Evidence map›Paper›PMID 33742194›Full record

Trial reportThe American journal of clinical nutrition2021

Exercise, diet, and cognition in a 4-year randomized controlled trial: Dose-Responses to Exercise Training (DR's EXTRA).

Pirjo Komulainen, Jaakko Tuomilehto, Kai Savonen, Reija Männikkö, Maija Hassinen, Timo A Lakka, Tuomo Hänninen, Vesa Kiviniemi, David R Jacobs, Miia Kivipelto and 1 more

Open access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The American journal of clinical nutrition, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 5 pooled it
7.1field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 5 syntheses or guidelines pooled it, 50 citations in OpenAlex.

  1. Pooled it
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  13. Microbiome: A Key Regulator of Body-Brain Interactions.Advances in experimental medicine and biology · 2025
    Review
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  20. Cardiorespiratory Fitness and Muscular Strength Do Not Predict Social Cognitive Capacity in Older Age.The journals of gerontology. Series B, Psychological sciences and social sciences · 2023
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 4 countries.

Pirjo KomulainenKuopio Research Institute of Exercise Medicine, Kuopio, Finland.
Jaakko TuomilehtoDepartment of Chronic Disease Prevention, National Institute of Health and Welfare, Helsinki, Finland.
Kai SavonenKuopio Research Institute of Exercise Medicine, Kuopio, Finland.
Reija MännikköKuopio Research Institute of Exercise Medicine, Kuopio, Finland.
Maija HassinenKuopio Research Institute of Exercise Medicine, Kuopio, Finland.
Timo A LakkaKuopio Research Institute of Exercise Medicine, Kuopio, Finland.
Tuomo HänninenDepartment of Neurology, Kuopio University Hospital, Kuopio, Finland.
Vesa KiviniemiFinnish Medicines Agency, Kuopio, Finland.
David R JacobsDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minnesota, MN, USA.
Miia KivipeltoDepartment of Neuroscience and Neurology, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.
Rainer RauramaaKuopio Research Institute of Exercise Medicine, Kuopio, Finland.
University of Eastern Finland · FIFinnish Institute for Health and Welfare · FIFinnish Medicines Agency Fimea · FIKarolinska University Hospital · SEKuopio University Hospital · FIUniversity of Minnesota · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEvidence for the effects of exercise and dietary interventions on cognition from long-term randomized controlled trials (RCTs) in large general populations remains insufficient.

objectiveThe objective of our study was to investigate the independent and combined effects of resistance and aerobic exercise and dietary interventions on cognition in a population sample of middle-aged and older individuals.

methodsWe conducted a 4-y RCT in 1401 men and women aged 57-78 y at baseline. The participants were randomly assigned to the resistance exercise, aerobic exercise, diet, combined resistance exercise and diet, combined aerobic exercise and diet, or control group. Exercise goals were at least moderate-intensity resistance exercise ≥2 times/wk and at least moderate-intensity aerobic exercise ≥5 times/wk. Dietary goals were ≥400 g/d of vegetables, fruit, and berries; ≥2 servings of fish/wk; ≥14 g fiber/1000 kcal; and ≤10% of energy of daily energy intake from SFAs. The primary outcome was the change in global cognition measured by the total score of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological tests [CERAD total score (CERAD-TS)]. The data were analyzed using the intention-to-treat principle and linear mixed-effects models.

resultsThere was a trend toward improved CERAD-TS over 4 y in the combined aerobic exercise and diet group compared with the control group (net increase: 1.4 points; 95% CI: 0.1, 2.7; P = 0.06) adjusted for age, sex, years of education, symptoms of depression, and waist circumference at baseline. No other differences in CERAD-TS changes were found across the 6 study groups. Diet did not potentiate the effect of aerobic or resistance exercise on CERAD-TS.

conclusionsA combination of at least moderate-intensity aerobic exercise and a healthy diet may improve cognition in older individuals over 4 y, but there was no effect of either of these interventions alone, resistance training alone, or resistance exercise with a healthy diet on cognition.

Indexed as

CognitionDietExerciseAgedBody CompositionFemaleHumansMaleMiddle Agedaerobic exercisecognitive functionhealthy dietolder individualsresistance exercise

Identifiers

PMID33742194
PMCPMC8244125
OpenAlexW3138852357

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.