Older Adult Health Promotion


Physical Therapists Recommending EnhanceFitness to Expand Reach (PT-REFER): HPRC is partnering with the national YMCA on a five-year core research project. The goal of the project is to design and evaluate a new system to build clinical-community linkages between physical therapists and evidence-based physical activity programs for older adults. Read more >


HPRC works with community organizations that reach and promote healthy levels of physical activity to large numbers of older adults through effective programs and policies.

EnhanceFitness: EnhanceFitness is a community-based exercise program which was developed collaboratively by HPRC and our community partners, Sound Generations (formerly know as Senior Services) and Group Health. HPRC is the organizational lead for EnhanceFitness research and evaluation.

Mall Walking: Walking has many health benefits and is highly accessible (requires no equipment or special attire and is free), adaptable (as it requires little to no skills or training), is appropriate for all fitness levels, is modifiable for all levels of mobility (slow vs. fast, using assistive device, with a disability), and adjustable in frequency, intensity, duration. Mall walking programs promote active aging by reducing the common barriers to physical activity among midlife and older adults. Malls provide climate controlled areas to walk, have on-site security personnel, flat and well lit paths, and provide social support through the presence of other walkers. HPRC developed Mall Walking: A Program Resource Guide which underscores the health benefits of walking, highlights the features and benefits of mall walking programs that make them particularly appropriate for the aging population, and provides practical information for planning, implementing and evaluating mall walking programs. The Guide received the 2016 APEX award for Publication Excellence in the Education and Training category.

Workplace Health: The workplace is a primary location for promoting physical activity among working adults. Our workplace health programs, Workplace Solutions and HealthLinks, help workplaces change policies and practices to support physical activity for their employees.

Depression Management

PEARLS: We partner with local, state, and national organizations to disseminate the depression care management program PEARLS (Program to Encourage Active, Rewarding LiveS.)

Developed at HPRC with local aging service providers, PEARLS is an evidence-based, in-home, brief counseling program that empowers adults to manage depression and improve their quality of life. It teaches three depression management techniques: problem solving, planning social and physical activities, and scheduling pleasant events. In the original PEARLS randomized controlled trial (1999-2003), published in JAMA, participants were three times more likely to significantly reduce depressive symptoms or completely eliminate their depression. Participants also improved their functional and emotional well-being. Study results also showed a strong trend toward reduced hospitalization.

PEARLS has also been studied in adults with epilepsy and co-occurring depression. Participants reduced depression and thoughts of suicide and increased emotional well-being. These effects persisted at one year after the study.

PEARLS technical assistance and training

  • The PEARLS website provides information to get started implementing PEARLS, including a free implementation manual (or toolkit), stories from PEARLS clients and information on in-person and online trainings.
  • PEARLS training sessions are available through HPRC’s partner CoMotion. They offer in-person trainings in Seattle and on-site, and online trainings for pre- or post-in-person training. To date, more than 800 participants from 28 states have been trained since training was first offered in 2004. Register for training at www.pearlsprogram.org. HPRC is partnering with Florida Health Networks to develop and pilot a PEARLS Master Training model in fall 2016.
  • HPRC provides technical assistance to adopters of the program to help facilitate program implementation. We are currently offering free monthly technical assistance conference calls for agencies that attend the PEARLS trainings. Contact Lesley Steinman at lesles@uw.edu to sign up. We recently published lessons learned from our technical assistance activities with several local community partners.

PEARLS evaluation and dissemination efforts

  • Organizations around the country offer the PEARLS program – including our original partner in the research study, Seattle-King County Aging and Disability Services (ADS) – and other aging services organizations, senior centers, community mental health agencies, and social service agencies that serve specific racial/ethnic groups and veterans. Currently, over 50 organizations are offering PEARLS in 18 states.
  • PEARLS is included in the National Registry of Evidence-based Programs and Practices of the Substance Abuse and Mental Health Services Agency (SAMSHA) and on the Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange,. PEARLS is also listed on the Administration for Community Living’s Aging and Disability Evidence-Based Programs and Practices, meeting the highest level for evidence-based program criteria that can be funded by states using Title III D funds from the Older American’s Act.
  • HPRC investigators are working with the Washington State Aging and Long-Term Care Administration (ALTSA), Department of Social and Health Services (DSHS), and Department of Health (DOH), the National Council on Aging, and other organizations on broader state and national program dissemination strategies. PEARLS is a member of the Evidence-Based Leadership Council, a collaborative of evidence-based program developers and community-based organizations working to facilitate the implementation of multiple evidence-based self-management programs.
  • HPRC is working with the Edmonds Senior Center on a Verdant Health Commission funded project to implement PEARLS along with EnhanceWellness at their senior center.
  • HPRC is providing technical assistance to Florida Health Networks (FHN) on an Administration on Community Living (ACL) funded grant to scale and sustain Chronic Disease Self-Management Education programs for older adults and adults with disabilities throughout the state of Florida. HPRC and FHN recently received a small grant from the UW Latino Center for Health to evaluate PEARLS with older Spanish-speaking Latinos/as.
  • HPRC is advising on several studies led by Dr. Jun Ma at the University of Illinois at Chicago to evaluate PEARLS in conjunction with a weight management program (Group Lifestyle Balance) for all-age obese adults with depression.
  • The PEARLS Champs Study pilot tested training PEARLS graduates who are veterans, veterans’ spouses or widows to conduct PEARLS outreach with their peers.
  • PEARLS received the 2011 Archstone Foundation Award for Excellence in Program Innovation.
  • In collaboration with ADS and other PEARLS program providers, HPRC investigators conducted the PEARLS Dissemination Study to 1) test the use of an implementation management team to improve program reach to older adults with depression; 2) pilot the delivery of PEARLS with an expanded client population, including younger older adults (aged 50-59), Russian and Somali-speaking older (using interpreters), and those with more severe clinical depression; and 3) develop and test a brief instrument to assess providers’ fidelity to the PEARLS treatment model.
  • As part of this study, HPRC partnered with the African-American Elders Program, Senior Services, and the International Drop-In Center to conduct focus groups and interviews with PEARLS counselors, referral staff, and former clients to explore how to better connect PEARLS to hard-to-reach communities. HPRC continues to meet regularly with local PEARLS programs to work together to improve program implementation and dissemination.
  • HPRC investigators partnered with the Washington State Aging and Disability Administration (now ALTSA) to add validated depression screening instruments (first the CES-D, now the PHQ-9) into their annual assessments of clients receiving home and community-based services.
  • A CDC-supported expert panel guided a systematic literature review of screening instruments and interventions for community-based older adults with late-life depression. The panel recommended depression care management programs, such as PEARLS, to public health and aging services networks. These recommendations were also included in the Community Guide after consideration of the findings from the literature review. HPRC investigators described real-world experiences of implementing these programs in several articles in Preventing Chronic Disease.
  • CDC HAN sponsored a webinar and related action brief on PEARLS (hosted by the National Council on Aging).