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Objectives  To investigate the effects of a high‐intensity functional exercise program on independence in activities of  daily living ( ADL s) and balance in older people with dementia and whether exercise effects differed between dementia types.    Design  Cluster‐randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study.    Setting  Residential care facilities, Umeå, Sweden.    Participants  Individuals aged 65 and older with a dementia diagnosis, a Mini‐Mental State Examination score of 10 or greater, and dependence in  ADL s (N = 186).    Intervention  Ninety‐three participants each were allocated to the high‐intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity.    Measurements  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.    Results  Linear mixed models showed no between‐group effect on  ADL  independence at 4 ( FIM =1.3, 95% confidence interval ( CI )=−1.6–4.3;  BI =0.6, 95%  CI =−0.2–1.4) or 7 ( FIM =0.8, 95%  CI =−2.2–3.8;  BI =0.6, 95%  CI =−0.3–1.4) months. A significant between‐group effect on balance favoring exercise was observed at 4 months ( BBS =4.2, 95%  CI =1.8–6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between‐group exercise effects were found in participants with non‐Alzheimer's dementia according to the  FIM  at 7 months and  BI  and  BBS  at 4 and 7 months.    Conclusion  In older people with mild to moderate dementia living in residential care facilities, a 4‐month high‐intensity functional exercise program appears to slow decline in  ADL  independence and improve balance, albeit only in participants with non‐Alzheimer's dementia.

Effects of a High‐Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia