Display options
Share it on

Sports Med. 2021 Dec 08; doi: 10.1007/s40279-021-01608-5. Epub 2021 Dec 08.

Effects of 5 Years Aerobic Exercise on Cognition in Older Adults: The Generation 100 Study: A Randomized Controlled Trial.

Sports medicine (Auckland, N.Z.)

Ekaterina Zotcheva, Asta Kristine Håberg, Ulrik Wisløff, Øyvind Salvesen, Geir Selbæk, Dorthe Stensvold, Linda Ernstsen

Affiliations

  1. Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Post Box 8905, 7491, Trondheim, Norway.
  2. Norwegian National Advisory Unit for Functional MRI, Department of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway.
  3. Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
  4. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
  5. School of Human Movement and Nutrition Science, University of Queensland, Brisbane, QLD, Australia.
  6. Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
  7. Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
  8. Faculty of Medicine, University of Oslo, Oslo, Norway.
  9. Department of Cardiology, St. Olav's University Hospital, Trondheim, Norway.
  10. Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Post Box 8905, 7491, Trondheim, Norway. [email protected].

PMID: 34878637 DOI: 10.1007/s40279-021-01608-5

Abstract

OBJECTIVE: The objective of this study was to investigate whether a 5-year exercise intervention and change in peak oxygen uptake ([Formula: see text]) is associated with cognitive function in older adults.

METHODS: Nine hundred and forty-five participants (48% women, mean age at study end 78.2 ± 2.02 years) from the Generation 100 Study were randomized 2:1:1 to a control group, moderate-intensity continuous training or high-intensity interval training twice weekly for 5 years. Peak oxygen uptake was measured using ergospirometry at baseline and after 5 years. Global cognition and mild cognitive impairment (MCI) were assessed with the Montreal Cognitive Assessment scale (MoCA) after 5 years.

RESULTS: Compared to the control group, the combined moderate-intensity continuous training plus high-intensity interval training (ExComb) group did not have significantly different cognitive scores (beta value 0.26, 95% confidence interval [CI] - 0.17, 0.69) or odds of MCI (odds ratio 0.86, 95% CI 0.66, 1.13). Men in the ExComb group had 0.80 points higher MoCA (95% CI 0.21, 1.40) and 32% lower odds of MCI compared with male controls (95% CI 0.47, 0.99), with no such findings in women. In the total sample, each 1 metabolic equivalent of task increase in [Formula: see text] corresponded to 0.46 points higher MoCA (95% CI 0.25, 0.67) and 27% lower odds of MCI (95% CI 0.63, 0.85). Compared to [Formula: see text] stable, participants whose [Formula: see text] increased did not have significantly different cognitive scores (beta value 0.24, CI - 0.68, 1.15) or odds of MCI (odds ratio 0.70, 95% CI 0.36, 1.34), whereas participants whose [Formula: see text] decreased had 0.64 points lower MoCA (95% CI - 1.15, - 0.14) and 35% higher odds of MCI (95% CI 0.98, 1.87).

CONCLUSIONS: Overall, exercise was not significantly associated with cognition among older adults. However, maintaining or increasing [Formula: see text] appeared to benefit cognition.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01666340.

© 2021. The Author(s).

References

  1. Prince M, Wimo A, Guerchet M, Ali G-C, Wu Y-T, Prina M. World Alzheimer Report 2015. The global impact of dementia An analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International; 2015. - PubMed
  2. Gjøra L, Strand BH, Bergh S, Borza T, Braekhus A, Engedal K, et al. Current and future prevalence estimates of mild cognitive impairment, dementia, and its subtypes in a population-based sample of people 70 years and older in Norway: the HUNT Study. J Alzheimers Dis. 2021;79(3):1213–26. https://doi.org/10.3233/JAD-201275 . - PubMed
  3. Engeroff T, Ingmann T, Banzer W. Physical activity throughout the adult life span and domain-specific cognitive function in old age: a systematic review of cross-sectional and longitudinal data. Sports Med. 2018;48(6):1405–36. https://doi.org/10.1007/s40279-018-0920-6 . - PubMed
  4. Guure CB, Ibrahim NA, Adam MB, Said SM. Impact of physical activity on cognitive decline, dementia, and its subtypes: meta-analysis of prospective studies. Biomed Res Int. 2017;2017:9016924. https://doi.org/10.1155/2017/9016924 . - PubMed
  5. Blondell SJ, Hammersley-Mather R, Veerman JL. Does physical activity prevent cognitive decline and dementia? A systematic review and meta-analysis of longitudinal studies. BMC Public Health. 2014;14:510. https://doi.org/10.1186/1471-2458-14-510 . - PubMed
  6. Barha CK, Davis JC, Falck RS, Nagamatsu LS, Liu-Ambrose T. Sex differences in exercise efficacy to improve cognition: a systematic review and meta-analysis of randomized controlled trials in older humans. Front Neuroendocrinol. 2017;46:71–85. https://doi.org/10.1016/j.yfrne.2017.04.002 . - PubMed
  7. Northey JM, Cherbuin N, Pumpa KL, Smee DJ, Rattray B. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. Br J Sports Med. 2018;52(3):154–60. https://doi.org/10.1136/bjsports-2016-096587 . - PubMed
  8. Young J, Angevaren M, Rusted J, Tabet N. Aerobic exercise to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.CD005381.pub4 . - PubMed
  9. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125–30. https://doi.org/10.1111/1467-9280.t01-1-01430 . - PubMed
  10. Barha CK, Liu-Ambrose T. Exercise and the aging brain: considerations for sex differences. Brain Plast. 2018;4(1):53–63. https://doi.org/10.3233/BPL-180067 . - PubMed
  11. Loprinzi PD, Frith E. The role of sex in memory function: considerations and recommendations in the context of exercise. J Clin Med. 2018;7(6):132. https://doi.org/10.3390/jcm7060132 . - PubMed
  12. Ross R, Blair SN, Arena R, Church TS, Despres JP, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016;134(24):e653–99. https://doi.org/10.1161/CIR.0000000000000461 . - PubMed
  13. Farrell SW, Abramowitz AR, Willis BL, Barlow CE, Weiner M, Falkowski J, et al. The relationship between cardiorespiratory fitness and Montreal Cognitive Assessment Scores in older adults. Gerontology. 2018;64(5):440–5. https://doi.org/10.1159/000489336 . - PubMed
  14. Edwards MK, Loprinzi PD. Combined associations of sedentary behavior and cardiorespiratory fitness on cognitive function among older adults. Int J Cardiol. 2017;229:71–4. https://doi.org/10.1016/j.ijcard.2016.11.264 . - PubMed
  15. Kramer AF, Hahn S, Cohen NJ, Banich MT, McAuley E, Harrison CR, et al. Ageing, fitness and neurocognitive function. Nature. 1999;400(6743):418–9. https://doi.org/10.1038/22682 . - PubMed
  16. Vidoni ED, Johnson DK, Morris JK, Van Sciver A, Greer CS, Billinger SA, et al. Dose-response of aerobic exercise on cognition: a community-based, pilot randomized controlled trial. PLoS ONE. 2015;10(7): e0131647. https://doi.org/10.1371/journal.pone.0131647 . - PubMed
  17. Billinger SA, Vidoni ED, Morris JK, Thyfault JP, Burns JM. Exercise test performance reveals evidence of the cardiorespiratory fitness hypothesis. J Aging Phys Act. 2017;25(2):240–6. https://doi.org/10.1123/japa.2015-0321 . - PubMed
  18. Erickson KI, Leckie RL, Weinstein AM. Physical activity, fitness, and gray matter volume. Neurobiol Aging. 2014;35(Suppl. 2):S20–8. https://doi.org/10.1016/j.neurobiolaging.2014.03.034 . - PubMed
  19. Zotcheva E, Pintzka CWS, Salvesen O, Selbaek G, Haberg AK, Ernstsen L. Associations of changes in cardiorespiratory fitness and symptoms of anxiety and depression with brain volumes: the HUNT Study. Front Behav Neurosci. 2019;13(53):53. https://doi.org/10.3389/fnbeh.2019.00053 . - PubMed
  20. Dougherty RJ, Boots EA, Lindheimer JB, Stegner AJ, Van Riper S, Edwards DF, et al. Fitness, independent of physical activity is associated with cerebral blood flow in adults at risk for Alzheimer’s disease. Brain Imaging Behav. 2020;14(4):1154–63. https://doi.org/10.1007/s11682-019-00068-w . - PubMed
  21. Johnson NF, Gold BT, Bailey AL, Clasey JL, Hakun JG, White M, et al. Cardiorespiratory fitness modifies the relationship between myocardial function and cerebral blood flow in older adults. Neuroimage. 2016;131:126–32. https://doi.org/10.1016/j.neuroimage.2015.05.063 . - PubMed
  22. Stensvold D, Viken H, Rognmo O, Skogvoll E, Steinshamn S, Vatten LJ, et al. A randomised controlled study of the long-term effects of exercise training on mortality in elderly people: study protocol for the Generation 100 study. BMJ Open. 2015;5(2): e007519. https://doi.org/10.1136/bmjopen-2014-007519 . - PubMed
  23. Helsedirektoratet. Fysisk aktivitet; Aktivitetshåndboken. 2011. Available from: https://helsedirektoratet.no/folkehelse/fysisk-aktivitet/anbefalinger/Sider/default.aspx . Accessed 29 Nov 2021. - PubMed
  24. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81. - PubMed
  25. Van Walsem MR, Tyvoll H. The Montreal Cognitive Assessment (MoCA) Norwegian version. 2010. http://www.mocetest.org . Accessed 20 Nov 2020. - PubMed
  26. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9. https://doi.org/10.1111/j.1532-5415.2005.53221.x . - PubMed
  27. Pugh EA, Kemp EC, van Dyck CH, Mecca AP, Sharp ES, Alzheimer’s Disease Neuroimaging Initiative. Effects of normative adjustments to the Montreal Cognitive Assessment. Am J Geriatr Psychiatry. 2018;26(12):1258–67. https://doi.org/10.1016/j.jagp.2018.09.009 . - PubMed
  28. Rossetti HC, Lacritz LH, Cullum CM, Weiner MF. Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample. Neurology. 2011;77(13):1272–5. https://doi.org/10.1212/WNL.0b013e318230208a . - PubMed
  29. Davis DH, Creavin ST, Yip JL, Noel-Storr AH, Brayne C, Cullum S. Montreal Cognitive Assessment for the diagnosis of Alzheimer’s disease and other dementias. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.CD010775.pub2 . - PubMed
  30. Waldron-Perrine B, Axelrod BN. Determining an appropriate cutting score for indication of impairment on the Montreal Cognitive Assessment. Int J Geriatr Psychiatry. 2012;27(11):1189–94. https://doi.org/10.1002/gps.3768 . - PubMed
  31. Borland E, Nagga K, Nilsson PM, Minthon L, Nilsson ED, Palmqvist S. The Montreal cognitive assessment: normative data from a large Swedish population-based cohort. J Alzheimers Dis. 2017;59(3):893–901. https://doi.org/10.3233/JAD-170203 . - PubMed
  32. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. - PubMed
  33. Stensvold D, Bucher Sandbakk S, Viken H, Zisko N, Reitlo LS, Nauman J, et al. Cardiorespiratory reference data in older adults: the Generation 100 Study. Med Sci Sports Exerc. 2017;49(11):2206–15. https://doi.org/10.1249/MSS.0000000000001343 . - PubMed
  34. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x . - PubMed
  35. Andersson T, Alfredsson L, Kallberg H, Zdravkovic S, Ahlbom A. Calculating measures of biological interaction. Eur J Epidemiol. 2005;20(7):575–9. https://doi.org/10.1007/s10654-005-7835-x . - PubMed
  36. Sink KM, Espeland MA, Castro CM, Church T, Cohen R, Dodson JA, et al. Effect of a 24-month physical activity intervention vs health education on cognitive outcomes in sedentary older adults: the LIFE randomized trial. JAMA. 2015;314(8):781–90. https://doi.org/10.1001/jama.2015.9617 . - PubMed
  37. Iso-Markku P, Waller K, Vuoksimaa E, Heikkila K, Rinne J, Kaprio J, et al. Midlife physical activity and cognition later in life: a prospective twin study. J Alzheimers Dis. 2016;54(4):1303–17. https://doi.org/10.3233/JAD-160377 . - PubMed
  38. Etgen T, Sander D, Huntgeburth U, Poppert H, Forstl H, Bickel H. Physical activity and incident cognitive impairment in elderly persons: the INVADE study. Arch Intern Med. 2010;170(2):186–93. https://doi.org/10.1001/archinternmed.2009.498 . - PubMed
  39. Rose G. Sick individuals and sick populations. Int J Epidemiol. 2001;30(3):427–32. https://doi.org/10.1093/ije/30.3.427 . - PubMed
  40. Stensvold D, Viken H, Steinshamn SL, Dalen H, Stoylen A, Loennechen JP, et al. Effect of exercise training for five years on all cause mortality in older adults: the Generation 100 study: randomised controlled trial. BMJ. 2020;371: m3485. https://doi.org/10.1136/bmj.m3485 . - PubMed
  41. Mitchell AJ, Shiri-Feshki M. Rate of progression of mild cognitive impairment to dementia: meta-analysis of 41 robust inception cohort studies. Acta Psychiatr Scand. 2009;119(4):252–65. https://doi.org/10.1111/j.1600-0447.2008.01326.x . - PubMed
  42. Wu CY, Hung SJ, Lin KC, Chen KH, Chen P, Tsay PK. Responsiveness, minimal clinically important difference, and validity of the MoCA in stroke rehabilitation. Occup Ther Int. 2019. https://doi.org/10.1155/2019/2517658 . - PubMed
  43. Baker LD, Frank LL, Foster-Schubert K, Green PS, Wilkinson CW, McTiernan A, et al. Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Arch Neurol. 2010;67(1):71–9. https://doi.org/10.1001/archneurol.2009.307 . - PubMed
  44. Petersen RC, Roberts RO, Knopman DS, Geda YE, Cha RH, Pankratz VS, et al. Prevalence of mild cognitive impairment is higher in men: the Mayo Clinic Study of Aging. Neurology. 2010;75(10):889–97. https://doi.org/10.1212/WNL.0b013e3181f11d85 . - PubMed
  45. Roberts RO, Geda YE, Knopman DS, Cha RH, Pankratz VS, Boeve BF, et al. The incidence of MCI differs by subtype and is higher in men: the Mayo Clinic Study of Aging. Neurology. 2012;78(5):342–51. https://doi.org/10.1212/WNL.0b013e3182452862 . - PubMed
  46. Bloomberg M, Dugravot A, Dumurgier J, Kivimaki M, Fayosse A, Steptoe A, et al. Sex differences and the role of education in cognitive ageing: analysis of two UK-based prospective cohort studies. Lancet Public Health. 2021;6(2):e106–15. https://doi.org/10.1016/S2468-2667(20)30258-9 . - PubMed
  47. McCarrey AC, An Y, Kitner-Triolo MH, Ferrucci L, Resnick SM. Sex differences in cognitive trajectories in clinically normal older adults. Psychol Aging. 2016;31(2):166–75. https://doi.org/10.1037/pag0000070 . - PubMed
  48. Catalogue of Bias Collaboration, Brassey J, Mahtan K, Spencer E, Heneghan C. Volunteer bias. 2017. http://www.catalogofbias.org/biases/volunteer-bias . Accessed 18 Nov 2020. - PubMed
  49. Kowalski K, Rhodes R, Naylor PJ, Tuokko H, MacDonald S. Direct and indirect measurement of physical activity in older adults: a systematic review of the literature. Int J Behav Nutr Phys Act. 2012;9:148. https://doi.org/10.1186/1479-5868-9-148 . - PubMed

Publication Types