title: Preventing loss of independence through exercise (PLIÉ): a pilot clinical trial in older adults with dementia.
abstract: BACKGROUND
  Current dementia medications have small effect sizes, many adverse effects and do not change the disease course. Therefore, it is critically important to study alternative treatment strategies. The goal of this study was to pilot-test a novel, integrative group exercise program for individuals with mild-to-moderate dementia called Preventing Loss of Independence through Exercise (PLIÉ), which focuses on training procedural memory for basic functional movements (e.g., sit-to-stand) while increasing mindful body awareness and facilitating social connection.
  
  
  METHODS
  We performed a 36-week cross-over pilot clinical trial to compare PLIÉ with usual care (UC) at an adult day program for individuals with dementia in San Francisco, CA. Assessments of physical performance, cognitive function, physical function, dementia-related behaviors, quality of life and caregiver burden were performed by blinded assessors at baseline, 18 weeks (cross-over) and 36 weeks. Our primary outcomes were effect sizes based on between-group comparisons of change from baseline to 18 weeks; secondary outcomes were within-group comparisons of change before and after cross-over.
  
  
  RESULTS
  Twelve individuals enrolled (7 PLIÉ, 5 UC) and 2 withdrew (1 PLIÉ, 18 weeks; 1 UC, 36 weeks). Participants were 82% women (mean age, 84 ± 4 years); caregivers were 82% daughters (mean age, 56 ± 13 years). Effect sizes were not statistically significant but suggested potentially clinically meaningful (≥ 0.25 SDs) improvement with PLIÉ versus UC for physical performance (Cohen's D: 0.34 SDs), cognitive function (0.76 SDs) and quality of life (0.83 SDs) as well as for caregiver measures of participant's quality of life (0.33 SDs) and caregiver burden (0.49 SDs). Results were similar when within-group comparisons were made before and after cross-over.
  
  
  CONCLUSIONS
  PLIÉ is a novel, integrative exercise program that shows promise for improving physical function, cognitive function, quality of life and caregiver burden in individuals with mild-to-moderate dementia. Larger randomized, controlled trials are warranted.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01371214.
authors: Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America; San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America.
authors: Deborah E
authors: DE
authors: Barnes
authors: Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, United States of America; Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors: Wolf
authors: W
authors: Mehling
authors: Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, United States of America; California Institute of Integral Studies, San Francisco, California, United States of America.
authors: Eveline
authors: E
authors: Wu
authors: Northern California Institute for Research and Education, San Francisco, California, United States of America; California School of Professional Psychology, San Francisco, California, United States of America.
authors: Matthew
authors: M
authors: Beristianos
authors: Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America; San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America; Department of Neurology, University of California San Francisco, San Francisco, California, United States of America.
authors: Kristine
authors: K
authors: Yaffe
authors: Institute on Aging, San Francisco, California, United States of America.
authors: Karyn
authors: K
authors: Skultety
authors: Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, United States of America; Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors: Margaret A
authors: MA
authors: Chesney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003071:Cognition; D018592:Cross-Over Studies; D003704:Dementia / Q000628:therapy*; D015444:Exercise; D005081:Exercise Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D012495:San Francisco; D016896:Treatment Outcome