A natural experiment to determine if FitEx works: Impact of a statewide walking program

The National Cooperative Extension System offers walking programs, but impacts are underreported. One program offered in two state systems is FitEx, an 8-week, group-based behavior change intervention. The purpose of this work was to evaluate FitEx through the RE-AIM (reach, effect, adoption, implementation, maintenance) Framework, with a primary focus on reach and effectiveness (individual-level dimensions). Through a pragmatic, natural experiment, the impact of FitEx was assessed from 2015 to 2020. Reach was operationalized as the number and characteristics of eligible community members who participated. Effectiveness was operationalized as changes in physical activity levels. From 2015 to 2020, there were 1995 FitEx participants (274 ± 233 participants per year) who were 45.22 ± 14.13 years of age, predominantly female (83%) and White (78%). At the start of the program, 33% met physical activity guidelines and during the program 58% met guidelines (X2(1, 1648) = 1.6; P < .0). The reach and effectiveness of FitEx are comparable to-and in some cases, greater than-similar community-based walking programs. FitEx consistently reached middle-aged insufficiently active adults. Future work is needed to reach a more diverse population, establish objectively measured impacts, and establish a process to scale FitEx across the nation.