Exercise and the brain in cardiovascular disease: A narrative review

Patients with cardiovascular diseases (CVDs) (including heart failure) are at increased risk of cognitive impairment and dementia. Vascular risk factors contribute to cognitive decline through cerebral small vessel diseases, pathological brain changes, and hypoperfusion. Habitual exercise and increased cardiorespiratory fitness are associated with higher cognitive function, greater cerebral blood flow, and attenuation of the decline in gray matter volume and white matter integrity. Furthermore, moderate-vigorous exercise training has been shown to improve cognitive function in healthy middle-aged and older adults. Cardiac rehabilitation (CR) is a class 1A recommendation for patients with CVD, which involves exercise training and intensive risk factor modification. This article reviews the current evidence for the effect of exercise-based CR on cognitive function, cerebrovascular function, and brain structure in patients with CVDs. Overall, exercise-based CR appears to improve global cognitive function and attention-psychomotor functions but not language processes. Furthermore, the effect of exercise-based CR on executive function and memory is less clear and there is limited research into the effect of exercise-based CR on cerebrovascular function and brain structure.