Perceived Barriers to Exercise among Older Adults with MCI and Early Dementia

Abstract

Increasing evidence suggests that exercise can benefit physical and cognitive function among older adults with mild cognitive impairment (MCI) and early dementia (MCI/dementia). Unfortunately, many older adults with MCI/dementia are not sufficiently active to achieve these benefits. Older adults with MCI/dementia experience barriers to exercise, some of which may be shared with older adults in general. There are likely to also be factors unique to their condition. Further, the social-ecological model (SEM) suggests that characteristics of the social and physical environmental factors may interact with individual factors and play important and dynamic roles in influencing health behaviours, including exercise. The objective of this study was to explore and characterize the perceived barriers, motivators, and facilitators to exercise among community-dwelling older adults with MCI/dementia guided by the SEM as a framework, from the perspectives of both older adults with MCI/dementia and their care partners. Additional objectives were to explore the perceived acceptability of exercise options among older adults with MCI/dementia and their care partners and to explore the supports and accommodations that may be needed to create inclusive conditions for persons with MCI/dementia to participate in community-based exercise programs. Ten older adults with MCI/dementia and 7 care partners were conveniently recruited to the study. Perspectives, experiences, and opinions of both persons with MCI/dementia and their care partners regarding exercise among persons with MCI/dementia were gathered qualitatively through four focus group discussions. Focus groups ranged in size from 3 to 6 participants. Pairs of focus groups, one for each participant group, ran simultaneously with a separate moderating team for each group. Group discussions were audio-recorded, transcribed verbatim, and reviewed to ensure consistency. Data analysis followed the general inductive thematic approach outlined by Braun and Clarke (2006). Thematic analysis revealed a complex and dynamic interplay between factors across levels of the SEM influencing exercise behaviour among persons with MCI/dementia. Key themes indicate that persons with MCI/dementia and their care partners viewed exercise as a positive, meaningful, and beneficial activity that had physical, mental, and social benefits. However, several barriers to exercise participation emerged including low intrinsic motivation, physical and mental health challenges and stigma against dementia. Despite challenges to engage in exercise, external support at the individual and community level could help overcome barriers. Low motivation to exercise among persons with MCI/dementia could be mediated by encouragement from their care partners and availability of enjoyable, social exercise opportunities. By providing transportation and acting as an exercise companion, the care partners could also help the person with MCI/dementia’s physical and cognitive limitations. Further, access to exercise opportunities that meet the individual physical and mental needs of the person with MCI/dementia could reduce the negative impact of physical and mental challenges experienced by persons with MCI/dementia on exercise engagement. The results suggest that increasing availability of preferred exercise opportunities, such as walking outdoors and exercise in social settings with others with whom they identify, is likely a worthwhile venture that may motivate and enable exercise among persons with dementia. Future research should determine and assess strategies to augment motivators and facilitators to exercise and reduce barriers, especially at the social and community-levels. Results should, however, be interpreted with caution as this study included primarily active participants from a single region and future studies should specifically target persons with MCI/dementia who are sedentary and from broad social and geographical environmental, as the factors that influence exercise are likely to be different.