Factors influencing adherence to home-based strength and balance exercises among older adults with mild cognitive impairment and early dementia: Promoting Activity, Independence and Stability in Early Dementia (PrAISED)

Abstract

Background Older adults with dementia are at a high risk of losing abilities and of accidental falls. Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is a 12-month person-centred exercise and activity programme which aims to increase activity and independence whilst reducing falls in people with early dementia. In this patient group, as well as many others, poor adherence to exercise interventions can undermine treatment effectiveness. We aimed to explore patterns of barriers and facilitators influencing PrAISED participants’ adherence to home-based strength and balance exercises. Methods Participants were a subsample of 20 individuals with mild cognitive impairment or early dementia and their carer(s) taking part in the PrAISED programme. Participants (with the support of a carer where necessary) kept a daily exercise diary. Participants’ adherence were categorised based upon reported number of times a week they undertook the PrAISED strength and balance exercises over a 4 month period (<3 times a week = low adherence, 3–4 = meeting adherence expectations, >5 = exceeding adherence expectations). Semi-structured interviews were conducted in month 4 of the PrAISED programme to explore barriers and facilitators to adherence. A mixture of deductive and inductive thematic analysis was employed with themes categorised using the Theoretical Domains Framework. Findings Participants completed on average 98 minutes of home-based strength and balance exercises per week, 3.8 sessions per week, for an average of 24 minutes per session. Five participants were categorised as exceeding adherence expectations, 7 as meeting adherence expectations, and 8 as low adherers. Analysis of interview data based on self-reported adherence revealed six interacting themes: 1) routine, 2) practical and emotional support, 3) memory support, 4) purpose, 5) past experiences of sport and exercise, and 6) belief in and experience of benefits. Conclusions Identifiable cognitive, psychological, and practical factors influence adherence to exercise, and should be addressed in future development of interventions with this population.

Client, caregiver, volunteer, and therapist views on a voluntary supported group exercise programme for older adults with dementia

“…Our results are in line with research on behaviour change theories, suggesting that individuals with dementia need extra support both to be able to start and continue with new activities [3]. Thus, identifying factors that influence adherence to exercise is crucial and should be included in development of interventions for this population [30]. The volunteers said they learned a lot from being part of this project, where the dementia diagnosis was not in focus, but rather the interesting person behind the diagnosis.…”

Feasibility and Effectiveness of a Biography-Based Physical Activity Intervention in Institutionalized People With Dementia: Quantitative and Qualitative Results From a Randomized Controlled Trial

“…However, individual preferences are identified as major intrapersonal motivators for physical activity . Furthermore, interviews with people with dementia indicate that a past experience of sports and exercise influences adherence to home-based exercising (Hancox et al, 2019). The focus groups in this study confirm this assumption with special regard to exercising outdoors.…”

“…Dependency on other people is a major barrier to physical activity for people with dementia (van Alphen, Hortobágyi, & van Heuvelen, 2016). Specifically, a lack of support by caregivers is confirmed as a barrier to exercising in this target group (Baert et al, 2016;Hancox et al, 2019). Nevertheless, approaches to counteract these hindrances are mainly missing in program implementation strategies in long-term care.…”

Promoting activity, Independence and stability in early dementia (PrAISED): a, multisite, randomised controlled, feasibility trial

“…It was not feasibly to have a sham control and it is common practice to have a ‘usual care’ control arm [6, 9, 21] for activity and exercise interventions for this patient group. Our research suggests participants are less likely to do the exercise without human contact (through supervision or support from carers) [42].…”