Is Midlife Cardiovascular Fitness Associated with Reduced Risk for Dementia?
BACKGROUND AND PURPOSE:
Multiple studies have reported an association between physical activity and decreased risk of dementia and preserved cognitive function
Research is limited by self-reporting of physical activity
Improved cognitive function may be related to social interaction rather than actual physical fitness
Hörder et al. (Neurology, 2018) tracked dementia incidence for 44 years to determine whether there is an association between midlife cardiovascular fitness and decreased risk for dementia
Population-based sample of women aged 38 to 60 years
Data derived from prospective Population Study of Women (PPSW), begun in 1968
Women were admitted to an exercise test
A stepwise-increased maximal ergometer cycling test (until exhaustion) to evaluate cardiovascular function was used, under physician supervision
Fitness Description: Crude peak workload into
Low: ≤80W or interrupted at submaximal workload)
Follow-up tests for dementia were conducted in 1974, 1980, 1992, 2000, 2005, and 2009
Dementia was diagnosed according to DSM-III-R criteria on the basis of information from neuropsychiatric examinations, informant interviews, hospital records, and registry data up to 2012
Socioeconomic, lifestyle, and medical confounders were adjusted for in the cox regression test
Data was collected from 1,462 women; the symptomatic cardiovascular subgroup consisted of 191 woman
29 were 38 years
41 were 46 years
37 were 50 years
47 were 54 years
37 were 60 years
Compared to medium fitness (referent population), high cardiovascular fitness was associated with significantly reduced risk of dementia
High fitness: Hazard ratio (HR) 0.12 (95% CI, 0.03–0.54)
Low fitness: HR 1.41 (95% CI, 0.72–2.79)
High fitness delayed age at dementia onset by 9.5 years and time to dementia onset by 5 years, compared to medium fitness
Based on the peak workload, the cumulative incidence of all-cause dementia was 32% for low fitness, 25% for medium fitness, and 5% for high ﬁtness
Among Swedish women, high cardiovascular fitness in midlife was correlated with reduced risk of subsequent dementia
High compared to medium ﬁtness decreased the risk of dementia by 88%
Fitness and physical activity are not identical and the former may have an underlying genetic component
Findings demonstrate a strong association between physical fitness and dementia but are associative and not causal
Future areas of study include understanding the underlying mechanisms
The authors state
The risk reduction of high ﬁtness on dementia was stronger for the crude peak workload than for peak workload/body weight. This is similar to studies on all-cause mortality in which obese ﬁt individuals have a mortality risk similar to that of normal-weight ﬁt individuals. This highlights the need for ﬁtness-driven, rather than weight loss–driven, approaches.
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