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

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.

Progressive exercise therapy in muscle dystrophy: two case studies in adult patients with DM2 and LGMD2D

These two case studies aimed to investigate the effect and acceptance of progressive strength training in patients with muscular dystrophy. Case 1 completed a progressive resistance exercise over 12 weeks. The results showed increases in leg extensor strength, hand strength and balance. Furthermore, the anaerobic test showed an increase in the maximum glycolysis rate. Creatine kinase levels were reduced while maintaining low muscle soreness. Case 2 conducted seven weeks of electronically assisted strength training and electromyostimulation. In the course of the training, an increase in the self-contribution of the performance in the execution of movement was observed in the assisted strength training. Furthermore, an increase in the intensity of external stimuli was observed. The creatine kinase showed a reduction with physiological behavior of muscle soreness. The results demonstrate the acceptance and feasibility of progressive exercise protocols used to increase performance in two cases of muscular dystrophy.

Effectiveness of a Group-Based Progressive Strength Training in Primary Care to Improve the Recurrence of Low Back Pain Exacerbations and Function: A Randomised Trial

Low back pain (LBP) is the leading cause of disability and one of the most common reasons for physician visits in primary care, with a 33% rate of recurrence during the first year. However, the most optimal exercise program in this context remains unknown. The objective was to evaluate the effectiveness of a group-based progressive strength training program in non-specific chronic LBP (CLBP) patients in primary care on pain recurrence and physical function. Eighty-five patients with non-specific CLBP were separated into two groups (Intervention group: completed a progressive strength training program 3 days per week for 8 weeks; Control group: received the usual care). The intervention group showed a recurrence rate of 8.3%, while the control group had a recurrence rate of 33.3% and a shorter time until the first recurrent episode. The intervention group showed increased lumbar extensor strength, left-hand handgrip strength, and reduced the number of pain sites compared with the control group. Results also showed greater odds for reducing LBP intensity and disability in the intervention group. In conclusion, a group-based progressive strength training program is a more effective and efficient alternative than Back-School programs and can easily be carried out in the primary health care context.

Safety and Effectiveness of Progressive Moderate-to-Vigorous Intensity Elastic Resistance Training on Physical Function and Pain in People With Hemophilia

Objective Strength training is recommended for people with hemophilia; however, published data are anecdotal and have methodological limitations. The purpose of this study was to evaluate the safety and effectiveness of progressive moderate-to-vigorous intensity elastic resistance training on physical function and pain in this patient population. Methods A randomized controlled trial was conducted in a university laboratory setting where 20 patients (17 with severe, 1 with moderate, and 2 with mild hemophilia) aged 21 to 53 years received evaluations at baseline and 8-week follow-up. Participants were allocated to intervention (progressive strength training) or control (usual daily activities) groups. The intervention group trained 2 days per week during 8 weeks with elastic resistance. Intensity during the first 2 weeks was a 20-repetition maximum and increased progressively toward 15, 12, and finally 10 repetition maximum. The primary outcome was muscle strength. Secondary outcomes were the Timed “Up and Go” Test score, sit-to-stand, range of motion, Haemophilia Joint Health Score, kinesiophobia score, global impression of pain change, general self-rated health status, and desire to exercise. Results The intervention group showed greater strength improvements than the control group in almost all of the joints, with moderate to high effect sizes. The intervention group also showed better Timed “Up and Go” and sit-to-stand scores than the control group (moderate effect size), greater range of motion at the knee flexion with the right leg (trivial effect size), and better Haemophilia Joint Health Score at the left knee (small effect size). The intervention group showed greater overall pain reduction, self-rated overall status, and desire to exercise than the control group. Conclusions Progressive strength training with elastic resistance performed twice a week during 8 weeks is safe and effective in people with hemophilia to improve muscle strength and functional capacity, reduce general pain, and improve self-rated health status and desire to exercise. Impact This study provides evidence for the use of a specific strength training regimen for people with hemophilia. Lay Summary People with hemophilia of differing levels of severity, with adequate coverage with clotting factor, can safely engage in progressive strength training and can improve their functioning.

Chronic Eccentric Cycling Training Improves Walking Economy in Healthy Individuals

ABSTRACT Background: Low muscular strength is associated with decline in ambulatory function. Progressive strength training has been demonstrated to improve physical functional outcomes. Because eccentric exercise is a potent stimulus for increasing muscle size, strength, and power, it has the potential to serve as a time-effective intervention to improve ambulatory function at a lower metabolic cost compared with traditional strength training. We examined the effect of a 6-week eccentric cycling training intervention on walking economy in healthy individuals. Methods: Eleven healthy individuals (age = 24 ± 3 years; body weight = 71 ± 9 kg; height = 1.7 ± 0.1 m) trained on an eccentric ergometer for 6 weeks (3×/week; 10–30 min; 54%–66% of maximum heart rate). The metabolic cost of walking was assessed 1 week prior to and 1 week following eccentric cycling training. Cost of walking was determined as the net energy cost (J·kg−1·s−1), divided by walking speed (m·s−1) during steady-state walking at 5 walking speeds (0.7, 1.11, 1.39, 1.67, and 1.9 m·s−1) Results: Posttraining cost of walking was significantly improved across all 5 walking speeds (0.7, 1.11, 1.39, 1.67, and 1.9 m·s−1; all P < 0.01) following eccentric cycling training. Conclusion: These results demonstrate that 6 weeks of chronic eccentric cycling training was effective in improving walking economy and can be safely administered and tolerated by healthy individuals. Enhancing ambulatory function through eccentric cycling ergometry would be beneficial for both athletic and mobility-limited populations.