Dr Rupy: Long Covid will unfortunately be the hallmark of the pandemic and is likely to affect hundreds of thousands of patients for years to come. But because the disease is so new, we have very limited information about how to treat it. Some patients, as has been my experience, are currently discharged from hospital with no formal recovery plan, which can result in a longer recovery process and prolonged side effects. So, when I heard about the free 12-week specialist recovery programme from Nuffield Health, I really wanted to learn more. And in addition to physical rehab, the programme actually includes topics such as coping with fatigue, managing breathlessness, anxiety, low mood, improving sleep, and eating for recovery, a real whole systems approach, which I absolutely love. So today I chat with Dr Ben Kelly, who leads the clinical research outcomes and data science functions within Nuffield Health. And alongside his Nuffield Health responsibilities, Ben has acted as head of interdisciplinary medicine and technology at the Medical Research Council with his clinical expertise in cardiology. And Paula More also joins us and is a business graduate and certified health and life coach, spending most of her career in senior management, retail management, I should say, who personally recovered from chronic stress and fatigue six years ago. So her personal experience does come out in today's discussion. Just as a side note, we do mention the term VO2 max during the podcast a few times without defining it. Put it simply, VO2 max is the maximum rate of oxygen your body is able to use during exercise. So the greater your VO2 max, the more oxygen your body can consume, and therefore it can more effectively use that oxygen to generate ATP for energy. And studies have shown that increasing your VO2 max can actually help your health and physical fitness well into your later years. And this may have a role in recovery from long Covid and mitigating symptoms such as fatigue and breathlessness. As always, you can find out everything you need to know about the free 12-week recovery programme for people affected by the long-term symptoms of COVID-19 on thedoctorskitchen.com podcast show notes, as well as lots of other information. But for now, I hope you enjoy my chat with Dr Ben and Paula More. Well, Ben, Paula, thank you so much for joining me on the podcast today. It's a pleasure to have you both. I'd love to talk initially actually about both of your backgrounds, if I may. Paula, I read in your bio that you've had some experience with fatigue and chronic stress, and I would love to dive into that a bit as it's as it's pretty pertinent to the topic we're going to be talking about, right?
Paula: Yeah, yeah. I experienced chronic fatigue, chronic stress, probably about six years ago now. And I myself, in my mindset, put that down to work and the demands of work, rather than it being my own mindset and how I control my own perception of my life and the things that I do and how I approach things. So it's a big learning curve for me, but that went on for a good couple of years and I got very, very ill from it, until I took that step back, asked for help, and actually started to understand that I am in control of that stuff. I have the ability to kind of change the way I see things and how I live my life to be a lot calmer and more relaxed. So yeah, I've gone from mega stress to mega chill.
Ben: Although, although Ben will probably contest that. You've gone from mega chill to making me mega stressed.
Dr Rupy: That's brilliant. And Ben, what's, we were talking a bit before we started recording about your background as well, previously wanted to go to cardiology, doing a stint in precision medicine. What's what's your been your journey?
Ben: Yeah, so clinical background as as we discussed, ended up in the world of clinical research, particularly cardiovascular and and metabolic disease. And my interest within all of that was how can we use a precision approach to identifying these super high risk people early, but then also knowing how we best tailor interventions for them, so that actually their road to recovery is hopefully much quicker, their outcomes are much better. And from a healthcare perspective, the cost saving is much much greater. And it should have been as simple as that. But it's, you know, it's it's super complicated as as well you know, and you know, lots of great work still ongoing. But I think my journey really through through all of that led me to a point of really understanding where my passion lay, and that was in management of those long-term conditions, particularly in that non-pharmacological space. You know, not not to say that we should negate pharmacology, but actually how can we optimize it with with lifestyle intervention wrapped around it. And that's really certainly for the past 10 years where where my focus has been and where we've we've done most research. But critically, you know, one of the one of the biggest things that that drives me and was certainly one of the the pushers back then was, you know, why do we not see more of the the findings translated into practice? You know, we know that clinical research, you know, for the right reasons is is a slow and heavy process. But I've always thought that there are ways and means to circumnavigate that, to disrupt that model a little bit, to actually get from bench to bedside much quicker. And that's that's certainly what we what we try and do over at Nuffield now. So yeah, very whistle stop tour.
Dr Rupy: Fab. Yeah, well I love already like this interplay between your background and and Paula's background as well. Why don't we get into it? So I did a podcast series a few weeks back now, it's maybe it's probably a few months ago now, where I spoke to an immunologist where we talked about long Covid. I talked to a patient who's also an infectious disease consultant, and I spoke to another colleague of mine who's doing some preliminary research into how diet and lifestyle might help with long Covid symptoms or at least prevent some of the prolonged issues that people have. What is the state of affairs right now with A, what we know about this very new condition, and B, what we can do about it in the in the present moment?
Ben: It's the million dollar question, right? We, what we know is that quite clearly it is much more complex than we we first gave it credit for. You know, it is a standalone multi-organ disease that actually seemingly at the moment is hard to predict how it will manifest in any given individual. You know, it's it's respiratory, it's cardiovascular, it's it's urological, neurological, gastro, so on and so forth. And actually, you get to the point where long Covid, whilst that is your diagnosis, you're actually then treating one of those other domains formally. Now, how do we tackle that? Well, again, it's a patient by patient basis and and whatever the presentation is, right? Treat what's what's in front of you and and however you you best tackle that. But I think what we're seeing certainly from the people coming through our service is, you know, they're almost replicating a multi-morbid population because very few of them are presenting with just a single issue. You know, there's there's always in the main the fatigue piece, the anxiety, either anxiety, stress, depression, or a multitude of all of them, not only is that consequential of the pathophysiology itself, but actually the fact that you're in this complete unknown world suffering with something that you don't know when the end point is coming. So you've got all those compounding factors. And and we've we've taken a quite a pragmatic approach, if I'm being perfectly honest with you, which is, you know, what is the thing that is fundamentally impacting predominantly your day-to-day activities? And we know roughly speaking, and we know the data is sketchy, right, in terms of prevalence, but there's, you know, well over 600, 700,000 people whose symptomology is impacting their day-to-day life, their activities of daily living. And and we work at it pragmatically in that sense. Exercise is a bone of contention, we know. Well, actually, it shouldn't be. I think this is a good good place to try and clear that up, right? So we know that exercise needs to be tackled very carefully in those individuals that have gone the step further into chronic fatigue syndrome, for obvious reasons, you know, because we we don't want to impact that. And I think what's certainly in the media, what has been misconstrued is is almost the blurring of lines between long Covid syndrome and chronic fatigue syndrome. You know, whilst the two are related, they are within a spectrum. But we have found that the the exercise component has been massively beneficial, particularly for those that, you know, one of one of the the presentations is severe MSK pain. Um, you know, whether that's a neurological connection or what, um, you know, who knows, you know, it may also depend on where the person's come from, right? So if they've come out of an ICU setting compared to someone who's who's not been that poorly, that they're also going to have inevitably those those MSK problems anyway. But to get that that strength back, that flexibility, just being able to get out of bed, put your shoes on, is is massive. But actually, if we look more broadly at the population, and what we know about aerobic capacity, VO2 and all the good stuff that sits around that, we know how strong a predictor it is of all cause mortality and morbidity. You know, one of the strongest predictors we we have. And we very much have taken a a view that, you know, if if the individual is right, fit, capable, suitable, then actually, you know, part having a part focus on improving that aerobic capacity has to be an important feature of of what we do. Um, so that yeah, that's a very specific piece. But I think if I take a step back broadly, we try and take a whole systems view. You know, we we can't just focus in on on the physiological. Um, you know, we we also consider the social impacts that the disease is having, um, the mental health and emotional well-being piece as well, and try and tie that into something that is um, I suppose as flexible but also as tailored for that individual as as possible.
Dr Rupy: Yeah. I want to touch on the VO2 max being a great predictor of all cause mortality in a bit, but I'll come back to you because I think it's a nice segue to Paula and your experience of fatigue and how this is different or along a spectrum of different fatigue syndromes. What's been your experience when chatting to patients who have come through the program at Nuffield and and how this is different to what we've seen before?
Paula: I think, you know, Ben touched on it, every patient is very different and they're presenting very different symptoms all the time. I think underlying, most of them are suffering the fatigue, a level of anxiety, breathlessness, um, and just very weak, struggling to cope with the demands of the lifestyle around them, whether that be children, work, as well as focusing on their recovery. Um, so I think it's it is it is different for every single patient. But a lot of the patients are saying that just having that support, that initial guide, somebody who is an expert, who is walking them through, listening to them, understanding what their specific needs are and tailoring the intervention to them is an absolute godsend because each one of them is different within each group. And it's taking, um, you know, the rehabilitation specialist a lot of time and focus to make sure it is individually tailored for them to to improve and help their recovery. But yeah, the the fatigue bit is huge. And the thing that we're seeing a lot coming through is when they're going back to work, when these patients are going back to work, there's a lack of understanding in the workplace of what these symptoms are and what they're going through because the symptoms aren't visible. Um, and and the biggest issue they're having is they've they've come through rehabilitation or they're on the journey to recovery, they're balancing children, they're balancing work, they're balancing all the other aspects of their life, you know, even general stuff like Ben said, day-to-day, like the, you know, just the food shopping, the washing, the gardening, um, they're trying to balance all of that, but they're not necessarily getting the support in the rest of the their life, whether that be friends, family, work, because the symptoms aren't visible. Um, so people just don't really understand. And that is the biggest problem that we're hearing. So for our interventions, um, specifically, for the rehabilitation specialist to really focus on that and give them the tools they need to kind of support them to manage that has been an absolute godsend to them and they're so grateful. And it's normalizing it as well. A lot of the things that we are saying, or our rehabilitation specialists are saying that it's okay not to be okay. It's okay to struggle for a little bit. It's okay for this to be the long game, you know, there is no short fix for this. Your journey is your journey and you will recover when you recover. And you take the steps you need to take for you at any given time. And once we've normalized it and made um, those interventions work for them in a way that is individual to them, then they start to see the progress. But it's that initial mindset shift between you are not going to be okay tomorrow. It's it's going to take some time and we're going to help you with the steps to do that. Um, so, yeah, I mean, I could talk forever about that kind of stuff.
Dr Rupy: But the Well, I was going to ask you actually, drawing a parallel with your own experience six years ago, um, where do you think things were lacking for you and and where do you think this particular program that we'll talk about in a bit more depth in a second is sort of filling the gaps?
Paula: Yeah, I think for me, there was there was many aspects. A lot of it was just very cultural and how I'd been brought up was to work hard and to put your all in and, uh, you know, do what it takes to be successful. And that, you know, that strong work ethic that put a lot of stress on me. Um, I think my mindset of feeling I had to prove myself all the time put a lot of stress and pressure on me. And yeah, just that cultural piece of that stiff upper lip that we have in in Britain where, you know, you you're told work hard, focus, get on with it, you know, get out of bed, get on with it, whatever it takes, get it done. Um, it's that it's that pressure that we put on ourselves. So for me, that's where it really came from. It was it was my mindset and kind of how I'd been brought up, I guess. I hope my parents aren't listening to this. So yeah, I think it yeah, for me, it was it was absolutely about that. And and learning when I really suffered, when I was at my worst, it was learning, well, actually, what what is it? What is in my control? What can I do to make this better? What is it about what I'm thinking, feeling, doing that's having that negative impact on my life? And I went through all sorts of things as we do, like blaming people, you know, you blame your work, you blame your relationships, you blame whatever's going on at the time. And it's actually, you know, it's getting over that blame and just looking at the the self-help and what can I do to get better. Um, and like we touched on before, definitely accepting that it's okay not to be okay sometimes. That's so important. You know, we try and struggle through so much and actually that struggling sets us back.
Dr Rupy: Yeah, yeah. I'm glad we're talking about the culture around this actually, because I think a lot of people, particularly within medicine and high pressure professions, but of course across the spectrum of people, um, from all walks of life, definitely put more pressure on themselves than is needed and they don't allow themselves space. I mean, when I was a medic and I qualified like 12 years ago now, I remember never wanting to demonstrate any sort of vulnerability at all for fear of not being seen as worthy enough of being part of the profession. Um, and I think that's that's that's really true across a lot of different people as well. Ben, you you mentioned uh, VO2 max, aerobic capacity. Let's talk a bit about that and why that's so important and how that might have an impact on outcomes for for patients with long Covid.
Ben: Yeah, it's um, it's an interesting one and I think it, you know, it all stems from great work a long time ago now, uh, within reason from Claude Bouchard and and his group, and then later, uh, Jamie Timmons, um, which really was we were able to start um, pulling out higher risk individuals and predicting those higher risk individuals, particularly those that had levels of of morbidity based on their aerobic capacity. Um, and I think not that we're using it in any predictive sense here, but the the interesting thing, um, and you know, we touched upon it before we we started was actually what is the trainability of someone? Because as important as VO2 is at a, you know, baseline prediction level, what's actually really important is how trainable is that? Because we know that, um, you know, the ability to reach a higher VO2, a higher threshold is the thing really that is is associated with reduced morbidity and mortality. So it's almost flipping the paradox on its head ever so slightly. Um, and I think what we, what we know is that what we didn't know previously until that work of Bouchard and Timmons and others is that actually fitness is just this thing that we think about as, you know, we go out for a 5k run and we keep doing that couch to 5k and we just get fitter and fitter and fitter. Um, but it's not not actually the case, you know, whilst it has a huge trainable element, there's also a genetic core component to that. So we're almost hardwired to a certain degree in terms of what is that upper peak or upper limit that we we can achieve. Um, and yeah, probably around 10 years ago now, maybe slightly less, we were able to not only predict those people that um, were were at higher risk, but also what their ability or trainability might be. And what's interesting is, you know, there's there is a population, albeit relatively small, but extrapolated up is a lot of people that, you know, if they dive into cardiovascular exercise as we know it, actually don't improve or go the opposite way, the so-called non-responders, right? And actually, that's really important from a tailoring perspective, particularly in in something like COVID, not that we're we're there yet, so I don't want to necessarily make those those parallels, but if you just take that notion in understanding how you you tailor rehabilitation particularly, well, actually, you're not going to go and start them on a cardiovascular or aerobic program. You know, you're going to focus more on um, the musculature, you know, resistance training and try and um, seek responses in in that format. So lots of work still to be done. I'm actually not sure if any work in that space has been done with a COVID population. Maybe something that we will we will look at. But just generally with multi-morbid populations of which COVID echoes, I think it's a really important thing to consider.
Dr Rupy: Yeah, absolutely. Um, you you might have mentioned at the start, but what's the current state of affairs right now with regard to the number of people that we think may be suffering with long Covid um, at the moment?
Ben: Yeah, it's a good question. I think, you know, we we know that there had been um, some issues with reporting, you know, classic technology and systems and and everything that goes in between. Um, certainly in in the UK, you know, we know that there are, so as of May, there's well over a million people, um, that we know of that have self-reported through through ONS data. Um, but globally, um, you know, those that are sort of on that trajectory of they've been suffering with symptoms for over a year, at least or at least a year, um, you know, numbers range from anywhere between five and eight million depending on on where you look at whether you look at Nature or BMJ or or whatever it may be. Um, but the crucial bit really for me is that there is that's just the known. Um, and like everything else, it's the unknown and those that aren't presenting formally, um, that we worry about. So whilst we can go with a broad estimate of of a million people, um, one, we know that that will increase and two, I suspect it probably undershoots it a little bit.
Dr Rupy: Yeah, yeah, absolutely. Um, so talk me through how this how this program works. Um, I mean, on the outset, I absolutely love it. You know, Ben, you've got this whole systems approach. Paula, you're bringing sort of the aspect of psychology, which is super important. I think often gets ignored. I almost feel like this program is necessary for everyone to sort of uh, gain some control over their health going forward. And I'd love to see that more in the NHS and in a preventative manner, uh, regardless. Um, but Paula, perhaps you can talk us through how the uh, the program actually started and and and what sort of ideas led to this?
Paula: Yeah, so, um, as as you may or may not know, Nuffield Health is a trading charity, um, and part of that charity, we have our flagship programs where we use all our knowledge, our expertise, um, to use interventions, um, for free where there's an unmet medical need, where we can help people. Um, and then obviously, the pandemic happened and it was natural for us to support the nation recover, um, and it became very natural for us to support the nation recover with long Covid. Uh, we've also got other programs, so we've got a joint pain program, um, which is very successful, been running for a couple of years and helped over 2,000 people so far. And the basis of that program actually forms the basis of the long Covid program. So a lot of work went into designing it for long Covid specifically, um, with a lot more emotional well-being content, um, and uh, you know, all all the other kind of symptoms we were guessing at the time to to support uh, the long Covid program. Um, and we pulled together um, a supportive journal, we pulled together this 12-week intervention and just had a look at how we could get that around the nation, um, to support as many people as we possibly could. So yeah, a lot of our experts, physiotherapists, emotional well-being experts, a lot of clinicians, even help from the NHS, um, all got involved to make this program what it is. And we work and we are linked and partnered with a lot of uh, NHS around the country who refer into the program. Um, so yeah, patients, once referred in, they can self-refer or they're referred in by their GP or or a clinician, and they enter the 12-week program, six weeks virtually, so they're in the comfort of their own home, but they have like a a Zoom call, um, or similar where they get um, rehabilitation specialist face-to-face. They get a one-to-one support call as well every single week. And then at week seven, they get to come into our one of our Nuffield Health gyms, experience uh, gym life, meet the community of people that these on their cohort and meet all the, you know, the like-minded people that they've been building relationships with virtually, which is it's a massive, massive part of the program that they say really helps them. And at that week seven point, their recovery really does um, accelerate because they realize that they're around people, uh, that's that are suffering as well. Um, a lot of them say it's a bit bittersweet, but it's nice to be around people suffering the same thing because they get to um, they get to support each other. So then, yeah, they're in the gym for seven, uh, seven weeks after that, and then they stay with us for for a further six weeks, um, on with a free program, um, free membership to to again enable the recovery. And what's really important about that is like you've just said, the preventative element, because they're learning the skills then to carry on with their recovery and with a healthier lifestyle going forward. So they're learning about uh, sleep management, they're learning about nutrition, they're learning about movement and exercise, um, and they're learning about all the emotional well-being aspects of it as well, all things that you can't unlearn once you've learned them, and they're going to get to apply that, um, after the program.
Dr Rupy: Yeah. I mean, when I heard about this, I thought it was phenomenal. Um, you know, it's 12 weeks, you don't have to be a member of Nuffield, it's for free. It's uh, a nice blend of virtual and in person as well. You're utilizing all the data and all the research looking at a whole systems approach, medicine, almost seems too good to be true. So what, like, how how many how many people have you had through and what what's the capacity? Given that we know the numbers globally, but, you know, even in the UK, it could be as much as a million. How many people can we get going through this program?
Paula: Yeah, numbers are increasing every day, um, because our sites are staggered and and rolling out constantly. So it's it's brilliant for me to watch as I operationalize the program, I just get to see those numbers increasing and knowing that we're helping more and more people. Um, we will definitely have have supported about 1,800 patients before the end of the year, um, which is, uh, which we're well on track for. And then obviously, we're all hoping that long Covid won't go on forever, um, but we're certainly on track to continue that run rate into next year as well. But we've got 40 sites live at the moment. We're looking at putting some more sites on just to obviously get this program accessible to as many people as possible. Uh, but yeah, we've had well over 1,500 referrals and a lot more coming in every day.
Dr Rupy: It's brilliant. And and Ben, what's the initial um, feedback and research looking at the the efficacy of the program beyond the anecdotes? I mean, I I can imagine a lot of people would be very, very happy. But overall, what what's the uh, sort of bird's eye view of how effective it is?
Ben: Um, so the simple answer is it's encouraging. Um, one of, one of I suppose when we when we entered into this, you know, our research heads, you know, always want to make sure that we've got the, the process and methodology, um, as tight as possible because you want to, you want to control for all those unknowns, right? But actually, it's a nonsense when you're working with the biggest unknown of them all, which is the disease itself, right? Um, and and just so you know, our our our methodology is is published now and is is open for everyone to access because one of the things we want is, you know, if it works for people to go and replicate it, the more people that can do it, the better. Um, and and one of the big unknowns and something that we hadn't looked at before, um, is this blended model of care, you know, half virtual and and half face-to-face. You know, we are quite, um, resource intensive in our in our other rehab programs. So there was a little bit of an unknown there, how would it work? How do we control for it? But actually, our approach like like most of our other research is, you know, it's it's real world evidence. That is what we focus on. It's translational research and it's service line evaluation. So, um, we we take it very much in in that spirit. Um, and when when we look at our outcomes and outcomes frameworks and the data that we want to work with, we typically will always look at symptom specific or something that is symptom specific, um, a utility metric so that we can start to establish, uh, quality adjusted life years and and basically the cost effectiveness side of things as well. Um, with this particular program, the emotional well-being piece is super important, so we need to make sure we pick up on that. And then a marker of functional capacity for all the reasons that we, you know, we've already spoken about. So, um, symptom specific, well, what do you choose? Because there are lots and lots. Um, but we used our own cohort and our own data to say, well, what's the most prevalent? Um, and for us, that was breathlessness. Um, so we used the Dyspnea 12, uh, measure. And what we've found, uh, is that on average, the completers at 12 weeks, uh, have a reduction in breathlessness of about 40%. Which is, which is huge for for us anyway, and certainly not not what we expected. Um, so functional capacity, so this is self-reported via the the DASI, um, questionnaire, which is just can you get up, get about and do your day-to-day. Um, that improves by 30%, or 29%, but I like to round it up. And then emotional well-being as well, that, you know, lots of different ways that you can measure it and and you know, we can argue until the cows come home which is the most appropriate. Um, and we did a lot of diligence on this because clearly there is a line, right, between knowing something works and then adding stress to an individual and putting more burden on them. So we, uh, we use GAD-7 as our our measure. Um, and that's that really focuses in on on anxiety. Um, and we've seen a 52% drop in anxiety from um, start to to post. And then fitness or aerobic capacity, um, we we use a 30-second sit to stand test, which we know is a is a really good correlate. Um, and yeah, and we have to be practical as well, particularly if people are doing this sort of stuff in in their homes, they want to track their own progress. You know, we're not going to go and put them on a gas analyzer and do breath by breath. Um, but we saw a, well, we're seeing a 46% increase, um, after after 12 weeks. Um, and you know, what I should say as well, just to just to add some context is, you know, this isn't a cohort of just, um, older age group, overweight, previously inactive people. These are people that range from, Paula, correct me, but from 18 years all the way up to 70 plus. And actually, these findings are so remarkable and so important because of the level of deconditioning that is associated with long Covid syndrome. So, you know, we've had people that were previously running marathons that now can't even put their socks on. So actually, it's it's you can't look at the data in in a traditional sense in that, well, actually, you've got people who have got varying start points, which we have, they are all of a quite tight strata right down at that low functioning, um, end. You know, our criteria for entry really is, um, no uncontrolled additional medical conditions and can mobilize at least 20 meters. And most people are down at that point. Not all, of course. So, so for us, you know, we're incredibly heartened and as more and more data comes in, um, that will be strengthened and of course, um, when we get to the end of this year, uh, we'll publish an update on our data, uh, openly.
Dr Rupy: Immense. That's awesome. Um, I think one of the frustrations that a lot of people have had around this time, um, and of course it comes with reason. I mean, we're dealing with something that is completely new and when you're dealing with an organization like the NHS, it's a slow, monolithic, bureaucratic organization that's very, very hard to uh, maneuver and react. Um, but a lot of people found themselves struggling to get this kind of support that you guys have been able to pull out the bag for for this many people. How how is the the program that you're doing different to the NHS long Covid support? Um, and how do we scale this up? Because the way I think about things is perhaps with a bit of a a tech mindset. I'm like, okay, we've got this great program, we've got these amazing results. We need to scale this. We need to take this across the country and as many different places as possible. Where is where is the the plan for that? So, why don't we start with the first question because I I realized I packaged two big ones into one.
Ben: So do the edit tackle the NHS bit first. Um, so as as Paula highlighted, you know, this and it's always a misconception with the NHS and the independent sector is that it's an us and them. Um, it's not, you know, we're very close, we work together on a daily basis on on everything that that we do. Um, not, you know, that was that was always the case pre pre-COVID. So, this this program has been developed, um, with their insight, with NHS knowledge. Um, you know, we're connected with Sally Singh and her group at Leicester who who have uh, led the uh, the My Covid Recovery. Um, and and there's no sort of, um, hiding of workings and and not wanting to share understanding. You know, we're absolutely in a in an open forum. We we have, um, members of our advisory panel that that advise on on that group as well. Um, so, you know, it's it's it's a good working relationship. How we differ is that clearly the the NHS has to think about scale straight away. You know, it has to provide something for the nation the moment it switches on. They don't have the luxury necessarily that someone like ourselves would have where we can almost slowly roll it out, make sure that it works, and then just slowly make sure that we uh, we expand it further and further. Um, how we differ though is that primarily, it's the access to a real human being that is supporting your care. Um, and that is that is the piece that straight away you go, well, that's the piece actually that makes it non-scalable. But actually, I think what we've found, and this is moving on to the second part of your question, I'll Paula will have a view as well, but what we've found is that we can make that work because it's it's how Nuffield Health is structured. You know, we we work with clinical populations in in a fitness and well-being setting day in, day out, and we can resource it appropriately. The blended model helps because it means that straight away, if you do a half and half, you double your capacity straight away. Uh, and we are also, and we do have a fully virtual model as well, which we're sort of testing in in isolation, um, that actually if if we prove is effective, we'll make sure it can be scaled. But critically, and we've touched upon it before, it's about making sure that no one is precious about it about ownership. You know, this is a a program that is here to support the nation. And actually, what we want to do, yes, as pioneers and the people who are going to put our necks on the line to to prove it out and put the investment in, but if we're proving that it works and we're sharing our methodology, we want to support other organizations to be able to deliver the same, to be able to get out there and support, whether they're a, you know, a commercial competitor of ours or part of the health service. For us, it doesn't really matter. For us, it's about that social return and making sure that as many people get access to quality care as as possible. So, multifaceted.
Dr Rupy: Yeah, yeah. Paula, do you have any thoughts on on scale?
Paula: Yeah, I'm um, it's a double-edged sword for me this one because obviously I get to speak to the patients and as much as half of me wants to scale it up, make it accessible to everybody in whatever way um, that can be done, which blows my mind when it comes to technology. Um, is, you know, that's the thing we want to do. We want to reach as many people, benefit as many people across the nation as quickly and as effectively as possible. Absolutely, that's a no-brainer. But then the other part of me sees the wonderful interactions between the rehabilitation specialist, between our physios, our team, the Nuffield Health team with that patient on a regular basis, you know, they get two to three hours touch points, um, if not a little bit more every single week. They then get to meet each other in the gym, the you know, the patients get to meet each other, but the rehab specialist gets to meet the patient they've been supporting virtually as well. And they build this community that ends up accelerating the recovery, but also ends up making like, yeah, a community and friendships and things as well. So I think it to take that element out for me would be a heartbreaking in a way, but you can't do that for everybody. So yeah, I scale it, yes, but keep that element for as many people as possible, yes, as well.
Dr Rupy: Yeah, I know, I see what you mean. I mean, it's that magic of social interaction that almost adds like another dimension to the the the program. And um, it's something similar actually that we're dealing with at Culinary Medicine, which is the nonprofit I started teaching uh, doctors and medical students how to cook as well as the foundations of nutrition. And one of the key elements of our course is this in-person learning experience where you get interaction with a dietitian, a professional chef, culinary students, and everyone cooks a family meal together and you discuss a clinical case. And obviously during the pandemic, we had to flip completely to virtual learning where a chef basically did the demonstration. So you lose that sort of visceral, uh, emotional connection with the the whole course experience. And I guess, you know, that that's definitely something that um, is the first thing to be sacrificed whenever we think about sort of scale and and and uh, trying to uh, deliver this content to as many people as possible. I I do want to ask you for for anyone that's listening to um, to this and and wondering where to start, particularly as this podcast is usually about nutrition, what kind of things do you talk to to patients about uh, when it comes to what they should be eating? Um, and obviously that's within the context of everything being individualized to A, their convenience and ability, and also their their taste preferences as well.
Ben: Yeah, I can start. So it's the holistic approach, isn't it? You know, it's it's not necessarily trying to reinvent the wheel. That's the key thing. Um, and like Paula mentioned earlier, it's about providing information and stuff that actually shouldn't and won't be forgotten. It's and the stuff that you and and your listeners will would almost see as the basics, but for a lot of the individuals that come through uh, through our program, it actually changes the whole way in which they they approach um, diet. So it will it will cover the fundamentals, right? So, you know, what does a healthy diet consist of? Um, things like portion control, you know, is is is a key piece. Um, things that might be associated with um, exacerbations of of particular uh, issues that they may or may not uh, have. Um, and understanding just about about timing and and linking into that emotional well-being piece as well about how you think about foods, what role food and diet actually plays in the wider context of your day-to-day in supporting your your recovery. Um, also the the negative impact it could potentially have, particularly when you link it to some of those uh, emotional well-being components. Um, you know, things to to avoid overeating, emotional eating, things things of that that nature. So, you know, in in essence, you know, we're not trying to to hammer people with science and throw the latest fad diet at them and say, you know, follow a particular route forward. And the other reason for that, right, is we've got to be careful because we just don't know. You know, we absolutely don't know. So if we just reiterate the stuff that we know are the core fundamentals, the stuff that we know if you are consistent with and it's part of a wider healthy lifestyle, um, actually, if nothing else, should in the background be keeping you at a at a risk level that, you know, will will allow you to focus on the recovery from your from your condition.
Dr Rupy: Yeah. And and Paula, when it comes to psychological well-being in terms of the things that have helped, uh, perhaps you personally, but also the patients that you're coming into contact now, where are the the key areas and what are the top sort of things that you you ask people to think about?
Paula: Just going back to that part of um, not punishing yourself for not being well, you know, it's it's all right for this to play out for a while, for you not to feel like yourself for a while. Um, just because you feel like this now, it doesn't mean that's your forever. But accept it now and put yourself first, you know, to be selfish for a little while is essential. Um, to put yourself first is not selfish, it is essential. And, um, yeah, to stop trying to be everything to everybody as well. Um, we get a lot of that. A lot of the the conversations that our rehab specialists are having with patients is, well, I've got to work, I've got to be a mom, I've got to do this, I'm a, you know, I'm a carer as well. And there's lots of people, um, that that need me. Um, you can't be that person for everybody until you're okay yourself. Um, so it's absolutely about overcoming that barrier of trying to speed up your recovery, um, for for everybody else. It's about slowing it down, go at pace, get yourself better, and then you can be everything to everybody else. Um, and that's the main crux of the conversations that we have with patients daily.
Dr Rupy: Brilliant. Well, I want as many people to check out the link and um, uh, look at the 12-week course on the website. Um, so we'll put all the links uh, on the podcast show notes on thedoctorskitchen.com. But for for anyone that can't access it or, you know, are there resources on the website as well that people can start at least reading and familiarizing themselves with if they can't get onto the course immediately?
Paula: Yeah, yeah. If you just go to nuffieldhealth.com/covid, there's so much information on there that can support even if you're not on the program, there's lots of information for anybody that's suffering or know anybody that's suffering that can access and and um, and just have a read and and just have a look at what we do.
Dr Rupy: Fab. Fab. Well, thank you so much, guys. It's been a pleasure chatting. And uh, yeah, I can't wait to hear about the results later on this year when you've got a bigger cohort and you've uh, sliced and diced the data even more.
Ben: We will do. And we'll keep you posted. So as soon as we get anything, uh, anything back at the end of the year, we'll uh, we'll be sure to share it with you.
Dr Rupy: That'd be amazing. Yeah, that'd be brilliant. Thank you so much, guys. Thank you so much for listening to today's podcast. You can find out everything you need to know about this 12-week free recovery program for people affected by the long-term symptoms of COVID-19 on thedoctorskitchen.com, almost forgot my own website there, thedoctorskitchen.com podcast show notes page, as well as lots of tips, hacks, and tricks as to help you live healthier, happier lives. I do hope you've enjoyed today's podcast episode. There'll be more and lots more information on the newsletter, which if you don't sign up to yet, you really should because I give you tips on what to eat, uh, listen to, watch, or read every single week to help you live healthier, happier lives. I hope you enjoyed this week and I will see you next time.
