Evidence-based Health Promotion
Programs for Recreational Therapists to Facilitate Productive Aging Among
Community-Dwelling Older Adults
Diane Skalko, MS, LRT/CTRS dskalko@pittcoa.com

Objectives of Presentation
1. Describe the rationale for providing evidence-based health promotion programs for Recreational Therapists to implement with community-dwelling older adults.
2. Identify at least 3 evidence-based programs and the evidence supporting each program’s benefits for Recreational
Therapists to utilize.

Objectives Continued
3. Develop awareness of available resources for Recreational Therapists implementing health promotion programs.

Administration on Aging, U.S. Dept. HHS, 2011

Administration on Aging, U.S. Dept. HHS, 2011

Incidence of Chronic Illness
 Medicare beneficiaries:
 ~ 68.4% of Medicare beneficiaries have
2+ chronic conditions
 Over 1/3 have 4+ chronic conditions
(Lochner & Cox, 2013)

Chronic Illness-Health Care
Spending
 “
84% of all health care spending in 2006 was for the 50% of the population who have one or more chronic medical conditions”
(Robert Wood Johnson Foundation, 2010)

Improving Chronic Disease
& Reducing Medical Costs
 Active people –Less healthcare costs
(CDC as cited in Center for Advancement & Health, 2006)
 Older adults can improve their health through regular physical activity
(CDC,
2013)

Improving Chronic Illness
& Reducing Medical Costs
 CDC study related to healthcare costs and chronic illness
(CDC as cited in the Center for Advancement & Health, 2006, p 1)
Center for Advancement & Health, 2006

 Proven research
 Assists with obtaining funding
 Helps with evaluating program effectiveness
 Helps with identification/choosing effective programs
NCOA, n.d. b.

CMS Report to Congress: Community
Based Wellness & Prevention
Programs
Phase I: Environmental scan, evidence review, pilot evaluation of
CDSMP
Phase II: Retrospective Analysis
Phase III: Prospective Study
CMS, 2013

Link to CMS Report http://innovation.cms.gov/Files/reports/CommunityWellnessRT
C.pdf
; CMS, 2013

Findings from CMS Report
4 community based wellness programs were identified as saving money for Medicare beneficiaries
CMS, 2013

Enhance®Fitness (EF)
 Formerly known as Lifetime
Fitness Program. Pilot initiated in 1993
 Managed by Senior Services
(Seattle, WA) and the Univer. of
WA Research Center
ACL, 2011; Senior Services, 2013

Enhance®Fitness (EF)
 Approved by AoA, NCoA, and
CDC Arthritis program
 Disseminated in over 550 sites
ACL, 2011; Senior Services, 2013

EF Program Description
 Physical activity program for older adults
(‘near frail’ to very active)
 Primary program goal:
 “Improve the overall functional fitness and well-being of older adults” (NCOA,
2011a., p. 1)
 Program website: www.project enhance.org/
NCOA, 2011a; Senior Services, Project Enhance, 2012

EF Program Description
 Minimal equipment
 Seated (Level 1) and/or standing (Level 2)
 Low cost
 Class size: 10 to 25
 New participants:
NCOA, 2011a

EF Class Description
Cardiovascular exercises (20 min)
Warm up
(5-8 min)
Cool-down
(3-5 min)
Strength training
(20 min)
Flexibility
(8-10 min)
Balance training interspersed
ACL, 2011; NCOA 2011a

Warm up
(5-8 min)
 Simple movements to warm up muscles
 Balance movements
 Increase intensity level
Senior Services, Project Enhance, 2012

Cardiovascular exercises (20 min)
 Walking
 Use of choreographed aerobic exercises
Senior Services, Project Enhance, 2012

Cool-down
(3-5 min)
 Lower heart rate
 Decrease metabolism
 Examples: Step touches, slow marching in place, fist & fling, balance exercises

Strength training (20 min)
 Required Exercises:
 Upper body
 Anterior/posterior deltoids
 Biceps/triceps
 Lower Body
 Hip abductors
 Hip extensors
 Knee extensors/flexors
 Plantar/dorsiflexors
 Sit to stand
Senior Services, Project Enhance, 2012

Flexibility/Stretching (8-10 min)
Required UB Exercises
 Neck stretch
 Shoulder shrug
 Deltoid stretch
 Biceps/triceps stretch
 Finger stretches
Required LB Exercises
 Quadriceps stretch
 Inner thigh stretch
 Calf stretch
 Hamstring stretch
 Soleus stretch
 Ankle pointing/flexing
Senior Services, Project Enhance, 2012

Balance training interspersed
Static
 Sit to stand
Dynamic
 Marching in place
 Ankle sways
 Tandem walking, walking on tip-toes
 Side twists
 Stepping over objects
 Walking with head turns and quick stops
 Stretching up tall
 Heel walk
 Sideways leans
Senior Services, Project Enhance, 2012

EF Outcome Measures
Fitness Checks: first week and at 4 months testing
Part of Fullerton Functional Fitness Test (Center for Successful Aging, 2010)
Biceps Curl Test
Chair Stand Test
8 Foot Up and Go
Optional tests
NCOA, 2011a

EF Leader Training
 One instructor per class; CPR certification
 Certified Instructor
 Group leading experience or background in related health field preferred
ACL, 2011; NCOA, 2011a

EF Other Costs & Equipment
 Training fee
 Site fee
 Site renewal fee
NCOA, 2011a

Example of EF Class http://www.cdc.gov/prc/programmaterial/enhance.htm