Rationale and Aims of The Centre for STRONG Medicine
In 1993, having completed my Geriatric specialist training in Australia, I went to Harvard University to obtain a fellowship in Geriatrics to further develop my specialty knowledge. Frailty is obvious to a Geriatrician, but as it had always seemed to be a problem without a solution, it was often ignored as a focus of treatment. At Tufts University in Boston, for the first time I saw frailty conceptualised as something that could be diagnosed and treated, rather than being seen as an inevitable consequence of ageing. It was as if in my Geriatric care I had been tinkering at the edges but missing the central problem because I saw it as immutable. At that moment, it was as though a light bulb appeared above my head. I returned to Australia in 1997 and have been applying the use of exercise, largely weight training, to various diseases including diabetes, osteoporosis, depression, arthritis, falls, hip fracture,renal disease, chronic lung disease neurological diseases and to counteract the effects of drugs ever since.
Strength Training Rehabilitation and Outreach to the unmet Needs in Geriatric medicine
Associate Professor Nalin Singh.
The rationale for establishing The Centre for STRONG Medicine lay in the emerging evidence base for the use of exercise not only in ageing, but also in the treatment of specific diseases and geriatric syndromes. The Centre serves to address the overlap among chronic diseases, disuse, ageing and disability, a complicated series of inter-relationships for which exercise is often the only available current therapy. Despite 50 years of research demonstrating the preventive and therapeutic benefits, exercise is still not widely or effectively applied in mainstream medical practice. This is likely due to the fact that it is not part of the core curriculum for medical students at virtually any medical school in the world. There are few health care professionals who have combined knowledge of medicine, geriatrics, and exercise physiology. This breadth of knowledge is critical for the full integration of these ideas into a patients medical management. In addition, medical reimbursement for exercise treatment, when available, has traditionally been disease-specific (e.g. cardiac or pulmonary rehabilitation) and time-limited (6-12 weeks). Such concepts have little utility when applied to the most common geriatric indication for exercise, frailty itself, which is neither disease or organ specific, nor time-limited. In using exercise as a specific medicine its use needs to be conceptualised as a drug. You cannot expect continued benefit for a chronic disease when you stop taking a drug. The appropriate exercise treatment for frailty is life-long, thus, the need for a centre specialising in the long-term management of this and similar syndromes in older adults and those with a disability.
The Gap in Current Practice
Thirty years of my clinical practice in public health aged care has crystalised to me what is missing in aged care. The problem was the exercise community was insufficiently trained in disease and ageing, and the medical and physiotherapy community did not have sufficient knowledge of exercise as lifelong treatment for disease and frailty. Therefore we aimed to set up a clinic with the expertise to both optimally manage complex geriatric patients and to treat a number of chronic diseases.
The mission of The Centre for STRONG Medicine today is to provide what experience has taught us is frequently missing in aged care in the public health system.
To meet our patients changing needs with continuity, a minimum of complexity and always with care.
To provide exercise as a core treatment of chronic disease.
To evolve to provide for most of the care needs of the ageing patient whose wish is to remain at home.