Wong R¹, Noyes L², Bellamy-Brown M; ¹Marymount University, Arlington, VA; ² Alzheimer’s Daycare Center, Falls Church. rwong@marymount.edu.

PURPOSE: This presentation describes a community/academic partnership to provide a physical therapy (PT) lead exercise program to individuals with moderate to severe Alzheimer’s disease (AD). The exercise program focused on maintaining mobility. The exercise leaders identified necessary exercise program modifications. Foundation: Deterioration of motor performance accompanies the progression of Alzheimer’s disease. The extent to which this deterioration relates directly to the disease process rather than deconditioning from inactivity is unclear, particularly in individuals with mid-to late-stage disease. DESCRIPTION: An Alzheimer’s Daycare Center (ADC) partnered with a PT academic program to provide exercise classes for individuals with AD. Following Institution Review Board approval, all clients at the ADC were invited to participate, regardless of physical or mental functioning. Twenty-four individuals with moderate to advanced AD participated. The exercise classes included 3 months of PT lead exercise, followed by 3 months of PT-lead exercise plus Tai Chi exercise. Local neurorehabilitation and geriatric specialists developed the exercise program based on best scientific evidence, clinical judgment, and their observations of the clients at the daycare center. The exercise program emphasized upper body /spinal extension, power extension of antigravity muscles, anterior weight shift when sitting, lateral stability when standing, and trunk rotation. The clinical director of the ADC trained exercise leaders in communication strategies for individuals with dementia. Exercise staff kept journals recording their observations of participant responses to exercise class, and changes they made based on these responses. At the end of the 6 month exercise program an exercise staff focus group discussed and summarized their reflections. OBSERVATIONS: Participants were divided into one of 3 subgroups based on their ability to perform standing exercise and/or group seated exercise. Exercise leader strategies emphasized manual and visual cues rather than verbal cues; limiting verbal cues to concrete, 1-2 step directions; flexibility in anticipated exercise performance; one-on-one help by exercise assistants; eye contact to maintain participant’s attention; use of native language; focus on purposeful movement; maintaining exercise consistency over time; and use of music with a clear beat and good cadence. Recommendations: Limited attention span and distractibility were significant barriers for some participants. The communication strategies training provided by ADC clinical director was invaluable. Exercise staff noted that it took about 2 weeks to familiarize participants with new exercise movements. Though most subjects did not appear to have declarative memory of the exercise movements, they did demonstrate procedural memory. A carefully crafted, flexible, and communication-sensitive exercise program for individuals with mid to late stage Alzheimer’s disease is realistic. FUNDING SOURCE: US Administration on Aging (AOA).

Copyright 2004 by the American Physical Therapy Association

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