Vigorous Physical Activity Linked to Reduced Cognitive Decline in Patients with High-Risk Hypertension

Vigorous physical activity (VPA) may decrease risk of mild cognitive impairment (MCI) and probable dementia in patients with high-risk hypertension, according to a study published in The Journal of the Alzheimer’s Association. The study, led by a research team from Wake Forest University School of Medicine, performed an ad-hoc analysis of data collected from the Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension (SPIRIT MIND) (NCT01206062) to assess connections between VPA, hypertension, and cognitive decline.

The findings showed that intensive control of BP in older adults significantly reduces the risk of developing MCI, which enhances quality-of-life and overall health outcomes. Image Credit: © Rido -stock.adobe.com

Statistics from the American Heart Association estimate that 47% of adults in the United States have hypertension, which is a proven risk factor for cardiovascular (CV) and cerebrovascular disease, as well as developing Alzheimer disease, vascular dementia, and cognitive impairment. However, evidence from almost a decade’s worth of research investigating the connection between physical activity (PA), hypertension, and Alzheimer disease have shown that VPA can slow cognitive decline.^1,2

SPIRIT MIND, a randomized, controlled, open-label trial, investigated the effect of intensive blood pressure treatment on the rate of MCI and probable dementia compared with standard blood pressure treatment. The study involved 9361 participants ages 50 years and older, of which 35.6% were women, with hypertension and systolic blood pressure (SBP) between 130 and 180 mmHg at enrollment. However, the study was discontinued in 2015 and many scheduled follow-up cognitive assessments were not completed, compromising the accuracy of results.^1,3,4

The study authors used the SPIRIT MIND study results as a dataset to conduct new analysis of the impact of habitual VPA on blood pressure (BP), as well as comparing how VPA affects cognitive health amongst patients with hypertension. The researchers assessed the VPA activity levels and cognitive impairment of the 9361 participants included in the SPIRIT MIND study.^1,3

VPA activity levels were investigated using a self-administered questionnaire, which was given to participants upon enrollment with questions involving frequency of VPA over the course of 12 months. VPA was characterized by activities—including recreational activities or conditional exercise—that induce sweating, increased heart rate, and increased breathing. The participants were given the following response options about their PA habits: (1) rarely or never, (2) 1 to 3 times per month, (3) 1 time per week, (4) 2 to 4 times per week, and (5) 5+ times per week. The results of the questionnaire were broken into 2 categories. Participants were categorized as either low VPA (<1 session/week) and high VPA (≥1 session/week).¹

Cognitive impairment was measured by administering the Montreal cognitive assessment (MoCA), a test of global cognitive function with a score ranging 0 to 30. Score cutoffs, which indicated which participants may be experiencing cognitive impairment, were varied based on educational background and race.

For participants with less than 12 years of education, a MoCA score below 19 indicated a need for additional testing, whereas those with 12 or more years of education had a higher cutoff score of less than 21. Considering the influence of racial disparities, non-White participants with less than 12 years of education had a MoCA score below 17, and for those with 12 or more years of education, the threshold was a score below 19. Additionally, participants who experienced a decline of 5 or more points in follow-up MoCA assessments were flagged for further cognitive evaluation.¹

According to the results, participants in the high VPA group experienced lower event rates (per 1000 person-years) of MCI (13.9 vs 19.7), probable dementia (6.3 vs 9.0), and MCI/probable dementia (18.5 vs 25.8), compared with low VPA. Using the multivariate Cox regression model, study authors determined high VPA, compared with low VPA, was associated with lower risk of MCI, probable dementia, and MCI/probable dementia (HR [95% CI]: 0.81 [0.68–0.97], 0.80 [0.63–1.03], and 0.82 [0.70–0.96]), respectively.¹

The study has various limitations, including incomplete data and discrepancies in self-reported PA, where some participants may have under or overestimated their exercise habits. However, nearly 60% of the participants reported VPA at least once per week, implying a potential increase in older adults engaging in physical exercise.

“It is welcome news that a higher number of older adults are engaging in physical exercise,” Richard Kazibwe, MD, assistant professor of internal medicine at Wake Forest University School of Medicine, said in a news release. “This also suggests that older adults who recognize the importance of exercise may be more inclined to exercise at higher intensity.”⁴

The findings showed that intensive control of BP in older adults significantly reduces the risk of developing MCI, which enhances quality-of-life and overall health outcomes. By mitigating cognitive decline through BP management, patients with hypertension can preserve cognitive function and reduce risk of dementia, thereby prolonging the ability to maintain independence as they age.

References

1. Kazibwe R, Schaich C, Muhammad A, et al. Effect of vigorous-intensity physical activity on incident cognitive impairment in high-risk hypertension. Alzheimer’s & Dementia. June 6, 2024. https://doi.org/10.1002/alz.13887

2. Hypertension and physical activity 2024 statistics infographic. American Heart Association. Accessed June 7, 2024. https://newsroom.heart.org/file/hypertension-and-physical-activity-2024-statistics-infographic?action=

3. The SPRINT MIND Investigators for the SPRINT Research Group. Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA. January 28, 2019. doi:10.1001/jama.2018.21442

4. Vigorous exercise may preserve cognition in high-risk patients with hypertension. EurekAlert. June 6, 2024. Accessed June 7, 2024. https://www.eurekalert.org/news-releases/1047106