Benefits of exercise and physical activity

•improving general cardiovascular health (relating to the heart and blood vessels) - it can reduce the risk of high blood pressure and heart disease
•reducing the risk of some types of cancer (in particular breast and colon cancer), stroke and type 2 diabetes
•improving physical function - maintaining muscle strength and joint flexibility can be a way of helping people maintain independence for longer
•helping to keep bones strong and reducing the risk of osteoporosis (a disease that affects the bones, making them weak and more likely to break)
•improved cognition - recent studies have shown that exercise may improve memory and slow down mental decline
•improving sleep
•opportunities for social interaction and reducing the feeling of isolation
•reducing the risk of falls - physical activity can improve strength and balance, and help to counteract the fear of falling
•enhanced confidence about the body and its capabilities - through improved body image and a sense of achievement.

Music and dance
Dancing to music can range from structured tea dances, and couple or group sessions, to more improvised movement involving ribbons, balloons or balls. Dancing to music can also be done in a seated position. Music can trigger past memories and emotions, which can be shared. This is a very social activity and an enjoyable way to participate in exercise. It can increase strength and flexibility, help with staying steady and agile, and reduce stress.

Seated exercises
People with dementia can benefit from a regular programme of seated exercise sessions at home or with a group at a local class. These exercises are aimed at building or maintaining muscle strength and balance, but are less strenuous than exercises in a standing position. Some examples of seated exercises include:
•marching
•turning the body from side to side
•raising the heels and toes
•bending the arms
•bending the legs
•clapping under the legs
•bicycling the legs
•making circles with the arms
•raising the opposite arm and leg
•practising moving from sitting to standing.

Exercise in the later stages of dementia

Physical activity can also be beneficial in the later stages of dementia. It may help to reduce the need for more supported care and minimise the adaptations needed to the home or surroundings. Exercises can range from changing position from sitting to standing, walking a short distance into another room or moving to sit in a different chair at each mealtime throughout the day.

Suggested exercises in the later stages of dementia

•When getting up or going to bed, move along the edge of the bed, in the sitting position, until the end is reached. This helps exercise the muscles needed for standing up from a chair.
•Balance in a standing position. This can be done holding onto a support if necessary. This exercise helps with balance and posture and can form part of everyday activities such as when showering or doing the washing up.
•Sit unsupported for a few minutes each day. This exercise helps to strengthen the stomach and back muscles used to support posture. This activity should always be carried out with someone else present as there is a risk of falling.
•Lie as flat as possible on the bed for 20-30 minutes each day. This exercise allows for a good stretch and gives the neck muscles a chance to relax.
•Stand up and move regularly. Moving regularly helps to keep leg muscles strong and maintain good balance.

When is exercise not appropriate?

If you experience pain while taking part, or after increasing activity levels, stop the exercise and seek medical advice.
Physical activity is not recommended for people who feel tired or unwell.

Restless legs, also known as Ekhom's Syndrome, are characterized by an unpleasant creeping sensation deep in the legs. The experience may be one of tickling, burning, prickling or aching deep within the muscles or bones. This is associated with restlessness in the legs and an irresistible urge to move them.
Most commonly, the symptoms are located in the calves. Occasionally, the feeling can spread to the feet and thighs and very rarely to the arms and hands. The discomfort is usually in both legs but can occur in one leg only.
The symptoms usually come on in the evening and at night in bed, disrupting sleep, although prolonged sitting at any time of the day my trigger discomfort.
Restless legs may affect 5% or more of the population, although many cases are very mild.
Men and women are both affected and the condition can occur at any age, although it is more common in those over 70 years old. There is some inconclusive evidence which suggests that restless legs are a family trait.
The exact cause is not known. Physical examination and diagnostic tests find no circulatory problems.
Ther is some evidence to show that the condition may be associated with pregnancy, uraemia (excessive amounts of nitrogenous waste in the blood due to kidney failure), and iron deficiency anaemia. In pregnancy the symptoms appear after four months and cease after delivery.
About one third of patients with rheumatoid arthritis have restless leg. This may be related to the iron deficiency that often accompanies this disorder.

Regular exercise is probably the only method that my prevent osteoporotic fractures, the true end point of the entire osteoporosis problem, by preventing both osteoporosis and falls. The evidence seems stronger for exercise preventing osteoporosis. Human and animal studies have shown that physical activity can increase bone mass, density and strength. The starting age of activity is crucial, the benefit to bone is doubled if the activity is started before or after puberty rather than after it. But bone tissue does also respond to exercise in adulthood, although this seems better at preserving bone rather than at adding new bone. Nevertheless the bone preserving action of exercise in adulthood may be important in maintaining bone strength and preventing osteoporotic fractures since only small percentages of bone mass and density preserved result in significant reductions in risk of fracture.
The osteogenic effects of exercise are clearly site specific, that is , the effect is normally seen in only loaded bone sites, but the type, frequency, intensity and duration od exercise that best produce the desired bone changes are not yet well determined. Current knowledge suggests that impact type of exercise that creates versatile strain distributions throughout the bone structure can best improve bone strength. Regular sports and brisk walking, climbing up and down stairs, dancing and calisthenics seem suitable.
Overall however, the evidence stongly suggests that regular physical activity, is the only cheap, safe, readily available and largely acceptable way of both improving bone strength and reducing the propensity to fall. It should therefore become an essential part of stategies aiming at controlling the alarming increase in osteoporotic fractures. Moreover, of all the methods of fracture prevention regular physical activity is the only one that provides considerable other health related benefits. For all those reasons we must get older people moving.

Arthritis In the eldery

Arthritis is a disease where joints become inflamed. There are well over two hundred different types which vary enormously in their rate of development, length of time they last and the amount of damage they do.
By far the most common type is osteoarthritis, followed by rheumatoid arthritis affecting just under 1% of the world's population.
In general, arthritis is associated with ageing, stress, excessive use of joints, infection with a bacteria or virus, injury, metabolic or chemical abnormalities, hormonal imbalances and/or problems with the immune system.
Whilst most varieties are incurable, there is ongoing progress in treatment and pain management so that with early diagnosis, the amount of damage can be minimised and symptoms controlled.
The type of diet followed may have a role to play in certain types of arthritis such as gout and rheumatoid arthritis. Some find that removal/addition of specific food types from their diet will make a huge difference to their symptoms and quality of life.
Excessive weight can aggravate certain types of arthritis, such as osteoarthritis. A well-balanced diet containing all nutrients your body needs to stay healthy is important for helping to alleviate arthritis, as is the need to consider including foods and supplements in the diet that may calm the inflammation processes which causes pain

Rheumatoid arthritis

Rheumatoid arthritis is a family of related diseases whose main characteristic is persistent inflammation of the synovial membrane lining a joint.
The process of inflammation is the body's reaction to damage or presence of a foreign substance - blood flow increases delivering white blood cells to fight infection, leading to inflammation. This is usually a good thing, helping to fight infection and aid recovery. But in rheumatoid arthritis, the body for some reason believes there is persistent damage/foreign substance in the joint and acts accordingly. The enhanced blood supply also leads to synovial membrane thickening and over-production of synovial fluid, leading to swollen and puffy joints with a narrowed joint space.
The exact causes of rheumatoid arthritis are unknown. It is an autoimmune disease - the body's own immune system does not operate normally, but instead attacks healthy joint tissue - starting a process of persistent inflammation that ultimately leads to irreversible joint damage. It is the body's reaction to the inflammation, rather than the inflammation itself, that inflicts most of the damage on the body.

The reasons why such an inflammatory response should persist to produce rheumatoid arthritis is an area of ongoing research.
Symptoms vary between individuals. Early on, tender, warm, swollen joints may occur on both sides of the body (symmetrical pattern of inflammation), unlike osteoarthritis which is more joint-specific. In general, the condition usually starts in the hands and feet, often affecting the wrist and finger joints closest to the hand itself. It can also affect the neck, spine, shoulder, elbow, hip and knee joints. The classic symptom is pain and stiffness in affected joints for an hour or more after prolonged rest, especially in the morning.
Because inflammation triggers an auto-immune reaction, sufferers can also feel tired, listless and generally run-down with aches and pains all over the body. Other general symptoms include anaemia, breathlessness, night sweats, temperature/fever, loss of appetite, weight loss and/or irritability.
As it progresses, some develop small lumps of tissue under the skin called rheumatoid nodules. These are usually not painful and occur in areas that receive pressure such as the back of the elbow. In the long term, prolonged flare-ups can damage inflamed joints as the bones of the joint erode, leading to deformities. Also, the swollen tissue may produce damage, causing tendons to rupture.
The disease often continues for many years and may burn itself out. However, for others it can come and go and settle down after a year or two. Active phases often become less and less frequent, and whilst it can take years, it is still possible that it may one day become inactive. Unfortunately, if it has been active for a long time, joints may well be permanently damaged and disfigured by the time this happens

Rheumatoid arthritis - disease progression
As the disease progresses, synovial cells begin to invade and destroy the cartilage within the joint. The cartilage becomes rough and pitted instead of smooth and slippery, making movement difficult and uncomfortable. Surrounding muscles, ligaments and tendons that support the joint become weak and unable to work normally.
The joint can eventually lose its alignment, causing pain, reduced movement and loss of function. The joints of the hand often appear most affected - they can be so badly damaged that fine movements are limited. Destruction of the joint can lead to the wrist turning towards the thumb side of the hand, causing what is known as ulnar drift of the fingers.

The inflammatory process can also affect other parts of the body to cause anaemia, breathlessness, weight loss and flu-like symptoms; it can also affect the nerves, the heart and the lungs