CONTEXT: Exercise training for patients with Alzheimer disease combined with teaching caregivers how to manage behavioural problems may help decease the frailty and behavioural impairment that are often prevalent in patients with Alzheimer disease. OBJECTIVE: To determine whether a home-based exercise program combined with caregiver training in behavioural management techniques would reduce functional dependence and delay institutionalisation among patients with Alzheimer disease. DESIGN, SETTING AND PATIENTS: Randomised controlled trial of 153 community-dwelling patients meeting National Institute of Neurological and Communicative Disease and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease, conducted between June 1994 and April 1999. INTERVENTIONS: Patient-caregiver dyads were randomly assigned to the combined exercise and caregiver training program, Reducing Disability in Alzheimer Disease (RDAD) or to routine medical care (RMC). The RDAD program was conducted in the patients' home over 3 months. MAIN OUTCOME MEASURES: Physical health and function (36-item Short-Form Health Survey's (SF-36) physical functioning and physical role functioning subscales and Sickness Impact Profiles Mobility subscale), and effective status (Hamilton Depression Rating Scale and Cornell Depression Scale for Depression in Dementia). RESULTS: At 3 months, in comparison with the routine care patients, more patients in the RDAD group exercised at least 60 min/wk (odds ratio (OR) 2.82; 95% confidence interval (CI) 1.25 to 6.39; p = 0.01) and had fewer days of restricted activity (OR 3.10; 95% CI 1.08 to 8.95; p < 0.001). Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group (mean difference 19.29; 95% CI 8.75 to 29.83; p < 0.001). Patients in the RDAD group also had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores (mean difference -1.03; 95% CI -0.17 to -1.91; p = 0.02) at 2 years, the RDAD patients continued to have better physical role functioning scores than the RMC patients (mean difference 10.89; 95% CI 3.62 to 18.16; p = 0.003) and showed a trend (19% versus 50%) for less institutionalisation due to behavioural disturbance. For patients with higher depression score at baseline, those in the RDAD group improved significantly more at 3 months on the Hamilton Depression Rating Scale (mean difference 2.21; 95% CI 0.22 to 4.20; p = 0.04) and maintained that improvement at 24 months (mean difference 2.14; 95% CI 0.14 to 4.17; p = 0.04). CONCLUSION: Exercise training combined with teaching caregivers behavioural management techniques improved physical health and depression in patients with Alzheimer disease.

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