Blood Flow Restriction (BFR) training has been used for years to help patients make greater gains during strength training.
But does BFR belong in oncology rehab?
Short answer: yes!
Dr. Kelly Martin, PT, is back on the podcast to discuss the benefits of BFR, plus important safety considerations for our oncology patients. Dr. Martin also shares her experiences using BFR in clinical practice, including protocols, patient responses, and the importance of education and reassurance for patients hesitant to engage in exercise. The conversation highlights the need for more research in this area and the potential for BFR to improve patient outcomes in oncology.
What is Blood Flow Restriction?
Blood Flow Restriction (BFR) uses the application of cuffs (typically pneumatic, aka air inflated cuffs) to decrease arterial blood supply to the target limb. The patient then performs resistance exercises with the cuff still on and inflated.
This technique causes blood pooling distal to the cuff, which can increase strength & muscle size, without increasing the resistance or load of the exercise.
As Kelly discusses in today’s episode, this allows the patient to maintain or even increase their strength even if they cannot tolerate higher loads.
Does BFR belong in oncology rehab?
BFR can be a bridge to higher intensity training for many patients, including those with cancer. patients recovering from surgery or treatment.
Especially with prehab becoming more of a hot topic in oncology, we may see BFR implemented more frequently as a method to help patients prepare their bodies for upcoming treatment, even to become candidates for various cancer treatments.
Challenges & Considerations for BFR in Oncology
Incorporating BFR training into oncology rehabilitation presents a promising opportunity to enhance patient outcomes. As with any modality, you must educate your patients thoroughly on BFR and reassure any hesitations they may have. Above all, Kelly discusses the need to ensure your patient feels equipped and empowered to consent and revoke consent to BFR at any time.
With its proven safety and effectiveness across diverse populations, including those with comorbidities, BFR has the potential to significantly improve quality of life and functional capacity in individuals with cancer. Even so, more research is necessary to expand the application of BFR into various oncology patient populations.
As oncology physical therapists, we should advocate for integrating BFR technology into clinical and prehabilitation settings, ensuring that patients have access to this powerful tool as they prepare for and navigate their treatment journey.
Want to join the conversation on BFR in Oncology?
Join TheOncoPT Specialization Community here.
Today’s Research Round-up Article: Blood Flow Restriction in Oncological Patients: Advantages and Safety Considerations
Watch the full episode on YouTube
Watch this week’s episode of TheOncoPT Podcast on our YouTube channel!
Transcript
Elise – @TheOncoPT (00:00)
Hey, Onco PT and welcome back to this episode of the Onco PT podcast. We are continuing with another one of our research roundup episodes with our amazing research assistant here at the Onco PT, Dr. Kelly Martin. Now, Kelly, would you mind reintroducing yourself to our listeners who maybe haven’t heard your voice on the podcast yet?
Kelly Martin (00:20)
Absolutely, Elise. So my name is Kelly Martin. I am a physical therapist in North Carolina and I practice currently in the outpatient setting. I see a good mix, but get to see a little bit of some patients with cancer diagnoses in my clinic as well. I’m trying to expand that horizon for myself.
Elise – @TheOncoPT (00:43)
Now, Kelly has been with the OncoPT team for several years now, and part of a big, actually big part of what she does these days is identifying different research roundup articles to review within our private OncoPT specialization community. And one such article that she brought to mind, I wasn’t even aware was pertinent or relevant to oncology. And so when Kelly suggested this article, I was like, whoa, whoa, whoa.
Back up first of all, because I didn’t even think this was possible. And I really appreciated how Kelly has this ability to find a lot of articles that are kind of outside of my very like oncology focus and bringing in what we know to be working really well in other areas of physical therapy that maybe oncology needs to catch up on. So Kelly, would you mind introducing us to today’s topic of our research roundup?
Kelly Martin (01:40)
Absolutely. So the article that I found that I thought caught my eye and was really interesting is discussing blood flow restriction training in the oncology population and kind of delves in in terms of what literature is even available. The advantages that potentially are out there for this population as well as some things they touch on some points about safety and application of the actual cuff to patients and so
What’s really interesting about it is that I use BFR, I had the opportunity to use BFR in my clinic setting in outpatient.
And so I have really only applied it mostly with our post -operative population. So post -op ACL, joint replacement, other scoped surgeries, whatever, when the idea is that the body at that time, the tissue, the healings that’s happening in those early phases of rehab.
doesn’t allow us to load the tissues at a high intensity that they need to start building those foundational bits of strength. And so we use it a lot early on and then as the body heals and is able to take on more load, we then kind of move away from them. But what’s really cool is that, you know,
Elise – @TheOncoPT (03:03)
Mm
Kelly Martin (03:09)
It’s an idea that you can get gains from muscle mass to trying to delay muscle wasting in these populations when people aren’t ready for those really high loads thinking like 60 to 80 % of a rep max. Just speaking a little bit of like.
ex -phys strength and conditioning kind of focus and so essentially what BFR is for those who don’t know or maybe heard about it in PT school, didn’t have a chance to use it or go beyond just a lecture on it. I know in my program we had the opportunity to talk about it and then we had a unit in our program so we got to use it as well so I got to experience it then and then I really didn’t get to come back around to it until I was in my current clinic where I practice and so essentially
Elise – @TheOncoPT (03:32)
Definitely.
Mm
Kelly Martin (03:59)
it’s taking a blood, a pressure cuff, some type of limb occlusion device. Usually it’s pneumatic, it’s kind of like getting your blood pressure taken essentially. And you take out a certain level, a certain percentage of, you occlude the limb to that percentage. Usually, I use it a lot with the lower body, so it’s somewhere between 60 to 80 % of occlusion.
And then the idea of it is that we take that away.
And essentially I like to think about it as like a supply and demand. So we’re going to have a patient do an exercise and anytime when we exercise our muscles need, they demand oxygen, nutrients, blood flow, like they need those things in order to keep us going. And with the cuff itself, we’ve kind of taken away some of that supply. So the muscles start asking for things that we just don’t, we’re not, we’re not giving it in a way.
And so that kind of teeter totter kind of flips a little bit. The demand’s not there, but we’re still demanding a higher, that’s what kind of creates that higher intensity. We’re creating an environment where the muscle needs more, but we’re not giving it, but it still has got to work anyways. And so what’s really cool is that at lower intensity activity, let’s say like a bridge or a straight leg raise or some like simple beginning progression you might use with a patient applying BFR, we can see a
And that exercise is less intense, but that might be the exercise the patient needs in that moment. We apply the blood pressure cuff or the BFR cuff.
And you can see people have gains as if we were loading them at 60 to 80 % of their one rec max, which is pretty crazy. To think about is you can take something simple and take a piece of technology and dial up the intensity and start to gain those, start to build those blocks of strength.
in that population. So I think that’s where it’s really cool to think about how this technology can be applied across the spectrum, across populations of people, across age ranges, and really start to build those foundational strength pieces and then be able to move on when they’re ready to do so. That’s a whole ramble.
Elise – @TheOncoPT (06:24)
Mm -hmm. And speaking to what you just said, Kelly, you mentioned this is applicable across different patient populations because originally, I think when I was first learning about blood flow restriction, it was very much in an orthopedic, kind of younger, more athletic patient population. And what I have come to find, especially through this article, is that BFR can really be used in many different patient populations.
including a really wide age group. talk a little bit, and I’m sure you can speak to this more in your practice, about you don’t have to be this young, young fit person to benefit from this. In fact, we’re seeing some really impressive gains, like you talked about even in our elderly patient population.
Kelly Martin (07:11)
Right, and if we think about who on average gets a cancer diagnosis, it’s typically our older population. Not to leave out our AYAs, they exist, they’re out there, their numbers are huge as well, but on average, we’re going a little bit later into the lifespan when we’re thinking about a cancer diagnosis. And so they’ve already, what I really like about this article and this kind of review of what’s out there is that they highlight
Elise – @TheOncoPT (07:21)
Absolutely.
Kelly Martin (07:41)
you know, we’ve seen BFR applied in our older adult population and whether that’s postoperatively or kind of more maybe even general, like a deconditioning situation, seeing these gains in lean muscle mass and hypertrophy and reducing risk for sarcopenia, all these things that we talk about in school a lot and even just in clinical practice that happens as we age and our bias, as you know,
We’ve got to continue moving. We’ve got to continue exercising. This is why strength training is important so that the older we get, can kind of, we know that it will decline, but how quick, how much can we slow that decline so people can be as functional as possible? And this is really where this technology comes into play is that we can take this and if at the time they’re not ready to be loaded, it’s not that we don’t load them. We do.
We make it intense in order to drive change. And we can use this to kind of in the meantime augment what we’re getting and still get what’s so crazy as mind blowing is we still get the same gains as if I took 75 year old into the back and got them underneath a barbell. Like if we found that weight for them, that’s truly that rep max.
Elise – @TheOncoPT (09:02)
Mm -hmm.
Kelly Martin (09:08)
However, you would look at it whether it was a true one rep or six sometimes people for safety use like six reps or eight reps, you know
Elise – @TheOncoPT (09:15)
Mm -hmm.
Kelly Martin (09:18)
we can take that information, that knowledge, and take this technology with it and you can actually take something a little bit more simple, a little bit less intense, but get the same gains and get the same bang for your buck. It really provides, I think, an opportunity to bridge, to be a bridge to something I’m all about, getting someone underneath a barbell or getting them with some weights in their hands, absolutely. But if they’re not ready for that in the moment, and I still know that they need
to build strength to get there, then this technology
Elise – @TheOncoPT (09:50)
Mm -hmm.
Kelly Martin (09:53)
is a great way to bridge that gap. And you can work on the foundational movement skills that get you to the back squat or a kettlebell squat or whatever you have in your clinic, whatever you have access to. You can take BFR, you can work on those foundational movements. It’ll be intense for them. You can start building that base and then you use that as your bridge to get to load them more when they’re ready. And so think that’s so,
Elise – @TheOncoPT (09:55)
Mm -hmm.
Mm
Kelly Martin (10:23)
really really cool to see it applied in our older population, our older population that has other diagnoses in their medical history. They chatted a lot, chatted, they wrote the article like having this applied to people with like COPD and so you’re also looking at them applying this technology to make it safe not only for
considering aging, but also considering as we age, some people have more comorbidities in their history. Is it still safe to apply this technology to get the gains that it offers in these populations where you’ve got a patient that has three or four other diagnoses, whether that’s diabetes and COPD? I think they discussed very briefly like in terms of like AIDS as well. Like they try to find some populations with multiple comorbidities or just
Elise – @TheOncoPT (11:13)
Yeah.
Kelly Martin (11:17)
single comorbidity and apply it and see the same see the same gains improvement in physical function improvement in your strength improvement in lean muscle mass improved frailty scores you know they see these same gains regardless of
the patient and some of their medical history. So I think being able to move in this direction in our oncology population, where they’re gonna, they’re not any, I mean, they are different, but they’re not any different. They are potentially an older adult. They have potentially other comorbidities aside from their new diagnosis. And we’re just adding that into the mix. And so the question that they’re really looking for is like, how can we in this article,
How do we, what’s out there and how do we bridge that gap to bring this technology to this population that deals with a lot of the same problems. We’re just adding a new, we’re adding a new diagnosis and new treatment thing. It’s a new treatment that may happen.
which only further increases their risk for all the things we’re trying to avoid with aging. Sarcopenia loss of bone mass, know, trying to improve their risk for frailty, allow them to be as functional for the majority of their life as much as possible. I mean, we’re dealing with all those same things. We’re just adding this new, this nuance and new set of diagnoses into the equation.
Elise – @TheOncoPT (12:46)
So for the listener and myself, because as Kelly and I talked about off air before we started the interview, I’ve never done BFR in clinic. I’ve heard about it. It sounds cool, but I’ve never thought that it really applied in my patient population until now. When you have decided, Kelly, okay, this patient, and this can be, you know, again, a very general orthopedic patient that you’ve worked with previously, when you’ve identified that this person would benefit from
blood flow restriction as part of your other physical therapy interventions that you’re doing, what does that look like? Can you kind of run us through like what would a session with you on with, you know, using blood flow restriction look like for a patient?
Kelly Martin (13:33)
Sure, I can actually use a little bit of a case example. So I’ve got a patient that I’ve been treating. I use it a lot in our post -operative population. That’s really anyone that I feel like will tolerate it. But this patient in particular, I met him.
Elise – @TheOncoPT (13:38)
Excellent.
Kelly Martin (13:58)
a little bit ago, he had some type of bone tumor. I do not remember what kind of tumor it is, but had a bone tumor in his femur, so ended up leading to tumor resection in terms of his treatment. And then as a result, because they resected so much, they ended up just doing a hip replacement.
So this guy’s in his 60s, he’s like in his early 60s, I think he’s like 63, 64, has had a hip replacement as a result of a bone tumor. And so he kind of falls into this population of he’s had some form of cancer. His treatment was resection.
I do not believe he had any other forms of chemotherapy or further treatment following resection. But then as a result had to have an orthopedic surgery on top of that. So he kind of falls into these two buckets where the bucket I would totally be like, all right, he’s an active guy, plays tennis, plays pickleball. Like he wants, like those are his goals. He wants to get back to that.
Elise – @TheOncoPT (14:50)
Mm
Kelly Martin (15:09)
after healing from the hip replacement. And so for him, the biggest things coming in is like, okay, knowing that
The reason why we even had a hip replacement is from a cancer diagnosis. So kind of collecting that information on, know, resection was the only thing they had to do. How often is he following up with his oncology, his oncologist? You know, then I’m kind of sifting through like, okay, what other, you know, just like we would do as a regular, as any other therapist would do, you know, sifting through, okay, what other comorbidities are we dealing with? He’s a very healthy guy. doesn’t really
have much else going on but some of your patients may have you know when you’re thinking about blood flow restriction you’re thinking about making sure that they don’t have you’re thinking about hypertension is it controlled do they have other like
vascular issues, do they have a history of vascular issues, a history of clotting disorders in their family or in their history? You know, you’re kind of sifting through that as you think about, this technology, how do I apply it? How do I be safe when I apply it? Even in some of our older population, like I even think about like as your skin loses some elasticity or they’re on some type of, you know, a coagulant, they may bruise easily and this cuff is gonna get, I always like to educate them, like the cuff gets pretty,
Elise – @TheOncoPT (16:16)
Mm -hmm.
Definitely.
Kelly Martin (16:32)
it’ll get tight, gets a little uncomfortable. And so then you kind of got to monitor like, they someone that’s going to really bruise easily? And so the application of the cuff is, is you have to consider it from that angle as well. So you’re kind of, before you even apply it and you start talking to them and educating them on like, we have this technology in our clinic. I think it would be a great way to kind of start building that strength foundation for you when we’re not quite ready to really load you up because your tissues are healing and from a safety
perspective it would be negligent to put you underneath a barbell or put you underneath more load but this is a way we can it’s a technology we have and
it’s shown great benefits to get us started. And so then you’re kind of making from a safety perspective, there’s other like those considerations from a like a vascular standpoint. they have they had a surgery in the last two or three weeks in the last month that they traveled for long periods of time. You’re checking those boxes to make sure that there’s not any risk for DVT or PE doing all that safety check. And then you say, okay, when I typically educate them, say, all right, we have a couple, we have two units in our clinic. So
One of the units is a Delphi unit, Delphi, like D -E -L -P -H -I, which they use that in their article or some of the other literature they looked at.
Elise – @TheOncoPT (17:52)
Mm -hmm. Mm -hmm.
Kelly Martin (17:53)
uses that device. So essentially it’s like this little, it’s a little box. It kind of sits on what looks like an IV pole. And so it’s a, I’m going to call it like a continuous cuff. So it’s connected to the pressure, the cuff itself is always connected to the
Elise – @TheOncoPT (18:02)
You
Kelly Martin (18:16)
monitor so it’s kind of as even as the person’s moving it’s constantly adjusting the pressure to meet what you set it at which is really cool because you always know no matter what you’re doing if you’ve if you’ve set it up to stay at 60 percent it collects that highest pressure value for the patient and then it’s actively like basically
Elise – @TheOncoPT (18:24)
Mm -hmm.
Kelly Martin (18:42)
revolving, like resetting itself to no matter how the pressure changes when they’re moving or exercising, it’s changing all the time to meet that 60%, let’s say for an example. So that’s one unit we have. And what’s nice about it is it does that. The difficult thing is that you have to keep them attached the whole time. So there’s only so much tubing to go. So you’re getting and making sure that they’re moving, that it doesn’t come out. And so there’s some like logistical
about having it constantly be attached, which can get in the way a little bit, but not too much. And then the other device that we have that I didn’t know existed until I got to my clinic is called SUJI, S -U -J -I, which I don’t think they talk about in this article at all, but it’s a device that it’s actually detachable. So you put the cuff on, you plug it in, you create a profile for the patient. So that’s where when it calibrates, it collects that
pressure and so it saves that and then you don’t ever have to calibrate it well I don’t say you don’t ever let’s not you can calibrate it as you see fit so sometimes if they’ve had a surgery and you notice you know they have some of the atrophy in their muscle atrophy in their limb really early on you may decide further along to recalibrate if you’re noticing that the muscle size is increasing just so you’re getting the most accurate results
Elise – @TheOncoPT (20:09)
Mm
Kelly Martin (20:14)
but you put the cuff on, you calibrate it, it saves that information into their specific profile so that if I apply it let’s say a week later and I set it to 60 % it’s going off of what’s in their profile and it’s just gonna it’s gonna inflate the cuff to 60 % and then you unplug it
from the actual pressure device, so then they’re free to move around. So that’s the one I feel like I default to a lot because it’s really easy to just plug it in, set it up, take it off, and then they can kind of move about and we just bring it with us. We just bring that with us if we need, we deflate. So that’s kind of how it’s set up. And so you do a calibration process. So that’s where I kind of educate the patient. This is as tight as it’s gonna get on your leg. And then every other time we’re using it during exercise,
Elise – @TheOncoPT (20:39)
Okay.
Mm
Kelly Martin (21:05)
it should not be getting this tight. you find it gets this tight, you let me know. Obviously technology doesn’t come without its faults, so we’re always making sure that it’s kind of running the way it’s supposed to. And then kind of to your point that you’d said earlier, there’s not a lot of… If you go digging into the BFR literature, you’ll find different protocols in terms of intervention and doing like…
Elise – @TheOncoPT (21:16)
Mm -hmm.
Kelly Martin (21:32)
The most common one you’ll see a lot is typically it’s four sets of exercise 30 reps in the first set you get 30 seconds of rest in between each set and Then the last three sets are 15 our sets of 15 So it goes 30 15 15 15 then you completely deflate the device You let them rest for a minute or two and then you can reinflate and then do the next thing So that’s often what you’ll see
Elise – @TheOncoPT (21:53)
Mm
Kelly Martin (22:02)
some of the literature. I know that in this in this article they kind of discussed that’s a part of the utilizing BFR is that there’s not necessarily some of these articles didn’t necessarily follow really strict like set sets and reps kind of protocol. They used it looked like they used a lot of like three sets of 20 to 30 reps. I’ll say that I
Elise – @TheOncoPT (22:25)
Mm
Kelly Martin (22:29)
I even in clinical practice go across the board a little bit. Sometimes I’m doing four sets of 15. Sometimes I’m even doing, instead of having rest, like rest in my sets of that, just 30 seconds of nothing, I’ll do a superset. So I might be doing, I’m just gonna throw out an example. I might do a squat for,
I might do four sets of 15, but I’ll do a squat for the first 15 reps. And then, and maybe I’m more so biasing the quads and then I’m doing a single leg RDL or maybe I’m doing a bridge variation or a thruster variation to get the hamstrings and the glutes. So I’m kind of using the rest period for the muscle group.
So resting the quads while I work the glutes and the hamstrings and then they’re going back to the quads. So you can kind of play around. I have definitely used a little bit of liberty, I guess, with how I use it as long as they’re getting some rest and then usually and then after the three, four sets you’re deflating fully.
Elise – @TheOncoPT (23:25)
Mm -hmm.
Mm -hmm.
Kelly Martin (23:46)
And so that’s kind of how the treatment session will go. And as you’re kind of bridging into more activity that doesn’t necessarily, you’re able to load them more so you don’t necessarily need to use the BFR cuff, you may still just use it. I find that I kind of start with using it or I don’t use it and then I might use it at the end or you can kind of play around with how you kind of.
bring it back, you take it out of the equation and then you’re just loading the patient the way you would because they’ve come to a certain point in their healing process that they’re able to tolerate it and then you can kind of move away from it.
Elise – @TheOncoPT (24:23)
Mm
So this might be a silly question, but you mentioned for your patient earlier, had the tumor resection of the femur then led to having a hip replacement, where exactly are you putting the cuff on that person? And then what muscle, like are you working muscle groups that are right at the site of that blood pressure cuff? Are you doing distal to the cuff? Like, again, I have never used it before.
walk me through these like super silly basic questions.
Kelly Martin (25:00)
Yeah, so the cuff for the lower extremity, you’re trying to get it up as high as you can. That’s comfortable. So upper thigh and then so that’s where it’s applied and calibrated and then utilized. And then same thing with the upper extremity. So you’re going to get it as high as you can up here on the arm as well.
in order to use it. so wherever the, so you’re working all, I will say you work all of the muscle groups, but where the cuff is, you’re usually getting those benefits distally from the cuff. So like for him.
Elise – @TheOncoPT (25:33)
That makes sense.
Kelly Martin (25:38)
For example, his like the difference in his quads on both sides, size -wise, atrophy -wise, very easily to be seen. So I put the cuff on and we’re gonna do, you know, resisted knee extensions, set up the resistance and we’re going, sometimes I’m for him might be four sets, 30 reps, 15, 15, 15.
And so then we’re getting those benefits distal to the quads. Obviously we’re working them in that example, but you you’re getting the hamstrings, you’re getting, you could do it and do a calf raise. Like if someone was dealing with a…
Achilles -ish like an Achilles tendinopathy, you could still put the cuff on the upper part of the thigh and then maybe you’re doing some heel raises. I mean that’s that’s also probable that you’re you are occluding the the vessels down the down the stream. So you’re getting those same benefits if you’re working some of those other groups as well. Anything below really is what’s being affected.
Elise – @TheOncoPT (26:45)
you.
And how, again, I’m not asking you to be like a results in two hours or less, but how soon are you kind of seeing these results for your patients in those gains we’ve talked about previously?
Kelly Martin (27:02)
say on average you’re looking at six to eight weeks to start seeing them change. I know in this kind of literature review that they offered their programming was 12 weeks. So anywhere from probably depending on the condition of I would say it depends depending on the condition of the patient when when this when they’re entering the in this case they’re entering these studies but when they’re entering your care
Elise – @TheOncoPT (27:21)
Yeah.
Kelly Martin (27:31)
I would say some people that are maybe a little bit more deep conditions may start seeing some jumps pretty early on. But realistically, anywhere from 8 to 12 weeks application.
you start seeing some at six to eight, then you’re really seeing some really seeing some noticeable differences and you know, some of the things they’re looking at in this article, they’re looking a lot at different like circumferential measures. They’re looking at, you know, body composition. They’re doing, I know, I know initially early on they did like a DEXA scan. Obviously they could repeat a DEXA scan. That’s really hard to come by in some settings, but if they’re going to repeat, that would be gold standard.
But they’re using a lot of anthropometric, that’s the word I was looking for as I’m talking about these things. They’re using those measures, those field measures, like circumference and maybe even skin calipers if you’re clinic -asm, you know, to kind of see the changes. So it does still take a good bit of time to drive some change.
Elise – @TheOncoPT (28:18)
Yeah.
Kelly Martin (28:35)
But it’s like, okay, we could use this technology and use it for eight to 12 weeks and see some benefits when the patient’s not ready to do some of the higher level things. And then that helps them be more ready to do those higher level things later down the line. If we don’t use it.
and we’re still not progressing away from lower intensity activity, then what have we been doing for eight weeks?
You could beg that question. How are we bridging them to the more higher intensity activities that will drive traditionally, if we’re gonna go the traditional route, how are we gonna bridge them? I think that’s where we get really creative as therapists, which is really cool. When you start seeing these different areas start to collide, I mean, you’re talking about driving strength gains and not, I mean,
CSCS or I don’t have a huge strength and conditioning background. I’m growing in that area but you start seeing…
that you start seeing that world collide with some of this kind of stuff. You start seeing physical therapy collide. I mean, you see a lot of different realms, medical stuff, it’s all kind of colliding around these topics and this technology and how can we use it to help our patients get better and drive change. It’s really cool, but it can be, I’m not even perfect at explaining it or utilizing it. I get better at it every day trying to think through it and apply it to the right patients.
Elise – @TheOncoPT (29:56)
Mm -hmm.
Kelly Martin (30:14)
I mean it’s to bridge that gap quicker for us so that patients can get back to what they really want at the end of the day is the goal being better each time you do it and apply it.
Elise – @TheOncoPT (30:21)
Right.
You know, and even as you were talking about some of those things, Kelly, a patient popped into my head, and I’m sure there’s multiple patient cases, but this particular patient underwent breast cancer treatment, came out on the other side, and was extremely deconditioned. And this patient, I mean, we worked together for months to try and build up her strength. And unfortunately, there were a lot of different issues that were contributing to this.
but it makes me really question what kind of benefits could we have seen because this patient was not able to tolerate those higher loads, like the increased weight that I really wanted to get her to as she’s doing these different strengthening exercises, et cetera. And so it took a really, really long time for us to build up her strength. And I think this is a great
clinical kind of example of what the authors of this particular study were, you know, they introduce as part of the why we thought to do this, why we’re, you know, compiling this information in this literature review, which is BFR has been used across different patient populations with varying disorders, varying diagnoses to help improve strength and then prevent or delay muscle wasting when the muscles can’t tolerate higher loads.
So it works in other patient populations. We also know that exercise is beneficial and important for people who are diagnosed with cancer and are long -term cancer survivors so that we can address some of these side effects and impairments as a result of cancer and cancer treatment. Okay, this is kind of coming together. But the big but is cancer survivors may be hesitant to engage in these higher loads
They may not be able physically to engage in these higher loads. So how can we ensure that they are seeing that they are going to get those benefits of the moderate to vigorous intensity exercise that we know and love to talk about in oncology when they’re not physically able to do that? And so this really brings us back to the article that we’ve been dancing around this whole time. And I really want to get into specifically Kelly.
So in this article, the authors identified, so again, this was like a literature review. They wanted to identify what are the benefits of BFR in oncology patients. They wanted to see how it could affect muscle strength, endurance, and hypertrophy specifically in oncology patients, and then also identify safety concerns, which I’m not gonna lie, I didn’t even consider any safety concerns with BFR, because that’s just, again, like, I don’t know what I don’t know because I don’t use BFR.
So, as you are looking through the research, first of all, why did you identify this particular article? What excited you or interested you about this particular article?
Kelly Martin (33:33)
I kind of a lot of what we’ve kind of talked about earlier is I’ve utilized, it’s like sometimes when I think about where I’m at in my journey of growing in the oncology rehab setting, it’s like they start talking about these treatment regimens and I’m like, I don’t know what that is. I have not gotten, I don’t have the knowledge base to understand why they’re doing this treatment regimen with these six different chemotherapy medications and how it’s affecting the body, et cetera. It’s like, okay, that’s a little bit too,
But at least for now it’s a little bit too big brain for me. I haven’t gotten there yet. But what really struck me was like, my, I was like, my gosh, I use BFR in my clinic. Like this is a technology that I’ve learned about that I’ve gotten to apply as a therapist.
And now we’re looking at it in this population I want to grow into. Okay, I already have a baseline understanding of what this technology can do. So I had some of that foundational knowledge. was like, all right, well, let’s see what they have to say about it. In my head, initially, before reading was like, well, heck yeah, of course it would be beneficial. Okay. But also thinking like, what are the, are there any big and scary that we need to be mindful of or avoid or altogether? So was like, okay, there’s some things I know and then there’s some
I’m really curious about and so as I read it, you know this idea of like of course this patient with a cancer diagnosis may have all our they’re at risk for all these other things like everyone else and I would probably argue that they’re at a higher risk for these things based on their diagnosis and their treatment regimen because it just if they if they can’t if they’re Fatigued and they’re not they create this if this negative cycle gets created
where there are the common other side effects and adverse effects of treatment like fatigue. When you’re fatigued, you don’t really want to exercise. You can’t really tolerate higher loads.
And then it just kind of repeats itself over and over. So then you don’t move. So then you have more fatigued and then you, you know, they start looking at those things like how this could help with cancer related fatigue. How could these things help with all the other things? Sarcopenia, myopenia, frailty, all these things that normal populations deal with normal. but also these newer populations like are patient with an oncology diagnosis. How can we, do we see the same thing? So it’s like, all right, well, that’s,
Elise – @TheOncoPT (35:38)
losing losing
Mm
Kelly Martin (36:07)
good experiment, let’s see if we get the same gains. I would love for us to see that, which they start showing a little bit in these five articles that they kind of selected out after they went through their whole, all of their methods and figuring out which were eligible and which were not.
Elise – @TheOncoPT (36:16)
Mm
Kelly Martin (36:24)
But then it also begs the question, there’s only five articles that talk about this use of technology and out of the five, a couple of them were mostly with abdominal cancers. And then you also have a cup that think there were two that talked about breast cancer specifically. Some were pre, I mean, you could get into the nitty gritty of like all the different articles. Some were post treatment, some were actually pre -treatment or the patients were awaiting some type of surgery.
Elise – @TheOncoPT (36:41)
Mm -hmm.
Right.
Kelly Martin (36:54)
in their treatment regimen. So I thought that was interesting of like, I think it opens the door of like, when is the best, okay, BFR is safe. They didn’t really have a lot of adverse events. They saw some good things happening like decreased time in the hospital, know, keeping some of their lean muscle mass, reducing some of their fatigue because they’re able to exercise.
Elise – @TheOncoPT (37:06)
Mm
Kelly Martin (37:16)
with lower intensity intervention, but the use of BFR gives them those benefits of higher intensity. But it’s like, when’s the timing? Should we do it, should it be pre -surgery? Which I would argue yes, of course it should be pre -surgery. How much can we build them up so that they can tolerate treatment, whatever that treatment is, tolerate treatment.
Elise – @TheOncoPT (37:23)
Right.
Mm -hmm.
Kelly Martin (37:44)
and then some of them were post -treatment. So it’s like, okay, well, of course that makes sense. If we’re seeing these benefits and it’s safe, let’s use it then so we can kind of minimize any effects that happen after the fact. I think what’s interesting for me…
is one, I would really, I know this technology, I’m learning this technology, I’m utilizing this technology as a clinician. There’s not enough literature in this population of people that I’m interested in. I think it would be really cool to explore on a deeper, even deeper level, know, skid some more studies out there to show that one, it’s safe, two, we’re seeing those benefits continuously, repeatably seeing those benefits in this population that just adds more
Elise – @TheOncoPT (38:24)
Mm -hmm.
Kelly Martin (38:31)
adds more evidence that this can be used and so anyone out there that’s listening to this that has that interest themselves, reach out to me because I would love to partner in that.
But I also think what’s really cool is that timing piece. I know that I shadowing in a hospital system, but I was on the outpatient side and they do a lot of pre -treatment kind of assessment, risk kind of assessment of where the patient is in that moment, but also this kind of like risk.
almost to answer the question of where are they at at baseline? Could they tolerate the treatment regimen that they’re go under? And so that is really cool to see the therapist. were kind of just, was observing her do one of these kind of initial consultations, evaluations of where this patient is at baseline and then kind of.
Elise – @TheOncoPT (39:23)
and
Kelly Martin (39:25)
Sharing like I send my recommendations on how physically they present so that which can give the medical team information of how they’re gonna tolerate this treatment if they receive it in the next Eight weeks or whatever that time frame is
And how cool would it be to be like, right, at baseline, this example, this patient, the therapist thought, know, she’s kind of teeter tottering, almost not ready to tolerate this treatment potentially. I think she may need six to eight weeks of intensive therapy to be ready before they go in and do all the whole shebang. And I was like, well, after reading this article, being like, huh.
Elise – @TheOncoPT (40:00)
Mm -hmm.
Kelly Martin (40:10)
that timing piece would be really important. And they talk about prehab or prehabilitation. know, what if this patient had access to eight weeks of structured exercise using BFR?
would that on the back end make them one, tolerate treatment when they had it, and then on the back end prevent some any, prevent any complications. And then whenever they were safe and ready to reinitiate this, they could go through another eight to 12 weeks of treatment of, BF, utilizing BFR and start trying to build those blocks again after they’ve already received treatment.
Elise – @TheOncoPT (40:44)
Mm -hmm.
Kelly Martin (40:50)
I think where my, which I think would be really, really cool to see longitudinally how that would benefit a patient. I think where it also gets a little interesting where I have questions are, you know, is there a way, it probably depends on a lot of things. It’s like, how do we utilize this in the acute setting if possible to mitigate the effects of treatment?
Now I recognize that, you know, when they’re undergoing their treatment, there are a lot more factors. Their numbers get, you know, their lab values get thrown off. It may not be feasible. Potentially, we don’t know the literature is not there. It may not be feasible to kind of utilize during as treatment is happening.
Elise – @TheOncoPT (41:40)
Mm -hmm.
Kelly Martin (41:41)
I think a lot of other literature in this population, in the population, in oncology population goes towards like how can we, what can we do to mitigate the effects of treatment so that they’re not as bad on the back end afterwards. And so potentially this technology is an option. It definitely depends on a lot of things. I like was reading it and then going back to the Maltzer article.
and just speaking of safety and just kind of looking over that article as well and being like all right these patients there’s patients that will have these different these risks and effects after after a treatment cycle can we are these things adverse events with bfr training would you have to teeter totter a gray area
Elise – @TheOncoPT (42:13)
Yep. Yep.
Kelly Martin (42:37)
And so that’s even a question that I don’t think has gotten looked into enough either is how would it be to apply it during treatment? But I definitely feel like pre and post, there’s opportunity.
Elise – @TheOncoPT (42:41)
Right.
Right. There’s pretty clear opportunities based on that article. And I really appreciate how we’ve talked about getting patients to the point that they could be candidates for some therapies. This is a really big concern in various patient populations within oncology. I’m thinking when it comes to abdominal surgery, that’s a pretty big one I hear about. Also, even lung cancer, for some patients, their condition, their
physical function and condition may be the factor that says you’re not a candidate for these surgeries. And so this is part of why, you know, this is one of the big pushes behind pre -hab and has been for so many years of we could help patients who are not candidates for again, surgery or whatever, become candidates. And we know that, you know, when a person is able to undergo cancer treatment, then their better, you know, their chances of survival on the other side are much greater. Can we utilize this tool?
BFR as a way to not only get patients to be candidates, but maybe help them become candidates faster, for example. Could we help even patients who are not candidates, even with physical therapy outside of BFR, could BFR be the factor that helps them then become candidates for these major procedures like we’ve talked about?
Again, I think that’s a little more of the hypothetical, but I think this is laying the foundation of these are the questions that we’re now starting to ask of based on this limited literature review, which they do acknowledge that in the article. don’t want anybody listening to this to be like, everything’s hunky dory, rainbows and sunshine. They do a great job of acknowledging some of these limitations that I can appreciate from the oncology side, but there’s still great support, it seems like you said, for
pre -hab especially, and of course on the post -treatment end. So I think there’s a lot of opportunity, but again, we really need more research to kind of determine what is that optimal dosing and prescription for our patients? What is the timing? Like you mentioned, Kelly, on when is it really best for our cancer survivor to be undergoing this treatment as, you know, kind of within the realm of their oncology journey? Were there any parts
of this article that maybe surprised you or you weren’t expecting as you were reading through this.
Kelly Martin (45:26)
So I think one of the things that surprised me is a quote from the article is, regardless of the benefits of exercise, many oncological patients are hesitant to engage in working out due to concerns about exacerbating symptoms or causing harm to their health. And so why that surprises me is that there’s so much literature out there that supports exercise, just a baseline exercise. I think a lot about
how a patient can respond when you’re like you’re feeling the effects of cancer related fatigue well let’s exercise and you’re like in their head they’re probably like that sounds backwards
Elise – @TheOncoPT (46:06)
Definitely.
Kelly Martin (46:07)
But then you see in these articles that apply exercise to look at cancer related fatigue and they’re seeing it work. so it’s amongst other things that exercise in general gives us better quality of life, improve physical function. Articles are hit or miss on affecting more of the like psychosocial aspects of how exercise can affect us.
Elise – @TheOncoPT (46:33)
Mm -hmm. Mm -hmm.
Kelly Martin (46:37)
it’s hit or miss sometimes where you see it doesn’t affect it at all or you see a positive benefit. I’ve never seen one that’s negative but sometimes you can find that the impacts are not significant. So I think what’s surprising is that you know at baseline people are afraid to exercise. don’t
They’re entering this journey and it’s scary and they’ve never been in it before. They don’t know what to expect. They don’t want to make anything any worse than it already is because it can be, I mean, it’s getting a cancer diagnosis is life changing. And it changes more, it changes not only your medical and physical well -being and affects you.
mentally and spiritually and emotionally and socially and there’s so much other so many other layers and so already at baseline regardless of how many how much you’re told that exercise is beneficial and it can help you during your survivorship there’s still people that are they’re hesitant and then
you, I think with this article in particular and talking about BFR is like you’re just, it’s a great technology, but you’re adding another layer of like, you’re gonna, we’re gonna exercise with this cuff on my arm or this cuff on my leg. Like I will say I’ve done BFR myself and it’s not the most, the, it’s not the most comfortable thing in the world.
Elise – @TheOncoPT (48:08)
Mm -hmm. Mm -hmm.
Kelly Martin (48:10)
I mean, it’s hard and it’s crazy to put the cuff on and even put it, let’s say 60 % on my leg and do four sets of straight leg rises or four sets of bridges. I mean, you feel the burn at set three and you’re like, I only get 30 seconds rest and I gotta do it again. And I personally, myself find what’s hard about BFR is not the working, it’s the resting and you’re waiting to start again.
And so I’ve even, mean, obviously I’m a normal and healthy individual, but it’s like, it’s not, you’re, you’re then going to talk to this patient about this technology and how it can help them. Just like you talk to them about how exercise can be beneficial for them. And maybe they were a previous exerciser and maybe they weren’t.
And then you’re adding this other thing that’s like kind of maybe gonna be a little uncomfortable to utilize. And it’s, I can just see how that perpetuates this like fear of I don’t wanna make anything any worse. This kind of is uncomfortable. Is it harming me? Or is it helping me? And so I think it really comes down to us educating our patients of like, know.
Elise – @TheOncoPT (49:12)
Mm -hmm.
Kelly Martin (49:23)
you know, this is beneficial. Let’s if you’re open to trying it, let’s try it. You know, it’s going to be uncomfortable, a little uncomfortable at first. That’s normal. I’ve even just using your own story of like I’ve used it. I’ve I’ve applied BFR to myself. This is how it felt for me. I get it. Rep set three in this is going to suck. I’ve been there. I’ve been in your shoes when it sucks. You know, giving them that reassurance of like,
Elise – @TheOncoPT (49:51)
Mm -hmm.
Kelly Martin (49:53)
I’ve done this, I’m not just taking this technology and applying it to you for the benefits and not having any experience myself on what it feels like. So being able to educate them on what it’s gonna feel like is very helpful and that’s across all patients. That’s not just patients with cancer.
Elise – @TheOncoPT (50:08)
course.
Kelly Martin (50:10)
all patients letting them know, hey, this going be little uncomfortable. And you get to set three and you’re going to not like me very much potentially, but it’s beneficial. also giving them the control of like, even during the calibration process, I say, this is the tightest the cuff’s ever going to get. It’s collecting that information so it can use the percentages. This is as tough as it gets, but if we get to our thing has like 10 steps of calibration,
Elise – @TheOncoPT (50:23)
Mm -hmm.
Kelly Martin (50:40)
If we get to step number five, you know, and you’re like, nah, Kelly, don’t want it. I’m not feeling this right now. I’m like, ball’s in your court. We deflate, we take it off, we move on.
Elise – @TheOncoPT (50:51)
Mm
Kelly Martin (50:53)
It’s a technology that can really help us, but if you’re not about it, I’d rather you be bought in. If you’re not bought in yet, that’s fine. Give them the control to take it off. So I think that’s also a big piece is like letting, letting up in this situation, situation with a survivor, know, letting them know, Hey, you don’t, they feel like I’m sure they feel like at times they don’t have control about what’s going on because who controls when and if you get cancer, no one.
Elise – @TheOncoPT (50:59)
Right.
Kelly Martin (51:22)
That’s what sucks about it. And so I think being able to even apply exercise or applying exercise in this technology of BFR, telling them, hey, you have control in any moment. You know, if you’re not digging the cuff, we take it off. It’s fine. We can still, we can still find ways to get you better, get you stronger, get you ready for treatment. You know, this is just an option we’ve got.
Elise – @TheOncoPT (51:49)
Mm -hmm.
Kelly Martin (51:50)
If you’re open to using it, there’s great benefit in it. And if you’re not…
That’s okay. That’s what we’re trained to do. We have been therapists and have been doing intervention long before BFR was a thing. So we can still do that. We can still do it that way. There’s nothing wrong with that. So being able to give them the ball in their court because it’s kind of surprising to be like, you see all these benefits and you still don’t want to try it or you’re afraid. And it’s just recognizing that it’s okay to be afraid if you’ve never done something before. And there’s so many other things that they’re experiencing and haven’t done before.
really shouldn’t have to deal with with the diagnosis, but you know, being able to come on alongside and educate them. I think that was one, that was one big thing was like, there’s the evidence is growing or the evidence is there that exercise is helpful, but people are still very hesitant to it. So thinking about why that is, understanding why that is and how we can educate.
Elise – @TheOncoPT (52:39)
Right.
Kelly Martin (52:46)
towards that to help them feel like okay I like we can do this and then applying that same concept to VFR because it’s it’s a new technology it would be a new technology they’ve never experienced it before it’s not always the most comfortable thing to utilize so working through that discomfort of having the pressure cuff on and giving them that control to take it off
Elise – @TheOncoPT (52:47)
Mm -hmm.
Kelly Martin (53:11)
I think the other piece was that of the five studies they selected, they were most often applied to patients with abdominal cancer and then breast cancer. There were no other forms of cancer being applied to. I know a lot of literature goes towards like breast cancer population for sure across the board, no matter what you’re looking at intervention wise, you’re seeing it applied to them. And so I think
Elise – @TheOncoPT (53:30)
Mm -hmm.
Right.
Kelly Martin (53:40)
I think it just kind of begs us to go in the direction of how does this apply to other populations? I I think of my patient that I talked about briefly earlier is that, I mean, he didn’t have breast cancer nor did he have an abdominal cancer. He had a bone cancer that led to a hip replacement. So he’s a patient with a cancer diagnosis who has an orthopedic condition that we’re dealing with. And so…
Elise – @TheOncoPT (53:57)
Mm -hmm.
Kelly Martin (54:07)
I think that is seeing it applied to some other populations moving forward would be, I’m surprised it hasn’t been applied to some of our other populations yet, but that’s just where it potentially needs to go. even seeing it applied, I think the lifespan across these articles is pretty large. I want to say,
Elise – @TheOncoPT (54:26)
Right.
Kelly Martin (54:37)
If I remember correctly, I mean you’re going from like early 30s all the way to like 70s, 80s, maybe longer than that. It’s pretty wide window. I think not to forget our AYA’s, but seeing it applied in that population, that younger population as well would be really cool to see it move into that realm because it’s definitely lacking across the board there. So those are probably the two things really that
Elise – @TheOncoPT (54:43)
Yeah, it was pretty wide. Yeah.
Mm -hmm.
Kelly Martin (55:07)
And I think it just goes to show that we’ve got a lot of, we still have a lot of education to do with our patients and utilizing, especially utilizing something new, just like an oncologist has a new treatment regimen is going to have to, it’s going to have to educate and explain the ins and outs of why treatment has gone in this direction, what the patient would expect. Would they be interested in participating in this clinical trial with this regimen? know, we get to do the same.
Elise – @TheOncoPT (55:07)
Mm
Kelly Martin (55:36)
opportunity to do the same thing with exercise and with potentially this new technology of BFR is educating all the nuances and being well versed in what it what the experience is like and what it’ll be like for them and giving them the control to try it out and buy it really buy into it and but also the control to maybe not be ready for it’s okay if they’re not ready for it we can keep working on being ready for it if it’s something that they want to try in the future
Elise – @TheOncoPT (56:01)
rhyme.
Right. For the oncopathy who has listened to this and is now saying, I might be a little interested in BFR. What information, what like encouragement would you give that therapist who is now maybe open to bringing BFR into their oncology practice?
Kelly Martin (56:28)
I think one is that the literature we have right now doesn’t lie. They’re utilizing BFR. Obviously there’s tweaks to make it better research, better trials, more specific dosage and that kind of stuff. But across the board, exercise plus BFR is improving patient quality of life. It’s reducing frailty. It’s improving functional capacity.
strength, lean muscle mass, reducing post -op complications if applied before, decreasing length of stay in the hospital. You’re seeing it can be reducing some of the things we talked about earlier, other things that we fight with aging, decreasing sarcopenia, myopenia, making sure these patients are as functional as possible.
Elise – @TheOncoPT (57:04)
Mm
Kelly Martin (57:24)
throughout their treatment and put in after their treatment.
I think that’s really, you’re seeing it across the board even just limitedly right now that there are these benefits for this population of people. You’re also seeing that it’s safe when applied, when it’s applied and we’re having limited adverse events. It’s not without screening and make sure they don’t have some other.
medical history that may say, hey, this isn’t appropriate, but I think reference going back and doing that quick screen, but also, you know, referencing the Malzahar article as needed, thinking about some of the other things they’re going to undergo during treatment. So if you’re interacting with them, maybe post treatment and you want to initiate BFR that
Elise – @TheOncoPT (58:14)
Mm -hmm.
Kelly Martin (58:18)
it’s be mindful of those things too. And you you’re constantly assessing like, this appropriate? And then if it’s not, then get away from it. I think that.
I think the other challenge with new technology is not every clinic is gonna have access to it. So as literature moves forward, you get more evidence in your bank for your clinic to invest in this kind of technology. Obviously for me, I already had access to it at baseline because the populations that I’m seeing in my clinic is more of that orthopedic sports realm. And I got lucky to
Elise – @TheOncoPT (58:46)
Right.
Kelly Martin (59:02)
have some patients that have an oncology diagnosis and I can apply it to them so I get to see this in action and see the benefits of it. But I recognize that if you’re primarily seeing a let’s say outpatient oncology population you may not this is something your clinic probably doesn’t have.
Elise – @TheOncoPT (59:23)
Mm -hmm.
Kelly Martin (59:25)
And so as literature comes out, like maybe you’re making a proposal to your team about investing in a device, which I think would be amazing. it’s being able to see that we’re pushing for more literature in this direction to see further what benefits are allows you to make that proposal in the future. So like keep on keeping on and looking for that.
And then, and even with that, you know, it comes down to there’s other, there’s device, there’s different devices out there. So you start having to kind of.
go into that wheelhouse of like, what’s the best device or what’s the most economically feasible if I want my clinic to invest in it. So then you start building relationships outside of the physical therapy world. You start building relationships with like, like companies and manufacturers that are making these devices. You know, you’re building relationships with the reps.
Elise – @TheOncoPT (1:00:18)
Mm -hmm.
Kelly Martin (1:00:25)
just like we would have a rep come into your clinic and talk about something that they’re selling, know, a certain type of compression sleeve or whatever that a patient might utilize. know, we’re starting, we get to start those relationships potentially to have our clinic spaces buy into this kind of technology. So I think that’s really exciting. There’s a lot of direction that this topic needs to go.
Elise – @TheOncoPT (1:00:39)
Mm -hmm.
Kelly Martin (1:00:54)
It’s looking promising so far and I think we continue to ask for it to move forward and you know my foot my and my extra plug you know if anyone else are out there is interested in this you know please reach out to me I would love to kind of connect on this stuff on a deeper level about
utilizing VFR and pushing this literature forward. So we get more than five articles out there talking about its benefits and where it can be applied. think it’s really, really awesome to potentially get patients ready for treatment or if it’s possible to utilize in treatment, that’s to be determined, but then even being able to safely apply it post -treatment as well to help these patients live their best lives.
Elise – @TheOncoPT (1:01:20)
Right.
Mm -hmm. And if you, the listener, are interested in continuing this conversation, like I mentioned at the top of this episode, this article was selected as part of our ongoing research roundups that we do within the Onco PT specialization community. And that community is free for anyone to join. I have linked that in the show notes for today’s episode. And you will find this article and many, many more that we are continuing to work through together.
These research roundups are ways that you can get your hands on kind of bite -size information. What is happening right now in oncology rehab research and how ultimately does it apply to your practice? A few months ago, I had a podcast guest on who talked about how it is so overwhelming to try and comb through the research on your own when you’ve already got X, Y, Z number of things to do. This is just one way that we’re helping you get your hands on the information. What is current
and new in the literature, and then how can you actually apply it to your own practice? So again, this article and more are available on our Onco PT specialization community. That link is in the show notes for you to join. And Kelly, thank you so much for coming back on the podcast to talk about this. This was an outstanding topic to really get into, especially as someone who doesn’t have experience with this and hasn’t used it in practice.
But the benefits are definitely there. And again, I’m thinking back to that one patient that I worked with so many years ago, how much further, how much faster could we have gotten to where we were trying to go with this kind of technology as an intervention alongside the other stuff we were working on? And I do think that we could have seen some more benefits, some maybe accelerated benefits for this patient.
So thank you so much for coming on today’s episode. We so appreciate you sharing your experience and your knowledge with us. Is there anything else you want to leave with us today?
Kelly Martin (1:03:42)
I think just always, it’s always a pleasure to be able to get on here and, you know, practice, you know, looking through the literature, applying it to thinking, reflecting on my own clinical practice, how I can be better, how I can utilize this technology better, and being able to start conversations with you, with other people in the cancer rehab community about making rehab better, cancer rehab better. I think it’s really, really fun to grow in that way and start some awesome conversations with people about
utilizing things or trying new things so that ultimately down the road we’re better for it and our patients are better for it. So it’s always an awesome opportunity. So thank you for bringing me in.
Elise – @TheOncoPT (1:04:22)
We will definitely be having Kelly back on the podcast in the future, so don’t you worry. But until next time, this is Elise with the Onco PT. And remember, you are exactly the physical therapist that your patients with cancer need. So let’s get to work.