Enrich Your Exercise Programs: Add a Cognitive Overlay
Published: 25 June 2017
Published: 25 June 2017
Every day she dresses the baby, feeds it, fails to notice that the baby does not swallow the food pooling on the floor, and gets angry if caregivers fail to acknowledge the baby’s existence.
It’s a delicate balance. Nobody knows what side to come down on - truth or profound despair?
Every practitioner who has ever worked with a patient suffering from neurocognitive decline has felt the urgent sense of uselessness. For a season, even physiotherapists gave up the ghost on the cost-effectiveness of skilled therapy (Sifferlin 2016) when working with patients with dementia. ‘What good am I doing?’ we would whisper. ‘She can’t remember a thing I just showed her.’
It’s true. It is challenging to work with patients with cognitive decline. But there isn’t a therapist on the planet who wouldn’t think it worthwhile if research showed such exercises made an actual, measurable, significant difference.
Well, guess what. They do (Tivadar 2017).
Regular aerobic training can improve aspects of cognitive function; in fact, adding exercise to a weekly regime both reduces the systems of dementia and slows its onset.
The raw truth is that cognitive abilities and physical exercise interact. Patients with exercise added to their rehabilitation program have been shown to have significant reductions in the behavioural and psychological symptoms of dementia (Fleiner et al. 2017).
In fact, by increasing physical activity a mere 10%, individuals are able to significantly reduce the risk of dementia and Alzheimer’s Disease (Tivadar 2017).
Aerobic training would seem to be a natural choice of exercise, but is it the right choice for patients with cognitive restrictions? Well, it depends.
Aerobic exercise, performed at a low intensity, has a beneficial effect on visual-spatial perception and attention. In contrast, a higher intensity physical activity (classified as moderate) seems to work its magic on working memory and attention and verbal memory and attention.
Just like adding any other new intervention, take care to make the transition period as calm as possible. Each patient is different, so it’s important to know their triggers and do your best to avoid them in their exercise routine (Yu et al. 2017).
Truly, professionals are in a bit of a quandary when prescribing physical activity to people with cognitive impairments (Tivadar 2017). Many experts believe higher intensities are necessary for positive results, while others opine that the higher the intensity, the less the patient can attend to the task at hand, resulting in problems with reduced reaction times, problems with selective attention and a reduction in flexibility.
It is no longer enough to decide what kind of exercise training should be performed. It is now necessary for clinicians to fully comprehend the power of training provided in an ‘enriched’ environment. Brains are wired to be mouldable. When neural pathways are blocked or damaged, the brain can create new pathways to get around these restrictions (Grosse 2013). Enriched environments take advantage of this phenomenon to combine cognitive and physical activities to create these new pathways.
So, what does an enriched environment for physical exercise for the patient with cognitive decline look like?
Ever considered breaking out your dancing shoes and swimming suit for rehab?
Researchers have found that adding an extra layer to physical exercises such as a pool or music can work wonders for cognitive function. In fact, patients who exercised with music were found to have more cognitive improvement than those that didn’t (Satoh et al. 2017).
It is also possible to layer physical exercise with the pool environment to deepen these neural connections. Aquatic exercise is in the news for its powerful dementia-reducing powers, improving the psychological wellbeing of patients (Henwood et al. 2017).
With these examples in mind, what does it look like to apply an enriched environment to your interventions with your patients?
While the actual exercise chosen is important, adding a cognitive layer is crucial. It is possible to use tools already at your disposal in an exercise intervention to deepen those neural pathways you are helping to build. Here are some of the best tips pulled from Brain Gym (Grosse 2013):
For those living with dementia, fundamental daily tasks become overwhelming. These patients struggle with things which were once taken for granted. Memory, attention to tasks, planning and decision-making skills have deteriorated over time, stealing quality of life from patients in small dribs and drabs.
However, you are not powerless. Add a cognitive element to your physical treatment and enjoy the enhanced benefits of your efforts.
Andrea Salzman, MS, PT graduated from the University of Alabama at Birmingham with a Master’s degree in physical therapy in 1992. Over the last two decades, she has held numerous prominent leadership roles in the physical therapy field, with a heavy emphasis on academic writing and administrative functions. Between 1995 and 1998, Salzman served as the Editor-in-Chief of an American Physical Therapy Association (APTA) journal. In 2010, Salzman received one of the highest honors given to a physical therapist from the American Physical Therapy Association, the Judy Cirullo Leadership Award. Between 2012 and the present, Salzman has written 12 physical therapy courses for Care2Learn, Relias Learning and reviewed over 100 other course offerings. Currently, Salzman continues in her writing, leadership and administrative roles at Aquatic Therapy University and 10K Health. See Educator Profile