Improving your heart health with exercise

Coronary Heart Disease is a leading cause of death in Australia. Whilst it’s not possible to remove some risk factors such as genetics, family history or age, there are ways you can improve your heart health and enhance recovery from Coronary Artery Disease (CAD).

Research has shown that gradually building up a regular exercise routine to improve cardiovascular fitness, along with a healthy, balanced diet can have many positive effects.

The right exercise can all also accelerate recovery times from cardiac events or surgery.

The Brellah Cardiac Health Program is led by an Exercise Physiologist and offers customised exercise and education in a supportive group setting for both prevention and recovery from illness.

Olivia Adoncello, Exercise Physiologist shares the Brellah Cardiac Health Program experience here:


Who are the participants attending these classes?

Our class sizes range from 2 to 5 people, with males and females aged in their 40s through to their 80s.

Typically our participants are seeking rehab from heart failure, CAD, acute coronary syndrome and myocardial infarctions.

We also have participants with high blood pressure seeking to improve their heart health.


Who can benefit from this program? 
  • Anyone who has had a cardiac event such as a heart attack, angina, heart failure, coronary artery disease
  • People who have had cardiac surgery such as a bypass, stents, heart transplants, valvular replacements or repairs
  • People with an implantable device including a pacemaker or defibrillator.

What objectives does this program aim to achieve?

Our classes are designed to help you to:

  • Improve your aerobic capacity
  • Become better educated and more informed about your condition and treatment
  • Achieve behavioural change outcomes such as appropriate lifestyle changes
  • Improve your strength and muscular endurance
  • Make exercise FUN and not a chore.



What kind of exercises are performed in these programs?

We do a combination of cardio, mobility, strength, coordination and balance exercises.

The level of cardio intensity is based on each person’s individual response to exercise.

We start off at a steady state, and progress to small intervals of 30 secs of work followed by 60 secs rest – and then eventually progress to a higher work/rest ratio such as 40 secs work and 20 secs rest.

With regards to strength and mobility, we start with basic movements such as sit to stands – and work to improve general mobility during this time.

From here, we look at improving functional ability and try to progress to more complex movement patterns such as squatting.


What are some great exercises to help enhance heart health? 
  • General cardio exercises such as walking, swimming or cycling
  • Stairs are really great as they offer a good combination of muscular and aerobic endurance 
  • Exercises that use the major muscle groups such as full body or compound strengthening exercises.

What exercises (or intensity) should be avoided if you have cardiac health issues?
  • Any exercise that requires you to hold your breath – we call this the valsalva manoeuvre 
  • It depends on the cardiac issue you have – if you have had heart failure we avoid high/vigorous intensity
  • Predominantly we stay in the moderate intensity zone as this actually provides more cardiac fitness benefits than high intensity. Interval training is great as it gives an opportunity for the heart to recover between each set.

What precautions should cardiac patients take into account when exercising? 

Beta blocker medication slows the heart rate down, so in this instance it’s not ideal to use the heart rate as an intensity measure.

I educate my patients to effectively use an RPE scale (Rating of Perceived Exertion) as this gives me a better gauge of how they’re coping and how to progress or regress the training from there.

Before each class I measure each participant’s resting blood pressure, O2 saturation levels and heart rate to make sure participants are okay to begin exercise.

Thereafter all patients know to communicate with me throughout so the exercises can be modified if necessary.

For post-surgical patients we need to place some restrictions on the level of weight used in strength building exercises.

Physical limitations of acute pain/mobility limitations post surgery are also considered.


What are some of the outcomes that have made you proud? 

Many of my current participants have continued beyond their initial 8-week program. They came from doing very little exercise to now doing bi-weekly classes with more exercise completed between their sessions here at Brellah.

I’ve found it so rewarding to have been able to change their lifestyle behaviours and improve their education and motivation to the point where they continue these great new habits outside of my classes.

They’ve become friends and enjoy the social and community aspect – and they hold each other accountable.

We work, we focus on our breathing, we move our bodies, hear each others’ stories and laugh alot!

We celebrate each others’ successes and the great sense of achievement that comes from doing awesome things with the body that were not previously thought possible.

It’s so rewarding getting to know my patients and to see their health and quality of life improve.

The Brellah Cardiac Health Program runs every WEDNESDAY AND FRIDAY at 10am.


Find out more or chat to Olivia

 

 

 

 

Pelvic pain – 6 things you need to know

Pelvic pain can arise in women and men at any time.

Pain levels can range in severity and be attributed to a variety of causes – often which resolve themselves – but on other occasions specialist intervention is required.

When is it important to seek professional help for pelvic pain? Our Pelvic Health Physio Jenni Davies tells us here.


What are some common pelvic pain symptoms?

My patients experience both internal and external pelvic pain symptoms of any kind, including:

  • Pain with intercourse or when using a tampon
  • Pain after specific activities such as prolonged sitting, riding a bike, lifting and carrying or rolling in bed
  • Pain after traumatic injuries (both internal and external)
  • Sports injuries that cause pelvic pain (internal or external)
  • Pain secondary to endometriosis, adenomyosis etc
  • Discomfort or pain when wearing tight clothing
  • Pain related to pregnancy or the post-partum period
  • Pain when emptying their bladder or bowel
  • Pain on the coccyx (tail bone)
  • Rectal spasms at random times of day or night
  • ‘normal’ back, pelvic or hip pains not responding to standard Physio/Chiro/Osteo treatment.

What signs can’t be ignored needing professional help?

Any pain or symptom that doesn’t spontaneously resolve within a few days, or does resolve but then repeatedly reoccurs, needs to be assessed professionally.

This includes ‘period pains’ or symptoms around your menstrual cycle that are strong enough that they don’t respond to basic over the counter medication such as panadol and ibuprofen, or that interfere with your normal activities.

For example, needing time off work or school, being unable to participate in usual activities or avoiding social engagements etc.

Any symptoms like this, despite what you may have been told by family members or medical practitioners, is not normal and needs investigating.

This includes other symptoms around the menstrual cycle such as nausea, marked bloating, dizziness, feeling faint and so on.


What could be the possible causes of pelvic pain?

Internal pelvic pain may be due to a multitude of factors including:

  • referral from the lower back or pelvis
  • nerve impingements/compressions such as pudendal neuralgia
  • muscle dysfunction (tight, weak, spasming etc)
  • internal trauma/injury (sexual abuse, sexual injury, penetrative injuries from falls)
  • other pathologies such is Lichen’s Schlerosis, infections, cancers, endometriosis, adenomyosis, cysts, thrush, inflammatory changes and so on.

External pelvic pain can also be due to a multitude of factors including:

  • hormonal and physical changes associated with pregnancy
  • referral from the nerves of the mid and low back
  • sacroiliac joint dysfunction, infection or inflammation
  • pubic symphysis dysfunction, infection or inflammation
  • stress fractures
  • traumatic injury (falls, blows etc) hip pathologies or dysfunction.

How do you treat those issues?

As Pelvic Health Physiotherapists, we ‘marry’ the internal with the external.

We assess externally for any muscle, nerve, joint, or movement dysfunction that may be contributing to the problem.

Then we also assess internally (when appropriate) to diagnose any musculoskeletal factors that could be contributing to the pain.

For example, with any syndrome that causes pain, such as endometriosis, there is usually a degree of protective muscle spasm that occurs.  This in turn can cause secondary pain, which ‘turns the volume up’ on your overall pain levels.

If the muscle dysfunction has been there long enough (average time to diagnosis for endometriosis is still approximately 9yrs which equates to a long period of chronic pain and symptoms), then there is usually also some stiffness/tightness/pain in the local joints and sensitisation of the neural system.

Both of these issues further exacerbate the overall sensation of pain.

Our treatments are aimed at ‘winding down’ the pain by releasing tight muscles, restoring normal motion to joints and the neural system, and restoring normal muscle function and control.

We obviously can’t alter the underlying pathology of something like endometriosis, but we can have a significant impact on your pain levels, thus restoring a level of empowerment over your symptoms, which in turn significantly improves your quality of life.

The actual techniques we use vary from person to person but may include:

  • manual release or mobilisation
  • education about pain physiology and the power of the brain
  • lifestyle alterations (nutrition, sleep, exercise, stress management etc)
  • learning self-management techniques including self-release, breathwork, mindfulness, activity modification/pacing
  • exercise programs that incorporate a multitude of techniques such as yoga and pilates to rebalance the body
  • other techniques such as TENS and acupuncture for pain management.

For the more external problems such as pelvic girdle pain from the sacroiliac joints or the pubic symphysis, besides the specific manual treatment techniques to restore normal movement and function to the body, we do progressive retraining programmes to correct any imbalances in the body.

These take you from a basic level, right through to high level training, lifting weights, sprinting etc and are aimed at not only resolving your problem, but also preventing it recurring.


Does pelvic pain affect men as well as women?

Yes, pelvic pain in men is one of the most under-treated areas of pelvic health problems.

It is most common in the 20-40yr old age group, but can occur at any age.

Typical pelvic pain symptoms for men (besides the ones as noted above) are:

  • pain or altered sensations in the groin, penis or scrotum
  • pain with intercourse
  • generalised internal pelvic pain – often diagnosed as prostatitis, but very commonly caused by pelvic floor muscle pain and dysfunction
  • pain or difficulty passing a bowel motion.

When do you suggest people see you – as opposed to their GP for pelvic pain?

If the pain is secondary to an injury, or mechanical cause I would recommend seeing a Pelvic Health Physio first.

However, for most other causes of pelvic pain we usually work hand in hand with the medical team. This may include the GP, and/or specialists.

Specific pathologies, such as cysts, infections etc often need to be ruled out as a cause of the pain. They can therefore see either of us first and we’ll cross-refer as necessary.

The most important thing to be aware of is that pelvic pain, traditionally, is very poorly managed or misdiagnosed.

It is not uncommon, for women especially, to be dismissed with ‘it’s just period pain’, or ‘it’s nothing to worry about’.

If you know that it’s not normal, seek a second opinion from someone specialising in pelvic pain.  Likewise, if you’re given a diagnosis, but it’s not responding to the treatment given, it may be that the diagnosis is incorrect.

Again, I would advise seeking a second opinion from a specialist.


To book an appointment with Jenni click here

This article is for information purposes only. It does not constitute medical advice, is general in nature, not tailored to your personal circumstances and you should seek your own medical advice from an independent medical professional with regards to what options are best for you.

 

What’s a pain specialist and why should I see one?

By Dr Tim Hucker, Pain Specialist at Brellah and Northern Beaches Pain Management.

 

Many patients referred to a pain specialist have usually seen quite a number of different specialists.

For example, for those of us troubled by back pain, most will have seen one or more of the following people – an orthopaedic surgeon, rheumatologist, neurosurgeon or musculoskeletal physician to name but a few.

In addition, most people have usually engaged with a physiotherapist or osteopath and have spoken to their GP.


Who is a pain specialist?

Qualifications. All pain specialists are doctors. Check first when you’re seeing a pain specialist that they are medically qualified doctors (they usually have the letters MBBS after their names) and are recognised as pain specialist doctors with the letters FFPMANZCA after their name.

All pain specialists have qualified in a primary specialty, and then gone on to do further training to specialise in pain management.

Many pain specialists have a background in anaesthetics or rehabilitation medicine, but could also be from backgrounds such as general practice, rheumatology, surgery or psychiatry.

Training. All pain specialists will have developed their interest in pain management during their training in their primary speciality.

For instance, anaesthetists will undergo training on how to treat the acute pain that a patient having surgery will experience. After this basic training, a pain specialist will complete at least two more years of formal training in centres of expertise in pain management.

They will be assessed regularly by senior pain specialists and have to pass assessments and exams before they are awarded FFPMANZCA.

Skills. During training a pain specialist will learn a number of different skills. They will learn more about different medications that help in chronic pain and how to use them safely and effectively.

Many pain specialists will learn specific injection techniques that can help with some pain problems.

Most importantly though, they learn how to combine pain remedies with working alongside a team of other practitioners such as general practitioners, physiotherapists, psychologists etc.

This ensures they know all about you, the patient, and use as many ways as possible to manage your pain. There’s no point for example referring someone to a physiotherapist to help with their back pain if, as a specialist, you don’t know what a physiotherapist does!


Why do people get referred to a pain specialist?

Patients are referred to pain specialists by their general practitioner, members of the allied health team such as a physio – or another specialist.

It’s preferable to get a referral from your general practitioner as this lasts longer. This referral has been made to use the above skills that a pain specialist has.

It is often the case that the pain you’ve experienced (usually for a long period of time) can’t be totally cured. This is because in many chronic pain situations the pain has developed as part of us getting older or we have developed other medical problems (eg arthritis or diabetes) that themselves cannot be cured and cause pain. This is often immensely frustrating.

The goal of a pain specialist is to ensure this pain, and its impact on your life is minimised.

See a pain specialist and their colleagues with an open mind and realistic expectations – and they will do their best to help you reach the goals you set.

What a pain specialist does at the first assessment, and the different options they use to manage your pain will be covered in further articles to come.


Dr Timothy Hucker MBBS FRCA FFPMANZCA FANZCA is a highly qualified pain specialist, with specific expertise in back and neck pain, nerve pain, pelvic pain and cancer-related pain.

In addition to being a Pain Specialist, Dr Hucker is an examiner for future pain specialists at the Faculty of Pain Medicine, an adviser for the Faculty of Pain Medicine on interventional pain management, a lecturer at Monash University, a published author of scientific papers and book chapters on Pain Medicine, and the Chair of the working party for adult cancer pain management guidelines at the Cancer Council Australia. Dr Hucker also lectures on cancer and chronic pain management. Read more or book here.

 

Brellah Holistic Health Care

A holistic approach to health and wellness has grown in popularity in recent years across a variety of medical settings around the world.

Holistic health aims for well co-ordinated care by bringing together a variety of health and wellness professionals to care for the whole person.

Since the human body functions as an interconnected unit, a holistic health care approach focusses on the connection of body, mind and lifestyle factors to enable long-term wellbeing of patients.


The benefits of Holistic Health Care

At Brellah Medical Centre, we are big advocates of a holistic (also known as a multidisciplinary) approach because:

  • It addresses the main cause of the problem rather than just dealing with the symptoms
  • It focusses on overall wellness and prevention, and not just specific diseases
  • By taking the whole body into account it may be more effective in focussing on long term solutions for existing illnesses
  • Whilst medications have their place, you won’t be prescribed an abundance of drugs to treat one issue, that may be potentially more harmful for your body
  • You’ll learn to live a more balanced lifestyle, with increased self-awareness.

You may even develop exciting new habits such as a passion for a particular type of exercise, or love for specific types of food.

A classic example that benefits from a holistic approach to healthcare is stress.

Stress is a psychological response, which may lead to physical symptoms such as higher blood pressure, headaches, weight gain, and body aches. It can also interfere with your sleep which may give rise to other physical, mental and cognitive issues.

Studies show that reducing the causes of your stress may reduce the incidence of headaches, raised blood pressure and other symptoms.

Understanding this, doctors who take an integrated, more holistic approach to healthcare don’t just treat your symptoms.

They consider the bigger picture, finding out about you — your overall health and your lifestyle — so they can make personalised recommendations to treat your illness and improve your wellbeing.


Checking off all the issues

With the Brellah Holistic Health Care Service, we’ll start with some medical observations by our practice nurse. and chat to you about your wellness concerns so we can uncover all the causes of your issues.

 

We’ll then draw in the relevant healthcare professionals from within our practice who together will apply a variety of clinically proven therapies — from medication, to nutrition, specialist medical care, exercise and potentially psychological counselling.

In addition, we may also recommend specific evidence-based alternative therapies, such as massage, Pilates or stretching for supportive care.

For example, if you have stomach pain or headaches frequently, rather than our GP simply prescribing medication – we may recommend that you see a Dietician to review your nutritional intake to see if that is causing headaches and inflammation, and also an Exercise Physiologist to look at your daily movement patterns.

Our Mental Health Nurse can also check in with you about your stress and anxiety, which may cause the pain or arise from your discomfort — and help with mental health support if you need it.

 

Simply put, rather than treating the pain, under the Brellah Holistic Health Care service we’ll treat you as a whole person, and use all the expertise within our network to help you manage it.


Collaboration – all from the one location

Rather than make a general recommendation to “exercise more” or send you across Sydney to see different specialists, your healthcare team will meet with you – together in our comfortable patient care lounge.

That means consolidated visits to the clinic instead of several – saving you time and money and keeping your team of specialists in the loop with shared information – so they can apply the most appropriate level of care that you need.


Making wellness achievable – and more cost effective

We all know we should eat healthier foods, drink more water, exercise more, sleep well and live a well balanced lifestyle.

But the reality of life means we’re juggling priorities or lack the willpower or knowledge, which doesn’t make it that easy.

As a team, we’re here to work with you – we’re here to motivate, empower and inform you with evidence based healthcare solutions.

 

Meet your Brellah Integrated Health Care team

Whether your needs are to improve your health, assist with weight loss, facilitate healthy ageing, or deal with womens’ or mens’ health specific issues our holistic health care team can work together to help you.


Meet the team here

 

 


Book here

This article is for information purposes only. It does not constitute medical advice, is general in nature, not tailored to your personal circumstances and you should seek your own medical advice from an independent medical professional with regards to what options are best for you.

 

Dealing with Dementia

Dementia is a topic that many people don’t feel comfortable thinking or talking about. It refers to the loss of brain function that affects speech, behavior, thinking, memory and mobility. This decline in mental ability becomes problematic when it interferes with daily life.

Alzheimer’s Disease is the most common cause of dementia accounting for about 70% of cases.

Although dementia mainly affects people as they get older, it should not be considered a normal part of ageing.

Thankfully, early diagnosis and awareness of dementia – and the right treatment and care – can lead to better outcomes and quality of life.

 

How common is dementia?

According to Dr Desmond Graham, geriatrician at Brellah Medical Centre, the prevalence of dementia is more common than people realise. Here are the statistics:

  • Dementia is the second leading cause of death of Australians
  • It’s estimated there were 250 new cases of dementia diagnosed in Australia each day
  • It’s the single greatest cause of disability in Australians aged 65 and older
  • People over the age of 65 have a 1 in 20 chance of developing dementia
  • Over the age of 80 that goes up to 1 in 5
  • Then up to the age of 100 years there’s a 1 in 2 chance of having dementia.

 

What are the signs?

Dr Des says that “being diagnosed with dementia can be a very difficult process for people, filled with stigma and denial. Therefore many people avoid seeking a diagnosis until the later stages of the condition”.

Here are the signs to be aware of that should be brought to the attention of a GP or geriatrician as soon as possible.

This is particularly the case as you become aware of these symptoms happening more frequently and affecting your quality of life.

Geriatricians do standardised cognitive testing to diagnose dementia. These check if what you or your loved ones are experiencing is normal memory loss relating to ageing – or if there is something else going on.

Therefore these signs may or may not lead to a diagnosis of dementia.


How is dementia cured?

There is no known cure for dementia. However there are many ways to help manage some of the symptoms and reduce the rate of progression.

Early diagnosis is important. When picked up early there are many things that can be done to address the issue. With the right support from medical practitioners, movement specialists and mental health experts, as well as loved ones and family, people can live well with dementia for many years.

  1. Medication

There are medications available to address the complex symptoms of dementia. This includes behavioural issues, anxiety/depression, and sleep disturbance.

Speak with a geriatrician who can discuss this further with you.

2. Keeping the mind and body active 

This is essential. Research has shown that regular exercise can benefit mental, emotional and physical health in people with mild cognitive impairment and mild to moderate dementia.

The sooner and longer people with dementia undertake regular exercise, the better their chances are of delaying disease progression or preventing dementia from developing.

The Brellah Move your Mind program has been developed to help with just that. It draws on clinical evidence and expertise to deliver group and individual classes that are engaging and effective. Participants are booked in for an assessment by an Exercise Physiologist to understand their strength, mobility, balance and coordination, in order to tailor an effective exercise program accordingly.

In addition, engaging in social activities and interests that engage the mind that are satisfying and fulfilling can help.

3. Complementary therapies 

Also sometimes described as ‘holistic’, things like eating well, supplements, manual treatments such as massage or osteopathy, mind-body practices and music therapy are other forms of treatment that may also reduce depression and anxiety.

 

What’s the prognosis?

Dementia is on a huge spectrum – some people with the condition can live home alone, and others are in nursing homes needing full time assistance with tasks like showering and eating.

According to Dr Des “The common fear people have is that they’ll end up in a nursing home, but that’s not always the case with the right measures and plans in place. Medication reviews, regular exercise, mood management, socialisation, support services and future planning all can make a difference.

Some of the things that can accelerate dementia are stresses on the brain. These include:

  • Infections
  • Some medications
  • Falls
  • Dehydration.

With the right care, dementia can be kept at bay, as opposed to progressively getting worse.

The hardest thing is knowing where to look for information and who to speak to. That’s when you need to speak to a geriatrician”.


Hear Dr Des speak about dementia on Radio 2GB here


Read more about the Brellah Move Your Mind program here

 

This article is for information purposes only. It does not constitute medical advice, is general in nature, not tailored to your personal circumstances and you should seek your own medical advice from an independent medical professional with regards to what options are best for you.

 

Using an Exercise Physiologist to treat chronic conditions

Meet Olivia Adoncello, Exercise Physiologist at Brellah Medical Centre. Olivia works with clients on an individual basis, and also runs group sessions in the Brellah Metabolic Health Program, Brellah Falls Prevention Program and Brellah Thrive Cancer Care program.

Olivia explains here how she helps treat patients with chronic conditions.

 

  1. When do we need to see an Exercise Physiologist? 

When you have a medical condition, injury or illness that requires professional exercise advice as a means of treatment, an Exercise Physiologist can guide you through the most appropriate forms of movement.

Some of these conditions include:

  • Post-surgery rehab to improve strength and function eg hip/knee replacement
  • Cardiovascular, pulmonary, metabolic, neurological and musculoskeletal disease (including arthritis, osteoporosis and musculoskeletal issues)
  • Depression and other mental health conditions
  • Cancer rehab
  • Advice on lifestyle modification to improve health status.

 

2. In what ways do Exercise Physiologists help their patients?
  • By helping to manage chronic conditions that require long-term care
  • By improving the individual’s education regarding their body and their bodily movements/functioning
  • With pain management strategies
  • Keeping motivation levels high
  • For long-term accountability and overall progression with their health and fitness goals.

 

3. How do Exercise Physiologists differ from physiotherapists?

Physiotherapists diagnose injuries and have a more hands-on approach to treatment (manual therapy).

EPs only use exercise as their means of medicine and are usually for more long-term management.

EPs also use behavioural change techniques and focus on improving overall quality of life for their patients.

 

4. What’s an example of how you’ve helped clients?

A client of mine is 16 years old and had leukaemia as a child. All the effects of radiation and chemo left him with spinal compression and other postural issues. He was training with me to prepare him for a surgery in order to realign his spine. In the time working with him (1 year) he has managed to avoid this surgery!

 

5. What do you enjoy about being an Exercise Physiologist?

Watching my patients go through their rehab or their program, and achieve their goals, inspires me to help more people. The more complex cases teach me problem-solving, which inspires me to continually learn – that’s what this industry is all about!!

We are all different people with different needs and abilities. There is no such thing as ‘one size fits all’ – and there are always improvements that can be made.

This inspires me to work closely with my patients to get to the bottom of their concerns/injuries etc, which gives me incredible relationships with these people and that is why I love what I do. It’s extremely rewarding!!


More about Olivia

Portrait photo of Olivia

Olivia is an Accredited Exercise Physiologist and Exercise & Sport Scientist. She has been working in the health and fitness industry for six years and has experience in private practice, group classes, home visits, personal training and gymnastics coaching. She has provided care and treatment to a vast range of clientele, including those with cognitive impairment, neurological conditions, cardio-metabolic conditions, musculoskeletal injuries as well as over 65s, pre and post-operative patients and cancer patients. 

 

This article is for information purposes only. It does not constitute medical advice, is general in nature, not tailored to your personal circumstances and you should seek your own medical advice from an independent medical professional with regards to what options are best for you.

Exercise as Treatment for Joint Pain

Pain. We all experience it, try to manage it, and have to deal with it. But we don’t all have to live with it.

Depending on the type of pain you are experiencing, treatment for pain may be more straight forward than you think.

Pain is one of Nathan Lum‘s (Brellah Exercise Physiologist) favourite topics and challenges. As he helps many of his patients deal with their pain, he shares his experiences here.


What
are the most common pain-related conditions you come across?

I come across a lot of people with chronic joint pain (pain lasting over 6 months). This usually occurs in the back, knees, hips, or shoulders.

In some cases an initial injury may have triggered it and the pain never resolved. However, some people cannot attribute their chronic pain to a specific event or injury.

Pain does not necessarily mean damage.

Particularly in relation to chronic musculoskeletal and joint pain, there’s a growing body of good evidence showing little correlation between degeneration of the structures around the joint (muscle, ligament, tendon, cartilage) and pain.

Rather, chronic pain is often the result of over-protective, guarding behaviour of the joint.


What is the prognosis for these conditions?

The majority of chronic musculoskeletal pain cases can be resolved with the right coaching and time.

There are many variables which determine the outcome of each case. Research shows that people with chronic pain who shift their perspective on physical activity is helpful – rather than detrimental for their joints.

This improves their self-efficacy (confidence and self-belief in their own ability). As a result they have much better 12-month outcomes than people who have pain-focussed and self limiting beliefs.

There is definitely hope for anyone with chronic pain to get to a stage where the pain no longer controls their life.


What role does exercise play in pain management?

Pain is a protective mechanism that helps us to survive.

In many chronic pain cases, this protective mechanism goes into overdrive resulting in guarding and fear avoidant movement patterns.

Gradual, graded progressive loading has a crucial role in rebuilding confidence and function by retraining the body out of over-guarding/protectiveness and conditioning movement as safe.


What kind of exercise do you prescribe to treat or prevent pain?

Although exercise plays a crucial role in treatment, in isolation it is not enough to address pain.

An effective exercise program would involve progressive loading which aims to gradually increase loading  the joint within pain limits to slowly but intentionally edge the boundaries of pain.

However, a crucial element of an effective program is providing education on the mechanisms of pain, independent strategies for managing flare-ups, and establishing a self-directed program for the person to perform by themselves throughout the week.

Ultimately, the goal of the sessions is to promote self-efficacy and independence rather than creating a reliance on the therapist.


Do you have any amazing case studies?

I have so many awesome stories! Here are just a few:

1. BRENDA 

  • Is in her early 70s and presented with chronic pain in her knees and lower back
  • She had undergone a total knee replacement about 6 months prior but said the pain had never resolved
  • She had completed her post-operative rehabilitation and was told she would not get any more progress regarding her knee and back pain.

When I first saw her, she could not stand from a chair without significant pain and found it difficult or was totally unable to perform her basic daily activities. During her first few sessions, she was extremely anxious and guarded with her movements and could not perform an unloaded squat due to flare-ups in her lower back.

It’s been approximately 6-months and Brenda can now perform a 40kg deadlift and a 30kg squat. The pain in her lower back has resolved and although she still gets some stiffness in her right knee, it occurs rarely and does not have any effect on her life. She has no issues with any of her daily activities and says she feels stronger than she ever has in her life. She exercises independently every day doing weights and regular 40 minute walks.


2. BRIAN

  • Is in his late 60s and has had chronic pain in both of his shoulders for over 10 years
  • He has had both shoulders replaced but was still experiencing pain and discomfort
  • When I first saw him, he was unable to lift a foam dumbbell weighing 0.3kg without pain.

Through a very gradual, graded exercise progression, he can now bench press 30kg repetitively and shoulder press 14kg overhead. We have also incorporated boxing into his program and Brian is now learning to box and has just gone through his first sparring match.


3. DAVID

  • Is in his early 70s and broke his tibia from a fall
  • He required surgery and could not put weight on his leg for 6 weeks as per the protocol
  • Even after 6 weeks, he could not walk without relying heavily on a forearm support frame or 4-wheel walker due to pain in his lower leg.

Now David can perform a deadlift of 70kg repetitively, and does a daily 60-minute bush walk without assistance. His last hurdle was significant pain in his knee whenever he knelt on the ground. Education was provided surrounding the nature of pain and he was given daily exercise tasks which gradually increased the load on his knee.

Within 3-weeks, he was able to kneel on the ground on his knee without pain and now starts the morning “walking around on his knees” just as a reminder that he can always improve.


4. KEITH

  • Is in his 90s and had severe instability in his right knee and could not walk without a 4-wheel walker and a person on each side supporting him
  • He could not climb up or down stairs and required heavy assistance to stand-up from a seated position.

Within 5 months, Keith could walk independently with a walking stick. Within 7 months, he was walking without any assistance and could hold a full plank for 15 seconds. It is now 12 months since he started and he walks every day to the beach by himself without any mobility aids.

He regularly performs 60 sit-to-stands without using his hands and can do squats while carrying a dining chair. He has set the goal to climb Mt. Kosciuszko in April 2022.


What made you decide to focus on pain management? 

I find pain fascinating as it’s an experience that every person goes through at one point or another in their life.

When I first started practicing, I was terrified by pain. I was worried whenever a client/patient presented with pain especially if it was following one of my sessions.

I decided that in order to effectively help my patients, I needed to understand pain and how to deal with it and so I started doing as much research as I could. The more I read the research, the more I realised I needed to learn and the more fascinated I became.

I’ve heard from many patients over the years that pain has stolen away parts of their life. There is nothing better than seeing a person who is anxious and controlled by their pain become empowered, confident, and strong.

It is amazing to see them do things they never thought they could do or get back movements and activities they thought they had lost forever.



Nathan Lum graduated from the University of Sydney in 2015 and is an Accredited Exercise Physiologist with Exercise and Sport Science Australia. He has experience in both private practice, workers compensation, and orthopaedic hospital settings where he championed evidence-based and patient-centred care. He is passionate about using exercise to empower people by aiming to change perceptions and lifestyle rather than just treating symptoms.


This article is for information purposes only. It does not constitute medical advice, is general in nature, not tailored to your personal circumstances and you should seek your own medical advice from an independent medical professional with regards to what options are best for you.

Congenital Heart Disease

Congenital Heart Disease (CHD) is the most common form of birth defect in Australia, affecting about 1 in every 100 newborn babies.

CHD occurs when normal development of the heart is disrupted in-utero. This can lead to a person being born with improper heart function, affecting the flow of blood around the body and back to the heart.

There are many types of CHD and severity ranges between individuals. Some defects are simple and don’t require treatment. Others may need surgical intervention over many years.

Thankfully, medical care and treatment have improved significantly over the past 50 years, and people with congenital heart defects are living longer and healthier lives.

Dr David Baker, Brellah Clinical Academic Cardiologist tells us more:


What are some common CHD conditions?

CHD encompasses a broad spectrum of heart defects, from relatively simple to extremely complex, more rare conditions.

Common simple conditions include:

  • Atrial and ventricular septal defects  – hole in the heart
  • Congenital valvular lesions – one or more of the heart’s valves not properly developed
  • Persistent ductus arteriosus – persistent opening between the two major blood vessels from the heart
  • Anomalous pulmonary venous drainage – the veins carrying blood back to the heart from the lungs are abnormal.

Some moderate conditions include:

  • Tetralogy of Fallot – the most common CHD causing low-oxygen levels or “blue” babies
  • Transposition of the great arteries – the two main arteries leaving the heart are switched
  • Ebstein anomaly – congenitally abnormal tricuspid valve, which often is severely leaky
  • Aortic coarctation – narrowing or constriction in the aorta which forces the heart to pump harder
  • Pulmonary atresia – where the valve controlling blood flow from the heart to the lungs doesn’t form.

Finally, the most severe conditions include those with significant unrepaired defects, or those with complex anatomy (repaired or unrepaired), including those who only have a single functioning heart pumping chamber (as opposed to the “normal” two).


What is the prognosis?

The prognosis for CHD has improved significantly over the past half-century, due to advances in surgical and medical care. This has led to more adults now living with CHD than children.

Although prognosis differs for each patient and each condition, for most simple to moderate lesions it is excellent with appropriate care. Improvements continue to be seen in the most complex of heart defects, where we are seeing adults live well into middle age.

Crucially, it has been shown that outcomes are improved when people living with CHD are managed by congenitally trained Cardiologists, as opposed to no specialist care, or even non-congenitally trained Cardiologists.


How can successful outcomes be achieved?  

For adults living with CHD, good heart health can be achieved by having an effective, long-term relationship with their medical team first and foremost.

Many complications of CHD may not lead to symptoms until it may be too late to safely intervene. Routine follow-up and surveillance are therefore vital to ensure that any abnormalities are recognised early, and effective treatments are initiated similarly.

Although “traditional” cardiology problems such as high cholesterol, diabetes, and heart attacks may be less of an issue, maintaining a healthy body weight, an adequate diet, and exercise capacity are very important.

Often, exercise capacity is reduced in moderate to complex CHD lesions, and actively working on this aspect is vital from a young age.

Historically, exercise may have been discouraged in young patients with heart disease, but we now work together to encourage and plan safe exercise routines.


What are the signs to look for with general heart health?

Common signs and symptoms for people with poor heart health include a declining exercise capacity, becoming more breathless, abnormal heart beats or palpitations, and dizzy episodes/black outs.

With abnormal hearts and prosthetic material, infection of the heart may be more common, and I educate all my patients on the warning signs for this as well (fever, anorexia, chills, night sweats, weight loss).

People living with congenital heart disease are a special population, who by the time of adulthood, have already undergone so much, such as major cardiac surgery or surgeries! It is common for patients to become accustomed to their own “normal” and therefore under-report symptoms. Thus, it is vital that routine follow-up is continued, even when patients are “feeling well”.


What made you decide to specialise in CHD?

Every person living with CHD and every heart is different. This population is often a younger cohort, who have already dealt with such adversity for their young age.

I find this nurtures a powerful resilience, optimism, and gratefulness.

It is extremely rewarding to support them through their adolescence, young adulthood and beyond, to achieve and maintain the quality of life they deserve.

I’ve been very fortunate to support and guide patients through major life events, such as planning and starting a family.


More about Dr David Baker

Dr David Baker is a Clinical Academic Cardiologist with special interests in Adult Congenital Heart Disease, advanced cardiac imaging (MRI), and broader interests in arrhythmia, heart failure and pulmonary hypertension.

David is a Staff Specialist at Royal Prince Alfred Hospital, following the completion of his sub-specialty training in Adult Congenital Heart Disease. He is furthering his expertise in advanced cardiac imaging (MRI), and is currently the Clinical Fellow at Cardiovascular Magnetic Resonance in Sydney.

David graduated from the University of Newcastle in 2007 and the Australian National University in 2011, before being awarded his FRACP in 2019 following medical and cardiology training at the John Hunter Hospital, Newcastle NSW.

A keen teacher, David is also a Clinical Lecturer for the Faculty of Medicine and Health, University of Sydney.

 


BOOK HERE TO SEE DR BAKER

This article is for information purposes only. It does not constitute medical advice, is not tailored to your personal circumstances and you should seek your own medical advice from an independent medical professional with regards to what options are best for you.

Measure your health, not just your weight

 

Body composition scanning is a useful, non-invasive way to measure how much fat, muscle and bone mass you have.

More comprehensive than a tape measure, scales (and your mirror), it can be a useful reference for fitness training, weight loss and for your overall health. 

 

How it works

Body Composition scanning using Bioelectrical Impedance Analysis (BIA)  is considered one of the most reliable and accessible methods of screening.

Taking just a couple of seconds, electrodes in the foot sensor pads send a low, safe electrical signal through the body. Weight is calculated along with other readings including body fat percentage, muscle mass, metabolic age and visceral fat.

The majority of the population can’t feel it and results are available within minutes.

 

What the scan tells you

BIA scanning takes 11 full body measurements:

    • Body Fat Percentage and Body Fat Mass
    • Segmental Body Fat Percentages
    • Muscle Mass
    • Muscle mass score
    • Total Body Water
    • Bone Mass
    • Physique Rating
    • Basal Metabolic Rate (BMR)
    • Metabolic Age
    • Body Mass Index Segmental
    • Visceral Fat.

Tracking your fat and muscle mass in this way can help reach your fitness and nutrition goals more effectively.

For example, if your health goal is to increase muscle mass or track your strength training, a traditional scale may not show much improvement at all. However, a BIA body composition scan will show a decrease in body fat percentage and increased muscle mass, although your overall weight has stayed relatively the same.

Importantly the scanner measures how much visceral fat you have surrounding your essential organs. This can indicate how much weight you may need to lose (and how) to obtain a safe and optimal level of metabolic health.

If you are lean and run or play alot of sport, a low fat mass analysis may indicate you need to gain more body fat to maintain good joint health.

And if you have shoulder, hip, knee or ankle injuries it can show imbalances between your left and right side. This may indicate the need for unilateral or specific strength training to minimise the risk of further injury.

You can also get a Body Composition scan as past of your annual Health Check to review alongside your blood pressure, blood tests and other any testing conducted by your GP.

 

Who should get a Body Composition scan?

If you’re starting a new training program or seeking to make subtle changes to your body, and want to be accountable, you can do a scan every one to six months.

Otherwise if want to make significant changes to your body composition in the form of weight loss (or gain) or building muscle mass it’s recommended you get a scan each four weeks to track your progress and ensure your training and nutrition strategy is working.

This machine has just landed at Brellah Medical Centre and Movement HQ. Many of the staff here have been keen to get their own readings, including Dr Des who gives it the thumbs up.

 

How much does it cost?

    • Initial Body Composition – COMPLIMENTARY
    • Follow-up session – $45
    • 2 follow-up sessions $80

Speak to your GP, PT, EP, or nutritionist for more information and also how a scan can help you effectively reach your goals.

 


Book now or find out more

 

At Brellah Health we use the Tanita Bioelectrical Impedance Analysis (BIA). This analysis is faster and less intrusive than many other means. The scanner is TGA approved, has only a 5% variation to a DEXA (X-Ray) scan, and is classified as a medical device. Tanita is recognised  as the world leader in precision electronic scales within the medical, health and fitness market.

 

This article is for information purposes only. It does not constitute medical advice, is not tailored to your personal circumstances and you should seek your own medical advice from an independent medical professional with regards to what options are best for you.

Taking charge of your metabolic health

Did you know two in three Australian adults are considered to be overweight or obese?

Anyone overweight is defined as having a Body Mass Index of over 25, and obese is over 30. Your BMI measures your weight in relation to your height, and a healthy range is 18.5 to 24.9.

A high BMI can be a sign of poor metabolic health. In some cases when left unmanaged, that can lead to conditions such as diabetes, high blood pressure, high cholesterol and stroke.

There are several lifestyle or genetic issues that contribute to our metabolic health, and as we get older or less active, we can gain excess weight.

 

Improving your metabolic health

According to Jemma Aitken, Exercise Physiologist at Brellah Medical Centre, “With the right intervention, metabolic health risks may be managed. Targeted exercise, nutrition and lifestyle changes can help.

That’s why we created the Brellah Metabolic Health Program. We help people manage their long term health with a balanced approach to exercise and nutrition.

We know early intervention is key, and prevention is easier than cure! We also know some of the barriers are cost and accessibility.

So we’ve designed a program that’s not only cost-effective, but offers access to specialists under one roof.

Our goal is to ​empower people with skills, tools and knowledge to help them feel better. And importantly, to live a longer and healthier life.”

 

How is your metabolic health measured?

You’re considered to have good metabolic health if you have ideal levels of blood sugar, cholesterol, blood pressure, high-density lipoprotein (HDL) and waist circumference, without medication.

Your General Practitioner or endocrinologist can confirm the status of your metabolic health.

 

Introducing the Brellah Metabolic Health Program

This program is for anyone who:

  • Has been advised by a medical practitioner they need specialist intervention
  • Wants to maximise results after weight-loss surgery
  • Is overweight or obese, and wants to avoid weight-loss surgery.

Combining individual and group sessions, we provide skills, tools and confidence to help you safely navigate the world of diet and exercise to:

  • Achieve and maintain healthy weight
  • Decrease blood pressure
  • Reduce heart disease risk
  • Achieve healthier blood sugar levels
  • Improve functional movement and mobility.

Jemma explains the mental benefits of focussed exercise over the longer term:

“We see significant changes for many people in mood, self-confidence and positivity with regular exercise and movement. And as we see downward trends in weight, many are excited to explore new, fresh food choices from our Dietitian.

True metabolic health is not achieved in the short term, and we find four to 12 month programs are more effective.

We see frustration when people put in the hard work for a short timeframe, only to find results aren’t sustainable.

The support we offer, as well as educating on the ‘why’ and ‘how’, we hope will lead to longer lasting results and true lifestyle change”.

 

Covering all bases

Because every body is different, the Brellah Metabolic Health Program is quite personalised, and treatment depends on what’s right for you.

Specialist attention

We offer the expertise of an Exercise Physiologist, Dietitian, Endocrinologist and Mental Health Specialist. This ensures all aspects leading to good metabolic health are covered, and we can also work with your referring doctor.

Targeted exercise

Following an initial assessment, the program offers targeted exercise and physical activity.

Jemma explains “Exercise and movement are literally medicine for our bodies! Exercise assists with weight loss, and supports a healthy, balanced diet.

And as well as reducing the risk of metabolic conditions it has been shown to have a beneficial effect on conditions like arthritis and depression.

Our bi-weekly group classes focus on building strength, cardiovascular fitness and endurance in a fun environment, with others on a similar journey.

We help with goal setting and behaviour change. We also look at how much physical activity needs to be done daily for health, well being and weight management.

What if you don’t enjoy exercise?

Jemma advises “There is honestly something for everyone! We often think of exercise as running, cardio, lifting heavy weights, or doing lots of push-ups, but that’s not the case.

Physical activity can include gardening, dancing, playing tennis or golf, walking, paddle boarding, swimming in the ocean.

Even walking the dog or kicking a soccer ball around with the kids. It’s so important to try different things until you find something you enjoy!

We look at different ways people can include more movement in their daily activities. Exercise shouldn’t have to feel like a chore.

It can be really challenging exercising for the first time, or after a long break. One of the best ways to make it easier is to start with small bouts – just 10 mins at a time – and build up to 30 mins on most days. Every bit counts!

As your fitness improves, you’ll find it easier to move for longer periods of time.

​Tailored nutrition plan

Each participant will also meet with our Dietitian every 4-12 weeks to make changes and check progress. This will help you make food choices that provide the right nutrients in terms of quantities and combinations.

For diabetics, food choices and meal timing to support safe and balanced blood glucose levels is covered.

For anyone post bariatric (weight-loss) surgery, our Dietitian will also guide you through an appropriate post-surgical nutrition plan with a gradual introduction to solid foods.

Mental health support

Psychological and mindset support is also provided if you need it.

 

Collectively, we empower every single person who participates in this program to be actively involved in their own journey to good health.

 

How to achieve good long-term success?

Jemma suggests: “Start small, set clear goals, and be consistent! If you’re persistent for long enough, results will come.

Make those goals achievable, for example do 10-20 mins of movement twice a day, or swap a chocolate bar for a nourishing snack. This will set you up for early wins.

Seeing progress in your initial weeks will drive your motivation”.

 

Get your health back on track with Brellah

  • Your choice of a Screening, Basic, Standard or Comprehensive Program, for 4 or 12 months 
  • Group exercise classes Tuesdays and Thursdays @ 9am for 60min, $30 per class
  • Initial consult with the Endocrinologist is partially subsidised by Medicare with GP Referral
  • Additional rebates may apply with GP Care Plan or private health insurance
  • People with Type II Diabetes may be eligible for rebates for exercise classes.

 

“The most rewarding thing about this program for me is seeing how much more energy people have. And how much they can truly enjoy life as they build healthier habits”

Jemma Aitken is an Accredited Exercise Physiologist with Exercise and Sports Science Australia. With experience in both private practice and worker’s compensation, she’s worked with a range of conditions including musculoskeletal rehab, chronic pain, weight loss and metabolic health. She has a special interest in exercise to support mood and mental health.

This article is for information purposes only. It does not constitute medical advice, is not tailored to your personal circumstances and you should seek your own medical advice from an independent medical professional with regards to what options are best for you.