Exercise is good for all of us both mentally and physically. ‘Whatever is good for your heart is good for your head. What people are looking for in dementia prevention is the same because the factors that everyone knows predispose to heart disease also predispose to dementia.’’ So says Dr. Lawence Whalley, a researcher at Scotland’s University of Aberdeen.
Evidence is building to show that regular exercise helps us retain our cognitive and physical abilities as we age. It is good for general health and can help slow the progression of the condition.
What are the benefits?
These are many good reasons to ensure your loved one gets plenty of exercise. These include:
- Reducing the risk of depression. Up to 32% of people with dementia experience some level of depression.
- Avoiding or reducing wandering and restlessness behaviour.
- Maintaining a healthy heart can prevent other health complications which could further affect how the person functions.
- Aiding, as dementia progresses, the retention of good balance and strength which helps avoid falls. It also assists the person to retain the ability to carry out daily tasks such as getting dressed, other simple chores and taking part in activities.
- Maintaining a good sleep pattern and avoiding waking and restlessness during the night.
- Increasing networks and reducing feelings of loneliness and isolation when exercising in a group or with someone else.
- Helping the person keep in touch with nature when exercising outdoors as well as providing enjoyment and feelings of wellbeing.
- Minimising the need for adaptions such as stair-lifts or walk in bath-tubes due to good physical wellbeing.
Make exercise meaningful
Everybody is different and enjoys different things. Many older people might see doing physical exercises as a chore, others may enjoy it – especially if done with someone or in a group or class. For many – even for those who do enjoy formal exercises – it is best to incorporate physical activities into the routine of daily life.
Individuals are more likely to do something that has meaning for them and gives enjoyment. To ensure this, utilise their past interests and work skills. You can then tap into and help them retain remaining abilities. This can include things like walking the dog, visiting local parks or gardens, bird watching, watering the garden, dancing, swimming, walking around the shopping centre, helping with chores around the home, playing golf or bowls.
Try anything they have enjoyed doing in the past until you hit on things that still give pleasure. Modify the activities to suit their remaining physical abilities and skills. You can suggest new activities that they may have expressed interest in and never tried. Many things you think will never work sometimes do. Bear in mind religious and spiritual needs. For example, a walk to a local church for a few minutes’ quiet prayer or contemplation may fit the bill.
It is good, if possible, to have a mix of activities, some which can be done together and others with a group. Also, ensure some are outside and others indoors.
What type and how much exercise
This can vary, depending on their fitness, age, other health issues and whether or not they have participated in much exercise in the past. Most studies recommend moderate exercise such as dancing or walking done frequently – three or four times a week. The Department of Health recommends about thirty minutes of moderate exercise on five days each week. This can be broken down into shorter sessions of ten or fifteen minute duration. This might be a fifteen minutes housework in the morning and then a short walk in the afternoon. The following day it might be gardening in the morning and a game of bowls in the afternoon. It is helpful to use a diary to plan this and establish a weekly routine.
If the person has not done any exercise recently you will need to start slowly. They might only be able to manage five minutes at first. You can add an extra minute each week to the sessions until they are able to exercise for the thirty minutes.
Do bear in mind if you are thinking of joining a gym or activity that involves a lot of bustle and noise that this can be overwhelming for someone with dementia. A Tai Chi, Yoga, balance exercise group or an activity that involves walking might be more appropriate.
If the person with dementia is young and/or physically fit the activities will need to be more exuberant and demanding. For dementia-friendly holidays and short breaks for all ages explore www.dementiaadventure.co.uk. What is on offer includes sailing, visits to national parks, etc. There is a wide range of activities that involve getting out and about and staying close to nature. Also, many councils have departments which organise active exercise events. Explore your local leisure centre website.
Before starting an exercise programme
Consult with a GP and organise a full medical check-up. This is especially important if the person is not used to regular exercise, has had heart problems, high blood pressure, breathing difficulties or other ailments. While most conditions might not stop anyone exercising - and may well be improved by it - your GP or healthcare profession will advise on the most suitable type of exercise. Physiotherapists can help you design programmes that take the person’s current health and abilities into account.
Bear in mind that, as the condition progresses, you will have to adapt and change the exercise regime to suit.
- Make sure the person drinks plenty of water before, during and after exercise
- If they feel dizzy or faint or experience any kind of pain stop the activity and consult a health care professional
- When doing outdoor activities make sure the person is wearing a medical alert bracelet or pendant and some kind of identification in case they get lost. Also ensure they are weather smart, wearing appropriate clothing for the time of year – whether bright sunshine (sunscreen and a hat), cold or raining.
- If the person can talk while exercising or walking they are usually comfortable. If they are gasping while speaking then slow down.
In the later stage
The amount of exercise will vary depending on the individual. It is beneficial to encourage the person to move about from room to room, change chairs and do simple activities to keep them mobile and active both physically and mentally as possible. Try to keep to keep to the two hour rule: if they have been sitting for two hours or more they should be encouraged to do some kind of movement. This will help maintain muscle strength, good balance and joint flexibility.
If the person becomes confined to bed because of illness, has become inactive because of arthritis or an injury seek advice from a physio or an occupational therapist. Regular, gentle exercise can help with keeping muscles and joints in healthy condition and be part of a continence programme but needs to be planned with a health professional to ensure it is appropriate and does not aggravate other conditions or is not dangerous.
Inform the GP of any new physical problems or marked changes.
In my experience the exercise which benefits most is whatever you and your loved have enjoyed in the past and still enjoy doing. Physical exercise, whatever form it takes, should be fun. And exercising together has built in benefits for both of you.
This article was written for Carewatch by Robin Dynes. Robin also wrote our Activity guides for people with dementia to help carers enrich the lives of those they support.
Robin has worked in the National Health Service, Social Services and Adult Education for over 30 years as a counsellor and trainer. His main role has been to develop innovative services to meet the needs of older people and others who are vulnerable.