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Intensity and Types of Physical Exercise in Relation to Dementia Risk Reduction in Community-Living Older Adults

      Abstract

      Objective

      To systematically examine the amount and type of physical exercise that might reduce the future risk of dementia in community-living older people.

      Design

      Six-year observational study.

      Setting

      All the Elderly Health Centers (EHCs) of the Department of Health in Hong Kong.

      Participants

      A total of 15,589 community-living Chinese aged 65 years and older with no history of stroke, clinical dementia, or Parkinson disease when they completed health assessment at the EHCs in the first 6 months of 2005.

      Measurements

      Self-reported habitual physical exercise patterns, including the frequency, duration, and type of exercise, at baseline and Year 3 were analyzed. The study outcome was incident dementia in 6 years. Dementia was defined by presence of clinical dementia in accordance with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems or Clinical Dementia Rating of 1 to 3.

      Results

      Both the cognitively stable and incident groups reported exercising a median of 7 days per week and 45 minutes per day at baseline and Year 3. The former practiced aerobic and mind-body exercises more at baseline and Year 3, whereas the latter practiced stretching and toning exercises more. The odds ratio for dementia remained significant for aerobic (0.81; 95% confidence interval 0.68–0.95; P = .01) and mind-body exercises (0.76; 0.63–0.92; P = .004) after excluding participants who developed dementia within 3 years after baseline and adjusting for important potential confounders, such as age, gender, educational level, and physical and psychiatric comorbidities.

      Conclusion

      Although physical exercise is widely promoted as a nonpharmacological intervention for dementia prevention, not all types of exercise appear to be useful in reducing risk of dementia in older people. Our findings suggest that daily participation in aerobic and mind-body but not stretching and toning exercises might protect community-living older adults from developing dementia.

      Keywords

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      References

      1. World Health Organization and Alzheimer's Disease International. Dementia—a public health priority, 2012. World Health Organization. Available at: http://www.who.int/mental_health/publications/dementia_report_2012/en. Accessed August 2, 2014.

        • Brookmeyer R.
        • Johnson E.
        • Ziegler-Graham K.
        • Arrighi H.M.
        Forecasting the global burden of Alzheimer's disease.
        Alzheimers Dement. 2007; 3: 186-191
        • Barnes D.E.
        • Yaffe K.
        The projected effect of risk factor reduction on Alzheimer's disease prevalence.
        Lancet Neurol. 2011; 10: 819-828
        • Norton S.
        • Matthews F.E.
        • Barnes D.E.
        • et al.
        Potential for primary prevention of Alzheimer's disease: An analysis of population-based data.
        Lancet Neurol. 2014; 13: 788-794
        • Lautenschlager N.T.
        • Almeida O.P.
        Physical activity and cognition in old age.
        Curr Opin Psychiatry. 2006; 19: 190-193
        • Hamer M.
        • Chida H.
        Physical activity and risk of neurodegenerative disease: A systematic review of prospective evidence.
        Psychol Med. 2009; 39: 3-11
        • Lautenschlager N.T.
        • Cox K.L.
        • Flicker L.
        • et al.
        Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: A randomized trial.
        JAMA. 2008; 300: 1027-1037
        • Rolland Y.
        • Abellan van Kan G.
        • Vellas B.
        Physical activity and Alzheimer's disease: From prevention to therapeutic perspectives.
        J Am Med Dir Assoc. 2008; 9: 390-405
        • Lam L.C.
        • Chau R.C.
        • Wong B.M.
        • et al.
        A 1-year randomized controlled trial comparing mind body exercise (Tai Chi) with stretching and toning exercise on cognitive function in older Chinese adults at risk of cognitive decline.
        J Am Med Dir Assoc. 2012; 13: 568.e15-568.e20
        • Barnes D.E.
        • Santos-Modesitt W.
        • Poelke G.
        • et al.
        The Mental Activity and eXercise (MAX) trial: A randomized controlled trial to enhance cognitive function in older adults.
        JAMA Intern Med. 2013; 173: 797-804
        • Angevaren M.
        • Aufdemkampe G.
        • Verhaar H.J.
        • et al.
        Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment.
        Cochrane Database Syst Rev. 2008; : CD005381
        • Blondell S.J.
        • Hammersley-Mather R.
        • Veerman J.L.
        Does physical activity prevent cognitive decline and dementia? A systematic review and meta-analysis of longitudinal studies.
        BMC Public Health. 2014; 14: 510
        • Ahlskog J.E.
        • Geda Y.E.
        • Graff-Radford N.R.
        • Petersen R.C.
        Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging.
        Mayo Clin Proc. 2011; 86: 876-884
        • Chiu H.F.
        • Lam L.C.
        • Chi I.
        • et al.
        Prevalence of dementia in Chinese elderly in Hong Kong.
        Neurology. 1998; 50: 1002-1009
        • Leung G.T.
        • Leung K.F.
        • Lam L.C.
        Classification of late-life leisure activities among elderly Chinese in Hong Kong.
        East Asian Arch Psychiatry. 2011; 21: 123-127
      2. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th revision, version for 2004. Available at: http://apps.who.int/classifications/apps/icd/icd10online2004/fr-icd.htm. Published October 29, 2004. Accessed August 2, 2014.

        • Morris J.C.
        Clinical dementia rating: A reliable and valid diagnostic and staging measure for dementia of the Alzheimer type.
        Int Psychogeriatr. 1997; 9: 173-176
        • Lam L.C.
        • Tam C.W.
        • Lui V.W.
        • et al.
        Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong.
        Int Psychogeriatr. 2008; 20: 135-148
      3. American Heart Association. Recommendations for physical activity in adults. Available at: http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/StartWalking/American-Heart-Association-Guidelines_UCM_307976_Article.jsp. Accessed January 18, 2015.

        • Colcombe S.
        • Kramer A.F.
        Fitness effects on the cognitive function of older adults: A meta-analytic study.
        Psychol Sci. 2003; 14: 125-130
        • Erikson K.I.
        • Voss M.W.
        • Prakash R.S.
        • et al.
        Exercise training increases size of hippocampus and improves memory.
        Proc Natl Acad Sci U S A. 2011; 108: 3017-3022
        • Intlekofer K.A.
        • Cotman C.W.
        Exercise counteracts declining hippocampal function in aging and Alzheimer's disease.
        Neurobiol Dis. 2013; 57: 47-55
        • Hariprasad V.R.
        • Koparde V.
        • Sivakumar P.T.
        • et al.
        Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects of cognitive function.
        Indian J Psychiatry. 2013; 55: S357-S363
        • Fratiglioni L.
        • Paillard-Borg S.
        • Winblad B.
        An active and socially integrated lifestyle in late life might protect against dementia.
        Lancet Neurol. 2004; 3: 343-353
        • Richards M.
        • Hardy R.
        • Wadsworth M.E.
        Does active leisure protect cognition? Evidence from a national birth cohort.
        Soc Sci Med. 2003; 56: 785-792
      4. Department of Health and Department of Community Medicine, University of Hong Kong. Population health survey 2003/2004. Available at: http://www.chp.gov.hk/files/pdf/full_report_on_population_health_survey_2003_2004_tc_20051024.pdf. Accessed May 15, 2015.

        • Wolf-Maier K.
        • Cooper R.S.
        • Banegas J.R.
        • et al.
        Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States.
        JAMA. 2003; 289: 2362-2369
        • Ma R.C.
        • Chan J.C.
        Type 2 diabetes in East Asians: Similarities and differences with populations in Europe and the United States.
        Ann N Y Acad Sci. 2013; 1281: 64-91
        • Yang G.
        • Wang Y.
        • Zeng Y.
        • et al.
        Rapid health transition in China, 1990–2010: Findings from the Global Burden of Disease Study 2010.
        Lancet. 2013; 381: 1987-2015
        • Prince M.
        • Acosta D.
        • Ferri C.P.
        • et al.
        Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: A 10/66 Dementia Research Group population-based cohort study.
        Lancet. 2012; 380: 50-58
        • Chan K.Y.
        • Wang W.
        • Wu J.J.
        • et al.
        Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990–2010: A systematic review and analysis.
        Lancet. 2013; 381: 2016-2023