The Science of Fitness Podcast
Welcome to the Science Of Fitness podcast where we aim to inspire you to live a healthier and more fulfilling life as we share evidence and anecdotes on all things health, fitness, performance, wellness and business.
Hosted by Kieran Maguire, Co-Owner and Director of Science Of Fitness with an Undergraduate degree in Exercise Science and Masters degree in High Performance, the podcast includes guests and friends of SOF from all walks of life sharing their knowledge and stories within their field of expertise.
Join us as we provide listeners with digestible and relatable educational tools and entertaining stories to inspire a healthier and more fulfilling life.
The Science of Fitness Podcast
S2 E24 The Power of Physical Activity in Healthcare w/ Sjaan Gomersall, Associate Professor
The Power of Physical Activity in Healthcare with Associate Professor Sjaan Gomersall
Associate Professor Sjaan Gomersall takes us on a captivating journey from the world of ballet dancing to becoming an influential figure in physiotherapy and health promotion. As the Associate Director and Principal Research Fellow at the Health and Wellbeing Centre for Research Innovation—cofounded with The University of Queensland and Health and Wellbeing Queensland—Sjaan has dedicated her career to integrating physical activity into healthcare. She is also an Associate Professor in Physiotherapy at the School of Health and Rehabilitation Sciences, The University of Queensland, and serves as the President of the International Society for Physical Activity and Health.
In this episode, we explore her unique path, shaped by her family's experiences with disabilities and a serendipitous academic decision that led her to specialise in physical activity measurement. Her inspiring transition from clinical practice to academia highlights her commitment to promoting exercise as a preventive strategy rather than just a treatment tool.
We dive into the evolving role of physical activity in healthcare, discussing key challenges faced by health professionals, such as time constraints and the difficulty of maintaining their own healthy habits. Sjaan shares insights on the critical differences between therapeutic exercise prescriptions and general physical activity promotion, emphasising the importance of starting small and leveraging behavior change strategies for long-term success.
The impact of social support and technology on fitness behavior is another key topic. From the communal energy of group workouts to the influence of wearable technology and e-health interventions, we examine how these factors shape our exercise habits. Sjaan also provides her perspective on the potential of these technologies to reach underserved populations and foster meaningful connections.
As Co-Chair of the Physical Activity in Healthcare Special Interest Group (Asia-Pacific Society for Physical Activity) and a Consultant for the World Health Organization's Physical Activity Unit, Sjaan offers invaluable insights into the integration of physical activity in healthcare consultations. We discuss the need for a cohesive approach that prioritises exercise as a vital component of patient care.
Join us for an enlightening discussion that will change the way you think about exercise, health promotion, and the role of physical activity in shaping a healthier future.
Welcome back, ladies and gentlemen, to the Science of Fitness podcast, and today we have Associate Professor Sian Gomisal on the episode. Sian welcome.
Speaker 1:Thank you very much and thank you very much for jumping on. Probably going to be one of the most interesting topics we discuss. I'm obsessed with it and fascinated by everything that you're looking at research-wise and then even your work within the School of Physiotherapy at UQ. But before we get into it, let's go into a quick rapid-fire series of true or false. Okay, Now, I know it's really hard for researchers to give hard yeses and nos and trues and falses and lots of maybes, so I'll ask you to try and limit the maybes. But I get it if you have to give me one.
Speaker 2:I'll do my best.
Speaker 1:All right. So, true or false, you need to exercise for at least an hour every day to see health benefits. False, true or false, sitting for long periods can be just as harmful as smoking.
Speaker 2:False.
Speaker 1:Asterix. Good, that's good, true or false? Technology-like?
Speaker 2:fitness trackers are the gold standard on physical activity. What about physical activity In?
Speaker 1:terms of measuring it and actually determining your physical activity. Okay, physical activity is equally effective for mental health as it is for physical health. True Healthcare providers should consistently recommend exercise as part of treatment plans. This is including the medical industry. Yes, definitely True, good E-health interventions work better for younger populations than older populations. False, interesting, and then true or false. Taking small, frequent breaks from sitting during your day can improve overall health, even if you don't exercise. Yes, cool Okay, cool Okay.
Speaker 2:Only one asterisk. I did so well. You did really well For an academic.
Speaker 1:I like it. Let's get into your story. So, associate professor, that's a pretty big deal. You've obviously done a lot of research and a lot of wonderful work in, I guess, broad spectrum, the health industry. But if we were to narrow down into some of the specifics of your research and, I guess, even reverse engineer it, how did you get here? Sure, let's start with that.
Speaker 2:Great start. I because I am a little unusual as a physio who now works primarily in health promotion. So I started physio as an undergraduate and I didn't know you could be an academic when you grew up. By the way, I was first in family to uni and so I had exposure to physio as a dancer and ballet dancer, and then also my brother, who has a physical and intellectual disability intellectual disability and so I started physio and then started to see that oh hey, there's people that actually teach and research the things that they're actually teaching us, which you don't get exposed to at school.
Speaker 2:And I just desperately wanted to be the best physio I could be and really kind of knew that I wanted to take the next step, get out of university or learning and schooling and all that sort of stuff, which is ironic, right, and I wanted to be a pediatric physio. Okay, then I ended up in neurorehabilitation as a physio and I picked an honors research project.
Speaker 2:I'm going to go full honesty disclosure here, I picked an honors project based on the fact that the supervisor used a Mac and I used a Mac. Oh wow, and I was like, hey, like he must be cool, I'm cool we used Macs. Well, there were just so many good things on offer.
Speaker 1:Yeah.
Speaker 2:And the project that was on offer was a measurement project and it was a physical activity measurement project, and so comparison for example, there were randomized controlled trials for kids in hydrotherapy and all sorts of you know things that may be on paper, may have looked more exciting, and there were lots of things I was interested in and I just got a really good vibe from the supervisor and that decision was a sliding door moment that has changed my entire life the entire course of my life.
Speaker 2:And that's why I like to say it's kind of like the deciding factor was that we used the same computer. Like you know, sometimes these things just do come down to something as small as that and you don't know until you look back. You know what those kind of moments entailed, and so I was doing my physio degree while concurrently doing research in time.
Speaker 2:Use so measuring physical activity so developing and validating a tool for time use to be able to more accurately measure physical activity in adults, and still desperately wanted to go and be a physio. I got one of the hospital rotation jobs the you know top one of the top jobs in the state in South Australia and very quickly realised that it's.
Speaker 2:It was a touch more repetitive than what I experienced as a student because you spend a long time on rotations and that was just something I didn't realise at the time, probably wouldn't suit me, and so moved into neurological rehab and just loved being able to spend more time with people and really bed down into one thing. And then I was actually presenting my honours research in Brisbane. So from Adelaide in Brisbane and I was at Armet's in the city you know, the top tourist restaurants in South Bank and my PhD.
Speaker 2:my honours supervisor leaned over and said hey, we just got this really big grant. Do you want to do your PhD on it?
Speaker 1:Wow.
Speaker 2:And I'd been working as physio at that point for about six months and I went probably not yet, but I don't think I can say no and so that's the other major sliding door moment. I probably wasn't ready. I would have liked to have stayed a clinician for a bit longer, but I already knew that the work and the things that I'd learnt about prevention sat better with me than the treating them after the fact, and that's the key kind of turning point in moving toward more health promotion Interesting, yeah. So I did my PhD in physical activity and did a big randomized controlled trial, got my moment in the sun to do one of those after a measurement study, and then was fortunate enough to get a job up here with one of the professors in physical activity at UQ. Wendy Brown diligently promised my mum it would be a three-year contract and I'd be home back in Adelaide before she knew it, and it's been 12 years this year.
Speaker 2:So for a long time I actually wasn't involved in the physio profession in a lot of ways. So I kind of moved entirely into physical activity, health promotion, behaviour change and then, as you do in academia, the short-term contracts kind of roll and don't roll and ended up taking a position as a permanent teaching and research academic in physio.
Speaker 1:Wow.
Speaker 2:And it was then that my two worlds collided and I thought, hey, why don't, instead of just kind of avoiding physio or avoiding healthcare because it's an after the fact and doesn't do a lot of prevention, how about my role being pulling prevention into healthcare? That's where I am now.
Speaker 1:Pulling prevention into healthcare and at a, I think, scale that is probably influential in the sense of you're working with the forthcoming practitioners and have been for a long time and giving them that awareness and that approach. You know, would you say if, when you're going through your undergrad, from a preventative mechanism and a preventative approach, was that part of what you were learning as a physio student, or was that just we just got to get you guys to understand this how to treat and then go for it?
Speaker 2:It was definitely the latter, it being a blank number of years ago.
Speaker 1:Yeah.
Speaker 2:So there is definitely more than what there was when I went through and it isn't one of the sort of how we deliver that content isn't dictated to us. So you know the idea that health promotion is embedded into physiotherapy curriculum in tertiary education. It is there but that's the extent to which it's dictated about how it might be delivered. So as long as there is something, it ticks the box around the fact that it's being delivered. So you know, some of the things that I've embedded into my teaching for physios is motivational interviewing, so how to actually have the conversations around behavior change and kind of understanding that simply telling someone to do something or that it's good for you is absolutely not enough. That learning about the actual health behaviours themselves.
Speaker 2:So physical activity, sedentary behaviour, how those two things are different and, critically as an exercise specialist, how physical activity promotion is different to therapeutic exercise prescription. So you have a sore X or a weak X, you know how to prescribe an exercise program to address that, but that is important. But it is different to physical activity promotion, which is about participation.
Speaker 1:Yep yeah, big time.
Speaker 2:Yeah, so I teach first year physios so I get to kind of get in early. Yeah Well, it's still a little bit plastic that's right, um, I teach first years and I ask them at the end of the course you know what's one thing you've learned, um about you know what's one thing you've learned from the course, and my favorite thing they tell me is that they've learned that they need to be more active wow, and that's it.
Speaker 2:That's like one of one one of my favorite thing that they tell me you know there's all the other bits that they obviously should learn about the actual you know theoretical bits. But if you can be more active as an individual, there are obviously lots of benefits to that which we'll talk about. But you are also more likely to promote physical activity to your patients if you're more active yourself.
Speaker 1:That's very interesting, and it's.
Speaker 1:I might get in trouble for saying this, but it's almost a criticism that I have, not only of physio but I guess to a degree of health, of medicine, of everything is that people aren't, and we'll discuss it, we'll bring it up, we hit it in the true and false. It's probably not promoted enough. Has it shifted significantly in the last 10 years? Absolutely, and I'm sure you probably have a better understanding of the hard data as to that promotive side and then, more important, the adherence from it. But you know my brother's in he's just finished med school and him telling me what they learnt through medicine. He did an undergrad in ex-phys and did his honors in that and then went into medicine.
Speaker 1:They don't touch it, they don't really talk about exercise, they don't talk about nutrition, they don't have time. It's so much content to learn, yet at the same time you kind of want to walk the walk as the practitioner. And how much of a role do you think? I don't know. Maybe there is research you can speak to Does a healthy therapist a healthy practitioner in terms of they present that way and they live that way? How much does it have an influence on, maybe, the decision-making of the subject, the patient in that case, if we have anything there?
Speaker 2:Yeah, sure. So any therapist, any health professional can have a positive influence from the perspective of health behaviours. It's just that we know you are more likely to promote it if you participate yourself, which?
Speaker 2:is likely because you are more comfortable, you're more confident, you know, in prescribing or promoting, you know that kind of behaviour. So even if they don't which they should participate themselves you are just simply more likely to. Time is the biggest barrier that we hear. You know, when I talk to health professionals, I very, very rarely have to convince them that physical activity is good for their patients.
Speaker 1:That's not the barrier here, okay.
Speaker 2:I almost can't recollect any conversation where I've had a health professional fight me on that point. The point is then is it within my scope of practice? And I don't have time for it.
Speaker 1:In the appointment side of things, or they don't have time in their life.
Speaker 2:I don't talk to them about their physical activity Okay good. I probably should and will eventually add that as an intervention, but my one of the things I'm focusing on right now is trying to effectively change the health professionals behavior for promoting physical activity. One of those avenues could be improving their physical activity, but that's really hard.
Speaker 1:That's really hard.
Speaker 2:Oh, I like to tackle hard things, but you don't have to convince them it's good for people. The barrier is time, and is it within my scope of practice? Is that my responsibility to do? And then it's the confidence around. What do I do if I do have?
Speaker 1:time, promote it and have time.
Speaker 2:And it's very easy for health professionals that are not exercise specialists, so not physios, not EPs, not that kind of group that I would class as those that feel very comfortable with exercise. It's not only their role. And it's very easy for all of the other health professions to say isn't that what EP do? Isn't that what physio do?
Speaker 1:Yeah.
Speaker 2:When in fact it's actually not EP physio's primary scope of practice either physical activity, and this is why the distinction between therapeutic exercise prescription and physical activity promotion is really important to maintain.
Speaker 1:Yeah.
Speaker 2:So it is every health professional's responsibility to promote health.
Speaker 1:Yep, yep, yep, and physical activity being one of the main things.
Speaker 2:Thank you, yes, I couldn't have said it better myself, but it goes broader than that. It is about health promotion, and physical activity is one of the best buys that you can do For the layman.
Speaker 1:How do you define physical activity?
Speaker 2:So physical activity, according to a Casperson definition, which is very old, is any movement, you know, skeletal muscle movement that produces energy expenditure.
Speaker 1:Brilliant.
Speaker 2:It's a bit simple.
Speaker 1:It sounds simple and it sounds. You know it's a bit simple. And I remember the same Mac the Mac guy said it's a bit simple. It sounds simple and it sounds. You know it's a bit simple.
Speaker 2:Yeah, and I remember the same Mac. The Mac guy said I hate this definition. If I ever see this again, I'm going to. So it's with a little another asterisk that I say that definition. But according to physical activity guidelines, movement that makes you huff and puff, so you can still talk, but you can't sing as a example, which is moderate intensity exercise. That's the threshold that we would consider physical activity and above okay.
Speaker 1:And then from a dosage perspective because that's variable you could go to the gym, lift weights and maybe intermittently be in a state of that, and then in and out over the hour you might play touch footy very big australian kind of thing, a state of that and then in and out over the hour you might play touch footy very big Australian kind of thing. A lot of people do that. You might go for your run, you might go for a walk. Dosage we've obviously got the health guidelines. What does that look like right now? And then, secondly, do you agree with it and does that need to change?
Speaker 2:Yep, so I fully agree with our physical activity guidelines. So we say that as we our research, I guess, has contributed. We recommend that people participate in at least 30 minutes of moderate intensity exercise per week per day, which is 150 minutes per week. Per week per day, which is 150 minutes per week, and the current guidelines say between 150 and 300 minutes per week, which is the up to an hour a day. Critically, they also include strength training guidelines.
Speaker 2:So, three times a week for strength training, in addition to those cardiovascular prescriptions. And we kind of call the strength guidelines the forgotten guidelines in lots of conversations, because people will promote the cardiovascular element of it, which is the 150 minutes or 30 minutes a day, but they'll often forget mentioning the strength part. The bit, though, that I agree with, especially as a health professional, very strongly, is that there are some qualifying statements under those numbers, and those qualifying statements say things like doing something is better than doing nothing, and to start doing whatever you can do and gradually improve. So any physical activity that you can do, even if it's below the threshold of that moderate intensity, will be giving you some kind of benefit Critically important at intensity will be giving you some kind of benefit.
Speaker 1:Critically important.
Speaker 2:Critically important.
Speaker 1:And it's so funny because I'm on the other end of the spectrum, I live in a bubble and everyone I interact with is active, and so I can't even fathom people that struggle with it. And then, every now and again, they might, you know, drip into here and they're busy, they have lifestyles, they have all sorts of stuff, and I will still say the same thing. I'm like don't compare yourself to me, don't compare yourself to an elite athlete and go oh, I can't. The worst part is, most of the fitness industry promotes it in a way that you should, and in doing so, it probably makes the consumer or the average person that feels almost so defeatist about themselves and going well, I'm not doing an hour, I can't go for a run, it hurts, I've got a bad knee, bad back, and they do nothing as opposed to what you're saying Just something and it becomes inaccessible.
Speaker 2:You know I can't go from zero to what you're doing and you, you know, are able to do all those things, and if you then try, it feels really shit.
Speaker 1:Can I say that yeah?
Speaker 2:It feels really shit right.
Speaker 2:So if someone goes from zero to a high intensity circuit class, my goodness, they're not going to be able to move for three, four days from DOMS alone, let alone. You know the feeling of being in a class where you don't feel confident and you know all of those run on things, and so what you see over time is maybe these kind of doubles and then the drop off, and then there'll be a period of time where you kind of get over that awful experience and then dabble when, if you compare that to a slow increase, where it's like, okay, my goal will maybe be come to one class per week and then on two other days I might go for a walk, and I'll do that for four weeks and then re-evaluate maybe add another class.
Speaker 2:Maybe add a strength training class on top of that you know. So it's the do something instead of doing nothing is, and do it gradually and build up rather than kind of. You'll see this term, you know boom, bust like boom and go hard and go. January is a perfect time for that We've seen it all, yeah. Oh, that's right. I was in their bars in December and now they're in my gyms in January.
Speaker 1:It's too funny, yeah. So you say strength training kind of slips under the radar contextually in that adherence, I guess, the sort of physical activity guidelines. Do you think that's because of maybe the evidence isn't quite as up to speed? I mean, it's pretty convincing, it's pretty good now. Or do you think there's potentially so much associated risk? Oh, absolutely.
Speaker 2:It's purely marketing, I think. I think it's purely that the guidelines talk about physical activity. Physical activity, people think about huff and puff exercise. The recommendations around the 150 minutes per week are probably easier to the first thing that people recall, not that they're easier than three times a week strength training but I just think it's the way that it's promoted per se.
Speaker 2:There is unequivocal evidence of the health benefits of strength training. There is unequivocal evidence of the health benefits of strength training. Perhaps it requires some more skill, depending on how you may set it up. I mean body weight. I don't really truly believe with that statement, but perhaps it's perceived as needing more skill or more equipment. So physical activity or cardiovascular exercise. You can go for a walk.
Speaker 1:Barriers of entry are low, exactly. Whereas strength training may be a little bit harder activity or cardiovascular exercise, you can go for a walk. Barriers of entry are low, exactly.
Speaker 2:Whereas strength training may be a little bit harder. I think there are also misconceptions about what strength training might do to you. You know, do it three times a week for four weeks and you'll end up.
Speaker 1:Massive, massive.
Speaker 2:I can guarantee you do it three times a week and you do not end up massive.
Speaker 1:I've been going for 15 years and I'm still waiting.
Speaker 2:That's right. So you know, good on you if that happens to you. But you know it's not going to happen, so there are just maybe some myths around it.
Speaker 1:And to an extent, I think, from an industry perspective one, the barrier of entry, I think, is the biggest sort of indicator. You can jump in a pool and go for a swim, you can go for a swim, you can go for a walk, you can ride a bike. Cardiovascular stimulus done, tick that box. And then I still think, from a fitness industry side of things, strength training is big guys in singlets and muscles and grunting and iron and it's very intimidating. It has evolved. I think the speed with which it's evolved in the last two or three years has been unbelievable. We have a fit over 50s class here at 10 am every single day. It's now at capacity, pretty much like we need to put more sessions on because everyone from the age of mid-50s onward is like need to lift weights.
Speaker 2:It makes my heart so happy.
Speaker 1:And again, I live in a bubble of you know.
Speaker 2:You do. But hey, at least they're doing it, they're doing it and they're interested in it.
Speaker 1:And you know somewhere, somehow health promotion contextually is landing, but I think we still as an industry, from a fitness industry side of things, lack quality in terms of accessible practitioners that are going to teach you how to do it well, safely and sustainably. And I say teach, not just train.
Speaker 2:Yeah.
Speaker 1:I think we're getting there Exercise physiology, exercise strength conditioning it's becoming accessible to the masses, which is really, really important. You know, I even look at and I'm saying this in the Australian market and you might be able to advise otherwise, but I think the Australian market, from access to high quality exercise, science-based practitioners, is probably the best in the world. I look outside of it lifestyle-wise. I've been to the States, I've looked at that. It's the amazing S&C coaches but they're all in elite sport because there's access to so much resource there and revenue and careers can be set up as an exercise professional.
Speaker 2:Yeah, and I mean Australia is one of the leading kind of places for the scope of practice around exercise physiology, but also around physio too. And so one thing that I've learnt just very recently around I knew somewhere in America, for example, physios don't have first contact practitioner rights. I also just learnt in Germany last year they have even less scope of practice and they actually have the prescription by a doctor that the physios then have to just teach. There's no decision-making around the actual content.
Speaker 1:Wow.
Speaker 2:So the doctor says you've got rotator cuff X physio prescribed this, that it just is quite varied, but I think in Australia we have a very strong exercise specialist profession and set of professions that are reasonably accessible for people with the resources to do so, and I do want to include personal trainers in the discussion too, because not everyone can only receive classes and training and things from EPs, physios. There is a huge amount of people who are engaging in grassroots sport coaches, pts, running any number of classes, probably right as we speak who all play a really important role in being able to help people access opportunities to participate in physical activity.
Speaker 1:I want to get into that a bit more but before we do, if we were to sort of consider the practitioners and the scope, as you just mentioned, of physiotherapists exercise physiologists, exercise scientists to a certain extent, what would you want to see improve from a, I guess, educational perspective and potentially a scope for lack of a better term perspective?
Speaker 2:Sure, so just exercise specialists.
Speaker 1:Yes, so let's go. Physio, ex-phys, you know, tertiary education.
Speaker 2:Yeah, so yeah, we do therapeutic exercise prescription as bread and butter right. So someone comes in with a problem.
Speaker 1:Prescribed Something, something.
Speaker 2:And then we will prescribe some kind of exercise, usually to be able to address that impairment right. That in itself is behaviour change, because you are asking someone to do something that they didn't do before. So skills around behaviour change are going to be really important, transferable skills to almost anything we do as health professionals, and so there are things that exercise specialists, health professionals, can do to optimise the chance that the person will actually carry that out. And one of the things that I I don't have to duck, but one of the things I love, is when I say oh hey, that exercise program didn't work. What did you do? When they came back and said they didn't do the exercise program, I gave them another home exercise program.
Speaker 1:Wow, yeah.
Speaker 2:Also guilty of it myself when I was working as a physio and it's not until I opened kind of my eyes and understanding of behaviour change science that you kind of know, hey, we actually maybe utilise intelligently guessing here, you know, 1% to 5% of the available behaviour change strategies and there is a whole heap of things that we can do and do differently and tailor to individuals that will help us actually increase the chance that they will actually do that. Because to me the dose response bit is pretty boring. We know if they do it they're going to get better. Right, it's the challenges actually in the doing.
Speaker 2:So, exactly, and so for me that's the sticky bit around the science and the learning is how do we actually bridge that gap between knowing what's going to be good for someone and actually supporting them to be able to do that, and do it over time? So behaviour change skills, yeah.
Speaker 1:And then how much? I mean, obviously that's heavily psychological, yeah.
Speaker 2:And then you know.
Speaker 1:Do students need to? Is that something that maybe could be explored? Do students have a better understanding psychologically of just you know? Do students need to? Is that something that maybe could be explored? Do students have a better understanding psychologically of just you know what we can know research-wise?
Speaker 2:A lot of students in health and exercise specialists will do a foundation psych course, but it's very, very broad.
Speaker 1:Because I mean, we did one and I was like, I'm seeing it, I'm not learning much. It was exactly that broad.
Speaker 2:Yeah, and so if, instead, that psych aspect of it could be applied to something like adherence and things, perhaps that may be more contextually relevant. Okay, there's also the way that we have those conversations. So I mentioned motivational interviewing before. There is a truckload of evidence on the fact that motivational interviewing works. It's around having open conversations being led by the patient and meeting them where they're at. It fits so nicely with patient-centered care that we do as bread and butter but, there is skill in motivational interviewing.
Speaker 2:So if you pair motivational interviewing, which is the way we communicate with people, with behaviour change techniques, which are the active ingredients of how we support behaviour change, you have a winning combination, in my humble opinion, and then you can use all that for good and not evil. And it can be for therapeutic exercise, it can be for physical activity promotion, it can, yeah.
Speaker 1:And so it goes. Yeah, really interesting. I mean, we're on the coalface here. You know, we in what we've sort of developed, I suppose, is physiotherapy, is often a trustworthy barrier of entry for someone that is in pain, be it back, be it knee, be it shoulder, whatever the issue is. They go to physio and then, whilst they're getting treated, they can look out onto the gym floor and see it.
Speaker 1:It's all those sort of behavioral change influential things and we encourage them. Come in tomorrow and do your rehab. This is the S&C coach. He has the EP, he'll be here, he'll be able to guide you through it and it's sort of opening that eye to, I guess, the consumer and giving them access to that and realizing that it is one and it's, you know, worth trusting. But you know, we're lucky, we're small and we've seen it, and we can be dynamic in terms of how we develop the program and then, therefore, the experience for the consumer.
Speaker 2:Yeah, and the entry point you know may be care right and treatment of impairment. You know that may be preventing people from doing something they want to do. That's not physical activity, but it's likely then also preventing them from doing physical activity right. So their goal may not be physical activity. Equally, there might be a participation element there as well for physical activity. But a credible source is a behaviour change technique. Receiving information from a credible source in and of itself is an actual, proper, evidence-based technique.
Speaker 1:Okay, and then how would one? I guess, what does the consumer? If you will decide, is a credible source. Ha-ha, is that up to the individual.
Speaker 2:It is certainly up to the individual, because I would you know for me that's a health professional, someone who's trained in the thing that you're getting information about People. This is a broad statement, but people would expect health professionals to be trustworthy around sources of information around health, which includes health promotion.
Speaker 1:Yes.
Speaker 2:Patients expect to be talked to about health promoting behaviours. The evidence has shown that they don't receive that often.
Speaker 1:Interesting, yeah, okay, other major behavioural change techniques, if you will, influential things.
Speaker 2:So we can code home exercise programs. So it's not that they are not a behavior change technique, you know. So you're modeling the behavior, which is a technique. You are giving them the chance to practice that. When you say, hey, can you show me what that looks like here before you go home, you know that is a behaviour change technique. You know, actually setting a goal of the prescription itself, you know I want you to do these exercises this many times per week, that is a goal and a goal setting is a behaviour change technique. And this is why I get so excited when I think about the potential that health professionals have, because behaviour change science if you can just kind of put that flavour on top of what we do every day, we are so ideally placed to do it. There are so many things that we do already that if we tweaked a little or optimised a little would be awesome. And not only awesome, but the ability to then have discretion around when you apply them, so they're not blanket things that everybody gets everything right.
Speaker 2:So you know social support is a behavior change technique for physical activity. If I go speak to a runner, I'm not going to flavor my discussion around social support right. Flavor my discussion around social support right. Like these are people who generally like their own company, that are very internally motivated, whereas me, I am a crowd exerciser. Okay, full, I get me a crowd. I will exercise with the crowd. As I've gotten a little older, a little busier, a little more stressed, I do like crowds that have a defined space of my own, like spin class.
Speaker 2:No one can touch me, but I'm still in a crowd, so social support is really important to me. If you tell me to go run, I don't like being no headphones listen to your own thoughts. Oh, that is terrifying. I hate the idea, and so this is the idea of individualizing the way that we support people to change their behavior and that behavior being, in this conversation, physical activity. No one size fits all.
Speaker 1:Absolutely, and having that sort of variability it's really interesting. I mean, it's obviously the social elements more influential and maybe more important to a lot more people than I think one might think of themself. We've built a business off the back of it, you know, and most of our industry has moved to a lot more people than I think one might think of themself.
Speaker 1:We've built a business off the back of it, you know, and most of our industry has moved to a group fitness type model and the traditional old big gym put your headphones on and train yourself has struggled and is struggling as we speak. So a lot of the big brands are moving in that direction, group sort of something's offered. I mean, look at run clubs in the last two years They've just gone crazy, particularly for the younger generation. But you know, finding older generations, they're no different I was gonna say physiology has no like difference.
Speaker 2:I was gonna say I still don't run, even if there's a social run club. But then you said it's the younger generation, so I was like I put myself in this hole but it's, it's you know, just the behavior change.
Speaker 1:It's just really interesting. And and then mean we've had members say it to us so many times came for the program, stayed for the people and you go. Oh, that's right, and it's all those little layers Psychologically. I think there's some members call it trauma bonding when they do hard sessions with other people. I'm like you'll be selective about that language, but we'll take it.
Speaker 2:Theoretically, here are some words you could use social identity exactly, and also group identification and um, and that the sense of belonging is just so critical, and I think what we're seeing here is an intersection of an increase in accessibility and, I think, increased awareness, particularly in our bubbles. We've talked about the fact that we are privileged to exist in places where this is valued, but we're seeing an intersection between that and loneliness, and I think that physical activity or loneliness, social isolation, you know feeling, you know tech is great, but it also means people work from home, you know so the only time people might be with other people might be their exercise session, you know so people are looking for ways to create a social identity and a sense of belonging to a group that exists beyond, perhaps, ways that they had before. We had the asterisk, major disruption into the way we live and work the way we live and work.
Speaker 1:We have to live. Yeah, very interesting, because it's sort of this conundrum that I think at least speaking as a reasonably young person, of maybe the information age, social media being informative media a lot of young people are much more healthier and they want to be, and there's evidence pointing to less drinking of alcohol, all these sorts of things. At one point in time that was the social behavior finish work, go to the pub and interact. And it's now turning into the modern day finish work, go for a run the run club or before work, we're going to go do that and that's sort of how that's evolving from a, I guess internet, social media influence behavior change, positive, negative. It seems more extreme. A lot of people are a lot more healthier because they're much more informed, but then a lot of people are a lot more lonelier. So how much do we know about that?
Speaker 2:if, if anything, it's such a tricky thing, social media tech. It gets a lot of bad rap around, you know, consuming our time and not being productive and all those sorts of things. But there are pockets of communities that have found connection and a sense of belonging that we were just talking about online, that they've never been able to find anywhere else before, because it transcends geographical locations. It, you know all, transcends the need to be physically out in public, you know so.
Speaker 2:Think of lgbtqia plus populations, for example, and particularly trans communities. You know people are finding ways to connect using social media. That's so important for their mental health and sense of belonging, and you know those sorts of things. So I think we always need to balance off the social media with the the positive and the negative benefits as you said.
Speaker 1:It's one of those irritating academic answers, sorry but no, no, I'm with you being used for good and not evil absolutely, and I think the other side of it is, and we see it again in our beautiful little bubble of everyone likes to be active.
Speaker 2:Exactly.
Speaker 1:We see people are way more informed. You know, a few weeks ago I had the owner of Pillar Performance on the podcast and he said you can't go to a barbecue now without talking about all-cause mortality. And he's like where is this language?
Speaker 2:coming from? What barbecues is he going to? Can I get an invitation?
Speaker 1:Yeah, you'd be the star of the show, but people are more aware generally and that sort of moves to. I guess tech and tech's influence both behavior change-wise, physical activity-wise, rehab-wise. It's probably what you're touching a lot of, given that you're doing the physio side, micro level, macro level, behavior change and seeing all that. Um, let's go wearables first. How has that evolved? What's the evidence around behavior change, and then, I guess, people, what they're getting out of it, and then pros and cons maybe yeah, sure.
Speaker 2:So I may just take this opportunity to elaborate on my true false answer. Yes, perfect as a start. Um, you asked whether activity trackers are a gold standard measure of being able to measure physical activity. Um, the closer the variable is to the actual thing that's being measured, the more accurate they are. So for things like heart rate, where you've got a, you know there's minimum tweaking, massaging algorithms, right, you know. So you've got your sensor on your device and you get this. You know there's very little that happens to that information before it shows up on your watch, right? Steps, also very simple. So it looks for the pattern of an arm swing and it will count that as a step. It's very minimal massaging Things like energy expenditure or may as well be a random number generator.
Speaker 1:Wow.
Speaker 2:But it's consistently random.
Speaker 1:Interesting. So we're talking calories burned today.
Speaker 2:Exactly so. If, for example, I do almost the same thing all the time, but I track it every time, and for a 45-minute spin class, the estimate of my calorie expenditure when you have a consistent effort, you know is very, very close. So it will consistently come up with about the same number, and so I can know that oh hey, you had a bit of a slight class that one.
Speaker 2:Or you know, or hey, that was hard, that felt hard and I can see that that was harder. However, the accuracy of the absolute number leaves a lot to be desired and has a lot of different influences. And so the device you know you can put in your body weight, you can put in your height, it'll know your heart rate intensity at the time. It tracks a lot of this information, but we don't actually know how the companies determine energy expenditure. Interesting those algorithms are their proprietary products and so I have tried. I can guarantee you they won't give them to you.
Speaker 2:So we did a study where we had four different activity trackers. We put them through their paces, measured a whole heap of things and then looked at the validity of them. One of them was the Apple Watch, and we published that paper and I had Apple contact me and say, hey, could you rerun that study? Because you put it on like other, which was the available thing at the time, and did a full, like mixed workout, right, and did other, and then you compared those values. They said, actually, we want you to do it again, but we want you to put it on cycling for cycling and this for this. And I said well, I understand what you're saying. However, that's not how people use it in practice. They're not going to do a 10 minute warm-up on the bike and then end their watch, go over and put it onto, you know, and so we wanted it to be, wanted the findings to be reflective of how people would use those data, then one of the other ones that so clearly the activity type is part of their algorithm.
Speaker 1:That's what I deduced from that.
Speaker 2:So they use some known variables around different activity types that's all published in the literature to be able to determine energy expenditure of that given activity. To be able to determine energy expenditure of that given activity One of the others I was diligently testing it and I was trying to fix, I was trying to work out something on it. Someone said it wasn't working or something didn't work on it and I had turned it on. I was wearing it and then I took it off and put it on my desk and it was meant to be cycling or meant you know whatever the activity type was, and I just saw it tick over the same number of calories every 15 seconds, and so that device was using none of the directly measured variables.
Speaker 2:Wow, so if you did the same time in that activity, you would get the exact same number of calories every time. And so I think there's an assumption that because they measure all of these things, all of that feeds into all the variables. So use with caution things like energy expenditure. Use with caution anything that you tangibly don't know exists, like, for example, strain yeah. What is strain? Yeah, I can't validate strain because I don't actually know what strain is.
Speaker 1:Yeah.
Speaker 2:You know. So we're a bit limited with hey, we can't actually say what, whether that variable is accurate or not. There's a bit of a pub test, you know. Does it match with how I'm feeling? Does it track with how I'm feeling? Is it useful for you to monitor those things over time? Then great, use it. I'm not saying don't, but just kind of take it with a bit of caution. The further you get from things that are very tangible and close to the thing that's actually being measured, we're very confident in the better.
Speaker 2:Gets a bit wobbly on the other end.
Speaker 1:Very interesting. I actually just read a weekly email and I sent one out, just sort of talking about tech and where it's at and how it's influencing our industry. And you know, at the end of the day, no one's designed anything that's given us the results that exercise can, and you have to do exercise, and the day we do, we'll be robots Like. I don't see us ever being able to get the benefits. There's no pill, there's no machine, there's no nothing.
Speaker 1:The one that I think I like the most personally for my own training is just data collection, and I made the point. Collecting data day to day is very unsexy, it's very boring, it's righteous. What sin? Okay, I'm saying this to a researcher. Yeah, exactly the average person. But you know, I've got spreadsheets of every session, every rep, every set that I've done and I've written it, written it, written it. But now it's five years old or it's probably ten years old now, and I can do a big graph and talk about how I've been at my strongest, what reps and sets I was doing, and then how that changed and suddenly it's very beautiful and I can actually tell this story.
Speaker 1:The wearables and then the tech influence is giving us more information to be able to tell that story and observe that story about ourselves In terms of people interacting with it. As you've said, energy expenditure as an example. People beat themselves up about calories they've burned that day. I need to go for it. I need to do this.
Speaker 2:Or that person burned more than I did, that's my personal issue with that.
Speaker 1:So, in terms of people interacting with it tech, wearable tech, particularly in general, I guess one of the major things you would suggest recommend to people in terms of short-term you've mentioned that what's close heart rate, those things are accurate. Long term, like longitudinally, how do people, what should people look at from a wearable?
Speaker 2:Sure, so this is going to oversimplify it, but if it works for you, it's the right thing for you, but also, if it doesn't, it doesn't mean you're not doing it right. Is the right thing for you? Um, and one of the. But also, if it doesn't, it doesn't mean you're not doing it right okay it's the flip side of this.
Speaker 2:You know, and I think you know, I I wear an apple watch, but the primary reason I wear an apple watch is because it helps me check things like my calendar and comms on the run. It's actually not because it's the best activity tracker. You know, I somewhat compulsively also track my exercise, you know, and I keep an eye on the. You know meeting, the rings and you know all that sort of stuff. But it won't make me go and do something at the end of the day, like so it's nice to monitor, but for me it's not a behaviour change kind of thing.
Speaker 1:Interesting.
Speaker 2:I have forgotten the question.
Speaker 1:No, no, that's right. It's more what do people look at?
Speaker 2:You got me on a tangent and then I was like oh yes, what are they? And the story I wanted to tell you about this, the first thing that came to mind. So I mentioned I do time use research and that I did a lot of it in the kind of few years ago. And part of collecting time use data is ringing someone and talking them through their whole day, and so we get more accurate measures of physical activity, because people are recalling everything rather than us saying to you so in the past week, how many times did you do at least 30 minutes of half a minute? So we collect everything. We say what's the first thing you did when you woke up? What did you do next? What did you do next? What did you do next?
Speaker 2:And I was talking to this lady who was in one of our trials and she said and so next I went out for a walk. I said okay, how long did you walk for? And she said I walked for 7,000 steps. And because I couldn't help myself, I said, oh, how do you measure that? And she said I count them. Wow, and she's like I've got a system. I, this is, she was an older adult. I got a system. I, you know, I count multiples of something. And then I collect up the multiples and for her, yeah, I was like hey, do you know what? That's amazing and it also has cognitive benefits, because it's a cognitive task on top of being physically active. And I was just blown away and I will never forget that moment as a reminder of the fact that wearable activity trackers are just not the panacea.
Speaker 2:That we may have thought they would have been and that actually this is. You know, there are lots of ways to um to get to the outcome and if an activity tracker is part of it and it helps go for your life, but you don't have to have one.
Speaker 1:Absolutely. That's very interesting. I mean, geez, my brain goes to the meditative side of that type of practice.
Speaker 2:Exactly.
Speaker 1:We do Concentrating.
Speaker 1:We do all sorts of classes and all sorts of stuff. But one of the big things I'll challenge people to do after a session, after a class, is count your breaths and slow your breath down and do three in and five out but see if you can do ten without getting distracted. That's like neurologically very challenging but in doing so it sort of builds those layers of concentration and focus et cetera. So yeah, that's fascinating In terms of the evidence we're starting to develop from a wearable perspective.
Speaker 1:You know you've had the luxury, if you will, of doing a wearable perspective. You know you've had the luxury, if you will, of doing a randomized controlled trial, study-wise, which is obviously the premier grade, top level evidence that we can get. Exercise is obviously much harder to do RCTs in that control group. You're not squatting, you guys are squatting. They're going to know. You know and it's like so we can't really execute that we're getting this longitudinal data from wearables and that sort of thing. Where do you think the evidence is going to go and sort of point towards? And I guess, from a research perspective, what are researchers looking at, trusting and maybe framing in terms of?
Speaker 2:So if we kind of bucket this as e-health, right. So e-health includes these devices, it includes apps, it also includes things like text messages, phone calls, you know. So it's anything that utilizes the internet, you know, and transcends distance, basically. So e-health is kind of is broader than what people would mostly assume, I think you know, and so we've done some trials around text messaging, prompts and various bits and pieces which are no different to pushing through notifications, that sort of stuff Harder to turn off though. So we really got very excited in physical activity when these kinds of devices became accessible, right, and these kinds of you know and tech started to infiltrate our world.
Speaker 2:There are clear benefits that tech provide, notwithstanding the fact that they you know the geographical reach of these kind of you know, these kind of opportunities are unrivaled. You know we talk a lot about reaching people that don't have access to equipment and people and resources, and tech clearly does that. Ehealth clearly does that. You know it can be very low cost, you know. Free apps free. You know my current role is co-funded by Health and Wellbeing Queensland. Health and Wellbeing Queensland have a whole website full of different exercises you can do at home, you know that's for free, if you can have the internet connection.
Speaker 2:We really got so excited. But we now have, you know, at least 10 years of research looking at these devices and again, blank number of years ago I started. So I've had kind of the whole journey, you know, and they're just as good as anything else in the short term on a group level. Yeah Right, we are very bad researchers in our field, but also others at looking at whether it's maintained over time, and it's a function of how we do research. Often there is not money for long-term follow-up. There isn't, you know. So there is not a lot of long-term data available around long-term maintenance and the available data shows us that it's not effective. Almost nothing we do is effective. Long-term, sustained participation is just one of the hardest nuts to crack for us.
Speaker 2:And it's an ongoing challenge. So, in answer to your question, the effectiveness is acceptable as much as anything else. It's not any better in any kind of age cohort. It's not any better in any kind of age cohort, you know. So you know you might. We could probably make assumptions around young people being more likely to adopt these things, but in fact there's quite a lot of evidence around older people as well. The effectiveness is generally similar. The patterns are similar in terms of we don't know a lot about maintenance. If it is there, it's poor. The thing that I always like to throw into a conversation about tech is the digital divide, and we live in these very privileged bubbles you know, and literally we, you and I we live in very privileged bubbles and tech has the ability to only make that digital divide worse.
Speaker 2:So if you say, who does e-health benefit the most, to quote Wendy Brown, the healthy, wealthy, wise, most likely Wow. So those who have the financial resources to buy the tech, the health literacy to be able to know, to engage in it, to interpret the data, to track the data, you know and they're probably already- a little bit healthy, right, and they're leaning on practitioners that then can infer the data and help them guide decisions.
Speaker 1:Yeah, because they've got money to be able to access to it.
Speaker 2:Exactly, and so you know the thing that tech does is that you don't have to go very far outside of. You know central Brisbane to be where you can't actually get a stable internet connection, or you've. You know it's low socioeconomic status where having a internet you know subscription for your house is actually a luxury, you know. And so I think we just always have to be so careful when we talk about tech being a solution, that it's not only benefiting those who already have other privileges as well.
Speaker 1:Yeah.
Speaker 2:And yeah, I read, I just recently saw that tech. If we look at patterns of effectiveness, there is no age group that it benefits more. It benefits men more than women, so men have a higher level of effectiveness. There is no age group that it benefits more. It benefits men more than women. So men have a higher level of effectiveness than women, which may play out in your story. Cause I was like, oh, you've got data, and then you're like I've got five years of strength data, so I'm tapped out here.
Speaker 1:That's right. So you know.
Speaker 2:I checked out already on the data, like out already on the data like oh, no, um, and there is no information on whether or not, though, there are those patterns with ses and health literacy, mostly because we can't even do interventions with, we don't attract people to participate. So I guess, yeah, just that little word of caution that it there's a bias in the effectiveness of of tech. It's great, works well, works really well for the right people.
Speaker 1:Yeah, yeah, yeah, okay, interesting, and I mean it's one of those. I remember speaking to Eliza Freeney, who's a high-performance dietitian. She was on the podcast and she did some time in Samoa, just in rugby programs, and she just remembered looking around and realizing the privilege of Australia. And you know they've got one of the biggest problems is cardiovascular disease and diabetes because fast food has moved in and they've had this major lifestyle change. It's affordable, it's accessible, and they don't have physical activity guidelines, they don't have access to internet and tech and all the wonderful things that we wander around with and think everybody's doing this.
Speaker 1:That's right yeah we're wandering in this special bubble.
Speaker 2:And still just over half are inactive. Remember.
Speaker 1:Yeah so resources.
Speaker 2:You know it's the old, build it, they will come idea that's not quite real.
Speaker 1:Yeah, and it's interesting and okay. So then, looping all of this back into physiotherapy Sure, they get presented, the average physio gets presented with a patient and you know, I think Australia, probably more than anywhere, you can comment much more than me is about the physical activity element from a physio perspective. And, as you're saying, there's the actual therapeutic exercise prescription. How have you seen it evolve in your career and even you know knowing about it now as a as an educator from physio used to be treat my shoulder it's sore, and then I walk out and then they started giving exercises. Now it's like the shoulder treatment's not going to last for the average person. Why has that changed? Last For the average person, why has that changed? What has the evidence done? And why is that? I go to the physio and they hardly touch me. They give me exercises. How come?
Speaker 2:I'm just going to the therapeutic exercise. I would challenge you that physio and EP have physical activity as part of their bread and butter right now.
Speaker 1:Yes.
Speaker 2:So I think that exercise has certainly taken up more space in consultations, I think, than ever before. I think in our profession, hands-on therapy still has absolutely a role to play, but you will often be prescribed some kind of exercise as well. Doing it, that's hard.
Speaker 1:Yes, yeah, and does the evidence point to that now more so? No, I don't think so. Okay, interesting.
Speaker 2:If you do it you will get better outcomes. But the physio research has been very much centred in dose response. If I have a group of people that do exactly as prescribed, does this work as a therapeutic treatment? Trying to force force, trying to encourage gently sometimes not so gently, trying to encourage even professions that are seen as exercise specialists to include physical activity, is even a struggle, because is that, even within my role, right, like if, if someone comes to see you, do you do a measure of their physical activity?
Speaker 2:as a physio or a ep, like, do you ask them about their yeah, like habitual physical activity, like it might be if it's related to their shoulder, as you said, maybe they will ask God, you know what do you do with your arm and how often do you do it and things, but it's not an overarching. Hey, what does your physical activity look like over a week? It's not standard practice and it's almost like the physical activity promotion bit is beyond.
Speaker 2:It is under the scope of an exercise specialist okay, that's interesting, I don't know if I've ever said that out loud before, and possibly on a podcast, is not the right time to say it for the first time, but you know, possibly, possibly that's the case.
Speaker 2:Right like promoting general physical activity yeah could be seen or felt as being under the scope or underutilizing the skills that we have. But all health professionals can even do something. It's like the physical activity guidelines Something is better than nothing. You don't have to give someone an entire physical activity program to give them an intervention on physical activity. We know measurement alone is an intervention, and quite a potent intervention. If you, as a health professional or an exercise specialist, dedicate five minutes to measuring physical activity, that says something.
Speaker 1:Okay.
Speaker 2:And if you follow it up and measure it again next time, that also says something. Follow it up and measure it again next time, that also says something you know and so, even without doing any education, that is communicating value importance. You know. Something as simple as including a measure of the behavior in your consultation is a behavior change technique absolutely then then you can also do something as simple as referring.
Speaker 2:Yeah, you know. So we talk about medical professions. They need to understand it's important, but then maybe their scope of practice is a brief intervention that goes, hey, I've measured it, it's not great. Maybe more nuance than that, don't quote me on that as a communication strategy. And goes, hey, you know, physical activity is really good for you, you could go to. If you, I can refer you to an EP and they can help set a program. They can, you know, do this or that. So maybe, or you know, oh, I'd love to be more active, but this knee's been really bothering me. So, hey, I can refer you to a physio.
Speaker 1:Some guided.
Speaker 2:That's right, and so even a referral can be a physical activity intervention, but it requires the whole health care. This is this is why I'm not sticking with physio, as you keep directing me to, but it requires the whole system yeah because if you get a doctor who says, hey, physical activity is good for you, I've measured it, it's lower than it should be and you could really get a lot of good out of this for everything yeah, yeah.
Speaker 2:They refer you to a physio. The physio treats what you were referred for and then doesn't pick up the conversation about physical activity. Missed opportunity, missed opportunity. So that's why I keep coming back to the system.
Speaker 1:Collective system.
Speaker 2:We all have to be singing from the same song sheet.
Speaker 1:Yeah, yeah, absolutely, because I think, for those listening to this, it has an influence on outcomes. Be it I'm going to the doctor for whatever health reason, I'm going to the therapist for whatever injury reason, it influences outcomes and the evidence points to that oh, it's absolutely unequivocal Like physical activity will make almost everything better.
Speaker 1:And you know it might sound ridiculous that sore shoulder will help if you go and walk regularly and it's sort of connecting the dots and practitioners now more than ever have an understanding of the biopsychosocial elements that contribute to pain, sickness and so forth. And I think the biggest thing that we see, and you know, in pursuit I went to high performance. I didn't even do ep, I went high performance sport and I hated the fact that we couldn't sorry just sorry, not clinical.
Speaker 1:I know it's controversial, but you only had two years. You only had two years to look after this athlete and I was like, well, let's get their technique right. Right and lifting Coach goes, mate, we're halfway through the season. I need them on the field. I don't have the time, I can't afford that. They don't care, they just don't have the time. So that's why I went into you know, the general pop stuff and why all the other layers. But in doing so, realising psychologically there's all the behavioural change things that are critical, in doing so realising there's a biochemical element, nutritionally, hormonally, what's going on? Realising there's the actual physics, the mechanics, the stuff that I love, that has an influence and is influenced by all those other three factors, and therefore a medical team, a health team that speaks to that, as you're saying, connects those dots.
Speaker 2:My dream, you know.
Speaker 2:Yes, let's lock in on this my dream is that every interaction you have with a healthcare professional you get physical activity. Health promotion Doesn't have to be long, doesn't have to be extensive, just some kind of reinforcement that, hey, physical activity is good for you, whether that's through measurement, whether that's through a check-in, anything, because the amount of benefit a little benefit across a large number of people is a huge impact. You know. So, if you can shift just a tiny little something, something over a large number of people, it's just unfathomable you know, and so you know a lot of people in the you know, especially in.
Speaker 2:You know medical or acute and things like that and we'll say, oh, you know, what about this profession and what about that profession? I'm like, yes, someone said, what about an ether test? I'm like, have you seen the predictors of? Like death during anesthetic, like physical activity is being physically fit, having high cardiovascular fitness, you will tolerate anesthetic much better. You know why shouldn't an etherhetist be someone who says, hey, like, how's your physical activity going? And I know that that statement, I prefaced it with the fact that it's a dream. I know that there are nuances. I'm an academic, got it, got it all the things. But that is my dream. That health promotion, and physical activity specifically, is so embedded into interactions with our healthcare system rather than something other than that. I think it can make a huge difference.
Speaker 1:Well, and it's not an opinion piece, it's an evidence-based piece.
Speaker 2:Yeah, I think because of unequivocal evidence that it will make an enormous difference.
Speaker 1:Yeah absolutely Well, sian. On that note, I think that's enough of a strong message for the listeners and those out there. But I think it's underestimated, as you're saying, and I want to reinforce it five minutes, ten minutes the amount of people that come and say I'm not an exerciser, or my husband I'd love to have me, but he's not an exerciser, and I'm like, oh, please, don't identify yourself as that. It's not that hard, it's just.
Speaker 2:I don't want you to think about it, just move a bit more.
Speaker 1:You have to sleep at night. You have to move your body.
Speaker 2:Yeah.
Speaker 1:And that's it. And that's been the case for our entire existence as a species, and we've slipped away from it for the last 20 to 40 years. Let's slip back into it and on we go.
Speaker 2:And do something, just something that makes you happy. So maybe this isn't the first step for him. No, but something.
Speaker 1:Something.
Speaker 2:Something is better than nothing, absolutely.
Speaker 1:Awesome. Well, sian, you're doing wonderful work and I think it's really nice to speak to someone that's looking at it on a macro scale. I'm in my bubble and I think a lot of people, practitioners-wise, are in their bubble around the healthy, fit people so to consider it on that level is really interesting and around the tech and the influence of the internet and how it's all evolving. I think it's a pretty exciting space. But yeah, out to those medical practitioners, hey, and not just medical practitioners, all health professionals.
Speaker 1:Health professionals, Just get people moving and all those people listening stay moving Please stay moving Awesome.
Speaker 2:Thank you very much. Cheers Bye. Thank you.