changes in cognition and mortality in relation to exercise in late life a population based study认知和死亡率的变化与运动生活年末人口为基础的研究.pdfVIP

Changes in Cognition and Mortality in Relation to Exercise in Late Life: A Population Based Study 1 1 1 2 1 Laura E. Middleton , Arnold Mitnitski , Nader Fallah , Susan A. Kirkland , Kenneth Rockwood * 1 Geriatric Medicine Research Unit, Centre for Health Care of the Elderly, Halifax, Nova Scotia, Canada, 2 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada Abstract Background: On average, cognition declines with age but this average hides considerable variability, including the chance of improvement. Here, we investigate how exercise is associated with cognitive change and mortality in older people and, particularly, whether exercise might paradoxically increase the risk of dementia by allowing people to live longer. Methods and Principal Findings: In the Canadian Study of Health and Aging (CSHA), of 8403 people who had baseline cognition measured and exercise reported at CSHA-1, 2219 had died and 5376 were re-examined at CSHA-2. We used a parametric Markov chain model to estimate the probabilities of cognitive improvement, decline, and death, adjusted for age and education, from any cognitive state as measured by the Modified Mini-Mental State Examination. High exercisers (at least three times per week, at least as intense as walking, n = 3264) had more frequent stable or improved cognition (42.3%, 95% confidence interval: 40.6–44.0) over 5 years than did low/no exercisers (all other exercisers and non exercisers, n = 4331) (27.8% (95% CI 26.4–29.2)). The difference widened as baseline cognition worsened. The proportion whose cognition declined was higher amongst the high exercisers but was more similar between exercise groups (39.4% (95% CI 37.7–41.1) for high exerc