Ageing and dementia

1. Ageing & Dementia
Judy Stevenson & Jill Dentith

2. Judy Stevenson
Public Health Hub Lead
Principal Lecturer, Academy
of Sport and Physical Activity
J.stevenson@shu.ac.uk
0114 225 3982
Jill Dentith
Head of Health
Sheffield City Trust
j.dentith@sivltd.com
0114 22 33 811
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3. Discussion
• Please share your ideas and contributions
• Share successful practice
• What would be helpful to you for your future
practice/work?
• Can you see possibilities for future
collaboration/research/service re-
design/CPD/events
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4. Introduction & Ice breaker
• How old is old?
• What words do we
think of when we think
of 'old'?
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5. Aims of the workshop
• Context for Ageing nationally
• Context for Ageing locally
• Dementia and Physical activity - where's the
evidence?
• Dementia pilot project
• Discussion
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6. National Drivers
• WHO and Alzheimer's International, Dementia: a public
health priority (2012)
• NICE Quality standard (QS30): Supporting people to live well
with dementia (2013)
• PHE & Alzheimer's Society: Dementia Friendly Societies
(2014)
• PHE Dementia Action Alliance- Dementia Friends (2013)
• NICE guidelines [PH16] : Occupational therapy and physical
activity interventions to promote the mental wellbeing of
older people in primary care and residential care (2008) +
evidence update (2015)
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7. Local Drivers
• Sheffield City Council, South Yorkshire Housing Association:
Fulfilling Lives, Ageing Better- Big Lottery Fund (2014)
• Sheffield Dementia Action Alliance (2013)
• Sheffield Hallam University http://ed.ted.com/on/wQqgWSdl
• National Centre for Sport & Exercise Medicine
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8. Sheffield

9. What is the NCSEM?
• 3 national partners - London, East Midlands & Sheffield
• Linked to Olympic legacy cabinet committee
• £30 million capital investment nationally
• £10 million capital in Sheffield
• Opportunity to have national and international impact
• Sheffield NCSEM project managed and led by SHU with a
range of key partners including SCC, NHS Sheffield CCG, 3 x
NHS Foundation Trusts, 2x Universities, Sheffield City Trust
and voluntary sector
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10. 5 Core themes
Physical Activity in Disease Prevention
Promote physical activity and healthy lifestyles as
a preventative therapy for long term conditions.
Chronic Disease Treatment
Develop the prescription of physical activity in
the treatment of chronic disease.
Musculoskeletal Health
Develop models for the use of physical activity in
diagnosis and management of musculoskeletal
disorders, and public cost savings through
reduction
in work absenteeism.
Mental Health and Wellbeing
Improve staff wellbeing, reduce
absenteeism and enhance
productivity, through physical activity.
Promote physical activity in the
treatment of mental illness and deliver
research, education and training in the
identification of eating disorders in
sport.
Performance Health
Research elite athlete performance to
further understand how to optimise
health for this population and make it
applicable to benefit other groups,
such as the ageing population.
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11. Objectives: NCSEM
• Co-locate expertise
• Develop and implement physical activity care pathways that
establish the business case for physical activity as medicine
• Provide opportunity for physical activity research that
improves clinical care
• Stimulate advances in tele-health and tele-medicine and
translate innovations into clinical practice
• Develop and implement programmes for disease prevention
through the city-wide Move More programme.
• Evidence the benefits
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12. NCSEM-Sheffield Vision
To create a culture of physical activity that results in
Sheffield becoming the most active city in the UK by
2020
NCSEM-Sheffield Mission
Make it easier for everyone in Sheffield to be active as
part of everyday life.
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13. Capital infrastructure
NCSEM capital investment establish an
innovative model to;
• co-locate patients, clinicians,
researchers, sport and exercise
medicine specialists and public
health professionals across the
City
• create community facilities to
extend the reach of Sport and
Exercise Medicine that include;
research, recreation, rehabilitation
and education.
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14. NCSEM Hub - Graves
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16. NCSEM Spoke - North Active
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17. NCSEM Spoke - Concord
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18. NCSEM Spoke - Concord
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19. Clinic Rooms
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20. Move More Sheffield
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21. Task
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22. How physically active are you?
• What are the physical
activity
recommendations for
• Adults?
• Older adults?
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23. Adults
• Adults should aim to be active daily. Over a week, activity should add up
to at least 150 minutes (2½ hours) of moderate intensity activity in bouts
of 10 minutes or more – one way to approach this is to do 30 minutes on
at least 5 days a week.
• Alternatively, comparable benefits can be achieved through 75 minutes of
vigorous intensity activity spread across the week or a combination of
moderate and vigorous intensity activity.
• Adults should also undertake physical activity to improve muscle strength
on at least two days a week.
• All adults should minimise the amount of time spent being sedentary
(sitting) for extended periods.
Start Active , Stay Active (2011) Chief Medical Officers Report
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24. Older Adults
• Older adults should aim to be active daily. Over a
week, activity should add up to at least 150
minutes (2½ hours) of moderate intensity activity
in bouts of 10 minutes or more – one way to
approach this is to do 30 minutes on at least 5
days a week.
• For those who are already regularly active at
moderate intensity, comparable benefits can be
achieved through 75 minutes of vigorous intensity
activity spread across the week or a combination
of moderate and vigorous activity.
• Older adults should also undertake physical
activity to improve muscle strength on at least two
days a week.
• Older adults at risk of falls should incorporate
physical activity to improve balance and co-
ordination on at least two days a week.
• All older adults should minimise the amount of
time spent being sedentary (sitting) for extended
periods.
Start Active , Stay Active
(2011) Chief Medical
Officers Report
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25. Percentage of Adults achieving 150 minutes
per week Physical Activity
Core City <30 mins 30-89 mins 90-149 mins 150+ mins
National 28.5% 8.1% 7.3% 56.0%
Sheffield 30.4% 8.8% 6.2% 54.6%
Birmingham 34.3% 9.9% 8.9% 46.9%
Bristol 28.4% 8.4% 7.8% 55.4%
Leeds 26.9% 6.4% 5.5% 61.3%
Liverpool 31.6% 6.8% 9.6% 52.0%
Manchester 40.2% 5.4% 2.8% 51.6%
Newcastle upon Tyne 25.6% 9.1% 7.6% 57.6%
Nottingham 33.2% 7.9% 7.0% 51.9%
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26. Physical Activity and older
adults
78% of men and 86% of women living in
care homes in Great Britain were
classified as inactive. This is twice as many
as those who live in private households
41% of adults in Great Britain over the age
of 70 years take a 20 minute walk (for
transport purposes) less than once a year
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National travel survey 2009. Department of Transport 2010.

27. Physical inactivity
Physical inactivity is described as;
“doing no or very little physical activity at work, at
home, for transport or during discretionary time … not
reaching physical activity guidelines deemed necessary
to benefit public health”
(Bull et al. in Lopez, Rodgers and Murray (eds) 2004)
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28. Sedentary behaviour
Sedentary behaviour refers to a group of behaviours that occur
whilst sitting or lying down and that typically require very low
energy expenditure
The low energy requirements distinguish sedentary behaviours
from other behaviours that also occur whilst seated, e.g. chair
based exercise, but which require greater effort and energy
expenditure.
Sedentary behaviour is not defined simply as a lack of physical
activity; it is a separate behaviour in its own right.
(Pate, O'Neill and Lobelo 2008)
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29. Dementia
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30. Dementia
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31. Physical Activity &
Dementia
The Cochrane collaboration Review (2013) 'Exercise
programmes for people with dementia'; included 16 trials with a
total of 937 participants. Most participants were older people
with Alzheimer’s disease (AD). The exercise programs varied
greatly; the length of time that they ran ranged from two weeks
to 12 months, and activities varied (e.g. hand movements,
sitting, walking, and upper and lower limb exercises) The review
suggests that exercise programs may have a significant impact
on improving cognitive functioning and the ability to perform
ADLs in people with dementia.
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(Laventure 2014)

32. Physical Activity & Dementia
• Blankevoort et al. (2010) assessed the effects of exercise on
physical function and activities of daily living in older people
with dementia. 10 RCT’s with a total of 492 participants.
• Littbrand et al. (2011) assessed the effects of exercise on
physical function, cognitive function and ADLs in people with
dementia. This review included only RCTS and included a
total of 10 studies with 622 participants.
• Martinez (2014) - a summary of 20 studies to improve
cognition, neuropsychiatric symptoms and physical function
in people with Mild Cognitive Impairment (MCI), dementia
and AD. Involving over 1,400 participants.
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(Laventure 2014)

33. Physical Activity & Dementia
Furthermore, the findings reveal that the burden
experienced by informal caregivers providing
care in the home may be reduced if they
supervise their family member with dementia
during participation in an exercise programme.
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(Laventure 2014)

34. Sheffield City Trust
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35. What is Sheffield City Trust?
• Sheffield City Trust (SCT) is an independent
registered charity
• Sheffield International Venues Ltd. (SIV) is a wholly
owned subsidiary of SCT – all profits reinvested
• SIV manages and operate a number of sports and
leisure facilities in Sheffield on behalf of SCT
• SIV hosts a range of events from local community
activities to world class sporting and entertainment
events
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36. SCT Charitable Objects
The objects of SCT are:
“To provide facilities for recreation for the
benefit of residents of Sheffield; to promote the
physical health of Sheffield residents; the
development and promotion of the arts and the
promotion of social welfare in the City.”
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37. SCT Sport and Leisure Centres
• Concord Sports Centre
• English Institute of Sport
• Heeley Pool and Gym
• Hillsborough Leisure Centre
• iceSheffield
• Ponds Forge International Sports Centre
• Springs Leisure Centre
• Westfield Sports Centre
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38. SCT Golf Courses and Entertainment
Venues
• Beauchief Golf Course
• Birley Wood Golf Course
• Tinsley Park Golf Course
• Motorpoint Arena
• Sheffield City Hall
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39. How can SCT help increase physical activity?
SCT have facilities and staff across the city to support people
to be more physically active whatever their age or ability:
– Start well e.g. aqua-natal, swimming lessons and
athletots
– Developing well e.g. team sports, athletics and
gymnastics
– Living and working well e.g. gym membership and
exercise classes
– Ageing well e.g. exercise referral, silver circuits and tea
dances
– Specific programmes for people through cardiac and
pulmonary rehab, Parkinson’s, stroke etc.
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40. *Plus one scheme
*Let me take you there
*Dementia and
physical activity
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41. SCT: a dementia friendly organisation
• Signed the SDAA charter
• Life-size cut outs to promote “Dementia Friends”
• Staff training and support
• Sheffield Dementia Friendly City of Culture
• Supporting people into main stream services
• Physical activity interventions for those with
dementia and their carers
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42. Pilot Project
• A taster day of activity took place in March 2015 at
Concord Sport Centre which included swimming,
badminton, use of the gym and sensory room.
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43. Question Feedback
What activity have you enjoyed today? Gym (6)
Badminton (5)
Table Tennis (4)
Treadmill (2)
Sensory Room (2)
What did you enjoy about the
activities?
Being active
Getting together with other people
Being part of a group of friends
Variety of activities
A qualified instructor explaining what to do
Being reminded that a gym might help me
Being competitive
Doing activities with people in similar positions
What are the things that have helped
you to take part today?
Having friendly and welcoming people around (4)
Having a support worker with me (3)
The Alzheimer's Society identifying my needs (2)
Staff taking each activity at the individuals pace
Not being rushed
Encouragement from everyone
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"Being part of a group where everyone is in the same boat"
"It was fun being with other people"
"Being part of a group and getting out. Everything was gentle and friendly"
"Staff very friendly and inclusive"

45. Is there anything that would have helped
to make this a better experience?
Would have liked the opportunity to swim (2)
Would have liked the squash to be included (2)
A different venue due to this being a long distance for some to travel
Should have been told to bring trainers
Are there other activities you would like
to try in the future?
Indoor bowls (7)
Dance (3)
Walking football (2)
Meditation/yoga/Pilates (2)
Exercise classes (2)
Swimming (2)
Trampoline
Do you take part in any sport or exercise,
if so what?
Walking (4)
Swimming (3)
Gym (2)
Dancing
Ten pin bowling
Table tennis
Golf driving range
Cycling
Keep fit
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47. "People challenged to try new things"
"Revived memories"
"There was an element of being serious, but it was also light-hearted and
fun"
"Being able to do the activities that have been part of my life for so long
without feeling rushed, and being understood by the instructor"
"We feel like we belonged and were made welcome"
"Norma became overwhelmed and said 'they understand our ways'" (Support
Worker)
"Encouragement from others and not feeling self-conscious"
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48. Next Steps
Proposal
To develop a funding bid - Big Lottery - Awards for All England - to deliver a
'programme' of activity for participants with Dementia. Evaluation will be undertaken
by Sheffield Hallam University after consultation with participants.
Partners
Sheffield City Trust (SCT) / Sheffield International Venues (SIV)
Sheffield Dementia Alliance Group including Sheffield Alzheimer’s Society and Public
Health at Sheffield City Council
The Public Health Hub - Sheffield Hallam University
Sheffield Health and Social Care NHS Foundation Trust
Ideas
8 week programme of activity at an SIV facility for those with early onset dementia
and their carers
Taster day at SIV golf range
Group Ten pin bowling activity
Sporting Memories session 48

49. Outcome Measures
• We will work with the clients and carers to establish 'what they would like
to measure'. This may include;
• Cognitive functioning
• Mobility and other physical function measures, and reduces decline in the
ability to perform ADLs.
• Improved, confidence, self esteem, positiveness - no evidence suggested
in BL paper,
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Furthermore, considering the PA recommendations we will
consider the feasibility of including some of these measures
•Reducing sedentary behaviour
•Aim to be active every day
•Accumulating 150 minutes of moderate- to vigorous-intensity
aerobic exercise per week, in bouts of 10 minutes or more
•Muscle strengthening activities using major muscle groups, at
least two times per week
•Balance and co-ordination activities are recommended for
those older adults at risk of falls.
Outcome Measures

51. Questions
51

52. Discussion
• Please share your ideas and contributions
• Share successful practice
• What would be helpful to you for your future
practice/work?
• Can you see possibilities for future
collaboration/research/service re-
design/CPD/events
52

53. References
Blankevoort , C. G., van Heuvelen, M. J. G., Boersma. F., Luning, H., de Jong, J. and Scherder. E. J.
A. Review of Effects of Physical Activity on Strength, Balance, Mobility and ADL Performance in
Elderly Subjects with Dementia. Dementia and Geriatric and Cognitive Disorders 2010;30:392-402
https://www.karger.com/Journal/Issue/254680
Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. (2013) Exercise programs for people with
dementia. Cochrane Database of Systematic Reviews 2013, Issue 12.
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006489.pub3/pdf
Laventure, B. Draft Briefing Paper; People living with dementia, physical activity and exercise.
Summary of current research – findings and implications for practice (2014)
Littbrand, H., Stenvall, M., and Rosendahl, E. Applicability and effects of physical exercise on
physical and cognitive functions and activities of daily living among people with dementia: A
systematic review. American Journal of Physical Medicine and Rehabilitation 2011;90:495-518
Martinez J.T. (2014) Dementia and Alzheimer’s Disease in Physical Activity and Mental Health
(Clow A. and Edmunds S. Eds.) Human Kinetics Champaign, Illinois.
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