Leisure-Time Physical Activity May Attenuate the Impact of Diabetes on Cognitive Decline in Middle-Aged and Older Adults
abstract
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Access this abstract nowOBJECTIVE
To assess leisure-time physical activity (LTPA) as a modifier of the diabetes/cognitive decline association in middle-aged and older participants in the Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) study.
RESEARCH DESIGN AND METHODS
ELSA-Brasil is a cohort of 15,105 participants (age 35-74 years) enrolled between 2008 and 2010. We evaluated global cognitive function, summing the scores of six standardized tests evaluating memory and verbal fluency, including the Trail-Making Test, at baseline and follow-up. Incident cognitive impairment was defined as a global cognitive function score at follow-up lower than -1 SD from baseline mean. Participants reporting ≥150 min/week of moderate to vigorous LTPA at baseline were classified as physically active. We assessed the association of LTPA with global cognition change in those with diabetes in the context of our overall sample through multivariable regression models.
RESULTS
Participants' (N = 12,214) mean age at baseline was 51.4 (SD 8.8) years, and 55.5% were women. During a mean follow-up of 8.1 (SD 0.6) years, 9,345 (76.5%) inactive participants and 1,731 (14.1%) participants with diabetes at baseline experienced faster declines in global cognition than those who were active (β = -0.003, -0.004, and -0.002) and those without diabetes (β = -0.004, -0.005, and -0.003), respectively. Diabetes increased the risk of cognitive impairment (hazard ratio [HR] 1.71; 95% Cl 1.22, 2.39) in inactive but not in active adults (HR 1.18; 95% CI 0.73, 1.90). Among participants with diabetes, those who were active showed a delay of 2.73 (95% CI 0.94, 4.51) years in the onset of cognitive impairment.
CONCLUSIONS
In adults living with diabetes, LTPA attenuated the deleterious association between diabetes and cognitive function.
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Additional Info
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Leisure-Time Physical Activity May Attenuate the Impact of Diabetes on Cognitive Decline in Middle-Aged and Older Adults: Findings From the ELSA-Brasil Study
Diabetes Care 2024 Mar 01;47(3)427-434, N Feter, D de Paula, RCP Dos Reis, D Raichlen, AL Patrão, SM Barreto, CK Suemoto, BB Duncan, MI SchmidtFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Individuals with diabetes are at elevated risk for cognitive decline and dementia. Approaches to preserve cognitive health in such individuals are needed, but they remain elusive. Recent reports suggest that physical activity may mitigate the impact of cardiovascular risk factors on incident dementia, although large-scale studies examining the relationship of physical activity with cognitive impairment in individuals with diabetes are lacking. In this longitudinal study of 12,214 middle-aged and older Brazilian adults participating in the ELSA-Brasil study, Feter et al examined the associations among diabetes, leisure-time physical activity (LTPA), and cognitive decline over a mean of 8.1 (SD, 0.6) years. Participants that self-reported ≥150 minutes/week of moderate-to-vigorous LTPA at baseline were classified as physically active (23.5%), and 14% of the sample had diabetes at baseline.
The study found that having diabetes and being physically inactive were each associated with a higher risk of cognitive impairment. In addition, the association between diabetes and incident cognitive impairment was moderated by physical activity, such that diabetes predicted increased risk of impairment only among physically inactive, but not active, adults. Further, in participants with diabetes, being physically inactive predicted an accelerated yearly decline in global cognitive function, whereas being physically active demonstrated a delay of 2.73 years (95% CI, 0.94–4.51) in the onset of cognitive impairment. Results persisted when including the incident cases of diabetes ascertained during follow-up and when accounting for levels of glycemic control in participants with diabetes (HbA1c, ≥8.0% vs <8.0%).
Taken together, this timely analysis by Feter and colleagues shows that physical activity attenuated both the rate of cognitive decline and the risk of incident impairment in individuals with diabetes. Although confirmatory clinical trials are needed, these findings suggest that the cognitive complications of diabetes are not immutable and emphasize the important role of physical activity in mitigating the risk for cognitive impairment, especially in individuals with diabetes.