Examining the Effectiveness and Implementation of Adaptive Functional Fitness for Adults with Mobility Disabilities - PROJECT SUMMARY Adults with mobility disabilities (MD) are at significantly higher risk for poor physical function, chronic disease, and social isolation. While clinic-based rehabilitation can temporarily address functional limitations, these programs are often short-term, insurance-restricted, and lack continuity into community-based exercise. Functional Fitness (FF) is a group-based, community-delivered exercise model focused on multi-joint movements that mirror activities of daily living. Adaptive FF offers scalable opportunities to improve physical function, yet it has not been rigorously evaluated in a randomized trial. This project will conduct an 18- month, Type I hybrid effectiveness-implementation randomized controlled trial to evaluate adaptive FF compared to a health education control (HEC) for improving physical function among 120 community-dwelling adults with MD across four sites. Participants randomized to FF will receive in-person, group-based classes delivered by certified adaptive FF trainers. HEC participants will receive virtual education sessions targeting health behaviors. The intervention consists of 6 months of active delivery (2x/week), 6 months of maintenance (1x/week), and a 6-month no-contact follow-up. Aim 1 will evaluate changes in patient-reported physical function at 6 months using the PROMIS® Physical Function for Mobility Aid Users. Secondary outcomes include performance-based functional assessments (strength, endurance, balance, and gait speed). Aim 2 will assess sustained improvements in physical function across 12 and 18 months, with additional analyses of mediators (e.g., session attendance, pain, fatigue) and moderators (e.g., sex, age, baseline function, ambulatory status). Aim 3 will examine the potential for future adoption and sustainability of adaptive FF using a mixed-methods approach guided by the PRISM framework. Pre-implementation, site readiness will be assessed using the Program Sustainability Assessment Tool. During and after implementation, we will track quantitative outcomes (e.g., attendance, fidelity, attrition, and trainer checklists) and conduct post-intervention interviews with a subset of participants from both groups and all FF trainers. A Community Advisory Board (CAB), including individuals with MD, will provide ongoing guidance to ensure the acceptability and relevance of all implementation tools. This study will generate critical data on the effectiveness and contextual implementation factors needed to scale adaptive FF across diverse settings. The proposed work directly responds to PAR-25-144 (Dissemination and Implementation Research in Health) and the priorities of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center for Medical Rehabilitation Research to improve physical function and health outcomes for individuals with disabilities.
