Exercise and dementia

For our next #demphd chat on THU 6th October 8pm, Caroline Bartle (@3spiritUKNZ) and her colleague Helen Behrens (@BehrensHelen) wrote a fitting blog on exercise and dementia:

Over the last few years there has been some exciting research emerging about the impact of exercise on dementia.

Exercise and physical activity are sometimes used interchangeably.  However ‘exercise’ is planned, structured and repetitive movement which aims to improve or maintain physical health and ‘Physical activity’ is any movement which contracts skeletal muscles and increases energy expenditure.

The main types of exercise are:

  • Aerobic:  increases breathing and heart rate.
  • Strength: make muscles stronger
  • Balance: may prevent falls
  • Flexibility: Improve range of movement

We have started to see exercise offered in front line services as part of prevention strategies, becoming more widely available as  research is emerging and policy and legislation (Care Act 2014) outline their vision for prevention. Organisations, for example Age UK offer chair based exercise and exercise has been targeted by some local authorities as an intervention to reduce the risk of falls and other health outcomes. The emergence of more collaborative working between health and social care has stimulated the growth of such initiatives; pooling funding to improve health outcomes as prevention.

Having opportunities for people living in care homes to exercise needs to be a priority and factors to be considered include: building design, access to outdoors, effective pain assessment and management, and education on the benefits of exercise. There may be a wider impact on these enablers, including improved mood, better sleep and potentially improved nutritional intake.

However, accessing and maintaining activity where comorbidity is present can be a challenge. If a person is older when they develop dementia they may also experience barriers to accessing and maintaining exercise. For example, pain, fear of falling, arthritis, restricted movement, mobility difficulties, sensory loss, and/or respiratory problems. Good assessment, including pain assessment should be completed to develop a plan that is appropriate to the individual together with advice from the GP. However not all people developing dementia are older, so exercise may be an appropriate targeted intervention for younger people with dementia.

Together with co-morbidity barriers, we need to consider the challenges dementia brings in potentially engaging in exercise. For example, difficulties with coordination, motor skills, visual perceptual challenge and memory difficulties.  These difficulties will require us to have a considered approach to the support systems needed to overcome these challenges.

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There is such a wide variety of exercise available to us that supports a person’s strengths from walking to dancing and using music. Music can provide rhythm and structure to support difficulties with memory. Challenges of this nature have historically led to individuals with dementia not being able to access rehabilitation services. Having left social work some years now, I do remember the days of working in rehabilitation where people with dementia where deemed ‘not suitable’ to access rehabilitation. Those days I hope are behind us now, as there is demonstrable evidence that (7) that rehabilitation exercise can improve motor performance.

Our role at 3 Spirit UK is to consider how can this be harnessed in education and curriculum in the courses that we develop for front line care staff. Health and Wellbeing is identified in the Dementia Care Skills Education and Training Framework (section 6), as a key area for education and development for staff working with people with dementia both at tier one and tier two. Section 6 includes health together with psychosocial activities as expected, and exercise is explicitly stated in the first outcome. We have interpreted this as a meaningful and measurable course outcome, with exercise linking to other aspects identified within this section, including, but not limited to falls and pain management. Alongside my health colleagues we have debated and developed the merits and outcomes of this course. We are keen to discuss and debate current and targeted research in this area, particularly how this can be utilised in education and services.

 

Caroline Bartle and Helen Behrens

 

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