Exercise Design and Progression for Clients with Alzheimer's Disease
Core components
Build sessions around aerobic activity, resistance training, balance, and flexibility, consistent with general older-adult guidelines but adjusted for cognition and safety. Aerobic work supports cardiovascular and functional health; resistance training addresses sarcopenia and fall risk; balance training targets a leading cause of injury.
Prescription principles
Start low and progress slowly. Use simple, repetitive, familiar movements with one instruction at a time. Session structure should be predictable-same warm-up, same order-because routine reduces confusion. Keep sessions shorter and more frequent if attention wanes.
Progression
Progress by manipulating one variable at a time: duration, then frequency, then intensity, or add complexity to balance tasks. A trap is progressing load and complexity simultaneously, or advancing intensity based on a good day. Use consistent, observable criteria (e.g., completed sets with steady form and no agitation) before advancing.
Safety considerations
Monitor for fatigue, dizziness, and behavioral signs of distress. Address wandering risk with secure environments, and avoid equipment that requires complex setup or unsupervised use. Hydration and toileting needs should be planned before sessions.
Rule of thumb
Progress one variable at a time, and only after two consecutive sessions of success with stable behavior.
Worked example
A client tolerates 10 minutes of walking with steady gait. Hold intensity and add 2 minutes per week until 20 minutes is comfortable, then consider adding a balance component-not both at once.