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Original Investigation |

Effects of the Finnish Alzheimer Disease Exercise Trial (FINALEX):  A Randomized Controlled Trial

Kaisu H. Pitkälä, MD, PhD; Minna M. Pöysti, MD, PhD; Marja-Liisa Laakkonen, MD, PhD; Reijo S. Tilvis, MD, PhD; Niina Savikko, RN, PhD; Hannu Kautiainen, PhD; Timo E. Strandberg, MD, PhD
JAMA Intern Med. 2013;173(10):894-901. doi:10.1001/jamainternmed.2013.359.
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Importance Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD).

Objectives To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services.

Design A randomized controlled trial.

Setting and Participants A total of 210 home-dwelling patients with AD living with their spousal caregiver.

Interventions The 3 trial arms included (1) group-based exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care.

Main Outcome Measures The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services.

Results All groups deteriorated in functioning during the year after randomization, but deterioration was significantly faster in the CG than in the HE or GE group at 6 (P = .003) and 12 (P = .015) months. The FIM changes at 12 months were −7.1 (95% CI, −3.7 to −10.5), −10.3 (95% CI, −6.7 to −13.9), and −14.4 (95% CI, −10.9 to −18.0) in the HE group, GE group, and CG, respectively. The HE and GE groups had significantly fewer falls than the CG during the follow-up year. The total costs of health and social services for the HE patient-caregiver dyads (in US dollars per dyad per year) were $25 112 (95% CI, $17 642 to $32 581) (P = .13 for comparison with the CG), $22 066 in the GE group ($15 931 to $28 199; P = .03 vs CG), and $34 121 ($24 559 to $43 681) in the CG.

Conclusions and Relevance An intensive and long-term exercise program had beneficial effects on the physical functioning of patients with AD without increasing the total costs of health and social services or causing any significant adverse effects.

Trial Registration anzctr.org.au Identifier: ACTRN12608000037303

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Figures

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Graphic Jump Location

Figure 1. Flowchart of the study. Participants were recruited and baseline assessments were performed from March 25, 2008, through August 8, 2009. The follow-up lasted until October 4, 2011.

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Figure 2. Changes in Functional Independence Measure (FIM) (A) and Short Physical Performance Battery (SPPB) (B) scores relative to baseline (adjusted for age, sex, and use of mobility devices).

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