10. How to Scale Lifestyle Medicine | Sami Mansfield

Sami is a key player in the world of lifestyle medicine, especially when it comes to cancer care. She’s all about making exercise programs work for survivors, sharing her insights on how to implement these strategies effectively. Whether you’re a patient looking to get healthier or a provider looking to implement a #LifestyleMedicine program, Sami’s got the experience and knowledge to guide you!

Caner Wellness for Life
My LifeStyle Shift

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Timestamps
0:00 - Intro to Sami Mansfield and Cancer Wellness for Life
2:34 - Sami's start in exercise oncology
5:27 - Sami's personal cancer journey and shift
9:51 - Disconnect between evidence and implementation
14:41 - Raising awareness with patients and providers
18:29 - Sami's career shift to lifestyle medicine consulting
21:22 - Barriers for oncologists to prescribe exercise
26:54 - Implementing lifestyle programs in healthcare systems
34:23 - Paying for lifestyle interventions
44:38 - Sami's Shift program and virtual resources

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Transcript

Ep 10. How to Scale Lifestyle Medicine | Sami Mansfield

Transcript

0:00

you said people are hungry for a healthier life people are looking for it

0:06

but don't know how to do it and so there really there's this innate hunger of I

0:11

want to live a better life I want help in that way and I want it in a way that's going to be for

0:21

me more than 73% of Americans have overweight or obesity while more than 12% have food insecurity America is

0:28

getting heavier sick and more isolated from each other every day our motto

0:34

moveie give reflects our belief that virtually every problem in America could be fixed if we took better care of

0:39

ourselves and took better care of each other welcome to interrupt hunger movie give podcast where we talk with experts

0:45

in exercise is medicine food is medicine and food insecurity and understanding that knowledge isn't always enough to

0:52

help you lose weight every other episode showcases someone who's lost at least 10% body weight to share exactly how

0:58

they did it interrup hunger is a 501c3 nonprofit which helps you lose weight

1:03

while feeding the hungry bring our free 12we weight loss challenge and donate your weight program to the places you

1:09

live work and pray we fund our mission with sales from our movie give bracelets and clothing so please visit us at

1:15

interrupt hunger. org to show your support 50 meals are donated for every item sold to the nation's largest hunger

1:22

relief Network so you get to look good while feeling good now on to today's

1:27

episode hey everyone Jolly here with interrupt h today we've got Sammy Mansfield founder

1:33

of Cancer Wellness for life with us today is an organization dedicated to developing implementing and optimizing

1:40

exercise onthology and lifestyle mive programs and resources for hospitals

1:45

Healthcare organizations pharmaceutical companies nonprofits and individuals

1:51

impacted by cancer Sammy is contributed significantly to several State cancer

1:56

control plans emphasizing lifestyle exercise and obesity management strategies in cancer prevention Survivor

2:03

ship she's been busy over the last several years she's helped off ASCO American Society for unic oncology ASO

2:10

guidelines on exercise nutrition and weight management during active treatment and the exercise

2:16

recommendation for people with bone metastases Sami is involved in several International lifestyle medicine

2:22

organizations and is currently the chair for the cancer member interest group for the American College of Lifestyle

2:29

medicine and with that Sammy welcome to podcast thanks for joining us today

2:34

thank you well um thanks for having me and uh part of this mission that you're on it's fantastic to be here oh thanks

2:41

yeah I appreciate that we talked last week and um I actually wrote down something you said oh this might be a

2:47

good place to start so you said people are hungry for a healthier life and that

2:54

is so cool it just feels like it feels like a momentum is Shifting coming out of Co and and the you know the glp1 meds

3:02

people are talking about it more so I I think just the time is right for that it's interesting sort of these things

3:08

come out of your mouth and like I think I've been pondering that concept for a really long time not only just with

3:14

cancer survivors you know thinking about the patient perspective but working with medical and Health Care Professionals

3:20

and organizational professionals I think there's a lot of things changing in how we live our life um ourselves as well as

3:27

our community and we're prioritizing things in such a different fashion right now looking at what is quality of life I

3:35

think a lot of us are thinking about you know we we started this career track track we started a maybe a family track

3:41

whatever that is to achieve or chase a goal chase a goal and then we kind of take a pause and think what are we after

3:49

and what does that mean for us in our daily life and I think that there are so many strategies out there I mean you can

3:56

Google or find anything resources research whatever it is about like how to do the quick fix the this the that

4:03

you know to have your you know five breathing strategies in the moment and what I that tells me is people are

4:08

looking for it but don't know how to do it and so they're really there's this innate hunger of I want to live a better

4:15

life I want help in that way and I want it in a way that's going to be for me

4:20

not just for something that is very much about my social media or what I tell somebody you know randomly so I think

4:26

that the world is shifting a little bit um on ourselves in that way and I think

4:32

that um we have a lot of work to do in making that solution available but I

4:37

think that there's just this hunger happening out there and this passion and why we're all excited to talk about

4:42

these topics like it's so much more fun than talking about research it just do

4:48

it really does make an impact so I'm excited to really have that kind of Landing point and really align with your

4:53

message with interrupt hunger because it makes so much sense okay yeah it's just I think people are just tired

5:00

of of falling for gimmicks falling for influencers all the shallow M misperceptions and myths and I just get

5:08

back to like what's it mean to be healthy and just Back to Basics like it

5:14

really is not complicated when you get down to it like finding what works for you is is kind of the hard part but yeah

5:22

very good all right so when I first got into this 12 years ago after getting

5:27

diagnosed with with typ of leukemia it was all about doing everything I could to stay alive as long as I can so I've

5:33

no been a nutrition and exercise and and found this beautiful field of medicine called exercise oncology and we know

5:40

some of the a lot of the same people which is really neat but then as interupt hunger started for me and I

5:46

kind of shifted outside of of not just um this niche of of of exercise for

5:54

cancer survivors but but for everyone and and you've kind of done the same with your career you were one of the the

5:59

the very first back in like the early thousands for really uh systematizing

6:06

exercise for for cancer survivors so why you just tell us how you got started and

6:11

uh yeah we'll take it from there it's always interesting to like you know I get asked this question of like well how

6:18

did you get where you are and I don't know if you could duplicate my path if you tried because so many things have

6:24

changed in 2003 when I started I was working in a community setting I Wasing

6:29

at a gym and I was referred a woman who at the time was a 2-year cancer survivor

6:35

she she had triple negative breast cancer and for our audience we're largely familiar with you know the risks

6:42

and also the prognosis of triple negative breast cancer being kind of one that you don't want to have right things

6:47

have changed in that but in 2003 that was a pretty scary diagnosis she had

6:53

breast reconstruction that had gone ay I mean she had an implant sliding under her armpit I mean weird wow crazy things

7:00

and breast cancer related lymphadema other concerns that we knew we know now are cardiotoxicity but we didn't really

7:07

understand then and she was referred to me and when I first talked to her and I said tell me about you she started

7:13

telling me all of these things that cancer kind of did to her physically and

7:18

mentally and she was really interested in exercising didn't know where to start and her last question to me was do you

7:24

think you can help me and at the time I was like well of course you know figure this out out and I look back and think I

7:31

don't know if I was sort of I was bold or I was a little crazy but I knew

7:36

innately like many of us do that exercise had one of the most powerful ways of helping somebody but we didn't

7:43

really have the evidence and we didn't have any recommendations so a lot has changed in

7:49

21 years um Kim the first person who started being this field is still a great friend of mine she earlier this

7:56

year became a grandma for the first time I mean it's exciting to see her quality of life and how she lives her life and

8:04

how much you know she's influenced but that is where I got my start and I would then go to I went to cancer centers and

8:10

hospitals and said hey I have this idea we ran Community programs you know we

8:15

found at that time we had a lot of cancer survivors that were hungry for quality of life they hadn't recovered

8:21

after treatment and we saw that passion and desire even before we had the

8:26

evidence so that is really where I started and then I I really moved my career into Healthcare back in 2010

8:35

worked in community and academic medicine um and research and and started really looking at like this is great and

8:42

everybody knows it's beneficial but how do we do it how do we bring it in so

8:47

exercise oncology could be part of the Cancer Care plan whatever that plan looked like even if it's just

8:54

surveillance and so I think that you know looking back we were ahead of the times but in a way it was great because

9:02

I think people were so excited about another tool in the tool belt even if they didn't understand how to do the

9:08

tool and the tool belt right so but we we was always very supportive from our oncologists really from day one oh

9:15

that's cool so you know on one hand we've got like a ton thousands of studies now yes thousands those people

9:23

away thousands of studies in exercise for cancer survivors whether it be prevention or doing active treat or the

9:30

best part is cancer survivors who exercise happen to live a lot longer uh and we're learning more and more about

9:36

different types of cancer and then you've got the oncology the the providers on the other hand and there is

9:43

a really really big gap in the middle yeah sure which you live firsthand so so

9:51

why is it is it so hard to connect this incredible body of evidence with all the

9:57

science with making it happen in the people going in the yeah in the office so I think one of the things that we

10:04

really should kind of start with is like what is the disconnect and I think that the disconnect on the external world is

10:11

the perception or preference of exercise as far as a supportive important tool

10:16

for oncologists and I I think that often people think well my oncologists didn't tell me this therefore they don't think

10:22

it's important and I would actually argue that in my 20 plus year career

10:27

there has been two situations very specific experiences I can recall where oncologists push back against my

10:34

recommendations and you know again this is a long Career One definitely made a lot of sense once I had more information

10:41

and I was very new to the field and so it was kind of you know that like a little bit more optimistic of what

10:46

really this meant for this particular patient and the second one was a miscommunication that we just we resolved but what I go back to is saying

10:54

is it's not that oncologists or advanced practice practitioners or even dietician

10:59

or whoever don't believe in this but I think that we need to remember two things medical professionals especially

11:06

oncology and you know this the field is evolving from a treatment perspective at a pace that I don't think we ever

11:13

expected as far as there's the Cancer Care plans that are coming out at rapid fire in diseases such as like lung

11:20

cancer where we didn't see progress for decades and so they're focused on that

11:25

scope of service and or not that scope of service let me backtrack oncologists

11:30

are focused on delivering cancer treatment plans what does the plan look like in 15 to 20 minute visits that you

11:38

know when do they talk about exercise now so I know that I think I know

11:43

they're supportive but they don't really understand it they may not exercise themselves they don't know how to refer it that's our job in exercise oncology

11:51

so I think that's one of the disconnects the second disconnect and we know this we do not have enough resources

11:58

available for Physicians or cancer Community programs I don't care who you

12:04

are to even refer to and especially if we think that most patients should have

12:09

supervised exercise and I think that while probably 100% of our patient

12:16

population would benefit from supervised exercise necessity kind of has a little bit of a different um discussion point

12:22

for me so I really feel like one of the disconnects is the lack of understanding

12:28

of what the clinical cancer treatment day looks like

12:34

in US recommending exercise I mean as an exercise oncology professional there is

12:40

not a no way I would assess someone and give them recommendations for exercise

12:45

in 15 minutes but our oncologists are assessing and recommending and treating

12:51

our patients sometimes in 15 minutes and so I think that it we should be mindful that maybe they can't fit it in and

12:58

that's our job and that's our job to build as you're doing community resources and education that sort of

13:04

bridge this Gap and I think we often my other concern is we create silos both

13:11

silos in how we build our Cancer Care teams but silos by disease type and so I

13:18

used to think is somewhere in my career we are going to have a breast cancer exercise plan and it's going to be laid

13:26

out you know what is a someone with breast cancer do at this time point with this treatment and then everything has

13:32

changed and evolved and moved forward and I don't think that that's reasonable to be giving exercise prescription based

13:39

on cancer type because everybody is different and so I think that now it really changed the lane where research

13:46

has often gone by cancer type and that's funding and support and clinical experience and things like that but I

13:53

think those are a couple of the disconnects however I really believe we're out of space now to your point

14:00

people are hungry for this information patients are starting to ask their caregivers are starting to ask in

14:06

organizations are starting to put this in all areas of support and so I think

14:12

that's really exciting when you go to an organization maybe a blood cancer organization as an example and you see

14:17

this section on the website that includes lifestyle so we've made a lot of progress but I think we need to keep

14:23

kind of talking about how to work together and how to make things more accessible and available both in time

14:29

time and dollars and knowledge and things like health literacy that all are important

14:35

barriers yeah this is fascinating time it's um we having to to raise awareness

14:41

raise the noise with both the the the patients the community the general population in large and and the

14:47

providers and and the health systems all all at the same time but it it it's did

14:53

in there so why don't you um kind of share some of the successes that you've

14:58

had where where did you start and then whether you want to go into you know your consulting services or or what

15:04

you're doing now or I'll just kind of let you lead the Le the conversation absolutely you know I think I can say

15:11

from looking back in my career I had so many really successful conversations and

15:18

opportunities working in the different aspects of Cancer Care again whether it was being an employee at a community-

15:25

based Cancer Center or an academic Medical Center where I ran a cancer exercise Clinic I had so much fantastic

15:32

experience the reason I moved to being a consultant was I realized when I was on

15:37

the front lines when I was running my own Clinic as many of our clinicians feel that you only have so many hours in

15:44

a day and you're taking care of the hottest fire in front of you and you you can't really make change however being

15:49

in that front lines i w I was able to sit at the table with other Allied Health colleagues and support service

15:56

teams um with other multi-is disciplinary teams and attend things like tumor conferences where we hear

16:03

everything from diagnostic readings pathology genomics and treatment plans

16:09

and kind of come forward and say wait a minute how is this person functioning where does that come into the lens of

16:15

working up the whole patient and until you sit at those those tables and understand that process it's really hard

16:22

to identify in my mind Solutions because otherwise you're kind of on the outside which is I think where a lot of our

16:29

colleagues end up you know there's not as many integrated programs or they're siloed off so I had really great seats

16:36

at the table from you know seite Administration right on down to

16:41

administrative scheduling staff to really look at the process of what our patients go through and then

16:48

understanding how to implement looked at what's important to a cancer program credentialing needs we want to keep our

16:55

patients out of the ER we don't want them readmitted you know process where do we fit in and I think that that

17:02

really was a great lens for me and the advice I give someone is I think that

17:09

rather than tell someone that exercise is important I'm pretty sure most people know this I don't care if you're a

17:14

clinician or administrator or scheduler whoever you are in Cancer Care a nurse it's more how do we talk about the house

17:22

like how do we talk about integrating this in and I think that was a unique position I had I learned very very early

17:27

on that Sammy was not as well received if she was the exercise person because

17:35

it was like wait a minute what are you here what are you making me do even with staff I come to staff meetings and

17:41

rather than have someone do you know a ton of exercises we would talk about balance or Mobility or things that

17:47

people thought you know it were a little bit more warm and in a good introduction

17:52

right then here's 10 squats we usually got to the 10 squats but that's not where I started so one of the advice you

17:59

know principles I give people is fit into their mold don't always make people

18:04

fit into yours because we have different biases maybe of the types of exercise or the modalities but unless we can speak a

18:12

language that makes sense to somebody else it's hard for them to really listen

18:17

to you and without their own biases so I think that's a really big piece that I learned both operationally as well as

18:24

relationships from the different aspects of my career but the reason I also

18:29

changed my direction is I realized that without all of the other pillars of

18:35

Lifestyle if we didn't talk about nutrition sleep and Stress Management

18:40

people were either exercising or they weren't and if they weren't exercising and they weren't doing anything else we

18:47

were not making forward progress on their lifestyle and so I realized that the most successful way to support

18:54

individuals with cancer caregivers my clinician friends and colleagues was to

19:00

really look at the six pillars of Lifestyle one being just avoiding unhealthy risky behaviors not just

19:07

alcohol and tobacco but physical inactivity or added sugars which we know

19:13

are harmful right so I I really decided that I was going to make a very strategic move to not be such a

19:20

specialist in just one pillar and take a step back and make sure that we were delivering all six of these pillars in a

19:27

way that people could access understand and most importantly Implement no matter who they were no

19:34

matter where they lived no matter what their budget was um and maybe where their you know health literacy is and I

19:40

think we need we've talked about this people know of all socioeconomic

19:46

classifications the importance of Lifestyle doing it is where the challenge is and I think where the work

19:52

that we're doing is really making some momentum because these are populations that once they have the knowledge get

19:59

really excited um and and really continue to make change so that's kind of why I changed um not right or wrong

20:07

just fit where I'm at in my career yeah it's I'm probably going to say this so that every single uh clinici or Allied

20:13

Health uh professional I talked to from now on I think everybody eventually is going to be a lifestyle medicine

20:20

specialist and an obesity medicine specialist it's just that you can just

20:25

again you just feel that's that's the direction that we're going it's a whole person you're not you don't have cancer

20:30

over here and you know sedentary life over here you know your diet full of ultra processed foods over here and no

20:37

sleep at the same time it's everything works together obviously okay so I've heard we'll kind of tackle this uh two

20:43

different ways so I've had a a fair amount of oncologists say when it comes

20:49

to an exercise referral one they don't know anything about it and they're scared to look

20:57

silly in front of their patients which is a very real concern because you definitely want to have the confidence

21:03

that you know what you're talking about you're the expert in the room and then the other thing I also hear is they're

21:09

scared that they they don't want to hurt their patients yeah so and then I guess the

21:16

third bucket would be how you pay for it so those are really the three big

21:22

buckets that that are preventing us and it's not just you know exercise for cancer survivors this is just type of

21:30

yeah health health system so I think that we are in such a great place right now you know you mentioned earlier um as

21:36

far as like just even my introduction two really great projects that we finally you know launched in 2022 were

21:45

the ASCO guidelines those were actually the during treatment guidelines so anyone undergoing any cancer survivor

21:52

undergoing treatment of Curative intent that was just the parameter that we use for these guidelines um should strive to

21:59

meet exercise recommendations now I think that we should shove the exercise recommendations number for a moment and

22:06

just focus on the time point that was the first guideline internationally that came out that looked at a very specific

22:13

on treat population then the metastic recommendations which are a little bit

22:19

different than guidelines but are more of an encouragement tool looked at the bone metastasis population and one of

22:27

the biggest things that we s we found through the literature which was Global was that the risks of

22:34

inactivity right outweighed the the the risks of

22:39

inactivity no yes the risks of inactivity if I can say this you know how a balance effect of like the risks

22:46

related to potentially hurting someone with exercise there were more benefits to exercise right than you know being

22:53

too protective to our patients to not exercise so what we learned was we need to encourage these patients with bone

23:00

met bone ma metastasis to exercise the caveat I say and I will continue to say

23:07

this this was definitely through the literature was that is a population that we recommend supervised exercise across

23:14

the board as a starting place even if there is no pain with the bone M that just we just do now I think then we move

23:21

forward to the general exercise recommendations from oncologists one of the reasons I think that they're scared

23:27

is oncologists are used to being prescriptive what do you do how much do you do I think that we need to continue

23:34

to be confident that we're not asking for prescriptive for oncologists we're not asking them to make any sort of

23:40

specific recommendations some do some don't but all we're looking for is a

23:46

green light this is important and here is how you do it and I don't think that

23:51

we as a field have done enough of that for our oncologists just to really push

23:58

the fact that we're just asking for a green light they don't need to be prescriptive they just need to give the

24:03

green light using whatever guidelines recommendations American College of sports medicine the moving through

24:09

cancer initiative whatever they are the third piece about this is paying for it

24:14

I think we need to think through this very thoughtfully that exercise in the general concept is free movement is

24:21

totally free and in I would argue the most accessible lifestyle medicine

24:28

pillar that exists because you and I can sit in the chair and we can get in movement right we don't need equipment

24:35

we don't need anything fancy we can get in movement that is planned which is now

24:42

defined as exercise where the payment side comes in is for supervised exercise

24:47

which in key populations is definitely important but I would argue is it

24:53

necessary and in some situations probably but a lot of necessity

24:58

I think could be debatable I think that we could give better exercise recommendations that could be modifiable

25:05

as an example if it's someone has neuropathy and balance challenges and I can't get them to go to a supervised

25:10

exercise session then I'm going to give them a chair-based exercise and I'm going to educate them on why I'm giving

25:16

them chair-based exercise or maybe just very supported exercise and I think that's hard for people to say like well

25:23

what if they hurt themselves honestly most people are going to do less than to

25:30

go hurt themselves right and are we harming them by not having them be active and then they fall right so you

25:38

know I kind of would argue that now I do feel we are making significant progress

25:44

and I suspect that we will continue to grow the field both of exercise oncology professionals that have cancer training

25:51

rehab professionals with cancer training more Community professionals with cancer training and in some of these these

25:57

scenarios we can get reimbursement and I do suspect that's growing I don't know

26:02

if we're going to see significant coverage changes in the next 5 years in

26:08

combination with Workforce to really see the outcome of that so in the meantime the question I ask myself is if we have

26:14

an estimated 18 million cancer survivors now where are we going to be in five years you know 22 is is sort of the

26:21

estimate maybe 23 I'm not exactly sure on the data what about all of these people so I think that we should able to

26:28

T tackle this in a multifactoral way but again I think about this is where lifestyle can really come into play if

26:35

someone is sleeping better they're going to have more energy they're going to be more likely to engage in activity

26:41

exercise and even go to supervise exercise they're going to be H willing to have a little more skin in the game

26:48

so I think that thinking creatively about this is important yeah I got it

26:54

okay so a um so someone in a administrative high level position or

27:01

maybe a clinician comes to you and they talk to some of their peers in a hospital

27:07

medical practice or or a health system and they they they obviously see the benefits of this and they want they want

27:15

to they want to start a program um you can generally speak or or

27:21

talk about your programs as much as you want how does how does that

27:26

happen well there's a lot of different ways I I think it really depends on what does the like we have to define a

27:32

program right what does a program look like for people you know we think about sometimes programs really look like just

27:39

delivering a way that we're implementing the education and the referral to

27:44

resources within the clinical care practice so a lot of times we as a

27:50

Consulting build in how do we assess a patient for functional needs that we

27:56

would refer to exercise rehab or community and we have validated Tools in

28:03

you know the the space of exercise and rehab that we can assess the patients need so sometimes it's we build in the

28:10

education a lot of times programs cancer programs that we work with whether they're in the community they're

28:16

academic or they're even a support organization all they have is you should exercise 150 minutes of moderate

28:22

physical activity per week people like what does that mean so part of it is just building in the what does does that

28:28

mean in a way that can now be implemented and then helping to identify what are the where are the processes we

28:34

can Implement chemo education is a great time point right um what is the the

28:40

piece that needs to go into that you know that time point and then most importantly especially because we

28:46

started this with administrators how do we measure the impact and the success so

28:52

we need to make sure that whatever we're doing we measure we measure this in in

28:58

patients that are are increasing their compliance to exercise and physical activity we can measure it in fatigue we

29:04

can measure it in Falls we can measure it in distress screen there's a lot of tools to measure it look a little

29:09

different but I think that those those are some programs we have programs that we have helped train staff exercise

29:16

oncology staff or other types of staff so sometimes we train nurses it's not in

29:23

a perfect solution but gives us another sort of foothold

29:28

into what's already happening what's already built and making sure exercise becomes part of that and then of course

29:35

you know there are definitely systems that we built programs for that have been fully staffed with exercise

29:41

professionals if we in the current landscape are going to do billing they need to be rehab professionals that's

29:48

just the current landscape if we're looking in the United States for Global Partners I mean those are going to be

29:53

physios right which is the version of our community but if we want something

29:59

that's billable that's the tool that we have right now so sorry are you find

30:06

specifically about like a DPT or this this like a master's level

30:11

exercise professional so I've staffed both but I've also staed both that you know we have not built for all of these

30:16

Services right we've just built these individuals in and then the health systems have paid for it if we want

30:22

reimbursement then they have to be somebody like a DPT oh wow okay all right how you realize that and and I

30:30

think that we need to be really thoughtful about this you know if and we build it into an Ideal World supervised

30:36

exercise prescription and Ideal World is probably going to be more than once a week we need to think about this from

30:43

like a co-pay side of things right and that's just another challenge a

30:48

scheduling side of things you know 8 to 5 Monday through Friday or whatever that is so I think that we need to be very

30:53

thoughtful about broad implementation and as you and I talked about before we mentioned

31:00

scalability in order to really make change we have to have scalable interventions that aren't considered to

31:06

be kind of concierge so scalable needs to have a little bit um less guard rails

31:15

in my mind than the typical clinical schedule and access that happens when I

31:22

was running an exercise Oncology Clinic at an NCI Cancer Center in Kansas City

31:27

my wait time or my waight time to appointment was over 30 days for one

31:34

person and I was kind of new to the practice exercise oncology was new this was

31:40

2012 and we were just growing the census for one of the busier clinics I'd see 12

31:47

to 15 patients a day the census that day was over 400 and one of the reasons that I really

31:53

left working in that field was I I remember in having a good C over this what about everybody else and there was

32:01

no answer there was no solution there wasn't really an opportunity to even bring an education and bring in

32:07

partnership with you know our rehab teams and because I was too busy in that Frontline day-to-day you know all of the

32:13

things that come with clinical care and I thought this is not going to be successful and the scalability option at

32:21

that situation was hire another me they didn't build for my services so there was not going to be a higher another me

32:28

so we I that's when I really started to realize we had to think very strategically about how to make this

32:34

successful intervention and also for me as a professional anybody that's

32:39

listening that has to chart and do things in the EMR they're nice for accessing information they are a lot of

32:46

work like charting and documenting notes take a lot of extra time for us so we

32:52

need to think about that strategically when we're asking our clinicians to do more how does do more

32:58

not mean do more in time but do more in making a referral or do more in giving

33:04

information to a resource I think doing more shouldn't com you know correlate to more time for them and I think that's

33:10

one of the barriers that we run into yeah that makes a lot of sense I'm thinking there's there's going to be

33:16

clinicians listening here there's going to be just general people listening here

33:23

and if this only happens to your point by exercise professional like

33:30

it's I mean it's just it's not a lost cause but there's so many I mean there's exponentially

33:38

more people so what if um a not just an an oncologist but general practitioner

33:45

or pediatrician or any type of specialist like

33:51

how is there a way for them to to build for this or is there a way for even just

33:57

an initial assessment there's got to be there's some amount of time you've got the physical activity is a Vital sign

34:03

and and a couple things that are that are getting out there more but like healthcare physical sping accounts or or

34:09

how do at the smallest level even maybe somebody in a rural setting they don't have access to World TOS facility or any

34:16

kind of facility but they want to help their patients like how does that how does it actually happen so I mean I

34:23

think there's some creative ways around this you know we have plenty of colleagues um in various professions

34:30

whether they're oncologists or APS or Primary Care to your point right there's a lots of oncologists many of my obesity

34:38

medicine colleagues are delivering in exercise and to the point that we're

34:44

kind of talking about broad lifestyle as part of their visits so professionals can do that that's why people get

34:50

certified by organizations like aclm or other functional medicine to deliver a certain amount of care if you deliver

34:57

your let's say I'm a primary care advanced practice practitioner let's just actually let's go more specific

35:04

let's say I'm an oncology nurse practitioner and I'm delivering care in a Cancer Treatment Center I can deliver

35:11

lifestyle medicine tools and strategies under my care I can do it as long as I

35:17

you know am delivering the scope of my service as far as a clinician I can still give the exercise resources there

35:25

are's some nuances about how prescript you can be in each of the disciplines based upon your training right and your

35:31

scope of your practice of where you are so of course that's going to be built for or you can build for that there is

35:38

also some groups that are doing share of medical visits um we see this mostly in primary care we see this in chronic you

35:44

know chronic disease management especially in the Medicare population we've got some really successful people doing this in a handful of clinics that

35:52

have built in a great model with nurses and Care coordinators and are you know

35:57

very viable like very viable financially however that's a complex system that

36:04

then how do you go from I'm a busy clinician to I'm starting a whole practice you've got to have a gap right for a lot of people you know I think the

36:11

best thing to do I think there's two things to do I think one can you fit this education piece in your current

36:17

scope of service no matter where you are I think that some clinicians do it

36:23

really depends on the practice and what maybe their rvus look like right if they if they have the time and they have the resources whatever that is I did some

36:30

work for um some uh education with the American

36:35

Academy of family physicians looking at obesity and survivorship you know kind of bringing these pieces together for

36:42

Primary Care who were caring for patients post treatment and yes we have

36:47

the survivorship care plan you know your little summary document of your treatment but a in the family practice

36:53

or the internal medicine side they weren't really sure like okay what do I do with that inside of what I do now and

36:58

what we learned was if we could build them a toolkit right which is a lot of the work that I do that they they just

37:05

have to plug and play the toolkit they can now have a conversation because I have a resource right in front of me

37:12

meaning I can introduce knowing that my here's my resource because that patient's going to go yes I'm interested

37:18

where do I get information and we have the wear already built the reason I

37:23

created shift in our whole lifestyle program to be a resource for clinicians

37:30

yes it has a patient facing side of it but most of the buyin is coming from

37:35

providers clinicians various colleagues in medicine who talk to patients about

37:42

lifestyle talk to patients about weight management talk to patients about resources and don't know where to refer

37:47

them where we don't we need tools that are based off cancer recommendations not just general broad recommendations I

37:55

mean yes they're valid but utilizing American Cancer Society recommendations and the American Institute of cancer

38:01

research recommendations are much more important in my mind than just generally

38:06

you know healthy Behavior change for the general population so I think that was one thing I really realized is most of

38:12

our clinicians said need a resource but there wasn't a resource you know and I think that was really one of the gaps

38:19

that I saw was building little resources was okay but I needed to build a

38:24

resource that could be a very broad resource and so that's kind of why I went that direction actually it's mostly

38:30

why I went that direction because I you know we needed to use trusted evidence it's really important for this

38:37

population that we follow the guidelines as much as possible but in a way that makes sense if you're in rural

38:42

Mississippi or you're in Maine or you're in Denver whatever that is right it it should be generalizable in that way yeah

38:50

sure so let's see here so um you said AP I think I mentioned it too uh for those

38:56

did say for advanced practice provider like a nurse practitioner or a physician assistant are they the are they the best

39:04

person to to have in this conversation with I mean I think you always need

39:09

physician Buy in which actually I would argue it's really easy to get when I worked in clinical practice and I would

39:14

say any of this you know exercise oncology when we go to the clinicians I would go to the clinicians and say Hey

39:19

listen is there any situation or any person or any criteria that you need

39:25

that you want me to come back and get your permission to give exercise recommendations to you know this could

39:30

be for a neuro oncologist or you know someone who deals with brain tumors or someone who deals with blood cancer

39:36

whatever and it was very rare that someone said oh I really need to you to talk to me about this situation now when

39:43

I needed a rehab referral i' need them to write the order but mostly they'd have a pre-approval so the nurse could

39:48

help me with that right to help the As We Know clinicians we need Buy in but they're very busy most of them are like

39:54

hands off they prefer to their Advanced CRA practice practition the conversation with those those

40:00

clinicians in my mind is less about the what it is and more about the how we do

40:07

it because they all get the why and the what but I think it's the how I think the yes but I think that to your point I

40:15

think that this is a group of professionals that tend to have a little bit more time with the patient there're

40:21

a lot at a little bit longer time they maybe do kind of follow-up visits or supportive care and I tend to feel that

40:27

they're very engaged in this um as well and they just they have they just they

40:33

very into resources they tend to be sort of that driver of resources not just tasks and not just prescriptive so I

40:40

think they're the some of the best but I also think like Partnerships with nutrition if you're an exercise professional I mean I have a lot of

40:47

nutrition training but not a lot of exercise professionals do they can be great resources we think that they

40:54

aren't sometimes but I think that we there's a lot of collaboration that can come in rehab professionals can be

40:59

another great resource as well but I think building any relationship um is key I think that makes a huge difference

41:06

to your success yeah of course two questions here um first of all I just uh

41:12

kind of focus in from the patient perspective how they pay for it and then

41:18

kind of a followup question is and and these are all businesses like

41:24

just to be blind like what's in it for the hospital like yeah where's where's the business side so so focus on like

41:31

how does the a typical patient pay for this do they have to come out of pocket

41:37

at least for the initial assessment if they're doing supervised exercise yes I mean you can like you

41:44

said you can utilize some of you know your health spending accounts but it just depends on the professional for

41:50

some soulle Proprietors it's just a lot of extra work that is not really reasonable so not every s proprietor

41:57

does it some do but most people will cash pay and try to offer you know groups or discounted rates or things

42:04

like of that nature for the health systems when we work to build programs

42:09

in Health Systems we look at Key metrics that are important to Health Systems yes Downstream revenue is is definitely one

42:16

that comes from a couple of things interestingly I mean rehab is great Downstream Revenue it's not really high

42:21

volume but it's pretty decent if we can really build cancer rehab programs they can pay for themselves

42:28

I also think that you know we look at very key metrics such as reducing ER

42:34

visits which is really significant for our cancer population Hospital read admittance length of stay we have great

42:40

evidence in all of these kind of these components right for the patient side we

42:47

also have great science that shows us that as an example meeting exercise recommendations if we're going to look

42:53

at the the number the 150 number and you know that we talk about reduces our

42:59

out-of-pocket healthare expenses and my overall General expenses so it can be a

43:05

savings account for people but you know getting them from A to B again you know

43:12

having people extend out of pocket they may not have out of pocket cash so

43:17

sometimes again that's where we think about okay maybe you don't have a chance for you don't have a lot of supervised

43:22

exercise but can you go to a rehab therapist once can you pay for an exercise oncology visit at once get a

43:28

plan implement the plan and then continue and come back so there's not a quick fix to this but I think that we do

43:36

have enough research to show both cost savings um as well as some revenue for

43:43

our particular you know Health Systems and interestingly we are starting to see that for employees this is also another

43:51

great tool that we engage with employees so when I was working in Health Systems I was very involved with employee nness

43:57

and we would sort of sneak in let's talk about the patients at the staff visits and then we would do employee things as

44:03

well and employees would ask and we would engage in that so there's there's some other ways to do metrics that you

44:09

know maybe aren't as fancy as a surgery but are still very meaningful to health

44:15

systems and can be measured but we have to measure and do assessments um

44:20

otherwise it's pretty hard to sell nice you know you're you're kind of selling the cherry on top now that makes sense

44:26

that makes sense so you've done um Le let on your program for a little bit

44:31

it's really pretty cool so you you've you've got a lot of virtual resources just kind of share like talk

44:38

about your program for a little bit so shifas where I've taken the six pillars

44:44

of Lifestyle medicine and we give anyone with cancer kind of the guidance on how

44:50

to use the six pillars so talking about those so exercise physical activity nutrition thinking plant predominant but

44:57

unprocessed nutrition is really our priority we do Stress Management sleep

45:03

social connections interestingly a lot of our community is looking for social connections and this healthy lifestyle

45:09

like they they want other healthy friends and then we talk about avoidance of risky habits or behaviors and so we

45:17

took all of these with the science of what do we know what's impactful we know that as an example there's not a

45:23

Curative food but a certain dietary pattern makes a lot of sense right and

45:28

we packaged it in a way that people can start to learn about how to implement these changes in their life no matter

45:35

where they are and we teach people how to read food labels and how to utilize some of the technology to make making

45:42

food choices at a restaurant or a grocery store easier how to exercise we give them exercise plans and we have

45:48

videos and content for any level of function and you know what do I do for

45:53

sleep what's my sleep routine you know how do I manage my stress here's some practical tips on breathing we make everything accessible in my mind the

46:01

biggest thing that I want people to know is that if they do a program like this it's not going to cost them more money

46:08

it's how do we utilize your time and your dollars differently and I think that's really important for people

46:14

because most people have such Financial toxicity from cancer and the majority of

46:20

Americans don't have a lot of leftover dollars or time so that's really one of

46:25

the reasons that we have focused on that particular modality isn't let's add more

46:30

supplements and in fact for most people I take them away and let's think about what's meaningful you know if you need

46:36

to sleep it's not about a supplement it's like what's your sleep routine look like this is free and also sustainable

46:43

and I think that's one of the most important things that I've learned about lifestyle in my personal space and maybe

46:50

this is actually an interesting reflection you know as we talk years ago I had a practitioner who taught res

46:56

resilience training for cancer survivors and staff ask me what's your tool for resilience Sammy and as you may imagine

47:04

I was like what exercise and she's like that doesn't work like that I was like what do you mean I I feel good and you

47:10

know this is probably in my 20s right that hey it was I thought I had it all figured out she said but wait a minute

47:16

what do you do when you're in a meeting or you know you're waiting for a

47:21

doctor's appointment or you know you're you're on a plane somewhere whatever it is you're stuck in traffic

47:27

how do you handle resilience in Stress Management and I was like oo that seems like I don't have a solution CL and she

47:34

turned me on to really thinking about breath work now I'm still not a great meditator in the traditional sense I

47:40

mean this has just never been where I've been successful but really understanding using the power of breathing which is

47:45

great for exercise any modality but what kinds of different breathing techniques that we have available and we have some

47:52

of them have a lot of evidence behind them as a tool from say managing stress

47:58

kind of improving your overall well-being and resilience to me that's a tool that is free available we're

48:03

already doing it but if we can maximize it how great is that and so that really

48:09

kind of changed those sort of things have changed my mindset about how I

48:14

deliver and why I deliver the the the way that I do and again I don't want someone to go to Google and search sleep

48:22

and find you know here's the $60 a month supplement to me like I don't know like

48:28

I I find that very predatory especially on our cancer population when the risks

48:34

and fear of dying is so high and so front of mind right so I I think that I'm just much more protective about that

48:40

and thinking about what's what's practical and what fits anybody so it's it's a little bit of a different mindset

48:46

of of why I've gone this way um but really follow the science which is phenomenal not all-encompassing but

48:52

we've got good science and we should use it it's funny as you're talking I'm thinking about this a few years back but there was a younger medical oncologist

48:59

at a in a private practice and he was he was telling about this one lady that every single time she was like you know

49:06

hey my neighbor across the street said I should try this you just need to walk well my aunt's doing this you just need

49:13

to walk well I'm saw this online you just need to walk it's like just freaking walk people just freaking walk

49:19

you or do something I don't care what you do anything yeah anything I was at a conference I was at a conference last

49:25

weekend and I was talking to to a lung oncologist and she's like oh I love to exercise and she's Egyptian so she does

49:33

belly dancing and she's like well maybe that's not like you know she like I know it's not strengthening but like that's what I do and I was like that's awesome

49:38

are you kidding me at the end of the day I mean if someone doesn't want to walk or doesn't want to but I'm kind of like

49:44

well why do you not want to walk or you know is it I think a lot of times we we tell people go walk around the block I

49:50

think they're embarrassed they're scared they live in an unsafe neighborhood they

49:56

don't eny eny it so maybe that's not the right thing but honestly one of the reasons I've been having a lot of fun

50:02

with our YouTube channel is because people ask me like all right what do I do in five minutes and I was like well I

50:07

got you and rather than me tell one person I was like I'll just make a little video on that so like one of the

50:12

things we started recently is every Friday we put out the Friday five it's a five minute workout it's all different

50:19

kinds of modalities and you know I tell people like no excuses and it's one of those sort of fun things that someone's

50:25

going to pick on on something and then they're going to I'm not going to do that one I'll do this one but it at least helps people think and I think

50:32

also kind of look at stuff from the comfort of their home where they don't have to worry about being embarrassed or

50:37

judged or they they feel terrible about themselves and I think that's sometimes

50:42

why people are so nervous about exercise they're just very intimidated and they don't want someone to judge them I

50:48

cannot tell you the number of times I'd want to send someone to rehab because they desperately needed it and they were

50:55

so uncomfortable going because they felt so debilitated they wanted to get stronger to go right and I'm like then I

51:03

and I I remember after that happened a couple times I thought I'm am not explaining this well I am missing

51:09

connecting with these patients and so it really took me kind of digging into understanding the barriers and so I

51:15

would tell people I know you feel embarrassed right now like I know that you don't feel as strong as you were

51:21

when you came in the door that's why I want you to go I just want you to go once and people would be like M but at

51:28

least we identified their barrier not just I I don't care about it and I think

51:33

that that's something that we need to do a better job in all of my field is hear what people say and hear what their

51:39

thoughts are yeah this it's Inc about how have learned uh just in the last few months uh we had a uh someone from uh

51:47

talking about obesity bias and stigma and and the number one by a very large

51:53

margin the number one place for the most bias complaints to things bias is is

51:58

Healthcare 100% And and I I started talking to more folks that are in lifestyle medicine and obesity medicine

52:05

and and and we also have guests on that that have lost 10% body weight or more to talk about their journey I used to

52:11

think like oh my gosh say why aren't you exercising like I don't care if it's ble ball or swimming or dancing whatever

52:16

like why aren't you moving but if you are either if you have if you have

52:23

obesity moving is not comfortable and and then you know on our conversation

52:28

today there's a lot of different types of of morbidities that come along with

52:35

having cancer and that hurts or is uncomfortable or is

52:40

tiring so like those are real obstacles that we have to like not skirt around

52:46

just just ask like try to figure out what's it's just so unique for every

52:52

single person whatever type of cancer you have or what your family Dynamics L but your you know what your professional

52:58

life is like and just where you are try to find something that work for them I wonder I heard that I was talking to a

53:05

friend of mine yesterday she was I worked with her as a clinical dietitian in a cancer practice um she happens to

53:10

live in the same area as I do now and we were talking about like the mindset of you know oh I have to do 150 minutes or

53:16

30 days five days a week or it does not count and I think that's actually a lot of our like clinicians and I think that

53:22

you know if we have these recommendations that that's what we're telling patients you know we care so

53:29

much about the recommendations and I'm like yeah I'll get you there but if I just chase the number am I doing

53:35

something meaningful and I I think sometimes like you know we get stuck in just giving someone recommendations but

53:41

not really again you know maybe identifying maybe where they are their barriers sometimes their schedule their

53:47

innate ability whatever it may be but it's like are we asking them and are we

53:54

just too busy trying to tell them how important the recommendations are versus asking them maybe their thoughts and

54:00

then you bring up another thing about bias so I have very specific types of exercise that I enjoy the most and one

54:06

of the things I've learned is just I have a bias of you know wanting to tell

54:12

someone like this is the best and having to kind of take a pause and say but be like well I really want to do yoga okay

54:18

tell me why Well yoga for strengthening is maybe going to look a certain way so

54:23

it's like you want to do yoga great here's here's where maybe what yoga is going to give you from a benefit but you

54:28

want to do yoga let's do yoga but I also want people to be educated where maybe that you know yoga is not going to build

54:35

their bone density right but they should still do yoga but maybe when they're

54:40

ready Next Step once they're with yoga to do maybe something to build more bone density whatever that is but if they

54:46

come to me so excited about their yoga class or their Zumba class their belly dancing or they're aquatic aerobics and

54:52

I'm like that's not the right exercise then I have lost that relationship and are they going to continue if I give

54:58

them like the most excited it's almost like with children right that's amazing let's do it and I think people need that

55:06

support we don't live in that sort of positive affirmation and I think that's actually when we've run the the thing

55:13

that I've really recognized as I run shift with like the live versions but we're coaching groups of people they

55:19

come there for the support in the community and I realized that they're looking for sort of that you know

55:25

positive coach and it's not like simple and small it's actually really powerful because I don't think people get a lot

55:32

of that positive feedback so whatever it is people do whatever you're listening and whatever you do today awesome just

55:39

do it I don't care if it's a minute or an hour so I think that you know that's something I've really learned along the

55:45

way is my biases I've had to really pause and make sure that I was listening

55:50

not just I want to tell you about the best exercise ever so lot just start where you are doesn't matter where you

55:55

start to start okay this has been good this has been a lot of fun wow is there

56:01

anything you want to share real quick that that we might have missed today before you I'll just throw that out

56:06

there real quick you know I really think that the more that I kind of sit back

56:12

and look at this like it kind of goes back to we sort of L the force in the trees bit when it comes to all of this

56:18

with with exercise andology and with lifestyle you know we're too busy looking for a perfect solution and I

56:24

think we've sort of lost the big picture to your point about a little something is better than nothing or avoiding

56:31

something less healthy or maybe more toxic for us whether that's a thing or a person or a habit is really powerful so

56:39

you know I I think that we innately know some of the things that we should start with and I think that we we've sort of

56:47

looked for this Perfection specifically in the cancer space and lifestyle is

56:53

never going to have the powerful evidence behind it that you know clinical trial do like that's just not what we do so I think that you know

56:59

whatever it is you do whatever it is people engage in regarding any of these give yourself a huge pat on the back and

57:06

I think that it doesn't have to be perfect and I I why I say that with exercise you know like just dig around

57:13

see what inspires you do that just do that I love that yeah have a just start

57:20

have a plan so you don't have to think about it make it a habit you can change it anytime you want just yeah just make

57:27

it easy as you're talking our um our mission for interrupt hunger I've held on this for a while it's it's prevent

57:33

chronic disease feed the hungry Foster Community I mean yeah we forgot how to

57:39

cook or we never learned how to cook not very many people know how to garden uh

57:44

we're really isolated and uh it's just getting back to you know getting back to how we used

57:51

to live several Generations ago taking care of each other and taking care of our so um Jolly have you seen the

57:58

research that was just published about cancer mortality and like related to so like social isolation and loneliness how

58:05

significant it is no so it was came out at ASCO 2023 um as an abstract and then

58:11

was published and I I have to find the research and you can put it in like show notes but I believe that

58:19

the I know that increases your IM mortality the current social isolation for people that report social isolation

58:26

increases their mortality I believe it's the equivalent of smoking a pack of cigarettes a day it's pretty

58:31

significant and what it reminds me is when I worked in the cancer space and people were looking for support groups I

58:38

found that they weren't often looking for like the sit around and talk about it group they were looking for a support of Hope camaraderie and Community you

58:47

know they were looking for someone that had been through their Journey that had lived to tell the tale or kind of go

58:52

yeah me too they were looking for someone to encourage them like you can do this you can do your you know

58:58

whatever kind of community or support and the community piece one of the things I love about when Community

59:04

groups and lifestyle is you always know what you're going to get so it's like that person you know that situation you

59:09

walk in the door and you just know it's going to be a positive experience and I don't think we have that guaranteed there's no Facebook group that always

59:15

has that there's no like Community you know location that always has that and I think that that's something that that is

59:21

something people are looking for even if they can't Define it but if we don't create these things and leverage the

59:27

work that you're doing we are increasing you know the risk of dying no matter how good the treatments are and that to me

59:34

is very telling that's social connection seems like a weird lifestyle pillar but it is really quite powerful it's very

59:39

real oh thanks for saying that I'll dig into that that's pretty me yeah I um I don't know my uh kind of one of my the

59:46

thing that's driving me now my my I fully believe virtually every PR in America could be fixed if we took better

59:53

care of ourselves and took better care of each other I I mean it's just I just care yeah I mean you know in the world

1:00:00

be fixed in the world yeah all right well this has been pretty great all right thanks a lot Sammy So how how do

1:00:06

uh how do people find you yep um so my website my main website is Cancer

1:00:12

Wellness forlife.com spelled f and you can find all of the information about

1:00:17

our resources information about the shift program and then I'm on various social media platforms LinkedIn

1:00:23

Instagram and YouTube um mostly through YouTube is our shift program so it's a patient facing side so anywhere like

1:00:30

that you can find me um and I try to answer and respond to everything um because I really believe that if someone

1:00:37

has the courage to ask a question then at least we'll provide a response or an answer so very nice thank you so much

1:00:42

for including me Jolly I appreciate it it's been a lot of fun talking about this yeah thank you yeah thanks so much

1:00:47

Sammy all right and we're going you too

1:00:56

thanks so much for listening please rate and review the podcast on the platform of your choice so we can reach more people and more people are recommended

1:01:02

this podcast and if you really liked it the single best way you can help us grow is by telling your

1:01:08

friends now for all the legal stuff the views and opinion expressed in this program are those of the speakers and do

1:01:14

not necessarily reflect the views or positions of any entities they represent for my day job I'm an employee of ABV

1:01:20

and appear on this podcast on my own accord and not in the professional capacity as an ABV employee all viewpoints provide Ed are my personal

1:01:26

opinions and not intended to reflect those of my employer if you have any questions or comments please shoot me an

1:01:32

email at Jolly interrupt hunger. let's go spread some Joy people

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