The Straits Times (25 March 2025)

TTSH trial patients gain muscle mass, lower body fat, see fewer re-admissions

After surviving a heart attack three years ago, Mr Tan Kim Kiang found himself feeling weak and experiencing difficulty in walking.

The heart attack had weakened his heart muscles, leading to heart failure. Walking short distances left him breathless, and even simple tasks such as getting up to go to the toilet posed a challenge.

It was then that Mr Tan – now 65 and working in a renovation company – joined the cardiac rehabilitation programme at Tan Tock Seng Hospital (TTSH).

Starting with slow walks, he progressed to brisk walking on a treadmill and cycling on a stationary bike.

He is one of more than 100 seniors who have benefited from HF Care, TTSH’s rehabilitation programme for elderly patients with advanced heart failure.

Trialled for a year between 2022 and 2023, the initiative was created to fulfil an “unmet need”, said Dr Violet Hoon, head of the hospital’s cardiac rehabilitation services.

Heart failure occurs when the heart is unable to pump enough blood for the body’s needs. Its symptoms include shortness of breath, excessive fatigue and swelling of the legs.

Advanced heart failure is its most severe stage, where the heart’s ability to pump blood is seriously compromised, impacting a patient’s day-to-day activities.

It is a misconception that elderly patients with advanced heart failure should not exercise, said Dr Hoon.

“According to the evidence, cardiac rehab actually improves quality of life, functional capacity, exercise performance, and reduces heart failure related hospitalisations.”

Developed by a multidisciplinary team with a cardiologist, physiotherapist and nurse clinician, the programme comprises 12 1½-hour sessions that include personalised exercise training, as well as psychological support and nutritional guidance.

In the first session, the cardiologist assesses a patient’s fitness level and clinical symptoms, including stress and anxiety evaluations, and a test to gauge how far a patient can walk over a six-minute period.

Patients then complete prescribed exercises conducted safely within their individual limits under the guidance of a physiotherapist. Those who are more frail begin with assisted motorised movement therapy, and gradually progress to other exercises as they become fitter.

A cardiologist monitors patients for breathlessness and abnormal heart rates in between workouts. A nurse clinician provides them with information on healthy lifestyle habits.

Dr Hoon noted that patients who went through the programme saw an 11 per cent mean reduction of body fat, and an 8 per cent increase in muscle mass. Re-admission rates also decreased by 20 per cent.

Between 4 per cent and 5 per cent of Singaporeans live with heart failure, compared with about per cent or 2 per cent of the population in the US and Europe.

IMPROVING QUALITY OF LIFE

According to the evidence, cardiac rehab actually improves quality of life, functional capacity, exercise performance, and reduces heart failure related hospitalisations." - DR VIOLET HOON, Tan Tock Seng Hospital’s cardiac rehabilitation services head, on the misconception that elderly patients with advanced heart failure should not exercise.

One of the reasons why this is the case is the greater prevalence of comorbidities such as diabetes and hypertension in Singapore and South-east Asia, said Dr Hoon.

For those here aged 65 or older, this number goes up to between 6 per cent and 10 per cent.

Dr Hoon noted that TTSH is seeing more heart failure patients who are elderly and frail, with multiple, complex comorbidities. About 80 per cent of heart failure patients at TTSH are above the age of 65.

This has contributed to higher re-admission rates and longer hospital stays.

This comes as Singapore’s population is rapidly ageing, with one in four people here expected to be 65 or older by 2030.

With the success shown in the initial trial, Dr Hoon said she hopes for HF Care to be scaled up, with 30 per cent to 40 per cent more patients coming under the programme over the next two to three years.

The team also plans to partner community organisations to ensure that patients can continue with cardiac rehabilitation even after completing the formal programme.

“We’ll continue training our allied health and nursing professionals to be confident in managing heart failure patients,” Dr Hoon added.

Meanwhile, Mr Tan now lives a healthier lifestyle, and is able to exercise regularly, brisk walking and cycling on alternate days.

He added that he was thankful to the team who helped him through his cardiac rehabilitation. “Coming to Tan Tock Seng changed my life,” he said.