The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial

Abstract

Prior research has found that cognitive benefits of physical exercise and brain health in older adults may be enhanced when mental exercise is interactive simultaneously, as in exergaming. It is unclear whether the cognitive benefit can be maximized by increasing the degree of mental challenge during exercise. This randomized clinical trial (RCT), the Aerobic and Cognitive Exercise Study (ACES) sought to replicate and extend prior findings of added cognitive benefit from exergaming to those with or at risk for mild cognitive impairment (MCI). ACES compares the effects of 6 months of an exer-tour (virtual reality bike rides) with the effects of a more effortful exer-score (pedaling through a videogame to score points). Fourteen community-dwelling older adults meeting screening criteria for MCI (sMCI) were adherent to their assigned exercise for 6 months. The primary outcome was executive function, while secondary outcomes included memory and everyday cognitive function. Exer-tour and exer-score yielded significant moderate effects on executive function (Stroop A/C; d's = 0.51 and 0.47); there was no significant interaction effect. However, after 3 months the exer-tour revealed a significant and moderate effect, while exer-score showed little impact, as did a game-only condition. Both exer-tour and exer-score conditions also resulted in significant improvements in verbal memory. Effects appear to generalize to self-reported everyday cognitive function. Pilot data, including salivary biomarkers and structural MRI, were gathered at baseline and 6 months; exercise dose was associated with increased BDNF as well as increased gray matter volume in the PFC and ACC. Improvement in memory was associated with an increase in the DLPFC. Improved executive function was associated with increased expression of exosomal miRNA-9. Interactive physical and cognitive exercise (both high and low mental challenge) yielded similarly significant cognitive benefit for adherent sMCI exercisers over 6 months. A larger RCT is needed to confirm these findings. Further innovation and clinical trial data are needed to develop accessible, yet engaging and effective interventions to combat cognitive decline for the growing MCI population.ClinicalTrials.gov ID: NCT02237560

Effects of an In-home Multicomponent Exergame Training on Physical Functions, Cognition, and Brain Volume of Older Adults: A Randomized Controlled Trial

“…Ji and colleagues showed an increase in brain volume in fontal areas after Nintendo Wii training (57). Anderson-Hanley and colleagues reported similar findings after training with a specifically developed exergame (stationary bicycles with an interactive virtual component) (58). They also showed increased BDNF levels after exergame training.…”

“…Moreover, changes in brain structure have been reported after cognitive training (29)(30)(31)(32)(33)137). To the best of our knowledge, only two studies have been conducted assessing the effects of exergame training on brain structure of older adults (57,58). Ji and colleagues showed an increase in brain volume in fontal areas after Nintendo Wii training (57).…”

“…First, most of the studies showing improvements in brain structure included longer intervention periods (6-12 months) (13,15,58,111,121,133,134). Hippocampal volume seems to be sensitive to the intervention duration: In a sample of older adults, an almost linear development in hippocampal volume enhancement was demonstrated after 6 and 12 months of aerobic training (13).…”

“…Compared to traditional cognitive or physical training (e.g., aerobic training), exergaming seems to be equally or slightly more effective for cognitive enhancement in older adults (52,53). On brain level, two studies assessed changes in brain structure after exergame training in older adults (57,58). To our knowledge, however, no past research has investigated the effect of home-based exergame training, tailored to older adults' needs, on physical and cognitive functions and on brain structure of the elderly.…”

Functional and/or structural brain changes in response to resistance exercises and resistance training lead to cognitive improvements – a systematic review

“…To date, none of these hypotheses satisfactorily explain the observed age-related changes in brain function [41], but all of these hypotheses emphasize the important role of the PFC in age-related functional brain changes. It is well recognized in the literature that physical exercises [28-30, 42, 43] and physical training [44][45][46][47] lead to positive changes in cognitive performance (e.g., executive functions) and brain activation patterns. Furthermore, the changes in brain activation patterns (i.e., shown by higher levels of oxygenated hemoglobin in brain regions) are associated with cognitive performance improvements [28][29][30]47], which illustrate the important role of physical interventions in preserving cognition and brain health.…”