The Active Ingredient of Cognitive Restoration: A Multicenter Randomized Controlled Trial of Sequential Combination of Aerobic Exercise and Computer-Based Cognitive Training in Stroke Survivors With Cognitive Decline

Ting-Ting Yeh; Ku-Chou Chang; Ching-Yi Wu

doi:10.1016/j.apmr.2018.12.020

The Active Ingredient of Cognitive Restoration: A Multicenter Randomized Controlled Trial of Sequential Combination of Aerobic Exercise and Computer-Based Cognitive Training in Stroke Survivors With Cognitive Decline

Arch Phys Med Rehabil. 2019 May;100(5):821-827. doi: 10.1016/j.apmr.2018.12.020. Epub 2019 Jan 9.

Authors

Ting-Ting Yeh¹, Ku-Chou Chang², Ching-Yi Wu³

Affiliations

¹ Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.
² Division of Cerebrovascular Diseases, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Discharge Planning Service Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Senior Citizen Service Management, Yuh-Ing Junior College, Kaohsiung, Taiwan.
³ Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. Electronic address: cywu@mail.cgu.edu.tw.

PMID: 30639273
DOI: 10.1016/j.apmr.2018.12.020

Abstract

Objective: To investigate the efficacy of a sequential combination of aerobic exercise and cognitive training on cognitive function and other health-related outcomes in stroke survivors with cognitive decline.

Design: Intervention study and randomized controlled trial.

Setting: Hospital-based rehabilitation units.

Participants: Survivors of stroke with cognitive decline (N=30) were randomized to sequential combination training (SEQ) (n=15) or an active control (n=15) group.

Interventions: The SEQ group received 30 minutes of aerobic exercise, followed by 30 minutes of computerized cognitive training. The control group received 30 minutes of nonaerobic physical exercise, followed by 30 minutes of unstructured mental activities.

Main outcome measures: The primary outcome measure was cognitive function. Secondary outcome measures included physical function, social participation, and quality of life.

Results: Compared with the control group, the SEQ group had significantly improved Montreal Cognitive Assessment scores (P=.03) and Wechsler Memory Scale span scores (P=.012) after training. The endurance and mobility level measured by the 6-minute walk test (P=.25) was also enhanced in the SEQ group relative to the control group. However, the transfer of sequential training to social participation (Community Integration Questionnaire) and quality of life (EuroQoL questionnaire) was limited (P>.05 for both).

Conclusions: Aerobic exercise combined with computerized cognitive training has better effects on the cognitive functional status of survivors of stroke than an active control. The cognitive functional status of stroke survivors was better after participation in aerobic exercise combined with computerized training than after active control therapy, demonstrating the clinical significance of this combination therapy.

Trial registration: ClinicalTrials.gov NCT03045991.

Keywords: Rehabilitation; Stroke.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cognition
Cognitive Dysfunction / etiology
Cognitive Dysfunction / rehabilitation*
Combined Modality Therapy
Exercise / psychology*
Exercise Therapy
Female
Humans
Male
Mental Status and Dementia Tests
Middle Aged
Quality of Life
Social Participation
Stroke / psychology*
Stroke Rehabilitation / methods*
Survivors / psychology
Therapy, Computer-Assisted*
Walk Test
Wechsler Memory Scale

Associated data

ClinicalTrials.gov/NCT03045991