Diet, exercise improved cognitive function in patients with obesity, HFpEF
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Key takeaways:
- A diet and exercise intervention improved neurocognitive function in patients with obesity and HFpEF.
- The benefits were observed on the Rey Auditory Verbal Learning Test and Montreal Cognitive Assessment.
Caloric restriction and exercise improved domains of cognitive function in a small study of older patients with obesity and HF with preserved ejection fraction, according to a research letter published in Circulation: Heart Failure.
“Exercise and caloric restriction interventions, shown to improve exercise capacity and quality of life among patients with HFpEF, seem to help preserve brain health in older people with obesity. Thus, neurocognitive dysfunction may be an underrecognized feature of HFpEF that is potentially amenable to lifestyle interventions known to improve other key outcomes,” Christopher L. Schaich, PhD, assistant professor of hypertension at Wake Forest University School of Medicine, and colleagues wrote. “However, no studies have systematically examined detailed cognitive function relative to normative population ranges or assessed the impact of caloric restriction and exercise on cognitive function, brain structure and cerebral blood flow in HFpEF.”
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To address this knowledge void, Schaich and colleagues conducted an ancillary analysis of the randomized, single-site SECRET-II trial, which evaluated the addition of resistance training to a 20-week caloric restriction and aerobic exercise intervention in 46 older adults with obesity and HFpEF (mean age, 69; 85% women; 54% Black).
The initial trial results were neutral on additional resistance training; however, the researchers did observe improved strength and muscle quality.
Another component of the SECRET-II trial was the completion of baseline and post-intervention brain morphology and cerebral blood flow assessment as well as cognitive testing via Rey Auditory Verbal Learning Test and Uniform Data Set, version 3, which includes the Montreal Cognitive Assessment.
For the present study, Schaich and colleagues compared baseline cognitive domain z scores of the entire SECRET-II cohort with those of national normative age-, sex-, race- and education-specific populations.
After the 20-week intervention, the researchers observed significant improvement in global domain z scores for Montreal Cognitive Assessment (+0.56; 95% CI, 0.31-0.81), Rey Auditory Verbal Learning Test of immediate recall (+0.55 words; 95% CI, 0.05-1.04) and Rey Auditory Verbal Learning Test of delayed recall (+0.87 words; 95% CI, 0.16-1.59); however, there was limited improvement in language scores including those for category fluency (+0.15; 95% CI, 0-0.31; P = .05) and phonemic fluency (+0.19; 95% CI, –0.03 to 0.39; P = .08).
In addition, improvement in Rey Auditory Verbal Learning Test immediate recall was attenuated after adjustment for change in peak oxygen consumption during exercise, from +0.55 words recalled to +0.34 words recalled (95% CI, –0.34 to 1.02).
Moreover, the researchers reported no changes in brain volumes or cerebral blood flow after the intervention.
“This ancillary study to a randomized trial found that older adults with obese HFpEF had significant baseline cognitive deficits in global and language fluency domains that improved following caloric restriction and exercise interventions,” the researchers wrote. “More detailed neurocognitive phenotyping is warranted to understand the pathological mechanisms underlying these impairments and their apparent improvement with caloric restriction and exercise and to design novel interventions to optimize brain health in older patients with HFpEF.”
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