The participants will carry out the exercise program by the same experienced physiotherapist at the Day Care Centre of the Alzheimer Association in Athens. They will receive 24 physiotherapy sessions of exercise, lasting 45 minutes each, twice a week. The duration of the physiotherapy program will be three months (12 weeks). The physiotherapy exercise program will include exercises selected from the Otago Exercise Program (OEP) which was developed and tested by the New Zealand Falls Prevention Research Group in New Zealand to reduce falls in older persons. Yet little research has investigated the use of OEP in people with dementia[17 (link),18 ]. In particular, OEP consists of a warm-up stage promoting circulation and preparing the body for the rest of the program. Participants will mobilize their joints and stretch their muscles. Strength exercises programs i.e. resistance training protocols with the use of weights, can improve muscle strength, physical performance and endurance in elders[19 (link)]. Balance is essential to improve posture and perform everyday activities. Dynamic and static balance exercises may also increase confidence and reduce the possibility of a fall. Finally, stretching exercises develop flexibility and promote relaxation. They reduce the likelihood of fatigue and revitalize the body at the end of an exercise session[20 ]. The exercise program may include the following: (1) easy marching, (2) head movements, (3) back extensions, (4) ankle movements, (5) front and back knee strengthening, (6) slide hip strengthening, (7) calf and toe raises hold, (8) toe and heel walking, (9) one leg stances, (10) sideways walking, (11) sit to stand, (12) back of thigh and calf stretches. All participants will perform identical exercises during their program. They will be able advance to the next level of exercises, according to the Otago protocol instructions[20 ].
All participants will be screened for their imagery ability. The experimental group will complete the Vividness of Movement Imagery Questionnaire (VMIQ) which examines movement imagery[21 ]. This instrument consists of 24 items related to movement imagery, including visual imagery of the movement itself and imagery of kinesthetic sensations. Participants are required to visualize movements and also to imagine someone else performing the same movements. The items fall into six groups of four items each relating to: (a) basic movements; (b) basic movement with more precision; (c) movement with control but with some unplanned risk; (d) movement controlling object; (e) movements which cause imbalance and recovery; and (f) movements requiring control in aerial situations. The VMIQ score is from 1, i.e., perfectly clear and as vivid as normal vision, to 5, i.e., no image at all, you only “know” that you are thinking of the skill. In the first four sessions of the intervention phase, participants will be informed about MI and get a brief report on its influence on clinical and healthy populations. They will follow exercises and instructions designed to develop their skills of MI in terms of self-perception, vividness and control during the first four sessions. A training period of MI is necessary to enable participants to see, control and vividly construct an image in their mind. During this training participants see images of themselves performing movements from everyday life i.e., single leg stance, walking, jogging, climbing stairs, going downstairs, going uphill, going downhill, swimming, etc.[22 ,23 (link)]. A relaxation technique will be performed before starting each imagery training session to facilitate clarity and vividness of imagery representations[24 ]. Participants will complete a manipulation check with a Likert scale ranging from 1 (not at all) to 5 (very much) at the end of every session to confirm whether they are imagining the content of the representation vividly and truthfully.
The same physiotherapist experienced in managing individuals with dementia will perform the assessments. The assessor that will perform the data collection is trained in the procedure and in using the study instruments. A blinded assessor will be involved in motor, cognitive and emotional assessment of participants.
All participants will be screened for their imagery ability. The experimental group will complete the Vividness of Movement Imagery Questionnaire (VMIQ) which examines movement imagery[21 ]. This instrument consists of 24 items related to movement imagery, including visual imagery of the movement itself and imagery of kinesthetic sensations. Participants are required to visualize movements and also to imagine someone else performing the same movements. The items fall into six groups of four items each relating to: (a) basic movements; (b) basic movement with more precision; (c) movement with control but with some unplanned risk; (d) movement controlling object; (e) movements which cause imbalance and recovery; and (f) movements requiring control in aerial situations. The VMIQ score is from 1, i.e., perfectly clear and as vivid as normal vision, to 5, i.e., no image at all, you only “know” that you are thinking of the skill. In the first four sessions of the intervention phase, participants will be informed about MI and get a brief report on its influence on clinical and healthy populations. They will follow exercises and instructions designed to develop their skills of MI in terms of self-perception, vividness and control during the first four sessions. A training period of MI is necessary to enable participants to see, control and vividly construct an image in their mind. During this training participants see images of themselves performing movements from everyday life i.e., single leg stance, walking, jogging, climbing stairs, going downstairs, going uphill, going downhill, swimming, etc.[22 ,23 (link)]. A relaxation technique will be performed before starting each imagery training session to facilitate clarity and vividness of imagery representations[24 ]. Participants will complete a manipulation check with a Likert scale ranging from 1 (not at all) to 5 (very much) at the end of every session to confirm whether they are imagining the content of the representation vividly and truthfully.
The same physiotherapist experienced in managing individuals with dementia will perform the assessments. The assessor that will perform the data collection is trained in the procedure and in using the study instruments. A blinded assessor will be involved in motor, cognitive and emotional assessment of participants.
