Does physical activity prevent cognitive decline and dementia?: A systematic review and meta-analysis of longitudinal studies

BMC Public Health

J Lennert Veerman¹  Rachel Hammersley-Mather²  Sarah J Blondell¹ 

[1] The University of Queensland, School of Population Health, 4006 Herston, Queensland, Australia;Counselling and Health at Student Services, University of Southern Queensland, 4350 Toowoomba, Queensland, Australia

关键词: Cognition;    Alzheimer’s disease;    Cognitive impairment;    Dementia;    Cognitive decline;    Exercise;    Physical activity;   

Others  :  1130217
DOI  :  10.1186/1471-2458-14-510

 received in 2014-04-01, accepted in 2014-05-08,  发布年份 2014

【 摘 要 】

Background

By 2050, it has been estimated that approximately one-fifth of the population will be made up of older adults (aged ≥60 years). Old age often comes with cognitive decline and dementia. Physical activity may prevent cognitive decline and dementia.

Methods

We reviewed and synthesised prospective studies into physical activity and cognitive decline, and physical activity and dementia, published until January 2014. Forty-seven cohorts, derived from two previous systematic reviews and an updated database search, were used in the meta-analyses. Included participants were aged ≥40 years, in good health and/or randomly selected from the community. Studies were assessed for methodological quality.

Results

Twenty-one cohorts on physical activity and cognitive decline and twenty-six cohorts on physical activity and dementia were included. Meta-analysis, using the quality-effects model, suggests that participants with higher levels of physical activity, when compared to those with lower levels, are at reduced risk of cognitive decline, RR 0.65, 95% CI 0.55-0.76, and dementia, RR 0.86, 95% CI 0.76-0.97. Sensitivity analyses revealed a more conservative estimate of the impact of physical activity on cognitive decline and dementia for high quality studies, studies reporting effect sizes as ORs, greater number of adjustments (≥10), and longer follow-up time (≥10 years). When one heavily weighted study was excluded, physical activity was associated with an 18% reduction in the risk of dementia (RR 0.82; 0.73-0.91).

Conclusions

Longitudinal observational studies show an association between higher levels of physical activity and a reduced risk of cognitive decline and dementia. A case can be made for a causal interpretation. Future research should use objective measures of physical activity, adjust for the full range of confounders and have adequate follow-up length. Ideally, randomised controlled trials will be conducted. Regardless of any effect on cognition, physical activity should be encouraged, as it has been shown to be beneficial on numerous levels.

【 授权许可】

   
2014 Blondell et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]World Health Organization: Dementia: A Public Health Priority. 2012. whqlibdoc.who.int/publications/2012/9789241564458_eng.pdf
• [2]Mortazavi SS, Mohammad K, Ardebili HE, Beni RD, Mahmoodi M, Keshteli AH: Mental disorder prevention and physical activity in Iranian elderly. Int J Prev Med 2012, 3(Suppl 1):S64-S72.
• [3]Angevaren M, Aufdemkampe G, Verhaar HJJ, Aleman A, Vanhees L: Physical activity and enhanced fitness improve cognitive function in older people without known cognitive impairment, a Cochrane Systematic Review. Parkinsonism Relat Disord 2008, 14:S44.
• [4]Miller DI, Taler V, Davidson PSR, Messier C: Measuring the impact of exercise on cognitive aging: methodological issues. Neurobiol Aging 2012, 33(3):622.e629-622.e643.
• [5]Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC: Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin Proc 2011, 86(9):876-884.
• [6]Rosenberg PB, Johnston D, Lykestos CG: A clinical appraoch to mild cognitive impairment. Am J Psychiatr 2006, 163(11):1884-1890.
• [7]Plassman BL, Williams JW Jr, Burke JR, Holsinger T, Benjamin S: Systematic review: factors associated with risk for and possible prevention of cognitive decline in later life. Ann Intern Med 2010, 153(3):182-193.
• [8]Ritchie K, Touchon J: Mild cognitive impairment: conceptual basis and current nosological status. Lancet 2000, 355(9199):225-228.
• [9]Lautenschlager NT, Cox K, Cyarto EV: The influence of exercise on brain aging and dementia. Biochim Biophys Acta (BBA) - Mol Basis Dis 2012, 1822(3):474-481.
• [10]Chertkow H, Nasreddine Z, Joanette Y, Drolet V, Kirk J, Massoud F, Belleville S, Bergman H: Mild cognitive impairment and cognitive impairment, no dementia: Part A, concept and diagnosis. Alzheimers Dement 2007, 3(4):266-282.
• [11]Molinuevo JL, Valls-Pedret C, Rami L: From mild cognitive impairment to prodromal Alzheimer disease: A nosological evolution. Eur Geriatr Med 2010, 1(3):146-154.
• [12]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR®. Washington, DC: American Psychiatric Pub; 2000.
• [13]Sosa-Ortiz AL, Acosta-Castillo I, Prince MJ: Epidemiology of dementias and Alzheimer’s disease. Archives of Medical Research 2012, 43(8):600-608.
• [14]Lin F, Friedman E, Quinn J, Chen DG, Mapstone M: Effect of leisure activities on inflammation and cognitive function in an aging sample. Arch Gerontol Geriatr 2012, 54(3):e398-e404.
• [15]Cyarto EV, Lautenschlager NT, Desmond PM, Ames D, Szoeke C, Salvado O, Sharman MJ, Ellis KA, Phal PM, Masters CM, Rowe CC, Martins RN, Cox KL: Protocol for a randomized controlled trial evaluating the effect of physical activity on delaying the progression of white matter changes on MRI in older adults with memory complaints and mild cognitive impairment: The AIBL Active trial. BMC psychiatry 2012, 12(1):167. BioMed Central Full Text
• [16]Aarsland D, Sardahaee FS, Anderssen S, Ballard C, the Alzheimer’s Society Systematic Review: Is physical activity a potential preventive factor for vascular dementia? A systematic review. Aging Ment Health 2010, 14(4):386-395.
• [17]Fuchs R: Physical Activity and Health. In International Encyclopedia of the Social & Behavioral Sciences. Edited by Neil JS, Paul BB. Oxford: Pergamon; 2001:11411-11415.
• [18]Tseng CN, Gau BS, Lou MF: The effectiveness of exercise on improving cognitive function in older people: a systematic review. J Nurs Res 2011, 19(2):119-131.
• [19]Benedict C, Brooks SJ, Kullberg J, Nordenskjold R, Burgos J, Le Greves M, Kilander L, Larsson EM, Johansson L, Ahlstrom H, Lind L, Schioth HB: Association between physical activity and brain health in older adults. Neurobiol Aging 2013, 34(1):83-90.
• [20]Sofi F, Valecchi D, Bacci D, Abbate R, Gensini GF, Casini A, Macchi C: Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J Intern Med 2011, 269(1):107-117.
• [21]Bowen ME: A prospective examination of the relationship between physical activity and dementia risk in later life. Am J Health Promot 2012, 26(6):333-340.
• [22]Ho SC, Woo J, Sham A, Chan SG, Yu AL: A 3-year follow-up study of social, lifestyle and health predictors of cognitive impairment in a Chinese older cohort. Int J Epidemiol 2001, 30(6):1389-1396.
• [23]Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K: Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol 2001, 58(3):498-504.
• [24]Schuit AJ, Feskens EJ, Launer LJ, Kromhout D: Physical activity and cognitive decline, the role of the apolipoprotein e4 allele. Med Sci Sports Exerc 2001, 33(5):772-777.
• [25]Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K: A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med 2001, 161(14):1703-1708.
• [26]Pignatti F, Rozzini R, Trabucchi M: Physical activity and cognitive decline in elderly persons. Arch Intern Med 2002, 162(3):361-362.
• [27]Lytle ME, Vander Bilt J, Pandav RS, Dodge HH, Ganguli M: Exercise level and cognitive decline: the MoVIES project. Alzheimer Dis Assoc Disord 2004, 18(2):57-64.
• [28]Flicker L, Almeida OP, Acres J, Le MT, Tuohy RJ, Jamrozik K, Hankey G, Norman P: Predictors of impaired cognitive function in men over the age of 80 years: results from the Health in Men Study. Age Ageing 2005, 34(1):77-80.
• [29]Singh-Manoux A, Hillsdon M, Brunner E, Marmot M: Effects of physical activity on cognitive functioning in middle age: evidence from the Whitehall II prospective cohort study. Am J Public Health 2005, 95(12):2252-2258.
• [30]Sumic A, Michael YL, Carlson NE, Howieson DB, Kaye JA: Physical activity and the risk of dementia in oldest old. J Aging Health 2007, 19(2):242-259.
• [31]Middleton L, Kirkland S, Rockwood K: Prevention of CIND by physical activity: different impact on VCI-ND compared with MCI. J Neurol Sci 2008, 269(1–2):80-84.
• [32]Niti M, Yap KB, Kua EH, Tan CH, Ng TP: Physical, social and productive leisure activities, cognitive decline and interaction with APOE-epsilon 4 genotype in Chinese older adults. Int Psychogeriatr 2008, 20(2):237-251.
• [33]Etgen T, Sander D, Huntgeburth U, Poppert H, Forstl H, Bickel H: Physical activity and incident cognitive impairment in elderly persons: the INVADE study. Arch Intern Med 2010, 170(2):186-193.
• [34]Hamer M, Chida Y: Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med 2009, 39(1):3-11.
• [35]Yoshitake T, Kiyohara Y, Kato I, Ohmura T, Iwamoto H, Nakayama K, Ohmori S, Nomiyama K, Kawano H, Ueda K, Sueishi K, Tsuneyoshi M, Fujishima M: Incidence and risk factors of vascular dementia and Alzheimer’s disease in a defined elderly Japanese population: the Hisayama Study. Neurology 1995, 45(6):1161-1168.
• [36]Fabrigoule C, Letenneur L, Dartigues JF, Zarrouk M, Commenges D, Barberger-Gateau P: Social and leisure activities and risk of dementia: a prospective longitudinal study. J Am Geriatr Soc 1995, 43(5):485-490.
• [37]Wilson RS, Bennett DA, Bienias JL, Aggarwal NT, Mendes De Leon CF, Morris MC, Schneider JA, Evans DA: Cognitive activity and incident AD in a population-based sample of older persons. Neurology 2002, 59(12):1910-1914.
• [38]Verghese J, Lipton RB, Katz MJ, Hall CB, Derby CA, Kuslansky G, Ambrose AF, Sliwinski M, Buschke H: Leisure activities and the risk of dementia in the elderly. N Engl J Med 2003, 348(25):2508-2516.
• [39]Abbott RD, White LR, Ross GW, Masaki KH, Curb JD, Petrovitch H: Walking and dementia in physically capable elderly men. JAMA 2004, 292(12):1447-1453.
• [40]Podewils LJ, Guallar E, Kuller LH, Fried LP, Lopez OL, Carlson M, Lyketsos CG: Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol 2005, 161(7):639-651.
• [41]Rovio S, Kareholt I, Helkala E, Viitanen M, Winblad B, Tuomilehto J, Soininen H, Nissinen A, Kivipelto M: Leisure-time physical activity at midlife and the risk of dementia and Alzheimer’s disease. Lancet Neurol 2005, 4:705-711.
• [42]Larson EB, Wang L, Bowen J, McCormick W, Teri L, Crane P, Kukull W: Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older. Ann Intern Med 2006, 144:73-81.
• [43]Doi SA, Thalib L: A quality-effects model for meta-analysis. Epidemiology 2008, 19(1):94-100.
• [44]Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009, 151(4):264-269.
• [45]Singh A, Uijtdewilligen L, Twisk JW, Van Mechelen W, Chinapaw MJ: Physical activity and performance at school: a systematic review of the literature including a methodological quality assessment. Arch Pediatr Adolesc Med 2012, 166(1):49-55.
• [46]Livingston JD, Boyd JE: Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med 2010, 71(12):2150-2161.
• [47]Iwasa H, Yoshida Y, Kai I, Suzuki T, Kim H, Yoshida H: Leisure activities and cognitive function in elderly community-dwelling individuals in Japan: A 5-year prospective cohort study. J Psychosom Res 2012, 72(2):159-164.
• [48]Lee S, Yuki A, Nishita Y, Tange C, Kim H, Kozakai R, Ando F, Shimokata H: Research relationship between light-intensity physical activity and cognitive function in a community-dwelling elderly population-an 8-year longitudinal study. J Am Geriatr Soc 2013, 61(3):452-453.
• [49]Middleton LE, Manini TM, Simonsick EM, Harris TB, Barnes DE, Tylavsky F, Brach JS, Everhart JE, Yaffe K: Activity energy expenditure and incident cognitive impairment in older adults. Arch Intern Med 2011, 171(14):1251-1257.
• [50]Morgan GS, Gallacher J, Bayer A, Fish M, Ebrahim S, Ben-Shlomo Y: Physical activity in middle-age and dementia in later life: findings from a prospective cohort of men in Caerphilly, South Wales and a meta-analysis. J Alzheimers Dis 2012, 31(3):569-580.
• [51]Verghese J, Cuiling W, Katz MJ, Sanders A, Lipton RB: Leisure activities and risk of vascular cognitive impairment in older adults. J Geriatr Psychiatry Neurol 2009, 22(2):110-118.
• [52]Buchman AS, Boyle PA, Yu L, Shah RC, Wilson RS, Bennett DA: Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology 2012, 78(17):1323-1329.
• [53]Chang M, Jonsson PV, Snaedal J, Bjornsson S, Saczynski JS, Aspelund T, Eiriksdottir G, Jonsdottir MK, Lopez OL, Harris TB, Gudnason V, Launer LJ: The effect of midlife physical activity on cognitive function among older adults: AGES–Reykjavik Study. J Gerontol A: Biol Med Sci 2010, 65(12):1369-1374.
• [54]De Bruijn RF, Schrijvers EM, De Groot KA, Witteman JC, Hofman A, Franco OH, Koudstaal PJ, Ikram MA: The association between physical activity and dementia in an elderly population: the Rotterdam Study. Eur J Epidemiol 2013, 28(3):277-283.
• [55]Gureje O, Ogunniyi A, Kola L, Abiona T: Incidence of and risk factors for dementia in the Ibadan Study of Aging. J Am Geriatr Soc 2011, 59(5):869-874.
• [56]Kim JM, Stewart R, Bae KY, Kim SW, Yang SJ, Park KH, Shin IS, Yoon JS: Role of BDNF val66met polymorphism on the association between physical activity and incident dementia. Neurobiol Aging 2011, 32(3):551 e555-512.
• [57]McCallum J, Simons LA, Simons J, Friedlander Y: Delaying dementia and nursing home placement: the Dubbo study of elderly Australians over a 14-year follow-up. Ann N Y Acad Sci 2007, 1114:121-129.
• [58]Ravaglia G, Forti P, Lucicesare A, Pisacane N, Rietti E, Bianchin M, Dalmonte E: Physical activity and dementia risk in the elderly: findings from a prospective Italian study. Neurology 2008, 70(19 Pt 2):1786-1794.
• [59]Rovio S, Kareholt I, Viitanen M, Winblad B, Tuomilehto J, Soininen H, Nissinen A, Kivipelto M: Work-related physical activity and the risk of dementia and Alzheimer’s disease. Int J Geriatr Psychiatry 2007, 22(9):874-882.
• [60]Scarmeas N, Luchsinger JA, Schupf N, Brickman AM, Cosentino S, Tang MX, Stern Y: Physical activity, diet, and risk of Alzheimer disease. JAMA 2009, 302(6):627-637.
• [61]Taaffe DR, Irie F, Masaki KH, Abbott RD, Petrovitch H, Ross GW, White LR: Physical activity, physical function, and incident dementia in elderly men: the Honolulu-Asia Aging Study. J Gerontol A: Biol Med Sci 2008, 63(5):529-535.
• [62]Sattler C, Erikson KI, Torro P, Shroder J: Physical fitness as a protective factor for cognitive impairment in a prospective population-based study in Germany. J Alzheimers Dis 2011, 26:709-718.
• [63]Ward AC: The role of causal criteria in causal inferences: Bradford Hill’s “aspects of association”. Epidemiol Perspect Innov 2009, 6:2. BioMed Central Full Text
• [64]Rothman KJ, Greenland S, Lash TL: Modern Epidemiology. Philadelphia, PA: Lippincott Williams & Wilkins; 2008.
• [65]Hofler M: The Bradford Hill considerations on causality: a counterfactual perspective. Emerg Themes Epidemiol 2005, 2:11. BioMed Central Full Text
• [66]Webb P, Bain C: Essential Epidemiology: An Introduction for Students and Health Professionals. Cambridge: Cambridge University Press; 2010.
• [67]Jacova C, Kertesz A, Blair M, Fisk JD, Feldman HH: Neuropsychological testing and assessment for dementia. Alzheimers Dement 2007, 3(4):299-317.
• [68]Tombaugh TN: Test-retest reliable coefficients and 5-year change scores for the MMSE and 3MS. Arch Clin Neuropsychol 2005, 20(4):485-503.
• [69]McDowell I, Kristjansson B, Hill GB, Hébert R: Community screening for dementia: The Mini Mental State Exam (MMSE) and modified Mini-Mental State Exam (3MS) compared. J Clin Epidemiol 1997, 50(4):377-383.
• [70]MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R, Godwin J, Dyer A, Stamler J: Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990, 335(8692):765-774.
• [71]Woodard JL, Nielson KA, Sugarman MA, Smith JC, Seidenberg M, Durgerian S, Butts A, Hantke N, Lancaster M, Matthews MA: Lifestyle and genetic contributions to cognitive decline and hippocampal integrity in healthy aging. Curr Alzheimer Res 2012, 9(4):436.
• [72]Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS, Patrick K, Pollock ML, Rippe JM, Sallis J, Wilmore JH: Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995, 273(5):402-407.
• [73]Fratiglioni L, Paillard-Borg S, Winblad B: An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol 2004, 3(6):343-353.
• [74]Ho AJ, Raji CA, Becker JT, Lopez OL, Kuller LH, Hua X, Dinov ID, Stein JL, Rosano C, Toga AW, Thompson PM: The effects of physical activity, education, and body mass index on the aging brain. Hum Brain Mapp 2011, 32(9):1371-1382.
• [75]Van Praag H, Shubert T, Zhao C, Gage FH: Exercise enhances learning and hippocampal neurogenesis in aged mice. J Neurosci 2005, 25(38):8680-8685.
• [76]Erickson KI, Weinstein AM, Lopez OL: Physical activity, brain plasticity, and Alzheimer’s disease. Arch Med Res 2012, 43(8):615-621.