Dementia

It is a syndrome that damages various cognitive functions caused by organic damage and has had a severe impact on work, life, and social interaction. Also called progressive memory impairment. Etiology and evaluation. The factors of memory impairment can include temporary causes, permanent sequelae, and advanced brain diseases. Temporary causes include TGA, TIA, transient cerebrovascular accident, mild brain injury, sleep disorders, drugs, drugs, or various mental health diseases. Permanent consequences include brain damage, encephalitis, cerebrovascular accident, hepatic encephalopathy, various mental illnesses, etc. The influencing factors of memory impairment include hypotension, infection, emotional stimulation, metabolic disorders, nutrition, etc. Dementia is divided into mild, moderate, and severe dementia. Symptom: 1. Memory impairment or forgetting recent events. 2. At least one disorder: aphasia, agnosia, apraxia, or interruption of executive ability. 3. Impairment of consciousness, such as looking forward. (What is AD, 2021;

Hallikainen et al, 2021)

9 2.2 Elderly people

The World Health Organization (WHO) defined that a person who has reached 60 years of age as an "elderly person." However, due to people's emphasis on health and the improvement of other living conditions, the population's life expectancy has become an increasing trend. The Higher Population Council on September 30, 2021, called for a redefinition of "elderly people"

and emphasized the improvement of health care and nursing work for the elderly. (Amman, 2021)

2.3 Aerobic exercise

Aerobic exercise means cardiorespiratory activities—for example walking quickly, jogging, running, bicycling, swimming, and dancing; these kinds of exercise stimulate 60–70% of most heart rates for 20 to 30 minutes or more. Effects aerobic exercise help re-synthesis of high energy compounds in the presence of O2, improves circulation, regulates weight, and controls glucose levels. (Miller-Keane Encyclopedia and Dictionary of Medicine, 2003)

Aerobic exercise is these kinds of types: swimming, walking, jogging, cycling, rowing, dance, and golf walking. Regular exercise is one of the best things for our health, and it may benefit, including improving people's overall health and fitness and reducing patients' risk for many chronic diseases. Aerobic exercise increases people's breathing and heart rate; it keeps the heart, lungs, and circulatory system healthy; To improve balance, they make it easier and safer to walk on uneven surfaces and help prevent falls, especially for older people. (Lee, S.

M., Joung, J. & Shin, S. H. 2020; Miller-Keane Encyclopedia, 2003; EBM Guidelines, 2015)

3. Aims and Objectives of this study

3.1 The study aims to explore safe and effective exercise ways to help older with Alzheimer's disease.

Dementia, and one of the primary types of dementia-Alzheimer's disease, are all listed in one of the top 10 death underlines causes worldwide. With the people's lifespan increasing more and more, especially over 65 age, Alzheimer disease numbers also raised quickly worldwide.

They are living with their loved ones, or caregivers, how to help them take efficient methods to prevent or slow down disease deterioration; How to maintain the quality of their life and protect their self-esteem? Modern medicines in the medical institution are the primary choice. Besides medicines, much research confirmed that aerobic exercise could postpone Alzheimer's symptoms worsen, improve balance, and prevent falling risk, keep body

10 foundation ability, stimulate the circulatory system, and even improve chronic diseases and underlying diseases. While what kind of aerobic exercise is suitable, efficient, and safe for older people? These are necessary and urgent problems to result. (NIA, 2021; EBM Guidelines, 2015)

3.2 The objective is to study the effectiveness of aerobic exercise in improving Alzheimer's disease from medical costs and risks.

Whereas it verified that medical treatment after disease might reduce disease progression and mortality, increases in disease prevalence will increase the population's total disease burden and healthcare cost. The modern approach to AD treatment may not be cost-effective in societies with extreme disease rates such as AD. A low-cost, low-risk intervention strategy with dual applicability for older people's prevention is likely advantageous. (International Journal of Alzheimer’s Disease, vol. 2012) Aerobic fitness can become a reliable public health tool to combat AD risk. Such a low-cost, low-risk effective strategy is likely to reduce disease burden and avoid the older adults at increased AD risk. Therefore, this paper aims to enhance scientific discussion on the role of aerobic exercise in the development of AD and related dementias and add clarity to the clinical utility of fitness adaptation in preventing AD in those at risk. (Lu W, et al, Frontiers in Aging Neuroscience. 2020; Asian News International, 2021) 3.3 Research Questions

What Aerobic exercise care for old peoples with Alzheimer’s disease? And what kinds of aerobic exercise can improve elderly people with AD?

4. Methodology 4.1 Data Collection

When searching for materials and documents in this literature review, the primary method is to enter "Laurea LibGuides" through Laurea's school homepage, then enter "Nursing," search for keywords in the trusted information search portal, and then set the time range if 12 months later. The recommended literature titles are screened, and the preliminary screening results are retained.

Searching for the keyword "Alzheimer's Disease" in "EBM Guidelines" yielded 15 results. Three usable results after screening.

11 In "ProQues Central" 5535 results were obtained by searching the keyword "Alzheimer and Aerobic exercise and Elderly people," 541 results were obtained after setting the time, and 6 usable results were obtained by title screening.

Searching for the keyword "definition of elderly" in "ProQuest Central" got 16 results and 1 usable result after filtering by title.

Reliable books and resources from websites are also used to collect materials.

Database Keyword Results Preliminary

accepted

The research method of this literature review is a comprehensive method of descriptive study by collecting literature reviews. The flowchart in Table 2 describes the specific screening method and review process.

First, search by keywords, and include the search range of "titles, keywords, abstracts, full text, periodicals, magazines, newspapers, publishing houses" in the database. Use the time to screen out the available documents in the most recent year and get 547—available

preliminary documents and 10 creditable books and websites after the title screening. Then evaluate the abstract and research methods and use 10 articles and 10 creditable books and websites.

12 Table 2: Database search results

When the resources that can be included in the study are determined, the author, year, and relevant important information are extracted, the subject content and the screening method of summary analysis are used to evaluate the availability of each resource, and a total of 20 resources are available. Among them, the 15 Quantitative articles used the 4 Qualitative articles, and one mixed article was used.

AUTHOR/YEAR SOURCE DATABASE METHODOLOGY

1 Miller-Keane Encyclopedia and Dictionary of Medicine,

2021

Medical dictionary Qualitative

2 SyndiGate Media Inc, 2021 ProQuest Central Quantitative

3 Remes et al. 2020 EBM Guidelines Quantitative

4 Chen et al. 2020 ProQuest Central Quantitative

5 Merja Hallikainen, 2015 EBM Guidelines Quantitative

6 YLE, 2021 Yle Quantitative

13

7 Amman, 2021 ProQuest Central Quantitative

8 Hallikainen et al. 2021 EBM Guidelines Quantitative

9 Fact Sheet, 2021 NIH Quantitative

10 Srinivas et al. 2021 ProQuest Central Quantitative 11 Basic of AD and Dementia,

2021

NIH Quantitative

12 What is AD, 2021 NIH Quantitative

13 Treatment AD, 2021 NHS Quantitative

14 Official Statistics of Finland, 2019

OSF Qualitative

15 Sok S et al. 2021 ProQuest Central Quantitative

16 Thomas O. Obisesan et al.2012

ProQuest Central Quantitative

17 Tao J et al.2017 ProQuest Central Quantitative

18 Kati Juva, 2021 Medical book Duodecim Qualitative&

Quantitative 19 Publisher: People's Sports

Publishing House, 2009

Book Qualitative

20 Parle M, 2005 Book Qualitative

Table 3: Analysis of the Data included in table

14 5. The effect of Aerobic exercise for older adults

5.1 Dance

Dance can improve brain volumes, a reach from the 6-month intervention for over 65 people that produced higher cognitive functions, such as operating memory and concentration, hence attenuating the age-related cognitive decline. Dance among older adults showed more

significant brain volume improvements, which focused on aerobic exercises, anaerobic strength, and stretching exercises. The result could be attributed to the multi-faceted nature of dance, encompassing spatial orientation, movement coordination, balance, endurance, interaction, and communication. Six months of dance intervention was performed for a group of elders. There were remarkable changes in terms of attention and cognition between the intervention and control groups. The corticospinal tracts in the group developed that underwent intervention (Gulyás B, Brain Scicen, 2021). Dance training is excellent for repeated physical exercise in inducing brain plasticity in the elderly.

5.2 Swimming

Swimming is a great aerobic activity, whatever older adults or children are benefited from it.

Regular swimming stimulates the maintenance and promotion of brain functions. The

underlying physiological mechanism for the improvement of memory appears to be the result of enhanced neurogenesis. Through a group of rodent’s animals’ investigation, that

underwent swimming regularly for 30- days. These research findings reinforce the concept that a well-planned exercise program would greatly help the aged citizens with or without Alzheimer’s disease improve their cognitive functions. (Parle M, 2005)

5.3 Fumanet

Fumanet, or square stepping exercise (SSE) is a type of fumanet task stepping one by one;

Fumanet, or square stepping exercise (SSE), is a task that steps one by one. It was influential in balance, gait, lower extremity muscle strength, memory recall, and concentration in the elderly with dementia or mild cognitive impairment. (Kim M. Effects of Cognitive, 2021) SSE includes multiple directional step patterns played on a small mat partitioned into squares 25 cm2 each and may include toe walking or a complex walking pattern as a progression.

People can also operate indoors, so it certainly appears beneficial over unidirectional and outdoor walking, which is less beneficial for fall prevention. SSE strengthens both legs' quadriceps and hamstring muscle and enhances balance.

15 Figure 1. The basic and task steps of humanet exercise. (mdpi.ijerph.18157848)

Physical-cognitive dual-task interventions for older people have proven efficacy in improving physical health (lower extremity muscle strength) and cognitive function (especially

executive function). Fumanet also promotes health status, decreases depression, and

increases life satisfaction by preventing and delaying dementia and balancing growth. (Kim M.

Effects of Cognitive, 2021)

16 Figure 2. The composition of cognitive/exercise dual-task program.

(mdpi.ijerph.18157848)

The span and frequency of application of SSE to obtain advantages were at 8 to 12 weeks, twice a week, and 40 to 50 min per session in previous studies. (Kim M. Effects of Cognitive, 2021)

5.4 Tai Chi Chuan and Baduanjin

Tai Chi, a national intangible cultural heritage, is based on the traditional Chinese Confucian and Taoist philosophy. Tai Chi has multiple functions, such as temperament maintenance, physical fitness, combat. Tai Chi combined with the internal and external, soft, slow, light, and flexible, rigid, and soft.

Ba Duan Jin is a set of independent and complete fitness exercises. It has been recorded as early as the Northern Song Dynasty, and it has a history of more than 800 years widely spread.

Chinese people loved it so much. Through the practice of Ba Duan Jin and paying attention to

17 the appearance and movement, it is also necessary to cooperate with the mind-keeping, breathing, and the sense of enlightenment of the movement. There are no necessary types of equipment and site requirements to practice Ba Duan Jin. The complete set of exercises is only more than 10 minutes, and people can do it every morning and evening.

A study compared how 12-weeks of Tai Chi Chuan and Baduanjin exercise can change brain structure and memory function in older adults. Conclusions noted that both Tai Chi Chuan and Baduanjin could significantly increase grey matter volume (GMV) in the insula, medial

temporal lobe, and putamen after 12-weeks of exercise. Ba duan jin also advanced cognitive control, attention, touching, and comprehension memory. (Tao J, A brain imaging study.

Alzheimer’s Dis. 2017) The book《Tai Chi Exercise》 elaborates on the physiological health effects of Tai Chi; To prove the health benefits of Tai Chi, Beijing Sports the Institute of Medicine has conducted more detailed medical examinations on older adults aged 50 to 89.

Among them, 32 are regular taijiquan, and 56 are normal elderly. The results of comparative observation prove that the former elderly is in better condition than the average elderly in terms of physique, cardiovascular system function, respiratory function, bone marrow system, and metabolic function." （People's Sports Publishing House, 2009）

6 Discussion and conclusion of study

6.1 Discussion about existing problems currently

This literature review aimed to review the qualitative literature on aerobic exercises profits in Alzheimer's disease with elderly, and how maximum maintain elderly independent body ability foundation and help them prevent falling down risk. The focus of this article was to identify qualitative research in the relationship between exercise and Alzheimer's old people.

Even though some studies and reports involved in the mice with dementia or healthy people over age 60 into experimental, the outcome research is still the valuables for knowing advanced aerobic for dementia, which helps the caregivers know base-evidence knowledge and apply efficient application assistances. This study is the same user for all those living with AD's old people. Besides that, it would be beneficial to warn young people and other age healthy that a healthy lifestyle and regular exercise can delay the cognition degenerating with the increase the age growing and reduce the risk of getting dementia.

18 Investigate the aerobic exercises improves for all people and not focus on only people who have Alzheimer's. The literature review results made it possible to understand the barriers in the rehabilitation, although the number of research studies was small. All studies focused on hoping to find a way to reverse the decline of cognition. However, as far as currently, not enough evidence signed aerobic exercises can cure Alzheimer's.

Although people already know taking regular exercises enhances Physical coordination ability and personal mobility, some obstacles are limiting elderly with AD often exercises.

1) age

Almost 85% of Alzheimer's patients are over 65 years old. During this age, people would like to stay at home or live in a nursing home. They are lack energy and inactivity; fatigue is one of the significant symptoms around them. Alzheimer's older more often with the other primary foundation disease, for example, high blood pressure, diabetes, insomnia; for these reasons, patients must take some drugs, which arouse sleeping or calm dawn. So, it is hard to let an older with Alzheimer's keep in mind exercises and effective implementation.

2) the progression of Alzheimer's disease

Alzheimer's disease is divided into three levers, mild degree, moderate degree, and severe degree. It is worth pointing out that patients with a moderate degree of Alzheimer's disease will experience different hallucinations, difficulties activity in daily living (e.g., dressing, washing). (EBM Guidelines. 2020) Serve degree shows impaired or lost comprehend speech;

limbs stiffen; The ability to walk will deteriorate and be lost; Urinary and fecal incontinence develop.

Epileptic seizures may sometimes occur.

The patient is no longer able to cope with activities of daily living (dressing, washing, toileting, and finally eating). (EBM Guidelines, 2020) because of the above two physical conditions, it is not difficult to imagine that aerobic exercise will encounter great difficulties and even bring injuries to patients. Then, the problem is obvious. The implementation of aerobic exercise is only suitable for Alzheimer's patients at the early stage or mild patients.

3) the ratio between caregivers and residences

In Finland, some caregivers and resident’s ratio are 1:6, weekend, or some worksheet maybe 1:8. Work time from usually morning 7 to 15:00 (morning worksheet), afternoon worksheet from 13:00 to 21:00; working responsible for the following:

19

Time working

7 am Worksheet report/morning washing (change diaper)/ dressing 8:30 Breakfast/ feeding/medicines/ cleaning/other

11:00 Launch/ feeding/medicines/ cleaning/ other 14:30 Coffee time/ feeding/medicines/ cleaning/ other 16:00 Dinner/ feeding/medicines/ cleaning/ other

19:00 Supper/ feeding/medicines/ night washing (change diaper) / change dressing/cleaning/ other

21:00 Worksheet report/ care record completed Table 4: The caregiver's work schedule

The daily tedious essential life nursing work has taken up time; no extra staff and time to complete this job; the safety of older residents with Alzheimer's disease should be

considered. At least one caregiver helps an older adult perform effective aerobic exercise.

Each aerobic exercise lasts at least 30 minutes and is guaranteed every day. There must be a more dedicated person responsible for this job and the whole 8 hours help 16 residents no rest.

The whole Finland society needs to hire more than 30,000 nurses by 2030 to meet the

requirements of an aged population, and the government advised to re-edit obligations of the law on social and healthcare services for the elderly. （Yle.fi,2021）

Finland plan to set the lowest nursing ratio for care at old-age institutions at seven caregivers for every ten residents. But the reality is that there is a severe shortage of nursing staff, the existing workload has overloaded, and there is no longer possible to help patients with necessary aerobic exercises.

20 6.2 Ethical Consideration, Reliability, and Validity

This study considered the relevant ethical considerations, ensuring that no harm, no voluntary participation, that anonymity, confidentiality, and consent was adhered to where necessary.

Authors qualitatively reviewed reliable resources, for example, EBM Guidelines, ProQuest Central, WHO. This study mentioned methods rigorously to assure replicability and seldom cost. The research data’s support result's validity. The nurse and their loved ones could carry out confidently these recommendations for Alzheimer's in their daily lives.

Considering that our research target group is Alzheimer's elderly people, authors remind nurses, and other relative caregivers, including older' family members, must consider the law and financial planning with dementia. For example, a will, living trust, an advance directive.

Start the discussion early, make and gather essential documents, review the plan regularly, and update the needed records.

6.3 Conclusion

This study identified the qualitative literature on Alzheimer's disease and the aerobic exercise relationship. The literature review result also identified what kinds of exercise are suitable for the elderly residents with AD. the research shows that after about 26- weeks of aerobic exercise training, older adults' memory biomarker, myokine Cathepsin B (CTSB), increased.

CTSB is a lysosomal enzyme secreted from muscle, enters circulation after exercise. CTSB relates to memory function and adult hippocampal neurogenesis. Older peoples with cognitive impairment have lower serum and cerebellum CTSB levels. "The positive association between CTSB and cognition, and the substantial modulation of lipid metabolites implicated in dementia, support the beneficial effects of exercise training on brain function and brain health in asymptomatic individuals at risk for Alzheimer's disease," said van Praag. (ANI，

2021)

The findings of this literature review led to the following conclusions:

1）Keep the planned and regularly Aerobic exercise for Alzheimer’s diseases, evidence presents the Aerobic exercise can help delay patients’ dementia degenerate.

2）Aerobic exercise promotes health status, decreases depression, and increases life satisfaction by preventing and delaying dementia and balancing growth.

21 3）Maintain long-term mild and routine exercise, stat at any age, we could delay the aging progress of our brain.

So far, the medical profession has not found a way to stop the memory and cognition losing of Alzheimer’s.

As The World Health Organization wards that dementia challenges, the number of dementias is growing to 78 million by 2030 and 139 million by 2050. Furthermore, the cost because of dementia is estimated to be US$ 1.3 trillion in 2019; this cost will be increased to US$ 1.7 trillion by 2030. (WHO,2021)

However, the lack of caregivers is a critical and acute problem currently. sufficient caregivers Prerequisites to solve this problem.

22 List of Abbreviations and acronyms

WHO-World Health Organization AD-Alzheimer's disease

OSF-Official statistics of Finland

OSF-Official statistics of Finland

In document Aerobic exercise care for older peoples with Alzheimer's disease －Literature Review (sivua 8-0)