Accelerated Age-related Cognitive Decline: Impact of Exercise on Executive Function and Neuroplasticity

Purpose

The purpose of this study is to see if 6 months of home-based walking will improve memory, and brain structure and function, compared to health education in older adults that have chronic kidney disease and mild cognitive impairment.

Conditions

  • Mild Cognitive Impairment
  • Chronic Kidney Diseases

Eligibility

Eligible Ages
Over 55 Years
Eligible Sex
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • • Diagnosed stage 3-4 chronic kidney disease (CKD, estimated glomerular filtration rate (eGFR) <60 to 20 ml/min); - >55 yrs of age - Mild cognitive impairment (18-26 on the MOCA) - ability to undergo an MR - no history of major head trauma (No head trauma/concussion with loss of consciousness) - Speaks, reads, writes English

Exclusion Criteria

  • • Diagnosed Dementia or a Clinical Dementia Rating Scale score of <2, or a MOCA of <18 - Participating in a supervised exercise program with intent to increase fitness levels 3 days/week, - Requires assistive ambulation - Limited exercise capacity due to claudication; unstable angina, severe arthritis, extreme dyspnea on exertion, unstable coronary artery disease - Class III-IV heart failure - History of uncontrolled sustained arrhythmias, severe/symptomatic aortic or mitral stenosis, hypertrophic obstructive cardiomyopathy, severe pulmonary hypertension, active myocarditis/pericarditis, thrombophlebitis, and recent systemic/pulmonary embolus - Resting systolic BP >200 mmHg or resting diastolic BP >110 mmHg - Any unforeseen illness or disability that would preclude cognitive testing or exercise training - One or more contraindication for MRI; cardiac pacemaker, aneurysm clip, cochlear implants, shrapnel, history of metal fragments in eyes, neurostimulators, diagnosed claustrophobia (MRI only) - Any self-reported major psychiatric disorders requiring medical therapy (e.g. schizophrenia, bipolar disorder). - Self-reported new diagnosis of clinical depression within 3 months of enrollment or unstable clinical depression requiring medication adjustment within 3 months of enrollment

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Intervention Model Description
Randomized controlled trial. Participants are randomized following baseline testing using block randomization of 2 and 4 to either an exercise intervention group or a health education group
Primary Purpose
Treatment
Masking
Double (Investigator, Outcomes Assessor)
Masking Description
The PI and the outcome assessors are blinded to group assignment

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
Home-based walking exercise 		A 6-month partially supervised walking exercise training using a tapered approach. Participants begin with exercising (walking) in person, on-site one time per week and 3 times per week at home for a minimum exercise dosage of 30 minutes of accumulated exercise per session during month 1. During month 2, participants will exercise on-site once every other week and 3-4 times per week at home a minimum exercise dosage of 30 minutes of accumulated exercise per session. During months 2-6, participants will exercise at home 4 times per week for a minimum exercise dosage of 30 minutes of accumulated exercise per session and they will receive a phone call every two weeks to help coach and address any problems. Participants will receive a Fitbit fitness tracker that will be used to deliver their personalized exercise program, exercise monitoring, feedback, and motivational messages.
  • Behavioral: Home-based walking exercise
    A 6-month partially supervised walking exercise program using a tapered approach.Participants will begin exercise (walking) at a relatively low intensity and progress to moderate intensity. Intensity will start at 40% and progress as tolerated up to 60-70%. Rating of perceived exertion of 12-14 (fairly light to moderate) will be used to aid intensity (Rating of perceived exertion 6-20 scale). This is an accepted method for achieving desired exercise intensity. Participants will progress over time to exercise 3-4/week for 30-45 minutes. The exercise program may need to be adjusted for (e.g. 10 minutes of exercise 3 times), to achieve the minimum exercise dose of 30 minutes. This will be determined for each individual participants as needed.
Placebo Comparator
Health education 		The health education group will receive the same amount of contact hours as the intervention group. The attention control group will receive health education and stretching exercises. Participants will be in person, on-site one time per week during month 1 for about 30 minutes. During month 2, participants will attend the health education on-site once every other week for about 30 minutes. During months 2-6 participants will receive a phone call every two weeks to help remind about the health education. Participants will receive a Fitbit fitness tracker that will be used for exercise monitoring.
  • Other: Attention control
    Health education and stretching

Recruiting Locations

Columbia University
New York, New York 10023
Contact:
Ulf Bronas, PhD
ub2154@cumc.columbia.edu

More Details

Status
Recruiting
Sponsor
Columbia University

Study Contact

Ulf G Bronas, PhD
212-305-0750
ub2154@cumc.columbia.edu

Detailed Description

Following informed consent, participants will undergo tests for heart health, physical function, memory testing, and brain structure and function using imaging (taking pictures of the brain with an MRI). Following these tests participants are randomized to a home-based walking program or health education for 6 months. Participants are given a fitness tracker and gets ongoing telephone coaching during the 6 months. After 6 months the tests are repeated.