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Newly Published – Gym Tonic Progressive Strength Training Program In Singapore's Elder Care Settings

(Image: Singaporean seniors daily strength training exercises using HUR equipment)

We are delighted to share the recently published article “Introducing Progressive Strength Training Program in Singapore's Elder Care Settings

The Gym Tonic research program launched in 2015 was a Finnish-Singaporean cross-national collaboration to evaluate and implement strength training in new settings where it had not previously been applied - in 24 elder care facilities across Singapore. Therefore, Singapore's elder care has provided a unique opportunity for gathering practice-based evidence in the area of strength training.

To facilitate the implementation three companies Raisoft, Pulsesync and HUR together with Kokkola University Consortium Chydenius WELMED came together to develop a solution. The developed strength training concept presents a combination of gym technology and assessment instruments making it possible to evaluate the persons' physical condition and training on a continuous basis. The project, Gym Tonic, was funded by the Lien Foundation to support the implementation.

Academic collaboration between HUR and WELMED started in 2007, resulting in several successful research studies which findings have been incorporated in the development of our equipment and products over the years. Today HUR offers a complete research environment, which enables the user to take full control of the exercise interventions. The HUR strength training equipment matches the body's natural muscular movement using smooth air-pressure technology, resulting in a safer, more effective exercise for people of all ages and abilities. During each movement, muscles are exercised in both eccentric and concentric phases which is vitally important for optimal muscle function.

The results of the study demonstrates that it is feasible to implement progressive strength training and promote healthy aging in real life settings, using technology. Study data showed significant improvements in muscle strength across the three existing gym settings: those participants living in the community and those residing in facilities. “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.” Measurement and assessment data from total 399 persons (72 ± 11.4 y, M 53%, F 47%) were included in the analyze of this study. The recommended progressive strength training period was set at 3 months, twice a week with two sets of exercises at each machine and the average time for every session was approximately 30 to 45 min. The progression of the training was suggested to be adjusted in terms of the repetition maximum (RM). Resistance level had been set to 15RM for weeks 1–2, 10RM for weeks 3–7 and 8RM for weeks 8–12, with simultaneously progressive loading. The average load increase was 21% during the three-month intervention.

The HUR equipment used in the study and installed at the 24 centers included the following SmartTouch machines:

Leg Extension/Curl, Leg Press, Chest Press Wheelchair Access, Lat Pull Wheelchair Access, Abdomen/Back Easy Access and  Hip Abduction/Adduction. For baseline assessments the HUR Performance Recorder for Isometric Muscle Testing and HUR iBalance for Balance Assessments were used. All HUR equipment operate within a cloud based software that links all HUR centres into one system, allowing you to workout wherever and whenever. The HUR SmartTouch® software attached to the machines records all training activity for automatic reporting. Individual exercise levels can be programmed into the system and the built-in progressive resistance algorithm allows automatic loading increments. The Gym Tonic sites were encouraged to set up the gyms in “pleasant” environments to make the gym experience a positive one for the users. WELMED assessments instruments and software, developed by the University of Jyvaskyla in Finland, were used in the Gym Tonic program.

Positive outcomes from the study.
The approach yielded consistent improvement rates in muscle strength comparable to results from randomized clinical trials (meta-analysis studies) showing that effective outcomes can be achieved in real life environments.
• Significant improvement rates in muscle strength were found in all three types of sites demonstrating the vast potential of strength training to promote resilient aging.
• The data supported a 3-month training intervention as an effective way of introducing strength training, this could be useful for policy makers looking for practical solutions in the war against frailty.
• Frontline staff were successfully trained in the use of the technology for gym training and assessments, suggesting that technology solutions can be applied in real life practice for strength training.
• Practice patterns could be detected using the data-driven approach highlighting the need and capabilities of information and assessment systems for decision making and continuous quality improvement.
Can we add some of the previous research papers with Welmed?

We would like to extend our sincere gratitude to all participants contributing to the success of this project. Special thanks to Lien Foundation for their support. We look forward to future collaborations and partnerships that strive to provide the best solutions for lifelong strength and wellbeing!

Front. Med., 30 September 2021

Please see GYM TONIC video links
Gym Tonic introducing Exercise-As-Medicine concept in Singapore
Gym Tonic by Gabriel Lim, Programme Director, Lien Foundation
Exercise becomes potent medicine for the frail elderly in 12 eldercare facilities under Lien Foundation’s latest $2.2m ‘GymTonic’ initiative

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