Can PT improve ADLs and Balance in older folks with dementia?

May 2017

Can a 4 month twice a week program led by a physical therapist and consisting of high-intensity functional exercise program improve independence in activities of daily living (ADLs) and balance in older people with dementia? You bet.

A study conducted in Sweden at a residential care facilities, Umeå, with 93 individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity.

Blinded assessors measured ADL independence using the Functional Independence Measure (FIM) and Barthel Index (BI) and balance using the Berg Balance Scale (BBS) at baseline and 4 (directly after intervention completion) and 7 months.
They found significant between-group effect on balance favoring exercise was observed at 4 months (BBS=4.2, 95% CI=1.8-6.6). They concluded that in older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program administered by a physical therapist appears to slow decline in ADL independence and improve balance.

The exercises had 5 components:

  1. Static and Dynamic Balance in combination with lower extremity strength exercise: Squats in parallel bars, step ups, directional lunges
  2. Dynamic Exercises in Walking: Walking over obstacles, soft surfaces, with multiple turns
  3. Static and Dynamic balance in standing: Trunk rotations, body weight transfer, side steps
  4. Lower extremity strength with continuous balance support: Squat in parallel bars while walking, STS, heel raises
  5. Walking with continuous balance support: Walking various directions, and numerous turns

All exercises can be increased by higher steps, deeper squats, narrowing base, and weighted belts.

Toots A, Littbrand H, Lindelöf N, Wiklund R, Holmberg H, Nordström P, et al. Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia. Am Geriatr Soc. 2016 Jan;64(1):55-64. doi: 10.1111/jgs.13880. Abstract available at Full article available at

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