Healthy Aging: Benefits of Physical Activity in Populations with Vascular Cognitive Impairments4/1/2025  W.R. Bud Jardine (88y 33d) sets the record for the oldest person (male) to perform a headstand (Guiness World Record, 2023). By Santina Temi and Klara Doelle In many countries worldwide, the combination of improved living conditions and advanced medical intervention has greatly increased human life expectancy. The world’s older adult population is increasing, and this is expected to continue. By 2050, a 22% increase in the population above the age of 60 is projected (WHO, 2024). This means an increased need for research on topics concerning this population. During the typical aging process, the skeletal muscle composition may weaken or atrophy, muscle metabolism is impaired, and there is often a decrease in muscle strength and mobility. Additionally, total brain volume decreases, often accompanied by a decline in global cognition, as well as specific domains such as memory and executive functions. The combined result is a reduced ability to perform a variety of physical and cognitive tasks compared with our younger selves. It is well known that physical activity has many benefits for the general population at any age. Specific to the aging population, exercise has been shown to be beneficial for mental, emotional, and physical wellbeing and to reduce risk factors for neurodegenerative diseases. An excellent example of healthy aging is my (Klara’s) grandfather, Bud Jardine. Over the years, more than one doctor told him he is “at least 10-12 years younger than his age”. At 88 years and 33 days old, Bud set the Guinness World Record for the oldest person to hold a headstand for more than 15 seconds. For Bud, exercise has always been an important aspect of healthy living, becoming even more so with age. At almost 90 years old now, he continues to maintain aerobic fitness through walking, or as he refers to it, marching. Three times per week he sets out for a 45-minute brisk walk. Bud complements his aerobic exercise with some strength training and a long-standing practice of tai chi, yoga, and meditation. His commitment to exercise in old age is a practice he calls “aging backwards” and lends credibility to the notion that regular exercise enables a good quality of cognitive and physical health for longer throughout one’s life. With increases in lifespan, dementia is an emerging issue for older adults. The most common form of dementia is Alzheimer disease, but a second, lesser known, form of dementia is vascular cognitive impairment. In vascular cognitive impairment, blood vessels that supply the brain are compromised. The most common cause of vascular cognitive impairment is cerebral small vessel disease, and it is estimated that by the age of 65, it has developed in 80% of the population (Bolandzadeh et al., 2015). Two sets of studies by Dr. Liu-Ambrose and colleagues have investigated the role of exercise in older adults living with cerebral small vessel disease, namely aerobic exercise and resistance training. Both studies included male and female participants who were diagnosed with mild vascular cognitive impairment due to cerebral small vessel disease.  In their studies on the effects of aerobic exercise (Liu-Ambrose et al., 2016; Hsu et al. 2018), participants (average age 74, sample size=71) were randomized into two groups. One group received an aerobic training program (progressive walking, up to 65-70% HRR, 60 min/class) three times per week, while the other group received a monthly educational cooking class (60 min/class); both lasted 6 months. The cooking class was used as a control for the effects of social interaction. At the end of the study period, individuals in the aerobic training group showed a significant improvement in general cognitive functions, especially memory, compared to the group in the educational cooking class.  In the studies on resistance training (Liu-Ambrose et al., 2021; Liu-Ambrose et al. 2024), participants (age 55 or over, sample size= 91) underwent either a progressive resistance training program or balance and tone classes twice a week, for 6 months. The training program consisted of Keiser circuit exercises and free weights: 2 sets of 10-12 reps. The balance and tone program involved stretches, Kegal and balance exercises in addition to functional movements, such as sit-to-stand. The balance and tone training group acted as a control and did not receive any progression in external loading. At the end of the training, older adults in the progressive resistance training group had a significant improvement in global cognition compared to the balance and tone group.
In both studies, when comparing results based on biological sex, females were found to have benefitted more from both aerobic and resistance training than males. Aerobic exercise particularly improved performance on measures of cognitive flexibility in females (Barha et al., 2017). Similarly, resistance training slowed the progression of white matter lesions in females with cerebral small vessel disease (Liu-Ambrose et al., 2024). The reason for such sex differences is unclear, but perhaps females benefitted more from these interventions because, according to some studies, resistance training increases insulin-like growth factor 1 (IGF-1) levels mainly in females and this, in turn, seems to be associated with lower white matter hyperdensities (Jiang et al., 2020; Cao et al., 2023). The take home message from these studies is that both aerobic and resistance training are beneficial for individuals (especially biological females) over the age of 65. Aerobic exercise seems to improve memory and executive functions (Liu Ambrose et al, 2016; Hsu et al. 2018), whereas resistance training improves global cognition in people with vascular cognitive impairment (Liu-Ambrose et al., 2012; Bolandzadeh et al., 2015). Overall, exercise can delay disease progression and the onset of dementia, while also improving quality of life in older adults. A shift towards more active lifestyles for older populations may allow current and future generations to live longer and healthier lives. This blog is a part of a series exploring how physical activity builds resilience against stress-related brain changes and mental health disorders. References:
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