How to Get Patients Moving

Perhaps the biggest caveat with all mental health conditions is how to motivate people in the early stages of a dementia such as Alzheimer’s, or even people who are struggling with Mild Cognitive Impairment, to exercise.

Dr. Noordsy offered some key suggestions:

1. Start with an assessment: “I start with an assessment of lifetime history of activity and current activity in my baseline assessment template,” Dr. Noordsy said. “I educate the patient on the potential effects of exercise on their disorder and how it fits on the menu of other treatment options.”
2. Make clear recommendations: “There is a lot of evidence in areas such as smoking cessation and in the addiction literature showing that a substantial subset of people will respond to very clear recommendations,” he said.
3. Offer motivational tools: A behavioral planner, for instance, that allows for goal setting, or connecting a patient with an exercise group can be helpful.
4. Consider the patient’s current activity capacity in recommending a regimen: “The general amount of exercise believed to result in a benefit is about 30 to 60 minutes per day, between 3 and 7 days per week.” Some studies have shown strength training to be as beneficial as aerobic activity. For the latter, Dr. Noordsy suggested that one easy method often used in determining maximum heart rate, in general, for people without heart disease or other conditions is to simply subtract their age from 220.
5. Help the patient find an activity that works best for them, rather than recommending anything specific, Dr. Noordsy suggested. “Have the patient choose the activity that is right for them.”
6. Help guide the patient to educational resources, such as information sources or books. “The book I’ve used the most with patients is John Ratey’s Spark: The Revolutionary New Science of Exercise and the Brain,” Dr. Noordsy recommended. “The book is very scientific and accessible to a lay audience,” he said.
7. Importantly, discussing the role of exercise in the context of human evolution might be a more effective approach with patients than the standard recommendation to get some exercise.“
   • Instead of ‘this is something you ought to be doing,’ we might instead say, ‘this is something humans are designed to do, and when we don’t do it, our bodies and brains fall apart’.”
8. Another important component in helping patients benefit from exercise is simply to improve awareness among clinicians, Dr. Noordsy added. He said,
   • “We see evidence on the benefits of exercise for… neurologic… conditions coming together, and there is a need to increase awareness of this among clinicians as well as reinforce the research community to be taking a more careful look at physical exercise.”
   • “This may not have as much of an industrial backing as some of the other interventions we use, but I think it’s quite exciting.”