Journal-Based CME ArticleAerobic Exercise to Improve Cognitive Function in Adults With Neurological Disorders: A Systematic Review
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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
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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.
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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.
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- 2.
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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.
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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.