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

Published:October 23, 2014DOI:



      Mild cognitive impairment (MCI) increases dementia risk with no pharmacologic treatment available.


      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.


      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].


      Resistance training significantly improved global cognitive function, with maintenance of executive and global benefits over 18 months.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Prince M.
        • Brycea R.
        • Albaneseb E.
        • et al.
        The global prevalence of dementia: A systematic review and metaanalysis.
        Alzheimers Dement. 2013; 9: 63-75
        • Petersen R.C.
        • Roberts R.O.
        • Knopman D.S.
        • et al.
        Mild cognitive impairment.
        Arch Neurol. 2009; 66: 1447-1455
        • Lehrner J.
        • Gufler R.
        • Guttmann G.
        • et al.
        Annual conversion to Alzheimer disease among patients with memory complaints attending an outpatient memory clinic: The influence of amnestic mild cognitive impairment and the predictive value of neuropsychological testing.
        Wiener Klinische Wochenschrift. 2005; 117: 629-635
        • Kaduszkiewicz H.
        • Zimmerman T.
        • Beck-Bornholdt H.
        • van der Bussche H.
        Cholinesterase inhibitors for patients with Alzheimer's disease: Systematic review of randomised clinical trails.
        BMJ. 2005; 331: 321-327
        • Barnes D.E.
        • Yaffe K.
        The projected effect of risk factor reduction on Alzheimer's disease prevalence.
        Lancet Neurol. 2011; 10: 819-828
        • Valenzuela M.J.
        Brain reserve and the prevention of dementia.
        Curr Opin Psychiatry. 2008; 21: 296-302
        • Cotman C.W.
        • Berchtold N.C.
        Exercise: A behavioural intervention to enhance brain health and plasticity.
        Trends Neurosci. 2002; 25: 295-301
        • Heyn P.C.
        • Johnson K.E.
        • Kramer A.F.
        Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: A meta-analysis.
        J Nutr Health Aging. 2008; 12: 401-409
        • Valenzuela M.J.
        • Sachdev P.
        Brain reserve and cognitive decline: A nonparametric systematic review.
        Psychol Med. 2006; 36: 1065-1073
        • Colcombe S.J.
        • Kramer A.F.
        Fitness effects on the cognitive function of older adults: A meta-analytic study.
        Am Psychol Soc. 2003; 14: 125-130
        • Gates N.
        • Fiatarone Singh M.A.
        • Sachdev P.S.
        • et al.
        The effect of exercise training on cognitive function in older adults with mild cognitive impairment: A meta-analysis of randomized controlled trials.
        Am J Geriatr Psychiatry. 2013; 21: 1086-1097
        • Gates N.J.
        • Sachdev P.S.
        • Fiatarone Singh M.A.
        • Valenzuela M.J.
        Cognitive and memory training in adults at risk of dementia: A systematic review.
        BMC Geriatr. 2011; 11: 55
        • Cotman C.W.
        • Berchtold N.C.
        • Christie L.
        Exercise builds brain health.
        Trends Neurosci. 2007; 30: 464-472
        • Nithianantharajah J.
        • Hannan A.J.
        The neurobiology of brain and cognitive reserve: Mental and physical activity as modulators of brain disorders.
        Prog Neurobiol. 2009; 89: 369-382
        • Nourhashemi F.
        • Andrieu S.
        • Gillette-Guyonnet S.
        • et al.
        Is there a relationship between fat-free soft tissue mass and low cognitive function? Results from a study of 7105 women.
        J Am Geriatr Soc. 2002; 50: 1796-1801
        • Burns J.M.
        • Johnson D.K.
        • Watts A.
        • et al.
        Reduced lean mass in early Alzheimer disease and its association with brain atrophy.
        Arch Neurol. 2010; 67: 428-433
        • Busse A.L.
        • Filho W.J.
        • Magaldi R.M.
        • et al.
        Effects of resistance training exercise on cognitive performance in elderly individulas with memory impairment: Results of a controlled trial.
        Einstein. 2008; 6: 402-407
        • Nagamatsu L.S.
        • Handy T.C.
        • Hsu C.L.
        • et al.
        Resistance training promotes cognitive and functional brain plasticity in seniors with probable mild cognitive impairment.
        Arch Neurol. 2012; 172: 666-668
        • Gates N.
        • Valenzuela M.
        • Sachdev P.
        • et al.
        Study of mental activity and regular training (SMART) in at risk individuals: A randomised double blind, sham controlled, longitudinal trial.
        BMC Geriatr. 2011; 11: 19
        • Rosen W.G.
        • Mohs R.C.
        • Davis K.L.
        A new rating scale for Alzheimer's disease.
        Am J Psychiatry. 1984; 141: 1356-1365
        • Hindmarch I.
        • Lehfeld H.
        • de Jongh P.
        • Erzigkeit H.
        The bayer activities of daily Living scale (B-ADL).
        Dement Geriatr Cogn Disord. 1998; 9: 20-26
        • Petersen R.C.
        • Smith G.M.
        • Ivnik R.J.
        • et al.
        Mild cognitive impairment:clinical characterisation and outcome.
        Arch Neurol. 1999; 56: 303-308
      1. Marker KR. (1986-2008) Marker Software. Heidelberg and Ladenburg.

        • Greenaway M.C.
        • Hanna S.M.
        • Lepore S.W.
        • Smith G.E.
        A behavioral rehabilitation intervention for amnestic mild cognitive impairment.
        Am J Alzheimers Dis Other Demen. 2008; 23: 451-461
      2. Wechsler D. Wechsler Memory Scale, 3rd ed. In: Corporation TP, ed. San Diego, CA: Harcourt Brace and Company; 1997.

        • Barber S.
        • Clegg A.P.
        • Young J.B.
        Is there a role for physical exercise in preventing decline in people with mild cognitive impairment?.
        Age Ageing. 2012; 41: 5-8
        • Smith P.
        • Blumenthal J.A.
        • Hoffman B.M.
        • et al.
        Aerobic exercise and neurocognitive performance: A meta-analytic review of randomised controlled trials.
        Psychosom Med. 2010; 72: 239-252
        • Van Uffelen J.G.Z.
        • Chinapaw M.J.M.
        • Van Mechelen W.
        Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomized controlled trial.
        Br J Sports Med. 2008; 42: 344-351
        • Baker L.D.
        • Frank L.L.
        • Foster-Schubert K.
        • et al.
        Effects of aerobic exercise on mild cognitive impairment.
        Arch Neurol. 2010; 67: 71-79
        • Scherder E.J.A.
        • Van Paasshen J.
        • Deijen J.-B.
        • et al.
        Physical activity and executive functions in the elderly with mild cognitive impairment.
        Aging Mental Health. 2005; 9: 272-280
        • Lautenschlager N.T.
        • Cox K.
        • Flicker L.
        • et al.
        Effects of physical activity on cognitive function in older adults at risk for Alzheimer disease.
        JAMA. 2008; 300: 1027-1037
        • Williamson J.D.
        • Espeland M.
        • Kritchevsky S.B.
        • et al.
        Changes in cognitive function in a randomized trial of physical activity: Results of the lifestyle interventions and independence for elders pilot study.
        J Gerontol Med Sci. 2009; 64A: 688-694
        • Brown A.K.
        • Liu-Ambrose T.
        • Tate R.
        • Lord S.R.
        The effect of group-based exercise on cognitive performance and mood in seniors residing in intermediate care and self-care retirement facilities: A randomised controlled trial.
        Br J Sports Med. 2009; 43: 608-614
        • Kimura K.
        • Obuchi S.
        • Arai T.
        • et al.
        The influence of short-term strength training on health related quality of life and executive cognitive function.
        J Physiol Anthropol. 2010; 3: 95-101
        • Molloy D.W.
        • Delaquerriere Richardson L.
        • Crilly R.G.
        The effects of a three-month exercise programme on neuropsychological function in elderly institutionalized women: a randomized controlled trial.
        Age Ageing. 1988; 17: 303-310
        • Barnes D.E.
        • Santos-Modesitt W.
        • Poelke G.
        • et al.
        The mental activity and eXercise (MAX) trial: A randomized controlled trial to enhance cognitive function in older adults.
        JAMA Intern Med. 2013; 173: 797-804
        • Fabre C.
        • Chamari K.
        • Mucci P.
        Improvement of cognitive function via mental and/or individualised aerobic training in healthy elderly subjects.
        Int J Sports Med. 2002; 23: 415-421
        • Oswald W.
        • Gunzelmann T.
        • Rupprecht R.
        Differential effects of single versus combined cognitive and physical training with older adults: The SimA study in a 5-year perspective.
        Eur J Ageing. 2006; 3: 179-192
        • Nader G.A.
        Concurrent strength and endurance training: From molecules to man.
        Med Sci Sports Exerc. 2006; 38: 1965-1970
      3. Coe R. Effect size calculator: A guide to using the spreadsheet. Available at: Accessed October 17, 2014.

      Linked Article

      • Erratum
        Journal of the American Medical Directors AssociationVol. 17Issue 8
        • Preview
          The authors, Fiatarone Singh MA, Gates N, Saigal N, et al. of the article, 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. J Am Med Dir Assoc 2014;15:873-880, wish to correct two typographical errors in Table 1 of their article. The errors are in the “Control” column under “ADAS-Cog” and “WAIS Matrices” and the correct numbers are bolded below. The authors regret any misconceptions these errors may have caused.
        • Full-Text
        • PDF
      • Erratum
        Journal of the American Medical Directors AssociationVol. 22Issue 2
        • Preview
          The Authors wish to make a correction to their article published in JAMDA ( ) “The SMART Study - Resistance Training and/or Cognitive Training in Mild Cognitive Impairment: A Randomized, Double-blind, Double-sham Controlled Trial”.
        • Full-Text
        • PDF