Combined exercise and cognitive stimulation for people with mild cognitive impairment – interdisciplinary perspectives

Older adults with mild cognitive impairment or Dementia (MCI/D) are at high risk for a decrease in both motor performance and cognitive abilities, leading to serious loss of autonomy. Physical exercise can not only counteract this tendency by improving physical fitness and the ability to perform everyday tasks but can also increase cognitive stimulation. However, the multi-faceted nature of MCI/D symptoms and the numerous consequences of a patient’s cognitive impairment require the development of tailored treatments and intervention programs based on an interdisciplinary approach. This investigation aimed to collect the perspectives of an interdisciplinary team on the implementation of an exercise programme for people with MCI; namely, to identify the main recommendations as well as concerns of different experts. Semi-structured interviews were conducted with a range of experts: (1) Medical Neurologists; (2) Exercise Physiologists; (3) Neuropsychologists; (4) Social Work Technicians; (5) Fitness instructors; (6) patients and caregivers/family. The interviews were based on three questions: (1) “What characteristics should be present in an exercise-based intervention for people with MCI?; (2) “What kind of cognitive stimulation should be utilized?”; and (3) “What are the main concerns about exercise in relation to this population?”. Each area of expertise identified major recommendations and concerns regarding the implementation of a combined exercise programme for people with MCI. The recommendations found include: the importance of engaging families and caregivers; the necessity of increasing families and caregivers’ knowledge about the significance of exercise in dementia; respecting a patient´s and caregiver’s willingness to participate; promoting the collaboration and involvement of the senior residence’s staff; ensuring caring, respectful and friendly treatment; creating a relationship of trust with the exercise professional; the appropriate design of the exercise and cognitive stimulation; an appropriate schedule; and a safe environment. Major concerns reported by all experts are related to the resistance of dementia patients and their caregivers in participating in programs, the inadequacy of activities or exercises, the risk of injury; the lack of the adaptation of exercises; the difficulty of patients to understand instructions; the physical space for the implementation of programs not always being the most adequate; and the lack of family support. The interdisciplinary approach revealed multiple barriers, but also the opportunity to design a more adequately structured intervention, which is tailored to and addresses the individual needs of older people with MCI in a community setting. The benefits of interdisciplinary collaboration are widely heralded by scientists in many fields, but the effectiveness of alternative strategies to promote such a collaboration is not well-understood. It is proposed that more research including interdisciplinary contributions be conducted on exercise programs for people with MCI in order to improve the quality of interventions and services.