Thursday, March 29, 2018

Memory, cognitive disorders don’t have to end outdoor activities

Florida Weekly 'Outdoors' column, 3/28/18

Anyone, including those with memory disorders, can benefit from taking a walk in this environment. COURTESY PHOTO
It’s no secret that remaining physically active as we reach our older years is an important aspect of quality of life. Reams of research confirm the physical and cognitive health benefits that result from regular exercise.

For many of us, our own individual experiences can back that up. Rewards are realized even for those dealing with significant health issues — and it may be even more important in such cases — so physicians commonly encourage their patients to continue whatever activities are enjoyable, possible and safe.

While it may be relatively easy to know what activities are enjoyable and possible, determining which are safe is more complicated. Sometimes it’s about staying away from activities that could worsen a specific condition, while in other cases it’s more about unintended or unexpected outcomes.

As memory disorders such as Alzheimer’s disease and other dementias affect so many of us as we age, the challenge of remaining physically active after diagnosis is relevant. It’s also a matter I’m personally dealing with on a regular basis, and I thought it worthy of writing about it.

My work in the bike and pedestrian field includes dealing with motorists’ behavior. One direct way I do that is by providing formal driving evaluations for a local driving school. Among those I assess are folks who have been diagnosed with memory disorders and other cognitive conditions.

In the majority of cases my clients are still good-to-go because they are in the early stages of their disorder and have been encouraged by their physician or family to get their baseline for comparison as their condition progresses. An important part of the evaluation is the pre-drive interview, which includes questions and discussion about exercise and recreation. Walking and bicycling are frequently included as activities of choice. It’s always a plus in my mind when someone I’m evaluating is a regular exerciser, and I encourage them to continue doing so. But, like my recommendations related to their driving, it comes with caveats.

Some of the obvious issues to consider for driving with cognitive decline include one’s ability to make quick and accurate decisions, geographic awareness and general wayfinding and remembering one’s destinations. Each of those are just as important — perhaps even more so — for anyone on foot or bike. But there are other elements to consider when the person isn’t protected by the safety features of their motor vehicle.

Getting lost and disoriented is an all too common occurrence for those with memory disorders. When someone is beginning to lose the ability to make sound decisions, crossing the street on foot or by bike is sometimes very difficult. Being unsure about one’s whereabouts may cause them to end up crossing more streets than usual or necessary as they attempt to get back on track. Being disoriented makes things that much more difficult.

Also, when vision, balance and stability are becoming compromised, the probability of a fall increases. Traversing uneven sidewalks or having to walk on the soft shoulder when sidewalks don’t exist can create major challenges. If a fall does occur — whether the person is on foot or riding a bike — even a minor head injury can exacerbate a person’s cognitive decline, as can any incident that requires medical care, particularly if surgery that includes anesthesia becomes necessary.

So, as you can see, sticking to one’s usual exercise routine when cognitive issues are present is tricky. It’s also a moving target since, in most cases, abilities are always declining.

But the rate of change is different for each person, as are the specific abilities and skills involved. And, just as having to stop driving is very difficult for most of us, so too is being relegated to a treadmill or stationary bike for those who enjoy running, walking and bicycling outdoors and on our own terms.

While there’s no room for compromise when it’s time to stop driving, there may be ways to stick to a preferred physical activity for some time after diagnosis.

Here are some suggestions I make to my driving evaluation clients and when I address caregivers.

  • Create a specific route within one’s own neighborhood with safe walking conditions. Minimize street crossings.
  • Have a partner when venturing out.
  • Let others know where you’ll be and when you expect to be back.
  • Always carry an ID that explains one’s condition and a cell phone that includes a tracking feature.
  • Finally, caregivers and the person with the condition must continually keep an eye out for signs of becoming at-risk for taking a fall, being unable to make appropriate decisions or not being able to find their way when venturing out alone.

For anyone dealing with dementia, it will eventually be necessary to undertake physical activity in a controlled and protected environment, such as the aforementioned treadmill or stationary bike. More information on this topic can be found at Dubin Alzheimer’s Resource Center,, and the local Alzheimer’s association chapter,

- Dan Moser is a long-time bicycle/pedestrian advocate and traffic safety professional who cycles, runs and walks regularly for transportation, recreation and fitness. Contact him at and 334-6417. 

For Lee County cycling and tri events visit Caloosa Riders Bicycle Club (; Florida Mudcutters (; and SW Florida Biking Meetup Group ( The Florida Bicycle Association ( is your source for statewide happenings. BikeWalkLee’s blog site has all the information you’ll need to stay abreast of advocacy efforts in Southwest Florida as well as statewide and nationally.

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