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Randomized Controlled Trial
. 2019 Mar;33(3):199-212.
doi: 10.1177/1545968319832605. Epub 2019 Feb 28.

Synergistic Benefits of Combined Aerobic and Cognitive Training on Fluid Intelligence and the Role of IGF-1 in Chronic Stroke

Michelle Ploughman  1 , Gail A Eskes  2 , Liam P Kelly  1 , Megan C Kirkland  1 , Augustine J Devasahayam  1 , Elizabeth M Wallack  1 , Beraki Abraha  1 , S M Mahmudul Hasan  1 , Matthew B Downer  1 , Laura Keeler  2 , Graham Wilson  2 , Elaine Skene  2 , Ishika Sharma  2 , Arthur R Chaves  1 , Marie E Curtis  1 , Emily Bedford  2 , George S Robertson  2 , Craig S Moore  1 , Jason McCarthy  1 , Marilyn Mackay-Lyons  2
Affiliations
Randomized Controlled Trial

Synergistic Benefits of Combined Aerobic and Cognitive Training on Fluid Intelligence and the Role of IGF-1 in Chronic Stroke

Michelle Ploughman et al. Neurorehabil Neural Repair. 2019 Mar.

Abstract

Background: Paired exercise and cognitive training have the potential to enhance cognition by "priming" the brain and upregulating neurotrophins.

Methods: Two-site randomized controlled trial. Fifty-two patients >6 months poststroke with concerns about cognitive impairment trained 50 to 70 minutes, 3× week for 10 weeks with 12-week follow-up. Participants were randomized to 1 of 2 physical interventions: Aerobic (>60% VO2peak using <10% body weight-supported treadmill) or Activity (range of movement and functional tasks). Exercise was paired with 1 of 2 cognitive interventions (computerized dual working memory training [COG] or control computer games [Games]). The primary outcome for the 4 groups (Aerobic + COG, Aerobic + Games, Activity + COG, and Activity + Games) was fluid intelligence measured using Raven's Progressive Matrices Test administered at baseline, posttraining, and 3-month follow-up. Serum neurotrophins collected at one site (N = 30) included brain-derived neurotrophic factor (BDNF) at rest (BDNFresting) and after a graded exercise test (BDNFresponse) and insulin-like growth factor-1 at the same timepoints (IGF-1rest, IGF-1response).

Results: At follow-up, fluid intelligence scores significantly improved compared to baseline in the Aerobic + COG and Activity + COG groups; however, only the Aerobic + COG group was significantly different (+47.8%) from control (Activity + Games -8.5%). Greater IGF-1response at baseline predicted 40% of the variance in cognitive improvement. There was no effect of the interventions on BDNFresting or BDNFresponse; nor was BDNF predictive of the outcome.

Conclusions: Aerobic exercise combined with cognitive training improved fluid intelligence by almost 50% in patients >6 months poststroke. Participants with more robust improvements in cognition were able to upregulate higher levels of serum IGF-1 suggesting that this neurotrophin may be involved in behaviorally induced plasticity.

Keywords: brain-derived neurotrophic factor; cognition; fluid intelligence; insulin-like growth factor–1; neuroplasticity; rehabilitation.

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