The average person in the US reaching the age of 65 years can expect to live another 20 years. For most older adults, good health supports continuing independence, security, and productivity. Unfortunately, millions struggle with health challenges like diabetes, arthritis, falls, mobility impairments and depression. The health of these older adults is of great concern during the coronavirus pandemic. They are at highest risk of nursing home placement, hospitalization, and death due to COVID-19 complications. Physical distancing and social isolation exacerbate many health conditions and only worsen an older person’s chances of recovery if infected by COVID-19.
Community-based organizations have long understood the impact of social isolation and health challenges on older adults. These organizations provide essential services to address these risks: transportation, home-delivered and congregate meals, technology classes and health promotion programs. These services keep people connected to others and provide valuable life, health and wellness supports. Among these services are evidence-based health promotion programs. Based on rigorous research, they are proven to provide reliable improvement in important health-related and functional measures. For example, participants in evidence-based physical activity programs improve in measures of balance and strength, with clear implications for improved well-being and continuing independence. And right now, many of these programs are being adapted to reach older adults in their homes as we all continue to physically distance.
Enhance®Fitness is one such program that has been operating in 43 states and the District of Columbia. This ongoing class is held three times per week in hour-long sessions. Classes include the exercises commonly used to maintain and build physical health in older adults: warm-up, cardiovascular workout, cool down, dynamic and static balance exercises, posture, strength training, and stretching. Upper- and lower-body strength training uses soft cuff wrist and ankle weights. Cardio training can range from 20 minutes of walking to choreographed aerobics. Classes are appropriate for near-frail to more active adults and are led by certified fitness instructors who receive additional training on Enhance®Fitness protocols and working with people who are older, have disabilities, and have chronic health conditions. Built-in assessments to measure improvements at the participant level make Enhance®Fitness a good choice for data-driven decision makers committed to addressing needs in a growing higher risk population.
Before COVID-19, over 25,000 older adults with multiple chronic conditions were participating in in-person Enhance®Fitness classes, annually. Since March 2020, when COVID-19 necessitated the adoption of physical distancing and shelter-at-home guidelines, program administrators, researchers and community-based organizations have come together to adapt the program for remote delivery. They have structured a new delivery model for this program, focused on the pillars of safety, social interaction, and progressive resistance training delivered via video conference platform. Pilot data will be evaluated to understand how remote compares to in-person delivery but early feedback from instructors and participants alike is encouraging.
Where public health agencies allow, physically distanced in-person Enhance®Fitness classes have restarted alongside remotely delivered options. Notably, fitness assessments for participants whose classes were paused due to COVID-19 closures demonstrated a decline in physical function across the board. But, when these participants have returned to in-person or remote classes, they have shown a regain in strength measured after 16 weeks of renewed participation. Adapted program delivery will continue to provide a continuum of care and connection through the existing network of safety net community providers to keep older vulnerable communities moving more and feeling better.
Paige Denison is Director of Project Enhance at Sound Generations, Seattle, WA and a Member of the ACSM Exercise is Medicine Older Adult Advisory Committee. Information about Enhance®Fitness is available at www.projectenhance.org.