Acute and chronic effects of exercise on inhibitory control in patients with coronary artery disease: a pilot study

Cardiovascular disease is associated with increased risk of cognitive decline and impaired executive functions, particularly inhibitory control, in patients with coronary artery disease (CAD). Exercise-based cardiac rehabilitation enhances cardiorespiratory fitness and may benefit cognition by improving cerebral perfusion and promoting neuroplasticity. This pilot study aimed to examine both the acute (pre- vs. post-exercise) and chronic (pre- vs. post-intervention) effects of aerobic exercise on inhibitory control in patients with CAD. This manuscript presents pilot data from the first 10 participants enrolled in a larger prospective, randomized, single-blind, multicenter trial. In this preliminary phase, ten clinically stable patients with CAD completed a 12-week aerobic exercise–based cardiac rehabilitation program. Peak oxygen uptake (VO₂ peak) was measured by cardiopulmonary exercise test (CPET). Cognitive inhibitory control was assessed using a computerized Stroop task at two time points (pre- and post-intervention) and at two time points within each assessment (rest vs. 15 min post-CPET), allowing evaluation of both chronic and acute effects. Reaction time and accuracy were analyzed using a two-way repeated-measures analysis of variance (ANOVA) with two factors: Acute (rest vs. post-CPET) and Chronic (pre- vs. post-intervention). VO₂ peak increased significantly after the intervention (mean difference = 3.4 ml·kg⁻¹·min⁻¹; p = .006; d = 1.14 ;95% CI [0.31, 1.93]). Accuracy remained at ceiling across conditions (88-100%). Acute exercise consistently improved reaction time in all Stroop conditions (η²p range: .450–.770). Only in the incongruent condition—the trial with the highest inhibitory demand —was chronic improvement observed (η²p = .434), indicating enhanced cognitive efficiency after the training program. Interaction effects were not statistically significant, although effect sizes suggested clinically meaningful changes. Aerobic exercise produces acute improvements in inhibitory control and may induce selective chronic benefits under high executive demand. These preliminary findings support the feasibility of the protocol and justify a fully powered trial to determine the extent of exercise-induced cognitive adaptations in this clinical population.