Sport, physical activity and dementia

On Thursday 16^th July nearly 150 people joined members of the Association for Dementia Studies team and the Senior Physical Activity & Adapted Sport (SPAAS) team for a webinar on ‘Sport, physical activity & dementia: Discussions for practice from the University of Worcester’.

Welcome

The webinar was opened and chaired by Dr Yvonne Thomas from the University’s School of Allied Health and Community, welcoming everyone and setting the scene for the rest of the session.

The experiences of people with dementia engaging in sport and physical activity within their local community leisure and fitness centre

Up first was Dr Chris Russell who presented on his recent PhD. Following an initial literature review of existing evidence and a scoping survey, Chris’ research focused on four people with dementia who participated in activities within three community leisure and fitness centres, giving the opportunity to get an in-depth understanding of their experiences. Using a participatory approach meant that Chris found himself joining in a variety of different sporting activities during his study.

From his work, Chris used insights from the study participants to identify four core themes relating to identity:

• Sociability
• Resilience
• Freedom
• Authenticity

Engaging in the sports activities enabled people with dementia to continue to form their identities in a way that is aspirational and forward looking, focusing on what they were still able to do rather than what they had lost. Consequently, this helped people to adjust to living with dementia. Chris was able to contextualise his findings and the interactions between different in the following diagram. Rather than trying to explain it here, please listen to the recording of the session to hear Chris talking you through it.

It’s always difficult to summarise a PhD in a few words, but Chris pulled together a set of key conclusions and recommendations for us to consider. In relation to the third point in particular, Chris felt that his research showed the importance of empathetic facilitation on the part of the Workers within Centres as they engaged alongside participants living with dementia. Fundamental to this was the quality of the welcome offered, active listening, and the building of rapport. These are skilled and nuanced aspects of practice, requiring careful thought and anticipation. The research provided insights into these elements, and forthcoming publications will offer more detail.

Sport reminiscence: lessons for practice from the experiences of women affected by dementia

Chris handed over to Becky Oatley who is part way through her own PhD. After giving a brief overview of sport reminiscence, and indeed reminiscence more broadly, Becky talked about her reasons for focusing specifically on the experiences of women. Sport reminiscence was originally designed to engage men in group activities, but this stereotyped notion can be unhelpful and exclusive for women living with dementia and female carers who attend such groups. Becky’s work is therefore trying to bring some of these unheard female voices to the fore.

Four main themes have emerged from Becky’s work. Firstly, social activity is the key draw that brings women to these sorts of groups. Even for women with a particular interest in sport, it’s the opportunity to meet new people that motivates them. However, the sporting environment may be helpful in terms of being more removed from the stigma of other services for older people.

Secondly, sport reminiscence activity itself – particularly when using objects or other non-verbal options – was often limited during sessions and could be an exclusive activity. Often, sessions can revolve around group discussions or quizzes that people with dementia may find it hard to participate in, especially if conversation is dominated by key individuals. The pace of conversations and group sizes can also exclude people who cannot keep up with conversations, leading to them being overlooked or even dismissed.

Thirdly, as a result of the previous point, group activities were often better suited to carers. This could have the additional impact of people with dementia being further excluded if they relied upon their carer to support them to participate, as they may be too caught up making the most of the peer support opportunity with fellow carers. The social needs of the carer and the person with dementia could therefore be in conflict, and without enough staff or volunteers to offer additional support it is likely to be the person with dementia who is excluded.

The fourth and final theme was that sport is a loaded context with cultural assumptions, but can be a meaningful topic for some women. During sessions many women dismissed their own connections to sport as irrelevant, when in fact they were actually significant and meaningful in their own right. Whether this was through playing typically ‘female’ sports (e.g. hockey or netball), supporting their husbands or children, or being a keen sportsperson themselves (e.g. champion motor sports competitor), sport-related memories can offer the opportunity for women to share aspects of their own identities. This can be really important for someone whose identity or sense of place in the world might be threatened by the stigma or dementia or old age.

Becky ended her session by presenting the following four key lessons for practice. As Becky’s PhD is still in progress, more is likely to come out of her study as new threads emerge and evolve, which is an exciting prospect.

Physical Activity Delivery – Practitioner Insight

Taking over from Becky were Dr Susie Scriven, University of Worcester Director of Sport Partnerships & Community Engagement, and Tom Howard, University of Worcester SPAAS Officer. For background, a core objective of the SPAAS programme is to educate clients to understand their level of health and well-being, then accept personal responsibility to manage the ongoing pursuit of a healthy, active lifestyle. The SPAAS instructors expect to lead each client on a personal health journey, aimed at overcoming social stereotypes such as “I’m too old” or “I haven’t played sport in 50 years”. They educate clients that age has little resonance with personal independence and active daily living.

Susie and Tom shared their experiences from delivering adapted physical activity sessions with groups of older people living with dementia in Meeting Centres and dementia cafes across Worcestershire. Despite being experienced instructors, they freely admitted feeling out of their comfort zone as they had not previously worked with clients with dementia.

Tom presented an overview of their experience of the sessions, having to contend with joining groups when other activities were already taking place, a variety of less-than-ideal room sizes, flooring and seating, people who did not necessarily wish to participate, and different behaviours and symptoms of dementia. Circumstances meant that ‘live risk assessments’ had to be carried out, and physical activity being adapted on the fly to reflect the abilities of the group. Sessions tended to last 45 minutes, and combined music as a mood enhancer and a range of equipment such as bands, balls and beanbags of various sizes, shapes, textures and weights.

In the second part of the presentation, Susie reflected on their preconceived expectations as instructors, versus their actual experiences during the sessions. For example, as instructors they are used to arriving first and being able to set everything up, so arriving during ongoing sessions made them feel mildly uncomfortable. Similarly, clients normally choose to attend sessions, whereas the people with dementia in the existing groups were often unaware why the physical activity sessions were happening. Communication and interaction between the instructors and clients was also different from the norm, with the people with dementia not always being able to discuss health conditions, understand and appreciate instructions or follow the plan as intended. Instead, they may take part in a way that suits them. Instructors are also used to progressing sessions week on week, but in reality found it better to be prepared to deliver each session as if it was the first.

To conclude their presentation, Tom and Susie shared some very honest reflections on their experiences. A particular highlight was that instead of feeling appreciated and getting a boost by people clapping their thanks at the end of a session, in practice they might have had a bit of chat and feedback with a couple of carers, but everyone else would head off for lunch as a more interesting prospect.

Finally, ‘What next’ was considered, raising issues that need to be addressed within the fitness industry as well as practical approaches to take forward in the future.

Concluding thoughts

The session was brought to a close by Yvonne, who put some of the questions raised during the presentations to the speakers. Some of the questions could not be answered during the webinar due to time constraints, but to see a list of the questions and answers, please see Sports webinar – questions and answers.

Barring a few issues with background noise, the session generated a lot of interest and food for thought. Hopefully there were also some networking opportunities taking place in the ‘chat’ facility, with participants sharing their own ideas and suggestions.

If you missed the webinar or want to watch it again, you can access the recording here.

Thanks to all the speakers and everyone involved in the webinar, we hope you found it interesting and it has given you lots of ideas to go away with.

For further information about this webinar, please get in touch at dementia@worc.ac.uk

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