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From PEKN 1P93 Winter 2014: Group 07: Disease Prevention, Dimentia/Alziemers
 PEKN 1P93 - Disease Prevention Dementia/Alzheimer's
 Overview of Alzheimer's
Alzheimer's Disease (AD) is a disease that worsens over time and is the most common form of dementia (Alzheimer's Society of Canada, 2013). It accounts for 64 percent of dementia cases in Canada (2013). Symptoms of Alzheimer's include difficulty remembering things, making decisions, preforming everyday activities, experiencing mood swings, loss in confidence, communication problems and feelings of sadness, anger or frustration by their increased loss in memory (2013)(Alzheimer's Society, 2012) As for right now there is no known cause for AD but there are many risk factors which increase your chances of developing AD such as:
Ageing: AD cannot be developed when a person is in their teens or in their twenties. A person's likeliness to develop AD increases with age because factors like blood pressure, stress and obesity increase (Alzheimer's Society of Canada, 2013).
Genetics: Genetics plays a role in ones development of AD but only in a small percentage of cases is associated with the specific gene which causes the inherited form of AD. Genes only increase the likely hood of developing AD not guarantee it will happen (Alzheimer's Society of Canada, 2013).
Other: Research is still being done on whether factors such as infections, toxins, education level, alcohol, tobacco,diet, and exercise play a role in the development of AD (Alzheimer's Society of Canada, 2013).
 Physical Activity
Developing physical activity programs for individuals suffering or susceptible to the effects of Dementia and Alzheimer's s crucial to improving the lives of the elderly. The Alzheimer's Society of Canada(2011) emphasizes that this age group is sometimes neglected when developing physical activity plans due to misconceptions that they are incapable of participating in physical activity(Alzheimer's Society Myths and reality of living with Dementia, 2011). Thus, focusing in programs to get these individuals both physically and mentally active is central. Promoting attainable, realistic and feasible fitness goals towards individuals in this age category (60 or older) should be a priority in our efforts as advocates for physical activity. The concern for physical fitness is abundant in youth and younger adults, which is certainly not a bad thing. However, bringing awareness to the benefits that physical activity has on people of all ages, especially those prone to Dementia, should be our next target of focus. This will aid in further development of physical literacy among our society, which will produce a population of individuals who are able to move with more confidence, competence, knowledge and understanding of many aspects of physical activity.
Pharmaceutical treatments have been developed and some have shown some ability to slow down the effects of Alzheimer's. However, these drugs do pose challenges as they do not affect all individuals the same way and often exhibit undesirable side effects. According to the National Institute on Aging Factsheet (2014)some common side effects include confusion, constipation, dizziness, nausea, vomiting, weight loss, sever loss of appetite, and loss of muscle mass or control (National Institute on Aging, 2014). These alarming side effects to medications further solidify the need for alternative therapy approaches such as physical activity.
The debilitating effects of Alzheimer's (AD) often leave both patients and their loved ones or caregivers with feelings of stress and frustration. In their research of the bi-directional relationship between the brain and physical activity,Loprinzi, Herod,Cardinal and Noakes (2013) found that low impact exercise has been shown to utilize and breakdown excess adrenaline that is produced by stress. They also emphasized how exercise also produces endorphines which promote feelings of happiness, joy and enthusiasm(Loprinzi, Herod, Cardinal & Noakes,2013). These positive emotions would benefit both the mental and physical well-being of participants. Being physically active also aids in developing a healthy appetite as your body craves the benefits from nutrient-rich foods (Alzheimer’s Society of Canada Living with dementia; day to day living, 2011). Physical activity also increases energy levels, which older individuals often complain they lack, and can induce a more relaxing and effective night's sleep as shown in Caspersen, Powell, and Christiensen's (1997) research paper "Physical Activity, Exercise,and Physical Fitness:Definitions and Distinctions for Health-Related Research." (Caspersen, Powell & Christenson, 1997). By communicating the benefits of mild physical activity towards older generations, it is likely that great strides will be taken to reducing the limiting effects of diseases such as AD. It can be inferred that not only does the brain control physical movements but utilizing the brain's ability to make the body move provides benefits for cognitive development and maintenance. Considering that according to both The Fisher Centre for Alzheimer's Research (The Fisher Center for Alzheimer's Research Foundation, 2014) and The National Alzheimer's Factsheet (Alzheimer's Society, 2007) 35 million people, world wide, suffer from AD tackling this issue with something as accessible and feasible as physical activity is revolutionary to disease prevention and health promotion.
In 1901, a woman by the name of Auguste Deter was admitted to the Frankfurt Asylum in Germany due to abnormal cognitive behaviour, her symptoms included drastic memory loss, confusion, and impaired cognition. Upon arrival at the mental institution, she would encounter German physician, Dr. Alois Alzheimer. Dr. Alzheimer followed Mrs. Deter's condition until her death in 1906. Deter's brain autopsy, performed by Dr. Alzheimer himself, displayed severe atrophy of the nerve cells in her brain, as well as atypical deposits and lesions in the brain. Upon further inquiry of the autopsy, Dr. Alzheimer was able to determine that the disease was identified by the knotted neurofibres and the build-up of amyloid plaque in the brain. In 1910, German psychiatrist Emil Kraepelin, a close colleague to Dr. Alzheimer, officially coined the term, "Alzheimer's disease," when referring to the condition (Suchy, 2013).
By 1968, neurological researchers were able to develop the first measurement scale for gauging cognitive decline in the elderly (Alzheimer`s Association, 2012).
By 1976, Alzheimer's disease is recognized as the most common cause of dementia by neurologist Robert Katzman (Alzheimer`s Association, 2012).
In 1984, the protein, beta amyloid, is identified as the primary marker for amyloid plaque build-up in the brain (Alzheimer`s Association, 2012).
In 1986, Tau proteins are identified as the primary marker for the tangling and knotting of neurofibres in the brain (Alzheimer`s Association, 2012).
In 1987, the first drug tailored specifically to target Alzheimer`s symptoms is put to trial by Warner-Lambert Pharmaceutical (Alzheimer`s Association, 2012).
Also in 1987, neuro-researchers were able to identify a form of rare, inheritable form of Alzheimer`s disease. Chromosome 21 harnesses this gene which can cause amyloid build-up (Alzheimer`s Association, 2012).
In 1980, the then president of the Federation of American scientists, Jeremy Stone, founded the Alzheimer`s Association. It is the first, and at the time the the only, proponent of the research towards fighting Alzheimer`s Disease (Suchy, 2013).
Alzheimer's Disease International, a foundation directly affiliated with the Alzheimer's Association, establishes the inaugural World Alzheimer's Day (or WAD), on September 21, 1984. The day is meant to recognize the achievement and the research being done on the field, as well as to spread knowledge about its ubiquity (Suchy, 2013).
For More on the History of Alzheimer`s Visit: http://www.alz.org/research/science/major_milestones_in_alzheimers.asp
 Target Audience
The intended audience for taking part in the physical activity programs is geared towards, but not limited to the elderly as they compose the majority of individuals affected by Alzheimer's Disease. An estimated 500,000 Canadians have AD or a related dementia (Alzheimer's Society of Toronto, 2010). Over 70,000 of them are under 65 and approximately 50,000 are under the age of 60 (Alzheimer's Society of Toronto, 2010). This means that most people with AD or a form of Dementia are over 65 which makes them a suitable target audience. Alzheimer's can also appear in middle aged people in their 40's, which is called early-on set Alzheimer's (Lautenschlager,et. al, 2008). Therefore it is also important for middle aged people to take part in the available programs and to be aware of the any information available on AD in order to be able to aid themselves in reducing the severity of the symptoms as the individual progresses. It is also believed by Smith,et. al (2013) that more research based around exercise on these individuals who are at an increased risk of developing AD should be completed. Any form of a caregiver that is looking after an individual with AD should also not be over looked as a part of the target audience. They should be aware of information available on the subject of AD in order to aid and know what to expect of their individual.
According to the Ontario Brain Institute (2002), "Alzheimer's disease is characterized by changes to brain structure and function that commonly results in a deterioration of cognition, memory, and physical function and mobility". AD is an irreversible condition, therefore it is important to learn and know the facts that can help better people with AD, but more importantly, prevent the need for future diagnosis of the disease. Due to the substantial number of people that carry the disease, multiple caregivers that help those with the disease and the economic burden of the disease, there is an urgent need to identify factors and ways to better the lives of these people. Including those carrying AD, family and caregivers who are affected, and also those who are prone to getting the disease in the future. Researchers have been studying easy, effective and convenient ways to prevent and help Alzheimer's disease due to the challenges and inconsistencies of of pharmaceutical treatment (Ontario Brain Institute, 2002).
 Ontario Brain Institute Research
To better understand how physical activity can help with the prevention and management of Alzheimer's disease and other forms of dementia, a research was conducted by the Ontario Brain Institute (2002), where 871 articles, all discussing the topic of physical activity and dementia, were reviewed and analyzed. After detailed reading and inspection of certain articles, it was found that physical activity improved quality of life, daily activities, and and lowered depression in older adults. For those who didn't carry AD, they has a 40% less chance of getting the disease if they were active than those who were inactive. It was also shown that 1 in 7 cases of AD could be prevented and deterioration could be slowed with the help of physical activity. Additionally, it is important to note that physical activity has many cost benefits, where potential savings yearly in Canada can be around 88 to 970 million dollars in healthcare costs and caregiver costs (Ontario Brain Institute, 2002).
 The Fitness for the Aging Brain Study
Lautenschlager (2008) wrote an article about The Fitness for the Aging Brain study done on people who had reported memory problems but did not exhibit criteria to be classified as having dementia. Participants were all over 50 years of age. A total of 170 participants were randomized and 138 participants completed the 18-month assessment. Participants were randomly placed into an care group facility or to a 24-week home-based program of physical activity. The 6-month program of physical activity displayed small improvements in cognition over an 18-month follow-up period. When the 18 months were over, the difference in outcome between those in the physical activity program and those in the usual care group were substantial. Those in the usual care group only improved 0.04 points on the Alzheimer's Disease Assessment Scale, whereas the participants placed in the physical activity intervention group improved a great 0.73 points on the Alzheimer's Disease Assessment Scale. The home-based physical activity intervention program that was used was CHAMPS (Community Health Activities Model Program for Seniors, see Existing Programs section for further details on CHAMPS). This is a safe and efficient program that helps seniors and those suffering with minor symptoms and/or dementia live a healthy lifestyle. An active and healthy lifestyle can help with the prevention of different forms of dementia (specifically Alzheimer's) and cognitive maintenance and the management of the disease (Lautenschlager, 2008). All in all, the study shoes that physical activity does help prevent and improve Alzheimer's Disease and other forms of dementia.
 CASI Study
Research was analyzed by The Canadian Centre for Activity and Aging(2012), called the CASI Study. The sample population for this particular case study was on older adults who were 65 years and older. CASI stands for Cognitive Screening Ability Instrument, which was the instrument used to conduct the study. CASI is a practical test used for universal, cross-cultural, epidemiological studies of dementia. It assesses and measures levels of attention, concentration, orientation, short-term memory, long-term memory, language abilities, visual construction, list-generating fluency, abstraction, and judgment. Those who scored an 86% or higher on the test were automatically added to the study, whereas those who scored lower than an 86% had to undergo more testing to ensure they really suited the aims of the study. A total sample of 1740 individuals was used for the study. A questionnaire was given to each of these individuals to determine the extent and details of their physical activity regime. After an extended period of time, 6.2 years, follow-ups occurred to determine the results physical activity had on the elderly participants. The results showed that of the 1740 individuals who participated, 1185 remained dementia free, which is nearing 70% of the sample population. Among the rest of the participants, 276 had died, 158 developed dementia(107 of which developed Alzheimer's), which is only amout 9% of the individuals, and 121 withdrew from the study altogether. This study not only shows the benefits of physical activity on your health, but it also recognizes that being consistent and a regular exerciser will provide further benefits. The incident rate of dementia of regular and consistent exercisers in this particular study was 13.0/100, whereas non-regular exercisers had an incident rate of 19.7/100 (The Canadian Centre for Activity and Aging, 2012). Thus, more attention to exercise for the elderly needs to be given.
 Physical Activity and Risk of Dementia in the Elderly
In accordance to the prevention of Alzheimer's disease through physical activity, the study conducted by Laurin, Verreault, Lindsay, MacPherson and Rockwood, undertakes the topic of the effect of physical activity to the risk of cognitive impairment and dementia in elderly persons (2001). The following study tackles the association between physical activity and the risk of cognitive abnormality, including the most common form of dementia, which is Alzheimer's disease. 6434 elderly subjects who were identified as cognitively stable were either assigned a daily physical routine to follow or assigned nothing. The routine for the individuals assigned physical activity included walking relative distances, swimming, or light yoga stretching. 4615 were able to complete a 5-year follow-up. After a series of screening both physical and clinical evaluations, 3894 remained without cognitive abnormality and only 285 were diagnosed as having dementia, not specifically Alzheimer's disease. The study concludes that regular physical activity could act as a protective measure for, if not prevent against, Alzheimer's development(Laurin et. al, 2001).
 Methodist Charlton Medical Center
According to Bassem Elsawy and Kim E. Higgins of the Methodist Charlton Medical Center(2010), the number of adults with Alzheimer's increases each year, fortunately researchers have identified that physical activity has numerous prevention and management benefits on the disease. Unfortunately, few adults actually achieve the recommended amount of physical activity per day, which can increase the number of people with Alzheimer's in America from 35 million to 70 million in the next 25 years. It has been proven that exercise is a public health strategy to improve life in everyone of all ages, but more importantly improve the quality of life of older people. Older adults tend to develop more and more health problems over time which is why it is crucial to implement healthy life habits early. Elsawy and Higgins also state that maintaining muscular function is very important in elderly people. As known, muscular strength decreases with age, which makes it even harder for older adults to exercise and live a healthy lifestyle. A study that examined the effects of progressive weight training was done on 142 healthy adults 60-80 years old. This study showed that long-term resistance training increased dynamic muscle strength, size of muscle, and one's functional capacity. All of these factors influence the amount of exercise that can be accomplished, how well it can be accomplished, and what kind of exercise are able to be accomplished. This provides big influence in preventing Alzheimer's disease and other forms of dementia. Additionally, exercising and staying active has shown to decrease the risk of delirium in older patients that are in hospital. 779 newly hospitalized patients over the age of 70 who did not have dementia were all examined, where the results were that being physically active lowered the risk of delirium by 24%(Elsawy & Higgins, 2010). This emphasizes both the benefits and the need for increased physical activity among the elderly.
 Nurses' Health Study
The Nurses' Health Study is an older study that included almost 20 000 women in the US who were 70-81 years old. Telephone assessments were done twice and the women participating were expected to be retested every 2 years. These phone assessments started in 1995 and continued up until 2003, where the women would be asked questions that would test general cognition, verbal memory, category fluency and attention. The results showed that higher levels of physical activity were associated with a better cognitive performance. The women who were the most active had a 20% less chance of developing a form of dementia compared to the women with lower participation in physical activity. It was also observed that there was less cognitive decline among the active women, producing scores of 0.04 standard units. This was 0.06 standard units more than those who were barely active at all (Weuve, Kang, Manson, Breteler & Ware, 2004). Long-term, consistent and regular physical activity has been shown to help better cognitive impairment on numerous occasions. Although this study was solely meant to study cognition in women, it is important to state that men have the same chances of developing a form of dementia if they do not also engage in some sort of physical activity or a healthier lifestyle.
Despite the nonexistent cure for Alzheimer's disease or other forms of dementia, researchers have now been able to identify and provide proof of ways to prevent and manage the disease, aside from pharmaceutical treatment. Although some may argue the research that as been done is considerably not enough to provide real proof, we are definitely starting to see more and more research being done and more interest in this area. All of the studies have shown the same results; that physical activity does help in the prevention and the cognitive maintenance of patients with Alzheimer's and dementia. Physical activity is an easy, cost effective, and fun way to get both those affected and their loved ones up and moving. Physical activity also prevents many other diseases and builds a healthy lifestyle for a longer, more enjoyable life.
 Existing Physical Activity Programs
 The Buddy Program
According to Northwestern University Feinburg School of Medicine (2013)that this program is more the community portion of programs. No physical activity is involved with this program. However the Buddy Program is based on routine, these routines help support people suffering from AD in the mild to moderate stages. Elders who suffer from AD get paired with a medical student to interact with on a weekly basis to keep in contact with someone in routine. At first there is orientation for 3 hours and then the medical students and people who have AD are paired up to meet with each other each week, and see if the routine helps with the memory of those with Alzheimer's. There is not just these weekly meet-ups there are also group meetings which occur monthly with everyone in the Buddy Program in their area. This helps the people diagnosed with AD get on a personal level with those who are in the medical and clinical field (Cognitive Neurology and Alzheimer's Disease Center,2013). 
 Community Healthy Activities Model Program for Seniors
The University of California, San Francisco, (1998) CHAMPS is a program specifically focused on the physical activity of seniors who possess any symptoms or have already acquired the disease of Alzheimer's. This program aims to promote physical activities to seniors in order to live a healthier lifestyle. There are three subprograms related to CHAMPS, each program has their own research to improve life expectancy for senior citizens. The program follows the lives of individuals and caters to their existing schedules by implementing realistic and attainable fitness programs and goals into their lives.
Champs I- For the first program of CHAMPS is a six month program based on people with low-income living conditions. All of those who sign up for this program are eligible no matter the health issues and concerns. In this program people enrolled have access to support, activity logs, meetings and written material consisting of new ideas, strategies for modifications and extra information for the client. This programs great because it is feasible and accessible to those living with low-income.
CHAMPS II- The second program of CHAMPS is a one year program instead of six months. This program focuses on change, self-efficacy and helpers keeping the clients motivated. In this yearly program the seniors have more access to different programs like sessions to plan their program personally, follow-up sessions to keep them motivated, in person and telephone support as well. The main change in the program components is that the CHAMPS II program has medical screening and functional fitness testing to keep the clients healthy and have them in the correct program without over exerting themselves in the wrong program. Fitness assessments are also another way to keep clients motivated to continue striving for fitness goals and a healthier lifestyle.
Champs III- This program is an off-shoot of CHAMPS II but focuses more on the low-income seniors and minorities in the community. CHAMPS III is more of a continuous program with no set limitations on how long the program is being run. Those programs in addition to CHAMPS II that were involved with the creation of CHAMPS III are Seniors in Motion for Health, Always Active and Aging with Energy (Sperber, 2009). 
 Human Kinetics Alzheimer's Exercise Program
James H. Rimmer, PhD, and Donald L. Smith, MS, RCEP (2007) created a program that is built for those with the Alzheimer Disease and it is designed to lower the rate of the disease using physical activity. This is a low intensity program but the intensities can fluctuate from person-to-person. Trainers are present to encourage and support for those involved. This allows individuals to feel safe, secure and know how well they are progressing.This program is very repetitive ensuring the clients attend or try to remember to attend the exercise classes. Since one of the first symptoms of AD is in fact memory loss this routine is central in slowing the progression of the disease. For this exercise program it is all aerobic activities that can be done in large groups. such as walking. The intensity for this program is usually low-intensity for 60 minutes. They focus on the enjoyment and their progression no matter how long it may take, whether it is the duration increases, or the activities can become more challenging (Rimmer, 2009). This program is trying to establish a routine for their clients and keep these clients happy by involving more enjoyable activities not just activities that seem like work. The three main training components of this program is strength, aerobic and flexibility training. 
 Canadian Center for Activity and Aging
Clara Fitzgerald (2012) states the many steps in this program; at first they assess the clients. Watch them do day-today chores, and trainers talk to family members and caregivers to learn what would make this program more enjoyable for participants. Then they determine what the client can do and what activities can improve their life outside of the program. Finally, they watch them succeed, success can be different for each individual whether it is the enjoyment levels increasing or the physical achievements the clients succeed in. The four main components involved mainly in this program are the physical tasks, motivational strategies, behavioral regulation and environmental or social support. Their program is a 40-60 minute session using activities that are familiar to the clients but ca also partake with a larger group of people with the same AD attributes as themselves. Activities may include walking, yoga, dancing, aqua-fit or other group fitness activities for seniors.(Fitzgerald, 2006). To learn more you are able to contact Leslie McAdam at 519-661-1607 or at email@example.com and Clara Fitzgerald at firstname.lastname@example.org. 
This program is to treat people with all forms of dementia including Alzheimer's. This program strives to enhance the skills of those affected with daily activities to help improve their lives. With this program it is important to have the clients keep their brain challenged to decrease the symptoms of Alzheimer's. Montessori's program use everyday materials to keep the clients brain on point and stimulated. The activities that are performed begin as simple, broken down components of an overall activity, to complex activities that the instructor uses minimal vocalization to lead. This encourages and allows individuals to gain and maintain some independence in both physical activities as well as daily chores. All of these activities in the program are set for the clients to succeed and minimize effects of failure for the clients (Menorah Park Center for Senior Living, 1999). 
 Best Practice Activity Suggestions
 Seated exercises
Individuals living with AD are not limited from participating in a regular fitness program. Adaptations to typical programs can be made, the easiest way to make these exercises accessible to all is by making them seated. The following are just a few suggestions for seated exercises:
- torso twists (turning the body from side to side)
- raising the heels and toes
- seated bicep curls (with resistance band or light dumbbells)
- flutter kicking or bicycling the legs
- arm circles
- moving from sitting to standing
- lifting a medicine ball above the head
- seated toe touches
These exercises aim to increase balance and maintain muscle strength without being high impact or strenuous. Maintaining muscle mass, rather then building bulky muscl, is important to those with AD because it allows them to remain more physically able and less dependent on others for longer periods of time. Balance is also key for these individuals as it has been shown to be linked with stimulating both muscle memory and mental memory capacity.(Alzheimer's Society, 2014).
 Swimming and Aqua-fit
Water based activities are excellent for individuals with low mobility and joint or bodily pain (major things associated with the effects of AD). In addition to being good low impact, cardiovascular exercise swimming can also be social if done with peers. Simply kicking with the aid of a flutter board allows one to hold a conversation with a friend while also getting in sufficient exercise. Swimming may not be as accessible or realistic for some individuals which is where another water based activity like aqua-fit become of interest. Aqua fit may also provide a safer feeling for all participants involved as there is a trained instructor present as well as lifeguards. Aqua fit targets both cardiovascular exercise as well as water resistance training. (Alzheimer's Society of Canada: Finding Suitable Activities, 2011). Most towns or cities have a public pool which offers lap swimming times as well as aqua fit, therefore these water based activities are readily available to most individuals in North America. A majority of public pools also have ramps or other methods of making the pool accessible to those with physical limitations or disabilities, thus these activities are accessible to most people. Caregivers are also welcome to join in on such activities.
 Yoga and Stretching
Research conducted at Beth Israel Deaconess Medical Center have put time and effort into studying the effects of yoga on slowing down the progression of AD. In their study, adults 55-90 years old were split into two experimental groups. One group took part in Mindfullness-Based Reduction (MBSR) through yoga and meditation while a control group received standard cognitive impairment care. The yoga focused group practiced yoga for a total of two hours per week in 15 to 30 minute sessions at their convenience. They continued this pattern for eight weeks. Prior to and following the study, all participants were required to undergo a functional MRI scan to allow researchers to observe any changes in brain activity over the eight week period. Their primary focus was on the hippocampus as it is responsible for learning, memory and emotions. This is also the brain structure that atrophies due to the presence and progression of AD. The fMRI scans revealed that the group who routinely practiced yoga displayed improved brain function. Both groups did still experience atrophy in the hippocampus, however the group that practiced yoga displayed significantly less (Tripp, 2013). Yoga is not only physically beneficial but it is also relatively inexpensive as it can be done in the home with minimal equipment, no more than a mat is really necessary to get in some daily yoga or stretching. Similar to swimming, it is low impact and low intensity which is ideal for people susceptible to or living with AD(Durstine, Moore, Painter, & Roberts, 2009). Practicing yoga or simply stretching for 15 to 20 minutes a day can be easily worked into individuals' existing daily schedules and can be performed at any time of day. Yoga and stretching can be modified to suit the mobility and ability of all participants, and can also be performed with a caregiver or family member. This is another way to get some social connection integrated into daily physical activity which is an added bonus.
Walking is another low impact activity that still gets individuals up and moving. It is another physical activity that can also include social interaction which can be motivation to become active. Walking outdoors has more benefits as fresh air and a change of scenery show to be beneficial contributors to improved cognitive function (Caspersen, Powell & Christenson, 1997;Durstine, Moore, Painter & Roberts, 2009). However, walking can also be done in doors on apparatus such as a treadmill, which could be used if an individual does not want to venture outside or if weather does not permit outdoor walks. Walks around the neighborhood, to the store, to the bank, to appointments, to the post office or any other near by location are great opportunities to implement physical activity into one's already existing schedule. It is important that the individual with AD be wearing something (ie. an identification bracelet) if they are walking alone, and walking alone is not recommended (Alzheimer's Society, 2007). To avoid walking alone one may find a buddy or caregiver to walk with or join a walking group in the community if that is a program that is offered.
Gardening is not typically characterized or thought of as a form of physical activity, but for someone with AD it can be beneficial (Alzheimer’s Society Canada, 2011). It is another outdoor activity which gives them access to fresh air and vitamin D from the sun, both of which have health benefits as previously discussed. Gardening is yet another activity which is low impact and can still be executed by those with low mobility. It is also another opportunity to incorporate social time into a task. Gardening also provides self fulfilment as individuals can see the results of their efforts.
 House Cleaning
Similar to gardening, performing house cleaning tasks can equate to physical exertion for someone with AD. Sweeping, vacuuming, dusting and washing cupboards or windows are just a few examples of tasks that require the individual to get up and moving. This is very low impact exercise that also accomplishes another daily task. This can be made more enjoyable by playing music while cleaning. Music may also encourage more physical movement as it is hard to resist the temptation to move to the beat of the music. Though this is not commonly thought of as physical activity, cleaning can be used as a reason for these individuals to not be sedentary and sitting for the majority of their day. Cleaning up around the house is also an activity that can be done year-round and at any time of day convenient to the individual, unlike gardening which is a seasonal activity.
 Montessori Based Activities
Activities for those with dementia are often criticized for being too childish and not having enough activities (Camp, 1999). People with dementia in long term care often make repetitive movements and do not get a feeling of self worth or sense of accomplishment when the task is completed (1999). It is important to provide meaningful activity to these individuals and not meaning less work (1999). It is necessary to provide Alzheimer's individuals with activities which help them to maintain and improve upon skills in their daily lives (1999). These skills which are improved are things such as self feeding, getting dressed, preparing basic meals, and participating in recreational activity (1999). Activities that would fall into this category are those such as: gardening, house cleaning,helping with laundry, wrapping silverware, cutting or spreading butter on real foods, pouring water.
 Future Directions
A crucial future direction in disease prevention of Alzheimer's is to work towards removing the stigma surrounding the disease and opening our eyes to the various possibilities of getting these individuals active. Active bodies lead to active minds. Creating more programs like CHAMPS should be a central focus for the near future of disease prevention of Alzheimer's. Programs that would get individuals out of the house, up and moving as well as being social with others experiencing similar things as them is where we need to start. Such programs could include walking clubs where people walk and talk together, gardening together, aqua fit, organized and accessible yoga or stretching modified to the individual's ability,even developing programs that get people together to do low impact and low intensity exercises and balance activities would be a beneficial program.
As far as the future direction that the research should take for people with Alzheimer's. More research around physical activity in Alzheimer's prevention should be put into those at a greater risk for the disease to try and combat the symptoms early on. Also since no major benefits from the research of medicine have helped those with Alzheimer's, focus should be pulled away from the area of medicine in the future when it come to looking for ways to help these individuals with Alzheimer's and look more into the benefits of physical activity for these individuals.
 External Links
Alzheimer`s Association http://www.alz.org
Alzheimer's Society of Canada http://www.alzheimer.ca/en
Alzheimer's Research and Prevention Foundation http://www.alzheimersprevention.org/
The Buddy Program http://www.brain.northwestern.edu/support/enrichment/buddy.html
CHAMPS Program http://dne2.ucsf.edu/public/champs/research/three/
Community Healthy Activities Model Program https://www.uwo.ca/actage/pdf/Alzheimer's%20Disease%20and%20Physical%20Activity%20-Nov%202010%20-Clara%20Fitzgerald.pdf
Fisher Centre for Alzheimer's Disease Research http://www.alzinfo.org/about-alzheimers?mtc=google&kwd=alzheimers_disease&gclid=CO3x2OL1zrwCFdFAMgodgXgAkw
Free online yoga videos with an instructor (beginner, intermediate & expert levels available for viewing) http://www.doyogawithme.com/yoga_programs
Montessouri-Based Activity Program http://www.healthpropress.com/store/camp-267X/excerpt.htm
National Institute on Aging http://www.nia.nih.gov/
 Notes and References
Alzheimer's Society. (2011). What is Alzheimer's Disease. Retrieved March 19, 2014 from http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=100
Alzheimer’s Society. (2007). Exercise and physical activity for people with dementia. Retrieved March 3, 2014 from http://www.alzheimers.org.uk/factsheet/529
Alzheimer’s Society, (2014). Leading the fight against Dementia: Exercise and physical activity for people with dementia. Retrieved February 27, 2014 from http://www.alzheimers.org.uk/factsheet/529
Alzheimer’s Society Canada. (2011). Finding suitable activities. Retrieved March 3, 2014 from http://www.alzheimer.ca/en/Living-with-dementia/Day-to-day-living/Staying-active/Finding-suitable-activities?gclid=CPXDx4vcq7wCFa9FMgodcz4Avw
Alzheimer’s Society of Canada. (2011). Living with dementia; day to day living. Retrieved from http://www.alzheimer.ca/en/Living-with-dementia/Day-to-day-living/Staying-active
Alzheimer’s Society of Canada. (2011). Myths and reality of living with Dementia. Retrieved from http://www.alzheimer.ca/en/Living-with-dementia/Day-to-day-living/Staying-active
Alzheimer's Society of Canada. (2013). What is Alzheimer's Disease. Retrieved March 19, 2014 from http://www.alzheimer.ca/en/About-dementia/Alzheimer-s-disease/What-is-Alzheimer-s-disease
Alzheimer's Society of Toronto. (2010). Statistics. Retrieved March 19, 2014 from http://www.alzheimertoronto.org/ad_Statistics.htm
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