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Original Investigation
July 23, 2001

A Prospective Study of Physical Activity and Cognitive Decline in Elderly Women: Women Who Walk

Author Affiliations

From the Departments of Psychiatry (Dr Yaffe), Neurology (Dr Yaffe), Epidemiology and Biostatistics (Drs Yaffe and Nevitt and Ms Lui), and Medicine (Dr Covinsky), University of California, San Francisco; the San Francisco Veterans Affairs Medical Center, San Francisco, Calif (Drs Yaffe and Covinsky); and the Department of Public Health and Epidemiology, University of California, Berkeley (Ms Barnes).

Arch Intern Med. 2001;161(14):1703-1708. doi:10.1001/archinte.161.14.1703

Background  Several studies have suggested that physical activity is positively associated with cognitive function in elderly persons. Evidence about this association has been limited by the cross-sectional design of most studies and by the frequent lack of adjustment for potential confounding variables. We determined whether physical activity is associated with cognitive decline in a prospective study of older women.

Methods  We studied 5925 predominantly white community-dwelling women (aged ≥65 years) who were recruited at 4 clinical centers and were without baseline cognitive impairment or physical limitations. We measured cognitive performance using a modified Mini-Mental State Examination at baseline and 6 to 8 years later. Physical activity was measured by self-reported blocks (1 block ≈ 160 m) walked per week and by total kilocalories (energy) expended per week in recreation, blocks walked, and stairs climbed. Cognitive decline was defined as a 3-point decline or greater on repeated modified Mini-Mental State Examination.

Results  Women with a greater physical activity level at baseline were less likely to experience cognitive decline during the 6 to 8 years of follow-up: cognitive decline occurred in 17%, 18%, 22%, and 24% of those in the highest, third, second, and lowest quartile of blocks walked per week (P<.001 for trend). Almost identical results were obtained by quartile of total kilocalories expended per week. After adjustment for age, educational level, comorbid conditions, smoking status, estrogen use, and functional limitation, women in the highest quartile remained less likely than women in the lowest quartile to develop cognitive decline (for blocks walked: odds ratio, 0.66 [95% confidence interval, 0.54-0.82]; for total kilocalories: odds ratio, 0.74 [95% confidence interval, 0.60-0.90]).

Conclusions  Women with higher levels of baseline physical activity were less likely to develop cognitive decline. This association was not explained by differences in baseline function or health status. This finding supports the hypothesis that physical activity prevents cognitive decline in older community-dwelling women.