Aquatic exercise is used for improving strength, agility, flexibility, balance, and relaxation. Aquatic exercise is an appropriate and pleasurable option for individuals with dementia. According to Ayan et al. being immersed in shallow water stimulates brain activity and enhances cortical activation. Aquatic exercise results in significantly greater stimulation of the corpus callosum. The corpus callosum makes communication between the left and right hemispheres in the brain faster and promotes higher-level reasoning. Not only is aquatic exercise beneficial in a physical manner but also has many behavioral and psychological benefits for dementia patients. Individuals with dementia experience negative psychological and behavioral symptoms that compromise their safety, challenge their independence and negatively impact their social life. The water helps to increase poor efficacy and halt problematic side effects. Psychological well-being is important for having a healthy sense of self and overall quality of life.
Neville et al. and Schilling et al. found that water helps to decrease behavioral symptoms and improve psychological well-being. Aquatic exercise leads to improved mood, self-esteem, socialization, facilitates remembrance, and contributes to the development of friendships. Most aquatic interventions are group based, this helps to resolve isolation of dementia patients and allows them to be social while getting their exercise. Many dementia patients find activities on land too difficult, such as walking. The water alleviates the mental or physical block the patient has on land and allows them to participate in physical activity. Aquatic exercise is shown to increase orientation and verbal responses, social interaction, relaxation, sleep, and appetite. Aquatic exercise is a unique intervention and significantly improves mood, socialization, cognitive function, and overall quality of life.
Mindfulness-Based Exercise With this intervention; individuals are extremely aware of what they are experiencing. Performing mindfulness exercise involves deep breathing, guided imagery, and other exercises that relax the body and mind while reducing stress. Barnes et al. and Plahay et al. observed the effects that mindfulness-based interventions have on dementia. Types of mindfulness- based exercises include yoga, tai chi, Feldenkrais, and dance movement therapy. Mindfulness activities improve body awareness, movement, memory, and functional skills. Plahay et al. found that coordination and balance are also positively affected with mindfulness exercises. Mindfulness-based interventions also lead to changes in emotion. Dementia patients seem to be more accepting of resting, sharing stories and feelings, and have a positive attitude towards mindfulness-based exercises. Like aquatic exercise, mindfulness-based exercises are usually done in group settings leading to more social interaction and making friends. Mindfulness-based exercises are very effective in improving the performance of ADLs in individuals with dementia.
Motor movement and implicit memory are also improved with mindfulness-based exercises. Most exercises consist of seated up and down body movements, sit-to-stand sequences, standing weight shifts, and stepping up and down and side to side sequences. Mindfulness-based activities are also suitable for dementia patients because they are usually designed with physical movements starting simple and advancing to more complex as the class progresses. Barnes et al. found that these type of classes are able to link physical functions with cognition, which means the individual with dementia is able to realize and appreciate the movement they are performing. Mindfulness-based exercise is shown to increase mood in dementia patients because they appreciate being aware and value the sensory experience of the movement. Mindfulness-based interventions are also calming for dementia patients with anxiety, confusion, and depression. Patients are able to pay attention to bodily sensations and breathing. Physical performance, cognitive function, and quality of life are improved; caregiver burden is also reduced.
Caregiver burden of dementia patients is taken very seriously. Caring for individuals with dementia is very challenging, and family caregivers are at an increased risk of physical and mental illnesses, themselves. Mindfulness-based stress interventions seem to be a promising method for subsiding the burden that family members caring for dementia patients seem to experience, according to Liu et. al. Mindfulness-based activities for caregivers are similar to the exercises included in the intervention for the dementia patients. Caregiver programs include a lot of stress reduction techniques such as breathing exercises and calming techniques. Calming music is usually used in the background of mindfulness-based stress reduction classes. Like dementia patients, caregiver classes are usually also done in groups, this helps caregivers to realize they are not alone in caring for a loved one with dementia. Although it is depressing for a caregiver to witness the deterioration of their loved one it is also very important that they engage in activities that reduce stress and improve their quality of life.
Exercise is great for everyone in every way! Aerobic, anaerobic, multi-component, high-intensity functional, aquatic, and mindfulness-based exercise interventions are all beneficial for individuals with dementing illnesses. Each type of exercise is unique and has advantages among the others. Gillis et al., Graff-Radford et al., Gregory et al., Henskens et al., Larson et al., Lee et al., and Liu-Ambrose et al. studied the effects of aerobic exercise on cognitive impairments such as dementia. Aerobic exercise is found to increase heart rate and fuel the brain with oxygen more efficiently. Aerobic exercise was significant in the improvement of executive functions compared to the other intervention types. Aerobic exercise was found to be the most effective intervention when the goal was to preserve cognitive health in older adults with risks of dementia. While aerobic exercise was undoubtedly found to be beneficial to individuals with dementia, anaerobic exercise had more hesitant results.
Gregory et al., Lee et al., Liu-Ambrose et al., Nagatmsu et al., and Radcliffe studied the effects anaerobic exercise had on dementia. Anaerobic exercise was found to promote neurotrophic factors that are valuable for the brain. According to Lee, muscle strength in the arms and legs is associated with reduced risk of dementia. Like aerobic exercise, anaerobic was found to lead to improvements in cognition. Multi-component exercise was studied by Bossers et al., Gillis et al., Henskens et al., Lee et al., Liu-Ambrose et al., Nagatmsu et al., and Sandoiu. Gillis et al. and Sandoiu found multi-component exercise to be far less beneficial for dementia than a single exercise intervention, like aerobic. Bossers et al., Henskens et al., Lee et al., Liu-Ambrose et al., and Nagatmsu et al. disagreed. This disagreement may be because the study was not split evenly between each exercise type or done in a manner where the researcher could keep track of progress from both interventions.
Bostrom et al., Lindelof et al., Olsen et al., and Toots et al. found that high-intensity functional exercise was very beneficial to dementia patients if they were able to participate. Moderate to high-intensity exercise is more effective than low-intensity exercise. HIFE slows the progression of dementia, reduces depression, promotes sleep, improves balance, maximizes independence, and improves the overall quality of life. Group exercises such as aquatic and mindfulness-based are very beneficial to dementia patients for different reasons. The social aspect of these two interventions really helps dementia patients feel involved and aware of what they are doing unlike a normal everyday activity would. Increased social activity leads to decreased risk and signs of depression in dementia patients. Aquatic interventions help make exercise enjoyable and doable for dementia patients.
Mindfulness-based activities are beneficial for depression, anxiety, and other mental health concerns that usually come along with dementia. Structural and neurophysiological changes in the brain and the decline of cognitive function come along with normal aging. Exercise helps combat these changes by altering brain chemistry. The brain is made up of cells called neurons that transmit chemical signals between each other and allow one to interpret the world. These chemical signals, neurotransmitters, are responsible for how you feel, think, and behave. Two neurotransmitters- endorphins and serotonin- are responsible for why you feel good when exercising. Endurance activities result in the release of endorphins, known as the body’s internal painkillers. Serotonin is also released when exercising and is known as the “happy chemical” because it promotes pleasure.
Physical activity level increases brain serotonin levels. Neurotransmitters associated with depression, anxiety, and stress as well as brain chemicals associated with learning are altered with exercise interventions. Physical activity shows similar effects to antidepressants in reducing depressive symptoms in people with dementia. Exercise helps reduce depressive symptoms. Increased levels of physical fitness are associated with decreased levels of depression. No medications are proven to reduce the risk of dementia or age-related cognitive decline. There is no cure for dementia, non-pharmacological interventions such as physical activity are a promising method for slowing down dementia-related decline. There is a positive correlation between fitness level and brain function. An active lifestyle is proven more effective in maintaining cognitive function. Exercise is crucial to an individuals’ physical health and just as important to mental health. Without physical activity, motor and cognitive functions decline and the progression of dementia accelerates.
Adults who regularly engage in physical activities, sports, or exercise in midlife carry a significantly lower risk for dementia in later years. There is a reduced incidence rate of dementia for people who exercise three or more times per week. Everyone, including all different levels of cognitive impairment, can benefit from exercise. Exercise leads to improved mood, resilience to stress and improved functions of the brain, such as processing speed, attention, short-term memory and cognitive flexibility. Physical activity increases cognitive functions, balance, strength, walking, endurance, mood and behavioral problems. Physical activity promotes neurogenesis and increases blood volumes and blood flow throughout the brain. Exercise is shown to significantly improve ADLs in individuals with dementia. Exercise, no matter what type, is a promising strategy for combating cognitive decline.
Future research is necessary in order to pinpoint what exercise interventions are most beneficial to dementia patients. All of the exercise interventions discussed in this review of literature are beneficial but no specific study goes into which intervention may be superior. More research should be done on if intensity, frequency, and duration of the exercise session matters. Although it is known that moderate to high-intensity interventions are better than low intensity it is not known if moderate intensity or high-intensity interventions are more suitable. In the Barnes et al. study the intervention required individuals to participate twice a week for forty-five minutes. The Barnes et al. study was a mindfulness-based intervention, done at low to moderate intensities in this case and mostly always. Barnes et al. failed to test different levels of intensities and then test for cognitive function.
The study also neglected to change the duration and frequency of exercise sessions. It would be very interesting to see if intensity, duration, and frequency of exercise interventions make a difference in cognitive function. For example, Barnes et al. could have had the participants exercise twice a week for forty-five minutes at high intensity for two weeks, moderate intensity two weeks, and low intensity another two weeks. This would show a better indication if the intensity of an exercise program makes a difference in delayed onset of dementia. The same could be done for both duration and frequency by manipulating the intervention differently every week. Another idea for furthering research on this topic is to interview participants and family caregivers on the efficiency of an exercise program.
Barnes et al. used surveys to help keep track of the progress of his dementia participants by asking questions. The questions were answered by both the participants and the caregivers of the participants. The questions ranged from asking about how the intervention has changed their quality of life to if they are likely to continue participating in mindfulness-based exercise. Asking questions instead of basing findings solely from numbers and observations is insightful. Receiving a first-hand opinion from the participant and caregiver would really help to see where the participant is heading and how they feel about the program. Henskens et al. study observed the effects that multi-component exercise has on dementia. With as controversial as this intervention is, there needs to be more research. Henskens et al. had eighty-seven participants in the study.
The study found that multi-component exercise was helpful in improving cognitive impairment, but with only eighty-seven participants, Henskens could not draw a conclusion with all the controversy over this specific intervention. In the future, Henskens or another researcher might want to include a larger sample size so that they can really investigate the effects that multi-component exercise has on dementia. With a small sample size, conclusions are drawn, but the study may not be as widely accepted as it would be with a bigger sample size. Another beneficial future study on this topic would be for the same researcher to study aerobic, anaerobic, and multi-component exercise interventions and use the same system. With each exercise intervention being done by a different researcher it is hard to tell if multi-component exercise or a single exercise intervention is more advantageous. If one researcher used the same aerobic and anaerobic exercises separately and then in a multi-component program and tested, in the same manner, the multi-component exercise controversy would die down.
Future research could also be done on what parts of the brain are affected by each type of exercise. For example, it is known that aerobic exercise is beneficial in preventing grey matter loss and increasing hippocampal space in the brain. The other interventions included in this review of literature do not mention which areas of the brain are mainly affected. If aerobic exercise is best and most beneficial for hippocampus performance, then maybe aerobic exercise can be deemed most beneficial to a dementia patient. If specific parts of the brain were individually tested in each type of intervention researchers may be able to pinpoint the best exercise programs to prescribe to dementia patients. With the expected growth of dementia, future research is very important!
