Well then ask your doctor what SPECIFICALLY will improve cognitive function. No specific answer; you don't have a functioning stroke doctor!
Mindfulness Training, Exercise May Not Help Subjective Cognitive Concerns
Stress, physical activity, and cognition may have complex relationship
Older adults with subjective cognitive concerns who engaged in mindfulness-based stress reduction (MBSR) training, physical exercise, or a combination of the two did not improve cognitive function, the MEDEXopens in a new tab or window (Mindfulness, Education, and Exercise) clinical trial showed.
Adults over age 65 randomized to one of four groups -- MBSR meditation for a target goal of 60 minutes daily; exercise with aerobic, strength, and functional components for at least 300 minutes weekly; a combination of MBSR and exercise; or a control group who received health education only -- showed no significant differences on the primary outcome of improvement in episodic memory or executive function at 6 months, reported Eric Lenze, MD, of Washington University School of Medicine in St. Louis, and colleagues in JAMAopens in a new tab or window.
Neither intervention had a significant effect on episodic memory at 6 months:
- MBSR vs no MBSR: memory composite score of 0.44 vs 0.48; mean difference –0.04 points (95% CI –0.15 to 0.07, P=0.50)
- Exercise vs no exercise: score of 0.49 vs 0.42; difference 0.07 points (95% CI –0.04 to 0.17, P=0.23)
Similarly, for executive function at 6 months:
- MBSR vs no MBSR: 0.39 vs 0.31; mean difference 0.08 points (95% CI –0.02 to 0.19, P=0.12)
- Exercise vs no exercise: 0.39 vs 0.32; difference 0.07 points (95% CI –0.03 to 0.18, P=0.17)
There was no significant interaction between mindfulness training and exercise (P=0.93 for memory and P=0.29 for executive function) at 6 months.
No intervention effects were observed for memory of executive function at 18 months, or in any other secondary endpoint including MRI structural changes in left and right hippocampal volume and left and right dorsolateral prefrontal cortex (DLPFC) surface area and cortical thickness.
"The findings show that the relationship between stress, physical exercise, and cognitive function is more complex than existing research may have suggested," noted Ipsit Vahia, MD, associate chief of geriatric psychiatry at McLean Hospital in Belmont, Massachusetts, who wasn't involved with the study.
The research "calls into question commonly held assumptions about the universal benefits of lifestyle interventions and highlights the importance of tailoring interventions for older adults so that general health, mood, as well as cognition, are considered," Vahia told MedPage Today. "This insight represents a significant advancement in clinical practice."
"The study does not include those with conditions such as depression or anxiety, both of which have been shown to respond well to both mindfulness as well as physical exercise. As such, we know that mood, stress, and cognition impact each other, but the precise nature of these interactions is not well understood," Vahia added.
Lenze and co-authors noted limitations to their study, including the relatively homogeneous study population of primarily white, college-educated participants which limited generalizability, and the focus on structural characteristics of hippocampus and DLPFC as proxies for brain health versus other, potentially more sensitive, endpoints.
"These null findings differ from positive findings in some randomized clinical trials of exerciseopens in a new tab or window and epidemiological data that have suggested that exercise was associated with improved cognitive opens in a new tab or windowand brain health in older adults, as well as a smaller body of literature supporting the beneficial role of mindfulnessopens in a new tab or window," the researchers wrote.
One possible explanation for this may be the lack of a robust negative control, given that all the interventions -- including health education -- benefited participants equally, they noted.
"In the exercise intervention, physiological and performance changes suggest participants benefited from exercise. Thus, the findings are similar to the Lifestyle Interventions and Independence for Elders Study,opens in a new tab or window which showed a beneficial effect of 24 months of exercise on disability prevention, but not cognitive performance," Lenze and co-authors said.
Subgroup analyses of participants with the greatest improvements in several physiological and performance measures showed that "even when the interventions produced beneficial changes in these putative mechanisms, they still did not lead to significant cognitive benefits," the researchers noted.
Lenze and colleagues used a 2×2 factorial design to randomize 585 older community-dwelling adults with self-reported, subjective cognitive concerns (but not dementia) in the 18-month trial. Mean age in the study was 71.5 and mean education level was 16.2 years; 72.5% of participants were women.
The trial was conducted at two U.S. sites from November 2015 to January 2019, with final follow-up in March 2020. In the first 6 months, participants had a median attendance of 90% at MBSR classes and 83.3% at exercise classes. Overall, 97.1% of participants completed 6-month assessments and 81.2% completed 18-month assessments.
![author['full_name']](https://clf1.medpagetoday.com/media/images/author/KKneisel_188.jpg)
Disclosures
The project was funded by NIH and the McKnight Brain Research Foundation, with additional funding from the Taylor Family Institute for Innovative Psychiatric Disorders at Washington University.
Lenze reported relationships with Boehringer Ingelheim, IngenioRx, Merck, Pritikin ICR, Prodeo, Janssen, Fast Grants, and the COVID Early Treatment Fund; other co-authors also reported relationships with industry.
Primary Source
JAMA
Source Reference: opens in a new tab or windowLenze EJ, et al "Effects of mindfulness training and exercise on cognitive function in older adults: A randomized clinical trial" JAMA 2022; DOI:10.1001/jama.2022.21680.
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