A combined Face-to-face and Telehealth Home-based Exercise Program for Older People with Dementia in Indonesia

Participants with dementia will participate in an individualised (tailored) home-based exercise program, delivered by a physiotherapist (with minimum 5 years’ experience). This exercise program is based on an existing home exercise program (the Otago program, https://www.livestronger.org.nz/assets/Uploads/acc1162-otago-exercise-manual.pdf). Exercise participation will be encouraged and monitored for safety through the carer, who will be trained by the physiotherapist (adapting the approach and resources used by Sari YM, Burton E, Lee D-CA, Hill KD. A Telehealth Home-Based Exercise Program for Community-Dwelling Older People with Dementia in Indonesia: A Feasibility Study. International Journal of Environmental Research and Public Health. 2023;20(4):3397 doi:10.3390/ijerph20043397). The exercises included warm up, balance, resistance and walking exercises, with the physiotherapist aiming for moderate-intensity exercise level, in terms of exercise demands and difficulty for each participant (e.g., by changing the repetitions, load, and foot position). Judgement of the level of challenge of the exercises relative to the participant’s ability will based on observation and questioning of the participant by the physiotherapist. As the exercise program has a multimodal focus (including balance exercises), use of a single domain tool such as the Borg RPE scale would not be able to be utilised across the variety of exercises used. The physiotherapist will select the appropriate exercises which will be tailored to address mobility, balance, and other physical problems identified from the assessments. A training manual and a training session will be provided by the researcher (YMS) to physiotherapists delivering the intervention. Participants with dementia will undertake the exercise program for 12 weeks, 5 sessions per week and 60 minutes per session and will receive two home visits (face to face) at participant’s home at weeks 1 and 6 and two online visits using zoom from the physiotherapist at weeks 3 and 10 during the 12-week intervention duration. Before the online visits, participating dyads (dyads of participants with dementia and carers) will attend an online orientation session led by the physiotherapist. The physiotherapist will explain and demonstrate the zoom software, testing the camera sound for performing the exercise program, setting the device distance and environment for performing the exercises and will explain about safe performance when undertaking the exercises. During the visits, the physiotherapist who will deliver the exercise program will monitor and tailor/modify the program where required and answer any questions in each visit. An exercise information booklet that is specifically designed for this study that explains the exercises in plain language will be provided to each participant or carer by the physiotherapist to give instructions and illustrations for the participant to undertake the exercise program independently. A set of ankle weights will also be provided to participants for undertaking strength exercises. The physiotherapist will contact participants or the carers at weeks 2, 5, 8 and 11 in between visits by telephone (four check-up phone calls during the exercise intervention period) to motivate participation with the exercise program, to inquire if they have experienced any negative effects or adverse events during the intervention and answer any questions about the exercise program. An online session via zoom about additional background information about dementia and support in caring for an older person with dementia will be provided by an Alzheimer’s Indonesia volunteer between the exercise and follow-up sessions. An exercise diary will be used to monitor adherence to the program (i.e., collecting data on times/week, type of exercise, sets, repetition and load (kgs) of exercises undertaken) by participants with the assistance of their carer. At the end of the 12-week program, a re-assessment of physical function by the physiotherapist assessor and a survey to explore the experience of participants with dementia, their carers and physiotherapist in this program will be conducted, and participants and their carers will be asked to continue the program on their own for an additional 6 weeks without physiotherapist visits or supervision. A follow up assessment by the physiotherapist assessor (different to the physiotherapist delivering the exercise intervention) and a survey to participants with dementia and their carers will be conducted 6 weeks after exercise program completion (18 weeks after baseline assessment) to provide preliminary data on the sustainability of exercise participation beyond the period with physiotherapist oversight.