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Program Improves Cognitive Function, Fitness

By Moira Keating

(Reprinted from Alzheimer’s Care Guide ( and ElderCare Activities Guide)

It was shortly after her father’s funeral, as her mother tried to write thank-you notes to family and friends, that Susan
Arkin first noticed that something was not quite right.  Her mother Beatrice, normally a highly verbal and articulate
woman, could barely pen two sentences.  Shortly thereafter, Beatrice, whose memory had greatly declined, was
diagnosed with early stage Alzheimer’s.  Knowing little about the disease at the time, Sharon asked about a plan for

“There is none,” the doctor responded.  “Come back in a year, and we will see how much she has deteriorated.”  
Discouraged but unwilling to lose hope, Susan, who was a PhD candidate in psychology at the time, began
experimenting on her mother with different memory and language stimulation activities.  “My mother became my
guinea pig,” say Arkin.  These initial intervention exercises eventually evolved into a nationally acclaimed study.  
Funded by the National Society on Aging, Arkin created and directed the Elder Rehab Program at the University of

Arkin’s program clearly proved that patients who participated in supervised exercise sessions had a marked increase
in physical fitness, improved moods, and a slower rate of cognitive decline.

During the course of the five-year study, 24 mild to moderate stage Alzheimer’s patients participated in twice weekly
exercise sessions, one supervised by a U of A student, the other by a family member or caregiver.  Language and
memory stimulation activities and weekly supervised volunteer work were also part of the program.  One of the
wonderful things about Arkin’s study, besides the incredible insight it gives into the disease, is the fact that it can be
easily replicated at nursing homes and other elder care facilities.

The key to starting your program begins with the three intervention components: exercise, memory and language
stimulation exercises, and volunteer work.

“The single most important benefit of a physical exercise program for dementia patients,” says Arkin “is that success
and improvement in function are virtually guaranteed.  And this is a welcomed experience for persons with dementia
who typically face daily failures as their dementia progresses.”

The exercise component should be a balanced one that includes aerobic activity, weight training, and stretching or
balancing activities.  Arkin recommends that participants complete 20-30 minutes of aerobic activity be it with
standard gym equipment like a treadmill, or if a gym is not available, household activities like raking leaves or
washing windows.  The aerobic activity should be coupled with 20-30 minutes of strength training and five to ten
minutes of stretching.  (See side bar for a list of exercise suggestions.)        

Patients should take part in two supervised exercise sessions per week; one can be supervised by a student/volunteer,
the other by a family member or caregiver.

Language and Memory Stimulation
Memory and language stimulation activities should be incorporated into the weekly student / volunteer supervised
exercise sessions.  “The students,” says Arkin “should conduct 10 to 12 memory and language activities during the
session” be it while the patient is on the treadmill or the exercise bike or during a rest period while weight training.  
Language and memory activities include anything form a discussion of controversial issues to word association.  The
activities not only provide practice in memory skills that ordinarily decrease in Alzheimer’s patients, they help to pass
the time and improve the patient’s conversational abilities.  (See side bar for a list of recommended activities.)

Volunteer work
Arkin included a volunteer component in the program because she found that her mother, though forgetful in the
early stages of the disease, was always better at remembering things she had to do for others than remembering her
own daily activities or obligations.  For example, Beatrice never forgot to water her neighbor’s plants when she was
out of town, or remind her friends in the apartment complex of their scheduled doctors’ appointments.  “And,” says
Arkin “my mom always felt good when she was helping someone out.”

It is important to keep in mind the interest of the patients when developing volunteer or service activities.  For
example, for those patients who enjoy walking, Arkin suggests contacting the Humane Society or local kennel for
they are always in need of dog walkers.  And for those who enjoy young children, day care centers often welcome
the elderly to read to or play with the children.  These activities, like the exercise components, always take place in
a one-on-one partnership with a student/volunteer.  This intervention enables the patient to not only feel useful and
appreciated but connected to the community as well.  (See side bar for volunteer suggestions.)

Finally, Arkin recommends that student/ volunteers incorporate twenty minutes of walking or some type of physical
activity into the “volunteer day.”

The Key to Success
One of the most important keys to a successful program is the use or presence of students.

“Most early stage patients,” says Arkin “loved being exposed to the students.  Usually they are in the care of an elderly
spouse or son or daughter whose primary concern is with the logistics of caregiving, getting them to appointments

“The students,” Arkin says, “were there just to stimulate them, entertain them and enjoy them.  Though you can
certainly recruit volunteers to staff your program, "The problem with volunteers,” says Arkin," is that you do not have
the leverage over them that you do with the students who are earning credit.  With students, you get 100 percent
compliance and 100 percent attendance something we didn’t even get with family members.”

Finding students however is not that difficult.  Many universities and colleges now require students to complete
service projects to graduate, and many college campuses now have internship programs that provide students with
credit for the internship experience.  Arkin suggests contacting your local university to see if such programs exist, or
contacting academic departments such as Speech and Hearing, Psychology, Nursing or Social Work to see if a
professor would offer independent study credits to students who participate in your program.
“An enterprising activity director,” says Arkin “can create an enduring and mutually beneficial partnership between
residents and enthusiastic young people with love and energy to give.  Get moving!”

Susan Arkin, PsyD, MEd, is a licensed clinical psychologist and Alzheimer rehabilitation consultant affiliated with
the University of Arizona’s Department of Speech and Hearing Sciences.  If you would like to contact Dr. Arkin, you
can email her at  If would like more information regarding her Elder Rehab Program visit her
website at

For those interested in initiating a language-enriched exercise program at their facility, beginning in January 2005,
the University of Arizona will offer a continuing education course pack which contains a 160- page workbook that
includes the exercises Dr. Arkin used in her program, as well as work sheets to track patients progress; and a video
that demonstrates all exercises and language activities .To order this packet, call 1-800-873-6759 or email

Suggested Exercises
Rowing machines
Stationary bikes
Climbing stairs
Weight Training
2 sets or 10-12 repetitions
Leg press
Chest press
Arm curls

Language and Memory Stimulation Activities
Word Association
Sentence Completion
Object naming
Advice and Opinion questions
Discussions of controversial topics
Proverb completion
Short story recall quizzes

Volunteer Activities
Reading for children at day care facilities
Stocking shelves or filling food boxes at the Community Food Bank
Stamping/shelving library books
Taking wheel chair bound patients for walks
Grooming dogs at the Humane Society
Serving at food kitchens
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From the pages of
Kate Lynch, Editor