Fit & Strong!®

Evidence-level

Evidence-Based (About evidence-level criteria)

Description

Osteoarthritis (OA) is a common chronic condition among older adults that limits physical activity and is a risk factor for related disabilities. Research has proven that arthritis-associated muscle weakness and endurance can be minimized or reversed with regular exercise. The Fit & Strong!® program was developed to assist older adults with lower extremity OA to improve mobility and maintain independent functioning. The program combines 2 components shown effective for OA: physical activity and behavioral health education.

The Fit & Strong! design focuses on affordability, easy replication, and involves an eight-week physical activity/behavior change program for older adults.

In 2017, the National Council on Aging approved the program as an evidence-based fall prevention approach. As of August 2020, the program is offered in many locations throughout 32 states, including several rural communities, and the District of Columbia.

In recent years, researchers have expanded the program and created a new program, Fit & Strong! Plus. This program combines interventions proven successful in prior studies: physical activity and weight management.

In response to COVID-19 — and as a way to better reach rural older adults — under development is a fully online/remote adaptation of Fit & Strong! with anticipated availability in the next 4 to 8 months.

Fit & Strong! offers online instructor training for new instructors. The asynchronous online training consists of 5 modules and uses videos, slides, pictures, and interactive test questions. The online training can be taken by instructors anywhere they have an internet connection.

Created by teams at the of Illinois at Chicago School of Public Health's Institute for Research and Health Policy, funding for the original program's development was provided by the Centers for Disease Control and Prevention, the National Institute on Aging, the Arthritis Foundation, and The Retirement Research Foundation.

Services offered

Fit & Strong! classes meet 3 times per week for 8 weeks or 2 times per week for 12 weeks (24 total sessions). The classes consist of multi-component exercises that focuses on:

• Flexibility
• Aerobic training
• Strength/resistance training
• Balance
• Health education and self-management for sustained behavior change
• Individualized health plans for post-class maintenance

Additionally, the program also includes warm-up and stretching/balance exercises and a group problem solving component that is very important in increasing participants' confidence in their ability to both exercise safely and remain motivated to continue a physically active lifestyle.

Before program completion, instructors negotiate exercise adherence contracts with participants and emphasize a lifestyle which includes three self-directed 1-hr exercise sessions per week.

Results

Published studies have demonstrated that Fit & Strong! participants will likely see these sustained improvements after 12-18 months after an 8-week course:

• Increased confidence in their ability to exercise safely with arthritis
• Increased participation in exercise
• Increased lower extremity strength and mobility
• Decreased lower extremity stiffness
• Decreased anxiety and depression

Originally designed using only physical therapists (PTs) as instructors, additional research found that certified exercise instructors (CEIs) provided similar outcomes for participants. CEIs are less expensive than PTs, and likely more available in rural areas, making Fit & Strong! easier to implement.

In addition to CEIs, individuals who are certified in comparable evidence-based exercise programs like A Matter of Balance and chronic disease self-management programs (CDSMP) can also be trained as Fit & Strong! Instructors.

For more detailed information about program effectiveness:

• Hughes SL, Tussing-Humphreys L, Schiffer L, Smith-Ray R, Marquez DX, DeMott AD, Berbaum ML, Fitzgibbon ML. (2020). Fit & Strong! Plus Trial Outcomes for Obese Older Adults with Osteoarthritis. Gerontologist. 60(3):558-570. Article Abstract.
• Fitzgibbon ML, Tussing-Humphreys L, Schiffer L, Smith-Ray R, Demott AD, Martinez M, Berbaum ML, Huber GM, Hughes SL. (2018). Fit & Strong! Plus: Descriptive Demographic and Risk Characteristics in a Comparative Effectiveness Trial For Older African-American Adults with Osteoarthritis. J Aging Res Clin Pract. 7(1):9-16.
• Der Ananian, C.A., Smith-Ray, R., Meacham, B., Shah, A. & Hughes, S. (2017). Translation of Fit & Strong! for use by Hispanics with Arthritis : A feasibility trial of ¡En Forma y Fuerte!. J Aging Phys Act. 25(4):628-638. Article Abstract.
• Hughes, S.L., Seymour, R.B., Campbell, R.T., Desai, P., Huber, G., & Chang, H.J. (2010). Fit & Strong!: Bolstering Maintenance of Physical Activity among Older Adults with Lower-extremity Osteoarthritis. American Journal of Health Behavior, 34(6), 750-63.
• Seymour, R.B., Hughes, S.L., Campbell, R.T., Huber, G.M., & Desai, P. (2009). Comparison of Two Methods Of Conducting the Fit and Strong! Program. Arthritis and Rheumatism, 61(7), 876-84.
• Brady, T.J., Jernick, S.L., Hootman, J.M., Sniezek, J.E. (2009). Public Health Interventions for Arthritis: Expanding the Toolbox of Evidence-based Interventions. Journal of Women's Health, 18(12),1905-17. Article Abstract
• Hughes, S.L., Seymour, R.B., Campbell, R.T., Huber, G., Pollak, N., Sharma, L., & Desai, P. (2006). Long-term Impact of Fit and Strong! On Older Adults With Osteoarthritis. The Gerontologist, 46(6), 801-14. Article Abstract

Replication

For those interested in starting a Fit & Strong! program, a 12-page guide is available providing information including readiness assessments, instructor requirements, support resources and quality assurance procedures.

Fit & Strong instructors must:

• Be certified by either a nationally recognized fitness organization or serve as a leader of another evidence-based exercise program
• Complete Fit & Strong! training and certification

Program costs will vary depending on space, instructor and equipment costs such as:

• Open area for walking, ideally with space to walk
• Chairs for participants
• Elastic exercise bands
• Adjustable ankle cuff weights
• Floor mats
• Fit & Strong! Instructor and Participant Manuals

The program is licensed by the University of Illinois, Chicago and licensing fees apply.

Contact Information

Andrew DeMott, Program Manager
Fit & Strong! Team
312.355.3174
ademot1@uic.edu