JGH launches DURAgym, Canada’s first hospital-based exercise program for older adults
DURAgym has also been adapted for seniors at the Saint Margaret Day Centre
Chat with Carole Lowsky-Burack for a few minutes and you begin to wonder why this energetic 87-year-old, who swims regularly, would choose to enroll at the JGH in a structured exercise program like DURAgym.
Phil Lieberman, 76, exercises by climbing stairs in the DURAgym Clinic program at the JGH. He is assisted by Kinesiologist Hussein Samhat, DURAgym’s Project Manager. (Click on this or any photo to enlarge it.)
With self-deprecating humour (“I’m a bit of a talker, you know”), she amiably discusses the importance of staying active, proudly recalling that until the age of 75, she regularly pulled her own golf clubs around an 18-hole course.
Yet, even for a relatively vigorous individual like Ms. Lowsky-Burack, DURAgym’s benefits soon become clear, confirming the value of what is Canada’s first hospital-embedded, evidence-based exercise program for individuals 65 and older.
When her physical condition was assessed before she entered the program, the JGH geriatrician noted that despite the benefits that Ms. Lowsky-Burack had derived from swimming, she was in need of weight-bearing exercises.
“When I swim, the water keeps me buoyant, which I enjoy,” she says. “But it seems I’m not properly training the leg muscles that keep me upright when I’m not in the water.”
By strengthening those muscles, she hopes to reduce her risk of falling—something that has happened on at least two prior occasions—and take better preventive care of an old stress fracture in her back.
Exercises customized for each participant
DURAgym has been introduced in two forms: DURAgym Clinic for individuals who need a structured program in a hospital setting, and DURAgym Community for older adults who can benefit from a less formal program in a location other than a hospital.
In DURAgym Clinic, which Ms. Lowsky-Burack attends at the JGH, participants are referred by a physician and then assessed by a kinesiologist. Based on this evaluation, they are guided into the appropriate DURAGym class, according to each person’s needs and physical capabilities.
Sessions are conducted in small groups, with participants of similar ability exercising together, under the supervision of a kinesiologist.
Key DURAgym goals
Among DURAgym’s objectives:
- To improve physical performance, balance, and confidence in mobility among those who are at risk of falling
- To prevent or slow the progression of frailty and age-related skeletal muscle disease through structured, supervised exercise
- To support functional recovery and a safe transition after hospitalization or a geriatric assessment
- To promote knowledge translation and inter-professional collaboration among clinical, research and community partners
DURAgym Clinic supports both patients seen at the JGH and eligible older adults referred from the community.
Participants can now be referred by physicians and nurse practitioners from any department within the JGH, as well as by physicians and nurse practitioners in the community, says Kinesiologist Hussein Samhat, Project Manager of the program and a Coordinator at Schouela CEDurable.
He explains that a clincian who sees older adults is in the best position to determine how much and what kind of exercise the prospective participant can tolerate—and this, in turn, enables DURAgym’s kinesiologists to customize a regimen for each person in the class.
For referral details and access to the referral form, please see the end of the article or visit the DURAgym website.
DURAgym Clinic was launched at the JGH in February at roughly the same time that DURAgym Community was introduced at the Saint Margaret Day Centre—the first non-hospital-based program of its kind in the country. The JGH and Saint Margaret are both member facilities of CIUSSS West-Central Montreal.
Included in Ms. Lowsky-Burack’s DURAgym Clinic routine are knee-bends, various balance exercises, movement through a simple obstacle course, lifting weights that are not too demanding, and carrying a ball after getting up from a seated position.
“I’ve noticed that I haven’t gotten stiff after a session ends, which is a good sign,” she says. “In the past, if I did something I hadn’t done in a while—like bowling, for example—I’d be stiff for the next couple of days. But that isn’t happening here.
“Hopefully, we’ll both be stronger by the end of it,” she adds, referring to her husband, Eddie, who is part of the same DURAgym group.
Also enrolled in the DURAgym Clinic program is Phil Lieberman, 76, whose involvement is essential to his gradual, ongoing recovery after an accident last August. After stepping on an uneven spot on a sidewalk, he suffered a serious fall and broke all of the ribs on his right side.
“With every breath, in and out, my ribs moved and I can’t tell you how it hurt,” he says. Not only did this affect the way he now walks, but even the quality of his handwriting seems to have changed.
Mr. Lieberman admits he has never had much interest in exercising before, but now he’s hoping the DURAgym Clinic will make a difference. “No matter how much effort it takes, I’m willing to do it,” he says.
International recognition
Like Vivifrail, which was introduced last year at the JGH, DURAgym was implemented in the Susan & Aron Lieberman Family Wellness in Aging Geriatric Centre under the leadership of Dr. Gustavo Duque.
Before moving to Canada in 2022, Dr. Duque had tested a similar hospital-based exercise model in Australia. It drew on internationally validated frameworks, such as the Otago Exercise Program, which originated in New Zealand and helped inform the development of DURAGym.
At the Saint Margaret Day Centre, educator Marc Fireman accompanies Fred Zummer, 98, a participant in the DURAgym Community program. To improve his balance and attention, Mr. Zummer walks across a room while keeping an object upright on a tray.
As was also the case with Vivifrail, DURAgym is supported by the Simone & Édouard Schouela RUISSS McGill Centre of Excellence for Sustainable Health of Seniors, commonly known as Schouela CEDurable.
Directed by Dr. Duque, Schouela CEDurable focuses on implementing evidence-based and innovative solutions that promote active, stronger and healthier aging by translating research into everyday clinical and community practice.
The basic problem for many senior adults is that they’re too sedentary, says Dr. Duque, who is Director of the Falls and Fractures Prevention Clinic in the JGH’s Division of Geriatric Medicine, and Chair of the Division of Geriatric Medicine at McGill University.
But even some older people who are willing to exercise may find commercial gyms intimidating, he continues. The overarching idea behind DURAgym is “to provide an environment where seniors can exercise comfortably in a validated program, without the pressure of having all of those muscular people around.”
A further advantage, Dr. Duque says, is that the DURAgym Clinic program acts as a bridge for patients who have finished their hospitalization and physiotherapy, but are not yet ready for a commercial or community gym.
“DURAgym requires less effort than physiotherapy, but it’s more structured than what you’d find in the community,” he says. “It’s also more customized, with the result that the participants are more easily able to acquire or build up their confidence, function, independence and well-being.”
Another feature that appeals to many in the DURAgym Clinic program is that the sessions conclude with a nutritional boost in the form of a protein shake for each participant. As they drink, they mingle and socialize, which helps to ward off feelings of isolation.
During this time, the kinesiologist also addresses topics such as nutrition, safe movement strategies and fall prevention, while answering participants’ questions in an informal atmosphere.
“The value to be gained from this program goes beyond physical activity,” says Dr. Elise Levinoff, Chief of the Division of Geriatric Medicine at the JGH.
“By promoting social stimulation, DURAgym is particularly important to people in their 80s and 90s, since it guides them toward healthy longevity in the context of whole-person care.”
The target users of DURAgym Clinic
Older adults who benefit from DURAgym Clinic include those who:
- Feel increasingly weak or unsteady
- Have a history of falls or a fear of falling
- Are recovering after a hospital stay or a decline in health
- Want to regain function by participating in a structured program
- Have no more than a mild cognitive impairment and can follow instructions
- Have been cleared for exercise by a physician
- Can walk unassisted, though they sometimes use a cane or walker
- Can arrange transportation to attend two sessions a week for six weeks, plus one visit during each of two additional weeks
At the Saint Margaret Day Centre, Mary Kikcio, 95, participates in the DURAgym Community program to improve her balance. As she performs upper-body strengthening exercises to improve arm and shoulder function, she is steadied by Kinesiologist Hussein Samhat, DURAgym’s Project Manager.
Each cycle of DURAgym Clinic runs for eight weeks, with an assessment conducted in weeks 1 and 8 to determine how far the participant has progressed during the program. In weeks 2 through 7, each person attends two one-hour exercise sessions per week.
In the DURAgym Community program, each person participates in a one-hour once a week for 12 weeks, says Yasmina Sleb, Manager of the Saint Margaret Day Centre.
Prevent falls, improve balance, gain confidence
Like DURAgym Clinic, DURAgym Community is designed to help clients prevent falls, improve their balance, and gain confidence while walking. Participants are supported by an interdisciplinary team that includes educators, nursing staff, an orderly and a specialist in clinical activities. This ensures close supervision in a community setting.
At the same time, the Day Centre remains available to regular clients who prefer to perform other types of exercise routines at their own pace, Ms. Sleb says.
Once a participant has finished the cycle for DURAgym Clinic, members of staff meet to discuss what that person should do next, says Mr. Samhat. For example, the individual might be referred to a DURAgym Community program, advised to perform the Vivifrail exercises at home, or told to continue exercising at a community centre.
The longer-range objective for Schouela CEDurable is to make both versions of DURAgym more widely available at various locations throughout Montreal and across Canada, with the headquarters at the JGH.
According to Dr. Duque, a DURAgym Clinic is planned for the St. Mary’s Hospital Centre. Expressions of interest have also been received from the McGill University Health Centre (MUHC), McMaster University in Hamilton and healthcare facilities in British Columbia.
For Ms. Lowsky-Burack, the age of 80 proved to be a crucial watershed. “Before then, the major milestones in my age did not make me feel like an old lady,” she says. “But from 80 on, I could see and feel the decline of my physical strength. Clearly, there was a need for what DURAgym is now giving me.
“As every doctor has told me, ‘Move it. If you don’t use it, you’ll lose it.’”
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Referral information
Referral forms and full program details are available in English and French on the DURAgym webpages.
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