Replicating the EnhanceFitness Physical Activity Program in Hawai<i's Multicultural Population, 2007-2010

Abstract

BackgroundDespite evidence of the benefits of regular physical activity, many older adults are not physically active. Health professionals are challenged to replicate evidence-based programs to address low levels of physical activity among members of their communities.Community ContextEnhanceFitness is an evidence-based group exercise program developed in Seattle to increase the strength, flexibility, and balance of older adults. Hawai`i's Healthy Aging Partnership supported the rural island of Kaua`i to select, adapt, implement, and evaluate EnhanceFitness to increase physical activity among older adult residents (75% Asian/Pacific Islander [API]).MethodsEvaluation measures of the replication of EnhanceFitness included fidelity of EnhanceFitness delivery and participants' attendance, satisfaction with the program, confidence to exercise regularly, and pre-post fitness check measures of physical performance (chair stands, arm curls, and the up-and-go test).OutcomesBetween July 2007 and December 2010, 223 Kaua`i residents enrolled in EnhanceFitness; 178 (80%) participated at least 4 months and completed the 4-month fitness checks. EnhanceFitness classes were offered with a high degree of fidelity, and both API and white participants significantly improved their physical performance (chair stands, t = −11.06, P < .001; arm curls, t = −6.66, P < .001; and up-and-go test, t = 6.56, P < .001). Participants reported high satisfaction with the program and instructors and high confidence to continue to exercise regularly.InterpretationEnhanceFitness is replicable in Hawai`i and increased physical performance among API and white older adults. This case study outlines a replication process that other communities can follow.

Enhance ® Fitness Dissemination and Implementation,

“…Overall, EF has reached a racially diverse population of older adults, including African Americans and Asian/ Pacific Islanders. 11,12 Participants are predominately female and aged 470 years. 5,6,[11][12][13] EF participants, on average, reported a range of 0.5-1.48 chronic conditions as indicated by the Charlson Comorbidity Index.…”

Considerations When Disseminating American-Developed, Evidence-Based Health Promotion Programs in China

“…A university partner could help identify cultural discrepancies to ensure a Westernbased program could be adapted to Chinese culture. The training manual would need to be translated and culturally sensitive marketing materials would need to be developed; the name EnhanceFitness might need to be changed to better resonate with locals (Tomioka, Sugihara, & Braun, 2012); and music played during the class would likely need to be adapted. The academic partner could also provide oversight to the program to assure program fidelity.…”

Implementation of an Evidence-Based Exercise Program for Older Adults in South Florida

“…Intervention studies have documented the efficacy of EF and have shown that EF improves performance on fitness assessments, perceived physical functioning, social functioning, mental health, and decreases bodily pain [15–18]. Limited evidence exists demonstrating that EF can be translated to community-based settings and still achieve improvements in fitness and wellbeing [19]. Therefore, we investigated the ability of HARC to implement and sustain the EF program in South Florida over a three-year period.…”