Fit and Strong!

Program Description

Fit and Strong! is a multicomponent physical activity and behavior change program for older adults with mild to 

moderate osteoarthritis in their lower extremities. Licensed physical therapists or certified exercise instructors 

who have completed the Fit and Strong! instructor training deliver the program through 90-minute sessions that 

are held three times per week for 8 weeks (24 sessions total). During the first 60 minutes of each session, 

participants engage in flexibility exercises, fitness walking, and resistance training with elastic exercise bands 

and ankle cuff weights. Over time, fitness walking increases in duration and complexity and progressively 

challenges balance. Strengthening exercises for the lower extremities and trunk use a graded task-specific 

approach (sit to stand and postural stabilization), and resistance is progressively increased over the course of the 

program by the addition of weight to the ankle cuff weights. All exercises are accompanied by music, and each 

60-minute exercise period includes a 10-minute warm-up and a 10-minute cool-down, which incorporate static 

and dynamic sitting and standing balance exercises. The last 30 minutes of each session include group 

discussions and educational components to help participants build skills and identify strategies to assist them in 

continuing physical activity over time. In week 6 of the program, instructors schedule 15- to 30-minute meetings 

with each participant to develop an individualized physical activity plan, which can include home-based exercise 

or an ongoing group- or facility-based program; this plan becomes a physical activity maintenance contract. Each 

participant also receives a participant manual. 

Descriptive Information

Areas of Interest Health and wellness

Outcomes

Review Date: January 2014

 Self-efficacy for physical activity

 Self-efficacy for ongoing exercise adherence

 Maintenance of physical activity

 Pain

 Stiffness

Ages 

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

Genders  Female 

 Male 

Races/Ethnicities

 Black or African American

 Hispanic or Latino

 White

 Race/ethnicity unspecified

Settings  Senior center

 Other community settings

1 
Geographic Locations Urban

Funding Partially/fully funded by National Institutes of Health

Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the 

developer.

Implementation History

Since 1998, Fit and Strong! has been implemented with over 3,100 participants. More 

than 160 instructors have been trained to deliver the program in sites across Arizona, 

Florida, Illinois, Michigan, North Carolina, Oregon, Texas, and West Virginia.

Adaptations A Spanish-language adaptation of Fit and Strong!, called ¡Fuerte y en Forma!, is 

available.

Quality of Research

Review Date: January 2014 

Documents Reviewed 

The documents below were reviewed for Quality of Research. The research point of contact can provide 

information regarding the studies reviewed and the availability of additional materials, including those from 

more recent studies that may have been conducted. 

Study 1

Hughes, S. L., Seymour, R. B., Campbell, R. T., Huber, G., Pollak, N., Sharma, L., & Desai, P. (2006). Long-term 

impact of Fit and Strong! on older adults with osteoarthritis. Gerontologist, 46(6), 801–814. PubMed abstract 

available at http://www.ncbi.nlm.nih.gov/pubmed/17169935

Supplementary Materials

Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., & Stitt, L. W. (1988). Validation study of WOMAC: 

A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug 

therapy in patients with osteoarthritis of the hip or knee. Journal of Rheumatology, 15(12), 1833–1840. PubMed 

abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3068365

Efficacy Informed Consent Form and Efficacy Proposal

Hughes, S. L., Edelman, P., Chang, R. W., Singer, R. H., & Schuette, P. (1991). The GERI-AIMS. Reliability and 

validity of the Arthritis Impact Measurement Scales adapted for elderly respondents. Arthritis and Rheumatism,

34(7), 856–865. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2059233

Hughes, S. L., Seymour, R. B., Campbell, R. T., Desai, P., Huber, G., & Chang, H. J. (2010). Fit and Strong!: 

Bolstering maintenance of physical activity among older adults with lower-extremity osteoarthritis. American 

Journal of Health Behavior, 34(6), 750–763. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/20604699

2 
Lorig, K., Stewart, A., Ritter, P., González, V., Laurent, D., & Lynch, J. (1996). Outcome measures for health 

education and other health care interventions (chap. 2 and appendix A). Thousand Oaks, CA: Sage Publications. 

McAuley, E., Lox, C., & Duncan, T. E. (1993). Long-term maintenance of exercise, self-efficacy, and physiological 

change in older adults. Journal of Gerontology, 48(4), P218–P224. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/8315239

McConnell, S., Kolopack, P., & Davis, A. M. (2001). The Western Ontario and McMaster Universities 

Osteoarthritis Index (WOMAC): A review of its utility and measurement properties. Arthritis Care & Research, 

45(5), 453–461.

Outcomes 

Outcome 1: Self-Efficacy for Physical Activity 

Description of Measures

Self-efficacy for physical activity was measured by the Efficacy for Exercise subscale of 

the Lorig Exercise Efficacy Scale. This subscale contains 3 items: 

 “How confident are you that you can do gentle exercises for muscle strength and 

flexibility 3 to 4 times/week (range of motion, using weights, etc.)?”

 “How confident are you that you can do aerobic exercise such as walking, 

swimming, or bicycling 3 to 4 times each week?”

 “How confident are you that you can exercise without making symptoms worse?”

Participants rated each item on a 10-point scale ranging from 1 (not at all confident) to 

10 (totally confident). Higher scores indicate greater self-efficacy for physical activity. 

Participants were assessed at baseline and at 2, 6, and 12 months after baseline.

Key Findings

Older adults with osteoarthritis of the hip or knee were randomized to the 

intervention group or the control group through a stratified randomized block design, 

with each block consisting of 30 participants (15 intervention and 15 control) stratified 

by arthritis severity. Control group participants received a copy of The Arthritis 

Helpbook and a list of exercise programs in the community. They also received a 

variety of self-care materials and handouts at each follow-up (2, 6, and 12 months after 

baseline). Participants in the control group also were offered the opportunity to 

receive the intervention at the conclusion of the study.

Participants in the intervention group had an improvement in self-efficacy for physical 

activity relative to participants in the control group from baseline to the 2-month 

follow-up (p = .001), from baseline to the 6-month follow-up (p = .005), and from 

baseline to the 12-month follow-up (p = .006). Specifically, the Efficacy for Exercise 

subscale scores for participants in the intervention group increased from baseline to 

the 2-month follow-up and remained slightly higher than baseline levels at the 6- and 

12-month follow-ups. In contrast, for participants in the control group, Efficacy for 

Exercise subscale scores declined steadily across all three time periods. 

Studies Measuring 

Outcome Study 1

3 
Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.6

Outcome 2: Self-Efficacy for Ongoing Exercise Adherence 

Description of Measures

Self-efficacy for ongoing exercise adherence was measured by the McAuley “Time” 

Exercise Adherence Scale, which includes 6 items related to participants’ level of selfefficacy to continue participating in regular exercise over 6 months. Participants were 

assessed at baseline and at 2, 6, and 12 months after baseline.

Key Findings

Older adults with osteoarthritis of the hip or knee were randomized to the 

intervention group or the control group through a stratified randomized block design, 

with each block consisting of 30 participants (15 intervention and 15 control) stratified 

by arthritis severity. Control group participants received a copy of The Arthritis 

Helpbook and a list of exercise programs in the community. They also received a 

variety of self-care materials and handouts at each follow-up (2, 6, and 12 months after 

baseline). Participants in the control group also were offered the opportunity to 

receive the intervention at the conclusion of the study.

Participants in the intervention group had an improvement in self-efficacy for ongoing 

exercise adherence relative to participants in the control group from baseline to the 6-

month follow-up (p = .001) and from baseline to the 12-month follow-up (p = .010). 

However, there was no significant between-group difference in self-efficacy for 

ongoing exercise adherence from baseline to the 2-month follow-up.

Studies Measuring 

Outcome Study 1

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.6

Outcome 3: Maintenance of Physical Activity 

Description of Measures

Maintenance of physical activity was measured by the Lorig Exercise Behaviors Scale, 

a 6-item measure that includes type of exercise (e.g., walking, swimming, biking), 

duration, and frequency. The total number of minutes of exercise per week was 

calculated for each participant. Participants were assessed at baseline and at 2, 6, and 

12 months after baseline.

Key Findings

Older adults with osteoarthritis of the hip or knee were randomized to the 

intervention group or the control group through a stratified randomized block design, 

with each block consisting of 30 participants (15 intervention and 15 control) stratified 

by arthritis severity. Control group participants received a copy of The Arthritis 

Helpbook and a list of exercise programs in the community. They also received a 

variety of self-care materials and handouts at each follow-up (2, 6, and 12 months after 

4 
baseline). Participants in the control group also were offered the opportunity to 

receive the intervention at the conclusion of the study.

Participants in the intervention group exercised more each week relative to 

participants in the control group from baseline to the 2-month follow-up (p < .001), 

from baseline to the 6-month follow-up (p = .001), and from baseline to the 12-month 

follow-up (p = .001). A comparison of data from baseline and the follow-ups indicated 

that participants in the intervention group had an 83.9% increase in minutes of 

exercise per week from baseline to the 2-month follow-up, a 58.5% increase in minutes 

from baseline to the 6-month follow-up, and a 55.6% increase in minutes from baseline 

to the 12-month follow-up. Although the minutes of exercise per week reported by 

participants in the intervention group at the 12-month follow-up were slightly less than 

the minutes reported at the 2-month follow-up, the levels of exercise continued to be 

above the goal of 90 minutes per week (i.e., 30 minutes of exercise at least three 

times per week). 

Studies Measuring 

Outcome Study 1

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.5

Outcome 4: Pain 

Description of Measures

Pain was measured by two scales: 

 The 5-item Pain subscale of the Western Ontario and McMaster Universities

Osteoarthritis Index (WOMAC), which measures pain experienced in lower 

extremities during walking, climbing stairs, sleeping in bed, resting (i.e., sitting or 

lying), and standing. 

 The 4-item Geri-AIMS Pain Scale, which assesses usual level of arthritis pain, 

frequency of severe arthritis-related pain, duration of morning stiffness from 

waking, and frequency of pain in two or more joints at the same time. Ratings are 

provided for the past month.

Key Findings

Older adults with osteoarthritis of the hip or knee were randomized to the

intervention group or the control group through a stratified randomized block design, 

with each block consisting of 30 participants (15 intervention and 15 control) stratified

by arthritis severity. Control group participants received a copy of The Arthritis

Helpbook and a list of exercise programs in the community. They also received a 

variety of self-care materials and handouts at each follow-up (2, 6, and 12 months 

after baseline). Participants in the control group also were offered the opportunity to 

receive the intervention at the conclusion of the study.

From baseline to the 6-month follow-up, participants in the intervention group had a 

decrease in pain relative to those in the control group (WOMAC, p = .040; Geri-AIMS, 

p = .039). There were no significant between-group differences in pain from baseline 

to the 2- and 12-month follow-ups. 

5 
Studies Measuring 

Outcome Study 1

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.6

Outcome 5: Stiffness 

Description of Measures Stiffness was rated by the 2-item Stiffness subscale of the WOMAC, which measures 

stiffness after first waking and later in the day.

Key Findings

Older adults with osteoarthritis of the hip or knee were randomized to the 

intervention group or the control group through a stratified randomized block 

design, with each block consisting of 30 participants (15 intervention and 15 control) 

stratified by arthritis severity. Control group participants received a copy of The 

Arthritis Helpbook and a list of exercise programs in the community. They also 

received a variety of self-care materials and handouts at each follow-up (2, 6, and 12 

months after baseline). Participants in the control group also were offered the 

opportunity to receive the intervention at the conclusion of the study.

Participants in the intervention group had a decrease in stiffness relative to those in 

the control group from baseline to the 2-month follow-up (p = .018) and from 

baseline to the 6-month follow-up (p = .032). However, there was no significant 

between-group difference in stiffness from baseline to the 12-month follow-up. 

Studies Measuring 

Outcome Study 1

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.6

Study Populations 

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity 

Study 1

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

 83.3% Female 

 16.7% Male 

 22.4% Black or African 

American

 2.6% Hispanic or Latino

 72.0% White

 3.0% Race/ethnicity 

unspecified

6 
Quality of Research Ratings by Criteria (0.0–4.0 scale) 

Criterion 

Ratings 

Outcome 1 Outcome 2 Outcome 3 Outcome 4 Outcome 5 

Reliability of 

Measures 4.0 4.0 3.4 3.9 3.6

Validity of Measures 4.0 3.9 4.0 4.0 4.0

Intervention Fidelity 3.5 3.5 3.5 3.5 3.5

Missing Data and 

Attrition 2.9 2.9 2.9 2.9 2.9

Potential 

Confounding 

Variables

3.8 3.8 3.8 3.8 3.8

Appropriateness of 

Analysis 4.0 4.0 4.0 4.0 4.0

Overall Rating 3.7 3.7 3.6 3.7 3.6 

Study Strengths 

The measures used to assess the outcomes had adequate to high internal consistency in the study, as well as in 

research by independent investigators. Adequate to high test-retest reliability estimates also were demonstrated by 

independent investigators. Most of the measures have support for multiple forms of validity, including convergent, 

discriminant, and construct validity. Intervention fidelity was addressed in several ways. All sessions were led by one 

of three trained physical therapists who shared responsibility for each 8-week program iteration. Instructor and 

participant manuals were developed and used during all iterations. The instructors maintained detailed notes on each 

session and shared the notes with each other and with the researchers so that treatment fidelity could be regularly 

monitored. Further, direct observation of sessions throughout each iteration was conducted by the researchers, who 

concluded that there was a high degree of consistency across sessions and instructors. The instructors and 

researchers had regular contact, including a debriefing period after each iteration of the program. Analyses were 

conducted to determine whether differential attrition occurred over time by group. These analyses demonstrated no 

baseline differences, on any of the outcome measures, between individuals who remained in the study for the 12-

month period and those who dropped out. Following selection into the study, individuals were randomized into 

intervention or control groups, stratified by degree of arthritis severity. Random effects modeling was used, which 

controls for baseline levels of the outcomes of interest, is particularly appropriate for studies with longitudinal data 

and multiple measures on the same individuals over time, and has more flexible assumptions about missing data than 

other approaches. 

7 
Study Weaknesses 

A psychometrically tested fidelity instrument was not used to monitor intervention fidelity. By the 12-month followup, there was substantial attrition. The sample size was small.

Readiness for Dissemination

Review Date: January 2014 

Materials Reviewed 

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can 

provide information regarding implementation of the program and the availability of additional, updated, or 

new materials.

Hughes, S., Huber, G., Shah, A., Smith-Ray, R., & Montoya, L. (n.d.). Fit & Strong instructor training—Day 1

[PowerPoint slides]. Chicago: University of Illinois at Chicago.

Hughes, S., Huber, G., Shah, A., Smith-Ray, R., & Montoya, L. (n.d.). Fit & Strong instructor training—Day 2

[PowerPoint slides]. Chicago: University of Illinois at Chicago.

Hughes, S., Huber, G., Smith-Ray, R., Shah, A., & Montoya, L. (n.d.). Fit & Strong master trainer training

[PowerPoint slides]. Chicago: University of Illinois at Chicago.

Hughes, S., Seymour, R., Huber, G., Desai, P., Der Ananian, C., & Kunkel, C. (2009). Fit & Strong! instructor 

manual. Chicago: University of Illinois at Chicago.

Hughes, S., Seymour, R., Huber, G., Desai, P., Der Ananian, C., & Kunkel, C. (2009). Fit & Strong! participant 

manual. Chicago: University of Illinois at Chicago.

Program Web site, http://www.fitandstrong.org

University of Illinois at Chicago. (n.d.). Fit and Strong! instructor training [Binder]. Chicago, IL: Author. 

University of Illinois at Chicago & Roybal Successful Aging Resource Center. (2013). Fit & Strong! guide to 

successful program implementation. Chicago, IL: Author.

Additional implementation materials:

• Attachment A: Fee Structure Document for Fit and Strong! License

• EXERCISE...Designed for YOU! [Flyer]

• Fit & Strong! [Brochure]

• Fit and Strong! An Evidence-Based Exercise Program for Older Adults With Lower-Extremity 

Osteoarthritis (Overview Document)

8 
• Fit & Strong! Attendance Sheet

• Fit and Strong! Consent

• Fit and Strong! Innovation Readiness Assessment

• Fit and Strong! Master License and Services Agreement

• Resource Requirements

Additional training and support materials:

• Fit & Strong! Instructor Training Agenda (Day 1)

• Fit & Strong! Instructor Training Agenda (Day 2)

• Fit & Strong! Master Trainer Training Agenda

• Fit & Strong! Network Quarterly Call Agenda

• Instructor Training Certificate

• Negotiated Adherence Contract

Quality assurance materials:

• Adopter Interview Guide

• Fit & Strong! Implementation Fidelity Checklist

• Fit and Strong! Instructor Program Evaluation

• Fit and Strong! Instructor Training Evaluation

• Fit and Strong! Participant Baseline/Outcomes Assessment

• Fit and Strong! Participant Program Evaluation

• Fit & Strong! Targeted Maintainers Tracking Table

Readiness for Dissemination Ratings by Criteria (0.0–4.0 scale) 

Criterion Rating 

Implementation Materials 4.0

Training and Support 4.0

Quality Assurance 3.9

Overall Rating 3.9

Dissemination Strengths 

Program materials—including a succinct and well-organized implementation guide, a clear and detailed instructor 

manual and separate participant manual, a site readiness assessment, and related implementation forms—clearly 

define all roles, responsibilities, and steps for successful implementation. High-quality training is provided to all new 

instructors, accompanied by supervision by a master trainer to further develop proficiency following the initial 

training. A training of master trainers is available to support sustainability at new sites. Program developers provide 

additional phone support to implementation sites on an ongoing basis. Multiple instruments are available to support 

9 
the collection of outcome, fidelity, and implementation quality data. Sites also may choose to enter outcome data 

online and receive analysis reports from the developer.

Dissemination Weaknesses 

Although program materials are available in Spanish, it is unclear how new implementers learn about and access 

these translated materials. Standardized resources are not available in easily accessible formats (e.g., exercise or 

lesson videos, online instructor materials, frequently asked questions) to support existing instructors who have time, 

language, or resource barriers to receiving support via phone. Aside from an initial fidelity assessment conducted 

with new sites, there is no robust and structured approach for monitoring ongoing quality and using associated data 

to improve program implementation.

Costs

The cost information below was provided by the developer. Although this cost information may have been 

updated by the developer since the time of review, it may not reflect the current costs or availability of items 

(including newly developed or discontinued items). The implementation point of contact can provide current 

information and discuss implementation requirements.

Implementation Materials 

Item Description Cost 

Required by 

Developer 

Site license (includes one 2-day, on-site instructor 

training per site, instructor manual, and instructor 

training binder)

 Year 1 fee: $2,000 per system, 

$1,000 per stand-alone site, 

and $400 per systemassociated site, plus all travel 

expenses

 Annual renewal fee: $200 per 

system, $200 per stand-alone 

site, and $100 per systemassociated site

Yes

Ankle cuff weights, elastic exercise bands, and floor 

mat for each participant

Varies depending on place of 

purchase and number of 

participants

Yes

Participant manual $35 each Yes

Additional instructor manuals $35 each No

Additional instructor training binders $5 each No

1-day Master Trainer Training $1,000 per site, plus travel 

expenses

No

10
Item Description Cost 

Required by 

Developer 

Technical assistance via Web site and hotline Free Yes

On-site fidelity check Varies depending on site needs 

and travel expenses 

Yes

Additional Information

Additional instructor trainings after the initial site training are available.

Translational Work

The Center for Research on Health and Aging (CRHA) at the University of Illinois at Chicago developed Fit and 

Strong! primarily for use with older adults who have osteoarthritis in their lower extremities. The developers at 

CRHA intended to provide a research-based approach to help these older adults better manage their arthritis, 

lead a healthier lifestyle, and engage regularly in safe and effective exercise.

A pilot study of Fit and Strong! began in 1996 at the Levy Center in Evanston, Illinois, and was supported by a 

grant from the Chicago Arthritis Foundation. With support from subsequent research grants from the National 

Institutes of Health, Fit and Strong! was tested for efficacy and effectiveness across multiple community-based 

organizations in Chicago. Dissemination into several area agencies on aging was facilitated by a grant from the 

Centers for Disease Control and Prevention (CDC), which enabled the development of tools needed for 

expansion in Illinois and nationally in multiple states, including North Carolina. Fit and Strong! has been 

recognized through awards from the American Society on Aging, the Archstone Foundation, and the American 

Public Health Association, and the program is also recognized by CDC as well as the Administration on Aging of 

the Administration for Community Living. Current partners include individuals, hospitals, universities, and 

national associations (e.g., the National Council on Aging, the National Association of Area Agencies on Aging).

One community site (in Brazos, Texas) chose to implement Fit and Strong! because of a growing interest in and 

need for physical activity opportunities for older adults. Fit and Strong!, as an evidence-based physical activity 

and behavioral change program, was selected to broaden and complement the existing repertoire of health selfmanagement, evidence-based programs currently offered by that site. Two community-based centers (in 

Chicago, Illinois, and Phoenix, Arizona) serving Latinos implemented the Spanish-language adaptation of Fit and 

Strong! (¡Fuerte y en Forma!), since Fit and Strong! is currently one of the few culturally relevant exercise 

programs available in Spanish for older adult Latinos with arthritis.

Participants are recruited through informational sessions, such as presentations to local senior groups, and the 

distribution of print materials (e.g., flyers, brochures, newspaper articles). Fit and Strong! also is promoted 

through the program Web site, quarterly calls, and monthly emails. Participants noted that they were recruited 

through community resources such as Gold Medallion Club, Senior Circle, and the Senior Expo. Health care 

providers/settings served as a referral source for only a small number of participants, as did instructor referrals. 

11
Fit and Strong! classes are held in community settings, including community centers and senior housing facilities. 

Most sites have implemented Fit and Strong! with fidelity and offer three iterations of Fit and Strong! per 

calendar year, on average. Some sites make small adaptations to the program. For example, some Chicago 

Department of Senior Services sites offer the program twice a week instead of three times a week, but they 

offer it for 12 weeks (as opposed to 8 weeks) and complete all 24 sessions. In two community-based centers 

serving Latinos, a bilingual, bicultural certified exercise instructor implemented the Spanish-language adaptation

of Fit and Strong! (¡Fuerte y en Forma!).

Fit and Strong! has demonstrated significant benefits on participants’ physical functioning, including 

improvements in lower-extremity strength, stiffness, and pain; gait speed; self-efficacy for arthritis symptom 

management and for adherence to exercise in the presence of barriers; participation in exercise activities; 

exercise capacity; body weight; self-rated health; and depression, anxiety, and fatigue. Participants enrolled in 

the program have been very enthusiastic, promoting additional participation among their family and friends 

through word of mouth. Participants have reported feeling healthier, having more energy, having better 

movement in their joints with less pain, and enjoying facility-based exercise. One study compared outcomes for 

iterations implemented by certified exercise instructors with those implemented by licensed physical therapists. 

There were no significant differences in outcomes for lower-extremity strength, pain, and stiffness; aerobic 

capacity; and physical function. Significant differences favoring the physical therapist–led classes were seen for 

two mediators: self-efficacy for exercise and barriers adherence self-efficacy. Participant evaluations rated both 

types of instructors equally highly, and attendance was identical in each group. In another study, participants 

who completed Fit and Strong! were randomized to one of two groups: the negotiated maintenance group or 

the mainstreamed group. Participants in the negotiated maintenance group developed the customary Fit and 

Strong! individualized physical activity maintenance contract, which reflected their preferences for an exercise 

plan after the program. Participants in the mainstreamed group were asked to enroll, as a follow-up, in a bestpractice group- or facility-based multicomponent program offered at the same facility. Half of the participants in 

both groups were then randomly assigned to receive telephone reinforcement that tapered off over time. 

Analyses by follow-up condition indicated that participants in the negotiated maintenance group with telephone 

reinforcement maintained the greatest improvement in caloric expenditure for all physical activity, with lesser 

benefits seen in the negotiated maintenance group without telephone reinforcement and the mainstreamed

groups with and without telephone reinforcement. An increased dose of telephone reinforcement had significant 

benefits for participants’ lower-extremity joint stiffness, pain, and function, as well as anxiety and depression.

Currently, the developers of Fit and Strong! are assessing the feasibility of bundling evidence-based programs to 

maximize the impact of participation for older adults. Specifically, they are assessing the use of Fit and Strong! 

with Matter of Balance (in Illinois) and the Chronic Disease Self-Management Program (in Texas). Area agencies 

on aging have adopted and embedded Fit and Strong! in Illinois, Michigan, North Carolina, and Texas. Instructors 

who have been trained as a master trainer can provide training to new instructors. Once equipment and other 

participant materials have been purchased, they can be used in subsequent implementations. Partnerships and 

collaborations are key to the program’s success, including keeping partners aware of new enhancements to the 

program. To maintain the program, sites may seek new grant funds, charge participant fees, and/or secure 

donations from other agencies.

12
Site With 

Translational 

Work 

References Describing Site’s Translational Work, by Category 

Planning/ 

Partners Adoption 

Reach/ 

Recruitment Implementation Effectiveness Maintenance 

Seven senior 

centers in 

Chicago, IL

References 

1 and 2 — References 1 and 2

References 

1 and 2

References 

1 and 2 — 

Two 

community 

sites in 

Chicago, IL, and 

Phoenix, AZ

— Reference 

3 — Reference 3 Reference 3 Reference 3

Brazos Valley, 

TX

Reference 

4

Reference 

4 — Reference 4 Reference 4 Reference 4

Reference 

Number Reference 

1 

Seymour, R. B., Hughes, S. L., Campbell, R. T., Huber, G. M., & Desai, P. (2009). Comparison of two 

methods of conducting the Fit and Strong! program. Arthritis & Rheumatism (Arthritis Care & Research), 

61(7), 876–884. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19565560

2 

Hughes, S. L., Seymour, R. B., Campbell, R. T., Desai, P., Huber, G., & Chang, H. J. (2010). Fit and 

Strong!: Bolstering maintenance of physical activity among older adults with lower-extremity 

osteoarthritis. American Journal of Health Behavior, 34(6), 750–763. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/20604699

3 

Der Ananian, C., Hughes, S. L., Miller, A., & Shah, A. (2014). Six-month outcomes of ¡Fuerte y en 

Forma! in Latinos with arthritis. Abstract submitted for the 67th Annual Scientific Meeting of the 

Gerontological Society of America.

4 Program on Healthy Aging, Texas A&M School of Rural Public Health. (2013, September). Fit & 

Strong! in the Brazos Valley: Community report. College Station, TX: Author.

Contacts

To learn more about implementation, contact:

Amy Shah, M.P.H. 

Center for Research on Health and Aging, 

University of Illinois at Chicago

(312) 355-3174

ashah93@uic.edu

To learn more about research contact:

Susan Hughes, Ph.D.

Center for Research on Health and Aging, 

University of Illinois at Chicago

(312) 996-1473

shughes@uic.edu

Additional program information can be obtained through the following Web site:

http://www.fitandstrong.org

13