Date of Award

Spring 5-15-2019

Author's School

Graduate School of Arts and Sciences

Author's Department

Rehabilitation and Participation Science

Degree Name

Doctor of Philosophy (PhD)

Degree Type



Falls are a growing public health problem among the aging population. Structured exercise programs are effective in preventing falls, and many have been implemented for community-dwelling older adults in the U.S. However, low adherence rates for structured exercise are reported consistently for this population. The need to translate alternative evidence-based exercise programs the diverse older adult population is important. One promising alternative program, the Lifestyle-integrated Functional Exercise Program (LiFE), can significantly reduce falls but has not yet been implemented for diverse older adults residing in the US. To initiate the translation of LiFE, we targeted older adults residing in medically underserved (MU) areas, who traditionally have less access to health prevention programs and have the lowest adherence rates for structured exercise programs.

First (Chapter 2), we used a scoping review to map the nature and extent of research conducted on exercise and physical activity (PA) participation, interventions and components of effective programs for MU older adults. We found that few exercise-based fall-prevention programs were available specifically for older adults, and adapted materials should be tailored to specific subgroups. This study confirmed the need for translating LiFE for MU older adults, and identified the crucial direction for the next phase of this dissertation study.

Second (Chapter 3), we developed an adapted LiFE program, Diverse Older Adults doing LiFE (DO LiFE), using a two-stage mixed method study. In the first stage, perspectives from local MU older adults and occupational therapy (OT) service providers were incorporated to develop a manual for new users. In the second stage, preliminary feasibility was established for DO LiFE in a single-group pilot study. We also developed critical insights for the next stage of the study, including using new recruitment strategies, refined inclusion criteria and measurements.

Last, we conducted a randomized feasibility study with attention control (flexibility exercise) to evaluate process outcomes of DO LiFE in preparation for larger studies. For diverse older adults residing in MU areas, DO LiFE has demonstrated good feasibility with high reach, adherence, fidelity, and acceptance, but a revision is needed that addresses barriers before proceeding to larger-scale translational studies.

Together, the results indicate that DO LiFE is feasible for further investigation in larger trials among diverse older adults residing in MU areas. The significance of this study is to accelerate translation of an evidence-based fall-prevention program for the in-need, diverse aging population into real-world settings.


English (en)

Chair and Committee

Susan Stark

Committee Members

Beau Ances, Carolyn Baum, Allison King, Nancy Morrow-Howell,


Permanent URL: https://doi.org/10.7936/hnjp-r164