Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial.

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.