Introduction
Methods
Design and sample
Clinical evaluation
Measurement of non-exercise physical activity (predictor variable)
Neuropsychological test scores (outcome variable)
Statistical analysis
Results
Demographics
Midlife | ||||||
---|---|---|---|---|---|---|
None (N = 68) | Light (N = 273) | Moderate (N = 748) | Heavy (N = 972) | Total (N = 2061) | p | |
Age (years) | 80.08 (5.24) | 78.82 (5.54) | 78.70 (5.40) | 78.72 (5.14) | 78.77 (5.30) | 0.181 |
Male sex, N (%) | 53 (77.9) | 65 (23.8) | 254 (34.0) | 668 (68.7) | 1040 (50.5) | < 0.012 |
Education (years) | 15.07 (3.08) | 14.17 (2.52) | 14.41 (2.62) | 14.02 (2.97) | 14.22 (2.80) | < 0.011 |
APOEε4 carrier, N (%) | 22 (32.4) | 67 (24.7){2} | 207 (27.8){3} | 251 (26.0){5} | 547 (26.7){10} | 0.502 |
Charlson index | 3.47 (2.85) | 3.31 (2.83) | 3.45 (3.18) | 3.68 (3.20) | 3.54 (3.13) | 0.281 |
BMI (kg/m2) | 28.18 (5.23){1} | 28.17 (5.56){4} | 27.69 (5.07){6} | 28.04 (4.69){7} | 27.93 (4.97){18} | 0.141 |
Follow-up time (years) | 5.00 (2.81) | 5.71 (2.84) | 5.81 (2.83) | 5.95 (2.85) | 5.83 (2.84) | 0.051 |
Diagnosis progression | ||||||
Remained CU, N (%) | 37 (54.4) | 205 (75.1) | 559 (74.7) | 734 (75.5) | 1535 (74.5) | |
MCI, N (%) | 25 (36.8) | 60 (22.0) | 158 (21.1) | 206 (21.2) | 449 (21.8) | |
Dementia, N (%) | 4 (5.9) | 8 (2.9) | 30 (4.0) | 31 (3.2) | 73 (3.5) | |
Residence | ||||||
House, N (%) | 34 (50.0) | 143 (52.4) | 430 (57.5) | 694 (71.4) | 1301 (63.1) | |
Apartment, N (%) | 21 (30.9) | 79 (28.9) | 212 (28.3) | 202 (20.8) | 514 (24.9) | |
Retirement comm., N (%) | 10 (14.7) | 42 (15.4) | 83 (11.1) | 62 (6.4) | 197 (9.6) | |
Nursing home, N (%) | 1 (1.5) | 0 (0.0) | 3 (0.4) | 1 (0.1) | 5 (0.2) | |
Cardiovascular risk factors | ||||||
Stroke, N (%) | 4 (5.9) | 11 (4.0) | 36 (4.8){1} | 36 (3.7) | 87 (4.2){1} | 0.622 |
Hypertension, N (%) | 53 (77.9) | 214 (78.4) | 587 (78.6){1} | 746 (76.7) | 1600 (77.7){1} | 0.822 |
Dyslipidemia, N (%) | 53 (77.9) | 239 (87.5) | 626 (83.8){1} | 817 (84.1) | 1735 (84.2){1} | 0.222 |
Diabetes, N (%) | 13 (19.1) | 53 (19.4) | 144 (19.3){1} | 186 (19.1) | 396 (19.2){1} | 1.002 |
Late-life | ||||||
---|---|---|---|---|---|---|
None (N = 179) | Light (N = 709) | Moderate (N = 781) | Heavy (N = 392) | Total (N = 2061) | p | |
Age (years) | 81.16 (5.45) | 79.92 (5.55) | 78.10 (4.94) | 76.93 (4.51) | 78.77 (5.30) | < 0.011 |
Male sex, N (%) | 122 (68.2) | 219 (30.9) | 403 (51.6) | 296 (75.5) | 1040 (50.5) | < 0.012 |
Education (years) | 13.86 (2.83) | 14.14 (2.66) | 14.44 (2.84) | 14.07 (2.96) | 14.22 (2.80) | 0.021 |
APOEε4 carrier, N (%) | 53 (29.6) | 168 (23.8){4} | 217 (27.9){3} | 109 (28.0){3} | 547 (26.7){10} | 0.202 |
Charlson index | 4.50 (3.40) | 3.70 (3.23) | 3.36 (2.98) | 3.15 (3.01) | 3.54 (3.13) | < 0.011 |
BMI (kg/m2) | 28.98 (5.51){5} | 28.13 (5.36){8} | 27.69 (4.90){5} | 27.58 (3.97) | 27.93 (4.97){18} | 0.041 |
Follow-up time (years) | 5.11 (2.90) | 5.66 (2.81) | 6.00 (2.85) | 6.14 (2.80) | 5.83 (2.84) | < 0.011 |
Diagnosis progression | ||||||
Remained CU, N (%) | 118 (65.9) | 515 (72.6) | 592 (75.8) | 310 (79.1) | 1535 (74.5) | |
MCI, N (%) | 47 (26.3) | 166 (23.4) | 164 (21.0) | 72 (18.4) | 449 (21.8) | |
Dementia, N (%) | 12 (6.7) | 27 (3.8) | 24 (3.1) | 10 (2.6) | 73 (3.5) | |
Residence | ||||||
House, N (%) | 90 (50.3) | 340 (48.0) | 521 (66.7) | 350 (89.3) | 1301 (63.1) | |
Apartment, N (%) | 56 (31.3) | 217 (30.6) | 204 (26.1) | 37 (9.4) | 514 (24.9) | |
Retirement comm., N (%) | 24 (13.4) | 125 (17.6) | 45 (5.8) | 3 (0.8) | 197 (9.6) | |
Nursing home, N (%) | 3 (1.7) | 2 (0.3) | 0 (0.0) | 0 (0.0) | 5 (0.2) | |
Cardiovascular risk factors | ||||||
Stroke, N (%) | 16 (8.9) | 34 (4.8){1} | 23 (2.9) | 14 (3.6) | 87 (4.2){1} | < 0.012 |
Hypertension, N (%) | 151 (84.4) | 578 (81.6){1} | 604 (77.3) | 267 (68.1) | 1600 (77.7){1} | < 0.012 |
Dyslipidemia, N (%) | 150 (83.8) | 609 (86.0){1} | 642 (82.2) | 334 (85.2) | 1735 (84.2){1} | 0.222 |
Diabetes, N (%) | 45 (25.1) | 137 (19.4){1} | 149 (19.1) | 65 (16.6) | 396 (19.2){1} | 0.122 |
Midlife | |||||
---|---|---|---|---|---|
None (N = 68) | Light (N = 273) | Moderate (N = 748) | Heavy (N = 972) | Total (N = 2061) | |
Memory | |||||
AVLT delayed recall | 6.37 (3.08){1} | 8.31 (3.34){4} | 7.70 (3.41){16} | 6.95 (3.12){25} | 7.39 (3.30){46} |
Logical memory | 15.85 (6.93) | 18.75 (7.11){6} | 17.98 (7.41){10} | 17.16 (7.11){17} | 17.62 (7.24){33} |
Visual reproduction | 20.50 (8.33) | 21.10 (7.99){10} | 21.38 (8.29){30} | 21.46 (8.24){32} | 21.35 (8.23){72} |
Language | |||||
BNT | 54.14 (4.64){3} | 54.42 (4.40){8} | 54.51 (4.51){32} | 54.75 (4.39){24} | 54.60 (4.44){67} |
Category fluency | 38.54 (7.96){5} | 43.89 (9.94){3} | 44.54 (9.52){12} | 42.00 (9.09){12} | 43.07 (9.44){32} |
Attention | |||||
WAISR-digit symbol | 39.24 (8.91){1} | 43.88 (11.11){9} | 44.20 (10.31){41} | 41.71 (10.0){36} | 42.81 (10.30){87} |
Trail making B (reverse) | 177.97 (55.08){1} | 196.01 (51.72){11} | 197.28 (45.52){40} | 196.34 (44.12){34} | 196.01 (46.19){86} |
Visuospatial | |||||
WAISR-picture completion | 13.31 (2.63){1} | 12.78 (3.34){9} | 12.94 (3.28){38} | 13.25 (3.23){27} | 13.08 (3.24){75} |
WAISR-block design | 21.72 (7.55){1} | 22.46 (8.17){13} | 23.20 (8.06){37} | 23.69 (8.49){34} | 23.29 (8.27){85} |
Z-scores | |||||
Memory | − 0.29 (0.90) | 0.18 (0.98){4} | 0.07 (1.04){10} | − 0.08 (0.97){16} | 0.00 (1.00){30} |
Language | − 0.35 (0.96){5} | 0.03 (1.05){8} | 0.08 (1.02){33} | − 0.05 (0.96){27} | 0.00 (1.00){73} |
Attention | − 0.42 (1.05){1} | 0.06 (1.10){11} | 0.09 (0.99){43} | − 0.06 (0.96){39} | 0.00 (1.00){94} |
Visuospatial | − 0.05 (0.88){2} | − 0.12 (0.98){14} | − 0.03 (0.99){43} | 0.06 (1.02){40} | 0.00 (1.00){99} |
Global | − 0.37 (0.97){7} | 0.06 (1.04){18} | 0.06 (1.01){56} | − 0.04 (0.98){59} | 0.00 (1.00){140} |
Late-life | |||||
---|---|---|---|---|---|
None (N = 179) | Light (N = 709) | Moderate (N = 781) | Heavy (N = 392) | Total (N = 2061) | |
Memory | |||||
AVLT delayed recall | 7.13 (3.30){6} | 7.71 (3.25){16} | 7.39 (3.39){16} | 6.93 (3.13){8} | 7.39 (3.30){46} |
Logical memory | 17.94 (7.30){5} | 17.73 (7.04){9} | 17.70 (7.47){13} | 17.13 (7.13){6} | 17.62 (7.24){33} |
Visual reproduction | 19.85 (8.45){10} | 20.79 (7.89){37} | 21.95 (8.51){18} | 21.81 (7.99){7} | 21.35 (8.23){72} |
Language | |||||
BNT | 53.54 (5.26){11} | 54.40 (4.31){29} | 54.75 (4.48){21} | 55.11 (4.13){6} | 54.60 (4.44){67} |
Category fluency | 39.99 (8.22){6} | 43.81 (9.52){11} | 43.59 (9.59){12} | 42.06 (9.15){3} | 43.07 (9.44){32} |
Attention | |||||
WAISR-digit symbol | 38.08 (8.98){13} | 42.68 (10.31){44} | 43.82 (10.46){22} | 43.09 (9.98){8} | 42.81 (10.30){87} |
Trail making B (reverse) | 182.64 (52.77){12} | 192.50 (49.58){44} | 199.16 (43.82){23} | 201.66 (39.70){7} | 196.01 (46.19){86} |
Visuospatial | |||||
WAISR-picture completion | 12.81 (3.32){9} | 12.90 (3.27){39} | 13.15 (3.30){21} | 13.39 (3.02){6} | 13.08 (3.24){75} |
WAISR-block design | 21.25 (7.67){10} | 22.64 (7.97){44} | 23.63 (8.35){24} | 24.62 (8.62){7} | 23.29 (8.27){85} |
Z-scores | |||||
Memory | − 0.09 (1.01){5} | 0.02 (0.98){9} | 0.03 (1.05){10} | − 0.07 (0.94){6} | 0.00 (1.00){30} |
Language | − 0.35 (1.02){11} | 0.02 (1.00){32} | 0.05 (1.01){24} | 0.01 (0.94){6} | 0.00 (1.00){73} |
Attention | − 0.42 (0.99){14} | − 0.05 (1.04){48} | 0.10 (0.99){23} | 0.08 (0.91){9} | 0.00 (1.00){94} |
Visuospatial | − 0.19 (0.97){13} | − 0.08 (0.98){51} | 0.04 (1.01){26} | 0.15 (1.02){9} | 0.00 (1.00){99} |
Global | − 0.33 (0.97){23} | − 0.03 (1.00){63} | 0.07 (1.02){39} | 0.06 (0.94){15} | 0.00 (1.00){140} |
Association between non-exercise physical activity and longitudinal cognitive changes
Memory | Language | Visuospatial | Attention | Global | |
---|---|---|---|---|---|
Midlife | |||||
T | − 0.110 (0.022)** | − 0.140 (0.021)** | − 0.077 (0.015)** | − 0.178 (0.022)** | − 0.173 (0.021)** |
Light | 0.273 (0.128)* | 0.238 (0.124) | 0.124 (0.121) | 0.263 (0.121)* | 0.285 (0.122)* |
Moderate | 0.211 (0.119) | 0.283 (0.115)* | 0.150 (0.112) | 0.332 (0.113)** | 0.316 (0.114)** |
Heavy | 0.232 (0.117)* | 0.283 (0.113)* | 0.182 (0.110) | 0.353 (0.110)** | 0.349 (0.111)** |
T × light | 0.045 (0.024) | 0.046 (0.023)* | 0.043 (0.017)** | 0.030 (0.024) | 0.057 (0.023)* |
T × moderate | 0.054 (0.023)* | 0.059 (0.022)** | 0.040 (0.016)* | 0.053 (0.023)* | 0.070 (0.021)** |
T × heavy | 0.053 (0.022)* | 0.065 (0.021)** | 0.045 (0.016)** | 0.059 (0.022)** | 0.076 (0.021)** |
Late-life | |||||
T | − 0.087 (0.014)** | − 0.096 (0.013)** | − 0.056 (0.010)** | − 0.177 (0.014)** | − 0.146 (0.013)** |
Light | − 0.035 (0.080) | 0.183 (0.078)* | 0.173 (0.077)* | 0.158 (0.077)* | 0.131 (0.078) |
Moderate | − 0.009 (0.079) | 0.159 (0.076)* | 0.139 (0.075) | 0.257 (0.076)** | 0.169 (0.076)* |
Heavy | − 0.053 (0.086) | 0.120 (0.083) | 0.129 (0.082) | 0.288 (0.082)** | 0.162 (0.083) |
T × light | 0.022 (0.015) | 0.002 (0.014) | 0.013 (0.011) | 0.032 (0.015)* | 0.026 (0.015) |
T × moderate | 0.027 (0.015) | 0.018 (0.014) | 0.027 (0.010)* | 0.063 (0.015)** | 0.051 (0.014)** |
T × heavy | 0.043 (0.016)** | 0.031 (0.015)* | 0.027 (0.011)* | 0.065 (0.016)** | 0.061 (0.015)** |
Stratification by APOE ε4 carrier status
Memory | Language | Visuospatial | Attention | Global | |
---|---|---|---|---|---|
Midlife | |||||
ε4+ | |||||
T | − 0.182 (0.041)** | − 0.168 (0.041)** | − 0.094 (0.030)** | − 0.220 (0.044)** | − 0.219 (0.039)** |
Light | 0.381 (0.238) | 0.405 (0.229) | 0.175 (0.225) | 0.409 (0.225) | 0.443 (0.223)* |
Moderate | 0.225 (0.214) | 0.465 (0.207)* | 0.303 (0.202) | 0.468 (0.203)* | 0.500 (0.201)* |
Heavy | 0.213 (0.210) | 0.352 (0.202) | 0.315 (0.198) | 0.500 (0.198)* | 0.481 (0.196)* |
T × light | 0.100 (0.047)* | 0.061 (0.047) | 0.065 (0.034) | 0.070 (0.050) | 0.095 (0.044)* |
T × moderate | 0.086 (0.043)* | 0.041 (0.043) | 0.048 (0.031) | 0.054 (0.046) | 0.072 (0.041) |
T × heavy | 0.101 (0.043)* | 0.073 (0.043) | 0.047 (0.031) | 0.066 (0.045) | 0.092 (0.040)* |
ε4− | |||||
T | − 0.076 (0.026)** | − 0.124 (0.024)** | − 0.067 (0.018)** | − 0.155 (0.025)** | − 0.147 (0.025)** |
Light | 0.211 (0.153) | 0.163 (0.148) | 0.083 (0.144) | 0.197 (0.145) | 0.206 (0.147) |
Moderate | 0.189 (0.144) | 0.208 (0.140) | 0.087 (0.135) | 0.271 (0.136)* | 0.235 (0.138) |
Heavy | 0.223 (0.141) | 0.239 (0.137) | 0.130 (0.132) | 0.290 (0.133)* | 0.283 (0.135)* |
T × light | 0.016 (0.028) | 0.034 (0.026) | 0.032 (0.019) | 0.008 (0.027) | 0.034 (0.027) |
T × moderate | 0.034 (0.026) | 0.058 (0.025)* | 0.033 (0.018) | 0.044 (0.026) | 0.060 (0.025)* |
T × heavy | 0.026 (0.026) | 0.055 (0.025)* | 0.040 (0.018)* | 0.047 (0.026) | 0.059 (0.025)* |
Late-life | |||||
ε4+ | |||||
T | − 0.076 (0.028)** | − 0.090 (0.028)** | − 0.069 (0.021)** | − 0.197 (0.030)** | − 0.137 (0.027)** |
Light | − 0.090 (0.151) | 0.124 (0.146) | 0.087 (0.144) | 0.096 (0.144) | 0.063 (0.143) |
Moderate | − 0.151 (0.147) | 0.123 (0.142) | 0.035 (0.140) | 0.094 (0.141) | 0.062 (0.140) |
Heavy | − 0.142 (0.162) | − 0.005 (0.157) | 0.023 (0.154) | 0.184 (0.155) | 0.051 (0.153) |
T × light | − 0.045 (0.031) | − 0.056 (0.031) | 0.012 (0.023) | 0.004 (0.034) | − 0.038 (0.030) |
T × moderate | 0.004 (0.030) | − 0.006 (0.030) | 0.031 (0.022) | 0.060 (0.032) | 0.019 (0.029) |
T × heavy | − 0.015 (0.033) | − 0.007 (0.033) | 0.027 (0.024) | 0.050 (0.035) | 0.014 (0.031) |
ε4− | |||||
T | − 0.089 (0.016)** | − 0.097 (0.015)** | − 0.050 (0.011)** | − 0.167 (0.016)** | − 0.147 (0.015)** |
Light | − 0.036 (0.095) | 0.194 (0.092)* | 0.209 (0.091)* | 0.182 (0.092)* | 0.145 (0.093) |
Moderate | 0.036 (0.093) | 0.172 (0.091) | 0.191 (0.089)* | 0.326 (0.090)** | 0.211 (0.091)* |
Heavy | − 0.023 (0.101) | 0.174 (0.098) | 0.188 (0.096) | 0.347 (0.097)** | 0.216 (0.098)* |
T × light | 0.042 (0.017)* | 0.019 (0.016) | 0.011 (0.012) | 0.037 (0.017)* | 0.045 (0.016)** |
T × moderate | 0.035 (0.017)* | 0.026 (0.016) | 0.024 (0.012)* | 0.062 (0.017)** | 0.061 (0.016)** |
T × heavy | 0.061 (0.018)** | 0.042 (0.017)* | 0.025 (0.012)* | 0.066 (0.018)** | 0.075 (0.017)** |
Stratification by sex
Memory | Language | Visuospatial | Attention | Global | |
---|---|---|---|---|---|
Midlife | |||||
F | |||||
T | − 0.174 (0.051)** | − 0.175 (0.050)** | − 0.099 (0.035)** | − 0.186 (0.048)** | − 0.222 (0.046)** |
Light | 0.374 (0.257) | 0.287 (0.247) | 0.148 (0.241) | 0.533 (0.248)* | 0.416 (0.246) |
Moderate | 0.309 (0.252) | 0.221 (0.242) | 0.156 (0.236) | 0.528 (0.243)* | 0.374 (0.241) |
Heavy | 0.324 (0.254) | 0.329 (0.245) | 0.204 (0.238) | 0.547 (0.245)* | 0.437 (0.243) |
T × light | 0.097 (0.052) | 0.076 (0.051) | 0.061 (0.036) | 0.027 (0.049) | 0.094 (0.047)* |
T × moderate | 0.103 (0.051)* | 0.082 (0.050) | 0.059 (0.035) | 0.055 (0.049) | 0.108 (0.046)* |
T × heavy | 0.103 (0.052)* | 0.069 (0.051) | 0.061 (0.035) | 0.043 (0.049) | 0.103 (0.047)* |
M | |||||
T | − 0.086 (0.022)** | − 0.125 (0.019)** | − 0.071 (0.016)** | − 0.175 (0.024)** | − 0.154 (0.021)** |
Light | 0.218 (0.166) | 0.066 (0.157) | 0.061 (0.158) | 0.044 (0.154) | 0.135 (0.155) |
Moderate | 0.181 (0.136) | 0.412 (0.129)** | 0.148 (0.128) | 0.323 (0.126)* | 0.363 (0.127)** |
Heavy | 0.201 (0.129) | 0.286 (0.122)* | 0.171 (0.121) | 0.332 (0.119)** | 0.343 (0.120)** |
T × light | 0.039 (0.029) | 0.050 (0.025)* | 0.052 (0.021)* | 0.060 (0.032) | 0.069 (0.028)* |
T × moderate | 0.050 (0.024)* | 0.063 (0.021)** | 0.039 (0.018)* | 0.059 (0.026)* | 0.068 (0.023)** |
T × heavy | 0.038 (0.023) | 0.066 (0.020)** | 0.042 (0.017)* | 0.068 (0.025)** | 0.069 (0.022)** |
Late-life | |||||
F | |||||
T | − 0.137 (0.028)** | − 0.128 (0.029)** | − 0.096 (0.020)** | − 0.269 (0.028)** | − 0.207 (0.027)** |
Light | 0.024 (0.137) | 0.362 (0.134)** | 0.244 (0.132) | 0.260 (0.137) | 0.267 (0.137) |
Moderate | 0.015 (0.142) | 0.368 (0.138)** | 0.213 (0.136) | 0.392 (0.141)** | 0.309 (0.141)* |
Heavy | − 0.108 (0.166) | 0.276 (0.161) | 0.128 (0.158) | 0.407 (0.163)* | 0.214 (0.163) |
T × light | 0.065 (0.029)* | 0.026 (0.030) | 0.052 (0.021)* | 0.123 (0.029)** | 0.080 (0.028)** |
T × moderate | 0.066 (0.029)* | 0.033 (0.030) | 0.067 (0.021)** | 0.146 (0.029)** | 0.103 (0.028)** |
T × heavy | 0.071 (0.033)* | 0.034 (0.034) | 0.056 (0.023)* | 0.120 (0.032)** | 0.100 (0.032)** |
M | |||||
T | − 0.061 (0.015)** | − 0.080 (0.013)** | − 0.043 (0.011)** | − 0.142 (0.016)** | − 0.116 (0.014)** |
Light | − 0.113 (0.102) | 0.100 (0.098) | 0.109 (0.098) | 0.119 (0.096) | 0.051 (0.097) |
Moderate | − 0.012 (0.094) | 0.037 (0.090) | 0.094 (0.089) | 0.170 (0.088) | 0.091 (0.088) |
Heavy | − 0.044 (0.099) | 0.061 (0.094) | 0.122 (0.094) | 0.236 (0.092)* | 0.134 (0.093) |
T × light | 0.003 (0.018) | − 0.002 (0.015) | 0.004 (0.013) | − 0.003 (0.020) | 0.009 (0.017) |
T × moderate | 0.012 (0.016) | 0.018 (0.014) | 0.013 (0.012) | 0.038 (0.018)* | 0.032 (0.016)* |
T × heavy | 0.029 (0.017) | 0.026 (0.014) | 0.018 (0.012) | 0.044 (0.018)* | 0.042 (0.016)** |