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Dr Rachel Harris is a sport and exercise physician (SEP) who has competed as an athlete at the highest level, representing Australia in swimming at the Sydney Olympic Games in 2000. Today, Dr Harris works in clinical practice in Perth. She has not, however, lost her connection to elite athletics. In 2024, she travelled to Paris as the Australian Paralympic Team Doctor.

As team doctor, Dr Harris had to monitor and treat athletes for COVID-19, and respiratory and gastrointestinal infections, as well as managing the mental health of athletes performing in a high-pressure situation.

“We had some whooping cough over there,” she says. “We had gastrointestinal illness after some athletes swam in the triathlon in the Seine.”

The scope of her work is surprisingly broad.

“When an athlete has had a neurological condition — whether or not it's a spinal cord injury or another condition that means they don't have sensation in the lower half of their body — they don't move their foot like we might to understand that they've got a lot of pressure on it,” Dr Harris says, explaining one example of the complications of treating a large group of high-performance athletes with disability.

“Sometimes the result of that is a pressure wound on their foot or on their sitting bones, so we had a number of athletes that were managing conditions like pressure sores.”

“We know that exercise absolutely improves overall health, and I really wish that everybody knew that this was a specialty for them.”

Now that she is back home in Perth, Dr Harris is providing the same gold-medal care to her everyday patients.

“There's a widely held belief that sport and exercise medicine is only for elite athletes,” she says. “But there's so much opportunity for improving injuries and illnesses that relate to people's exercise abilities and sporting abilities. We know that exercise absolutely improves overall health, and I really wish that everybody knew that this was a specialty for them.”

Particular benefits offered by a SEP like Dr Harris stem from the holistic approach she is able to take.

“We often get people coming in just for knee arthritis or just for a sore shoulder, but there's so much in the way of exercise prescription that considers the whole body in terms of managing mental health, in terms of managing physical health as well,” she says.

“We have the opportunity to spend a bit more time with our patients. Most of us spend between 30 and 45 minutes with our patients the first time that we see them, so we're able to understand a lot about their background and a lot about what their goals are in terms of exercise and sport.

“We can assist them in optimising their health, optimising their outcomes and helping them to achieve their goals in life.”

One arena in which Dr Louise Tulloh has seen results from sport and exercise medicine (SEM) is her patients’ mental health.

“We know that exercise improves mental wellness … We also know that if someone relies on exercise for their mental wellness and they can't exercise because they have an injury, then that can be a provoking factor.”

The Sydney-based sport and exercise physician estimates that three-quarters of her practice consists of mental health problems that present as musculoskeletal pain.

“We know that exercise improves mental wellness,” she says. “Particularly aerobic training and strength training improve mood and reduce anxiousness.

“We also know that if someone relies on exercise for their mental wellness and they can't exercise because they have an injury, then that can be a provoking factor, so we will often look for ways that people can exercise with their injury — what they can do to keep active while acknowledging that it's important for them.”

For other patients, the impact of an injury or condition can itself have negative effects on mental health.

Dr Tulloh also has a particular interest in how SEM can help patients with menopause and perimenopause.

“We see women presenting at our practices with multiple pains — tendon problems here, knee problems here — it just seems to be one thing after another,” she says.

“They go to the physio for their shoulder, then they go to the physio for their hip, and the physio for their foot. And that's compounded during the hormonal changes of perimenopause by sleep disorders and mood disorders: the anxiousness, irritability and poor sleep all feed back into that chronic pain.

“They have these musculoskeletal pains and aches which are quite non-specific. They have an increased prevalence of frozen shoulder and tendonitis, and then they have the other perimenopausal symptoms, which make that experience worse.”

When it comes to treatment in these cases, Dr Tulloh considers a variety of options, reflective of the diversity of approaches taken by SEPs. Often, she focuses on simplifying the path to effectively treat root causes.

“When someone starts hormone treatment in that setting, by their GP or me, what they'll notice within two or three weeks is all the stiffness in the morning and the stiff hands and feet settles down, and their sleep is improved.

“Then they're left with their tendon problem. They can take many problems and make it a more isolated problem, which they can then go and work on with their physio.”

Dr John Orchard is a sport and exercise physician who collaborated in the care of Janice, a patient who had been diagnosed with pancreatic cancer.

“GPs send a lot of musculoskeletal stuff to us, but they don't send that many cancer patients,” Dr Orchard says.

“But Janice was a fantastic self-advocate in that she was diagnosed with disseminated cancer — so it was cancer that had a very poor prognosis.”

She didn't reject traditional medicine. She did follow the recommendations of her oncologist and the chemotherapy she was prescribed.

“But she said, ‘I want to run a marathon’, and she had this epiphany that this was going to help her.”

This, Dr Orchard said, was 15 years ago, when mainstream medicine did not understand the link between exercise and cancer treatment. When he began treating Janice, Dr Orchard was concerned about the severity of her cancer but saw no reason for it to prevent her from training to run the marathon.

“Attempting to achieve that goal can only help you,” he told her. “I didn't think exercise necessarily had a direct potential to cure or to suppress cancer, but I thought positive attitude and doing what you want to do should be encouraged.”

Together with Janice, Dr Orchard worked to help her achieve her goals — running a certain number of kilometres each week, for instance.

“The happy ending is that not only did she complete a marathon, but she eventually had total remission of the cancer; she's still alive and she's still running,” he says.

Since then, Dr Orchard has seen medical science evolve to catch up with Janice’s intuition.

“I've read all this literature saying that exercise actually treats a lot of cancers — it actually improves rates of survival,” he said.

“Now it's much more evidence-based, a lot of the oncologists are sending people deliberately to exercise programs. It is part of breast cancer treatment, for example, now, and bowel cancer treatment.”