The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Is Cardiorespiratory Fitness Level in Midlife Associated with Later-Life Dementia? The Cooper Center Longitudinal Study

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Live well

Friday, Nov 10, 2017

As the median age and average life expectancy of U.S. adults continue to increase, the issue of dementia has come to the forefront as a public health issue. Annual health care costs for the ~5.4 million Americans with dementia are increasing sharply. Unlike cardiovascular disease and cancer, each of which has guidelines for lifestyle changes geared toward prevention, there is not sufficient evidence at this time to promote lifestyle changes for prevention of dementia. Among the reasons is a lack of large, long-term studies that focus on lifestyle-influenced risk factors for dementia.

One promising area for the prevention of dementia is cardiorespiratory fitness level, which is a marker for physical activity. A recent paper by DeFina and colleagues1 at The Cooper Institute addressed this important issue. A total of 19,458 apparently healthy men and women with an average age of 50 years were given a baseline comprehensive physical examination at the Cooper Clinic. A maximal treadmill exercise test was used to assess cardiorespiratory fitness (CRF). Patients were divided into 5 categories (quintiles) of CRF based on age and gender. Medicare data were obtained from the Centers for Medicare and Medicaid Services. During an average follow-up period of 24 years, 1659 cases of all-cause dementia were diagnosed. As baseline level of CRF increased, the risk of developing subsequent all-cause dementia decreased. In fact, men and women who scored in the highest CRF quintile at baseline were 36% less likely to develop dementia during the follow-up compared to men and women in the lowest CRF category! These results are shown in Figure 1 below.

Figure 1. Baseline cardiorespiratory fitness (CRF) by quintile and subsequent risk of developing all-cause dementia. CCLS, 2013.


Mechanisms by which moderate to higher levels of CRF might protect against the development of dementia were discussed in the paper. For example, individuals with higher levels of CRF are less likely to develop hypertension and diabetes, both of which are risk factors for dementia. Higher fitness levels have also been shown to be associated with preservation of brain mass over the aging process. The authors emphasized the need for studies which examine the effect of midlife physical activity and CRF on brain structure and function. In the meantime, all adults are urged to meet the minimal public health guidelines for physical activity. These guidelines call for a minimum of 150 minutes per week of moderate intensity aerobic activity, as well as a minimum of 2 days per week of strength training.

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DeFina, L.F., Willis, B.L., Radford, N.B., Gao, A., Leonard, D., Haskell, W.L., Weiner, M.G., Berry, J.D. (2013).  The association between midlife cardiorespiratory fitness levels and later-life dementia.  Annals of Internal Medicine, 158:162-168.