The Role of Community Partnerships in Testing Three New Versions of Fit and Strong!

1. The Role of Community Partnerships in Testing Three New Versions of Fit and Strong! Susan Hughes,PhD Renae Smith-Ray, PhD Yolanda Curry, MPA Sue Vega Colleen Lammel-Harmon, RD, LDN Claudia Aquilina

2. Introductions • Susan Hughes, PhD(Professor, School of Public Health and Director, Center for Research on Health & Aging, University of Illinois at Chicago) • Renae Smith-Ray, PhD(Research Scientist for Center for Research on Health and Aging, UIC) • Yolanda Curry, MPA(Chicago Department of Family and Support Services-Area Agency on Aging) • Sue Vega(Senior Programs Manager at Alivio Medical Center) • Colleen Lammel-Harmon, RD, LDN(Wellness Manager at Chicago Park District) • Claudia Aquilina (Activity Director, Senior Services Associates, Inc.)

3. Today’s Objectives • Brief overview of Fit & Strong! • Describe three examples of how Fit & Strong! has been adapted : • Inclusion of weight management / dietary change strategies • For Spanish-speaking participants • Bundling with other evidence-based programs such as Matter of Balance • Describe initiatives for system-level dissemination of Fit & Strong!

4. Fit and Strong!

5. F&S!- An Evidence-Based Program An 8-week multiple component physical activity / behavior-change program for older adults with lower-extremity pain and stiffness • 3 sessions per week, 90 minutes per session • First 60 minutes = physical activity • Last 30 minutes = group discussion / problem solving • Implemented and evaluated in community-based settings, tested through efficacy, effectiveness, and dissemination trials, and has achieved significant outcomes

6. Adapting Evidence-Based Programs for Community-Based Practice • Core Components of the program should not be changed! • These components are critical to achieving significant improvements • A good program will be somewhat adaptable to enhance dissemination within a variety of settings and contexts Program Fidelity Program Reinvention or Adaption

7. Dissemination of Fit & Strong! Fidelity monitored Essential Elements Defined Program manuals for participants and instructors Good participant retention Ease of Implementation Program support available from Fit & Strong! team Standardized Training for Fit & Strong! Instructors

8. Adaptation Example 1: Fit and Strong! Plus • Comparative effectiveness trial examining whether Fit & Strong! is more effective with an added weight management/dietary change component • Osteoarthritis symptoms exacerbated by obesity • Weight loss of 5.1 kg over a 10-year period decreases the odds of developing knee OA by more than 50% (Felson 1992) • Currently, no evidence-based program exists that combines physical activity with weight loss for overweight/obese older adults with osteoarthritis

9. Adaptation Example 2: Hispanic Version of Fit and Strong! • Need for more evidence-based programming for Hispanic older adults • All Fit & Strong! materials translated into Spanish • Hispanic version tested in Chicago and Phoenix • Significant improvements in physical activity, self-efficacy, and OA symptoms Sources: : US Administration on Aging http://www.aoa.gov/AoARoot/Aging_Statistics/minority_aging/Facts-on-Hispanic-Elderly.aspx and Centers for Disease Control and Prevention 2012 Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion

10. Adaptation Example 3: The Importance of Bundling Evidence-Based Programs The Need • No systematic way for older adults to graduate from program A and move on to program B The Potential of Bundling • Provides a roadmap • Provides a way for individuals to progress their exercise intensity • Boosts maintenance of positive health promotion behaviors Example: Fit & Strong! and Matter of Balance • MOB-An evidence-based program designed to reduce fear of falling and increase activity levels among older adults • Both Matter of Balance (MOB) and Fit and Strong (F&S) offered over past year at multiple Senior Services Associates sites

11. Chicago Department of Family & Support Services, Senior Services Yolanda Curry, MPA Deputy Commissioner, DFSS

12. DFSS SENIOR CENTERS • 6 Regional Senior Centers 15 Satellite Senior Centers • Fitness Classes* Wellness Talks*Medication Management * Health Screenings*Social Work Consultations*Support Groups* Arts & Crafts * Benefits Assistance *Computer Instruction*Lecture Series* Information and Assistance* Wide Range of Learning Experiences*Drop-in Activities* Trips & Tours *Flu Clinics • 274,175 Visits to Regional Centers in 2012 • 264,316 Visits to Satellite Centers in 2012 • 538,491 Total Visits 2012 WHERE ADULTS 60 OR BETTER* “ENJOY MORE” LAUGH MORE * MOVE MORE * EXPLORE MORE *EXPRESS MORE * LEARN MORE * CARE MORE *Satellite Centers currently have Boomer Clubs where participant eligibility begins at 55 or better.

13. What is a Senior Center? Recognized as the most diverse service available to older adults nationally: Senior Centers are designated as community focal points (Older American Act) or as places where “older adults come together for services and activities that reflect their experience and skills, respond to their diverse needs and interests, enhance their dignity, support their independence, and encourage their involvement in and with the center and the community.”

14. The Importance of Senior Centers Research has shown that people who regularly attend senior centers: • Are in need of a support system to help them improve or maintain their health and quality of life. • Have healthier behaviors in terms of the foods they eat and their participation in exercise. • Have fewer mental health problems, such as depression. • Have a more positive outlook on life. • Believe their attendance helps them to maintain their independence and to keep them socially connected. • Say they enjoy having somewhere to go every day. • Often volunteer, which can help empower them especially if they feel that life after retirement has diminished the meaning of their lives.

15. DFSS SENIOR CENTERS Demographic Profile

16. Chicago Senior Centers and Fit & Strong! : A Natural Fit • City of Chicago Senior Centers administers a nationally recognized senior fitness program. • Harvard University Innovations in Government Semi-Finalist. • National Council on Aging 10 Best Practice Program. • City of Chicago Fitness Program provides group exercise and/or personal training in 40+ locations. In 2012, there were 8,747 unduplicated clients served in City of Chicago’s Fitness Program. • Chicago Senior Centers were early research sites for Fit & Strong! • In 2012 renewed effort to begin offering Fit & Strong! broadly throughout Chicago senior centers. • Fit & Strong is highly regarded by participants. We have received positive feedback from both instructors and participants. • Received an Aldermanic request for current Fit & Strong participants to continue in the newer program offerings.

17. Partnership Between Pilsen Senior Center and UIC Susan Vega

18. Pilsen Satellite Senior Centerat Casa Maravilla • Three public and private organizations in partnership • Programming designed to meet specific needs of older adults in the community • Focus on getting people what they need as articulated by them • A very Latino / Mexican-Mexican American place

19. Key Lessons Learned • It is not necessary to wait for optimal conditions • Focus on what you cando • Find people in the community who share and support your vision • Keep a sharp eye on the mission • When in doubt, check in with your constituents

20. ¡Fuerte y en Forma! at the Center • Strong effort to recruit people in the building and program participants • Good participation from Center members; building residents • Rave reviews of program / instructor • Big demand for program to continue • Program of great benefit to community

21. Participant Feedback • “Program seemed designed for me! Helped me to know how to keep active”. Participant A. • “Provided practical advice, clear messages and opportunity to learn how to manage my arthritis”. Participant B. • “Introduced us to the Center. Helped us start on a path to increased physical activity”. Mr. and Mrs. Participants C. • Another couple that was not included in the intervention learned about the Center and became regulars.

22. Susan Vega Senior Programs Manager Alivio Medical Center 312-743-0493 svega@aliviomedicalcenter.org

23. Chicago Department of Family & Support Services, Senior Services Colleen Lammel-Harmon Wellness Manager, Chicago Park District

24. Our Mission: -To enhance the quality of life in Chicago by becoming the leading provider of recreation and leisure opportunities. -To provide safe, inviting, and beautifully maintained parks and facilities. -To create a customer-focused and responsive park system.

25. Chicago Park District • Every adult is a kid at heart. That’s why the Chicago Park District provides adult programming for our big kids to stay fit and active. • The Chicago Park District operates many adult classes including aerobics, kickboxing, swimming, aquatic exercise, basketball, boxing, volleyball, yoga, and conditioning. • We are the leading provider of recreation, fitness, and leisure activities. • Right now we offer numerous physical activities and programs for all ages. • Family Focus is the goal of the Chicago Park District. • We want to offer a variety of programs for all Chicagoans at an affordable cost.

26. Senior Programs Over 380 senior programs , including senior club, games, sewing, dance, and 200 focused on fitness style programs including aquatic exercise, fitness, yoga, conditioning, and even 1 power lifting. Encourage structured programs for those needing social support and instruction. Offer unstructured programs for those desiring less curriculum. Senior Games- Olympic Program

27. Objectives of Chicago Park District and Fit and Strong Plus: • Increased physical activity for seniors; • Develop healthier eating habits; and • Build sustainable partnership to impact various levels of the city; • Sustain “joint” partner programs and increase level of fitness to seniors to adopt better life satisfaction and skill. • Refer non active seniors to a tremendous high level program like Fit and Strong Plus.

28. Fitness Classes and Centers (71) We offer several fitness classes for beginners to advanced, kids to seniors.Many Flavors. All senior only classes Free. All others- Seniors get 50% off prices ranging $12-20/session

29. Testimonies- Fit and Strong! Plus “Thank you for making me more healthy” “I can move my arms better now and eating much healthier” “I have had 2 knee replacements and bad asthma and after taking the Fit and Strong Plus program I feel so much better!” “This program is great, this program is great, this program is great and I can move my BODY! Thank you!” “Since taking the program, my doctor is amazed at results, I have stopped taking so much medication and have been told I can avoid my check up and extra tests for 3 months” “This program was a God sent and I now read labels before I buy and eat. I suffered from Arthritis from head to toe and I can now move freely”

30. Benefits of Fit and Strong! Program Partnership with CPD • Highly qualified program for non active seniors • Nutrition aspect well received • Introduces Seniors to other programs to build sustainability • Have worked with UIC to engage seniors to resume and continue exercise program • Seniors have great retention in programs. • Win – win for both Partners- Save rental fees and gain new participants. • Joint Fitness Trainings to staff

31. Other Options for Fit and Strong! Plus- Fitness Prescription Waiver Prescription for Exercise Offers free fitness sessions (3 months) to patrons with doctor’s prescription to exercise for obesity related disease and BMI >25

32. New ideas learned from F/S program: • Senior Fitness and Nutrition Classes • Team Seniors with Teens and Youth • Combine non-fitness with fitness class for hook and catch! • Develop more Active Senior Clubs For more information: www.chicagoparkdistrict.com/ wellnessCOLLEEN.LAMMEL@CHICAGOPARKDISTRICT.COMyou for attending!For more information: www.chicagoparkdistrict.comCOLLEEN.LAMMEL@CHICAGOPARKDISTRICT.COM

33. Bundling Two Evidence-Based Disease Prevention ProgramsFrom the Facilitator/Instructor’sPerspective Senior Services Associates, Inc. Presented By: Claudia Aquilina, Activity Director

34. Bundling Matter of Balance and Fit & Strong! • SSA started MOB 2 ½ years ago. We have had 5 sessions since 2011. • SSA started F & S! 2012 and have had 4 sessions. • Both being evidence based programs have been beneficial to our organization. • Programs supported with information and training to lead/facilitate classes. • Fidelity.

35. Bundling Matter of Balance and Fit & Strong! • MOB participants goal is to graduate to F & S! • A percentage of F & S! participants continue exercising with a lay F & S! instructor all year around. • We are able to do this at our center. • Must have the room to accommodate. • Senior Services is very honored to be able to offer MOB and see the participants that graduate into F & S! • YES! Bundle Matter of Balance and Fit & Strong!

36. Matter of Balance 72% of participants had fallen in the past 6 months before starting MOB 91% of participants have not fallen since finishing MOB

37. Matter of Balance • “Informative and very well run program. MOB has definitely helped my issues.” • “Enjoyed the class. I want to do the class again.” • “MOB helped me walking as well as thinking.” • “Awareness helps for prevention of my falling or tripping.”“Sorry this class is over.” • “Appreciated being able to exchange suggestions with class members. The tips on footwear were great. Coaches were really great!”

38. Matter of Balance • “Everybody should join the class. Thank you very much.” • “I have learned many more ways for keeping the right balance to avoid falling. It’s a great help.” • “Very good exercises; very informative.” • “Keep up the good work.”

39. Fit & Strong! • “Great program; wish it was permanent.” • “I found the program suited me perfectly.” • “Needs to keep going through the year.” • “I really enjoyed it and look forward to doing it again.”

40. Fit & Strong! • “My bone density was higher than my last visit.” • “My cholesterol went from 225 down to 190 since starting Fit & Strong!. • “Great program; wish it was permanent.” • “I found the program suited me perfectly.” • “Needs to keep going through the year.” • “I really enjoyed it and look forward to doing it again.”

41. Testimonials From Participants Who Completed Multiple Programs • “Multiple classes gave us several different exercises for our legs. It kept mine from getting stiff.” • “Since I’ve been going to these classes, my limbs are stronger. It motivates you all the way around. I have been educating other seniors about what I have learned.” • “The information helped us learn more about our own medical conditions, and we learned about how our peers coped with the same conditions.” • “By taking these classes, I feel strong. I am motivated to sign up for whatever they offer because I enjoy exercising and learning with the group!”

42. THANK YOU!Claudia AquilinaActivity Director and Office CoordinatorSenior Services Associates, Inc.110 W Woodstock StreetCrystal Lake, IL 60012815-356-7457 caquilina@seniorservicesassoc.org

43. The Future of Fit & Strong! • Initiatives for system-level dissemination of Fit & Strong! • Implementation of evidence-based programs just makes sense (read: cents ¢) • CMS prospective evaluation of Fit & Strong! • Expand program REACH • Hoping to develop partnerships with Managed Care Plans- natural partnership given common goal of keeping older adults functioning for as long as possible in their homes and communities.