#VisualAbstract: Aerobic-resistance exercise is an effective adjunct for improving cognition in mild cognitive impairment

1. Patients with mild cognitive impairment (MCI) randomized to a combined intervention of aerobic-resistance exercise and computerized cognitive training, had significantly improved cognitive scores compared to control.

2. There was no significant difference in cognitive improvement when comparing interventions with and without Vitamin D supplementation.

Evidence Rating Level: 1 (Excellent)

For individuals with mild cognitive impairment (MCI), interventions that have improved cognition include Vitamin D supplementation, aerobic exercise, resistance training, and computer-based cognitive training. However, the effectiveness of multidomain interventions have not been well-studied. Therefore, this double-masked, randomized controlled trial based in Canada aimed to examine the cognitive improvements in MCI patients from an aerobic-resistance exercise regimen, with and without cognitive training and vitamin D supplementation. Known as the SYNERGIC Trial (Synchronizing Exercises, Remedies in Gait and Cognition), this study enrolled MCI patients between 60 and 85 years old, randomized equally across 5 arms: Arm 1 (exercise, cognitive training, and vitamin D), Arm 2 (exercise, cognitive training, and placebo Vitamin D), Arm 3 (exercise, sham cognitive training, and vitamin D), Arm 4 (exercise, sham cognitive training, and placebo vitamin D), and Arm 5 (balance and toning exercise, sham cognitive training, and placebo vitamin D). The primary outcome of cognitive improvement was assessed through the ADAS-Cog-13, at baseline, 6 months, and 12 months. In total, there were 175 patients included, with a mean (SD) baseline ADAS-Cog-13 of 15.2 (6.8). The study showed that, compared to the control (Arm 5), the aerobic-resistance exercise regimen (Arms 1 and 2) combined with cognitive training significantly improved cognitive scores (mean change -2.64 points, 95% CI -4.42 to -0.87, p = 0.005 for Arm 1; mean change -2.39 points, 95% CI -4.20 to -0.57, p = 0.01 for Arm 2). No significant improvements in cognitive scores occurred in the Arms with sham cognitive training (Arms 3 and 4) compared to control. Overall, this study demonstrated that a multidomain intervention with aerobic-resistance exercise and computerized cognitive training improved cognitive scores significantly, and that Vitamin D had no noticeable effect.

Click to read the study in JAMA Network Open

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