Expanding the Reach of Fit and Strong! A Comparison of Implementation Methods

Osteoarthritis (OA) is the most common condition affecting older people and the leading cause of disability among older adults. Fit and Strong! is a low-cost, evidence-based, award winning multiple component exercise program that combines flexibility, aerobic walking and strength training with health education for sustained behavior change among older adults with lower extremity OA. To prevent harm to participants, we involved Master's trained physical therapists in the development and implementation of the program during its efficacy stage. However, because we now seek to expand the program's reach, to reduce costs we have trained Certified Exercise Instructors (CEI) to conduct it! Preliminary analyses comparing PT-led classes (117 participants) to CEI-led classes (151participant) found no significant differences in demographic characteristics by group. Across groups, participants have a mean age of 70, the majority are female (85%), high school graduates (85%), and have Class II ARA functional class scores (74%). Approximately 64% of participants are minorities, 36% are low income, and 81% are obese or overweight at entry to the program. Importantly, we saw no significant differences by group on outcomes at 2 months, including lower extremity strength, aerobic capacity, pain, stiffness, or physical function. Significant differences favoring the PT-led classes were seen on two mediators, self-efficacy for exercise and self-efficacy for exercise adherence in the face of barriers. Participant evaluations also rated both types of instruction equally highly. Practical issues, including recruiting and monitoring skilled exercise instructors, and methods for monitoring the fidelity of Fit and Strong!, will be discussed.