Health Promotion Research Center, University of Washington, Seattle.
Department of Health Services, University of Washington, Seattle.
J Geriatr Phys Ther. 2019 Oct/Dec;42(4):230-242. doi: 10.1519/JPT.0000000000000202.
Declines in strength, flexibility, and balance in older adults can lead to injuries and loss of independence and are particularly common in those of greater age and in worse health. EnhanceFitness (EF) is a nationally disseminated, evidence-based group exercise program for older adults that has been shown to improve function through cardiovascular, strength, flexibility, and balance exercises. This article examines changes in, and predictors of, participant physical function from baseline through 2 program cycles of EF as measured by 3 physical function tests: arm curls, chair stands, and 8-foot up-and-go.
We analyzed data on participants who attended at least 2 consecutive 16-week program cycles between January 2005 and June 2016. We ran 3 random-effects linear regression models, 1 for each physical function test, and accounted for missing data and clustering by class site. Independent variables included attendance, demographics, and health status.
A total of 7483 participants completed baseline and 2 sets of follow-up physical function tests. For all 3 physical function tests, participants showed some degree of improved physical function at each follow-up, and greater program attendance predicted clinically significant improvements. Some participants had less improvement: females, those less active at baseline, older than 75 years, not married or partnered, or in fair or poor health, those who had experienced at least 1 fall, and those with a disability.
EnhanceFitness program providers may need to implement additional measures to support the participants who could benefit most from EF, such as targeting messaging, coordinating with referring providers to emphasize attendance and general activity in specific participants, and offering additional support to groups who show less improvement during classes. The evidence presented here may inform clinical decision making for older adult patients and increase health care provider confidence in EF and similar exercise programs, thereby providing a mechanism to maintain and continue functional gains made in clinical or rehabilitation settings.
老年人的力量、灵活性和平衡能力下降会导致受伤和丧失独立性，而且在年龄较大和健康状况较差的人群中更为常见。EnhanceFitness（EF）是一种在全国范围内推广的、基于证据的老年人团体运动项目，已被证明通过心血管、力量、灵活性和平衡练习来改善功能。本文通过 3 项身体功能测试（手臂卷曲、椅子站立和 8 英尺快走），检查了 EF 项目 2 个周期中参与者的身体功能变化及其预测因素。
我们分析了至少连续参加 2 个 16 周项目周期的参与者的数据，这些参与者参加时间为 2005 年 1 月至 2016 年 6 月。我们运行了 3 个随机效应线性回归模型，每个模型用于 1 项身体功能测试，并考虑了班级地点的缺失数据和聚类。自变量包括出勤率、人口统计学和健康状况。
共有 7483 名参与者完成了基线和 2 套随访身体功能测试。在所有 3 项身体功能测试中，参与者在每次随访中都表现出一定程度的身体功能改善，更高的项目出勤率预示着更显著的改善。一些参与者的改善程度较低：女性、基线活动较少、年龄大于 75 岁、未婚或无伴侣、健康状况为一般或较差、至少经历过 1 次跌倒、有残疾。
EF 项目提供者可能需要实施额外措施来支持那些最能从 EF 中受益的参与者，例如针对特定参与者发送消息、与转诊提供者协调以强调出勤率和一般活动、为显示出改善程度较低的小组提供额外支持。这里提出的证据可以为老年患者的临床决策提供信息，并提高医疗保健提供者对 EF 和类似运动项目的信心，从而为在临床或康复环境中保持和继续获得功能提供一种机制。
