Leisure-time physical activity may attenuate the impact of diabetes on cognitive decline in middle-aged and older adults - Findings from the ELSA-Brasil Study.

OBJECTIVE: To assess leisure-time physical activity (LTPA) as a modifier of the diabetes/cognitive decline association in middle-aged and older participants of the Estudo Longitudinal de Saude do Adulto (ELSA-Brasil).

RESEARCH DESIGN AND METHODS: ELSA-Brasil is a cohort of 15105 participants (35-74 years) enrolled between 2008-2010. We evaluated global cognitive function summing scores of six standardized tests evaluating memory and verbal fluency and including the Trail Making test at baseline and follow-up. Incident cognitive impairment was defined as a global cognitive function score at follow up lower than -1 standard deviation from baseline mean. Participants reporting ≥150 min/week of moderate-to-vigorous LTPA at baseline were classified as physically active. We assessed the association of LTPA with global cognition change in those with diabetes in the context of our overall sample through multivariable regression models.

RESULTS: Participants (n=12,214) mean age at baseline was 51.4 (8.8) years, 55.5% being women. During a mean follow-up of 8.1(0.6) years, 9,345 (76.5%) inactive participants and 1,731 (14.1%) participants with diabetes at baseline experienced faster declines in global cognition than those active (β=-0.003; -0.004, -0.002) and those without diabetes (β=-0.004; -0.005, -0.003), respectively. Diabetes increased the risk of cognitive impairment (HR=1.71; 95%Cl 1.22, 2.39) among inactive but not among active adults (HR: 1.18; 95%CI 0.73, 1.90). Among participants with diabetes, active subjects showed a 2.73 (95%CI 0.94, 4.51) years delay in the onset of cognitive impairment.

CONCLUSION: In adults living with diabetes, LTPA attenuated the deleterious association between diabetes and cognitive function.