Physiotherapy for dementia · home visits across Hong Kong
Physiotherapy for dementia,
keeping up physical function
As an older adult's memory slowly declines, physical function is often lost without anyone noticing, with poorer balance, weaker muscles and a risk of falling that doubles. Families should know that exercise may not reverse the decline in cognitive function, but it can help to maintain physical mobility, improve balance and reduce falls, so that the patient can live at home more safely and with more dignity.
- Registered physiotherapists in Hong Kong
- Home visits across Hong Kong
- 1 hour $1,000 · 1.5 hours $1,300
- Exercise training, fall prevention and maintaining physical function
Research evidence on exercise, cognitive function and physical function
Common misunderstandings about exercise in dementia
Many families hope that more exercise will make an older adult's memory better. On this point it needs to be stated clearly that the scientific evidence that exercise improves cognitive functionis rather weak, and most large studies found no clear benefit. The evidence that exercise improves physical function, prevents falls and eases low mood, however, is very firm. Separating these two points is what lets us help the patient and family in a real way.
- Thinking that more exercise will improve memoryLarge randomised controlled trials such as DAPA (494 people) showed that exercise does not slow cognitive decline
- Thinking that since exercise cannot improve memory, it is no useExercise really does work for maintaining physical function, preventing falls and steadying mood, and these are the most worthwhile aims of rehabilitation
- Thinking that fall prevention exercises for healthy older adults can be copied directlyOrdinary fall prevention programmes may not suit people with dementia. If the exercise intensity is too low and nobody supervises, the risk of falling may even rise
- Maintaining self-care in daily life (ADL)A Cochrane review showed that exercise clearly improves patients' self-care in daily life (ADL) (SMD 0.68)
- Fall prevention training aimed at dementiaCommunity research shows that targeted exercise intervention can lower the risk of falling by about 32% (Burton 2015)
- Helps mood, sleep and wanderingExercise as a non-drug intervention helps to ease agitation and improve sleep at night
The same Cochrane review points out that no clear benefit of exercise for cognitive function has been found(the certainty of the evidence is rated very low). The largest trial, DAPA, further showed that moderate to high intensity exercise did not slow cognitive decline, and the cognitive scores of the exercise group were even slightly lower than those of the usual care group(Lamb 2018). The aim of physiotherapy is therefore to maintain the patient's physical function and quality of life, and not to reverse cognitive decline.
Our training methods and priorities
Main areas of intervention in exercise for dementia
Our training has four priorities, all designed around the real needs of people with dementia. What the patient needs is more than moving about at random. It is exercise that is aimed at preventing falls and maintaining daily function, and that knows how to guide the patient to take part.
Setting the aim: maintaining physical function, and not improving memory
We do not exaggerate by claiming that exercise can cure memory decline. We put the aim of training where the scientific evidence is strongest, which is maintaining the patient's walking, balance and self-care in daily life, so that the patient can live at home more safely and with more dignity.
Fall prevention training suited to the features of dementia
The risk of falling in people with dementia is several times that of other older adults. Besides poorer balance, weaker judgement and great difficulty with walking while thinking about something else (dual task) are the key reasons for falls. Fall prevention training must therefore be designed around these problems and cannot simply copy the fall prevention exercises used for healthy older adults.
Varied combined exercise
Combining aerobic exercise, strength training, balance practice and dual-task training improves walking speed and mobility more clearly than doing any one alone. Training is kept simple, safe and enjoyable, and adjusted flexibly to the patient's mental and physical state that day.
Knowing how to guide the patient to take part, so that training has a real effect
For people with dementia, how the patient is guided to do an exercise often matters more than which exercise it is. We give only one simple instruction at a time, demonstrate while speaking, set up a fixed daily routine, and allow the patient to be imperfect. Whether home exercise works depends on a professional supervising and adjusting step by step.
Why therapy at home
Home training settings for dementia rehabilitation
For a person with dementia, the surroundings are themselves part of the treatment. An unfamiliar clinic easily brings confusion and resistance, and when the familiar daily routine is disturbed, performance often gets worse. Training at home in familiar surroundings, on the other hand, makes the patient far more willing to take part. The traps at home that really cause falls can also only be found and fixed on the spot through home physiotherapy.
Training map of the home HOME SETTINGS
Clinical evidence
The research on exercise in dementia
Randomised controlled trial data EVIDENCE
What exercise training can clearly improve is physical function and fewer falls, and it does not improve cognitive ability or memory. Stating this plainly lets families put their limited time and energy where it can really help.
If an older adult at home is walking more slowly or falls easily, tell us about the situation and a physiotherapist will answer your questions directly.
WhatsApp for a free enquiry and home assessmentFrom the basics to the detail
Physiotherapy for dementia: further reading
To learn how much exercise really helps cognition, how to prevent falls, what training suits each stage, or how a carer can encourage the patient to exercise, see the related topics below.
Related topics across professions 03
Occupational therapy for cognitive impairmentCognitive training, memory and executive function practice, and training in self-care at homeGeneral exercise and fall preventionExercise arrangements and balance training for older adults in generalPhysiotherapy for sarcopeniaDealing with muscle loss, which often accompanies dementiaFAQ · exercise and results
Physiotherapy for dementia: frequently asked questions
Does exercise really improve memory in people with dementia?
The evidence is mixed, and this needs to be stated clearly. The most authoritative Cochrane review (17 trials, 1,067 people) found no clear benefit of exercise for cognitive function. The largest single randomised controlled trial to date, DAPA (494 people), showed that moderate to high intensity exercise did not slow cognitive decline, and cognitive scores were even slightly worse than in the usual care group. Some pooled analyses (Groot, 18 RCTs) found a small positive effect of aerobic exercise on cognition (SMD 0.42). Exercise may therefore help cognition, but this is uncertain and is no guarantee. The most definite and worthwhile benefits of exercise are in maintaining physical function, balance and self-care in daily life, and it does not reverse cognitive decline.
What is the biggest benefit of exercise for people with dementia?
The benefits at the physical level, which have the firmest evidence: preventing falls (one community study showed the risk of falling can fall by about 32%), keeping up self-care in daily life (ADL), and improving balance and strength. Exercise may also help mood and sleep and reduce apathy and agitation. These are the core aims of physiotherapy exercise intervention.
What kind of exercise should people with dementia do?
A varied combination of exercise (aerobic + strength + balance) is recommended. Research shows that combined exercise improves walking speed, mobility and balance more clearly than resistance training alone. Aerobic exercise has the most prominent potential benefit for cognition, so it is included in moderation. The exercise itself should be simple, safe and enjoyable, and matched to the patient's ability. Dual-task training (such as counting while walking) can be added to train the body and attention together.
How can safety be ensured when people with dementia exercise?
Balance training must be supervised by someone at the patient's side. At home, remove rugs and clutter, make sure the lighting is good, install grab rails in the bathroom and wear non-slip shoes. Instructions should be short and clear, spoken while demonstrating, with more encouragement than criticism. A home-visit physiotherapist can assess the real fall risks in the patient's familiar home and train the carer in correct ways of helping and supporting the patient. This is an advantage that a clinic setting can hardly replace.
How much exercise is enough for people with dementia?
General adult guidelines recommend about 150 minutes of moderate-intensity activity a week, which can be divided into shorter bouts. Note, however, that this is the World Health Organization's overall activity recommendation for adults in general and is not an evidence-based treatment dose for dementia. A more practical principle for patients is that even a short period of light exercise is better than none at all. The point is to be continuing, regular and safe, and to adjust to the patient's condition that day.
If you have questions along the way as a carer, you are welcome to message us at any time.
WhatsApp for a free enquiry and home assessment1 hour $1,000 · 1.5 hours $1,300 · no minimum spend · Prices for all services
Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.
References
- Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J., & Forbes, S. (2015). Exercise programs for people with dementia. Cochrane Database of Systematic Reviews, (4), CD006489. PubMed
- Blankevoort, C. G., van Heuvelen, M. J. G., Boersma, F., Luning, H., de Jong, J., & Scherder, E. J. A. (2010). Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dementia and Geriatric Cognitive Disorders, 30(5), 392–402. PubMed
- Burton, E., Cavalheri, V., Adams, R., Oakley Browne, C., Bovery-Spencer, P., Fenton, A. M., Campbell, B. W., & Hill, K. D. (2015). Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis. Clinical Interventions in Aging, 10, 421–434. PubMed
- Groot, C., Hooghiemstra, A. M., Raijmakers, P. G. H. M., van Berckel, B. N. M., Scheltens, P., Scherder, E. J. A., van der Flier, W. M., & Ossenkoppele, R. (2016). The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Research Reviews, 25, 13–23. PubMed
- Lamb, S. E., Sheehan, B., Atherton, N., Nichols, V., Collins, H., Mistry, D., Dosanjh, S., Slowther, A. M., Khan, I., Petrou, S., & Lall, R. (2018). Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial. BMJ, 361, k1675. PubMed
- Telenius, E. W., Engedal, K., & Bergland, A. (2015). Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: an assessor blinded randomized controlled trial. PLoS One, 10(5), e0126102. PubMed