Introduction. A combined training using physical exercise and cognitive stimulus with music could assist professionals regarding communication and behavioural approaches with institutionalized people with dementia. Objective. To determine the effects of listening to music before physical exercise on neuropsychiatric symptoms in institutionalized older people with moderate to advanced dementia. Method. A randomized controlled pilot trial was conducted with 17 institutionalized older people with moderate to advanced dementia. The participants were randomized into Training with Music Group (TMG) and Training without Music Group (TG). The TMG listened to 20 minutes of researcher-selected music (popular songs from their youth) prior to completing a physical exercise protocol. They performed light exercises with progression of intensity, lasting 40 to 45 minutes per session and mainly focused on maintaining or improving mobility. The TG performed the same exercises, without music. Both individual programs lasted 12 weeks with 1 session per week. The assessments included cardiovascular measures, facial expressions, and the Neuropsychiatric Inventory. Results. A tendency of worsening in heart rate variability after 12 weeks in the TMG was found (p=.065). No significant differences between groups and assessments were found regarding heart rate, heart blood systolic and diastolic pressure values, facial expression, neuropsychiatric symptoms and caregiver burden level. Discussion and Conclusion. Listening to music before physical exercise does not increase positive effects on neuropsychiatric symptoms in institutionalized older people with dementia.