JGH implements innovative, WHO-endorsed exercise program to bolster seniors’ mobility and autonomy

Hospital is first in Quebec to embrace Vivifrail regimen to help seniors prevent falls and fractures

The JGH has become the first hospital in Quebec—and one of the few in Canada—to implement Vivifrail, a program to assess the physical capabilities of older individuals and provide them with customized exercises to maximize their functioning and autonomy.

A page from one of Vivifrail’s Physical Exercise Passports, demonstrating an exercise for seniors at level A (someone with a disability). (Click to enlarge.)

Endorsed by the World Health Organization (WHO), Vivifrail went into use this past spring in the hospital’s Division of Geriatric Medicine to help sustain or improve the mobility of seniors over the age of 70, while preventing falls and fractures.

Vivifrail is primarily geared to those who are frail, approaching frailty or have a disability. However, the program is considered to be of benefit to all seniors, which is why some of the exercises have been designed for individuals who are in good or very good shape.

Balance and muscle strength are enhanced through simple exercises at home, using common items such as a chair (for standing and sitting repeatedly), plastic bottles of water (weights to be lifted), a towel (twisted with two hands) and a ball (squeezed with one hand).

The Vivifrail resources are free to all healthcare professionals, with a testing process that requires no special equipment. As a result, the patient’s balance, gait speed and ability to repeatedly sit down and stand up can easily be assessed in almost any office by a family physician, geriatrician or other clinician.

Dr. Mikel Izquierdo, the founder of Vivifrail, visited the JGH in May to acquaint hospital clinicians with the exercise program’s goals and benefits.

However, Vivifrail is being introduced in a hospital setting to maximize the program’s exposure and to jump-start its broader use across the province, says Dr. Gustavo Duque, Director of the Falls and Fractures Prevention Clinic in the Division of Geriatric Medicine.

This makes Vivifrail the latest in a long series of pace-setting practices introduced by the JGH to anticipate and tend to the needs of older persons. For at least the past 50 years, the hospital has served a disproportionately large number of older adults, placing it at the forefront of innovations in geriatric care in Quebec.

To help build momentum and recognition for Vivifrail, the program has received support from the Simone & Edouard Schouela RUISSS McGill Centre of Excellence for the Sustainable Health of Seniors, commonly known as Schouela CEDurable.

The objective of this non-profit organzation—where Dr. Duque serves as Director—is to transform the evidence-based results of research into everyday practices that allow seniors to remain as mobile, active and healthy as possible.

Vivifrail was created and developed in 2013 by Dr. Mikel Izquierdo, a Spanish clinician and researcher, whose innovative program has been translated into more than 20 languages and implemented in numerous countries.

To mark Vivifrail’s launch at the JGH, Dr. Izquierdo visited the hospital this past May to acquaint clinicians with details of the program’s goals and benefits.

“In a very real sense, exercise is medicine,” says Dr. Duque, who is also Director of the Division of Geriatric Medicine at McGill University. “Unfortunately, doctors don’t always know the proper exercises to recommend to their patients or how to accurately determine the extent of their patients’ capabilities.”

Vivifrail eliminates the guesswork, Dr. Duque explains, by giving the doctor (or nurse, physiotherapist, occupational therapist or kinesiologist) a list of specific tasks for the patient to perform during the assessment, which takes about 30 minutes.

Depending on how well each task is completed, the patient receives a certain number of points. When the points are added up, the patient is placed at one of seven Vivifrail levels (see sidebar) and is given the appropriate Physical Exercise Passport for that level.

This booklet contains instructions and illustrations depicting exercises that must be performed regularly over a 12-week period. Once the patient and healthcare professional have reviewed the exercise routine, the patient records his or her daily activities in the passport’s diary pages.

If the patient manages to perform the exercises with increasing proficiency, he or she might be assigned to a different—and possibly more challenging—level with its own passport and exercises, to be performed over the next three months.

Cover of a Physical Exercise Passport, one of seven types of instructional booklets in the Vivifrail program. Passport A is intended for those with a disability.

Vivifrail’s categories for seniors

After an older individual (70 and up) is tested by a healthcare professional, that person is placed at one of Vivifrail’s five levels or two sub-levels, depending on their physical capabilities. He or she then receives a Physical Exercise Passport, which contains instructions for a series of exercises that are appropriate for people at that level.

The categories:

• A: Having a disability
• B: Fragile
• B+: Fragile with a risk of falling
• C: Pre-fragile
• C+: Pre-fragile with a risk of falling
• D: Robust
• E: Robust – advanced

Dr. Duque notes that Vivifrail yields its greatest benefits when its exercises are integrated into an overall care plan that includes balanced nutrition, suitable medication and precautions against falls and fractures.

Andréa Faust, Team Manager of Schouela CEDurable at the JGH, says her organization became involved, because it and Vivifrail have compatible objectives and shared goals. Both are committed to using clinically validated research as the basis for hands-on measures that have been shown to improve mobility and autonomy among older people.

A key advantage of the program, she explains, is that it is specific about the exercises that need to be performed. This is a far cry from doctors giving patients vague instructions such as, “Try to move around more.”

Ms. Faust says the JGH’s patients also benefit from the fact that Dr. Duque gained experience in implementing Vivifrail in Australia before moving to Canada in 2022. In addition, he collaborated with Dr. Izquierdo on research and a scholarly paper that was published earlier this year.

“This is one of the best programs of its kind for us to establish and put into practice,” says Dr. Duque. “As the proportion of older people in society continues to grow, we need new ways of helping them remain healthy and avoid hospitalization.”

A Vivifrail poster illustrates exercises for seniors at level A. This corresponds to material in the Physical Exercise Passport for level A.