Preventing Loss of Independence through Exercise (PLIÉ): A Pilot Clinical Trial in Older Adults with Dementia

Abstract

BackgroundCurrent 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.MethodsWe 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.ResultsTwelve 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.ConclusionsPLIÉ 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.Trial RegistrationClinicalTrials.gov NCT01371214

The Happy Antics programme: Holistic exercise for people with dementia

“…The findings agree with those of Barnes et al (2012Barnes et al ( , 2013 In their study, the efficacy of PLIÉ was tested in people with dementia who attended an adult day care centre. Six people with dementia with early to middle stage dementia participated in PLIÉ and five people with dementia received usual care.…”

“…Research on holistic exercise is very new, with only one study published on the effects of holistic exercise on physical and cognitive function in people with dementia (Barnes et al, 2012(Barnes et al, , 2013. No additional publications were found in relation to holistic exercise and people with dementia and Alzheimer's disease from searching six online databases (AMED, Science Direct, CINAHL, Medline, SPORTDiscus, Psychology and Behavioral Sciences Collection).…”

“…Whereas Barnes et al (2012Barnes et al ( , 2013 uses of the other parts of the fruit trees. As an example, the leaves of the papaya trees contain enzymes that are able to tenderize raw meat (Krishna et al 2008).…”

Exercise Training for Persons with Alzheimer's Disease and Caregivers: A Review of Dyadic Exercise Interventions

“…However, there was no significant difference regarding depression and stress between the exercise group and a group following a nutrition education program (King, 2002). A recent 36-week crossover pilot clinical trial investigated the effect of exercise in both individuals with AD and caregivers but was not included in Table 1 (Barnes et al, 2015). Even though participants and caregivers were enrolled as dyads, caregivers were not actively following the exercise protocol and caregiver measures included questionnaires about the participants’ functional status, quality of life, and dementia-related behaviors as well as their own level of distress with behaviors and overall burden (Barnes et al, 2015).…”

Menopause and exercise

“…[97][98][99] In addition, exercise programs may improve physical and cognitive function, as well as decrease caregiver burden with individuals with existing dementia. 100 …”