Synergistic Benefits of Combined Aerobic and Cognitive Training on Fluid Intelligence and the Role of IGF-1 in Chronic Stroke

Author:

Ploughman Michelle1ORCID,Eskes Gail A.2,Kelly Liam P.1,Kirkland Megan C.1,Devasahayam Augustine J.1,Wallack Elizabeth M.1,Abraha Beraki1,Hasan S. M. Mahmudul1,Downer Matthew B.1,Keeler Laura2,Wilson Graham2,Skene Elaine2,Sharma Ishika2,Chaves Arthur R.1,Curtis Marie E.1ORCID,Bedford Emily2,Robertson George S.2,Moore Craig S.1,McCarthy Jason1,Mackay-Lyons Marilyn2

Affiliation:

1. Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada

2. Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada

Abstract

Background. Paired exercise and cognitive training have the potential to enhance cognition by “priming” the brain and upregulating neurotrophins. Methods. Two-site randomized controlled trial. Fifty-two patients >6 months poststroke with concerns about cognitive impairment trained 50 to 70 minutes, 3× week for 10 weeks with 12-week follow-up. Participants were randomized to 1 of 2 physical interventions: Aerobic (>60% VO2peak using <10% body weight–supported treadmill) or Activity (range of movement and functional tasks). Exercise was paired with 1 of 2 cognitive interventions (computerized dual working memory training [COG] or control computer games [Games]). The primary outcome for the 4 groups (Aerobic + COG, Aerobic + Games, Activity + COG, and Activity + Games) was fluid intelligence measured using Raven’s Progressive Matrices Test administered at baseline, posttraining, and 3-month follow-up. Serum neurotrophins collected at one site (N = 30) included brain-derived neurotrophic factor (BDNF) at rest (BDNFresting) and after a graded exercise test (BDNFresponse) and insulin-like growth factor–1 at the same timepoints (IGF-1rest, IGF-1response). Results. At follow-up, fluid intelligence scores significantly improved compared to baseline in the Aerobic + COG and Activity + COG groups; however, only the Aerobic + COG group was significantly different (+47.8%) from control (Activity + Games −8.5%). Greater IGF-1response at baseline predicted 40% of the variance in cognitive improvement. There was no effect of the interventions on BDNFresting or BDNFresponse; nor was BDNF predictive of the outcome. Conclusions. Aerobic exercise combined with cognitive training improved fluid intelligence by almost 50% in patients >6 months poststroke. Participants with more robust improvements in cognition were able to upregulate higher levels of serum IGF-1 suggesting that this neurotrophin may be involved in behaviorally induced plasticity.

Funder

Heart and Stroke Foundation Canadian Partnership for Stroke Recovery

Dalhousie University Faculty of Health Professions Innovation Fund

Newfoundland & Labrador Research and Development Corporation

Canada Foundation for Innovation

Nova Scotia Health Research Foundation

Canada Research Chairs

Capital Health Research Foundation

Publisher

SAGE Publications

Subject

General Medicine

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