11Ağu

Prof. Dr. Füsun UYSAL
İstanbul Florence Nightingale Hastanesi FTR Kliniği

Alzheimer hastalarında düzenli egzersiz, tüm bireylerde olduğu gibi, kalp damar sistemi ve bağışıklık sisteminde gelişme sağlarken kas gücü ve dayanıklılığında da artmaya hizmet eder. Hangi evrede olursa olsun Alzheimer hastalarında uygulanan egzersizin, düşme ve buna bağlı kırıkları azalttığı da gösterilmiştir. Düzenli egzersiz programları Alzheimer Hastalığı’na ait bulgulardan bazılarına da yararlıdır.

Yapılan tıbbi çalışmalar, egzersiz yapan Alzheimer hastalarında depresyon ve davranışsal problemlerin daha az görüldüğünü, hafıza ve sosyal becerilerde gelişme olduğunu göstermiştir.

Burada önemli olan, yapılacak egzersizin hastalığın dönemine uygun olması gerektiğidir. Bu nedenle, mutlaka bu konuda uzman bir doktora danışılarak kişiye özel bir egzersiz programı düzenlenmesi gerekir.

Önerilen egzersiz programı:

Alzheimer’da yapılan egzersizin hastada esneklik, kuvvet, dayanıklılık ve denge artışı sağlaması gerekir. Örnek bir egzersiz programında şu aşamalar olabilir:

  1. 5 dakikalık hafif germe egzersizleriyle ısınma
  2. 20 dakikalık aerobik egzersiz (yürüme veya egzersiz bisikleti)
  3. Güçlendirme egzersizleri
  4. 10 dakika boyunca germe egzersizleri ile soğuma

Hastanın haftada üç ya da dört gün bu egzersiz programını sürdürmesi önerilir.

Egzersiz programına başlamadan önce:

  1. Hastanın doktoruna danışılması ve tıbbi bir kontrolden geçmesi gerekir. Eklem romatizması ve yüksek kan basıncı gibi sağlık problemleri, egzersizin güvenli olarak yapılması açısından bazı kısıtlamalara neden olabilir.
  2. Kişiye uygun egzersiz programının oluşturulması için bir fizik tedavi ve rehabilitasyon uzmanının durumu değerlendirmesi ve hastaya uygun gözetimli egzersiz programını oluşturması gerekir.
  3. Tüm hastalarda egzersiz seanslarına çok yavaş başlanmalı, bazen sadece beş dakikalık bir egzersiz programıyla başlayıp aylar içerisinde birer dakika artırarak toplamda 30 dakikaya çıkılması hedeflenir.
  4. Hastaya her aktivitenin tam olarak gösterilmesi ve hastadan bire bir takip etmesinin istenmesi gerekir.
  5. Hastanın sıkılmaması için aktivitelerin çeşitlendirilmesi ve ilginç hale getirilmesi önerilir.

Egzersiz tipleri:

Hastanın yaşamı içerisinde yapmaktan hoşlandığı bir spor varsa, onu mümkün olduğunca sürdürebilmesi sağlanabilir. Bunun dışında en uygun egzersiz önerileri:

  1. Yürüme: En ucuz ve hiçbir ekipman gerektirmeyen ve hemen her yerde yapılabilen bir egzersizdir. Özellikle Alzheimer hastalarında sık görülen dolaşma ihtiyacı için de uygundur. Mutlaka güvenli bir ortamda ve gözetim altında yapılması gerekir.
  2. Bisiklet: Hastada diz ve kalça problemi olmadığı takdirde ve doktor tarafından uygun bulunduğunda egzersiz bisikleti kullanılabilir.
  3. Kuvvetlendirme egzersizleri: Spor salonunda veya evde yine gözetim altında düşük ağırlık ve çok tekrar prensibine dayanan küçük ağırlık çalışmaları yapılabilir.

Egzersizin takibi:

Alzheimer hastasının egzersizle sağladığı gelişmenin izlenmesi önemlidir. Bu nedenle hastanın yürünme mesafesi, egzersiz süresi, kaldırdığı ağırlık ve tekrar sayısı gibi bilgilerin kaydedilmesi gerekir. Örneğin kişinin 5 dakikada yürüdüğü mesafenin artması, hastanın aerobik kapasitesinin, yani dayanıklılığının geliştiğinin bir göstergesidir.

Güvenlik tedbirleri:

  1. Dış ortamda yapılan egzersizler için mutlaka güvenli bir ortamın oluşturulması ve hastanın mutlaka kontrol edilmesi gerekir.
  2. Hastanın ağırlıklarla çalışırken mutlaka gözetim altında olması gerekir.
  3. Hastanın ağırlıkları düşürmesi ihtimaline karşın, uygun kalın ayakkabılar giymesi gerekir.
  4. Hasta egzersiz yaparken konuşabiliyorsa aerobik olarak rahat bir durumda olduğu kabul edilir. Hasta egzersiz yaparken konuşmakta zorlanmaya başlarsa biraz yavaşlaması gerektiği anlaşılır.
  5. Açık havadaki aktiviteler için güneş koruyucuları ve uygun giyimin sağlanması, mutlaka bir şapka takılması önerilir.
  6. Hastanın egzersizden önce, sırasında ve sonrasında bolca su içmesi sağlanmalıdır.
  7. Hasta kendini yorgun ve halsiz hissettiği takdirde, ya da herhangi bir ağrısı olduğu durumda aktivitenin durdurulması ve bir doktora başvurulması gerekir.

Alzheimer hastalarında egzersizin birçok sistem üzerindeki olumlu etkisinin yanı sıra hastalığın sonuçları üzerinde de olumlu etkileri olduğu unutulmamalıdır. Ancak bu etkilere ulaşabilmek için mutlaka doktor önerisiyle planlanmış ve hastaya özel bir egzersiz programının yaşamın bir parçası haline getirilmesi gerekir.

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