Int J Sports Med 2022; 43(10): 850-858
DOI: 10.1055/a-1639-2307
Physiology & Biochemistry

Exercise Dose and Aerobic Fitness Response in Alzheimerʼs Dementia: Findings from the FIT-AD Trial

Dereck Salisbury
1   School of Nursing, University of Minnesota Twin Cities, Minneapolis, United States
,
Michelle A. Mathiason
1   School of Nursing, University of Minnesota Twin Cities, Minneapolis, United States
,
Fang Yu
2   Edison College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
› Author Affiliations

Abstract

The purpose of this study was to examine the effects of a 6-month cycling aerobic exercise intervention on cardiorespiratory fitness and the dose-response relationship in community-dwelling older adults with mild-to-moderate Alzheimerʼs dementia. The FIT-AD trial was a single blind, 2-parallel group, pilot randomized controlled trial. The aerobic exercise group participated in a 6-month, thrice weekly, moderate-vigorous intensity cycling intervention while control group performed stretching. Cardiorespiratory fitness was evaluated by peak oxygen consumption from cardiopulmonary exercise test and peak walking distance from the shuttle walk test and 6-minute walk test. Aerobic exercise dose was calculated using the novel heart rate physical activity score. The aerobic exercise group significantly increased peak oxygen consumption (1.28 ml/kg/min; p=0.03) in subgroup who achieved maximal criteria on cardiopulmonary exercise test. Changes in peak oxygen consumption and peak walking distance on the shuttle walk and 6-minute walk tests did not significantly differ between aerobic exercise and stretching groups. Notably, the aerobic exercise dose was strongly and significantly correlated to change in peak oxygen consumption (r=0.60; n=16; p=0.01), in subset who met maximal test criteria. Emphasis on exercise dose is needed in aerobic exercise programs to maximize cardiorespiratory fitness gains in persons with mild-moderate Alzheimerʼs dementia.



Publication History

Received: 13 May 2021

Accepted: 03 September 2021

Accepted Manuscript online:
07 September 2021

Article published online:
11 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Yu F, Salisbury DL, Kelly K. The Alzheimerʼs Rx Aerobic Exercise. Lexington, KY: Bowker; 2019
  • 2 Colcombe SJ, Erickson KI, Raz N. et al. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Sci 2003; 58: 176-180
  • 3 Sobol NA, Hoffmann K, Frederiksen KS. et al. Effect of aerobic exercise on physical performance in patients with Alzheimerʼs disease. Alzheimers Dement 2016; 12: 1207-1215
  • 4 McGough EL, Lin SY, Belza B. et al. A scoping review of physical performance outcome measures used in exercise interventions for older adults with Alzheimer disease and related dementias. J Geriatr Phys Ther 2019; 42: 28-47
  • 5 Salisbury DL, Yu F. Aerobic fitness and cognition changes after exercise training in Alzheimerʼs disease. J Clin Exerc Physiol 2017; 6: 22-28
  • 6 Salisbury DL, Yu F. A comparison of cardiopulmonary exercise testing and field walking tests in community-dwelling older adults with mild-to-moderate Alzheimerʼs dementia. J Aging Phys Act 2020; 1: 911-919
  • 7 American College of Sports Medicine (10th). ACSMʼs Guidelines for Exercise Testing and Prescription. Philadelphia, PA: Wolters Kluwer; 2018
  • 8 Morris JK, Vidoni ED, Johnson DK. et al. Aerobic exercise for Alzheimerʼs disease: a randomized controlled pilot trial. PLoS One 2017; 12: e0170547
  • 9 Sobol NA, Dall CH, Hogh P. et al. Change in fitness and the relation to change in cognition and neuropsychiatric symptoms after aerobic exercise in patients with mild Alzheimerʼs disease. J Alzheimers Dis 2018; 65: 137-145
  • 10 Garber CE, Blissmer B, Deschenes MR. et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43: 1334-1359
  • 11 Huang G, Wang R, Chen P. et al. Dose-response relationship of cardiorespiratory fitness adaptation to controlled endurance training in sedentary older adults. Eur J Prev Cardiol 2016; 23: 518-529
  • 12 Schnohr P, Marott JL, Jensen JS. et al. Intensity versus duration of cycling, impact on all-cause and coronary heart disease mortality: The Copenhagen City heart study. Eur J Prev Cardiol 2012; 19: 73-80
  • 13 Pescatello LS, MacDonald HV, Lamberti L. et al. Exercise for hypertension: A prescription update integrating existing recommendations with emerging research. Curr Hypertens Rep 2015; 17: 87-97
  • 14 Colberg SR, Sigal RJ, Fernhall B. et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010; 33: 147-167
  • 15 Ross R, de Lannoy L, Stotz PJ. Separate effects of intensity and amount of exercise on interindividual cardiorespiratory fitness response. Mayo Clin Proc 2015; 90: 1506-1514
  • 16 Vidoni ED, Johnson DK, Morris JK. et al. Dose-response of aerobic exercise on cognition: A community-based, pilot randomized controlled trial. PLoS One 2015; 10: e0131647
  • 17 Yu F, Bronas UG, Konety S. et al. Effects of aerobic exercise on cognition and hippocampal volume in Alzheimerʼs disease: study protocol of a randomized controlled trial (The FIT-AD trial). Trials 2014; 15: 394
  • 18 Yu F, Vock D, Zhang L. et al. Cognitive effects of aerobic exercise in Alzheimerʼs disease: a pilot randomized controlled trial. J Alzheimerʼs Dis 2021; 80: 233-244
  • 19 Chan AW, Tetzlaff JM, Altman DG. et al. SPIRIT 2013 statement: Defining standard protocol items for clinical trials. Ann Intern Med 2013; 158: 200-207
  • 20 Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010; 152: 726-732
  • 21 Jeste DV, Palmer BW, Appelbaum PS. et al. A new brief instrument for assessing decisional capacity for clinical research. Arch Gen Psychiatry 2007; 64: 966-974
  • 22 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
  • 23 Morris JC. The clinical dementia rating (CDR): Current version and scoring rules. Neurology 1993; 43: 2412-2414
  • 24 Peters O, Fuentes M, Joachim LK. et al. Combined treatment with memantine and galantamine-CR compared with galantamine-CR only in antidementia drug naïve patients with mild-to-moderate Alzheimerʼs disease. Alzheimers Dement 2015; 1: 198-204
  • 25 Salisbury D, Yu F. Establishing reference cardiorespiratory fitness parameters in Alzheimerʼs disease. Sports Med Int Open 2020; 4: E1-E7
  • 26 Singh SJ, Morgan MD, Scott S. et al. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992; 47: 1019-1024
  • 27 Singh S, Moiz JA, Ali MS. et al. Reliability, validity, and responsiveness of the incremental shuttle walk test in patients with interstitial lung disease. J Cardiopulm Rehabil Prev 2018; 38: 425-429
  • 28 Wilkinson T, Xenophontos SM, Gould D. et al. Test-retest reliability, validation, and "minimal detectable change" scores for frequently reported tests of objective physical function in patients with non-dialysis chronic kidney disease. Physiother Theory Pract 2019; 35: 565-576
  • 29 American Thoracic Society.. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111–117
  • 30 Ries JD, Echternach JL, Nof L. et al. Test-retest reliability and minimal detectable change scores for the timed "up & go" test, the six-minute walk test, and gait speed in people with Alzheimer disease. Phys Ther 2009; 89: 569-579
  • 31 Tappen RM, Roach KE, Buchner D. et al. Reliability of physical performance measures in nursing home residents with Alzheimerʼs disease. J Gerontol A Biol Sci Med Sci 1997; 52: 52-55
  • 32 Miller FL, OʼConnor DP, Herring MP. et al. Exercise dose, exercise adherence, and associated health outcomes in the TIGER study. Med Sci Sports Exerc 2014; 46: 69-75
  • 33 American College of Sports Medicine. Chodzko-Zajko WJ, Proctor DN. et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 2009; 41: 1510-1530
  • 34 Bouaziz W, Kanagaratnam L, Vogel T. et al. Effect of aerobic training on peak oxygen uptake among seniors aged 70 or older: A meta-analysis of randomized controlled trials. Rejuvenation Res 2018; 21: 341-349
  • 35 Bailey DM, Marley CJ, Brugniaux JV. et al. Elevated aerobic fitness sustained throughout the adult lifespan is associated with improved cerebral hemodynamics. Stroke 2013; 44: 3235-3238
  • 36 Goldman WP, Baty JD, Buckles VD. et al. Motor dysfunction in mildly demented AD individuals without extrapyramidal signs. Neurology 1999; 53: 956-962
  • 37 Borges M, Radanovic M, Forlenza OV. Fear of falling and falls in older adults with mild cognitive impairment and Alzheimerʼs disease. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2015; 22: 312-321
  • 38 Wittwer JE, Webster KE, Menz HB. A longitudinal study of measures of walking in people with Alzheimerʼs Disease. Gait Posture 2010; 32: 113-117
  • 39 Venturelli M, Scarsini R, Schena F. Six-month walking program changes cognitive and ADL performance in patients with Alzheimerʼs disease. Am J Alzheimerʼs Dis Other Demen 2011; 26: 381-388
  • 40 Tappen RM, Roach KE, Applegate EB. et al. Effect of a combined walking and conversation intervention on functional mobility of nursing home residents with Alzheimer disease. Alzheimer Dis Assoc Disord 2000; 14: 196-201
  • 41 Yu F, Salisbury D, Mathiason MA. Interindividual differences in the responses to aerobic exercise in Alzheimerʼs disease: Findings from the FIT-AD trial. J Sport Health Sci 2020; 10: 65-72
  • 42 Raasch CC, Zajac FE. Locomotor strategy for pedaling: muscle groups and biomechanical functions. J Neurophysiol 1999; 82: 515-525
  • 43 Ferrucci L, Bandinelli S, Benvenuti E. et al. Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc 2000; 48: 1618-1625
  • 44 Schirinzi T, Di Lorenzo F, Sancesario GM. et al. Amyloid-mediated cholinergic dysfunction in motor impairment related to Alzheimerʼs disease. J Alzheimers Dis 2018; 64: 525-532
  • 45 Burns JM, Johnson DK, Watts A. et al. Reduced lean mass in early Alzheimer disease and its association with brain atrophy. Arch Neurol 2010; 67: 428-433
  • 46 Burns JM, Cronk BB, Anderson HS. et al. Cardiorespiratory fitness and brain atrophy in early Alzheimer disease. Neurology 2008; 71: 210-216
  • 47 Kurl S, Laukkanen JA, Lonnroos E. et al. Cardiorespiratory fitness and risk of dementia: a prospective population-based cohort study. Age Ageing 2018; 47: 611-614
  • 48 Barnes DE, Yaffe K, Satariano WA. et al. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc 2003; 51: 459-465
  • 49 Bouaziz W, Malgoyre A, Schmitt E. et al. Effect of high-intensity interval training and continuous endurance training on peak oxygen uptake among seniors aged 65 or older: A meta-analysis of randomized controlled trials. Int J Clin Pract 2020; 74: e13490