**Background:** Population aging is accelerating, with many older adults facing disability, chronic conditions, and frailty, especially among socioeconomically disadvantaged groups. Prior work showed that older adults are often unaware of biological aging mechanisms but desire to learn about them to adopt lifestyle changes. The AFRESH program was developed to address this gap by combining education on bioenergetics (energy homeostasis), physical activity facilitation, and habit formation. The pilot aimed to assess preliminary efficacy on physical function and self-reported outcomes in disadvantaged older adults.
**Methods:** The study was conducted as a quality improvement project in a newly constructed older adult apartment community. Twenty participants (63% of 32 new residents) enrolled; mean age 68.35 years (SD 5.82), 80% Black, 45% female. Exclusion criteria included any disability precluding independent walking (one excluded for blindness). The 10-week AFRESH program (October–December 2020) consisted of weekly 1-hour sessions via Zoom (with in-person make-ups) covering: overview, physical activity, nutrition, safety, mind/body health, social engagement, medication management, advance care planning, and a summary. Each session included 30 minutes didactic content, discussion, and a 2-minute bioenergetics booster. An exercise physiologist designed individualized exercise plans (walking, recumbent bike, resistance bands). Data were collected at baseline (T1), 12 weeks (T2, n=16), and 36 weeks (T3, n=12). Objective measures: grip strength (lbs), 6-minute walk test (meters), BMI, Borg perceived exertion. Self-report measures: Rapid Assessment of Physical Activity (RAPA), Chalder Fatigue Scale, Pittsburgh Sleep Quality Index (PSQI), Cognitive and Affective Mindfulness Scale, NIH Psychological Well-Being, and single-item exercise importance/confidence. Growth curve modeling (linear mixed effects) was used, with Cohen's d effect sizes.
**Key Results:** Significant improvements were observed for grip strength (T1: 56.2 lbs; T2: 65.0 lbs, d=0.77; T3: 69.4 lbs, d=0.62; p=0.001), 6-minute walk distance (T1: 327.6 m; T2: 388.7 m, d=0.99; T3: 363.3 m, d=0.60; p=0.001), RAPA strength/flexibility score (linear change β=2.23, p<0.01; quadratic attenuation β=-0.53, p<0.05), and PSQI global score (linear change β=7.0, p<0.001; quadratic attenuation β=-2.38, p<0.01). For grip strength, no quadratic effect was estimated, indicating sustained improvement. No significant changes were found for BMI, Borg perceived exertion, Chalder fatigue, exercise importance/confidence, RAPA aerobic score, well-being, or mindfulness. No moderation by age or sex was detected. Attrition: 2 lost to unavoidable circumstances (traffic accident, COVID-19 hospitalization); 16 provided T2 data (80%), 12 provided T3 data (60%).
**Clinical Implications:** The AFRESH pilot demonstrates that a community-based, multicomponent intervention can produce clinically meaningful improvements in gait speed and grip strength—key markers of physical function and frailty risk—in disadvantaged older adults. The novel emphasis on bioenergetics may enhance intrinsic motivation by helping individuals understand the biological consequences of inactivity. Attenuation of some effects by 36 weeks suggests the need for ongoing support or booster sessions. Limitations include small sample size, single-site design, and quality improvement (not randomized) approach. Future research should test AFRESH in a larger, controlled trial with attention to intervention fidelity and scalability.