The effect of aerobic exercise on cerebral perfusion in patients with vascular cognitive impairment, the Excersion-VCI randomised controlled clinical trial

Aerobic exercise may improve cerebral perfusion and may thereby attenuate, or delay, cognitive decline. Excersion-VCI aimed to evaluate the effect of aerobic exercise on cerebral perfusion in patients with vascular cognitive impairment (VCI). This Randomized Controlled Trial included non-demented adults ≥50 years diagnosed with VCI. Patients were randomly assigned either home-based aerobic interval training (exercise group) or information sessions (control group). Primary outcome was change in Arterial Spin Labelling MRI grey matter cerebral perfusion from baseline to 14-week follow-up. Per-protocol analysis was performed in patients who completed the follow-up. Secondary outcomes were VO_2max and cognitive function. Exploratory outcomes were depression and apathy, White Matter Hyperintensities, cerebral volumes, and blood biomarkers. Fifty-eight VCI patients (mean age 67.0 ± 6.7 years) were allocated to the exercise (<i>n</i> = 28) or control group (<i>n</i> = 30). Intention-to-treat analyses showed that change in grey matter cerebral perfusion in the exercise group did not differ from the control group (<i>p</i> = 0.38), nor were there group differences in change in VO2max (<i>p</i> = 0.17). The exercise group showed an increase in triglycerides compared to the control group (<i>p</i> = 0.04). No group differences were found for other outcomes. Per protocol analyses showed improvement in VO_2max in the exercise group compared to the control group (<i>p</i> = 0.04). An aerobic exercise program in VCI patients improved cardiorespiratory fitness in those who adhered to the protocol, but did not show significant effects on grey matter cerebral perfusion or other outcomes. The intervention duration of 14-weeks may have been too short to measure changes in perfusion or improvements in cognitive function.