Barriers and facilitators to adherence to walking group exercise in older people living with dementia in the community: a systematic review

Abstract

Summary Background & Aims Evidence suggests that targeted exercise is important for people living with dementia. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to walking group exercise of older people living with dementia in the community. Methods We have searched appropriate electronic databases between January 1990 until September 2019, in any language. Additionally, we searched trial registries (clinicaltrial.gov and WHO ICTRP) for ongoing studies. We included all study designs. Studies were excluded when participants were either healthy older people or people suffering from dementia but living in residential care. Narrative synthesis was used. Findings 10 papers met the inclusion criteria. The narrative analysis focused on barriers, facilitators, and adherence. All studies reported on barriers and facilitators. Barriers included: bio-medical reasons (including mental wellbeing and physical ability); relationship dynamics; and socio-economic reasons and environmental issues. Facilitators included: bio-medical benefits & benefits related to physical ability; staff, group relationship dynamics and social aspect of walking group; environmental issues and individual tailoring; and participants perceptions about the walks & the program. Most studies did not provide data about adherence or attendance; where reported, adherence ranged from 47 to 89%. Conclusions This systematic review of literature has highlighted known barriers and facilitators to adherence to walking groups type of exercise for people living with dementia in community. Carers’ willingness to engage, their circumstances, perspectives and previous experiences of exercise seem to play a key role in facilitating adherence but there is little research that explores these. Also, the design, location and organisation of walking groups facilitate adherence. This reflects the need for such activities to be part of a wider ‘program of care’, tailored to the needs of the individual, flexible and convenient. Knowledgeable and well-trained instructors or healthcare professionals are recommended as group exercise leaders.

Contributing Factors for (Non)Adherence to a Physical Exercise Program for People With Neurocognitive Disorder From the Caregivers’ Perspective

“…14 Evidence suggests that having a knowledgeable, understanding, and friendly exercise provider is as important as having a technically skilled professional. 21,40,41 In addition, according to our study results, caregivers were interested in this intervention because they believed in the potential benefits to their care recipients' physical and mental health. In fact, along with care recipients' participation, the observed positive effects of exercise on maintenance and/or mitigation of cognitive and functional capacities were identified by caregivers as factors that facilitated the continuity of care recipients in the program.…”

“…In this sense, the professionals who led exercise sessions had a major influence on facilitating a socially favorable atmosphere,16,39 probably as a result of the specific training that they received concerning NCD clinical features and progression, communication strategies, challenging behaviors, and safety issues 14. Evidence suggests that having a knowledgeable, understanding, and friendly exercise provider is as much important as having a technically skilled professional 21,40,41…”

Factors Affecting Physical Activity in People with Dementia: A Systematic Review and Narrative Synthesis

“…Van Alphen et al [40] evaluated and summarized primarily opinion-based barriers, facilitators and motivators. Another review by Vseteckova et al [41] used both opinion-based and empirical methods to examine barriers and facilitators, but limited itself to adherence to walking group exercise. To our knowledge, no previous review has evaluated the barriers, facilitators and motivators affecting PA using empirical data from actual implementations.…”

The dementia-inclusive choices in exercise project: Using participatory action research to improve physical activity supports for persons with dementia

“…Physical activity is an opportunity for persons with dementia to maintain and strengthen their personal identity and be connected to their community (Cedervall et al, 2015; Dupuis et al, 2019; Kielsgaard et al, 2021; Malthouse & Fox, 2014; Roland & Chappell, 2015; van Alphen et al, 2016). Physical activity programs also support the development and maintenance of relationships and are an opportunity to be encouraged and supported by others (Bechard et al, 2020; Cedervall & Aberg, 2010; Cedervall et al, 2015; Genoe & Dupuis, 2014; Hobson et al, 2020; McDuff & Phinney, 2015; Phinney et al, 2016; Vseteckova et al, 2020; Wright, 2018). Physical activity participation, along with other leisure, can bring joy to persons with dementia (Dupuis & Alzheimer, 2008; Dupuis et al, 2012a; Genoe & Dupuis, 2011, 2014; Malthouse & Fox, 2014; Phinney et al, 2007, 2016; Wiersma & Denton, 2016).…”