Exercise as it relates to Disease/Do focus groups work to improve physical activity engagement in cognitive impairment?

This page is a critique of the research article: van der Wardt, V. et al. (2019) 'Physical activity engagement strategies in people with mild cognitive impairment or dementia - a focus group study'. Aging & Mental Health. vol.24(8), pp.1326-33.

Critique was undertaken as an assignment for the unit Health, Disease, and Exercise (8340) at the University of Canberra, during Semester 2 of 2020.

Mild Cognitive Impairment and Dementia
With mild cognitive impairment (MCI) and dementia comes a decrease in cognitive and physical functionality, both of which have been shown to have positive benefits from the introduction of regular physical activity. Yet the introduction and maintenance of physical activity programs and habits is difficult in the affected groups due to the barriers and facilitators influencing the participation in physical activity.

Dementia and MCI affects many globally, and is an expensive and disabling burden on those affected. Along with dementia and MCI comes a reduction in memory, function, attention and physical performance reducing the patients ability to maintain balance and mobility. Physical activity introduction has been shown to be both feasible, and successful in improving mood (such as depression), cognitive function, physical function (allowing them to be more independent and mobile), and overall improve one's quality of life. However for individual patients, there are many factors the influence their participation in physical activity, either restricting, or promoting their participation. This article sought to understand those factors, and how they may interact with each other, and whether focus groups were a useful tool to discovering these factors and improving a patients participation in the long run.

How was the research performed?
The research consisted of using focus groups, which have been shown very useful in understanding mechanisms and processes through group interactions. The focus groups allow open discussion and construction of meaning about a topic.

Four focus groups were assembled, and a semi-structured interview guide was given so to allow the participants the opportunities to talk freely. Three of the four groups were people who had Dementia or MCI, and their carers. The last group was a group of health professionals. The research was cunducted in the United Kingdom.

The group of clinicians were provided a draft of ideas for exercise interventions, to allow the clinicians to focus their role in these interventions, and how to develop and implement interventions. The groups of people with dementia or MCI were asked questions on exercise motivation and engagement in exercise.

A schedule of questions was used, but all participants were encouraged to talk freely. The groups' discussions were recorded, transcribed and analysed afterwards. The interview transcripts and recordings were analysed using a method known as 'thematic analysis'. This method is for analysing qualitative data and aids with observing common topics.

A couple observations in this particular study with focus groups found that some participants views were influenced by the group discussions. Firstly some participants displayed a tendency to join opinions, support, and agree with one another. The worry is then if participants were providing views that are 'socially desirable' to the groups, rather than their own opinions. The other observable influence was that the discussions appeared to influence an increased interest in physical activity and exercise among the participants who had dementia or MCI.

How did they encourage themselves?
Some people found their memories hindered them, so they use notes and cues to remind them to exercise. But many still desired assistance from family and professionals, Such as to be walked by family so that they find their way home if they lost their way. Self-motivating was useful to some people to encourage themselves: giving themselves little rewards when finishing, some set goals. Although some found goal setting to discourage them as they saw it as a way to fail. Setting routine and habit was important too many, and the biggest factor being how enjoyable the exercise or physical activity was to the individual. Many people utilised motivating aspects of their lives, such as being active with their partners or wives, the necessity of walking a dog, being in a visually pleasing area like a park or river. Places such as being in a city were sometimes found to be disencouraging as they're not very appealing to some. Information about how to perform certain activities was useful, but not if the information came from leaflets or brochures, participants wished for the information to be more personal. Some people considered whether to perform activities in groups, individually, or with clinicians. It all varied on each person, some liked groups, some preferred to exercise alone.

Cost was an issue for some (particularly pensioners). Some did not want to travel large distances to perform their activities. Medical conditions and issues presented many issues. Time away from the house, particularly when people owned pets was an issue, which also meant that exercise and physical activity needed to be worked around their routines with their dogs.

The interaction of the barriers and motivators to exercise was discussed. Some understood the benefits of exercise, but found it difficult to do, due to mental health issues and memory problems. In such a case, one participant found the support from his wife, and mobile phone reminders, and his positive perspective of physical activity to be very important in combatting those difficulties. Depression and memory were problems again for others. Another interaction was patients enjoying walking their dogs, however their environments, a city, did not encourage them to walk more frequently.

How does this help?
From the results of the focus groups there are several barriers and facilitators for patients who have MCI or dementia, to partcipate in physcial activities. Many things discourage them such as: cost of exercise, interest if they do not like either where they exercise or the type of exercise itself, memory problems to maintain habits, scheduling the activities around there daily lives, and how personal the exercise programs are to themselves. The "one-size-fits-all" strategy to excercise does not help deal with the issues presented in these groups. Taking advantage of the motivators may prove to be a useful approach. Identifying motivating factors such as: being active with a friend/partner, activities involving pets, their love of certain activities, should help encourage patients to engage in their programs. The focus groups did appear to be useful. They allowed for people with dementia and MCI to voice their opinions and show how the interactions of the barriers and motivators needs to be considered too. Where someone may love being physcially active they may also struggle with memory problems causing them to forget to be active. In this case, a support or memory system to remind and encourage them to exercise may be useful. The interactions of the barriers and motivators is where the exercise programs need to be customised (as desired by the participants). A more individualised approach with tailoring of exercise programs to individuals may help motivate those with MCI or dementia to become active, by suiting them and their lives.

Practical advice
If someone reading this has concerns for themselves or someone they know about their physcial activity engagements, you could try implementing some of the engagement strategies mentioned in this research. Use of the notes around the house, phone alarms, being active with friends and loved ones, or go and see a health professional. Any concerns about engagement, how to engage, and what activities to partake in can easily be directed by a qualified health professional. A suggestion would be to make sure that any prescribed programs are personally tailored to your schedule and desires for participation of exercise, so as to maximise enjoyment and engagement. Another reason to seek professional assistance is in circumstances where someone may have pre-existing health conditions that may complicate participation in physcial activity, such as conditions making exercise potentially too strenuous and demanding, making them possibly dangerous for certain people.

Further information/resources
For some guidance on what levels of activity should be attained: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#npa1864

For further assistance or information about dementia: https://www.dementia.org.au

For some ideas to help you engage in physcial activity: https://www.betterhealth.vic.gov.au/health/HealthyLiving/Physical-activity-how-to-get-active-when-you-are-busy