WASHINGTON – A regular exercise program not only promotes flexibility, balance, and strength in elderly people with dementia, but it also might improve their mental function.
“You won't get oxygen to the brain if you don't get air down into the alveoli,” said Marge A. Coalman, Ed.D., vice president of wellness and programs at Touchmark, an Oregon-based company that operates a range of retirement communities including nursing homes and skilled nursing facilities in the United States and Canada. She spoke at a joint conference of the American Society on Aging and the National Council on Aging.
The World Health Organization and the President's Council on Physical Fitness and Sport endorse exercise for people with Alzheimer's disease (AD) and other dementias, Dr. Coalman pointed out. The first research confirming that stand came 5 years ago in a randomized, controlled trial of 153 AD patients, she added. Those who participated in supervised exercise for at least 60 minutes per week had significantly better physical function and less depression than did patients who didn't exercise (JAMA 2003;290:2015–22). Since then, studies in mice and people have suggested that exercise creates new cells in areas of the brain that are affected by age-related memory loss.
If nothing else, exercise offers hope to people with dementia that they can improve their condition. “There's so little hope you can hold out to people with this diagnosis,” Dr. Coalman said. “Something as simple as a predictable exercise routine makes a huge difference.”
The “memory care exercise program” developed for residents with dementia and used at Touchmark facilities rests on four fundamentals–deep breathing, posture, range of motion, and strength. The degree of participation varies according to the resident's condition. Some patients continue exercising for as long as 30 minutes, but the average is 7 minutes.
Dr. Coalman's tips for conducting an exercise program with elderly dementia patients include keeping the movements slow but smooth, using straight-backed chairs with good back support, and invoking visual imagery such as marching in place to make the movements purposeful and fun.
Dr. Coalman described one exercise program developed by a physical therapist for Touchmark that starts with participants taking one to three deep breaths while raising their arms overhead. This promotes airflow into the lower parts of the lungs.
The program then addresses posture, which is important for balance and stability. A caregiver places a rolled-up towel or small inflatable ball behind a resident's back to help the person sit upright and attain maximum movement. The resident then rotates his or her neck and bends the head toward each shoulder, promoting range of motion in the neck.
To strengthen the lower body, residents are instructed to make circles with their ankles and to straighten one knee at a time and hold the lower leg up for a few seconds.
Finally, the exercise class ends with “stand-up sit-down” exercises for residents who are willing and able to rise from a sitting position with little or no assistance. A caregiver should stand next to each resident and assist the person slightly, as needed.
To stand, residents are encouraged to scoot to the fronts of their chairs and use the chair's armrests to push themselves up. To sit, they are reminded to simply reverse the process. Start patients with one repetition and work toward five rounds of stand-up sit-down, Dr. Coalman advised. The primary goal of any exercise program for people with dementia is “to keep [them] away from assistive devices as long as possible,” said Dr. Coalman. Greater independence promotes a better quality of life, she said.
An inflatable ball behind the back helps the person attain maximum movement. Touchmark