Health Promotion Research Center

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 University of Washington Health Promotion Research Center (UW HPRC) 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.

UW Health Promotion Research Center collaborates with Sound Generations to provide technical assistance and support with data collection and analysis as needed. In addition, we engage other partners to conduct research on best methods to increase the reach of Enhance®Fitness to older adults.

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Enhance®Fitness Across the U.S.

National Reach

99,500+ people
1,485 sites
441 organizations
47 states + D.C.

Washington Reach

9,520 people
181 sites
90 organizations
18 counties

Washington state map with 18 counties colored in red to represent EnhanceFitness being there.

History & Background

The Enhance®Fitness pilot study began in 1993 at Northshore Senior Center in Bothell, Washington, and the program was first implemented in 1995. The program was disseminated across Washington state beginning in 1997 and throughout other states beginning in 2000. (Source: Administration for Community Living)

In 2006, the U.S. Health and Human Services Administration on Aging included Enhance®Fitness as one of the approved programs for the Choices for Independence grants, placing it in the administration’s highest tier of evidence-based programs. This designation significantly increased program adoption. Program growth continued when the U.S. Centers for Disease Control and Prevention Arthritis Program (CDC-AP) reviewed and classified Enhance®Fitness as “arthritis-friendly” in 2007 and the program was adopted as a recommended intervention by the Arthritis Program. (Source: A 20-Year Dissemination History of Enhance®Fitness)

Expanding the Evidence Base

These studies and projects with the UW Health Promotion Research Center have helped advance and expand the evidence behind the Enhance®Fitness program.

2006: Effect on Older Adults’ Function & Health

This study examined the effectiveness of participation in Enhance®Fitness.
With the 2,889 study participants, self-ratings of health improved at eight months. All participants improved on performance tests.
This study showed that implementation of performance-based measures in community studies is possible. Challenges included selecting measures, staff training, collecting performance measures, and deciding on time points for data collection.
This study also provided evidence that older adults can maintain and/or improve physical function through participation in the Enhance®Fitness program.
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2014-2019: Physical Therapists Recommending Enhance®Fitness

During this study, researchers heard a clear and consistent desire from YMCAs for support and tools on outreach when it came to expanding the Enhance®Fitness program through referrals from physical therapists.
Along with partners at the YMCA of the USA (Y-USA) and Sound Generations, UW Health Promotion Research Center developed and tested an intervention to increase the outreach capacity of YMCAs to physical therapy clinics about referring older adult patients to Enhance®Fitness.
This study resulted in a toolkit that organizations can use to support their outreach efforts. The toolkit is being disseminated by Sound Generations.
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2015: Beyond Strength

This study examined the expected and experienced benefits among participants in Enhance®Fitness.
Researchers conducted 20 semi-structured interviews with program participants who were motivated to join Enhance®Fitness for expected physical benefits and the social environment of a group-based class.
Experienced benefits of participation in the program included physical, social, functional, and improved self-image or sense of well-being. Participants valued the practical application of class exercises to daily activities that support independent living, such as lifting objects and completing household chores.
Organizations looking to implement the Enhance®Fitness program or currently offering program classes can improve reach, implementation, and maintenance by incorporating participants’ expressed motivations and valued benefits in program marketing and by improving organizational support to meet participant needs.
Understanding participants’ motivations and valued benefits can improve Enhance®Fitness dissemination and can also help organizations improve the program’s sustainability.
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2015 & 2018: Enhance®Fitness in China

Considerations When Disseminating American-Developed, Evidence-Based Health Promotion Programs in China (2015)
Given the popularity, beneficial outcomes, and cost-effectiveness of Enhance®Fitness in the United States, it would be worthwhile to explore disseminating this program in China. These endeavors should be coupled with improving awareness of evidence-based programs with public and health care professionals, identifying cultural discrepancies, and building partnerships to ensure the American-developed Enhance®Fitness would be readily adapted for people in China.
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A Case for Enhance®Fitness in Changsha, China (2018)
Evidence-based programs are good approaches to promote physical activity but are limited in China. Adopting existing programs can be a viable option. Prior to that, readiness assessment is needed. This study aimed to assess community readiness levels for disseminating evidence-based physical activity programs to older adults in Changsha, China.
The overall community stage readiness score of Changsha was 3 out of 9, which is categorized as ‘vague awareness.’ Developing strategies to improve community readiness levels may increase evidence-based physical activity program dissemination in Changsha, China.
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