Researcher Highlights
A prescription for exercise

Dr Sarah Valkenborghs’ research aims to deliver the evidence needed so that everyone gets the right advice on the exercise they need to improve their health outcomes.

“When I was studying to become a medical doctor I was surprised that there was almost no discussion around the benefits of exercise and how doctors should be advising people to be active,” Sarah says. “We know it works, but there’s not much hard evidence on what’s best – so that’s when I thought ‘here’s my calling’.”

Sarah wants to provide the evidence of the physiological effects of exercise that are beneficial for our health – for people with and without disease.

In her research, Sarah collaborates widely with clinicians, public health researchers, biomedical scientists and implementation scientists – and, most importantly, with patients. Sarah’s looking at conditions as diverse as cancer, stroke and MS, and is also working with healthy subjects. “One project that I’ve been working on with Professor Dave Lubans is demonstrating the benefits of HIIT (High Intensity Interval Training) with HSC students. We’re trying to find the evidence needed to get policy change so HSC students do 10 minutes of HIIT during the day at school.”

Will it help with stress? Will it improve brain function and plasticity? That’s where Sarah’s work comes in. She’s looking for changes that show what’s happening in these young, fit brains that are still capable of developing. It’s an exciting project.

“I came to Australia to do a PhD and become a lecturer, and teaching is a very important part of what I do,” Sarah says. “My teaching gives me a strong foundation in the physiology of a range of different clinical conditions, while my research keeps me up-to-date and informs my teaching content. They really go hand-in-hand for me.”

A lecturer at the University, Sarah’s passion for teaching is evident, and has been acknowledged with her short-listing for a Teaching Excellence Award. “Teaching is something I really pride myself on, so this means so much to me.” And that excellence permeates everything she does.

As a physiologist, Sarah uses high-tech equipment such as multi-modal MRI (Magnetic Resonating Imaging), DeXa scanning and VO_2max testing to precisely pinpoint exactly what exercise does for our bodies. She’s particularly interested in the benefits for our brain – exploring changes in structure, function and metabolism due to exercise.

“For me, MRI is integral to the wide variety of work that I do. The beauty of MRI is that it’s not invasive,” Sarah says. “For a clinical population it’s an easy process – you just have to lie there and the machinery tells us what we need to know. For many of the patients we work with, it’s probably one of the easiest appointments they have.”

Sarah is working to understand how exercise changes things at a basic molecular level. “We have a research question and hypothesis and then we identify the areas of the brain we’d like examined. The MRI operator captures the information, then I examine the data.”

“What we’re trying to demonstrate through looking at the physiological effects of exercise, is how it is beneficial in a range of conditions.”

Movement is the best prescription

Just about every cohort that Sarah is dealing with has had something catastrophic happen to their body; whether it’s sudden like a stroke or a degenerative condition like MS. Sarah says that with all the people she’s worked with, exercise can help them take some control of their situation again. “I think agency over your body is important as it gives you a sense of autonomy,” Sarah says. “When you have a chronic health condition you often feel as though you have no control over your situation. But doing some simple exercise empowers people and gives them a sense of purpose.”

This is something that Sarah’s seen over and over at Newcastle’s Kaden Centre, a purpose-built exercise facility for people with cancer and other chronic conditions. Working with the Kaden Centre team and a range of health researchers, Sarah is aiming to deliver the scientific evidence that backs up what the Kaden Centre team see happening with their clients.

Sarah believes that there should be an individual approach to developing an exercise program to aid people with cancer. “We’ve done some preliminary research into this area, and it’s exciting to note that exercise seems to have proven benefits for people going through cancer treatments,” Sarah says. “And there’s also growing evidence of the importance of ‘pre-habilitation’ to prepare people’s bodies for what’s ahead.”

Sarah is also working alongside clinicians such as Dr Craig Gedye. “One thing we’re looking at is whether exercising while receiving treatment will deliver more blood, and potentially more drug, to the actual tumour in real time.”

Different conditions, similar physiologies

Sarah is also working with Dr Vicki Maltby on how lifestyle interventions may improve fatigue in people living with MS. This work builds on Sarah’s PhD work in stroke where they discovered that fatigue was the one thing that varied widely between the control group and the exercise group.

“With MS, one of the things that people don’t understand at a physiological level is why they’re so tired,” Sarah explains. “Mindfulness and Pilates seem to help, but nobody really knows why. So that’s why we’re doing an MRI spectroscopy study to see if there’s any shift in a person’s brain metabolism with these activities.”

The most important aspect of a research clinical trial is participants. Sarah has found that no matter what condition people are living with, all are happy to contribute to future knowledge. “They are happy to get involved in research because more and more people are seeing that exercise is important and they’re often frustrated that nobody has told them how or why they could or should be exercising.”

In fact, for many, they’re told the exact opposite – to go home and rest.

However, where the real challenge lies is that many people with a clinical condition, also have (at least) another. These co-morbidities make things extra challenging. “What you’re trying to do is juggle maybe two or three conditions at the same time and find the happy medium of an exercise that treats one and doesn’t exacerbate the other, or treats both at the same time.”

“Physiology is complex,” Sarah admits. “There are so many ways that things can impact on the body, then you layer on comorbidities and the pharmacological effects of medications on top of exercise… That’s why it’s such a niche area. There’s so much happening.”

“It’s total systems physiology, you can’t just think of one organ system at one time,” Sarah says. “That’s why this work keeps me on my toes. It keeps me interested.”

“But we know that exercise is beneficial for the vast majority of people, we just need the evidence to back it up,” Sarah says. “My research is trying to find the right type and dose of exercise for each individual depending on their condition(s).”