4. Exercise in the early to middle stages of dementia
There are many suitable exercise opportunities that may be beneficial for people in the early or middle-stages of dementia. Local community or sports centres often provide a range of organised exercise and physical activity sessions, such as ball games, seated exercises, tai chi, music and dance, indoor bowls or swimming. You may be able to use a personal budget, in the form of a direct payment from your local authority to pay for these. Some of these activities can be modified and carried out at home. Walking, gardening and housework are also good forms of everyday physical activity.
People in the early stages of dementia may experience no new difficulties in sports and other physical activities they enjoy. They ought to be encouraged to continue these activities where possible.
What is the right amount of activity in the early to middle stages of dementia?
There is no definitive answer to this question and the right amount of exercise will vary from person to person. The Department of Health recommends 150 minutes of moderately strenuous physical activity per week. This equates to 30 minutes of activity per day, for at least five days a week. This can be broken up into shorter sessions throughout the day, with each session lasting a minimum of 10 minutes. For example, it could be a 15-minute walk to the local shops, and then housework or gardening tasks in the afternoon.
Below are some examples of the types of exercise that a person may perform. This is by no means an exhaustive list - any form of exercise can bring benefits.
Gardening is a physical activity that provides an opportunity to get outdoors and is enjoyed by many people. The activity level can be varied to suit someone's abilities. It could be something that requires less exertion like weeding or pruning, or a more strenuous activity like raking or mowing grass. These activities may help strengthen the body's muscles and improve breathing. Gardening can be an enjoyable activity for people at all stages of dementia.
Some people may retain their bowling skills or continue to participate in other ball games, and so may enjoy indoor carpet bowls or skittles. Some local leisure centres offer indoor bowls sessions, or sets can be purchased from toy or sports stores.
Dancing can range from tea dances and couple or group sessions to more improvised movement involving ribbons, balloons or balls. Dancing can also be done in a seated position. This is a very social activity and an enjoyable way to participate in exercise. It can increase strength and flexibility, help with staying steady and agile, and reduce stress.
People with dementia can benefit from a regular programme of seated exercise sessions at home or with a group at a local class. It is often a good idea to see these exercises demonstrated at least once by an instructor or on a video. These exercises are aimed at building or maintaining muscle strength and balance, and are less strenuous than exercises in a standing position. They can be part of a developing programme, with the number of repetitions of each exercise increased over time. Some examples of seated exercises include:
- turning the upper body from side to side
- raising the heels and toes
- raising the arms towards the ceiling
- raising the opposite arm and leg
- bending the legs
- clapping under the legs
- bicycling the legs
- making circles with the arms
- practising moving from sitting to standing.
Swimming, under supervision, is a good activity for people with dementia. Many people find the sensation of being in the water soothing and calming. Some studies have also shown that swimming may improve balance and reduce the risk of falls in older people.
Tai chi and qigong are gentle forms of Chinese martial arts that combine simple physical movements and meditation, with the aim of improving balance and health. The movements concentrate on a series of integrated exercises. These forms of exercise focus on balance and stability, which are important in staying agile and may reduce the risk of falls.
Walking suits all abilities. It is free, does not need specialist equipment, and can be done anywhere. The distance and time spent walking can be varied to suit fitness levels. Some local leisure centres and other organisations arrange group walks, supported by a walk leader, of various lengths, so it can also be a social activity (see 'Other useful organisations').