Dementia is a growing public health concern. It is not an inevitable part of aging, but a largely preventable neurological condition. Executive function is important for maintaining independence in activities of daily living, and includes the abilities to: make decisions, reason, problem-solve, initiate and maintain tasks, as well as adapt to changing cognitive conditions. However, people living with dementia have poor executive function, as well as greater morbidity and mortality than cognitively intact older adults. Mounting evidence suggests that strength and balance interventions at least 3x/week are safe and effective at improving cognition and mobility, as well as reducing falls in cognitively intact community-dwelling older adults. Despite the efficacy of exercise in cognitively intact older adults, these findings cannot be translated to people living with dementia because they have been largely systematically excluded from intervention trials due to researchers? ineligibility criteria. Few studies have explored the effects of exercise on cognition, mobility, and falls, with the vast majority have shown no effects. Refining the prescription of exercise for people living with dementia may been necessary to observe improvements. Therefore, the purpose of this study is to conduct a pilot 6-month assessor-blinded randomized controlled trial to determine if the Otago Exercise Program plus usual care improves executive function (primary outcome measure), reduces inflammation, improves balance, improves strength, and improves quality of life (secondary outcome measures) in people living with dementia compared to usual care alone. We will recruit 42 people living with mild to moderate dementia living in a nursing home and randomly assign them to the Otago Exercise Program plus usual care (n=21) or usual care only (n=21). The Otago Exercise Program will be a physical therapist-led group intervention, strength and balance training as well as walking over 6 months. Participants will be tested at baseline and at the follow-up on cognition, physical function, falls, and inflammatory blood biomarkers.