Exercise Physiology with Roy Papalia
What is Exercise Physiology?
We discuss all things exercise physiology with our highly regarded exercise physiologist Roy Papalia.
1. What inspired you to become an exercise physiologist?
RP: “Well, I sort of fell into this role so initially I wasn’t sure what I wanted to at the start. When I was at university there wasn’t a direct pathway to becoming an Accredited Exercise Physiologist. In fact, I was one of a handful of students that not only expressed an interest in how the body works and responds to exercise but more importantly had the desire to help others improve their health and wellbeing through exercise and activity. If anything, in a weird way Exercise Physiology chose me.”
2. What are some of the biggest challenges and rewards of your job?
RP: “From time to time, I have had clients with end stage cancer or motor neurone disease be referred to me in which they have decided to engage in exercise to slow down the progression of muscle decline and maintain as much quality of life as possible. It is always a significant challenge swallowing the idea that eventually the disease will catch up to my clients and that this will be the reason why they will no longer be able to see me,”
“The biggest reward, I would say is now…being a mentor to other Exercise Physiologists in the industry and help create more of a ripple effect in helping more people change their lives for the better, which can then lead to such a positive and far-reaching impact on both individuals and professionals.”
3. What are some common health conditions that exercise physiology can help manage or improve?
RP: “One of my specialisations is to help my clients better understand and manage chronic or persistent pain. As a result, I am often head hunted in this space and therefore tend to see more clients suffering from chronic pain. We also have a very popular Strength For Life Program running at Resilient Health Group, which helps our older population engage in safe exercises in a community environment to “live longer and live stronger”. Often, they are referred to us for management of a cardiovascular disease, arthritis, lower back pain, heart disease, stroke rehabilitation, falls prevention, and recently for oncology rehabilitation.”
4. Can you share a success story about a client who benefited from your services?
RP: “I was referred a client who was recently diagnosed with Complex Regional Pain Syndrome. For those who do not know, this is a chronic pain condition that is characterised by severe and debilitating widespread pain after a surgery or injury, stemming from a heightened sensitivity and upregulated reaction to pain signals. My client was limited to staying home, could not move their arm without significant pain and inflammation, and felt so hopeless and helpless. A great success story was helping my client identify and then slowly overcome the significant biopsychosocial factors that were having such a profound impact on their pain presentation. It was a very long journey, with highs and plenty of lows along the way, especially considering this condition is often concurrent with a mental health component. However, I was able to help my client better understand the foundations of their condition, the associated triggers, and most importantly identify pacing and timing approaches to activities rather than booming and busting. But we had a great Doctor and an amazing Psychologist on board, and we definitely worked well as a team to help our client return to the community.”
5. Can you describe a time when you developed a personalised exercise program for a client with specific health concerns?
RP: “I remember one time when a client was referred to me with severe non-dominant upper limb pain. The pain was real, and enhanced by something called Central Sensitisation, which is a condition where the central nervous system becomes over-reactive to pain signals, leading to heightened pain sensitivity. In our first gym session together, we initially went through some basic cardio on a recumbent bike, some light exercises on the other arm, and a few leg exercises. My initial method of approach was to work everywhere else other than the non-dominant upper limb to work at desensitising its perception of pain in a gym environment. I warned my client that they will likely experience some heightened pain in their injured upper limb, as central sensitisation often kicks in a few days after exercise. They immediately dismissed it, saying it’s impossible as we didn’t even touch his injured upper limb. About three days later, I received a call. Their injured upper limb was an 11 out of 10. They felt defeated. This was such an integral stage of their recovery as step one is often understanding the concepts of Central Sensitisation and how it works. From there, I developed a very personalised exercise program tailored to this condition. A key focus was to always work well below pain windup levels and slowly increase thresholds by a small percentage every week. In fact, it took about a month until we were able to introduce a few repetitions on the injured upper limb. The end result, in about four or so months…my client was bench pressing at least 50kg and shoulder pressing 10kg dumbbells on either side. Most importantly, they were able to eventually achieve their goal in returning to both work and sport.”
6. What strategies do you use to motivate clients and ensure they adhere to their exercise programs long-term?
RP: “This is a hard one. I guess education and reassurance goes a long way. It is always important to discuss progress, periodise the program (including weeks where we reduce the intensity of the program for a short period), and with my clients who experience chronic pain reassure them that often pain is a reaction to booming and busting or increased danger receptors rather than due to an injury or re-injury. We need to continue to move and exercise with pain at times. More importantly it is about developing SMART (Specific, Measurable, Achievable, Realistic, Time Focussed) goals rather than BHAGs (Big, Hairy, Audacious Goals). It also helps when we have such a safe and supported environment at Resilient Health Group where we have such a large emphasis on community engagement. Half the battle is rocking up! This amazing environment that we have created encourages our clients to attend even if they are struggling to get out of bed or are having a bad day. And motivation is often what you end with, rather than what you start with so they feel a lot better in themselves once they have attended.”
7. What role does exercise play in preventing and managing chronic diseases?
RP: “Exercise plays such a vital role in both preventing and managing chronic diseases. In prevention, it can reduce the risk of developing chronic disease such as stroke (strengthens the heart and improves circulation), type 2 diabetes (improves insulin sensitivity), obesity (helps maintain a healthy weight), and certain inflammatory conditions (boosts the immune system). It also promotes mental well-being. In management, it improves symptoms and overall quality of life, can reduce reliance on medication (often we say to our clients that “Exercise is Medicine”), it can slow disease progression, and particularly for our ageing population it improves balance and reduces falls. We as humans are living longer, and with this are living longer with chronic disease that can become quite debilitating morbidities. Exercise plays such a vital role to help us all live stronger!”
8. How do you ensure your exercise programs are inclusive and cater to a diverse range of clients?
RP: “Each exercise program that I prescribed is always individual and tailored. Thus, it is designed with my client and is based on a thorough subjective assessment, objective testing and safe capacity reviewing, and goal setting. Our Health Hub is in fact an inclusive space for our clients and fosters and harvests an environment of safety and community engagement. We focus on accessibility, use inclusive language, always positively reinforce, are always very mindful of the diverse needs and abilities of our clients, and are always asking for feedback and advise on what we can do better. Our equipment is also state of the art, so we can prescribe any exercise program that we want!”
9. What are some common barriers clients face when trying to incorporate exercise into their lives, and how do you help them overcome these barriers?
RP: “I would say with my clients, kinesiophobia (i.e. an excessive and at times irrational fear of injury or re-injury with physical movement and activity) and pain catastrophising (i.e. a maladaptive coping style characterized by excessive negative thoughts, feelings and behaviours in response to actual or anticipated pain) are very common barriers, and understandably so! Education and reassurance are always the first step! In general, we would also see a lack of time, a lack of motivation, a lack of resources, and low self-confidence as common barriers that our clients face. We strive to help them identify their barriers and then work on developing individual and tailored strategies around this. We therefore help our clients identify suitable time slots to incorporate exercise and at times break down workouts into shorter and more manageable programs. We attempt to make our programs fun with great variety and always encourage an exercise buddy for added motivation and encouragement. We attempt to make our Health Hub as cost effective as possible and often prescribe home based exercises. We also encourage self-compassion and reiterate to our clients that fitness and exercise is a journey, and that we will be there with them every step of the way.”
10. How do you see the field of exercise physiology evolving in the future?
RP: “I am very confident that the field of Exercise Physiology is nicely poised for significant evolution in the future. In fact, I personally believe that Exercise Physiology is now booming. Advancements in exercise prescription software combined with the use of telehealth also allows us to reach our clients further and further away. Shifting health paradigms and our ability to adapt and transform around this makes us a prime Allied Health Discipline to an ageing population and a more inclusive community.”
11. What are your career goals for the next 5-10 years?
RP: “My career goals over the next 5-10 years are to be an accessible mentor to other Exercise Physiologists in the industry. I want to help create more of a ripple effect in helping more people change their lives for the better, which can then lead to such a positive and far-reaching impact on both individuals and professionals. I also have developed a passion in advocating for accessibility and inclusivity for all. As a result, we at Resilient Health Group are already brainstorming about building a very much larger all accessible and all-inclusive Health Hub. We want wheelchair basketball, sensory rooms, all accessible equipment, Pilates, a nice open café, and a community hub.”