Speaker:Scarlett: and then the very practical thing of your legs are strong so you can get to
Speaker:Scarlett: the toilet by yourself so you're not waiting for someone to come and help you the bedpan or.
Speaker:Scarlett: You know, you can be in control much more and you're more likely at your surgery
Speaker:Scarlett: on a day case basis, if the pathway allows that.
Speaker:Scarlett: So actually, it does really make a difference.
Speaker:Scarlett: And we got the evidence now of why.
Speaker:Scarlett: And similarly, you've built up muscle and muscle's a store of protein,
Speaker:Scarlett: which helps for wound healing, it helps for antibodies.
Speaker:Scarlett: So basically, it's a win-win because people are four times more likely to have
Speaker:Scarlett: a complication if they're physically inactive and over four times more likely
Speaker:Scarlett: if they're frail, which is not having enough muscle mass.
Speaker:Scarlett: These are very important interventions and they work at tiny doses.
Speaker:Scarlett: Whereas, as I said, a quarter of people, a quarter of elective patients are
Speaker:Scarlett: cancelled, of the ones cancelled on the day, a quarter is because of medical,
Speaker:Scarlett: issues that many that people knew about but just haven't been quite optimized.
Speaker:Scarlett: And, you know, I haven't really seen HbA1Cs come down quickly for diabetes.
Speaker:Scarlett: All of these things that we try, I'm not going to say, my experience,
Speaker:Scarlett: they're not nearly as effective as exercise and nutrition and,
Speaker:Scarlett: as I say, stopping smoking.
Speaker:Hussain: In terms of realistically supporting our patients that maybe are very sedentary,
Speaker:Hussain: let's say doing less than 30 minutes a week,
Speaker:Hussain: is there a worthwhile minimum dose of increased activity that's still going
Speaker:Hussain: to make a tangible difference before a surgery?
Speaker:Hussain: If I'm in an appointment with a patient, can I realistically say just even doing
Speaker:Hussain: 10 or 15 minutes more per week will make a difference or is there some other
Speaker:Hussain: figure that I should be looking for?
Speaker:Scarlett: Um yes just doing something just getting up and shaking it all about walking around the block,
Speaker:Scarlett: getting up and moving breaking up sedentary time all of that makes a difference
Speaker:Scarlett: and in fact the biggest difference is when people move from nothing at all as
Speaker:Scarlett: in less than 30 minutes per week to 30,
Speaker:Scarlett: minutes in a week that that actually is the biggest reduction in risk um,
Speaker:Scarlett: so there's nothing i'm gonna say
Speaker:Scarlett: nothing to lose just people it's just do something and then do a bit more.
Speaker:Hussain: And that will mean something in terms of reducing that risk before the.
Speaker:Scarlett: Surgery okay.
Speaker:Hussain: And how about you how do you fit in time to exercise given you know you've got
Speaker:Hussain: more roles than i care to even remember when i was doing a bit of research before
Speaker:Hussain: this podcast how do you fit it in.
Speaker:Scarlett: So i cycle to work And in fact, I've just done a clinic,
Speaker:Scarlett: and I've cycled back across Eastbourne. It took longer than I planned because
Speaker:Scarlett: it was raining. So I put my waterproof trousers on and I had to get my hood out of the thing and,
Speaker:Scarlett: it's great past all the traffic get going but and actually that that works for
Speaker:Scarlett: me because everyone should be aiming at,
Speaker:Scarlett: a minimum of 150 minutes per week because it's about 22 minutes a day so yeah
Speaker:Scarlett: cycle to work cycle home that would be enough but actually,
Speaker:Scarlett: i i go out on an electric mountain bike when i can and i've got a house with
Speaker:Scarlett: lots of stairs and i sometimes deliberately go up and to up and down a few times
Speaker:Scarlett: because partly because i'm a bit forgetful but it just I know it's good for me.
Speaker:Hussain: Yeah, yeah, yeah. Definitely. Because when I'm on the phone to my dad,
Speaker:Hussain: it's often quite long. So I just
Speaker:Hussain: sort of generally wander around the house going up and down the stairs.
Speaker:Hussain: I do mainly the listening in that conversation. And yeah, just finding moments
Speaker:Hussain: like that, even the stairs, think of it as an exercise device in your house.
Speaker:Hussain: I like that. I like that. Okay. Now, in reality, many patients can be quite anxious,
Speaker:Hussain: in pain or they feel that they should rest, you know, as you mentioned before,
Speaker:Hussain: rest is best, you know, before surgery, like any tips on how we can reframe that?
Speaker:Scarlett: It's so difficult because what we really need to do is get into the mainstream
Speaker:Scarlett: media or soap operas or something.
Speaker:Scarlett: But it's to change the expectation and the mentality. It's getting people's
Speaker:Scarlett: family members to come into the clinic or the consultation as well so that they're
Speaker:Scarlett: committed to whatever happens.
Speaker:Scarlett: But sometimes some very simple messages do work.
Speaker:Scarlett: I've just submitted my latest BMJ article. I write in the British Medical Journal every couple of weeks.
Speaker:Scarlett: On the new cancer plan, saying what we also need to do is get the exercise in,
Speaker:Scarlett: alongside because it really helps people's preparation for cancer treatment and recovery.
Speaker:Hussain: Oh, 100%. I'm actually putting together an article and like a video teach on that very topic.
Speaker:Hussain: And I actually was blown away by the impacts that it has in terms of cancer survivorship.
Speaker:Hussain: Because you obviously know about the improvements in terms of prevention and
Speaker:Hussain: reducing the potential risk of having cancer.
Speaker:Hussain: But I didn't know just how impactful movement can be even during the diagnosis
Speaker:Hussain: or if you've been doing it before, once you've got the diagnosis in terms of
Speaker:Hussain: the outcomes, which I thought was brilliant.
Speaker:Hussain: Now, one thing that I often get from patients is they can be worried that if
Speaker:Hussain: they start being physically active before the surgery,
Speaker:Hussain: that a lot of the benefits that they gain will be lost because they're going
Speaker:Hussain: to be off their feet for one reason or another.
Speaker:Hussain: Let's say they're having um a certain procedure which means they they're less
Speaker:Hussain: mobile what would your what would your advice be to a patient like that who's
Speaker:Hussain: worried that you know what's the point of putting in the work now because i'm
Speaker:Hussain: just going to lose it in a few weeks.
Speaker:Scarlett: Um, but just put in the work because it is so worth it.
Speaker:Scarlett: And you have that store of muscle, your body kind of learns how to get into
Speaker:Scarlett: the habit so that then you can count the days until you're allowed to do stuff
Speaker:Scarlett: again and then get going again.
Speaker:Scarlett: And that will benefit your future life. Um, um, yeah, I mean,
Speaker:Scarlett: as an aside, I know what they mean. Um, I, uh.
Speaker:Scarlett: I had a couple of procedures last year i had a cardiac ablation um,
Speaker:Scarlett: and for that you can't move because it's a little nick in the in a vein in the
Speaker:Scarlett: groin and you're not allowed to move and i had the big plummeting,
Speaker:Scarlett: endorphin loss of endorphins of not being able to do anything so i i had to
Speaker:Scarlett: do lots of writing and reading i found it very frustrating,
Speaker:Scarlett: but equally i had a hip replacement last year and um I knew I could get fit beforehand um,
Speaker:Scarlett: and I got fit I went out on my electric bike every day um because I couldn't my hip hurt,
Speaker:Scarlett: um but it could go up and down I'd wake up at night because it was so painful
Speaker:Scarlett: because I twisted and it would be painful when I twisted and I couldn't get off the bike once I'd,
Speaker:Scarlett: got to finish my ride i had to do a very funny maneuver where i had to hop a
Speaker:Scarlett: bit and lean the bike on one side but i could cycle and i was trying i was aiming for for um,
Speaker:Scarlett: yeah i cycled every day and i was um a day case for my last hip replacement
Speaker:Scarlett: um because i could hop to the toilet on the other leg um.
Speaker:Scarlett: Uh afterwards and amazing and get going because i'm just only 1.5 of people
Speaker:Scarlett: are day case for hip replacement but the critical thing is that if we if we
Speaker:Scarlett: aim that some people will be,
Speaker:Scarlett: then you reduce the length of stay from three days to two or from two days to one do you see,
Speaker:Scarlett: what you say it has we need to use that in.
Speaker:Hussain: Terms of reducing risk of infections in the hospital or you know dvts sitting around in bed.
Speaker:Scarlett: Absolutely but but we need to it isn't the problem is it isn't like the olympics
Speaker:Scarlett: where you watch it and you think oh wow that jessica in his heels amazing saying
Speaker:Scarlett: gosh i'm just going to sit here on the sofa and eat my chips and watch her,
Speaker:Scarlett: it's kind of it's what can people actually do to start that will make a bit
Speaker:Scarlett: of a difference and everything makes a bit of a difference even if it's as you
Speaker:Scarlett: say reducing an infection a bit or um,
Speaker:Scarlett: getting out of hospital a day sooner not necessarily a day so um definitely
Speaker:Scarlett: definitely needs that message needs to get out there i don't really know how.
Speaker:Hussain: I loved your idea of of bringing it into storylines and soaps because I was
Speaker:Hussain: just realizing that actually like making in kind of a background storyline or
Speaker:Hussain: normalizing it that's real change there and I don't think anyone's ever thought of trying to,
Speaker:Hussain: engage in that that's something I'm going to take away and see if I can get
Speaker:Hussain: in touch with with a few just to bring in those kind of normalized you know
Speaker:Hussain: habits and behaviors that we want to showcase brilliant idea,
Speaker:Hussain: Now, in terms of making movement in the perioperative period kind of a norm
Speaker:Hussain: rather than the exception,
Speaker:Hussain: who are the key players here? Do you think everyone should be involved from
Speaker:Hussain: the GP making the referral to the people doing the pre-op assessment?
Speaker:Hussain: Is it everyone or is there a key few individuals that you think we should target
Speaker:Hussain: some more training and awareness for?
Speaker:Scarlett: I think everyone should be involved, including the receptionists,
Speaker:Scarlett: the healthcare assistants, the normalizing it,
Speaker:Scarlett: everyone involved. Having said that,
Speaker:Scarlett: The really trusted sources do make the biggest impact.
Speaker:Scarlett: So when I was ill, my GP saying, you've got to go for a walk every day.
Speaker:Scarlett: I remembered him saying that and thinking, oh, that applies to me.
Speaker:Scarlett: Okay. You know, so that message.
Speaker:Scarlett: And the difficult bit for me is that if we wait for the physio to teach people
Speaker:Scarlett: things, then the physio might not be on duty that day, or you haven't got the
Speaker:Scarlett: business case to get a physio.
Speaker:Scarlett: We need everybody to say, no, just do it.
Speaker:Scarlett: And then do a bit more, find something, get up.
Speaker:Hussain: Yeah, we can often rely on that. It's like, oh, they're going to see the physio,
Speaker:Hussain: they're going to talk about that.
Speaker:Hussain: And it puts a lot of pressure all on those appointments. And if we at least
Speaker:Hussain: start sowing seeds and start building up this narrative, it will be an easier
Speaker:Hussain: task, even when it comes to the physio, if they've had people that have been
Speaker:Hussain: telling the patient the importance of movement. Yes, so I see what I mean. Okay.
Speaker:Scarlett: Sorry, the other thing is, it isn't just physios. It should be exercise,
Speaker:Scarlett: practitioners rather than you know the health physio yeah um but there are different
Speaker:Scarlett: levels of of training that everyone needs to do a little bit everyone should be have permission,
Speaker:Scarlett: to do that little bit and then bring in the specialist team when required yeah.
Speaker:Hussain: And do many nhs teams have access to you know the exercise professionals and
Speaker:Hussain: exercise physiologists kind of thing.
Speaker:Scarlett: So there's quite a few pockets of excellence where they have prehabilitation
Speaker:Scarlett: services and they have very good results.
Speaker:Scarlett: So it's an exercise, it's nutrition, it's talking about such things.
Speaker:Scarlett: But the problem for me is all those people left behind in the places that don't have it.
Speaker:Scarlett: And, you know, some you can kind of get in with sort of a surgery school concept,
Speaker:Scarlett: where, because then you get a bit of peer-to-peer support and discussion.
Speaker:Scarlett: You and I have talked before about group clinics, that people do get something
Speaker:Scarlett: from knowing someone else is going through something.
Speaker:Scarlett: And I worry about the NHS app,
Speaker:Scarlett: being considered the best way forward, for example, because you do need some human in there as well.
Speaker:Scarlett: And particularly a human that you know understands your medical problems and
Speaker:Scarlett: that you don't feel you're being fobbed off or have something made worse.
Speaker:Hussain: Definitely and for a lot of people like the concern around the impact on their
Speaker:Hussain: health and the complex array of long-term conditions that they may be suffering from
Speaker:Hussain: it really does provide a number of barriers i noticed just just so far you've
Speaker:Hussain: mentioned a few health challenges that you've had and clearly the knowledge
Speaker:Hussain: that you've had has allowed you to,
Speaker:Hussain: overcome many of those barriers but has has health been a stumbling block for
Speaker:Hussain: you in terms of navigating physical activity and wider lifestyle.
Speaker:Scarlett: Well, yeah, actually, and I think that's one reason I go and give talks as often
Speaker:Scarlett: as I can, and I write whenever I can. I'm half time in the NHS now as a surgeon.
Speaker:Scarlett: Because I was catastrophically ill end of 2018, I've got myeloma,
Speaker:Scarlett: cancer of the plasma cells, and cardiac amyloidosis.
Speaker:Scarlett: So those abnormal plasma cells that are supposed to make antibodies or immunoglobulins,
Speaker:Scarlett: the abnormal protein has gone around my heart.
Speaker:Scarlett: And so I had a restricted cardiomyopathy. My heart wasn't you know pumping well,
Speaker:Scarlett: so uh so basically i had heart failure and um cancer at the same time which um is very unfair um and,
Speaker:Scarlett: uh and i had chemo for a bit um because that's the treatment i have fantastic
Speaker:Scarlett: care and all that stuff but the chemo wasn't in my head working i was still
Speaker:Scarlett: i i get short of breath walking up a few stairs i couldn't um you know walk
Speaker:Scarlett: down to the end of the road without stopping to breathe um
Speaker:Scarlett: i could feel my liver you know all that stuff um,
Speaker:Scarlett: and i knew i wanted a stem cell transplant because that can put myeloma into
Speaker:Scarlett: remission but i was told i wasn't fit enough because my heart was so bad,
Speaker:Scarlett: um and then i found out about electric bikes because i thought what can i do
Speaker:Scarlett: should i go to a swimming pool you know i was then driving to eastbourne seafront.
Speaker:Scarlett: And using my blue badge and then walking because it's flat along and back um
Speaker:Scarlett: and that was i felt all i could do but i got an electric bike and sure i was
Speaker:Scarlett: still having chemo getting me a bit better and a bit better but i went on my
Speaker:Scarlett: electric bike every day rain shine hail,
Speaker:Scarlett: everything i just went out as if it was my medicine i went out um,
Speaker:Scarlett: aiming for 45 minutes a day and i got fit enough um so i made them do a bruise
Speaker:Scarlett: protocol to see how fit i was the cardiomyomunary exercise where you go on a
Speaker:Scarlett: treadmill at different angles,
Speaker:Scarlett: um and I made them do that and uh and I have the fitness level then of a woman
Speaker:Scarlett: in her 20s which doesn't say much for the UK population but I was,
Speaker:Scarlett: you know I was then I then had the harvest February 2020,
Speaker:Scarlett: and I'd gone back to work by then because the chemo you know worked and I had
Speaker:Scarlett: lots of you know diuretics and things,
Speaker:Scarlett: anyway um then there was a pandemic and i was shielding um but then i went the
Speaker:Scarlett: second batch in after the first after the lockdown listed lifted in,
Speaker:Scarlett: autumn of 2020 and i had a stem cell transplant.
Speaker:Scarlett: And and actually you know the exercise i kept obviously the exercise over the
Speaker:Scarlett: summer but it was so good when you're losing loads of weight with the,
Speaker:Scarlett: big chemo and everything i had some muscle ready to use um and uh and,
Speaker:Scarlett: yeah it worked and I'm so I feel like if I hadn't found an electric bike I'd
Speaker:Scarlett: have been really I might have been dead um,
Speaker:Scarlett: and that's quite a wake-up call.
Speaker:Hussain: Yeah no absolutely do you know like myeloma at your age as well like is is really rare and so,
Speaker:Hussain: in so many levels you must have felt must have been gutting to have that experience but to hear,
Speaker:Hussain: how you use that to you know still find a way to you know bring movement into
Speaker:Hussain: your life and use it to improve your chances during,
Speaker:Hussain: the procedure as well as your mental health in that time just incredible absolutely incredible.
Speaker:Scarlett: There's something that sometimes suddenly gets people where you think,
Speaker:Scarlett: i can do this this is what i'm going to do and you see people whose lives have
Speaker:Scarlett: been transformed when they've had to go through something their kids horribly
Speaker:Scarlett: ill or they're you know they've,
Speaker:Scarlett: you could see something that just kicks in and i had a kid doing gcse's and
Speaker:Scarlett: a kid doing a levels and i just thought i can't,
Speaker:Scarlett: this is not my time but i think people have different needs and wants at different
Speaker:Scarlett: phases of life um and you know we need to be slightly careful with some of the,
Speaker:Scarlett: um some of treatments around um in in
Speaker:Scarlett: very old people that have a different view on what they want out of their lives
Speaker:Scarlett: in terms of the treatments but yeah exercise for everybody yeah you know absolutely
Speaker:Scarlett: should be the first prescription.
Speaker:Hussain: Well thank you so much i had no idea of that background and i've known you a
Speaker:Hussain: few years. I already thought you were incredible.
Speaker:Hussain: I don't know how to describe you now, if I'm being honest.
Speaker:Hussain: But let's move on because one of the things that I often get from my colleagues
Speaker:Hussain: in primary care is we've got a patient, they've been discharged, they're now at home.
Speaker:Hussain: And if we're going to be talking about physical activity post-operation and
Speaker:Hussain: the patient asks, when can I do X, Y, Z,
Speaker:Hussain: we don't have any training to kind of know, let's say, post-hip operation or
Speaker:Hussain: knee, like when is the right time to talk about these things.
Speaker:Hussain: And yes, we've got physios that sometimes the patients will engage with, sometimes not so much.
Speaker:Hussain: But how can we get it right? Because we're often worried that we're going to
Speaker:Hussain: get it wrong and cause more harm, and then we'll get an angry letter from the
Speaker:Hussain: surgeon saying we messed it all up.
Speaker:Scarlett: Well, I'm sorry, surgeons are still sending angry letters.
Speaker:Scarlett: So basically, the whole surgery is great nowadays. The technical bit's got better and better.
Speaker:Scarlett: And the aim is that people are, it's stable and safe afterwards.
Speaker:Scarlett: So we get people up and we get people going.
Speaker:Scarlett: There's a few people you have to hold back, like, you know, don't go running
Speaker:Scarlett: on this now kind of thing.
Speaker:Scarlett: But in general at six weeks you can do anything in general,
Speaker:Scarlett: but building up so that people break up their sedentary time they move all their
Speaker:Scarlett: joints particularly trying to walk around a bit um
Speaker:Scarlett: and actually arm weights you know getting all of that it depends what you know
Speaker:Scarlett: what operations you've had but,
Speaker:Scarlett: you know arm weights and walking everyone,
Speaker:Scarlett: should be doing really.
Speaker:Hussain: Okay yeah got you And in terms of kind of the pain management side,
Speaker:Hussain: if people are in still a bit of discomfort and it's potentially inhibiting them
Speaker:Hussain: from moving, like, should we be relatively,
Speaker:Hussain: I don't know whether liberal is the right word, but should we be focusing on
Speaker:Hussain: trying to get that pain sorted to get them moving?
Speaker:Hussain: Or should we be careful about giving analgesia for too long post a procedure?
Speaker:Hussain: I know this is maybe a complicated question, but what are your thoughts?
Speaker:Scarlett: So there's a whole different, we could have a whole different podcast on that.
Speaker:Scarlett: And actually the CPOC website, cpoc.org.uk has got things and we've worked with
Speaker:Scarlett: people on opioid prescribing and so forth.
Speaker:Scarlett: What I feel is in the past, we used to say, well, get on top of your pain and
Speaker:Scarlett: then you can do stuff. And now I think we need to be more honest with patient
Speaker:Scarlett: about you've had an operation.
Speaker:Scarlett: It is going to hurt. You've got to get moving with it. It's not going to hurt more.
Speaker:Scarlett: And I remember with, you know, once all the blockers were worn off after my
Speaker:Scarlett: hip replacement, it was painful. But it was like, wow, that's so much better
Speaker:Scarlett: than the arthritic pain, you know. And I didn't want to take the opiates and
Speaker:Scarlett: get constipated or whatever.
Speaker:Hussain: But actually kind of pain-free may never come and may not even be achievable,
Speaker:Hussain: and there may be side effects involved in that process so okay so it's kind
Speaker:Hussain: of balancing that manageable pain,
Speaker:Hussain: uh you know okay now would you say that within surgical pathways at the moment,
Speaker:Hussain: do we have physical activity pretty well embedded or is there still a journey to go on.
Speaker:Scarlett: No, there's a huge journey to go. And as I say, the Centre for Pediatric Care
Speaker:Scarlett: has been going for six years, hosted at Royal College of Anaesthetists,
Speaker:Scarlett: and many people still don't know about it.
Speaker:Scarlett: And there are many resources there for patients and for staff,
Speaker:Scarlett: including, as I say, reception staff, leaflets for patients about what to do.
Speaker:Scarlett: We've got a video there of Joe Wicks doing some exercises with a patient.
Speaker:Scarlett: So i think people need the practicalities i think part of the problem with the,
Speaker:Scarlett: in general the kind of people who are in charge are the people who don't some
Speaker:Scarlett: thinking and writing and,
Speaker:Scarlett: you know having the academic stuff and actually what you really need is the people that do stuff um,
Speaker:Scarlett: so they you know you need the practicalities you need to have your bring your
Speaker:Scarlett: shoes into the hospital so you can practice walking kind of instruction uh rather
Speaker:Scarlett: than the oh let's be nice and we'll look after you kind of instruction.
Speaker:Hussain: Now, this may be a strange question, but if I could allow you to redesign the
Speaker:Hussain: ward that your patients are on,
Speaker:Hussain: sort of during their stay in hospital, anything that you would do in terms of
Speaker:Hussain: redesigning it in a way that you thought would help outcomes?
Speaker:Scarlett: In fact, I avoid having patients in hospital at all. So they're not on the ward,
Speaker:Scarlett: they're having care as a day case.
Speaker:Scarlett: And that gets them going automatically.
Speaker:Scarlett: And the problem is you can put an exercise bike there,
Speaker:Scarlett: But,
Speaker:Scarlett: I've been having treatment at the cancer center in London for six years now.
Speaker:Scarlett: It's top-up treatment now.
Speaker:Scarlett: And they've got an exercise bike there, and I've only ever seen one other person use it.
Speaker:Scarlett: So it isn't just the space.
Speaker:Scarlett: It's the humans. We need more human. You need someone saying,
Speaker:Scarlett: oh, okay, so a bit like, oh, you've had your blood pressure done, right?
Speaker:Scarlett: Well we need to see um uh what number you can get if you do four minutes there
Speaker:Scarlett: okay sit there off you go thanks very much we need we need someone like that
Speaker:Scarlett: so it's a bit like it's on a clipboard you've just got to do it um,
Speaker:Scarlett: because it needs to be factored needs to be factored in otherwise people just
Speaker:Scarlett: don't do it they just there's a block thinking that you can't or you shouldn't yeah.
Speaker:Hussain: Okay understood and you mentioned there that you feel like there's a gap and
Speaker:Hussain: there's still a journey we need to go on um what changes at a system level would
Speaker:Hussain: most accelerate progress as far as you're concerned.
Speaker:Scarlett: Well it's difficult because obviously the amazing rehabilitation services are
Speaker:Scarlett: amazing and they work very well where they work um,
Speaker:Scarlett: but it's the what happens to everyone else so if we had all the money in the
Speaker:Scarlett: world and put in rehab prehab services that would be great linkedin with rehab and all that,
Speaker:Scarlett: but it's how we get just little messages to get across um so maybe some of that could be in um,
Speaker:Scarlett: As I say, in the screening that you have to do when you go on the waiting list,
Speaker:Scarlett: when you have your blood pressure checked or something, there should be something
Speaker:Scarlett: that maybe bringing back what you've done and some accountability,
Speaker:Scarlett: the preoperative assessment service should talk about it, should.
Speaker:Scarlett: Explain it to patients maybe. And I think anyone having a major case should go to a surgery school.
Speaker:Scarlett: So that's like a couple of hours, say, on a Wednesday afternoon,
Speaker:Scarlett: so that they learn what they're supposed to do. They learn what the operation
Speaker:Scarlett: will be like, and they meet the other patients having it. They meet some of the team.
Speaker:Scarlett: Surgery schools are probably the – they should be completely normal,
Speaker:Scarlett: and sadly they're not for anyone having major surgery.
Speaker:Scarlett: So it still feels like it's quite bitty, and we need lots of things, but we don't want to,
Speaker:Scarlett: suddenly bring in a new initiative for places that are doing amazing work already
Speaker:Scarlett: and the other thing is then going back to the surgeons that when people put
Speaker:Scarlett: on the waiting list saying you've got to use that word,
Speaker:Scarlett: you've got to talk about it because otherwise we're abrogating responsibility
Speaker:Scarlett: assuming that other people will do it and,
Speaker:Scarlett: and i think one of the reasons we hate discussing you know,
Speaker:Scarlett: you don't discuss obesity or things with patients because you don't want to
Speaker:Scarlett: be accused of calling people fat and lazy by mistake.
Speaker:Scarlett: And and my top tip actually is the movingmedicine.ac.uk website moving medicine
Speaker:Scarlett: because you learn the motivational interviewing skills just in a couple of minutes
Speaker:Scarlett: i know there are courses but,
Speaker:Scarlett: in order to retrofit that education people need to be confident that what they're
Speaker:Scarlett: saying isn't bad yeah um and and but then also we need to change the staffing,
Speaker:Scarlett: So that there's someone in the room next door. So you go, actually,
Speaker:Scarlett: it's really important for you to get ready for this operation.
Speaker:Scarlett: Do you want to see Rashmi's going to sort it out, go through it?
Speaker:Scarlett: Is that okay? And then they go and do it. You know, you have,
Speaker:Scarlett: you know, healthcare assistants, trained doctor's assistants,
Speaker:Scarlett: people whose job it is to do that.
Speaker:Scarlett: But at the moment, it's also passive and people are waiting for the surgeon
Speaker:Scarlett: to say what needs to happen rather than that shared decision making,
Speaker:Scarlett: rather than that optimization of the non-medical stuff.
Speaker:Scarlett: And then the surgeon's busy doing all the computer stuff. It just feels like,
Speaker:Scarlett: we're using the wrong people's skills to do the wrong tasks.
Speaker:Scarlett: But anyway, it does need the surgeons to give permission.
Speaker:Hussain: Yeah, I understood. and do you think we,
Speaker:Hussain: do we need to incentivize this because a lot of what we hear when i have experts
Speaker:Hussain: from primary care they talk about if we want to really start embedding more
Speaker:Hussain: physical activity into primary care more conversations more awareness amongst staff
Speaker:Hussain: we need to incentivize it in the same way that we incentivize other targets
Speaker:Hussain: that we're trying to do in primary care we use things like coiff and double if that kind of thing,
Speaker:Hussain: is that something you think in a surgical domain if they were financially incentivized
Speaker:Hussain: or incentives in some format, do you think that would make a difference or do
Speaker:Hussain: you think that's not really the stumbling block?
Speaker:Scarlett: So, I don't have much experience with funding in primary care.
Speaker:Scarlett: And the problem with surgery, the problem, you know, in surgical clinics, we're just too busy.
Speaker:Scarlett: We just, we've got extra clinics, extra patients.
Speaker:Scarlett: We got, you know, I had five different computer systems to get on today.
Speaker:Scarlett: And I had two different IT people coming to the room to check something was
Speaker:Scarlett: okay, because last week there was a problem.
Speaker:Scarlett: So, all of that takes time. And yet you've got to be nice to the patients.
Speaker:Scarlett: And, you know, in the old days, you'd have a registrar in one room,
Speaker:Scarlett: an SHO in another room, a physio in another room, and you'd just swan around
Speaker:Scarlett: going, oh, I've heard you've got dreadful arthritis.
Speaker:Scarlett: Oh, goodness me, yes, Dr. Sermon-Soo's explained that to me.
Speaker:Scarlett: Well, you know, blah, blah, blah, thank you, carry on. Do you see what I mean?
Speaker:Scarlett: It would be a little bit more.
Speaker:Scarlett: And actually, so we haven't got enough time. But we could, if we redesigned clinics a bit better,
Speaker:Scarlett: we that tasks what do we need people for they've got good feedback with mega
Speaker:Scarlett: clinics in northern ireland and in um wales,
Speaker:Scarlett: because also you need some medical input for some people who have a very high
Speaker:Scarlett: risk of complications for an anesthetic um,
Speaker:Scarlett: and you know people talking to them about you know in the shared decision making
Speaker:Scarlett: about whether to go with surgery at all what the alternatives are,
Speaker:Scarlett: how much improvement could be made, all of that sort of thing, needs to be honest.
Speaker:Scarlett: And at the moment, everyone's too busy, and it's very binary on the waiting list not.
Speaker:Scarlett: And there isn't enough time. So yeah, actually, you couldn't incentivize my,
Speaker:Scarlett: lovely colleagues anymore, I don't think, because...
Speaker:Scarlett: We're full and we don't, the money, you know, doesn't, it's a different system.
Speaker:Scarlett: And there are people with pension issues and taxation issues for not taking
Speaker:Scarlett: on more work. So no, but it needs the hospital maybe to be incentivized.
Speaker:Hussain: Yeah, it needs to be kind of, there needs to be a bit of a restructure in order
Speaker:Hussain: to build in a bit of space to allow for these things, which in the long term
Speaker:Hussain: It's going to improve productivity and quality.
Speaker:Hussain: But at the current state, I can't believe that you've got five systems you're
Speaker:Hussain: having to navigate. I thought it was bad in primary care. I think you've got
Speaker:Hussain: it far worse from the sounds of it.
Speaker:Hussain: But I want to move us to a positive note.
Speaker:Scarlett: Yes.
Speaker:Hussain: And I want to ask you, what excites you most about the future of perioptic care
Speaker:Hussain: and the role that physical activity can play?
Speaker:Scarlett: I think it's one of these things, once you've got it, once you understand the
Speaker:Scarlett: concept, you just can't unsee it.
Speaker:Scarlett: And then it makes things so much better.
Speaker:Scarlett: So the patients have better outcomes. The patients are positive.
Speaker:Scarlett: The staff have a feel-good day.
Speaker:Scarlett: More people being day cases mean you can do more work. So you increase your productivity.
Speaker:Scarlett: Everyone knows what's happening next. You're not having to manage complications,
Speaker:Scarlett: readmissions, all that sort of thing.
Speaker:Scarlett: So it's it's it's cost effective a better patient better staff those are three
Speaker:Scarlett: you know big wins but basically it means that the team,
Speaker:Scarlett: has a great day and knows they're doing good work and the patient has a great
Speaker:Scarlett: outcome it's like what what isn't isn't to love about that.
Speaker:Hussain: Okay i love that all right so for my final question scarlet,
Speaker:Hussain: If we look at data from the 1960s and we compare it to now, we are sadly,
Speaker:Hussain: if you look at physical activity as a whole, we're 20% less active as a population.
Speaker:Hussain: Now, in 50 years from now, do you think we'll be as active as we are now,
Speaker:Hussain: more active, or less active on average?
Speaker:Scarlett: Inactivity is very related to different inequalities and different groups of people.
Speaker:Scarlett: And so for example cycling uh,
Speaker:Scarlett: at any age group twice as many or three times as many men cycle as women and so we need to fix,
Speaker:Scarlett: cycle lanes and improve safety and have people somewhere you can park electric
Speaker:Scarlett: bikes so they don't get nicked all that kind of and have somewhere to hang your
Speaker:Scarlett: coat when you get to work so i think i'm hoping that the penny will drop,
Speaker:Scarlett: and that people uh the decision makers will put in the facilities to allow everybody to be more active
Speaker:Scarlett: because we absolutely cannot afford what's coming in terms of the numbers of
Speaker:Scarlett: older people um who are very inactive who then require a great deal of care and there aren't enough,
Speaker:Scarlett: people to look after them so i think as i say i think it's going to be tough,
Speaker:Scarlett: but i think the penny will drop and we will people will have to become more
Speaker:Scarlett: active because we can't manage otherwise.
Speaker:Hussain: Brilliant thank you so much Scarlett really appreciated your insights and sharing
Speaker:Hussain: your personal story as well thank you so much.
Speaker:Scarlett: It's been a pleasure thank you.
Speaker:Hussain: That was Professor Scarlett McNally sharing such a clear and compelling case
Speaker:Hussain: for embedding movement throughout the surgical pathway.
Speaker:Hussain: For me, the key takeaway is simple. Fitter in, faster out.
Speaker:Hussain: Supporting people to move before and after surgery isn't an optional extra.
Speaker:Hussain: It's often one of the most impactful, low-cost ways we can improve outcomes,
Speaker:Hussain: reduce complications, and help people return to the lives they value.
Speaker:Hussain: If today's episode of Spark's Ideas, think about one small change you could make this week.
Speaker:Hussain: Perhaps starting the physical activity conversation earlier,
Speaker:Hussain: signposting to local support, going on the Moving Medicines website to have
Speaker:Hussain: a look at their one-minute and five-minute motivational interviewing structure consultations.
Speaker:Hussain: If you enjoyed the discussion, please subscribe, share with colleagues, and leave a review.
Speaker:Hussain: It helps more clinicians discover the podcast and keeps the movement growing.
Speaker:Hussain: Until next time, remember, movement is not just prevention, it's treatment,
Speaker:Hussain: rehabilitation, and recovery too.
Speaker:Hussain: Thanks for listening to the Movement Prescription Podcast.
Speaker:Intro and Outro: Hi, it's Callum. I really hope you enjoyed the episode.
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Speaker:Intro and Outro: If you want to find out more, please head to bslm.org.uk.
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