The feasibility, acceptability, and effects of the adapted 6-month Otago exercise program on cognitive, physical, and psychological function in people living with dementia in residential care facilities: The ENABLED randomized controlled trial

Background: People living with dementia (PWD) have poor executive function, which impacts their independence and fall risk. Exercise is a promising strategy but needs to be adapted for PWD in residential care settings. Thus, the feasibility, acceptability, and efficacy of adapted exercise on executive function need to be established. Objective: The purpose of the 6-month assessor-blinded strENgth And BaLance exercise on Executive function in people living with Dementia (ENABLED) randomized controlled trial was to determine 1) the feasibility and acceptability, and 2) if the adapted physical therapist-led Otago Exercise Program (OEP) plus usual care would improve executive function (primary) and secondary cognitive, physical, and psychological function measures as well as falls compared to usual care only in PWD in residential care facilities. Methods: We randomized PWD to the exercise (n = 21) or usual care group (n = 21) at two residential care facilities in our parallel, assessor-blinded RCT (1:1) [NCT05488951]. A physical therapist delivered our adapted OEP 3x/week over 6 months. We examined feasibility and acceptability. Participants completed a battery of assessments, with the Color-Word Stroop as our primary outcome. Results: Attrition (19.0%), exercise adherence (60.2 ± 34.5%; 47/78 sessions), and satisfaction were acceptable (4.2/5 points). We found no differences in the Color-Word Stroop, but better working memory, leg strength, and quality of life following exercise relative to usual care (p < 0.05). No differences in falls emerged. Conclusions: This feasible and acceptable RCT indicates that exercise improves working memory, leg strength, and quality of life and has implications for the design of therapeutic intervention in PWD.