- In the early stages of the condition, participation is extremely important in terms of establishing some sort of regular routine that the client can sustain for as long as possible.
- Emotional instability or outbursts may affect the exercise program in the later stages.
- Low-intensity exercise should be the main focus, involving activities that the person enjoys and can successfully perform.
- Constant supervision during physical activity is necessary during the mid to later stages of Alzheimer’s.
The middle stage of AD presents a different set of challenges for the exercise leader. As the disease progresses, the program should become more simple and the leader should consider what reasonable criteria should be used to terminate the program. One of the major concerns during later stages of AD involves behavior. Because agitation is one of the hallmark symptoms of the disease, it is not unusual for a client to become resistant to continuing the exercise program. A client with good exercise adherence during the early stage may suddenly decide to drop out. Memory loss during this stage is more pronounced than earlier, and the client may need verbal or physical guidance in maintaining the exercise routine.
Extreme outbursts of anger and physical aggression can occur during this stage. Often such behavior will last for only a few minutes and the client will immediately forget that the incident occurred. The exercise leader must remember that this is a symptom of the disease and therefore should not take such outbursts personally. He or she must work through the agitation with the support of the caregiver, who may or may not be present during the exercise session. For some caregivers, the brief period away from their loved one is much desired. However, if the individual has a high level of agitation, it may be necessary to have the caregiver present to work through certain behaviors. In some cases, the caregiver may be in the facility and “on call” but wouldn’t necessarily have to be in the same room. Sometimes music can help the person relax during the exercise session provided that it is not too loud and has a sound that is appealing to the participant.
During the advanced and final stage of the disease, the client will require constant supervision and physical assistance. Language skills will be greatly diminished and language comprehension extremely limited. The exercise program must be guided on an individual basis. Incontinence and limited mobility are common. Range of motion and strength exercises will be the major focus during this stage.
People with AD commonly have a higher level of restlessness or agitation at the end of the day, which experts have labeled “sundowning.” This increased state of agitation, activity, and negative behaviors is associated with high levels of fatigue and tiredness later in the day. Therefore the exercise program should be scheduled for an earlier time in the day, preferably in the morning, when the client’s agitation level is usually at its lowest and mental cognition is at its highest.
If the client is exercising at home with a family member, a daily walk may be the optimal way to establish a structured routine. However, if the client refuses to exercise at home, attending a day care program once or twice a week may be better. As the disease progresses, walking may be the only exercise the individual is capable of carrying out; and once ambulation is no longer a possibility, because of either the inability to walk or the risk of wandering, maintenance of range of motion becomes crucial.
The hallmark exercise program is one that keeps the client active at various times during the day (e.g., 10 min exercise routines), poses a low risk of injury from falls, and has a strong behavioral component (e.g., effective reinforcement strategies).
When developing the training program be sure to consider the following elements:
Strength Training: Therabands
- Strengthen postural muscles.
- Focus on areas of weakness (i.e., quadriceps, hip extensors).
- Use 10 to 12 reps or less as tolerated.
Aerobic Training: Walking and Chair Aerobic Exercises
- Emphasize enjoyment.
- Maintain function.
- Stretch postural muscle groups.
- Focus on exercises that can be done on a raised platform (i.e., mat table) or chair; getting down or up from the floor will be difficult.