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November 15, 2016; 87 (20) Article

Aerobic exercise and vascular cognitive impairment

A randomized controlled trial

Teresa Liu-Ambrose, John R. Best, Jennifer C. Davis, Janice J. Eng, Philip E. Lee, Claudia Jacova, Lara A. Boyd, Penelope M. Brasher, Michelle Munkacsy, Winnie Cheung, Ging-Yuek R. Hsiung
First published October 19, 2016, DOI: https://doi.org/10.1212/WNL.0000000000003332
Teresa Liu-Ambrose
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John R. Best
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Jennifer C. Davis
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Janice J. Eng
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Philip E. Lee
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Claudia Jacova
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Lara A. Boyd
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Penelope M. Brasher
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Michelle Munkacsy
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Winnie Cheung
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Ging-Yuek R. Hsiung
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Citation
Aerobic exercise and vascular cognitive impairment
A randomized controlled trial
Teresa Liu-Ambrose, John R. Best, Jennifer C. Davis, Janice J. Eng, Philip E. Lee, Claudia Jacova, Lara A. Boyd, Penelope M. Brasher, Michelle Munkacsy, Winnie Cheung, Ging-Yuek R. Hsiung
Neurology Nov 2016, 87 (20) 2082-2090; DOI: 10.1212/WNL.0000000000003332

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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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