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Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial

IMPORTANCE: Exercise, cognitive training, and vitamin D may enhance cognition in older adults with mild cognitive impairment (MCI). OBJECTIVE: To determine whether aerobic-resistance exercises would improve cognition relative to an active control and if a multidomain intervention including exercises...

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Autores principales: Montero-Odasso, Manuel, Zou, Guangyong, Speechley, Mark, Almeida, Quincy J., Liu-Ambrose, Teresa, Middleton, Laura E., Camicioli, Richard, Bray, Nick W., Li, Karen Z. H., Fraser, Sarah, Pieruccini-Faria, Frederico, Berryman, Nicolas, Lussier, Maxime, Shoemaker, J. Kevin, Son, Surim, Bherer, Louis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359965/
https://www.ncbi.nlm.nih.gov/pubmed/37471089
http://dx.doi.org/10.1001/jamanetworkopen.2023.24465
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author Montero-Odasso, Manuel
Zou, Guangyong
Speechley, Mark
Almeida, Quincy J.
Liu-Ambrose, Teresa
Middleton, Laura E.
Camicioli, Richard
Bray, Nick W.
Li, Karen Z. H.
Fraser, Sarah
Pieruccini-Faria, Frederico
Berryman, Nicolas
Lussier, Maxime
Shoemaker, J. Kevin
Son, Surim
Bherer, Louis
author_facet Montero-Odasso, Manuel
Zou, Guangyong
Speechley, Mark
Almeida, Quincy J.
Liu-Ambrose, Teresa
Middleton, Laura E.
Camicioli, Richard
Bray, Nick W.
Li, Karen Z. H.
Fraser, Sarah
Pieruccini-Faria, Frederico
Berryman, Nicolas
Lussier, Maxime
Shoemaker, J. Kevin
Son, Surim
Bherer, Louis
author_sort Montero-Odasso, Manuel
collection PubMed
description IMPORTANCE: Exercise, cognitive training, and vitamin D may enhance cognition in older adults with mild cognitive impairment (MCI). OBJECTIVE: To determine whether aerobic-resistance exercises would improve cognition relative to an active control and if a multidomain intervention including exercises, computerized cognitive training, and vitamin D supplementation would show greater improvements than exercise alone. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial (the SYNERGIC Study) was a multisite, double-masked, fractional factorial trial that evaluated the effects of aerobic-resistance exercise, computerized cognitive training, and vitamin D on cognition. Eligible participants were between ages 65 and 84 years with MCI enrolled from September 19, 2016, to April 7, 2020. Data were analyzed from February 2021 to December 2022. INTERVENTIONS: Participants were randomized to 5 study arms and treated for 20 weeks: arm 1 (multidomain intervention with 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 (control group with balance-toning exercise, sham cognitive training, and placebo vitamin D). The vitamin D regimen was a 10 000 IU dose 3 times weekly. MAIN OUTCOMES AND MEASURES: Primary outcomes were changes in ADAS-Cog-13 and Plus variant at 6 months. RESULTS: Among 175 randomized participants (mean [SD] age, 73.1 [6.6] years; 86 [49.1%] women), 144 (82%) completed the intervention and 133 (76%) completed the follow-up (month 12). At 6 months, all active arms (ie, arms 1 through 4) with aerobic-resistance exercise regardless of the addition of cognitive training or vitamin D, improved ADAS-Cog-13 when compared with control (mean difference, −1.79 points; 95% CI, −3.27 to −0.31 points; P = .02; d = 0.64). Compared with exercise alone (arms 3 and 4), exercise and cognitive training (arms 1 and 2) improved the ADAS-Cog-13 (mean difference, −1.45 points; 95% CI, −2.70 to −0.21 points; P = .02; d = 0.39). No significant improvement was found with vitamin D. Finally, the multidomain intervention (arm 1) improved the ADAS-Cog-13 score significantly compared with control (mean difference, −2.64 points; 95% CI, −4.42 to −0.80 points; P = .005; d = 0.71). Changes in ADAS-Cog-Plus were not significant. CONCLUSIONS AND RELEVANCE: In this clinical trial, older adults with MCI receiving aerobic-resistance exercises with sequential computerized cognitive training significantly improved cognition, although some results were inconsistent. Vitamin D supplementation had no effect. Our findings suggest that this multidomain intervention may improve cognition and potentially delay dementia onset in MCI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02808676
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spelling pubmed-103599652023-07-22 Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial Montero-Odasso, Manuel Zou, Guangyong Speechley, Mark Almeida, Quincy J. Liu-Ambrose, Teresa Middleton, Laura E. Camicioli, Richard Bray, Nick W. Li, Karen Z. H. Fraser, Sarah Pieruccini-Faria, Frederico Berryman, Nicolas Lussier, Maxime Shoemaker, J. Kevin Son, Surim Bherer, Louis JAMA Netw Open Original Investigation IMPORTANCE: Exercise, cognitive training, and vitamin D may enhance cognition in older adults with mild cognitive impairment (MCI). OBJECTIVE: To determine whether aerobic-resistance exercises would improve cognition relative to an active control and if a multidomain intervention including exercises, computerized cognitive training, and vitamin D supplementation would show greater improvements than exercise alone. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial (the SYNERGIC Study) was a multisite, double-masked, fractional factorial trial that evaluated the effects of aerobic-resistance exercise, computerized cognitive training, and vitamin D on cognition. Eligible participants were between ages 65 and 84 years with MCI enrolled from September 19, 2016, to April 7, 2020. Data were analyzed from February 2021 to December 2022. INTERVENTIONS: Participants were randomized to 5 study arms and treated for 20 weeks: arm 1 (multidomain intervention with 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 (control group with balance-toning exercise, sham cognitive training, and placebo vitamin D). The vitamin D regimen was a 10 000 IU dose 3 times weekly. MAIN OUTCOMES AND MEASURES: Primary outcomes were changes in ADAS-Cog-13 and Plus variant at 6 months. RESULTS: Among 175 randomized participants (mean [SD] age, 73.1 [6.6] years; 86 [49.1%] women), 144 (82%) completed the intervention and 133 (76%) completed the follow-up (month 12). At 6 months, all active arms (ie, arms 1 through 4) with aerobic-resistance exercise regardless of the addition of cognitive training or vitamin D, improved ADAS-Cog-13 when compared with control (mean difference, −1.79 points; 95% CI, −3.27 to −0.31 points; P = .02; d = 0.64). Compared with exercise alone (arms 3 and 4), exercise and cognitive training (arms 1 and 2) improved the ADAS-Cog-13 (mean difference, −1.45 points; 95% CI, −2.70 to −0.21 points; P = .02; d = 0.39). No significant improvement was found with vitamin D. Finally, the multidomain intervention (arm 1) improved the ADAS-Cog-13 score significantly compared with control (mean difference, −2.64 points; 95% CI, −4.42 to −0.80 points; P = .005; d = 0.71). Changes in ADAS-Cog-Plus were not significant. CONCLUSIONS AND RELEVANCE: In this clinical trial, older adults with MCI receiving aerobic-resistance exercises with sequential computerized cognitive training significantly improved cognition, although some results were inconsistent. Vitamin D supplementation had no effect. Our findings suggest that this multidomain intervention may improve cognition and potentially delay dementia onset in MCI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02808676 American Medical Association 2023-07-20 /pmc/articles/PMC10359965/ /pubmed/37471089 http://dx.doi.org/10.1001/jamanetworkopen.2023.24465 Text en Copyright 2023 Montero-Odasso M et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Montero-Odasso, Manuel
Zou, Guangyong
Speechley, Mark
Almeida, Quincy J.
Liu-Ambrose, Teresa
Middleton, Laura E.
Camicioli, Richard
Bray, Nick W.
Li, Karen Z. H.
Fraser, Sarah
Pieruccini-Faria, Frederico
Berryman, Nicolas
Lussier, Maxime
Shoemaker, J. Kevin
Son, Surim
Bherer, Louis
Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial
title Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial
title_full Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial
title_fullStr Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial
title_full_unstemmed Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial
title_short Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial
title_sort effects of exercise alone or combined with cognitive training and vitamin d supplementation to improve cognition in adults with mild cognitive impairment: a randomized clinical trial
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359965/
https://www.ncbi.nlm.nih.gov/pubmed/37471089
http://dx.doi.org/10.1001/jamanetworkopen.2023.24465
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