Associations between physical activity intensity and cognitive performance in older adults with and without stroke

Abstract

Introduction & Purpose: Stroke remains the third leading cause of acquired disability worldwide. Approximately 60% of stroke survivors face cognitive impairments, which are directly linked to reduced quality of life, increased functional decline and higher mortality risk. Physical activity (PA) is well established as an effective means of delaying cognitive decline in neurologically healthy older adults. Recent evidence indicates that, beyond improving cardiorespiratory fitness, increased physical activity after stroke enhances cognitive performance. However, it is not yet established whether the cognitive benefits of high-intensity PA observed in neurologically healthy older adults are comparable among stroke survivors. The present study investigated the association between PA intensity and cognitive function in individuals with a history of stroke.

Methods: Using data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES), we analyzed adults aged 60 and older with valid accelerometer data and complete cognitive assessment. The intensity gradient (IG) was used to quantify the 24-h intensity distribution of PA, while cognition was assessed via the Digit Symbol Substitution Test (DSST), Animal Fluency and CERAD Delayed Recall Test. Survey-weighted linear regression models, adjusted for sociodemographic and cardiometabolic factors, were fitted for each cognitive outcome. Stroke history was included as a predictor along with the IG. 

Results: Physical activity intensity was positively associated with cognitive performance across all domains. Specifically, higher physical activity intensity was associated with better performance on DSST (β = 10.44 [6.12, 14.75], p <0.001), Animal Fluency (β = 1.75 [0.11, 3.40], p = 0.039), and CERAD Delayed Recall (β = 1.06 [0.48, 1.64], p = 0.002). Significant interactions between physical activity and stroke history indicated that the association of physical activity and DSST (β = 8.56 [0.27, 16.84], p = 0.044) as well as Animal Fluency (β = 3.67 [0.85, 6.49], p = 0.014) was stronger among participants with a history of stroke, whereas no significant interaction was observed for CERAD Delayed Recall (β = 1.26 [-0.30, 2.82], p = 0.105).

Conclusion: Higher intensity activity patterns (higher IG) are associated with better cognitive performance in older adults, and this relationship may be particularly notable among individuals with a history of stroke. These findings highlight the potential importance of supporting more active lifestyles, particularly in post-stroke populations, although causal relationships should be established in future research.

References

Colcombe, S., & Kramer, A. F. (2003). Fitness effects on the cognitive function of older adults: A meta-analytic study. Psychological Science, 14(2), 125–130. https://doi.org/10.1111/1467-9280.t01-1-0143

Gjellesvik, T. I., Becker, F., Tjønna, A. E., Indredavik, B., Lundgaard, E., Solbakken, H., . . . Askim, T. (2021). Effects of high-intensity interval training after stroke (the HIIT stroke study) on physical and cognitive function: A multicenter randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 102(9), 1683–1691. https://doi.org/10.1016/j.apmr.2021.05.008

Rajan, K. B., Aggarwal, N. T., Wilson, R. S., Everson-Rose, S. A., & Evans, D. A. (2014). Association of cognitive functioning, incident stroke, and mortality in older adults. Stroke, 45(9), 2563–2567. https://doi.org/10.1161/STROKEAHA.114.005143