Abstract
BackgroundThe extent to which mental and physical exercise may slow cognitive decline in adults with early signs of cognitive impairment is unknown. This article provides the rationale and methodology of the first trial to investigate the isolated and combined effects of cognitive training (CT) and progressive resistance training (PRT) on general cognitive function and functional independence in older adults with early cognitive impairment: Study of Mental and Regular Training (SMART). Our secondary aim is to quantify the differential adaptations to these interventions in terms of brain morphology and function, cardiovascular and metabolic function, exercise capacity, psychological state and body composition, to identify the potential mechanisms of benefit and broader health status effects.MethodsSMART is a double-blind randomized, double sham-controlled trial. One hundred and thirty-two community-dwelling volunteers will be recruited. Primary inclusion criteria are: at risk for cognitive decline as defined by neuropsychology assessment, low physical activity levels, stable disease, and age over 55 years. The two active interventions are computerized CT and whole body, high intensity PRT. The two sham interventions are educational videos and seated calisthenics. Participants are randomized into 1 of 4 supervised training groups (2 d/wk × 6 mo) in a fully factorial design. Primary outcomes measured at baseline, 6, and 18 months are the Alzheimer's Disease Assessment Scale (ADAS-Cog), neuropsychological test scores, and Bayer Informant Instrumental Activities of Daily Living (B-IADLs). Secondary outcomes are psychological well-being, quality of life, cardiovascular and musculoskeletal function, body composition, insulin resistance, systemic inflammation and anabolic/neurotrophic hormones, and brain morphology and function via Magnetic Resonance Imaging (MRI) and Spectroscopy (fMRS).DiscussionSMART will provide a novel evaluation of the immediate and long term benefits of CT, PRT, and combined CT and PRT on global cognitive function and brain morphology, as well as potential underlying mechanisms of adaptation in older adults at risk of further cognitive decline.Trial RegistrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ANZCTRN12608000489392
Highlights
The extent to which mental and physical exercise may slow cognitive decline in adults with early signs of cognitive impairment is unknown
All active training interventions will improve brain morphology and biochemistry compared to the sham control condition, as defined by: increased hippocampal volume by Magnetic Resonance Imaging (MRI) scanning; positive localised Voxel-Based Morphometry (VBM) brain changes; decreased whole brain volume of White Matter Hyper-intensities (WMHs); and lead to beneficial hippocampal and posterior cingulate magnetic resonance spectrometry (MRS) metabolite changes (% increase in N-acetylaspartate, and increase in phosphocreatine metabolites)
We originally estimated the need for a sample size 10% larger than our expected effect size required (n = 132)
Summary
The extent to which mental and physical exercise may slow cognitive decline in adults with early signs of cognitive impairment is unknown. This article provides the rationale and methodology of the first trial to investigate the isolated and combined effects of cognitive training (CT) and progressive resistance training (PRT) on general cognitive function and functional independence in older adults with early cognitive impairment: Study of Mental and Regular Training (SMART). Two studies to directly compare single and combined physical and mental exercise found effect sizes across a range of cognitive outcomes to be much larger in the combined condition [12,16]. Both of these studies had design flaws, including very small sample sizes [16] and high dropout rates [12], limiting conclusions. A robustly designed trial is required to investigate the comparative benefits of isolated and combined physical and mental training
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