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Predictors of Improvement in Physical Function in Older Adults in an Evidence-Based Physical Activity Program (EnhanceFitness)

Fishleder, Sarah PhD1,2; Petrescu-Prahova, Miruna PhD1,2; Harris, Jeffrey R. MD1,2; Leroux, Brian PhD3,4; Bennett, Kimberly PhD5; Helfrich, Christian D. PhD2; Kohn, Marlana MPH1; Hannon, Peggy PhD1,2

Journal of Geriatric Physical Therapy: October/December 2019 - Volume 42 - Issue 4 - p 230–242
doi: 10.1519/JPT.0000000000000202
Research Reports

Background and Purpose: Declines in strength, flexibility, and balance in older adults can lead to injuries and loss of independence and are particularly common in those of greater age and in worse health. EnhanceFitness (EF) is a nationally disseminated, evidence-based group exercise program for older adults that has been shown to improve function through cardiovascular, strength, flexibility, and balance exercises. This article examines changes in, and predictors of, participant physical function from baseline through 2 program cycles of EF as measured by 3 physical function tests: arm curls, chair stands, and 8-foot up-and-go.

Methods: We analyzed data on participants who attended at least 2 consecutive 16-week program cycles between January 2005 and June 2016. We ran 3 random-effects linear regression models, 1 for each physical function test, and accounted for missing data and clustering by class site. Independent variables included attendance, demographics, and health status.

Results and Discussion: A total of 7483 participants completed baseline and 2 sets of follow-up physical function tests. For all 3 physical function tests, participants showed some degree of improved physical function at each follow-up, and greater program attendance predicted clinically significant improvements. Some participants had less improvement: females, those less active at baseline, older than 75 years, not married or partnered, or in fair or poor health, those who had experienced at least 1 fall, and those with a disability.

Conclusion: EnhanceFitness program providers may need to implement additional measures to support the participants who could benefit most from EF, such as targeting messaging, coordinating with referring providers to emphasize attendance and general activity in specific participants, and offering additional support to groups who show less improvement during classes. The evidence presented here may inform clinical decision making for older adult patients and increase health care provider confidence in EF and similar exercise programs, thereby providing a mechanism to maintain and continue functional gains made in clinical or rehabilitation settings.

1Health Promotion Research Center, University of Washington, Seattle.

2Department of Health Services, University of Washington, Seattle.

3Department of Biostatistics, University of Washington, Seattle.

4Department of Oral Health Sciences, University of Washington, Seattle.

5Department of Rehabilitative Medicine, University of Washington, Seattle.

Address correspondence to: Sarah Fishleder, PhD, Health Promotion Research Center, Department of Health Services, University of Washington, 1107 NE 45th St #200, Seattle, WA 98105 (

An early iteration of this paper was presented as a poster at the Academy Health Annual Research Meeting in New Orleans, June 25-27, 2017.

This work was supported by a Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Number U48DP005013 from the Centers for Disease Control and Prevention. The findings and conclusions in this manuscript are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The authors declare no conflicts of interest.

Richard Bohannon was the Decision Editor.

© 2019 Academy of Geriatric Physical Therapy, APTA
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