Abstract
Introduction: Physical inactivity is a leading contributor of global disability-adjusted life-years (DALYs), incurring significant costs to patients and providers. Singapore recently announced Healthier SG, a nationwide initiative emphasising preventive health, including strategies to boost activity. The Singapore Physical Activity Guidelines are also regularly updated to encourage movement. Despite ongoing efforts, the proportion of residents achieving sufficient physical activity has declined. This paper presents the strategic integrative plan of Singapore’s National Healthcare Group, a sub-national public healthcare provider group, to create an active lifestyle ecosystem for sarcopaenia, exercise medicine, and musculoskeletal and joint health.
Life Course Approach: People begin life in good health, but suffer chronic diseases like osteosarcopaenia as they age, increasing risk of frailty and functional deterioration. Using a physical travelator analogy and a Life Course approach highlights opportunities for stakeholders to intervene with primary, secondary, and tertiary prevention strategies.
We established a multidisciplinary Steering Committee in 2020 to gather experts to develop clinical strategies, service development plans and integrate care across these fields to help residents increase years of healthy life.
Current Gaps: Through comprehensive literature review and consulting internal and external experts, the committee identified five key gaps:
1) Residents are not exercising enough, increasing physical inactivity and associated comorbidities.
2) Physical Activity Vital Signs and other measures like gait speed are not routinely captured, reducing valuable information to help professionals manage residents.
3) Widespread use of safe exercise guidelines for population subgroups (e.g. those with disabilities or comorbidities) is lacking, thereby reducing physical activity.
4) Integrated pathways linking residents in primary or tertiary care back to community care are lacking, overburdening these services.
5) There are insufficient services and manpower in primary and preventive care, so residents may not receive prompt treatment, increasing disease chronicity and morbidity.
Strategic Thrusts: To bridge these gaps, the committee developed a vision for an active lifestyle ecosystem, anchored on three strategic thrusts: collective learning, care integration, and health and ecosystem mapping.
First, education, community engagement, and collaborative learning will reinforce the importance and adoption of physical activity. Second, care integration and information sharing improve outcomes with equivalent manpower. Third, mapping residents’ physical activity along standardised measures will enable data analytics to tailor precision population interventions.
Desired Outcomes And Future State: Our Physical Health programmes have shown initial success. The Collaborative Model of Care Between Orthopaedics and Allied Health Professional for Knee Osteoarthritis (CONNACT Plus) shifted osteoarthritis care from a hospital-centric episodic model to a community-centric chronic care model. Patients showed improved knee function and pain scores, with reduced healthcare costs. Other successful programmes include shared care models for non-surgical musculoskeletal care, and early community-based screening and intervention for frailty.
Outcomes align with national Healthier SG efforts, including physical activity levels, reduced emergency department attendance, and DALYs. Ecosystem-wide collection and review of physical activity measures are another success indicator.
The desired future is an active lifestyle ecosystem leveraging physical health measures, where individual ownership of one’s health naturally leads to adopting an active lifestyle, unconstrained by health status, disability, or age.