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Carole Johannesson, centre, 79, of Kitchener, Ont., participates in her Tai Chi class.

Fred Lum/The Globe and Mail

Alzheimer’s disease and other forms of dementia can hamper balance, coordination and motivation, making it difficult for people to participate in physical activities that can make them feel more alert and improve their quality of life.

Now, a national research team led by the University of Waterloo is working to make it easier for people with dementia to stay active by training community-fitness providers and personal trainers on how to provide dementia-inclusive exercise. This involves providing fitness environments and activities that still give people a challenging physical workout, but can be adapted to their cognitive abilities.

As the number of Canadians with dementia rises, “we kind of have a duty to help these people ... live the best life that they can, despite the fact that they’re living with a disability,” said Lauren Bechard, a PhD student in the department of kinesiology at the University of Waterloo.

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Over the past few years, Ms. Bechard, her adviser Laura Middleton and their colleagues have been collecting input from individuals with dementia and their caregivers across the country about their barriers to exercise. They are now using that information to design tools and strategies to boost their participation in physical activity.

Among them is what Ms. Bechard describes as a “passport advocacy tool.” It is a card that people with dementia can bring with them to their local community centres that would introduce them and provide information about their condition and what they need to participate in fitness activities.

Another is a training program for fitness providers and personal trainers on how to deliver exercise programs for individuals with dementia. This involves debunking stereotypes, since many people can be physically fit and active as they live with mild dementia for years, said Dr. Middleton, an associate professor of kinesiology. It also involves using simple language, offering choices and support when clients struggle with attention or memory. Fitness providers and personal trainers should also be aware that loud music, bright lights and mirrors can be overwhelming for those with sensory issues, Dr. Middleton said.

In Kitchener, Ont., Carole Johannesson,79, said she has been physically active all her life and was determined to stay active after she was diagnosed with dementia about four years ago. She regularly participates in tai chi classes and goes for walks. Lately, she said, she has felt wobbly in tai chi and has contemplated quitting. But she has informed her instructor of her diagnosis and she follows along in class by taking up a position behind one of her fellow participants, whom she mimics.

Exercise doesn’t necessarily improve her dementia symptoms, but she says she has fun and it makes her feel capable.

"Tons of people who should be getting exercise probably aren’t because they think they can’t go to an ordinary exercise class,” she said.

Jennifer Heisz, an associate professor in the department of kinesiology at McMaster University who is not involved in the University of Waterloo-led initiative, said researchers are still trying to figure out the ideal type, frequency, duration and intensity of exercise for individuals with dementia. But her own research suggests it may be possible to prevent or slow the progression of dementia by staying physically active.

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Exercise appears to promote the growth of new cells in the hippocampus, an area of the brain involved in memory, Dr. Heisz said. High-intensity exercise, in particular, also gives people a boost immediately afterward of a protein called brain-derived neurotrophic factor (BDNF), which she described as a fertilizer that supports brain-cell growth and function. People with dementia tend to have a dearth of this protein, she said. So through exercise, this combination of promoting new cells and boosting BDNF may help fortify and protect the hippocampus from the damage caused by diseases like Alzheimer’s.

Although it’s still unclear whether exercise can actually improve the cognitive abilities of people with dementia, it does tend to boost their mood, alertness and sense of well-being.

Bill Heibein, 78, who owns and runs a horse-breeding farm near Kakabeka Falls, Ont., believes strenuous daily physical activity is the reason he is still alive. Mr. Heibein was diagnosed with early onset Alzheimer’s disease in 2000, but his disease has not progressed as expected.

Today, he drives and lives independently. He said he has too often seen people become sedentary after being diagnosed with dementia.

“If there’s something you enjoy doing, even though you’ve been diagnosed, boy, you can go carry on and keep doing it as long as you possibly can,” he said.

Dr. Middleton explained she began looking for ways to make existing community fitness programs and centres dementia-inclusive because she recognized dementia-specific programs cannot adequately meet the needs of everyone. For example, she said, an exercise and social program called Minds in Motion run by the Alzheimer’s Society of Ontario and the Alzheimer’s Society of B.C., is popular and effective for improving participants’ fitness and well-being, but it is typically offered once a week and may not be well-suited to those in their 40s and 50s, who are younger than the average participant. Ideally, she said, people would be exercising several times a week.

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She added that people with dementia have a right to participate in exercise and recreation, which is protected under the United Nations Convention on the Rights of Persons with Disabilities.

As such, making facilities and programs dementia-inclusive is "really something that we must do ... and it’s not just a nice [thing] to do,” she said.

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