Aerobic dance training maintains cognition in older people with CSVD

A rater-blind randomized trial conducted by the Chinese University of Hong Kong (CUHK) in collaboration with the Hong Kong Polytechnic University and BrainNow Research Institute in Shenzhen, China, has found that regular aerobic exercise led to pulse and blood pressure (BP) reductions as well as maintenance of global cognition in older people with moderate to severe subclinical cerebral small vessel disease (CSVD).

“Age and high BP are the two most important interrelated aetiological risk factors for CSVD, which in its severe form increases the risk of incident dementia,” wrote the researchers. [Alzheimers Dement 2016;12:1167‐1176; Lancet Neurol 2010;9:689‐701] “Ideally, intervention should target the subclinical stage for prevention of disabling events.”

The CU–AEROBIC (The Chinese University of Hong Kong–Aerobic Exercise in Older People with Subclinical SporadIc CSVD) study was a rater‐blind randomized controlled trial (RCT) exploring the short‐term (ie, 24 weeks) effects of aerobic dance training (ADT) on clinical (cognition, mood, motor functions) and haemodynamic measures in patients with subclinical sporadic CSVD. ADT participants practiced a dance led by a physiotherapist once per week for the first 2 months and twice per week between months 3 and 6. Participants in the control group received a weekly 3‐hour group‐based programme consisting of stretching exercises and health education. [Alzheimers Dement (N Y) 2021;doi:10.1002/trc2.12224]

Final analysis included 49 participants in the ADT group and 48 in the control group. There was no difference in any of the demographics (mean age, 76.1 years vs 75.2 years; female, 64.8 percent vs 67.9 percent; education years, 7.9 vs 8.3), medical history, imaging features, and baseline outcome measures between the ADT and control groups.

While there was no significant between‐group difference in the primary endpoint of cognitive change from baseline at week 24 or at other time points, several notable changes were found in secondary and tertiary outcomes.

“Between‐group comparisons of haemodynamic measures showed a significant reduction from baseline in systolic BP in the ADT group [p=0.038] and a trend favouring the ADT group in reduction of pulse pressure [PP] from baseline [p=0.055] vs the control group,” reported the researchers. The ADT-associated change in PP became significant (p=0.047) at week 24 and persisted until week 36 (p=0.021, per protocol).

Performance in all memory subdomains (verbal learning, verbal delayed recall, recognition memory, nonverbal delayed recall) showed significant improvement at weeks 12, 24 and 36 for both groups, while the language domain improved significantly only for the ADT group (at weeks 24 and 36).

“We observed that a greater reduction in PP/systolic BP [which was reported in the ADT group] was associated with greater improvement in memory functions and global cognition. Taken together, these findings suggest that among older people with advanced CSVD, the prescribed ADT may reduce aortic stiffness, thereby conferring benefits upon certain cognitive functions,” commented the researchers.

“Intriguingly, the reduction in PP/systolic BP was associated with worsening in processing speed in the ADT group,” reported the researchers. “The exact mechanisms explaining this lack of improvement in processing speed and the diverging impacts of a reduction in PP/systolic BP on different cognitive domains are unknown. On one hand, reduction in PP/systolic BP may improve cognition because of a reduction in pulsatile flow or improved endothelial functions, but on the other, it may lead to reduced cerebral perfusion if there is impaired cerebral autoregulation, which could have been present in our subjects.”