University of Washington Health Promotion Research Center

Increasing Reach of Enhance Fitness at YMCAs by Increasing Provider Recommendations to Older Adults


Arthritis is one of most common causes of disability in the nation, and it can interfere with work and daily activities such as walking. It can also complicate the management of other chronic diseases. Arthritis affects people of all ages but is more common in older adults. Its disabling effects are disproportionately prevalent in racial and ethnic minorities.

Evidence-based programs (EBPs) for group exercise are an underutilized opportunity for engaging older adults in physical activity. Clinical-community connections, such as referrals from healthcare providers, may help community-based organizations expand EBP reach.

EnhanceFitness, developed by the University of Washington Health Promotion Center (HPRC), Kaiser Permanente Washington (previously known as Group Health Cooperative), and Sound Generations (previously known as Senior Services), is an accessible and effective group physical activity program shown to improve health and functioning among participants. To date, the program has reached more than 89,000 older adults in 44 states and is offered by many community organizations such as senior and community centers, YMCAs, and retirement communities.

Due to the personal connection and high levels of trust between physical therapists and their patients, the goal of this project is to design and evaluate a new outreach intervention to facilitate YMCA partnerships with physical therapy clinics to increase referrals of older patients to Enhance Fitness.

Research Approach

Phase 1: Gather Information (2014-2015)

Learn how physical therapists exchange information with their patients about ongoing physical activity and community resources through clinical observation and interviews with physical therapists.

Learn how YMCAs engage with healthcare providers in their community, including physical therapists, through interviews with YMCA staff.

Phase 2: Design the System (2015)

Work with the YMCA and physical therapy clinics to create a system for engaging physical therapists to recommend EnhanceFitness at the YMCA to their older adult patients when appropriate.

Phase 3: Test the System (2016-2018)

Carry out a randomized controlled trial with one group of YMCAs using the system to engage physical therapists, and another group of YMCAs conducting business as usual. Compare results between groups to determine if the system is effective, feasible, and acceptable to physical therapists and YMCA staff.

Current Partners

  • HPRC
  • Y-USA
  • Sound Generations
  • Project Advisory Group–assists the research team with strategic planning, study design, and troubleshooting when issues arise. Project Advisory Group members represent many important categories of stakeholders, including: local, state, and national YMCA operations; EnhanceFitness operations; physical therapy research and practice; and evidence-based programs.

Researchers aim to build an approach to obtaining provider recommendations for EnhanceFitness and other physical activity programs that is effective, affordable, and can be adopted by YMCA Associations and other community organizations across the country.

Project Identifier PT-REFER (Physical Therapists Recommending EnhanceFitness to Expand Reach)

Funding Source PRC Program

Project Status Active

Host Institution University of Washington, Seattle

Health Topics Arthritis | Aging & elderly health | Physical activity

Research setting Medical or clinical site | Community

Race or ethnicity No specific focus

Gender No specific focus

Age group Older adults (50 years and older)

Contact Information Center
University of Washington Prevention Research Center
1107 NE 45th St. Suite 400
Seattle, WA 98105

Principal Investigator
Miruna Petrescu-Prahova, PhD
Phone: (206) 616-4724

PRC Deputy Director
Leah Westra, MPH
Phone: (206) 685-7258