Possible Link Between Aerobic Exercise and Improvement in Cognitive Function in Patients With Vascular-Based Impairment

‘Proof of Concept’ Study Points to Possible Link Between Aerobic Exercise and Improvement in Cognitive Function in Patients With Vascular-Based Impairment

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Although results are far from conclusive, a recently published “proof of concept” study points to the possibility that aerobic exercise could improve cognitive performance among older adults with a type of impairment caused by problems with blood supply to the brain.

The study, conducted in Canada between 2009 and 2014, focused on 70 adults (with an average age of 74) diagnosed with mild subcortical ischemic vascular cognitive impairment (SIVCI). Participants were placed into 2 groups: the first group received usual care and monthly educational materials on maintaining a healthy diet; the second group received usual care but also took part in a 6-month walking program with progressive aerobic intensity. Researchers used 3 tests to measure cognitive function at baseline, at 6 months after the start of the program, and again after 1 year: the Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog), the Executive Interview (EXIT-25), and the Alzheimer’s Disease Cooperative Study – Activities of Daily Living (ADCS-ADL) scale.

Authors of the study, which appears in Neurology (abstract only available for free), found that after 6 months, the aerobic group had improved scores on the ADAS-Cog, with an average decrease of 1.71 on the 70-point scale (a higher ADAS-Cog number indicates greater impairment). There were no significant differences in scores on the other 2 tests, and the ADAS-Cog differences seemed to disappear at the 1-year mark, or 6 months after the exercise program had ended. While authors acknowledge that a drop of 4 points on the ADAS-Cog is considered clinically meaningful, they describe the 1.71 decline as “significant.”

The exercise program consisted of 60-minute walking sessions held 3 times a week. All walking took place outdoors, and providers monitored each participant’s heart rate reserve (HRR), gradually increasing the intensity of the exercise from an initial 40% of HRR to 65% of HRR, and keeping it there for the rest of the program. Participants in the aerobic group were also given pedometers and encouraged to track the number of steps they took every day.

Authors believe that the slight improvement is likely related to a drop in the aerobic participants’ diastolic blood pressure, “a key and modifiable risk factor for SIVCI,” and a possible protection against future stroke.

An editorial accompanying the study characterizes it as one of the first to point to a possible connection between physical activity and improvement in cognition among patients with SIVCI, and asserts that the findings should “encourage further studies on larger groups of people with [vascular cognitive impairment].” Authors of the editorial write that while it was “surprising” that the program didn’t improve executive functions as measured by the EXIT-25, “physical activity may require a longer period to improve executive function, as it may exert its effect by lowering the diastolic blood pressure, as demonstrated in this study.”

As for the lack of difference in the 2 groups at the 1-year mark, authors of the study believe the effect could be countered by better “sustainability” strategies.

“This might entail a longer intervention period (eg, 12 months) or the inclusion of behavioral components (eg, self-monitoring or incentive schemes) to facilitate maintenance of this frequency and intensity of walking upon intervention cessation,” authors write.

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