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Effects of exercise on cognition and Alzheimer's biomarkers in a randomized controlled trial of adults with mild cognitive impairment: the EXERT study [with consumer summary]
Baker LD, Pa JA, Katula JA, Aslanyan V, Salmon DP, Jacobs DM, Chmelo EA, Hodge H, Morrison R, Matthews G, Brewer J, Jung Y, Rissman RA, Taylor C, Leger GC, Messer K, Evans AC, Okonkwo OC, Shadyab AH, Zou J, Jin S, Thomas RG, Zhang J, La Croix AZ, Cotman CW, Feldman HH, on behalf of the EXERT Study Group
Alzheimer's & Dementia 2025 Apr;21(4):e14586
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

INTRODUCTION: The EXERT study (Exercise in Adults with Mild Memory Problems) was a Phase 3, multicenter, randomized controlled trial that examined effects of exercise on cognition and other measures of brain health in sedentary older adults with amnestic mild cognitive impairment (MCI). METHODS: Participants were randomized to moderate-high intensity aerobic training (AX) or low-intensity stretching/balance/range of motion (SBR) for 18 months. Exercise was supervised for the first 12 months. Assessments were administered at baseline and every 6 months. The primary outcome was a global cognitive composite. RESULTS: A total of 296 participants were enrolled, and intervention adherence was high (supervised session attendance: AX 81%, SBR 87%). Intervention effects on cognition did not differ for AX and SBR (regression -0.078, standard error (SE) 0.074; p = 0.3). Notably, there was no 12 month cognition decline for either group, and mean 12 month hippocampal volume loss for both groups was low at 0.51%. DISCUSSION: Exercise intensity did not differentially affect cognitive trajectory. Intervention delivery was successful (high adherence) and cognition remained stable over 12 months for both MCI groups, an association that warrants further study.

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