Introduction

Dementia is an umbrella term used to describe a decline in a person's cognitive abilities, including memory, thinking and communication. While dementia primarily affects the brain, it can also have a significant impact on physical function as the condition progresses. People living with dementia may experience changes in balance, coordination, strength and mobility, which can increase their risk of falls and make everyday activities more challenging.

This is where physiotherapy can play an important role. By focusing on movement, strength, balance and independence, physiotherapy can support the physical wellbeing and quality of life of people living with dementia.

How Physiotherapy Can Help

A systematic review involving almost 4,000 people with mild cognitive impairment or dementia across 43 clinical trials found that supervised exercise can improve a range of physical outcomes, including walking ability and the time it takes to stand up from a chair.

Let's look at some of the ways physiotherapy can support people living with dementia.

Maintaining Independence with Everyday Activities

Physiotherapy aims to help people maintain their independence for as long as possible. This may include balance exercises, strengthening exercises and practising movements that are important for everyday activities.

Physiotherapists can also recommend changes to a person's routine or home environment to make daily activities easier and safer. The goal is to support people to continue doing the things that are important to them.

Reducing the Risk of Falls

Changes in balance, strength and coordination can increase the risk of falls for people living with dementia. Physiotherapists can assess these areas and develop personalised exercise programs to help improve strength, balance and confidence with movement.

Where appropriate, a physiotherapist may also recommend and provide training with a walking aid. Making the home environment safer and identifying potential hazards can further help reduce the risk of falls.

Supporting Safe and Efficient Walking

Dementia can sometimes be associated with changes in walking, including slower walking speed, changes in step length, reduced balance or changes in posture. Physiotherapy can help assess these changes and identify strategies to support safer and more efficient walking.

This may include strengthening exercises, balance and coordination activities, walking practice, postural exercises and assessment of whether a walking aid would be beneficial.

Regular physiotherapy reassessments also allow exercises and mobility strategies to be adjusted as a person's needs change. Supporting safe mobility can help people maintain their independence, confidence and dignity.

Conclusion

Physiotherapy is not just about improving strength or mobility. It is about helping people living with dementia continue doing the things that matter to them.

Your In Home Rehab's physiotherapists work with each person to provide personalised exercise programs, mobility advice, home safety assessments and guidance around assistive equipment. By focusing on each person's individual goals and abilities, physiotherapy can help support independence, safety and quality of life throughout their journey with dementia.

Written by Katie Prunty, Physiotherapist (AHPRA registered)

Falls can happen to anyone — slips and trips are a part of life. However, falls become more common and potentially more significant as we age.

Falls in older people are often dismissed as just a "part of getting older" or having always had "balance problems." However, they can sometimes be a warning sign that something may require medical attention.

Unfortunately, falls are one of the main reasons older people are admitted to hospital or need to move to more supported accommodation. They occur more frequently as we age for several reasons: the natural changes that happen to our bodies over time (such as muscle loss), environmental factors (such as a cluttered home, loose rugs, or difficulty getting up from a chair), and leading a more sedentary lifestyle where everyday movements gradually become harder.

The good news is that many falls can be prevented, and the injuries caused by falls can be reduced — helping you maintain your health and independence.

Understanding Your Risk

There are many reasons why people fall, and often it is a combination of factors. These are known as 'risk factors' — the more risk factors you have, the higher your risk of falling. If we can identify them, we can work to modify them and reduce that risk.

Not all risk factors can be changed. For example, age itself cannot be modified — but reduced lower limb strength can be improved with the right exercise program.

To help you understand your risk, you can do a preliminary self-appraisal using the factors below. However, a full assessment is best carried out by a medical professional, physiotherapist, or occupational therapist. If your risk appears medium to high, please seek further professional advice.

Key Risk Factors to Consider

History of falls and fear of falling: Reflect on any past falls or near-falls. Falling more than once in the past year may indicate an increased risk. A history of falls can also lead to a fear of falling, which sometimes causes people to become less active to stay "safe" — however, this inactivity can then weaken muscles and function, creating further risk. Have you had any recent falls?

Walking patterns and footwear: Proper footwear with good grip and support is important for maintaining balance, especially on uneven or slippery surfaces. Healthy, pain-free feet are also important. A Podiatrist can provide guidance on foot health. Changes to your walking pattern — for many possible reasons — can affect balance and increase fall risk.

Balance: Do you frequently feel unsteady when walking, standing, getting up from a chair, or changing positions?

Vision and hearing: Impairments in vision (such as cataracts) and hearing can both affect balance. Ensure you have regular check-ups for eyes and ears, and that any hearing aids or prescription eyewear are up to date.

Muscle strength and flexibility: Weak muscles and limited flexibility can influence balance. Current guidelines recommend 2–3 hours of moderate activity per week to support strength and reduce fall risk. A physiotherapist can guide you on appropriate exercises for your situation.

Dizziness or vertigo: Frequent episodes of dizziness or vertigo can significantly affect balance. Consult a healthcare professional if you experience these symptoms.

Medications: Some medications can affect balance and increase fall risk. Review your current medications with a healthcare professional to understand whether this may be a contributing factor.

Home environment: Evaluate your living space for potential hazards — remove clutter, secure loose rugs, and install handrails in bathrooms and on stairs. An Occupational Therapist can conduct a home safety assessment tailored to your specific environment and needs.

Chronic conditions: Certain medical conditions such as arthritis, Parkinson's disease, or neuropathy can affect balance. If you have any of these conditions, discuss fall prevention strategies and appropriate exercises with your healthcare professional. It is also worth asking about Vitamin D levels and bone density if you have osteoporosis.

Can you identify any of these risk factors in your own life? Note them down so you can discuss and action them with a healthcare professional.

Remember — everyone's health and balance are unique. A personalised evaluation from a registered health practitioner is the most effective way to address your specific concerns.

How We Can Help

If you identify with some of the risk factors above, a thorough consultation and assessment with one of our registered healthcare professionals can help you take meaningful steps to address them. There are many ways to lower your fall risk and improve your physical function over time.

Your In Home Rehab offers a multidisciplinary team with tailored assessments, home safety evaluations, and evidence-based exercise programs specifically designed for falls prevention and balance rehabilitation. We can help strengthen the right muscles and work with you toward the 2–3 hours of weekly activity recommended to support your ongoing health and independence.

Written by Kylie Doyle, Physiotherapist (AHPRA registered)

References

Falls | Australian Commission on Safety and Quality in Health Care

Preventing falls in community care — Fact sheet | Australian Commission on Safety and Quality in Health Care

Osteoporosis and osteopenia are common age-related conditions characterised by reduced bone mineral density (BMD), increasing the risk of fractures. They are particularly prevalent in postmenopausal women due to the rapid decline in oestrogen, a hormone that plays a vital role in maintaining bone mass. As our population continues to age, exercise (particularly resistance training) has become a cornerstone of both preventing and managing these conditions.

Among all exercise interventions, heavy resistance training is emerging as one of the most effective non-pharmacological strategies for improving bone health.

One of the biggest misconceptions is that lifting heavy weights is dangerous if you have low bone density. While poor technique or inappropriate loading can increase injury risk, the opposite is often true when training is prescribed correctly. Progressive, well-supervised resistance training can be a highly effective way to maintain — and in some cases improve — your bone health.

The reason is simple: bone is living tissue that adapts to mechanical stress. When you place greater loads through your skeleton, your bones respond by becoming stronger and denser. Although this response is reduced in people with osteoporosis and osteopenia, it is certainly not absent. In fact, mechanical loading remains one of the few proven ways to stimulate new bone formation.

Not all exercise creates the same response. Walking and other light activities are excellent for general health, but they typically do not provide enough mechanical strain to significantly improve bone density. Research consistently shows that heavier, progressive resistance training is far more effective.

What the Research Shows

A position statement published in the Journal of Bone Metabolism found that resistance training performed three times per week was more effective than twice weekly for postmenopausal women. Participants gradually progressed from around 50% to 85% of their one-repetition maximum (1RM) over four to five sets, providing the level of loading required to stimulate bone formation. Heavy resistance training also increases muscle strength, improves balance, and creates greater forces through the skeleton, all of which contribute to healthier bones and a lower risk of falls.

The evidence suggests the greatest benefits occur when training is:

• High intensity (70–85% of 1RM)
• Progressive, with loads increasing over time
• Focused on compound movements such as squats, deadlifts and overhead presses
• Performed consistently, ideally three times per week

The LIFTMOR Trial

One of the landmark studies in this area was the LIFTMOR Trial. Over an eight-month intervention, postmenopausal women with osteopenia showed improvements in lumbar spine bone density of approximately 3% while maintaining or slightly improving hip bone density. Results varied between participants, and these figures reflect outcomes within this specific research cohort rather than a guarantee of individual results.

The program was straightforward: participants progressively worked towards five sets of five repetitions at 80–85% of their 1RM, performing back squats, deadlifts and overhead presses, alongside jumping chin-up landings to provide safe impact loading. Participants began with lighter loads before gradually progressing to higher intensities under supervision. For those unable to tolerate heavy lifting due to arthritis or other conditions, moderate-intensity resistance training still provided meaningful benefits.

Safety Considerations

Safety is understandably a common concern. However, research consistently shows that when heavy resistance training is introduced gradually, performed with good technique, and supervised where appropriate, it does not increase fracture risk. Instead, it improves strength, balance, coordination and confidence — factors that are just as important as bone density when it comes to preventing fractures.

Setting Realistic Expectations

Improvements in bone density from resistance training are typically modest and vary between individuals — research studies have reported changes in the range of 1–3% per year, though individual responses depend on factors such as genetics, nutrition, medications and existing health conditions. It is important to understand that simply maintaining bone density is a significant clinical outcome, as untreated osteoporosis is characterised by ongoing bone loss. Slowing or stopping that decline can substantially reduce fracture risk and help maintain independence.

Even when bone density changes are relatively small, heavy resistance training consistently improves strength, physical function and reduces the likelihood of falls and fractures. An individualised exercise program, designed by a registered health practitioner, ensures that training is appropriate for your specific circumstances and health status.

Moving Forward

For many older adults — particularly postmenopausal women — heavy resistance training is not something to fear. When assessed and prescribed appropriately by a qualified practitioner, it is one of the most well-supported exercise strategies available for maintaining healthy bones and staying active for longer.

Written by Jake Te Whare, Physiotherapist (AHPRA registered)

This article is for general informational purposes only and does not constitute clinical advice. Individual results vary. Please consult a registered health practitioner (AHPRA-registered) before commencing or modifying any exercise program. References available on request.

This article is for general informational purposes only and does not constitute clinical advice. Individual results may vary. Please consult a registered health practitioner before commencing or modifying any treatment or exercise program.

Exercise is considered one of the most effective non-pharmacological methods for managing Parkinson’s disease. While traditional medications like levodopa treat symptoms by replacing missing dopamine, they do not change the underlying course of the disease. Exercise, however, has demonstrated the potential to be disease-modifying, meaning it may slow or even protect the brain at a neuronal level.

High-Intensity  Interval Training  (HIIT) and Neuroprotection

Recent research, particularly a proof-of-concept study from Yale, suggests that high-intensity exercise can induce brain-protective effects that may reverse neurodegeneration.

• Biological Changes: Six months of intense aerobic exercise (reaching 80–85% of age-predicted maximum heart rate) was shown to increase dopamine transporter (DAT) availability and neuromelanin concentrations in the substantia nigra.
• Improved Functionality: These changes suggest that the remaining dopaminergic neurons become healthier and more functional, reversing the natural decline typically seen in PD patients.
• Growth Factors: High-intensity exercise may also increase Brain-Derived Neurotrophic Factor (BDNF), which supports the growth of new neurons and improves neural function.

Strength and Resistance Training

A systematic review of strength training indicates it is a well-tolerated and suitable activity for those with mild to moderate PD.

• Benefits: Strength training performed against external resistance (such as weights, elastic bands, or water) improves both physical parameters and quality of life.
• Outcomes: Studies show improvements in muscle strength, manual dexterity, and aerobic performance. However, its specific impact on balance remains less certain and requires further study.

Planning an exercise program

When designing an exercise program for someone with PD, several factors must be considered:

• Disease Variability: Symptoms like tremors and rigidity can fluctuate daily; programs should be flexible to accommodate how a person feels during a specific session.
• Medication Timing: Exercise should ideally be performed during "on" periods when medications are most effective and motor symptoms are minimized.
• Safety and Mode: For those with balance issues, HIIT can be performed on stationary cycles or seated rowers to prevent falls.
• Instruction: Because some patients experience cognitive deficits, instructions should be kept simple and repeated as necessary.

Summary of Exercise Benefits

In conclusion, exercise is an essential component of Parkinson’s Disease treatment that should be "prescribed" alongside medication to help slow disease progression and maintain functional independence.

Written by Gerard Smith, Clinical Director & Physiotherapist (AHPRA registered)

This article is for general informational purposes only and does not constitute clinical advice. Individual results may vary. Please consult a registered health practitioner before commencing or modifying any treatment or exercise program.

Sources:

1. 1. Yale School of Medicine. High-intensity Exercise May Reverse Neurodegeneration in Parkinson’s Disease. Proof-of-concept study investigating the effects of high-intensity aerobic exercise on dopamine transporter (DAT) availability and neuromelanin in Parkinson’s disease.
   2. npj Parkinson’s Disease. Imaging Evidence of Exercise-Induced Changes in Parkinson’s Disease (s41531-024-00641-1). Research demonstrating increased dopamine transporter (DAT) availability and neuromelanin concentrations following high-intensity exercise.
   3. Clinical Interventions in Aging. Strength Training in Parkinson’s Disease: A Systematic Review (cia-12-619). Review evaluating the effects of resistance training on strength, physical performance, and quality of life in people with Parkinson’s disease.
   4. HIIT Training for Parkinson’s Disease Management. Review discussing the role of high-intensity interval training (HIIT) in supporting motor function, neuroplasticity, and overall Parkinson’s disease management.
   5. Cleveland Clinic. Parkinson’s Disease: Overview. Comprehensive overview of Parkinson’s disease, including pathophysiology, symptoms, diagnosis, and treatment options.
   6. Parkinson’s Foundation. Understanding Parkinson’s Disease. Educational resource covering the causes, symptoms, and management of Parkinson’s disease.
   7. World Health Organization (WHO). Parkinson Disease Fact Sheet. Global overview of Parkinson’s disease, including epidemiology, rehabilitation, and public health considerations.