Sedentary Older Adults Need Help to EXERT Themselves

Sedentary older adults with amnestic mild cognitive impairment who engaged in regular exercise for a year maintained their cognition without decline, according to topline data presented during the recent Alzheimer's Association International Conference.

In this interview, Laura Baker, PhD, of Wake Forest University School of Medicine in Winston-Salem, North Carolina, discusses the EXERT trial and why implementation of this program is tougher than it sounds for patients.

Following is a transcript of her remarks:

We found that you can get people with mild cognitive impairment to stick to a 12-month intensive exercise program. And by intensive, I mean you have to work four times a week, you have to show up, you have to do this. We had, our final enrollment number was 296. So I'm very proud of that. It was just four short. But of our 296 people in 12 months, they completed 31,000 exercise sessions.

And I think for me, that is a success already, no matter what, because with mild cognitive impairment, they have their challenges every single day. Getting from point A to point B is not the same that it is for people without mild cognitive impairment. So that's their daily challenge and they were able to work in the exercise. So to me, that's an important part that, what I'm going to show you is that there was benefit, so the question you always say, well, will they do it though? And my first point is, yes, they will do it.

I think a key ingredient is all of our people were sedentary coming in. So, what we see is that any change -- so these people went from zero, they had no exercise, to they're doing regular exercise for 12 months, completing 31,000 sessions. When you start at sedentary and you add exercise to your life, regardless of what type, your cognitive decline stops. And so we're continuing to look at other measures that we have, but so far all signals that we look at, no matter what test we're looking at -- we have other tests -- we're all seeing the same thing. That there's no decline in these people who should have declined.

So this opens the door for anybody who's willing to increase their activity. And our amount of time, the recommendation we're going to put out is the amount of time our participants in both groups exercise was about 120 to 150 minutes per week. That is what our recommendation is going to be, is that for people with mild cognitive impairment, who are sedentary, we are suggesting an increase of 120 to 150 minutes per week of any type of exercise. Whatever's going to work for them, whatever's going to feel good for them, is going to be a risk reduction strategy.

And so for me, the public health implication is that this is doable for everybody. If it was only aerobic, then we're going to leave out a lot of people, maybe, probably 75% of people are not willing to do that. But if it's any kind of exercise, that's possible.

And the last point I want to make is our intervention involved a lot of support. And so, what I would want to see is the standard recommendation going out to clinicians that you need to get your folks exercising. Well, that's a great idea, but we have learned, and that for all my studies, this is always true -- you cannot expect someone with mild cognitive impairment to go exercise on his or her own. It's not possible. And if you expect them to exercise on their own, this program will fail. It will absolutely fail. And it's possible that it's the support element to this that is synergistic with the exercise to give them a boost. And I feel like it's that message that really needs to go out there.

I hear over and over from clinicians that they're trying to get their patients to start exercising more, but in MCI, mild cognitive impairment, your ability to initiate and organize and get going on new projects, that's what's impaired. And so to ask someone to start exercising without support, these folks just don't know how to do it. And if they can do it once, they can't sustain it.

And so I think that is really a critical ingredient, a new recommendation has to be supported, not necessarily by a trainer, but it has to be some buddy system. Something where that someone is with that person to help them stick to the program.

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