Exercise training improves cognition in chronic stroke: A 6‐month randomized controlled trial

Abstract

AbstractBackgroundA stroke doubles one’s risk for dementia. Impairment in multiple domains of cognition are common following stroke. Thus, stroke survivors represent a target population in need of intervention strategies to promote cognitive function and prevent dementia. We assessed whether targeted exercise training or cognitive and social enrichment activities would promote cognitive function in community‐dwelling adults with chronic stroke (i.e., > 12 months since stroke event).MethodsA three‐arm parallel, single‐blinded, 6‐month randomized controlled trial with 120 adults with chronic stroke who were randomized (2:2:3) to: 1) targeted exercise training (EX; n=34)) modeled after the Fitness And Mobility Exercise (FAME) program (Eng, Top Geriatr Rehabil, 2010); 2) cognitive and social enrichment activities (Cog‐Plus; n=34); and 3) an active control group (CON; n=52). Each experimental arm was group‐based and 2x/week. The primary outcome was the ADAS‐Cog‐Plus, a global measure of cognitive performance using multidimensional item response theory to summarize scores from the 13‐item ADAS‐Cog and other standard cognitive assessments (i.e., Trail Making Test Parts A and B, Digit Span Forward and Backward, and Animal and Vegetable Fluency). Lower ADAS‐Cog‐Plus scores represent better cognitive performance; ADAS‐Cog‐Plus scores of approximately −1.0 indicate healthy cognitive performance, 0.0 indicate mild cognitive impairment, and 1.0 indicate dementia. The primary analysis using linear mixed model compared changes in ADAS‐Cog‐Plus performance from baseline to month 6, with baseline ADAS‐Cog‐Plus and Mini‐Mental State Examination scores as covariates. Two planned simple contrasts (i.e., EX vs. CON; Cog‐Plus vs. CON) were performed using the Dunnett test.ResultMean baseline Fugl‐Meyer score was 81.21 (SD=23.85; range: 6‐100) and mean baseline Montreal Cognitive Assessment score was 21.89 points out of 30. An overall attrition rate of 14% was observed (EX=6; Cog‐Plus=5; CON=6). Participants in the EX group had significantly better ADAS‐Cog Plus performance than CON at trial completion (estimated mean difference: ‐0.23; 95%CI:[‐0.43, ‐0.03]; p=.024). There was no significant difference in ADAS‐Cog Plus performance between the Cog‐Plus and CON group at trial completion (estimated mean difference: ‐0.10; 95% CI:[‐0.30, 0.10]; p=.314).ConclusionTargeted exercise training may be efficacious in improving cognition in adults with chronic stroke and should be promoted among individuals with chronic stroke.