Factors influencing adherence to home-based strength and balance exercises among older adults with mild cognitive impairment and early dementia: Promoting Activity, Independence and Stability in Early Dementia (PrAISED)

Hancox, Jennie E.; van der Wardt, Veronika; Pollock, Kristian; Booth, Vicky; Vedhara, Kavita; Harwood, Rowan H.

Abstract

Background
Older adults with dementia are at a high risk of losing abilities and of accidental falls. Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is a 12-month person-centred exercise and activity programme which aims to increase activity and independence whilst reducing falls in people with early dementia. In this patient group, as well as many others, poor adherence to exercise interventions can undermine treatment effectiveness. We aimed to explore patterns of barriers and facilitators influencing PrAISED participants’ adherence to home-based strength and balance exercises.

Methods
Participants were a subsample of 20 individuals with mild cognitive impairment or early dementia and their carer(s) taking part in the PrAISED programme. Participants (with the support of a carer where necessary) kept a daily exercise diary. Participants’ adherence were categorised based upon reported number of times a week they undertook the PrAISED strength and balance exercises over a 4 month period (5 = exceeding adherence expectations). Semi-structured interviews were conducted in month 4 of the PrAISED programme to explore barriers and facilitators to adherence. A mixture of deductive and inductive thematic analysis was employed with themes categorised using the Theoretical Domains Framework.

Findings
Participants completed on average 98 minutes of home-based strength and balance exercises per week, 3.8 sessions per week, for an average of 24 minutes per session. Five participants were categorised as exceeding adherence expectations, 7 as meeting adherence expectations, and 8 as low adherers. Analysis of interview data based on self-reported adherence revealed six interacting themes: 1) routine, 2) practical and emotional support, 3) memory support, 4) purpose, 5) past experiences of sport and exercise, and 6) belief in and experience of benefits.

Conclusions
Identifiable cognitive, psychological, and practical factors influence adherence to exercise, and should be addressed in future development of interventions with this population.

Citation

Hancox, J. E., van der Wardt, V., Pollock, K., Booth, V., Vedhara, K., & Harwood, R. H. (2019). Factors influencing adherence to home-based strength and balance exercises among older adults with mild cognitive impairment and early dementia: Promoting Activity, Independence and Stability in Early Dementia (PrAISED). PLoS ONE, 14(5), https://doi.org/10.1371/journal.pone.0217387

• Journal Article Type: Article
• Acceptance Date: May 10, 2019
• Online Publication Date: May 23, 2019
• Publication Date: May 23, 2019
• Deposit Date: May 17, 2019
• Publicly Available Date: May 29, 2019
• Journal: PLoS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 5
• Article Number: e0217387
• DOI: https://doi.org/10.1371/journal.pone.0217387
• Public URL: https://nottingham-repository.worktribe.com/output/2060972
• Publisher URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217387