Exercise interveNtion outdoor proJect in the cOmmunitY (ENJOY) program in Dementia

Physical activity intervention - Participants from the intervention group will undergo 3 months supervised structured physical activity program using the Seniors Exercise Park outdoor equipment followed by a 3 months maintenance phase (unstructured independent exercise). The Seniors Exercise Park - is outdoor playground equipment specifically designed for older people to improve strength, balance, joint movements and mobility and function. It comprises multiple equipment stations that target specific function or movement (upper and lower limb) such as shoulder range of movement, static and dynamic balance (walking on uneven surfaces, walking on a movable bridge), functional movement of walking up/down stairs, sit to stand. Example of the exercises can be found here: https://www.youtube.com/watch?v=PaYuCMtnlYk Structured supervised 12 weeks exercise program: Participants will undergo a 12-week supervised exercise intervention program twice a week using the seniors exercise park. Participants will perform exercises that focus on strength, balance, coordination, mobility and flexibility. The exercise park sessions will be provided two times a week (each class approximately 1 to 1.5 hours duration) and will be supervised by a qualified physiotherapist or an accredited exercise physiologist with the assistance of another supervisor (Aged Care staff; Physiotherapist/Diversional Therapist). Each session will consist of 5-7 minutes warm-up exercises, followed by 45-75 minutes on the equipment stations, and will conclude with 5-7 minutes of cool down exercises. The exercise classes will include 3-4 participants and will be circuit-based. A familiarisation session will be organised for each participant prior to commencement of the exercise program. The initial level of the exercise difficulty will be determined during the familiarisation session and will be tailored to the capabilities of the participant with the primary consideration of safety. To maximise social interaction and enjoyment, morning/afternoon tea will be organised following the exercise sessions. The general exercise program structure will follow our previous published protocol (Levinger, P., et al., Exercise interveNtion outdoor proJect in the cOmmunitY for older people - the ENJOY Senior Exercise Park project translation research protocol. BMC Public Health, 2019. 19(1): p. 933), however given this is a feasibility study with a different clinical cohort, we anticipate modifications in the program and will be recording any variation. Principle of exercise progression and intensity: Week Number; Set Time; Rest Time 1 to 2; 60 seconds; 30-60 seconds to change over and rest 3 to 5; 60 seconds; less than or equal to 30 seconds change over and rest 6 to 9; 75 seconds; less than or equal to 30 seconds change over and rest 10 to 12; 90 seconds; less than or equal to 30 seconds change over and rest Maintenance phase - Independent usage 12-24 weeks post baseline After completion of the 12-week program, it is expected that participants will be familiar with the equipment and the exercises and therefore able to exercise more independently. Pre-scheduled sessions will be available for participants to access and use the Seniors Exercise Park under supervision (Physiotherapist/ Diversional Therapist staff from the facility, who are trained in using the equipment). To facilitate independence and empowerment, participants will be encouraged to exercise independently (supervised but unstructured sessions). Small exercise cards with graphic images will be placed in each exercise station to aid participants to progress through the stations. Adherence - weekly attendance to both the structured supervised and maintenance phases will be monitored using attendance logs. The attendance logs will be recorded by the research staff.