The Watermemories Swimming Club for People with Dementia: Cluster Randomised Controlled Trial

Inclusion criteria: Eligibility criteria for RACFs: 1. > 50 high care beds 2. > 40% residents with dementia 3. within 25 kms of Toowoomba CBD Eligibility criteria for residents: 1. Past history of swimming or a desire to go swimming 2. Residing in a residential aged care facility (low or high care) 3. Diagnosis of dementia 4. Able to walk a minimum of 10 metres self‐ambulating or with a walking cane or wheelie walker Exclusion criteria: Exclusion criteria for residents: 1. Unstable or terminal illness 2. Wheel‐chair or bed bound 3. Medications contradictory to exercise 4. Unable to obtain medical clearance from GP to participate 5. Unable to obtain substitute decision‐maker consent. The intervention will be implemented over 12 weeks, post‐intervention will assessment will be at 12 weeks and follow‐up assessment will be completed at 26 weeks. The Watermemories Swimming Club (WSC) is an established aquatic exercise intervention designed by a team which includes a gerontological exercise physiologist and dementia experts. This intervention targets resistance, balance, flexibility and aerobic training, and includes a warm up and cool down phase. Exercises include walking, marching and weight transfer, lower and upper body resistance activities. Following each session the intervention has a time allowance of up to 15 minutes for free swimming so participants can engage in laps, playing or relaxing. Specific exercises can be tapered to cater for both group and individual capacity. Sessions are delivered by experienced swimming instructors and in‐pool assistants trained in the intervention delivery. The Watermemories aquatic exercise intervention is designed to increase physical activity, improve health as well as enhance social, BPSD and affective outcomes. The need to increase physical activity in people with dementia is straight‐forward. The beauty of swimming is that not only is accessible, simple, measurable, safe, non‐invasive, inexpensive and enjoyable but it addresses the adverse physical effects of inactivity as well as having a significant impact on BPSD, psychological distress, anxiety and depression. Water is a supportive environment ideal for people with arthritis and at risk of falls and importantly, offers resistance to maintain exercise progression and intensity. From the perspective of person‐centered care, it is appropriate for people who have a history of aquatic exercise, or do not like, or are unable to partake in, common alternatives such as gym exercise, walking, dancing or gardening. Adults in facilities participating in the WSC intervention will partake in the WSC program, after receiving consent from a substitute decision‐maker and medical clearance from a GP. The program involves twice‐weekly, 45 minute sessions over a 12 week period. Adults will be accompanied in the pool by trained volunteers. In addition, the pool will have at least one life guard on duty and an exercise physiologist will regularly attend sessions to assist with supervision. A maximum of 10 adults with dementia will attend each session. At the beginning and conclusion of the 12 week period, all participants will receive physical and psychological assessments. Throughout the intervention period, a weekly attendance list will be generated by each facility so that participant attendance and adherence to the program can be monitored. Behaviour and psychological symptoms of dementia, as assessed by the Revised Memory and Behaviour Checklist ;Psychological well‐being, as assessed by the Psychological Well‐Being in Cognitively Impaired Persons test;Functional capacity, assessed by the Balance Outcome Measure for Elder Rehabilitation (BOOMER) test Functional capacity, as assessed by the Index of Independence in Activities of Daily Living Evaluation Form;Depression, as assessed by the Cornell Scale for Depression;Anxiety, as assessed by the Geriatric Anxiety Inventory;Functional capacity, as assessed by the Short Physical Performance Battery ;Daily physical activity and ambulatory activities, as as essed by an Actigraph triaxial accelerometer activity monitor worn on the wrist of participants during waking hours for 7‐day periods.