The association between midlife cardiorespiratory fitness levels and later-life dementia: A cohort study

Laura F. DeFina, Benjamin L. Willis, Nina B. Radford, Ang Gao, David Leonard, William L. Haskell, Myron F. Weiner, Jarett D. Berry

Research output: Contribution to journalArticle

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Abstract

Background: Primary prevention of Alzheimer disease and other types of dementia (all-cause dementia) is an important public health goal. Evidence to date is insufficient to recommend any lifestyle change to prevent or delay the onset of dementia. Objective: To assess the association between objectively measured midlife cardiorespiratory fitness ("fitness") levels and development of all-cause dementia in advanced age. Design: Prospective, observational cohort study. Setting: Preventive medicine clinic. Patients: 19 458 community-dwelling, nonelderly adults who had a baseline fitness examination. Measurements: Fitness levels, assessed using the modified Balke treadmill protocol between 1971 and 2009, and incident all-cause dementia using Medicare Parts A and B claims data from 1999 to 2009. Results: 1659 cases of incident all-cause dementia occurred during 125 700 person-years of Medicare follow-up (median follow-up, 25 years [interquartile range, 19 to 30 years]). After multivariable adjustment, participants in the highest quintile of fitness level had lower hazard of all-cause dementia than those in the lowest quintile (hazard ratio, 0.64 [95% CI, 0.54 to 0.77]). Higher fitness levels were associated with lower hazard of all-cause dementia with previous stroke (hazard ratio, 0.74 [CI, 0.53 to 1.04]) or without previous stroke (hazard ratio, 0.74 [CI, 0.61 to 0.90]). Limitations: Dementia diagnoses were based on Medicare claims, and participants generally were non-Hispanic white, healthy, and well-educated and had access to preventive health care. This study evaluated fitness levels, so a specific exercise prescription cannot be generated from results and the findings may not be causal. Conclusion: Higher midlife fitness levels seem to be associated with lower hazards of developing all-cause dementia later in life. The magnitude and direction of the association were similar with or without previous stroke, suggesting that higher fitness levels earlier in life may lower risk for dementia later in life, independent of cerebrovascular disease. Primary Funding Source: The Cooper Institute; University of Texas Southwestern Medical Center; National Heart, Lung, and Blood Institute; and American Heart Association.

Original languageEnglish (US)
Pages (from-to)162-168
Number of pages7
JournalAnnals of Internal Medicine
Volume158
Issue number3
StatePublished - Feb 5 2013

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Dementia
Cohort Studies
Stroke
Medicare
Medicare Part A
Medicare Part B
Cardiorespiratory Fitness
Preventive Health Services
National Heart, Lung, and Blood Institute (U.S.)
Independent Living
Social Adjustment
Cerebrovascular Disorders
Preventive Medicine
Health Services Accessibility
Primary Prevention
Observational Studies
Prescriptions
Life Style
Alzheimer Disease
Public Health

ASJC Scopus subject areas

  • Internal Medicine

Cite this

DeFina, L. F., Willis, B. L., Radford, N. B., Gao, A., Leonard, D., Haskell, W. L., ... Berry, J. D. (2013). The association between midlife cardiorespiratory fitness levels and later-life dementia: A cohort study. Annals of Internal Medicine, 158(3), 162-168.

The association between midlife cardiorespiratory fitness levels and later-life dementia : A cohort study. / DeFina, Laura F.; Willis, Benjamin L.; Radford, Nina B.; Gao, Ang; Leonard, David; Haskell, William L.; Weiner, Myron F.; Berry, Jarett D.

In: Annals of Internal Medicine, Vol. 158, No. 3, 05.02.2013, p. 162-168.

Research output: Contribution to journalArticle

DeFina, LF, Willis, BL, Radford, NB, Gao, A, Leonard, D, Haskell, WL, Weiner, MF & Berry, JD 2013, 'The association between midlife cardiorespiratory fitness levels and later-life dementia: A cohort study', Annals of Internal Medicine, vol. 158, no. 3, pp. 162-168.
DeFina LF, Willis BL, Radford NB, Gao A, Leonard D, Haskell WL et al. The association between midlife cardiorespiratory fitness levels and later-life dementia: A cohort study. Annals of Internal Medicine. 2013 Feb 5;158(3):162-168.
DeFina, Laura F. ; Willis, Benjamin L. ; Radford, Nina B. ; Gao, Ang ; Leonard, David ; Haskell, William L. ; Weiner, Myron F. ; Berry, Jarett D. / The association between midlife cardiorespiratory fitness levels and later-life dementia : A cohort study. In: Annals of Internal Medicine. 2013 ; Vol. 158, No. 3. pp. 162-168.
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