Aerobic exercise in older people with subclinical sporadic cerebral small vessel disease: A randomized clinical trial.

Introduction: The benefit and risk of aerobic exercise among older people harboring advanced cerebral small vessel disease (CSVD) upon cognition, mood, and motor functions are unknown.
Methods: This rater-blind randomized trial examined effects of a 24-week aerobic exercise training (60 min/session, twice/week) upon clinical (cognition, mood, motor functions) and hemodynamic (pulse pressure [PP], blood pressure [BP], pulsatility index) measures in older people harboring moderate to severe CSVD, as evidenced by confluent white matter hyperintensity and/or ≥2 lacunes on magnetic resonance imaging. We further investigated interactions between treatment conditions and hemodynamics measures.
Results: Fifty-three and 54 subjects were randomized into the active and control group, respectively. There was no between-group difference in any of the clinical outcomes. The active group had a greater between-group reduction in systolic BP and PP than the control group. Within-group comparison showed that global cognition of the active group remained similar at end of the study compared to baseline, whereas it declined significantly in the control group. We observed "diverging" interaction effects in that greater reduction in systolic BP/PP was associated with greater improvement in memory functions and global cognition but worsening in processing speed in the active group. Side effects were comparable between the two groups.
Discussion: Future study should investigate the mechanisms of the diverging impacts of aerobic exercise upon different cognitive domains so that the benefit-risk ratio of aerobic exercise in older people harboring more advanced CSVD can be better defined.
Competing Interests: In the past 36 months, Adrian Wong reports payment from Hong Kong Court (payment made to him). Margaret Kit Yi Mak reports conference attendance support from The Hong Kong Polytechnic University to attend the XXVI World Congress on Parkinson's Disease and Related Disorders May 1–4, 2021. Linda Chiu Wa Lam reports consulting fees from the second expert Colloquium on Early Alzheimer's Disease organized by Eisai Pharmaceutical (zoom meeting in 2020); and giving a lecture and preparing a newsletter article on mental disorders for dentists for the Hong Kong Dental Association (2020); and she is a member of the Advisory Committee on Mental Health at the Food and Health Bureau of the HKSAR government. Sin Ki Yeung reports the provision of reading materials by the professor for the submitted work. Lin Shi reports grants from Hong Kong General Research Fund and Innovation and Technology Fund. Thomas Wai Hong Leung is the president of Hong Kong Neurological Society (unpaid). Yannie Oi Yan Soo reports grants from Hong Kong Health and Medical Research Fund (payment made to CUHK) and Emerging Markets Thrombosis Investigator‐Initiated Research Program from Pfizer (payment made to CUHK); and honorarium for being a speaker from Amgen (payment made to her), honorarium for being a speaker from Daiichi and Boehringer Ingelheim (Hong Kong) Ltd (payment made to CUHK); and support for conference attendance by Hong Kong Neurological and Hong Kong Stroke Societies (no direct payment involved). Timothy Chi Yui Kwok is the director of Jockey Club Centre for positive ageing, Hong Kong; reports honorarium for attending a hearing for guardianship board, Hong Kong; and payment from Hong Kong government for expert report for coroner office; and donation for research (donation made to CUHK). Ho Ko reports grants from Croucher Innovation Award, Collaborative Research Fund of the Research Grants Council, Hong Kong and Area of Excellence Scheme of the Research Grants Council, Hong Kong (payments made to CUHK); and consulting fees from Videns Incorporation Limited. He has patents on the identifications of new potential disease‐modifying therapeutics for Niemann‐Pick disease type C, a method for slowing down brain aging, and new methods for achieving rapid and deep immunostaining. All other authors declare no financial disclosures or conflicts of interest.
(© 2021 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.)