Reshaping the path of vascular cognitive impairment with resistance training: a study protocol for a randomized controlled trial

Abstract

Background Subcortical 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. Methods Eighty-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. Discussion The 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 registration ClinicalTrials.gov NCT02669394. Registered on February 1, 2016

Effects of a 12-Week Periodized Resistance Training Program on Resting Brain Activity and Cerebrovascular Function: A Nonrandomized Pilot Trial

“…Larger studies are needed to confirm these findings and re-test associations with fluid cognition. 69 A major benefit of conducting these small proof-of-concept clinical trials is generating these preliminary signals of efficacy that can redirect investigators toward the most important research questions and the most promising study designs.…”

Functional Neural Networks of Physical Reserve Moderate the Association between White Matter Hyperintensity and Postural Balance in Older Adults with Subcortical Ischemic Vascular Cognitive Impairment

“…Details of the study can be found from the published study protocol (ClinicalTrials.gov; NCT02669394). 27 All 93 participants underwent baseline magnetic resonance imaging (MRI) scanning, however, baseline resting-state functional magnetic resonance imaging (fMRI) were acquired from only a subset (n = 38, Fig. 2).…”

Prevention of Vascular Contributions to Cognitive Impairment and Dementia: The Role of Physical Activity and Exercise

“…18 These results are supported by the Study of Mental Activity and Resistance Training, which reported a modest regression of WMHs in periventricular and parietal regions after 6 months of RT, while the non-RT groups exhibited WMH progression; however, these results did not survive whole-brain correction. 19 Forthcoming data from the Reshaping the Path of Vascular Cognitive Impairment study 20 -a 12-month RCT of progressive RT-will further elucidate the effect of RT on WMH progression and the mechanisms by which RT may be neuroprotective. Physiological adaptations associated with RT are particularly beneficial for cerebral white matter, and results from early studies demonstrate that RT may be a promising strategy to prevent or slow WMH progression.…”

“…56 Regarding the effect of RT on cognitive function in people with CSVD, the Study of Mental and Resistance Training found that RT improved performance on the Alzheimer's Disease Assessment Scale-Cognitive Subscale, but not on memory. Forthcoming data from the Reshaping the Path of Vascular Cognitive Impairment study 20 will further elucidate the effect of RT on cognitive function in people with CSVD. Additionally, future studies should consider progressive exercise interventions that include strength, aerobic, agility, and balance training exercises, such as the FAME (Fitness and Mobility Exercise) Progam.…”