Reshaping the path of vascular cognitive impairment with progressive resistance training: A 12‐Month Randomized Trial

Abstract Background Subcortical ischaemic vascular cognitive impairment (SIVCI) is the most common form of vascular cognitive impairment. Importantly, SIVCI is considered the most treatable form of cognitive impairment, due to its modifiable risk factors such as hypertension and diabetes mellitus. Exercise training is a promising intervention to delay the progression of SIVCI, as it actively targets these cardiometabolic risk factors. Despite the demonstrated benefits of resistance training on cognitive function and emerging evidence suggesting resistance training may reduce the progression of white matter hyperintensities, research on SIVCI has predominantly focused on the use of aerobic exercise. Thus, we examined the efficacy of a 12‐month, twice‐weekly progressive resistance training (RT) program on cognitive function in older adults with SIVCI. Method We conducted a 12‐month single‐blinded, randomized controlled trial with 91 adults with SIVCI who were randomly allocated to: 1) progressive RT; or 2) balance and tone exercises (BAT; control). Study eligibility included: 1) age 55 years and older; 2) neuroimaging evidence of cerebral small vessel disease at study entry; 3) mild cognitive impairment, as indicated by Montreal Cognitive Assessment scores < 26/30; and 4) the absence of dementia. Measurements occurred at baseline, 6 months, and 12 months. The primary outcome for cognitive function was the Alzheimer’s Disease Assessment Scale‐Cognitive‐Plus (ADAS‐Cog 13 with additional cognitive tests). Gait speed over 4 meters was also assessed as impaired mobility is common among those with SIVCI. Result Forty‐five participants were randomized to the RT group and 46 to the BAT group. Mean baseline age was 74.6 years (SD = 5.7 years), 66% of participants were female, and the median Fazekas score was 1. After adjusting for baseline, participants in the RT group had significantly better ADAS‐Cog Plus performance at 12 months vs. BAT (estimated mean difference [RT – BAT]:‐0.20; 95% CI:[‐0.39, ‐0.01]; p = 0.039). In addition, participants in RT had significantly faster gait speed at 12 months vs. BAT (estimated mean difference: ‐0.08 m/s; 95% CI: [‐0.16, 0.00]; p = 0.047). Conclusion The prevalence and burden of SIVCI will only increase due to the world’s aging population. Our results suggest progressive resistance training should be considered in the management and treatment of individuals with SIVCI.