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Dementia

Open the conversation

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Would you be happy to spend 4-5 minutes talking about something that can make a big difference to your future health and wellbeing?

Insight

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Spending a moment to set the scene and ask permission can open a constructive person-centred conversation around behaviour change. This keeps the individual actively engaged in the conversation and decision making.

Did you know?

Every conversation you have with people about physical activity is important in supporting behavioural change over the life course

Brisk walking can be easily incorporated into everyday life for many people and is an acceptable form of physical activity.

The least active individuals stand to gain the most from a small increase in physical activity

Real impact

“Brain health has been associated with greater involvement in social engagement, cognitive engagement and physical activities”

“Why haven’t I received [physical activity on prescription] before? I have been in pain for many years.”

“Challenge your brain with learning new things as you get older.”

Assess impact of the condition

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How has your dementia affected your physical activity levels and the things you enjoy?

Insight

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Whilst not yet focusing on becoming more active, this open question can get the person talking about how things may have changed for the worse … and thus may increase their readiness for change and recovery. Most people are ambivalent about, rather than resistant to, increasing their physical activity levels. Your challenge is to help an individual to consider and share their own ‘pros’ for increasing their physical activity levels and help them to develop these ideas into a workable plan that fits into their life.

Try to understand their perspective, agenda and priorities and do not assume they:

  • ought to change
  • want to change
  • are primarily motivated by their health
  • either ARE or ARE NOT motivated to increase their activity levels
  • will respond well to a tough approach from you
  • must (or will) follow your advice

Learning skills like motivational interviewing can help you avoid common pitfalls that sometimes make conversations about behaviour change unrewarding and ineffective. Visit our education section to learn more.

Did you know?

Every conversation you have with people about physical activity is important in supporting behavioural change over the life course

Brisk walking can be easily incorporated into everyday life for many people and is an acceptable form of physical activity.

The least active individuals stand to gain the most from a small increase in physical activity

Real impact

“Brain health has been associated with greater involvement in social engagement, cognitive engagement and physical activities”

“Why haven’t I received [physical activity on prescription] before? I have been in pain for many years.”

“Challenge your brain with learning new things as you get older.”

Find out what they already know

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What do you know about the benefits of physical activity in people with dementia?

Insight

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As an individual is more likely to change if they can personally identify with the ‘pros’ for change, help them to identify how they might benefit from being more active. Find out what they know first so that you can add to their existing understanding by sharing some of the wide-ranging benefits of being more active.

Did you know?

The least active individuals stand to gain the most from a small increase in physical activity

Twice weekly strength sessions and specific balance and coordination training for the over-65s is also recommended

Move more by breaking up sitting time – stand up during TV advertisement breaks or walk around the office.

Real impact

“Keeping your body fit and happy helps keep your brain fit and happy.”

“Exercises shouldn’t be framed as six weeks, but forever. It only reinforces it as a short term thing.”

“Research shows that if you engage in regular physical activity, you decrease your risk of Alzheimer’s disease”

Share benefits

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Can I share some other things people find beneficial to see what you make of them.

Insight

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Based on your discussion so far, choose to share the benefits you judge will be most relevant and important to them. Some benefits are quite generic and others will be condition specific.

Remember the conversation won’t work if you take away their control. Ask permission and keep this a conversation not a lecture.

Did you know?

The least active individuals stand to gain the most from a small increase in physical activity

Twice weekly strength sessions and specific balance and coordination training for the over-65s is also recommended

Move more by breaking up sitting time – stand up during TV advertisement breaks or walk around the office.

Real impact

“Keeping your body fit and happy helps keep your brain fit and happy.”

“Exercises shouldn’t be framed as six weeks, but forever. It only reinforces it as a short term thing.”

“Research shows that if you engage in regular physical activity, you decrease your risk of Alzheimer’s disease”

Encourage reflection

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What do you make of what I have just said?

Insight

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Allow some space for people to talk and explore the information rather than asking ‘do you understand?’ which can shut things down. Ask if they need anything clarifying and what concerns they might have about how the information applies to them.

Listen and reflect their concerns: ‘you’re worried about X’. Help them to address these issues by sharing the experience of other people: ‘other people I’ve worked with have had those concerns, but what typically happens when they get started is…’ or ‘whilst there is a small risk of X when you get started, this is outweighed by the risk reduction you experience once you have started moving more’. Ask what they think about what you have said.

Did you know?

The least active individuals stand to gain the most from a small increase in physical activity

Twice weekly strength sessions and specific balance and coordination training for the over-65s is also recommended

Move more by breaking up sitting time – stand up during TV advertisement breaks or walk around the office.

Real impact

“Keeping your body fit and happy helps keep your brain fit and happy.”

“Exercises shouldn’t be framed as six weeks, but forever. It only reinforces it as a short term thing.”

“Research shows that if you engage in regular physical activity, you decrease your risk of Alzheimer’s disease”

Make it personal

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What would be the top 2-3 reasons for you personally becoming more active, if you decided to?

In addition to the personal benefits that being active can have, living an active life can reduce the risk of many common medical conditions by up to 50%

Offer to share some of this evidence if you feel they might be interested in finding out more about the impact of physical activity on disease prevention.

Insight

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Help them to generate and articulate their own reasons, which may or may not be health-related and recognise they might not be interested in long term disease prevention.

Saying ‘if you decided to’ reminds them that they are the decision maker, not you. This helps keep the discussion open and active, focusing your role on providing support.

Did you know?

The least active individuals stand to gain the most from a small increase in physical activity

Twice weekly strength sessions and specific balance and coordination training for the over-65s is also recommended

Move more by breaking up sitting time – stand up during TV advertisement breaks or walk around the office.

Real impact

“Keeping your body fit and happy helps keep your brain fit and happy.”

“Exercises shouldn’t be framed as six weeks, but forever. It only reinforces it as a short term thing.”

“Research shows that if you engage in regular physical activity, you decrease your risk of Alzheimer’s disease”

Summarise without adding anything

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Can I summarise what I think you have said?

Insight

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Don’t be tempted to impose your own plan at this stage – they may agree with you just to end the conversation. Summarise the main points of the conversation and find out what they are thinking

This may sound something like: ‘so some of the benefits of physical activity for someone like you with X include A and B and C. The most important reasons for you personally would be P and W’.

Using a summary can be a good way to demonstrate and express empathy, that you can see the world from their perspective. Empathy contributes to outcomes in a range of settings.

Did you know?

Local parks offer a great opportunity to be active for free

Deconditioning from inactivity can start a vicious cycle: understand how to break it

For most people any increase in physical activity is encouraged. In order to benefit health, research has shown that activities need to be of at least moderate intensity. For most people, this will mean experiencing an increased heart rate and breathing rate during the activity.

Real impact

“Staying physically active and mentally engaged appears to reduce the risk of dementia”

“I would like a group with people of a similar age and issues to me.”

“What is good for the heart is good for the brain – evidence that the same sort of exercise that benefits cardiovascular function, also reduces the risk of dementia”

Ask the key question

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So, what do you think you will do?

If they decide that they are NOT ready:

Thank them for taking the time to talk with you about physical activity and offer an opportunity to review the conversation. Reassure them that help is available when they feel ready to change.

If they decide to become more active:

THEN move on to planning. Continue to keep the focus on them generating their own ideas for change, rather than telling and instructing. People are much more likely to make successful changes if they develop their own plans.

Insight

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The individual has heard about the benefits of physical activity for someone like them and has had the chance to consider the benefits they would most like to experience. They have heard their ideas spoken back to them, which can help to reinforce them. Now it’s decision time. Asking an open question ‘what do you think you will do?’ rather than a closed question ‘so, are you going to do physical activity?’ helps remind them that they – not you – are the decision maker. If they are not ready to change now this can be challenging for you, but they might have good reasons to keep things the same for now. Encouraging further reflection can be an important part of the process of helping people to make successful changes over time. Offer an opportunity to follow up on this conversation to review their thoughts about making changes.

Did you know?

Local parks offer a great opportunity to be active for free

Deconditioning from inactivity can start a vicious cycle: understand how to break it

For most people any increase in physical activity is encouraged. In order to benefit health, research has shown that activities need to be of at least moderate intensity. For most people, this will mean experiencing an increased heart rate and breathing rate during the activity.

Real impact

“Staying physically active and mentally engaged appears to reduce the risk of dementia”

“I would like a group with people of a similar age and issues to me.”

“What is good for the heart is good for the brain – evidence that the same sort of exercise that benefits cardiovascular function, also reduces the risk of dementia”

Agree a plan

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Can I share with you some things people find helpful when making a plan?

If they agree, ask them which of these might suit them

Share the relevant resource from the list below with your patient

Increase walking

This simple and progressive 12 week walking programme, developed by the ‘PACE-UP’ trial team is proven to help increase walking and health in the long term

Set some goals

Use our active lifestyles workbook to help those who are interested in building resilience and setting structured goals to create a roadmap for behaviour change

Use a diary

Creating a personalised monthly schedule helps work out where, when and how someone can start to fit opportunities to become more active into their own life

Use an app

EXi iPrescribe Exercise is a NHS approved app, which provides a personalised 12 week physical activity plan with tailored support for people with long term health conditions. It is free to use, just add the code ‘moving’ when logging on

Insight

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Aim to keep the focus on the individual generating their own ideas about change, rather than telling and instructing. People are much more likely to make successful changes if they develop their own plans.

Did you know?

Local parks offer a great opportunity to be active for free

Deconditioning from inactivity can start a vicious cycle: understand how to break it

For most people any increase in physical activity is encouraged. In order to benefit health, research has shown that activities need to be of at least moderate intensity. For most people, this will mean experiencing an increased heart rate and breathing rate during the activity.

Real impact

“Staying physically active and mentally engaged appears to reduce the risk of dementia”

“I would like a group with people of a similar age and issues to me.”

“What is good for the heart is good for the brain – evidence that the same sort of exercise that benefits cardiovascular function, also reduces the risk of dementia”

Arrange follow up

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How would you feel about coming back another time to build on the thoughts and ideas you’ve shared with me today?

Offer a follow up opportunity with you or a colleague appropriate to the environment you work in and resources available.

Insight

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A follow up appointment can be important after a five minute conversation. Spending more time enables you or a colleague to help the individual build on their own reasons for becoming more active and make them more likely to sustain successful behaviour change in the long term.

The arrangement of a follow up appointment would also be appropriate for those people deciding not to become more active yet, but who want to ‘think about it some more’.  The follow up appointment could be face to face but could also be via telephone or text.

Did you know?

Local parks offer a great opportunity to be active for free

Deconditioning from inactivity can start a vicious cycle: understand how to break it

For most people any increase in physical activity is encouraged. In order to benefit health, research has shown that activities need to be of at least moderate intensity. For most people, this will mean experiencing an increased heart rate and breathing rate during the activity.

Real impact

“Staying physically active and mentally engaged appears to reduce the risk of dementia”

“I would like a group with people of a similar age and issues to me.”

“What is good for the heart is good for the brain – evidence that the same sort of exercise that benefits cardiovascular function, also reduces the risk of dementia”

Signpost support organisations

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There are some great, free resources available here and on other websites by people who understand what it’s like living with your condition if you’d be interested to have a look

Support organisations
We Are Undefeatable

“We Are Undefeatable” is a national campaign by 15 leading health and social care charities to inspire and support people with long-term health conditions to build physical activity into their lives, in a way that suits them.

Insight

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People may or may not be interested in accessing information and support groups, but they can offer unique support for people contemplating physical activity behavioural change with their condition. Particularly given the range and reliability of information on the internet, trusted resources are important to highlight.

Did you know?

Local parks offer a great opportunity to be active for free

Deconditioning from inactivity can start a vicious cycle: understand how to break it

For most people any increase in physical activity is encouraged. In order to benefit health, research has shown that activities need to be of at least moderate intensity. For most people, this will mean experiencing an increased heart rate and breathing rate during the activity.

Real impact

“Staying physically active and mentally engaged appears to reduce the risk of dementia”

“I would like a group with people of a similar age and issues to me.”

“What is good for the heart is good for the brain – evidence that the same sort of exercise that benefits cardiovascular function, also reduces the risk of dementia”