title: The Study of Mental and Resistance Training (SMART) study—resistance training and/or cognitive training in mild cognitive impairment: a randomized, double-blind, double-sham controlled trial.
abstract: BACKGROUND
  Mild cognitive impairment (MCI) increases dementia risk with no pharmacologic treatment available.
  
  
  METHODS
  The Study of Mental and Resistance Training was a randomized, double-blind, double-sham controlled trial of adults with MCI. Participants were randomized to 2 supervised interventions: active or sham physical training (high intensity progressive resistance training vs seated calisthenics) plus active or sham cognitive training (computerized, multidomain cognitive training vs watching videos/quizzes), 2-3 days/week for 6 months with 18-month follow-up. Primary outcomes were global cognitive function (Alzheimer's Disease Assessment Scale-cognitive subscale; ADAS-Cog) and functional independence (Bayer Activities of Daily Living). Secondary outcomes included executive function, memory, and speed/attention tests, and cognitive domain scores.
  
  
  RESULTS
  One hundred adults with MCI [70.1 (6.7) years; 68% women] were enrolled and analyzed. Resistance training significantly improved the primary outcome ADAS-Cog; [relative effect size (95% confidence interval) -0.33 (-0.73, 0.06); P < .05] at 6 months and executive function (Wechsler Adult Intelligence Scale Matrices; P = .016) across 18 months. Normal ADAS-Cog scores occurred in 48% (24/49) after resistance training vs 27% (14/51) without resistance training [P < .03; odds ratio (95% confidence interval) 3.50 (1.18, 10.48)]. Cognitive training only attenuated decline in Memory Domain at 6 months (P < .02). Resistance training 18-month benefit was 74% higher (P = .02) for Executive Domain compared with combined training [z-score change = 0.42 (0.22, 0.63) resistance training vs 0.11 (-0.60, 0.28) combined] and 48% higher (P < .04) for Global Domain [z-score change = .0.45 (0.29, 0.61) resistance training vs 0.23 (0.10, 0.36) combined].
  
  
  CONCLUSIONS
  Resistance training significantly improved global cognitive function, with maintenance of executive and global benefits over 18 months.
authors.affiliation: Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, Sydney Medical School, The University of Sydney, Lidcombe, New South Wales, Australia; Hebrew SeniorLife, Boston, MA; Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA. Electronic address: maria.fiataronesingh@sydney.edu.au.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Fiatarone Singh
authors.affiliation: Private Neuropsychology Practice, Mosman, New South Wales, Australia.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gates
authors.affiliation: Exercise Health and Performance, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Saigal
authors.affiliation: Exercise Health and Performance, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia.
authors.forename: Guy C
authors.initials: GC
authors.lastname: Wilson
authors.affiliation: Exercise Health and Performance, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia.
authors.forename: Jacinda
authors.initials: J
authors.lastname: Meiklejohn
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Center for Healthy Brain Ageing (CHeBA), NPI, Euroa Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors.forename: Wei
authors.initials: W
authors.lastname: Wen
authors.affiliation: Royal Prince Alfred and Balmain Hospital Balmain Hospital, Balmain, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Nalin
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Bernhard T
authors.initials: BT
authors.lastname: Baune
authors.affiliation: Monash Clinical and Imaging Neuroscience, School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia.
authors.forename: Chao
authors.initials: C
authors.lastname: Suo
authors.affiliation: Exercise Health and Performance, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia; Australian Catholic University, New South Wales, Australia.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Baker
authors.affiliation: Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia.
authors.forename: Nasim
authors.initials: N
authors.lastname: Foroughi
authors.affiliation: Department of Medicine and the Diabetes Center, University of California at San Francisco, San Francisco, CA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Center for Healthy Brain Ageing (CHeBA), NPI, Euroa Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors.forename: Perminder S
authors.initials: PS
authors.lastname: Sachdev
authors.affiliation: Regenerative Neuroscience Group, Brain and Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Valenzuela
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D060825:Cognitive Dysfunction / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D055070:Resistance Training / Q000379:methods*; D016896:Treatment Outcome
keywords: Mild cognitive impairment; cognitive training; resistance training