About 10 per cent of people aged 65 and over has dementia. SPD physiotherapist Gerda de Jong shares in this article how exercise can have a positive impact on the well-being of people with dementia.

Dementia is a syndrome that affects a person’s cognitive functions, such as memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. It is an increasingly common disease among the elderly population, with about 10 per cent of people aged 65 and over having the disease.

Exercise can have a significant impact on the well-being of people with dementia. Some of the benefits of physical exercise are:

• improvement to the health of heart and blood vessels, thus reducing the risk of cardiovascular diseases such as hypertension, heart disease and stroke,
• reduction in the risk of falls by improving strength and balance,
• reduction in the risk of type 2 diabetes, and improving blood glucose control for patients already diagnosed with the disease,
•  improvement to a person’s ability to dress, feed and bath himself – strong muscles and flexible joints can help people maintain independence for longer,
•  improvement in cognition,
• stress reduction as physical activity is thought to have a positive effect on mood, and people with dementia who are also depressed may gain particular benefits from being physically active,
•  improvement in sleep – people that are active during the day tend to sleep better at night, and
•  provision of opportunities for social interaction as many types of exercises can be done in a group setting.

The Health Promotion Board (HPB) recommends 150 minutes of moderately intensive exercise per week for older adults, which means an average of about 30 minutes each day. This recommendation is also for people with dementia, provided they are in good health. However, it is important to seek medical advice before embarking on an exercise routine if there are other health conditions.

During the early stages of dementia, it is important to establish an exercise routine that the person with dementia can sustain for as long as possible.

The focus should be on exercises of low-to-moderate intensity that the he enjoys and can successfully perform. Walking is an excellent form of aerobic exercise which can be done anywhere without requiring any special equipment. Walking speeds can be adjusted to each individual’s abilities. Swimming is another beneficial form of exercise as many find being in the water calming and soothing. However, this activity should be supervised by a caregiver for safety reasons. Other non-traditional activities may also be as effective and provide a structured exercise routine. Gardening and dancing are activities enjoyed by many older adults and are wonderful ways to increase fitness and strength.

During the later stages of dementia, an individual becomes less mobile and tend to spend more time sitting down. At this point, exercise routines should be adjusted to become simpler, focusing on maintaining his functions as long as possible. Examples of exercises at this stage would be ambulation and sit-to-stand, as well as balance training. These exercises should also be incorporated into his daily routine as much as possible. For example, when walking to the toilet, he can be encouraged to walk an extra round within the house. Short bursts of activities throughout the day are recommended as this encourages him to stay independent in his daily activities as long as possible.

Seated exercises are a safe way to conduct exercises when the individual becomes less mobile. They can be done in a group setting, thereby combining exercise with the benefits of social interaction.

Those with dementia are often reliant on their wheelchairs in the final stages. Exercises should then be focused on maintaining as much range of motion and strength as possible. In this way, they can help the caregiver with the activities of daily. For example, if the client can still stand with support, he can help to reduce the physical burden for his caregiver when transferring from bed to wheelchair or when bathing.

Day care centres for dementia patients provide their clients with the opportunity to interact with peers and to participate in activities such as music, craft work and exercises. Some centres also offer specialised services such as physiotherapy and occupational therapy. Trained therapists are able to tailor the exercise and activity programmes to the needs of the individual, taking his personal preferences and functional status into consideration. In partnership with a number of day care centres in Singapore, SPD’s physical and occupational therapists work together with the (nursing) staff at the centres to provide their clients with comprehensive therapy programmes.