Effects of Resistance Training Exercise on Cognitive Functioning in Older Adults with and without Chronic Obstructive Pulmonary Disease (COPD)

Effects of Resistance Training Exercise on Cognitive Functioning in Older Adults with and without Chronic Obstructive Pulmonary Disease (COPD) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Resistance Training Exercise on Cognitive Functioning in Older Adults with and without Chronic Obstructive Pulmonary Disease (COPD) Marita Andreassen, Even Olai Larsen, Knut Sindre Mølmen, Torvald Ask, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4842070/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: A positive relationship between physical exercise training and cognitive function in humans is well-established. However, knowledge of how resistance exercise training affects patients with chronic obstructive pulmonary disease (COPD) is limited. COPD is usually followed by declines in cognitive functioning. Thus, an examination of how resistance exercise training affects cognitive functioning in COPD is warranted. The purpose of this study was to examine the effect of resistance exercise training on cognitive functioning in COPD participants. Method Thirty-six older adults (> 65 years) with COPD ( n = 8) and healthy controls ( n = 28) completed the study protocol. Cognitive functioning using the Montreal Cognitive Assessment (MoCA) was measured before and after a 13-week resistance exercise training intervention. Results For the healthy control group, resistance exercise training had no significant positive effects on cognitive functioning. For the COPD group, resistance exercise training displayed negative effects on cognitive functioning, contrary to our hypothesis. Conclusion While some participants without COPD had minor improvements from resistance exercise, COPD participants had adverse effects from the exercise intervention on cognitive functioning. COPD exercise cognitive functioning older adults Figures Figure 1 Figure 2 Figure 3 Introduction Chronic obstructive pulmonary disease (COPD) is a respiratory condition which is characterized by limitation of airflow and significant health issues (Vestbo et al., 2013). Hospitalization and mortality of COPD is high, and the condition has been declared as a global health problem that is considered to increase by 25% from 2020 to 2050 (Axon et al., 2020; Boers et al., 2023; Vestbo et al., 2013). COPD has a substantial number of co-occurring comorbidities, either caused by COPD or as a cause of the development of COPD, such as increased gastroesophageal reflux disease, osteoporosis, poor sleep-quality, and dysfunction of skeletal muscles (Barnes & Celli, 2009; Yohannes et al., 2020). Furthermore, an increase in cognitive impairment is common (Bonnevie et al., 2020; Dodd et al., 2010; Klein et al., 2010; Simargi et al., 2022, Yohannes et al., 2020), affecting factors such as attention, orientation, language, reaction time, visual learning, executive domains, and logical thinking among others (Klein et al., 2010; Tsai et al., 2023). Many patients with COPD are not physically active, and studies have found that exercise can be beneficial for this group of patients in primary care (Fastenau et al., 2020; Li et al., 2020). The cognitive effect of physical activity in patients with COPD can be improved (Desvaux et al., 2018). COPD is a condition that may prevent and reduce the original physical activity level of diagnosed individuals and re-engaging them in physical activity may be extremely important for their functioning in everyday life. A better understanding of how COPD patients are affected by exercise is also important in order to learn more about possible limitations and to help them achieve a higher quality of life. COPD The World Health Organization (WHO) states that chronic obstructive pulmonary disease is a progressive, life-threatening lung disease that causes breathlessness (initially with exertion) and predisposes to exacerbations and serious illness (WHO, 2023). The prevalence of COPD in general populations is 8.9%, but it is much higher for smokers (24.3%; Olortegui-Rodriguez et al., 2022). Incidence rates for the general population have been estimated at 3.4%. COPD caused 3.23 million deaths in 2019 and is thus considered as the third world leading cause of death on a global basis and is not curable, but smoking and second-hand smoking have been identified as the most significant risk factors (Song et al., 2021; WHO, 2023). Other risk factors are indoor and outdoor air pollution, occupational dust and chemicals, and frequent lower respiratory infections during childhood (WHO, 2023). COPD is a multi-component disease, associated with numerous mental and social problems (Dodd et al., 2010). Patients with COPD have an increased risk of mild cognitive impairment and dementia (Xie & Xie, 2019; Morris et al., 2019; Yohannes et al., 2020). Neuronal damage may be a result of comorbidities, such as smoking or vascular diseases, or from COPD connected problems, like hypoxaemia or hypercapnia (Dodd et al., 2010; Xie & Xie, 2019). Hypoxaemia and hypoxia refer to a reduction of oxygen levels in the body, and may affect metabolism, gene expression, hormone secretion, and hormone response (Nikinmaa, 2013). Cognitive Functioning in COPD Cognitive impairment has been demonstrated in 77% of COPD patients with hypoxaemia, and impaired cognitive performance on tests may be a predictor for mortality and disability (Dodd et al., 2010; Tsai et al., 2023). Deficits in cognitive functioning (such as attention, language, abstraction, delayed recall, orientation, and visuospatial executive domains) is one of the most important extrapulmonary manifestations in COPD patients, which also seem to decrease with time (Dodd et al., 2010; Zheng et al., 2008; Tsai et al., 2023). Several factors may influence the cognitive functioning in COPD, such as sociodemographic factors (e.g. age, gender, education level, and tobacco consumption), the severity of the disease, and physical and psychological functioning (Dodd et al., 2010; Pereira et al., 2011). More than 50% of COPD patients have coexisting vascular diseases, which may account for some of the cognitive impairment. However, the pattern of cognitive function is distinctive between COPD patients and those with only vascular disease, suggesting that vascular comorbidities may not solely cause impaired cognitive functions. Also, lung function may, instead of being a direct cause of cognitive impairment, be a predictor of physical activity, which in turn may be more directly associated with cognitive abilities (Dodd et al., 2010). Another possible mechanism underlying cognitive decline is the neuronal damage caused by hypoxia. However, non-hypoxic patients with severe COPD also showed significantly altered cerebral metabolism, distinctive from the changes observed in patients with heart failure and diabetes (Dodd et al., 2010), suggesting that hypoxia may not be the only cause for impaired cognitive functions. Cognitive impairment in COPD patients is prevalent and consistent across disease stages, emphasizing the need for cognitive evaluations in COPD care (Cleutjens et al., 2017). Individuals with COPD have a significantly lower score on Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) than controls (Crisan et al., 2014). Many studies examining the cognitive state of COPD patients used the mini mental state examination (MMSE), which is a less sensitive and accurate examination than MoCA (see Biazus-Sehn et al., 2020). One of the main critiques with MMSE is focus on language and verbal performance, as language is usually not an early impaired domain in dementia (Nasreddine et al., 2005). The Cognitive Effect of Exercise The influence of exercise on cognitive functioning, wellbeing, and stress reduction is well documented (Basso & Suzuki, 2017). Cognitive dysfunction in COPD is linked to reduced physical fitness, especially in heart failure cases, indicating a complex interplay between respiratory health, cognitive function, and physical fitness (Alosco et al., 2015). Combined aerobic and resistance training for COPD patients showed more increased functional outcomes, in terms of body strength and lean body mass, compared to participants in the non-exercise control group and those who performed resistance or aerobic exercise alone (Penedo & Dahn, 2005). Studies also show that in mild COPD, both walking and non-walking activities affect cognitive function differently, suggesting that a diverse exercise approach benefits health (Egoshi et al., 2022). These findings underline the importance of integrating physical activity into treatment plans to support both cognitive and physical aspects of COPD. Aquino and colleagues (2016) found that combined aerobic and strength exercise is more effective than aerobic exercise alone. This supports previous claims that combined aerobic and strength exercise is more effective than aerobic exercise alone (e.g., Penedo & Dahn, 2005; Colcombe & Kramer, 2003). Aquino and colleagues (2016) found, after a 4-week intervention program consisting of an aerobic group and a combined aerobic and strength group, that combined exercise resulted in significantly higher scores on long-term memory (LTM), verbal fluency, attention, apraxia, and reasoning skills. Previous meta-analyses (Colcombe & Kramer 2003; Smith et al., 2010) reported significant positive benefits of exercise on cognitive functioning. Colcombe & Kramer (2003) found significant benefits of exercise, particularly combined strength, and aerobic regimens, on executive processing, with varying effects by training duration, gender, and age. Contrarily, Smith et al. (2010) found modest cognitive improvements with exercise, excluding working memory impacts, and noted enhanced memory gains in mildly cognitively impaired individuals. Both analyses indicated that even minimal exercise could positively affect cognitive functions in specific populations, like those with mild COPD. Recent meta-analyses have identified the influence of exercise on cognitive functioning in clinical samples. Gates et al. (2013) found limited support that exercise improves cognitive functioning in individuals with Mild Cognitive Impairment (MCI), at risk for dementia. However, Song et al. (2018) looked at the impact of physical exercise on cognitive and psychological well-being in adults with MCI. They report significant improvements in overall cognitive function following physical exercise routines. Aerobic activities like moderate intensity walking and cycling showed medium effect sizes (SMD=.58 & .57 respectively), whereas resistance training, while also significant, had smaller effects (SMD=.41) on improving cognitive function. A more recent meta-analysis (Biazus-Sehn et al., 2020), looking at physical exercise in MCI patients found smaller effects on global cognitive functioning (SMD = .348), executive functioning (SMD = .213), and delayed recall (SMD =.180). These findings suggest that physical exercise, both aerobic and anaerobic exercise, may have beneficial effects on global cognition in MCI patients, but the effect of exercises’ impact on cognitive ability may be more difficult to estimate. While the studies found positive results of exercise on cognitive functioning, a Cochrane review (Young et al., 2015) examined the impact of aerobic exercise on cognitive function in older individuals without cognitive impairment. It included 12 trials with 754 participants and found no significant cognitive benefits from aerobic exercise, even when it improved cardiorespiratory fitness. The review also highlighted the need for larger studies to explore potential moderators and confirm the effects of aerobic training on cognition. The aforementioned meta-analyses included both aerobic and anaerobic exercise interventions find positive results, while the Young et al. (2015) meta-analysis only looked at aerobic interventions. The issue of exercise intensity and performance was studied in a comprehensive meta-analysis by Basso and Suzuki (2017). They found that exercise with intensities varying from very low to very high all had beneficial effects on cognitive functioning. They found that different levels of intensity may be related to different aspects of cognitive functioning. Specifically, exercise with moderate intensity might enhance executive functioning (Tower of London and Stroop), while exercise with high intensity might improve information processing (Paced Auditory Serial Addition) more. Physical exercise stimulates blood flow in the brain and might contribute to an increase in cerebral reserves, which may explain the protective effect on neurodegenerative conditions, such as Alzheimer's (Mandolesi et al., 2018). A recent meta-analysis investigated the impact of resistance training on exercise capacity in elderly COPD patients, revealing significant improvements in functional, endurance, and peak exercise capacities (Li et al., 2020). It highlighted the potential of resistance training as a rehabilitative tool for enhancing the physical capabilities of COPD patients, suggesting its integration into treatment plans. However, it also noted the need for larger, more comprehensive studies to fully understand the effects and optimal approaches of resistance training for this demographic. Objectives Based on the findings described above, combined with the reduced lung capacity and skeletal muscle dysfunction limit COPD patient’s opportunity to engage in longer sessions of endurance training, this intervention's focus was on the lower body as older adults lose muscle mass. Muscle strength in the lower body is important to regain (Mølmen et al., 2021a). Consequently, COPD subjects may be better suited for a resistance exercise intervention. Strength (resistance) training has been effective in reducing sarcopenia and maintaining functionality in both healthy samples and samples with COPD (Ries et al., 2007). However, traditional endurance training is usually applied to samples with COPD, without the same beneficial effect as in strength training (Ries et al., 2007; Troosters et al., 2010). Reduced cardiorespiratory functioning may prevent individuals with COPD from reaching sufficiently high intensity on endurance training (Zheng et al., 2008). Thus, resistance training enables muscle strain and gives increased effect, compared to endurance training for COPD subjects. High resistance training (HRT; anaerobic) is regarded as the most effective for optimal strength (Schoenfeld, 2010). However, low resistance training (LRT; aerobic) may be as effective (Campos et al., 2002). This may specially be the case for COPD subjects due to their reduced cardiorespiratory functioning. The purpose of this study is to examine the potential cognitive benefits associated with a resistance exercise intervention in participants with COPD and a healthy control group. It was hypothesized that COPD participants would benefit as much from a resistance-based intervention on cognitive performance as healthy controls would. Methods Participants Thirty-six ( N female = 27; n = 1 not reported) elderly participants (> 60 years) with ( n = 8; N female = 3) diagnosed COPD and healthy controls ( n = 28; N female = 19) were recruited to investigate the effects of vitamin D3 supplementation and resistance exercise training on quality of life in COPD participants. The vitamin D3 perspective of the study is covered elsewhere (see Mølmen et al., 2021b). Participants were recruited from the Lillehammer area through local (e.g., the local newspaper) and social media (e.g., Facebook). Participants were also recruited through consultations at Granheim Lung Hospital and local clinics. Resistance exercise training protocol All participants conducted the same whole-body resistance-exercise training program, consisting of two ~ 75-min sessions per week for 13 weeks. In each training session, the participants performed the following exercises (listed in order of conductance): unilateral leg press, unilateral knee extension, unilateral knee flexion, chest press, and lat pulldown. Leg exercises were performed unilaterally as three series of 10 repetitions (high-load) for one leg and 30 repetitions (low-load) to exhaustion for the other leg, to allow for within-participant differentiation of resistance training load (see Mølmen et al., 2021a). Exercises and sets were separated by 2 min of rest. For leg exercises, all three sets for one leg were conducted before the other leg was exercised. For all exercises, training loads were adjusted from session to session, i.e., when participants managed to perform more than 12 or 35 repetitions per set for high- and low-load training, respectively. All training sessions were conducted at Inland Norway University, campus Lillehammer, and were supervised by qualified personnel to ensure maximal efforts through verbal encouragement. Measurements The Montreal Cognitive Assessment The Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) is a ~ 10-minute cognitive screening tool to detect mild cognitive impairments. For this study, the Norwegian version of MoCA 7.1 (pre intervention) and 7.2 (post intervention) were administered to prevent any learning effect. The MoCA consists of 10 items. A short-term memory recall task, which involves a learning trial of five nouns and recall after approximately 5 minutes. A clock-drawing task and a three-dimensional cube copy task are used to assess visuospatial abilities. An adapted Trail Making B task, a phonemic verbal task, and two-item verbal abstraction task measure various aspects of executive functioning. Concentration, attention, and working memory are assessed using a sustained attention task, a serial subtraction task, and digit span (forward and backward). Language is evaluated using a three-item confrontation naming task with low-familiarity animals, the repetition of two syntactically complex sentences, and a verbal fluency task (recall as many words that begin with a certain letter within one minute). Understanding of time and place is evaluated last. Cut-off scores for mild cognitive impairment (MCI) is < 26. Item analysis shows the overall psychometric adequacy of the MoCA items (Freitas et al., 2012). The items for time and place usually give higher scores, and therefore there is a lower correlation with both any cognitive domain and with the total MoCA score. The MoCA has also shown good reliability (Cronbach’s ɑ=.90; Freitas et al., 2012). Ethical considerations The study was approved by the Regional Committee for Medical and Health Research Ethics - South-East Norway (reference no: 2013/1094) and preregistered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT02598830). All participants were informed about the potential risks and discomforts associated with the study and gave their informed consent prior to study enrolment. The study was conducted according to the Declaration of Helsinki. Statistical Analysis Data was analyzed using JASP v.0.18.3 (JASP Team, 2024). An independent sample t-test was conducted to calculate the difference between pre- and post-scores of MoCA. A repeated measures ANOVA was conducted to determine if there was a significant difference between and within the COPD and the control group on pre- and post-MoCA scores. Effect sizes were calculated based on Cohen´s (1992) formulas. The conventional α-level of .05 was used. Results Means and standard deviations for both groups can be found in Table 1 and plots showing individual changes for the groups are shown in Figure 1. Table 1: Descriptive Statistics for Mean and Standard Deviations (SD) of Pre- and Post Scores Pre MOCA (SD) Post MOCA(SD) t p CI LL CI UL Cohen's d Control (n = 28) 25.34 (2.29) 26.03 (2.56) -1.26 .22 -1.81 0.43 -0.28 COPD (n=8) 24.13 (3.36) 22.25 (5.18) 1.67 .14 -0.79 4.54 0.43 MoCA: Montreal Cognitive Assessment To test the hypothesis that exercise improved performance on the Montreal Cognitive Assessment (MoCA) a repeated measures analysis of variance was performed between the COPD and control participants on pre and post MoCA scores. Results show significant within ( F (1,35) = 4.61, p = .039, ⍵ 2 =.026 (see Figure 1; small effects) and between conditions ( F (1,35) = 6.26, p <.01, ⍵ 2 =.068 (medium effect size; see Figure 2). We further examined the effects of exercise on the word recall task of the MoCA where we recorded the number of correct words given starting with a specific letter (pre-test letter “F”; post-test letter “S”). While no differences between the groups was found ( F =.03, p = .866), there were positive significant increases within each group after the exercise intervention ( F = 6.48, p = .016, ⍵ 2 = .058; M diff Control = 2.03; M Diff COPD = 4.08; see Figure 3). Discussion This study aimed to assess the potential cognitive benefits of a resistance exercise program among individuals both with and without COPD. Our results indicate that the intervention had adverse effects on cognitive functioning in participants diagnosed with COPD, whereas the control group, consisting of older healthy adults, did not exhibit significant cognitive improvements following the same intervention. Baseline scores on the MoCA justify the assumption that COPD participants have reduced cognitive abilities compared to a healthy sample, which is in line with previous studies (Yohannes et al., 2020). Smith’s (2010) findings that those with mild cognitive impairments improved more than those without impairments, indicates that COPD participants would benefit more than the control group in this study. However, the small to medium reduction of MoCA scores after the training intervention was not predicted. Nevertheless, these results are not consistent with an earlier finding that COPD participants benefit from a training intervention (Biazus-Sehn et al., 2020; Song et al., 2018). Dodd et al. (2010) found that low intensity training improves cognitive functioning in COPD subjects, which may indicate that the intervention in this study was too hard. Other studies found a combination of combined aerobic exercise and resistance training improved attention and working memory, while aerobic exercise alone did not improve working memory (Aquino et al., 2016; Colcombe & Kramer 2003; Smith et al., 2010). It could be that neither aerobic exercise nor resistance training affect cognitive functioning separately. This is important to consider in future research. However, assuming that the decline could be due to fatigue, there are neurobiological factors indicating that training will reduce the decline in cognitive functioning for all participants (Young et al., 2015). As cognitive decline seems to increase with time, especially for individuals with COPD, exercise may have an important preventive effect (Li et al., 2020), even though we did not find improved cognitive performance for COPD participants as measured by the MoCA test in this study, but both the control and COPD groups significantly improved in verbal fluency (see Fig. 3 ). How physical activity improves the immune system may be an important factor for preventing further impairments for individuals with COPD. Infections or other diseases may further limit COPD participant’s physical activity level, and thus speed up decline in cognitive functioning. In this way, physical activity helps people stay physically active (Egoshi et al., 2022; Fastenau et al., 2020; Li et al., 2020). The control group had a small positive effect from the training intervention on MoCA, although not statistically significant, this finding can be interpreted as indicative of stability in cognitive function within the control group (Jonasson et al., 2017). The control group had a small positive effect from the training intervention on MoCA, and at post-test the group mean was over the MoCA cut-off score (> 26). These findings are more consistent with previous findings on exercise and cognitive functioning (Young et al., 2015). Several factors may be involved in this enhanced performance. Increased motivation may have enhanced performance on cognitive tasks and may lead to increased or sustained physical activity, and further recovery or increase of well-being and cognitive abilities. It is also important to note that there could be a learning effect between the pre and the post MoCA completion. Learning effects are known to be frequent in clinical trials when measuring individuals with cognitive impairments (Desveaux et al., 2018). To avoid or reduce this effect, we presented the participants with two different versions of MoCA (version 7.1 and 7.2). However, there are some common features between the two versions. It could be that the participants were more familiar with the test conditions at post-test, which could lower the level of anxiousness at post-test. Furthermore, both groups improved in verbal fluency between pre and post. They had to recall as many words as possible that begin with “F” (pre) and “S” (post). It's worth noting that cultural bias may have influenced the results, as it may be easier to recall words that start with "F" compared to "S" in the Norwegian language. Cognitive decline in individuals with COPD may both be globally or in particular domains, but the effect of exercise seems predominantly to be on executive functioning (Gates et al., 2013). It is therefore possible that the effect exercise has on cognitive performance in individuals with COPD is dependent on what domain they experience cognitive impairment. Possibly cognitive impairments on executive functioning will have the most beneficial effect of exercise. As Smith et al. (2010) found in their meta-analysis, executive functions had the most beneficial effect of exercise, including both strength and aerobics, something this study found on verbal fluency improvements. However, it is important to note that there was no effect on working memory when it was excluded from executive functioning. Smith et al. (2010) used brain scans of individuals completing an exercise program as supporting evidence, where they did not find any cerebral alteration in dorsolateral prefrontal cortex, an area associated with working memory. Limitations Limitations in this study include a low number of participants in the COPD group ( n = 8) vs. the control group ( n = 28). There was also a gender difference (27 females, whereas 19 of these were in the control group and 3 in the COPD group). There were twice as many males ( n = 6) in the COPD group than females ( n = 3). This gender difference is not in line with a recent article that claims the growth of COPD is expected to increase more for females than males (Boers et al., 2023). However, the prevalence for COPD in Norway is higher among men than women (Bhatta et al., 2018). There are some methodological issues. Three participants withdrew their participation in this study (one from the COPD group and two from the control group), which could limit the statistical power. The analysis also uncovered two outliers within the COPD group. Removing these two participants would show equal benefits within the groups and the visual analysis (Fig. 2 ) would show equal slopes. Also, the exercise intervention lasted for 13 weeks. Since there are no established standards for intervention length, this timeframe might have been more exhaustive for the COPD group. All testing on cognitive functioning (MoCA) was conducted immediately after the participant`s last training session. While the conditions were consistent for both groups, individuals with COPD may have perceived the training intervention as more stressful or fatiguing compared to the healthy group, likely due to their reduced physical capacity. This could be a cause for the decline in MoCA scores for COPD participants, and the results could be different if the participants had recovery time between sessions. Further research is needed to examine the potential impact of resistance training on cognitive functioning over a longer period of time. Other RCT studies had an exercise intervention which lasted for four months, followed by an additional follow-up after six months (Fastenau et al., 2020). This could be implemented in future studies, considering that there could be a level of fatigue after a training session which could impact the findings. However, Aquino and colleagues (2016) found that a combination of aerobic and strength improved cognitive scores after a 4-week intervention program. Conclusion In the present study, we investigated the impact of a 13-week resistance exercise program on cognitive functioning among older adults with Chronic Obstructive Pulmonary Disease (COPD) compared to a healthy control group. Our findings reveal a significant impairment in cognitive functioning among individuals with COPD when compared to their healthy counterparts. Interestingly, the implementation of resistance training did not yield improvements in cognitive functioning for either the COPD or the healthy group. However, although not significant, the control group showed a small positive effect. Notably, the timing of cognitive assessments immediately post-resistance training suggests a potential association of fatigue. For future studies, we suggest alternative timing for cognitive testing to mitigate potential confounding effects of fatigue for the COPD group. Declarations Author Contribution M.A. collected data, analyzed the data, and wrote the initial draft of the manuscript. E.L. collected data and wrote the initial draft of the manuscript. K.M. designed the study, conducted the intervention, and reviewed and edited the manuscript. T.A. reviewed and edited the manuscript. R.L. collected data, analyzed the data, and reviewed and edited the manuscript. Acknowledgments: Ricardo Gregorio Lugo is supported by the EU Horizon2020 project MariCybERA (agreement No. 952360) Correspondence should be addressed to Marita Andreassen, Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway. E-mail: [email protected] Data Availability Data are available upon request to the principal investigator, Knut Sindre Mølmen ( [email protected] ). References Alosco, M. L., Spitznagel, M. B., Josephson, R., Hughes, J., & Gunstad, J. (2015). COPD is associated with cognitive dysfunction and poor physical fitness in heart failure. Heart & Lung, 44 (1), 21-26. Aquino, G., Iuliano, E., Di Cagno, A., Vardaro, A., Fiorilli, G., Moffa, S., ... & Calcagno, G. (2016). Effects of combined training vs aerobic training on cognitive functions in COPD: a randomized controlled trial. International journal of chronic obstructive pulmonary disease , 11 , 711. https://doi.org/10.2147/copd.s96663 Axson, E.L., Ragutheeswaran, K., Sundaram, V., Bloom, C. I., Bottle, A., Cowie, M. R., & Quint, J. K. (2020). Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis. Respiratory Research, 21 (54), 1-13 Barnes, P. J., & Celli, B. R. (2009). Systemic manifestations and comorbidities of COPD. European respiratory journal , 33 (5), 1165-1185. Basso, J. C., & Suzuki, W. A. (2017). The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: A review. Brain Plasticity , 2 (2), 127-152. Bhatta, L., Leivseth, L., Mai, X-M., Chen, Y., Henriksen, A. H., Langhammer, A., & Brumpton, B. M. (2018). Prevalence and trend of COPD from 1995-1997 to 2006-2008: The HUNT study, Norway. Respiratory Medicine, 138, 50-56 Biazus-Sehn, L. F., Schuch, F. B., Firth, J., & de Souza Stigger, F. (2020). Effects of physical exercise on cognitive function of older adults with mild cognitive impairment: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 89 , 104048. Boers, E., Barrett, M., Su J. G., Benjafield, A. V., Sinha, S., Kaye, L., … & Malhotra, A. (2023). Global Burden of Chronic Obstructive Pulmonary Disease Through 2050. JAMA Netw Open, 6 (12), e2346598. Bonnevie, T., Medrinal, C., Combret, Y., Debeaumont, D., Lamia, B., Muir, J-F., Cuvelier, A., Prieur, G., & Gravier, F-E. (2020). Mid-Term Effects of Pulmonary Rehabilitation on Cognitive Function in People with Severe Chronic Obstructive Pulmonary Disease. International Journal of Chronic Obstructive Pulmonary Disease, 15 , 1111-1121 Campos, G. E., Luecke, T. J., Wendeln, H. K., Toma, K., Hagerman, F. C., Murray, T. F., ... & Staron, R. S. (2002). Muscular adaptations in response to three different resistance- training regimens: specificity of repetition maximum training zones. European journal of applied physiology , 88 (1-2), 50-60 Cleutjens, F. A., Spruit, M. A., Ponds, R. W., Vanfleteren, L. E., Franssen, F. M., Gijsen, C., ... & Janssen, D. J. (2018). Cognitive impairment and clinical characteristics in patients with chronic obstructive pulmonary disease. Chronic respiratory disease, 15(2), 91-102. Colombe, S., & Kramer, A. G. (2003). Fitness effects on the cognitive function of older adults: A metaanalytic study. Psychological Science, 14 , 125-130 https://doi.org/10.1111/1467-9280.t01-1-01430 Crisan, A. F., Oancea, C., Timar, B., Fira-Mladinescu, O., Crişan, A., & Tudorache, V. (2014). Cognitive Impairment in Chronic Obstructive Pulmonary Disease. PLoS ONE, 9 (7), e102468 Desveaux, L., Harrison, S. L., Gagnon, J-F., Goldstein, R. S., Brooks, D., & Pepin, V. (2018). Effects of exercise training on cognition in chronic obstructive pulmonary disease: A systematic review. Respiratory Medicine, 139, 110-116 Dodd, J. W., Getov, S. V., & Jones P. W. (2010). Cognitive function in COPD. European Respiratory Journal,35 (4),913-922. Doi: 10.1183/09031936.00125109 Dodd, J. W., Chung, A. W., van den Broek, M. D., Barrick, T. R., Charlton, R. A., & Jones, P. W. (2012). Brain structure and function in chronic obstructive pulmonary disease: a multimodal cranial magnetic resonance imaging study. American Journal of Respiratory and Critical Care Medicine , 186 (3), 240-245. Egoshi, S., Horie, J., Nakagawa, A., Matsunaga, Y., & Hayashi, S. (2022). Relationships of Walking and non-Walking Physical Activities in Daily Life with Cognitive Function and Physical Characteristics in Male Patients with Mild Chronic Obstructive Pulmonary Disease. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 16 , 11795484221146374 Fastenau, A., van Schayck, O. C. P., Winkens, B., Aretz, K., Gosselink, R., & Muris, J. W. M. (2020). Effectiveness of an exercise training programme COPD in primary care: A randomized controlled trial. Respiratory Medicine, 165, 105943 Freitas, S., Simoes, M. R., Marôco, J., Alves, L., & Santana, I. (2012). Construct validity of the Montreal Cognitive assessment (MoCA). Journal of the International Neuropsychological Society , 18 (2), 242-250. Gates, N., Singh, M. A. F., Sachdev, P. S., & Valenzuela, M. (2013). The Effect of Exercise Training on Cognitive Function in Older Adults with Mild Cognitive Impairment: A Meta-analysis of Randomized Controlled Trials. The American Journal of Geriatric Psychiatry, 21 (11), 1086-1097 JASP Team (2024). JASP (Version 0.18.3) [Computer software]. Jonasson, L. S., Nyberg, L., Kramer, A. F., Lundquist, A., Riklund, K., & Boraxbekk, C-J. (2017). Aerobic Exercise Intervention, Cognitive Performance, and Brain Structure: Results from the Physical Influences on Brain in Aging (PHIBRA) Study. Frontiers in Aging Neuroscience, 8, 336 Klein, M., Gauggel, S., Sachs, G., & Pohl, W. (2010). Impact of chronic obstructive pulmonary disease (COPD) on attention functions. Respiratory Medicine, 104 , 52-60 Li, N., Li, P., Lu, Y., Wang, Z., Li, J., Liu, X., & Wu, W. (2020). Effects of resistance training on exercise capacity in elderly patients with chronic obstructive pulmonary disease: a meta-analysis and systematic review. Aging Clinical and Experimental Research, 32 , 1911–1922 Mandolesi, L., Polverino, A., Montuori, S., Foti, F., Ferraioli, G., Sorrentino, P., & Sorrentino, G. (2018). Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits. Frontiers in Psychology , 9 . Morris, C., Mitchell, J. W., Moorey, H., Younan, H-C., Tadros, G., Turner, A. M. (2019). Memory, attention and fluency deficits in COPD may be a specific form of cognitive impairment. ERJ Open Research, 5 , 1-9 Mølmen, K. S., Hammarström, D., Falch, G. S., Grundtvig, M., Koll, L., Hanestadhaugen, M., … & Ellefsen, S. (2021a). Chronic obstructive pulmonary disease does not impair responses to resistance training. Journal of Translational Medicine, 19 (292), 1-22 Mølmen, K. S., Hammarström, D., Pedersen, K., Lie, A. C. L., Steile, R. B., Nygaard, H., … & Ellefsen (2021b). Vitamin D3 supplementation does not enhance the effects of resistance training in older adults. Journal of Cachexia, Sarcopenia and Muscle, 12, 599-628 Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., & Chertkow, H. (2005). The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society , 53 (4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x Nikinmaa, M. (2013). What is hypoxia? Acta Physiologica , 209 (1), 1-4 https://doi.org/10.1111/apha.12146 Olortegui-Rodriguez, J. J., Soriano-Moreno, D. R., Benites-Bullón, A., Pelayo-Luis, P. P., & Huaringa-Marcelo, J. (2022). Prevalence and incidence of chronic obstructive pulmonary disease in Latin America and the Caribbean: a systematic review and meta-analysis. BMC Pulmonary Medicine, 22 (1), 273. Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Current opinion in psychiatry , 18 (2), 189-193. Pereira, E. D. B., Viana, C. S., Taunay, T. C. E., Sales, P. U., Lima, J. W. O., & Holanda, M. A. (2011). Improvement of cognitive function after a three-month pulmonary rehabilitation program for COPD patients. Lung, 189 (4),279-285. https://doi.org/10.1007/s00408-011-9303-6 Ries, A. L., Bauldoff, G. S., Carlin, B. W., Casaburi, R., Emery, C. F., Mahler, D. A., ... & Herrerias, C. (2007). Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest , 131 (5), 4S-42. Schoenfeld, B. J. (2010). The mechanisms of muscle hypertrophy and their application to resistance training. The Journal of Strength & Conditioning Research , 24 (10), 2857 - 2872 Simargi, Y., Mansyur, M., Turana, Y., Harahap, A. R., Ramli, Y., Siste, K., Prasetyo, M., & Rumende, C. M. (2022). Risk of developing cognitive impairment on patients with chronic obstructive pulmonary disease. Medicine, 101 (25), e29235 Smith, P. J., Blumenthal, J. A., Hoffman, B. M., Cooper, H., Strauman, T. A., Welsh- Bohmer, K., ... & Sherwood, A. (2010). Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosomatic medicine , 72 (3), 239. https://dx.doi.org/10.1097%2FPSY.0b013e3181d14633 Song, D., Doris, S. F., Li, P. W., & Lei, Y. (2018). The effectiveness of physical exercise on cognitive and psychological outcomes in individuals with mild cognitive impairment: a systematic review and meta-analysis. International journal of nursing studies, 79 , 155-164. Song, Q., Chen, P., & Liu, X-M. (2021). The role of cigarette smoke-induced pulmonary vascular endothelial cell apoptosis in COPD. Respiratory Research, 2 2(39), 1-15. Troosters, T., Gosselink, R., Janssens, W., & Decramer, M. (2010). Exercise training and pulmonary rehabilitation: new insights and remaining challenges. European Respiratory Review , 19 (115), 24-29 Tsai, C-L., Chang, W. P., Lin, Y-K., Ho, S-C., & Lin, Y-H. (2023). Physical frailty related to cognitive impairment and COPD exacerbation: A cross-sectional study. Respiratory Medicine, 208 , 107129 Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... & Rodriguez-Roisin, R. (2013). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American journal of respiratory and critical care medicine , 187 (4), 347-365. World Health Organization (2023, March 16). Chronic Obstructive Pulmonary Disease (COPD). online: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd) Xie, F., & Xie, L. (2019). COPD and the risk of mild cognitive impairment and dementia: a cohort study based on the Chinese Longitudinal Health Longevity Survey. International Journal of Chronic Obstructive Pulmonary Disease, 14 , 403-408 Yohannes, A. M., Eakin, M. N., Holbrook, J. T., Sugar, E. A., Henderson, R., Baker, A. M., Casper, A. S., Kaminsky, D. A., Rea, A. L., Mathews, A. M., Que, L. G., Ramsdell, J. W., Gerald, L. B., Wise, R. A., Hanania, N. A. (2020). Association of mild cognitive impairment and characteristic of COPD and overall health status in a cohort study. Expert Review of Respiratory Medicine, 15 (1), 153-159 Young, J., Angevaren, M., Rusted, J., & Tabet, N. (2015). Aerobic exercise to improve cognitive function in older people without known cognitive impairment. Cochrane Database of Systematic Reviews, (4) Zheng, G. Q., Wang, Y., & Wang, X. T. (2008). Chronic hypoxia-hypercapnia influences cognitive function: a possible new model of cognitive dysfunction in chronic obstructive pulmonary disease. Medical Hypotheses , 71 (1), 111-113. https://doi.org/10.1016/j.mehy.2008.01.025 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4842070","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":344464921,"identity":"432bf684-6a90-45df-9a01-12ba009a40d1","order_by":0,"name":"Marita Andreassen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYJCCAxAqAcplb2wgrOUAihaeg4S1MKBqkUjAoQwKdNvPPjz8oYZB3pw99+GDH3/q5MwlH7c9LmC4I4dLi9mZdIMDB44xGO7seW5s2Nt22NhydmK78QyGZ8Y4tRxIA/qFjYFxw400NgnehgOJG24ntknzMBxOxOUjs/PPgFr+MdgDtbD//POnrn7DzYMEtNwA2nKwjSERZAszDxtzgsENRkJagLac7ZNI3nDmGbO0bNthww1nQA4zOIzbL+fTmD9UfLOx3XA8jfHjmz918gbHjz+T5qk4jDPEoEACXcCAgIZRMApGwSgYBXgBALA6XuHMc660AAAAAElFTkSuQmCC","orcid":"","institution":"Inland Norway University of Applied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Marita","middleName":"","lastName":"Andreassen","suffix":""},{"id":344464923,"identity":"a8203491-84a9-462f-9dba-bc1be840d8d6","order_by":1,"name":"Even Olai Larsen","email":"","orcid":"","institution":"Sorlandet Hospital Trust","correspondingAuthor":false,"prefix":"","firstName":"Even","middleName":"Olai","lastName":"Larsen","suffix":""},{"id":344464924,"identity":"6ba53db1-e56f-4b81-9d77-a523fd620e5d","order_by":2,"name":"Knut Sindre Mølmen","email":"","orcid":"","institution":"Inland Norway University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Knut","middleName":"Sindre","lastName":"Mølmen","suffix":""},{"id":344464930,"identity":"3834285e-1e50-4913-a781-e7f95c9f1818","order_by":3,"name":"Torvald Ask","email":"","orcid":"","institution":"Norwegian University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Torvald","middleName":"","lastName":"Ask","suffix":""},{"id":344464932,"identity":"7229e18e-e4e7-4686-955f-1f86d94371c2","order_by":4,"name":"Ricardo Gregorio Lugo","email":"","orcid":"","institution":"Østfold University College","correspondingAuthor":false,"prefix":"","firstName":"Ricardo","middleName":"Gregorio","lastName":"Lugo","suffix":""}],"badges":[],"createdAt":"2024-08-01 12:14:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4842070/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4842070/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65787890,"identity":"3f21305a-c84d-4673-b190-70293236db73","added_by":"auto","created_at":"2024-10-02 16:46:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65168,"visible":true,"origin":"","legend":"\u003cp\u003eRaincloud plots illustrate MoCA scores pre (depicted in green) and post (depicted in orange) the resistance exercise intervention for both the control group (left) and COPD group (right). MoCA cut-off score for MCI is \u0026lt; 26.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4842070/v1/010203655c4af186bc83c43d.png"},{"id":65787891,"identity":"391a78ef-3c2c-4f3c-bf12-f1b00a7a8a29","added_by":"auto","created_at":"2024-10-02 16:46:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22083,"visible":true,"origin":"","legend":"\u003cp\u003eRepeated measures analysis of variance (ANOVA) on MoCA scores assessed pre and post resistance exercise intervention of the two groups (COPD and healthy controls). MoCA cut-off score for MCI is \u0026lt; 26.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4842070/v1/bc656697c26bed7d08134415.png"},{"id":65787892,"identity":"92fd9f40-edd6-40d5-b5e7-5bdee6505090","added_by":"auto","created_at":"2024-10-02 16:46:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":25729,"visible":true,"origin":"","legend":"\u003cp\u003eRepeated measures analysis of variance (ANOVA) on MoCA Verbal Fluency task assessed pre and post resistance exercise intervention of the two groups (COPD and healthy controls).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4842070/v1/ffc0ec6c3d9cac4fd2df800c.png"},{"id":68210932,"identity":"43a118af-7729-4054-8f37-5ad464b8a55c","added_by":"auto","created_at":"2024-11-04 17:31:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":529626,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4842070/v1/17210211-2208-4b08-8e4a-346b88b47b84.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Resistance Training Exercise on Cognitive Functioning in Older Adults with and without Chronic Obstructive Pulmonary Disease (COPD)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic obstructive pulmonary disease (COPD) is a respiratory condition which is characterized by limitation of airflow and significant health issues (Vestbo et al., 2013). Hospitalization and mortality of COPD is high, and the condition has been declared as a global health problem that is considered to increase by 25% from 2020 to 2050 (Axon et al., 2020; Boers et al., 2023; Vestbo et al., 2013). COPD has a substantial number of co-occurring comorbidities, either caused by COPD or as a cause of the development of COPD, such as increased gastroesophageal reflux disease, osteoporosis, poor sleep-quality, and dysfunction of skeletal muscles (Barnes \u0026amp; Celli, 2009; Yohannes et al., 2020). Furthermore, an increase in cognitive impairment is common (Bonnevie et al., 2020; Dodd et al., 2010; Klein et al., 2010; Simargi et al., 2022, Yohannes et al., 2020), affecting factors such as attention, orientation, language, reaction time, visual learning, executive domains, and logical thinking among others (Klein et al., 2010; Tsai et al., 2023). Many patients with COPD are not physically active, and studies have found that exercise can be beneficial for this group of patients in primary care (Fastenau et al., 2020; Li et al., 2020). The cognitive effect of physical activity in patients with COPD can be improved (Desvaux et al., 2018). COPD is a condition that may prevent and reduce the original physical activity level of diagnosed individuals and re-engaging them in physical activity may be extremely important for their functioning in everyday life. A better understanding of how COPD patients are affected by exercise is also important in order to learn more about possible limitations and to help them achieve a higher quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOPD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe World Health Organization (WHO) states that chronic obstructive pulmonary disease is a progressive, life-threatening lung disease that causes breathlessness (initially with exertion) and predisposes to exacerbations and serious illness (WHO, 2023). The prevalence of COPD in general populations is 8.9%, but it is much higher for smokers (24.3%; Olortegui-Rodriguez et al., 2022). Incidence rates for the general population have been estimated at 3.4%. COPD caused 3.23 million deaths in 2019 and is thus considered as the third world leading cause of death on a global basis and is not curable, but smoking and second-hand smoking have been identified as the most significant risk factors (Song et al., 2021; WHO, 2023). Other risk factors are indoor and outdoor air pollution, occupational dust and chemicals, and frequent lower respiratory infections during childhood (WHO, 2023). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCOPD is a multi-component disease, associated with numerous mental and social problems (Dodd et al., 2010). Patients with COPD have an increased risk of mild cognitive impairment and dementia (Xie \u0026amp; Xie, 2019; Morris et al., 2019; Yohannes et al., 2020). Neuronal damage may be a result of comorbidities, such as smoking or vascular diseases, or from COPD connected problems, like hypoxaemia or hypercapnia (Dodd et al., 2010; Xie \u0026amp; Xie, 2019). Hypoxaemia and hypoxia refer to a reduction of oxygen levels in the body, and may affect metabolism, gene expression, hormone secretion, and hormone response (Nikinmaa, 2013).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCognitive Functioning in COPD\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCognitive impairment has been demonstrated in 77% of COPD patients with hypoxaemia, and impaired cognitive performance on tests may be a predictor for mortality and disability (Dodd et al., 2010; Tsai et al., 2023). Deficits in cognitive functioning (such as attention, language, abstraction, delayed recall, orientation, and visuospatial executive domains) is one of the most important extrapulmonary manifestations in COPD patients, which also seem to decrease with time (Dodd et al., 2010; Zheng et al., 2008; Tsai et al., 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral factors may influence the cognitive functioning in COPD, such as sociodemographic factors (e.g. age, gender, education level, and tobacco consumption), the severity of the disease, and physical and psychological functioning (Dodd et al., 2010; Pereira et al., 2011). More than 50% of COPD patients have coexisting vascular diseases, which may account for some of the cognitive impairment. However, the pattern of cognitive function is distinctive between COPD patients and those with only vascular disease, suggesting that vascular comorbidities may not solely cause impaired cognitive functions. Also, lung function may, instead of being a direct cause of cognitive impairment, be a predictor of physical activity, which in turn may be more directly associated with cognitive abilities (Dodd et al., 2010). Another possible mechanism underlying cognitive decline is the neuronal damage caused by hypoxia. However, non-hypoxic patients with severe COPD also showed significantly altered cerebral metabolism, distinctive from the changes observed in patients with heart failure and diabetes (Dodd et al., 2010), suggesting that hypoxia may not be the only cause for impaired cognitive functions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCognitive impairment in COPD patients is prevalent and consistent across disease stages, emphasizing the need for cognitive evaluations in COPD care (Cleutjens et al., 2017). Individuals with COPD have a significantly lower score on Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) than controls (Crisan et al., 2014). Many studies examining the cognitive state of COPD patients used the mini mental state examination (MMSE), which is a less sensitive and accurate examination than MoCA (see Biazus-Sehn et al., 2020). One of the main critiques with MMSE is focus on language and verbal performance, as language is usually not an early impaired domain in dementia (Nasreddine et al., 2005).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Cognitive Effect of Exercise\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The influence of exercise on cognitive functioning, wellbeing, and stress reduction is well documented (Basso \u0026amp; Suzuki, 2017).\u0026nbsp;Cognitive dysfunction in COPD is linked to reduced physical fitness, especially in heart failure cases, indicating a complex interplay between respiratory health, cognitive function, and physical fitness (Alosco et al., 2015). Combined aerobic and resistance training for COPD patients showed more increased functional outcomes, in terms of body strength and lean body mass, compared to participants in the non-exercise control group and those who performed resistance or aerobic exercise alone (Penedo \u0026amp; Dahn, 2005). Studies also show that in mild COPD, both walking and non-walking activities affect cognitive function differently, suggesting that a diverse exercise approach benefits health (Egoshi et al., 2022). These findings underline the importance of integrating physical activity into treatment plans to support both cognitive and physical aspects of COPD. Aquino and colleagues (2016) found that combined aerobic and strength exercise is more effective than aerobic exercise alone. This supports previous claims that combined aerobic and strength exercise is more effective than aerobic exercise alone (e.g., Penedo \u0026amp; Dahn, 2005; Colcombe \u0026amp; Kramer, 2003). Aquino and colleagues (2016) found, after a 4-week intervention program consisting of an aerobic group and a combined aerobic and strength group, that combined exercise resulted in significantly higher scores on long-term memory (LTM), verbal fluency, attention, apraxia, and reasoning skills. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePrevious meta-analyses (Colcombe \u0026amp; Kramer 2003; Smith et al., 2010) reported significant positive benefits of exercise on cognitive functioning. Colcombe \u0026amp; Kramer (2003) found significant benefits of exercise, particularly combined strength, and aerobic regimens, on executive processing, with varying effects by training duration, gender, and age. Contrarily, Smith et al. (2010) found modest cognitive improvements with exercise, excluding working memory impacts, and noted enhanced memory gains in mildly cognitively impaired individuals. Both analyses indicated that even minimal exercise could positively affect cognitive functions in specific populations, like those with mild COPD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecent meta-analyses have identified the influence of exercise on cognitive functioning in clinical samples. Gates et al. (2013) found limited support that exercise improves cognitive functioning in individuals with Mild Cognitive Impairment (MCI), at risk for dementia. However, Song et al. (2018) looked at the impact of physical exercise on cognitive and psychological well-being in adults with MCI. They report significant improvements in overall cognitive function following physical exercise routines. Aerobic activities like moderate intensity walking and cycling showed medium effect sizes (SMD=.58 \u0026amp; .57 respectively), whereas resistance training, while also significant, had smaller effects (SMD=.41) on improving cognitive function. A more recent meta-analysis (Biazus-Sehn et al., 2020), looking at physical exercise in MCI patients found smaller effects on global cognitive functioning (SMD = .348), executive functioning (SMD = .213), and delayed recall (SMD =.180). These findings suggest that physical exercise, both aerobic and anaerobic exercise, may have beneficial effects on global cognition in MCI patients, but the effect of exercises\u0026rsquo; impact on cognitive ability may be more difficult to estimate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile the studies found positive results of exercise on cognitive functioning, a Cochrane review (Young et al., 2015) examined the impact of aerobic exercise on cognitive function in older individuals without cognitive impairment. It included 12 trials with 754 participants and found no significant cognitive benefits from aerobic exercise, even when it improved cardiorespiratory fitness. The review also highlighted the need for larger studies to explore potential moderators and confirm the effects of aerobic training on cognition.\u003c/p\u003e\n\u003cp\u003eThe aforementioned meta-analyses included both aerobic and anaerobic exercise interventions find positive results, while the Young et al. (2015) meta-analysis only looked at aerobic interventions. The issue of exercise intensity and performance was studied in a comprehensive meta-analysis by Basso and Suzuki\u0026nbsp;(2017). They found that exercise with intensities varying from very low to very high all had beneficial effects on cognitive functioning. They found that different levels of intensity may be related to different aspects of cognitive functioning. Specifically, exercise with moderate intensity might enhance executive functioning (Tower of London and Stroop), while exercise with high intensity might improve information processing (Paced Auditory Serial Addition) more.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePhysical exercise stimulates blood flow in the brain and might contribute to an increase in cerebral reserves, which may explain the protective effect on neurodegenerative conditions, such as Alzheimer\u0026apos;s (Mandolesi et al., 2018). A recent meta-analysis investigated the impact of resistance training on exercise capacity in elderly COPD patients, revealing significant improvements in functional, endurance, and peak exercise capacities (Li et al., 2020). It highlighted the potential of resistance training as a rehabilitative tool for enhancing the physical capabilities of COPD patients, suggesting its integration into treatment plans. However, it also noted the need for larger, more comprehensive studies to fully understand the effects and optimal approaches of resistance training for this demographic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the findings described above, combined with the reduced lung capacity and skeletal muscle dysfunction limit COPD patient\u0026rsquo;s opportunity to engage in longer sessions of endurance training, this intervention\u0026apos;s focus was on the lower body as older adults lose muscle mass. Muscle strength in the lower body is important to regain (M\u0026oslash;lmen et al., 2021a). Consequently, COPD subjects may be better suited for a resistance exercise intervention. Strength (resistance) training has been effective in reducing sarcopenia and maintaining functionality in both healthy samples and samples with COPD (Ries et al., 2007). However, traditional endurance training is usually applied to samples with COPD, without the same beneficial effect as in strength training (Ries et al., 2007; Troosters et al., 2010). Reduced cardiorespiratory functioning may prevent individuals with COPD from reaching sufficiently high intensity on endurance training (Zheng et al., 2008). Thus, resistance training enables muscle strain and gives increased effect, compared to endurance training for COPD subjects. High resistance training (HRT; anaerobic) is regarded as the most effective for optimal strength (Schoenfeld, 2010). However, low resistance training (LRT; aerobic) may be as effective (Campos et al., 2002). This may specially be the case for COPD subjects due to their reduced cardiorespiratory functioning. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe purpose of this study is to examine the potential cognitive benefits associated with a resistance exercise intervention in participants with COPD and a healthy control group. It was hypothesized that COPD participants would benefit as much from a resistance-based intervention on cognitive performance as healthy controls would.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThirty-six (\u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003efemale\u003c/em\u003e\u003c/sub\u003e = 27; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1 not reported) elderly participants (\u0026gt;\u0026thinsp;60 years) with (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8; \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003efemale\u003c/em\u003e\u003c/sub\u003e = 3) diagnosed COPD and healthy controls (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28; \u003cem\u003eN\u003c/em\u003e\u003csub\u003e\u003cem\u003efemale\u003c/em\u003e\u003c/sub\u003e = 19) were recruited to investigate the effects of vitamin D3 supplementation and resistance exercise training on quality of life in COPD participants. The vitamin D3 perspective of the study is covered elsewhere (see M\u0026oslash;lmen et al., 2021b). Participants were recruited from the Lillehammer area through local (e.g., the local newspaper) and social media (e.g., Facebook). Participants were also recruited through consultations at Granheim Lung Hospital and local clinics.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eResistance exercise training protocol\u003c/h2\u003e \u003cp\u003eAll participants conducted the same whole-body resistance-exercise training program, consisting of two\u0026thinsp;~\u0026thinsp;75-min sessions per week for 13 weeks. In each training session, the participants performed the following exercises (listed in order of conductance): unilateral leg press, unilateral knee extension, unilateral knee flexion, chest press, and lat pulldown. Leg exercises were performed unilaterally as three series of 10 repetitions (high-load) for one leg and 30 repetitions (low-load) to exhaustion for the other leg, to allow for within-participant differentiation of resistance training load (see M\u0026oslash;lmen et al., 2021a). Exercises and sets were separated by 2 min of rest. For leg exercises, all three sets for one leg were conducted before the other leg was exercised. For all exercises, training loads were adjusted from session to session, i.e., when participants managed to perform more than 12 or 35 repetitions per set for high- and low-load training, respectively. All training sessions were conducted at Inland Norway University, campus Lillehammer, and were supervised by qualified personnel to ensure maximal efforts through verbal encouragement.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eMeasurements\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section4\"\u003e \u003ch2\u003eThe Montreal Cognitive Assessment\u003c/h2\u003e \u003cp\u003eThe Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) is a\u0026thinsp;~\u0026thinsp;10-minute cognitive screening tool to detect mild cognitive impairments. For this study, the Norwegian version of MoCA 7.1 (pre intervention) and 7.2 (post intervention) were administered to prevent any learning effect. The MoCA consists of 10 items. A short-term memory recall task, which involves a learning trial of five nouns and recall after approximately 5 minutes. A clock-drawing task and a three-dimensional cube copy task are used to assess visuospatial abilities. An adapted Trail Making B task, a phonemic verbal task, and two-item verbal abstraction task measure various aspects of executive functioning. Concentration, attention, and working memory are assessed using a sustained attention task, a serial subtraction task, and digit span (forward and backward). Language is evaluated using a three-item confrontation naming task with low-familiarity animals, the repetition of two syntactically complex sentences, and a verbal fluency task (recall as many words that begin with a certain letter within one minute). Understanding of time and place is evaluated last. Cut-off scores for mild cognitive impairment (MCI) is \u0026lt;\u0026thinsp;26.\u003c/p\u003e \u003cp\u003eItem analysis shows the overall psychometric adequacy of the MoCA items (Freitas et al., 2012). The items for time and place usually give higher scores, and therefore there is a lower correlation with both any cognitive domain and with the total MoCA score. The MoCA has also shown good reliability (Cronbach\u0026rsquo;s ɑ=.90; Freitas et al., 2012).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The study was approved by the Regional Committee for Medical and Health Research Ethics - South-East Norway (reference no: 2013/1094) and preregistered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT02598830). All participants were informed about the potential risks and discomforts associated with the study and gave their informed consent prior to study enrolment. The study was conducted according to the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData was analyzed using JASP v.0.18.3 (JASP Team, 2024). An independent sample t-test was conducted to calculate the difference between pre- and post-scores of MoCA. A repeated measures ANOVA was conducted to determine if there was a significant difference between and within the COPD and the control group on pre- and post-MoCA scores. Effect sizes were calculated based on Cohen\u0026acute;s (1992) formulas. The conventional α-level of .05 was used.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eMeans and standard deviations for both groups can be found in Table 1 and plots showing individual changes for the groups are shown in Figure 1.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eTable 1: Descriptive Statistics for Mean and Standard Deviations (SD) of Pre- and Post Scores\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePre MOCA (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePost MOCA(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCI LL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCI UL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCohen\u0026apos;s \u003cem\u003ed\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Control (n = 28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.34 (2.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.03 (2.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;COPD (n=8) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.13 (3.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.25 (5.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMoCA: Montreal Cognitive Assessment\u003c/p\u003e\n\u003cp\u003eTo test the hypothesis that exercise improved performance on the Montreal Cognitive Assessment (MoCA) a repeated measures analysis of variance was performed between the COPD and control participants on pre and post MoCA scores. Results show significant within (\u003cem\u003eF\u003c/em\u003e(1,35) = 4.61, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e= .039,\u0026nbsp;⍵\u003csup\u003e2\u003c/sup\u003e=.026 (see Figure 1; small effects) and between conditions (\u003cem\u003eF\u003c/em\u003e(1,35) = 6.26, \u003cem\u003ep\u003c/em\u003e\u0026lt;.01, ⍵\u003csup\u003e2\u003c/sup\u003e=.068 (medium effect size; see Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe further examined the effects of exercise on the word recall task of the MoCA where we recorded the number of correct words given starting with a specific letter (pre-test letter \u0026ldquo;F\u0026rdquo;; post-test letter \u0026ldquo;S\u0026rdquo;).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eWhile no differences between the groups was found (\u003cem\u003eF\u0026nbsp;\u003c/em\u003e=.03, \u003cem\u003ep\u003c/em\u003e = .866), there were positive significant increases within each group after the exercise intervention (\u003cem\u003eF\u003c/em\u003e = 6.48, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e= .016,\u0026nbsp;⍵\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= .058; \u003cem\u003eM\u003csub\u003ediff\u003c/sub\u003e\u003c/em\u003e\u003csub\u003e\u0026nbsp;\u003c/sub\u003eControl = 2.03; \u003cem\u003eM\u003csub\u003eDiff\u003c/sub\u003e\u003c/em\u003e\u003csub\u003e\u0026nbsp;\u003c/sub\u003eCOPD = 4.08; see Figure 3).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to assess the potential cognitive benefits of a resistance exercise program among individuals both with and without COPD. Our results indicate that the intervention had adverse effects on cognitive functioning in participants diagnosed with COPD, whereas the control group, consisting of older healthy adults, did not exhibit significant cognitive improvements following the same intervention. Baseline scores on the MoCA justify the assumption that COPD participants have reduced cognitive abilities compared to a healthy sample, which is in line with previous studies (Yohannes et al., 2020). Smith\u0026rsquo;s (2010) findings that those with mild cognitive impairments improved more than those without impairments, indicates that COPD participants would benefit more than the control group in this study. However, the small to medium reduction of MoCA scores after the training intervention was not predicted. Nevertheless, these results are not consistent with an earlier finding that COPD participants benefit from a training intervention (Biazus-Sehn et al., 2020; Song et al., 2018). Dodd et al. (2010) found that low intensity training improves cognitive functioning in COPD subjects, which may indicate that the intervention in this study was too hard. Other studies found a combination of combined aerobic exercise and resistance training improved attention and working memory, while aerobic exercise alone did not improve working memory (Aquino et al., 2016; Colcombe \u0026amp; Kramer 2003; Smith et al., 2010). It could be that neither aerobic exercise nor resistance training affect cognitive functioning separately. This is important to consider in future research. However, assuming that the decline could be due to fatigue, there are neurobiological factors indicating that training will reduce the decline in cognitive functioning for all participants (Young et al., 2015). As cognitive decline seems to increase with time, especially for individuals with COPD, exercise may have an important preventive effect (Li et al., 2020), even though we did not find improved cognitive performance for COPD participants as measured by the MoCA test in this study, but both the control and COPD groups significantly improved in verbal fluency (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). How physical activity improves the immune system may be an important factor for preventing further impairments for individuals with COPD. Infections or other diseases may further limit COPD participant\u0026rsquo;s physical activity level, and thus speed up decline in cognitive functioning. In this way, physical activity helps people stay physically active (Egoshi et al., 2022; Fastenau et al., 2020; Li et al., 2020).\u003c/p\u003e \u003cp\u003eThe control group had a small positive effect from the training intervention on MoCA, although not statistically significant, this finding can be interpreted as indicative of stability in cognitive function within the control group (Jonasson et al., 2017). The control group had a small positive effect from the training intervention on MoCA, and at post-test the group mean was over the MoCA cut-off score (\u0026gt;\u0026thinsp;26). These findings are more consistent with previous findings on exercise and cognitive functioning (Young et al., 2015). Several factors may be involved in this enhanced performance. Increased motivation may have enhanced performance on cognitive tasks and may lead to increased or sustained physical activity, and further recovery or increase of well-being and cognitive abilities.\u003c/p\u003e \u003cp\u003eIt is also important to note that there could be a learning effect between the pre and the post MoCA completion. Learning effects are known to be frequent in clinical trials when measuring individuals with cognitive impairments (Desveaux et al., 2018). To avoid or reduce this effect, we presented the participants with two different versions of MoCA (version 7.1 and 7.2). However, there are some common features between the two versions. It could be that the participants were more familiar with the test conditions at post-test, which could lower the level of anxiousness at post-test. Furthermore, both groups improved in verbal fluency between pre and post. They had to recall as many words as possible that begin with \u0026ldquo;F\u0026rdquo; (pre) and \u0026ldquo;S\u0026rdquo; (post). It's worth noting that cultural bias may have influenced the results, as it may be easier to recall words that start with \"F\" compared to \"S\" in the Norwegian language.\u003c/p\u003e \u003cp\u003eCognitive decline in individuals with COPD may both be globally or in particular domains, but the effect of exercise seems predominantly to be on executive functioning (Gates et al., 2013). It is therefore possible that the effect exercise has on cognitive performance in individuals with COPD is dependent on what domain they experience cognitive impairment. Possibly cognitive impairments on executive functioning will have the most beneficial effect of exercise. As Smith et al. (2010) found in their meta-analysis, executive functions had the most beneficial effect of exercise, including both strength and aerobics, something this study found on verbal fluency improvements. However, it is important to note that there was no effect on working memory when it was excluded from executive functioning. Smith et al. (2010) used brain scans of individuals completing an exercise program as supporting evidence, where they did not find any cerebral alteration in dorsolateral prefrontal cortex, an area associated with working memory.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eLimitations in this study include a low number of participants in the COPD group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8) vs. the control group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28). There was also a gender difference (27 females, whereas 19 of these were in the control group and 3 in the COPD group). There were twice as many males (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6) in the COPD group than females (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3). This gender difference is not in line with a recent article that claims the growth of COPD is expected to increase more for females than males (Boers et al., 2023). However, the prevalence for COPD in Norway is higher among men than women (Bhatta et al., 2018). There are some methodological issues. Three participants withdrew their participation in this study (one from the COPD group and two from the control group), which could limit the statistical power. The analysis also uncovered two outliers within the COPD group. Removing these two participants would show equal benefits within the groups and the visual analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) would show equal slopes. Also, the exercise intervention lasted for 13 weeks. Since there are no established standards for intervention length, this timeframe might have been more exhaustive for the COPD group. All testing on cognitive functioning (MoCA) was conducted immediately after the participant`s last training session. While the conditions were consistent for both groups, individuals with COPD may have perceived the training intervention as more stressful or fatiguing compared to the healthy group, likely due to their reduced physical capacity. This could be a cause for the decline in MoCA scores for COPD participants, and the results could be different if the participants had recovery time between sessions. Further research is needed to examine the potential impact of resistance training on cognitive functioning over a longer period of time. Other RCT studies had an exercise intervention which lasted for four months, followed by an additional follow-up after six months (Fastenau et al., 2020). This could be implemented in future studies, considering that there could be a level of fatigue after a training session which could impact the findings. However, Aquino and colleagues (2016) found that a combination of aerobic and strength improved cognitive scores after a 4-week intervention program.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the present study, we investigated the impact of a 13-week resistance exercise program on cognitive functioning among older adults with Chronic Obstructive Pulmonary Disease (COPD) compared to a healthy control group. Our findings reveal a significant impairment in cognitive functioning among individuals with COPD when compared to their healthy counterparts. Interestingly, the implementation of resistance training did not yield improvements in cognitive functioning for either the COPD or the healthy group. However, although not significant, the control group showed a small positive effect. Notably, the timing of cognitive assessments immediately post-resistance training suggests a potential association of fatigue. For future studies, we suggest alternative timing for cognitive testing to mitigate potential confounding effects of fatigue for the COPD group.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.A. collected data, analyzed the data, and wrote the initial draft of the manuscript. E.L. collected data and wrote the initial draft of the manuscript. K.M. designed the study, conducted the intervention, and reviewed and edited the manuscript. T.A. reviewed and edited the manuscript. R.L. collected data, analyzed the data, and reviewed and edited the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eRicardo Gregorio Lugo is supported by the EU Horizon2020 project MariCybERA (agreement No. 952360)\u003c/p\u003e \u003cp\u003eCorrespondence should be addressed to Marita Andreassen, Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway. E-mail: \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\[email protected]\u003c/span\u003e\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData are available upon request to the principal investigator, Knut Sindre M\u0026oslash;lmen ([email protected]).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlosco, M. L., Spitznagel, M. B., Josephson, R., Hughes, J., \u0026amp; Gunstad, J. (2015). COPD is associated with cognitive dysfunction and poor physical fitness in heart failure. \u003cem\u003eHeart\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026amp; Lung, 44\u003c/em\u003e(1), 21-26.\u003c/li\u003e\n \u003cli\u003eAquino, G., Iuliano, E., Di Cagno, A., Vardaro, A., Fiorilli, G., Moffa, S., ... \u0026amp; Calcagno, G. (2016). Effects of combined training vs aerobic training on cognitive functions in COPD: a randomized controlled trial. \u003cem\u003eInternational journal of chronic obstructive pulmonary disease\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e, 711. https://doi.org/10.2147/copd.s96663\u003c/li\u003e\n \u003cli\u003eAxson, E.L., Ragutheeswaran, K., Sundaram, V., Bloom, C. I., Bottle, A., Cowie, M. R., \u0026amp; Quint, J. K. (2020). Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis.\u003cem\u003e\u0026nbsp;Respiratory Research, 21\u003c/em\u003e(54), 1-13\u003c/li\u003e\n \u003cli\u003eBarnes, P. J., \u0026amp; Celli, B. R. (2009). Systemic manifestations and comorbidities of COPD. \u003cem\u003eEuropean respiratory journal\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(5), 1165-1185.\u003c/li\u003e\n \u003cli\u003eBasso, J. C., \u0026amp; Suzuki, W. A. (2017). The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: A review. \u003cem\u003eBrain Plasticity\u003c/em\u003e,\u003cem\u003e\u0026nbsp;2\u003c/em\u003e(2), 127-152.\u003c/li\u003e\n \u003cli\u003eBhatta, L., Leivseth, L., Mai, X-M., Chen, Y., Henriksen, A. H., Langhammer, A., \u0026amp; Brumpton, B. M. (2018). Prevalence and trend of COPD from 1995-1997 to 2006-2008: The HUNT study, Norway. \u003cem\u003eRespiratory Medicine, 138,\u003c/em\u003e 50-56\u003c/li\u003e\n \u003cli\u003eBiazus-Sehn, L. F., Schuch, F. B., Firth, J., \u0026amp; de Souza Stigger, F. (2020). Effects of physical exercise on cognitive function of older adults with mild cognitive impairment: A systematic review and meta-analysis. \u003cem\u003eArchives of Gerontology and Geriatrics, 89\u003c/em\u003e, 104048.\u003c/li\u003e\n \u003cli\u003eBoers, E., Barrett, M., Su J. G., Benjafield, A. V., Sinha, S., Kaye, L., \u0026hellip; \u0026amp; Malhotra, A. (2023). Global Burden of Chronic Obstructive Pulmonary Disease Through 2050. \u003cem\u003eJAMA Netw Open, 6\u003c/em\u003e(12), e2346598.\u003c/li\u003e\n \u003cli\u003eBonnevie, T., Medrinal, C., Combret, Y., Debeaumont, D., Lamia, B., Muir, J-F., Cuvelier, A., Prieur, G., \u0026amp; Gravier, F-E. (2020). Mid-Term Effects of Pulmonary Rehabilitation on Cognitive Function in People with Severe Chronic Obstructive Pulmonary Disease. \u003cem\u003eInternational Journal of Chronic Obstructive Pulmonary Disease, 15\u003c/em\u003e, 1111-1121\u003c/li\u003e\n \u003cli\u003eCampos, G. E., Luecke, T. J., Wendeln, H. K., Toma, K., Hagerman, F. C., Murray, T. F., ... \u0026amp; Staron, R. S. (2002). Muscular adaptations in response to three different resistance- training regimens: specificity of repetition maximum training zones. \u003cem\u003eEuropean journal of applied physiology\u003c/em\u003e, \u003cem\u003e88\u003c/em\u003e(1-2), 50-60\u003c/li\u003e\n \u003cli\u003eCleutjens, F. A., Spruit, M. A., Ponds, R. W., Vanfleteren, L. E., Franssen, F. M., Gijsen, C., ... \u0026amp; Janssen, D. J. (2018). Cognitive impairment and clinical characteristics in patients with chronic obstructive pulmonary disease. Chronic respiratory disease, 15(2), 91-102.\u003c/li\u003e\n \u003cli\u003eColombe, S., \u0026amp; Kramer, A. G. (2003). Fitness effects on the cognitive function of older adults: A metaanalytic study. \u003cem\u003ePsychological Science, 14\u003c/em\u003e, 125-130 https://doi.org/10.1111/1467-9280.t01-1-01430\u003c/li\u003e\n \u003cli\u003eCrisan, A. F., Oancea, C., Timar, B., Fira-Mladinescu, O., Crişan, A., \u0026amp; Tudorache, V. (2014). Cognitive Impairment in Chronic Obstructive Pulmonary Disease. \u003cem\u003ePLoS ONE, 9\u003c/em\u003e(7), e102468\u003c/li\u003e\n \u003cli\u003eDesveaux, L., Harrison, S. L., Gagnon, J-F., Goldstein, R. S., Brooks, D., \u0026amp; Pepin, V. (2018). Effects of exercise training on cognition in chronic obstructive pulmonary disease: A systematic review. \u003cem\u003eRespiratory Medicine, 139,\u0026nbsp;\u003c/em\u003e110-116\u003c/li\u003e\n \u003cli\u003eDodd, J. W., Getov, S. V., \u0026amp; Jones P. W. (2010). Cognitive function in COPD. \u003cem\u003eEuropean Respiratory Journal,35\u003c/em\u003e(4),913-922. Doi: 10.1183/09031936.00125109\u003c/li\u003e\n \u003cli\u003eDodd, J. W., Chung, A. W., van den Broek, M. D., Barrick, T. R., Charlton, R. A., \u0026amp; Jones, P. W. (2012). Brain structure and function in chronic obstructive pulmonary disease: a multimodal cranial magnetic resonance imaging study. \u003cem\u003eAmerican Journal of Respiratory and Critical Care Medicine\u003c/em\u003e, \u003cem\u003e186\u003c/em\u003e(3), 240-245.\u003c/li\u003e\n \u003cli\u003eEgoshi, S., Horie, J., Nakagawa, A., Matsunaga, Y., \u0026amp; Hayashi, S. (2022). Relationships of Walking and non-Walking Physical Activities in Daily Life with Cognitive Function and Physical Characteristics in Male Patients with Mild Chronic Obstructive Pulmonary Disease. \u003cem\u003eClinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 16\u003c/em\u003e, 11795484221146374\u003c/li\u003e\n \u003cli\u003eFastenau, A., van Schayck, O. C. P., Winkens, B., Aretz, K., Gosselink, R., \u0026amp; Muris, J. W. M. (2020). Effectiveness of an exercise training programme COPD in primary care: A randomized controlled trial. \u003cem\u003eRespiratory Medicine, 165,\u003c/em\u003e 105943\u003c/li\u003e\n \u003cli\u003eFreitas, S., Simoes, M. R., Mar\u0026ocirc;co, J., Alves, L., \u0026amp; Santana, I. (2012). Construct validity of the Montreal Cognitive assessment (MoCA). \u003cem\u003eJournal of the International Neuropsychological Society\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(2), 242-250.\u003c/li\u003e\n \u003cli\u003eGates, N., Singh, M. A. F., Sachdev, P. S., \u0026amp; Valenzuela, M. (2013). The Effect of Exercise Training on Cognitive Function in Older Adults with Mild Cognitive Impairment: A Meta-analysis of Randomized Controlled Trials.\u003cem\u003e\u0026nbsp;The American Journal of Geriatric Psychiatry, 21\u003c/em\u003e(11), 1086-1097\u003cbr\u003eJASP Team (2024). JASP (Version 0.18.3) [Computer software].\u003c/li\u003e\n \u003cli\u003eJonasson, L. S., Nyberg, L., Kramer, A. F., Lundquist, A., Riklund, K., \u0026amp; Boraxbekk, C-J. (2017). Aerobic Exercise Intervention, Cognitive Performance, and Brain Structure: Results from the Physical Influences on Brain in Aging (PHIBRA) Study.\u003cem\u003e\u0026nbsp;Frontiers in Aging Neuroscience, 8,\u003c/em\u003e 336\u003c/li\u003e\n \u003cli\u003eKlein, M., Gauggel, S., Sachs, G., \u0026amp; Pohl, W. (2010). Impact of chronic obstructive pulmonary disease (COPD) on attention functions. \u003cem\u003eRespiratory Medicine, 104\u003c/em\u003e, 52-60\u003c/li\u003e\n \u003cli\u003eLi, N., Li, P., Lu, Y., Wang, Z., Li, J., Liu, X., \u0026amp; Wu, W. (2020). Effects of resistance training on exercise capacity in elderly patients with chronic obstructive pulmonary disease: a meta-analysis and systematic review. \u003cem\u003eAging Clinical and Experimental Research, 32\u003c/em\u003e, 1911\u0026ndash;1922\u003c/li\u003e\n \u003cli\u003eMandolesi, L., Polverino, A., Montuori, S., Foti, F., Ferraioli, G., Sorrentino, P., \u0026amp; Sorrentino, G. (2018). Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eMorris, C., Mitchell, J. W., Moorey, H., Younan, H-C., Tadros, G., Turner, A. M. (2019). Memory, attention and fluency deficits in COPD may be a specific form of cognitive impairment. \u003cem\u003eERJ Open Research, 5\u003c/em\u003e, 1-9\u003c/li\u003e\n \u003cli\u003eM\u0026oslash;lmen, K. S., Hammarstr\u0026ouml;m, D., Falch, G. S., Grundtvig, M., Koll, L., Hanestadhaugen, M., \u0026hellip; \u0026amp; Ellefsen, S. (2021a). Chronic obstructive pulmonary disease does not impair responses to resistance training.\u003cem\u003e\u0026nbsp;Journal of Translational Medicine, 19\u003c/em\u003e(292), 1-22\u003c/li\u003e\n \u003cli\u003eM\u0026oslash;lmen, K. S., Hammarstr\u0026ouml;m, D., Pedersen, K., Lie, A. C. L., Steile, R. B., Nygaard, H., \u0026hellip; \u0026amp; Ellefsen (2021b). Vitamin D3 supplementation does not enhance the effects of resistance training in older adults.\u003cem\u003e\u0026nbsp;Journal of Cachexia, Sarcopenia and Muscle, 12,\u003c/em\u003e 599-628\u003c/li\u003e\n \u003cli\u003eNasreddine, Z. S., Phillips, N. A., B\u0026eacute;dirian, V., Charbonneau, S., Whitehead, V., Collin, I., \u0026amp; Chertkow, H. (2005). The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. \u003cem\u003eJournal of the American Geriatrics Society\u003c/em\u003e, \u003cem\u003e53\u003c/em\u003e(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x\u003c/li\u003e\n \u003cli\u003eNikinmaa, M. (2013). What is hypoxia? \u003cem\u003eActa Physiologica\u003c/em\u003e, \u003cem\u003e209\u003c/em\u003e(1), 1-4 https://doi.org/10.1111/apha.12146\u003c/li\u003e\n \u003cli\u003eOlortegui-Rodriguez, J. J., Soriano-Moreno, D. R., Benites-Bull\u0026oacute;n, A., Pelayo-Luis, P. P., \u0026amp; Huaringa-Marcelo, J. (2022).\u003c/li\u003e\n \u003cli\u003ePrevalence and incidence of chronic obstructive pulmonary disease in Latin America and the Caribbean: a systematic review and meta-analysis. \u003cem\u003eBMC Pulmonary Medicine, 22\u003c/em\u003e(1), 273.\u003c/li\u003e\n \u003cli\u003ePenedo, F. J., \u0026amp; Dahn, J. R. (2005). Exercise and well-being: a review of mental and physical health benefits associated with physical activity. \u003cem\u003eCurrent opinion in psychiatry\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(2), 189-193.\u003c/li\u003e\n \u003cli\u003ePereira, E. D. B., Viana, C. S., Taunay, T. C. E., Sales, P. U., Lima, J. W. O., \u0026amp; Holanda, M. A. (2011). Improvement of cognitive function after a three-month pulmonary rehabilitation program for COPD patients. \u003cem\u003eLung, 189\u003c/em\u003e(4),279-285. https://doi.org/10.1007/s00408-011-9303-6\u003c/li\u003e\n \u003cli\u003eRies, A. L., Bauldoff, G. S., Carlin, B. W., Casaburi, R., Emery, C. F., Mahler, D. A., ... \u0026amp; Herrerias, C. (2007). Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. \u003cem\u003eChest\u003c/em\u003e, \u003cem\u003e131\u003c/em\u003e(5), 4S-42.\u003c/li\u003e\n \u003cli\u003eSchoenfeld, B. J. (2010). The mechanisms of muscle hypertrophy and their application to resistance training. \u003cem\u003eThe Journal of Strength \u0026amp; Conditioning Research\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(10), 2857 - 2872\u003c/li\u003e\n \u003cli\u003eSimargi, Y., Mansyur, M., Turana, Y., Harahap, A. R., Ramli, Y., Siste, K., Prasetyo, M., \u0026amp; Rumende, C. M. (2022). Risk of developing cognitive impairment on patients with chronic obstructive pulmonary disease. \u003cem\u003eMedicine, 101\u003c/em\u003e(25), e29235\u003c/li\u003e\n \u003cli\u003eSmith, P. J., Blumenthal, J. A., Hoffman, B. M., Cooper, H., Strauman, T. A., Welsh- Bohmer, K., ... \u0026amp; Sherwood, A. (2010). Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. \u003cem\u003ePsychosomatic medicine\u003c/em\u003e, \u003cem\u003e72\u003c/em\u003e(3), 239. https://dx.doi.org/10.1097%2FPSY.0b013e3181d14633\u003c/li\u003e\n \u003cli\u003eSong, D., Doris, S. F., Li, P. W., \u0026amp; Lei, Y. (2018). The effectiveness of physical exercise on cognitive and psychological outcomes in individuals with mild cognitive impairment: a systematic review and meta-analysis. \u003cem\u003eInternational journal of nursing studies, 79\u003c/em\u003e, 155-164.\u003c/li\u003e\n \u003cli\u003eSong, Q., Chen, P., \u0026amp; Liu, X-M. (2021). The role of cigarette smoke-induced pulmonary vascular endothelial cell apoptosis in COPD.\u003cem\u003e\u0026nbsp;Respiratory Research, 2\u003c/em\u003e2(39), 1-15.\u003c/li\u003e\n \u003cli\u003eTroosters, T., Gosselink, R., Janssens, W., \u0026amp; Decramer, M. (2010). Exercise training and pulmonary rehabilitation: new insights and remaining challenges. \u003cem\u003eEuropean Respiratory Review\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(115), 24-29\u003c/li\u003e\n \u003cli\u003eTsai, C-L., Chang, W. P., Lin, Y-K., Ho, S-C., \u0026amp; Lin, Y-H. (2023). Physical frailty related to cognitive impairment and COPD exacerbation: A cross-sectional study. \u003cem\u003eRespiratory Medicine, 208\u003c/em\u003e, 107129\u003c/li\u003e\n \u003cli\u003eVestbo, J., Hurd, S. S., Agust\u0026iacute;, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... \u0026amp; Rodriguez-Roisin, R. (2013). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. \u003cem\u003eAmerican journal of respiratory and critical care medicine\u003c/em\u003e, \u003cem\u003e187\u003c/em\u003e(4), 347-365.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization (2023, March 16). Chronic Obstructive Pulmonary Disease (COPD). online: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)\u003c/li\u003e\n \u003cli\u003eXie, F., \u0026amp; Xie, L. (2019). COPD and the risk of mild cognitive impairment and dementia: a cohort study based on the Chinese Longitudinal Health Longevity Survey. \u003cem\u003eInternational Journal of Chronic Obstructive Pulmonary Disease, 14\u003c/em\u003e, 403-408\u003c/li\u003e\n \u003cli\u003eYohannes, A. M., Eakin, M. N., Holbrook, J. T., Sugar, E. A., Henderson, R., Baker, A. M., Casper, A. S., Kaminsky, D. A., Rea, A. L., Mathews, A. M., Que, L. G., Ramsdell, J. W., Gerald, L. B., Wise, R. A., Hanania, N. A. (2020). Association of mild cognitive impairment and characteristic of COPD and overall health status in a cohort study. \u003cem\u003e\u0026nbsp;Expert Review of Respiratory Medicine, 15\u003c/em\u003e(1), 153-159\u003c/li\u003e\n \u003cli\u003eYoung, J., Angevaren, M., Rusted, J., \u0026amp; Tabet, N. (2015). Aerobic exercise to improve cognitive function in older people without known cognitive impairment.\u003cem\u003e\u0026nbsp;Cochrane\u0026nbsp;\u003c/em\u003e\u003cem\u003eDatabase of Systematic Reviews, (4)\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eZheng, G. Q., Wang, Y., \u0026amp; Wang, X. T. (2008). Chronic hypoxia-hypercapnia influences cognitive function: a possible new model of cognitive dysfunction in chronic obstructive pulmonary disease. \u003cem\u003eMedical Hypotheses\u003c/em\u003e, \u003cem\u003e71\u003c/em\u003e(1), 111-113. https://doi.org/10.1016/j.mehy.2008.01.025\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COPD, exercise, cognitive functioning, older adults","lastPublishedDoi":"10.21203/rs.3.rs-4842070/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4842070/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eA positive relationship between physical exercise training and cognitive function in humans is well-established. However, knowledge of how resistance exercise training affects patients with chronic obstructive pulmonary disease (COPD) is limited. COPD is usually followed by declines in cognitive functioning. Thus, an examination of how resistance exercise training affects cognitive functioning in COPD is warranted. The purpose of this study was to examine the effect of resistance exercise training on cognitive functioning in COPD participants.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThirty-six older adults (\u0026gt;\u0026thinsp;65 years) with COPD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8) and healthy controls (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28) completed the study protocol. Cognitive functioning using the Montreal Cognitive Assessment (MoCA) was measured before and after a 13-week resistance exercise training intervention.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFor the healthy control group, resistance exercise training had no significant positive effects on cognitive functioning. For the COPD group, resistance exercise training displayed negative effects on cognitive functioning, contrary to our hypothesis.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWhile some participants without COPD had minor improvements from resistance exercise, COPD participants had adverse effects from the exercise intervention on cognitive functioning.\u003c/p\u003e","manuscriptTitle":"Effects of Resistance Training Exercise on Cognitive Functioning in Older Adults with and without Chronic Obstructive Pulmonary Disease (COPD)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-02 16:46:14","doi":"10.21203/rs.3.rs-4842070/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a50df4a3-54a3-491e-b715-e1a2ecb92edb","owner":[],"postedDate":"October 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-04T17:23:35+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-02 16:46:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4842070","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4842070","identity":"rs-4842070","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}