Sunday, April 14, 2024

Rebecca Robinson | The Running Doctor

by Domhnall

Athlete, Academic, and Consultant in Sport and Exercise Medicine

Rebecca Robinson is a Consultant in Sport and Exercise Medicine with a special interest in exercise in cancer care, frailty, and female athlete health.

Rebecca has a portfolio career that includes clinical time at Marylebone Health (CHHP), professional sport, and the NHS

She graduated from Newcastle University, and trained in both hospital medicine and Sport and Exercise Medicine.  Her research includes work on the impact of physical activity on chronic illness, clinical research in oncology to address barriers and opportunities to integrate exercise prescription into medical care. Her current clinical work includes musculoskeletal medicine, sport and exercise medicine for elite athletes and event medicine. She is also involved in helping Long COVID’ patients get back to exercise safely.

Rebecca is an international athlete competing both on the road and in the mountains.

My work in cancer is a passion, I guess. I had an inclination it would be important from where I was working in hospital with patients who are affected by cancer…It was the common perception that people with cancer would not be able to maintain fitness and muscle mass because of the cachexia, wasting process driven by the metabolism during cancer, and sarcopenia which means loss of muscle mass. But it looks like some of these processes can be attenuated.”

Watch the video, listen to the podcast, read the transcript below

Rebecca, you’re one of the new generation of sport and exercise medicine consultants. Tell us about your career.

Rebecca Robinson:  New, I guess, in terms of when I started my training. The curriculum in sport and exercise medicine was in probably in one of its first iterations then, back in 2010. I went through training first as a hospital trained doctor and then moved into sport and exercise with the aim of continuing what I still work in which is, primarily, looking at frailty and exercise, and exercise and cancer, and also assessing female athlete health. And you mentioned, that this week, I’m abroad with sport, because the job does also involve working with sports teams and keeping people healthy right up to competition.

DMacA: Let me bring you back to your work on cancer. Your work is really interesting in that you encourage people to be active after their diagnosis of cancer. Tell us about that.

RR: My work in cancer is a passion, I guess. I had an inclination it would be important from where I was working in hospital with patients who are affected by cancer. And, as I’ve been working as a clinician, a lot of the research has grown up around this area and it’s still growing. It was the common perception that people with cancer would not be able to maintain fitness and muscle mass because of the cachexia, wasting process driven by the metabolism during cancer, and sarcopenia which means loss of muscle mass. But it looks like some of these processes can be attenuated. So, if we have good nutrition, if we can manage even a small amount of activity, it can really help to keep someone less frail and more resilient through their cancer journey.

And from the evidence that we have so far, it does look like in some cancers, particularly with colorectal and breast cancer, that it may have a beneficial effect. It may reduce recurrence and it may also impact survival. But I think the bigger message, perhaps, is that by keeping people resilient during and after treatment, we can also hope to reduce some of the secondary effects, such as, for example, the cardiotoxicity of medications. It’s certainly a growing field, but there’s an awful lot still to be done.

“… the bigger message, perhaps, is that by keeping people resilient during and after treatment, we can also hope to reduce some of the secondary effects, such as, for example, the cardiotoxicity of medications. It’s certainly a growing field, but there’s an awful lot still to be done.”

DMacA: Give us some practical examples. What advice would you give to particular patients.

RR:  I think it’s a case of working out what patients were doing before and what they enjoy. I have some patients who’ve never really been particularly physically active. They’ve had quite demanding jobs and lifestyles, or where they’re looking up after the generation older than them, or the generation younger than them. So, they haven’t had access to being active. For those patients it’s a case of finding out what they could enjoy, how they can access moving a little, and some of the fears around physical activity which may be related to their worries about cancer. Sometimes it’s just getting people off the first rung of that ladder.

Basically I like to try and find out what people enjoy doing. Some people have not had a history of being physically active. It’s trying to find out what they might enjoy, who they might go with, what is within their understanding of exercise, and what they have access to. Because, if they’ve got a diagnosis of cancer, you don’t want to make people feel it’s punitive or that they’ve got to do something that they don’t enjoy, or isn’t actually feasible for them. And then on the other side, I find I have some patients who are very physically active. Sometimes it’s a case of us looking at their normal level of physical activity, which can be quite a lot if they’re a triathlete or a cyclist or a swimmer, and saying, well, actually this is going to be a bit different now. Sometimes they are going to have chemotherapy or surgery and it might be really hard for them to alter their normal goals around being active.

We’re looking at framing this as a period of time where their health comes first, but not losing sight of the things that they still want to be doing. I learn a lot from those patients, both groups of patients, those for whom we find physical activity and they discover something that they really enjoy that they didn’t have before, but also from those who continue being active through the treatments. Sometimes medically, you have to say, I’m not so sure how we’ll do this, but we can come to a plan between the patient and myself and sometimes with other members of the team.

“… having a menstrual cycle, for example, is not an illness in itself, but it can certainly have dysfunctional symptoms and syndromes… And then we have other issues around that hormonal lifestyle that are different for a woman such as, considering a pregnancy, return to sport afterwards, looking at the menopause”

DMacA: There’s another group of athletes, and we really shouldn’t call them patients, female athletes. You have a particular interest in the female athlete?

RR:  As a female athlete myself as well as a medic, I didn’t really think there was an awful lot that we didn’t appreciate, didn’t learn or know about, but there is. As more women have come into sport, the more we realize that having a menstrual cycle, for example, is not an illness in itself, but it can certainly have dysfunctional symptoms and syndromes around it that we need to be on top of in order that the female athlete can be as available on the pitch, in the gym, on the track, as the male athletes.

And then we have other issues around that hormonal lifestyle that are different for a woman such as, considering a pregnancy, return to sport afterwards, looking at the menopause. There are some different aspects around the fluctuations of a woman’s menstrual life and general health and fitness. It has become an interesting area that’s still growing. And we’re also learning about it too. So that’s been a really interesting part of my work as well.

“Go for it” is usually my advice… it’s a career in which you can make it how you want to work it. I still work very much in a portfolio job, and I’m really hoping that the balance of my job will be more towards exercise medicine over the coming years. It’s hard work to shape it.

DMacA: As one of the new generation of sport and exercise medicine consultants, I’m sure you’re often asked by people who want to take up that specialty, what’s your advice to them?

RR: “Go for it” is usually my advice. I’d say it’s a career in which you can make it how you want to work it. I still work very much in a portfolio job, and I’m really hoping that the balance of my job will be more towards exercise medicine over the coming years. It’s hard work to shape it. The generation before me, those who founded sports medicine, they really paved the way. And every time I think, ‘oh gosh it’s quite hard’, because certain aspects of the work that I do are not embedded, I think, well, hang on, others worked really hard to set this up, so I can’t rest on my laurels. You’ve got to have energy and drive and sometimes you can feel a little bit isolated. So, I’d probably say as well, talk to other people that do the job because we can all share some of the frustrations as well as the successes.

DMacA:  Finally, let me ask you about your own sporting career, because you’ve been a top class marathon runner and hill runner.

RR:  Most of my fastest running was when I was a junior doctor as well. So, I certainly didn’t particularly protect the time around it. I guess I was just doing all things at once. But yes, I’ve been lucky to run the marathon for Great Britain, and on the mountains too, and I think it’s definitely helped me around understanding the demands on elite athletes, but all levels of athletes, and even some of the people that I work with, who haven’t done physical activity before.  I’ll say, maybe you should do some training because we think it’ll have an impact on the illness, but we know that it can be fun as well.

The balance of fitting it in is sometimes challenging, especially if I get injured, which I’ve done a couple of times. But I think getting that mix into a busy life is really essential for me.

DMacA: Well, it’s certainly a busy life. You’re talking to us from Milan today. Give us was a flavour of where you’ve been in the last 12 months.

RR: It sounds exotic over here, but actually we’re mostly in a boxing gym. But I’ve also worked quite a bit with tennis, so was at the Eastbourne Tennis Tournament, which is not overseas, but there were a lot of international athletes. And also working with cricket. I’m not particularly a follower of cricket but it’s a big deal and a massively respected sport and I love working with the athletes and the Manchester Originals, the Hundreds team from Northwest, got to Lord’s and the Oval within 24 hours last summer. We’re hoping to repeat that this year and go all of the way. So definitely some eclectic experiences.

DMacA: Rebecca, it’s been a pleasure talking to you today. Thank you very much for joining us. May I wish you every success with your continued career in sport and exercise, medicine and on the road.

RR: Thank you very much. Thank you very much for inviting me.

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