1. 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

2. 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.

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

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

6. 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)

7. 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)

8. 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)

9. 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

10. Group Evidence- Based Health Promotion Programs

11. 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.

12. 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

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

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

15. 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

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

17. 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

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

19. 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

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

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

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

23. 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

24. 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

25. 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

26. EF Outcome Measures Fitness Checks: first week and at 4 months testing Part of Fullerton Functional Fitness Test (Center for Successful Aging, 2010) Optional tests NCOA, 2011a Biceps Curl TestChair Stand Test8 Foot Up and Go

27. 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

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

29. Example of EF Class http://www.cdc.gov/prc/program- material/enhance.htm