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Preventing loss of independence through exercise (PLIE): a pilot clinical trial in older adults with dementia


Barnes, D. E., Mehling, W., Wu, E., Beristianos, M., Yaffe, K., Skultety, K., Chesney, M. A.


Plos One, Volume: 10, No.: 2, Pages.: e0113367

Year of Publication



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 (PLIE), 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 PLIE 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 PLIE, 5 UC) and 2 withdrew (1 PLIE, 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 PLIE 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: PLIE 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 REGISTRATION: NCT01371214.

Bibtex Citation

@article{Barnes_2015, doi = {10.1371/journal.pone.0113367}, url = {}, year = 2015, month = {feb}, publisher = {Public Library of Science ({PLoS})}, volume = {10}, number = {2}, pages = {e0113367}, author = {Deborah E. Barnes and Wolf Mehling and Eveline Wu and Matthew Beristianos and Kristine Yaffe and Karyn Skultety and Margaret A. Chesney}, title = {Preventing Loss of Independence through Exercise ({PLI}{'{E}}): A Pilot Clinical Trial in Older Adults with Dementia}, journal = {{PLOS} {ONE}} }


adult, adverse effects, aged, aged, 80 and over, caregivers, chi, cognition, dementia, exercise, exercise therapy, feldenkrais, female, humans, male, middle aged, pilot projects, quality of life, san francisco, tai, therapy, treatment outcome, yoga

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Behaviour, Carer Burden (instruments measuring burden), Cognition, Physical Health, Quality of Life of Person With Dementia


Day Care

Type of Interventions

Non-pharmacological Treatment

Non-Pharmaceutical Interventions

Complementary therapies, Exercise (inc. dancing)