Authors: Hakon Ihle-Hansen and Guri Hagberg,
Affiliation: Vestre Viken Hospital Trust, Norway

Fitness training for brain health – what is good for your heart is god for your brain?

We know that aerobic exercise improves cognition and increases brain volume, but the mechanisms are less clear. Accelerated rates of brain atrophy and cognitive decline are seen in stroke survivors, and as physical activities are easy accessible, inexpensive, and with little side effects, it seems unreasonable not to include physical activities as an important part of our follow-up after stroke.

Some studies have shown promising results, but there is an urgent need for well-designed studies that addresses this topic. We need studies that could lead to implementation of our knowledge, and give us a better understanding of the mechanisms involved.

Yesterday, the protocol of the The Post Ischemic Stroke Cardiovascular Exercise Study (PISCE) was published online in the European Stroke Journal. The study aims to randomize stroke survivors two months post-stroke to a fitness training intervention combining aerobic exercise and resistance training for eight weeks or to balance and stretching training in active controls. The hypothesis is that aerobic and resistance training will provide a slower decline in hippocampal volume, a brain region thought to increase with physical activity and crucial to memory. Other outcome measures includes total brain volume, measures of cognition, cardiorespiratory fitness and fatigue. The intervention is modeled on cardiac rehabilitation, a service that is already widely available for cardiac patients.

Stroke research with outcome measures in relation to cognitive function, and easy apply able interventions to preserve cognition after stroke are needed. We hope that this study will give more information regarding the tolerability and effect of moderate-to high intensive interventions in a relatively early phase, how to maintain motivations for these interventions, and to give us more understanding of underlying mechanisms. Today, persons more adherent to physical activity rather than part of an intervention seems to have better brain health.

As stroke physicians and researches involved in vascular cognitive impairments, waiting for the results of this study, we keep in mind that known preventive strategies for cognition involve interventions for midlife hypertension, diabetes, obesity, physical inactivity, sleep, diet and smoking, in addition to support education and rich social life. The brain is like a muscle, use it or lose it.

Original Article: The Post Ischaemic Stroke Cardiovascular Exercise Study: Protocol for a randomised controlled trial of fitness training for brain health. 
Liam Johnson, Emilio Werden, Chris Shirbin, Laura Bird, Elizabeth Landau, Toby Cumming, Leonid Churilov, Julie A Bernhardt, Vincent Thijs and Amy Brodtmann

ESJ Online first:

Guri Hagberg

Hege Ihle-Hansen