One other observation is that participation and retention tended to be higher in implementation sites with participants from Asian cultures compared to those with East African cultures where organized exercise in general and Tai Ji Quan specifically may be less known or preferred. However, the Asian organizations represented also tended to have older adult programs in place and pre-existing relationships with the bilingual Tai Ji Quan leaders, which could well have contributed to differences in participation. This outcome

will www.selleckchem.com/products/z-vad-fmk.html be further evaluated in 2013 with the implementation of the program in an East African community center with existing programs and leader relationships with participants. An important issue in implementing evidence-based programs is fidelity. While critical elements for program implementation were emphasized during the leaders’ initial 2-day training there was considerable variation among leaders during implementation. Although all bilingual leaders were

successful in getting their participants engaged in Tai Ji Quan forms and related movements specified in the training protocol, some were more successful than others in leading the protocol as provided in training. This variability was addressed in the follow-up sessions led by a local leader who had extensive Tai Ji Quan experience and was willing

to learn the program protocol. In several situations, one-to-one coaching was provided to raise leader PFI-2 nmr competence and align it to the program protocol. This effort appears to be needed and helpful from time to time during implementation. Although the protocol is adapted from classic Tai Ji Quan, it has been extensively tailored towards therapeutic training for improving balance in older adults. It is, therefore, critically important, from a program fidelity perspective, that the local trained leaders and/or experts selected are willing to thoroughly adopt the protocol and implement the program as used in the studies conducted.7 and 8 In this project, having local Tai Ji Quan expertise that was grounded Amisulpride in this protocol to provide follow-up support after the initial 2-day training was an important success factor in the initial stages of implementation. Two significant practical factors are worthy noting in future efforts. First, although a standard program fidelity checklist is available, making a simpler version for the “lay” community leaders/instructors would appear to greatly facilitate ease of program evaluation in community practice. Such a checklist should simplify the evaluation process but retain the major program elements to be evaluated by qualified evaluators.