Implementation and maintenance of EnhanceFitness at YMCA-Affiliated sites: Strategies for success

Strategies used by instructors delivering an evidence-based program can make a difference for successful program implementation and maintenance.  We examine facilitators and barriers to the initial implementation and long-term maintenance of EnhanceFitness (EF) at YMCA-affiliated sites, focusing on strategies employed by program instructors to overcome challenges. This qualitative study used semi-structured individual phone interviews with 15 instructors and 2 master trainers from different Y-affiliated sites. Interviews were digitally recorded, transcribed, and analyzed within the RE-AIM framework. Facilitators reported include high quality and usefulness of the training instructors receive as part of certification to teach EF, and advantages of working for the YMCA, with its well-established infrastructure to support and promote the EF program.  Among barriers reported were participants’ age and health.  Instructors report various strategies for adapting program implementation to the age, health, and functional status of the participants, from wearing brightly-colored shoes so participants can see them better to adjusting exercises in order to prevent injuries. EF instructors attribute the successful maintenance of EF to its effectiveness (“it works in very real and personal ways”), social benefits for participants (“It’s like a social club, because they come to meet other people as well”), and inclusion of older adults  with all levels of ability (“even if you were with a walker or completely mobile, there was something that you could do.”). Research findings may inform the implementation of EF in other community settings and may inform the development of best practices for overcoming program-related barriers to implementation and maintenance.