Effect of an exercise intervention on global cognition after transient ischemic attack or minor stroke: the MoveIT randomized controlled trial

Abstract

Background Patients with a transient ischemic attack (TIA) or ischemic stroke are at increased risk of developing cognitive impairment in the subacute phase. At present, the effects of exercise on cognitive functioning following a TIA or stroke are not fully known. The purpose of this trial was to investigate the effect of exercise on global cognition. Methods The MoveIT trial is a single-centre, observer-blinded, randomized controlled trial involving a 1-year exercise intervention consisting of a 12-week group exercise program, combined with three counselling visits to the physiotherapists over a 9-month period. The control group received standard care. The primary outcome was global cognitive functioning, assessed at one year, using the Montreal Cognitive Assessment (MoCA). Secondary outcomes included cardiorespiratory fitness, the cardiovascular profile, and attainment of secondary prevention targets, anxiety, depression and fatigue at one and two years. Results The experimental group consisted of 60 patients, while the control group consisted of 59 patients. The mean age was 64.3 years and 41% were female. No between-group differences were found on global cognitive functioning (MD, 0.7 out of 30, 95% CI, − 0.2 to 1.6) or on secondary outcome measures at 12 months. The only significant between-group difference was found for fatigue, in favour of the experimental group at 12 months (MD, 0.6 out of 63, 95% CI, 0.1 to 1.1). Conclusions No benefit of this exercise intervention was found regarding global cognition. Future studies need to focus on optimizing rehabilitation strategies for this vulnerable group of patients. Trial registration http://www.trialregister.nl. Unique identifier: NL3721. Date first registration: 06-03-2013.

Is Cardiorespiratory Fitness Independently Associated with Fatigue in Patients with Transient Ischemic Attack or Minor Stroke?

“…Patients in the intervention group received more guidance toward achieving an active lifestyle, and more exercise training to achieve a better CRF, than patients in the control group, which may have affected the association between PSF and CRF. However, this neutral trial found no significant difference between the intervention and control groups on the primary outcome of global cognition, as assessed by the Montreal Cognitive Assessment (MoCA), or on CRF [ 19 ]. Because this trial did found a significant between-group difference in fatigue (in favor of the experimental group at 12 months), we included treatment allocation in the analysis.…”

“…Treatment allocation turned out not to be a confounder in the association between PSF and CRF. The present study was part of a neutral trial [ 19 ]. Patients allocated to the experimental intervention received CRF, whereas the control group received motivational interview-based counselling that focused on the attainment of secondary prevention and the improvement of both lifestyle factors and physical activity.…”

“…The current cross-sectional association study used data from the “MoveIT” trial, a single-center, observer-blinded, randomized controlled trial that examines the effects of a one-year exercise intervention on cognition in patients post-TIA or minor ischemic stroke [ 19 ]. The participants in this study were 119 patients who had suffered a TIA or a minor stroke.…”

“…The only significant between-group difference was found for fatigue, which was less in the experimental group than in the control group at 12 months. The neutral outcome of our trial suggests that an exercise intervention comprising a 12-week group exercise program and a nine-month follow-up, both under the guidance of specialized physiotherapists, has no favorable effect on global cognitive functioning [ 19 ].…”

“…CRF is also decreased in patients with TIA or minor stroke. Their levels of physical activity often do not meet physical activity recommendations and are low compared to those of healthy peers [ 19 , 20 , 21 ]. However, the association between PSF and CRF in patients with TIA and minor stroke has been poorly investigated.…”