Facilitating participation and improving the quality of life: People with dementia benefit from athletic activities because sport helps to improve both physical as well emotional and mental health. It improves walking ability and gait performance but also memory and concentration for example. A pilot project in North Rhine-Westphalia (NRW), Germany has now attempted to make this effect last with concerted group activities.
Dr. Georg Schick
Dr. Georg Schick from the BRSNW Disability and Rehabilitation Sports Association (German: Behinderten- und Rehabilitationssportverband Nordrhein-Westfalen) was the managing director of the pilot project (from 2014 to 2016) and has accompanied the "Sport to Engage People with Dementia" (German: Sport für Menschen mit Demenz) project together with a number of partners. In this interview with REHACARE.com, he describes the sustained successes of the pilot project.
Dr. Schick, what role does athletic activity play in the daily lives of people with dementia?
Dr. Georg Schick: It still does not play a big enough role yet. People affected by this disease tend to experience a loss of initiative and an intrinsic lack of motivation. They withdraw and reduce or stop their social activities altogether. That’s why it is essential that people with dementia are encouraged in a group setting, so they obtain external stimulation that motivates them to move.
How did the "Sport to Engage People with Dementia" project come about?
Dr. Schick: For more than 60 years, the core objective of the BRSNW has been to focus on movement and athletic activities for people with disabilities and chronic illnesses. People with dementia became an emphasis for us because organizations approached us with specific requests. For example, some members of a local orthopedic group experienced signs of dementia. This prompted questions like: What can we do to help? Can these members stay? Can we educate ourselves? Can you help us? This gave us the initial spark four or five years ago to undertake this pilot project with the support of the Regional Sports Association of NRW.
And that’s also why we created training and continuing education structures. For example, in sports rehabilitation, "neurology instructors" are trained to guide people with dementia later on.
In addition, we specifically promoted tandem arrangements at the community level, which include one athletic partner and one who needs care and support. Right from the start, is was very important to us to incorporate both the sports expertise as well knowledge from the care sector and dementia counseling into this endeavor. In doing so, we were able to jointly develop sports programs that integrate and reflect the lifestyle of people with dementia.
What were you able to accomplish in the past three years?
Dr. Schick: Our goal was to establish at least 40 local tandem partnerships and to create a joint exercise and physical activity program. But then we ended up with 74 local projects right from the start. Five of them dropped out and five took their place. What’s more, in the past three years we were also able to ensure that they continue to stand on their own feet – from an organizational, financial and staff aspect.
Many people with dementia are particularly fond of sports activities with music and dance.
What are some actual sports options for people with dementia?
Dr. Schick: All disciplines are basically an option. The selection ranges from strength training, balance training, games, dance to walking. As it pertains to sustained participation in group events, enjoyable activities such as joint matches or music activities have proven especially successful. That’s why we take a very personal approach and address people at the relationship level. The objective is to elicit positive emotions through playful activities that people haven’t engaged in for some time: music, games, and dance are activities where people feel very positive about themselves and the group setting.
Even though tough physical training would basically also be an option, it tends to be discouraging, especially for beginner athletes. Having said that, it might obviously be perfect for people with dementia who have an athletic background. Needless to say, they want to continue to be physically challenged even after their diagnosis.
Have you ever had such a case?
Dr. Schick: Yes, we had a 52-year-old triathlete. She is a competitive triathlete and wanted to continue her training but needed assistance while training in the woods to make her way out again. Luckily we had a colleague at the Dementia Service Center Bergisch-Land, Arnd Bader, who is also a triathlete. He took on the task.
What role do family caregivers play in this project?
Dr. Schick: If you don’t win over family caregivers, you also won’t reach the people who are affected by dementia. Some family members would also like to join in on the activities. There are groups with one on one care where seven affected patients and seven family caregivers exercise in a tandem arrangement.
That being said, sometimes family caregivers just want respite and relief. That’s when we involve specially trained volunteer assistants, dementia companions or caregivers. This option is mostly utilized by those family members who are personally very stressed on a physical and mental level.
In some instances, the athletic options for people with dementia are complemented by options for family caregivers: relaxation classes, back therapy training, discussion groups, hiking or walking groups. Those subsequently turn into virtual support groups where you can compare notes with other family caregivers.
Depending on the physical condition, very different sports activities are suitable for people with dementia.
Could this project also inspire imitation by other areas in Germany?
Dr. Schick: We already had several inquiries from other German states such as Rhineland-Palatinate, Hesse or Mecklenburg-Vorpommern. To that effect, the project also appeals to areas outside of NRW – not just as far as representing our project contents is concerned but also as it pertains to the scientific support by the TU Dortmund, which has evaluated and documented these findings. For example, Professor Monika Reichert and her scientific assistant Veronique Wolter also present their evaluation at national and international conventions and events and educate the scientific community about the pilot project.
Can this concept promote an increased social participation of people with dementia?
Dr. Schick: Absolutely! This has also been one of our mottos: health, quality of life, participation. It has been the focus of the project. Needless to say, we have not transformed all of NRW yet. However, the pilot project was inspiring and we have raised awareness for the subject. We had activities where 1,500 participants joined in. This was especially the case with inclusive group events.
We were also able to reach a large number of instructors with our structures. Approximately 1,000 course participants attended 67 advanced training courses and in-house classes. We enjoyed over 500 visitors at our nationwide workshops. This proves that we didn’t just sporadically affect the grass-roots level, we actually achieved great coverage with 74 local projects.
Now the goal is to frequently tend to these tiny beacons, these tiny seeds, to ensure that they will experience sustainable growth. And although we are still at the very beginning, we feel very encouraged. Inclusion in and through sports is a tough nut to crack but we keep at it.