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Association Between Exercise Capacity and Late Onset of Dementia, Alzheimer Disease, and Cognitive Impairment

  • Jan Müller
    Correspondence: Address to Jan Müller, MSc, PhD, Institute of Preventive Pediatrics, Technische Universität München, Uptown München-Campus D, Georg-Brauchle-Ring 60/62, 80992 München, Germany.
    Institute of Preventive Pediatrics, Technische Universität München, München, Germany

    Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA

    Stanford University School of Medicine, Stanford, CA
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  • Khin Chan
    Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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  • Jonathan N. Myers
    Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA

    Stanford University School of Medicine, Stanford, CA
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Published:January 09, 2017DOI:



      To address the association between exercise capacity and the onset of dementia, Alzheimer disease, and cognitive impairment.

      Patients and Methods

      For 6104 consecutive veteran patients (mean ± SD age: 59.2±11.4 years) referred for treadmill exercise testing, the combined end point of dementia, Alzheimer disease, and cognitive impairment was abstracted from the Veterans Affairs computerized patient record system.


      After mean ± SD follow-up of 10.3±5.5 years, 353 patients (5.8%) developed the composite end point at a mean ± SD age of 76.7±10.3 years. After correction for confounders in multivariate Cox proportional hazards regression, higher age at exercise testing (hazard ratio [HR]=1.08; 95% CI, 1.07-1.09; P<.001), current smoking (HR=1.44; 95% CI, 1.08-1.93; P=.01), and exercise capacity (HR=0.92; 95% CI, 0.89-0.96; P<.001) emerged as predictors of cognitive impairment. Each 1–metabolic equivalent increase in exercise capacity conferred a nearly 8% reduction in the incidence of cognitive impairment. Meeting the recommendations for daily activity was not associated with a delay in onset of cognitive impairment (HR=1.07; 95% CI, 0.86-1.32; P=.55).


      Exercise capacity is strongly associated with cognitive function; the inverse association between fitness and cognitive impairment provides an additional impetus for health care providers to promote physical activity.

      Abbreviations and Acronyms:

      ACE (angiotensin-converting enzyme), BMI (body mass index), CVD (cardiovascular disease), HR (hazard ratio), MET (metabolic equivalent)
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