title: Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia.
abstract: OBJECTIVE
  To investigate the effects of a high-intensity functional exercise program on independence in activities of daily living (ADLs) and balance in older people with dementia and whether exercise effects differed between dementia types.
  
  
  METHODS
  Cluster-randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study.
  
  
  METHODS
  Residential care facilities, Umeå, Sweden.
  
  
  METHODS
  Individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs (N=186).
  
  
  METHODS
  Ninety-three participants each were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity.
  
  
  METHODS
  Blinded assessors measured ADL independence using the Functional Independence Measure (FIM) and Barthel Index (BI) and balance using the Berg Balance Scale (BBS) at baseline and 4 (directly after intervention completion) and 7 months.
  
  
  RESULTS
  Linear mixed models showed no between-group effect on ADL independence at 4 (FIM=1.3, 95% confidence interval (CI)=-1.6-4.3; BI=0.6, 95% CI=-0.2-1.4) or 7 (FIM=0.8, 95% CI=-2.2-3.8; BI=0.6, 95% CI=-0.3-1.4) months. A significant between-group effect on balance favoring exercise was observed at 4 months (BBS=4.2, 95% CI=1.8-6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between-group exercise effects were found in participants with non-Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months.
  
  
  CONCLUSIONS
  In older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non-Alzheimer's dementia.
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.|Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Toots
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.|Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Littbrand
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.|Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Nina
authors.initials: N
authors.lastname: Lindelöf
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.|Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Robert
authors.initials: R
authors.lastname: Wiklund
authors.affiliation: Department of Community Medicine and Rehabilitation, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Holmberg
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Nordström
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
authors.forename: Lillemor
authors.initials: L
authors.lastname: Lundin-Olsson
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Yngve
authors.initials: Y
authors.lastname: Gustafson
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.|Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Rosendahl
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000503:physiopathology / Q000534:rehabilitation*; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D004856:Postural Balance / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: activities of daily living; dementia; exercise; postural balance; residential facilities