Journal-Based CME Article
Aerobic Exercise to Improve Cognitive Function in Adults With Neurological Disorders: A Systematic Review

https://doi.org/10.1016/j.apmr.2011.01.021Get rights and content

Abstract

McDonnell MN, Smith AE, Mackintosh SF. Aerobic exercise to improve cognitive function in adults with neurological disorders: a systematic review.

Objective

To evaluate whether aerobic exercise improves cognition in adults diagnosed with neurologic disorders.

Data Sources

The Cochrane Central Register of Controlled Clinical Trials, MEDLINE, CINAHL, PubMed, EMBASE, PEDro, AMED, SPORTDiscus, PsycINFO, ERIC, and Google Scholar, with the last search performed in December 2010.

Study Selection

We included controlled clinical trials and randomized controlled trials with adults diagnosed with a neurologic disorder. Studies were included if they compared a control group with a group involved in an aerobic exercise program to improve cardiorespiratory fitness and if they measured cognition as an outcome.

Data Extraction

Two reviewers independently extracted data and methodologic quality of the included trials.

Data Synthesis

From the 67 trials reviewed, a total of 7 trials, involving 249 participants, were included. Two trials compared the effectiveness of yoga and aerobic exercise in adults with multiple sclerosis. Two trials evaluated the effect of exercise on patients with dementia, and 2 trials evaluated the effectiveness of exercise to improve cognition after traumatic brain injury. One trial studied the effect of a cycling program in people with chronic stroke. Lack of commonality between measures of cognition limited meta-analyses. Results from individual studies show that aerobic exercise improved cognition in people with dementia, improved attention and cognitive flexibility in patients with traumatic brain injury, improved choice reaction time in people with multiple sclerosis, and enhanced motor learning in people with chronic stroke.

Conclusions

There is limited evidence to support the use of aerobic exercise to improve cognition in adults with neurologic disorders. Of the 67 studies retrieved, less than half included cognition as an outcome, and few studies continued the aerobic exercise program long enough to be considered effective. Further studies investigating the effect of aerobic exercise interventions on cognition in people with neurologic conditions are required.

Section snippets

Program Overview

Cognitive deficits affect a significant proportion of persons following stroke or traumatic brain injury as well as patients with Parkinson's disease. Cognitive deficits are known to have a negative effect on response to rehabilitation, social functioning and independence. Despite the prevalence of cognitive deficits in neurological disorders there is no established treatment, although there is some evidence that cognitive therapy may be useful in the rehabilitation of attention and

Accreditation Statement

This journal-based activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint-sponsorship of the Elsevier Office of Continuing Medical Education (EOCME) and the Archives of Physical Medicine and Rehabilitation. The EOCME is accredited by the ACCME to provide continuing medical education (CME) for physicians.

Credit Designation Statement

The EOCME designates this journal-based activity for a maximum of 3.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other health care professionals completing continuing education credit for this activity will be issued a certificate of participation.

Educational Objectives

To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  • 1.

    Recognize that cognitive impairment is common in patients with neurological disorders and that it negatively impacts rehabilitation, social functioning and independence

  • 2.

    Summarize the emerging evidence that supports the value of increasing physical activity on cognitive function

  • 3.

    Measure cognitive abilities and physical activity levels in adults with neurological

Planning Committee

Michelle N. McDonnell, PhD; Ashleigh E. Smith, BSc; Shylie F. Mackintosh, PhD; Leighton Chan, MD, MPH; Tania Dickson, PhD.

Faculty Profiles & Disclosure Information

As a sponsor accredited by the ACCME, it is the policy of the EOCME to require the disclosure of anyone who is in a position to control the content of an educational activity. All relevant financial relationships with any commercial interests and/or manufacturers must be disclosed to participants at the beginning of each activity. The faculty of this educational activity discloses the following:

Michelle N. McDonnell, PhD

NHMRC Research Fellow

Sansom Institute for Health Research

Division of Health Sciences

University of South Australia

Adelaide, South Australia, Australia

Disclosures: Has nothing to disclose.

Ashleigh E. Smith, BSc

Doctoral Candidate

Robinson Institute

The University of Adelaide

Adelaide, South Australia, Australia

Disclosures: Has nothing to disclose.

Shylie F. Mackintosh, PhD

Senior Lecturer

Sansom Institute for Health Research

Division of Health Sciences

University of South Australia

Adelaide, South Australia, Australia

Disclosures: Has nothing to disclose.

Leighton Chan, MD, MPH

Deputy Editor

Archives of Physical Medicine and Rehabilitation

Bethesda, MD.

Disclosures: Has nothing to disclose.

EOCME STAFF

Tania Dickson, PhD

Disclosures: Has nothing to disclose.

Resolution of Conflict of Interest

The EOCME has implemented a process to resolve conflict of interest for each CME activity. In order to help ensure content objectivity, independence, and fair balance, and to ensure that the content is aligned with the interest of the public, the EOCME has resolved the conflict by external content review.

Unapproved/Off-Label Use Disclosure

The EOCME requires CME faculty to disclose to the participants:

  • 1.

    When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and

  • 2.

    Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Faculty may discuss information about pharmaceutical agents that is outside of FDA-approved labeling. This

Intended Audience

This program is intended for physicians and healthcare professionals responsible for the comprehensive care for individuals with chronic illness and disabilities.

Method of Participation

In order to claim credit, participants must complete the following:

  • 1.

    Pre-activity self-assessment questions

  • 2.

    Read the activity

  • 3.

    Complete the CME Test and Evaluation. Participants must achieve a score of 70% on the CME Test.

Participants can complete the pre-activity self-assessment and CME Test and Evaluation online by logging-on to www.elsevierocme.com/910472-3. Upon successful completion of the online tests and evaluation form, you can instantly download and print your certificate of credit.

To

CME Inquiries

For all CME certificate inquiries, please contact us at [email protected].

Release Date of Activity: July 2011

Expiration Date of Activity for

AMA PRA Credit: June 30, 2012

Estimated Time to Complete This Activity: 3.0 hours

Rationale for Review

Cognitive deficits affect up to two thirds of people after stroke,8 and this is known to have a negative effect on response to rehabilitation, social functioning, and independence.9 A recent report found that 33% of adults with TBI have impaired cognitive function on discharge from the hospital, although this does recover to some extent in the first year after the injury.10 Other neurodegenerative diseases such as Parkinson's disease and multiple sclerosis result in significant cognitive

Search Strategy

The search strategy, created in consultation with a medical librarian, combined Medical Subject Headings and key terms to find studies that incorporated all 3 aspects of our question: exercise, cognition, and neurologic disorders. We searched the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, CINAHL, PubMed, EMBASE, PEDro, AMED, SPORTDiscus, PsycINFO, ERIC, and Google Scholar with no date limits. The last search was performed in December 2010. We hand-searched relevant

Identification and Selection of Studies

A total of 1731 abstracts were identified from preliminary searching. Two reviewers (M.N.M., A.E.S.) disregarded obviously irrelevant trials from the abstract or the title. This left 67 potentially relevant trials (fig 1). The most common reasons for exclusion were that the exercise duration was not sufficient to improve cardiorespiratory fitness (ie, more than 1 session a week for at least 4 weeks), the patient population was poorly defined, or the study was not a controlled trial. After

Discussion

Despite the strong evidence to suggest that exercise can improve cognition in healthy older adults1 and in those with cognitive impairment,15, 26 there is insufficient evidence to support the use of exercise to improve cognition in those with cerebral neurologic deficits. The articles included in this review provide some evidence for aerobic exercise to improve speed of information processing, global cognition, attention, and cognitive flexibility; these significant findings are the result of

Conclusions

The results from this review provide limited evidence from individual studies that aerobic exercise interventions to improve cardiorespiratory fitness can improve cognition in adults with neurologic disorders such as TBI, MS, and dementia. Lack of commonality between measures of cognition limited meta-analyses. Although at present there is insufficient evidence to suggest that aerobic exercise can improve multiple measures of cognition in these populations, it is because of the limited number

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  • Cited by (0)

    M.N.M. is supported by a National Health and Medical Research Council Research Training Fellowship (grant no. 570133). This work is supported by a grant from the Australian Technology Network Centre for Metabolic Fitness (grant no. ATN-CMF 0054-2009).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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