Dementia - activities and exercise

You don’t need a great memory to enjoy yourself. Every day there are many things that give us purpose and pleasure. A person with dementia still needs a good quality of life, but without some help from family and carers it is much harder for them to find that purpose and pleasure.

There are many ways to plan and provide suitable activities for a person with dementia. Ideally, activities should be sensitive to the person’s cultural background. Understanding the person helps you plan activities that suit them.

This means knowing their former lifestyle, work history, hobbies, recreational and social interests, past travel and significant life events.

Plan activities around the person#

Good activities can re-establish old roles, offer relaxation and pleasure, and give an opportunity for enjoyment and social contact. Aim to:

• compensate for lost abilities
• promote self-esteem
• maintain remaining skills, without requiring new learning
• create an emotional connection
• include enjoyable sensory experiences

Try not to overstimulate the person#

Avoid crowds, constant movement and noise, which many people with dementia find overwhelming. If different people are caring for the person, it can help to write out an activities care plan. This keeps activities consistent and suited to the person’s needs.

Make use of skills that have not been forgotten, such as buttering bread, washing up, watering plants, sweeping or raking in the garden. These let the person contribute to the household and feel useful. Encourage them to take responsibility for something, no matter how small.

A person with dementia may enjoy an outing even if they do not remember where they have been. What matters is that the moment is enjoyed, even though the experience may soon be forgotten.

Keep activities simple and unhurried#

Give the time and space needed to let the person do as much as they can. Focus on one thing at a time, and communicate one instruction at a time.

Break activities into simple, manageable steps. People with dementia often have difficulty with visual perception and coordination, so keep surfaces uncluttered, with few distractions and as little noise as possible.

Good lighting (without glare), comfortable seating and correct work heights are also important. Using plastic containers can help avoid breakages.

Allow for good days and bad days#

Don’t let activities reinforce a sense of inadequacy or add stress. Levels of ability can change from day to day. An activity can be adapted and tried again another time if it was not successful or enjoyable at first.

For the best results, choose times of day when the person is at their best. Walking, for example, is sometimes best in the morning or early afternoon. For someone who becomes restless later in the day, or who has had a long or empty day, a late afternoon walk may suit better.

Use movement, music and memories#

For many people with dementia, a sense of movement and rhythm is retained. Listening to music, dancing, or contact with babies, children or animals can bring positive feelings. Many people with dementia have excellent memories of past events, and looking through old photos, memorabilia and books can help them recall earlier times. The chance to relive treasured moments can be deeply satisfying.

If reading skills have declined, make recordings for them, or find picture books and magazines on subjects they enjoy.

Sensory experiences the person might like include:

• enjoying a hand, neck or foot massage
• having their hair brushed
• smelling fresh flowers or potpourri
• using essential oils and fragrances
• stroking an animal or different textured materials
• rummaging in a box of things they have been interested in
• visiting a herb farm or a flower show

Activities and challenging behaviors#

Activities play a significant part in managing challenging behaviors. Knowing what helps to calm or distract a person when they are restless or distressed is very important, and can be especially helpful for a respite carer.

Above all, don’t give up. Mistakes and failures will happen, but don’t let the person with dementia feel like a failure. Keep trying.

Dementia and exercise#

A person with dementia gains the same benefits from regular exercise as anyone else, including improved cardiovascular fitness, strength and endurance. Always talk with the person’s doctor about their exercise routine, or before starting any new program.

Exercise can offer many benefits, including:

• improved mood
• better sleep
• reduced likelihood of constipation
• maintenance of motor skills
• reduced risk of falls through better strength and balance
• a slower rate of disease-related mental decline
• improved memory
• better communication and social skills
• improved behavior, such as reduced wandering, swearing and aggression

Getting started#

To begin an exercise program for a person with dementia:

• Talk with the person’s doctor and arrange a full medical check-up. Other conditions, such as arthritis or high blood pressure, may limit which exercises are safe.
• Ask a physiotherapist to design a program that takes the person’s current health and abilities into account.

Start slowly. Perhaps five minutes of continuous exercise is all the person can manage at first. Over a period of months, add an extra minute at a time until they can comfortably exercise for about 30 minutes. Demonstrate the activity yourself and ask the person to follow your lead.

Boredom kills motivation, so mix up the activities to keep them interesting. If the person used to enjoy a particular form of exercise, such as golf, encourage them to take it up again with your support.

Types of exercise#

• Walking is one of the best all-round exercises and it is free. It also helps work off the restless urge to wander. Try combining a walk with a useful errand, such as buying milk or walking the dog.
• Cycling on a tandem bicycle lets you sit up front and steer while the person pedals behind you. If they have balance problems, a three-wheeled bicycle they can ride while you cycle alongside may help.
• Aerobics can be done together, either at a class or with low-impact workout videos.
• Gym work, such as treadmills, stationary bicycles and weight machines, can also be suitable.

Exercise that doesn’t feel like exercise#

Exercise is any physical activity that raises the heart rate. Activities that don’t feel like structured exercise include:

• Dancing. Social clubs often include dancing in their calendar. Simple dances such as square dancing can be learned, as long as a partner takes the lead.
• Gardening. Raking and mowing the lawn are good forms of exercise. Be on hand to help if needed.
• Housework, such as vacuuming and folding laundry. Many people with dementia can continue certain housework with supervision.

Safety concerns#

Exercise can be helpful, but activities must be safe. To improve safety:

• Speak with the person’s doctor or physiotherapist about suitable exercise as the condition progresses.
• For outdoor activities, make sure the person wears a medical alert bracelet or pendant, or some form of identification in case they get lost.
• Use weight machines rather than dumbbells or barbells that can be dropped.
• If the person can still talk while exercising, they are in a comfortable aerobic state. Keep the conversation going to gauge how puffed they are, and slow down if they cannot talk without gasping.
• For outdoor activities, protect the person from the sun by covering up with clothing and a hat and applying sunscreen to exposed skin.
• Make sure the person drinks plenty of water before, during and after exercise.
• If the person feels dizzy or faint, or reports any kind of pain, stop the activity and talk to their doctor.

Key points#

• What is important is that the moment is enjoyed, even though the experience may soon be forgotten
• Good lighting (without glare), seating preferences and correct work heights are also important
• Knowing what helps to calm or divert a person when they are restless or distressed is very important
• Importantly, don’t give up
• Exercise can be helpful for people with dementia, but it is important that activities are safe

Where to get help#