In an era where the prevalence of hypertension and cognitive impairment is on the rise, understanding the interplay between physical activity and cognitive health is crucial. Hypertension, affecting over a third of adults worldwide, is a well-established risk factor for both cardiovascular and cerebrovascular diseases. Concurrently, the global burden of dementia is expected to surge, with projections indicating over 175 million people will be affected by 2050. Notably, individuals with hypertension are at an increased risk of cognitive decline, encompassing conditions such as mild cognitive impairment (MCI), Alzheimer’s disease, and vascular dementia.

Emerging evidence suggests that physical activity, particularly vigorous-intensity physical activity (VPA), may play a pivotal role in mitigating cognitive decline. However, the optimal volume and intensity of physical activity required to confer these cognitive benefits remain unclear. The study “Effect of Vigorous-Intensity Physical Activity on Incident Cognitive Impairment in High-Risk Hypertension“, conducted by Kazibwe et al., delves into this issue by examining the impact of VPA on cognitive health among individuals with high-risk hypertension.

In this article we aim to provide an overview and detailed analysis of the study’s findings, highlighting the significant reduction in the risk of cognitive impairment associated with regular VPA. We also discuss the implications for us as fitness professionals, offering practical guidance on how to incorporate these findings into effective exercise programmes. Additionally, we’ve designed a periodised high-intensity interval training (HIIT) programme to maximise the cognitive and physical benefits for our clients. By understanding and applying these insights, we can enhance our clients’ health outcomes, particularly in reducing the risk of cognitive decline.

Study Analysis

The study, by Kazibwe et al., explores the relationship between vigorous physical activity (VPA) and cognitive health among individuals with high-risk hypertension. Given the rising prevalence of hypertension and its established risk factor for cognitive impairment, the study aims to fill the knowledge gap on the optimal type and frequency of physical activity necessary to mitigate cognitive decline.


The research is a post hoc analysis of data from the SPRINT MIND study, a component of the larger SPRINT trial. This randomised, controlled trial included 9361 non-diabetic adults in the U.S. with hypertension. Participants’ vigorous physical activity was self-reported and categorised into low VPA (<1 session/week) and high VPA (≥1 session/week). Cognitive assessments were performed at baseline and follow-up periods, using tools like the Montreal Cognitive Assessment (MoCA) and the Functional Activities Questionnaire (FAQ).


The analysis included 7670 participants, with a follow-up period averaging 4.5 years. Key findings include:

  • Participants engaging in high VPA had significantly lower incidences of mild cognitive impairment (MCI), probable dementia, and a composite of both.
  • High VPA was associated with a 20% reduced risk of MCI and an 18% reduced risk of the composite MCI/probable dementia outcome.
  • The benefits of high VPA were consistent across various subgroups, though more pronounced in participants under 75 and Black participants.
  • The protective effect of VPA was observed regardless of the intensity of blood pressure treatment, indicating the robustness of physical activity as an independent factor.

The study underscores the importance of vigorous physical activity in reducing cognitive decline risk among individuals with hypertension. The mechanisms through which VPA exerts its benefits may include enhanced neurogenesis, improved cardiovascular health, and increased production of neurotrophic factors. The findings advocate for incorporating VPA into regular health regimens, particularly for high-risk populations.

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Applying this Knowledge

We can leverage these insights to design effective exercise programmes for our clients, especially those at high risk of cognitive decline. Emphasising the inclusion of VPA can help mitigate the risk of dementia and related conditions. We can:

  1. Educate Clients: Inform clients about the cognitive benefits of VPA and motivate them to incorporate such activities into their routines.
  2. Tailor Programmes: Customise exercise plans that gradually increase the intensity to reach vigorous levels safely.
  3. Monitor Progress: Regularly assess clients’ cognitive health and physical fitness to adjust exercise intensity and ensure maximum benefits.

Periodised HIIT Training Programme

Phase 1: Foundation (Weeks 1-4)

  • Objective: Build a base level of fitness and ensure clients are comfortable with exercise.
  • Frequency: 3 sessions per week.
  • Structure:
    • Warm-Up: 10 minutes of light cardio and dynamic stretching.
    • HIIT Session:
      • 4 rounds of 30 seconds high-intensity (e.g., sprinting, burpees) followed by 90 seconds of low-intensity (walking or slow jogging).
    • Cool-Down: 10 minutes of static stretching and breathing exercises.

Phase 2: Development (Weeks 5-8)

  • Objective: Increase intensity and endurance.
  • Frequency: 4 sessions per week.
  • Structure:
    • Warm-Up: 10 minutes of moderate cardio and mobility exercises.
    • HIIT Session:
      • 6 rounds of 40 seconds high-intensity followed by 80 seconds of low-intensity.
    • Cool-Down: 10 minutes of static stretching and foam rolling.

Phase 3: Performance (Weeks 9-12)

  • Objective: Peak intensity and improve overall fitness.
  • Frequency: 4-5 sessions per week.
  • Structure:
    • Warm-Up: 10 minutes of dynamic stretching and light cardio.
    • HIIT Session:
      • 8 rounds of 50 seconds high-intensity followed by 70 seconds of low-intensity.
    • Cool-Down: 10 minutes of static stretching and relaxation techniques.

Phase 4: Maintenance (Weeks 13-16)

  • Objective: Maintain fitness gains and prevent burnout.
  • Frequency: 3 sessions per week.
  • Structure:
    • Warm-Up: 10 minutes of light to moderate cardio.
    • HIIT Session:
      • 5 rounds of 40 seconds high-intensity followed by 80 seconds of low-intensity.
    • Cool-Down: 10 minutes of static stretching and deep breathing.

Before you begin, ensure the client has medical clearance, where necessary, then make sure you adjust the programme based on individual client needs, fitness levels and progress. Regularly monitor and modify the intensity and volume to ensure continued improvement and prevent injuries.

The study provides compelling evidence on the cognitive benefits of vigorous physical activity, especially for individuals with high-risk hypertension. The findings highlight that engaging in at least one session of vigorous physical activity per week can significantly reduce the risk of mild cognitive impairment and probable dementia. These benefits are consistent across various demographics, including age and race, reinforcing the importance of integrating VPA into regular health routines.

These insights offer us a valuable opportunity to enhance client outcomes. By educating clients about the cognitive benefits of VPA, customising exercise plans, and monitoring progress, we can help mitigate the risk of cognitive decline in high-risk populations. The periodised HIIT training programme provided can serve as a practical tool for us to implement these findings effectively.

Incorporating VPA into daily routines not only improves cardiovascular and metabolic health but also plays a crucial role in maintaining cognitive function, particularly in those with hypertension. As the study suggests, a proactive approach to physical activity can be a powerful intervention in the fight against cognitive decline and related conditions, underscoring the broader public health implications of exercise.

By promoting vigorous physical activity to suitable clients, we can make a substantial impact on the long-term health and quality of life of their clients, demonstrating the far-reaching benefits of regular, intense exercise beyond physical fitness alone.


Kazibwe, R., Schaich, C. L., Muhammad, A. I., Epiu, I., Namutebi, J. H., Chevli, P. A., … & Yeboah, J. (2024). Effect of vigorous-intensity physical activity on incident cognitive impairment in high-risk hypertension. Alzheimer’s & Dementia. Click here to review the full research article.

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