Water-based Activity to Enhance Recall in Veterans
Condition: Mild Cognitive Impairment
MeSH terms: Cognitive Dysfunction
Study type: Interventional

Summary: 
      This two-year study will evaluate the feasibility of an exercise training augmentation for
      cognitive training intervention to improve memory performance in Veterans with a diagnosis of
      amnestic Mild Cognitive Impairment (aMCI). This is a two-phased trial: 1) an exercise phase
      and 2) a cognitive training program. The exercise phase will be an aquatic based exercise
      program. A combination of exercise and cognitive training programs designed for persons
      without cognitive impairment have significantly improved memory more than other single
      intervention groups (exercise only, cognitive training only) and given the success of
      combination training programs with healthy older adults, it is important to adapt these
      programs for persons beginning to exhibit clinically significant memory problems, such as
      those with aMCI.
    

Detailed description: 
      The primary research question of the proposed study is this: Is a combination water-based
      physical exercise + cognitive training program for older Veterans with amnestic Mild
      Cognitive Impairment (MCI) feasible? The primary aims of the proposed research are: 1)
      demonstrate adequate recruitment and retention rates; 2) refinement of inclusion/exclusion
      criteria; and 3) further refine the combination waterbased physical exercise + cognitive
      training (WATER+CT) intervention.

      These aims will be tested in a two-phase clinical trial with a single group design: 1)
      exercise training phase and 2) a cognitive training phase. The exercise training phase
      consists of a water-based physical exercise program that emphasizes cardiovascular fitness
      and strength training through a combination of non-weight bearing exercises that include
      land-based stretching and water-based activities. This 2-year pilot project will include 50
      Veterans diagnosed with amnestic MCI age 50-90. The exercise component consists of a
      six-month water-based exercise program followed by a four-week cognitive training program.
      For the first two months of the water-based exercise program, Veterans will come to
      thrice-weekly group sessions at Aquatic Therapy Center at the VA Palo Alto Health Care
      System. This will transition to a self-paced exercise program for the remaining four months.
      After completion of the exercise program, Veterans will begin classroom-based cognitive
      training at the VA Palo Alto Health Care System (VAPAHCS). The cognitive training is based on
      an efficacious cognitive program that is structured around two components, pre-training and
      mnemonic training, both of which have been used successfully in persons with aMCI.
      Assessments of adherence will be administered throughout treatment and measures of
      feasibility will be completed post-treatment.

      Participants will complete a variety of neuropsychological measures taping into areas of
      cognition such as attention, executive functioning, and memory. To study possible predictors
      of treatment response, the investigators will also collect biological (cardiovascular
      functioning and brain derived neurotrophic factor [BDNF] plasma levels) and genetic data
      (APOE and BDNF genotypes) from these participants. The investigators hope to provide initial
      evidence of the feasibility of a waterbased exercise training augmentation for cognitive
      training thus laying the groundwork for full-scale clinical trials targeting the lessening of
      cognitive impairment in persons with amnestic MCI by non-pharmacological means.
    

Intervention name(s): Water-based Activity + Cognitive Training
Intervention type(s): Behavioral
Intervention description(s): This is an 8 month long two phase intervention. The first phase consists of 6 months of thrice weekly pool based physical activity occurring at the Palo Alto VA Health Care System. After completion of the 6 month long water based physical activity, participants transition to a ten session cognitive training program at the Palo Alto VA. The cognitive training classes are approximately two hours in length and will be spread over ten sessions across 4 weeks.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Mild Cognitive Impairment; memory impairment; Physical Activity; Exercise; Cognitive Training; Veterans; Older Adults