The Impact of the COVID-19 Pandemic on Older Adults Who Participate in Group Physical Exercise Program.

The COVID pandemic exposed the vulnerability of older adults in myriad ways and social service organizations faced unprecedented challenges in safely providing support for older adults. Since 2007, Hawai'i Healthy Aging Partnership (HHAP) has offered Enhance®Fitness, an evidence-based program to reduce the risk of falls and promote health among older adults. Due to the pandemic, all the Enhance®Fitness sites had to close and stop offering the program. The HHAP started to provide alternative activities remotely in May 2020. To explore the pandemic's impact, the feasibility of online exercise programs, and the support needed among older adults to stay physically active, HHAP surveyed existing Enhance®Fitness participants and received 291 responses (59% response rate). The study used frequency distributions, comparison of means, and chi-square to analyze the survey data. Findings showed that the shutdown of the group exercise program during the pandemic led to a health status decline, a reduction in physical activities, and a shift from group to individual physical activities among older adult participants. Most respondents tried the remote exercise opportunities during the pandemic and would consider joining the remote programs in the future. However, about one-fourth of the respondents did not participate in remote exercise activities due to the lack of electronic devices, internet access, or interest in remote activity formats. To ensure equitable access to physical exercise programs for older adults in the post-pandemic era, it is critical to address the access challenges and resources needed for providing multiple programming options.

Twelve-Month Retention in and Impact of Enhance®Fitness on Older Adults in Hawai'i.

INTRODUCTION: Enhance®Fitness is a low-cost group exercise program designed specifically for older adults (60+ years) to improve physical performance. The Hawai'i Healthy Aging Partnership, a statewide health promotion initiative, has continuously offered Enhance®Fitness to Hawai'i's multicultural population since 2007. This study examined 12-month participation in and impact of Enhance®Fitness on physical performance among older adults in Hawai'i. METHOD: Linear mixed-effects models were applied to analyze the physical performance measures (chair-stands, arm curls, and the up-and-go test) collected at baseline (month 0) and at 4, 8, and 12 months. We also compared the characteristics of participants who participated in the program for 12 months with those who dropped out in order to gain insights on participant retention. RESULTS: Of 1,202 older adults with baseline data, 427 (35.5%) were continuously enrolled in Enhance®Fitness for 12 months and participated in follow-up data collection. On average, participants attended 63.7% of thrice-weekly classes each month. Participants' physical performance measures improved after 4 months, continued to improve until 8 months, and were maintained thereafter. Besides continuous attendance, performance-measure improvements were associated with younger age, male gender, living with others (vs. alone), and fewer chronic conditions. Compared to those who completed 12 months of the program, the 775 who left the program over the course of the year were more likely to be younger, to be Caucasian (vs. Asian or Pacific Islander), to self-report depression as a chronic condition, and to have lower levels of fitness at baseline. Common reasons for dropping out were illness, relocation, time conflicts, lost interest, and transportation issues. CONCLUSIONS: Long-term participants in Enhance®Fitness initially improved and then maintained physical performance. Future research is needed to identify strategies to maintain enrollment of older adults in the exercise programs over time.

Perceptions of Factors Impacting Longevity among Hawai'i Older Adults.

With increased life expectancy, people need more education about healthy aging. This paper examines older adult perceptions regarding various factors impacting longevity, including genetics, lifestyle, and the environment. Data were collected from 733 Hawai'i adults age 50 years and older (39% Caucasian, 27% Japanese, 19% Native Hawaiian and Pacific Islander (NHOPI), 9% Chinese, and 7% Filipino) through randomized telephone interviews. Participants were asked to rate a variety of factors as having "great impact," "some impact," or "no impact" on lifespan. Regardless of ethnicity, more than half of the participants felt that eating habits, exercise, health information, health care, and the environment had great impact on lifespan. Less than half felt that economic status and community had great impact. Compared to the all ethnic groups, Filipino respondents were significantly less likely to feel that smoking (44%, compared with an average across all race/ethnicities of 64%) and stress (48%, average 62%) had great impact. Chinese participants were more likely to feel that drinking alcohol (64%) had great impact (average 38%). Filipinos and Chinese were more likely to perceive that working conditions have great impact (65% and 56%, respectively; average 45%), and NHOPI and Filipinos were more likely to perceive the natural environment as having great impact (59% and 54%, respectively; average 46%). Findings suggest that cultural values and experiences may shape older adults' perceptions of factors associated with lifespan, providing guidance for health professionals on how to tailor health messages to older adults in different ethnic groups.

Improving behavioral and clinical indicators in Asians and Pacific Islanders with diabetes: findings from a community clinic-based program.

AIMS: This project tested the six-month impact of Stanford's Diabetes Self-Management Program (DSMP), adapted for Asians and Pacific Islanders (APIs), on behavioral and clinical indicators. METHODS: Participants attended DSMP workshops at a community health center. Employing a one-group, pre-post-test design, data were collected at baseline and six-months. Ninety-six eligible API adults were enrolled. All attended four or more of the six weekly sessions, and 82 completed data collection. Measures included body mass index, blood pressure, blood lipids, blood glucose, HbA1c, as well as health behaviors. Data were analyzed by descriptive statistics and paired t-tests. RESULTS: Adaptations to DSMP were minimal, but critical to the local acceptance of the program. At six-months, significant behavioral improvements included: (1) increased minutes in stretching and aerobic exercise per week (p<0.001); (2) reduced symptoms of hypoglycemia and hyperglycemia (p<0.001); (3) increased self-efficacy (p<0.001); and (4) increased number of days and times testing blood sugar levels (p<0.001). Significant clinical improvements included: (1) lower BMI (p<0.001); (2) lower HbA1c (p<0.001); (3) lower total cholesterol, triglycerides, and LDL (p<0.001); and (4) lower blood pressure (p<0.001). CONCLUSIONS: Findings suggest that the DSMP can be successfully adapted to API populations and can improve clinical measures as well as health behaviors.

Examining Sustainability Factors for Organizations that Adopted Stanford's Chronic Disease Self-Management Program.

In 2006, funds were received to replicate Stanford's Chronic Disease Self-Management Program (CDSMP) among eldercare providers in Honolulu. This case study, conducted 1 year after the close of the initial 3-year replication grant, explored factors for sustaining the delivery of CDSMP, with an aim to create guidelines for cultivating sustainability. Face-to-face semi-structured interviews were conducted with one representative from each of eight eldercare agencies, with the representative specified by the agency. Representatives discussed the presence and strength (low, medium, or high) of sustainability factors, including readiness, champions, technical assistance, perceived fit of CDSMP with their agency, CDSMP modifiability, perceived benefits of CDSMP, and other. Only three of the eight agencies (38%) were still offering CDSMP by the end of 2010. Agencies who sustained CDSMP rated higher on all sustainability factors compared to those that did not sustain the program. Additional factors identified by representatives as important were funding and ongoing access to pools of elders from which to recruit program participants. When replicating evidence-based programs, sustainability factors must be consciously nurtured. For example, readiness must be cultivated, multiple champions must be developed, agencies must be helped to modify the program to best fit their clientele, evaluation findings demonstrating program benefit should be shared, and linkages to funding may be needed.

Implementing evidence-based programs: a four-step protocol for assuring replication with fidelity.

Health care providers are challenged to replicate evidence-based programs in their communities. These programs may be adapted to fit new communities, but the key components must be delivered with fidelity. This article describes a four-step fidelity assurance protocol developed by the Hawai'i's Healthy Aging Partnership as it adapted and replicated evidence-based health promotion programs for Hawai'i's older adults. The four steps are the following: (a) deconstruct the program into its components and prepare a step-by-step plan for program replication; (b) identify agencies ready to replicate the program, and sponsor excellent training to local staff who will deliver and coordinate it; (c) monitor the fidelity of program delivery using standardized checklists; and (d) track participant outcomes to assure achievement of expected outcomes. The protocol is illustrated with examples from Hawai'i's Healthy Aging Partnership's experience replicating EnhanceFitness, a senior exercise program. This protocol is transferrable to other communities wanting to adapt and replicate evidence-based, public health programs.

Replicating the EnhanceFitness physical activity program in Hawai`i's multicultural population, 2007-2010.

BACKGROUND: Despite 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 CONTEXT: EnhanceFitness 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]). METHODS: Evaluation 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). OUTCOMES: Between 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. INTERPRETATION: EnhanceFitness 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.

Adapting Stanford's Chronic Disease Self-Management Program to Hawaii's multicultural population.

PURPOSE OF THE STUDY: Stanford's Chronic Disease Self-Management Program (CDSMP) has been proven to increase patients' ability to manage distress. We describe how we replicated CDSMP in Asian and Pacific Islander (API) communities. DESIGN AND METHODS: We used the "track changes" tool to deconstruct CDSMP into its various components (e.g., recruitment and staffing) and the "adaptation traffic light" to identify allowable modifications to the original program. We monitored local leaders' fidelity of delivery of CDSMP and tracked participants' attendance, satisfaction, and 6-month outcomes. RESULTS: Between July 2007 and February 2010, 584 completed a CDSMP workshop. Baseline and 6-month data were available for 422 (72%), including 53 Caucasians, 177 Asians, and 194 Pacific Islanders. All 3 groups realized significant decreases in social and role activity limitations and significant increases in communication with physicians. Asians and Pacific Islanders also realized significant increases in self-rated health and time spent engaging in stretching/strengthening exercise. Asians also reported significant reductions in health distress and self-reported physician visits and increases in time spent in aerobic exercise, ability to cope with symptoms, and self-efficacy. IMPLICATIONS: Our experience suggests that CDSMP can be modified for increased cultural appropriateness for API communities while maintaining the key components responsible for behavior change.

Cost-benefit estimates of an elderly exercise program on Kaua'i.

The elderly consume a disproportionate amount of health care resources, and the recent trend in obesity will only escalate costs. EnhanceFitness® (EF) is an exercise program designed to increase the strength, flexibility, and balance of older adults. A comprehensive controlled study in Washington state of an elderly population has shown that participants who attend at least one EF class per week reduce healthcare costs by 20% per year. The present study reports the costs and potential benefits of replicating EF on Kaua'i. For Kaua'i the annual cost of an EF pilot program for 132 clients would be $204,735. Attendance records of the Kaua'i program showed that 96 (73%) of those enrolled attended at least weekly. Based on national reports of healthcare costs for the elderly, averting 20% of the costs for these 96 elderly would save $344,256 per year. The expected investment to return ratio, I-R ratio, for EF on Kaua'i is about 1-1.8. On economic grounds, a case can be made to support and expand these types of programs. In these times of budget cuts, cost-benefit analysis provides a common economic "language" to prioritize among different programs.

Caregiving and older Japanese adults: lessons learned from the periodical literature.

The United States is on the threshold of a substantial growth of older adults that increasingly reflects the cultural diversity inherent in this nation. Culture shapes the experience of aging and caregiving, and thus becomes an important factor when considering social services for older adults. One culturally distinct minority group--Japanese--is reputed to have one of the longest life expectancies in the US population, and, thus, information about their experiences may expand knowledge on aging and culture. A periodical literature review of older Japanese adults was undertaken to assess lessons learned about the association of aging and culture. Two important lessons that emerged emphasized the influence of cultural values on family caregiving, and women as caregivers. Implications for practice with this population are drawn and broad directions for the profession of social work are provided.