Exercise combined with cognitive training improves brain health in older adults

Key takeaways:

• The effects of exercise plus cognitive training slightly dropped at 12 months but did not fall back to baseline scores.
• The addition of vitamin D supplementation had no significant effect.

Aerobic-resistance exercises combined with cognitive training improved cognition compared with exercise alone in older adults with mild cognitive impairment, a recent study found.

According to Manuel Montero-Odasso, MD, PhD, FRCPC, AGSF, FGSA, a professor at the University of Western Ontario, and colleagues, aerobic exercises, resistance exercises, computer-based cognitive training and vitamin D have all previously demonstrated potential benefits for cognition among older adults.

“Thus, providing these interventions together, as a multidomain treatment, has the potential to delay progression from [mild cognitive impairment (MCI)] to dementia,” they wrote in JAMA Network Open.

To determine the outcomes of these combined interventions, the researchers conducted the Synchronizing Exercises, Remedies in Gait and Cognition (SYNERGIC) trial, a double-masked, five-arm randomized trial that took place over 20 weeks.

During SYNERGIC, 175 Canadian adults aged 60 to 85 years who met MCI criteria were assigned to one of five arms:

• arm 1, which consisted of aerobic-resistance exercise, cognitive training and vitamin D;
• arm 2, which consisted of aerobic-resistance exercise, cognitive training and placebo;
• arm 3, which consisted of aerobic-resistance exercise, sham cognitive training and vitamin D;
• arm 4; which consisted of aerobic-resistance exercise, sham cognitive training and placebo; and
• arm 5, the control group which consisted of balance-toning exercise, sham cognitive training and placebo.

The participants (49.1% women; mean age, 73 years) completed the intervention sessions three times a week during the 20 weeks, spending 30 minutes on cognitive training and 60 minutes on aerobic-resistance exercise during each session.

The researchers assessed changes in cognitive function using the Alzheimer Disease Assessment Scale Cognitive 13 (ADAS-Cog-13) and the scale’s Plus variant (ADAS-Cog-Plus).

Overall, 82% of participants completed their assigned intervention and 76% completed the 12-month follow up.

Montero-Odasso and colleagues found that at 6 months, all arms with aerobic-resistance exercise — regardless of cognitive training or vitamin D — improved ADAS-Cog-13 when compared with the control group (mean difference [MD] = –1.79; 95% CI, –3.27 to –0.31).

Additionally, arms with exercise and cognitive training improved ADAS-Cog-13 when compared with arms that had exercise alone (MD = –1.45; 95% CI, –2.7 to –0.21), with specific improvements seen in episodic memory, orientation and attention.

The first arm with all three interventions significantly improved ADA-Cog-13 when compared with the control arm (MD = –2.64; 95% CI, –4.42 to –0.8). However, further analyses revealed that vitamin D did not significantly impact scores.

The improvements in ADA-Cog-13 were slightly reduced at 12 months; however, they did not decrease back to baseline scores, “suggesting a lasting effect even without participants engaging in exercise regimes during the follow-up period,” the researchers wrote.

Montero and colleagues added the 2.64-point improvement from exposure to arm 1 “is larger than changes seen in previous pharmaceutical trials among individuals with MCI or mild dementia, and approaches the 3 points considered clinically meaningful.”

The study was limited by the COVID-19 pandemic, which prevented the researchers from achieving their desired sample size. Further, most of the participants were already sufficient in vitamin D at baseline, which may have reduced any potential effects of its implementation.

Montero and colleagues concluded that the intervention may ultimately have meaningful change in cognitive function for older adults, “which may have important implications for their quality of life.”