Study of Mental Activity and Regular Training (SMART) in at risk individuals: A randomised double blind, sham controlled, longitudinal trial

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

Effects of a long-term aerobic exercise intervention on institutionalized patients with dementia

“…Some have suggested the implementation of resistance training programs since they have a better potential for long-term adherence than aerobic exercise. 30 The high number of dropouts that we observed once the intervention started were mainly related to death, serious medical events and individuals moving to different areas of the country; the dropouts were not related to the exercise program itself. Other studies performed in elderly subjects with dementia also reported a significant proportion of dropouts due to complications, hospital admissions and deaths, all of which are common events occurring in these frail populations.…”

The Benefits of Cognitive Stimulation or Training/Rehabilitation upon Brain Function as an Efficacious Treatment for Diagnosed Dementia or Mild Cognitive Decline

“…Goal oriented rehabilitation was seen as a clinically effective intervention for early stages of Alzheimer disease, vascular or mixed dementia, and a multi-centre study is ongoing [12].Studies are investigating the dual effects of cognitive training and progressive resistance training to capture the combined impact of physical and cognitive variables [13]. A seven week program (Cognitive Stimulation Therapy) was shown to be beneficial; however, there was less conclusive evidence for the effects of this therapy over an extended period prompting another study with the addition of 16 weeks of maintenance.…”

Körperliche Aktivität und Hirnfunktion

“…Zur Zeit läuft die SMART Studie, die als randomisierte, doppelblinde, place bokontrollierte longitudinale Studie ver sucht, die Wirkung von kognitivem und körperlichem Training auf Menschen mit frühen Anzeichen einer Demenz zu be weisen [16].…”