I’m going to be honest and say that dementia is a very depressing situation to be in. To watch a loved ones mind slowly slip away to the point that they develop Alzheimer’s or other conditions is heart breaking. I’ve experienced a little of this with my grandmother, but I have also worked with clients that had different stages of dementia. My most recent client has a rather severe case of dementia, but he has also been one of the most exciting clients for me to train. It has been quite a journey discovering which exercises work and don’t work with my dementia client.

Dementia can have a very wide range of severity when it comes to its symptoms. This can vary from memory loss, inability to follow directions, depth perceptions, and other cognitive dysfunctions. Studies show that exercise can yield massive benefits to their cognitive abilities. They can do just about any exercise, however, my recommended list of exercises are:

• Sit to Stand
• Band Pull apart
• Shoulder matrix
• Lat pull down
• Chest press
• Recumbent Bike

Common facts regarding dementia

According to the CDC dementia is a generic term for cognitive decline. Someone with dementia will show more signs than just memory loss. They will have issues making decisions, following directions, depth perception (steps can look higher or lower than they really are), and have a difficult time with their activities of daily living².

There was an estimated 5 million people with dementia in 2014, and this number is expected to jump to 14 million by 2060. The most common population that dementia seems to affect are those 65 years and older⁶.

To put this estimated dementia population into a different perspective let us look at the total population increases. The estimated population of those 65+ is estimated to increase from 900 million in 2015 to 2 billion in 2050, according to the WHO. This means that the percentage of people with dementia will increase from 0.56% to 0.7%.

The actual causes of dementia are still unknown, but there are certain factors that can possibly contribute. Genetics is an obvious contributor to someone developing dementia later on in life. Overall health is also another contributing factor. Those that are overweight, smoke, sedentary, and inactivity can help increase the chances of developing dementia. Not everyone that is unhealthy will develop dementia, but it does increase your chances.

Benefits of starting an exercise program for dementia

Exercise is not just a way for people to get super fit and look good. Exercise is a modality that has amazing benefits for people that are afflicted with different diseases. Resistance and cardio exercise have been shown to have incredible benefits for those with dementia or Alzheimer’s disease¹.

Better Sleep

Regular exercise helps with sleep quality. By increasing sleep quantity and quality, a healthy person can expect to see better cognition throughout the day. Have you ever had bad sleep and tried to tell a story or recall something from yesterday? Sometimes you can go into a complete brain fart and have no recollection of the events that made it memorable.

According to a study by Lianne J Trigiani, “Low quality of sleep can perpetuate the accumulation of toxic protein aggregates in the parenchyma and around blood vessels, rendering clearance via the glymphatic system or other mechanisms less efficient.” Better sleep will allow better clearance of these proteins which will give those suffering from dementia a better chance at improving their symptoms³.

Most studies show that there are benefits to having a dementia patient exercising. They typically have results that show they have better function, sleep, mood, and cognition. However, there are studies that don’t show as great results or any benefits at all^1,5.

Unfortunately there are no guarantees

Some of the studies show that there are no improvements in cognitive ability.

All the studies show that their physical abilities are better which allow them to do their activities of daily living and make it much easier to care for them⁷.

Most of the studies show improved behavior and mood. I think that with better sleep and better physical abilities, there are less times for that individual to get frustrated. I think the cognitive impairment of some of the patients outweighs the benefits they get from exercise. This is simply my interpretation of the findings of these studies.

Dementia is so complicated and those that are afflicted by it vary a great deal in terms of their severity. So, it seems only natural that some studies will yield results while some will not, since not every person with dementia is the same. Overall, with the proper training regime and guidance there are no negatives to beginning an exercise program for those with dementia.

What exercises should be avoided with dementia

Exercises that are heavily driven by technique should be avoided. Of course, everything really depends on the individual. If they have a long history of multiple types of training, then they may be able to perform more complicated exercises. However, the big compound exercises should be avoided such as:

• Barbell squat
• Deadlift
• Shoulder press
• Bench press

These exercises have multiple moving parts which requires more focus and a greater understanding of the technique to avoid injuries.

It is possible to work your way up to these exercises, but this all depends on the individual. If they can follow directions clearly and have great body awareness (knowing where they are in space) then eventually transitioning to the big compound lifts is a possibility.

However, if they are anything like my current client then you must take things one step at a time. The most difficult exercises I can get him to do are sit to stands and band pull aparts. He is better now at performing the exercises, but there are still days where there is an obvious decline in cognition. I attempted to try a new exercise and he was unable to perform it correctly, and it through him off for the rest of the session.

They have every ability that a normal person would have, but you must take everything very slowly and pay very close attention to what they are doing.

How often should you exercise with dementia

Humans in general thrive off being in some sort of routine. A routine allows the brain to know what to expect next throughout the day. So instead of reacting to a situation you are simply following a guided plan which is much easier to do. If you have heard of the workings of Hal Elrod’s The Miracle Morning, then you can see some of the benefits of following a routine. Following this principle, working out 5-7 days a week will be optimal for the best results.

Each week should consist of 1-2 days of strength training (preferably 2) and the remaining days should be some sort of cardio. There is a lot more research that needs to be done regarding exercising with dementia, this is solely based on my experience, education, and research. For more information check out my article that describes how often older adults should exercise.

I have already explained how better sleep can influence their cognitive abilities. Exercise has been shown to improve one’s ability to fall asleep and stay asleep. This can have a compound effect on their abilities for their regular activities of daily life. In the end, this has the potential to improve their overall mood and independence. If they don’t respond super positively to the training, then at the very least it makes their care giver’s job much easier. Their mind may not be stronger, but they will have a better, stronger body which will make caring for them easier.

What you can expect for the first week

The first week of working with a client with dementia can come with a lot of frustrations. Their inability to follow directions is the main variable that makes the experience so frustrating. Therefore, starting with some exercises that mimic what they possibly do already in their daily life will help with coaching.

You can expect this person to have a very difficult time attempting to do some, if not all, exercises correctly. So, expect to have an extreme amount of patience. The typical coaching cues may not work, and you may have to resort to something a little more tangible. For example, I had my client do a chest press with a resistance band, and to complete each rep I had him reach out and give me a fist bump. This forced him to not overreach or unexpectedly begin walking forward. This gave him just the range that I wanted him to do to be safe and effective with the exercise.

You must be ready to pivot when something is clearly not working and build upon the successes that they seem to understand easily. Sometimes something will just click, and they can suddenly rapid fire each exercise perfectly. No one knows what will happen, not even the client, so be ready to adapt to the situation.

Recommended list of exercises with dementia

Careful observation of the client is a must when it comes to performing every repetition. A constant reminder of every cue they should be paying attention to is also crucial, because they will often forget certain things from one repetition to another. My most recommended exercises would start with…

• Sit to Stand – This exercise will be one of the more crucial exercises for building their leg strength. Other leg exercises that would require more balancing such as a lunge may be out of the question to start. Machines based exercises can also be difficult to instruct the client to properly get into and begin the motion as well. This will at least create functional strength since they are more connected to the ground.
• Band Pull Apart – Staying with trying to be as functional as possible, this will be a great exercise to improve posture while also being connected to the ground. This will strengthen the arm and back muscles while being a very simple exercise. Stretch the band as far as you can and hold for a second before releasing.
• Shoulder Matrix – The shoulder matrix is a really great exercise to challenge the shoulders as well as cognition. Start by bringing the arms straight out to the side, then straight out in front (like a zombie), then reach for the ceiling, finally reverse each movement until you are back to the start position.
• Lat Pull Down – I put a lot of emphasis on building the back muscles. After all, those are the muscles that keep us upright. This one is difficult for anyone to really mess up and hurt themselves. Focus on slow and controlled reps as well as holding the bottom squeeze for a moment. The only thing to watch out for is to make sure they don’t lean backward thinking there is a back rest.
• Chest press (Machine or Resistance Band) – I would love to have them do some sort of push up. If they have the ability or cognitive ability to do a push up safely then they should be the primary exercise. However, if they have a difficult time with push-ups then moving onto the chest press machine will be best. Stronger chest muscles will still benefit them in the event they fall.
• Recumbent bike – This I would recommend as the main source of aerobic/cardio exercise. There is too much risk involved with the treadmill and elliptical. They can get seriously hurt if they forget to turn off the treadmill. The elliptical can be difficult to control, and it is also a little high and difficult to get off. A stationary bicycle will be the safest option to ensure they are able to operate it safely.

Don’t be discouraged keep going!!

It is true that not every study proves that there is a positive outcome when it comes to exercising for those with dementia⁴. But I haven’t come across any studies that said there are negative effects from exercise. Each study showed a bigger decline in cognitive abilities in the control group in comparison to the group that exercised^4,7. Some days will look better than others, but you must keep the ball rolling. Staying consistent with this activity will reap the best rewards.

Citations

1. Yu F, Swartwood RM. Feasibility and Perception of the Impact From Aerobic Exercise in Older Adults With Alzheimer’s Disease. American Journal of Alzheimer’s Disease & Other Dementias®. September 2012:397-405. doi:10.1177/1533317512453492

2. Centers for Disease Control and Prevention. (2019, April 5). What is dementia? Centers for Disease Control and Prevention. Retrieved November 11, 2021, from https://www.cdc.gov/aging/dementia/index.html.  

3. Trigiani LJ, Hamel E. An endothelial link between the benefits of physical exercise in dementia. Journal of Cerebral Blood Flow & Metabolism. 2017;37(8):2649-2664. doi:10.1177/0271678X17714655

4. Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S. Exercise programs for people with dementia. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD006489. DOI: 10.1002/14651858.CD006489.pub4. Accessed 15 November 2021.

5. Steinberg, M. (2008). Evaluation of a home-based exercise program in the treatment of Alzheimer’s disease: The Maximizing Independence in Dementia (MIND) study. International Journal of Geriatric Psychiatry, 24(7).

6. World Health Organization. (2021, October 4). Ageing and health. World Health Organization. Retrieved November 15, 2021, from https://www.who.int/news-room/fact-sheets/detail/ageing-and-health.

7. Thuné-Boyle, I., Iliffe, S., Cerga-Pashoja, A., Lowery, D., & Warner, J. (2012). The effect of exercise on behavioral and psychological symptoms of dementia: Towards a research agenda. International Psychogeriatrics, 24(7), 1046-1057. doi:10.1017/S1041610211002365