Question: Does a regular exercise program improve the ability of nursing home residents with Alzheimer's disease to perform activities of daily living (ADL)? Design: Randomised, controlled trial with concealed allocation and blinded outcome assessment. Setting: Five nursing homes in France. Participants: Nursing home residents with Alzheimer's disease who were able to transfer from a chair and walk six metres without assistance. Vascular dementia, Parkinson's disease, and cardiac conditions contraindicating exercise were exclusion criteria. Randomisation of 134 participants allotted 67 to an exercise training group and 67 to a control group. Interventions: Both groups received routine management, including nursing, physiotherapy and medical care. In addition, the exercise training group participated in a one-hour group exercise session twice per week for one year. At least half of each session consisted of walking at an intensity intended to induce moderate breathlessness. The walking course passed the room of each member of the exercise group. The remainder of the session included strength, flexibility, and balance training. The control group received no exercise or behaviour management training. Outcome measures: The primary outcome was the change in Katz ADL score at the end of the 12-month training period. The Katz ADL score is the sum of scores for six activities, each scored as 0 for requiring complete help, 0.5 for requiring little help, and 1 for independent. Secondary outcome measures were the Katz ADL score at 6 months, 6-metre walking speed, the get-up-and-go test, the one-leg balance test, and indices of nutrition, behavioural disturbance, and depression. Results: One hundred and ten participants completed the study. At the end of the one-year training period, the deterioration in Katz ADL score was significantly less in the exercise group, by 0.4 (95% CI 0.1 to 0.7). At 6 months, the ADL scores did not differ significantly. Walking speed improved significantly more in the exercising than in the control group at 6 months (by 0.04 m/sec) (95% CI 0.01 to 0.07) and at 12 months (by 0.05 m/sec) (95% CI 0.02 to 0.08). The groups did not differ significantly on the remaining secondary outcomes. Conclusion: As an adjunct to standard care, a one-year exercise program significantly slows the decline in the ability of nursing home residents with Alzheimer's disease to perform ADLs independently. [95% CIs calculated by the CAP Co-ordinator]
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