5. The effect of Aerobic exercise for older adults
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
ACE-Angiotensin-converting enzyme inhibitors EBM Guidelines-Evidence-Based Medicine Guidelines NIH-National Institute of Health
NIA-National Institute on Aging GMV-grey matter volume
HPC-The Higher Population Council ACHE-acetylcholinesterase inhibitors CST-Cognitive Stimulation Therapy SSE-square stepping exercise
23 Figures and Tables
Figure 1. The basic and task steps of humanet exercise. (mdpi.ijerph.18157848)
Figure 2. The composition of cognitive/exercise dual-task program. (mdpi.ijerph.18157848) Table 1: Research data table
Table 2: Database search results
Table 3: Analysis of the Data included in table Table 4: The caregiver's work schedule
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