Combining Exercise and Cognitive Training to Improve Everyday Function (EXACT)

The purpose of this randomized, controlled, prospective study is to evaluate the benefits of combining aerobic exercise with cognitive training for optimizing cognitive function. The study will enroll 109 men and women, age 55-75 years who are in stable health and without contraindications to exercise or evidence of dementia or cognitive impairment. Individuals will be randomly assigned to one of four groups for six months: Aerobic Exercise and Health Education, Home Exercise and Cognitive Training, Aerobic Exercise and Cognitive Training, and Home Exercise and Health Education. Participants will undergo measurements of cognitive function, physical performance, and complete questionaires about daily activities, physical activity, and quality of life at baseline (pre-intervention), and at 6 and 12 months after baseline.

Study Overview

• Status: Completed
• Conditions: Effect of Exercise on Cognitive Function
• Intervention / Treatment: Behavioral: Intensive Exercise; Behavioral: Cognitive Training; Behavioral: Health Education; Behavioral: Home Exercise

• Study Type: Interventional
• Enrollment (Actual): 96
• Phase: Phase 3

Contacts and Locations

Study Locations

• United States
  • Missouri
    • St. Louis, Missouri, United States, 63108
      • Washington University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• age 55-75 years (inclusive)
• English-speaking
• sufficient visual and auditory perception to complete testing
• available informant (someone who knows the individual well)
• Clinical Dementia Rating of 0 (non-demented per the screening assessment).

Exclusion Criteria:

• participation in a regular exercise program in last 6 months
• participation in a cognitive training program in last 6 months
• inability to walk on a treadmill or ride an exercise bike
• less than a 10th grade education
• mild cognitive impairment or dementia
• cigarette smoking within the previous year
• history of alcohol or substance abuse
• BMI greater than 35
• insulin-dependent diabetes

• major and/or unstable medical, neurological, or psychiatric disorder, including:

  • active congestive heart failure
  • unstable angina
  • effort angina
  • nocturnal angina
  • MI within previous 6 months
  • ECG evidence of serious arrhythmias and/or acute myocardial ischemia reflected by ST-segment depression of 0.3 mm
  • resting blood pressure above 170 systolic or 100 diastolic
  • chronic infections
  • advanced arthritis
  • contractures or weakness due to CVA that would prevent adequate performance of the exercises.
  • disabling stroke
  • late stage renal or liver disease
  • major affective disorder with active symptoms

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Combined; Aerobic Exercise + Cognitive Training	Behavioral: Intensive Exercise; Standardized aerobic training program that is individualized to each participant's fitness level, and supervised by a certified exercise specialist. Participants attend 3 training sessions per week for 6 months. The session begins with a 10-15 minute warm-up. Participants then exercise on a treadmill or stationary bike, followed by "cool-down" activities. Heart rate and rating of perceived exertion are used to evaluate exercise intensity. Participants begin at ~30 min/day 60-70% of HR max and/or an equivalent level of RPE, and progress to 45-50 minutes at 75-85% for HR max.; Behavioral: Cognitive Training; Computer-based training that is is administered 3 days per week for 8 weeks during months 5 and 6. The training program focuses on 3 types of cognitive processes: task coordination, prospective memory, and retrospective memory retrieval. One day of the week is devoted to each of the three cognitive processes. Some training sessions include a homework assignment for application and practice of the target cognitive processes in everyday activities.
Experimental: Exercise; Aerobic Exercise + Health Education	Behavioral: Intensive Exercise; Standardized aerobic training program that is individualized to each participant's fitness level, and supervised by a certified exercise specialist. Participants attend 3 training sessions per week for 6 months. The session begins with a 10-15 minute warm-up. Participants then exercise on a treadmill or stationary bike, followed by "cool-down" activities. Heart rate and rating of perceived exertion are used to evaluate exercise intensity. Participants begin at ~30 min/day 60-70% of HR max and/or an equivalent level of RPE, and progress to 45-50 minutes at 75-85% for HR max.; Behavioral: Health Education; Weekly educational sessions are administered during months 5 and 6, conducted at the recreational center by research staff. Sessions last 1 hour, and cover health and other topics unrelated to exercise or cognition, such as nutrition, hearing loss, stroke, and saving energy in one's home. At the completion of each session, participants are given a "homework" assignment.
Experimental: Cognitive; Home Exercise + Cognitive Training	Behavioral: Cognitive Training; Computer-based training that is is administered 3 days per week for 8 weeks during months 5 and 6. The training program focuses on 3 types of cognitive processes: task coordination, prospective memory, and retrospective memory retrieval. One day of the week is devoted to each of the three cognitive processes. Some training sessions include a homework assignment for application and practice of the target cognitive processes in everyday activities.; Behavioral: Home Exercise; Exercise program consisting of stretching, range of motion, and simple yoga exercises designed to improve flexibility. Each participant has a 60-minute sessions with an exercise trainer to teach them how to perform the exercises correctly. They are also given diagrams illustrating the exercises, along with written instructions. They are instructed to perform these exercises at home at least 3 times per week for 30 - 45 minutes. They also go to the recreational center monthly to meet with an exercise trainer to ensure that they are doing the exercises correctly. Participants record their exercise activities on a calendar for the 6 months.
Experimental: Control; Home Exercise + Health Education	Behavioral: Health Education; Weekly educational sessions are administered during months 5 and 6, conducted at the recreational center by research staff. Sessions last 1 hour, and cover health and other topics unrelated to exercise or cognition, such as nutrition, hearing loss, stroke, and saving energy in one's home. At the completion of each session, participants are given a "homework" assignment.; Behavioral: Home Exercise; Exercise program consisting of stretching, range of motion, and simple yoga exercises designed to improve flexibility. Each participant has a 60-minute sessions with an exercise trainer to teach them how to perform the exercises correctly. They are also given diagrams illustrating the exercises, along with written instructions. They are instructed to perform these exercises at home at least 3 times per week for 30 - 45 minutes. They also go to the recreational center monthly to meet with an exercise trainer to ensure that they are doing the exercises correctly. Participants record their exercise activities on a calendar for the 6 months.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Memory for Medical Information	This task measures the ability of the individual to learn and recall complex medical information, and the source of the information.	Change in memory task performance between baseline and 6 months
Cooking Breakfast task	Participants engage in a computerized laboratory simulation of a cooking task to assesses cognitive dimensions of planning, prospective memory, monitoring the progress of ongoing activity, anticipating potential problems, task switching, and task coordination.	Change in task performance between baseline and 6 months
Virtual Week task	Participants engage a computerized board game that simulates choices about, and recall of, daily and weekly activities.	Change in task performance between baseline and 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Activities of Daily Living--Yale Physical Activity Scale (YPAS)	Questionnaire that objectively measures frequency and time spent per week performing common physical activities, which are used to caculate total weekly metabolic work (KCals).	Baseline, Month 3, Month 6, Month 12
Uniform Data Set (UDS)	A standardized interview to ascertain and assess demographic information, health status, cognitive status, medications, and functional status. The interview is conducted with the research participant and a collateral source historian.	Baseline, Month 12
Geriatric Depression Scale	A 15-item questionnaire to assess for symptoms of depression.	Baseline, Month 12
Late Life Function & Disability Index (LLFDI)	A standardized questionnaire to assess performance of activities of daily living (ADLs) and the level of difficulty experienced while performing each activity.	Baseline, Month 6, Month 12
Pittsburgh Sleep Quality Index (PSQI)	Questionnaire to assess sleep quality and events in the prior month. Includes a section for roommate/bed partner response.	Baseline, Month 6, Month 12
Objective Physical Performance Tests	Physical Performance Test, Senior Fit Test, Dual Task Walking Speed. These tests objectively measure walking speed, muscle strength, balance, and coordination.	Baseline, Month 6
Prospective and Retrospective Memory Questionnaire (PMRQ)	Objective questionnaires to measure ability to learn and recall information.	Baseline, Month 6, Month 12
Peak Aerobic Power	The participant walks on a treadmill, with a progressively increased grade (level of incline)over a 8-15 minute period, with continuous measurements of expired oxygen and carbon dioxide. Information obtained is used to measure the total amount of work that the person performs during the test. The participant has continuous ECG monitoring during the test.	Baseline, Month 6
Cognitive assessment battery	Array of cognitive tasks to assess performance in a variety of areas. Includes Stroop (response time and attentional control), Trials A/B (sequencing), Crossing Off (motor control), Logical Memory (story recall), and Digit Symbol (corresponding symbols to digits).	Baseline, Month 6, Month 12

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: St. Louis Jewish Community Center; St. Louis Naturally Occurring Retirement Community (NORC)
• Investigators: Principal Investigator: Ellen Binder, MD, Washington University School of Medicine

Study record dates

Study Major Dates

• Study Start: March 1, 2010
• Primary Completion (Actual): August 1, 2012
• Study Completion (Actual): June 1, 2013

Study Registration Dates

• First Submitted: May 2, 2012
• First Submitted That Met QC Criteria: May 18, 2012
• First Posted (Estimate): May 23, 2012

Study Record Updates

• Last Update Posted (Estimate): September 3, 2014
• Last Update Submitted That Met QC Criteria: August 29, 2014
• Last Verified: August 1, 2014

More Information

Terms related to this study

• Keywords: memory; adult; exercise; cognition
• Other Study ID Numbers: 201102416; 1R01AG034581-01 (U.S. NIH Grant/Contract)