Arthritis-Appropriate, Evidence-Based Interventions (AAEBI)
Arthritis-Appropriate, Evidence-Based Interventions (AAEBI)
The Osteoarthritis Action Alliance (OAAA) recently completed a Centers for Disease Control and Prevention (CDC)-funded review of select evidence-based interventions to identify community-based programs that met established criteria to be classified as an arthritis-appropriate evidence-based intervention (AAEBI).
The OAAA has expanded the menu of recognized AAEBI programs by adding eleven programs to the list of recognized AAEBIs, including six physical activity interventions and five self-management education interventions.
These newly recognized programs expand the current list of recognized Lifestyle Management Programs for arthritis. All programs – existing and newly recognized – are listed below.
Does your organization deliver any of these recognized AAEBIs? Download the seal of recognition and post it to your site to show participants that you value evidence-based programs and provide them for your community!
Physical Activity Programs
- Arthritis Foundation Aquatic Program
- Active Living Everyday
- Fit & Strong!
- Walk with Ease – Group
Newly Recognized Programs
- AEA Arthritis Foundation Exercise Program
- Camine Con Gusto
- Fit & Strong! Plus
- Tai Chi for Arthritis
- Tai Ji Quan: Moving for Better Balance
- Walk With Ease – Self-Directed
Self-Management Education Programs
- Chronic Disease Self-Management Program
- Tomando Control de su Salud
Newly Recognized Programs
- Better Choices, Better Health®
- Chronic Pain Self-Management Program
- Program to Encourage Active, Rewarding Lives (PEARLS)
- Workplace Chronic Disease Self-Management Program
Arthritis Foundation Aquatic Program
The Arthritis Foundation Aquatic Program (AFAP) is a water exercise program created by the Arthritis Foundation and the Y-USA for people with arthritis and related conditions. The classes are conducted by a trained instructor and include joint range of motion, stretching, breathing, and light aerobic activities. The classes typically meet two or three times per week for one hour for six to 10 weeks.
Active Living Everyday
Active Living Everyday (ALED) is a group-based program developed at the Cooper Institute that focuses on helping sedentary people become and stay physically active. Participants learn skills needed to become more physically active, such as identifying and overcoming barriers, setting goals, and creating an action plan. The program addresses a variety of moderate and vigorous physical activities, and provides background information that can be used to make personal decisions about the type and amount of exercise to pursue. Participants do their actual physical activity outside of the group setting. Classes meet once a week for 12 to 20 weeks. Trained and certified facilitators (instructors) teach the course in conjunction with a participant book.
Enhance®Fitness (formerly Lifetime Fitness) is a community-based physical activity program proven to increase strength, boost activity levels, and elevate mood. EF instructors are trained and certified to offer this program that focuses on stretching, flexibility, balance, low impact aerobics, and strength training exercises. Typically classes meet three times a week for one hour.
Fit & Strong!
Fit & Strong! is a community-based physical activity and behavior change intervention offering stretching, balance, aerobic, and endurance exercises. Health education, problem solving and goal setting also are important components of Fit & Strong!. The program was designed to target sedentary older adults who are experiencing lower-extremity joint pain and stiffness and adults with osteoarthritis. Fit & Strong! classes are 90 minutes 3 times per week for 8 weeks and are delivered by a certified exercise instructor.
Walk with Ease – Group
Walk with Ease (WWE)–Group is a community-based walking program developed by the Arthritis Foundation. WWE group sessions meet three times per week for 6 weeks. Trained group exercise leaders begin each session with a pre-walk discussion covering a specified topic related to exercise and arthritis, followed by a 10- to 40-minute walk that includes a warm-up and a cool-down period.
Newly Recognized Programs
AEA Arthritis Foundation Exercise Program
The AEA Arthritis Foundation Exercise Program (AFEP) is a low-impact recreational exercise program that incorporates a brief educational component. The goals of the program are to reduce pain and stiffness; restore or maintain joint range of motion; maintain or increase muscle strength; improve balance and coordination; decrease fatigue and increase endurance; and improve overall perceived health status. The class meets for one hour, two to three times a week. Although developed as an 8-to-12-week program, it can be extended to include ongoing classes. AFEP is offered in some YMCAs and by other community organizations, fitness centers, recreation centers, retirement and assisted living facilities.
Camine Con Gusto (Spanish version of the Walk With Ease Self-Directed Program)
Camine Con Gusto (CCG) Self-Directed arthritis physical activity program was developed by researchers at the Thurston Arthritis Research Center, UNC-Chapel Hill and is owned by the Arthritis Foundation. The primary audience is adults who have been either self or medically diagnosed with arthritis or have other chronic conditions and wish to be more physically active. The CCG guidebook leads participants through the program, including setting goals, identifying barriers, conducting self-assessments, stretching exercises, strengthening exercises, and – of course – walking. Participants are encouraged to walk at least three times per week, working up to 30 min per session or more.
CCG addresses four primary goals: (1) to provide education about safe and effective physical activity for people with arthritis; (2) to provide basic information about arthritis and arthritis symptom management; (3) to guide participants through key behavior change steps to increase physical activity; and (4) to provide participants with a step-by-step approach to increasing and maintaining physical activity levels based on the latest research and recommendations.
Fit & Strong! Plus
https://www.fitandstrong.org (check back for an updated link to Fit & Strong! Plus)
Fit & Strong! Plus is the physical activity plus weight loss version of the Fit & Strong! program, a recognized physical activity AAEBI. Fit & Strong! Plus has the same structure (twenty-four 90-minute classes consisting of 60 minutes of physical activity and 30 minutes of health education, goal setting and group problem solving). The physical activity routine (warm-up, low-impact aerobics, lower extremity strength training, and cool down) is the same as the traditional program, but the health education has been modified to include a systematic participant-engaged curriculum on healthy eating and weight loss. Participants are also regularly weighed in class and perform homework activities like keeping food diaries, reading labels, healthy shopping, and food preparation. The goals of Fit & Strong! Plus are to help adults with lower extremity arthritis adopt healthy eating habits in addition to physical activity to manage their weight and osteoarthritis. Workshops are led by certified fitness instructors trained in Fit & Strong! Plus.
Tai Chi for Arthritis
Tai Chi for Arthritis (TCA) was developed to improve health with an emphasis on evidence-based efficacy and safety. Tai Chi’s Sun style was used for its ability to improve health, relieve arthritis pain, function, and its ease of use for older adults. Movements are performed at a higher stance to make it easier for older participants and those with arthritis and disability. Movements can be modified to accommodate mobility issues for any participant and can be done seated as a starting exercise. TCA, also known as Tai Chi for Arthritis and Fall Prevention, is led by a Tai Chi for Health Institute (TCHI) Board certified instructor. Participants should attend a minimum of one hour per week for 16 weeks or two hours per week for eight weeks.
TCA incorporates tai chi principles. It has three components: warmup and cooldown exercise, six basic core movements, and six advanced extension movements. Another nine movements may be added to maintain participant interest and enhance program sustainability.
Tai Ji Quan: Moving for Better Balance
Tai Ji Quan: Moving for Better Balance® (TJQMBB) is an evidence-based balance training regimen designed for older adults at risk of falling and people with balance disorders. TJQMBB represents a substantive enhancement of traditional Tai Ji Quan training and performance as it transforms martial arts movements into a therapeutic regimen aimed at improving postural stability, awareness and mindful control of body positioning in space, functional walking, movement symmetry and coordination, range of motion around the ankle and hip joints, lower-extremity muscle strength, and global cognitive function. The program is delivered by a trained lay leader/facilitator, fitness instructor, physical therapist, occupational therapist, nurse, or certified fitness instructor during two one-hour sessions each week for 24 weeks. Each session consists of warm-up exercises; core practices, which include a mix of practice of forms, variations of forms, and mini-therapeutic movements; and brief cool-down exercises.
Walk With Ease – Self-Directed
The Arthritis Foundation’s Walk With Ease (WWE) Self-Directed arthritis physical activity program was developed by researchers at the Thurston Arthritis Research Center, UNC-Chapel Hill. The primary audience is adults who may be either self- or medically diagnosed with arthritis, or who have other chronic conditions and wish to be more physically active. The CCG guidebook leads participants through the program, including setting goals, identifying barriers, conducting self-assessments, stretching exercises, strengthening exercises, and – of course – walking. Participants are encouraged to walk at least three times per week, working up to 30 min per session or more.
The self-directed program addresses four primary goals: (1) to provide education about safe and effective physical activity for people with arthritis; (2) to provide basic information about arthritis and arthritis symptom management; (3) to guide participants through key behavior change steps to increase physical activity; and (4) to provide participants with a step-by-step approach to increasing and maintaining physical activity levels based on the latest research and recommendations.
Chronic Disease Self-Management Program
The Chronic Diseases Self-Management Program (CDSMP) is an effective self-management education workshop for people with chronic health problems including arthritis, diabetes, lung and heart disease. This program covers topics such as: techniques to deal with problems associated with chronic disease, appropriate exercise, appropriate use of medications, communicating effectively with family, friends, and health professionals, nutrition, and, how to evaluate new treatments. Participants demonstrated significant improvements in exercise, ability to do social and household activities, less depression, fear and frustration or worry about their health, reduction in symptoms like pain, and increased confidence in their ability to manage their condition.
Tomando Control de su Salud
(Spanish Chronic Disease Self-Management Program)
Tomando Control de su Salud is a self-management education program developed for Spanish-speaking people with chronic health problems. Tomando Control de su Salud was developed to address the health content and topics in a culturally appropriate manner. Topics covered in the program include: appropriate use of the health care system, how to evaluate new treatments, communicating effectively with family, friends, and health professionals, healthy eating, appropriate use of medications, techniques to deal with problems, and appropriate exercises for maintaining and improving strength, flexibility, and endurance.
Newly Recognized Programs
Better Choices, Better Health®
Better Choices, Better Health® (BCBH) is an internet-based group workshop that uses content from the Chronic Disease Self-Management Program. It focuses on chronic disease management, decision making, problem-solving, and action-planning. Participants log on at their convenience 2-3 times per week for a total of approximately two hours; participants do not need to log on at the same time. Trained peer coaches facilitate the group dynamic and provide additional support to workshop participants. All the interactions occur through the secure web application and are designed to leverage both self-discovery and peer interactions to increase participants’ self-efficacy.
Enhance®Wellness (EW) is an evidence-based program that connects participants with a trained personal health and wellness coach to improve physical, emotional, and social well-being. Based on the Chronic Care Model, EW’s participant-centered approach uses motivational interviewing techniques and validated assessment tools in ten+ domains to guide Health Action Plan creation and accountability. Through the use of problem-solving strategies, participants clarify goals, responsibilities, and activities as they work toward health-related behavioral change. The goal of the program is to maintain or increase the health and functional status of older adults with chronic conditions and people aging with disability.
Program to Encourage Active, Rewarding Lives (PEARLS)
The Program to Encourage Active, Rewarding Lives (PEARLS), an intervention for adults and older adults with depression, aims to reduce symptoms of depression and suicidal ideation and improve quality of life.
PEARLS is delivered in six to eight 1-hour sessions by a trained health or social service professional (e.g., social worker, case manager, community health worker) in the client’s home or other community-based setting. Sessions are initially held weekly and become less frequent over a four- to five-month period. During sessions, clients choose the problems they would like to discuss, and the trained coach guides, teaches, and supports them in developing action plans that are implemented by the client between sessions to address these problems. Clients also plan meaningful and accessible physical, social, and pleasant activities to improve mood and energy.
Chronic Pain Self-Management Program
The Chronic Pain Self-Management Program (CPSMP), was developed for people who have a primary or secondary diagnosis of chronic pain. Pain is defined as being chronic or long term when it lasts for longer than 3 to 6 months (such as pain from arthritis), or beyond the normal healing time of an injury. The CPSMP may also benefit those who have conditions such as persistent headache, Crohn’s disease, irritable bowel syndrome, diabetic neuropathy, or those who experience severe muscular pain due to conditions such as multiple sclerosis. The CPSMP is held during a 2.5-hour session once a week over a six-week period. Classes are highly participative, where mutual support and success build the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives. Classes are led by two trained leaders, one or both of whom are non-health professionals with chronic pain themselves. All leaders must be certified in the CPSMP. The CPSMP can be offered by telephone, video platform, or in person. It is available in English and Spanish
Workplace Chronic Disease Self-Management Program
The Workplace Chronic Disease Self-Management Program (wCDSMP) is an adapted version of the Chronic Disease Self-Management Program (CDSMP, originally developed at Stanford) for use in the workplace. The primary goals and objectives for the program are to: 1. Improve self-management skills of employees with one or more chronic conditions; 2. Improve physical and mental health indicators of employees who participate in the program; and 3. Improve work performance and productivity indicators of employees who participate in the program. The program is conducted in a small group workshop during a 50-55 minute session, with two sessions held per week for six weeks. Classes are led by two trained CDSMP leaders, who have also attended the wCDSMP update, one or both of whom are non-health professionals with chronic disease themselves. The classes are available in person or by video platform in both English and Spanish.
AAEBI Evaluation Overview
The purpose of the Arthritis-Appropriate, Evidence-Based Intervention (AAEBI) Evaluation Process is to review the Centers for Disease Control and Prevention’s published process for program evaluation, update the process as needed, and employ the process to screen promising intervention programs for elevation to recognized interventions that are proven to improve the quality of life of people with arthritis. Learn more about the AAEBI program review process and criteria here.
Programs were evaluated by a national group of reviewers with extensive expertise in arthritis research, AAEBIs, program evaluation, and program implementation. This activity was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $865,211 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS, or the U.S. Government.