Research Spotlight

Page Last Updated:  09/17/2009

Highlights of HMC Research-Sue Hughes

Maintenance of Exercise Adherence Among Older Adults with Osteoarthritis

Fit and Strong! is an award-winning, evidence-based physical activity/behavior change program that effectively targets older adults with lower-extremity osteoarthritis.  It addresses documented strength and aerobic deficits in this population and is inexpensive and simple to replicate (Hughes, et al., 2004; Hughes, et al., 2006).   Fit and Strong! is a group and facility-based program that meets for 90 minutes three times per week for eight weeks (24 sessions total).  The first 60 minutes consist of a multiple-component exercise program that incorporates flexibility/balance, aerobic walking and/or low impact aerobics and lower-extremity strength training using elastic exercise bands and adjustable ankle cuff weights.  The remaining 30 minutes of each session are devoted to group problem-solving and education using a curriculum designed to facilitate arthritis symptom management, self-efficacy (SE) for exercise, and commitment to lifestyle change.  In Week 6, participants meet with instructors to develop an individualized physical activity plan of their choice that can include home-based exercise or an ongoing group/facility-based program (or combination of the two) with the goal of maintaining 20 minutes of flexibility, 20 minutes of aerobic and 20 minutes of resistance training a minimum of 3 times per week.  This plan becomes a physical activity maintenance contract that each participant signs at a graduation ceremony on the last day of class.

As part of our HMC-funded study, we replicated Fit and Strong! at senior centers in Chicago  to compare different methods of fostering maintenance of physical activity after Fit and Strong! ended. We enrolled 536 study participants over the course of six iterations of Fit and Strong! held at six Chicago Department on Aging Senior Centers.   All study participants enrolled in Fit and Strong! and were randomized at 8 weeks to either a negotiated maintenance arm or a mainstreamed arm  Negotiated group participants developed an individualized maintenance plan that reflected their exercise preferences. Mainstreamed participants were asked to enroll in a best practice multiple component program offered at the same facility.    Half of the participants in both arms were then assigned to receive telephone reinforcement (TR) that tapered off over time. All participants were assessed at 2,6,12 and18 months.  Although we are still analyzing outcomes, preliminary findings  demonstrate consistently strong outcomes for all participants in Fit and Strong! on exercise maintenance over time, performance measures (sit-stand and 6-minute distance walk), and on arthritis-related variables such as lower extremity pain, stiffness, and physical function.  These benefits have been observed at 2 months (end of Fit and Strong!) and were maintained at 6, 12 and 18 months.

As part of this trial we tested moving from using physical therapist instructors to using certified exercise instructors who are less expensive and more accessible in rural areas.   Identical outcomes obtained on 161 participants in PT-led classes compared to 190 in CEI-led classes have shown no difference on 12 of 14 outcomes tested, indicating that use of CEIs is safe and effective (Seymour, Hughes et al, 2009), We have also developed participant and instructor manuals, an 8-hour instructor training curriculum, a cadre of trained instructors and master trainers, and an instructor hotline.  We have also developed an interactive website that tracks attendance, participant pre and post outcomes, participant program evaluations and instructor program evaluations.  We have the capacity to monitor fidelity to Fit and Strong! through master trainer visits to adopting sites in weeks 2-5 of program implementation. 

The Fit and Strong! website (www.fitandstrong.org) provides information about Fit and Strong! to interested providers across the U.S. and internationally. The site enables us to track enrollment of participants in Fit and Strong! at participating sites, track program attendance, and track the administration of pre/posttest participant outcomes and program evaluations via a secure login.  It also enables us to post information about instructor trainings as they become available and to communicate with providers about any problems that they encounter replicating Fit and Strong! in their communities.

Interested in having your HMC research highlighted?  Please email Meghan Wernicke for more details.