Review 1 Mention
Physical activity as a protective factor for dementia and Alzheimer’s disease: systematic review, meta-analysis and quality assessment of cohort and case–control studies
Paula Iso‐Markku•2022
Urho M. KujalaKeegan Phillip Knittle
Top 1% · 99th Percentile
430 citations · Psychiatry and Mental health
Open Access

TLDR

People who are more physically active tend to develop dementia less often, including Alzheimer’s disease, even decades later. Staying active during adult life may help protect brain health, although this does not prove activity is the direct cause.

Summary

1 Study Aim

The authors examined whether physical activity protects against all-cause dementia (dementia from any cause), Alzheimer’s disease (a common form of dementia), and vascular dementia (dementia linked to blood-vessel problems). They focused on long follow-ups and younger starting ages to reduce reverse causation, where early disease lowers activity. The study also tested whether age, study quality, inherited risk, education, activity type, and funding changed the results. The researchers wanted to know whether staying active earlier in life is linked with fewer later memory problems.

2 Study Design

The researchers conducted a systematic review (structured evidence search) and meta-analysis (statistical combination of study results). They included 58 prospective cohort or case–control studies involving adults, with follow-ups longer than one year. Studies measured physical activity at the start and later assessed dementia using cognitive tests or records. Searches covered six databases through October 2021. The team combined relative risks (comparisons of likelihood) using random-effects models, assessed study quality, examined dose-response patterns, and tested possible publication bias. The researchers combined results from 58 long-term observational studies to compare active and inactive adults.

3 Findings

The study found that higher physical activity was associated with lower risk of all-cause dementia, Alzheimer’s disease, and vascular dementia. Pooled relative risks were 0.80, 0.86, and 0.79, respectively. Associations remained for all-cause dementia and Alzheimer’s disease after follow-ups of at least 20 years. Age, follow-up length, and study quality did not significantly change the associations. Dose-response patterns supported lower all-cause dementia risk with more activity, but evidence for Alzheimer’s disease was less consistent. Funnel plots suggested possible publication bias. The authors recommend promoting activity while noting that observational evidence cannot prove cause and effect. They call for stronger long-term studies and trials. Being active was linked with fewer cases later, but better research is still needed to prove activity prevents dementia.

Abstract

OBJECTIVE: Physical activity (PA) is associated with a decreased incidence of dementia, but much of the evidence comes from short follow-ups prone to reverse causation. This meta-analysis investigates the effect of study length on the association. DESIGN: A systematic review and meta-analysis. Pooled effect sizes, dose-response analysis and funnel plots were used to synthesise the results. DATA SOURCES: CINAHL (last search 19 October 2021), PsycInfo, Scopus, PubMed, Web of Science (21 October 2021) and SPORTDiscus (26 October 2021). ELIGIBILITY CRITERIA: Studies of adults with a prospective follow-up of at least 1 year, a valid cognitive measure or cohort in mid-life at baseline and an estimate of the association between baseline PA and follow-up all-cause dementia, Alzheimer's disease or vascular dementia were included (n=58). RESULTS: PA was associated with a decreased risk of all-cause dementia (pooled relative risk 0.80, 95% CI 0.77 to 0.84, n=257 983), Alzheimer's disease (0.86, 95% CI 0.80 to 0.93, n=128 261) and vascular dementia (0.79, 95% CI 0.66 to 0.95, n=33 870), even in longer follow-ups (≥20 years) for all-cause dementia and Alzheimer's disease. Neither baseline age, follow-up length nor study quality significantly moderated the associations. Dose-response meta-analyses revealed significant linear, spline and quadratic trends within estimates for all-cause dementia incidence, but only a significant spline trend for Alzheimer's disease. Funnel plots showed possible publication bias for all-cause dementia and Alzheimer's disease. CONCLUSION: PA was associated with lower incidence of all-cause dementia and Alzheimer's disease, even in longer follow-ups, supporting PA as a modifiable protective lifestyle factor, even after reducing the effects of reverse causation.

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