Questions and Answers
The core elements of the program are the multiple component exercises (flexibility, aerobics, and lower extremity strength training), accompanied by the health education/behavior change sessions following a structured 24 session curriculum focused on managing osteoarthritis with a physically active lifestyle.
Session Frequency. The standard program meets three times per week for 8 weeks. Each session last 90 minutes (60 minutes of exercise followed by 30 minutes of health ed discussion). If offering the program three times a week is challenging for providers they can offer it twice a week instead, but they need to extend the length of the program to 12 weeks in order to accommodate the total number of sessions. A number of adopting sites around the country have chosen this option.
Target Participants. Fit and Strong! has targeted participants with pain and stiffness in their lower extremity joints due to osteoarthritis. We have shown benefits on lower extremity strengths and mobility in this population out to 18 months (Hughes et al., 2010). Because of this track record, we also think the program is appropriate for and would benefit persons with balance challenges and persons with Parkinsons- in other words, any population that is suffering from lower extremity strength, flexibility and balance challenges would be appropriate. We believe that participants with chronic conditions such as type II diabetes and hypertension/cardiovascular disease will also benefit from this program with physician consent.
Appropriateness for persons with upper body issues. The program also includes upper extremity flexibility and strength training exercises. Instructors are taught to complete the lower extremity exercises in every session and add the upper extremity as time permits. Thus, although priority is given to lower extremity exercises, instructors also address and the program is appropriate for persons with upper extremity OA as well.
Any persons that it should not be adapted for. The program has not been tested with persons with rheumatoid arthritis. Its effectiveness with that population is currently unknown.
Facilitators. We train certified exercise instructors to provide Fit and Strong! Sites that already have certified exercise instructors on staff or those who currently contract with them have a very easy time offering and maintaining Fit and Strong! These sites are typically large Senior Centers, Parks and Recreation sites, YMCAs, Medical Centers, and can include Senior Housing residences and Independent and Assisted Living facilities. We need a good sized room for the exercise component, can use hallways for the brisk walking component, and use ankle cuff weights and exercise bands that are frequently used by the above listed providers. We can also put providers in touch with sources to access exercise equipment.
Challenges. The main challenges faced by providers are the costs involved in paying the instructor and purchasing the equipment. Importantly, the equipment is a one-time cost; once the equipment is purchased it can be used over multiple iterations of the class. Sites can offset some of the cost of paying an instructor through facility memberships or class fees.
Questions. We have a standard set of evaluation tools that we ask all providers to use once they have adopted the program. The tools include a pre-post participant outcome assessment, participant attendance, and participant and instructor program evaluations. All of these tools are available on our interactive website. Instructors learn how to administer and enter these data during the instructor trainings.
Tools. See above. If practitioners adapt the program we would always be very happy to work with them to provide suggested evaluation tools; for example, if a site wanted to target balance we would be happy to work with them to select appropriate balance outcome measures.
Hispanic Fit and Strong! We recently finished a pilot test of the new Hispanic version of Fit and Strong- Fuerte y en Forma. We tested the program in two cities and obtained baseline, 8 week and 6 month outcomes. Findings were very positive and we look forward to their publication very soon.
Bundling Fit and Strong with other evidence-based programs. We currently have a grant that is enabling us to test a lay leader instructor model. In this model, we take persons who are instructors for programs like the Chronic Disease Management Program and A Matter of Balance and train them in Fit and Strong. We are obtaining our standard outcome measures described about for participants and instructors and will compare these data to those obtained using the Certified Instructor model.