title: Association Between Exercise Capacity and Late Onset of Dementia, Alzheimer Disease, and Cognitive Impairment.
abstract: To address the association between exercise capacity and the onset of dementia, Alzheimer disease, and cognitive impairment.
  
  
  
  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.
authors.affiliation: 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. Electronic address: j.mueller@tum.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Müller
authors.affiliation: Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Khin
authors.initials: K
authors.lastname: Chan
authors.affiliation: Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford University School of Medicine, Stanford, CA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Myers
mesh_terms: D017677:Age Distribution; D000368:Aged; D000544:Alzheimer Disease / Q000453:epidemiology; D015992:Body Mass Index; D000072599:Cardiorespiratory Fitness; D003072:Cognition Disorders / Q000453:epidemiology*; D003704:Dementia / Q000453:epidemiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D058014:Veterans Health / Q000706:statistics & numerical data*