Summary: New findings from the EXERT study reveal that both low and moderate-high intensity exercise may help preserve cognitive function in older adults with mild memory problems—a major risk factor for Alzheimer’s disease. Over 12 months, participants who engaged in either form of exercise showed significantly less cognitive decline and reduced brain volume loss, especially in the prefrontal cortex, compared to a usual-care group.
This research highlights the value of accessible, community-based fitness interventions for individuals at high risk of dementia. Even low-intensity activities like stretching and balance exercises proved effective in slowing decline, suggesting a simple and feasible path toward brain health.
Key Facts:
- Slowed Decline: Both low and moderate-high intensity exercise stabilized cognitive function over 12 months.
- Brain Volume Preservation: Participants in both exercise groups showed less brain volume loss, particularly in the prefrontal cortex.
- Community Feasibility: The trial partnered with local YMCAs, showing real-world implementation is possible.
Source: UCSD
Researchers at University of California San Diego and Wake Forest University have found that both low and moderate-high intensity exercise could be valuable tools in the fight against Alzheimer’s.
The new research, published as two papers in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, describes the results of the EXERT study (Exercise in Adults with Mild Memory Problems), a multi-site clinical trial of lower or moderate-high intensity exercise in sedentary older adults with amnestic mild cognitive impairment, a major risk factor for Alzheimer’s dementia.
The researchers also compared their results to an existing dataset of comparable individuals who only received usual care, such as regular check-ups with health care providers and medication management.
The researchers found:
- In EXERT participants, cognitive function remained stable over 12 months in both low and moderate-high intensity exercise groups.
- Both forms of exercise were associated with significantly less cognitive decline over 12 months when compared to individuals who were not involved in the exercise study.
- Both EXERT exercise groups tended to show less brain volume loss over 12 months, including in the prefrontal cortex.
Individuals with amnestic mild cognitive impairment, a condition characterized by memory complaints and objective memory decline, are at high risk of developing Alzheimer’s dementia, with approximately 16% of people with this condition progressing to Alzheimer’s each year.
“This is a critical time to intervene in this population, because they don’t have dementia yet, but are at a very high risk,” said Aladdin Shadyab, Ph.D., M.P.H., lead author of one of the new papers and associate professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science and School of Medicine.
“Together, these findings show us that even low intensity exercise may slow cognitive decline in at-risk older adults.”
While previous studies have suggested that exercise may be beneficial for cognitive health, the evidence has been mixed, and large, well-designed studies are needed to fully understand the potential benefits of exercise for older adults with mild cognitive impairment.
The EXERT study, coordinated by the Alzheimer’s Disease Cooperative Study (ADCS) at UC San Diego, in partnership with Wake Forest University School of Medicine, fills this gap.
“EXERT was one of the first large clinical trials of exercise that partnered with the YMCA and its trainers to bring the intervention closer to home for research participants,” said Howard Feldman, M.D., ADCS director.
“This approach brings us one step closer to its implementation in the community.”
The ADCS was formed in 1991 under a cooperative agreement between the National Institute on Aging and UC San Diego and is one of the key initiatives for Alzheimer’s research supported by the federal government, addressing treatments for both cognitive and behavioral symptoms of Alzheimer’s.
“There’s an urgent need to identify effective and feasible ways to prevent and treat Alzheimer’s dementia, and UC San Diego has been a leader in this field for many years,” added Feldman, who is also a professor in the Department of Neurosciences at UC San Diego School of Medicine.
EXERT included nearly 300 sedentary older adults with mild cognitive impairment who were randomly assigned to either moderate-high intensity aerobic training or lower-intensity stretching, balance and range of motion activities.
Participants completed their assigned exercise 3-4 times per week for 12 months under the supervision of a YMCA trainer, and the study also included regular assessments of cognitive function and brain volume.
“EXERT is a landmark study because it’s the largest rigorous trial of exercise ever conducted in adults with mild cognitive impairment,” said Laura Baker, Ph.D., principal investigator of the EXERT study and professor of gerontology and geriatric medicine at Wake Forest University School of Medicine.
“Exercise has well-documented benefits to nearly every aspect of human health, but we’re still unlocking the full potential of exercise as medicine for older adults with memory problems.
Though the researchers expected to see further cognitive decline in EXERT participants, they actually found that cognitive function remained stable for both exercise groups over the course of the study. This suggests that both lower and higher intensity exercise could slow cognitive decline.
Another possible explanation for the results is that participating in research itself, regardless of the treatment, may offer protection against cognitive decline due to the intellectual and social stimulation involved.
Overall, the findings of both studies taken together suggest that exercise may be a promising, safe, and feasible strategy to promote brain health and prevent continued cognitive decline for older adults with mild cognitive impairment.
“While there’s still a lot to learn, these findings show that regular intensity exercise, even at low intensity, could go a long way toward helping older adults slow or delay cognitive decline, and this is promising news for those who are at high risk for dementia,” added Shadyab.
Funding: The EXERT study was supported through the National Institutes of Health/National Institute on Aging (U19AG010483-25 and AG058644) and by the Brain Research Foundation (BRF ECD-2014-01).
Disclosures: Feldman receives grant funding from the National Institute on Aging (U19AG010483-22), from Biohaven Pharmaceuticals, Vivoryon (Probiodrug), and LuMind Foundation; service agreements for consulting activities with LuMind, Axon Neuroscience, Novo Nordisk, Arrowhead Pharmaceuticals, Roche/Genentech Pharmaceuticals (DMC/DSMB), Tau Consortium (SAB), and Janssen Research & Development (DSMB); support for travel from Novo Nordisk, Royal Society of Canada, Translating Research in Elder Care (TREC), Association for Frontotemporal Dementia (AFTD), and Rainwater Charitable Foundation; and a philanthropic donation for the Epstein Family Alzheimer Research Collaboration.
No personal funds have been received for these activities. Feldman personally receives royalties for patent: Feldman HH (filed November 26, 2008). Detecting and Treating Dementia Serial Number 12/3-2691 U.S. Patent No. PCT/US2007/07008. Washington, DC: U.S. Patent and Trademark Office.
About this Alzheimer’s disease and exercise research news
Author: Miles Martin
Source: UCSD
Contact: Miles Martin – UCSD
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Effects of exercise on cognition and Alzheimer’s biomarkers in a randomized controlled trial of adults with mild cognitive impairment: The EXERT study” by Aladdin Shadyab et al. Alzheimer’s & Dementia
Open access.
“Effects of exercise versus usual care on older adults with amnestic mild cognitive impairment: EXERT versus ADNI” by Aladdin Shadyab et al. Alzheimer’s & Dementia
Abstract
Effects of exercise on cognition and Alzheimer’s biomarkers in a randomized controlled trial of adults with mild cognitive impairment: The EXERT study
INTRODUCTION
The EXERT study (Exercise in Adults with Mild Memory Problems) was a Phase 3, multicenter, randomized controlled trial that examined effects of exercise on cognition and other measures of brain health in sedentary older adults with amnestic mild cognitive impairment (MCI).
METHODS
Participants were randomized to moderate-high intensity aerobic training (AX) or low-intensity stretching/balance/range of motion (SBR) for 18 months. Exercise was supervised for the first 12 months. Assessments were administered at baseline and every 6 months. The primary outcome was a global cognitive composite.
RESULTS
A total of 296 participants were enrolled, and intervention adherence was high (supervised session attendance: AX = 81%, SBR = 87%). Intervention effects on cognition did not differ for AX and SBR (regression = –0.078, standard error [SE] = 0.074; p = 0.3). Notably, there was no 12 month cognition decline for either group, and mean 12 month hippocampal volume loss for both groups was low at 0.51%.
DISCUSSION
Exercise intensity did not differentially affect cognitive trajectory. Intervention delivery was successful (high adherence) and cognition remained stable over 12 months for both MCI groups, an association that warrants further study.
Highlights
- Exercise in Adults with Mild Memory Problems (EXERT) was a large multisite randomized controlled trial of moderate-high intensity aerobic training versus lower-intensity flexibility and balance exercise in sedentary older adults with amnestic mild cognitive impairment (MCI).
- A sensitive and validated measure of global cognitive function, the Alzheimer’s Disease Assessment Scale-Cognition supplemented with tests of executive function (ADAS-Cog-Exec), was used to assess intervention efficacy with 12 months of supervised exercise.
- There was no intervention group difference on the 12-month cognitive trajectory of the ADAS-Cog-Exec.
- Intervention delivery was successful (high adherence), and cognition remained stable over 12 months for both exercise groups.
- Regular supported moderate-high or lower-intensity exercise may stall decline in adults with amnestic MCI, but further investigation is needed.
Abstract
Effects of exercise versus usual care on older adults with amnestic mild cognitive impairment: EXERT versus ADNI
INTRODUCTION
EXERT was a multisite randomized controlled trial (RCT) examining the effects of moderate-high intensity aerobic training (AX) versus lower-intensity stretching/balance/range of motion (SBR) on cognitive trajectories in older adults with amnestic mild cognitive impairment (aMCI).
METHODS
Preplanned post-hoc analyses were conducted to compare each arm to a propensity-matched usual care (no intervention) group from Alzheimer’s Disease Neuroimaging Initiative 1 (ADNI-1) selected for similarity across key characteristics. Differences in 12-month trajectories in the primary endpoint (ADAS-Cog-Exec) and magnetic resonance imaging (MRI) volumes in prespecified brain regions were compared.
RESULTS
AX and SBR showed significantly less 12-month cognitive decline than ADNI-1 (AX:n = 109, β = 0.169, 95% confidence interval [CI] 0.011–0.328; SBR:n = 105, β = 0.181, 95% CI 0.007–0.354). There were trends of less prefrontal cortex volume loss for both EXERT groups and less AD signature region volume loss for SBR relative to ADNI-1 over 12 months.
DISCUSSION
Moderate-high intensity aerobic or low-intensity flexibility exercise for 12 months in participants with aMCI may provide protection against decline relative to usual care.
CLINICAL TRIAL REGISTRATION
The EXERT clinical trial is registered at clinicaltrials.gov (NCT02814526).
Highlights
- EXERT was a randomized controlled trial in sedentary older adults with aMCI.
- EXERT arms were propensity-matched to a usual care (no intervention) group (Alzheimer’s Disease Neuroimaging Initiative 1 [ADNI-1]).
- High and low-intensity exercise arms had less 12-mo cognitive decline than ADNI-1.
- There were trends of less prefrontal cortex volume loss for each arm versus ADNI-1.
