TOPLINE

Adults aged 50 years or older who maintained high levels of structured exercise and cognitive-social engagement had an estimated 7.2 additional years without cognitive impairment from the age of 50 years compared with those with low levels of both, a study showed. High levels of either domain alone were associated with a lower risk for cognitive impairment than low levels of both but maintaining high levels of both behaviors was associated with the greatest benefit.

METHODOLOGY

• Researchers harmonized repeated longitudinal data from four aging studies, namely CHARLS, HRS, ELSA, and KLoSA. A total of 47,254 participants aged 50 years or older without cognitive impairment at baseline (pooled mean age, 59.2 years; 53.8% women) were included.
• Structured exercise was defined as physical activity undertaken on purpose, by plan, or during leisure time for fitness, recreation, or health. Cognitive-social engagement covered mentally stimulating or socially interactive pursuits such as volunteering, hobbies, games, educational activities, internet use, social contact, community group participation, and religious and cultural events.
• Participants were cross-classified into four groups: those with low levels of exercise and low cognitive-social engagement (LL; 26.8%), those with high levels of exercise and low cognitive-social engagement (HL; 13.2%), those with low levels of exercise and high cognitive-social engagement (LH; 35.2%), and those with high levels of both exercise and cognitive-social engagement (HH; 24.8%).
• Researchers assessed incident cognitive impairment and cognitive impairment-free life expectancy from the age of 50 years. 
• The analysis was adjusted for age, sex, partner status, education, smoking status, alcohol consumption, BMI, and the presence of chronic conditions.

TAKEAWAY

• After full adjustment, the risk for incident cognitive impairment was lower in the HL (hazard ratio [HR], 0.80; 95% CI, 0.73-0.88), LH (HR, 0.79; 95% CI, 0.66-0.95), and HH (HR, 0.70; 95% CI, 0.61-0.81) groups than in the LL group.
• Direct pairwise comparisons showed that the HH category was associated with a lower risk for cognitive impairment than the HL category (HR, 0.87; 95% CI, 0.79-0.96) and LH category (HR, 0.89; 95% CI, 0.84-0.93).
• The HL category was not significantly different from the LH category (HR, 1.01; 95% CI, 0.89-1.16), suggesting that structured exercise and cognitive-social engagement could not fully substitute for each other.
• Total remaining life expectancy from the age of 50 years was 28 years, 35.7 years, 33.9 years, and 39.1 years in the LL, HL, LH, and HH groups, respectively. Life expectancy without cognitive impairment was 17.5 years, 23.2 years, 20.1 years, and 24.7 years in the LL, HL, LH, and HH groups, respectively.

IN PRACTICE

"Current public health messages often emphasize physical activity, social participation, or cognitive stimulation as separate lifestyle recommendations. Our results suggest that dementia-prevention strategies may benefit from a dual-track approach that promotes structured exercise together with sustained cognitive and social engagement," the investigators wrote.

SOURCE

The study was led by Xiangwei Li, School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China. It was published online on October 13 in Alzheimer's & Dementia.

LIMITATIONS

The study was limited by its observational design, reliance on self-reported, harmonized data for structured exercise and cognitive-social engagement, varied definitions of cognitive impairment across cohorts, lack of study of mechanisms, and potential residual confounding and reverse causation.

DISCLOSURES

The study was funded by the National Natural Science Foundation of China, Hainan Provincial Natural Science Foundation of China, and the startup fund for Principal Investigators from the School of Medicine, Shanghai Jiao Tong University. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.