Physical Exercise Programs in Early Stage Alzheimer’s

The story goes something like this:

• There is a hospitalization, fall, or illness
• A physical or occupational therapist provides skilled interventions to increase strength, ambulation, function, and/or balance.  (setting could be a hospital, inpatient rehab center, skilled nursing facility, home health, or outpatient clinic).
• The therapist discharges the patient with a home exercise program that  is intended to maintain the level achieved during the rehab episode
• At home, the exercise program gets stuffed into The Drawer of Good Intentions, never to be seen again.

In order for these exercise programs to be of any benefit to someone with Alzheimer’s, a caregiver needs to be instructed on the correct technique, frequency, and expectations for the program.  It is not enough to simply train the patient using traditional educational techniques (i.e. verbal communication and written language) and expect consistent compliance.

If anything, home exercises programs are yet another task to pile onto the shoulders of a worn out caregiver.  Even for someone in the earliest stages of Alzheimer’s, consistent and independent carryover of a home program is not realistic.

So how much help is needed?  What is the best program format to maximize independent participation?  What are realistic expectations related to home exercise programs and follow through?  Here are some general guidelines based on Claudia Allen’s work:

Early stage

Recommended format:  written with pictures

Recommended assistance: reminders to initiate, help with nuances like speed and duration, cues to refer to the program rather than ask the caregiver

Exercise Focus:  core strengthening, rotational exercises, high intensity balance training with aerobic activity *

Expect: A person with early stage Alzheimer’s has the ability to learn something with maximum repetition.  Like anything, activities that are highly valued are easier to habituate.  Give the habituation process at least three weeks, or longer, to take hold.  Work the exercise program into the daily routine.  Expect good days and bad, periods of cooperativeness and resistance.  This is normal.

Don’t Expect: Because Alzheimer’s Disease usually affects memory and language first, it is not realistic to expect a person in the early stage to remember when to initiate and how to perform each exercise. Language is a challenge- finding words and understanding words.  The visual cortex is quite healthy in the early stage, so use that to your benefit through gestures and demonstration.

Tips:  Group exercise programs are great, both for the socialization and for the instruction that comes from someone other than the caregiver.  Senior centers, YMCA, assisted living facilities, and adult day centers usually offer these programs.

* Exercises should be instructed by a licensed physical or occupational therapist familiar with the patient.  These suggestions are for healthy individuals, but many programs target specific diagnoses and problems and should only be modified by a healthcare professional.