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Borges-Machado F, Barros D, Silva P, Marques P, Carvalho J, Ribeiro O. Contributing Factors for (Non)Adherence to a Physical Exercise Program for People With Neurocognitive Disorder From the Caregivers' Perspective. J Geriatr Phys Ther 2024; 47:58-66. [PMID: 36854067 DOI: 10.1519/jpt.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND AND PURPOSE To explore the perception of informal caregivers about the barriers, motivators, and facilitators toward the participation of care recipients with neurocognitive disorder (NCD) in a physical exercise program. METHODS This is an exploratory qualitative study, including 20 informal caregivers (67.5 ± 13.94 years old; age range: 37-86; 65% male) from the "Body & Brain" community intervention project. Semistructured interviews were performed by a trained researcher; data analysis followed Braun and Clarke's thematic analysis guidelines, under the socioecological framework. RESULTS Two main barriers, 3 motivators, and 5 facilitators to participation in a physical exercise program were perceived by caregivers, illustrating the relationship between the intrapersonal, interpersonal, and community levels toward individuals' participation. Care recipients' reluctance to participate and physical environment constraints emerged as the main barriers to participation, whereas the health professionals' advice, the need for a stimulating activity, and the potential physical and mental health benefits emerged as motivators. Factors facilitating the involvement and maintenance in the program included care recipients' satisfaction and enjoyment, benefits on their general health, routine, and social connectedness; an overall positive evaluation of the physical exercise program's structure and organization was also highlighted. CONCLUSIONS Exercise interventions targeting people with NCD should promote a welcoming environment that facilitates individuals' well-being and social interaction. Caregivers have a key role in promoting care recipients' motivation. Health professionals play an important role in recommending participation by raising awareness of potential benefits to recipients and caregivers. Future interventions should be conducted in appropriate community settings and implemented by a specialized professional in small groups. These findings provide insights into the factors that may increase the success rate of exercise interventions specifically designed for individuals with NCD.
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Affiliation(s)
- Flávia Borges-Machado
- CIAFEL-Research Centre in Physical Activity, Health and Leisure, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Duarte Barros
- CIAFEL-Research Centre in Physical Activity, Health and Leisure, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Paula Silva
- CIAFEL-Research Centre in Physical Activity, Health and Leisure, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Pedro Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Joana Carvalho
- CIAFEL-Research Centre in Physical Activity, Health and Leisure, Porto, Portugal
- Faculty of Sports, University of Porto, Porto, Portugal
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Oscar Ribeiro
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
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Feenstra RW, de Bruin LJE, van Heuvelen MJG. Factors Affecting Physical Activity in People with Dementia: A Systematic Review and Narrative Synthesis. Behav Sci (Basel) 2023; 13:913. [PMID: 37998660 PMCID: PMC10669736 DOI: 10.3390/bs13110913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/27/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023] Open
Abstract
Physical activity (PA) has positive effects on the physical and cognitive functioning of people with dementia. Knowledge about what limits and stimulates people with dementia to participate in PA is essential to promote effective PA implementation and enhance PA levels. Previous reviews primarily included opinion-based studies, using data from interviews, focus groups or dyads. By including implementation studies, we aimed to elaborate on previous reviews by identifying new barriers to PA and new facilitators and motivators for PA. We conducted systematic searches in Pubmed, PsychInfo and Web of Science for studies published up to the 21st of September 2021. Search terms were related to the population of people with dementia, PA interventions and implementation outcomes. Studies were included if PA participation was investigated during actual PA implementation. No restrictions were made regarding study design, date of publication, PA type or outcome measures. Studies not implementing PA or not evaluating the implementation were excluded. Based on 13 empirical studies, we identified 35 barriers, 19 facilitators and 12 motivators. Of these, 21 barriers, 11 facilitators and 4 motivators were not identified by previous reviews. New factors are related to the support for people with dementia from informal and formal caregivers, e.g., revealing the importance of a trusting relationship. Furthermore, support for staff from the institution or an external party is needed to overcome doubts about PA, for example, related to safety and effects. New factors also suggested specific recommendations for the content and organization of the PA intervention, for instance, related to how to give instructions. Overall, factors affecting PA identified with opinion-based or implementation studies are complementary. Our extended overview shows the complexity of PA implementation and may help to personalize PA, develop implementation strategies, facilitate actual PA implementation and free up resources needed for effective implementation.
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Affiliation(s)
| | | | - Marieke J. G. van Heuvelen
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands
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Lawler K, Taylor NF, Shields N. Let families decide: Barriers and enablers to participation in family-assisted therapy for older people in transition care. Australas J Ageing 2023; 42:499-507. [PMID: 36527306 DOI: 10.1111/ajag.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/19/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To understand the barriers and enablers to participation in family-assisted therapy for older people in Transition Care. METHODS A qualitative study, underpinned by interpretive description, was conducted at two public health services in Melbourne, Australia. Participants included patients in Transition Care, or their family members, who either participated in or chose not to participate in a family-assisted therapy trial. Semi-structured interviews were conducted, transcribed verbatim and analysed thematically. RESULTS Forty-four participants were interviewed (17 patients and 27 family members). The unifying theme was to let families decide about participation in family-assisted therapy. The unifying theme was illustrated by three subthemes. The first, what is possible for the family now, described practical considerations including geography, paid and unpaid work structure and commitments and the presence of fit and willing social networks. The second, what is important to the family now, recognised the role of family priorities in deciding. Physical rehabilitation and extra therapy were of high importance to some families. For others, emotional support or searching for a residential aged care bed were more important at the time. Finally, how the family functions described the complexity of relationships and family history that impacted the decision to participate. CONCLUSIONS The decision to participate in family-assisted therapy is complex and is best made by patients and their families. Clinicians offering family-assisted therapy are encouraged to avoid assuming what will or will not work for families and instead, to let families decide.
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Affiliation(s)
- Katherine Lawler
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Divecha AA, Bialek A, Kumar DS, Garn RM, Currie LEJ, Campos T, Friel KM. Effects of a 12-week, seated, virtual, home-based tele-exercise programme compared with a prerecorded video-based exercise programme in people with chronic neurological impairments: protocol for a randomised controlled trial. BMJ Open 2023; 13:e065032. [PMID: 36693691 PMCID: PMC9884574 DOI: 10.1136/bmjopen-2022-065032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Exercise is vital to staying well and preventing secondary complications in people with chronic neurological impairments (CNI). Appropriate exercise is often inaccessible to this population. The purpose of the study is to investigate the effects of a seated, virtual exercise programme on heart rate, recovery, fatigue, pain, motivation, enjoyment and quality of life in people with CNI. METHODS AND ANALYSIS Individuals with CNI will be screened for eligibility, and 60 participants will be randomised 1:1 into either a live or prerecorded group. There is no geographical limitation to where participants reside, since participation is virtual. The study will be coordinated by one site in White Plains, New York, USA. The live group will exercise with an instructor via Zoom while the prerecorded group will exercise at their chosen time using prerecorded videos, 3×/week for 12 weeks. PRIMARY OUTCOME MEASURES change in heart rate during exercise/recovery. SECONDARY OUTCOME MEASURES fatigue, motivation, level of pain and exertion, physical well-being, enjoyment of physical activity, motivation and quality of life. Outcomes will be assessed at baseline, midpoint, end of study and 1-month poststudy. Adverse events, medication changes and physical activity will be tracked throughout. Within-group and between-group comparisons will be performed by using analysis of covariance and regression. ETHICS AND DISSEMINATION BRANY IRB approval: 22 September 2020, protocol #20-08-388-512. All participants will provide written informed consent. Results will be disseminated through presentations, publications and ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04564495.
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Affiliation(s)
| | - Amy Bialek
- Burke Neurological Institute, White Plains, New York, USA
| | - Devina S Kumar
- Burke Neurological Institute, White Plains, New York, USA
| | - Rachel M Garn
- Burke Neurological Institute, White Plains, New York, USA
- School of Medicine, State of New York Upstate Medical University, Syracuse, NY, USA
| | | | - Talita Campos
- Burke Neurological Institute, White Plains, New York, USA
- School of Nursing, Columbia University Irving Medical Center, New York, NY, USA
| | - Kathleen M Friel
- Burke Neurological Institute, White Plains, New York, USA
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
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Shang B, Duan Y, Brehm W, Liang W. Subjective Theories of Chinese Office Workers With Irregular Physical Activity: An Interview-Based Study. Front Psychol 2022; 13:854855. [PMID: 35529547 PMCID: PMC9072660 DOI: 10.3389/fpsyg.2022.854855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives Individuals with irregular physical activity (PA) participation are defined as fluctuators. This study aimed to comprehend how fluctuators’ perceived barriers and motivators in their subjective theories are exhibited and cognitively represented in relation to their everyday PA practices and lapses. Methods The design of “Research Program Subjective Theories” was used to explore and present fluctuators’ cognition concerning PA participation. Thirty fluctuators were invited to a semi-structured interview. By inductive and deductive coding, fluctuators’ verbal data were converted into word categories for extracting commonalities and comparing differences. By retaining the remaining word categories of high frequency and exploring the interrelationships among the remained word categories using statistical analyses, a superstructure (i.e., visualized representation of fluctuators’ overall cognition) including fluctuators’ main PA motivators, barriers, and behavioral outcomes was compiled. Results Fluctuators face common motivators as barriers, such as lack of time, lack of willpower, lack of social support, and physical reasons (discomfort, injuries, or diseases). Fluctuators’ subjective theories primarily differed in motivational configurations. The physically motivated fluctuators (i.e., those predominantly motivated by physically related motivators) were more linked with low PA level, while the mixed motivated fluctuators (i.e., motivated by both physically related and emotionally or socially related motivators) were more likely associated with moderate PA level. The exemplars of the three typical fluctuators were also demonstrated to reveal their real experiences and situations in the daily life context. Conclusion Due to the fact that fluctuation research is still in its infancy, this study represents a significant opportunity to promote knowledge growth in this area. Future studies are recommended to convert findings of the present study into interventions that benefit fluctuators in overcoming perceived barriers and enhancing motivations to eventually participate in regular PA.
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Affiliation(s)
- Borui Shang
- Department of Social Sciences, Hebei Sport University, Shijiazhuang, China
| | - Yanping Duan
- Department of Sport, Physical Education and Health, Faculty of Social Sciences, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China.,Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Walter Brehm
- Institute of Sports Science, University of Bayreuth, Bayreuth, Germany
| | - Wei Liang
- Department of Sport, Physical Education and Health, Faculty of Social Sciences, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China.,Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
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Hirt J, Vetsch J, Heinrich S. Facilitators and barriers to implement nurse-led physical activities for people with dementia in nursing homes: a protocol for a mixed-methods systematic review. BMJ Open 2021. [PMCID: PMC8719182 DOI: 10.1136/bmjopen-2021-056353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction Dementia is a major neurocognitive disorder and accounts for a great proportion of nursing home residents. Bodily symptoms such as gait, balance difficulties and muscle weakness are common in people with dementia. Physical activities are important to maintain and promote physical functioning and activities of daily living. Nurses are a prone stakeholder to deliver physical activity interventions in nursing homes. However, several barriers have been reported for implementing nurse-led physical activity programmes. Also synthesised strategies for sustainable implementation in nursing homes are lacking. We, therefore, aim to synthesise the evidence on physical activity interventions which can be led by nurses and to identify facilitators and barriers of sustainable implementation of physical activity for people with dementia. Methods and analysis We will conduct a mixed-methods systematic review to (1) describe the characteristics of nurse-led physical activities for people with dementia living in nursing homes and to (2) determine facilitators and barriers for sustainable implementation of nurse-led physical activities for people with dementia in nursing homes. We will search four different electronic databases, do forward and backward citation tracking and will web-search additionally. We will also search through guideline databases. Two reviewers will independently screen the identified studies for their eligibility. Data extraction and critical appraisal of included studies will be performed by one reviewer and double-checked by another reviewer. We will analyse the data using an integrative mixed-method synthesis and we will summarise the findings narratively. Ethics and dissemination No ethics approval is needed to perform this systematic review. We will publish our review results as scientific and non-scientific journal articles and we will hold an oral or a poster conference presentation. The review results will inform the development of structured and easy to understand guidance for nurses to initiate tailored physical activities for people with dementia in nursing homes.
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Affiliation(s)
- Julian Hirt
- Institute of Applied Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St.Gallen, Switzerland
- International Graduate Academy, Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Janine Vetsch
- Institute of Applied Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St.Gallen, Switzerland
| | - Steffen Heinrich
- Institute of Applied Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St.Gallen, Switzerland
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Gebhard D, Mir E. What Moves People Living With Dementia? Exploring Barriers and Motivators for Physical Activity Perceived by People Living With Dementia in Care Homes. QUALITATIVE HEALTH RESEARCH 2021; 31:1319-1334. [PMID: 33825572 PMCID: PMC8182331 DOI: 10.1177/10497323211002822] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There is a lack of intervention promoting physical activity targeted toward people living with dementia because their input has not been prioritized in the development of exercise programs. The aim of this study is to investigate motivators and barriers concerning physical activity in people living with dementia in care homes and to give recommendations for intervention development. Qualitative semi-structured interviews were conducted; transcripts were analyzed using qualitative content analysis. Following a tailored procedural model, inductive and deductive category development was applied. The value of Cohen's κ = .94 indicates the high intercoder reliability of the category system developed. Ten interviewees reported 24 different barriers and 12 motivators concerning physical activity in the context of the social-ecological model. The strong impact of intrapersonal factors and the living environment became apparent. Points of reference for how people living with dementia can overcome barriers and activate their motivators to achieve more physical activity are provided.
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Affiliation(s)
| | - Eva Mir
- Carinthia University of Applied
Sciences, Feldkirchen, Austria
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Farina N, Williams A, Clarke K, Hughes LJ, Thomas S, Lowry RG, Banerjee S. Barriers, motivators and facilitators of physical activity in people with dementia and their family carers in England: dyadic interviews. Aging Ment Health 2021; 25:1115-1124. [PMID: 32067474 DOI: 10.1080/13607863.2020.1727852] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Physical activity may have a number of physical and mental health benefits for people with dementia and their carers. However, there is limited evidence about factors that influence physical activity participation in these groups. This study therefore looks at the barriers, facilitators and motivators of physical activity in people with dementia, from both the perspective of the person with dementia and their carer. METHOD Thirty participants (15 sets of community-dwelling people with dementia and their family carers) were recruited from the South East of England. The participants took part in semi-structured dyadic interviews about their views of physical activity. Interviews were analysed using inductive thematic analysis at an individual level and comparisons were made between the groups. RESULTS Common motivator themes across persons with dementia and family carers were emotional and physical wellbeing, and social connectedness. Physical health was seen as a common barrier in both groups. Physical activity in the person with dementia was encouraged and supported by the family carer. For the carer, their caring role, and limited time acted as barriers to their participation. CONCLUSION Themes such as social connectedness, positive emotion and health were seen as key motivators to physical activity, which indicate that people with dementia and carers use physical activity as a means to maintain and improve their quality of life. Supporting family members to better facilitate such activities could encourage physical activity in people with dementia.
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Affiliation(s)
- Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Alice Williams
- Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Kirsty Clarke
- Global and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Laura J Hughes
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Serena Thomas
- Research and Development, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Ruth G Lowry
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
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Dawson N, Judge K. Accepting the Challenge-Moderate-Intensity Exercise with Individuals with Dementia: A Case Series. Rehabil Process Outcome 2019; 8:1179572719853592. [PMID: 34497462 PMCID: PMC8282150 DOI: 10.1177/1179572719853592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background and purpose: The global impact of dementia demands a response from researchers and clinicians to not only assist with prevention and a cure, but also to assist in the management of symptoms related to this progressive disease. The purpose of this case series is to highlight the participation of 3 individuals with varying levels of dementia in a moderate-intensity functional exercise program. Intervention: The intervention, developed using principles from exercise science and a Strength-Based Approach, consisted of 24 sessions of moderate-intensity exercises delivered in participant’s home. Outcomes: Each participant completed a pre- and post-assessment including gait speed, strength, balance, depressive symptoms, cognition, and perceived difficulty with activities of daily living. Despite various clinical presentations, each participant successfully completed all 24 sessions with noted improvements in at least two measures. Discussion: These findings highlight the flexibility of using the Strength-Based Approach to enhance participation in a standardized exercise program.
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Affiliation(s)
- Nicole Dawson
- Division of Physical Therapy, UCF School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, USA
| | - Katherine Judge
- Department of Psychology, Cleveland State University, Cleveland, OH, USA
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