I was invited to umpire a rather unusual and utterly inspiring tennis tournament last year, and this year I had the privilege of playing in it.

This was the Metro national tennis tournament, organised for and by people with visual impairments (VI), also known as ‘VI tennis’. Much to my surprise, it is a fast and furious game.

Many people can’t see their opponent, so the rule is to always shout ‘ready?’ and when the opponent replies ‘yes’, the server will shout ‘play’ when the serve is about to be hit. Everyone is allowed two ball bounces, with those who have very low vision / totally blind being allowed three. The ball contains a bell or ball bearings, which gives the players the auditory input necessary to find the ball on the court.

As a Physio, I was astounded at their ability to stay upright as they ran towards a ball with significantly limited visual information, and the determination of those who did fall quite badly, obtain a huge carpet graze, and got straight back up again as if nothing had happened.

I was also amazed at the brain’s ability to find the ball so quickly and to somehow get the racket in the right place at the right time.

As well as the usual doubles and singles, the tournament also put on a mixed vision tournament, whereby a fully sighted player would partner up with a visually impaired player. I was invited to play by Paul, who has macular degeneration.

It took a bit of getting used to the shorter court, ball and racket (and I was only allowed one bounce and not allowed to volley), but it turned out to be a challenging and fun game.

Personally, I enjoy being around inspiring people undertaking great things. It’s also satisfying to support a new and emerging sport, and to teach newcomers how it all works. This is not just a sport, but a social opportunity for people who may have become quite isolated. I also recognise that if I were to lose my own sight and be unable to play tennis, I would suffer greatly so it’s a pleasure to be able to facilitate the sport.

Metro are trying to get the game into the Paralympics one day, and this year during the Paralympics showcased the sport at St. Paul’s cathedral. Funds are still required to develop the unique ball, and to ensure new players get the right coaching and opportunities. Physios may be in a perfect place to identify new players, or to signpost visually impaired people to this unique sporting opportunity.

The sport is very new, so finding more players is essential to further expand the game and ensure there are sufficient numbers of people to play competitively.

Maybe you know someone who is visually impaired, or have impairment yourself? Maybe you could help set up a group or help with sessions near you? Maybe you’d just like to be involved? If you or anyone you know would like to find out more about VI tennis, either as a participant or volunteer, see: www.metroblindsport.org.uk

I know everyone gets irritated by shops trying to flog us Christmas decorations in October, but if you have an illness that might be affected by Christmas, this is probably the right time to start planning.

Christmas is very different for different people, but inevitably there is something special about it: either there is an increase in hustle, bustle, food, engagements, noise, preparations or else it might be a time where the absence of such things might make us more thoughtful, or we might find the lack of routine and structure a problem.

Whatever the case for you, it can so useful to sit down in advance and have a good think. What will I be doing? What preparations can I make? How can I avoid being overly active, or overly anxious? What can I do to make sure I get the right balance: seeing people I enjoy being with, and at the same time ensuring I have time to rest, or to take part in the routines that keep me healthy? How can I ensure I have enjoyable activities in my diary over Christmas, without taking on too much reponsiblity, or spending too much in the kitchen?

Here’s an exercise you can do to help you to think about Christmas and make sure it works in harmony with your health:

• What are my priorities? What do I really want to do? (vs ‘duty’ or ‘obligation’)
• What things do I want to keep in my routine: what things keep me healthy?
• What will I need to communicate to others, to help manage expectations?
• What practical steps can I take to mimise the risk of overdoing it?
• Who can I ask to support me over this time?
• What will my week actually look like? Will it work?
• What can I do now, in the run-up, to take pressure off?

Whatever you choose to do, have a wonderful December and really take time to enjoy the preparations you make.

Emma has just completed a rehabilitation programme and has this story to tell:

Getting through Final Year of University … with PVFS

Final year was always going to be difficult and stressful, not to mention exhausting. When I was diagnosed with Post-viral fatigue in the November of my final year however, these difficulties took on a whole new form. Rather than cramming in writing history essays and French translations into the few spare hours I had between lectures, fitness classes and my 4 hockey sessions each week, I found myself too drained, exhausted and dizzy to even contemplate getting out of bed.

By second term, I was lucky to have been put in touch with Jessica. She helped me regain structure to my daily routine, and stopped me sleeping when it wasn’t night time so that I wouldn’t get stuck in the habit. It was difficult at first to ‘rest’ but not fall asleep when I was so desperately tired, even after the rare occurrence of a good night’s sleep. But I persevered, and soon found that I felt a little more human during the day, and able to do some work. I really noticed a difference when I stopped being stubborn and decided to follow her guidance rigorously, sticking to my morning and evening routines so that I wouldn’t burn out in the day and could get the best sleep possible at night.

Having reluctantly and eventually been forced by my body to reduce my hockey time from 10 hours a week to just 1, I felt I was losing myself to the fatigue. Jess helped me find myself. We worked together to find me a base of exercise I could do each day- on both good and bad days. This was difficult at first, keeping myself motivated to go to the gym for a few minutes each day even when all I felt like doing sometimes was napping. I persevered, my will to get better and back to hockey propelling me through, and with the structure Jess helped me add to my daily routine too, I was able to slightly increase the amount of exercise I was doing each day. 4 minutes seems a tiny increase, but to me it was monumental- I was well and truly on the road to recovery!

This gradual increase in exercise helped me regain my sanity, made me feel healthier, stronger and more like myself. It was what got me out of bed in the morning- I’d go to the gym, then get started on my revision. My days would be the same so I could monitor my progress and any changes in how I felt. My evening routine would be the same too- dinner, watch tv, shower, stretches, relaxing music, then (fingers crossed) I’d go to sleep and sleep well, ready for the next day. Keeping everything the same but gradually increasing my exercise when my body was ready, meant I could really feel myself getting better and decrease the likelihood of relapsing and doing too much. I’ve now worked myself up to being capable of doing a ‘normal’ amount in the gym. My body is able to cope better with setbacks and when I overdo it because it is fitter and stronger- much like how a ‘healthy’ fitter person would cope better with exercise than an unfit ‘healthy’ person . I’ve had one relapse in the last 6 months, but the structure and guidelines Jessica worked with me on have helped me see how and why that happened, and I’m now back on track and feeling 85% better- 90% on a good day!

Nick Thomas has recorded an in-depth interview outlining the key aspects to his recovery from CFS/ME and has shared this online via Secrets to Recovery for other people to gain inspiration from his story.

Please click here: Secrets to Recovery to hear story (52mins) 

In this open and frank interview in which he explores many important recovery topics such as restorative rest and relaxation, good nutrition, and a graded approach to exercise, he describes how he went from being a high-flying businessman to being unable to work due to CFS/ME.

During this interview (approx 30mins in to the story) he describes the difference Graded Exercise Therapy made to his recovery, and explains what it was like to undertake the programme. He describes how he started to get hopeful again, and that being able to see incremental and sustained improvements was a “major turning point”. He describes how getting into the swimming pool again was “massively liberating” as was being able to see changes to his strength, fitness and symptoms.

Nick describes himself as fully recovered after being unwell for many years, and has now set up his own business, Pear. Pear works with Organisations and individuals to build their employees’ Performance, Energy and Resilience through Coaching, Training and Consultancy. www.http://www.thepearcompany.org

Thank you, Nick, for sharing this with us: hearing direct, positive recovery stories is so important and show us not only that it’s possible, but also gives us a roadmap a to what we can do to make it possible.

Anyone wishing to find out more about Graded Exercise Therapy or to book on a programme, contact info@vitality360.co.uk.

Someone I am working with was talking about my recent blog about ‘What Can I do and How?” and told me that this was not her problem. Trying to get motivated to do something, or overcoming a fear was not her experience, but rather the opposite: she didn’t know when to stop, until it was too late. How can she (and many of us in the same boat), learn to read her body’s signals and stop before we over-do things and feel worse? My own feeling is that it comes from that old chestnut “know thyself”. The better we understand ourselves, our habits, our symptoms, and our tendencies, our personality… our physiology and thought patterns, the response of our body… then the better equipped we are to understand what our body is telling us. So here’s my advice to anyone trying to work all of this out: go and explore – observe your activities, your responses – analyse, like scientist would: look at inter-connections, relationships, and speculate on what might be going on – then, when you have a theory, try it out. Do I feel better with exercise? Let’s see! Is it better if I go home a bit sooner rather than say longer? Let’s give it a try – note the results.  With a positive and inquisitive mind you’ll notice things you never realised were there, and in doing so you will gain much more control over your health than you ever thought possible.

When our health is not as good as we’d like it to be, or when illness changes what we can do, it can be a real time for reflection. What can I do with my future, given my current limitations? What can I create for myself, based on what most inspires and interests me personally? Sometimes, having to stop work or cut back on activity gives us thinking time to consider our priorities and give us an unforeseen opportunity we didn’t have before.

However, sometimes this new blank canvas can be quite daunting, and it can be hard to imagine what llfe could be like.

Here’s a helpful starting point, based on working out what your values are:

1) go to: http://motivationalinterview.net/library/valuescardsort.pdf
2) Print out the different words and cut them out
3) Place them under 3 headings:
VERY IMPORTANT TO ME
IMPORTANT TO ME
NOT IMPORTANT TO ME
4) Then, choose your top few cards.
5) Reflect on these and consider what actions you might take to ensure that the activities you do in your day match these values, and that you consider these when you plan your goals, your future, and how you spend your time.

I take no credit for this work: it is based on the work of W.R. Miller, J. C’de Baca, D.B. Matthews, P.L. Wilbourne, University of New Mexico, 2001 who have made this freely available for others to benefit.

I watched a man with one leg cycle around the velodrome today and it was nothing short of amazing. It made me wonder what his family said when he told them he would like to take up cycling, and the looks he gets as he cycles in his local community. Maybe they know him, and he’s a local star – or maybe they laugh at him and throw stones and it takes great courage to step outside the door or get up in the morning. I heard he lost his leg in an accident and was depressed for a number of years. Whatever people’s responses, one thing is for sure: he had to really overcome something to get on that bike.

Yet, every day I talk to people with such stories: I hear how one person has managed to get back to work despite being off for 5 years, or another person who gets out for a walk every day even though they’ve become afraid of stepping outside. You tell me that you got up and out of bed every day even though every cell in your body was sucking you back into the bed, and that you’ve just registered for a 5K run even though you can only walk for 15minutes. You may never wish to be a Paralympic champion, but you’ll have your own version, requiring the same courage and commitment. This is one reason I love my job: I get to celebrate with you the steps you make towards your own version of amazing.

I came across a pretty groovy App the other day called Headspace, and have been trying it out. Illustrated clearly via short video clips and then split into short and easy daily sections, this App tells you all about mindfulness meditation and gives you the opportunity to ‘Take 10.’ Take 10 is a programme of mindfulness meditation – a snapshot, or a taster – that lasts for 10 minutes, over 10 days. People who wish to take it further can then subscribe to a larger programme of mindfulness meditation. I’ve recommended it to a few people I’ve been working with and for some it’s become a real eye-opener and a great opportunity to explore a technique that has been shown in research to have many positive health benefits. It’s really the perfect mind-body rest break: so whether you tend to run around all day without resting, or have never really thought how to rest effectively – here’s a starting point. www.getsomeheadspace.com: or Headspace App (it has an icon with a person and a large yellow head – presumably a wonderful warm glow of headspace!).

So often when we are unwell or have not been able to do our usual activities for a while, we get stuck with this idea that we can’t do things anymore. So, inevitably we don’t. Then, the impact of not doing things we enjoy becomes too apparent – we feel sad, or a real sense of loss – or even angry or depressed. NOT doing things then can make us feel physically worse, too, as they overall level of activity goes down – muscles get weaker, we become less fit, more stiff and we withdraw from people a bit more.

It might be different for different people, but might sound like “if I can’t do that, there’s no point”, or “I can’t do that, so I won’t go,” or it might be packing away something that you used to love like the bits and pieces associated with a hobby. But is it really true that you can’t do it? Sure, you might need to think about doing it differently, or planning the activity so that it works better for you, but is it true that you can’t do it AT ALL?

Here’s something to consider doing:
1) Write a list of all of the things you’ve stopped doing since becoming unwell or injured*
2) Add to this list the things you used to enjoy doing
3) Then add the things that you think you might like to do, or things you’ve always wanted to do
4) Ignore your head when it says “that’s all very well, but I can’t do that!”
5) Now go through your list and ask yourself – what CAN I do? Maybe you can’t go to the full wedding, meal and dance afterwards but you can go to the part you’d enjoy most, see a few people and then leave? Maybe you can do an online learning course, at your own pace instead of a course where you have to go in and attend regularly after a long journey? Maybe you can pick up your camera again and visit some places you find inspiring or peaceful?
6) Ask yourself HOW can I do it? This describes the steps you might need to take to make sure that your plan really works for you, and it might involve extending the journey, taking rest breaks or thinking about where you could get some quiet time, splitting the activity up into smaller chunks, for example, or having a strategy to make you leave when you said you would (recruiting friends to help can also make a difference).
7) Notice what new options and possibilities open up for you
Keep your list somewhere visually and handy, so it becomes a living, breathing ideas bank of things you can do.
9) And now the important bit: do them

* If this makes you feel sad, then make sure you move on to the next step, or talk to your therapist about how to move on.

.. and I was reminded about something very interesting about the impact of sitting still. I was on a HUGE 5 hour journey from Glasgow and was quite absorbed in doing a piece of work on my laptop. A couple of hours in, I noticed my back starting to ache, and a tension in the top part of my neck. I had a bit of a headache, too, although I was quite happy and relaxed doing what I was doing. When I got off the train, my legs hurt. My thighs and calf muscles actually felt stiff and sore. I am fortunate to be fit and well person, so these symptoms were not coming from any illness or disease process. It made me think about the human body and how it really doesn’t like inactivity, and how poorly designed we are to be inactive. Our body actually complains and has something to say about it if we rest for too long.

When we are unwell, resting is something that we usually do: either because we’re feeling really rough, or because it just seems to make sense. It does make sense when we are fighting an infection for example, and we all need to settle and relax every now and again. However, resting too much also has a significant and powerfully negative impact on the body if we do too much of it. Science tells us we can lose up to 10% of our muscle strength by just spending 2 weeks in bed – wow! That’s a lot! Of course, what is ‘too much’ and what its the ‘right amount’ is a constant question that needs asking, and there’s no clear answer for we need to stop and rest during periods of activity as well: our muscles need a chance to rest, and so does our mind – it can refresh us and make us feel restored. Sometimes, when our body hurts or when we are tired, are bodies are telling us to rest. However, sometimes they are actually telling us to be more active: my legs didn’t want ANY more sitting down, and neither did my neck and head want me to do anything else on the laptop! Interpreting and making sense of these messages is a constant learning process.

I sometimes get asked about Yoga, and whether it helps people with CFS or Fibromyalgia. The short answer is: yes, but only if done carefully and gently, and under appropriate supervision and guidance. The longer answer involves a number of considerations: what can you do comfortably now? (going to an hour’s Yoga class might be too much). What is your current strength like (some postures require a fair bit of strength and may not be the first thing to start with). How about your current flexibility? (you will NEVER EVER be able to do what your teacher does: I am constanly amazed at what my Yoga teacher Barbara manages to do without falling over). Other things to consider include: how do your muscles respond to stretching? How hard to you push yourself? How comfortable do you feel in  a room with other people? Does your teacher understand your condition? How long will it take to get to a Yoga class and what might the impact be? Might you need to start by doing gentle stretches from home, then progressing onto a DVD – maybe a Yoga class is the goal, rather than a starting point? Regarding benefits: there’s little doubt that Yoga exercises can help – Yoga focusses on flexibility and strength, but it also focusses on breathing properly and slowly which in turn can help you to feel more relaxed.  I was recently introduced to The Yoga Deck, a series of different postures that you can build into your programme once you’ve discussed them with your physio: together you can figure out the right starting place and progression.

Vitality360 dietitian, Sue Luscombe, highlights an interesting article for anyone considering working with a nutritional therapist. On Monday 16th January, Which? Magazine published a report “Nutritional therapists: gambling with your health?” outlining what they say are dangerous practices by some nutrition therapists working in the UK. Have a look for yourself, and make sure you are fully informed before considering working with any practitioner who makes promises to get you better. Always make sure any claims can be backed up by solid research evidence. Click here to read about the difference between nutritionists and dieticians. In summary: a dietician is fully degree trained, experienced and regulated, and a nutritionist can be anyone who chooses to call themselves one. If anyone would like to have a dietetic assessment or would like some dietary advice from Sue, please get in touch to discuss further. 

I know how devastated some of you must be as snow blankets your path and stops you going out and doing your daily walk. Maybe you’re worried about slipping, maybe it’s just TOO COLD to even think about going out. Even though it’s VERY PRETTY INDEED you might just find yourself tempted to watch from INSIDE. So, if you’ve noticed your motivation changing ever-so-slightly in the last week, here’s a few thoughts as to what you can do to keep on track with your health in the cold snap:

Do something indoors that is roughly equivalent to your current baseline:
– perhaps 5 minutes tidying a kitchen cupboard is about the same as a 5 minute walk?
– is cleaning the kitchen floor the same as a 20 minute walk?
- dancing in your bedroom: that must surely be the same as a 6 minute walk? (no-one needs to know)
- how about playing with your cat: that can be quite active (especially, in my experience, the ‘douvet game’)
- have you considered aerobic housework or active organising (filing, cupboards etc)?
- how about cooking: you’ll need to stand and move your arms, reach into cupboards?

Of course, there is always the option of getting on 2 paris of socks, sticking on the skiing trousers and getting into your balaclava whilst cuddling a hot water bottle…..

Whatever you choose to replace your walk, just try to keep it roughly the same duration and intensity (using a clock, heart rate monitor and Borg scale if you want to be sure you don’t over-do it).

You never know: bit by bit, you might even achieve something really valuable over the next week if you plan it out and tackle it in small manageable chunks.

This comes up a lot, so I thought I would write a little something to help guide you as to when to increase, stay the same (or possibly even decrease) your physical activity whilst on a GET programme for CFS/ME.

When to maintain:

When you are just starting a baseline of new activity. Keep the same intensity (ie speed) and duration (time) for at least a few days, if not a couple of weeks. It is normal for it to feel quite hard, and for activity to stir up symptoms as a normal physiological process associated with doing more. However if symptoms are stirred up badly and then stay worse, then take the activity back down again and talk to your therapist. No harm will be done, but you just might find it too hard.

When you are increasing other types of activity eg returning to work, increasing your housework or when something unexpected or hectic is going on (eg Christmas, someone being unwell you have to care for). At such times, maintaining your activity might be the most realistic and sensible choice.

When to increase:

Increase when you are ready to. How will you know? Firstly, you’ll want to take it up a step. It will feel right. This is both a confidence thing and a physical thing. Physically, if you have been monitoring your exertion (using a Borg scale) you’ll notice that over time the activity becomes easier as you get stronger. Once it feels easier and the Borg rating goes down, this is the time to challenge yourself again to the next, gentle level.

When to decrease:

We try not to decrease where possible, as it makes it harder to progress, and if we decrease for too long we can get weaker. Decreasing also means that our body doesn’t adapt to the higher level. However, sometimes it just doesn’t make sense to carry on, and pushing yourself if not a good idea eg:

If you are unwell with an infection or fever (tested on a thermometer or when you have other clear signs like sneezing or phlegm on your chest)

If an increase in activity is too hard to maintain, you might want to drop back slightly but try not to drop back to where you were before. You can always do the same amount but in 2 or 3 smaller sections, eg a 6-minute walk could be split up into 2 x 3 minute walks.

There is never really an easy answer to this question, but I hope this gives you some ideas. If in any doubt, you should discuss the best course of action with your therapist.

The NICE guidelines also offers some advice on this, in the full CFS/ME guideline, page 249.

It can be so frightening and confusing to feel so unwell and not know why. Sometimes we fear undiagnosed illnesses or tumours, and worry that there MUST be something doctors are missing. In my experience working with people with CFS/ME this is one of the hardest things to understand: Why do my muscles hurt? Why am I so exhausted? Why does my heart race? Whilst doctors have not found a specific positive medical test, it doesn’t mean there’s nothing wrong. If course there is – but what? How can we explain this to people who don’t understand? How can we understand it ourselves? Our body is a hugely powerful machine, and you can start to understand just how powerful by visiting the Kings College Chronic Fatigue and Treatment Unit Website: here you’ll find clear explanations as to what’s going on and why. Share this with your friends and family, too.

Once we understand why we feel so awful, we can start to understand solutions, too. Once we understand the impact of poor or irregular sleep, we can commit to a programme to improve it. Once we see what happens when our muscles weaken, we can start to strengthen them. Once we can see how our worries affect our pain, we can see what we can do about resolving or managing them differently.

Umm… well, the short answer is (sadly) … No.

Why would anyone think such a thing? Well, BBC Food Hospital (December 2011) showed a programme looking at whether eating 45g chocolate per day helps someone with CFS/ME. Apparently: “Chocolate contains compounds that kick off neurotransmitters in the brain that deal with stimulation, happiness and pleasure.” Whenever we find such claims, we always need to delve into the detail: a) who sponsored the trial? b) How many people were involved? c) Was the design of the study good? d) Did it show anything conclusive? e) Is the scientific rationale any good? f) have reputable scientific institutions picked upon it and now offer it to patients? For this study, the answers are: a) dodgy b) a tiny tiny number c) no d) no e) no f) no, it won’t be on NHS prescription.

So, as much as we’d like to be told “eat chocolate every day!”, this won’t help. Not only that, but you’ll pile on the spare type and give yourself a caffeine / sugar high that may well not only be highly unpleasant but will probably stop you from sleeping.

Remember: Don’t believe what people say about miracle cures. Go and find out the truth.

Finally….A big thank you to Vitality360′s registered dietitian, Sue Luscombe, whose material I used in composing this blog.

OK, this is a blog so you don’t need to tell me the truth. However, a coupe of people recently have been admitting to taking their beloved iPhones, iPads, Blackberries and laptops into bed with them. Is this a good idea? Well, let’s have a look.

1) Is it a sign of an addiction? Can you bear to be apart?

2) Is it just far too exciting and will it therefore keep you awake?

3) Do you REALLY need to check your Facebook page or emails in bed?

Recently I found out that the frequency of the backlighting on these devices is actually much worse than TV, and makes it much harder to wind down and to sleep. Also the games, emails, apps, social networking on these devices are all designed to stimulate you – bright lights, colours, trying to beat your record…. trying to grip your attention with facts, weather reports, things to click, drag and swipe…..

STIMULATION = WAKING UP not GOING TO SLEEP.

Therefore, here’s my advice:

Keep them out of the bedroom

If they call your name and tempt you to answer them, turn them OFF

Have an alarm set: a cut-off time in the evening. Avoid them for an hour before bed-time.

If you cannot bear to be without them, consider weaning yourself off gradually or going cold turkey. Some people genuinely have an iPhone or media addiction, which won’t be helping matters.

Remember: Your bed is for SLEEPING IN

Sue Luscombe is a Registered Dietitian who I’ve mentioned before as she’s done a huge amount of work with CFS and in getting good, evidence-based educational materials circulated. She gave us some interesting things to consider about Irritatble Bowel Syndrome in a Study Day yesterday. Dr Imran Aziz (Gastroenterology Clincial Research Fellow) also told us a few things to look out for and gave an excellent overview of the condition.

A few handy links for you:

NICE Guidelines for Irritable Bowel Syndrome

Irritable Bowel Syndrome and Diet Factsheet

Food Factsheet: The Glycaemic Index

The truth about allergy testing: British Dietetic Association

The difference between a dietitian and nutritionist

Support Group for IBS

Upper Safe Limits for Vitamins and Minerals: Food Standards Agency (2003)

Any questions or concerns? Just ask.

Yesterday I went to a Sleep and Diet Study Day to find out what’s new in the world of CFS. There were some fantastic speakers from the Papworth Sleep Centre who gave all sorts of interesting information. I’ve gathered up some interesting links you can explore:

Assess Your Sleep Habits

Achieving Better Sleep: Patient Guide

Restless Leg Syndrome

Obstructive Sleep Anpoea

Book Recommendation: Overcoming Insomnia

If you think after reading any of these materials that you might have restless leg syndrome or sleep anpoea, please talk to me about it as you can be assessed, and there are effective treatments available. If you fancy doing the Assess Your Sleep Habits questionnaire, let me have a copy so we can discuss a plan based on what you find.

The Epworth Sleepiness Scale can be a handy thing to fill out as it helps give a bit of a measure of your sleepiness. If the score is quite high, then it can be worth ruling out sleep disorders.

I saw this Chinese proverb the other day and have been reflecting on it with people I have been working with this week. Some people have noticed that they feel worse when they are inactive and resting for too long – joints start to stiffen, they start turning ‘chair-shaped’ and fatigued, and as such would agree with the proverb. One person noticed that the sheer boredom associated with being unwell, or ‘standing still’, can play havoc with the mind and start a whole race of unwelcome thoughts and worries. Worries in themselves consume a fair bit of energy, have you noticed? Others have talked about how counter-intuitive it is to be active when you are unwell, and that they fear making their symptoms worse – in this case, ‘standing still’ seems to make most sense. Then, people start to notice that TV or having an unproductive day makes them feel tired, whereas going for a short and carefully timed walk actually seems to give them energy and ease their symptoms. No doubt this proverb was intended to relate to people who are well, but equally people I work with notice the same can be said for them, too. We often talk about getting the balance right – here’s another example!