Comparing the effects of cognitive training and physical exercise on cognition and cerebral autoregulation in men and women with heart failure

In-Person: Centre EPIC de l"Institute de Cardiologie de Montréal Research Topic: Clinical Science, Public Health, Prevention Heath Areas: Heart Failure, Primary prevention/rehabilitation, Cardiovascular rehabilitation, Brain-heart Connection, cognition Compensation for participants: No

Comparing the effects of cognitive training and physical exercise on cognition and cerebral autoregulation in men and women with heart failure
Principal Investigator: Dr. Louis Bherer

RECARDIO study

Background: cognitive impairment affects up to 50% of patients with chronic heart failure (HF) and is associated with high mortality rates, poor quality of life, and reduced functional capacities. Non-pharmacological strategies, including cognitive and physical training, have been suggested as effective approaches to improve cognition in HF patients. Combining exercise and cognitive interventions could have synergistic effects on cognition in these patients, yet scientific evidence supporting this hypothesis remains limited. Additionally, it is unclear how men and women with HF respond to non-pharmacological interventions.

Objective: this randomized controlled trial will examine the effects of combined physical and cognitive training versus physical training alone and standard cardiac rehabilitation on cognition and cerebral autoregulation in men and women with HF.

Methods: two hundred and sixteen participants (216, 50% women) with stable HF, irrespective of etiology and left ventricular ejection fraction (LVEF), will be randomized into one of three groups:

1. Combined physical and cognitive training (6 months, 3 times/week, 1.5 hours per session)

2. Physical training alone (6 months, 3 times/week, 1 hour per session)

3. Usual medical care with standard cardiac rehabilitation (3 months, 2 times/week, 1 hour per session)

The physical training sessions are individualized to each participant's physical capacity, including aerobic and strength exercises, and are supervised by a certified clinical kinesiologist. The participation period lasts 6 months with evaluations at baseline, 3 months, and 6 months. Assessments include blood tests, a cardiopulmonary exercise test supervised by a cardiologist, a medical visit, neuropsychological tests, functional tests to assess mobility, brain imaging (cerebral autoregulation), and questionnaires on psychological health and quality of life. Participation can be hybrid, with both online and on-site assessments and training (with at least once per week on-site at the EPIC Centre of the Montreal Heart Institute).

At the end of the study (after 6 months), all participants receive a 6-month membership to the EPIC Centre to continue training (free of charge). They will also be invited to participate in additional evaluations at 1 year (the same assessments as other follow-up periods).

The primary outcome will be the change in cognitive performance between baseline and six months (global cognitive function, memory, executive functions, processing speed). Secondary outcomes will include changes in cerebral autoregulation, assessed by near-infrared spectroscopy and transcranial Doppler. Tertiary outcomes will include cardiorespiratory fitness (VO_2max), physical functioning, and quality of life.

Conclusions: this randomized trial will document the additional benefits of combined cognitive and physical training on brain health in men and women with chronic heart failure.