Preventing Loss of Independence through Exercise (PLIÉ):
Clinical Trials in Older Adults with Dementia

The primary goal of the Preventing Loss of Independence through Exercise (PLIÉ) studies is to determine whether a novel, multi-modal, integrative exercise program can improve function and quality of life in people with dementia and reduce the burden of their caregivers.

We are collaborating with the Veterans Affairs Administration in a trial of a four-month adult day care center-based group class intervention for affected individuals. We are also collaborating with Kaiser Permanente Oakland Medical Center in another study of Integrative Exercise adapted from PLIÉ to be performed safely at home by caregivers and affected individuals (Paired PLIÉ). Paired PLIÉ consists of three months of classes at Kaiser Oakland, four home visits,  and a video to support home practice.

Both are randomized controlled trials to test the efficacy of the PLIÉ and the Paired PLIÉ programs versus waitlist control on participant and caregiver outcomes. We use outcome measures that are the standard in pharmaceutical research for dementia. In addition, we use Fitbit electronic tracking devices to document home practice time, and we are pioneering non-invasive Near-Infrared Spectroscopy with a Verbal Fluency Task to explore whether the Paired PLIÉ program induces changes in brain oxygenation. We are collaborating with the Veterans Affairs Medical Center, which performs brain scans in some of our participants to study potential changes in brain connectivity.

Given that there are currently no medications that stop or even slow the progression of dementia, it is critically important to develop and test novel non-pharmacological approaches. Home-based exercise activities are needed, as adult day programs are not feasible for many people with dementia. These studies utilize a rigorous cross-over design to test the efficacy of highly innovative and promising multi-modal approaches to exercise that. If these programs prove to be effective, they could be widely disseminated at relatively low cost, potentially helping to improve function and quality of life in millions of affected individuals and those who care for them.

PLIÉ is highly innovative and capitalizes on recent discoveries in neuroscience and experimental psychology, which have found that, although explicit memory (the ability to consciously recall new information) is impaired in people with dementia, implicit memory (unconscious learning that typically occurs through repeated exposure) is relatively preserved, especially implicit motor memory. PLIÉ therefore targets the abilities and neural mechanisms that are most intact in people with dementia and has three key elements:

  1. training implicit memory of procedures (procedural or ‘muscle’ memory) for movements that are most needed for daily function (e.g., transitioning safely from sitting to standing);
  2. enhancing in-the-moment, mindful body awareness; and
  3. facilitating social and emotional connection through shared movement. Another key innovation is the adaptation of PLIÉ so that it can be performed by caregivers safely at home (Paired PLIÉ) with pamphlet and video support.

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