Should Structured Exercise Be Promoted As a Model of Care? Dissemination of the Department of Veterans Affairs Gerofit Program

Abstract

Exercise provides a wide range of health-promoting benefits, but support is limited for clinical programs that use exercise as a means of health promotion. This stands in contrast to restorative or rehabilitative exercise, which is considered an essential medical service. We propose that there is a place for ongoing, structured wellness and health promotion programs, with exercise as the primary therapeutic focus. Such programs have long-lasting health benefits, are easily implementable, and are associated with high levels of participant satisfaction. We describe the dissemination and implementation of a long-standing exercise and health promotion program, Gerofit, for which significant gains in physical function that have been maintained over 5 years of follow-up, improvements in well-being, and a 10-year 25% survival benefit among program adherents have been documented. The program has been replicated at 6 Veterans Affairs Medical Centers. The pooled characteristics of enrolled participants (n = 691) demonstrate substantial baseline functional impairment (usual gait speed 1.05 ± 0.3 m/s, 8-foot up and go 8.7 ± 6.7 seconds, 30-second chair stands 10.7 ± 5.1, 6-minute walk distance 404.31 ± 141.9 m), highlighting the need for such programs. Change scores over baseline for 3, 6, and 12 months of follow-up are clinically and statistically significant (P < .05 all measures) and replicate findings from the parent program. Patient satisfaction ratings of high ranged from 88% to 94%. We describe the implementation process and present 1-year outcomes. We suggest that such programs be considered essential elements of healthcare systems.

Keywords: elderly; exercise; implementation; mobility; prevention.

Conflict of interest statement

Conflict of Interest: None.

© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Figures

Figure 1

Change from baseline at 3, 6, and 12 months in (A) usual gait speed, (B) number of chair stands completed in 30 seconds, (C) 6-minute walk distance, and (D) 8-foot up and go test. The dotted line indicates a threshold for high risk of loss of independence for the sex and mean age of the study sample. Above the line indicates better function except for the 8-foot up and go test. Models were limited to participants with baseline and at least one follow-up and included control for the baseline value of variable of interest. Sample sizes were n=366 at baseline and n=294, n=213, and n=128 for each successive time point. Some sites did not have time to accrue participants for the 12-month follow-up. P-values are shown for change from baseline.

Figure 2

Differences between baseline and change from baseline at 3, 6, and 12 months between the Durham Veterans Affairs parent site and the new programs combined for (A) usual gait speed, (B) number of chair stands completed in 30 seconds, (C) 6-minute walk distance, and (D) 8-foot up and go test. The dotted line indicates a threshold for high risk of loss of independence for the sex and mean age of the study sample. Above the line indicates better function except for the 8 foot up and go test. Models were limited to participants with baseline and at least one follow-up and included control for the baseline value of variable of interest. Samples sizes were n=163 at baseline for Durham and n=127, n=106, and n=84 for each successive timepoint and n=336 at baseline for all other sites combined and n=294, n=213, and n=128 for each successive timepoint. Some sites did not have time to accrue participants for 12-month follow-up. P-values are shown for the difference between Durham and all other sites at each timepoint.

Figure 3

Differences between baseline and change from baseline at 3, 6, and 12 months between program participants living in urban and rural sites for (A) usual gait speed, (B) number of chair stands completed in 30 seconds, (C) 6-minute walk distance, and (D) 8-foot up and go test. The dotted line indicates a threshold for high risk of loss of independence for the sex and mean age of the study sample. Above the line indicates better function except for the 8 foot up and go test. Models were limited to participants with baseline and at least one follow-up and included control for the baseline value of variable of interest. Samples sizes were n=348 at baseline and n=283, n=218, and n=150 for each successive timepoint for participants in urban settings and n=151 at baseline n=138, n=102, and n=62 for each successive timepoint for participants in rural settings. Some sites did not have time to accrue participants for 12-month follow-up. P-values are shown for the differences between urban and rural sites.