Skip to main content Accessibility help

Aquatic exercise for residential aged care adults with dementia: benefits and barriers to participation

  • Timothy Henwood (a1) (a2) (a3), Christine Neville (a1), Chantelle Baguley (a1) and Elizabeth Beattie (a4)



Pilot work by our group has demonstrated that aquatic exercise has valuable functional and psychosocial benefits for adults living in the residential aged care setting with dementia. The aim of the currents study was to advance this work by delivering the Watermemories Swimming Club aquatic exercise program to a more representative population of older, institutionalized adults with dementia.


The benefits of 12 weeks of twice weekly participation in the Watermemories Swimming Club aquatic exercise program were assessed among an exercise and usual care control group of residential aged care adults with advanced dementia. A battery of physical and psychosocial measures were collected before and after the intervention period, and program implementation was also investigated.


Seven residential aged care facilities of 24 approached, agreed to participate and 56 residents were purposefully allocated to exercise or control. Twenty-three participants per group were included in the final analysis. Both groups experienced decreases in skeletal muscle index and lean mass (p < 0.001), but exercise stifled losses in muscle strength and transition into sarcopenic. Behavioral and psychological symptoms of dementia and activities of daily living approached significance (p = 0.06) with positive trends observed across other psychosocial measures.


This study demonstrates the value of exercise participation, and specifically aquatic exercise in comparison to usual care for older, institutionalized adults with advanced dementia. However, it also highlights a number of barriers to participation. To overcome these barriers and ensure opportunity to residents increased provider and sector support is required.


Corresponding author

Correspondence should be addressed to: Dr Timothy Henwood, The University of Queensland, Brisbane Qld 4305, Australia. Phone: +61 7 424078209. Email:


Hide All
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271284.
Alzhiemer's Australia NSW. (2014). The benefits of Physical activity and exercsie for people living with dementia. NSW. Available at:; last accessed August 18, 2016.
Alzhiemer's Disease International. (2010). World Alzheimer Report 2010 The Global Economic Impact of Dementia. London: Alzhiemer's Disease International.
Australain Government (2014). Water Therapy. Available at:; last accessed November 2015.
Australian Insitute of Health and Welfare. (2012). Dementia in Australia. Canberra: AIHW.
Barnes, D. E., Whitmer, R. A. and Yaffe, K. (2007). Physical activity and dementia: the need for prevention trials. Exercise and Sports Science Reviews, 35, 2429.
Bonnefoy, M. et al. (2003). The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. British Journal of Nurition, 89, 731739.
Brett, L., Traynor, V. and Stapley, P. (2016). Effects of physical exercise on health and well-being of individuals living with a dementia in nursing homes: a systematic review. Journal of the American Medical Directors Association, 17, 104116.
Burge, E., Kuhne, N., Berchtold, A., Maupetit, C. and Von, G. A. (2012). Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review. European Review of Aging and Physical Activity, 9, 2739.
Burgener, S. C., Jirovec, M., Murrell, L. and Barton, D. (1992). Caregiver and environmental variables related to difficult behaviors in institutionalized, demented elderly persons. Journals of Gerontology, 47, P242P249.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Hillsdale, N.J.: L. Erlbaum Associates.
Conradsson, M., Littbrand, H., Bostrom, G., Lindelof, N., Gustafson, Y. and Rosendahl, E. (2013). Is a change in functional capacity or dependency in activities of daily living associated with a change in mental health among older people living in residential care facilities? Clinical Interventions in Aging, 8, 15611568.
Cruz-Jentoft, A. J. et al. (2010). Sarcopenia: European consensus on definition and diagnosis: report of the European working group on Sarcopenia in older people. Age and Ageing, 39, 412423.
Dewing, J. (2010). Responding agitation in people with dementia. Nursing in Older People, 22, 1825.
Fiatarone, M. A. et al. (1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine, 330, 17691775.
Fiatarone, M. A., Marks, E. C., Ryan, N. D., Meredith, C. N., Lipsitz, L. A. and Evans, W. J. (1990). High-intensity strength training in nonagenarians. Effects on skeletal muscle. Journal of the American Medical Association, 263, 30293034.
Goldberg, L. R. et al. (2014). Hydration in older adults: the contribution of bioelectrical impedance analysis. International Journal of Speech and Language Pathology, 16, 273281.
Goss, J. (2008). Projection of Australain Health Care Expenditure by Disease, 2003 to 2033. Canberra: AIHW.
Guralnik, J. M. et al. (1994). A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journals of Gerontology, 49, M85M94.
Haines, T., Kuys, S. S., Morrison, G., Clarke, J., Bew, P. and Mcphail, S. (2007). Development and validation of the balance outcome measure for elder rehabilitation. Archives of Physical and Medical Rehabilitation, 88, 16141621.
Hancock, G. A., Woods, B., Challis, D. and Orrell, M. (2006). The needs of older people with dementia in residential care. International Journal of Geriatric Psychiatry, 21, 4349.
Henwood, T., Baguley, C. and Neville, C. (2015a). Achieving ethics approval in residential aged care research: a protective process or barrier. Australasian Journal on Ageing, 34, 201.
Henwood, T., Neville, C., Baguley, C., Clifton, K. and Beattie, E. (2015b). Physical and functional implications of aquatic exercise for nursing home residents with dementia. Geriatric Nurings, 36, 3539.
Heyn, P., Abreu, B. C. and Ottenbacher, K. J. (2004). The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Archives of Physical and Medical Rehabilitation, 85, 16941704.
Janssen, I., Heymsfield, S. B., Baumgartner, R. N. and Ross, R. (2000). Estimation of skeletal muscle mass by bioelectrical impedance analysis. Journal of Applied Physiology, 89, 465471.
Jorm, A. F. et al. (1995). The psychogeriatric assessment scales - a multidimensional alternative to categorical diagnoses of dementia and depression in the elderly. Psychological Medicine, 25, 447460.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. JAMA, 185, 914919.
Laurin, D., Verreault, R., Lindsay, J., Macpherson, K. and Rockwood, K. (2001). Physical activity and risk of cognitive impairment and dementia in elderly persons. Archives of Neurology, 58, 498504.
Littbrand, H., Stenvall, M. and Rosendahl, E. (2011). Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review. American Journal of Physical and Medical Rehabilitation, 90, 495518.
Liu-Ambrose, T. and Donaldson, M. G. (2009). Exercise and cognition in older adults: is there a role for resistance training programmes? British Journal of Sports Medicine, 43, 2527.
Miranda-Castillo, C., Woods, B. and Orrell, M. (2010). People with dementia living alone: what are their needs and what kind of support are they receiving? International Psychogeriatrics, 22, 607617.
Neville, C., Clifton, K., Henwood, T., Beattie, E. and Mckenzie, M. A. (2013). Watermemories a swimming club for adults with dementia. Journal of Gerontological Nursing, 39, 2125.
Neville, C. and Henwood, T. (2013). Watermemories: A Swimming Club for People With Dementia: A Manual for Aged Care Service Provider and Program Instructors. Brisbane, Australia: University of Queensland Press.
Neville, C., Henwood, T., Beattie, E. and Fielding, E. (2014). Exploring the effect of aquatic exercise on behaviour and psychological well-being in people with moderate to severe dementia: a pilot study of the Watermemories swimming club. Australasian Journal on Ageing, 33, 124127.
Neville, C., Henwood, T., Clifton, K. and Beattie, E. (2012). The watermemories swim club for people with dementia. Journal of Aging and Physical Activity, 20, S8S9.
Ouslander, J. G. et al. (2011). Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project. Journal of the American Geriatric Society, 59, 745753.
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the geriatric anxiety inventory. International Psychogeriatrics, 19, 103114.
Reisberg, B. (1988). Functional assessment staging (FAST). Psychopharmacolical Bulliten, 24, 653659.
Scherder, E. J., Bogen, T., Eggermont, L. H., Hamers, J. P. and Swaab, D. F. (2010). The more physical inactivity, the more agitation in dementia. 22, 12031208.
Smith, P. (2003). Waterworks. Working with Older People, 7, 3940.
Teri, L. et al. (2003). Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA, 290, 20152022.
Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S. and Vitaliano, P. P. (1992). Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychological Aging, 7, 622631.
Thune-Boyle, I., Lliffe, S., Cerga-Pashoja, A., Lowery, D. and Warner, J. (2012). The effect of exercise on behavioral and psychological symptoms of dementia: towards a research agenda. International Psychogeriatrics 24, 10461057.
Tilden, V. P., Thompson, S. A., Gajewski, B. J., Buescher, C. M. and Bott, M. J. (2013). Sampling challenges in nursing home research. Journal of the American Medical Directors Association, 14, 2528.
Williams, C. L. and Tappen, R. M. (2007). Effect of exercise on mood in nursing home residents with Alzheimer's disease. American Journal of Alzheimers Disease and Other Demenia's, 22, 389397.


Related content

Powered by UNSILO

Aquatic exercise for residential aged care adults with dementia: benefits and barriers to participation

  • Timothy Henwood (a1) (a2) (a3), Christine Neville (a1), Chantelle Baguley (a1) and Elizabeth Beattie (a4)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.