Standing up for Dementia: exchanging knowledge on developing a patient and professional pathway for physical activity and exercise.

Dementia is currently a major healthcare problem. As our population ages, the number of people suffering from dementia increases yearly. This comes at both a large human and financial cost. Currently, there is no cure for dementia but medication can help to delay the progress of the disease although this has varying degrees of success - other treatment options which involve the patient more directly in their own care are therefore a necessity.

Mild cognitive impairment (MCI - defined as a level of cognitive impairment which although noticeable, does not impact sufficiently on an individual's life to be diagnosed as dementia) is seen a stepping stone in the development of dementia, with large numbers of people diagnosed going on to develop dementia over the coming years. One of the main symptoms of dementia and MCI is the detrimental effect that it has on cognitive processes (for example memory, planning, perception and orientation). Within an elderly age group, research suggests that increasing physical activity can have beneficial effects on cognitive processes in later life and this may also be the case in individuals with MCI. This can also be protective as people who are more physically active in their younger years are at less risk of developing dementia as they get older.

Unfortunately, many of the studies carried out so far in groups with MCI have not been performed to a high methodological standard, often with mixed groups of dementia participants with different diagnoses of dementia (it is likely that different types of dementia will respond differently to physical activity, just as they do with medications prescribed), in different care settings and without comparable cognitive assessment tools. This means that there is no current clinical advice for individuals with MCI, their caregivers and healthcare professionals as to what sort of physical activity may be beneficial to them as an alternative to current treatments.

We propose to develop a behaviour change program which promotes the use of physical activity to maintain cognitive function and prevent cognitive decline in older adults at risk of dementia (those with MCI). This will aim to change the behaviour of both the individual with MCI and the healthcare professionals responsible for their care with the ultimate aim that physical activity can be offered as a healthcare 'prescription' to individuals.

The Movement as Medicine for Cognition project has significant potential for impact within the fields of promotion of wellbeing and disease management, with a clear and transparent route to that impact being realised. The potential impacts of the project and the routes to realisation are as follows:

1: PROVIDE A PATIENT AND PROFESSIONAL DEVELOPMENT PATHWAY FOR PHYSICAL ACTIVITY AND EXERCISE IN THE MANAGEMENT OF MCI: We will provide an alternative treatment option for healthcare professionals and patients under their care with the aim of promoting cognitive performance. We will do this through the use of experience based design of professional and patient MCI management. This will result in an accessible resource for health care professionals to utilize in clinic with clients with MCI and will engage the client in their own care package. This will be a free and widely accessible tool.

2: PROVIDE A PATIENT AND PROFESSIONAL DEVELOPMENT PATHWAY FOR PHYSICAL ACTIVITY AND EXERCISE IN THE PREVENTION OF DEMENTIA: We will address an unmet need for the provision of a behavior change program which promotes physical activity as a feasible and effective disease prevention strategy in healthy older adults and those at risk of developing dementia. We will do this through the use of experience based design of professional and patient dementia prevention. This will result in an accessible resource for healthy older-age adults providing advice and guidance on undertaking physical activity with the aim of maintaining cognitive function. This will be a free and widely accessible tool.

This project will therefore have impact for the health and wellbeing of the general public and patients within 12 months, providing physical activity advice informed by well conducted research findings. This will provide training to healthcare professionals in the use of the Movement as Medicine for Cognition package and will be developed with their input. Patients will play a more active role in their own disease management and within a healthy group, benefits of physical activity will also result in reduced costs to the NHS in other healthcare areas (as the reduced rates of a wide range of diseases though physical activity has bee widely reported). The NHS will also benefit from a reduction of resource dependence through lower conversion rates from MCI to dementia and the current burden placed on nursing homes will hopefully be alleviated in the longer term.