Accelerated Age-related Cognitive Decline: Impact of Exercise on Executive Function and Neuroplasticity

Inclusion Criteria:

* • Diagnosed stage 3-4 chronic kidney disease (CKD, estimated glomerular filtration rate (eGFR) \<60 to 20 ml/min);

  * \>55 yrs of age
  * Mild cognitive impairment (18-26 on the MOCA)
  * ability to undergo an MR
  * no history of major head trauma (No head trauma/concussion with loss of consciousness)
  * Speaks, reads, writes English

Exclusion Criteria:

* • Diagnosed Dementia or a Clinical Dementia Rating Scale score of \<2, or a MOCA of \<18

  * Participating in a supervised exercise program with intent to increase fitness levels 3 days/week,
  * Requires assistive ambulation
  * Limited exercise capacity due to claudication; unstable angina, severe arthritis, extreme dyspnea on exertion, unstable coronary artery disease
  * Class III-IV heart failure
  * History of uncontrolled sustained arrhythmias, severe/symptomatic aortic or mitral stenosis, hypertrophic obstructive cardiomyopathy, severe pulmonary hypertension, active myocarditis/pericarditis, thrombophlebitis, and recent systemic/pulmonary embolus
  * Resting systolic BP \>200 mmHg or resting diastolic BP \>110 mmHg
  * Any unforeseen illness or disability that would preclude cognitive testing or exercise training
  * One or more contraindication for MRI; cardiac pacemaker, aneurysm clip, cochlear implants, shrapnel, history of metal fragments in eyes, neurostimulators, diagnosed claustrophobia (MRI only)
  * Any self-reported major psychiatric disorders requiring medical therapy (e.g. schizophrenia, bipolar disorder).
  * Self-reported new diagnosis of clinical depression within 3 months of enrollment or unstable clinical depression requiring medication adjustment within 3 months of enrollment