Long, Annabelle Louisa
(2023)
The characteristics and core components needed to implement exercise classes for people with dementia in the community.
PhD thesis, University of Nottingham.
Abstract
Background
Dementia is a significant cause of disability and dependency in adults, and its growing prevalence has produced both individual and societal challenges. Exercise has been identified as an intervention with the potential to provide physical, mental and well-being benefits for those experiencing symptoms of dementia. This thesis explores the proposition that exercising within a group setting may provide benefits beyond the exercise's physiological mechanisms, offering social and support elements that would be absent when exercising alone.
Aim
By adopting a pragmatic mixed methods approach, the thesis aimed to identify the key characteristics and core components that are necessary to successfully implement an exercise class for older people living with dementia in the community. An ecological perspective underpins an exploration of whether older people living with dementia want to access exercise classes and, if they do, whether classes are available and the factors that may facilitate or prevent prolonged engagement.
Methods
A mixed methods literature review initiated the search to identify the key characteristics of group exercise interventions designed for older people living with dementia and the barriers and facilitators to attendance. Subsequently, a mixed methods study explored the benefits of an existing class for the client group that was operating before the outbreak of COVID-19. A mapping and spatial analysis established where and how many exercise classes were taking place. An ethnographic study explored the context-specific characteristics of classes and how these may have changed during the pandemic. Finally, the main chapters were synthesised to provide recommendations to encourage older people living with dementia to attend and continue participating in exercise classes.
Results
The mixed methods review, and subsequent mixed methods study, established four main findings for this client group. Firstly, multicomponent interventions that included aerobic, strength and balance activities improved physical function. Secondly, people living with dementia experience a wide range of benefits (physical, psychological, and social) from exercise interventions. Thirdly barriers to participation can be overcome with positive attitudes, and suitable environments and interventions that included a social dimension in their design were more likely to yield positive outcomes. Finally, people living with dementia want to take part in community exercise classes, and their participation produces a positive impact for both the person living with dementia and the carer, which increases the likelihood of continued participation and maintenance of those benefits.
In relation to the availability of appropriate classes, the main findings were that although exercise classes for older adults are widely distributed, many are held in locations where there is a low percentage of the population over 65, and there are very few dementia-specific classes available. The final key finding was that older adults, especially those living with dementia, appreciate knowledgeable, trained, and motivated staff. However, there is a lack of specific training available for exercise instructors, which limits their ability to offer inclusive classes.
Conclusions
Recommendations based on the main findings are provided on how community exercise classes could be adapted to encourage participation over the longer term. Multicomponent classes that include opportunities for social interaction and are delivered face-to-face are ideal for people living with dementia. Exercise instructors who are appropriately trained and have positive attitudes will enhance motivation and enable the provision of fully inclusive classes. This will allow people living with dementia to participate in classes that can suitably address their needs and expectations.
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