Abstract
BackgroundSubcortical ischemic vascular cognitive impairment (SIVCI) is the most common form of vascular cognitive impairment. Importantly, SIVCI is considered the most treatable form of cognitive impairment in older adults, due to its modifiable risk factors such as hypertension, diabetes mellitus, and hypercholesterolemia. Exercise training is a promising intervention to delay the progression of SIVCI, as it actively targets these cardiometabolic risk factors. Despite the demonstrated benefits of resistance training on cognitive function and emerging evidence suggesting resistance training may reduce the progression of white matter hyperintensities (WMHs), research on SIVCI has predominantly focused on the use of aerobic exercise. Thus, the primary aim of this proof-of-concept randomized controlled trial is to investigate the efficacy of a 12-month, twice-weekly progressive resistance training program on cognitive function and WMH progression in adults with SIVCI. We will also assess the efficiency of the intervention.MethodsEighty-eight community-dwelling adults, aged > 55 years, with SIVCI from metropolitan Vancouver will be recruited to participate in this study. SIVCI will be determined by the presence of cognitive impairment (Montreal Cognitive Assessment < 26) and cerebral small vessel disease using computed tomography or magnetic resonance imaging. Participants will be randomly allocated to a twice-weekly exercise program of (1) progressive resistance training or (2) balance and tone training (i.e., active control). The primary outcomes are cognitive function measured by the Alzheimer’s Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-13 with additional cognitive tests) and WMH progression.DiscussionThe burden of SIVCI is immense, and to our knowledge, this will be the first study to quantify the effect of progressive resistance training on cognitive function and WMH progression among adults with SIVCI. Slowing the rate of cognitive decline and WMH progression could preserve functional independence and quality of life. This could lead to reduced health care costs and avoidance of early institutional care.Trial registrationClinicalTrials.gov NCT02669394. Registered on February 1, 2016
Highlights
Worldwide, one new case of dementia is detected every 4 s [1]
The burden of Subcortical ischemic vascular cognitive impairment (SIVCI) is immense, and to our knowledge, this will be the first study to quantify the effect of progressive resistance training on cognitive function and white matter hyperintensities (WMHs) progression among adults with SIVCI
We demonstrated twice-weekly progressive resistance training (PRT) slowed WMH progression in older women; the effect size observed was 0.60 (Cohen’s d)
Summary
Design We will conduct a 12-month, parallel group, proof-ofconcept RCT of 88 community-dwelling adults with SIVCI, aged 55 years and older. Our prior 6-month RCT of aerobic exercise on cognitive function, as measured by the ADAS-Cog-11, in adults with SIVCI observed an effect size of 0.89 (Cohen’s d) in the complete-case analysis [51]. The ADAS-Cog-Plus includes the original 13-item assessment of memory, language, and praxis [53] with additional measures of executive functions and verbal fluency. No additional loading will be applied to any of the exercises This training has not been shown to improve cognitive function [82] and will serve as a control for confounding variables such as physical training received by traveling to the training centers, social interaction, and changes in lifestyle secondary to study participation.
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