Former teacher Tay Cheng Choo, 69, used to go for jazz dance classes but found it hard to just walk after an operation to remove a tumour in her left thigh in late 2014.
That is, until she was put under the Exercise is Medicine Singapore (EIMS) programme, which aims to make physical activity and exercise a standard part of preventing and treating diseases.
Ms Tay's operation meant that a relatively large chunk of her thigh muscle, which she described as the size of a mango, had to go.
It weakened her left leg and she went for physiotherapy sessions at Changi General Hospital (CGH).
"I went for several sessions before they told me that was all they could do for me," said Ms Tay.
"I went in with a walking stick and could walk after that, but I felt that I couldn't walk that well yet."
UNCONVENTIONAL BUT EFFECTIVE
The conventional way is to use muscle-specific machines but we got Ms Tay to use her body weight and other tools such as resistance bands, too. We challenge her in other ways to stimulate her muscle growth, such as making her do things on uneven surfaces.
EXERCISE PHYSIOLOGIST SHAYNE HU
Ms Tay also had private physiotherapy sessions, but the cost, at more than $100 per session, was a deterrent. So, she asked her gasteroenterologist at CGH to refer her to the hospital's sports medicine department, which linked her up with certified EIMS allied health professional and exercise physiologist Shayne Hu.
Ms Hu helped design and implement a training programme aimed at restoring Ms Tay's functional ability. Ms Tay went through a nine-month programme, starting with 45-minute sessions twice a week, then once a week. She also did some of the exercises at home.
Her initial sessions with Ms Hu were less intense than her physiotherapy sessions, which she felt were a little too tough. "Shayne understood what I was going through and could see how much exercise I could do," Ms Tay said.
She added: "Previously, I had so much fear because everytime I went back, I had aches and pain."
Ms Hu put her on lower weights initially and gradually increased them as Ms Tay gained strength.
"The conventional way is to use muscle-specific machines but we got Ms Tay to use her body weight and other tools such as resistance bands, too," said Ms Hu.
"We challenge her in other ways to stimulate her muscle growth, such as making her do things on uneven surfaces."
Ms Tay has completed the programme and regained much of her muscle strength. In March, she even went back to dancing.
Ms Hu said exercise physiologists like herself will formulate training goals for patients who are referred to them by doctors. They know what to look out for to help patients avoid injuries or complications, as they are clinically trained.
Physiotherapists help patients gain mobility and independence generally, while exercise physiologists focus on helping patients to return to sports or to reach more difficult goals, for instance.
EIMS equips them with the competency to safely supervise exercise prescribed for the client by his or her doctor, said Ms Hu.
For instance, they would measure the blood glucose level of diabetes patients before the session.
"If the level is high, we may continue the session with caution or refer the patient back to the doctor," said Ms Hu.
In Ms Tay's case, the goal was to strengthen her quads such that she could walk normally and return to her usual daily activities.
"Her quadricep muscle in the left leg was removed so it's impossible to have equal strength in both legs," said Ms Hu. "But she has done well. She managed to compensate for the loss of the muscle in her left thigh. She doesn't have a penguin gait."
Dr Benedict Tan, sports medicine chief at CGH and chairman of EIMS, said there is overwhelming research to demonstrate the benefits of exercise. "The problem is that the research is not translating into practice - fitness levels are dropping and the chronic disease burden is increasing."
Doctors and other healthcare givers play an important role in getting people to be healthier through regular exercise, he said.
"Unfortunately, time constraints and a lack of confidence in prescribing exercise are often cited as reasons why healthcare givers are not spending more time having a conversation with their patients on their exercise habits."
EIMS comes in to train doctors as well as allied health and fitness professionals to prescribe exercise safely and efficiently, he added.
Since its launch in 2011, EIMS has certified 677 doctors, including 109 local doctors and 136 overseas doctors last year. It has also certified 418 allied health and fitness professionals, including 40 local ones and 185 foreigners last year.
EIMS also worked with Sport Singapore and CGH on the first Active Health Lab at Our Tampines Hub, which was launched in August. They equipped Active Health experts at the lab with the knowledge and skills to recommend physical activity to prevent and manage common chronic health conditions.