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Physical Activity and Cognitive Decline Among Older Adults
Quick Takes
- These data report only minimal association between physical activity and cognition.
- The identified weak association between physical activity and cognition was persistent, regardless of the preceding level of cognition or cohort age.
- Overall, these findings suggest that physical activity might postpone cognitive decline at a population health level but only to a very small extent.
Study Questions:
Is physical activity associated with global and domain-specific cognitive decline, examining cognition both categorically and continuously?
Methods:
The investigators included prospective cohort studies or case-control studies presenting an estimate of association between baseline physical activity and cognition. Observational studies of adults with a prospective follow-up of ≥1 year, a valid baseline cognitive measure or midlife cohort, and an estimate of the association of baseline physical activity and follow-up cognition were sought from PsycInfo, Scopus, CINAHL, Web of Science, SPORTDiscus, and PubMed. Two independent researchers screened titles with abstracts and full-text reports, independently assessed study quality, and extracted data. Pooled estimates of association were calculated with random-effects meta-analyses. An extensive set of moderators, funnel plots, and scatter plots of physical activity amount were examined. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Pooled estimates of the associations between physical activity and global cognition, as well as specific cognitive domains, were examined.
Results:
A total of 104 studies with 341,471 participants were assessed. Analysis of binary outcomes included 45 studies with 102,452 individuals, analysis of follow-up global cognition included 14 studies with 41,045 individuals, and analysis of change in global cognition included 25 studies with 67,463 individuals. Physical activity was associated with a decreased incidence of cognitive impairment or decline after correction for funnel plot asymmetry (pooled risk ratio, 0.97; 95% confidence interval [CI], 0.97-0.99), but there was no significant association in follow-ups >10 years. Physical activity was associated with follow-up global cognition (standardized regression coefficient, 0.03; 95% CI, 0.02-0.03) and change in global cognition (standardized regression coefficient, 0.01; 95% CI, 0.01-0.02) from trim-and-fill analyses, with no clear dose-response or moderation by follow-up length, baseline age, study quality, or adjustment for baseline cognition. The specific cognitive domains associated with physical activity were episodic memory (standardized regression coefficient, 0.03; 95% CI, 0.02-0.04) and verbal fluency (standardized regression coefficient, 0.05; 95% CI, 0.03-0.08).
Conclusions:
The authors report weak association of physical activity with better late-life cognition.
Perspective:
This systematic review and meta-analysis found only minimal associations between physical activity and cognition. However, the identified weak association between physical activity and cognition was persistent, regardless of the preceding level of cognition or cohort age. Overall, these findings suggest that physical activity might postpone cognitive decline at a population health level but only to a very small extent. Given limited evidence base, additional high-quality cohort studies with follow-ups longer than 10-20 years, fine-grained measures of physical activity and cognition at baseline, and high participation and follow-up rates are indicated to strengthen the evidence base in this area.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise
Keywords: Exercise, Cognitive Aging
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