Prospective association between moderate-to-vigorous physical activity trajectories and cognitive function in middle-aged and older adults
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摘要:
目的 探索中国社区中老年人中高强度体力活动轨迹与认知功能之间的关系。 方法 利用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)2011―2018年数据，收集社会人口学特征、个人健康状况、生活方式和健康相关行为信息。采用组基轨迹模型中的删失正态模型识别中高强度体力活动轨迹并分组，采用线性混合模型分析中高强度体力活动轨迹与认知功能的关联。 结果 纳入4 989名≥45岁的中老年人，中位随访7.0年，识别出低水平-波动组(55.42%)和高水平-下降组(44.58%)2个轨迹组。与低水平-波动组相比，高水平-下降组的认知功能下降速度减缓(β=0.11, 95% CI: 0.07~0.16, P < 0.001)。在高水平-下降组中，与文盲学历相比，小学学历者认知功能下降速度减慢(β=0.17, 95% CI: 0.10~0.23, P=0.023)。 结论 识别出2组中老年人中高强度体力活动轨迹，结果提示长期保持较高水平体力活动有助于延缓认知功能的下降，尤其在学历较低的人群中具有积极意义。 Abstract:Objective To explore the association between moderate-to-vigorous physical activity (MVPA) trajectories and cognitive function among middle-aged and older adults in Chinese communities. Methods We used data from the 2011 to 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS), including sociodemographic characteristics, health status, lifestyle factors, and health-related behaviors. MVPA trajectories were identified using group-based trajectory model (GBTM) with a censored normal distribution. Linear mixed-effects model was used to examine the association between MVPA trajectories and cognitive function. Results A total of 4 989 individuals aged 45 years and older were included, with a median follow-up of 7.0 years. Two distinct MVPA trajectories were identified: low-fluctuating group (55.42%) and high-declining group (44.58%). High-declining group exhibited a significantly slower decline in cognitive function (β=0.11, 95% CI: 0.07-0.16, P < 0.001) compared to low-fluctuating group. Among those in high-declining group, individuals with primary school education had a slower rate of cognitive decline than illiterate (β=0.17, 95% CI: 0.10-0.23, P=0.023). Conclusions We identify two distinct trajectories of MVPA among middle-aged and older adults. The findings suggest that maintaining a higher level of physical activity over time may help slow cognitive decline, particularly among individuals with lower levels of education. -
图 1 中老年人中高强度体力活动轨迹
Figure 1. Moderate-to-vigorous physical activity trajectories among middle-aged and older adults
表 1 基线人群特征
Table 1. Characteristics of baseline information
变量
Variable总人群
Total低水平-波动组
Low level-
fluctuation group高水平-下降组
High leve-
declining groupχ2/t值
valueP值
value年龄/岁Age/years 58.61±9.04 60.39±9.64 56.41±7.69 16.23 < 0.001 BMI/(kg·m-2) 23.38±3.45 23.70±3.60 22.97±3.20 7.57 < 0.001 认知得分/分Cognitive score/score 12.05±3.37 12.25±3.43 11.80±3.28 4.14 < 0.001 性别Gender 26.50 < 0.001 男Male 2 288(45.86) 1 178(42.60) 1 110(49.91) 女Female 2 701(54.14) 1 587(57.40) 1 114(50.09) 学历Educational background 8.12 0.017 文盲Illiterate 1 406(28.18) 768(27.78) 638(28.69) 小学Primary school 2 059(41.27) 1 107(40.03) 952(42.80) 中学及以上High school diploma or above 1 524(30.55) 890(32.19) 634(28.51) 婚姻状况Marital status 67.12 < 0.001 未婚及其他Unmarried and other 587(11.77) 418(15.12) 169(7.60) 已婚Married 4 402(88.23) 2 347(84.88) 2 055(92.40) 居住地Residence 213.05 < 0.001 城市Urban 1 780(35.68) 1 232(44.56) 548(24.64) 农村Rural 3 209(64.32) 1 533(55.44) 1 676(75.36) 吸烟Smoking 20.15 < 0.001 否No 3 121(62.56) 1 806(65.32) 1 315(59.13) 是Yes 1 868(37.44) 959(34.68) 909(40.87) 饮酒Drinking 32.02 < 0.001 否No 3 090(61.94) 1 809(65.42) 1 281(57.60) 是Yes 1 899(38.06) 956(34.58) 943(42.40) 抑郁症Depression 6.07 0.015 否No 3 160(63.34) 1 793(64.85) 1 367(61.47) 是Yes 1 829(36.66) 972(35.15) 857(38.53) 慢性非传染性疾病情况Types of chronic diseases 29.82 < 0.001 无Not have 1 909(38.26) 819(29.62) 753(33.86) 1种One kind 1 572(31.51) 795(28.75) 713(32.06) 多种Multiple 1 508(30.23) 1 151(41.63) 758(34.08) 注: 学历、慢性非传染性疾病情况的组间差异比较采用秩和检验，其余变量采用χ2检验；分类变量以人数(占比/%)表示，连续型变量以x±s表示。
Note: Comparisons of between-group differences in education and types of chronic diseases were made suing the rank-sum test, other variables were tested using the χ2 test; Categorical variables were presented as number of people (proportion/%), continuous variables were presented as x±s.
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表 2 中高强度体力活动轨迹与认知功能下降的线性混合模型
Table 2. Linear mixed-effects model for the association between moderate-to-vigorous physical activity trajectories and cognitive decline
轨迹组
Trajectory group模型1 Model 1 模型2 Model 2 模型3 Model 3 β值value
(95% CI)P值
valueβ值value
(95% CI)P值
valueβ值value
(95% CI)P值
value低水平-波动组Low level-fluctuation group 1.00 1.00 1.00 高水平-下降组High level-declining group 0.13(0.08~0.18) < 0.001 0.13(0.09~0.17) < 0.001 0.11(0.07~0.16) < 0.001 注：模型1未调整；模型2调整年龄、性别、婚姻状况、居住地、学历；模型3在模型2基础上调整吸烟、饮酒、BMI、慢性非传染性疾病情况、抑郁症。
Note：Model 1 unadjusted; Model 2 adjusting for age, gender, marital status, residence, education; Model 3 adjusting for smoking, drinking, BMI, types of chronic diseases, and depression based on model 2.
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表 3 中高强度体力活动轨迹与认知功能下降关联的亚组分析
Table 3. Subgroup analysis of the association between moderate-to-vigorous physical activity trajectories and cognitive decline
分组Group 人数Number of people β值value (95% CI) 交互作用P值P for interaction 性别Gender 0.361 男Female 2 288 0.10(0.04~0.16) 女Male 2 701 0.13(0.06~0.19) 婚姻状况Marital status 0.619 未婚及其他Unmarried and other 587 0.14(-0.01~0.28) 已婚Married 4 402 0.11(0.07~0.16) 学历Educational background 0.023 文盲Illiterate 1 406 0.02(-0.09~0.13) 小学Primary school 2 059 0.17(0.10~0.23) 中学及以上High school diploma or above 1 524 0.08(-0.02~0.15) 抑郁症Depression 0.074 否No 3 160 0.14(0.09~0.20) 是Yes 1 829 0.06(-0.02~0.14)
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