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Abstract
Objective: To assess the efficacy of a progressive aerobic exercise training program on cognitive and everyday function among adults with mild subcortical ischemic vascular cognitive impairment (SIVCI).
Methods: This was a proof-of-concept single-blind randomized controlled trial comparing a 6-month, thrice-weekly, progressive aerobic exercise training program (AT) with usual care plus education on cognitive and everyday function with a follow-up assessment 6 months after the formal cessation of aerobic exercise training. Primary outcomes assessed were general cognitive function (Alzheimer's Disease Assessment Scale–Cognitive subscale [ADAS-Cog]), executive functions (Executive Interview [EXIT-25]), and activities of daily living (Alzheimer's Disease Cooperative Study–Activities of Daily Living [ADCS-ADL]).
Results: Seventy adults randomized to aerobic exercise training or usual care were included in intention-to-treat analyses (mean age 74 years, 51% female, n = 35 per group). At the end of the intervention, the aerobic exercise training group had significantly improved ADAS-Cog performance compared with the usual care plus education group (−1.71 point difference, 95% confidence interval [CI] −3.15 to −0.26, p = 0.02); however, this difference was not significant at the 6-month follow-up (−0.63 point difference, 95% CI −2.34 to 1.07, p = 0.46). There were no significant between-group differences at intervention completion and at the 6-month follow-up in EXIT-25 or ADCS-ADL performance. Examination of secondary measures showed between-group differences at intervention completion favoring the AT group in 6-minute walk distance (30.35 meter difference, 95% CI 5.82 to 54.86, p = 0.02) and in diastolic blood pressure (−6.89 mm Hg difference, 95% CI −12.52 to −1.26, p = 0.02).
Conclusions: This study provides preliminary evidence for the efficacy of 6 months of thrice-weekly progressive aerobic training in community-dwelling adults with mild SIVCI, relative to usual care plus education.
ClinicalTrials.gov identifier: NCT01027858.
Classification of evidence: This study provides Class II evidence that for adults with mild SIVCI, an aerobic exercise program for 6 months results in a small, significant improvement in ADAS-Cog performance.
GLOSSARY
- 6MWT=
- 6-Minute Walk Test;
- AD=
- Alzheimer disease;
- ADCS-ADL=
- Alzheimer's Disease Cooperative Study–Activities of Daily Living;
- ADAS-Cog=
- Alzheimer's Disease Assessment Scale–Cognitive subscale;
- AT=
- aerobic training;
- CON=
- usual care plus education;
- EF=
- executive functions;
- EXIT-25=
- Executive Interview;
- HRR=
- heart rate reserve;
- MMSE=
- Mini-Mental State Examination;
- MoCA=
- Montreal Cognitive Assessment;
- RPE=
- Rating of Perceived Exertion;
- SIVCI=
- subcortical ischemic vascular cognitive impairment;
- VCI=
- vascular cognitive impairment;
- VADAS-Cog=
- Vascular Dementia Assessment Scale cognitive subscale;
- WML=
- white matter lesion
Footnotes
An abstract of preliminary analyses was presented at the Alzheimer's Association International Conference, Washington, DC, July 23, 2015.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
Editorial, page 2072
- Received February 9, 2016.
- Accepted in final form July 5, 2016.
- © 2016 American Academy of Neurology
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