Table 2. Summary of State Adaptations to LIFT Program State.

Virginia	Wyoming	Pennsylvania	North Carolina
Setting
Delivered in a variety of facilities including YMCA, schools, libraries, churches, and through Parks and Recreation	Discontinued. In 2017, there were 6 nutrition educators; by 2020, only 2 across the state. Educators and administrators did not have resources to support delivery	Delivered by trained instructors across the county through Cooperative Extension, with a standardized fee	Delivered predominantly online due to COVID-19
Selected audience
Adults ages ≥65 y who are inactive or insufficiently active	NA	Adults ages ≥65 y, fee-based program (with tuition options for lower incomes); predominantly female; many participants continue program participation throughout the year (ie, not new participants every session)	Expanded to those aged <65 y; “During our initial discussions our target audience was defined as limited-resource individuals of any age”
Mode of delivery
Virtual delivery allows more modes available for in 2020	NA	Predominantly in person; exploring virtual and in person with masks during COVID-19 public health restrictions	Added a Facebook Live session delivery option during COVID-19
Cultural adaptations—Agents expressed concern for LIFT imagery, including White-only and lean-bodied older adult models. More representation in LIFT materials is needed for all states.
Core components
Added yoga asanas in 2020 to improve flexibility and balance outcomes	NA	Added some advanced Strong Women/Strong Bones exercises (indicated on the process evaluation form); added state’s nutrition education handouts (ie, beyond LIFT’s embedded nutrition messaging)	NA

Abbreviation: LIFT, Lifelong Improvements through Fitness Together; NA, not available.