Summary: New findings from the EXERT study indicate that lower- and moderate-high-intensity exercise may aid in the preservation of cognitive function in older people with mild memory loss, a significant risk factor for Alzheimer’s disease. Over 12 months, participants who engaged in either form of exercise showed significantly less mental decline and diminished brain size damage, especially in the prefrontal cortex, compared to a usual-care group.
This study highlights the value of available, community-based fitness programs for dementia patients. Also low-intensity activities like stretching and balance exercises showed promise for halting decline, indicating a straightforward and practical way to brain health.
Important Facts:
- Slowing the decline: Over the course of 12 months, both small and moderate-high strength exercise stabilized mental function.
- Participants in both workout groups showed less mental volume loss, especially in the cerebral cortex.
- Community Feasibility: The test partnered with regional YMCAs, showing real-world application is possible.
Origin: UCSD
Low- and moderate-high-intensity practice may be useful tools in the fight against Alzheimer’s, according to research from Wake Forest University and the University of California, San Diego.
The new research, published as two papers in , Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, describes the results of the EXERT study ( Exercise in Adults with Mild Memory Problems ), a multi-site clinical trial of lower or moderate-high intensity exercise in sedentary older adults with amnestic mild cognitive impairment, a major risk factor for Alzheimer’s dementia.
The researchers also compared their results to an existing database of superior individuals who only received regular maintenance, such as standard check-ups with health care providers and medication supervision.
The experts discovered:
- Mental function in both small and moderate-high strength exercise groups remained stable over the course of 12 months in EXERT participants.
- Both forms of exercise were associated with considerably less mental reduction over 12 weeks when compared to people who were not involved in the training research.
- Over the course of 12 months, both EXERT practice groups showed a decrease in brain volume, particularly in the cerebral cortex.  ,
People with amnestic mild cognitive impairment, a problem characterized by recollection issues and objective memory decline, are at high risk of developing Alzheimer’s dementia, with about 16 % of people with this condition moving to Alzheimer’s each month.
Aladdin Shadyab, Ph. D., said,” This is a crucial time to intervene in this population, because they are at a very high risk, but they don’t have dementia yet.” Dr. Herbert Wertheim, associate professor at the UC San Diego School of Public Health and Human Longevity Science and School of Medicine, and lead author of one of the new papers.
” Together, these findings show us that even low intensity exercise may slow cognitive decline in at-risk older adults”.
Although previous studies have suggested that exercise may improve cognitive health, extensive, well-designed studies are required to fully understand the potential benefits of exercise for older adults with mild cognitive impairment.
This gap is filled by the EXERT study, which is coordinated by the Alzheimer’s Disease Cooperative Study ( ADCS) at UC San Diego and Wake Forest University School of Medicine.
” EXERT was one of the first large clinical trials of exercise that partnered with the YMCA and its trainers to bring the intervention closer to home for research participants”, said Howard Feldman, M. D., ADCS director.
” This approach brings us one step closer to its implementation in the community.”
The National Institute on Aging and UC San Diego collaborated to form the ADCS in 1991, making it one of the most important initiatives for Alzheimer’s research supported by the federal government that addresses treatments for both cognitive and behavioral symptoms of the disease.
” There’s an urgent need to identify effective and feasible ways to prevent and treat Alzheimer’s dementia, and UC San Diego has been a leader in this field for many years”, added Feldman, who is also a professor in the Department of Neurosciences at UC San Diego School of Medicine.
Nearly 300 sedentary older adults with mild cognitive impairment were randomly assigned to either moderate-high intensity aerobic exercise or lower-intensity stretching, balance, and range of motion activities.
The study included regular assessments of cognitive function and brain volume, and participants completed their assigned exercise three to four times per week for a 12-month period under the supervision of a YMCA trainer.
” EXERT is a landmark study because it’s the largest rigorous trial of exercise ever conducted in adults with mild cognitive impairment”, said Laura Baker, Ph. D., professor of gerontology and geriatric medicine at Wake Forest University School of Medicine, and principal investigator of the EXERT study.
” We’re still unlocking the full potential of exercise as a medicine for older adults with memory problems, despite the well-documented benefits to nearly every aspect of human health.
Though the researchers expected to see further cognitive decline in EXERT participants, they actually found that cognitive function remained stable for both exercise groups over the course of the study. This suggests that both moderate and vigorous exercise may help to slow cognitive decline.
Another possible explanation for the results is that participating in research itself, regardless of the treatment, may provide protection against cognitive decline as a result of the involved intellectual and social stimulation.
Overall, the findings of both studies taken together suggest that exercise may be a promising, safe, and feasible strategy to promote brain health and prevent continued cognitive decline for older adults with mild cognitive impairment.
Although there is still a lot to learn, these findings indicate that regular exercise, even at low intensity, could be very effective in helping older adults slow or delay cognitive decline, which is encouraging for those who are at high risk for dementia, Shadyab continued.
Funding: The Brain Research Foundation ( BRF ECD-2014-01 ) and the National Institutes of Health/National Institute on Aging ( U19AG010483-25 and AG058644 ) provided funding for the EXERT study.
Disclosures: Feldman receives grant funding from the National Institute on Aging ( U19AG010483-22 ), from Biohaven Pharmaceuticals, Vivoryon ( Probiodrug), and LuMind Foundation, service agreements for consulting activities with LuMind, Axon Neuroscience, Novo Nordisk, Arrowhead Pharmaceuticals, Roche/Genentech Pharmaceuticals ( DMC/DSMB), Tau Consortium ( SAB), and Janssen Research &, Development ( DSMB), support for travel from Novo Nordisk, Royal Society of Canada, Translating Research in Elder Care ( TREC ), Association for Frontotemporal Dementia ( AFTD), and Rainwater Charitable Foundation, and a philanthropic donation for the Epstein Family Alzheimer Research Collaboration.
No personal funds have been given out for these endeavors. Feldman HH ( filed November 26, 2008 ) personally receives royalties for the patent. Detecting and Treating Dementia Serial Number 12/3-2691 U. S. Patent No. PCT/US2007/07008 U.S. Patent and Trademark Office in Washington, D.C.
About this Alzheimer’s disease and exercise research news
Author: Miles Martin
Source: UCSD
Contact: Miles Martin – UCSD
Image: The image is credited to Neuroscience News
Open access to original research
” Effects of exercise on cognition and Alzheimer’s biomarkers in a randomized controlled trial of adults with mild cognitive impairment: The EXERT study” by Aladdin Shadyab et al. Dementia and Alzheimer’s
open access
” Effects of exercise versus usual care on older adults with amnestic mild cognitive impairment: EXERT versus ADNI” by Aladdin Shadyab et al. Dementia and Alzheimer’s
Abstract
Exercise’s effects on cognition and Alzheimer’s biomarkers in a randomized controlled trial of adults with mild cognitive impairment: the EXERT study.
INTRODUCTION
The EXERT study ( Exercise in Adults with Mild Memory Problems ) was a Phase 3, multicenter, randomized controlled trial that examined effects of exercise on cognition and other measures of brain health in sedentary older adults with amnestic mild cognitive impairment (MCI).
METHODS
Participants were randomly chosen to receive moderate-high intensity aerobic training ( AX ) or low-intensity stretching, balance, and range of motion ( SBR ) over the course of 18 months. For the first twelve and a half months, exercise was supervised. Assessments were administered at baseline and every 6 , months. A global cognitive composite was the main outcome.
RESULTS
A total of 296 participants were enrolled, and the intervention adherence rate was high ( supervised session attendance: AX = 81 %; SBR = 87 % ). Intervention effects on cognition did not differ for AX and SBR ( regression = –0.078, standard error]SE]  , = , 0.074,  , p , = , 0.3 ). Notably, neither group experienced any 12 , month , cognition decline, and both groups had a mean 12 , month , hippocampal volume loss of 0.51 %.
DISCUSSION
Exercise intensity did not have a different impact on cognitive trajectory. Intervention delivery was successful ( high adherence ) and cognition remained stable over 12 , months , for both MCI groups, an association that warrants further study.
Highlights
- A large, multisite randomized controlled trial comparing moderate-high intensity aerobic exercise to lower-intensity flexibility and balance exercises in sedentary older adults with amnestic mild cognitive impairment (MCI) was conducted.
- The Alzheimer’s Disease Assessment Scale-Cognition, which includes executive function tests ( ADAS-Cog-Exec), was used to evaluate the efficacy of the intervention after 12 months of supervised exercise, using a sensitive and validated measure of global cognitive function.
- There was no intervention group difference on the 12-month cognitive trajectory of the ADAS-Cog-Exec.
- Both exercise groups ‘ cognition remained stable over the course of 12 months and the intervention delivery was successful ( high adherence ).
- Adults with amnestic MCI may stop decline with regular, moderate-high or lower-intensity exercise, but further investigation is required.
Abstract
Effects of exercise versus usual care on older adults with amnestic mild cognitive impairment: EXERT versus ADNI
INTRODUCTION
EXERT was a multisite randomized controlled trial (RCT) that looked at the effects of moderate-high intensity aerobic training ( AX ) versus lower-intensity stretching/balance/range of motion ( SBR ) on cognitive trajectories in older adults with amnestic mild cognitive impairment (ACMI ).
METHODS
A propensity-matched, follow-up analysis was conducted to compare each arm to a group from the Alzheimer’s Disease Neuroimaging Initiative 1 ( ADNI-1 )’s ( ADNI-1 ) propensity-matched regular care ( no intervention ) study that had been screened for similarity across key characteristics. Differences in 12-month trajectories in the primary endpoint ( ADAS-Cog-Exec) and magnetic resonance imaging ( MRI ) volumes in prespecified brain regions were compared.
RESULTS
AX and SBR showed significantly less 12-month cognitive decline than ADNI-1 ( AX: n , = , 109,  , = , 0. 169; SBR: n , = , 105; 95 % CI 0.007–0, 304 ). In comparison to ADNI-1, there were signs of less prefrontal cortex volume loss in both EXERT groups over the course of a year.
DISCUSSION
Moderate-high intensity aerobic or low-intensity flexibility exercise for 12 months in participants with aMCI may provide protection against decline relative to usual care.
CLINICAL TRIAL REGISTRATION
Clinicaltrials.com has registered the EXERT clinical trial. gov (NCT02814526 ).
Highlights
- A randomized controlled trial was conducted on aMCI in sedentary older adults.
- EXERT arms were propensity-matched to a group receiving standard care ( no intervention ) ( ADNI-1, Alzheimer’s Disease Neuroimaging Initiative ).
- High and low-intensity exercise arms had less 12-mo cognitive decline than ADNI-1.
- There were indications that ADNI-1 had less prefrontal cortex volume loss for each arm.
