Prehabilitation is the concept of increasing an individual’s exercise capacity to physically prepare them for their upcoming surgery. The prehabilitation programme in St. James’ Hospital is the first pre-operative exercise programme for patients who are scheduled for cancer surgery in Ireland. We have based our programme on the current research on pre-operative rehabilitation, and also the Macmillan “Principles and Guidance for Prehabilitation within the Management and Support of People with Cancer” (2019).

All patients scheduled for cancer surgery in >2 weeks are referred to the programme by their surgical teams and invited to attend physiotherapy for a 1:1 assessment. During this assessment, The physiotherapist carries out an assessment of physical fitness, muscle strength, frailty and function, and gives advice and information on exercise and lifestyle factors such as smoking, alcohol intake and sleep where appropriate. They are then invited to attend either an online or in person exercise class in the physiotherapy department where they are guided through a structured programme of resistance, aerobic and chest clearance exercises as a group.

Patients who are unable or do not wish to attend the programme are prescribed an individualised home-based exercise programme with regular follow-up telephone calls from the physiotherapist, as indicated.

For more information on the Prehabilitation programme please contact physiotherapist Sarah Wade (0874001157, swade@stjames.ie)

Prehab Patient Booklet 2023 with weights

There is an inpatient physiotherapy service on both the Hollywood and Burkitt Wards. The physiotherapist will assess your functional capacity and treat any physical issues relating to your diagnosis and treatment. We also assess and treat breast care patients following their surgery on the wards with follow up in our outpatient department.

Your consultant will refer you to the physiotherapist as needed regardless of what ward your are admitted to. If you have any concerns regarding your mobility during your inpatient stay, please feel free to touch base with your team who will refer you to our service.

Exercising Safely While Platelets are Low

Exercise booklet for Hollywood ward

Breast Care Booklet 1 - Set A Exercises

Breast Care Booklet 2 - Set B Exercises

Breast Care Booklet 3 - General Exercise

Deep Inferior Epigastric Perforators (DIEP) Reconstruction exercises

Physiotherapy Latissimus Dorsi Flap Reconstruction excercises

• Since January 2021 the physiotherapy department has developed early intervention strategies centered around the establishment of an “Early Detection of Lymphodema” service at St. James's Hospital.
• Lymphoedema is a common, lifelong and debilitating side effect of cancer treatment.  Lymphoedema develops when the lymphatic system is disrupted or overloaded and fluid gathers causing swelling, skin changes and reduced function if not managed early.
• Bioimpedance Spectroscopy (BIS) is used to detect and monitor fluid levels in patients at risk of lymphoedema. The early detection service is a screening and surveillance service. It detects lymphoedema sub-clinically. The early detection service provides treatment with short term compression garments, exercise and education. The service aims to manage the condition in the acute phase and potentially prevent long term chronic issues developing.
• Currently all high breast care and gynaecological patients scheduled for surgery are now been assessed pre-operatively. Following surgery, they enter a surveillance program for 2 years. The aim is to detect lymphoedema at a time when it is reversible (stage 0 and stage1). The main goal of the service is to education and empower patients on risk reduction with a large emphasis on proactive, preventative patient led care.
• The service focuses on enabling the patient to become and expert by instilling in them the confidence to recognise the signs and symptoms of lymphoedema. This allows for an earlier intervention which ultimately improves outcome.
• For more information, you can contact Claire Murtagh on 01-4162503/clmurtagh@stjames.ie

The Physiotherapy Department works in partnership with the trinity college exercise oncology research group to conduct research into the role of exercise in cancer care. The core value of this research programme is to conduct patient-centred, interprofessional, clinically pragmatic research that has the potential to positively benefit patient care. Further information can be found here https://www.tcd.ie/medicine/physiotherapy/research/exercise-oncology.php

The Physiotherapy Department, St James’s and Trinity College Physiotherapy are currently running the Pre-hiit trial (preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus), funded by the MRCG/HRB joint funding scheme 2018. This project will examine the influence of exercise prehabilitation on physiological outcomes and postoperative recovery and through evaluation of health economics, the impact of prehabilitation on hospital costs.

Exercise after surgery

Patients are referred to the outpatient Lymphology clinic if they present with problems of oedema from lymphatic origin (Primary/Secondary lymphoedema), from vascular origin, from systemic origin or from complex combined origin. Diagnostic is essential for the patient and to determine the plan and course of treatment. In some complex situations, the gold standard tool for diagnostic of lymphatic function deficiency is the Lymphoscintigraphy.

Although there is no cure for lymphoedema , it can be managed through minimising the risk factors and triggers, and through patient education and advice.

These precautions are detailed and explained to the patient during their initial assessment

In relation to the extent of the problems and in agreement with the patient, the therapeutic treatment of lymphoedema consists globally in 2 phases:

1. Intensive phase - education, skin care, exercise, measurements and sleeve/stocking prescription. Manual lymphatic drainage and bandaging if required.

2. Maintenance phase - intermittent measurements and garment prescription. May include manual lymphatic drainage.

   There is a strong emphasis on self-management as an important part of long term maintenance.
   Lymph Advice Booklet - Leg
   Lymph Advice Booklet- Arm

The first exercise rehabilitation service for patients in a national cancer centre was started in October 2021. The aim of the service is to:

• Provide best practice, evidence-based rehabilitation assessments and treatment to patients living with, and beyond cancer in St. James’s Hospital
• Prescribe individualised exercise programmes designed to reduce the late and long-term side-effects of cancer and its treatment
• Create a rehabilitation pathway from prehabilitation to cancer survivorship, including the development of pathways from acute to primary care.
• Act as an educational resource on the management of the physical side-effects of cancer to other allied health professionals and hospital staff.

In the first year of the service, a total of 482 patients were referred to the service, including patients with head and neck, breast, upper GI, colorectal, prostate, gynaecological and lung cancer. The majority of patients required individualised assessments and treatment programmes from the clinical specialist physiotherapist, and three structured exercise programmes were established for patients. These include:

• In-person exercise programmes in the physiotherapy gym in St James’s Hospital twice weekly
• Online programme twice weekly
• A maintenance class (online) for those who have completed the above programmes

The service also sends onward referrals for cancer rehabilitation within St. James’ Hospital eg. to the lymphoedema service and outside of the hospital to primary care centres based physiotherapy in patient’s community. More information about community based exercise rehabilitation can be found here: www.cancerrehabilitation.ie