Exercise Effects on Brain Health and Learning From Minutes to Months (EXTEND)

• ClinicalTrials.gov Identifier: NCT03114150
• Recruitment Status: Recruiting
• First Posted: April 14, 2017
• Last Update Posted: May 24, 2022
• Sponsor: Michelle W. Voss
• Information provided by (Responsible Party): Michelle W. Voss, University of Iowa

Study Description

Brief Summary:

Given the accelerating growth of older adults worldwide and the decline in cognitive function with aging, therapeutics that remediate age-related cognitive decline are needed more than ever. The proposed research seeks to better understand and enhance the detection of exercise effects on hippocampal network function and learning and memory, which decline with aging and Alzheimer's. Success would lead to new ways to detect benefits of exercise on cognitive aging and would lead to mechanistic insight on how such plasticity is possible while also informing prevention strategies.

Condition or disease	Intervention/treatment	Phase
Sedentary Lifestyle	Behavioral: Cardiorespiratory fitness training; Behavioral: Functional fitness training	Not Applicable

Detailed Description:

Animal models robustly support that exercise protects brain areas vulnerable to aging such as the hippocampus and that these benefits lead to better learning. In contrast, there are mixed findings from human studies on the cognitive benefits of exercise with healthy older adults. This contrast indicates there is still a lack of understanding for how exercise could change the course of cognitive decline in aging adults. However, no human studies have comprehensively tested exercise effects on cognition in older adults with learning tasks inspired from basic exercise neuroscience. The objective in the proposed research is to fill this translational gap by determining if different types of exercise improve the same kinds of learning in older adults that have been shown to improve in animal models by improving hippocampal function. This will bring the investigators closer to a long-term goal of determining how exercise protects the brain from adverse effects of aging in order to develop interventions that minimize age-related cognitive decline. The overall hypothesis is that exercise improves learning when it increases functional hippocampal-cortical communication that otherwise declines with aging. The investigators will test this in a sample of healthy older adults by determining if increases in functional hippocampal-cortical connectivity from exercise training improve learning on an array of tasks that require the hippocampus for acquisition of new relational memories compared to conditions of the same tasks that should not require the hippocampus for learning and memory.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 120 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Participant, Outcomes Assessor)
• Primary Purpose: Basic Science
• Official Title: Exercise to Improve Hippocampal Connectivity and Learning in Older Adults
• Actual Study Start Date: May 1, 2018
• Estimated Primary Completion Date: May 2023
• Estimated Study Completion Date: May 2024

Arms and Interventions

Arm	Intervention/treatment
Experimental: Cardiorespiratory fitness training; Cardiorespiratory fitness training will be a 24-week supervised cycling program designed to improve cardiorespiratory fitness, with supervision directly from the research team. All participants will first receive a one-on-one orientation with an exercise training specialist that has been trained by Dr. Gary Pierce in monitoring an exercise program for healthy older adults. Training will start with a 5 minute-warm-up, 20 minutes moderate intensity cycling and 30 minutes light intensity cycling, and 5 minute cool-down per session, for 3 sessions/week. In each additional week, 6 minutes of moderate intensity cycling per session will be added, until the total time for moderate intensity is 50 minutes per session by the start of week 5 (with additional 5 minute warm-up and 5 minute cool-down).	Behavioral: Cardiorespiratory fitness training; Physical exercise of moderate intensity designed to improve cardiorespiratory fitness
Active Comparator: Functional fitness training; Functional fitness training will be a 24-week supervised exercise program designed to focus on functional flexibility and mobility, with supervision directly from our research team. All participants will first receive a one-on-one orientation with an exercise training specialist that has been trained by Dr. Gary Pierce in monitoring an exercise program for healthy older adults. Training will start with a 5 minute-warm-up, 20 minutes of light intensity cycling and 20 minutes of dynamic stretching to increase range of motion and functional fitness, for 3 sessions/week. In each additional week, additional stretches will be added to maintain variety and improve flexibility of all major muscle groups.	Behavioral: Functional fitness training; Physical exercise of light intensity designed to improve functional fitness

Outcome Measures

Primary Outcome Measures :

1. Change in hippocampal-dependent learning [ Time Frame: Baseline, 24-weeks ]
   Learning rate on constructs that have been examined in animal models including context acquisition, episodic associations, and spatial navigation.

Secondary Outcome Measures :

1. Change in hippocampal-cortical functional connectivity [ Time Frame: Baseline, 30 minutes ]
   The strength of the correlation between the spontaneous functional magnetic resonance imaging (fMRI) signal in the hippocampus and cortical regions in a hippocampal-cortical memory system.
2. Change in hippocampal-cortical functional connectivity [ Time Frame: Baseline, 24-weeks ]
   The strength of the correlation between the spontaneous functional magnetic resonance imaging (fMRI) signal in the hippocampus and cortical regions in a hippocampal-cortical memory system.
3. Change in cardiorespiratory fitness [ Time Frame: Baseline, 24-weeks ]
   Cardiorespiratory fitness will be measured during a maximal exercise test. Oxygen uptake (VO2) will be measured from expired air samples taken at 30 second intervals until a peak VO2, the highest VO2, is attained at the point of test termination due to symptom limitation and/or volitional exhaustion.

Eligibility Criteria

• Ages Eligible for Study: 55 Years to 80 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

• Eligible to participate in an aerobic exercise intervention based on the Physical Activity Readiness Questionnaire, and corrected vision of 20/40.
• Approval from a physician that monitored electrocardiography (ECG) response during a maximal aerobic fitness test that is part of the second study visit described below.
• Exercising less than 60 minutes a week for the past calendar year

Exclusion Criteria:

• Not between the ages of 55 and 80 years old
• Not fluent in English
• Score < 20 (out of 30) on the Montreal Cognitive Assessment (MoCA)
• Inability to comply with experimental instructions
• Qualify as "high risk" for acute cardiovascular event by the published standards of the American College of Sports Medicine
• Previous diagnosis of neurological, metabolic, or psychiatric condition, and no previous brain injury associated with loss of consciousness
• Inability to complete an MRI

Contacts and Locations

Contacts

Contact: Michelle W Voss, PhD; 319-335-2057; michelle-voss@uiowa.edu

Locations

United States, Iowa

University of Iowa; Recruiting

Iowa City, Iowa, United States, 52242-1401

Contact: Michelle Voss 319-335-2057 michelle-voss@uiowa.edu

Sponsors and Collaborators

Michelle W. Voss

Investigators

• Principal Investigator: Michelle W Voss, PhD; University of Iowa

  Study Documents (Full-Text)

Documents provided by Michelle W. Voss, University of Iowa:

Statistical Analysis Plan  [PDF] December 6, 2019

More Information

Additional Information:

This study is run from the Health, Brain, and Cognition Laboratory 

• Responsible Party: Michelle W. Voss, Associate Professor of Psychological and Brain Sciences, University of Iowa
• ClinicalTrials.gov Identifier: NCT03114150
• Other Study ID Numbers: 201705800
• First Posted: April 14, 2017
• Last Update Posted: May 24, 2022
• Last Verified: May 2022

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: In accord with NIH regulations, the investigators will make the data and relevant documentation available to other investigators upon acceptance of the main findings from the study for publication. The investigators will share analysis tools as they are developed. Because the collected data are to remain anonymous, only a subject number will identify all data. To further protect the privacy and confidentiality of the data, data and documentation will be made available only under a data-sharing agreement that provides for restrictions for the transferring of data to others and a commitment that the data will be used for research purposes only and not for a profit-making enterprise.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF); Analytic Code
• Time Frame: We will share baseline neuroimaging data and phenotypic data upon completion of data collection. We will share the intervention outcome data after we have published our results from each primary aim.
• Access Criteria: We will share on an open platform such as OpenNeuro (https://openneuro.org/).

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Michelle W. Voss, University of Iowa:

physical activity; aging; learning and memory; exercise; brain