Staying Active with Dementia

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Nathaniel Wheeler
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1 Moving for Health Lesson Series Facilitator s Guide Staying Active with Dementia Objective This lesson will provide information for caregivers of persons with dementia about the importance of activity for the disorder. Examples of ways to include daily activities at an appropriate level will be included. At the end of the lesson, participants will be able to answer the following questions: What are dementia and Alzheimer s disease? Why is physical activity important for persons with dementia? What are some examples of games or activities appropriate for persons with dementia? Key Teaching Points: There is much attention being given to the importance of physical activity now to maintain mental health later in life. However, often the importance of physical activity for those persons already experiencing dementia is overlooked. Regular physical activity can help to relieve the symptoms of depression and Alzheimer s disease. Physical activity for persons with Alzheimer s disease can include household chores, games and structured exercise. Lesson Preparation and Suggestions: This lesson may be most appropriate for family caregivers who have an interest in keeping a loved one with dementia active and healthy. This lesson presents an opportunity to collaborate with your area Senior Center, an Alzheimer s Association representative, or a health professional experienced in the content area of dementia. The activity for this lesson can be taken directly from the examples given in the text of the Facilitator s Guide. Choose an activity or game to do with the group you are instructing. This book can be very helpful for finding activities for Alzheimer s patients. It contains useful information and is recommended by the Alzheimer s Association Greater Kentucky and Southern Indiana Chapter. Bell, Virginia, et al. Best Friends Book of Alzheimer Activities, Baltimore: Health Professional Press, 2004.

2 Materials Needed: A PowerPoint presentation of this lesson has been developed to assist in teaching for a classroom setting. Some equipment such as chairs or balls may be needed, depending on the activity you choose to do with your group. Look under Physical Activity and the Caregiver for activity ideas and equipment needs. Handouts Active Ideas for Dementia: Help for Caregivers Fact Sheet Evaluation Answers 1) T 2) T 3) T 4) F 5) T

3 Staying Active with Dementia Lesson Evaluation Mark the following statements as True or False. Please give this form to your lesson leader when you are finished. 1) Regular physical activity can help in the management of cognitive disorders such as Alzheimer s disease. 2) When instructing groups with dementia, use very specific directions, but avoid words that require memory skills such as right or left. 3) Household chores can be a form of physical activity for persons with dementia. 4) Activities that involve a lot of repetition are not ideal for persons with Alzheimer s disease. 5) When walking for physical activity you should go the same time each day, exit the same door and take the same route. Educational programs of Kentucky Cooperative Extension serve all people regardless of race, color, age, sex, religion, disability, or national origin.

4 Moving for Health Lesson Series Facilitator s Guide Staying Active with Dementia What is dementia? Dementia is the term given to a group of conditions marked by the destruction of brain cells. The cells are destroyed gradually and this eventually leads to a decrease in mental function. Alzheimer s disease is a form of dementia. With Alzheimer s disease, the brain cell destruction leads to loss of memory. The abilities to learn, reason, make judgments and communicate are also lost. A decrease in the ability carry out daily activities will result. What does this mean for physical health and activity levels? There is much attention being given to the importance of physical activity now to maintain mental health later. However, often the importance of physical activity for those persons already experiencing dementia is overlooked. The loss of ability to do daily activities as a result of mental changes can lead to a decrease of general physical activity. Keeping older adults with dementia physically active can be challenging. The loss of memory and the abilities to learn and communicate make it difficult to introduce new activities. An activity or game will most likely need to be taught each time it is played. In addition, constant supervision is needed for safety. Personality changes are also associated with Alzheimer s disease. Anxiety and agitation can make it difficult to keep persons motivated and involved in the activity. Gentle reassurance and verbal prompts are often needed to help a person remain involved in activities. Despite these challenges, including physical activity in the daily routine of persons with Alzheimer s disease can be beneficial to overall health and wellbeing. The World Health Organization states that physical activity can help in the management of disorders such as depression and Alzheimer s disease. In addition, something as simple as casual walks can: Provide social and community connectedness. Reduce feelings of loneliness. Improve self-confidence and self-sufficiency. Regular physical activity can improve cardiovascular endurance, muscle strength and flexibility. These benefits lead to an improved ability to move and maintain

5 balance. The ability to move well enables one to perform the normal activities of daily living such as walking, cleaning and personal hygiene. Physical Activity and the Caregiver As mentioned above, the mental decline associated with Alzheimer s disease requires constant supervision for physical activities. The caregiver can provide this needed support and supervision. For the purposes of this lesson, we will review some general guidelines for instruction and list several activities that can be done with individuals or groups. General Guidelines for Physical Activities and Alzheimer s Use simple and easy to follow activities Make directions simple and avoid directions that require memory skills such as the words right or left Keep intensity very low for beginners Make sure participants keep breathing normally Stop and rest about every five minutes and have a conversation Watch closely for overexertion or fatigue Stop an activity if participants lose interest Activities should be meaningful for persons with dementia. It may be helpful to take a participant s personal history into consideration when choosing activities. Feelings of pleasure and enjoyment often result when familiar activities are performed. This can be applied to household chores, games, and physical activities in general such as walking. Household Chores for Activity Household chores can provide both activity for the body and feelings of accomplishment for the participant. These chores can be developed into a daily routine. Choose tasks that are: Simple. Free of risk for injury. Include repetitive movements. Activities might include: Setting a dinner table with napkins and placemats Raking leaves Dusting furniture Mopping floors Picking up sticks, pinecones, or fallen fruit

6 Games for Activity Playing games together is a great activity for families and groups. It allows families to spend time together. Here are a few games that involve physical activity. Bat the Ball o Form a circle of players. Take an inflated beach ball and use your hands to bat it from one person to another. Ball Pass o Players should be seated or standing in a circle. A beach ball is passed to the person next to you. As you pass the ball, try to say that person s name. Bucket Ball o Players should be seated or standing in a circle. Place a bucket, empty trash can, or basket in the center of the circle. Players try to throw a medium sized rubber ball into the bucket. If the player makes it the caregiver gets the ball and rolls it back to the participant. If not, the ball goes to the next participant in the circle. Exercises for Activity Physical activity can be included in a daily routine by using structured exercise. This can include exercises with endurance, strength and flexibility focus. Walking o Walking can be a great option for endurance activity and can allow the patient to get outside if the weather is nice. When walking with persons who have dementia: Choose a peaceful, quiet path. Try to go the same time each day. Use the same entrance door each time. Take the same route each day. o When the weather is bad try walking indoors to music, or use an indoor area during quieter times like a store in the early morning. Resistance training o Resistance training builds muscle strength which can be lost through the natural aging process. Try the following activities: Passing a weighted ball to each other around a circle Half squats using a chair for support and balance Exercise bands or tubes Flexibility exercises o Flexibility allows the joints to move through their full range of motion. This can make daily activities less of a challenge to perform. o A full body stretch that addresses all major muscle groups can improve flexibility. Be sure to: Warm up the muscles before stretching. Ease into the stretch and hold. Hold each stretch for 30 seconds.

7 Perform each stretch at least four times. Chair exercises o Chair exercises can include all three types of training. When done with a more advanced group at a faster pace, the heart rate can be slightly elevated which makes it an endurance activity. Strength and flexibility can also be addressed by reaching and lifting the arms and legs. All of the exercises below are performed from a seated position and require a slow, controlled movement. Perform each exercise 8 to 12 times. Reach for the Floor Sit up straight with arms straight down at sides Bend forward towards the floor and hold (participants do not need to touch the floor just reach towards it) Slowly return to the starting position Kick It Up Sit up straight with feet flat on the floor Extend one leg out in front of you as if kicking a ball Hold the leg out for two seconds Return the leg to starting position, rest and then raise the opposite leg Seated March Sit up straight with feet flat on the floor Keeping the knee bent, slowly raise one foot off the ground Return the foot to the floor and raise the opposite foot as if in a slow marching motion Rest often and perform very slowly Reach High Sit up straight with arms at sides Slowly extend the arms up to shoulder level Slowly continue to extend the arms over the head In the same motion, return to the starting position

8 Sources Alzheimer s Association, What is Alzheimer s Disease?, available online at Bell, Virginia, et al. Best Friends Book of Alzheimer Activities, Baltimore: Health Professional Press, Harrison AL and English L. Developing a therapeutic exercise program for older adults with diverse cognitive abilities. Activities Directors Quarterly for Alzheimer s & Other Dementia Patients. 2005; 6(2): Sheriden, Carmel, Failure-free activities for the Alzheimer s patient: A guidebook for caregivers, Oakland: Cottage Books, World Health Organization, Physical activity and older people, available online at Prepared by: Lori L. Rice, M.S., C.N. Extension Associate for Health University of Kentucky Cooperative Extension HEEL Program May 2006 For information on health issues in Kentucky, log onto: Educational programs of Kentucky Cooperative Extension serve all people regardless of race, color, age, sex, religion, disability, or national origin.

Stretch It Out. Materials Needed: Lesson Activity A large open area where children have room to stretch is needed for this lesson.

Stretch It Out. Materials Needed: Lesson Activity A large open area where children have room to stretch is needed for this lesson. Youth Health Lesson Series Facilitators Guide Stretch It Out Objective: This lesson will educate children on the importance of including stretching and flexibility exercises into their physical activity