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Research Article - (2022) Volume 16, Issue 1

The Effect of Combined Exercise Versus Aerobic Exercise on Cognition and Mood among Hypertensive Older Adults: Randomized Clinical Trial

Wellington Santos1*, Amanda Sardeli1,2, Daisa Fabiele1, Victor Gadelha1, Arthur Fernandes Gaspari1, Claudia Cavaglieri1,2, Laura Middleton3 and Mara Patricia Chacon-Mikahil1,2
1Laboratory of Exercise Physiology (FISEX), Faculty of Physical Education, Brazil
2Gerontology Program, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
3Brain Body Lab, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada, Canada
*Correspondence: Wellington Santos, Laboratory of Exercise Physiology (FISEX), Faculty of Physical Education, Brazil, Email:

Received: 29-Dec-2021, Manuscript No. iphsj-21-12205; Editor assigned: 31-Dec-2021, Pre QC No. P-12205; Reviewed: 14-Jan-2022, QC No. Q-12205; Revised: 19-Jan-2022, Manuscript No. iphsj-21-12205 (R); Published: 27-Jan-2022, DOI: I: 10.36648/1791-809X.16.1.909


Comorbidities such as hypertension is a risky factor to impair cognitive function in elderly. Both strength and aerobics (CT, combined exercise) or aerobics (AT) has potential benefits for healthy as well as hypertensive elderly. Our goal was to evaluate the effects of CT and AT on cognition and mood. 52 hypertensive older adults were randomized to 16 weeks of CT (n=26) or group control (GC) (n=26), after this period subjects in the CONTROL began AT (AT) for 16 weeks. Delta between post and pre were calculated and normality was tested. One-way ANOVA to compared groups (CT, AT and CONTROL) follow by post-hoc of by Hechberg and Kruskal-Wallis test followed by Mann-Whitney, for CT and GC or Wilcoxon for GC and AT, depending upon parametric assumption. Improvements in aerobics fitness for both CT and AT (H (2) = 13.89 p<0.001 and p<0.001), working memory (H (2) = 10.07, p=0.02 and p=0.007), speed processing (H (2) = 10.51, p=0.004 and p=0.019), and overall executive function (F (2, 42) = 4.862, p=0.05 and p=0.01) when compared to CONTROL. Improvement in depressive symptoms to CT (H (2) = 18.08, p<0.001) compared to CONTROL only and tendencies to improve short-term memory (F (2, 47) = 3.26, p=0.06) Both CT and AT improve cognitive functions (working memory, overall executive function, speed processing), only CT were able to modified depressive symptoms and shortterm memory. Additional benefits for CT would be attached to social interaction, improvement in blood flow or IGF-I release.


Aging; Exercise; Dementia; Combined exercise; Aerobic exercise


Dementia prevalence is expected to double or triple over the next generation [1-6], making identification of preventative strategies is crucial. Sedentary lifestyle and hypertension are risky factors which lead to cognitive problems and vascular dementia by deposition of β-amyloid, as well as white matter lesions, commonly named as silent brain lesions [7]. Exercise has potential benefits for hypertensive people [2].

Aerobic (AT) and resistance training (RT) may improve cognition and mood among older adults without healthy problems [4,5]. Combined training (CT) may have additive effects, as AT and RT may act through different pathways [1]. We compared 16 weeks of CT, AT on cognition and depressive symptoms among hypertensive older adults.


52 hypertensive older adults were randomized to 16 weeks of CT (n=26) or CONTROL (n=26) (, U1111-1181-4455); methods are detailed elsewhere [8]. CONTROL participants were invited to 16weeks of AT after the CONTROL period (Figure 1). Briefly, participants were ≥ 60 years, had hypertension, and did physical activity ≤ 2x/week. Participants provided written informed consent. The Ethics Committee at University of Campinas (CAEE 54943216.7.0000.5404) approved the study.


AT and CT participants completed 50min of AT 3x/week on a treadmill at a speed corresponding to 63% VO2 max, as identified in a progressive maximum exercise test (VO2peak). In 2 sessions/ week, CT participants also did 15min of RT prior to AT, performing 15 repetitions of 6 exercises across major muscle groups at an intensity of 5-6 (“strong”) on the 10-point Borg rating of perceived exertion scale. The CONTROL participants have maintained their baseline physical activity level.

Assessments were at baseline, 16 weeks, and 32 weeks (AT only). Short- and long-term memory were measured using Shopping List Test and working memory (errors to find the right pathway), inhibitory control (perseverative errors), and overall executive function (sum of scores) were assessed with the Groton Maze Task (Cog State), depression by Geriatric Depression Scale (GDS) and blood samples for BDNF analyses (Premixed Multiplex). Chi-square was used to compare categorical data. One-way ANOVA, followed by Hechberg post hoc was performed, or Kruskal-Wallis test followed by Mann-Whitney, for CT and GC or Wilcoxon for GC and AT, depending upon parametric assumption (p<0.05) (R Core team, Vienna, Austria).


Twenty participants in CT and 23 in CONTROL completed the trial (Figure 1). From CONTROL, 15 agreed to participate in AT with an additional 2 recruited; 14 of 17 completed.

Table 1 shows baseline characteristics and changes over 16-weeks. Compared to CONTROL, CT and AT improved aerobic fitness (H (2) = 13.89 p<0.001 and p<0.001), working memory (H (2) = 10.07, p=0.02 and p=0.007), speed processing (H (2) = 10.51, p=0.004 and p=0.019), and overall executive function (F (2, 42) = 4.862, p=0.05 and p=0.01). CT also improved depressive symptoms (H (2) = 18.08, p<0.001) and neared significance for short-term memory (F (2, 47) = 3.26, p=0.06) compared to CONTROL; participants in AT kept unchanged to CONTROL for depressive symptoms (H (2) = 18.08, p< 0.73) and short-term memory (F (2, 47) = 13.67, p=0.99).

  CT (N =20) AT (N=14) CONTROL (N=23) p-value
Age 64.9 (4.3) 67.9 (6.1) 66.3 (5.5) 0.13
Gender, % women 70 (14.0) 64 (9.0) 60 (14) 0.92
Age 64.9 (4.3) 67.9 (6.1) 66.3 (5.5) 0.13
Height (m) 1.5 (0.1) 1.5 (0.1) 1.5 (0.1) 0.37
Weight (kg) 78.8 (12.6) 73.7 (9.8) 78.9 (11.2) 0.07
BMI 29.1 (4.2) 28.8 (4.3) 30.3 (3.3) 0.13
SBP (mmHg) 133.5 (17) 134.1 (12.6) 134.9 (24.4) 0.45
DBP (mmHg) 87.2 (10.6)a 75.6 (9.7) 82.9 (12.2) 0.01
MMSE (0-30) 24.9 (2.7) 25.8 (2.5) 26.2 (2.6) 0.08
Years of study 10.8 (4.5) 10.4 (4.8) 11.2 (4.1) 0.73
GDS (0 - 15) 4.4 (2.9) 2.0 (1.1) 3 (2.58) 0.49
Change over 16weeks on Cognition
Working memory (GM RER) -2.76 (6.9) b -2.77 (4.7) c 2.32 (4.0) <0.001
Inhibitory control (GM PER) -0.24 (0.9) -0.08 (0.3) -0.05(0.2) 0.80
Overall Executive function (GM TER) -3.47 (7.9) b -5.18 (4.5) c 1.71 (5.2) 0.01
Short-term memory (SL3) 1.53 (2.4) d -0.08 (2.1) 0 (1.7) 0.04
Long-term memory (SLR) 0.71 (2.2) -0.08 (2.1) -0.12 (1.6) 0.13
Speed processing (Time I) -0.22 (0.3) b -0.25 (0.3) b 0.07 (0.2) <0.001
Change over 16weeks on mechanics behind cognitive function changing
VO2 (ml/kg/min) 2.87 (3.4) b 2.63 (2.1) c -0.38 (2.3) <0.001
BDNF (pg/dL) -1129.86 (4289.2) 588.6 (3316.9) 943.62 (6203.4) 0.42
GDS (0-15) -2.79 (2.2) a. b -0.09 (0.7) 0.05 (1.6) <0.001

Table 1 Baseline characteristics and changes in outcomes over 16-week period, expressed as mean (SD) or % (n).

Discussion and Conclusion

Among hypertensive older adults, 16 weeks of AT or CT improved executive function and speed processing. CT also improved depressive symptoms and neared significance for short-term memory, whereas AT did not, providing evidence that CT may be more beneficial for mental health in aging.

There are several reasons for which CT may carry more benefits. One study suggests that RT acts through an IGF-1 pathway, whereas AT acts through a BDNF pathway [1]. CT stimulates pathways, inducing more brain changes even though, no changes in BDNF levels. Improvements in CF for CT lays in social engagement hypothesis, since AT has less human contact and did not improve depressive symptoms and short-term memory [3].

In conclusion, our study suggests that both AT and CT are beneficial to cognitive function. Additional benefits can be achieved by CT, on memory because possibly by human contact.


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Citation: Santos W, Sardeli A, Fabiele D, Gadelha V, Gáspari AF, et al. (2021) The Effect of Combined Exercise Versus Aerobic Exercise on Cognition and Mood among Hypertensive Older Adults: Randomized Clinical Trial. Health Sci J. Vol. 16 No. 1: 909.