Talk:Exercise and metabolic disease/BCRL

Reflection

The purpose of this reflection is a learning process which is aimed at aiding constructive practice in order to improve scholarly work as well as think critically about the resource and its information. The following questions have been used to assist the reflection process.

1. What parts of the resource were most useful in working with the "client" and why?

I believe it is relevant for Exercise Physiologists to understand their specific role when dealing with individuals with BCRL in establishing a focus on preventing the progression as well as reducing the severity of chronic lymphedema, as indicated in the ‘Diagnosis’ section. This is important in enabling these women undertake their normal activities of daily living in their utmost functional capacity. This naturally allows them to maintain or improve their self-esteem/ self-confidence in carrying out their daily tasks and, as a consequence, feeling better about themselves.

The general overview of treatment options of BCRL is stated in the ‘Medical and Clinical Considerations’ section with a link to the following website: National Lymphedema Network website - http://www.lymphnet.org/pdfDocs/nlntreatment.pdf 	                 As an EP, I believe it is good to know the generic treatment options that are provided for these women, and therefore have an understanding of how the treatment provided by Exercise Physiologists (EPs) plays a role in the treatment process, as well as the interactions with other treatment modalities.

The risk factors and complications of BCRL, which are further mentioned in this section, are also important to have an understanding of and take into consideration when working with these clients.

Exercise training has been proven through recent research to have positive benefits for this client base from improving overall quality of life through to specific physiological adaptations/changes. The wiki provides an overall understanding of these benefits together with the research backing it up, which I believe equips the EP health professional with sound knowledge to explain why it is important and encourage the client to undertake an exercise training program. There is also some information about how exercise can improve lymphedema as well as mentioning where the current literature is heading in terms of research regarding optimal exercise prescription.

The exercise prescription guidelines provide a foundation for safe exercise implementation, backed up with research evidence. It is specifically mentioned that some patients may experience inevitable deterioration in their physical capacity with cancer treatment, where exercise can assist in reducing these declines. I think this is important for the EP health professional to understand this and consequently adjust their exercise program accordingly.

'''2. Can you suggest improvements to the practical use of the resource? Rationalise any improvements and provide examples where possible.'''

Improvements can always be made to the wiki to further enhance its effective practical use in the clinical setting. Goal setting is one point that could be added to the wiki in order to highlight the importance of goals''' (goals that are specific, measurable, achievable, realistic and timely) as an effective tool in making progress to assist in motivating the patient reach their goals by helping them work towards their objectives and providing measurable outcomes for the EP health professional.

I also think that the wiki could have placed more emphasis on directing the health professional towards understanding empathy and engaging in empathy towards the clients they are working with. Perhaps discussing and focusing more on the burden that lymphedema places on these individuals, additional to their experience of breast cancer, can help create an environment of empathy. In essence, I believe this would assist in building an effective client-health professional relationship and therefore better health outcomes.

Providing information of support groups for ladies with breast cancer such as Cancer Council support groups and Abreast equips the EP with tools to give the client in gaining support with their experience. Social interactions and building positive relationships I believe creates better outcomes for those experiencing BCRL.

'''3. Was the resource factually accurate? Use references to support your response.'''

The wiki resource is factually accurate with all the information supported with relevant evidence from research papers, position stands from, and Cancer Council'''. The wiki is properly referenced throughout with the references displayed at the bottom of each page in the bibliography. If the reader is interested in further reading, they can access the references online through the reference list.

'''4. What are your thoughts on the layout of the resource? Describe what changes you might make to improve ease of understanding of the resource. If you are aware of anything that may improve the resource (e.g. a video, reference to further reading etc) include them here.'''

I believe the wiki to be quite easy to read and understand myself and this would also be the case for a reader who does not have an exercise physiology background. I think the highlighted links for definitions to some words provides a good method in assisting the readability of the information. For example, an individual who experiences BCRL can access this wiki site and find it useful in providing information on exercise relating to BCRL without feeling as though the language used is out of their scope.

However, there is always room for improvement and I think that the ‘Exercise Training’ section could be further broken down into subheadings to help with the readability. This will also help the reader to scan through the information to look for something relevant, especially when time is an issue, such as in clinical practice.

Providing a link for a youtube on some specific exercises in the ‘Exercise Prescription’ section could be a great way to show different exercise ideas that are interesting and fun, but also safe and effective.

I am in favour of the use of diagrams and tables to graphically explain information in the text or give further information, such as the lymphatic system diagrams of the human body showing the lymph system and the table of the blood pressure ranges.

5. Describe any personal experiences you have had, or anticipate, in professional life and how such a resource might be used in practice.

As a personal trainer in a female gym environment, I have had experience in training with women who have chronic illnesses and specific medical conditions. BCRL is one condition I have been exposed to and I believe that having access to this wiki would have provided me with the tools to safely undertake an effective exercise training program. It would have given me access to the following:

-	The background knowledge of the condition

-	Advising how exercise may assist in improving the condition

-	What to take into consideration, for example contraindications and risk factors

-	What is generally summarised in the current literature regarding exercise, and

-	Exercise training guidelines.

Having access to a wiki regarding a specific condition is a very useful tool in the clinical setting and can be adapted by any health professional to utilise at their discretion.

--Nina Semenov (talk) 02:13, 4 April 2012 (UTC)

Reflection: BCRL
This reflection is based on the use of the breast cancer related lymphedema resource in a client consultation situation.

The breast cancer related lymphedema page was a very useful resource for conducting a consultation with a client. The most useful parts of the resource when working with a client were:
 * The pathophysiology page – this page enabled the exercise physiologist too quickly re-read about the disease so if the client had any physiology based questions they could be answered.
 * Contraindications and precautions to exercise are listed in a very easy to read format, making it very easy to know what to look out for.
 * The benefits of exercise for breast cancer related lymphedema patients are summarized in dot point form; this made it very easy to explain how exercise can help the client. This was particularly useful as many patients suffering from this disease have mixed views about exercise in relation to their circumstances.

This page is a useful resource for retrieving any required information quickly. But it could be set up in a way that is more focused on client consultations:
 * Mentioning goals would be useful.
 * Suggesting more specific exercise programs, including specific exercises, with progression in mind would make it more user friendly in a client consultation.
 * More emphasis on the client and how to deal with them.
 * Mention of the benefits of exercise other than just the physical, disease related ones. For example; the possible social benefits.

This resource was very factually accurate and well referenced. Examples of this are provided below:
 * The statistics are derived from recent studies that are relevant to Australia(1)(2).
 * When it comes to exercise training and prescription every statement is supported by a recent peer reviewed reference. This makes it very hard to dispute any of the statements made. For example the statment that exercise may not enhance the likelihood of developing BCRL nor exacerbate the condition, but instead create positive health benefits in this patient population, is backed up by a number of references including one reference which directly challenged the myth that exercise in this population group caused harm, finding results which support the mentioned statement(3).
 * Links to reliable resources such as Exercise and Sports Science Australia (ESSA) and the National Cancer Institutes are provided for those who require more information or confirmation of the information provided.

The layout of the resource is very simple, making it very easy to use. There are no long winded paragraphs anywhere and everything is labeled well, making it easy to skip straight to the information you are seeking. A lot of the information is presented in dot point format; this makes relaying information to the client much easier. Pictures are used well; this is another feature that can make explaining quite complex processes to a client a lot easier. One way to improve the layout of this resource would be to simply expand on the noted good features of the layout. The inclusion of more pictures and presenting more information in either dot point form or in a table would make it even more user friendly.

I can see this resource being very useful in situations where you haven’t had to deal with this specific condition for an extended period of time. It will be very useful for quickly brushing up on the key points of the disease prior to a consultation with a client. Also if a client wants to go away and learn more about their condition some very easy to understand and informative references are provided.

References

1. Jemal, A., et al., Cancer statistics, 2002. CA: A Cancer Journal for Clinicians, 2002. 52(1): p. 23-47.

2. Edwards, T.L., Prevalence and aetiology of lymphoedema after breast cancer treatment in southern Tasmania. Australian and New Zealand Journal of Surgery, 2000. 70(6): p. 412-418.

3. Harris, S.R. and S.L. Niesen‐Vertommen, Challenging the myth of exercise‐induced lymphedema following breast cancer: A series of case reports. Journal of Surgical Oncology, 2000. 74(2): p. 95-98.

Ben Griffin