Abstract
IntroductionMild cognitive impairment is considered a precursor to dementia and significantly impacts upon quality of life. The prevalence of mild cognitive impairment is higher in the post-surgical cardiac population than in the general population, with older age and comorbidities further increasing the risk of cognitive decline. Exercise improves neurogenesis, synaptic plasticity and inflammatory and neurotrophic factor pathways, which may help to augment the effects of cognitive decline. However, the effects of resistance training on cognitive, functional and overall patient-reported recovery have not been investigated in the surgical cardiac population. This study aims to determine the effect of early moderate-intensity resistance training, compared to standard care, on cognitive recovery following cardiac surgery via a median sternotomy. The safety, feasibility and effect on functional recovery will also be examined.MethodsThis study will be a prospective, pragmatic, pilot randomised controlled trial comparing a standard care group (low-intensity aerobic exercise) and a moderate-intensity resistance training group. Participants aged 18 years and older with coronary artery and/or valve disease requiring surgical intervention will be recruited pre-operatively and randomised 1:1 to either the resistance training or standard care group post-operatively. The primary outcome, cognitive function, will be assessed using the Alzheimer’s Disease Assessment Scale and cognitive subscale. Secondary measures include safety, feasibility, muscular strength, physical function, multiple-domain quality of recovery, dynamic balance and patient satisfaction. Assessments will be conducted at baseline (pre-operatively) and post-operatively at 2 weeks, 8 weeks, 14 weeks and 6 months.DiscussionThe results of this pilot study will be used to determine the feasibility of a future large-scale randomised controlled trial that promotes the integration of early resistance training into existing aerobic-based cardiac rehabilitation programs in Australia.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001430325p. Registered on 9 October 2017. Universal Trial Number (UTN): U1111-1203-2131.
Highlights
Mild cognitive impairment is considered a precursor to dementia and significantly impacts upon quality of life
Et al Trials (2020) 21:649 (Continued from previous page). The results of this pilot study will be used to determine the feasibility of a future large-scale randomised controlled trial that promotes the integration of early resistance training into existing aerobic-based cardiac rehabilitation programs in Australia
This study aims to examine the effect of moderateintensity resistance training compared to a control group who receive standard cardiac rehabilitation involving low-intensity aerobic training within the community setting on post-operative cognitive recovery following cardiac surgery via median sternotomy
Summary
Mild cognitive impairment is considered a precursor to dementia and significantly impacts upon quality of life. The effects of resistance training on cognitive, functional and overall patient-reported recovery have not been investigated in the surgical cardiac population. Background and rationale Following cardiac surgery, mild cognitive impairment (MCI) affects 15–40% of patients, with the elderly affected at a greater rate [1,2,3]. This has the potential to become a significant health problem, as mild cognitive impairment is considered a precursor to dementia [4, 5]. Despite the high prevalence of cognitive impairment, cognitive recovery is not assessed or considered in current cardiac rehabilitation programs, and the focus of programs to date has been on screening for depression, physical outcomes and at times functional outcomes [10]
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