September 30, 2021

Reducing Arthritis Pain by Improving Access to Group Exercise During COVID-19

Group, exercise program for older adults

Although arthritis is a common, leading cause of pain and disability in the United States, people face barriers to improving their quality of life while living with this condition. The COVID-19 pandemic has exacerbated existing barriers while creating additional ones. Kushang Patel, his research team, and their partners aim to help reduce the barriers to the physical exercise people with arthritis need by evaluating the effectiveness of a community-based, group exercise program that is delivered online.  

Kushang Patel
Kushang Patel

Patel is a research associate professor in the University of Washington (UW) Department of Anesthesiology and Pain Medicine and the research core director at the Harborview Injury Prevention and Research Center. He is an epidemiologist and gerontologist whose research aims to reduce the risk of disability and injury as well as improve pain management among older adults. This arthritis project is funded as a Special Interest Project through the CDC Prevention Research Centers network, which the UW Health Promotion Research Center (UW HPRC) has been a part of since 1986. 

Because of his expertise, Patel knows that clinical guidelines recommend physical activity to slow the progression of arthritis, reduce pain, and improve being able to do everyday activities. But participation in exercise is low among adults with arthritis and has been, even before the pandemic. This could be because of barriers, such as lack of professional guidance and/or social support. Recognizing these barriers and the benefits of exercise for people with arthritis, the CDC promotes evidence-based walking and exercise programs that are group-based and led by instructors in the community. One of these programs is Enhance®Fitness

Enhance®Fitness is a low-cost, evidence-based group exercise and falls prevention program that helps older adults at all levels of fitness become more active, energized, and empowered to sustain independent lives. The UW Health Promotion Research Center and Group Health Cooperative (now known as Kaiser Permanente) developed the program in the 1990s along with collaboration from Senior Services (now known as Sound Generations), a non-profit community-based organization. The Enhance®Fitness program is now run and licensed by Sound Generations, while the UW Health Promotion Research Center continues to provide technical assistance and support with data collection and analysis as needed. 

“Having a group, a community, that exercises together, while supporting one another, is the exactly what many people with arthritis need and want to get stronger and healthier and reduce their pain,” Patel said. “We have to help people connect to programs and services they need, while also helping organizations adapt their programs to meet those needs, especially during the pandemic.” 

Many organizations, such as local YMCAs, had to suspend in-person programs like Enhance®Fitness, because of safety measures during the COVID-19 pandemic. Without access to such exercise programs, people with arthritis may experience poorer health and increased difficulty with everyday activities.

In the spring and summer of 2020, Patel and his team collaborated with Sound Generations to adapt Enhance®Fitness to be accessible online. Now, Patel’s team will partner with Sound Generations and Y-USA to evaluate whether the online Enhance®Fitness produces similar benefits as the in-person version of the program. The team will work with adults with arthritis, including those who have physical limitations, lower incomes, and/or live in a rural areas. Participants will choose to attend Enhance®Fitness online or in-person one hour a day for three days a week over 16 weeks. They will also be asked to complete several surveys over the course of the project to track their physical abilities, pain severity, interference of pain in their daily lives, mood, participation in social activities, and feelings of loneliness. 

Even before the pandemic, access to evidence-based exercise programs was already severely limited in rural areas and for people with limited transportation options. Because of these barriers, there is a critical need for remote delivery of evidence-based exercise programs like Enhance®Fitness. To help reduce barriers, the study team will also review best practices for recruiting and retaining participants in exercise programs with a focus on underserved communities. 

With all the information the team gathers throughout the project, they will work with their partners to create a toolkit for organizations to provide Enhance®Fitness online. Ultimately, the toolkit will help improve access to vital exercise and better quality of life for people with arthritis, even during the COVID-19 pandemic.

This project (SIP 21-003) is made possible thanks to $1.2 million in Special Interest Project (SIP) funding from the U.S. Centers for Disease Control and Prevention (CDC) Prevention Research Center (PRC) network. The UW Health Promotion Research Center (UW HPRC) is a member of the PRC network. The contents of this blog post are those of the UW HPRC and do not necessarily represent the official views of, nor an endorsement, by the CDC, or the U.S. Government.

This project is known as Delivery of Enhance®Fitness Trial (DEFT).

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