Exercise, diet, and cognition in a 4-year randomized controlled trial: Dose-Responses to Exercise Training (DR's EXTRA)

Pirjo Komulainen 1, Jaakko Tuomilehto 2 3, Kai Savonen 1 4, Reija Männikkö 1 5, Maija Hassinen 1, Timo A Lakka 1 4 6, Tuomo Hänninen 7, Vesa Kiviniemi 8, David R Jacobs 9, Miia Kivipelto 10 11, Rainer Rauramaa 1


 

Affiliations

01 June 2021

-

doi: 10.1093/ajcn/nqab018

Abstract

Background: Evidence for the effects of exercise and dietary interventions on cognition from long-term randomized controlled trials (RCTs) in large general populations remains insufficient.

Objective: The objective of our study was to investigate the independent and combined effects of resistance and aerobic exercise and dietary interventions on cognition in a population sample of middle-aged and older individuals.

Methods: We conducted a 4-y RCT in 1401 men and women aged 57-78 y at baseline. The participants were randomly assigned to the resistance exercise, aerobic exercise, diet, combined resistance exercise and diet, combined aerobic exercise and diet, or control group. Exercise goals were at least moderate-intensity resistance exercise ≥2 times/wk and at least moderate-intensity aerobic exercise ≥5 times/wk. Dietary goals were ≥400 g/d of vegetables, fruit, and berries; ≥2 servings of fish/wk; ≥14 g fiber/1000 kcal; and ≤10% of energy of daily energy intake from SFAs. The primary outcome was the change in global cognition measured by the total score of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological tests [CERAD total score (CERAD-TS)]. The data were analyzed using the intention-to-treat principle and linear mixed-effects models.

Results: There was a trend toward improved CERAD-TS over 4 y in the combined aerobic exercise and diet group compared with the control group (net increase: 1.4 points; 95% CI: 0.1, 2.7; P = 0.06) adjusted for age, sex, years of education, symptoms of depression, and waist circumference at baseline. No other differences in CERAD-TS changes were found across the 6 study groups. Diet did not potentiate the effect of aerobic or resistance exercise on CERAD-TS.

Conclusions: A combination of at least moderate-intensity aerobic exercise and a healthy diet may improve cognition in older individuals over 4 y, but there was no effect of either of these interventions alone, resistance training alone, or resistance exercise with a healthy diet on cognition.

Keywords: aerobic exercise; cognitive function; healthy diet; older individuals; resistance exercise.

References

  1.  
    1. Barnes DE, Santos-Modesitt W, Poelke G, Kramer AF, Castro C, Middleton LE, Yaffe K. The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. JAMA Intern Med. 2013;173:797–804. - PMC - PubMed
  2.  
    1. Cassillhas RC, Viana VA, Grassman V, Santos RT, Santos RF, Tufik S, Mello MT. The impact of resistance exercise on the cognitive function of the elderly. Med Sci Sports Exerc. 2007;39:1401–7. - PubMed
  3.  
    1. Napoli N, Shah K, Waters DL, Sinacore DR, Qualls C, Villareal DT. Effect of weight loss, exercise, or both on cognition and quality of life in obese older adults. Am J Clin Nutr. 2014;100:189–98. - PMC - PubMed
  4.  
    1. van Uffelen JG, Chin A, Paw MJ, Hopman-Rock M, van Mechelen W. The effects of exercise on cognition in older adults with and without cognitive decline: a systematic review. Clin J Sport Med. 2008;18:486–500. - PubMed
  5.  
    1. Young J, Angevaren M, Rusted J, Tabet N. Aerobic exercise to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev. 2015;4:CD005381. - PubMed
  6.  
    1. Brasure M, Desai P, Davila H, Nelson VA, Calvert C, Jutkowitz E, Butler M, Flink HA, Ratner E, Hemmy LSet al. . Physical activity interventions in preventing cognitive decline and Alzheimer-type dementia: a systematic review. Ann Intern Med. 2018;168:30–8. - PubMed
  7.  
    1. Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C, Brennan S. The impact of exercise on the cognitive functioning of healthy older adults: a systematic review and meta-analysis. Ageing Res Rev. 2014;16:12–31. - PubMed
  8.  
    1. Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92:1189–96. - PubMed
  9.  
    1. Lourida I, Soni M, Thompson-Coon J, Purandare N, Lang IA, Ukoumunne OC, Llewellyn DJ. Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology. 2013;24:479–89. - PubMed
  10.  
    1. van de Rest O, Berendsen AA, Haveman-Nies A, de Groot LC. Dietary patterns, cognitive decline, and dementia: a systematic review. Adv Nutr. 2015;6:154–68. - PMC - PubMed
  11.  
    1. Solfrizzi V, Custodero C, Lozupone M, Imbimbo BP, Valiani V, Agosti P, Schilardi A, D'Introno A, La Montagna M, Calvani Met al. . Relationships of dietary patterns, foods, and micro- and macronutrients with Alzheimer's disease and late-life cognitive disorders: a systematic review. J Alzheimer's Dis. 2017;59:815–49. - PubMed
  12.  
    1. Loughrey DG, Lavecchia S, Brennan S, Lawlor BA, Kelly ME. The impact of the Mediterranean diet on the cognitive functioning of healthy older adults: a systematic review and meta-analysis. Adv Nutr. 2017;8:571–86. - PMC - PubMed
  13.  
    1. Martinez-Lapiscina EH, Clavero P, Toledo E, Estruch R, Salas-Salvado J, San Julian B, Sanchez-Tainta A, Ros E, Valls-Pedret C, Martinez-Gonzalez MA. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. J Neurol Neurosurg Psychiatry. 2013;84:1318–25. - PubMed
  14.  
    1. Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martinez-Gonzalez MA, Martinez-Lapiscina EH, Fito M, Perez-Heras A, Salas-Salvado Jet al. . Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med. 2015;175:1094–103. - PubMed
  15.  
    1. Knight A, Bryan J, Wilson C, Hodgson JM, Davis CR, Murphy KJ. The Mediterranean diet and cognitive function among healthy older adults in a 6-month randomised controlled trial: the MedLey Study. Nutrients. 2016;8(9):E579. - PMC - PubMed
  16.  
    1. Smith PJ, Blumenthal JA, Hoffman BM, Cooper H, Strauman TA, Welsh-Bohmer K, Browndyke JN, Sherwood A. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med. 2010;72:239–52. - PMC - PubMed
  17.  
    1. Ngandu T, Lehtisalo J, Solomon A, Levalahti E, Ahtiluoto S, Antikainen R, Backman L, Hanninen T, Jula A, Laatikainen Tet al. . A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet North Am Ed. 2015;385:2255–63. - PubMed
  18.  
    1. Snowden M, Steinman L, Mochan K, Grodstein F, Prohaska TR, Thurman DJ, Brown DR, Laditka JN, Soares J, Zweiback DJet al. . Effect of exercise on cognitive performance in community-dwelling older adults: review of intervention trials and recommendations for public health practice and research. J Am Geriatr Soc. 2011;59:704–16. - PubMed
  19.  
    1. Howley ET. Type of activity: resistance, aerobic and leisure versus occupational physical activity. Med Sci Sports Exerc. 2001;33(6 Suppl):20. - PubMed
  20.  
    1. American Diabetes Association; Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, Hoogwerf BJ, Lichtenstein AH, Mayer-Davis E, Mooradian ADet al. . Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31(Suppl 1):61–78. - PubMed
  21.  
    1. Morris J, Heyman A, Mohs R, Hughes J, van Belle G, Fillenbaum G, Mellits ED, Clark C. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology. 1989;39:1159–65. - PubMed
  22.  
    1. Chandler MJ, Lacritz LH, Hynan LS, Barnard HD, Allen G, Deschner M, Weiner MF, Cullum CM. A total score for the CERAD neuropsychological battery. Neurology. 2005;65:102–6. - PubMed
  23.  
    1. Lakka TA, Venalainen JM, Rauramaa R, Salonen R, Tuomilehto J, Salonen JT. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction. N Engl J Med. 1994;330:1549–54. - PubMed
  24.  
    1. Taylor HL, Jacobs DR Jr, Schucker B, Knudsen J, Leon AS, Debacker G. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis. 1978;31:741–55. - PubMed
  25.  
    1. Hakola L, Hassinen M, Komulainen P, Lakka TA, Savonen K, Rauramaa R. Correlates of low physical activity levels in aging men and women: the DR's EXTRA study (ISRCTN45977199). J Aging Phys Act. 2015;23:247–55. - PubMed
  26.  
    1. Kouki R, Schwab U, Lakka TA, Hassinen M, Savonen K, Komulainen P, Krachler B, Rauramaa R. Diet, fitness and metabolic syndrome—the DR's EXTRA study. Nutr Metab Cardiovasc Dis. 2012;22(7):553–60. - PubMed
  27.  
    1. Pietinen P, Hartman AM, Haapa E, Rasanen L, Haapakoski J, Palmgren J, Albanes D, Virtamo J, Huttunen JK. Reproducibility and validity of dietary assessment instruments. I. A self-administered food use questionnaire with a portion size picture booklet. Am J Epidemiol. 1988;128:655–66. - PubMed
  28.  
    1. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.
  29.  
    1. Rauramaa R, Halonen P, Vaisanen SB, Lakka TA, Schmidt-Trucksass A, Berg A, Penttila IM, Rankinen T, Bouchard C. Effects of aerobic physical exercise on inflammation and atherosclerosis in men: the DNASCO study: a six-year randomized, controlled trial. Ann Intern Med. 2004;140:1007–14. - PubMed
  30.  
    1. Twisk J, Bosman L, Hoekstra T, Rijnhart J, Welten M, Heymans M. Different ways to estimate treatment effects in randomised controlled trials. Contemp Clin Trials Commun. 2018;10:80–5. - PMC - PubMed
  31.  
    1. Cumming G, Finch S. A primer on the understanding, use, and calculation of confidence intervals that are based on central and noncentral distributions. Educ Psychol Meas. 2001;61:532.
  32.  
    1. Benjamini Y, Krieger AM, Yekutieli D. Adaptive linear step-up procedures that control the false discovery rate. Biometrika. 2006;93:491–507.
  33.  
    1. Stevens JR, Al Masud A, Suyundikov A. A comparison of multiple testing adjustment methods with block-correlation positively-dependent tests. PLoS One. 2017;12:e0176124. - PMC - PubMed
  34.  
    1. Barha CK, Davis JC, Falck RS, Nagamatsu LS, Liu-Ambrose T. Sex differences in exercise efficacy to improve cognition: a systematic review and meta-analysis of randomized controlled trials in older humans. Front Neuroendocrinol. 2017;46:71–85. - PubMed
  35.  
    1. Muscari A, Giannoni C, Pierpaoli L, Berzigotti A, Maietta P, Foschi E, Ravaioli C, Poggiopollini G, Bianchi G, Magalotti Det al. . Chronic endurance exercise training prevents aging-related cognitive decline in healthy older adults: a randomized controlled trial. Int J Geriat Psychiatry. 2009;25:1055–64. - PubMed
  36.  
    1. Lehtisalo J, Lindstrom J, Ngandu T, Kivipelto M, Ahtiluoto S, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Eriksson JG, Uusitupa M, Tuomilehto Jet al. . Association of long-term dietary fat intake, exercise, and weight with later cognitive function in the Finnish Diabetes Prevention Study. J Nutr Health Aging. 2016;20:146–54. - PubMed
  37.  
    1. Woodside JV, Gallagher NE, Neville CE, McKinley MC. Mediterranean diet interventions to prevent cognitive decline—opportunities and challenges. Eur J Clin Nutr. 2014;68:1241–4. - PubMed
  38.  
    1. McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67:267–77. - PMC - PubMed
  39.  
    1. Waters L, Reeves M, Fjeldsoe B, Eakin E. Control group improvements in physical activity intervention trials and possible explanatory factors: a systematic review. J Phys Act Health. 2012;9:884–95. - PubMed
  40.  
    1. US Department of Health and Human Services . Physical activity and health: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
  41.  
    1. Krauss RM, Deckelbaum RJ, Ernst N, Fisher E, Howard BV, Knopp RH, Kotchen T, Lichtenstein AH, McGill HC, Pearson TAet al. . Dietary guidelines for healthy American adults. A statement for health professionals from the Nutrition Committee, American Heart Association. Circulation. 1996;94:1795–800. - PubMed
  42.  
    1. Shim JS, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiol Health. 2014;36:e2014009. - PMC - PubMed
  43.  
    1. Paajanen T, Hanninen T, Tunnard C, Mecocci P, Sobow T, Tsolaki M, Vellas B, Lovestone S, Soininen H; AddNeuroMed Consortium . CERAD neuropsychological battery total score in multinational mild cognitive impairment and control populations: the AddNeuroMed study. J Alzheimer's Dis. 2011;22:1089–97. - PubMed
  44.  
    1. Calamia M, Markon K, Tranel D. Scoring higher the second time around: meta-analyses of practice effects in neuropsychological assessment. Clin Neuropsychol. 2012;26:543–70. - PubMed
  45.  
    1. Brookmeyer R, Gray S, Kawas C. Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset. Am J Public Health. 1998;88:1337–42. - PMC - PubMed

Page Navigation