Preventing loss of independence through exercise (PLIÉ) for persons with dementia: A randomized, controlled trial

Abstract

Background: Preventing Loss of Independence through Exercise (PLIé) is an integrative group movement program for persons with dementia (PWD) that combines exercises to maintain daily function with mindful body awareness and social engagement. We performed a randomized, controlled trial to examine PLIé's effects on physical, cognitive, and social/emotional outcomes using quantitative and qualitative methods. Methods: PWD were randomly assigned to immediate or delayed start in PLIé (1 hour, 2-3 days/week, 18 weeks). Quantitative outcome data were collected at 0, 18 and 36 weeks by blinded assessors. Outcomes included physical performance, cognitive function, and self-rated quality of life in PWD (primary); caregiver (CG)-reported independence, behaviors, and fall concern for PWD; and CG-rated mood, burden, and feelings about caregiving for CGs (secondary). CGs also received anonymous evaluation surveys with satisfaction ratings (5-point Likert) and open-ended questions about changes in PWD related to PLIé. We used mixed effects linear models adjusting for baseline differences for quantitative data and content analysis for qualitative data. Results: 88 dyads enrolled at 5 study sites, of whom 68 (77%) completed the 18-week assessment, 55 (62.5%) completed the 36-week assessment, and 47 (53%) returned evaluation surveys. PWD were 80±8 years old, 67% men, 60% Veterans and 86% non-Hispanic White; CGs were 67±14 years old, 83% women and 84% non- Hispanic White. There were no significant differences between groups over time in primary or secondary quantitative outcomes, with the exception of increased CG burden in the immediate- vs. delayedstart group (p=0.03). However, satisfaction ratings were high (mean: 4.5±0.9), and CGs reported qualitative improvements in PWD in 4 domains: psychological well-being, physical function, cognitive function and social engagement. In addition, many CGs reported improvements in multiple domains (Table). Conclusion: Although there was no overall benefit in quantitative measures commonly used in dementia studies, many CGs reported qualitative benefits in multiple domains in response to PLIé. More sensitive measures may be needed to fully evaluate the effects of this program. (Table Presented).