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Hopkins-Rosseel D1, Brunt A1, Albines D1
1Queen's University, School of Rehabilitation Therapy, Faculty of Health Sciences, Kingston, Ontario, Canada
Background: Cardiovascular(CVD), peripheral vascular(PVD) and cerebrovascular disease(CD) are sources of high morbidity and mortality globally, with the prevalence increasing in some younger adult populations. Regrettably, patients with known vascular disease are at increased risk for cognitive impairments. Although researchers do not know the direct cause of these pathologies, there have been documented links to physiological mechanisms. Further, these mechanisms have been linked to sedentarism. More recently, exercise has been shown to increase cognitive performance in both healthy elderly populations and those with mild cognitive impairments.
Purpose: We explored the literature to advance our understanding of whether or not exercise is a viable modality to improve cognition in those with vascular disease, including a focus on any dose-response relationship.
Methods: A systematic literature search was conducted from inception through to June 2017 using CINAHL, Cochrane Wiley Library, Ovid Embase, and MEDLINE electronic databases. Eligible studies examined the effect of exercise interventions on memory and cognition in adult participants of any age with known CVD, PVD or CD, including myocardial infarction, atherosclerosis, and/or a history of stroke due to atherosclerosis. Data extracted included intervention and comparison group characteristics, research question, study methodology, study findings and authors' conclusions. Extraction in the area of study methodology and outcomes included a specific focus on exercise prescription/dosage and outcomes measures for cognition and memory. Both the initial determination of studies to be included in our review and subsequent data extraction were undertaken independently by two of the authors, with the third consulted for any incongruities. The critical appraisal of each paper was undertaken using the Oxford Centre for Evidence-Based Medicine Levels of Evidence criteria, 2011, and the PEDro Scale, 1999. The PRISMA-P statement and checklist were utilized to ensure a robust preparation and reporting of our protocol for the systematic review.
Results: Twenty-two studies [12 CVD, 10 CDs] met our inclusion criteria and were included in the review. Interventions included aerobic, resistance or a combination of exercise training. Additionally, multiple neuropsychological test batteries assessing cognitive function were employed. In CVD populations, 5 studies demonstrated improved cardiovascular fitness and cognitive function with aerobic exercise training, with an additional 7 studies suggesting a dose-response relationship. In the cerebrovascular trials, 4 studies reported improved cognitive function with aerobic exercise but no effects were observed in the 5th study. Further, one study of persons with CD found enhanced cognition with resistance training and 4 studies demonstrated a positive association between improvements in functional capacity and increases in cognitive function following combined aerobic and resistance training.
Conclusion(s): Our findings suggest that exercise is able to positively affect cognitive performance in those with known vascular disease. In addition, there is evidence to submit that a dose-response relationship may exist, with greater cognitive benefits with increased volume of aerobic exercise. Further research is required to make recommendations.
Implications: Physiotherapists, with their unique dual understanding of pathophysiology and of exercise prescription, should be addressing the prevention and management of cognitive impairments in these individuals.
Keywords: Vascular disease, exercise, cognition
Funding acknowledgements: This was an unfunded project.
Purpose: We explored the literature to advance our understanding of whether or not exercise is a viable modality to improve cognition in those with vascular disease, including a focus on any dose-response relationship.
Methods: A systematic literature search was conducted from inception through to June 2017 using CINAHL, Cochrane Wiley Library, Ovid Embase, and MEDLINE electronic databases. Eligible studies examined the effect of exercise interventions on memory and cognition in adult participants of any age with known CVD, PVD or CD, including myocardial infarction, atherosclerosis, and/or a history of stroke due to atherosclerosis. Data extracted included intervention and comparison group characteristics, research question, study methodology, study findings and authors' conclusions. Extraction in the area of study methodology and outcomes included a specific focus on exercise prescription/dosage and outcomes measures for cognition and memory. Both the initial determination of studies to be included in our review and subsequent data extraction were undertaken independently by two of the authors, with the third consulted for any incongruities. The critical appraisal of each paper was undertaken using the Oxford Centre for Evidence-Based Medicine Levels of Evidence criteria, 2011, and the PEDro Scale, 1999. The PRISMA-P statement and checklist were utilized to ensure a robust preparation and reporting of our protocol for the systematic review.
Results: Twenty-two studies [12 CVD, 10 CDs] met our inclusion criteria and were included in the review. Interventions included aerobic, resistance or a combination of exercise training. Additionally, multiple neuropsychological test batteries assessing cognitive function were employed. In CVD populations, 5 studies demonstrated improved cardiovascular fitness and cognitive function with aerobic exercise training, with an additional 7 studies suggesting a dose-response relationship. In the cerebrovascular trials, 4 studies reported improved cognitive function with aerobic exercise but no effects were observed in the 5th study. Further, one study of persons with CD found enhanced cognition with resistance training and 4 studies demonstrated a positive association between improvements in functional capacity and increases in cognitive function following combined aerobic and resistance training.
Conclusion(s): Our findings suggest that exercise is able to positively affect cognitive performance in those with known vascular disease. In addition, there is evidence to submit that a dose-response relationship may exist, with greater cognitive benefits with increased volume of aerobic exercise. Further research is required to make recommendations.
Implications: Physiotherapists, with their unique dual understanding of pathophysiology and of exercise prescription, should be addressing the prevention and management of cognitive impairments in these individuals.
Keywords: Vascular disease, exercise, cognition
Funding acknowledgements: This was an unfunded project.
Topic: Cardiorespiratory; Intellectual disability; Mental health
Ethics approval required: No
Institution: Queen's University
Ethics committee: Health Sciences Research Ethics Board
Reason not required: Ethics approval of the Queen’s University Health Sciences Research Ethics Board does not require approval if the work is a systematic review of the literature.
All authors, affiliations and abstracts have been published as submitted.
