Should Structured Exercise Be Promoted As a Model of Care? Dissemination of the Department of Veterans Affairs Gerofit Program

Abstract

Exercise provides a wide range of health-promoting benefits, but support is limited for clinical programs that use exercise as a means of health promotion. This stands in contrast to restorative or rehabilitative exercise, which is considered an essential medical service. We propose that there is a place for ongoing, structured wellness and health promotion programs, with exercise as the primary therapeutic focus. Such programs have long-lasting health benefits, are easily implementable, and are associated with high levels of participant satisfaction. We describe the dissemination and implementation of a long-standing exercise and health promotion program, Gerofit, for which significant gains in physical function that have been maintained over 5 years of follow-up, improvements in well-being, and a 10-year 25% survival benefit among program adherents have been documented. The program has been replicated at 6 Veterans Affairs Medical Centers. The pooled characteristics of enrolled participants (n = 691) demonstrate substantial baseline functional impairment (usual gait speed 1.05 ± 0.3 m/s, 8-foot up and go 8.7 ± 6.7 seconds, 30-second chair stands 10.7 ± 5.1, 6-minute walk distance 404.31 ± 141.9 m), highlighting the need for such programs. Change scores over baseline for 3, 6, and 12 months of follow-up are clinically and statistically significant (P < .05 all measures) and replicate findings from the parent program. Patient satisfaction ratings of high ranged from 88% to 94%. We describe the implementation process and present 1-year outcomes. We suggest that such programs be considered essential elements of healthcare systems.

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19

“…The Gerofit facility-based program is offered at 17 VA medical centers across the United States and is described in full elsewhere (Morey et al, 2018). The program is standardized for delivery across sites and provides individually tailored guidance for older adults' participation.…”

Mobility Improvements Are Found in Older Veterans After 6 Months of Gerofit Regardless of Body Mass Index Classification

“…Furthermore, it is likely that, due to this high burden of comorbid conditions, many of these veterans would also struggle with exercise participation and compliance to a highly structured, progressive program, especially without clinical supervision. While we did not examine adherence or attendance in this current analysis, in our previous study, we reported that 53% of veterans were still active in the program after 3 months, and 42% after 6 months (Morey et al, 2018). This suggests that long-term participation in Gerofit is feasible.…”

“…We have previously published on the implementation of Gerofit across six sites: Baltimore, MD; Canandaigua, NY; Los Angeles, CA; Durham, NC; Salem, VA; and Honolulu, HI (Morey et al, 2018). For this secondary analysis, veterans enrolled into the Gerofit clinical demonstration program from these VA medical center's catchment areas prior to September 1, 2016, with complete baseline, 3-and 6-month mobility assessments were included in the analysis.…”

“…Gerofit is an outpatient exercise and health promotion program designed specifically for veterans aged 65 years and older who are at risk for mobility decline due to chronic disease or deconditioning (Morey, Crowley, Robbins, Cowper, & Sullivan, 1994;Morey et al, 2018). Enrollment is continuous, and participation in the program is open-ended, with veterans encouraged to exercise up to 3 days per week in a supervised setting.…”

“…Enrollment is continuous, and participation in the program is open-ended, with veterans encouraged to exercise up to 3 days per week in a supervised setting. We have previously demonstrated that veterans who participate in Gerofit for 3-6 months improve their mobility function (Morey et al, 1994(Morey et al, , 2018; however, the effect of obesity status on these gains is currently unknown and may provide important insight as to how best to prevent functional decline in this high-risk population. Thus, we sought to compare the changes in mobility function across obese, overweight, and normal-weight older veterans participating in Gerofit.…”