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Upfront About Breast Cancer Podcast

What You Don't Know Until You Do, with Dr Charlotte Tottman: Episode 9

Episode 9: Upfront About Breast Cancer – What You Don't Know Until You Do, with Charlotte Tottman: Exercise is Annoying (‘cos it works): The Psychological and Physical Benefits

Let’s be Upfront about the psychological and physical benefits of exercise during and after cancer treatment.  

In this episode of What You Don’t Know Until You Do, with Dr Charlotte Tottman, we hear about the major benefits, both psychologically and physically, of exercise during breast cancer treatment, the different exercise types and formats that can be beneficial to treatment, as well as hearing Charlotte’s rehab story and how she discovered what worked for her.  

We recommend that listeners exercise self-care when listening to this podcast, as some may find the content upsetting. BCNA’s Helpline provides a free confidential telephone and email service for people diagnosed with breast cancer, their family and friends. Our experienced team can help with your questions and concerns and direct you to relevant resources and services. Call 1800 500 258 or email contact@bcna.org.au

Resources:

Upfront About Breast Cancer is a production of Breast Cancer Network Australia. Our theme music is by the late Tara Simmons, and this episode is proudly brought to you by JT Reid. 

Want to get in touch? Visit our website at bcna.org.au, email us at contact@bcna.org.au, or call our Helpline on 1800 500 258 

TRANSCRIPT:

Ad [00:00:00] BCNA’s helpline provides a free confidential telephone and email service for people diagnosed with breast cancer, their family and friends. Our experienced team can help with your questions and concerns and direct you to relevant resources and services. Call 1800 500 258 or email contact@bcna.org.au.

Kellie [00:00:40] Welcome back to the Breast Cancer Network Australia's podcast Upfront About Breast Cancer - What You Don't Know Until You Do, a 10 part series with Dr Charlotte Tottman, who's a clinical psychologist specialising in cancer distress, and also with lived experience as a woman diagnosed with breast cancer. In this episode, we are talking exercise. The major benefits of exercise both psychological and physical during and following breast cancer treatment are well documented. So why do so many not do it? Dr Charlotte is going to share her own story of how she began and built on her physical rehab and suggests ways for even the most reluctant to get going. A reminder what you're about to listen to is an unscripted conversation. The topics discussed are not intended to replace medical advice or cover the full spectrum of experience or clinical option, so always exercise self-care. And if you find the subject triggering, please contact your health professional. Welcome back, Dr Charlotte. The magic pill, exercise.

Charlotte [00:01:46] Hi, Kellie. Yes, I do talk about it as nature's antidepressant.

Kellie [00:01:50] But you also talk about it as annoying. Why is that?

Charlotte [00:01:54] Yeah, it's annoying because it works. It helps everything. If it didn't work, I wouldn't have to do it. But because it works, I kind of have to do it.

Kellie [00:02:05] And when we say exercise, are we talking aerobics? Are we talking cardio or are we just talking movement?

Charlotte [00:02:13] Yeah, look, fundamentally, we're talking movement. I was talking with a fabulous client even just the other day, and we were talking about how sometimes just using language again, language is so important when you use words like exercise or fitness that sometimes it can come with pressure. So just moving and just starting to think about, maybe I'm just going to start moving a bit more can be a really helpful way to start.

Kellie [00:02:37] And for those who are already into exercise prior to a diagnosis, they might be really keen to get back into it versus those who were never really big fans of it. And then after a diagnosis during that post adjustment? Yeah, it must seem like just another thing they need to do.

Charlotte [00:02:57] Yeah. And a bit like when we were talking in some of the previous episodes about self-care, it's the first thing that goes. It's arguably one of the last things that should go. But we are very good at going, you know, I haven't got time. Mostly, it is that time thing and women with busy lives and you know that ball juggling multiple commitments sort of situation. It's very easy to justify, you know, not taking that 10, 15 minutes, which you know, might be the minimum for a lot of people. Exercising takes a lot longer than that because if they've got to travel somewhere or they've got to make arrangements to to find that time in their life, it can actually be more like an hour. And that's hard to do, and it's hard to do on a regular basis if you're feeling pretty crappy as a result of the cancer diagnosis and treatment. And also, if exercise hasn't been your thing, then the idea of like, you know, embracing this when you're already feeling pretty subpar can be a really hard thing to do. A lot of my clients are a little bemused in the early sessions with me that this is one of the things I often recommend. It's kind of like, you know, but I came to your, you know, a psychologist and you're telling me to exercise and it's like, Yeah, I know, I know we'll get on to that like, you know, hid stuff in a minute. But if we don't get the basics sorted, if we don't get things like sleep and nutrition but mobility sorted, then other things are going to be much harder. So I'm a big advocate for regular movement. My strong preference for me and other people is about 15 or 20 minutes a day, preferably at a point where you're kind of getting warm, so it doesn't have to be like you dripping in sweat. But if you're kind of only strolling and your heart rate's not really getting up, it's better than nothing. But it's better if you're doing something that's just making you feel a bit warm, because that means that your heart rate is up, and that means that you're getting a bit of an oxygen boost and a bit of an endorphin hit. It's a great thing when you get an endorphin hit, but I think there's probably another side to the chemical argument that's not perhaps as talked about as much. There are these other two chemicals that are released in our system when we are stressed and anxious and struggling, and they are cortisol and adrenaline. And what we know for sure is that exercise regular exercise combats those two chemicals, reduces those, and that makes us feel and so far better.

Kellie [00:05:25] So can you share with us your experience with exercise both prior to diagnosis, during when you were at your most fragile?  

Charlotte [00:05:38] After surgery and since was as a young person. Listen, I'm very much into sport and exercise, my mum was a fitted lecturer, and so we just played every sport there ever was. And I really enjoyed it and was part of my life as a as an adult and as a mum and a wife and a person with a job. I think like everybody else, my, I guess, my kind of regular what I'd call sort of organised exercise kind of went to the wayside and I might have done a little bit of incidental exercise, you know, the occasional walk or the occasional swim. But there wasn't what I'd call, you know, it wasn't a regular part of my life, and I was probably a bit fortunate there because again, my mum was an athlete. And so we were blessed with some reasonable genetics in that department, obviously not in the cancer department, but I was able to maintain a level of kind of fitness and stamina without doing too much. So that was, you know, lucky me, what it probably also did was it made me a bit complacent. You know, I sort of kind of took that for granted. And I also didn't really until cancer, I didn't really understand just how important to my overall functioning regular exercise is.

Kellie [00:06:53] Do you mean to your mental health?

Charlotte [00:06:56] Yeah, I mean to my mental health. So I'm out. I'll talk about this in some more detail as we go on. But I mean, I am now at a point where if I don't do something of some sort, at least every couple of days, I really notice it. I really notice how I feel so much better when I've done something. And I like to say, you know, I do, I bounce out of bed and grab those trainers and, you know, I want to do it. No, I do not. But when I've done it, I really feel like, Oh yeah, OK, there we go again. Reminder that was worthwhile.

Kellie [00:07:32] So it's intentional exercise that way.

Charlotte [00:07:36] It is intentional exercise. When I was diagnosed and I had the surgery fairly quickly after my double mastectomy, I mean, the amount of information that that certainly I was given around exercise then just post-surgery was pretty small and I had to do a bit of research about, you know, what would be safe and appropriate given, you know, my chest was cut across fully across from when I'm under one arm to the other. But I wanted to stop moving and certainly, I think most medical procedures, you know, whether it's cancer related or not, we are now much more commonly recommended to get moving sooner rather than later. You know, people who have knee operations that often kind of almost walking out of the of the hospital the following day, I was kind of wanting to get going. I didn't really do very much in the probably the first few months, which was when I went back to work and did too much too soon. So that's a good kind of point around the fact that I was busy hiding in my work and I wasn't looking after myself. I wasn't looking after myself really at all. So when I had the meltdown, which we described in one of the earlier episodes, one of the things that I did was I started very consciously, very intentionally to move. I did two things. Probably one was I did the moving, and the second thing was I kept a log, and I don't want to spend too much time on it because we talked about it before. But essentially all it was an Excel spreadsheet. Honestly, it could have been on the back of an envelope. It wasn't sophisticated. It was just me keeping track of each day how many minutes I walked for. I had a couple of little one point five kilo weights and I would just with the Spice Girls as my friend for five minutes, I would just move my arms just like lifting the weights. Just like, what do they call bicep curls. I think up and down, like for five minutes and gradually over the months that I had away, I just built up from sort of 10, 15 minutes to walking up to about 45 minutes. And I think the biceps curls for about five minutes with the Spice Girls stayed about the same, but it got easier and I was probably doing more. I think they call them reps. You know, I was doing more bicep curls in the same amount of time, and I started to swim some laps and I kept track of that. And at the same time, I also kept track of how much sleep I was having, what other medication I was taking and what my mood was like. I kept a mood score out of 10. What this tracking allowed me to do was it was allowed. It allowed me to see that at the same time that I was building stamina and able to exercise a little bit more things like my mood and my sleep were improving. So there was this really clear evidence in front of me every day that this was helping and that acted as a motivator for me to keep doing it. It was kind of accidental that I did it. And I'm I mean, I'm not sure what would have happened if I hadn't kept the. Log, I mean, maybe I would have kept going, but I feel really, really sure that it was a really helpful thing that I sort of did by accident.

Kellie [00:10:48] Did you not flow on effects, positive things?

Charlotte [00:10:52] Yeah, I did. I think it made it so blindingly clear that when I went back home and I was still off work and I had this plan that I was going to go back to work gradually a couple of months later, which is what happened, that having exercise as part of my daily or regular routine was no longer just some nice idea. It was actually essential and that if a fire was going to not end up in another big puddle, then this was going to be something that I should do, but also something that I could do. And the things that I would do was doing. They weren't costing me any money. I wasn't signed up to a gym. I wasn't paying a. I wasn't doing anything like a class or whatever. It was free and it was pretty straightforward low rent, as they say.

Kellie [00:11:47] And of course, there's so many free apps available that can get you to commit for five minutes or seven minutes.

Charlotte [00:11:54] Yes, one of the one of the clever things. I mean, technology is so helpful with this stuff, but one of the clever things that I've seen is apps out there, and these are research backed apps where they've looked at the benefits of exercise. But one of the principles they've used is what's the minimum amount of time someone can not justify doing exercise? And so one of them, for example, is based on a seven minute workout. And that's because basically, who hasn't got seven minutes in a day? Now, even 10 minutes might be too much, but seven minutes, it's like, I don't know, seven minutes is like, I just have a shorter shower. I'll just get up seven minutes earlier or go to bed seven minutes later. And it's really based around that whole idea of being time poor and also being very good at making excuses, not to do stuff.

Kellie [00:12:46] And of course, the research is well documented now about doing exercise during treatment to how that actually improves the benefits of medical therapy.

Charlotte [00:12:58] Yeah, absolutely. So I think probably, you know, maybe 10, 20 years ago, it may have been something like your oncologist might have said, you know, sure. If you want to go for a walk or do some exercise, that might be that might be cool. Or it might have sometimes been recommended on Sunday. Sometimes not. Now it is actually part of regular conversations and recommendations from oncologists that you do, where possible, some regular exercise during treatment. And there is now very solid research that supports that. Things like the effectiveness of chemotherapy is enhanced by regular exercise. I, as a non non-medical doctor, I don't technically know the mechanism for why that is the case. But my brain tells me that if you're putting a chemical into a body and you want that chemical to get as far into every nook and cranny as possible, then if you increase mobility, that's going to increase things like, you know, blood pumping around your body, then logically, that would mean that the blood is going to pump that chemical to every nook and cranny and get it to do its work. So it's so, so helpful to have that understanding that it's not something that you need to or should wait to do until you get to that post-treatment adjustment phase that you can actually engage in some sort of exercise while you're going through through treatment. And the benefits of that are not just to the effectiveness of treatment, but also to about facilitating your coping generally during that really hard time business.

Ad [00:14:38] Online Network is an active peer to peer support community where people affected by breast cancer can find information and connect with others who understand what you're going through. Read posts, write your own, ask a question, start a discussion and support others. The online network is available for you at every stage of your breast cancer journey, as well as your family, partner and friends. For more information, visit BCNA dot org dot au forward slash online network.

Kellie [00:15:10] One of the really debilitating side effects of treatment or post-surgery is fatigue. And yet if you actually do some movement or exercise, that will improve fatigue.

Charlotte [00:15:26] Yes, it's quite counterintuitive. Again, I think I've said before, I have a whiteboard in my consulting room, and when I'm talking about this stuff, I talk about the fact that when you're fatigued, so I write fatigue in the middle of. A white board, and then I write two arrows going either side of the fatigue, and I say, you can do one of two things you can rest or you can build stamina, which is exercise. And if you rest, you will actually deconditioned further and you will feel more fatigued if you only build stamina. You risk getting more fatigued, so you probably need to do a balance, a combination of both some resting and some exercising, and you will find that you will actually feel less fatigued as a result of that. And like I said, it can feel counterintuitive. I mean, most people, when they feel knackered, they just want to. They just want to rest. And the idea that somebody says, you know, go out and like feel even more tired doesn't seem to make sense. But if you think about it from the point of view that you are actually building strength, then you are going to be stronger overall. You are going to be less tired because you are you are going to be able to cope with more than you could before.

Kellie [00:16:35] I know, particularly during COVID, everybody's catch cry is go for a walk. Oh, really? Go for a walk. Is it really enough? Is it really enough to release some sort of endorphins to make you feel better?

Charlotte [00:16:52] I was giving a talk at one of the BCNA conferences a few years ago, and there was this wonderful medical oncologist called I think I'll get his name right when I say Professor Mitra, and he gave this really great presentation about breast cancer, a lot of medical technical stuff, which was really interesting. But then at the end, he was up on a stage and it was quite a wide stage. It's hard to describe this over audio, but then he said when everything else, those files just do this. And he walked almost a bit like John Cleese. It was a bit of a funny walk. Just write the full length of the stage with his head down. And he said walking is a superpower. And point he was making was that it's something we can all do. It doesn't cost any money. We already know how to do it. It's pretty low risk. And it really, if you don't do anything other than that, that will be beneficial. There's lots of parts to walking that may not necessarily be obvious. So yes, there's movement. You don't have to be a power walking like Kath and Kim. But if you walk with some speed, you kind of get a bit of a rhythm going and human beings like rhythm. Psychologically, we do well with rhythm. That's like, that's why we like things like the tide. It's why babies settle when they're patted on the back. We like rhythm, so getting into a movement where you're doing something rhythmic is a good kind of soothing thing for us psychologically. The other thing that happens with walking is for most people, not always, but most people walk and there's usually some fresh air. There's quite often some sunshine. There's often if you like a grounding experience, which means that you feel connected to your environment, so you feel connected to your community. You will see landmarks. You will make eye contact with other people as you walk past them. Now, they all sound like really small things, but what it does is it validates your presence on the earth. It says that I am here and I do matter. And when you’re having a tough time, that's that stuff really does count. So all of those parts can fade into why, you know what sounds like just kind of a walk around the block can actually be quite helpful. And the other thing about walking is that you can do other things while you're walking. You can listen to a podcast, for example.

Kellie [00:19:14] I wonder which one?

Charlotte [00:19:15] I wonder which one you can walk with a friend. You can walk with your dog, you can walk with your kids, you can listen to music so you can pair it with other things that also, you know, enhance the experience or make it a more efficient experience. I quite often suggest walk and talks with parents and adolescents because it is it's a side by side activity. You shoulder to shoulder. It's much less stressful. It doesn't feel like a Spanish interrogation, and you can have quite a meaningful conversation with some of the people that matter in your life. So there are lots and lots and lots of positives to something as simple as walking.

Kellie [00:19:48] If we like rhythm as humans are, we likely to walk further? If we walk to music, you know you forget the actual activity.

Charlotte [00:19:59] I mean, the short answer is very probably yes. For example, what that's making me think of is I walk on a treadmill a lot of the time I bought it on Gumtree for 100 bucks. So these things are possible even if you don't have much cash. I quite often will watch David Attenborough's series about the Universe God. I never used to watch this stuff, but I love it now. And what I find is that if I'm watching that stuff, the time goes much quicker on the treadmill. If I'm watching the news and the blessed coronavirus, it feels interminable. So I have learnt that there are definitely ways to make the experience of exercise more enjoyable, less sort of punitive. And yeah, that whole thing of kind of like not being so conscious of how many minutes I've been doing it.

Kellie [00:20:53] Okay. So for those that are struggling to just start, what are some of the things that could help them get started? I have heard of people who go to bed in there and leisurewear so that they don't have to think when they get up to contemplate exercises that they just literally get up and off they go. And it's a little bit extreme. It's a little bit extreme. But is that what we need like the path of least resistance?

Charlotte [00:21:25] Yeah, yeah. We want to remove all barriers, all obstacles. So when you're starting something new and particularly for people who maybe haven't really ever exercised as a thing or they haven't done it for a long time, this falls under the heading of what we call behaviour change. And perhaps. Maybe change is most successful when there's a significant enough positive consequence or a significant enough negative consequence. So it's not uncommon for people when they're first diagnosed with cancer to get quite enthusiastic about things like diet and exercise they like, right? This is the wakeup call that I needed. I am going to kind of, you know, revolutionise my life. And then a few weeks later, when they're in the thick of it, when they're in the thick of treatment, some of that enthusiasm has well and truly waned, and they aren't actually able to combat things like the nausea and the fatigue to do anything much at all. And unfortunately, that can lead to kind of like the feeling of like, well, I wasn't able to achieve it at the beginning. I wasn't able to be successful, so I may as well not bother going forward. Brings us back to what I was saying a while ago, which is basically just do something starting small. So behaviour change is from the research. We know that behaviour change is much more likely to be sustained if you make small change in increments over time. This is why crash diets don't work because you make this massive change. You do it for a week and then after that you just cannot do this and you flip flop back to what you were doing a week ago. So what you best to do is to start really small, almost just one step above nothing. I did this again because this is the nature of exercise. You do it for a while and then you maybe stop or whine and you start again. So earlier this year, probably about February, I realised that I had really just let my exercise game go. And this is when I got the $100 treadmill. And I thought, All right, well, what am I going to do to give myself the best chance of actually doing this? So my barriers were time, so I decided I was going to start with just doing if I could manage to do it once a day on weekdays, then that would be good and I would start with ten minutes a day on the treadmill. And I worked out from previous experience that if I did it in the morning, there was some chance it was going to happen. And this is born out by the research as well that if you're going to do things like mobility or exercise or some sort of exercise activity, the earlier you do it in the day, the more likely it is to happen. So I actually said to my husband because I knew that without awareness by him, I didn't need him to be my coach or my policeman, but I did need him to kind of know what I was trying to do. So I said to him, ‘Look, darling’, in the mornings, normally we have a coffee at 6am and we watch the news for half an hour. And I said to him, ‘I'm going to still have the coffee and watch the news, but only for 15 minutes. And then I'm going on the treadmill for 10 minutes and I don't need you to do anything differently other than not other than not question me about it. Don't sort of go are really like, really, you know, just sort of go, Yep, cool’. And so I started doing that in February. And the other thing I did was I. I wasn't sleeping in my gym gear. But what I what I do is I put my runners, with my socks, in the runners by my bed and I sleep in a nightie. And so now I get up with my nightie on. I put my runners on with my socks on my runners on, go to the loo, step onto the treadmill in my nightie. It's not glamour.

Kellie [00:25:02] If you tell me it's velour, I'm going to lose it.

Charlotte [00:25:10] But I've I've worked out that even the requirement to get out of my nightie into like a pair of leggings and a T-shirt. That's a barrier that will very probably stop me or stop me some of the time. And honestly, I mean, I mean, my house is only me and my husband doesn't really matter what I'm wearing. So they're some of the strategies that I use now. I started at 10 minutes and look, this is not in any way to make me sound like I am some sort of a legend. I'm so far from that, but what I've done is I have used the fact that exercise can be measurable. And that's a really helpful thing because you can use numbers to, if you want to, to monitor your progress. So I started doing 10 minutes, and I think I know what the numbers on the treadmill mean because it didn't come with a manual.

Kellie [00:26:05] That’s what happens when you buy on gumtree.

Charlotte [00:26:09] I think I'm I think I'm was. I start. I think I started at five ks an hour, so I did 10 minutes at five KS. Well, it's now September, and I'm doing. I'm seven ks an hour and I do two K's in about nearly 18 minutes and I do that most days. Oh my god, I'm proud of myself when I say this. Most days, most weekdays, I do that morning and night.

Kellie [00:26:33] So you are a legend in a nightie.

Charlotte [00:26:36] I'm a legend in a nightie. There never be photographic evidence of. But I feel so much better than I did in February. Not that I was I wasn't a train wreck in February, though I was in 2019, but I feel so much better. My body image stuff is helped. So these are the things that that exercise helps. My body image stuff is helped by this. My sleep is helped by this. My mood is helped. My side effects from things like the effects of hormone blocker, my fear of recurrence is helped and my overall coping with just life is helped. All of those things I know to be true for sure.

Kellie [00:27:21] And that fear of recurrence is likely to be reduced because we know regular exercise actually does statistically reduce the chance of other cancers.

Charlotte [00:27:36] Exactly so. So, you can actually benefit physically and psychologically because you are arguably, you know, fitter and healthier as a human being. Your risk of of all sorts of medical things is reduced, but also your risk of recurrence is reduced. And that in turn reduces your fear around risk of recurrence so it can be incredibly helpful

Kellie [00:27:59] And your mobility obviously is increased and therefore the likelihood of falling or injuries is reduced. And I take it that your balance is improved.

Charlotte [00:28:13] All of those things. And so because and again, this is obviously not the case for everybody, but for a lot of people, cancer comes as they are in their middle to older years. And so other medical things, other frailties. And because we deconditioned so much faster than we recondition if we are in treatment for several months, as is often the case with cancer, we can become much weaker. The other thing that I that I see and we actually haven't talked about this in the rest of the series but is really relevant, is that one of the really common psychological responses to cancer is a drop in confidence? And people feel much less confident about a whole range of things about a lot of activities they used to do about things like work, but also about their body and how confident because they can feel like either their bodies betrayed them or that something terrible has befallen their body and that it will never be the same. And so they can be very cautious around things like mobility. And of course, the more cautious you are, the less you're likely to do. And then, in fact, the more vulnerable you become, so you end up getting more of what you didn't want. So all of this stuff is really important.

Kellie [00:29:29] And women, by their very nature and science backed, is that the vast majority already have body issues way before cancer enters the game.

Charlotte [00:29:39] Absolutely. And so, we talked about that in a in a mirror image episode. And so, the stats around that are that more than 90 per cent of western women have body image concerns separate to cancer. And then you get a diagnosis of cancer. And through the treatment, the effects give your brain something to focus on, something to be really unhappy about. So body image is a very common experience and something that people wrestle with, not just during the treatment, but for potentially for many years to come. And certainly I do, too. One of the things that I recommend and we talked about this in the previous episode was about focussing on what your body can do rather than what your body looks like. And again, it sounds easy, but exercise is so important there. And one of the things again, I stumbled on this strategy without I sound like a great psychologist, and I just stumbled

Kellie [00:30:36] Just got it out of a conflict.

Charlotte [00:30:40] Exactly. So I was using my little hand weights, the ones that I was talking about the 1.5 kilos and the Spice Girls, and I were doing those for five minutes. Then I was trying to think what is different? And so this is at home with me in. And I was trying to think what's different about this experience to say if I was at a gym and I thought mirrors mirrors is one of the things that's different now. Mirrors can act as a big trigger for body image, which is a reason a lot of people will stay away from mirrors and stay away from gyms when they're struggling. But what I found? And again, this was by accident. I just got one of those like a mirror that you'd have in the dressing room, just a long, thin mirror. I just stuck that up against the wall and I did the Spice Girls hand white thing in front of a mirror. And what I found so interesting was that my brain responded very positively to seeing my biceps flex when I moved my arms and this and this was all, of course, my biceps are right next to my scar. So this is all my chest. This is my vulnerability area, if you like. So I'm watching my, I suppose my whole upper torso moves in a way that sends my brain a message that says I am not broken. I can move. I have strength. It was so sort of startling to me that I'd been exercising for quite a while before I stumbled on this strategy. And then I found, God, this really makes me feel better. And I found it so interesting because typically I would have thought looking at myself in the mirror more as we've discussed previously, would be likely to make me feel less good. But it was looking at myself in the mirror, moving make where my muscles were. Now I don't have very big muscles, but I could see whatever muscle I did have made me feel really good. So that's something that I recommend.

Kellie [00:32:45] And like you have talked before, the brain and associations of negative things can stop you wanting to do something. So is, is it about not doing too much too soon because you don't want to do that fad and either hurt yourself or be exhausted or have pain and then go, No, I'm not going to do that. So it's yeah, it's just building up, slowly over time.

Charlotte [00:33:07] Absolutely. We make these negative or positive associations very quickly. You've really only got to have one bad experience where something really jazz or hurt for your brain to interpret that as a threat and to go, that's a bad thing to do, and I'm going to stay away from that. And of course, you you're going to get people around you saying, Yeah, don't do that like you don't and don't do that again. That was bad for you. So it is about recognising what your starting point is, and this is where quite often we do recommend that people go and visit with an exercise physiologist even just as a one off. And what can be really helpful about that is that the exercise physiologist can assess you, and that means they actually take account of like, you know, things like your age, your overall health, what your physical experience is, where your particular vulnerabilities might be and give you guidance about the sort of mobility and the sort of exercises that will be really safe for you. And if you like, work out now, when I see a program that makes it sound like much bigger and fancier than it needs to be, it might just be. These five exercises would be a good thing for you to do. Or maybe you might want to stay away from doing this type of thing, but that can be really helpful just in terms of setting you up for success. And then what I always recommend is you're a little bit. Just like I was saying at the beginning February, it was 10 minutes each day and then over what I was to September, how’s my maths, about eight months. It's gone up to be more than that and I'm stronger and able to do that. I've done that incrementally over those eight months,

Kellie [00:34:45] Stronger in the mind and body. Absolutely. So the magic pill is there. It's there for everyone. It's free. Take the exercise pill.

Charlotte [00:34:55] Yeah, take the exercise pill. Recognise that when you start, the hardest part is likely to be the first two weeks, even if you're feeling, you know, full of enthusiasm and feeling really committed. Often when we start doing something that we haven't done before, you might feel a bit stiff. You might feel like your muscles are really noticing the fact that they're doing something. And it's in those first few days, in fact, that you're most likely to quit. So it's almost like you want to double down and OK, well, it's not so much about how I feel in the first five minutes. It's going to be more like the first few days and then that's going to be the time when I really have to go. Now I've got to push through this and keep going. And once you get through about the first couple of weeks, that's when you started to actually create some stamina and you're getting some progress and runs on the board. It gets easier after that. But the other thing to be mindful of is that behaviour change takes time. It takes time for a new behaviour to become an established behaviour. There's some research that I was having a look at a while ago, and it was what's called a meta-analysis, which is just a lot of a big study of a lot of other studies and the average number of days for a new behaviour to become an established behaviour, it was 77, which is 11 weeks.

Kellie [00:36:11] I thought it was 30 days, 30 days to break a habit or form ahead. Yeah, that

Charlotte [00:36:15] That that’s what it used to be, no longer. It used to be. Yeah, six weeks was what most people thought, but it's a bit longer. But the reason that I highlight that is that it's about kind of setting expectations and going, Okay, well, if I'm going to, I'm going to do this. And if I fall off the wagon after a couple of weeks, which a lot of people do, it's about getting back on the wagon and doing it again, but also feeling like if I'm able to manage to do this for, like a school term, if I can do. Something every couple of days for about a school term, the chances are that's going to have embedded itself in my life as part of my routine. And that's a really nice thing to kind of look forward to, I guess.

Kellie [00:36:50] I would hope that inspires everyone to get up and get moving. But don't forget to get back to the podcast, too. For our next episode, Fear of Recurrence, and if this episode on exercises helped you, why not share it with someone else who might benefit? We'd love you to write and review the podcast as well and subscribe so you never miss an episode. And also in the show notes, is a survey. It takes a few minutes and will help us to tailor and create content that's relevant. And if you're looking for your information specific to your diagnosis, download BCNA’s, My Journey, visit my journey dot org dot au. It will provide all the information you need and nothing you don't. The connection with real people who share your experience, BCNA’s online network is a great hub of peer to peer support, joined through BCNA’s website. And in our next and final episode. We're talking about fear of recurrence.

Episode preview [00:37:47] Big trigger for fear of recurrence is physical symptoms. It doesn't have to be a physical symptom in the same way that it was when you were first diagnosed. Or it could be. So it doesn't have to be a lump, but it can be other things. It can be headaches, it can be bone aches. It can be a change in the rhythm of your body. It can be a rash, a bump, a lump. It can be anything, really. And what is extraordinary is the brain's ability to, upon noticing that particular symptom is to instantly make the link between that and a recurrence. And it happens to me. I can get a headache which could be born of fatigue or dehydration or stress. And in an instant, I can have convinced myself that I've got brain mets.

Kellie [00:38:35] Our theme music for this series is by the late Tara Simmons, who lost her life to breast cancer. We're very grateful to her family for allowing us to use her music. I'm Kellie Curtain, and it's good to be upfront with you.

Ends [00:38:51] Thanks for listening to Upfront About Breast Cancer, What You Don't Know Until You Do with Dr Charlotte Tottman brought to you by the Breast Cancer Network Australia and proudly supported by JT Reid.