To date more than six million Americans are living with Alzheimer's disease with a projected increase to 13 million by 2050. During the Covid-19 pandemic, deaths from Alzheimer's and other dementias increased by 16%. Current statistics report that one in three seniors dies with dementia, accounting for more deaths than breast cancer and prostate cancer combined (Alzheimer's Association, 2021).

Current interventions are focused on minimizing decline, promoting independence, managing behaviors, and providing the best possible quality of life. Kouloutbani et al. (2019) identified several studies that suggest benefit of physical activity for individuals suffering from various dementias. The studies supported a role for physical activity in stabilization and improvement in cognitive function and a reduction or delay in severe neuropsychiatric symptoms such as apathy, depression, and confusion. physical activity can improve executive functioning and independence in activities of daily living, as well as reduce fall risk. Still to be determined is the degree of benefit and how it relates to types of exercise, frequency, intensity, and duration. Despite these few unknowns, the addition of an exercise intervention should be addressed by home healthcare clinicians with all patients and specifically those struggling with varying degrees of neurocognitive impairment. According to Graff-Radford (2021), specialist in aging at The Mayo Clinic, exercising several times a week for 30 to 60 minutes improves memory, reasoning, judgment, and thinking skills for individuals with mild cognitive impairment by increasing the size of the hippocampus which is associated with memory. Physical activity facilitates the flow of blood, increases chemicals that protect the brain, and counters some of the natural reduction in brain connections that occur in aging.

The key to an effective physical exercise plan is to modify as needed for safety and individual needs. Most patients will not be able to perform 30 minutes of exercise of any degree or intensity due to impairments and/or stamina. Physical activities need to be modified to meet the needs of the individual. Activities can be performed in a group setting, with a caregiver or independently depending on the patient. Physical activities can be broken down into 5- to 10-minute intervals several times a day and can consist of a variety of exercises. The physical therapist on the team should identify appropriate exercises and a plan of implementation with the patient. Caregivers and other members of the team should participate to model the activity and support the patient's engagement. Activities can be set to age-appropriate music and adequate hydration should be offered before and after the activity. Breaks in the activity are helpful as are handheld props such as flags, pom poms, maracas, or tambourines. Walking or wheeling one's wheelchair or walker are excellent forms of exercise. For those who are wheelchair-bound, chair exercises to music should be designed to be easy and repetitive. Emphasis can be placed on breathing during specific exercises as deep and rhythmic breathing can improve respiratory status and promote feelings of release and calm.

Physical exercise is an important element in the care of neurocognitively impaired patients. It should be addressed by the home healthcare team and will ultimately provide some improvement in quality of life.

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