Midlife physical activity is associated with lower incidence of vascular dementia but not Alzheimer’s disease

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Abstract

Background

Physical activity might reduce the risk of developing dementia. However, it is still unclear whether the protective effect differs depending on the subtype of dementia. We aimed to investigate if midlife physical activity affects the development of vascular dementia (VaD) and Alzheimer’s disease (AD) differently in two large study populations with different designs.

Methods

Using a prospective observational design, we studied whether long-distance skiers of the Swedish Vasaloppet ( n = 197,685) exhibited reduced incidence of VaD or AD compared to matched individuals from the general population ( n = 197,684) during 21 years of follow-up (median 10, interquartile range (IQR) 5–15 years). Next, we studied the association between self-reported physical activity, stated twice 5 years apart, and incident VaD and AD in 20,639 participants in the Swedish population-based Malmo Diet and Cancer Study during 18 years of follow-up (median 15, IQR 14–17 years). Finally, we used a mouse model of AD and studied brain levels of amyloid-β, synaptic proteins, and cognitive function following 6 months of voluntary wheel running.

Results

Vasaloppet skiers (median age 36.0 years [IQR 29.0–46.0], 38% women) had lower incidence of all-cause dementia (adjusted hazard ratio (HR) 0.63, 95% CI 0.52–0.75) and VaD (adjusted HR 0.49, 95% CI 0.33–0.73), but not AD, compared to non-skiers. Further, faster skiers exhibited a reduced incidence of VaD (adjusted HR 0.38, 95% CI 0.16–0.95), but not AD or all-cause dementia compared to slower skiers. In the Malmo Diet and Cancer Study (median age 57.5 years [IQR 51.0–63.8], 60% women), higher physical activity was associated with reduced incidence of VaD (adjusted HR 0.65, 95% CI 0.49-0.87), but not AD nor all-cause dementia. These findings were also independent of APOE-ε4 genotype. In AD mice, voluntary running did not improve memory, amyloid-β, or synaptic proteins.

Conclusions

Our results indicate that physical activity in midlife is associated with lower incidence of VaD. Using three different study designs, we found no significant association between physical activity and subsequent development of AD.

Related collections

Most cited references 38

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The Malmo Diet and Cancer Study. Design and feasibility.

G Berglund, S Elmstáhl, L. Janzon … (1993)

The Malmö Diet and Cancer study is a 10-year prospective case-control study in 45-64-year-old men and women (n = 53,000) living in a city with 230,000 inhabitants. One objective is to clarify whether a western diet is associated with certain forms of cancer whilst taking other life-style factors into account. Another broad question is whether oxidative stress and the activity in DNA-repairing systems influence the impact of diet on the development of all or certain forms of cancer. The study is also to act as a resource available for testing new hypotheses emanating from other studies. Initially food intake, heredity, socio-economic factors, life-style pattern, occupational situation, previous and current diseases, symptoms and medications, will be determined. Viable lymphocytes, granulocytes, erythrocytes, and plasma/serum will be stored in a biological bank together with tumour specimens gathered from cases. The incidence and mortality of all cancer forms will then be followed for 10 years by existing registries. Data from the initial examination in these cases will then be compared with those of control subjects not having developed any form of cancer. A biomarker programme, utilizing the biological bank, has been developed and is aimed at finding predictors and/or precursors of cancer. A high participation rate (> 70%) and a high quality biological bank are prerequisites for a successful project. The experience gathered so far indicates that these goals are feasible.

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The Malmö Diet and Cancer Study: representativity, cancer incidence and mortality in participants and non-participants.

B Gullberg, J Manjer, S Elmstáhl … (2001)

In order to investigate potential selection bias in population-based cohort studies, participants (n = 28098) and non-participants (n = 40807) in the Malmö Diet and Cancer Study (MDCS) were compared with regard to cancer incidence and mortality. MDCS participants were also compared with participants in a mailed health survey with regard to subjective health, socio-demographic characteristics and lifestyle. Cancer incidence prior to recruitment was lower in non-participants, Cox proportional hazards analysis yielded a relative risk (RR) with a 95% confidence interval of 0.95 (0.90-1.00), compared with participants. During recruitment, cancer incidence was higher in non-participants, RR: 1.08 (1.01-1.17). Mortality was higher in non-participants both during, 3.55 (3.13-4.03), and following the recruitment period, 2.21 (2.03-2.41). The proportion reporting good health was higher in the MDCS than in the mailed health survey (where 74.6% participated), but the socio-demographic structure was similar. We conclude that mortality is higher in non-participants than in participants during recruitment and follow-up. It is also suggested that non-participants may have a lower cancer incidence prior to recruitment but a higher incidence during the recruitment period.

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Is Open Access

Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial

Sarah E Lamb, Bart Sheehan, Nicky Atherton … (2018)

Abstract Objective To estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia. Design Multicentre, pragmatic, investigator masked, randomised controlled trial. Setting National Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions. Participants 494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm. Interventions Usual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises. Main outcome measures The primary outcome was score on the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention. Results The average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference −1.4, 95% confidence interval −2.6 to −0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer’s disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m). Conclusion A moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes. Trial registration Current Controlled Trials ISRCTN10416500.

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Author and article information

Contributors

Oskar Hansson: +46 (0)72 226 7745 , oskar.hansson@med.lu.se

Martina Svensson: martina.svensson@med.lu.se

Anna-Märta Gustavsson: anna-marta.gustavsson@med.lu.se

Emelie Andersson: emelie.andersson@med.lu.se

Yiyi Yang: yiyi.yang@med.lu.se

Katarina Nägga: katarina.nagga@med.lu.se

Ulf Hållmarker: ulf.hallmarker@ltdalarna.se

Stefan James: stefan.james@ucr.uu.se

Tomas Deierborg: +46 (0)70 970 8212 , tomas.deierborg@med.lu.se

Journal

Journal ID (nlm-ta): Alzheimers Res Ther

Journal ID (iso-abbrev): Alzheimers Res Ther

Title: Alzheimer's Research & Therapy

Publisher: BioMed Central (London )

ISSN (Electronic): 1758-9193

Publication date (Electronic): 20 October 2019

Publication date PMC-release: 20 October 2019

Publication date Collection: 2019

Volume: 11

Electronic Location Identifier: 87

Affiliations

[1 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Clinical Memory Research Unit, Department of Clinical Sciences Malmö, , Lund University, ; Malmö, Sweden

[2 ]ISNI 0000 0004 0623 9987, GRID grid.411843.b, Memory Clinic, , Skåne University Hospital, ; Malmö, Sweden

[3 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Experimental Neuroinflammation Laboratory, Department of Experimental Medical Science, , Lund University, ; 221 84 Lund, Sweden

[4 ]ISNI 0000 0001 2162 9922, GRID grid.5640.7, Department of Acute Internal Medicine and Geriatrics, , Linköping University, ; Linköping, Sweden

[5 ]ISNI 0000 0004 1936 9457, GRID grid.8993.b, Department of Medical Sciences, Cardiology, , Uppsala University, ; Uppsala, Sweden

Article

Publisher ID: 538

DOI: 10.1186/s13195-019-0538-4

PMC ID: 6802179

PubMed ID: 31630687

SO-VID: a33ad12a-9166-457f-a4dc-460845ac9bc8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 26 March 2019

Date accepted : 10 September 2019