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

Group Evidence-Based Health

Promotion Programs

Rationale for Providing Evidence-Based Programs

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 III: Prospective Study

Phase II: Retrospective Analysis

Phase I: Environmental scan, evidence review, pilot evaluation of CDSMP

CMS, 2013

Link to CMS Report

http://innovation.cms.gov/Files/reports/CommunityWellnessRTC.pdf;

CMS, 2013

Findings from CMS Report

Enhance® Fitness

Matter of Balance

Arthritis Foundation

Exercise Program

Arthritis Foundation

Tai Chi Program

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

Strength training (20 min)

Balance training interspersed

Cool-down (3-5 min)

Cardiovascular exercises (20 min)

Warm up (5-8 min)

Flexibility (8-10 min)

EF Class Description

ACL, 2011; NCOA 2011a

Simple movements to warm up muscles

Balance movements

Increase intensity level

Warm up (5-8 min)

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 deltoidsBiceps/triceps

Lower BodyHip abductorsHip extensorsKnee extensors/flexorsPlantar/dorsiflexorsSit to standSenior Services, Project Enhance, 2012

Flexibility/Stretching (8-10 min)

Required UB Exercises

Neck stretch

Shoulder shrug

Deltoid stretch

Biceps/triceps stretch

Finger stretches

Senior Services, Project Enhance, 2012

Required LB Exercises Quadriceps stretch Inner thigh stretch Calf stretch Hamstring stretch Soleus stretch Ankle pointing/flexing

Balance training interspersed

Static

Sit to stand

Ankle sways

Side twists

Stretching up tall

Sideways leans

Dynamic Marching in place

Tandem walking, walking on tip-toes

Stepping over objects

Walking with head turns and quick stops

Heel walk

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)

Optional testsNCOA, 2011a

Biceps Curl Test

Chair Stand Test

8 Foot Up and Go

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/program-material/enhance.htm