Sarah Fraser

The relationship between exercise intensity, cerebral oxygenation and cognitive performance in young adults

PurposeTo assess the relationship between exercise intensity, cerebral HbO2 and cognitive performance (Executive and non-Executive) in young adults.MethodsWe measured reaction time (RT) and accuracy, during a computerized Stroop task, in 19 young adults (7 males and 12 females). Their meanxa0±xa0SD age, height, body mass and body mass index (BMI) were 24xa0±xa04xa0years, 1.67xa0±xa00.07xa0m, 72xa0±xa014xa0kg and 25xa0±xa03xa0kgxa0m−2, respectively. Each subject performed the Stroop task at rest and during cycling at exercise of low intensity [40xa0% of peak power output (PPO)], moderate intensity (60xa0% of PPO) and high intensity (85xa0% of PPO). Cerebral oxygenation was monitored during the resting and exercise conditions over the prefrontal cortex (PFC) using near-infrared spectroscopy (NIRS).ResultsHigh-intensity exercise slowed RT in both the Naming (pxa0=xa00.04) and the Executive condition (pxa0=xa00.04). The analysis also revealed that high-intensity exercise was associated with a decreased accuracy when compared to low-intensity exercise (pxa0=xa00.021). Neuroimaging results confirm a decrease of cerebral oxygenation during high-intensity exercise in comparison to low- (pxa0=xa00.004) and moderate-intensity exercise (pxa0=xa00.003). Correlations revealed that a lower cerebral HbO2 in the prefrontal cortex was associated with slower RT in the Executive condition only (pxa0=xa00.04, gxa0=xa0−0.72).ConclusionResults of the present study suggest that low to moderate exercise intensity does not alter Executive functioning, but that exercise impairs cognitive functions (Executive and non-Executive) when the physical workload becomes heavy. The cerebral HbO2 correlation suggests that a lower availability of HbO2 was associated with slower RT in the Executive condition only.

Comparable Cerebral Oxygenation Patterns in Younger and Older Adults during Dual-Task Walking with Increasing Load

The neuroimaging literature on dual-task gait clearly demonstrates increased prefrontal cortex (PFC) involvement when performing a cognitive task while walking. However, findings from direct comparisons of the cerebral oxygenation patterns of younger (YA) and older (OA) adults during dual-task walking are mixed and it is unclear how YA and OA respond to increasing cognitive load (difficulty) while walking. This functional near infra-red (fNIRS) study examined cerebral oxygenation of YA and OA during self-paced dual-task treadmill walking at two different levels of cognitive load (auditory n-back). Changes in accuracy (%) as well as oxygenated (HbO) and deoxygenated (HbR) hemoglobin were examined. For the HbO and HbR measures, eight regions of interest (ROIs) were assessed: the anterior and posterior dorsolateral and ventrolateral PFC (aDLPFC, pDLPFC, aVLPFC, pVLPFC) in each hemisphere. Nineteen YA (M = 21.83 years) and 14 OA (M = 66.85 years) walked at a self-selected pace while performing auditory 1-back and 2-back tasks. Walking alone (single motor: SM) and performing the cognitive tasks alone (single cognitive: SC) were compared to dual-task walking (DT = SM + SC). In the behavioural data, participants were more accurate in the lowest level of load (1-back) compared to the highest (2-back; p < 0.001). YA were more accurate than OA overall (p = 0.009), and particularly in the 2-back task (p = 0.048). In the fNIRS data, both younger and older adults had task effects (SM < DT) in specific ROIs for ΔHbO (three YA, one OA) and ΔHbR (seven YA, eight OA). After controlling for walk speed differences, direct comparisons between YA and OA did not reveal significant age differences, but did reveal a difficulty effect in HbO in the left aDLPFC (p = 0.028) and significant task effects (SM < DT) in HbR for six of the eight ROIs. Findings suggest that YA and OA respond similarly to manipulations of cognitive load when walking on a treadmill at a self-selected pace.

Does Combined Physical and Cognitive Training Improve Dual-Task Balance and Gait Outcomes in Sedentary Older Adults?

Everyday activities like walking and talking can put an older adult at risk for a fall if they have difficulty dividing their attention between motor and cognitive tasks. Training studies have demonstrated that both cognitive and physical training regimens can improve motor and cognitive task performance. Few studies have examined the benefits of combined training (cognitive and physical) and whether or not this type of combined training would transfer to walking or balancing dual-tasks. This study examines the dual-task benefits of combined training in a sample of sedentary older adults. Seventy-two older adults (≥60 years) were randomly assigned to one of four training groups: Aerobic + Cognitive training (CT), Aerobic + Computer lessons (CL), Stretch + CT and Stretch + CL. It was expected that the Aerobic + CT group would demonstrate the largest benefits and that the active placebo control (Stretch + CL) would show the least benefits after training. Walking and standing balance were paired with an auditory n-back with two levels of difficulty (0- and 1-back). Dual-task walking and balance were assessed with: walk speed (m/s), cognitive accuracy (% correct) and several mediolateral sway measures for pre- to post-test improvements. All groups demonstrated improvements in walk speed from pre- (M = 1.33 m/s) to post-test (M = 1.42 m/s, p < 0.001) and in accuracy from pre- (M = 97.57%) to post-test (M = 98.57%, p = 0.005).They also increased their walk speed in the more difficult 1-back (M = 1.38 m/s) in comparison to the 0-back (M = 1.36 m/s, p < 0.001) but reduced their accuracy in the 1-back (M = 96.39%) in comparison to the 0-back (M = 99.92%, p < 0.001). Three out of the five mediolateral sway variables (Peak, SD, RMS) demonstrated significant reductions in sway from pre to post test (p-values < 0.05). With the exception of a group difference between Aerobic + CT and Stretch + CT in accuracy, there were no significant group differences after training. Results suggest that there can be dual-task benefits from training but that in this sedentary sample Aerobic + CT training was not more beneficial than other types of combined training.

SYNERGIC TRIAL (SYNchronizing Exercises, Remedies in Gait and Cognition) a multi-Centre randomized controlled double blind trial to improve gait and cognition in mild cognitive impairment

BackgroundPhysical exercise, cognitive training, and vitamin D are low cost interventions that have the potential to enhance cognitive function and mobility in older adults, especially in pre-dementia states such as Mild Cognitive Impairment (MCI). Aerobic and progressive resistance exercises have benefits to cognitive performance, though evidence is somewhat inconsistent. We postulate that combined aerobic exercise (AE) and progressive resistance training (RT) (combined exercise) will have a better effect on cognition than a balance and toning control (BAT) intervention in older adults with MCI. We also expect that adding cognitive training and vitamin D supplementation to the combined exercise, as a multimodal intervention, will have synergistic efficacy.MethodsThe SYNERGIC trial (SYNchronizing Exercises, Remedies in GaIt and Cognition) is a multi-site, double-blinded, five-arm, controlled trial that assesses the potential synergic effect of combined AE and RT on cognition and mobility, with and without cognitive training and vitamin D supplementation in older adults with MCI. Two-hundred participants with MCI aged 60 to 85xa0years old will be randomized to one of five arms, four of which include combined exercise plus combinations of dual-task cognitive training (real vs. sham) and vitamin D supplementation (3u2009×u200910,000xa0IU/wk. vs. placebo) in a quasi-factorial design, and one arm which receives all control interventions. The primary outcome measure is the ADAS-Cog (13 and plus modalities) measured at baseline and at 6 months of follow-up. Secondary outcomes include neuroimaging, neuro-cognitive performance, gait and mobility performance, and serum biomarkers of inflammation (C reactive protein and interleukin 6), neuroplasticity (brain-derived neurotropic factor), endothelial markers (vascular endothelial growth factor 1), and vitamin D serum levels.DiscussionThe SYNERGIC Trial will establish the efficacy and feasibility of a multimodal intervention to improve cognitive performance and mobility outcomes in MCI. These interventions may contribute to new approaches to stabilize and reverse cognitive-mobility decline in older individuals with MCI.Trial RegistrationIdentifier: NCT02808676. https://www.clinicaltrials.gov/ct2/show/NCT02808676.

Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA)

Abstract Background A new paradigm is emerging in which mobility and cognitive impairments, previously studied, diagnosed, and managed separately in older adults, are in fact regulated by shared brain resources. Deterioration in these shared brain mechanisms by normal aging and neurodegeneration increases the risk of developing dementia, falls, and fractures. This new paradigm requires an integrated approach to measuring both domains. We aim to identify a complementary battery of existing tests of mobility and cognition in community-dwelling older adults that enable assessment of motor-cognitive interactions. Methods Experts on mobility and cognition in aging participated in a semistructured consensus based on the Delphi process. After performing a scoping review to select candidate tests, multiple rounds of consultations provided structured feedback on tests that captured shared characteristics of mobility and cognition. These tests needed to be sensitive to changes in both mobility and cognition, applicable across research studies and clinics, sensitive to interventions, feasible to perform in older adults, been previously validated, and have minimal ceiling/floor effects. Results From 17 tests appraised, 10 tests fulfilled prespecified criteria and were selected as part of the “Core-battery” of tests. The expert panel also recommended a “Minimum-battery” of tests that included gait speed, dual-task gait speed, the Montreal Cognitive Assessment and Trail Making Test A&B. Conclusions A standardized assessment battery that captures shared characteristics of mobility and cognition seen in aging and neurodegeneration may increase comparability across research studies, detection of subtle or common reversible factors, and accelerate research progress in dementia, falls, and aging-related disabilities.

Guidelines for Gait Assessments in the Canadian Consortium on Neurodegeneration in Aging (CCNA)

Background Motor and cognitive impairments are common among older adults and often co-exist, increasing their risk of dementia, falls, and fractures. Gait performance is an accepted indicator of global health and it has been proposed as a valid motor marker to detect older adults at risk of developing mobility and cognitive declines including future falls and incident dementia. Our goal was to provide a gait assessment protocol to be used for clinical and research purposes. Methods Based on a consensus that identified common evaluations to assess motor–cognitive interactions in community-dwelling older individuals, a protocol on how to evaluate gait in older adults for the Canadian Consortium on Neurodegeneration in Aging (CCNA) was developed. Results The CCNA gait assessment includes preferred and fast pace gait, and dual-task gait that comprises walking while performing three cognitively demanding tasks: counting backwards by ones, counting backwards by sevens, and naming animals. This gait protocol can be implemented using an electronic-walkway, as well as by using a regular stopwatch. The latter approach provides a simple manner to evaluate quantitative gait performance in clinics. Conclusions Establishing a standardized gait assessment protocol will help to assess motor–cognitive interactions in aging and neurodegeneration, to compare results across studies, and to feasibly implement and translate gait testing in clinics for detecting impending cognitive and mobility decline.

Higher cardiovascular fitness level is associated to better cognitive dual-task performance in Master Athletes: Mediation by cardiac autonomic control

Introduction/Purpose: This study compared cognitive performances and cardiac autonomic measures of higher fit and lower fit middle‐aged and older highly active adults. The working hypotheses were that higher fit (master athletes) would show cognitive benefits in executive control conditions due to a high level of fitness compared to lower fit people and that this effect would be mediated by better cardiac autonomic adaptations in athletes. Methods: We recruited 39 highly active middle aged and older adults from Master Athletes’ organizations. All participants performed a Rockport walking test and a computerized dual‐task. Cardiac autonomic control was assessed with a measure of heart rate variability. Based on the VO2max estimated by the Rockport test, a median split was performed to assess the influence of fitness level on cognitive performance and the link with heart rate variability. Those with the highest fitness level were considered Master Athletes. Results: Master Athletes showed better dual‐task performances than lower fit individuals. A positive relationship between the VO2max and dual‐task performances was also observed. Master Athletes demonstrated a lower resting HR and higher RR interval than lower fit individuals, and this index was specifically related to the executive conditions of the dual task. Conclusion: Our results highlight the role of fitness level on executive function in highly active middle aged and older adults and suggest that the better performances observed in highly fit individuals is mediated by cardiac autonomic control. HIGHLIGHTSFirst paper to compare executive function between lower and higher fit active people.Fitness is a major determinant of executive performance in cognitive dual task.Cardiac parasympathetic control is involved in executive performance.

A comparison of the impact of physical exercise, cognitive training and combined intervention on spontaneous walking speed in older adults

BackgroundSpontaneous walking speed (SWS) is one of the most important indicators of health in older adults. Studies have shown benefits of physical trainings on SWS in older adults but the impact of cognitive training and multidomain interventions remains understudied.AimsThis original study aimed at comparing the impact of aerobic/resistance exercise, computerized cognitive training and the combination of both interventions compared with active control conditions on SWS in healthy older adults.MethodsNinety community-dwelling older adults were randomly assigned to four different combinations composed of two active interventions: physical aerobic/resistance and cognitive dual-task trainings, and two active control conditions: stretching exercises and computer lessons. The four combinations were the following: (1) aerobic/resistance and cognitive dual task (nu2009=u200928), (2) aerobic/resistance and computer lessons (nu2009=u200921), (3) stretching exercises and cognitive dual task and (nu2009=u200923), (4) stretching exercises and computer lessons (nu2009=u200918). Training sessions were held three times/week for three months. SWS for 30xa0s was assessed before and after the intervention.ResultsRepeated-measures ANOVA showed a main effect of time and a significant three-way interaction suggesting differential improvement in SWS according to training combinations. A clinical meaningful improvement in SWS was observed in groups 1–3 (0.08–0.14xa0m/s; effect sizes: small to moderate) but not in the active control group 4.DiscussionResults of this study suggest that aerobic/resistance exercise and computerized dual-task training are two non-pharmacological interventions by which SWS, a functional vital sign, can be clinically improved in older adults.ConclusionThis original study pointed out different tools to prevent functional decline in older people.

Cardiovascular and cerebral hemodynamics during exercise and recovery in obese individuals as a function of their fitness status

The aim of this study was to compare cardiovascular hemodynamics and cerebral oxygenation/perfusion (COP) during and after maximal incremental exercise in obese individuals according to their aerobic fitness versus age‐matched healthy controls (AMHC). Fifty‐four middle–aged obese (OB) and 16 AMHC were recruited. Maximal cardiopulmonary function (gas exchange analysis), cardiac hemodynamics (impedance cardiography), and left frontal COP (near‐infrared spectroscopy: NIRS) were measured continuously during a maximal incremental ergocycle test. During recovery, reoxygenation/perfusion rate (ROPR: oxyhemoglobin: ΔO2Hb, deoxyhemoglobin: ΔHHb and total hemoglobin: ΔtHb; with NIRS) was also measured. Obese participants (OB, n = 54) were divided into two groups according to the median V˙O2 peak: the low‐fit obese (LF‐OB, n = 27) and the high‐fit obese (HF‐OB, n = 27). During exercise, end tidal pressure of CO2 (PETCO2), and COP (ΔO2Hb, ΔHHb and ΔtHb) did not differ between groups (OB, LF‐OB, HF‐OB, AMHC). During recovery, PETCO2 and ROPR (ΔO2Hb, ΔHHb and ΔtHb) were similar between the groups (OB, LF‐OB, HF‐OB, AMHC). During exercise and recovery, cardiac index was lower (P < 0.05) in LF‐OB versus the other two groups (HF‐OB, AMHC). As well, systolic blood pressure was higher during exercise in the OB, LF‐OB and HF‐OB groups versus AMHC (P < 0.05). When compared to AMHC, obese individuals (OB, LF‐OB, HF‐OB) have a similar cerebral vasoreactivity by CO2 and cerebral hemodynamics during exercise and recovery, but a higher systolic blood pressure during exercise. Higher fitness in obese subjects (HF‐OB) seems to preserve their cardiopulmonary and cardiac function during exercise and recovery.