The effects of six months of the adapted Otago Exercise Program on cognition and falls relative to usual care alone among people living with dementia in residential care facilities: A pilot feasibility randomized controlled trial
Bibliographic record
Abstract
Abstract Background There are no evidence‐based exercise guidelines to reduce falls in people living with dementia (PWD). The purpose of this pilot randomized controlled trial (RCT) was to determine the 1) feasibility and acceptability, and 2) effect of exercise on cognition and falls (exploratory) relative to usual care alone among PWD. Methods We randomized PWD to the exercise (n = 21) or usual care group (n = 21) at two residential care facilities in our pilot parallel, assessor‐blinded RCT (1:1) [NCT05488951]. We examined feasibility (recruitment, data collection, dropout rates, adverse events, adherence) and acceptability (satisfaction). Our adapted physical therapist‐led Otago Exercise Program consisted of 1 hour of strength, balance, and walking 3x/week for 6 months in groups of 5‐7 PWD. At baseline and 6 months, participants completed the Color‐Word Stroop 3‐2 (primary), Montreal Cognitive Assessment (MOCA); Trail‐Making test, Digit Span Forward/Backward; Benton Judgment of Line Orientation; Boston Naming Test; Rey Auditory Verbal Learning Test; Digit Symbol Substitution Test, and the Health Utilities Index‐3 (HUI‐3). We pulled falls monthly from medical charts. We performed intent‐to‐treat (ITT; n = 42) and per protocol analyses (n = 9 with ≥2x/week exercise adherence, n = 21 usual care), controlling for age, race, sex, and the MOCA. Results Recruitment and enrolment were completed in 7 months (36% female; 17% African Americans; Age:82.1±8.1years; MOCA:10.2±5.9points). The attrition rate was 19.0%, exercise adherence was moderate (60.2±34.5%; 47/78 exercise sessions), and satisfaction was good (4.2/5 points). The trial established protocol safety, with no adverse events related to the intervention. The ITT analysis revealed no differences in the Color‐Word Stroop (primary), but better executive function (Digit Span Backwards) following exercise relative to usual care (p<0.05). The per‐protocol analysis revealed better executive function (Digit Span Backwards) and HUI‐3 following exercise relative to usual care (p<0.05). There were no effects on falls (exercise:13 falls, n = 8 recurrent, n = 1 injurious; usual care:13 falls, n = 10 recurrent, n = 4 injurious). Conclusion This pilot RCT was feasible and acceptable. Any amount of exercise appears to improve executive function, with at least 2x/week exercise also benefiting quality of life among PWD. These findings may have implications for targeted treatment strategies and inform a larger trial powered for falls in PWD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".