Feasibility of improving strength and functioning and decreasing the risk of falls in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial

•The exercise program is an effective strategy that reduces motor impairment•Physical exercise improves the clinical course of the Alzheimer's disease•The multimodal intervention is feasible for reducing the incidence of falls•Home-based exercise has high adherence among older people with Alzheimer's disease•The home-based exercise program is feasible for improving strength and functioning To determine the effects of a Home-based multimodal exercise program for older people with Alzheimer's disease (AD-HOMEX) on muscle strength, mobility, the risk of falls and functioning. A trial with a blinded assessor was conducted involving 40 older people with mild to moderate AD randomized to an intervention group (IG) or control group (CG). The IG participated in a 16-week protocol with three 60-minute sessions per week. The sessions were performed at the participant's home by a physiotherapist and involved progressive individualized physical exercises. Muscle strength (5X Sit-to-Stand Test [5XSTS], 30-Second Chair Stand test, isokinetic and hand-grip dynamometer), functioning (DAFS-R and ADL-Q), mobility and the risk of falls (TUG) were assessed at baseline and after training. Intention-to-treat analysis was adopted. There was a significant group-evaluation time interaction for the 5XSTS (p = 0.011). The IG demonstrated an improved performance on the 5XSTS (p = 0.020) and a reduced risk of falls (p = 0.000), whereas the CG exhibited a worse functional limitation (p = 0.008) after 16 weeks. The CG had an increased risk of falls (p = 0.006) and worse performance on the ADL-Q (p = 0.047) at the follow-up evaluation. An improvement in the IG and worsening in the CG were found regarding transition patterns between severity levels of functional limitation based on the ADL-Q. Home-based physical exercise for older people with mild to moderate AD is an effective strategy that decreases the risk of falls and improves strength and functioning.