***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare training and follow-up effects of combined aerobic and strength training versus aerobic-only training on cognitive and motor function in institutionalized patients with dementia and to explore whether improved motor function mediates improved cognitive function . METHODS Using a 9-week , parallel , three-group , single-blind , r and omized , controlled trial with a follow-up assessment at week 18 , we assessed 109 patients with dementia ( age 85.5 ± 5.1 years ) in a psycho-geriatric nursing home . Each 9-week intervention consisted of 36 , 30-minute sessions . A combined group ( N = 37 ) received and completed two strength and two walking sessions per week , an aerobic group ( N = 36 ) completed four walking sessions , and a social group ( N = 36 ) completed four social visits per  week . Cognitive and motor functions were assessed at baseline , after the 9-week intervention , and after a consecutive 9 weeks of usual care . RESULTS Baseline corrected post-test scores in the combined versus the social group were higher for global cognition , visual memory , verbal memory , executive function , walking endurance , leg muscle strength , and balance . Aerobic versus social group scores were higher for executive function . Follow-up effects reversed toward baseline values . Motor improvement did not significantly mediate cognitive improvement . CONCLUSION Compared with a nonexercise control group , a combination of aerobic and strength training is more effective than aerobic-only training in slowing cognitive and motor decline in patients with dementia . No mediating effects between improvements in cognitive function via improved motor function were found . Future research into the underlying mechanistic associations is needed OBJECTIVES To investigate the effects of exercise on gait speed , when tested using walking aids and without , and whether effects differed according to amount of support in the test . DESIGN A cluster-r and omized controlled trial . SETTING The Umeå Dementia and Exercise ( UMDEX ) study was set in 16 nursing homes in Umeå , Sweden . PARTICIPANTS One hundred forty-one women and 45 men ( mean age 85 years ) with dementia , of whom 145 ( 78 % ) habitually used walking aids . INTERVENTION Participants were r and omized to the high-intensity functional exercise program or a seated attention control activity . MEASUREMENTS Blinded assessors measured 4-m usual gait speed with walking aids if any gait speed ( GS ) , and without walking aids and with minimum amount of support , at baseline , 4 months ( on intervention completion ) , and 7 months . RESULTS Linear mixed models showed no between-group effect in either gait speed test at 4 or 7 months . In interaction analyses  exercise effects differed significantly between participants who walked unsupported compared with when walking aids or minimum support was used . Positive between-group exercise effects on gait speed ( m/s ) were found in subgroups that walked unsupported at 4 and 7 months ( GS : 0.07 , P = .009 and 0.13 , P < .001 ; and GS test without walking aids : 0.05 , P = .011 and 0.07 , P = .029 , respectively ) . CONCLUSIONS In people with dementia living in nursing homes  exercise had positive effects on gait when tested unsupported compared with when walking aids or minimum support was used . The study suggests that the use of walking aids in gait speed tests may conceal exercise effects Background Dementia is among the leading causes of functional loss and disability in older adults . Research has demonstrated that nursing home patients without dementia can improve their function in activities of daily living , strength , balance and mental well being by physical exercise . The evidence on effect of physical exercise among nursing home patients with dementia is scarce and ambiguous . Thus , the primary objective of this study was to investigate the effect of a high intensity functional exercise program on the performance of balance in nursing home residents with dementia . The secondary objective was to examine the effect of this exercise on muscle strength , mobility , activities of daily living , quality of life and neuropsychiatric symptoms . Design and Methods This single blinded r and omized controlled trial was conducted among 170 persons with dementia living in nursing homes . Mean age was 86.7 years ( SD = 7.4 ) and 74 % were women . The participants were r and omly allocated to an intervention ( n = 87 ) or a control group ( n = 83 ) . The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks . The control condition was leisure activities . Results The intervention group improved the score on Bergs Balance Scale by 2.9 points , which was significantly more than the control group who improved by 1.2 points ( p = 0.02 ) . Having exercised 12 times or more was significantly associated with improved strength after intervention ( p<0.05 ) . The level of apathy was lower in the exercise group after the intervention , compared to the control group ( p = 0.048 ) . Conclusion The results from our study indicate that a high intensity functional exercise program improved balance and muscle strength as well as reduced apathy in nursing home patients with dementia . Trial Registration Clinical Trials.gov Aims : This study aim ed to investigate the effect of 6-month physical exercise with a multicomponent cognitive program ( MCP ) on the cognitive function of older adults with moderate to severe Alzheimer 's disease ( AD ) . Methods : We included 33 participants with AD in a 6-month r and omized controlled trial . The intervention group participated in physical exercise and received a MCP . The control group received only the MCP . Before and after the intervention , cognitive outcomes were assessed using the Alzheimer 's Disease Assessment Scale-Cognitive Subscale ( ADAS-cog ) , Mini-Mental State Examination , and the Clock Drawing Test . Physical performance was evaluated by exercise time , the number of pedal rotation , total load , grip strength , and the Berg Balance Scale ( BBS ) . Results : In all cognitive measures , there were no significant improvements between the two groups after 6 months in the baseline value-adjusted primary analysis . However , the ADAS-cog score was significantly lower between the two groups in secondary analysis adjusted for baseline value , age , sex , and education years . All physical outcomes were significantly higher in the intervention group except for total load compared with baseline measurements . Conclusion : This study indicates that it is possible to improve cognitive function in older adults with moderate to severe AD through 6-month physical exercise with a multicomponent cognitive intervention BACKGROUND / OBJECTIVE Balance problems are common in older adults with Alzheimer 's disease ( AD ) . The objective was to study the effects of a Wii-Fit interactive video-game-led physical exercise program to a walking program on measures of balance in older adults with mild AD . METHODS A prospect i ve r and omized controlled parallel-group trial ( Wii-Fit versus walking ) was conducted in thirty community-dwelling older adults ( 73±6.2 years ) with mild AD .  Home-based exercises were performed under caregiver supervision for 8 weeks . Primary ( Berg Balance Scale , BBS ) and secondary outcomes ( fear of falls and quality of life ) were measured at baseline , 8 weeks ( end of intervention ) , and 16 weeks ( 8-weeks post-intervention ) . RESULTS At 8 weeks , there was a significantly greater improvement ( average inter-group difference [ 95 % CI ] ) in the Wii-Fit group compared to the walking group in BBS ( 4.8 [ 3.3 - 6.2 ] , p < 0.001 ) , after adjusting for baseline . This improvement was sustained at 16 weeks ( 3.5 [ 2.0 - 5.0 ] , p < 0.001 ) . Analyses of the secondary outcome measures indicated that there was a significantly greater improvement in the Wii-Fit group compared to walking group in Activity-specific Balance Confidence scale ( 6.5 [ 3.6 - 9.4 ] , p < 0.001 ) and Falls Efficacy Scale ( -4.8 [ -7.6 to -2.0 ] , p = 0.002 ) at 8 weeks . However , this effect was not sustained at 16 weeks . Quality of life improved in both groups at 8 weeks ; however , there were no inter-group differences ( p = 0.445 ) . CONCLUSION Home-based , caregiver-supervised Wii-Fit exercises  improve balance and may reduce fear of falling in community-dwelling older adults with mild AD Objective : To evaluate the feasibility and safety of a home-based exercise programme for people with Alzheimer ’s disease , and to provide preliminary evidence of programme effectiveness in improving balance and mobility and reducing falls risk . Design : A r and omized controlled trial . Setting : Community . Participants : Forty people with mild to moderate Alzheimer ’s disease ( mean age 81.9 , SD 5.72 ; 62.5 % female ) . Interventions : Participants were r and omized to a six-month home-based individually tailored balance , strengthening and walking exercise programme ( physiotherapist ) or a six-month home-based education programme ( control ) ( occupational therapist ) . Both programmes provided six home-visits and five follow-up phone calls . Main measures : Balance , mobility , falls and falls risk were measured at baseline and programme completion . Intention-to-treat analysis using a generalized linear model with group allocation as a predictor variable was performed to evaluate programme effectiveness . Feasibility and adverse events were systematic ally recorded at each contact . Results : Fifty-eight per cent of the exercise group finished the programme , completing an average of 83 % of prescribed sessions , with no adverse events reported . Functional Reach improved significantly ( P = 0.002 ) in the exercise group ( mean ( SD ) , 2.28 ( 4.36 ) ) compared to the control group ( –2.99 ( 4.87 ) ) . Significant improvement was also observed for the Falls Risk for Older People – Community score ( P = 0.008 ) and trends for improvement on several other balance , mobility , falls and falls risk measures for the exercise group compared to the control group . Conclusions : The exercise programme was feasible and safe and may help improve balance and mobility performance and reduce falls risk in people with Alzheimer ’s disease OBJECTIVES Long-term interventions aim ed at analyzing the impact of physical exercise on important health markers in institutionalized individuals with dementia are relatively scarce . This longitudinal study intends to identify the effects of a physical exercise program on cognitive decline , memory , depression , functional dependence and neuropsychiatric disturbances in institutionalized individuals with dementia . DESIGN R and omized controlled trial . METHODS Homecare residents with dementia were assigned to an exercise ( EG ) or to a control group ( CG ) . Participants in the EG cycled for at least 15min daily during 15 months , while those in the CG performed alternative sedentary recreational activities . The Mini-Mental State Examination ( MEC ) , the Timed " Up & Go " Test , the Neuropsychiatric Inventory , the Katz Index , the Cornell Scale for Depression in Dementia and the Fuld Object Memory Evaluation were administered before and after the intervention . RESULTS Sixty-three individuals in the CG and 51 individuals in the EG completed the intervention . A statistically significant decline in cognitive function was observed in individuals included in the CG ( p=0.015 ) , while a slight improvement was observed in those included in the EG . Significant improvement was observed in the neuropsychiatric symptoms ( p=0.020 ) , memory function ( p=0.028 ) and functional mobility ( p=0.043 ) among those who exercised . Exercise seemed to have a greater effect in those suffering from severe cognitive impairment . CONCLUSIONS This study provides evidence that aerobic physical exercise has a significant impact on improving cognitive functioning , behavior , and functional mobility in institutionalized individuals with dementia RATIONALE Dementia is a common neurodegenerative condition in older age associated with functional decline across multiple domains . This decline impacts not only on the person with dementia , but also on their informal carers and health and aged care systems . With the number of people with dementia rapidly increasing and few effective treatments , there is now a critical need for interventions to improve functional ability in those with the condition . AIMS AND OBJECTIVE This study assesses the effectiveness of a community-based home exercise programme in improving cognitive and physical function and independence in activities of daily living ( ADL ) in people with Alzheimer 's disease , the most common form of dementia . METHODS In a 4-month r and omized controlled trial , 40 community-dwelling patients diagnosed with Alzheimer 's disease and their informal carers were r and omly allocated to either the treatment ( exercise plus usual treatment ) or control ( usual treatment ) group . The exercise programme consisted of daily exercises and walking under the supervision of their carer . Patients were assessed at baseline and 4-months follow-up by a blinded assessor on primary outcome measures of cognitive and physical function and ADL using st and ardized assessment scales . RESULTS Sixteen men and 24 women diagnosed with Alzheimer 's disease participated in the study . They had a mean age of 74.1 years ( range 51 - 89 ) and a mean Mini Mental State Examination score of 22.0 ( range 10 - 28 ) , indicating mild to moderate dementia . At 4-months follow-up , patients who exercised , compared with controls , had improved cognition ( increased Mini Mental State Examination scores by 2.6 points , p < 0.001 ) , better mobility ( 2.9 seconds faster on Timed Up and Go , p = 0.004 ) and increased Instrumental Activities of Daily Living scores by 1.6 ( p = 0.007 ) . CONCLUSION This study suggests that participation in a community-based exercise programme can improve cognitive and physical function and independence in ADL in people 
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Sufficient relative reliability supports the conclusiveness of recommended assessment s at group level , while unacceptable absolute reliability advices caution in assessing intra-individual changes .
Moreover , influences on test-retest reliability suggest tailoring assessment s and instructions to IWD and applying cueing only where it is inevitable .