Increased self-efficacy: the experience of high-intensity exercise of nursing home residents with dementia – a qualitative study

Abstract

BackgroundThere has been increasing interest in the use of non-pharmacological interventions, such as physical exercise, to improve the well-being of nursing home residents with dementia. For reasons regarding disease symptoms, persons with dementia might find it difficult to participate in exercise programs. Therefore, it is important to find ways to successfully promote regular exercise for patients in residential care. Several quantitative studies have established the positive effects of exercise on biopsychosocial factors, such as self-efficacy in older people; however, little is known regarding the qualitative aspects of participating in an exercise program among older people with dementia. From the perspective of residents, we explored the experiences of participating in a high-intensity functional exercise program among nursing home residents with dementia.MethodsThe participants were eight elderly people with mild-to-moderate dementia. We conducted semi-structured interviews one week after they had finished a 10-week supervised high-intensity exercise program. We analyzed the data using an inductive content analysis.ResultsFive overreaching and interrelated themes emerged from the interviews: “Pushing the limits,” “Being invested in,” “Relationships facilitate exercise participation,” “Exercise revives the body, increases independence and improves self-esteem” and “Physical activity is a basic human necessity—use it or lose it!” The results were interpreted in light of Bandura’s self-efficacy theory. The exercise program seemed to improve self-efficacy through several mechanisms. By being involved, “being invested in” and having something expected of them, the participants gained a sense of empowerment in their everyday lives. The importance of social influences related to the exercise instructor and the exercise group was accentuated by the participants.ConclusionsThe nursing home residents had, for the most part, positive experiences with regard to participating in the exercise program. The program seemed to increase their self-efficacy through several mechanisms. The instructor competence emerged as an important facilitating factor. The participants emphasized the importance of physical activity in the nursing home.

Attitudes and needs of residents in long‐term care facilities regarding physical activity—A systematic review and synthesis of qualitative studies

“…They realised that these activities improve their physical conditions (Chen & Li, ; Cooney et al, ; Guerin et al, ; Lindelöf et al, ; Olsen et al, ; Stathi & Simey, ) and have an enhancing effect on their cognition as well (Lindelöf et al, ; Olsen et al, ; Stathi & Simey, ). Sometimes, they recognise a positive effect on the whole body, as it “revives the body” (Chen & Li, ; Cooney et al, ; Olsen et al, ; Stathi & Simey, ). Furthermore, being physically active allows them to perceive life at the nursing home as positive.…”

“…Residents view requirement for support as dependency and describe this as a worst‐case scenario (Behr et al, ; Chen & Li, ; Lindelöf et al, ; Stathi & Simey, ; Taylor et al, ). In some cases, they experience their rooms and beds as a threat (Behr et al, ; Bourret et al, ; Chen, ; Olsen et al, ; Stathi & Simey, ) and actually describe their rooms as a “prison cell” (Stathi & Simey, ).…”

“…Additionally, a training programme should consider individual conditions as physical impairments have an influence on being physically active (Chen, ; Guerin et al, ; Olsen et al, ). Disease‐related physical symptoms, such as pain or fatigue, could keep the residents from participating in an exercise activity (Chen, ; Guerin et al, ) and so can mental illness, for example, depression (Guerin et al, ), or the wish to relax (Benjamin et al, ; Chen, ; Guerin et al, ).…”

“…Lack of information, triggered through unawareness and impaired cognition, can be a barrier to taking part in the activities offered by the institution (Chen, ; Guerin et al, ; Taylor et al, ). The residents want the institution to provide sufficient information to them (Olsen et al, ).…”

Applicability of an elastic band exercise program to wheelchair‐bound older adults with and without dementia: A self‐rating survey

“…Furthermore, in one recent qualitative study, researchers interviewed participants with dementia, and confirmed their ability to adhere to a high‐intensity functional exercise program safely, understanding the requirements, and expressing their pleasure and strength they gained from the program . Another study with a similar design also reported an increased self‐efficacy after high‐intensity exercises of nursing home residents with dementia . Hence, it would be possible and feasible for people with dementia to evaluate the applicability of an exercise program.…”