When cognition is impaired, often called cognitive impairment, an individual has trouble with intellectual abilities such as learning new things or remembering. This process can have a major impact on health as it begins to affect everyday life. People of all ages may experience cognitive impairment, which can range from mild to severe.
Subjective cognitive decline (SCD) is the self-perceived worsening or more frequent loss of memory, confusion or other cognitive problems (AA, 2019). Subjective cognitive decline is self-reported, independent of cognitive testing, clinical diagnosis or anyone else noticing the individual’s mental decline (Gaugler et al., 2019).
Mild cognitive impairment, or MCI, is a condition in which an older adult may have some minor changes in the ability to think clearly and remember things such as appointments or conversations from the past. With this condition, memory lapses are severe enough to be noticed by others and are identified during cognitive tests, but do not affect daily life (AA, 2019; Blondell et al., 2014; Daviglus et al., 2010). People living with MCI are at an increased risk of developing dementia. However, in some cases, MCI may be caused by other factors, such as medication side-effects, and the condition may be reversed.
Dementia is a decline in cognition severe enough to interfere with daily living and independent functioning. Dementia is not a specific disease, but rather, it’s an overall term that describes a wide range of symptoms associated with a decline in memory and other intellectual domains such as learning, comprehension or judgment (AA, 2019). Individuals with more severe cognitive impairment usually have difficulty expressing themselves and understanding others. They may be unable to complete tasks such as preparing meals, managing finances or managing their medications. Eventually, individuals may become unable to care for themselves.
Exercise benefits:
- Promotes the release of neurotransmitters and hormones known to promote the growth of new brain cells and synapses (e.g., neuroplasticity)
- Prevents or reduces the risk of many health problems that seem to come with older age, which include some of the chronic conditions and diseases associated with declines in brain health (e.g., cardiovascular conditions – stroke, heart disease)
- Reduces the risk of falls by improving strength and balance
Consistent physical activity and regular exercise can help individuals maintain the ability to perform activities of daily living (ADLs) such as, the ability to get dressed, clean and cook. “With regard to cognition, exercise training appears to play a stronger role in delaying the onset of dementia symptoms than it does in slowing or reversing cognitive decline after dementia is established (Moore, G., Durstine, J. L., Painter, P., 2016).”
Exercise guidelines:
- Symptoms of cognitive impairment may be less in the earlier part of the day so attending morning classes may be beneficial.
- For individuals with dementia, an exercise program should consider the person’s abilities and needs.
- Establishing a regular routine is important in the early stages of dementia.
- Exercise should be enjoyable and easily accomplished.
- Simple exercises with a high degree of repetition and familiarity may attract more participation than more complex routines. A structured routine is important and so is the social engagement that comes with participating in exercise classes.
- Drills that target range of motion, leg strength and balance are important to maintain ambulatory abilities.
- As dementia progresses, memory loss and the risk of wandering may require constant supervision.
SilverSneakers class recommendations:
- Classic and Circuit, if tolerated, will help increase balance, muscular strength and joint mobility as well as provide open-skilled exercises. In addition, Circuit will provide some cardiovascular exercise to improve stamina and endurance.
- SilverSneakers Yoga, SilverSneakers Stability® and EnerChi can aid in improving balance and reduce the risk of falls.
- Classes such as EnerChi incorporate exercises where the limbs cross the midline of the body which improves coordination.
Instructor tips for participants with cognitive impairment:
- Speak clearly. Give direct, concise verbal cues, and provide visual cues as well.
- Provide progressions and regressions for each move as needed, based on the class participants’ ability levels. Layer in progressions slowly and as needed. Provide plenty of time to rehearse a new exercise, movement or skill.
- Teach participants movement patterns in a way that encourages learning. Break movements down into their simplest form, then allow for additional progressions to test memory and improve neuromuscular functions.
- Music can serve as a great tool for engaging individuals with cognitive impairment. Utilizing music from the participants’ younger years can produce positive nostalgic feelings that improve mood and well-being.
- Social engagement is important. Engage with the participant through eye contact, facial expressions and introduce the participant to other class members.
- Encourage a family member, or friend, to attend class with the participant.
- Teach exercises to improve coordination. Complex exercises, as well as movements that cross the midline of the body, improve neurophysiological fitness.