Living well with dementia: guidance for exercise ... - Vida Wellness

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march” will provide a client with a moremeaningful (and visual) image of the taskrequired.Changes in awareness of the body and spatialorientation. These changes may limita person’s ability to perform whole-bodymovements and move the body into certainpositions.Dementia also affects people’s abilities toremember how to do something—walkingand swimming, for example.2. Communication strategiesMarge Coalman, EdD, summarizes arange of communication strategies forwellness and exercise instructors workingwith clients with dementia—“the invisiblepopulation”—in an article publishedpreviously in the Journal on Active Aging. 7[Ed. Coalman’s article is posted in themembers only “Articles archives” (Mentalhealth) at www.icaa.cc.] In the earlystages of practice, however, there may beno substitute for working with an experienceddementia professional to observeand understand the unique interactionbetween professional and participant, aswell as appropriate communication stylesand strategies.It is important to consider the distinctionbetween communication and conversationin people with dementia. Most descriptionsof communication refer to:• remembering words or meaningsof words;• understanding abstract concepts;• finishing sentences or expressing ideas;• mixing up words or producing theright sounds;• confusing past and present; and• talking to someone who is known,rather than a stranger.Given that over 80% of communicationamong healthy people is nonverbal,wellness instructors should explore manymore avenues of communication withclients living with dementia. Examplesinclude body language, poses and stancesadopted, speed of body or limb movement,facial expressions, eye-to-eyecontact, and touch as a means of communicating/indicatingdesired actionsand activities.3. Challenging behaviorsAs individuals each make their dementiajourney, they may exhibit unique andchallenging behavioral symptoms. Thesemight include pacing, wandering, aggression,anger and depression, and insome cases, hallucinations and delusions. 8Wellness instructors need to understandthe reasons behind such behaviors (e.g.,unmet needs, pain, anxiety), plus becomeproficient in resolving potentially difficultsituations that may become distressingto the individual, other participants orthe instructor. A participant’s care/livingplan will indicate patterns of challengingbehaviors. Some behaviors may arise,however, as a result of physical activityparticipation—for example, increasedagitation due to overstimulation or adesire to be somewhere else, or anxietybrought about by a new face, unfamiliaractivity or environment. Professionalcaregivers employ a range of strategies insuch situations. Key to these strategiesis avoidance of a confrontation and anescalation of anxiety, which would causefurther distress.The use of appropriate communicationskills helps with building a trusting relationshipbetween instructor and participant.Some behaviors may simply reveala participant’s feelings at a particularmoment or indicate longer-term anxietyand/or depression, which is commonin people living with dementia. People’slikes, dislikes and interest levels maychange, and what worked well last weekmay not be so successful today. There isalso a danger that by highlighting and anticipatingchallenging behaviors, we maystereotype people living with dementia asContinued on page 66ResourcesAdditional learningFor wellness professionals who wantto learn more about working withpeople with dementia, training providershave now moved towards arange of online and distance learningpackages. Examples include:• Inside the Brain: An InteractiveTourwww.alz.org/alzheimers_disease_4719.asp• California Distance LearningProjectwww.cdlponline.org• Social Care TV Dementia CareTrainingwww.scie.org.uk/socialcaretv/default.aspKey resource articleThe Seattle ProtocolsBased on social learning and gerontologytheories, The Seattle Protocolsare grounded in an understanding ofthe neuropsychological and behavioralchanges that occur in people livingwith dementia. They have been usedto develop a standardized approach tocare that focuses on:1. identifying, initiating and maintainingparticipation in enjoyablephysical activity;2. teaching behavioral strategies andproblem-solving skills for overcomingsuch obstacles to suchactivities;3. engaging interpersonal support tomaintain exercise programs; and4. encouraging walking and othereasy-to-achieve accessible andavailable physical activities in thecommunity.Publication source: Teri, L., Logsdon,R. G., & McCurry, S. M. (2008). Exerciseinterventions for Dementia andCognitive Impairment: The SeattleProtocols. Journal of Nutrition, Healthand Aging, 12(6), 391–394The Journal on Active Aging • September/October 2010 65
Living well with dementia: guidance for exerciseinstructors & wellness leaders Continued from page 65being difficult. Person-centered planningtells us that knowledge of the individualis the starting point for both communicationskills and understanding differentbehaviors, but there are few specific rules.4. Adaptations and performanceAs suggested previously, the developmentof aerobic, strength and balance activitiesis integral to programming for peopleliving with dementia. To ensure theseclients have access to physical activity andexercise programming, exercise instructorswill need to enhance their ability toadapt activities to the individual level ofability and interest.Large whole-body movements withsimple movement patterns and lots ofrepetition will greatly assist with achievingaerobic activity. The person-centeredchoice, however, indicates that this kindof activity can be achieved through theuse of exercise machines (e.g., crosstrainer, rower, treadmill), regular walking(indoors or outdoors), dancing andswimming.Similarly, strength and balance trainingcan be achieved in numerous ways.Examples include a regular (two to threetimes per week) strength and balanceprogram in a gym; use of resistancebands; regular engagement in strengthand balance activities (e.g., climbingstairs, gardening) or functional activities(e.g., Sit to Stand, directional stepping);or activities such as tai chi, qigong ordance.Themed activity sessions may more easilymotivate individuals. These themedsessions may involve mime or copying(playing musical instruments or conductingan orchestra, for example), completinga home and housework routine, orrecalling an activity from previous times.Additional dimensions toprogrammingIn addition to the key factors describedabove, wellness instructors can furtherdevelop their skills and programs byexamining, and including, other areasof program development. The followingelements—which “sit outside” theindividual with dementia—are part ofstrategies to enhance an activity friendlyand supportive environment, designed toensure appropriate and purposefulparticipation.Home-based and independentactivityWellness instructors are committed torunning safe, enjoyable programs forparticipants, and to ensuring participants(when able) take part independently intheir own time and in their own home, 6,9thus increasing both activity frequencyand potential for greater returns. Inmany cases, people living with dementiamay require support strategies to achievehome-based and independent activity. Acouple of examples include a home activitybuddy/partner and laminated exerciseor cue cards. 9 For individuals with moresignificant cognitive impairment, trainingcan include a family member, friendor professional who can assist them withregular and additional participation.The role of the family caregiverFor wellness instructors, another importantconsideration is the role of thefamily caregiver, as well as the caregiver’sphysical activity and health needs. Familycaregivers have a critical part to playin increasing client motivation andparticipation by offering prompts andreminders, more active support such asbuddying and, where appropriate, sharingparticipation. Their knowledge of,and motivation towards, regular physicalactivity will be influential. This influencecan be potentially negative as well aspositive, however—and rather than sharingparticipation by accompanying someoneto class, a caregiver may see it as anopportunity to do something different,recharge batteries and rest. Caregivers canalso help if they understand the programmingneeds of the person with dementiaand know the specifics of any programdevised for the individual.Worldwide costs ofdementia set to soarThe total estimated worldwide costsof dementia in 2010 are $604 billion(US), according to the WorldAlzheimer Report 2010: The GlobalEconomic Impact of Dementia, 1released in September by Alzheimer’sDisease International (ADI). Basedon the predicted rise in the numberof people with dementia, worldwidesocietal costs will increase 85% by2030, the report states—a very conservativeestimate considering onlyincreases in the number of peoplewith dementia. Last year’s reportestimated that 35.6 million peopleworldwide are currently living withdementia, with that number projectedto rise to 65.7 million by 2030.It is well known that family caregiverscan experience significant distress, anxietyand depression as a result of their commitmentto caregiving. In many cases, thecaregiver’s own health may deteriorate.Consequently, wellness instructors shouldseek ways to work with caregivers to lookat how they, too, can participate in physicalactivity, with or without the personfor whom they care.Program schedulingOne indicator of the importance ofphysical activity programming may bethe extent to which the schedule is fixedin the minds of all concerned and seen asa nonmovable activity, integral to the lifeof an organization or individuals. Thiswould entail the following:• Preparation of the physical activityarea is routinely completed.Continued on page 6866The Journal on Active Aging • September/October 2010
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