1 Research Centre and Centre EPIC, Montreal Heart Institute, Montreal, Quebec, Canada.
2 Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
3 Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada.
4 Department of Physics, Concordia University, Montreal, Quebec, Canada.
5 Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Quebec, Canada.
6 Department of Psychology, Université de Montréal, Montréal, Quebec, Canada.
7 Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.
8 Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
9 Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
10 Department of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
11 Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
12 Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.

Cognitive impairment can affect up to 50% of patients with chronic heart failure (CHF) and is associated with reduced treatment adherence, high mortality rates, and poor quality of life. Nonpharmacologic strategies, including cognitive intervention and physical exercise training, may help enhance cognition in patients with CHF. Recent studies in dementia prevention have shown that combining cognitive and exercise interventions could have synergistic effects on cognition, but scientific evidence for the benefits in CHF patients is lacking. Moreover, how men and women with heart failure may differ in their response to nonpharmacologic interventions is also unknown. This randomized controlled trial will investigate the effects of combining cognitive and exercise training, on cognition and cerebral blood flow regulation in men and women with CHF. To achieve this, 216 participants (50% female) with stable CHF regardless of etiology and left ventricular ejection fraction will be randomized to 1 of the 3 following arms: 1. combined cognitive and exercise training; 2. exercise training alone; 3. usual medical care with standard cardiovascular rehabilitation. The first 2 groups will engage in a 6-month intervention, whereas those in group 3 will take part in a standard 3-month cardiac rehabilitation program. The primary endpoint will be changes in cognitive performance from baseline to 6 months based on 4 cognitive composite scores (global cognitive functioning, memory, executive functions, processing speed). Secondary outcomes will include changes in cerebral blood flow regulation (neurovascular coupling, pulsatility, and autoregulation). Tertiary outcomes will include cardiorespiratory fitness, physical functioning, and quality of life.

Clinical trial registration: NCT04970888.