Healthy Aging: Cognition and Physical Activity

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Healthy Aging: Cognition and Physical Activity

[Silence from 0:00:00 to 0:00:32] Hi, good afternoon This is Lynn Shaull again with ASTHO, and thank you very much for joining Todayís webinar is hosted by ASTHO and the Centers for Disease Control and Prevention, and itís on cognitive health and physical activity And if anybody is having any trouble joining the audio portion, please just send me a message through the chat, or contact my colleague, Kristin Mendoza And just so folks know everybody is on mute this afternoon, but if you have any questions, please donít hesitate to type it into the chat box, and at the end of each ñ or at the end of all the presentations, weíll have an open discussion section where you can continue typing questions through the chat or press star-seven to unmute your line and ask your question verbally Also following the webinar, weíll send everyone who registered a link so that you can access the PowerPoint presentations as well as the webinar recording So for todayís webinar, first we have Dr Lynda Anderson She is the Director of CDCís Healthy Aging Program, and weíll be providing some background on CDCís Healthy Brain Initiative And Dr. Anderson, this is just a reminder to please press star-seven to unmute your line All right And so Iíll do a sound check Can you hear me, Lynn? We can hear you, yeah All right Thank you So on behalf of CDCís Healthy Aging Program, I want to thank you all for attending the webinar today and send a particular thanks to ASTHO for developing the webinar series So as Lynn indicated, I want to give a brief update about the CDCís Healthy Brain Initiative And so as most of you know, the numbers and proportion of older adults in the US is increasing And we can see from this slide, for those who are 65 and older, beginning in about 2011 where there were 35 million older adults, weíre going to see a doubling of that ñ expected to be about 20 percent of the population ñ a projected number of 72 million older adults And then at the bottom of this slide that weíll see thereíll also be a doubling of those 85 and older, and this is important because this is the age thatís the most vulnerable to frailty There is no time limit to when people can benefit from physical activity So Iím sure the speakers will talk about that And then I also wanted to talk about ñ we see that in terms of the leading causes of death in the United States, this is dated from 2010, that in all ages, Alzheimerís disease is the sixth leading cause of death In those who are 65 and older, itís the fifth leading cause, and there are some recent data from the National Institutes of Aging that documents increased excess and mortality due to Alzheimerís disease And so probably these are estimates or even higher due to an underreporting of Alzheimerís disease in death certificates So again this is a very important issue In terms of thinking about the work that CDC has done with the Alzheimerís Association and many partners, in 2007 we developed a first roadmap, which helped serve as a catalyst for numerous accomplishments by CDC as well as our partners And one of these, I wanted to point out is the Healthy People 2020 There is a new topic area on dementias, including Alzheimerís disease, that has two objectives: one, to increase the proportion of persons with diagnosed Alzheimerís disease or other dementias or a proxy like their caregiver who are aware of their diagnosis, and then to reduce the portion of preventable hospitalizations in persons diagnosed with Alzheimer’s disease and dementias And then there are several cognitive measures also in a new topic area on older adults And I point this out because I think itís very important when we think of understanding

of sort of cognitive health thatíll be talked about today, and itís not just the absence of disease In the last slide, we were talking about sort of leading causes of death, but really cognitive health really refers as a multidimensional construct It refers to our memory It refers to our ability to use language ñ executive functioning ñ things like planning, and it includes things like learned activities such as driving And itís really all of those abilities through cognition that help us maintain our social connectedness, that gives us this ongoing sense of purpose, our abilities to function independently, a very important issue in ñ for all of us, in particularly for older adults ñ and also permits recovery from illness or injury and to be able to cope if thereís any residual, functional deficits And so I hope that everyone keeps this definition in mind as we begin to talk about the issues today And then finally Iíd like to just remind you we have a new roadmap in ñ itís the second in our series, and this one, the Public Health Roadmap, focuses on states and national partnerships We used a participatory method including ñ invited over 280 experts who were familiar with this ñ about half of them from states and local It includes 35 actions the public health community can do with kind of a focus on the next 3 to 5 years, and we just released it in July of 2014 And so this webinar series is a way to begin to talk about some of those action items So related to the action items that weíll be thinking about and hearing about today, I just wanted to point out four of those, and our four domains that are in the roadmap involve monitor and evaluate, educate and empower the nation, to develop policy and mobilize partnerships, as well as ensuring a confident workforce So Iíve just given four examples here, one that relates to the topics that will be talked about today And so one will start up with monitor and evaluate One of the things that we have done in the past, and we want to have an update, is to update and disseminate national level reviews on public health impact of physical activity programs and other behavioral risk factors associated with cognitive health and impairment especially as the science evolves And then in terms of education, we want to continue to create awareness by contributing public health information and data about cognitive health and impairment to national reports and partners And then in terms of policy, we want to integrate cognitive health and impairment into state and local plans And in particular here are things and thinking about chronic disease management, coordinated chronic disease, falls prevention, and transportation plans And weíve recently had a webinar series on falls And then to ensure competent workforce: develop strategies to help ensure that state public health departments have expertise in cognitive health and impairment related to research and best practices And again part of this ASTHO seminar series is an effort to do that And so I point this out because Iím hoping that you will all join us to look more carefully at the roadmap and look at how the actions will really relate to your work And on this final slide, I have our CDC website for the Healthy Aging Program, which includes the Healthy Brain Initiative And so with that, I turn it over ñ back over to the seminar speakers and moving this forward Thank you Thank you so much, Dr. Anderson And again if anybody has any questions, please feel free to type them in the chat box And next we have ASTHOís very own Elizabeth Walker Romero She is Senior Director for Health Improvement here at ASTHO presenting on the role of state public health in supporting the physical activity guidelines for older adults Thank you so much, Lynn, and thank you Dr Anderson and CDC for their support today Weíre just so excited for this seminar series because we feel it really helps to highlight all these different components that help us be as cognitively healthy and as physically healthy as possible as we age and the role of state healthy agencies in doing that Next slide As you can see, ASTHO has been ñ was able to partner with the Office of Disease Prevention and Health Promotion and really were able to understand how can we better integrate and get the physical activity guidelines integrated across the entire ñ across all of our work here at ASTHO Next slide The goals of the project were to document the current uses of the physical active guidelines

across the state health agencies, highlight how the states were using the guidelines, and provide information Next slide Some of the things that we also recognize is when we thought about this, we said, ìWell, we want to ensure we understood and were able to communicate we mean 150 minutes, at least 2 and a half hours a week of moderate intensity, aerobic activity or 75 minutes of vigorous intensity, aerobic activity, or an equivalent combination of the two And then obviously very important in our older and aging adults for falls prevention, muscle strengthening at least two days a week The critical component of this as we think about our work with aging and cognitive health and physical health is the importance of really providing opportunities for all adults to be able to be active And when we were doing our case studies, we were able to find a state that actually weíre really looking at how can state health agencies support the work across sectors to support our aging populations for physical activity, and Michigan is that state So we wanted to ñ and next slide ñ highlight some of the other examples that you can see Oh, Iím sorry, the recommendations for the state health agencies We use these as a guideline, and I think, many of the folks here today recognize that itís really important to look at multi-sector, diverse stakeholders providing state-specific, technical assistance building upon existing, successful initiatives, leveraging cross-sector community partnerships, and conducting cross-sector specific comprehensive needs assessments And from that, again ñ next slide ñ we were able to highlight these five states here, but Michigan, specifically, struck us as a state that really tried to use these recommendations for their older population And so with this brief sort of high level work that ASTHOís been doing to support this age group, we turn it over to Michigan to talk about their amazing work to support physically active older adults Okay, thank you My name is Meghan Faulkner, and I am from the Michigan Arthritis Program at the Michigan Department of Community Health, and Iím going to speak today about EnhanceFitness, the program that we are implementing in Michigan for older adults EnhanceFitness is an evidence-based, group physical activity program for older adults, and itís designed specifically to improve functional fitness and well being Itís been shown effective at helping older adults of all fitness levels become more active and maintain their independence Iíll get the hang of this slide progression thing, I promise The program was developed by Project Enhance of Senior Services Theyíre a nonprofit in Seattle in partnership with the University of Washington and Group Health Cooperative, which is a nonprofit health care system The classes are one hour long They meet three days a week, and theyíre led by certified instructors Theyíre relatively low-cost They only require chairs for balance and/or seated participation as well as flexible wrist and ankle weights Each one-hour class consists of a warm-up, aerobic strength training, balance and flexibility exercises, and a cool down, and classes typically have less than 25 participants So the class is designed to be highly adaptable People from fit to frail can participate together In terms of the programís evidence base, the class has been proven to increase strength People who regularly attend class grow stronger They improve their balance, and they become more limber The class also boosts activity levels Even the unfit quickly find themselves able to do the things that they want to do safely and independently as well as elevate mood Research has shown that exercise can help prevent depression, and EnhanceFitness participants say that they feel better both physically and emotionally And the class is incredibly popular with participants with 99 percent saying they would recommend it to a friend In Michigan, almost 35 percent of adults older than 65 are not engaged in any leisure time physical activity So to address this, the Michigan Department of Community Health Arthritis Program partners with multiple community-based organizations to increase physical activity among adults with Arthritis, most of whom are older adults The Arthritis Program saw an opportunity to offer EF as itís low-cost, evidence-based, and endorsed by the CDC So here I have listed an action item from the Brain Health Initiative, M02, and this

is, uses surveillance data to enhance awareness and action in public health programming In 2007, the Arthritis Program took action based on this data and partnered with Senior Services and the CDC to host the first ever EnhanceFitness master training to take place outside of Seattle at Senior Services And this training was attended by representatives from various different community organizations like the YMCAs, some senior centers, and some other community partners and nonprofits This resulted in a group of Michigan-based EF trainers who would then help build statewide capacity by training new instructors Following the training, the Arthritis Program worked with these partner organizations to begin implementing the program in community-based settings So in terms of what we do now in the Arthritis Program, we continue to work on supporting and expanding EnhanceFitness In 2012, we began collecting and analyzing EnhanceFitness data from all the Michigan sites This had previously been done at Project Enhance in Seattle, but they were in the midst of transitioning from a paper-based data collection system, where class instructors would submit their paper forms to Project Enhance, on over to a web-based system where the instructors would need to enter the data themselves And the Arthritis Program feared that cost, time, lack of computer access ñ all those things could be a barrier for instructors to enter their own data So we took over that centralized data collection, which has been a significant investment in terms of staff time but has allowed us to identify data collection gaps and the technical assistance needs across different partner sites We also host a yearly statewide conference that highlights program fidelity, refresher sessions, as well as informational sessions on working with older adults and people with disabilities These efforts have helped build a sense of shared identity and purpose among our statewide affiliates We support marketing efforts by providing a comprehensive listing of available classes online at the Michigan EnhanceFitness Network partnership website, and we also provide brochures to partners Finally, we create and disseminate a biannual newsletter thatís sent out to instructors, coordinators, and any other partners or stakeholders who we can get on our list And under that last bullet, youíll see the action item E02, coordinating national and state efforts to disseminate evidence-based program messages about risk production for preserving cognitive health A little bit of information about the participants in Michigan During our fiscal year between October 2012 and September 2013, we had over 4,000 participants in the state 91 percent of those participants were over the age of 59 with 54 percent of them actually being between 70 and 89 In terms of race, the breakdown was 52 percent of the participants were white, 45 percent black or African-American, and 5 percent were Hispanic or Latino And as we see with other evidence-based programs, participants were overwhelmingly female with 88 percent being women and 12 percent being men So these 4,000 participants were reached throughout 90 classes offered at 76 different sites statewide And we had 11 partner affiliates putting those classes on Some of the lessons we learned in building the statewide capacity was that having access to master trainers is key to success in order to sustain the program and ensure that fidelity and quality of the program is met Different partners require different amounts of support There was no one-size-fits-all start-up package, and whatever support is offered, we found that a memorandum of understanding or other contractual agreement was very important and may increase the likelihood of long-term success and sustainability I think without that memorandum of understanding, participants found it a little too easy to back out when maybe the program didnít take off right away, and then that was often a serious loss of investment in our time and funding Also an annual meeting is key as it helps foster a sense of shared identity and purpose among the affiliates, and itís important for skill building and information sharing as well as ensuring program fidelity and ensuring that the data collection is consistent That centralized data collection is valuable to us, but itís also valuable for our partners in that allows us to better monitor how the programís being delivered and offer more specialized technical assistance So in terms of some experience from the field, although at the Arthritis Program, our aim

is to increase the number of adults with Arthritis in EnhanceFitness, we know that thereís an overlap between people with Arthritis and people with cognitive disabilities like dementia We do have partners that implement the program in residential facilities, some that specialize in memory care as well as partners that implement the class specifically for people with developmental disabilities and other cognitive disabilities These classes have been very successful over time Iím gonna share with you some things that instructors of those classes that have participants with disabilities have had to offer to us One instructor that works in a memory care, residential facility works to incorporate cognitive stimulation into her classes, and a few examples of how she accomplishes that: sheís begun instituting what she calls ìmemory Mondays.î She begins the class by giving participants a fact such as ìGreyhound dogs can see better than any other breed of dog.î She then asks the group to remember this fact while exercising, and depending on the group, she may repeat the fact throughout the class, but at the very end of the class, she asks the group for the fact And the first person to shout it out gets a small token She mentioned giving out a pencil sharpener to show that participant how sharp they were that day She also works in games that involve participants remembering a series of movements paired with words Sheís found that when working in memory care, residential facilities it helps to count the moves or do rhythms with hands while singing a song or using various marches that keep a constant beat But whether working with participants with dementia or not, many EnhanceFitness instructors utilize creativity to keep things interesting in classes Some of them, weíve heard, come up with certain theme days like a sock hop day where they will do all their exercises to music from the ë50s, and they may dress up During football season, sometimes theyíll have tailgate days where theyíll encourage the participants to wear regalia from their favorite sports team Just a lot of different things to keep participants engaged And then another suggestion someone had to offer was to utilize seated exercise, and because of the adaptable nature of EnhanceFitness, all exercises can be done in the seated or standing position, and some classes, depending on the participants, are conducted entirely in the seated position Finally, she suggested utilizing assistants So while most classes only have one instructor, it may be helpful to bring in extra help utilizing another instructor that may teach nearby Staff of residential facilities have also been very helpful and especially utilizing other caregivers Having a few more sets of hands is helpful should a participant need extra help completing a certain exercise Or sometimes participants may wish to discontinue class for that day or need to leave for some other reason, and if there are extra people available, it really allows the instructor to continue to lead class while still accommodating someone who may need a little extra help So physical activity is important for all people including older adults and people with dementia and other disabilities, but it can really be a balancing act to be inclusive to those with dementia and other disabilities while still maintaining fidelity to the program So a golden rule that instructors in Michigan follow is that participants must be able to take part without disruption Instructors often accomplish this by letting participants and caregivers know when they first begin class that thereís a policy about this and that itís nothing personal Weíve also heard from instructors that it can sometimes be a challenge for them, but itís important when working with people with dementia and other disabilities to remember that they need to let go of the outcome They may be concerned that a participant with dementia or other disability is not getting as much out of the class as others Maybe theyíre not participating the same way or maybe not as consistently as others in the class Maybe theyíre only able to come once a week instead of three times a week due to when their caregiverís available to help them But what the participant gets out of the class is not really for the instructor to determine So provided participants are not disruptive, and theyíre able to attend class safely, their participation should be encouraged and supported So in terms of what the research says, although thereís accumulating evidence supporting the benefits of physical activity programs like EnhanceFitness to maintain cognitive functioning, I donít know of any published studies that have looked at the cognitive benefits of EF And I reached out to Senior Services and the University of Washington and confirmed that there arenít any studies available at this time

However the researchers at the University of Washington are currently piloting an adaptation of EnhanceFitness called Enhance Mobility This is for those with middle to later forms of dementia Although they are not currently investigating the cognitive benefits of that program, theyíre investigating the daily, physical function effects so thatís something that may be able to be looked at in the future So at this time, EnhanceFitness can be used as an example of an exercise program that includes a component, both strength training as well as aerobic, that may impact cognitive functioning or delay onset of dementia And the final action item I have here is M11, examining the chronic disease, self-management program and other evidence-based programs such as EnhanceFitness to determine their ability to include persons with dementia and their care partners, which is what theyíre doing at the University of Washington at this time And finally here is my contact information as well as the Project Enhance website, the developers of the program, and then the EnhanceFitness Michigan Network Partnership website where more information can be found Thank you very much for having me today, and I can either take questions at the end of this via the chat feature, or feel free to email me if something comes up later Thank you Great, thank you so much, Meghan And our final presenter today, last, but certainly not least, is Dr. Wayne Osness Heís Professor Emeritus with the Department of Health, Sport, and Exercise Sciences at the University of Kansas, and he also currently serves on the Kansas Governorís Council on Fitness And Dr. Osness, this is just a reminder to please press star-seven to unmute your line There we go Can you hear me now? Yes, yeah, we can Thank you Well, first of all, I want to thank you for inviting me to be part of this group Iíve learned a lot already today, and I appreciate the fact that we have people that are concerned about physical activity and mental function My presentationís gonna relate to a community program that we have here in the state of Kansas, and specifically Lawrence, Kansas, that we have been doing for probably 20 years and hopefully 20 more But the point is that many of the programs that we are experiencing now are programs that are about a year or two, and they have very little sustainability The program that we are working on conducting here in Lawrence was started with a grant from the Kansas Health Foundation over 20 years ago And the grant allowed for 70 cities to set up programs relating to lifestyle management And the grant also included money to train people from these 70 cities to provide programs in nutrition and in exercise And I donít know how many of those are still going, but the University ñ but we have a program here still in place, and so that certainly is an indication of good sustainability The programs were designed to work with people over 60 years to develop and maintain healthy lifestyles and to maintain the physical and mental functions and to help the participants remain independent and functional for a longer period of time Now this doesnít relate directly to mental function, but as we look at the research, which is rather sparse as indicated earlier, we find that most of the research relating to mental function is observational research as opposed to data research So itís very difficult to draw conclusions, but the point is that itís very clear that exercise is important for maintaining physical and mental function And so based on that, part of our program is based on the exercise and physical activity and the other on nutrition Our program is called Path: P-A-T-H, which stands for Personal Action Toward Health And I think that name is a good indicator of what weíre attempting to do

If we have someone who is paid to run a program, we know that itís gonna have a given length of life If we, however, train the individuals to do the programs themselves, then ñ and make good decisions about their lifestyle, we have a better chance of sustainability And all of this is based on the fact that our Surgeon General for the last ten years has indicated the importance of prevention and the fact that 53 percent of our illnesses today are self-imposed In other words, weíre making bad decisions about our lifestyle But the point is the average individual over 60 years has very little to go on to make good decisions either about the nutrition or about their exercise And we know that as we increase in age, we find that if the exercise is too vigorous, we can create problems If itís not vigorous enough, it ñ itís meaningless And so we have to hit that fraction that is helpful to those people who are involved And that takes some background A lot of that, however, comes from individual decisions that are made every day Now we have here on our slide the PATH program and the components of that program: exercise, education, nutrition education, exercise and nutrition practical experience Now these are very specific in that the exercise education and nutrition education is very important because we have found that older individuals will be involved in a program, but unless they understand why theyíre involved in the program ñ and the physiological and physical good that is coming from that program is very important to them And if they donít understand the education part of it in the background, chances are theyíll be with it for a while, and then that itíll be a very short program So and the exercise and nutrition practical experience has to be one that those involved enjoy If it isnít something that you enjoy, it isnít gonna happen For example if we talk about the beginning of an exercise program which is walking around the block Well, if walking around the block is all weíre doing, chances are weíre not gonna do it very long But as weíre walking around the block, if weíre looking at the flowers, and weíre looking at the trees that are beginning to show leaves If we look at ñ pay attention to the things that are going on in our neighborhood, then everything changes Weíve got to ñ itís important that it isnít just the walking thatís important but the fact that we enjoy the exercise And if we do that, then chances are weíre going to stay with it And so itís a combination of education and positive, practical experience Now the program outcomes are many And ñ but today we want to talk about the relationship between exercise and mental function Unfortunately, we donít have a lot of data to support the mental function because thereís a lack of assessment techniques in mental function for older individuals The educational, for example, with exercise includes exercise and cancer, exercise and cardiovascular disease, exercise and pulmonary disease These are things that are very important to these people, but on the other hand, they donít realize the fact that exercise is so critical to maintaining their health status and reducing the incidents of things happening to them in these areas or realizing that some of their friends are affected by these problems and could be improved by exercise And so we ñ letís go on to our next slide and talk about the components ñ about the objectives of the program ñ weíre still looking at components Oh, here we go We got it So as I indicated earlier, we are trying to help the individuals provide the information they need to make good decisions about their lifestyle, provide positive experience for

the participants to implement that lifestyle Now just as an example, our programs last either ñ we started with eight weeks, and weíre now down to six weeks And so that means we have six lectures, and we have six examples of preparing food for a positive lifestyle And so the lectures relate to the people in a more positive way and a more direct way So after the participants then finish the six or eight week program, we do pre and post assessments Now those assessments relate to hand-eye coordination ñ of course very important to physical function ñ to agility and balance, to strength, and to flexibility We also have a ñ we started with endurance, but with the number of participants that we have, the endurance evaluation takes a lot of time All the programs that we have ñ assessment programs that we have are related to similar assessments in an exercise physiology lab, and so thereís good reliability and validity If an assessment does not have good reliability, in other words, to be able to measure it over time and to get a good number for the subject, itís not that helpful In fact, we can ñ hell, we can display numbers that are actually inaccurate, and that would not be helpful at all to those people who are involved in the program Now the reliability and validity of these six parameters were developed at six different colleges and universities around the country, and so we have a lot of good input In fact it resulted in a public case of functional fitness assessment for adults over 60 years And this was published by the Kent Hunt publishers, and it had two publications But right now, I think weíre in between publications In fact, Iím not sure that weíll do a third one Actually, it doesnít make any difference because the parameters that weíre looking at now, and the procedures we use to get numbers for those parameters, are something that is somewhat ageless, and so we can use it for a long period of time All of the equipment that is used can be found in a normal home environment, and basically individuals could actually do it themselves Then also included in this are the norms: the first, second, and third, fourth quartiles that tell an individual how they relate to other people their age and sex And we have a computer program that will accept data from a given individual, compare that to about 12,000 other individuals who have taken this test, and provide a printout, and the printout is in a linear form, and it gives the individual percentile In other words, in that ñ in flexibility, are they in the eighth percentile, or are they in the 98th percentile compared to other people their age and sex? So this has been very critical for us and very meaningful for those involved in the program Now once the person is involved in the program for the six or eight weeks, then they are invited to the ñ what we call the graduate program We hold the initial program at one of our parks and recreation buildings in Lawrence, and then in our graduate programs, we have two churches that allow us to use their activity rooms These programs are run by graduates of our program so itís ñ these people have been involved in the program and involved as participants and they have graduated to the point where they are then the leaders of the program And why this is important is because our budget here is relatively zero

We ñ all of the people who are involved with the program are volunteers And so the program ñ the people themselves are running the program after the additional ñ the initial instructional program And so this is really critical and one of the reasons for the sustainability My experience has been that the program could be sustained, but the finance probably isnít gonna last that long, and as a result, the program will stop And so sustainability is really critical, and I would hope that anyone who would be thinking about doing a program like this would be thinking about sustainability The other thing that I want to reemphasize here is to provide a positive experience for the participants to implement that lifestyle For example, many of our programs are kind of modifications of a marine training program, and obviously for older individuals, this can do more harm than good And so the experience has to be something that is reasonably easy for the participants to do that they can sustain over a long period of time and that they can implement into their lifestyle And very seldom would this be done if the experience they had was a negative one So as I said, weíve been doing this now for 20 years, and itís been very good for us, but I think some of the things that are involved in the program have determined why weíre able to do it for 20 years And so I would suggest that other people give some thought to setting up a program that is self-sustainable and teaching the participants what they need to know so they can then pass on this information to their peers, and the program will continue as a result of that So I, too ñ I donít have an address here on my slide, but Iíll give you my email address: [email protected] So please drop me a note, and Iíll ñ we can talk about some of these issues, and I can provide you with some more information if you would like So thank you very much for listening All right Thank you very much, Dr. Osness, and thank you again to all of our presenters who shared such valuable information this afternoon I wanted to go ahead and open it up to questions A couple have come through the chat box so Iíll start with those One question was how might employers with workers over 60 be a part of implementing EnhanceFitness or PATH Meghan, I donít know if you wanted to start, and then weíll turn it over to Dr. Osness Sure Can you hear me? Yes Okay, good We actually have one of our area agencies on aging in the state They just started up a class in house that is for some of their employees or members of the public as well, and that seems to be going really well I think EnhanceFitness lends itself to worksites very well as itís set days and times, and at an hour at a time, itís easy to fit in over the lunch break, theyíre finding And I think as the workforce in general becomes an older population that there are a lot of opportunities here Really, itís a fairly low-cost program only needing to pay for the instructorís time Oftentimes the instructors will have their own sets of weights and then a room with chairs So I think this program, in general, lends itself excellently in terms of being a worksite wellness program I think a lot of the wellness worksite programs that Iím aware of use walking or speed walking or maybe even jogging I think walking is best This is another indication that you donít have to have necessarily athletic clothes to wear It can be done within a break in the afternoon It can be done over the lunch hour and is relatively safe to do And so it seems to me like that would be probably the best thing to do at the worksite Okay, and we had another question through chat

Have either of the programís features been supported by SNAP-Ed funds? Iíll go ahead and discuss that with EnhanceFitness Not as far as Iím aware Thereís a lot of grant-funded programs out there, and then also weíre seeing some health plans actually step up and support the program and the instructorsí time and offer it to members of their health plans So thatís really the main ways that workshops ñ Iím sorry ñ that classes are funded, but I donít know of any SNAP-Ed funded classes I think funding is a major issue because a lot of these people donít have a lot of ready cash, and a small amount of money is very meaningful to them And so theyíre probably not going to spend it The point is that if the leaders of the program are not willing to volunteer to do it, this creates a problem The only other solution youíd have is to train the individuals who are over 60 to do it themselves, but my experience has been if thereís a cost associated with it, itís gonna have a shorter lifespan Thank you both And that was it for questions through our chat box Does anybody have any questions theyíd like to ask verbally? Just press star-seven to unmute your line Or you can add questions now through the chat box Lynn, this is Lynda Anderson Can you hear me? Yes I just wanted to, and Lynn will send this out to everyone, but know that we did a review of physical activity programs in 2011 It was published, and a number of my colleagues, particularly those in the Division of Nutrition and Physical Activity ñ and what weíve found was that although thereís a lot of observational studies, and I think both speakers mentioned this that related to physical activity being positively associated with cognitive outcomes What we found was that when people are structuring these programs ñ one that they havenít really given it the consideration to how much exercise, and many of them are very short term So I was delighted to hear that EnhanceFitness, and Iím aware of some of the work by Rebecca Logsdon and her group at the University of Washington that are doing pilot tests on people that have various cognitive impairments as well as looking at sort of cognitive health But weíll send a ñ that article out, and if anyone has questions ëcause again the feel that, I think, the work that the National Institutes of Aging has a number of large studies now that hopefully weíll be seeing more work in terms of knowing about the dose response, the length of what physical activity ñ and we all know that physical activity is a very important and positive aspect And so weíre hoping to learn more in the future about cognition and glad to see this work going on I think a very important aspect of this is the fact that we have a good assessment You need to know whether the programs are making a difference whether theyíre changing the participants or not and what the change would be Ours had to do with performance assessment, which was really critical to us because performance not only means their health status but also their independence And so ñ but in order to do that, you have to take the time to do the assessment, and you have to have a reliable and valid assessment Now in ñ and I think this is a problem that we have with brain function The ones that I know about have to do with repeating random numbers or a series of random numbers, answering questions about certain dialog, and so on and so forth But none of them, that I know of at least, have good reliability and validity So maybe some of you here do know those that are reliable and valid Well, one thing that I would like to mention is that in the National Institutes of Aging and Health have been working on a toolbox, the Promise Toolbox, which includes both reliable

assessments in the area of mental health ñ many aspects of that and including cognitive function So I think there are recommended tools now, and the Promise and the other NIH Toolbox have those measures available, and I think weíre seeing them more into everyday practice I think not only do we have to see those, but I think also the physical activity, as was mentioned earlier, have to meet sort of the physical activity guidelines in order to be able to see those kind of impacts And there are many evidence-based physical activity programs I think what weíre beginning to see is again assessing those in terms of cognition And many of my colleagues are on the phone today from the Division of Nutrition, Physical Activity, and Obesity, and on their website, they list many evidence-based as well as CDCís Arthritis Program, which are really looking at many of the physical aspects as well as mental health aspects And I think I want to encourage everyone to look for and see the evidence around cognitive health as some of these very large trials will be coming to fruition in the future and these very interesting pilot trials as well I think another thing thatís very important, and I hope maybe some of these research programs have it is that it provides feedback to the individuals who are doing the program In other words, if we have an assessment, and the person scores a 67, what does that mean compared to what? And so we need a large database so that we can tell that individual, ì67 is well, like 47th percentile of people your age and sex.î And so but it takes a while to develop that because that database has to be using the same protocol and same procedures Right, and I would say the same thing for physical functioning and other aspects of that as well in terms of the kinds of feedback that we give to individuals in programs Right Thatís a very good point Okay, we have just a few minutes left Does anybody on the line have any questions theyíd like to ask now while we have the presenters here? Okay, well, if not, just a few closing comments Once you close the ReadyTalk box, youíll be taken to a survey evaluation So please take the time to complete that so we can continue to improve our webinars And also if you have any questions, you can ask them there And you can also feel free to contact me through email or phone if you have any questions, and I can get in touch with the presenter most likely to know the answer to that question if I canít answer it for you And then coming up next in May on May 27th at 2:00 PM, Eastern Time, we will have the next webinar in our Health Aging and Cognitive Health Webinar series It will be on program and policy considerations for supporting caregivers of persons with dementia and other ñ Alzheimer’s and other dementia And so please mark your calendars now, and we will be sending out the formal invitation in the next couple weeks And, of course, please feel free to visit ASTHOís website We have all of our past recordings posted up there as well as notices for our future recordings So thank you again, everyone, for attending Please donít hesitate to contact me with any further questions Have a wonderful afternoon [End of Audio]