Vision

To ensure that people living with dementia are supported to include purposeful and meaningful physical activity in their lives

Aims and Learning Outcomes

This course is designed to provide physical activity and exercise instructors, teachers and instructors with both theoretical perspectives and practical applications to increase access and participation for people living with dementia.
The course aims to provide the participant with:

  • An understanding of the dementia journey and the potential of physical activity experiences for people living with dementia
  • Information on the impact of physical activity and exercise participation on the dementia journey
  • The opportunity to develop skills required to adapt programmes for people living with dementia and their care–givers
  • The opportunity to reflect upon their current practice, take action and seek further information.

On completion of the course participants will be able to:

  • Describe the dementia journey and the potential of physical activity and exercise
  • Identify how participation in programmes can be affected by dementia and increased by adaptations to leadership strategies
  • Demonstrate how to adapt leadership strategies to enhance access to programmes
  • Identify, though reflection, the next steps required for further leadership development
  • Know where to access additional information and support.

Content

The course comprises a mixture of theory and practical activities and is designed to cover the following content:

Session 1 – Understanding people living with dementia and physical activity

  • Reflective task – living with dementia, physical activity and the journey
  • Priorities for people living with dementia – the evidence
  • Can physical activity make a difference for people living with dementia?

Session 2 – Programme planning – principles

  • Person centred planning – the dementia journey and case studies
  • Problem solving – communication skills and activities
  • The person and the environment

Session 3 – Communication and leadership skills

  • Problem solving (cont.)
  • Key programme components – aerobic activity, strength and balance
  • Motivation and the role of the informal carer

Session 4 – Additional leadership skills and activities

  • Key programme components (cont.)
  • Walking – guidance
  • Evaluation strategies

Next steps for participants, resources and further information, reflection on practice and action planning.

A Dementia: 1st Steps course flyer can be downloaded here.

Duration

1st Steps comprises a one-day course programme beginning at 9.30 a.m. and finishes at 4.30 pm with a maximum of 25 participants. Participants are expected to undertake pre-course tasks which are emailed out prior to the course date and also a professional reflective task.

Resources

All participants are provided with a course support pack which includes sources of additional materials and a comprehensive reading list. Participants are also directed towards additional areas of learning to improve their skills and experience in working with people living with dementia.

Certification

Successful learners will receive a Later Life Training Qualification Certificate. The Certificate states that the learner has been awarded 6 REPs CPD points.

Introduction

Around 800,000 people in the UK have dementia and the cost to the economy is estimated to be c. £23 billion per annum. By 2040, the number of people affected is expected to double with associated costs likely to treble.

In March 2012, the Government launched the Dementia Challenge – a programme of work designed to make a real difference to the lives of people with dementia and their families and carers. The challenge builds on the progress made in the National Dementia Strategy (2009) and focuses on three main areas for action, driving improvements in: Health and care, creating dementia friendly communities and improving dementia research. More details of the challenge can be here.

Dementia is not a natural or normal part of ageing, although it primarily affects people in old age. Each persons’ experience (or journey) is subjective and unique. However, over the last 10 years, a growing body of evidence is emerging that indicates that there is a clear rationale for the inclusion of people living with dementia in physical activity and exercise programmes.

Healthcare providers who work with people with dementia and their caregivers should feel confident in promoting exercise among this population, as decreasing the progression of cognitive decline and dependence in ADLs will have significant benefits for people with dementia and their family caregivers’ quality of life, and possibly delay the need for placement in long-term care settings”.
(Cochrane Collaboration Review 2013)

To support Dementia Awareness Week (2017) LLT ‘had a conversation’ with local Alzheimer Society Service User Review Panels (SURPs) in England. Bob Laventure had a series of informal conversations with people living with dementia about taking part in physical activity. They talked about their views, interests and experiences and the challenges they face in taking up and/or continuing a range of physical activities during their dementia journey.In particular they were asked what would support them in being more active.


You can download a brief report on our conversations with people living with dementia here.

 

 

 

Key References

A summary of the most recent evidence on the effectiveness of exercise programmes for people living with dementia.

Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. (2013) Exercise programs for people with dementia. Cochrane Collaboration Review

Guidance on Risk Enablement for professionals working with people living with dementia

Department of Health (2010) ‘Nothing Ventured, Nothing Gained’: Risk Guidance for
people with dementia

A summary of the Dementia Care Pathway – NICE Dementia Pathway (2013)

A journal article providing an overview of how exercise instructors and teachers can plan for person centred programing.
Laventure, R.M.E. & Aherne, C (2010) Living Well with dementia: guidance for exercise instructors and wellness leaders. Journal on Active Ageing, ICAA

Original Development Team

Contributors to the course development included:

  • Simon Hanna (Cambridge PCT)
  • Edye Hoffmann (Dementia Compass)
  • Bob Laventure
  • Prof Dawn Skelton
  • Bex Townley

And professionals from Cambridge, Kirklees and Wigan who took part in the pilot programmes.

This training has been endorsed by REPS and PD:Approval (now managing all endorsements previously of Skills Active)  and receives 6 CPD points as there is no assessment.

Research on the effectiveness of physical activity and exercise participation for people living with dementia is still relatively limited compared with other populations. This may be because

  • Little attention has been given to this topic in the past
  • People living with dementia are often excluded from research trials
  • Recruitment and adherence to programmes is challenging
  • Programme design is often criticised as being poor

The following provides a summary of evidence from:

  • The Cochrane Collaboration Review
  • Other systematic reviews and selected Randomised Control Trials (RCTs)
  • Other guidelines

Evidence to support the role of exercise and physical activity for the care of people living with dementia
Since the Cochrane Collaboration conducted its original review in 2008, many more systematic reviews and RCTs of exercise for people living with dementia have been published. The 2013 update is now timely and determines what we currently know about the effects of exercise programs on key outcomes as well as on burden, health, quality of life and mortality for family caregivers, and cost of healthcare services.
The Cochrane review set out to establish if exercise programs for older people with dementia improve cognition, Activities of Daily Living (ADLs), challenging behaviour, depression, and mortality in older people with dementia.

The secondary objectives were to establish if exercise programs for older people with dementia have an indirect impact on family caregivers’ burden, quality of life, and mortality and if exercise programs for older people with dementia reduce the use of healthcare services (e.g. visits to the emergency department) by participants and their family caregivers.

Summary of main results
The review included 16 trials with a total of 937 participants. Most participants were older people with Alzheimer’s Disease (AD). The exercise programs varied greatly; the length of time that they ran ranged from two weeks to 12 months, and activities varied (e.g. hand movements, sitting, walking, and upper and lower limb exercises).
This review found no significant effect of exercise on challenging behaviours or depression.
A slowing of both cognitive decline and the development of dependence in ADLs is critical for enhancing the quality of life for people with dementia, and will have an impact on the family caregivers’ ability to sustain their caregiving role.
Key statements from the Cochrane review
The review suggests that exercise programs may have a significant impact on improving cognitive functioning and the ability to perform ADLs in people with dementia. In addition, the findings reveal that the burden experienced by informal caregivers providing care in the home may be reduced if they supervise their family member with dementia during participation in an exercise programme.
Key learning point
The largest improvements were found after interventions of 12 weeks or more, and a frequency of participation rate of 3 times a week with a 45-60 minute session. This represents a significant challenge

Recent systematic reviews of evidence
Blankevoort CG, et al (2010) assessed the effects of exercise on physical function and activities of daily living in older people with dementia, 10 Randomised Controlled Trials with a total of 492 participants.
Littbrand H, et al (2011) assessed the effects of exercise on physical function, cognitive function and ADLs in people with dementia. This review included only Randomised Controlled Trials and included a total of 10 studies with 622 participants.
Martinez J.T. (2014) – a summary of 20 studies to improve cognition, neuropsychiatric symptoms and physical function in people with Mild Cognitive Impairment (MCI), dementia and AD. involving over 1,400 participants.
The main conclusions from these reviews were that there are positive effects of exercise programmes on physical function, eg:

  • Multi-component exercise interventions (i.e. strength, endurance and flexibility training) tended to have more and larger positive effects than walking or progressive resistance training interventions
  • The largest improvements were found after interventions of 12 weeks or more, and a frequency of 3 times a week with a 45-60 minute session
  • Functional weight-bearing exercise seems applicable for use in clients with Alzheimer’s Disease in residential care
  • There is some evidence that exercise improves mobility and other physical function measures, and reduces decline in the ability to perform ADLs
  • There is also some evidence that individually performed walking exercise reduces decline in walking performance.

Safety
It is valuable to note that no trials have reported adverse events related to exercise programs with people living with dementia.
What we (still) don’t know
In spite of these advances, finding robust evidence that demonstrates further effect remains challenging and whilst a growing number of individual studies have demonstrated some and promising effects, more research is required and in particular in the following areas:

  • Behaviours that challenge
  • Falls prevention
  • Depression and anxiety
  • Working with people living in residential settings.

What type of exercise and physical activity for people living with dementia?
Evidence from the variety of studies currently available indicates the largest improvements are found after interventions of 12 weeks or more, and a frequency of 3 times a week with a 45-60 minute session.
Other research has revealed that aerobic-type exercise has a clear benefit over strength training, and moderate intensity exercise of at least one hour a day, three to five times or more a week may be more effective in improving cognition.

Further research is necessary to identify the optimal exercise modalities particularly in terms of frequency, intensity, and duration for people with different types and severity of dementia and to identify barriers and facilitators to improving adherence.

“Attempting to match the exercise programs with the needs, capabilities, and preferences of people with dementia, and ensuring adequate funding to provide regular, appropriate programmes, over extended periods, by qualified instructors may increase adherence.” (Cochrane 2013)

There is no formal assessment on this course, but participants are given the opportunity for personal and professional reflection on their current practice and identify how the course content can enhance their future work as individuals or as a member of a team or service through an individual action plan.

The one day course cost is £110 plus VAT per applicant and includes the Course Manuals and resources.

We currently have the following dates available to book onto: check dates here

Please download and complete the application form and send to the LLT Office.
We ask that you first ensure you have read the eligibility guidelines and statement about Medical Conditions and Learning Support Requirements and our Terms & Conditions.

Medical Conditions and Learning Support Requirements

We encourage everyone to be responsible for their own learning. In light of this, we ask that you please inform us, at point of application, about any learning support requirements and/or medical conditions support that will help you to access our course content and learn effectively. All information will be treated confidentially and we will make reasonable adjustments to meet your needs.

Hosting a course

If you want to host a bespoke course (£1,200 + VAT) in your area, please contact the LLT Office.

The Dementia 1st Steps course is accredited on REPS as CPD (Continuing Professional Development). Therefore as a standalone qualification it does not give entry onto REPS. For many people that attend the Dementia:1st Steps course (eg. technical assistants and physiotherapists) they do not need to be on REPS as they are registered with either the CSP or the Health and Care Professions Council. If you wish to gain entry to REPS, you must first complete a course which gains entry onto REPS. LLT do not deliver any courses which gain entry onto REPS, only CPD for those already on REPS, or L4 courses for those who have the pre-requisite entry qualifications for REPS.

You can of course attend any of LLTs other CPD courses next 🙂

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