Aerobic exercise prevents white matter microstructural degeneration in MCI adults

Background While the use of non‐pharmacological interventions—such as physical activity, nutritional supplementation and cognitive stimulation—to prevent or delay cognitive decline and the onset of Alzheimer’s disease (AD) has received increasing attention, evidence supporting the benefits of these interventions have been mixed, and underlying mechanisms are not well‐understood. Method In participants enrolled in the PACE‐2 trial, which examined the impacts of 6‐month physical activity intervention on brain and cognitive outcomes, we evaluated the effects of aerobic exercise (n = 15, 63±10 yrs) on longitudinal changes in brain morphometry and white matter microstructure compared to stretching exercise controls (n = 17, 67±7 yrs.) using MRI among pre‐diabetic mild cognitive impairment adults. High‐resolution structural T1‐weighted and diffusion‐weighted images (DTI) were acquired before and after exercise intervention. Group differences in MRI markers (cortical volume and thickness, white matter DTI and free water metrics) after intervention and their longitudinal changes were compared for 68 cortical (Desikan‐Killany Atlas) and 48 white matter (JHU WM Atlas) regions using FreeSurfer SPM, FSL and Nextflow. Result No statistically significant group difference in cortical thickness, volumes and conventional DTI metrics was observed. On the other hand, free water (FW)‐corrected fractional anisotropy (FA) remained unchanged in aerobic exercise group (p = 0.32) while FA decreased in stretching controls in the right cerebral peduncle(p<0.001), resulting in group differences in FW‐corrected FA after 6‐month exercise intervention (p = 0.02 after Bonferroni correction). These changes in stretching exercise group were negatively correlated with FW fraction changes (marker related with neuroinflammation) (r = ‐0.71, p = 0.001). Conclusion Aerobic exercise could have neuroprotective effects by preventing white matter degeneration, and FW fraction and FW‐corrected imaging markers could be useful for more sensitive detection of early AD sign.