Study for Rural Innovations in the Delivery of Exercise (STRIDE)

Falls are the primary cause of injury among older adults. Community-based exercise programs can help reduce the risk of falling, but these programs are generally not available in rural areas. In partnership with Arbor Health and Sound Generations, researchers from UW assessed the feasibility of delivering the Enhance®Fitness (EF) exercise program virtually to older adults living in rural areas.

Executive Summary

Falls are the primary cause of injury and a leading cause of disability and mortality among older adults. Risk factors for falling are common among older adults with knee osteoarthritis (OA) – a highly prevalent condition. Physical exercise is the most effective way to prevent falls in older adults, but access to exercise programs is severely limited in rural areas. This project adapted the Enhance®Fitness (EF) exercise program, an evidence-based exercise program, for remote delivery by engaging rural older adults. In partnership with Arbor Health and Sound Generations, researchers assessed the feasibility and acceptability of the tele-exercise version of EF by conducting a pilot trial in older adults.

Study Overview: The research team partnered with Arbor Health, a rural serving health care system in Lewis County, Washington, to recruit older adults with knee OA to participate in the study. Researchers interviewed the study participants to understand their technology needs and preferences for virtually delivered exercise (tele-EF). The study participants attended 1-hour tele-EF classes 3 days a week for 12 weeks. After completing the tele-EF program, participants were asked about their satisfaction with the program and suggestions for improving it.

Funding Award: Dr. Patel was awarded funding as a part of an Exploratory Research Project administered by the Harborview Injury Prevention & Research Center (HIPRC) at the University of Washington and funded by the Centers for Disease Control and Prevention.

Study Team

Principal Investigator

Kushang Patel, PhD, MPH

Dr. Patel, the HIPRC Interim Associate Center Director and Research Core Director, is a Research Associate Professor in the Department of Anesthesiology and Pain Medicine at the University of Washington. He completed doctoral and postdoctoral training in epidemiology, gerontology, and health disparities research at the University of Texas Medical Branch and National Institute on Aging/NIH. His research investigates exercise and other non-pharmacologic treatments to improve pain management in older adults with arthritis. In addition, he conducts epidemiologic research on pain, aging, and physical activity using a variety of methods and data sources.


Elizabeth Phelan, MD, MS

Dr. Phelan is Associate Professor, Gerontology and Geriatric Medicine, University of Washington School of Medicine, Adjunct Associate Professor of Health Services, UW School of Public Health, and affiliate investigator with the Kaiser Permanente Washington Health Research Institute. She is director of the Northwest Geriatrics Workforce Enhancement Center and founding director of the UW Medicine Fall Prevention clinic. Her research typically involves collaborative partnerships with healthcare and community organizations that serve older persons.


Nancy Gell, PT, PhD, MPH

Dr. Gell is an Associate Professor in the Department of Rehabilitation and Movement Science at the University of Vermont. Her research focuses on testing interventions to support physical activity and exercise participation among people aging with cancer and osteoarthritis, and examining factors associated with fall risk in older adults. Dr. Gell has more than 25 years of clinical experience as a physical therapist as well as training in public health and exercise science.

Research Coordinator

Elise Hoffman, BS

Elise Hoffman is a Research Coordinator in the Department of Anesthesiology and Pain Medicine at the University of Washington. Elise received a BS in Public Health from the University of Washington and works with Dr. Patel on several studies focused on older adults with knee osteoarthritis.

Study Background

Older adults with chronic conditions have many barriers to participating in exercise. Recognizing these barriers and the public health benefits of exercise for management of OA, the Centers for Disease Control and Prevention (CDC) has promoted evidence-based exercise programs that are group-based and led by instructors in the community. However, access to these programs is severely limited in rural areas.  However, videoconferencing technology can enable rural older adults to participate in traditional group-based exercise programs from home. Accordingly, this project aims to adapt the Enhance®Fitness (EF) exercise program.