Central West Health & Rehabilitation
P: (08)9965 0697 F: (08)9964 7528


Centrals - Gym Safety Course Jun 23rd, 2015
Joining a gym is a ‘recreational activity’ involving physical activity. Physical activity and sport in general contain inherently dangerous elements, and participation involves an assumption of risk. Accidents can and do happen which may result in personal injury, death or property damage. 

The following pages provide information of exercise safety including:

  1. General Safety and Exercise Technique

  2. Strength Training with Free Weights

  3. Cardio Equipment

  4. Treadmills

  5. Brief quiz to confirm you have watched all the videos

Next - Strength Training with Free Weights

Back - Centrals Gym Safety Procedure

After Hours Gym - Exercise Safety Jun 20th, 2015
Joining a gym is a ‘recreational activity’ involving physical activity. Physical activity and sport in general contain inherently dangerous elements, and participation involves an assumption of risk. Accidents can and do happen which may result in personal injury, death or property damage. Prior to joining, you should ensure you are aware and comfortable with the risks involved, including those risks associated with any health condition you may have.

To the best of our knowledge, the facilities and physical activity programs offered by Central West Health and Rehabilitation have been designed and established to provide the optimum level of beneficial exercise and enjoyment without compromising the health and safety of those who utilize the facilities or participate in the activities. Because of the nature of the programs made available at Central West Health and Rehabilitation, and the equipment, which is an integral part of many of the activities, there is an inherent risk of injury which characterizes any exercise activity resulting in a practical limitation placed on Central West Health and Rehabilitation in its efforts to prevent injuries to participants, whether actively participating in exercises, utilizing the equipment or taking advantage of the various other facilities at the Centre.

Central West Health and Rehabilitation enlists your assistance in assuring that the facilities and the equipment are utilized in a proper manner so that the inherent risks which exist under the control of the Centre, as well as those outside the control of the Centre and partially within the control of each individual participant, are minimized by the participant’s thoughtful and cautious use of both the equipment and the facilities.

Following are a number of short videos on exercise safety. To confirm you have watched each there is a brief quiz.

Next - Strength Training with Free Weights


After Hours Gym - Strength Training with Free Weights Jun 20th, 2015
Resistance training (also called strength training or weight training) is the use of resistance to muscular contraction to build the strength, anaerobic endurance and size of skeletal muscles. When you do resistance training repeatedly and consistently, your muscles become stronger.

Resistance training can be dangerous if your technique is not right. It is important to pay attention to safety and good form to reduce the risk of injury. If you are interested in starting resistance training, make sure you have an assessment and program written for your specific needs. Make sure you follow any medical advice and are shown the exercises by a physiotherapist, exercise rehabilitation professional or qualified gymnasium instructor.

Safety tips for resistance training

  1. Proper technique is essential. If you’re not sure whether you’re doing a particular exercise correctly, ask a qualified personal trainer, gym instructor or exercise physiologist for help.

  2. Start slowly. If you’re starting out, you may find that you’re able to lift only a few kilograms. That’s okay. Once your muscles, tendons and ligaments get used to weight training exercises, you may be surprised at how quickly you progress. Once you can easily do 12 repetitions with a particular weight, gradually increase the weight.

  3. Only use safe and well-maintained equipment. Faulty equipment will significantly increase your risk of injury.

  4. Don’t hold your breath. Breathe normally while lifting by exhaling during the exertion or harder phase and inhaling during the easier or relaxation phase.

  5. Control the weights at all times. Don’t throw them up and down or use momentum to ‘swing’ the weights through their range of motion.

  6. Maintain a strong form while lifting, as this will prevent injury through incorrect technique. Always lift weights within your own capabilities and slow down or stop if you feel the weight is out of control or too heavy.

  7. Use the full range of motion. It is important when lifting a weight that it travels through the full range of motion of the joint. This develops strength of the muscle at all points of the motion of the joint and decreases the chance of injury through over-stretching.

  8. Wear appropriate clothing and safety equipment such as gloves. Dress comfortably and practically (for example, wear clothes that do not restrict movement and allow you to sweat easily).

  9. Maintain correct posture and body positioning (form) to reduce the risk of injury at all times.

  10. Once you have finished a set, gently place the weights on the floor – don’t drop them. Otherwise, you could injure yourself or people nearby.

  11. Don’t train if you are over-tired or feeling ill.

  12. Don’t try to train through an injury. Stop your workout immediately and seek medical advice.

  13. Muscle needs time to repair and grow after a workout. A good rule of thumb is to rest the muscle group for at least 24 hours before working the same muscle group again.

Next - Cardio Equipment


After Hours Gym - Cardio Equipment Jun 20th, 2015
Aerobic (cardiovascular) fitness is one of the most important components of physical fitness. Cardiovascular fitness is measured as the amount of oxygen transported in the blood and pumped by the heart to the working muscles and as the efficiency of the muscles to use that oxygen. Increasing cardiovascular fitness means increasing the capability of the heart and the rest of the cardiovascular system in their most important task, to supply oxygen and energy to your body. Cardiovascular fitness is related to age, gender, exercise habits, heredity and cardiovascular clinical status.

Having good cardiovascular fitness has many health benefits. For example, it decreases your risk of cardiovascular diseases, stroke, high blood pressure, diabetes and other diseases.

Cardiovascular fitness is best improved by activities, which employ large muscle groups working dynamically. Such activities include walking, jogging, running, swimming, skating, cycling, stair climbing and cross-country skiing.

Next - Treadmills



After Hours Gym - Treadmills Jun 20th, 2015
A treadmill is a piece of exercising equipment that consists of a conveyor belt rotated either manually or by a motor. The user will normally walk, jog or run on this device.

The most significant risk associated with the use of treadmills is friction burns, especially to young children playing on or near a treadmill. The results of these injuries can range from minor burns to serious burns requiring skin grafts and potential permanent loss of the use of hands or fingers.

Next - Safety Quiz

Jun 20th, 2015

The management of musculoskeletal disorders in the workplace Jun 16th, 2015
On balance, well-designed work carries net health benefits. Poorly designed work and unemployment are major social determinants of health inequalities. In some cases, a patient's work may have contributed to the development of their musculoskeletal disorder (MSD), or may lead to deterioration in their disorder.

Physical factors at work such as frequent or prolonged work in awkward postures or exposure to vibration may result in specific MSDs, for example, osteoarthritis of the hips in certain groups of farmers. Non-specific disorders, such as diffuse arm pain, are much less likely to be caused by physical factors at work.

Care must be taken before attributing work as the cause of an MSD; causation is usually multifactorial and work may not be the only or even the main cause. Many factors come into play, including physical and psychological aspects of the job, relationships with managers and peers and the worker's perceptions of organisational justice.

If it is believed that work has contributed to, or aggravated, a patient's disease or disorder, there is a duty to try to ensure that other workers in the same environment are not further exposed to the same risk (primary prevention). If an injuried worker is to return to the same working environment, they should endeavour to ensure that exposure to an ongoing hazard is minimised (secondary prevention).

If the patient works for an organisation that has access to injury management services, the best approach is to contact the service and explain your concerns (provided your employee consents to you doing this).

Next- Assessing Fitness for Return to Work

Assessing Fitness for Return to Work Jun 16th, 2015
'Worklessness' has profound negative effects on the injuried individual and their family. People who are unemployed suffer from poorer general health and they are more likely to participate in risk-taking behaviours such as alcohol and drug abuse, sexual promiscuity and smoking.

Unemployment also leads to wider social inequalities, and economic stress can impact on families with implications played out over decades. Importantly, regaining work may reverse these adverse health effects, and re-entry into work leads to an improvement in health.

There are several principles that health-care professionals need to take into account when assessing an individual's fitness for work.


It is important to consider not only if the person is likely to be able to perform their duties effectively, without harm to themselves, but also if the patient's return to work may lead to risk to others.

Inclusive approach

Individuals do not need to be symptom free to work. Many medical conditions, and virtually all minor health problems, have minimal implications for work and should not prevent employment.

The majority of people who are off work due to MSDs return to work within 4 weeks without vocational rehab advice or intervention. The priority at this stage is to support and encourage restoration of function and to avoid exacerbating disability, as there is evidence that occupational outcomes for most people with MSDs are improved by early return to some work.

Once an individual has been off work with an MSD for 4 weeks, an intervention to assist return to work is more likely to be required. By 26 weeks of absence, incapacity is likely to have become entrenched and rehabilitation becomes much more difficult. Therefore, the period of 4-26 weeks is often referred to as the ‘window of opportunity’ for effective return-to-work management.

Medical fitness should be assessed in relation to the particular demands of the work, such as hours; shiftwork; exposure to physical, chemical, biological and psychosocial hazards; work relationships; physical work environment; and requirement to travel.

An in-depth knowledge of the workplace and the duties of the job invaluable when assessing a employees fitness for work. Another reason this process should be done by the workplace injury management co-ordinator or injury management provider.  OH service. If such a person is not available majority descisions regards fitness to work are therefore undertaken by general practitioners (GPs) or hospital-based health professionals. These individuals often have limited knowledge of an employees workplace and roles.

Assessment of work capability is complex, and despite its importance, there is very limited scientific evidence to base RTW decisions on in part as there is no standard or valid methodology for assessing suitability for RTW used over all professions.

Outcomes from fitness for work assessments may range from ‘fit’ to ‘unfit’, with intermediate categories such as ‘fit subject to work modifications’, ‘fit with restrictions’ or ‘conditionally fit (temporarily, permanently)’. Workplace modifications to improve or adjust working conditions should always be considered.

Suitable Duties

Adjustments to work may be temporary or permanent, and they may take many forms. They may include shorter working hours, different shift patterns, avoidance of manual handling or transferring someone from a physical to a sedentary post.

For example, an employee with arthritis may benefit from starting work slightly later in the morning to allow time for the medication to take effect and early morning stiffness to reduce.

It is important to consider how individuals travel to work. Employers may be able to provide workers with a parking space to facilitate their access to work. Individuals who use public transport may temporarily or permanently benefit from travelling before or after the rush hour, so as to ensure that they get a seat.

Return to Work

Patients should be forewarned that they are likely to experience disproportionate fatigue on return to work. This symptom is likely to be more prominent in individuals with inflammatory MSDs. This can be mitigated in some cases by simple strategies such as returning to work on alternate days for the first week; returning in the middle rather than the beginning of the working week; and, if possible, working shortened hours, gradually increasing to usual working hours over a period of a few weeks.

Next - Pre-employment Physical Assessments

Physical Assessment and Return to Work Jun 16th, 2015
Work health and safety laws in Australia and other jurisdictions also require employers to provide a "safe system of work". For example, section 19 of the Work Health and Safety Act 2011 states that the "primary duty of care" is to "ensure, so far as is reasonably practicable, the health and safety of workers" by, among other things, "provision and maintenance of safe systems of work".

Pre-employment physical assessments provide vital information for such decisions, and will find more and more value as our workforce gradually ages over the coming 2-3 decades. Information gained form Physical Assessments can also be helpful in establishing pre-existing physical capacity, whch asssits in establishing return to work goals.

It is important for recruiting employers to make clear to applicants the reason why health-related questions are asked pre-employment and the purposes for which the information will be used. 

Once a job has been offered, and accepted employers may, if they wish, ask additional medical questions. If a condition is revealed that might cause the candidate problems in performing the job, then adjustments must be considered. If no adjustments are possible, or the adjustment is not considered to be reasonable by the employer, then the job offer may need to be withdrawn.

It is important that an organisation ask the advice of medical/health professionals before turning down an individual for work on health grounds.


RTW is most successful if a clear return to work plan is agreed upon; the employer is willing to make adjustments to the person's job or working environment and all health-care workers involved with the patient communicate with each other .

Main Points

  • Be inclusive in your RTW process, by considering what injuried employees can or may be able to do, rather than what they cannot do.

  • It is important an employer can entertain reasonable adjustments recommended by an employees treating GP. Alternatively an employer must be ready to provide suitable alternatives to enable employees with MSDs to return to work, stay in work or access work.

  • There is strong evidence that return to work is most successful if it involves a partnership and understanding between employers, the worker and health-care professionals.

  • There is strong evidence that temporarily modified work can facilitate early return to work.

Diabetes Support Group Jun 15th, 2015

Centrals - Physical Activity Readiness Questionnaire Jun 11th, 2015
The following is a standardised Physical Activity Readiness Questionnaire. If you answer yes to any of the following questions it is strongly recommended you discuss your answers with your Doctor or a suitable health professional. 

Once completed you will be provided a link to continue the gym use process.

Centrals - After Hours Gym Safety Questionnaire Jun 11th, 2015

To confirm you have completed our gym safety induction please answer the following questions. 

Gym Program - Beginner 1 Jun 8th, 2015


Half Pushup

Lat Pulldown

Seated Row

Bicep Curl

Tricep Pushdown

Lateral Dumbell Raise

Sidge Bridge

Bird Dog


Gym Program - Beginner 2 Jun 8th, 2015

Leg Press

Bench Press

Lat Pulldown

One Arm Row

Bicep Curl

Tricep Pushdown

Lateral Dumbell Raise

Sidge Bridge

Bird Dog


Medical Observer - Pharmacy’s $19b deal a ‘political’ move May 29th, 2015

This article was written by Flynn Murphy

DOCTORS and consumer groups say the government has folded to the pharmacy sector with a new $19 billion agreement that puts politics above patient care.

As general practice shoulders the burden of an MBS rebate freeze, the massive funding boost for pharmacies includes a doubling of the allocation for pharmacy-delivered primary care to $1.26 billion.

Health Minister Sussan Ley introduced the legislation on Wednesday, telling parliament the Sixth Community Pharmacy Agreement would let the sector “innovate and transition from a focus on medicines supply to medicines management and pharmacy services”.

As previously revealed by Medical Observer, wound care programs, staged supply of medicine for mental health, and basic arthritis checks are likely beneficiaries of $600 million in new and expanded pharmacy services.

No specifics have yet been announced. A $50 million Pharmacy Trial Program will be established to decide which of the services meet the cut, and new and existing programs will need to be approved by the Medical Services Advisory Committee (MSAC) to be funded.

Existing services like medication adherence and medication management programs, including clinical interventions, have been allocated $613 million.

That’s despite what RACGP head Dr Frank Jones says is a lack of evidence such programs have worked.

“We wrote a strongly worded letter to the minister [in March] suggesting that there was little evidence provided – at least publicly – that what pharmacists were doing was improving patient care,” Dr Jones said.

“After that there was not really much feedback; negotiations continued between the department, the minister and the pharmacists.”

Dr Jones said the government had “given in” to the pharmacy sector.

“Our views were very plain right from the start – we really wanted to know where these dollars were going to improve patient care.”

A Pharmacy Guild of Australia spokesman said pharmacy-delivered programs were evidence-based and he did not expect any of the current programs to be knocked out by the MSAC.

He ruled vaccination programs out of the process, saying they were paid for by patients rather than the government.

Dr Brian Morton, AMA chair of general practice, said it was “amazingly short-sighted and hypocritical to give such a massive handout to the pharmacists – specifically the massive handout for expanding their scope of practice and doing primary care”.

“It’s not the way to design a healthcare system. If you’re treating a minor wound, a pharmacist would have a direct conflict of interest – are they going to sell them the cheapest dressing? Or a particularly expensive one? An ointment that could be complementary?”

Dr Morton said the money should be spent on establishing a Practice Incentives Programme payment for GPs to employ non-dispensing pharmacists in their clinics.

“That’s where there will be significant returns to quality prescribing,” he said.

Dr Jones said the agreement was a “political decision” and questioned whether it was good scientific practice to hand out the money before a two-year pharmacy review had been carried out, particularly in light of a scathing audit report about the previous agreement.

“Why didn’t we look retrospectively at what’s happening to see whether we’re spending money sensibly, as opposed to doing it prospectively when the money’s actually been given to them?”

The Sixth Community Pharmacy Agreement is one plank of the government’s five year Pharmaceutical Benefits Scheme Access and Sustainability Package, which also includes an agreement with the Generic Medicines Industry Association.

An agreement with Medicines Australia will see drug manufacturers absorb around $6.6 billion in PBS cuts.

Medicines Australia CEO Tim James said: “In response to the government’s budgetary challenges, we have agreed to meet all of the government’s savings targets… Our members have been given a number of undertakings and concessions regarding any future price-related savings throughout the life of the agreement.”

Medicines Australia and the Pharmacy Guild had both rattled their sabres in the lead-up to the federal budget, but observers say the guild came out on top while the medicines body bore the brunt of the government’s quest for budget savings.

Consumers Health Forum head Leanne Wells welcomed the measures to bring down the prices of some drugs, to announce the listing of new drugs and the introduction of an optional $1 discount on prescription medicines – which is still being fought by the guild.

But she called the pharmacy agreement a “lost opportunity to drive reforms to loosen the grip of pharmacy owners on the anti-competition rules and provision of patient services”.

Australian Doctor - Diabetes Care Project fails on cost May 25th, 2015
This article was written by 

A three-year trial of capitation and pay-for-performance funding for GP diabetes care has shown they are much more expensive than the existing MBS items.  

The $34 million Diabetes Care Project program involved 184 general practices and 7781 patients with type 1 or type 2 diabetes and was meant to test alternatives to the current MBS items for chronic disease management.

While the trial - one of the biggest in Australian general practice - showed that new funding models improved HbA1c and other clinical outcomes, there was a higher overall cost of $203 per patient than existing Medicare item-based care.

The cost was so large that researchers said the funding model used in the trial would not be value for money.

The pilot of an enrolment-based ‘healthcare home' model replaced GP Medicare payments and care plans with a flexible funding model that included lump-sum payments per patient and funding for care co-ordinators.

When adopted by practices in Victoria, Queensland and SA, patients had a statistically significant 0.2% improvement in HbA1c compared with a control group.

Improvements were also seen in outcomes such as blood pressure, lipids and waist circumference, as well as for aspects of diabetes care such as care-plan take-up, completion of recommended ‘annual cycles of care,' and allied health practitioner visits.

However, the program that offered general practices flexible payments of $200-300 per diabetes patient would not be cost-effective if implemented on a wider scale, the evaluation report concluded.

Despite reducing hospitalisation costs by $461 per patient, the Diabetes Care Project had an estimated cost per QALY of $100,000 to $250,000, well below the threshold of $50,000 deemed necessary for cost-effectiveness.

The report authors said a diabetes co-ordinated care program might be cost-effective if funding was targeted more at the highest-risk patients.

Their analysis showed that more than 60% of costs were incurred by 5% of patients with complex needs.

They therefore recommended a ‘re-calibrated' program with funding of up to $700 for high-risk diabetes patients and $100 for low-risk patients.

Dr Gary Deed (pictured), a GP with a special interest in diabetes, said the modest changes in clinical outcomes were achieved at a high cost, and one of the main lessons from the Diabetes Care Project was the need to focus on the highest-risk patients with diabetes.

"The project didn't really address the frequent flyers, the highly complex patients and their risk stratification. So really, the study may be telling us that we need more evidence before we implement broad changes to funding models in diabetes care," he told Australian Doctor.

The evaluation report also showed that when implemented without the flexible funding component, the use of IT tools for care planning and Continuous Quality Improvement processes did not improve outcomes.

Federal Health Minister Sussan Ley said the findings from the Diabetes Care Project report would be considered by the Primary Health Care Advisory Group, whose remit was to develop innovative care and funding models for people with complex and chronic illness.

It would also be used to inform the National Diabetes Strategy, with the consultation period for the advisory group extended to 31 May to allow time for feedback on the Diabetes Care Project report.

Couch to 2k Initial Questions - HBF Geraldton RunFest Program May 21st, 2015
The following is a standardised Physical Activity Readiness Questionnaire. If you answer yes to any of the following questions it is strongly recommended you discuss your answers with your Doctor or a suitable health professional. 

On clicking the 'submit' button you will be provided a link to your running program and a brief clip on running technique. We are collecting a name and email address in the event that some form of correspondence is required.


Do Patients Return to Sports and Work After Total Shoulder Replacement Surgery? May 21st, 2015

Total shoulder arthroplasty (TSA) is a well-established treatment option for degenerative pathologic abnormalities of the shoulder joint and has shown satisfactory long-term functional outcomes.

As life expectancy increases and shoulder replacement surgery is routinely performed in young and active patients with degenerative conditions as well as in the elderly population, new goals of shoulder joint replacement are becoming more important, such as the ability to resume sports and return to work.

The above study demonstrated a good rate of successful return to sports in patients undergoing TSA with primary glenohumeral arthritis. Overall, 57% of patients who had ever participated in sports in their lives were doing so at final follow-up. All patients that participated in sports right before surgery were successfully able to return.

The results for return to work were far less encouraging; however, it is important to note most of the study participants were retired at the time of follow-up.

While only 14% of patients were able to return to work after shoulder replacement surgery. Using statistical assumptions, the authors suggest the majority of participants (61%) did not retire or stop their work because of TSA.

30 patients (20%) had to change their work because of shoulder replacement surgery. Six patients (3.9%) of the entire cohort were not pursuing their work at the time of recent follow-up because of problems with the affected shoulders.

It is encouraging that a large proportion of patients did progress back to normal recreational activities following TSA, which would suggest that the RTW outcomes may also be more favourable in a younger, currently working population.

Couch to 2k - HBF Geraldton RunFest Program May 20th, 2015

Next Dietitian Talk Monday 25th May 2015 at 12 noon. May 18th, 2015

Temika Lee's next Dietitian Talk is on Monday 25th May, 12 noon at Central West Health & Rehabilitation in Geraldton. This talk is free for gym members and people who are completing Central West Health & Rehab's Diabetes Management and Chronic Disease Prevention programs.

This talk covers:

  • Healthy Eating Habits

  • Glycemic Index

  • Fat Types and Cholesterol

  • Recipe Modification Label Reading

Lumbar compression forces while lifting and carrying May 12th, 2015
In the construction industry, lifting loads is a frequent occurrence. Manual material handling (MMH), in terms of lifting is associated with an increased incidence of work-related back disorders.

To prevent work-related back disorders as a result of lifting, the maximum load mass to be lifted by one worker has been set at 25 kg in the Netherlands, and the maximum load for manually lifting is set at 50 kg when lifted by two workers. Loads above 50 kg should always be lifted mechanically (Visser et al, 2015). However, mechanical transportation is not always feasible and when not available the loads should be lifted by more workers (team lifting), while not exceeding 25 kg per worker.

The above study examined the lumbar compression forces of handling loads, which occurs daily at construction sites. It was found that a 50-kg two-worker lift resulted in higher mean and maximum peak lumbar compression forces compared with a 100-kg four-worker lift.

Carrying a load while stepping over an obstacle resulted in higher mean and maximum peak lumbar compression forces compared with carrying on level ground. The variability of the peak lumbar compression forces during the carrying tasks was higher while stepping over an obstacle compared to carrying on level ground for carrying 50-kg and 100-kg loads.

Compared to lifting, carrying a 100-kg load while stepping over an obstacle or up a platform led to a higher variability. Carrying a load up a platform resulted in the highest compression forces.

To reduce peak lumbar compression forces, lifting a fixed load mass with additional workers is advised. However, the benefits of additional workers are task-dependent (e.g., carrying vs. lifting). Additionally, the question remains whether the use of an additional worker is feasible in practice.

Two overall recommendations were made:

  1. Efforts should be made to prevent manual lifting and carrying of objects to reduce exposure of high compression forces during lifting and carrying.

  2. When mechanical transportation is not possible and loads are handled manually, carrying routes should be free of any obstacles to be overcome.

Australian Doctor - Diabetes Strategy urges GP payment overhaul Apr 15th, 2015
This appeared in todays Australian Doctor written by Michael Woodhead.

Pay-for-performance incentives that would see GPs paid on the basis of how many patients they screen and treat for diabetes form a central plank of a new national diabetes strategy.

The National Diabetes Strategy consultation paper states that fee-for-service payments are not working for diabetes and should be supplemented by payments based on quality and outcomes measures.

The Federal Government's paper, released on Wednesday, lays out five key target areas for change, which include:

- increasing the number of people who are screened and diagnosed early with diabetes

- boosting the number of patients with diabetes receiving structured management programs in primary care

It notes that currently only 18% of patients with diabetes had an annual cycle of care completed by a GP, and suggested that this could be improved by linking performance benchmarks to reimbursement

"The fee-for-service model does not incentivise long-term follow-up or the proactive care of people with chronic conditions. As such, more innovative funding models are needed that combine fee-for-service reimbursement with other payment types, such as population-based payments and quality-based payments," the consultation paper said.

"The government could consider exploring (potentially through demonstration projects) an innovative combination of payment models, such as pooled funds, ‘medical homes,' capitation payments, pay for performance, and pay for quality and outcomes based on performance indicators."

The paper also suggests new funding models for allied health professionals.

Among the other proposals are a national program for detecting prediabetes and early diabetes based on the AUSDRISK tools, and programs based in Primary Health Networks to encourage annual screening for complications

The National Diabetes Strategy should also include measures to improve access to medications and devices such as insulin pumps, and encourage uptake of the PCEHR by people with diabetes, the consultation paper suggests.

The proposals have been released by the National Diabetes Strategy Advisory group, set up by former health minister Peter Dutton in 2013, which is led by endocrinologist Professor Paul Zimmet and former MP Judi Moylan.

It is accepting feedback on the proposals until 17 May and will release a final National Diabetes Strategy in late 2015.

The proposals have been backed by RACGP resident Dr Frank Jones, who said they were in line with the college's newly released new primary healthcare funding model that proposes a move away from fee-for service funding.

"[The Diabetes Strategy proposal] basically reinforces our viewpoint that you can't look after patients with chronic disease with the Medicare model that we have," he told Australian Doctor.

Dr Jones said the RACGP model would retain fee for service for acute episodic care, but would introduce patient enrolment and replace PIP and SIP incentives with practitioner and practice-directed loading payments based on "comprehensiveness" and complexity of care.

The new reimbursement would recognise the ongoing work that GPs did with patients such as those with chronic and complex diseases, according to Dr Jones.

"We really believe that GPs who provide quality care ought to be recognised," he said.

Pacing your Lifestyle and Exercise Apr 14th, 2015
“Pacing is an active self-management strategy whereby individuals develop self-efficacy through learning to balance time spent on activity and rest for the purpose of achieving increased function.”

Jamieson-Lega et al (2013)

Pacing involves learning to balance your time spent on exercise and activities, to avoid overactivity or underactivity. It is about being able to manage your chronic pain more effectively, to achieve a balance between rest and activity. This enables you to perform meaningful activities with less pain interference.

When you start an exercise program, you may struggle to adopt the right pace and technique in developing your fitness training. As a result, exercise can feel like a struggle. If you’ve experienced difficulty sticking with your exercise regime, the problem is likely to be one of pacing judgment and intensity:

a) Starting your exercise too quickly and paying the price later on

b) Completing sessions too conservatively and feeling you’ve got a lot more left in the tank

The solution is learning how to evaluate your training intensity and match it to your session so that you get maximum training benefits — and importantly, enjoy your training sessions.

“After having a serious illness a few years ago, and not being able to exercise without pain, I was unsure of how to begin an exercise plan without making my symptoms worse. I then realized that if I paced myself, I might be able to exercise successfully without the symptoms getting worse. I changed my thought processes from trying to lose weight and getting fit, to relieving the symptoms of my chronic pain. I started at a very slow pace, not pushing myself at all, a pace that I could do on my worst days, and then as it became easier, with no pain I increased the pace of my exercise program” Anonymous

Rhianne Turner Physiotherapist

Next- Pacing Your Lifestyle



Pacing your Lifestyle Apr 14th, 2015
“Pacing and balancing tasks become skills that can assist with managing chronic pain”

It is important to prioritise activities so that the most important tasks get done first. This way if you are unable to finish every task, then at least the most important tasks are done. Also, try to leave yourself plenty of time to complete each task. Pacing your lifestyle will provide you with an effective means of achieving your goal, provided you are realistic in choosing the priorities in your life.

Performing one major task in small steps each day can lead to feelings of achievement and build your coping strategies. This will take time and patience. Try not to compare yourself to what you used to be able to achieve before the onset of chronic pain, this may not be realistic initially.

Following a routine of less pleasurable activities/chores followed by enjoyable activities can also assist in the pacing process, rewarding yourself for your achievements.


Chronic pain commonly leads to ‘Good days and Bad days’. It is important not to use good days for going hard at physical activity – as you will surely feel those bad days and need some time to rest and recover.

An increase in muscle pain is to be expected as you are using muscles and joints in new ways, known as Exercise Induced Muscle Soreness (EIMS).

Boom – Bust Approach is when a person does too much all at once, crashes, rests, starts to feel better and does too much once again. If activities or exercises are not spread out, a boom-bust cycle will occur. At times this may be inevitable; however when Boom-Bust approaches become habitual it can result in exhaustion, sleep disturbances, insomnia, appetite and weight changes, or mood swings. You should learn to recognise contributors such as fear avoidance, attitudes and beliefs.

Watch out for Boom-Bust signs as they can significantly increase pain levels, such as:

a) being highly motivated to achieve your goal that you significantly increase pain levels

b) being apprehensive about what may happen if things don’t get done

c) having a high number of commitments or responsibilities to meet


  1. Be consistent. Be persistent. Be patient with yourself.

  2. Choose something you enjoy

  3. Have a realistic timeframe, gradually making the activity harder and changing the environment (from walking on level ground to walking uphill or on the beach)

  4. Pace your activities, even on bad days (avoid good day, bad day behaviour)

  5. Have rest periods

  6. Listen to your Body: The body sends us signs and signals when it is being overworked, so it is important to balance rest and activity

  7. Stick to your designated time limit: use a timer and be disciplined in starting and stopping activities

  8. Use a diary to record your progress so you can pace accordingly and measure your achievements

  9. Avoid too large of an increase in activity to avoid a ‘Boom-Bust’ approach to exercise

  10. To improve your pacing, undertake a little more each week, gradually building up physical activity over time. It is important to set SMART goals to pace yourself so that these realistic goals can be met

Rhianne Turner Physiotherapist

Infographic- SMART Goals Apr 14th, 2015