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Abstract

The purpose of this article is to describe the conceptual model and implementation strategies of an evidence-based, aquatic exercise program specifically targeting individuals with dementia-The Watermemories Swimming Club (WSC). Physical exercise not only improves the functional capacity of people with dementia but also has significant effects on other aspects of quality of life such as sleep, appetite, behavioral and psychological symptoms, depression, and falls. Additionally, exercise can improve a person's overall sense of well-being and positively enhance their sociability. The WSC was designed to increase physical exercise while being easy to implement, safe, and pleasurable. Many challenges were faced along the way, and we discuss how these were overcome. Implications for nurses are also provided.
... Achieving ethics approval in residential aged care research: A protective process or barrier Dear Editor, For individuals with dementia, exercise is shown to improve physical, functional and cognitive performance [1,2]. In addition, exercise can reduce behavioural and psychological symptoms among those with advanced dementia living in a residential aged care facility (RACFs), and decrease staff distress [3,4]. Given these benefits, it could be important to investigate potential programmes that could be integrated into RACF daily activities. ...
... For individuals with dementia, exercise is shown to improve physical, functional and cognitive performance [1,2]. In addition, exercise can reduce behavioural and psychological symptoms among those with advanced dementia living in a residential aged care facility (RACFs), and decrease staff distress [3,4]. Given these benefits, it could be important to investigate potential programmes that could be integrated into RACF daily activities. ...
... Programs have been created within nursing homes for individuals with dementia, and community groups for such individuals have been very successfully formed, potentially providing meaningful venues for outcomes assessment. 72,73 There are some potential physiologic reasons for the use of aquatic exercise programs in MCI and dementia. As detailed in the beginning of this article, cerebral blood flow is positively affected by immersion and aquatic exercise. ...
Article
Aquatic therapy has been used extensively in a number of neurologic diseases and pathologies. This review will describe disease‐specific rehabilitative applications for this population. Recent research has offered scientific support for use in common neurological diseases that are part of rehabilitative practice, and very recent findings may create even firmer support for its use in these as well as other conditions. Stroke, Parkinsonism, and multiple sclerosis are areas that have recently received a significant number of published studies. Dementia is another area that has been more recently studied and received basic science support. Cerebral palsy has also had recent supportive evidence published. Available literature is reviewed to create a more evidence‐based support for the use of aquatic therapy in neurorehabilitation. This article is protected by copyright. All rights reserved.
... Water Memories swimming clubs were developed in Australia and combine the benefits of a fun social activity that evokes happy memories with the positive benefits of physical exercise for people living with dementia (Neville et al 2013). ...
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In New Zealand's South Island, Dementia Canterbury has trialled an alternative respite service model that provides a broad range of community-based activity groups to help people living with dementia enjoy meaningful activities in normal social settings, while also helping to support care partners.
... Water Memories swimming clubs were developed in Australia and combine the benefits of a fun social activity that evokes happy memories with the positive benefits of physical exercise for people living with dementia (Neville et al 2013). ...
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There is general acknowledgement of the importance of early diagnosis of dementia, yet there are still high rates of undetected dementia internationally. The aim of this cross-sectional study was to determine the sociodemographic characteristics associated with possible undetected dementia in a large sample of community-dwelling older New Zealanders. The sample consisted of older people (age≥65) who had received the homecare version of the international Residential Assessment (interRAI HC 9.1) over a 2-year period and who were screened positive for possible dementia on the interRAI’s Cognitive Performance Scale (CPS). People with possible alternative explanations for impaired cognitive performance such as depression and other neurological conditions were excluded from analysis. The 5202 eligible individuals were categorized into two groups: (1) those with a recorded diagnosis of dementia (64%) and (2) those without a recorded diagnosis of dementia (i.e. possible undetected dementia group) (36%). Logistic regression was used to evaluate the association between individual characteristics and possible undetected dementia. Significant risk factors for being in the possible undetected dementia group included Asian ethnicity, living alone, not having participated in long-standing social activities recently, major life stressors, and limited accessibility of their house. The knowledge gained from this study could enable targeting of services and resources for the groups at risk of undetected dementia to have a more equitable access to early diagnosis.
... Participants also enjoy the opportunity to gather together for a coffee at the end of each session.Many people living with a dementia have positive memories of swimming and water-based activities that can be rekindled by pleasure-based water activities. Water memories swimming clubs were developed in Australia to combine the benefits of a fun social activity that evokes happy memories, with the positive benefits of physical exercise for people living with dementia[34]. ...
Research
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With or without dementia, meaningful activities and meaningful relationships are at the heart of a positive and enjoyable life. We are proud to share our positive experience of offering an activity programme that concentrates on providing meaningful community based activities for people living with dementia in normal social settings.
... Multiple studies have been conducted to show the benefits of aquatics in other populations such as people with Parkinson's, arthritis, stroke, dementia, multiple sclerosis, neuropathy, and more. In these studies, aquatic therapy has improved quality of life while reducing muscle tension, stress, anxiety, and pain (Al-Qubaeissy, Fatoye, Goodwin, & Yohannes, 2012; Brown & Gerbarg, 2005;Cadmus et al., 2010;Konlian, 1999;Munguia-Izquierdo and Legaz-Arrese, 2008;Neville, Clifton, Henwood, Beattie, & McKenzie, 2013;Roehrs & Karst, 2004;Stroller, Greuel, Cimini, Fowler, & Koomar, 2012;Tecic, Lefering, Althaus, Rangger, & Neugebauer, 2012). According to one systematic review determining the effectiveness of aquatic exercise for relieving pain in adults with neurologic or musculoskeletal disease, aquatic exercise has shown a small but significant pain-relieving effect on pain intensity when compared to controlled treatment groups (Hall, Swinkels, Briddon, & McCabe, 2008). ...
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The prevalence of post-traumatic stress disorder (PTSD) continues to increase. Symptomology of PTSD include sensory deficits much like those displayed in children with sensory integration (SI) disorder. The aim of this scoping review is to review symptoms of PTSD and SI, and make a case of how aquatic therapy may be an effective modality in treating clients with PTSD. Eighteen articles were selected for review. From this review, it is suggested that aquatic therapy can be an effective modality in reducing symptoms of PTSD; however, future research is essential in determining its effectiveness.
... To promote project uptake and adherence, all facilities staff participating in bringing residents to and from trainings, and/or assessments, undertook project training seminars, and exercise and assessment sessions are grounded in evidence via lessons learnt by our group from previous nursing care deliveries. 20,21 For this sub-study, four facilities agreed to participate and eligible residents from the parent study who did not have a pacemaker were recruited and consented into the study. This process involved residents being informed by staff about the project and given a participant information sheet to read. ...
Article
The impact of progressive resistance training on sarcopenia among very old institutionalized adults was investigated. Residents of Nursing Care Facilities were included in a controlled trial of twice weekly resistance and balance exercise program for six months (Age: 85.9 ± 7.5 years, Time in care: 707.1 ± 707.5 days, N = 21 per group). Sarcopenia was measured based on the European Working Group on Sarcopenia in Older People criteria. Of the recruited 42 participants, 35.7% had sarcopenia at baseline, with prevalence increasing in the control group post-intervention (42.9%-52.4%). Following training, the exercise group experienced a significant increase in grip strength when compared to controls (p = .02), and a within-group decrease in body mass index and increase in grip strength (p ≤ .007). Resistance and balance exercise has positive benefits for older adults residing in a nursing care facilities which may transfer to reduce disability and sarcopenia transition, but more work is needed to ensure improved program uptake among residents.
Article
Background Post-Traumatic Stress Disorder (PTSD) is a substantial problem for Veterans and active members of armed forces across the globe, resulting in debilitating mental and physical comorbidities. Evidence-based treatments have demonstrated some success; however, many Veterans remain symptomatic mandating the urgent need for innovative treatment strategies. Purpose The purpose of this study was to explore the lived experience of military Veterans with PTSD symptoms who participated in a therapeutic warm water immersion intervention aimed at reducing their symptoms. Methods and Procedures A standardized warm 33 °C (92 °F) water immersion intervention to the chest, lasting 45 min was implemented. Semi-structured interviews were conducted with the 13 participants (age 23–41) after engaging in the intervention. Using a qualitative descriptive design informed by phenomenology, thematic analysis was completed, applying criteria of rigor throughout the process. Results Five main themes explicated the participants’ experience: the rhythm of relaxed, embracing the properties of the water, the pain floats away, acclimatize to calmness, and a place to set your mind. Participants described a sense of relaxation, calmness, pain reduction, and a means to control intrusive thoughts. All indicated they would recommend the intervention and provided feedback on how to refine it. Conclusions As a component of a larger study, these qualitative findings revealed the potential for therapeutic effects of a novel water immersion intervention. The findings serve to inform revisions to the intervention for future research and practice. Immersion provides a fast-acting, non-stigmatizing adjunct therapy for student Veterans who continue to experience symptoms during and after standard evidence-based treatment.
Article
Background: Pilot work by our group has demonstrated that aquatic exercise has valuable functional and psychosocial benefits for adults living in the residential aged care setting with dementia. The aim of the currents study was to advance this work by delivering the Watermemories Swimming Club aquatic exercise program to a more representative population of older, institutionalized adults with dementia. Methods: The benefits of 12 weeks of twice weekly participation in the Watermemories Swimming Club aquatic exercise program were assessed among an exercise and usual care control group of residential aged care adults with advanced dementia. A battery of physical and psychosocial measures were collected before and after the intervention period, and program implementation was also investigated. Results: Seven residential aged care facilities of 24 approached, agreed to participate and 56 residents were purposefully allocated to exercise or control. Twenty-three participants per group were included in the final analysis. Both groups experienced decreases in skeletal muscle index and lean mass (p < 0.001), but exercise stifled losses in muscle strength and transition into sarcopenic. Behavioral and psychological symptoms of dementia and activities of daily living approached significance (p = 0.06) with positive trends observed across other psychosocial measures. Conclusions: This study demonstrates the value of exercise participation, and specifically aquatic exercise in comparison to usual care for older, institutionalized adults with advanced dementia. However, it also highlights a number of barriers to participation. To overcome these barriers and ensure opportunity to residents increased provider and sector support is required.
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Elderly individuals with dementia are vulnerable for a decline in physical functioning and basic activities of daily living (BADL) which can lead to a decline in autonomy and participation. This study reviews the effect of physical activity on physical functioning and BADL in elderly subjects with dementia. A systematic search of the literature was performed. Key words related to the elderly, dementia, exercise interventions and physical outcome measures were used. Sixteen studies were included. It was found that physical activity was beneficial in all stages of dementia. Multicomponent interventions (e.g. a combination of endurance, strength and balance) led to larger improvements in gait speed, functional mobility and balance, compared to progressive resistance training alone. BADL and endurance improved but were only assessed in multicomponent interventions. Lower-limb strength improved equally in multicomponent interventions and progressive resistance training. Multicomponent interventions can improve physical functioning and BADL in elderly subjects regardless of the stage of dementia. The best results were obtained in the interventions with the largest training volume. However, the small number of high-quality studies, and heterogeneity of the participants and interventions prevent us from drawing firm conclusions. Recommendations are given with respect to methodological issues, further research and practical guidelines.
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To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD). Randomized, controlled trial. Five nursing homes. One hundred thirty-four ambulatory patients with mild to severe AD. Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months. ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis. ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred. A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.
Article
AD is a public health epidemic, which seriously impacts cognition, mood and daily activities; however, one type of activity, exercise, has been shown to alter these states. Accordingly, we sought to investigate the relationship between exercise and mood, in early-stage AD patients (N=104) from California, over a 1-year period. Patients completed the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Blessed-Roth Dementia Rating Scale (BRDRS), while their caregivers completed the Yale Physical Activity Survey (YALE), Profile of Mood States (POMS), the Neuropsychiatric Inventory (NPI) and Functional Abilities Questionnaire (FAQ). Approximately half of the participants were female, from a variety of ethnic groups (Caucasian=69.8%; Latino/Hispanic Americans=20.1%). Our results demonstrated that the patients spent little time engaged in physical activity in general, their overall activity levels decreased over time, and this was paired with a change in global cognition (e.g., MMSE total score) and affect/mood (e.g., POMS score). Patients were parsed into Active and Sedentary groups based on their Yale profiles, with Active participants engaged in walking activities, weekly, over 1 year. Here, Sedentary patients had a significant decline in MMSE scores, while the Active patients had an attenuation in global cognitive decline. Importantly, among the Active AD patients, those individuals who engaged in walking for more than 2h/week had a significant improvement in MMSE scores. Structured clinical trials which seek to increase the amount of time AD patients were engaged in walking activities and evaluate the nature and scope of beneficial effects in the brain are warranted.
Article
Behavioral and psychological symptoms of dementia (BPSD) are common and are core symptoms of the condition. They cause considerable distress to the person with dementia and their carers and predict early institutionalization and death. Historically, these symptoms have been managed with anxiolytic and antipsychotic medication. Although potentially effective, such medication has been used too widely and is associated with serious adverse side-effects and increased mortality. Consequently, there is a need to evaluate non-pharmacological therapies for behavioral and psychological symptoms in this population. One such therapy is physical activity, which has widespread health benefits. The aim of this review is to summarize the current findings of the efficacy of physical activity on BPSD. Published articles were identified using electronic and manual searches. Rather than systematically aggregating data, this review adopted a rapid critical interpretive approach to synthesize the literature. Exercise appears to be beneficial in reducing some BPSD, especially depressed mood, agitation, and wandering, and may also improve night-time sleep. Evidence of the efficacy of exercise on improving other symptoms such as anxiety, apathy, and repetitive behaviors is currently weak or lacking. The beneficial effect of exercise type, its duration, and frequency is unclear although some studies suggest that walking for at least 30 minutes, several times a week, may enhance outcome. The methodological shortcomings of current work in this area are substantial. The research and clinical implications of current findings are discussed.
Article
Previous research suggests that water exercise improves the activities of daily living (ADL) ability of the frail elderly, but the specific frequency and intensity of such programs is unclear. This study aims at comparing the effects of once- and twice-weekly water exercise on the ADL ability of frail elderly receiving nursing care for 2 years. The design is a prospective randomized longitudinal study. Participants were assigned to two different exercise groups (Group 1 and Group 2). Group 1 participated in a 60-min exercise session once a week, for 2 years, while Group 2 attended the session twice a week. Exercise sessions were divided into a 10-min warm-up on land and 50 min of exercise in water. The 50-min water exercise program consisted of 20 min walking, 10 min ADL exercise, 10 min stretching and strength exercises, and 10 min relaxation in water. ADL ability and lower muscle strength were measured before the beginning of exercise and 6 months, 1 year, and 2 years after the program had started. Significant group differences occurred for bathing transfer and stair climbing at the 2-year measurement. These results suggested that at least twice-weekly water exercise was necessary to maintain the ADL ability and KEX of the frail elderly during the 1-year water exercise period and for one additional year afterward.
Article
Depression is common in Alzheimer's disease (AD; 5-35%). It is associated with increased disability, cost of care and carer burden. Exercise is known to be associated with a lower prevalence of depression across the age range but little is known about its relationship to depression in AD. To investigate exercise and putative risk factors for depression in a community based sample of people with AD representative of the range of cognitive impairment found in the population with dementia. Information was collected from 224 people with AD and their caregiver using standardised cognitive, psychological and behavioural instruments. Exercise levels were classified into three categories: absent, moderate, and vigorous, using the previous two weeks exercise levels to confirm regularity and recency. 9/51 (17.6%) depressed participants took exercise compared with 76/173 (43.9%) non-depressed [odds ratio (OR)=2.9, confidence interval (CI)=1.5-5.6, p=0.001]. Not taking part in other activities (hobbies and interests) was associated with depression but less so than lack of exercise. Independent predictors of depression were: lack of exercise (p <0.001, OR=3.4, CI = 1.7-7.2), taking cholinesterase inhibitors (p <0.05, OR=2.4, CI = 1.2-4.9) and having less involvement in hobbies or interests (p <0.05, OR = 1.2, CI = 1.0-1.5). None of the traditional risk factors for depression in older people were associated with depression in AD. Taking regular exercise may protect against depression in AD.
Splash party. Long-Term Living Magazine
  • J Brierley
The Watermemories Swimming Club: Program manual and DVD
  • C Neville
  • T Henwood
  • Neville C.