Dementia - activities and exercise

You don’t need a great memory to enjoy yourself. Each day, there are many things that provide us with purpose and pleasure. A person with dementia still needs a good quality of life, but without some assistance from families and carers, it is much more difficult for them to achieve purpose and pleasure. There are many ways to plan and provide appropriate activities for people with dementia.

Ideally, activities should:

• compensate for lost abilities
• promote self-esteem
• maintain residual skills and not involve new learning
• provide an opportunity for enjoyment, pleasure and social contact
• be sensitive to the person’s cultural background.

Planning activities for people with dementia

Understanding the person with dementia will help you to plan appropriate activities for them. This means knowing the person’s former lifestyle, work history, hobbies, recreational and social interests, past travel experience and significant life events.

Try not to overstimulate the person with dementia. Be selective with outings. Avoid crowds, constant movement and noise, which many people with dementia find overwhelming.

It can be helpful to write out an activities care plan if different people are caring for the person. This will help make sure that the activities are consistent and are suited to the needs of the person with dementia.

Activities can re-establish old roles

Make use of skills that have not been forgotten, such as buttering bread, washing up or watering, sweeping and raking in the garden. These are also ways in which the person with dementia can contribute to the household and feel useful. Encourage them to have something that is their responsibility, no matter how small.

Activities can give relaxation and pleasure

A person with dementia may enjoy an outing, even if they do not remember where they have been. What is important is that the moment is enjoyed, even though the experience may be soon forgotten.

Simple and unhurried activities are best. Give the time and space necessary to allow the person to do as much as possible. Focus on one thing at a time. Communicate one instruction at a time. Break down activities into simple, manageable steps.

Prepare a safe working area

People with dementia often have difficulty with visual perception and coordination. Ensure that surfaces are uncluttered, with few distractions and as little noise as possible. Good lighting (without glare), seating preferences and correct work heights are also important. Use plastic containers to help avoid breakages.

Don’t allow activities to reinforce inadequacy or increase stress. Levels of ability can change from day to day. Activities can be adapted and tried another time if they were not successful or enjoyable the first time.

Use times that suit the person’s best level of functioning

To achieve the most success when carrying out activities, consider the times of the day when the person is at their best. For example, sometimes walking is best done in the morning or the early afternoon. For people who become restless later in the day or who have had a particularly long or meaningless day, a late afternoon walk may be better.

Encourage an emotional connection

For many people with dementia, a sense of movement and rhythm is often retained. Listening to music, dancing, or contact with babies, children or animals provide positive feelings. People with dementia often have excellent memories of past events, and looking through old photos, memorabilia and books can help the person to recall earlier times.

The opportunity to relive treasured moments can be deeply satisfying. If reading skills have deteriorated, make recordings for them. Locate picture books and magazines in the person’s areas of interest.

Include enjoyable sensory experiences

Some sensory experiences that the person with dementia might like include:

• enjoying a hand, neck or foot massage
• brushing their hair
• smelling fresh flowers or pot pourri
• using essential oils and fragrances
• stroking an animal or differently textured materials
• visiting a herb farm or a flower show
• rummaging in a box containing things that the person has been interested in.

Activities can be useful in managing challenging behaviours

Activities play a significant part in dealing with challenging behaviours. Knowing what helps to calm or divert a person when they are restless or distressed is very important. This can be particularly helpful for a respite carer.

Importantly, don’t give up. Mistakes and failures will happen, but don’t let the person with dementia feel like a failure. Keep trying.

Dementia and exercise

A person with Alzheimer’s disease gains the same kind of benefits from regular exercise as anyone else, including improved cardiovascular fitness, strength and endurance. Always talk with the person’s doctor about their exercise program or before starting on any new exercise program.

Exercise can give many health benefits including:

• improved mood
• better sleep
• reduced likelihood of constipation
• maintenance of motor skills
• reduced risk of falls because of improved strength and balance
• reduced rate of disease-associated mental decline
• improved memory
• improved behaviour, such as reduced rate of wandering, swearing and acting aggressively
• better communication and social skills.

Getting started on an exercise program

Suggestions to start an exercise program for a person with dementia include:

• Talk with the person’s doctor and organise a full medical check-up. Other health conditions, such as arthritis or high blood pressure, may limit the types of exercises the person with dementia can safely perform.
• A physiotherapist can design an exercise program that takes the person’s current health and abilities into account.
• Start slowly. For example, perhaps five minutes of continuous exercise is all the person can manage at first. Over a period of months, add one extra minute at a time until the person can comfortably exercise for 30 minutes.
• Demonstrate the activity yourself and ask the person to follow your lead.
• Boredom kills off motivation, so mix up the activities to keep it interesting.

Types of exercise for people with dementia

If the person used to enjoy a particular form of exercise, such as golf, encourage them to take it up again with your support. Other suggestions include:

• walking – this is one of the best all-round exercises, and it’s free. Walking also helps to work off the restless urge to wander that is typical of Alzheimer’s patients. Try combining the walk with a useful errand, such as going to the shops for milk or exercising the dog
• cycling – a tandem bicycle allows you to sit up front and control the bike, while your passenger sits in the back seat and pedals. If the person with dementia has problems with their balance, you could try hiring a three-wheeled bicycle for them to ride, while you cycle alongside them
• gym work – such as treadmills, stationary bicycles and weight machines
• aerobics – you could attend classes together or hire appropriate low-impact aerobic workout videos.

Exercise that doesn’t feel like exercise

Exercise is any physical activity that raises the heart rate. Suggestions for activities that don’t feel like structured exercise include:

• dancing – seniors clubs often include dancing parties in their social calendar. If the person with dementia doesn’t know how to dance, simple dances such as square dancing can be learned and enjoyed, as long as their partner can take the lead
• gardening – raking and mowing the lawn are good forms of exercise. Make sure you are on hand to help if required
• housework – such as vacuuming and folding laundry. Most people with Alzheimer’s disease can continue to perform certain types of housework if they are supervised.

Safety concerns for people with dementia

Exercise can be helpful for people with dementia, but it is important that activities are safe.

Suggestions to improve safety include:

• Speak with the person’s doctor and physiotherapist about appropriate exercise as the person’s condition progresses.
• For outside activities, make sure the person is wearing a medical alert bracelet or pendant, and some kind of identification, in case they wander off and get lost.
• Use weight machines rather than dumbbells or barbells that can be dropped.
• If the person can still talk while exercising, they’re in a comfortable aerobic state. Keep the conversation flowing to monitor how puffed they’re getting. Slow it down if they can’t talk without gasping.
• For outdoor activities, make sure the person is sun smart – cover up with clothing and a hat, and apply sunscreen to all exposed areas of their skin.
• Ensure that the person drinks plenty of water before, during and after exercise.
• If the person complains of feeling dizzy or faint, or says they have any kind of pain, stop the activity and talk to their doctor.

Where to get help

• Your GP (doctor)
• Your local council
• Your local community health centre
• National Dementia Helpline, Dementia Australia Tel. 1800 100 500
• Aged Care Assessment Services Tel. 1300 135 090
• My aged care Tel. 1800 200 422
• Cognitive Dementia and Memory Service (CDAMS) clinics
• Carers Victoria Tel. 1800 514 845
• Carer Gateway Tel. 1800 422 737
• Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers