Strategies to engage older adults with behavioral and psychological symptoms of dementia in exercise: A multiple case study.

Alzheimer’s disease (AD) affects 5.2 million Americans in 2016 and this number will increase to 14.7 million by 2050. Unfortunately, AD cannot yet be prevented, slowed, or cured. Aerobic exercise is potentially therapeutic for Alzheimer’s disease (AD) as it favorably affects brain structure and function. A critical determinant in testing its effectiveness is optimal adherence to the exercise prescription. AD symptoms, particularly behavioral and psychological symptoms of dementia (BPSD), however, make exercise delivery and adherence challenging. The purpose of this paper is to discuss the strategies used for managing BPSD during exercise using a multiple case study design. Three cases with BPSD that met the eligibility criteria were selected from the FIT-AD Trial. The FIT-AD Trial is an ongoing randomized controlled trial that tests the effects of a 6-month moderate intensity aerobic exercise on cognition and hippocampal volume in community-dwelling persons with AD. The cases included: a 77-year-old woman with mild AD, a 79-year-old woman with mild AD, and a 69-year-old man with moderate AD. The participants exhibited anxiety, repetitive questioning, irritability, hostility, extreme distractedness, resistance to instruction, and hoarding during exercise. The symptoms were effectively addressed using person-centered strategies such as routine schedules, reassurance, timely communications, distraction, small rewards, rephrasing, immediate answers, selective withdrawal from conversations that were hostile, step by step instructions, building on rapport and relationship with staff, and affirmation. They achieved 83.3%–100% attendance and 52.8%–81.7% session adherence, respectively. In conclusion, individualized strategies for BPSD are necessary to ensure optimal exercise adherence.