Mar 22 2024 This Week in Cardiology
Vigorous Exercise May Protect Cognitive Health In People With Hypertension
Impairment of cognitive function can affect all aspects of a person's life, including quality of life and day-to-day activities.
Multiple factors can contribute to someone's risk of developing problems in cognitive function, including high blood pressure, or hypertension. Researchers are interested in finding potential protective actions that people with high blood pressure can take.
A new study published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association examined the relationship between vigorous physical activity and risk for mild cognitive impairment among people with high blood pressure.
Researchers found that participants who engaged in one or more sessions of vigorous physical activity each week were at a lower risk for mild cognitive impairment and probable dementia.
The results suggest that vigorous exercise may help preserve cognitive function among certain individuals.
High blood pressure occurs when the force of blood pressing against blood vessel walls gets outside of a certain range. It can lead to damaged blood vessels and increase people's risk for heart problems and stroke.
A normal blood pressure reading is less than 120/80 millimeter of mercury (mmHg), and doctors may diagnose someone with high blood pressure when a systolic reading 130 mmHg or more or when a diastolic reading is 80 mmHg or more.
Previous research has also linked high blood pressure in midlife with a higher risk for cognitive disorders. The authors of the current study note that people with high blood pressure are at a higher risk for Alzheimer's disease, vascular dementia, and mild cognitive impairment.
José Morales, MD, a vascular neurologist and neurointerventional surgeon at the Pacific Neuroscience Institute in Santa Monica, CA, not involved in the current research, explained to Medical News Today that:
"Hypertension damages the small blood vessels in our brain and also causes them to malfunction. This results in progressive damage to the brain, which in turn leads to cognitive impairment."
The researchers who conducted the current study wanted to evaluate if vigorous exercise helped with the risk for mild cognitive impairment and probable dementia.
This study was a post hoc analysis using data from the SPRINT MIND STUDY, which formed part of the SPRINT trial. This trial involved over 9,000 adults in the United States who had high blood pressure.
At enrolment, participants were asked about the frequency of participating in vigorous physical activity. Vigorous physical activity was defined as activities that induced sweat, increased heart rate, or increased breathing.
Participants could pick their level of vigorous physical activity from the following categories:
In the analysis, researchers divided participants into a low-vigorous physical activity group and a high-vigorous physical activity group.
The low-vigorous physical activity group had less than one vigorous activity session a week, and the high-vigorous physical activity group had one or more vigorous activity sessions a week.
All participants also underwent cognitive assessment tests, and covariates included components like age, education, smoking, use of antihypertensive medication, body mass index (BMI), and alcohol use.
The researchers excluded participants who had limited physical function or missing cognitive assessments, allowing them to include 7,670 participants in their final analysis.
The average follow-up time with participants was 4.5 years, and over this time, there were identified cases of mild cognitive impairment and probable dementia.
Overall, participants in the high vigorous physical activity group were at a lower risk for mild cognitive impairment and probable dementia.
The association was stronger among participants less than 75 years old at baseline, and Black participants. The association also appeared stronger in participants with prior cardiovascular disease.
Study author Richard Kazibwe, MD, from Wake Forest University School of Medicine in Winston-Salem, NC, noted to MNT that:
"Engaging in vigorous physical activity at least once a week may help slow cognitive decline in individuals with hypertension. This level of physical activity may offer protection against both dementia and mild cognitive impairment. The study is unique because it focuses on individuals with high-risk hypertension, a population more likely to develop cognitive impairment. Previous studies have not specifically addressed this group."
According to Morales, "[t]his is an interesting study that demonstrates what many people with uncontrolled hypertension find counterintuitive."
"Exercise helps to regulate our autonomic nervous system and reduces the impact of these vascular risk factors on our health," he explained.
"People should be encouraged to see the impact lifestyle changes can have on modifying the consequences of vascular risk factors such as hypertension, as well as preserve brain health and functioning," added Morales.
Despite the intriguing findings, this study does face some specific limitations.
First, some of the data came from participants' self-reports, which means it can be inaccurate. Then, almost 65% of participants were white, and about 35% were women, indicating the need for greater diversity in future research and a limited ability to generalize the results.
The findings also cannot be generalized to groups with certain conditions not represented in the SPRINT study, such as those with diabetes. The exclusion criteria of the current analysis could also have impacted the results.
The authors further acknowledge that their study "likely lacked the adequate statistical power to detect the benefit of [vigorous physical actvity] on the risk of probable dementia."
There is also a potential confounding risk, and researchers only looked at baseline data for vigorous physical activity. Changes in vigorous physical activity could have impacted cognitive outcomes.
Moreover, the researchers did not look at how moderate physical activity or the potential negatives of sedentary behavior could affect cognitive status. Finally, mild cognitive impairment "at the time of enrolment was not adjudicated," which could have impacted the results.
Future research can allow for longer follow-up times to confirm the findings of this research. Kazibwe noted that future research could include "[s]tudies using device-assessed physical activity in large and diverse populations are needed to investigate the benefits of vigorous physical activity for protecting against cognitive decline."
Vigorous Exercise Linked To Lower Dementia Risk In Hypertensive Individuals
In a recent study published in Alzheimer's and Dementia, a group of researchers investigated the effect of vigorous physical activity (VPA) on the risk of incident mild cognitive impairment (MCI) and probable dementia among individuals with high-risk hypertension.
Study: Effect of vigorous-intensity physical activity on incident cognitive impairment in high-risk hypertension. Image Credit: Evgeny Atamanenko/Shutterstock.Com
Hypertension, affecting one-third of adults worldwide, significantly increases the risk of cardiovascular diseases (CVDs) and dementia, projected to impact over 175 million people by 2050. As a key modifiable risk factor for cognitive impairments, including MCI, Alzheimer's, and vascular dementia, hypertension's impact on cognitive health is profound.
The Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension (SPRINT MIND) study highlighted that intensive blood pressure control can prevent cognitive impairment.
While physical activity (PA) also slows cognitive decline, the optimal volume and intensity for maximum benefit are unclear, necessitating further research to determine the most effective PA regimen for reducing cognitive impairment risk in high-risk hypertensive individuals.
About the studyThe present post hoc analysis used data from the SPRINT MIND study, part of the SPRINT trial (NCT01206062), which included 9361 nondiabetic United States (U.S.) adults aged 50 and older with hypertension and high CVD risk.
The trial compared the effects of intensive (target systolic blood pressure (SBP) <120 mm Hg) versus standard (target SBP <140 mm Hg) blood pressure treatment on various health outcomes, including myocardial infarction, stroke, heart failure, and cognitive function. The trial was halted early due to significant benefits in the intensive treatment group.
The study focused on the impact of intensive blood pressure treatment on rates of MCI and probable dementia. Data was sourced from the National Heart, Lung, and Blood Institute, with all participants providing informed consent. Cognitive assessments were conducted at baseline, at 2 and 4 years, and at study closeout.
Participants were divided into low (<1 session/week) and high (≥1 session/week) VPA groups. Exclusions included significant physical limitations or missing data, resulting in 7670 participants.
Statistical analysis used Cox proportional hazards models to examine the association between VPA and cognitive outcomes, with sensitivity analyses accounting for competing risks and additional comorbidities. Analyses were conducted using SAS and R software.
Study resultsOverall, the participants had an average age of 70.0 years (Standard deviation (SD) 9.2), with 34.5% being women and 59.4% identified as White. Notably, 59.3% of participants reported engaging in VPA at least once weekly, placing them in the high VPA category.
Compared to their high VPA counterparts, participants in the low VPA group were more likely to be female, current smokers, less educated, have higher body mass index (BMI), higher prevalence of chronic kidney disease (CKD), and require more antihypertensive medications.
Over a maximum follow-up of 7.4 years (median [25%, 75%] = 4.5 [3.6, 5.9] years), there were 570 adjudicated events of MCI, 273 events of probable dementia, and 759 events of the combined MCI/probable dementia outcome.
The incidence of MCI, probable dementia, and the combined MCI/probable dementia outcome were lower in the high VPA group compared to the low VPA group, with rates of 6.5% versus 8.8%, 3.1% versus 4.3%, and 8.7% versus 11.7%, respectively.
Similarly, event rates per 1,000 person-years were lower for the high VPA group: 13.9 versus 19.7 for MCI, 6.3 versus 9.0 for probable dementia, and 18.5 versus 25.8 for the combined outcome.
Cumulative incidence (CI) rates of cognitive impairment were significantly higher in the low VPA group. After adjusting for sociodemographic factors, the high VPA group had a substantially lower risk of MCI (Hazard ratio (HR) = 0.80, 95% CI: 0.67–0.95) and combined MCI/probable dementia (HR = 0.82, 95% CI: 0.70–0.94) compared to the low VPA group.
The association between higher VPA and lower risk of probable dementia approached significance (HR = 0.80, 95% CI: 0.63–1.02). Further adjustments for other factors did not alter these associations. There was significant heterogeneity by age and race, with stronger associations for those under 75 and Black participants.
Participants included in the analysis were similar in age, blood pressure, and randomization to the intensive SBP lowering trial arm compared to those excluded. Excluded participants were more likely to be female, less educated, current smokers, and had a higher prevalence of depression, CKD, and CVD.
Considering the competing risk of death, HR remained consistent with the main analysis. Adjustments for additional comorbidities and the exclusion of early MCI cases did not significantly change the results, indicating that different self-reported frequencies of VPA were consistently associated with a lower risk of cognitive impairment outcomes.
ConclusionsTo summarize, participants who engaged in VPA had a lower risk of MCI and probable dementia compared to those with less frequent VPA, regardless of SBP treatment intensity.
The results were consistent across various subgroups, with some variations by age and race. The study highlights VPA as a potential low-risk intervention to preserve cognitive function in hypertensive patients.
Study: Vigorous Exercise May Play Role In Lower Dementia Risk Among Elderly
Vigorous exercise at least twice a week may play a role in lowering the risk of cognitive impairment, including dementia, for people with high blood pressure, according to a study from researchers at Wake Forest University School of Medicine.
The study has been posted on the website of Alzheimer's & Dementia: The Journal of the Alzheimer's Association.
"We know that physical exercise offers many benefits, including lowering blood pressure, improving heart health and potentially delaying cognitive decline," said Dr. Richard Kazibwe, lead author and assistant professor of internal medicine at the medical school.
"However, the amount and the intensity of exercise needed to preserve cognition is unknown. More research is needed to include device-based physical activity measurements and more diverse participant populations."
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Kazibwe said that nearly 60% of study participants reported vigorous physical activity at least once a week, even among those aged 75 and up.
However, the research team found the protective impact of vigorous exercise was more pronounced for those under 75.
"It is welcome news that a higher number of older adults are engaging in physical exercise," Kazibwe said. "This also suggests that older adults who recognize the importance of exercise may be more inclined to exercise at higher intensity.
The Wake Forest medical school study feeds off findings and follow-ups from the landmark Systolic Blood Pressure Intervention Trial, known by the acronym SPRINT.
SPRINT began in fall 2009 with more than 9,300 participants with hypertension ages 50 and older, recruited from about 100 medical centers and clinical practices throughout the United States.
Participants were randomly assigned to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment) or less than 140 mm Hg (standard treatment).
The National Institutes of Health stopped the blood pressure intervention earlier than originally planned to quickly disseminate the significant preliminary results, resulting in a new set of guidelines for controlling blood pressure.
In 2015, published SPRINT findings demonstrated that intensive blood pressure management reduced cardiovascular disease and lowered the risk of death.
In 2019, results of the ancillary SPRINT MIND trial led by the medical school showed that intensive control of blood pressure in older people significantly reduced the risk of developing mild cognitive impairment, a precursor of early dementia.
A secondary analysis of that trial examined the effect of self-reported sessions of vigorous physical activity (at least once a week) on the risk of mild cognitive impairment and dementia.
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