Objective. While physical activity can improve verbal memory performance in subjects with coronary artery disease (CAD), there is large variability in response. Elevated cortisol production has been suggested to negatively affect verbal memory performance, yet cortisol concentrations have not been assessed as a predictor of response to exercise intervention in those with CAD. Methods. CAD patients participating in a one-year cardiac rehabilitation program were recruited. Memory was assessed with the California Verbal Learning Test second edition at baseline and one year. Cortisol was measured from a 20？mg, 3.0？cm hair sample collected at baseline. Results. In patients with CAD ( , mean？±？SD age？=？ , 86% male), higher cortisol (hair cortisol concentrations？≥？153.2？ng/g) significantly predicted less memory improvement ( , ) when controlling for age ( , ), gender ( , ), maximal oxygen uptake ( , ), and body mass index ( , ). Conclusion. Prolonged hypothalamic pituitary adrenal axis activation may interfere with exercise-related improvements in memory in CAD. 1. Introduction Coronary artery disease (CAD) is associated with an increased rate of decline in verbal memory [1]. For those with CAD, cognitive performance represents a significant determinant of long-term quality of life [2] as exemplified by associations with poor outcomes including unemployment, mortality, and failure to comply with risk factor management [2–4]. However, the mechanisms underlying cognitive changes in CAD are incompletely understood. Epidemiological studies show that cardiopulmonary fitness is associated with better cognitive performance in older subjects [5], particularly in those with CAD [6]. Exercise interventions, such as cardiac rehabilitation (CR), can improve cognitive performance, although interindividual responses to exercise training can vary [7]. CAD and related cardiovascular risk factors have also been associated with higher cortisol concentrations [8]. While prolonged elevations in cortisol have been associated with memory impairment [9], dysregulation of the hypothalamic pituitary adrenal (HPA) axis has not been probed as a predictor of cognitive response to exercise in this population. The objective of the present study was to assess the relationship between baseline hair cortisol concentrations and change in verbal memory performance in subjects with CAD undertaking CR. Hair cortisol has been suggested to reflect longer term cortisol secretion [10, 11] rather than state concentrations, suggesting a potential clinically useful marker. We hypothesized that cortisol
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