A Brief Look at Exercise and Pregnancy

A Brief Look at Exercise and Pregnancy

Author: Danielle Noblitt Spangler

Working with pregnant clients in a training scenario can be done safely in many cases and throughout much of the pregnancy. The medical recommendations for pregnant women have changed over the years to increase amounts and types of exercise to benefit both the mother and her developing fetus. Awareness and precautions must be taken to create programs for these women as they progress through their pregnancy, and learning about the risk factors associated with pregnancy and your client specifically is a logical step to take when training pregnant clients. 

Historically, prenatal physical activity has been influenced by necessity, race, ethnicity, social status, wealth, and culture. In the 18th century royal mothers-in-waiting may have been confined to bed while their equally pregnant servants catered to their needs. Peasant women were expected to work alongside their husbands, bear their children in the fields, and return immediately to their labors while the high-born women were lavished with care in late 19th century, early 20th century China. 

As recently as the twentieth century, there were varying philosophies regarding the appropriate level of physical activity for prenatal women. In the 1920s and 1930s, a program of prenatal exercise was introduced in the United States with the goal of improving prenatal fitness to facilitate delivery, aid in return to pre-pregnancy weight, reducing labor pain, and improved fetal oxygenation. (Symons Downs 2012) 

However, by 1949, the standard level of physical activity recommended for prenatal women consisted of housework, gardening, occasional swims, and short daily walks totaling one mile. Sports were to be avoided. (Symons Downs 2012)

In 1985, the American College of Gynecologists and Obstetricians (ACOG) issued its first recommendations for prenatal physical activity that endorsed aerobic exercise but cautioned care when engaging in high impact activities. Limits on duration were advised at no more than 15 minutes of strenuous activity, a heart rate of no greater than 140 beats per minute, and a core body temperature of no more than 100.4°F. These very conservative guidelines were developed by a panel of obstetricians, evidently without the input of pre and postnatal women. (Symons Downs 2012).

ACOG has since modified the pre and postnatal exercise recommendations. As of 1994 ACOG has changed their strict stance on maintaining a heart rate range below 140 bpm to accepting the rate of perceived exertion from mild-moderate, and a heart rate guideline of 50 -60% of maximum heart rate (HRmax). 

ACOG maintains its stance to avoid exercises where there is a risk of falling or abdominal trauma and recommends 30 minutes or more of daily moderate exercise when no obstetric complications are present.

Benefits of Exercise during Pregnancy

Some benefits of prenatal exercise are obvious, whereas others may not be as initially evident. The benefits of prenatal exercise for weight and body fat control, increasing endurance and strength throughout pregnancy and delivery, and promoting/improving circulation and posture are widely known. But perhaps more importantly, the subtle benefits of prenatal exercise can reduce the incidence of pregnancy-induced hypertension. This lowers risk for pre-eclampsia and toxemia. 

In addition, benefits of prenatal exercise include: (ACSM 2018)

  • prevention of excessive gestational weight gain
  • prevention of gestational diabetes mellitus 
  • helps control gestational diabetes when it occurs
  • decreased risk of preeclampsia
  • decreased incidence/symptoms of low back pain
  • decreased risk of urinary incontinence
  • maintenance of fitness level
  • improves emotional well-being
  • reduces the time needed to recover from delivery and aids in postpartum weight loss
  • speeds time to return to pre-pregnancy state
  • decreases the experience of postpartum depression

The developing fetus also benefits from exercise. According to a breakthrough study, “Mother’s Exercise During Pregnancy Programs Vasomotor Function in Adult Offspring.” (Bahls 2014), women who engage in regular aerobic exercise during pregnancy appear to improve the physical and mental health of their children into adulthood. The authors of the study opined that, based on their study, evidence suggests that aerobic exercise during pregnancy has the potential of programing the arteries of the infant to be more resilient and efficient. This appears to reduce susceptibility to cardiovascular disease across the lifespan. 

They added: “A second important aspect of the findings in our study is that previous research identified the endothelium, which is the single-cell layer lining all blood vessels, to be susceptible to fetal-programming interventions. Contrarily, we show that the vascular smooth muscle was significantly altered in adult offspring from exercise trained mothers.”

Although no studies at this time suggest a risk to the fetus during maternal exercise, the relationship between fetal temperature, low birthweight, and maternal exercise is being investigated. 

Fetal temperature is .5 degrees higher than the mother under normal conditions and most fetal heat is transferred to the mother across the placenta. Fetal heat is also transferred across fetal skin, amniotic fluid, and the uterine wall. 

Exercise increases maternal and fetal internal temperatures taking more than one hour to return to normal. Studies show that exercising more than 5 times a week after the 34th week may result in lower birthweight babies. However, despite its earlier more conservative approach to prenatal physical activity, the American College of Obstetricians and Gynecologists updated its Committee Opinion number 650 (December 2015) to replace Committee Opinion 267 (January 2002) that incorporates a more liberal approach to maternal exercise.

All who are pregnant or those who may be pregnant should see their physician and have physician’s consent before initiating or continuing exercise. The doctor can determine the risk of exercise during pregnancy depending on the mother’s health/pregnancy history and other factors. 

High Risk Pregnancy

Pregnancies are considered high risk if one or more of the following factors are present:

  • The mother is age 35 or over
  • The pregnancy is a multiple gestation (more than one baby)
  • The mother has a history of miscarriages
  • If the mother has diabetes
  • If the mother has thyroid disorders
  • If the mother has anemia
  • The mother is obese
  • The mother has a sedentary lifestyle

There is a lot to learn and understand to safely work with pregnant clients. You want to guide your client through a pregnancy safely with an exercise program that will enhance the health of the mother and child. For more information about pregnancy and exercise see:

A Modern Approach to Exercise During Pregnancy by Danielle Noblitt Spangler. 

An interactive online 4 hour Continuing Education Course with over 55 short instructional videos including exercises to use with your clients. Use code PREGNANCY20 to receive 20% off this course now through April 30, 2022!

Additionally, check out these video clips of exercises for pregnant women:

References:

  • American College of Sports Medicine (ACSM) (2018) ACSM’s Guidelines for Exercise Testing and Prescription. 10th edition. Wolters, Kluwer publisher.
  • Bahls M et al. (2014)  Mother’s exercise during pregnancy programmes vasomotor function in adult offspring. Exp Physiol. 99(1):205-19.
  • Downs, Danielle & Chasan-Taber, Lisa (2012) Physical activity & pregnancy. past & present evidence & future recommendations. Research Quarterly for Exercise and Sport. Dec. 83, 485-502.

Healthy Heart for a Healthy Life!

Healthy Heart for a Healthy Life!

February is widely recognized as Heart Month, and in honor of that we are offering up some heart healthy goodness for ya! Read all the way through for a treat for yourself as well <3

This post features an excerpt from our CEC Course, Healthy Heart for a Healthy Life. Trainers work with people from all walks of life, and trainees returning to an exercise program after medical procedures or diagnoses will likely be part of your training experience. Rehabilitation following a cardiac event is a multi-step process, and this piece gives an overview of the progression.

Cardiac Rehabilitation and Return to Unsupervised Exercise

Cardiac Rehabilitation is a medically based, professionally supervised program that assists people in recovering from heart attacks, heart surgeries, and other coronary interventions such as PTCA (angioplasty) and stenting.

Cardiac rehab intervention, most often prescribed by doctor referral, has been shown to reduce rates of re-hospitalization, lower mortality rate, decrease the need for cardiac medications, and increase the rate at which people return to work.

In cardiac rehabilitation, clients are carefully monitored and under the supervision of a cardiac registered nurse and other medical professionals. There is a crash cart present in the facility for if an emergency arises. Clients are taught to self monitor and connect with their body through Rate of Perceived Exertion (RPE) and other means in order to listen to their body, monitor symptoms, and to exercise safely and appropriately.

Special medical training and equipment is required in cardiac rehabilitation. Although clients may want to skip a long drive to go into town to go to cardiac rehab, or it may not be at convenient times, it is important that cardiac rehab be completed and they are cleared to join/participate in a community setting. It is very unwise to allow clients to participate in community programs without proper participation and clearance from cardiac rehabilitation. Physician’s consent for participation in a group fitness certification class, personal training, or small group training is strongly advised and initial (preferably ongoing) communication with the cardiac rehab team is encouraged.

Phases of Cardiac Rehabilitation

Phase

Description

Phase I (Inpatient)

  • Provide patient education concerning lifestyle changes (heart healthy food choices, regular exercise and risk factor modification)
  • Provide education on intervention or surgery when hospitalized (signs/symptoms or heart attack, CHF, stent placement, CABG, PAD, etc.)
  • Ambulate patient if possible and provide information on home exercise program.
  • If patient has had open heart surgery, ROM exercises and/or ambulation daily, incentive spirometry, coughing/splinting and home activity guidelines especially for post discharge care.

Phase II (Outpatient)

  • Post-intervention patients
  • Physician referral needed
  • All patients monitored by telemetry units during individualized exercise program.
  • Patients taught how to monitor heart rate, RPE (rate of perceived exertion) and symptoms during exercise
  • Exercise sessions include ~30+ minutes of cardiovascular activity, moderate strength training (approval needed), and cardiovascular risk factor modification education on at least 3 days/week
  • Number of exercise sessions depends on condition and physical response to exercise

Phase III
(Wellness/Maintenance)

  • Non-monitored, supervised maintenance program
  • Can be located in hospital or other fitness facility
  • Exercise guidelines provided by progress in Phase II, physician recommendations, and patient’s needs/goals

Phase IV
(Wellness/Maintenance)

  • Home exercise guidelines given
  • May exercise at community facility
  • Encouraged to monitor Intensity (HR, RPE, symptoms, etc.)
  • Focus on making positive lifestyle changes
  • Some programs are Phase III/IV combined

Working with clients that have heart disease in a group or individual setting requires fitness professionals to follow safe guidelines and recommendations. It is important to understand these exercise guidelines especially for those who have heart disease and have attended cardiac rehabilitation phase 2. Educate yourself, seek advice, and consider shadowing an experienced professional when creating a client base for those who have been cleared to exercise in cardiac rehabilitation phase 3 and 4 programs.

The information in this course is from the NAFC Continuing education course “Healthy Heart for a Healthy Life” by Tina Schmidt-McNulty.

Alright, now for your treat! We are offering a discount on this course all February. When you purchase it, use discount code HEART2020 for 25% off the list price. This course is worth .3 CECs toward your certification renewal!

Career Development via CECs and Special Offer!

Career Development via CECs and Special Offer!

Many degrees and certifications require continuing education to remain current. Many holders of these degrees and certifications procrastinate the continuing ed process until the very last minute while dreading it every second, too! We know…we are also fitness professionals 😉

It’s a requirement of the credential and not always what we choose, and that can be difficult to accept…it also requires expenditure of precious resources (time, money, energy, etc) to complete those credits.

While the requirement itself may not always be inspiring, there are many valid reasons for continuing education conditions to remain in the health and fitness industry. Part of the reasoning can be put to valuable use for you by expanding your usable knowledge and credential base…aka career development. Making it work for you can lead to places never envisioned upon completing that first certification! Intentional pursuit of your personal development can be a fantastic side effect of filling the req’s, and that is the intended message in this post 🙂

We are committed to helping health and fitness professionals build meaningful and vibrant careers, and the pursuit of continuing education is a big part of our service offerings to our students and program graduates. June Chewning, our Director of Education shares a bit of her continuing ed story with us here:

Hi Everyone,

My name is June Chewning. I am the president of Fitness Learning Systems and the new Director of Education for NAFC. I just wanted to share that a few days ago I looked in my wallet and found 6 expired CPR cards and one current card. It made me realize that in my 41-year fitness professional career, I think I have renewed my CPR over 25 times. It could be more because there was a long period of time when Red Cross required renewal every year.

That made me start thinking of needing renewal for certifications, and I started thinking about all the conferences and workshops I have attended and all of the courses I have taken. For many years I considered CE for Cert renewals a total pain in the glutes. But then I looked back at all I have learned, and it made me realize after all these years how grateful I am that continuing education is required.  Even coming out of college with a Bachelor’s degree in Physical Education and then pursuing a Master’s degree in Exercise Physiology did not give me all of the knowledge nor experience I needed to be a great fitness professional.  It was all that continuing education that was the icing on the delicious cake.

I am most grateful that for some reason all of these years I have taken my continuing education seriously… it defined me as a professional and led me to numerous job opportunities that allowed me to make a living as a fitness professional.  It allowed me to diversify. It led me from a physical education teacher, to a group fitness instructor and personal trainer, to a Master Trainer position, to an international presenter, to doing research and writing training manuals and courses, to an education consultant and research committee lead, to a gym owner for 18 years, to a college professor and developer of college curriculum, to the president of Fitness Learning Systems and currently to Director of Education for NAFC. I would have to say without doubt that the biggest factor in my ability to diversify was my continuing education. Knowledge IS power.

So, this crusty old health-fitness professional would like to encourage you to invest in quality continuing education and make it count. That, more than anything in your career, pays off consistently with career benefits.  Pay attention and carefully plan your career path, making each CEC count. It will maximize your potential for success in this industry. I have loved being a fitness professional for 41 years. From teaching aerobics bare foot with leg warmers, to teaching and constructing courses for medical exercise, it has been worth the sometimes bumpy ride.

Thanks a bunch for that share, June! We are so honored to have you part of our team, and we don’t think you’re crusty at all (insert smoochy face emoji).

CECs are a great investment in yourself, your career, and those who benefit from your work efforts. If you don’t already know about it, we have an awesome special going right now…all PowerCerts and CECs are 40% off until midnight on 1/5/20 with code CEC40. Click here to check out the offerings. As always, you’ve got 18 months from date of purchase to complete the coursework, so it’s a valuable investment to make now and use as your schedule allows over the remainder of your certification period.

Big, happy New Year to you all!

– Your NAFC team

Hey, Hero! Help Your Clients Pave their Path to Sustaining Gains…BP Version

Hey, Hero! Help Your Clients Pave Their Path to Sustaining Gains…BP Version

Trainers and Fitness Professionals have so much influence with their clients.

Wait, that’s you!!!

As Fitness Professionals, you have a front and center position of authority and influence with the people who hire your services…whether attending your class, joining your gym, or hiring you to create personalized programs for them, these are people looking to you for guidance. As such, you have an enormous opportunity to positively impact each of these people every time you interact with them, especially when they are in your care and they’ve received news from their docs!

When clients receive news from the doc

So many of our clients have received news from their health care practitioners regarding blood pressure (BP) test results, and generalized actions to take with regard to those results. But, many of these clients don’t really know what those actions can look like in a daily activity perspective. The translation between a broad-stroke, indiscriminate set of guidelines given to them by a health care professional and specific, customized instructions on daily practices can fall directly in your purview.

You have the tools to help them create a very detailed and action-oriented plan to generate sustainable results…read on for some info that can help augment your current knowledge level!

 

The following is compiled by June M. Chewning BS, MA and is from “Blood Pressure, Hypertension, and Exercise,” a continuing education course offered by NAFC.

Did you know as a health-fitness professional you can have a positive affect on a client’s health, longevity, and brain function by simply helping them prevent and manage hypertension? The good news is that it is easy- just get them to exercise regularly! The influence of exercise on blood pressure is significant, and for most clients promoting healthy blood pressure is as easy as learning how to assess BP, prescribe regular exercise, and re-assess BP.  Almost every client with elevated BP will see results with regular exercise…so why not be the BP hero?

To be a BP hero, it is important to be educated in the anatomy of BP, how BP works, how to assess BP, BP disease exercise warning signs, and what has a positive effect on maintaining a good BP or lowering an elevated BP. This article gives you a snapshot insight into the fascinating world of blood pressure and exercise.

The body delivers vital oxygen and nutrients and removes waste and metabolic by-products through the combined effort of the cardiovascular and respiratory systems, referred to in combination as the cardiorespiratory (CR) system. The lungs in the pulmonary system are of particular interest as the closed loop vascular system passes through the lungs to pick up oxygen and dispose of carbon dioxide. The success of this closed-loop system relies heavily on a delicate balance to provide effective distribution of blood to virtually all organs and cells in the body.

The proper function of the cardiorespiratory system, and the ability of blood to continuously loop though the system, depends on maintaining the proper pressure in the vessels and organs of the cardiorespiratory system. The pressure is primarily controlled by the vascular system. The pressure maintained in the CR system is measured and monitored by blood pressure.

Blood Pressure is defined as the pressure/force exerted on the arterial walls with each heart beat. (Cleveland Clinic 2019) Blood pressure can be measured directly by a catheter in the artery, or indirectly with a blood pressure cuff and sphygmomanometer. Two pressures in the arteries are measured to determine blood pressure:

  • Systolic Blood Pressure (SBP): represents the highest pressure (against the artery walls) in the artery occurring during ventricular systole, or ventricular contraction, and ventricular blood ejection.
  • Diastolic Blood Pressure (DBP): represents the lowest pressure (against the artery walls) in the artery occurring during ventricular diastole, or ventricular relaxation, which allows the heart to refill.

Blood pressure is the amount of force (hydrostatic pressure) that pushes the blood through the vascular system. Pressure drops gradually as the large arterial vessels branch resulting in lower venous pressures (compared to artery pressure) as the blood progresses through the closed loop system. Blood pressure and associated measures are commonly expressed in millimeters of mercury or “mmHg.”

BP is expressed by ventricular systole over ventricular diastole, for example 120/80. Blood pressure does not remain constant and varies throughout the day or over time in the aging process depending on many factors including exercise, stress, body position, medication, cardiovascular condition, respiratory health, proper hydration, and age.

 

Fun Fact #1

Blood Pressure depends primarily on body size.

So, children and young adolescents have much lower blood pressures than adults. (Kenney 2019)

Current Guidelines for BP Classification and Management – American Heart Association 2019 (www.heart.org)

Systolic     BP

Diastolic BP

Classification

*Recommendations

<120 and

<80

Normal

Healthy lifestyle choices and yearly checks.

120-129 and

<80

Elevated Blood Pressure

Healthy lifestyle changes and reassessed in 3-6 months

130-139 or

80-89

High Blood Pressure Stage I

10 year heart disease and stroke risk assessment. If less than 10% risk, lifestyle changes and reassessed in 3-6 months. If higher after reassessment, lifestyle changes and medication with monthly follow-ups until BP is controlled.

≥140 or

≥90

High Blood Pressure Stage II

Lifestyle changes and 2 different classes of medicine, with monthly follow-ups until BP is controlled.

*Individual recommendations need to come from health care provider.

Source: American Heart Association’s Journal Hypertension published November 13, 2017.

Hypertension is defined as:

“Having a resting systolic blood pressure (SBP) >140 mmHg and/or a resting diastolic blood pressure (DBP) >90 mmHg, confirmed by a minimum of two measures taken on at least two separate days, or taking antihypertensive medication for the purpose of blood pressure control.” (ACSM 2018)

This chronic medical condition is called the “silent killer” because there are typically no symptoms. Learning how to assess BP for your client can put you forefront in the fight to detect and fight this deadly chronic disease.  Elevated blood pressure can increase the risk for coronary artery disease, stroke, heart attack, kidney disease, peripheral artery disease, and heart failure. There are both genetic and lifestyle factors that can affect the development of hypertension.

A client with hypertension should engage in regular exercise after their blood pressure is effectively controlled. Exercise to control and manage high blood pressure should only be initiated after the client has seen their health care professional and is under medical supervision and treatment.  Systolic blood pressure can increase significantly during exercise, so the client coming to you with high blood pressure should not exercise without medical clearance.

 

Fun Fact #2

Hypertension causes the heart to work harder than normal at rest and with activity because it must pump blood from the left ventricle against a greater resistance in the arteries. (Kenney 2019)

The American Heart Association updated guidelines recommend treatment options including lifestyle changes and blood pressure lowering medications. The lifestyle modifications for those with hypertension can lower systolic approximately 4 to 11 mmHg with the largest impact from diet and exercise. (Whelton et al., 2017)

It is well documented in research that even light-moderate exercise can help control and lower blood pressure if you have hypertension. The World Health Organization (WHO) recommends a minimum threshold of 150 minutes per week of moderate intensity physical activity for health and quality of life. This threshold of physical activity plays an important role in cardiorespiratory health, longevity, brain health, muscle/bone health, balance and fall prevention, and function to name a few. Maintaining physical activity/exercise is recommended for prevention and control of virtually all chronic diseases.

In most people, hypertension responds very well to using physical activity/exercise as an adjunct therapy. Starting regular exercise typically helps you control hypertension with lower medication doses. As a health-fitness professional, it is very rewarding to see a client reduce or eliminate blood pressure medication through a regular exercise program.

Thanks a bunch, June!

Fit Pros, the info June shared with us here is so relevant for many of the people we have the opportunity to serve. While this news can be tough for a client to hear, we are resourced to help guide them to sustainable, improved results. To learn more, consider taking continuing education courses about blood pressure and exercise. Knowledge is powerful, and will help you to become a BP hero!

 

References

  1. Chewning, J and Schmidt-McNulty T. (2019) Blood Pressure, Hypertension, and Exercise.
  2. American College of Sports Medicine (ACSM). (2018) ACSM’ Guidelines for Exercise Testing and Prescription. 10th Wolters Kluwer.
  3. Kenney WL, Wilmore JH, Costill DL. (2015) Physiology of Sport and Exercise. 6th Human Kinetics.
  4. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison-Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, and Wright JT Jr. (2017) ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. doi: 10.1161/HYP.0000000000000065

Risk Factors and Stages of Alzheimer’s Disease

Risk Factors and Stages of Alzheimer’s Disease

The information in this post is from the Alzheimer’s Prevention and Intervention Specialist Certificate Program: Course 1: Exercise Prescription for Alzheimer’s Prevention and Intervention.
Authored by Dharma Singh Khalsa M.D., Founding President/Medical Director of Alzheimer’s Research and Prevention Foundation.

There is a growing body of research on modifiable risk factors for dementia. However, modern medicine still hasn’t discovered all the answers in this field. Therefore, prevention supports available evidence targeting risk factors for vascular disease such as diabetes, hypertension, obesity, smoking, hyperlipidemia, and physical inactivity. (Dementia: A World Health Priority 2016) Many of these risk factors can be controlled effectively by making healthy lifestyle choices to aid in the prevention of Alzheimer’s disease.

Most experts believe that Alzheimer’s disease, similar to other common chronic diseases, develops as a result of multiple factors instead of a single cause. They also support the idea that some risk factors can be controlled by making smart lifestyle choices.

Physical exercise on a regular basis is a valuable habit to help decrease the risk of Alzheimer’s and vascular dementia. Exercise may benefit the brain cells directly by improving both oxygen and blood flow to the brain. An evidence-based and medically approved exercise program is recommended as part of an overall wellness plan. (Prevention and Risk of Alzheimer’s and Dementia 2016)

There are a number of risk factors that may lead to cognitive decline.
(Adapted from Alzheimer’s Risk Factors 2016 and 2016 Alzheimer’s Disease Facts and Figures 2016)

  • Age
  • Family History
  • Genetic Predisposition
  • Stroke
  • Depression
  • Head/Brain Injury
  • Lack of Adequate Sleep
  • Cardiovascular Disease and Risk Factors.
    • Smoking
    • Diabetes
    • Hypertension (high blood pressure)
    • High cholesterol
    • Physical inactivity
    • Obesity

Exercise is an important part of treatment. Research shows that it may help slow the progression of disease. Be patient and creative when working with clients who have Alzheimer’s disease. Have an understanding of the disease progression, be vigilant in identifying physical decline, and overall, adjust their exercise program to maintain safety. The seven stage model that is commonly accepted and used to stage the progression of Alzheimer’s is provided below. 

When working with clients, it is helpful to understand the stage of progression (often identified by disease symptoms) they are experiencing. This will give you ideas and guidelines for how to most effectively communicate and motivate the client in order to produce results. Different strategies may be required for communication, programming, and expectations during different stages of disease progression.

For more information on risk factors, risk factor reduction, stages of progression, and The 4 Pillars of Alzheimer’s Prevention™, see the FLS course Introduction to Alzheimer’s Disease. Or visit the Alzheimer’s Research and Prevention Foundation Website at www.alzheimersprevention.org.

Seven Stage Alzheimer’s Disease Progression Model for Help with Expectations during Disease Progression.
(Alzheimer’s Disease: Symptoms, Stages, Diagnosis and Coping 2016) 
(Reprinted with permission from HelpGuide.org)

Stage 1:
Subjective Cognitive Decline (SCD). No impairment. Memory and cognitive abilities appear normal, but individual complains of memory difficulties.

Stage 2: 
Minimal Impairment/Normal Forgetfulness. Memory lapses and changes in thinking are rarely detected by friends, family, or medical personnel, especially as about half of all people over 65 begin noticing problems in concentration and word recall.

Stage 3: 
Early Confusional/Mild Cognitive Impairment. While subtle difficulties begin to impact function, the person may consciously or subconsciously try to cover up his or her problems. Difficulty with retrieving words, planning, organization, misplacing objects, and forgetting recent learning, which can affect life at home and work. Depression and other changes in mood can also occur. Duration: 2 to 7 years.

Stage 4: 
Late Confusional/Mild Alzheimer’s. Problems handling finances result from mathematical challenges. Recent events and conversations are increasingly forgotten, although most people in this stage still know themselves and their family. Problems carrying out sequential tasks, including cooking, driving, ordering food at restaurants, and shopping. Often withdraw from social situations, become defensive, and deny problems. Accurate diagnosis of Alzheimer’s disease is possible at this stage. Lasts roughly 2 years.

Stage 5: 
Early Dementia/Moderate Alzheimer’s disease. Decline is more severe and requires assistance. No longer able to manage independently or recall personal history details and contact information. Frequently disoriented regarding place and or time. People in this stage experience a severe decline in numerical abilities and judgment skills, which can leave them vulnerable to scams and at risk from safety issues. Basic daily living tasks like eating and dressing require increased supervision. Duration: an average of 1.5 years.

Stage 6: 
Middle Dementia/Moderately Severe Alzheimer’s disease. Total lack of awareness of present events and inability to accurately remember the past. People in this stage progressively lose the ability to take care of daily living activities like dressing, toileting, and eating but are still able to respond to nonverbal stimuli, and communicate pleasure and pain via behavior. Agitation and hallucinations often show up in the late afternoon or evening. Dramatic personality changes such as wandering or suspicion of family members are common. Many can’t remember close family members, but know they are familiar. Lasts approximately 2.5 years.

Stage 7: 
Late or Severe Dementia and Failure to Thrive. In this final stage, speech becomes severely limited, as well as the ability to walk or sit. Total support around the clock is needed for all functions of daily living and care. Duration is impacted by quality of care and average length is 1 to 2.5 years.

References: