What Moves People Living With Dementia? Exploring Barriers and Motivators for Physical Activity Perceived by People Living With Dementia in Care Homes

Abstract

There is a lack of intervention promoting physical activity targeted toward people living with dementia because their input has not been prioritized in the development of exercise programs. The aim of this study is to investigate motivators and barriers concerning physical activity in people living with dementia in care homes and to give recommendations for intervention development. Qualitative semi-structured interviews were conducted; transcripts were analyzed using qualitative content analysis. Following a tailored procedural model, inductive and deductive category development was applied. The value of Cohen’s κ = .94 indicates the high intercoder reliability of the category system developed. Ten interviewees reported 24 different barriers and 12 motivators concerning physical activity in the context of the social-ecological model. The strong impact of intrapersonal factors and the living environment became apparent. Points of reference for how people living with dementia can overcome barriers and activate their motivators to achieve more physical activity are provided.

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

“…The participants in three out of five exercise groups stated that the outdoor training environment was a favorite aspect. Considering that the physical activity biographies of this generation are characterized by exercises performed outdoors (Gebhard & Mir, 2021), this finding indicates an outstanding appreciation of long-standing familiar training conditions. Moreover, this result is in line with previous studies confirming outdoor environments as valuable and enjoyable spaces for people with dementia when exercising (Cedervall, Torres, & Aberg, 2015;Olsson, Lampic, Skovdahl, & Engström, 2013).…”

“…The development of the physical activity intervention followed a transdisciplinary mixed-methods approach. The results of a systematic review (Gebhard, 2016), workshops with nursing staff (Gebhard & Schmid, 2018), and interviews with institutionalized people with dementia (Gebhard & Mir, 2021) were merged through a convergence coding matrix (Farmer, Robinson, Elliott, & Eyles, 2006). During the 3-hr workshop, hindrances and facilitating factors for successfully implementing physical activity programs in nursing homes were discussed by 32 nurses in five groups.…”

“…However, 23.66% of the eligible residents (26 out of 91) declined to participate. Reasons for refusal may occur due to intraand interpersonal barriers to physical activities (Gebhard & Mir, 2021), for example, lack of motivation for physical activity, fear of injuries and falls, or refusing group-based exercises. One way to help residents with dementia overcome these barriers could be a nonbinding offer to participate in a test physical activity session.…”

“…Applied equipment in intervention studies, for example, treadmills (Arcoverde et al, 2014), leg presses (Garuffi et al, 2013), cycling ergometers (Hauer et al, 2012), and other machine-based training regimes hardly reflect residents' desires and preferences. Furthermore, these studies most likely fail to tie in with participants' physical activity biography or interests (Gebhard & Mir, 2021). Most physical activity programs using the label tailored or individualized focus on the physical conditions of people with dementia, for example, customizing the intensity and progression of the exercises.…”

Barriers and Facilitators of Physical Activity

“…Several factors have been identified to influence PA among adults [4][5][6][7][8][9][10][11][12] ; these factors exist in three levels: intrapersonal (or individual), interpersonal, and environmental (or community) levels. [4][5][6][7] At the intrapersonal level, educational status, medical knowledge, motivation to maintain physical and mental health, self-consciousness, sport skills, level of commitment to PA, availability of time and financial resources, interest in exercise, socioeconomic status, and emotions (anger, frustration, and anxiety) are the factors that have been identified.…”