If anyone had told Federal Court judge Deirdre O'Connor that at age 71, she'd be pumping iron, doing sit-ups and planking: ''I would have replied, 'you're mad!''' declares her honour.
''I'm ridiculously proud of my new biceps; I'm even having muscle flexing contests with my eight-year-old grandson,'' the now-retired judge adds, laughing.
Her vigorous new fitness regime is all the more remarkable as the lead-up was a fairly sedentary lifestyle as a judge; then in 2009 discovering breast cancer requiring a mastectomy; then suffering severe heart disease requiring open-heart surgery with five bypasses.
O'Connor is part of the increasing wave of people who've suffered or still suffer chronic diseases and are now using exercise as medicine. Not just a token walk in the park, but vigorous sessions of muscle strengthening and aerobic exercises that increase heart rate and raise a sweat, tailored for her by a qualified exercise physiologist.
Twice weekly, she joins the hundreds of patients who attend the Lifestyle Clinic at the University of NSW's faculty of medicine. The clinic was established six years ago to conduct research and provide treatment for the community. People with chronic diseases - such as diabetes, osteoporosis, arthritis, bowel, breast and prostate cancer, cardiovascular disorders, depression and multiple sclerosis - use rowing machines, lateral pulldowns and abdominal machines with glowing faces and positive attitudes.
The clinic's main workout room is ringed with an array of high-grade exercise equipment and looks like a gym, but there's no Lycra or pounding music. The supervising staff are all exercise physiologists, a relatively new but growing profession, requiring a four-year university degree plus 500 hours' clinical practise. They study anatomy, physiology, biochemistry and the effects of illness, injury and medications on bodies, in order to understand the types of exercise that ill or recovering patients can do safely to gain health benefits.
Lifestyle Clinic director Chris Tzar explains that each patient is given ''doses'' of specific exercises, at a graded level of intensity and duration. ''The exercise regime is determined with the same level of medical care that doses of pills would be prescribed on a script, only there are no adverse side effects,'' Tzar says.
To clarify confusion about professions that may seem similar, Tzar explains: ''Exercise physiologists design exercises that the patients themselves carry out. Physiotherapists do more manual, passive or manipulative treatments. Both have university degrees and are part of the medical system, with Medicare provider numbers.
''Whereas personal trainers can do as little as a six-week course, and may have many other terrific skills, but are part of the sport-and-recreation sector.''
Like most of the population, O'Connor had no idea that exercise physiologists existed. ''I'm not a joiner, I wouldn't have gone near a gym, and I didn't know there was an alternative,'' she admits.
''After four cancer operations, I was unfit, overweight, feeling terrible, taking pills; very sorry for myself and wondering when something else would go wrong. Then my new oncologist, Dr Eva Segelov, very firmly said, 'There's a lot you can do to help yourself. You can lose 15 kilos, get fit, lead a healthier lifestyle, and the research shows that your chances of a cancer recurrence will be significantly less.'
''I gaped at this, decided to stop whingeing and get truly fit. I'm addicted to exercise now, it's transformed my life.''
Segelov, associate professor of medicine and a medical oncologist at St Vincent's Hospital, Sydney, has been a committed believer in the value of exercise as medicine, for at least the past five years.
''With cancer patients, we get what's called 'a teachable moment' and an increasing number of cancer centres are now teaching their patients that exercise is an essential part of holistic cancer treatment,'' she explains. ''We used to think that exercise was taboo for cancer patients, particularly for patients with widespread cancer.
''Now the medical knowledge is changing. It's not just a matter of being trendy; the scientific data is irrefutable. A number of studies, specifically following people with breast cancer and bowel cancer, consistently show that people with normal weight, who exercise the proper amount, have lower rates of cancer recurrence than people who don't exercise.
''Exercise also helps combat side effects of chemotherapy and there is now good data showing that people who exercise have a higher chance of completing a course of chemotherapy, rather than dropping out, and having a better quality of life.
''We still don't know exactly how exercise works, but it causes beneficial physical, physiological (cells, tissues, organs), chemical and hormonal changes, as well as a psychological boost.
''But the last thing we want is people racing out to the gym and doing inappropriate things, and risking harming themselves, '' Segelov says. ''Patients need to consult an accredited exercise physiologist, who will do a thorough clinical assessment … The exercise must be continually done three to five times a week for at least 30 minutes - not just a binge then abandoned. It requires a real lifestyle change to reap the rewards.''
Imagine if a new miracle drug was invented, backed by scientific studies, that could reduce your likelihood of suffering all top-10 chronic diseases, slow down the effects of ageing and increase your life expectancy. People would no doubt rush to get it.
But because this miracle drug is regular, vigorous exercise, requires personal effort and can be done for free in your own home after some initial guidance - people tend to think, ''Oh yeah, I know exercise is good for me, but I never get around to it …''.
O'Connor says no doctor had ever asked if she was doing regular exercise, until Segelov.
''Local GPs would sometimes say it would be a good thing if I lost weight, but they never sent me to a dietician or exercise physiologist.''
Her career as a judge required a lot of sitting. ''My husband and I would spend our annual holidays doing walking tours, so I'd try to get fit before we left, but I was never properly fit, I only just managed.''
She now works out on five machines, ''chest press, pulldown, rowing, arm and leg-strength machines, and then I do abdominal and core-strength exercises''.
''My family burst out laughing when I told them I was planking. I wouldn't have believed anyone would ask a 71-year-old woman to get down on a mat, pull up my stomach muscles and extend my body into a plank, but age is no bar.
''I've discovered muscles that have been lying dormant for decades. I'm fitter, happier, healthier and wearing size-12 dresses,'' she says. She's also taken up line dancing.
''It would be wonderful if all doctors were more proactive in sending their unfit patients off to do prescribed exercise, instead of just writing prescriptions for pills,'' O'Connor says. ''If the federal government is about preventative medicine, they should push for this.
''I've seen frail people arrive at the exercise clinic on sticks and learn to walk freely again. It's not rocket science, it's just monitored exercise.''
Patients often arrive at the Lifestyle Clinic with a basket of conditions, including anxiety and depression.
A professor of psychiatry at University NSW, Gordon Parker, says it's important that people with depression exercise daily, as endorphin levels rise during exercise, contributing to enhanced mood.
Susan Foster always led a very fit and healthy lifestyle, never suffering depression, but her world became unstuck about two years ago when, at age 47, she was shocked to learn she had aggressive breast cancer.
''Three lots of surgery, removal of lymph nodes, then finally a bilateral mastectomy, plus radiotherapy and chemotherapy, occupied a full year and left me utterly exhausted,'' Foster says.
''When the treatment ended and I no longer had regular contact with my health providers, I suffered debilitating anxiety and felt highly vulnerable.
''I was prescribed daily chemotherapy pills for five years, and the medication was causing joint pain, back pain, joint stiffness, fatigue, and [it] carries a risk of osteoporosis. For months after surgery, the tightness of the skin being sewn together felt like someone standing on my chest, and it was hard to take a deep breath.''
A breast-care nurse recommended the Lifestyle Clinic.
''I was worried; I'd had major surgery and thought I might pop open,'' Foster says, ''so I spoke to my oncologist and he was very supportive - yet he hadn't suggested it.
''I was still very fearful when I started; this concept of exercise as medicine was completely new to me.
''I was battling with my self-esteem and body image, having lost two breasts, lost all my hair including my eyebrows and eye lashes, but the staff was so understanding that I felt safe.''
She began an exercise program using six different strength resistance machines, plus floor work.
''I now have a very perceivable difference in my strength and stability, endurance and range of motion,'' she says. ''I no longer suffer any side effects from the medication, so it's freed me up immensely. My anxiety has gone; I have more energy; I now swim and run again. I can't believe how far I've come in 12 months.''
Bruce Larter, at age 35, was in a car accident where the vehicle rolled seven times and he ended up with 38 broken bones, including his back and neck. A gutsy character, he pushed on despite chronic pain, worsening arthritis in every joint and two knee replacements.
Now 67, Larter says: ''It reached the point where I could barely walk 50 metres because of excruciating pain. I couldn't bend over to pick anything up without falling over, I couldn't lift anything and I couldn't push myself up out of bed. I was on high doses of insulin for diabetes, and pain-killer drugs were causing me kidney failure and liver problems … then a GP told me my only hope was to exercise my way out of it.''
It's two months since Larter began exercises to strengthen muscles around his arthritic joints, increase stability and decrease pain.
''They started me on weights, which were bloody painful, not easy, but I can now lift 30 kilos, whereas before I couldn't lift a thing,'' he says.
''I was walking stooped over, as my back and neck muscles were so weak; now they've got me walking upright. My leg muscles are improving. I can crouch down to pick things up without falling over.
''My level of pain is diminishing; I've greatly reduced my pain medication and halved my diabetes medication. I wake up and do an hour of exercises they've given me, instead of taking pills. I've got something to go for now.''
An older patient, Margaret Keen, 80, who's been doing her strength training and aerobic routine for the past year, has now gone from being a high-level diabetic, to a non-diabetic, thanks to exercise.
Tzar says there are now 2600 accredited exercise physiologists nationally, a figure that's grown from only 250 seven years ago. Private exercise physiology clinics are now mushrooming in all states.
Patients are either referred to exercise physiologists by medical practitioners, and arrive with clinical notes, or they can self refer.
''We're still only scratching the surface of what exercise can do for many diseases, including cancer,'' Tzar says.
''The cancer-exercise research is where heart disease and exercise research was back in the 1980s. We used to recommend meditation and passive activities for cancer patients, now it's strength and aerobic training. Likewise, 15 years ago it was thought strength training would aggravate diabetes, now we know the reverse.
''We don't claim that exercise is a panacea for everything, but it can help numerous links in the chain.
''It improves hormonal balance, cognitive function, circulatory system, lung function, cardiovascular function, improves the immune system, bone health, muscle strength and flexibility, and overall sense of well-being. And it's free.''