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Differences in 12\u2010month trajectories in the primary endpoint (ADAS\u2010Cog\u2010Exec) and magnetic resonance imaging (MRI) volumes in prespecified brain regions were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>AX and SBR showed significantly less 12\u2010month cognitive decline than ADNI\u20101 (AX:<jats:italic>n<\/jats:italic>\u00a0=\u00a0109, <jats:italic>\u03b2\u00a0<\/jats:italic>=\u00a00.169, 95% confidence interval [CI] 0.011\u20130.328; SBR:<jats:italic>n<\/jats:italic>\u00a0=\u00a0105, <jats:italic>\u03b2<\/jats:italic>\u00a0=\u00a00.181, 95% CI 0.007\u20130.354). There were trends of less prefrontal cortex volume loss for both EXERT groups and less AD signature region volume loss for SBR relative to ADNI\u20101 over 12 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>DISCUSSION<\/jats:title><jats:p>Moderate\u2010high intensity aerobic or low\u2010intensity flexibility exercise for 12 months in participants with aMCI may provide protection against decline relative to usual care.<\/jats:p><\/jats:sec><jats:sec><jats:title>CLINICAL TRIAL REGISTRATION<\/jats:title><jats:p>The EXERT clinical trial is registered at clinicaltrials.gov (NCT02814526).<\/jats:p><\/jats:sec><jats:sec><jats:title>Highlights<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>EXERT was a randomized controlled trial in sedentary older adults with aMCI.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>EXERT arms were propensity\u2010matched to a usual care (no intervention) group (Alzheimer's Disease Neuroimaging Initiative 1 [ADNI\u20101]).<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>High and low\u2010intensity exercise arms had less 12\u2010mo cognitive decline than ADNI\u20101.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>There were trends of less prefrontal cortex volume loss for each arm versus ADNI\u20101.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.70118","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T07:00:40Z","timestamp":1745478040000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Effects of exercise versus usual care on older adults with amnestic mild cognitive impairment: EXERT versus ADNI"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9693-0522","authenticated-orcid":false,"given":"Aladdin H.","family":"Shadyab","sequence":"first","affiliation":[{"name":"Herbert Wertheim School of 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Public Health and Human Longevity Science University of California San Diego  La Jolla California USA"},{"name":"Alzheimer's Disease Cooperative Study University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald G.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Herbert Wertheim School of Public Health and Human Longevity Science University of California San Diego  La Jolla California USA"},{"name":"Alzheimer's Disease Cooperative Study University of California San Diego  La Jolla California USA"},{"name":"Department of Neurosciences University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Z.","family":"LaCroix","sequence":"additional","affiliation":[{"name":"Herbert Wertheim School of Public Health and Human Longevity Science University of California San Diego  La Jolla California USA"},{"name":"Alzheimer's Disease 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