Objectives-To compare the impact of negotiated vs. mainstreamed follow-up with telephone reinforcement (TR) on maintenance of physical activity (PA) after Fit and Strong! ended. Methods-A multisite comparative effectiveness trial with repeated measures.Results-Single group random effects analyses showed significant improvements at 2, 6, 12, and 18 months on PA maintenance, lower-extremity (LE) pain and stiffness, LE function, sit-stand, 6-minute distance walk, and anxiety/depression. Analyses by follow-up condition showed persons in the negotiated with TR group maintained a 21% increase in caloric expenditures over baseline at 18 months, with lesser benefits seen in the negotiated-only, mainstreamed-with-TR, and mainstreamed-only groups. Significant benefits of telephone dose were also seen on LE joint stiffness, pain, and function as well as anxiety and anxiety/depression. Conclusions-The negotiated follow-up contract that Fit and Strong! uses, bolstered by TR, is associated with enhanced long-term PA maintenance and health outcomes.Address correspondence to Dr Hughes, Center for Research on Health and Aging, 1747 W Roosevelt Road, Rm 558, Chicago, IL 60608. shughes@uic.edu. NIH Public Access Author ManuscriptAm J Health Behav. Author manuscript; available in PMC 2014 May 27. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript Keywords maintenance; trial; physical activity; arthritis; fit and strong Osteoarthritis (OA) is the most common chronic condition among older adults and also constitutes a major barrier to their participation in physical activity. [1][2][3] Lower-extremity joint impairment, in particular, that is caused by OA is a known risk factor for disability and institutionalization. 4,5 To date, 15 randomized trials of exercise interventions have been conducted among persons with OA. Most trials report positive short-term outcomes at 3 months or less. Only 5 have reported mixed findings on longer-term adherence and related outcomes. [5][6][7][8][9] Three of the 5 used telephone reinforcement (TR) for the maintenance phase of their studies; however, these trials did not explicitly examine the effect of this technique on maintenance itself. This paucity of data on maintenance and facilitators of maintenance of exercise behavior among persons with OA indicates an urgent need for additional studies of this issue.Fit and Strong! is an evidence-based physical activity/behavior-change program that effectively targets this highrisk group. 10,11 Fit and Strong! addresses documented strength and aerobic deficits in this population 12,13 and is inexpensive and simple to replicate as demonstrated by the fact that it has been adopted by 42 community providers to date. It is a group and facility-based program that meets for 90 minutes 3 times per week for 8 weeks (24 sessions total). The first 60 minutes consist of a multiple-component exercise program that incorporates flexibility/balance, aerobic walking and/or low impact aerobics, and lowerextremity strength training using elast...

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The study on which this article is based addressed the issue of the proportion of adult day care centers (ADCs) existing in 1986 that would qualify for Medicare funding under the 1989 U.S. Senate Medicare Adult Day Care Amendments. It also estimated the impact of the criteria on two policy-relevant subgroups of ADCs-that is, Alzheimer's vs. non-Alzheimer's and rural vs. urban-using data from a 1986 national census survey of ADCs. The five proposed Medicare criteria and the percentage of ADCs meeting them were: services to be provided directly, 14.6%; multi-disciplinary team, 20%; services to be provided directly or indirectly, 16%; program activities, 42%; and other, 53%. Only 3% met all five criteria while 13% met four out of five. Alzheimer's centers met the criteria more often than non-Alzheimer's centers, while urban centers qualified more often than rural centers. Based on the findings, implications for Medicare funding policy are discussed.