Project Profile: Evaluation of Fit Squad®

A Fit Squad® participant exercising with their mentor. Image from the “We Are Community Partners!” video

PROJECT: Adapting a fitness promotion program (InSHAPE) for people with severe mental illness—for people with intellectual and developmental disabilities (IDD), called the Fit Squad® program.

VIDEO : We Are Community Partners!

This video shows the Fit Squad® program in action, featuring comments from health mentors, home providers, day staff providers, and participants.

GOAL: To determine whether the program helps obese and sedentary people with IDD to become more fit and healthy, and whether this is a model that can be used by other area agencies in New Hampshire and across the country.

METHODS:

  • Weekly individual meetings with a certified fitness trainer (“health mentor”)
  • Free gym memberships for participants and their caregivers
  • Monthly caregiver group educational meetings on healthy eating
  • Web-based portal to track healthy behaviors and provide fitness tips

“It’s been very exciting to have this opportunity to work on developing an evidence-based program that can not only improve our clients’ health, but help increase their self-confidence and their sense of belonging to their communities.”

– Brian Collins

Quotes from Qualitative Interviews given by people who live with and care for Fit Squad® participants

“She did not want to join at first because she did not believe she could ever make changes. But she fell in love with the mentor and felt safe and supported. She has gone from a size 20 to a size 14 and is still going.”

     (Female, 35)

“Being part of the program has motivated him to pay attention and exercise. He likes the social opportunity to be with others and to be supported.”

   (Male, 40)

“He enjoys going to the mentor who has incorporated wrestling into his exercise program to make it personal to him and keep his interest.”

(Male, 24)

“Staff is engaged—they are cheerleaders. Instead of sitting down, they are doing, and there has been spillover into the community. People see the positive camaraderie, people doing things together.”

(Female, 22)

OBJECTIVES:

  • Enroll at least 10 participants and their caregivers within 3 months
  • Achieve attendance or participation of 70% or greater
  • Within 6 months, participants should achieve:
    • – decrease in weight;
    • – increase in regular exercise and cardiovascular endurance;
    • – have regular attendance at a fitness facility;
  • Collect qualitative data through interviews and reporting on life satisfaction, quality of relationships, and sense of belonging in the community

RESULTS:

  • Enrolled 10 participants and their caregivers within first month
  • Attendance was excellent (81%), with all participants completing assessments at baseline, 3 months, and 6 months
  • At 6 months:
    • – average weight loss was 4.5 pounds (4 people lost weight, 2 maintained, and 2 gained)
    • – endurance results (via 6-minute walk test) were mixed (2 people increased walk distance, 6 decreased, and 2 maintained); not having a consistent, appropriate location for the walk test may have affected these results
    • – overall, participants’ readiness to change was high (at baseline), and they self-reported significant improvements in eating habits and weekly exercise minutes
  • Average scores for physical and emotional well-being decreased slightly, while scores on social inclusion, a key element of the program, increased measurably.

CAREGIVERS’ PERSPECTIVE:

All caregivers viewed the health mentor (certified personal trainer) as a major asset to participants, with many believing that participants experienced increases in confidence, ability to problem solve, and a sense of personal responsibility as a result of the program. Some also noted less resistance to ADL (activities of daily living) skills, greater openness to new foods and routines, and new knowledge gained about nutrition and exercise.

The primary critical feedback was lack of time for monthly group caregiver sessions. Caregivers also did not utilize the web-based tool that was developed to track health behaviors of participants.

VIDEO: Fit Squad® at Community Partners!

This video provides an overview of the Fit Squad® program, including its key components and how and why the program was created.

COMMUNITY PARTNERS: Community Partners Behavioral Health & Developmental Services of Strafford County, Ken Jue & Associates, the University of New Hampshire Institute on Disability, NH Disability & Public Health Project, the Geisel School of Medicine at Dartmouth.

RESEARCH TEAM: Sarah Pratt, PhD (PI), Assistant Professor of psychiatry at Geisel and of The Dartmouth Institute for Health Policy and Clinical Practice; Brian Collins (Co-PI), Executive Director of Community Partners NH.

FUNDING: NH Charitable Foundation, Dartmouth Clinical and Translational Science Institute (aka SYNERGY).

BACKGROUND: The life expectancy of people with developmental disabilities is 15-20 years less than the general population, largely because of higher rates of obesity, sedentary lifestyle, cardiovascular disease, and poor nutritional habits. Community Partners serves more than 300 such individuals—at least 40 percent of whom are overweight or obese—who share the same health risks, including social isolation.

After witnessing the profound improvements that the In Shape program had on the lives of his clients with severe and persistent mental illness, Community Partners Executive Director Brian Collins reached out to Dartmouth researcher Sarah Pratt (who had participated in the development of In Shape) in 2015 for help in adapting the program for his clients with intellectual and developmental disabilities. With support from the NH Charitable Foundation and a SYNERGY Community Engagement Pilot Award—this project was born.

“Usually, a researcher approaches the community with a study proposal and essentially gets them to sign off on it. Here was someone (Brian Collins) with expertise in providing vital services in the community reaching out to us. Not only was he identifying a real need, he wanted to partner with us in a research effort.”

– Sarah Pratt

Next Steps: The Fit Squad® development team continues to meet monthly to discuss and plan the next iteration of the program, with the goal of doing a larger pilot study. They are exploring ways to use technology to track and prompt fitness behaviors, while investigating funding sources such as the Robert Wood Johnson Foundation and the Eunice Kennedy Shriver National Institute for Child and Human Development.

More Information/Contact:

Sarah.I.Pratt@dartmouth.edu