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Reaching at-risk populations to improve clinical measures of physical activity: Delivery of EnhanceFitness to low-income African American adults in Houston, Texas
Abstract
Background: Although the benefi ts of physical activity for
older adults are widely recognized, evidence-based exercise
programs for seniors have not traditionally reached minority
and other at-risk subgroups.
Purposes: The purposes of this study are to describe the reach
of EnhanceFitness to underserved older African Americans in
the Greater Houston area and examine the effectiveness of the
program to improve clinical measures of physical activity.
Methods: Data were analyzed from 423 participants who
enrolled in EnhanceFitness in the Greater Houston area.
Changes in three clinical measures (i.e., Ten Foot Up-and-Go
Test, Arm Curl Test, and 30-Second Chair Stand Test) were
assessed from baseline to the fi rst 4-month follow-up period
(i.e., 63 matched cases).
Results: Results indicate signifi cant improvements in all clinical measures from baseline to follow-up.
Conclusions: Findings show that evidence-based physical
activity programs are effi cacious for older lower-income African American populations. To continue reaching these underserved and at-risk populations in the Greater Houston area,
efforts are being initiated to incorporate a train-the-trainer
model for broader dissemination and sustainability as well as
the development of a partnership network for enhancing the
adoption of other evidence-based chronic disease management programs.
... Earlier studies have investigated the impact of Enhance ® Fitness on physical performance [15][16][17][18][19][20]. For example, Belza and colleagues examined 2,889 Enhance ® Fitness participants who participated in outcomes testing and found improvements at 4 and 8 months on performance tests [15]. ...
... Each class enrolls up to 25 participants, depending on the space of the site. e classes are offered in a variety of community settings, such as residential and retirement communities, senior housing facilities, adult day care centers, YMCAs, private gyms, churches, and multipurpose centers [15][16][17][18][19][20][21]. ...
... Improvements in physical performance were also found in multiple previous Enhance ® Fitness studies, as shown in the scoping review of qualitative and quantitative studies conducted by Petrescu-Prahova and colleagues [20]. Other studies show its effectiveness with minority populations [15,17,18] and at a variety of Enhance ® Fitness sites [16]. ...
Introduction:
Enhance®Fitness is a low-cost group exercise program designed specifically for older adults (60+ years) to improve physical performance. The Hawai'i Healthy Aging Partnership, a statewide health promotion initiative, has continuously offered Enhance®Fitness to Hawai'i's multicultural population since 2007. This study examined 12-month participation in and impact of Enhance®Fitness on physical performance among older adults in Hawai'i.
Method:
Linear mixed-effects models were applied to analyze the physical performance measures (chair-stands, arm curls, and the up-and-go test) collected at baseline (month 0) and at 4, 8, and 12 months. We also compared the characteristics of participants who participated in the program for 12 months with those who dropped out in order to gain insights on participant retention.
Results:
Of 1,202 older adults with baseline data, 427 (35.5%) were continuously enrolled in Enhance®Fitness for 12 months and participated in follow-up data collection. On average, participants attended 63.7% of thrice-weekly classes each month. Participants' physical performance measures improved after 4 months, continued to improve until 8 months, and were maintained thereafter. Besides continuous attendance, performance-measure improvements were associated with younger age, male gender, living with others (vs. alone), and fewer chronic conditions. Compared to those who completed 12 months of the program, the 775 who left the program over the course of the year were more likely to be younger, to be Caucasian (vs. Asian or Pacific Islander), to self-report depression as a chronic condition, and to have lower levels of fitness at baseline. Common reasons for dropping out were illness, relocation, time conflicts, lost interest, and transportation issues.
Conclusions:
Long-term participants in Enhance®Fitness initially improved and then maintained physical performance. Future research is needed to identify strategies to maintain enrollment of older adults in the exercise programs over time.
... Overall, EF has reached a racially diverse population of older adults, including African Americans and Asian/ Pacific Islanders. 11,12 Participants are predominately female and aged 470 years. 5,6,11-13 EF participants, on average, reported a range of 0.5-1.48 ...
... 13 Effectiveness Although this search yielded no RCTs, three studies reported results based on pre-post designs, which the authors believe align with the effectiveness concept in the RE-AIM framework. These studies 11,12,14 found significant improvements in the measures of physical function assessed during EF participation: 8-or 10-Foot Up-and-Go, 30-second Arm Curl, and 30-second Chair Stand. 15 In addition, physical function measures were significantly poorer for participants in residential settings compared with senior centers. ...
Introduction:
Physical activity has many benefits for older adult physical and mental health. Enhance®Fitness (EF) is an evidence-based group exercise program delivered by community-based organizations. The purpose of this study was to review recent evidence on the dissemination and implementation of EF.
Methods:
A scoping review of qualitative and quantitative studies with EF as main focus was conducted. CINAHL, PubMed, PubMed Central, SCOPUS, Web of Science, PsycINFO, and Google Scholar were searched between October and November 2015 for data-based studies on EF published in 2010-2015. Two team members abstracted each paper independently using a data abstraction tool. Results were summarized using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Results:
Seventeen publications met inclusion criteria. EF has reached and is effective across a broad population base, including individuals with low SES and diverse ethnic/racial backgrounds. EF participation may be associated with reduced risk for falls requiring medical care, and is associated with fewer hospital admissions. Analyses of medical cost savings from EF participation and program implementation costs suggest economic benefits of EF implementation for communities. Organization-level maintenance is facilitated by program-specific and organizational factors, such as instructor training and funding. Individual-level maintenance is facilitated by program structure, absence of pain, and increased quality of life.
Conclusions:
More-rigorous evidence is needed about the association between participation in EF and conditions such as falls. Evaluation of program fidelity, adaptations, and sustainability is limited; more-systematic examination across population groups and types of organizations would help ensure older adults continue to benefit from EF participation.
... Significant outcomes included improvement in the arm curl test, chair stand test, and functional mobility at the four-month follow-up. Improvements on the TUG were at a level commensurate with a reduced risk of institutionalization [41]. ...
Purpose of Review
Community-based exercise and fall prevention programs afford older adults the opportunity to engage in group-based activities that promote health and wellness, physical activity, and social interaction. This review will analyze eight programs, commonly offered to older adults, that utilize various instructional modes to target health promotion through exercise, falls efficacy, and education.
Recent Findings
All of the programs are supported by randomized control or quasi- experimental designs and have been found to reduce falls, reinforce falls efficacy, or improve some aspect of functional mobility. Program designs vary and include seminar-style instruction, exercise class activities, or a hybrid approach with interprofessional outreach. Physical performance benefits are based on a variety of outcomes. The Timed Up and Go (TUG) assessment was the most frequently administered outcome among programs, though the magnitude of improvement varied. Programs have become more accessible as outreach has extended to rural underserved areas and nontraditional settings such as faith-based organizations.
Summary
Community-based programs offer older adults health promotion opportunities through exercise and education initiatives. Program designs vary and target different constructs of exercise and wellness to meet the needs of a wide variety of aging seniors. As a result of large-scale dissemination endeavors, programs are now extending to rural areas while maintaining operational fidelity.
... Offering prevention programs such as those focusing on chronic disease self-management, fall prevention, and physical activity within this service infrastructure brings these services closer to participants' homes and has potential to reduce travel-related attrition due to distance [25]. Further, these programs have shown to reach diverse populations [23,26], improve health status indicators [48,49], and increase physical functioning and mobility [50]. ...
Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients.
... These data show that the programme might have some influence on increasing the participants' knowledge in selecting and identifying healthy foods. This in turn validates findings by researchers who explored links between low-income families and support and information provision (Kaiser, Brown, and Baumann 2010;Smith et al. 2011). ...
The central focus of the Red Apple Healthy Lifestyles Programme (RAHLP) was the delivery of practical activities on healthy eating, cooking, promoting sustainable changes in health and shopping behaviours among low socio-economic families and young people in the rural communities. The study aimed to answer the following question: how do the activities offered by the RAHLP (1) increase the knowledge and skills of participants to better adopt healthy eating behaviours, and (2) increase parents' ability to establish healthy eating behaviours in their children? The study also aimed to identify any barriers to the adoption of healthy eating choices. Convenience sampling was utilised to access a cross-sectional sample of approximately 200 participants and finally a total of 176 people participated in the programme. After participation in the programme, the highest proportion of participants indicated that they are able to identify healthy foods to eat. Eating breakfast insignificantly increased from 69% before the participation to 75% after their participation in the programme, and continued to increase by 86% in 3 months. Confidence levels of participants have been sustained after the 3-month survey with further increases in relation to children's healthy lunchboxes (increasing from 57% to 80%), and understanding suitable food for babies (from 50% to 70%). The stated benefits of the programme by participants are improved knowledge and lifestyle skills, the adoption of healthy eating behaviours, increased parent ability to establish healthy eating patterns among children, and increased self-reliance in relation to aspects of healthy food choices.
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