O5‐04‐04: Vascular cognitive impairment and aerobic exercise: A 6‐month randomized controlled trial

Worldwide, vascular cognitive impairment (VCI) is the second most common etiology contributing to cognitive impairment among older adults. Yet, VCI may be the most treatable form of cognitive impairment as many of its risk factors can be reduced with exercise. Nevertheless, few randomized controlled trials to date have specifically assessed the efficacy of exercise training on cognitive function in this high-risk group. Thus, we conducted a 6-month proof-of-concept randomized controlled trial of thrice-weekly aerobic exercise training (AE) among adults with mild sub-cortical ischemic VCI (SIVCI). Seventy-one adults (56-96 years) with SIVCI were recruited and randomized (1:1) to one of two experimental groups: 1) 3x/week AE or 2) usual care (UC). SIVCI was confirmed by: 1) evidence of subcortical white matter lesions from neuroimaging (i.e., CT or MRI); 2) a score of less than 26 on the Montreal Cognitive Assessment (MoCA); and 3) clinical assessment by neurologist. The primary outcome for this study was the Alzheimer's Disease Assessment Scale (ADAS-Cog). The AE classes were 60 minutes in duration and led by certified fitness instructors. Target heart rates were determined by the Karvonen formula. Participants of the UC group received an education seminar on nutrition once per month. Between-group differences in ADAS-Cog at trial completion was determined by analysis of covariance, with baseline ADAS-Cog and baseline MoCA score included as covariates. At trial completion, 62 of the 71 participants completed the trial. There were 2 drop outs from AE group and 7 from the UC group. Two additional individuals from the AE group were excluded from analyses due to medical reasons: 1 due to terminal and aggressive brain tumor and 1 due to rapid decline in overall function (likely due to mixed dementia). Compared with the UC group, participants in the AE group significant improved their cognitive function, as measured by the ADAS-Cog (p < 0.05). We also observed significant between-group differences in the Six-Minute Walk Test, providing evidence of treatment fidelity. AE may be an efficacious approach to improve cognitive function among individuals with mild SIVCI, and thereby, may prolong their functional independence and quality of life.