the gait alterations. All patients suffering from symptoms associated with OA should be educated about the need for both aerobic and resistive exercise and encouraged to participate in both types of training. Short bouts of frequent aerobic activity may also help individuals in this population meet the target goal of 150–300 minutes of moderate activity per week (Liguori & American College of Sports Medicine, 2020). With some minor modifications, older adults with OA should be able to get the exercise they need through participation in both aerobic and resistive exercise. exercise sessions, with one-fifth of participants completely dropping out of their exercise program over a one-year period (Rolland et al., 2007). This dropout rate demonstrates the difficulty that may be experienced when prescribing an exercise program for older adults with dementia without such supervision/guidance. Additionally, older adults with dementia, particularly those with advanced dementia, may require additional cueing to complete an exercise safely and due to poor body mechanics may not be able to exercise safely without supervision. For this reason, family members and/or caregivers may need to be educated about how to assist with an exercise program (Teri et al., 2003). Exercises may need to be adapted to be performed at home or in another familiar and comfortable environment outside of the clinic or gym to reduce distractions for those with dementia (Teri et al., 2003). Finding activities that older adults with dementia routinely enjoyed in the past may also help improve adherence to an exercise program. For those with advanced dementia, a simple walking program may be an effective way to safely encourage aerobic exercise. Group exercise has also been successfully done in long- term care settings (Toots et al., 2016). For those who become easily agitated, short bouts of activity or one-on- one exercise sessions may be needed and ideally should be implemented when the client is in their passive state, rather than an agitated one (Cohen-Mansfield et al., 2010). Even short bouts of activity are beneficial to health and with some creative planning may be more easily implemented than longer durations. For example, older adults residing in nursing homes or centers for dementia care may benefit from the implementation of a routine walking program. Getting residents to walk several minutes to and from meals or activities every day can result in an accumulation of time spent exercising, leading to numerous health benefits. Dance and movement therapy (DMT) is a multifaceted intervention that improves many functions for clients and also prevents declining cognitive abilities (Ho et al., 2018). Instrumental music with exercise can help increase motivation and participation in an exercise program by older adults with Alzheimer’s disease, and dancing is more function based than are movements in resistance exercises, which may be difficult to learn given the cognitive deficits associated with dementia. While it may require some additional creativity and patience, exercise is critical for older adults with dementia and should be encouraged.
Joint pain associated with exercise should decrease within 24 hours. If joint pain is significantly worse 24 hours after the exercise session, the activity may need to be modified at the following sessions to allow pain to decrease, and the program should be carefully modified to reduce joint pain. Reductions in the weight, duration, or types of exercise may be necessary to alleviate joint pain. The exercise session should not induce changes in the patient’s gait (Vincent & Vincent, 2012). If the exercise increases joint pain to the point that the patient is limping or altering their gait pattern, then the exercise should be modified or reduced to avoid Dementia Dementia is a progressive neurodegenerative disorder characterized by deficits of memory loss, motor planning, language, and executive functioning (Ho et al., 2020). As age increases, so does the prevalence of dementia. Alzheimer’s disease accounts for 60% to 80% or all dementias and is typically a late onset disease, after age 65 (Liguori & American College of Sports Medicine, 2020). Exercise may result in decreased depression in those with dementia and help associated muscles loss along with decreased gait speed and functional ability (Ho et al., 2020). Several systematic reviews have also found that aerobic exercise results in improved physical function in older adults with dementia (Forbes et al., 2015; Ho et al., 2020; Kumar et al., 2022). Research into the effects of exercise on mobility and function in those with dementia is sparse, but literature syntheses consistently demonstrate that physical exercise (both aerobic and resistive) lead to improvements in mobility, functional cognitive performance, and physical functioning in older adults with dementia, though aerobic exercise has been found to be slightly more effective (de Castro Cezar et al., 2021; Forbes et al., 2013, 2015; Kumar et al., 2022; Pitkala et al., 2013). However, older adults with dementia present several unique challenges related to prescribing exercise. Those with advanced dementia traditionally have low compliance with exercise programs and require additional motivation and/or supervision. Individuals with dementia may have increased difficulty adhering to exercise programs due to avolition or confusion due to motor coordination deficits and bradyphrenia (Peabody, 2013). Activities also have to be functional and relevant to the client due to reduced abstract reasoning ability. Therefore, it would be beneficial to demonstrate or model exercises for the client in a functional and relevant way (e.g., kicking a ball rather than sitting and extending a leg without a functional task) and to give the client a longer time to process and respond to requests to copy the demonstrated exercise (Peabody, 2013). Use function rather than free weights to elicit physical movements from clients. Clients have more consistent and safe isolated muscle movements if they are related to tasks that are familiar in motor praxis. Supervised and guided participation in exercise is critical to ensure compliance from clients who have dementia due to some of the aforementioned deficits. One study found that those with Alzheimer’s disease completed on average only 33 out of 88 FITT for improving cognitive function in older adults In a study comparing the effectiveness of aerobic and resistance exercises on optimizing cognitive function in patients, Kumar et al. found that both protocols showed improvements in cognitive function, but there were more
improvements in the aerobic group (Kumar et al., 2022). As they relate to optimizing cognitive function, the FITT principle of cognitive function exercise prescription for aerobic and resistance exercises are shown in Table 17.
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