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Open Access 01-12-2022 | Stroke | Research

Effect of an exercise intervention on global cognition after transient ischemic attack or minor stroke: the MoveIT randomized controlled trial

Authors: Inger A. Deijle, Roelofjan Hemmes, H. Myrthe Boss, Edwin C. de Melker, Bob T. J. van den Berg, Gert Kwakkel, Erwin van Wegen, Wendy M. Bosboom, Henry C. Weinstein, Sander M. van Schaik, Renske M. Van den Berg-Vos

Published in: BMC Neurology | Issue 1/2022

Abstract

Background

Patients with a transient ischemic attack (TIA) or ischemic stroke are at increased risk of developing cognitive impairment in the subacute phase. At present, the effects of exercise on cognitive functioning following a TIA or stroke are not fully known. The purpose of this trial was to investigate the effect of exercise on global cognition.

Methods

The MoveIT trial is a single-centre, observer-blinded, randomized controlled trial involving a 1-year exercise intervention consisting of a 12-week group exercise program, combined with three counselling visits to the physiotherapists over a 9-month period. The control group received standard care. The primary outcome was global cognitive functioning, assessed at one year, using the Montreal Cognitive Assessment (MoCA). Secondary outcomes included cardiorespiratory fitness, the cardiovascular profile, and attainment of secondary prevention targets, anxiety, depression and fatigue at one and two years.

Results

The experimental group consisted of 60 patients, while the control group consisted of 59 patients. The mean age was 64.3 years and 41% were female. No between-group differences were found on global cognitive functioning (MD, 0.7 out of 30, 95% CI, − 0.2 to 1.6) or on secondary outcome measures at 12 months. The only significant between-group difference was found for fatigue, in favour of the experimental group at 12 months (MD, 0.6 out of 63, 95% CI, 0.1 to 1.1).

Conclusions

No benefit of this exercise intervention was found regarding global cognition. Future studies need to focus on optimizing rehabilitation strategies for this vulnerable group of patients.

Trial registration

http://www.trialregister.nl. Unique identifier: NL3721.

Date first registration: 06-03-2013.

Gottesman RF, Hillis AE. Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurol. 2010;9(9):895–905. https://doi.org/10.1016/S1474-4422(10)70164-2.CrossRefPubMedPubMedCentral

Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8(11):1006–18. https://doi.org/10.1016/S1474-4422(09)70236-4.CrossRefPubMed

van Rooij FG, Kessels RP, Richard E, De Leeuw FE, van Dijk EJ. Cognitive impairment in transient ischemic attack patients: a systematic review. Cerebrovasc Dis. 2016;42(1–2):1–9. https://doi.org/10.1159/000444282.CrossRefPubMed

Ballard C, Rowan E, Stephens S, Kalaria R, Kenny RA. Prospective follow-up study between 3 and 15 months after stroke: improvements and decline in cognitive function among dementia-free stroke survivors >75 years of age. Stroke. 2003;34(10):2440–4. https://doi.org/10.1161/01.STR.0000089923.29724.CE.CrossRefPubMed

Weuve J, Kang JH, Manson JE, Breteler MM, Ware JH, Grodstein F. Physical activity, including walking, and cognitive function in older women. JAMA. 2004;292(12):1454–61. https://doi.org/10.1001/jama.292.12.1454.CrossRefPubMed

Groot C, Hooghiemstra AM, Raijmakers PG, van Berckel BN, Scheltens P, Scherder EJ, et al. The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing Res Rev. 2016;25:13–23. https://doi.org/10.1016/j.arr.2015.11.005.CrossRefPubMed

Buchman AS, Boyle PA, Yu L, Shah RC, Wilson RS, Bennett DA. Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology. 2012;78(17):1323–9. https://doi.org/10.1212/WNL.0b013e3182535d35.CrossRefPubMedPubMedCentral

Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–31.PubMedPubMedCentral

Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(8):2532–53. https://doi.org/10.1161/STR.0000000000000022.CrossRefPubMed

10.

Saunders DH, Sanderson M, Hayes S, Kilrane M, Greig CA, Brazzelli M, et al. Physical fitness training for stroke patients. Cochrane Database Syst Rev. 2016;3:CD003316. https://doi.org/10.1002/14651858.CD003316.pub6.CrossRefPubMed

11.

Oberlin LE, Waiwood AM, Cumming TB, Marsland AL, Bernhardt J, Erickson KI. Effects of physical activity on Poststroke cognitive function: a Meta-analysis of randomized controlled trials. Stroke. 2017;48(11):3093–100. https://doi.org/10.1161/STROKEAHA.117.017319.CrossRefPubMedPubMedCentral

12.

Zheng G, Zhou W, Xia R, Tao J, Chen L. Aerobic exercises for cognition rehabilitation following stroke: a systematic review. J Stroke Cerebrovasc Dis. 2016;25(11):2780–9. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.07.035.CrossRefPubMed

13.

Marzolini S, Oh P, McIlroy W, Brooks D. The effects of an aerobic and resistance exercise training program on cognition following stroke. Neurorehabil Neural Repair. 2013;27(5):392–402. https://doi.org/10.1177/1545968312465192.CrossRefPubMed

14.

Verdelho A, Madureira S, Ferro JM, Baezner H, Blahak C, Poggesi A, et al. Physical activity prevents progression for cognitive impairment and vascular dementia: results from the LADIS (Leukoaraiosis and disability) study. Stroke. 2012;43(12):3331–5. https://doi.org/10.1161/STROKEAHA.112.661793.CrossRefPubMed

15.

Boss HM, Van Schaik SM, Deijle IA, de Melker EC, van den Berg BT, Scherder EJ, et al. Safety and feasibility of post-stroke care and exercise after minor ischemic stroke or transient ischemic attack: MotiveS & MoveIT. NeuroRehabilitation. 2014;34(3):401–7. https://doi.org/10.3233/NRE-141049.CrossRefPubMed

16.

Boss HM, Van Schaik SM, Deijle IA, de Melker EC, van den Berg BT, Scherder EJ, et al. A randomised controlled trial of aerobic exercise after transient ischaemic attack or minor stroke to prevent cognitive decline: the MoveIT study protocol. BMJ Open. 2014;4(12):e007065. https://doi.org/10.1136/bmjopen-2014-007065.CrossRefPubMedPubMedCentral

17.

Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70. https://doi.org/10.1161/01.str.20.7.864.CrossRefPubMed

18.

American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription, ed 8. Baltimore: Wolters Kluwer; 2010.

19.

Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9. https://doi.org/10.1111/j.1532-5415.2005.53221.x.CrossRefPubMed

20.

Washburn RA, Smith KW, Jette AM, Janney CA. The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol. 1993;46(2):153–62. https://doi.org/10.1016/0895-4356(93)90053-4.CrossRefPubMed

21.

Schuit AJ, Schouten EG, Westerterp KR, Saris WH. Validity of the physical activity scale for the elderly (PASE): according to energy expenditure assessed by the doubly labeled water method. J Clin Epidemiol. 1997;50(5):541–6. https://doi.org/10.1016/s0895-4356(97)00010-3.CrossRefPubMed

22.

Saposnik G, Goodman SG, Leiter LA, Yan RT, Fitchett DH, Bayer NH, et al. Applying the evidence: do patients with stroke, coronary artery disease, or both achieve similar treatment goals? Stroke. 2009;40(4):1417–24. https://doi.org/10.1161/STROKEAHA.108.533018.CrossRefPubMed

23.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.CrossRefPubMed

24.

Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121–3. https://doi.org/10.1001/archneur.1989.00520460115022.CrossRefPubMed

25.

NVN. Richtlijn 'Diagnostiek, behandeling en zorg voor patienten met een beroerte. 2008. https://www.nvvcnl/media/richtlijn/13/Richtlijn%20Beroerte%20def-2009pdf25. Accessed Jan 2012.

26.

Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.CrossRef

27.

Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on exercise reporting template (CERT): explanation and elaboration statement. Br J Sports Med. 2016;50(23):1428–37. https://doi.org/10.1136/bjsports-2016-096651.CrossRefPubMed

28.

Pendlebury ST, Cuthbertson FC, Welch SJ, Mehta Z, Rothwell PM. Underestimation of cognitive impairment by Mini-mental state examination versus the Montreal cognitive assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke. 2010;41(6):1290–3. https://doi.org/10.1161/STROKEAHA.110.579888.CrossRefPubMed

29.

Sachdev PS, Brodaty H, Valenzuela MJ, Lorentz LM, Koschera A. Progression of cognitive impairment in stroke patients. Neurology. 2004;63(9):1618–23. https://doi.org/10.1212/01.wnl.0000142964.83484.de.CrossRefPubMed

30.

Popovic IM, Seric V, Demarin V. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci. 2007;257(1–2):185–93. https://doi.org/10.1016/j.jns.2007.01.029.CrossRefPubMed

31.

Ploughman M, Windle V, MacLellan CL, White N, Dore JJ, Corbett D. Brain-derived neurotrophic factor contributes to recovery of skilled reaching after focal ischemia in rats. Stroke. 2009;40(4):1490–5. https://doi.org/10.1161/STROKEAHA.108.531806.CrossRefPubMed

32.

Kamm CP, Schmid JP, Muri RM, Mattle HP, Eser P, Saner H. Interdisciplinary cardiovascular and neurologic outpatient rehabilitation in patients surviving transient ischemic attack or stroke with minor or no residual deficits. Arch Phys Med Rehabil. 2014;95(4):656–62. https://doi.org/10.1016/j.apmr.2013.10.013.CrossRefPubMed

33.

Choi HE, Kim C, Sohn Y. Cardiac rehabilitation exercise training for high-risk cardiac patients. Ann Rehabil Med. 2017;41(4):650–8. https://doi.org/10.5535/arm.2017.41.4.650.CrossRefPubMedPubMedCentral

34.

Marzolini S, Danells C, Oh PI, Jagroop D, Brooks D. Feasibility and effects of cardiac rehabilitation for individuals after transient ischemic attack. J Stroke Cerebrovasc Dis. 2016;25(10):2453–63. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.06.018.CrossRefPubMed

35.

Boss HM, Deijle IA, Van Schaik SM, de Melker EC, van den Berg BTJ, Weinstein HC, et al. Cardiorespiratory fitness after transient ischemic attack and minor ischemic stroke: baseline data of the MoveIT study. J Stroke Cerebrovasc Dis. 2017;26(5):1114–20. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.12.029.CrossRefPubMed

36.

Arwert HJ, Meesters JJL, Boiten J, Balk F, Wolterbeek R, Vliet Vlieland TPM. Poststroke depression: a long-term problem for stroke survivors. Am J Phys Med Rehabil. 2018;97(8):565–71. https://doi.org/10.1097/PHM.0000000000000918.CrossRefPubMed

37.

Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Chronic posttraumatic stress symptoms after nonsevere stroke. Neurology. 2006;66(4):513–6. https://doi.org/10.1212/01.wnl.0000194210.98757.49.CrossRefPubMed

38.

Sackley CM, Mant J, McManus RJ, Humphreys G, Sharp L, Mares K, et al. Functional and emotional outcomes after transient ischemic attack: a 12-month prospective controlled cohort study. Int J Stroke. 2019;14(5):522–9. https://doi.org/10.1177/1747493018823158.CrossRefPubMed

39.

van Rooij FG, Plaizier NO, Vermeer SE, Goraj BM, Koudstaal PJ, Richard E, et al. Subjective cognitive impairment, depressive symptoms, and fatigue after a TIA or transient neurological attack: a prospective study. Behav Neurol. 2017;2017:5181024. https://doi.org/10.1155/2017/5181024.CrossRefPubMedPubMedCentral

40.

Snaphaan L, van der Werf S, Kanselaar K, de Leeuw FE. Post-stroke depressive symptoms are associated with post-stroke characteristics. Cerebrovasc Dis. 2009;28(6):551–7. https://doi.org/10.1159/000247598.CrossRefPubMed

41.

Wu CY, Hung SJ, Lin KC, Chen KH, Chen P, Tsay PK. Responsiveness, minimal clinically important difference, and validity of the MoCA in stroke rehabilitation. Occup Ther Int. 2019;2019:2517658. https://doi.org/10.1155/2019/2517658.CrossRefPubMedPubMedCentral

42.

Tang WK, Lu JY, Chen YK, Mok VC, Ungvari GS, Wong KS. Is fatigue associated with short-term health-related quality of life in stroke? Arch Phys Med Rehabil. 2010;91(10):1511–5. https://doi.org/10.1016/j.apmr.2010.06.026.CrossRefPubMed

43.

van de Port IG, Kwakkel G, Schepers VP, Heinemans CT, Lindeman E. Is fatigue an independent factor associated with activities of daily living, instrumental activities of daily living and health-related quality of life in chronic stroke? Cerebrovasc Dis. 2007;23(1):40–5. https://doi.org/10.1159/000095757.CrossRefPubMed

Title: Effect of an exercise intervention on global cognition after transient ischemic attack or minor stroke: the MoveIT randomized controlled trial
Authors: Inger A. Deijle
Roelofjan Hemmes
H. Myrthe Boss
Edwin C. de Melker
Bob T. J. van den Berg
Gert Kwakkel
Erwin van Wegen
Wendy M. Bosboom
Henry C. Weinstein
Sander M. van Schaik
Renske M. Van den Berg-Vos
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Stroke
Published in: BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-022-02805-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of an exercise intervention on global cognition after transient ischemic attack or minor stroke: the MoveIT randomized controlled trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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