title: Improvements in gait characteristics after intensive resistance and functional training in people with dementia: a randomised controlled trial.
abstract: BACKGROUND
  Preventing and rehabilitating gait disorders in people with dementia during early disease stage is of high importance for staying independent and ambulating safely. However, the evidence gathered in randomized controlled trials (RCTs) on the effectiveness of exercise training for improving spatio-temporal gait parameters in people with dementia is scarce. The aim of the present study was to determine whether a specific, standardized training regimen can improve gait characteristics in people with dementia.
  
  
  METHODS
  Sixty-one individuals (mean age: 81.9 years) with confirmed mild to moderate stage dementia took part in a 3-month double-blinded outpatient RCT. Subjects in the intervention group (IG) received supervised, progressive resistance and functional group training for 3 months (2 times per week for two hours) specifically developed for people with dementia. Subjects in the control group (CG) conducted a low-intensity motor placebo activity program. Gait characteristics were measured before and after the intervention period using a computerized gait analysis system (GAITRite®).
  
  
  RESULTS
  Adherence to the intervention was excellent, averaging 91.9% in the IG and 94.4% in the CG. The exercise training significantly improved gait speed (P < 0.001), cadence (P = 0.002), stride length (P = 0.008), stride time (P = 0.001), and double support (P = 0.001) in the IG compared to the CG. Effect sizes were large for all gait parameters that improved significantly (Cohen's d: 0.80-1.27). No improvements were found for step width (P = 0.999), step time variability (P = 0.425) and Walk-Ratio (P = 0.554). Interestingly, low baseline motor status, but not cognitive status, predicted positive training response (relative change in gait speed from baseline).
  
  
  CONCLUSIONS
  The intensive, dementia-adjusted training was feasible and improved clinically meaningful gait variables in people with dementia. The exercise program may represent a model for preventing and rehabilitating gait deficits in the target group. Further research is required for improving specific gait characteristics such as gait variability in people with dementia.
  
  
  BACKGROUND
  ISRCTN49243245.
authors.affiliation: Department of Geriatric Research, Bethanien-Hospital/ Geriatric Center at the University of Heidelberg, Heidelberg, Germany. mschwenk@surgery.arizona.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwenk
authors.forename: Tania
authors.initials: T
authors.lastname: Zieschang
authors.forename: Stefan
authors.initials: S
authors.lastname: Englert
authors.forename: Gurtej
authors.initials: G
authors.lastname: Grewal
authors.forename: Bijan
authors.initials: B
authors.lastname: Najafi
authors.forename: Klaus
authors.initials: K
authors.lastname: Hauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D004311:Double-Blind Method; D042241:Early Diagnosis; D005081:Exercise Therapy / Q000379:methods* / Q000639:trends; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D004856:Postural Balance / Q000502:physiology; D055070:Resistance Training / Q000379:methods / Q000639:trends*; D016896:Treatment Outcome