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      Association Between Physical Activity and Risk of Disabling Dementia in Japan

      research-article
      , PT, PhD 1 , , MD, PhD 1 , , , MD, PhD 1 , , MD, PhD 2 , , MD, PhD 3 , , MD, PhD 1 , , MD, PhD 1 , , MD, PhD 1 , 4
      JAMA Network Open
      American Medical Association

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          Key Points

          Question

          What are the associations of daily total physical activity, total moderate-to-vigorous physical activity (MVPA), and leisure-time MVPA with risk of dementia in the general population in Japan?

          Findings

          This cohort study including 43 896 participants investigated associations of daily total physical activity and total MVPA with risk of disabling dementia. However, a higher level of leisure-time MVPA was statistically significantly associated with decreased risk of disabling dementia in men.

          Meaning

          These findings suggest that higher leisure-time MVPA may be associated with the prevention of disabling dementia in men.

          Abstract

          This cohort study assesses the association between physical activity and risk of disabling dementia in Japan.

          Abstract

          Importance

          The associations of daily total physical activity and total moderate to vigorous physical activity (MVPA) with dementia are still unclear.

          Objective

          To investigate the association between daily total physical activity and subsequent risk of disabling dementia in large-scale, extended follow-up prospective study.

          Design, Setting, and Participants

          This prospective cohort study used data from questionnaires collected between 2000 and 2003 from 8 areas from the Japan Public Health Center-based Prospective Disabling Dementia Study. Participants included adults aged 50 to 79 years in with available follow-up data on disabling dementia. Data analysis was performed from February 1, 2019, to July 31, 2021.

          Exposures

          Daily total physical activity, total MVPA, and leisure-time MVPA.

          Main Outcomes and Measures

          The main outcome was incidence of disabling dementia during the dementia ascertainment period between 2006 and 2016, based on the national long-term care insurance system. Risks of dementia in association with daily total physical activity, total MVPA, and leisure time MVPA were calculated using multivariable adjusted hazard ratios (aHRs).

          Results

          Among 43 896 participants (mean [SD] age, 61.0 [7.5] years; 23 659 [53.9%] women), 5010 participants were newly diagnosed with disabling dementia during a mean (SD) of 9.5 (2.8) years in the dementia ascertainment period. In the highest daily total physical activity group, compared with the lowest activity group, risk of dementia was lower in men (aHR, 0.75 [95% CI, 0.66-0.85]; P for trend < .001) and women (aHR, 0.75 [95% CI, 0.67-0.84]; P for trend < .001). Similar inverse associations were observed in men and women for total MVPA (men: aHR, 0.74 [95% CI, 0.65-0.84]; P for trend < .001; women: aHR, 0.74 [95% CI, 0.66-0.83]; P for trend < .001) and leisure-time MVPA (men: aHR, 0.59 [95% CI, 0.53-0.67]; P for trend < .001; women: aHR, 0.70 [95% CI, 0.63-0.78]; P for trend < .001). However, these inverse associations disappeared when participants diagnosed with disabling dementia within 7 years of the starting point were excluded in men (aHR, 0.93 [95%CI, 0.77-1.12]) and within 8 years were excluded in women (aHR, 0.86 [95%CI, 0.71-1.04]). The association remained significant among men in the highest vs lowest group of leisure-time MVPA, after excluding participants diagnosed within the first 9 years (aHR, 0.72 [95% CI, 0.56-0.92]; P for trend = .004).

          Conclusions and Relevance

          This cohort study examined associations of daily total physical activity and total MVPA with risk of disabling dementia. The findings suggest that a high level of leisure-time MVPA was associated with decreased risk of disabling dementia in men.

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          Most cited references47

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          A Proportional Hazards Model for the Subdistribution of a Competing Risk

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            • Article: not found

            Compendium of Physical Activities: an update of activity codes and MET intensities

            We provide an updated version of the Compendium of Physical Activities, a coding scheme that classifies specific physical activity (PA) by rate of energy expenditure. It was developed to enhance the comparability of results across studies using self-reports of PA. The Compendium coding scheme links a five-digit code that describes physical activities by major headings (e.g., occupation, transportation, etc.) and specific activities within each major heading with its intensity, defined as the ratio of work metabolic rate to a standard resting metabolic rate (MET). Energy expenditure in MET-minutes, MET-hours, kcal, or kcal per kilogram body weight can be estimated for specific activities by type or MET intensity. Additions to the Compendium were obtained from studies describing daily PA patterns of adults and studies measuring the energy cost of specific physical activities in field settings. The updated version includes two new major headings of volunteer and religious activities, extends the number of specific activities from 477 to 605, and provides updated MET intensity levels for selected activities.
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              Risk factors for Alzheimer's disease: a prospective analysis from the Canadian Study of Health and Aging.

              J. Lindsay (2002)
              A prospective analysis of risk factors for Alzheimer's disease was a major objective of the Canadian Study of Health and Aging, a nationwide, population-based study. Of 6,434 eligible subjects aged 65 years or older in 1991, 4,615 were alive in 1996 and participated in the follow-up study. All participants were cognitively normal in 1991 when they completed a risk factor questionnaire. Their cognitive status was reassessed 5 years later by using a similar two-phase procedure, including a screening interview, followed by a clinical examination when indicated. The analysis included 194 Alzheimer's disease cases and 3,894 cognitively normal controls. Increasing age, fewer years of education, and the apolipoprotein E epsilon4 allele were significantly associated with increased risk of Alzheimer's disease. Use of nonsteroidal anti-inflammatory drugs, wine consumption, coffee consumption, and regular physical activity were associated with a reduced risk of Alzheimer's disease. No statistically significant association was found for family history of dementia, sex, history of depression, estrogen replacement therapy, head trauma, antiperspirant or antacid use, smoking, high blood pressure, heart disease, or stroke. The protective associations warrant further study. In particular, regular physical activity could be an important component of a preventive strategy against Alzheimer's disease and many other conditions.
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                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                29 March 2022
                March 2022
                29 March 2022
                : 5
                : 3
                : e224590
                Affiliations
                [1 ]Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
                [2 ]Department of Public Health, Kochi University Medical School, Kochi, Japan
                [3 ]Health Services Research and Development Center, Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
                [4 ]National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
                Author notes
                Article Information
                Accepted for Publication: February 9, 2022.
                Published: March 29, 2022. doi:10.1001/jamanetworkopen.2022.4590
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Ihira H et al. JAMA Network Open.
                Corresponding Author: Norie Sawada, MD, PhD, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan ( nsawada@ 123456ncc.go.jp ).
                Author Contributions: Dr Sawada had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: Ihira, Sawada, Inoue, Yasuda, Yamagishi, Iwasaki, Tsugane.
                Acquisition, analysis, or interpretation of data: All authors.
                Drafting of the manuscript: Ihira.
                Critical revision of the manuscript for important intellectual content: All authors.
                Statistical analysis: Ihira, Yasuda, Charvat.
                Obtained funding: Yasuda, Tsugane.
                Administrative, technical, or material support: Ihira, Sawada, Yamagishi, Tsugane.
                Supervision: Sawada, Inoue, Tsugane.
                Conflict of Interest Disclosures: None reported.
                Funding/Support: This study was supported by grants from the National Cancer Centre Research and Development Fund (grant No. 23-A-31 [toku] and 26-A-2, 29-A-4 [since 2011]), a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour and Welfare in Japan (from 1989 to 2010), and a Grant-in-Aid for Scientific Research (B) (grant No. 16H05246 [from 2016 to 2019; Dr Yasuda] and 21H03194 [since 2021; Dr Yamagishi]).
                Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                Additional Contributions: Members of the Japan Public Health Center-based Prospective Study (JPHC) study group are listed in the eAppendix in the Supplement.
                Article
                zoi220160
                10.1001/jamanetworkopen.2022.4590
                8965633
                35348711
                4f4298b0-38fd-4a89-96e6-75e481eb10c7
                Copyright 2022 Ihira H et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 18 August 2021
                : 9 February 2022
                Categories
                Research
                Original Investigation
                Online Only
                Geriatrics

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