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Physical activity and dementia

Sylvie Silver explores the benefits of physical activity for those with dementia and shares some examples of best practice.

Has your New Year resolution to exercise more already faded away or have you discovered the benefits of being a bit fitter? The prospect of increased physical activity can make some people groan as visions of the gym loom large but we are often told now that just increasing the amount we walk can make a difference to both health and wellbeing.

These principles are just as pertinent to those living with dementia. For many, physical activity is a vital contributor to their well-being and mental health, for others, encouragement and motivation are needed to simply keep limbs moving and maintain as much independence as possible.

The Alzheimer’s Society website has an excellent section on the importance of physical activity. It details not only the health conditions that can be relieved, like reducing the risk of strokes, but also other benefits like improving sleep patterns. Recent studies have shown that exercise may improve memory and slow down mental decline too.

Within the care sector a lot of work has been done on falls prevention and physical activity has been shown to improve strength and balance and help to counteract the fear of falling. We also have guidance on what types of exercise are appropriate, and the benefits of each, at the different stages of living with dementia.

The correct level of activity

What is the right amount of activity in the early to mid-stages of dementia?

  • People who are not currently active should be doing about 30 minutes of activity at least five days a week.
  • This can be broken up into shorter sessions throughout the day, i.e. a 15 minute walk to the local shops or round the grounds and then housework or gardening tasks in the afternoon.
  • Regular physical activity is recommended to maximise benefits.

What is the right amount of activity in the later stages of dementia?

  • People in the later stages of dementia should be encouraged to move about regularly.
  • There should be opportunities to sit unsupported (as far as possible) with supervision on a daily basis.
  • A daily routine involving moving around the home can help to maintain muscle strength and joint flexibility.
  • Exercise can range from changing position from sitting to standing, walking a short distance into another room or moving to sit in a different chair at each mealtime throughout the day.

I guess that the majority of care providers know most of this already but I doubt if many carry out an audit of physical activity with their residents. I wonder how many care plans identify how physical activity and exercise needs will be met.

Best practice

I spend quite a lot of time working in care homes with care teams. We talk a lot in our training sessions about the impact on wellbeing of physical activity, and many care staff recognise the importance but struggle to see how they could meet these recommendations. I get them to identify the routine day-to-day work that is carried out in a home. Things like table laying and sorting laundry always feature early on the list. Eventually we might include delivering the post or newspapers, collecting prescriptions or putting away deliveries. I then encourage them to think about how residents could be motivated to join in with these things. Could they think of a regular ‘job’ for every single resident? Many residents enjoy the responsibility of sharing a job with a carer. It can raise self-esteem, build relationships, and offer social interaction in addition to meeting physical activity needs. I have heard many great examples of good practice – here are just a few.

  • A lady cared for in her room puts cut flowers into small vases for the dining room twice a week. This encourages upper body movement and fine finger control.
  • A gentleman, accompanied by a carer, delivers the daily menus to every room every day maintaining his mobility and self-esteem.
  • An energetic resident who enjoys walking helps the laundry lady push a clothes rail of clean items around the home every day. The physical effort seems to help her sleep better.

Some care homes have a very structured approach to physical exercise. I was pleasantly surprised when visiting Queen Elizabeth House in Bromley to suddenly be surrounded in the lounge by both residents and staff – it felt a bit like a flash-mob but they had all descended for the daily 10 o’clock exercise session. It lasted 15 minutes, used four familiar pieces of music and was led in part by a resident who was at one time a League of Health and Beauty instructor. The catering assistant said it really helped with her stiff shoulder and a resident said she wouldn’t miss it for the world.

I am particularly impressed by Avondale Care Home in Aylesbury where they have developed a well-equipped gym and every resident has set their own goal. At least one resident wants to build up his strength to aid transferring and limit the use of a hoist. Jordan Collins, their Leisure and Wellness Co-Ordinator, told me, ‘We spoke to each resident about setting their goals, we then made suitable action plans. These plans will be used to focus work on specific areas to improve them to help them get closer to their goals.’

Ashley House Residential Care Home in Borden has installed extra doors to easily access the gardens, this has encouraged residents to walk outdoors more which helps to maintain their physical fitness and their wellbeing. They also have a vegetable patch for added interest outdoors and to encourage meaningful activity. All of these homes have a large cohort of residents living with dementia who benefit greatly from physical activity.

Benefits to business

Recognising the benefits to residents is the priority but there are many benefits to a care home business too. The most obvious one is that a resident that maintains physical mobility is less dependent on the care team to get about or transfer, needs fewer moving and handling aids and is likely to stay healthier. Caring for lots of physically dependent residents can be exhausting and have a negative impact on staff morale and the budget.

The Care Quality Commission has made it quite clear that quality ratings will be based just as much on how residents spend their day as on any other criteria. A home that is positively promoting physical activity for those living with dementia will do far better than one that is not addressing this fundamental element of every resident’s day. Reducing medication has a far greater chance of success when the resident has plenty of meaningful activity to occupy them and this often entails access to the outdoors and the freedom to walk at will. Also, getting residents out and connecting with the local community is the best possible way to promote a positive image of a care setting. It is also far easier to go out with ambulant residents, which requires fewer staff, than those dependent on wheelchairs. Getting out, even into the garden, is now seen by inspectors as more important than it ever has been in the past.

Essential to life

Every care home has the ability to use music to encourage dance and movement and many carers are happy to set up a spontaneous dance session. I would like to see these planned a bit more, perhaps on a daily basis – every afternoon before supper seems to work well to encourage more physical activity for everyone. Throw in some playfulness and fun and it can be a very uplifting way to end the day. I struggle to envisage a life without physical activity and I’m hoping that by the time I am in need of care that it will be seen as just as essential as taking me to the toilet.

Sylvie Silver is Director of National Activity Providers Association sylvie@napa-activities.co.uk

To read Exercise and physical activity for people with dementia, visit http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1764

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