Exercise Is a Top Prescription for Mild Cognitive Impairment

New recommendations from the American Academy of Neurology (AAN) prescribe aerobic exercise rather than pharmacological medication for patients with mild cognitive impairment (MCI) to improve their memory and thinking. The latest guidelines for MCI were published today in the online issue of Neurology, the medical journal of the AAN.

These new recommendations are an update to the AAN's previous guideline on mild cognitive impairment and are endorsed by the Alzheimer's Association. The academy's new guidelines were updated after a Mayo Clinic-led team of researchers from a variety of institutions conducted a meta-analysis of all available MCI studies.

MCI is an intermediate stage of cognitive decline that is less serious than the declines associated with dementia. People with MCI demonstrate some cognitive impairment but have minimal impairment of instrumental activities of daily living (IADL). Symptoms of mild cognitive impairment include problems with memory, language, overall thinking, and judgment that tend to be more severe than typical age-related changes in cognition.

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The most significant takeaway of these new guidelines is that six-month studies showed twice-weekly workouts could help people with mild cognitive impairment as part of an overall approach to managing their symptoms. Notably, the new MCI guidelines do not recommend the use of medication. Instead, the latest recommendation is for health care practitioners to prescribe aerobic exercise to improve both thinking and memory of MCI patients.

The authors summarize their findings in the study abstract: “No high-quality evidence exists to support pharmacologic treatments for MCI. In patients with MCI, exercise training (6 months) is likely to improve cognitive measures and cognitive training may improve cognitive measures.”

The lead author of this study is Ronald Petersen, director of the Mayo Clinic’s Alzheimer's Disease Research Center and the Mayo Clinic Study of Aging (MCSA). Decades ago, Petersen played a fundamental role in developing the first clinical trials for MCI. He remains a global thought leader and investigator of best practices to stop or reverse the symptoms of mild cognitive impairment.

In a statement, Petersen said: “We need not look at aging as a passive process; we can do something about the course of our aging. So if I'm destined to become cognitively impaired at age 72, I can exercise and push that back to 75 or 78. That's a big deal."

Petersen encourages people from all walks of life to do some form of aerobic exercise. In terms of a dose-response, he suggests walking briskly, jogging, cycling, or doing any type of moderate-to-vigorous physical activity (MVPA) that fits your lifestyle, for 150 minutes a week. Your exercise regimen can be broken down into any blocks of time that work for you (i.e., 50 minutes, three times; 30 minutes, five times).

Regarding the level of cardiorespiratory intensity and physical exertion, Petersen says that your aerobic workout should be vigorous enough to work up a bit of a sweat but doesn't need to be so rigorous that you can't hold a conversation.

According to the American Academy of Neurology, more than 6 percent of people in their 60s suffer from MCI. This condition becomes more prevalent as we age. More than 37 percent of people 85 and older have mild cognitive impairment. "Because MCI may progress to dementia, it is particularly important that MCI is diagnosed early," Petersen said. "It's exciting that exercise may help improve memory at this stage, as it's something most people can do and of course it has overall health benefits."

"If you or others have noticed that you are forgetful and are having trouble with complex tasks, you should see your doctor to be evaluated and not assume that it is just part of normal aging," Petersen concluded. "Sometimes memory problems are a side effect of medications, sleep disturbances, depression, or other causes that can be treated. It is important to meet with your doctor to determine the root cause. Early action may keep memory problems from getting worse."