Use “Active Ageing” to age better and reduce dementia risk: part 2

Many people worry about how their physical and mental abilities will reduce as they grow old. Dementia caregivers also worry about their risk of getting dementia.

Ramani Sundaram, a neuroscience research scientist working at Nightingales Medical Trust, has designed and managed the “Active Ageing” program at the Nightingales Trust Bagchi Centre for Active Ageing (Bangalore). It is a holistic program that uses a multi-modal activity-based approach. It is based on the ThinkingFit study conducted in the UK, and aims to bring lifestyle modification and ensure health and happiness of the elderly, thus making ageing a positive experience. The focus is on minimizing the risk of dementia, controlling hypertension, diabetes, and depression, and preventing falls.

This interview series shares information and suggestions for persons interested in ageing well. [note] In part 1, we talked about program and its context and objectives, how participants are assessed before they join, and also listed the three components of the program. The first component, physical activity, was discussed. Below, in Part 2, we discuss the mental and social components of the program and talk about how persons who can’t leave home (like many caregivers) can adapt and use these. We also talk about the use of the program for persons mild cognitive impairment or early dementia.

Dementia Care Notes: Let’s move to the second component of your Active Ageing program, cognitive engagement (mental stimulation). What sort of mental stimulation do you include in this?

Ramani Sundaram, neuroscience research scientist: It is puzzling to see that it is general perception that body needs physical exercise to keep fit while brain fitness is not considered as important.

The brain needs mental exercise to stay active and not deteriorate.

…we work on different cognitive domains (areas) such as memory, concentration, language, perception, speed of processing, etc. Our activities are designed to be both engaging and meaningful. The idea is to make participants do cognitive activities that have positive effects on their daily functions.

In our program, we work on different cognitive domains (areas) such as memory, concentration, language, perception, speed of processing, etc. Our activities are designed to be both engaging and meaningful. The idea is to make participants do cognitive activities that have positive effects on their daily functions. These activities provide long lasting positive effects.

These cognitive areas are vast. There are many combinations that can be used to stimulate skill sets. For example, just looking at memory, we have several aspects to consider and combine, such as activities that improve visual/auditory memory, short term/immediate memory, verbal/nonverbal memory, and working memory. A well-designed program is therefore needed.

Our mental stimulation component is one hour every day, 4 to 5 days a week.

DCN: A variety of activities for one hour daily, most days a week is much more than the single daily Sudoku which many articles claim is all we need to do 🙂 Could you describe your mental stimulation session?

RS: As I mentioned earlier, many cognitive domains (areas) need to be stimulated for different kind of skill sets.

We divide our mental health routine depending on the cognitive domain. We keep selecting a focus for a week, and look at various subdomains of it during the days of that week.

A monotonous activity is not as stimulating as doing a different activity each time. One can do sudoku once in a while, but it is not very beneficial to do it every day. Novelty stimulates the brain better.

For example, in our “memory week”, we take up one subdomain of memory on each day. The subdomains can be visual/auditory memory, short term/immediate memory, verbal/nonverbal memory, and working memory. And in our “Behavioural flexibility activities week”, we would look at things like logical reasoning, decision making, speed of processing, coordination, and attention activities.

The reason behind tapping different activities each time is to do something different. A monotonous activity is not as stimulating as doing a different activity each time. One can do sudoku once in a while, but it is not very beneficial to do it every day. Novelty stimulates the brain better.

The duration of around an hour may sound too much, but if the activity is engaging, participants remain engrossed and even want more. Some activities are paper pencil based, some are Power Point based and some are sign language based. The instructor takes additional effort to make each activity more engaging.

DCN: Are these mental exercises/ activities individual or group-based?

RS: We use both modes. Most of the times our activities are group based, but we also have some individual activities.

For example, say we have group of 15 members, we give each member a different set of unrelated 10 words. Each member has to make a story using these ten words then we divide them into 3 groups. Each group now has 5 different stories. We ask each group to combine all stories in to 1. Now we have three stories which are either enacted as mime /drama. These activities tap the creativity area and also allows members to interact with each other.

DCN: What similar approach or set of activities do you suggest for homebound persons who cannot leave home to regularly attend a program like yours?

RS: There are a set of activities that can be done at home.

One of the simplest activity is to write with a non-dominant hand (use the left hand if you are right-handed, or use the right hand if you are left-handed)…Writing activities can be further divided into mirror writing, reverse writing, and blind writing.

One of the simplest activity is to write with a non-dominant hand (use the left hand if you are right-handed, or use the right hand if you are left-handed). It is a simple, yet very effective activity. Writing activities can be further divided into mirror writing, reverse writing, and blind writing.

Another example is reading a short story and then trying to rewrite it the next day nearly the same way as it was read.

There are many more such activities. For example, one good way to improve attention is doing a “word search” game with a timer on. Another activity is making a word chain (making a new word with ending alphabet of the first word) which may be done using related words or unrelated words. Solving matchstick puzzles, making geometrical shapes with matchsticks, etc., are some other activities to start with.

DCN: Many caregivers ask us about software packages they can use — do you have any comments about them?

RS: Many software packages are available for cognitive stimulation. The activities differ depending on the package. Most of these packages are good but the issue is that there are limited types of activities in each such package. It is therefore advisable to look for packages that have more number of activities and can be upgraded or lowered as per the abilities.

We have found that unlike physical activity, when someone find mental activities challenging they tend to give up, hence it is important to select activities based on interest and speed.

Some activities are available for free in the app stores. While these are not put together as a package, they can be good as standalone activities. Examples are Hangman, Word search, Cows and Bulls, Memory Buzz etc.

DCN: How can we keep adjusting our personal program so that it remains effective as mental stimulation?

RS: Changing a routine and comfort activity might be difficult initially, but it’s beneficial as we go along.

It is not necessary to do all activities at a time. Activities can be assigned weekly. A particular week can be for computer/phone based activity while the next week can be for Sudoku, crossword etc. Sometimes, you can just juggle the routine.

The most important aspect is to find activities that are enjoyable, not just ‘useful’.

The most important aspect is to find activities that are enjoyable, not just ‘useful’. If they are enjoyable they can engage a person for long. Motivation to do them can also be improved by involving family members and friends.

DCN: How do you know if a mental stimulation routine is effective? How would a homebound person know?

RS: We do periodic assessments that help us study the effect of mental stimulation routine.

Sometimes the activities themselves work as assessment tool. Say someone is able to remember 15 items in a memory game, and after three months this participant is able to remember 25. Or someone is able to finish the same cognitive task more quickly. Many times, the participants themselves notice the improvement in their memory. They find they are better at remembering names and words, or are faster in understanding and doing things (better speed of processing).

Similarly, persons doing such mental stimulation activities at home can use tasks to assess their improvement. Take the example of a coding activity where each alphabet is given a number, say A is 1, B is 2 and so on, and the activity requires writing a small paragraph using this numeric code instead of alphabets. Suppose they are doing a coding activity in half an hour now. After a month or two, they can check how much time the activity takes. This will show if there is improvement.

It is important to understand that, unlike physical activity, improvement in mental skills is not as evident to the person or others. But the person can notice the impact through improvement in functional activities, the sort of normal activities they do regularly for themselves or others.

DCN: The third component of your program is socialization. Socializing is often difficult to achieve for someone like a caregiver who is homebound and cannot go out to meet people. Any suggestions for this?

RS: Socialization is perhaps the most important aspect of the program. Meeting different people and talking to them is highly stimulating. This can be challenging for homebound persons though it is surely important for them to socialize.

Some possibilities: Become a member in a club. It may not be possible to go most of the time, but try to start with once or twice a month. Taking part in a group activity is a good way to start. Also. though not the same as face-to-face meetings with persons, options for homebound persons include social media, phone calls, etc.

There aren’t any strict parameters to determine useful social activity; it is only about enjoying or benefiting from the group.

Our elders include introverts and extroverts. When they go out to watch a movie /picnic they all enjoy. Many may still not know each other but being in a group is a positive experience for them all.

DCN: Your program includes seniors with dementia. How have you helped seniors without dementia to understand and feel comfortable with those with dementia?

RS: We start our program by introducing all participants about the need of the program. This includes a brief session on dementia.

Our “active ageing centre and our dementia day care centre are both at the same premises. This enables our program participants to see and understand their peers with dementia. The briefing and continuous information update about dementia and its behavioural aspect also helps the participating seniors to understand their friends with dementia better. We also have get-togethers, parties, and social events that include both sets of members and thus set the stage for interactions.

We have been successful in making program participants understand that seniors with dementia can also contribute in many activities. Our program participants view dementia like any other age-related issue (diabetes, hypertension, etc.), just one where the manifestation of symptoms is different.

DCN: Dementia risk reduction is one of your objectives. Can the physical, mental, and social stimulation of a program like yours reduce the risk of dementia?

RS: Our aim is to work on the modifiable risk factors and reduce the risk of dementia.

Decades of research has shown that vascular risk factors and inactive lifestyle are associated with dementia. It remains a plausible hypothesis that mental stimulation, social engagement and physical activities have a preventive effect on age related conditions. Furthermore, activities of the sort included in our program have been associated with several outcomes like a lower death rate, better cognition, fewer illnesses, and increase in general well-being. An engaged lifestyle during the 60’s has also been associated with a longer life.

Having said that, we have to also understand that a lot more research is needed to understand dementia better. These programs are one of the ways to explore the potential for dementia prevention or achieving better quality of life as people age.

As of now there are some risk factors established for dementia, and our program works to reduce those risk factors. The ThinkingFit research study on which our program is based, has shown encouraging results in risk reduction, and we have been able to replicate similar results in a larger cohort.

DCN: Can your program benefit someone who already has mild cognitive impairment? Or someone with dementia? How is the program adapted for their participation?

…people with MCI/dementia…do many social activities with the other groups, but they do the physical and cognitive activities in this special separate group. This allows us to do the activities according to the capacity and potential of these people.

RS: The active ageing program can be very effective for people with mild cognitive impairment (MCI) and for people with dementia (early stages).

We have a separate group for people with MCI/dementia. They do many social activities with the other groups, but they do the physical and cognitive activities in this special separate group. This allows us to do the activities according to the capacity and potential of these people. In a combined session, the people with MCI/dementia tend to feel overpowered by the others. A separate group gives them a more encouraging environment.

In general, activities are made easier for them and they enjoy when they are able to complete an activity despite their limitations. As their abilities deteriorate, we adjust the activities so that they can still do and enjoy them given their current potential.

DCN: Do you have any final words for persons who want the benefits of a program like “Active Ageing” but cannot enrol for regular participation because they are homebound?

RS: Our Active Ageing program is a highly structured program driven by standard protocols and trained instructors. It may not be possible to entirely use the program at home, but some aspects of the program can definitely be adopted. Some aspects of all three components can be done at home.

…this is a lifestyle modification program and the benefits are not evident immediately. However, as people age, the benefits of the activities tend to show. The key is to start, change, and sustain the activities so that they are both meaningful and engaging.

As I explained before, even if a person is homebound and cannot attend the program at the centre regularly, the person can initially visit the centre for an assessment and guidance about what they can do safely and effectively at home. At the centre, they can understand and practice the suitable exercises under the guidance of the physiotherapist till they do them properly and safely, so that they can start doing them at home. They can also revisit the centre periodically to confirm they are doing the exercises properly and also get any new advice for using elements of our “Active Ageing” program given their situation .

Remember that this is a lifestyle modification program and the benefits are not evident immediately. However, as people age, the benefits of the activities tend to show. The key is to start, change, and sustain the activities so that they are both meaningful and engaging.

Thank you very much for this detailed explanation of your program and its underlying concepts and design, and how it benefits elders, even those with mild cognitive impairment or early dementia. It was also very useful to learn how homebound persons like many family caregivers can benefit from some of its components. Readers would definitely find it useful to age better and also reduce their dementia risk!

Read part 1 here.)

Ms Ramani Sundaram may be contacted by email at ramanisuba@gmail.com. The centre running the program described here can be reached by contacting Nightingales Trust Bagchi Centre for Active Ageing, Bangalore (Email: nbcaa@nightingaleseldercare.com Phone: 080-69999775).

Note: In this interview series, Ramani Sundaram shares information and suggestions based on her Active Ageing program. Before starting any exercise program, please consult your doctor as appropriate.

[This is part of the expert interviews on this site. View the list of all interviews of health care professionals and volunteers]
Note: This is an interview of an expert/ volunteer. The views expressed and the suggestions given are those of the interviewed person, and not a recommendation being made by Dementia Care Notes. Suitability and applicability of the suggestions remain the responsibility of the reader. For professional advice suitable for your situation, please consult an appropriate professional.

Use “Active Ageing” to age better and reduce dementia risk: part 1

Many people worry about how their physical and mental abilities will reduce as they grow old. Dementia caregivers also worry about their risk of getting dementia.

Ramani Sundaram, a neuroscience research scientist working at Nightingales Medical Trust, has designed and managed the “Active Ageing” program at the Nightingales Trust Bagchi Centre for Active Ageing (Bangalore). It is a holistic program that uses a multi-modal activity-based approach. It is based on the ThinkingFit study conducted in the UK, and aims to bring lifestyle modification and ensure health and happiness of the elderly, thus making ageing a positive experience. The focus is on minimizing the risk of dementia, controlling hypertension, diabetes, and depression, and preventing falls.

In this two-part interview, Ramani explains the program’s concepts and components, shares the benefits seen in participants, and discusses how some elements of the program can be used by people who can’t leave home (like many caregivers). [note] Part 1 below introduces us to the program and its context and objectives, how participants are assessed before they join, and the three components of the program. The first component, i.e., physical activity, is also discussed.

Questions/ Comments by Dementia Care Notes: Please share your perspective on ageing in our society, which is the context within which your program is designed.

Ramani Sundaram, neuroscience research scientist: Longevity is here to stay and ageing is a natural phenomenon. However, ageing also brings anxiety of various age-related conditions like cardiovascular diseases and memory loss (dementia). Age-related conditions are mostly not treatable. They require lifelong management. Costs associated with managing such disabling conditions are high. Most people are therefore scared of problems they fear ageing will bring, such as decline of physical and mental health, reduced social connections, and possible financial problems.

Our experience of ageing depends on our surroundings. Unfortunately, our surroundings promote ageism. They make ageing seem a negative experience. For example, cosmetics are promoted to look younger and anti-ageing creams are heavily advertised. We do not notice that older people have their own beauty and don’t need special cosmetics to make them look younger. The media also portrays older people as frail and fragile, requiring help all the time.

All this makes growing older seem undesirable, and so, in our current surroundings, most people are anxious about getting older. Programs like our Active Ageing program use a systematic approach to improve the ageing experience.

DCN: Please give us a brief introduction to your Active Ageing program

RS: The fact is that improvement of health and well-being is possible at any age.

Our “Active Ageing” program is designed to enable older people to realize their potential for physical, social, and mental wellbeing. It is a systematic approach that includes physical activity and cognitive engagement in a social environment.

Our “Active Ageing” program is designed to enable older people to realize their potential for physical, social, and mental wellbeing. It is a systematic approach that includes physical activity and cognitive engagement in a social environment. The aim of the program is to help participants age well— this doesn’t equate to becoming a younger version of themselves but to enjoy the maximum of the current abilities and to dismantle ageism.

Our program has been functioning at the Nightingales Trust Bagchi Centre for Active Ageing, Bangalore since October 2014. Till end 2016, over 350 participants have benefitted through this program. They have been in the age-range of 50 -100 years and they attend it three days a week. All participants undergo periodic assessments every three months. A minimum of three months of active participation is required to measure the benefits of the program. Data is gathered to evaluate and confirm its effectiveness with respect to specified parameters of health, functionality and well-being. The program is now also functional at some other centres in Bangalore.

Our program is an ongoing program. Some participants stay with the program. Others take it for three months, or six months, or a year, depending on their schedule. Some participants tend to take a break and re-join later.

DCN: What is your program based on? Why is it called “Active Ageing”?

RS: “Active Ageing” is an approach that illustrates how people can become healthier and happier while they age, compared to how they were earlier. Our program design fits into the official definition of Active Ageing by WHO (see box).

“Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. It applies to both individuals and population groups.” (From: WHO’s page on Active ageing Opens in new window)

We started this program because we wanted a lifestyle modification intervention to reduce the risk of dementia. Elders may not be interested in something called “dementia risk reduction” either because they are unaware of dementia, or because they consider it stigmatizing. By calling our program “Active Ageing” we reach and benefit many more elders. Also, “Active Ageing” is an acceptable and positive term and conveys the essence of what we are doing.

Our design is based on the ThinkingFit Study, a three-year research carried out by Dr. Thomas Dannhauser and his colleagues from The North Essex Foundation Trust and University College, London. This team developed a program which combines physical, social and mental activities in a fun way that keeps the elderly active. This study showed significant improvement in the participants’ physical fitness, cardiovascular health, memory, and quality of life. (see footnote for the reference paper)

DCN: “Active Ageing” is a phrase we see more and more in use by centres and programs. Are all these the same program? If not, how does one decide between them?

RS: Yes, there are now many active ageing centres promoting the concept of ageing well, which is encouraging. The programs offered are different and depend on who is offering them. I suggest that people look for something where there is equal importance to physical activity, mental stimulation, and social engagement.

Our Active Ageing program is a standard program which includes physical, cognitive, and social parameters that are essential components of the term “Active Ageing”. Our program is evidence-based, data driven, and piloted. People can therefore compare it to other active ageing programs to decide whether they want to try it.

DCN: What are the main components of your Active Ageing program?

RS: Our program looks at various age-related problems and how we can reduce the risk factors for these (or manage them better).

For example, most cardiovascular risk factors are modifiable. They can be prevented and managed through activities which include physical exercise, cognitive stimulation, and social interaction. We also know that after retirement, people may become less active physically and mentally, and may become more isolated socially. So, we aim to prepare people above the age of 60 years to participate in new activities and facilitate substantial lifestyle change.

Our hypothesis is that mental stimulation, social engagement, and physical activities have a preventive effect on age related conditions. This hypothesis is supported by scientific literature, and these activities have been associated with outcomes like enhanced cognition (improved mental and intellectual abilities), lower morbidity (reduced change of illnesses), and general well-being.

The main components of our program are:

  • Physical activity: These include aerobics, chair based exercises, flexibility and strength training, dance routines; resistance exercises, and fall prevention exercises.
  • Cognitive Engagement (mental stimulation): Activities in this component are designed for various cognitive processes such as memory, executive function, language, visuospatial abilities, speed of processing, etc.
  • Socialization: The most important aspect of the program is socialization and thus all physical and cognitive activities are done in a group. There are exclusive social engagement programs which are mostly fun-driven, such as antakshari and musical chairs, etc. We also organize group outings.

DCN: Please describe the physical exercise component.

RS: The main aim of the physical activity component is to ensure that elders feel good after the session. They gradually enjoy health benefits through better management of cardiovascular parameters. The goals of the physical activities differ according to the regime followed on a particular day. We provide a variety of exercises that can be done by anyone irrespective of their medical/physical condition/history. The exercise intensity is adjusted based on the individual’s capacity and medical history.

Many older people initially found the concept of a gym an unsuitable for their age. However, as they started using various equipment, their perception about using a gym changed.

Our exercises include:

  1. Chair based exercises: This is the core physical activity that we find highly beneficial for the elders. This is a part of cardiovascular regime. It’s a very intensive workout and allows people to undergo good training while sitting on the chair. It is one of the safest types of exercises and at the same time the most enjoyable for the elders. We provide varieties of chair exercises by including resistance bands, free weights, etc.
  2. Elders Gym: Our Centre has an exclusive gym designed for the elders. Many older people initially found the concept of a gym an unsuitable for their age. However, as they started using various equipment, their perception about using a gym changed. The gym sessions allow us to make elders do exercises at their target heart rate for 30 mins. We are able to monitor their heart rates during these sessions, and that gives us and the elders a better understanding of their cardiac endurance.
  3. Yoga: As we all know, yoga has many benefits. Also, it is a very popular concept among elders. We have customized the asanas to suit the requirement of the age groups of our participants.
  4. Strength and Endurance: We have various workouts to enhance the core strength and endurance among the elders.
  5. Off Routine Cardio: These include dance aerobics, cardio kick boxing, and step based balance training.

DCN: What is the structure of a physical exercise session? How often is this done?

RS: The session is usually for 50 mins. It has 10 minutes of warm up, 30 minutes of intensive work out, and 10 minutes of cool down. Physical activity is done three days a week (every alternate day), and is under the guidance and supervision of the physical trainer (trained physiotherapist).

The sessions are done in a group of 15 persons. This includes people from different age groups which increases the sense of involvement and motivation for all participants. The sessions are enhanced by Bollywood beats (old songs and sometimes new ones, based on what they demand).

Doing any exercise for an hour can be boring and may seem undoable, but when done in a group, it becomes an enjoyable experience. In our groups, members actively participate by counting with instructor, motivating each other, and singing songs in absence of music and use many such ways to remain cheerful and active. They enjoy the workouts.

DCN: Sounds great! Can you share some preliminary results of how this physical exercise component has affected seniors?

We get feedback from them and their family about reduction in blood sugar, blood pressure, cholesterol, etc., which, in turn, results in their doctors reducing their medicine dosages.

RS: One thing is that we have received feedback from the participants about the benefits they have experienced. They tell us they feel more energetic and happy as they do these activities regularly. They are also able to manage their cardiovascular conditions better. We get feedback from them and their family about reduction in blood sugar, blood pressure, cholesterol, etc., which, in turn, results in their doctors reducing their medicine dosages. This reduction of dosage /monitoring is done by their own GP – we get the information from the family and update our records for the changed dosage.

As the program is evidence-based, we also gather data for our own analysis.

Our preliminary results have been encouraging. We have seen substantial improvement in physical well-being and cardiovascular fitness in the parameters we have been monitoring. These include the fitness index which serves as a measure for cardiac endurance, blood glucose levels, and BMI. Other parameters where we found significant changes are weight management, balance, and flexibility. Most of the times these improvements reflect in their medical reports (from their own doctors), which can confirm/ supplement our observations.

DCN: What type of examination and analysis is needed to decide on an individual’s program?

RS: All the older people who register for the program undergo a compulsory initial assessment. This includes physical, cognitive, and medical assessment.

The physical assessment is done by a physiotherapist while the medical assessment is done by a doctor. People need to bring their past medical reports and current list of medications. The physical and medical assessment covers detailed medical history, basic parameters (such as BMI, FAT%, RBS, BP, and target heart rate), modified step test results, and a general review by our centre’s physician. The physician assessment is done fine-tune the individual’s physical activities.

Most of the exercises in our program can be done by all older persons. However, our physiotherapist notifies each individual about the precautions to be taken as per the individual’s physical and medical limitations. Exercises are sometimes modified to be more suitable for the individual. Individuals are also reminded of these precautions and modifications when they are doing the exercises.

In our cognitive assessment, we look at the participant’s cognitive ability in various cognitive areas. This includes visual and auditory divided attention task, long term and short-term memory task, verbal fluency, visuospatial, and working memory task. The tools used are ACE-r, Digit Span, CVLT and TMT. In addition, the WHOQOL-Bref (WHO quality of life scale) is used to measure quality of life and everyday activities.

DCN: What check-ups do homebound persons (like many caregivers) need to start such exercise at home? What sort of training and supervision do they need, and how can they set up their home for the exercise?

RS: Anyone starting any exercise program needs to undergo a proper check-up and get suitable advice just like any participant in our program. If a homebound person wants to start such physical activities, they can approach the centre and get themselves screened. This will allow them to interact with the physiotherapist to understand the Do’s and Don’ts’.

It is ideal to do the prescribed physical activities under the supervision of physiotherapist. Homebound persons such as family caregivers can probably first attend some sessions at the centre before they start doing them at home. If they can make time, may be couple of hours a week, to undergo a few sessions after assessment, the physiotherapist can understand their potential and limitations, and explain the proper way of exercising and any risks and cautions involved. Thereafter, they can do some exercises at home. They should stay in touch with centre for periodic assessments/feedback.

Some simple exercises can be done at home, and these can be demonstrated and explained by the physiotherapist. These include walking at home, chair exercises, and free weights. Many heart rate monitoring devices are now available in the market. These can help people exercise at their target heart rate. Chair exercises only need a sturdy chair, and walk at home needs non-slippery flooring and some minimal space. American Heart Association has the walk at home regime that is available online (see box). And free weights may also be used–up to 1kg can be used (you can also use half/one litre water bottle). We advise wearing sport shoes during such workouts.

The American Heart Association explains how to start a walking program. It discusses how to get ready, what techniques are used, how to pick up pace, and how to remain safe. See their page: Walking 101 Opens in new window)

… warm up and cool down are very important and should not be skipped when doing the exercises at home.

Exercises using resistance bands and stability balls are better done under supervision as the chances of injury are high. So, they may not be suitable for doing at home. Again, I strongly recommend that the person visit the centre and see the exercise steps and understand the benefits and risks associated. They can spend a couple of hours a week for this at the centre before starting doing these at home. And I want to emphasize that warm up and cool down are very important and should not be skipped when doing the exercises at home.

In part 2 , we discuss the mental and social components of the program and talk about how homebound persons can adapt and use these. We also talk about the use of the program for persons with mild cognitive impairment or early dementia.

Reference: *(Dannhauser, Thomas M., et al. “A complex multimodal activity intervention to reduce the risk of dementia in mild cognitive impairment–ThinkingFit: pilot and feasibility study for a randomized controlled trial.” BMC psychiatry 14.1 (2014): 129.)

Ms Ramani Sundaram may be contacted by email at ramanisuba@gmail.com. The centre running the program described here can be reached by contacting Nightingales Trust Bagchi Centre for Active Ageing, Bangalore (Email: nbcaa@nightingaleseldercare.com Phone: 080-69999775).

Note: In this interview series, Ramani Sundaram shares information and suggestions based on her Active Ageing program. Before starting any exercise program, please consult your doctor as appropriate.

[This is part of the expert interviews on this site. View the list of all interviews of health care professionals and volunteers]
Note: This is an interview of an expert/ volunteer. The views expressed and the suggestions given are those of the interviewed person, and not a recommendation being made by Dementia Care Notes. Suitability and applicability of the suggestions remain the responsibility of the reader. For professional advice suitable for your situation, please consult an appropriate professional.