Introducing Progressive Strength Training Program in Singapore's Elder Care Settings

Abstract

The use of progressive strength training among the elderly has become an accepted part of evidence-based practice for preventive and rehabilitative care. Exercise is undoubtedly one of the pillars for resilient aging. While research has shown impressive outcomes from strength training, the challenge remains to get elderly persons to exercise. Here we describe a Finnish-Singaporean cross-national project that provides a unique opportunity to evaluate the implementation of strength training in settings where it had previously not been applied. We report from the first 2 years of implementation using assessment data and surveys directed to frontline therapists responsible for the implementation. The strength training concept was progressively implemented in 24 elder care locations in Singapore including residential homes, day rehab/care centers, and senior activity centers. Each location was provided with training, support, gym equipment and technology solutions. It remained for individual sites to enroll elderly to the program, to perform assessments, and to direct the progressive strength training. Based on data from the first 2 years of implementation, improvements in lower body muscle strength were found in Leg Curl (ave 11.1-48.8%), Leg Extension (ave 10.2-24.0%) and Hip Abduction/Hip Adduction (ave 7.0-15.8%). Of the trained therapists, 95% strongly agreed or agreed to some extent that the implementation had been successful. The practice-based evidence from the project has demonstrated that it is feasible to implement progressive strength training in real life settings, using technology. While the implementation initially required handholding and support, the approach yielded consistent improvement rates in muscle strength comparable to results from randomized clinical trials (meta-analysis studies). Significant improvement rates in muscle strength were found in all three types of sites, demonstrating that gym training can be employed broadly in elder care. The Senior Activity Centers offer an interesting model for reaching seniors with preventive actions at an early stage. The data support a 3-month training as an effective intervention of introducing strength training in elder care settings, promoting healthy aging.

Keywords: elder care; exercise as medicine; implementation; interRAI; strength training.

Figure 1

The Gym Tonic process and the data collection. Thousand five hundred participants were registered. The sites were asked to deliver data on those who had properly completed the 12-week training and the pre and post assessments (N = 399). Welmed stands for a test protocol summerized by the upper right box. FTSTS, five times sit to stand; BBS, Berg balance scale; pt, physiotherapist; et, exercise therapist.

Figure 2

Average strength results (kgf/body weight) for a subgroup of 37 participants who trained for an extended period. LegExt_R, leg extension right leg; LegExt_L, leg extension left leg; HipAbd, hip abduction; HipAdd, hip adduction; LegCurl_R, leg curl right leg; LegCurl_L, leg curl left leg.

Figure 3

Post-pre change in terms of improvement rate calculated as mean (post-pre)/mean (pre) for Right Leg Extension and Curl strength for Gym Tonic (N = 399) and “reference” groups and averaged over gender. AGEILITY (N = 12) and FIN80 (N = 28) were tightly supervised exercise groups.

Figure 4

Implementation questionnaire. Staff responses of those trained in Finland for Gym Tonic (N = 40) and those trained locally for Gym Tonic (N = 22).