Within-Group Changes^*and Effect Sizes in Participant and Caregiver Measures, Group 1.

<p>SPPB, Short Physical Performance Battery; ADAS-cog, Alzheimer’s Disease Assessment Scale—cognitive subscale; QOL-AD, Quality of Life in Alzheimer’s Disease scale; SFT, Senior Fitness Test; ADCS-ADL, Alzheimer’s Disease Cooperative Study—Activities of Daily Living scale; NPI-FS, Neuropsychiatric Inventory—frequency*severity subscale; NPI-CD, Neuropsychiatric Inventory—caregiver distress subscale; CBI, Caregiver Burden Inventory.</p><p>a: higher scores better;</p><p>b: lower scores better.</p><p>*Means (SD).</p><p>**Effect size calculated by subtracting mean change from 19 to 36 weeks from mean change from 0 to 18 weeks and dividing by the baseline standard deviation; + values favor PLIÉ, and − values favor Usual Care. Bolded effect sizes favor PLIÉ and were ≥ 0.25. Data missing as follows: SFT back scratch (n = 1, both time points) SFT—8 foot up and go (n = 1, 0 to 18 weeks), NPI-FS (n = 1, 19 to 36 weeks).</p><p>Within-Group Changes^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#t005fn004" target="_blank">*</a>}and Effect Sizes in Participant and Caregiver Measures, Group 1.</p

Flow Diagram of Study Participants.

<p>A total of 22 participant (PT)/caregiver (CG) dyads were assessed for eligibility, of whom 10 were excluded and 12 were enrolled and allocated to Group 1 (n = 7) or Group 2 (n = 5). Group 1 participated in the Preventing Loss of Independence through Exercise (PLIÉ) program while Group 2 participated in Usual Care activities from weeks 1 to 18. The groups then crossed over, and Group 1 returned to Usual Care activities while Group 2 participated in PLIÉ from weeks 19 to 36. Assessments were performed at baseline, 18 weeks and 36 weeks. One participant withdrew from Group 1 prior to the 18-week assessment and one participant withdrew from Group 2 prior to the 36-week assessment. In addition, one CG in Group 2 did not complete the 18- or 36-week assessments.</p

Within-Group Changes^* and Effect Sizes in Participant and Caregiver Measures, Group 2.

<p>SPPB, Short Physical Performance Battery; ADAS-cog, Alzheimer’s Disease Assessment Scale—cognitive subscale; QOL-AD, Quality of Life in Alzheimer’s Disease scale; SFT, Senior Fitness Test; ADCS-ADL, Alzheimer’s Disease Cooperative Study—Activities of Daily Living scale; NPI-FS, Neuropsychiatric Inventory—frequency*severity subscale; NPI-CD, Neuropsychiatric Inventory—caregiver distress subscale; CBI, Caregiver Burden Inventory.</p><p>a: higher scores better;</p><p>b: lower scores better.</p><p>*Means (SD).</p><p>**Effect sizes calculated by subtracting mean change 19 to 36 weeks from mean change 0 to 18 weeks and dividing by the baseline standard deviation. + values favor PLIÉ, and − values favor Usual Care. Bolded effect sizes favor PLIÉ and were ≥ 0.25.</p><p>Within-Group Changes^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#t006fn004" target="_blank">*</a>} and Effect Sizes in Participant and Caregiver Measures, Group 2.</p

Preventing Loss of Independence through Exercise (PLIÉ) Guiding Principles.

<p>*<u>Physical therapy</u> is a health care profession that focuses on maintaining, restoring and improving movement, activity and health to promote optimal function and quality of life.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref053" target="_blank">53</a>] This is accomplished by examining, evaluating and diagnosing clients and working with them to identify their specific goals and develop an action plan that includes physical exercises such as stretching, strengthening and coordination activities to improve function in daily activities. Physical therapy has a participant-centered goal orientation (Guiding Principal [GP] 4) and exercises are repeated with variations (GP 1) and often involve progressive functional movements (GP 2). <u>Occupational therapy</u> is a health care profession that helps people to participate in the things they want and need to do through the therapeutic use of everyday activities (occupations).[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref054" target="_blank">54</a>] It involves performing an individualized evaluation to determine a person’s goals related to functional activities, developing a customized intervention that may include adaptation of the environment as well as specific activities to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and to make changes to the intervention plan as needed, recognizing the functional and social/emotional needs of clients. Occupational therapy has a participant-centered goal orientation (GP 4) and may involve physical exercises that repeat with variations (GP 1) or target progressive functional movements (GP 2); in addition, occupational therapy interventions in people with dementia often utilize a slow pace and step-by-step instruction (GP 3) and emphasize social interaction (GP 6) and positive emotions (GP 7). <u>Yoga</u> is a movement practice from India that seeks to join the mind, body and spirit in a harmonious experience.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref055" target="_blank">55</a>] Yoga primarily includes physical postures, conscious breathing techniques, and meditation practice and sometimes incorporates visualization and the use of sounds or chanting. While hatha yoga is the form of yoga first popularized in the west, there are many forms of yoga, and our study integrated a form of yoga called Healing Yoga[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref056" target="_blank">56</a>] that emphasizes nonjudgmental instruction, comfort while moving, and attention to breathing and body sensations. Yoga typically involves repetition of movements with variation (GP 1); a slow pace and step-by-step instruction (GP 3); a focus on body awareness, mindfulness and breathing (GP 6); and promotion of positive emotions (GP 7). <u>Tai chi</u> is a mind-body health practice that originated in China as an internal martial art.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref057" target="_blank">57</a>] It involves performing slow, fluid movement sequences following established forms that are learned over time. Sometimes called ‘moving meditation,’ tai chi practice emphasizes staying aligned, grounded and balanced while moving, with attention to mental and physical relaxation, promoted by deep, diaphragmatic breathing.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref058" target="_blank">58</a>] Tai chi involves repetition of movements with variation (GP 1); a slow pace and step-by-step instruction (GP 3); training of body awareness, mindfulness and breathing (GP 5), and a focus on positive emotions (GP 7). The <u>Feldenkrais Method</u> is a form of somatic (of the body) education that seeks to improve movement, function, range of motion, flexibility and coordination.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref059" target="_blank">59</a>] It is designed to provide an opportunity for neuromuscular re-education through sensory-motor awareness through hundreds of movement sequences called ‘Awareness Through Movement’ that progress in complexity, using variations in positions, attention to body sensation, gentle movement and frequent rests as strategies to change habitual ways of moving, sensing, thinking and feeling.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref060" target="_blank">60</a>] Feldenkrais involves performing basic functional movements that gradually increase in complexity (GP 2); movements are typically taught in a slow, step-by-step manner (GP 3) and are designed to enhance body awareness (GP 5) and promote positive emotions (GP 7). <u>Rosen Method</u> movement classes are set to music and involve slow, easy movements that are designed to improve alignment and flexibility, increase range of motion and ease of breathing, and deepen awareness of the body.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref061" target="_blank">61</a>] The group format of movement classes utilizes social interaction to facilitate a nonjudgmental, relaxed learning environment. It involves learning progressive functional movements (GP 2) in a slow, step-by-step manner (GP 3) with a focus on body awareness, mindfulness and breathing (GP 5), social interaction (GP 6) and positive emotions (GP 7). <u>Dance Movement Therapy</u> is defined as the psychotherapeutic use of movement to promote emotional, social, cognitive and physical integration of the individual.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref062" target="_blank">62</a>] Dance movement therapy in groups with seniors are often in a circle seated formation, usually have a beginning greeting and closing ritual, and involve nonjudgmental explorations combined with verbal processing to facilitate emotional growth and social relatedness.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#pone.0113367.ref063" target="_blank">63</a>] Dance movement therapy includes repetition of dance movement sequences with variations (GP 1), step-by-step instructions (GP 3), and a focus on social interactions (GP 6) and positive emotions (GP 7).</p><p>Preventing Loss of Independence through Exercise (PLIÉ) Guiding Principles.</p

Between-Group Change in Caregiver Measures^*, Baseline to 18 Weeks.

<p>ADCS-ADL, Alzheimer’s Disease Cooperative Study—Activities of Daily Living scale; QOL-AD, Quality of Life in Alzheimer’s Disease; NPI-FS, Neuropsychiatric Inventory—frequency*severity subscale; NPI-CD, Neuropsychiatric Inventory—caregiver distress subscale; CBI, Caregiver Burden Inventory.</p><p>a: higher scores better;</p><p>b: lower scores better.</p><p>*Means (SD).</p><p>**Effect size calculated by subtracting mean change in Group 1 from mean change in Group 2 and dividing by the pooled baseline standard deviation; + values favor PLIÉ, and − values favor Usual Care. Bolded effect sizes favor PLIÉ and were ≥ 0.25.</p><p>Between-Group Change in Caregiver Measures^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#t004fn004" target="_blank">*</a>}, Baseline to 18 Weeks.</p

Between-Group Effect Sizes in Participant Measures^*, Baseline to 18 Weeks.

<p>SPPB, Short Physical Performance Battery; ADAS-cog (Alzheimer’s Disease Assessment Scale—cognitive subscale; QOL-AD, Quality of Life in Alzheimer’s Disease; SFT, Senior Fitness Test.</p><p>a: higher scores better;</p><p>b: lower scores better.</p><p>*Means (SD).</p><p>**Effect size calculated by subtracting mean change in Group 1 from mean change in Group 2 and dividing by the pooled baseline standard deviation; + values favor PLIÉ, and − values favor Usual Care. Bolded effect sizes favor PLIÉ and were ≥ 0.25. Data missing as follows: SFT back scratch (group 1, n = 1, both time points).</p><p>Between-Group Effect Sizes in Participant Measures^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113367#t003fn004" target="_blank">*</a>}, Baseline to 18 Weeks.</p